Grow old with me
Trends magazine reprint
The following article is reprinted from the January/February 2005 issue of Trends magazine.
Grow old with me
Increasingly, owners are willing to take on home-nursing tasks to keep their aging pets with them as long as possible. How can practices help their clients be good caretakers?
by Garry Boulard
When Coyote, a 14-year-old mixed, short-hair tabby, was diagnosed with progressive kidney disease, his owner, Carolyn Linville, instantly wanted to know two things: How long did he have to live? And what could be done to prolong his life while keeping him as pain free as possible?
“I felt that I owed at least that much to him,” says Linville, who found Coyote when he was about two years old. “He was really a grand ole tough sort of male cat, and I thought he deserved to live as long as he could, provided he wasn’t in pain.”
In short order, Gretchen Bassett, DVM, co-owner of Arvada Flats Veterinary Hospital in Arvada, Colo., gave Linville her answer: without medical attention, Coyote probably would die within a month. With intensive care, though, which would require a good deal of home nursing by Linville, Coyote’s life might be extended by up to half a year or more.
Increasingly, because veterinary practices are delivering higher-quality medical care to family pets, animals are living well past what used to be considered a normal life span. Likewise, veterinary practices are diagnosing and outlining treatments for greater numbers of chronic and age-related diseases, including the kind of longer-term, regular care that Linville gave Coyote. For the practice team, the upshot is that staff members may need to cultivate new training skills to help clients become extensions of the veterinary health care team.
Clients want training
When Linville opted to help Coyote live comfortably as long as possible, she had to learn how to give him twice-daily shots of subcutaneous fluids, always using a new needle and inserting it in the region between Coyote’s shoulder blades. “I had to make certain that I broke the skin, but never went into his muscles,” she says. “It was all about learning how to find the exact right place.”
Bassett also showed Linville how to set up the IV line connected to the fluid bag and how to put the needle at the end, making certain that all the air was extracted from the line before she inserted the needle. Because Coyote had a microchip between his shoulders, Bassett showed Linville how to work around it and avoid muscle tissue. “I had to demonstrate that I knew what I was doing by going through a mock insertion,” Linville recalls.
In the early weeks, Linville also had to bring Coyote regularly to Bassett’s office for a series of tests to monitor his condition. Some six weeks later, Bassett thought Linville could reduce Coyote’s fluid-by-needle intake from twice daily to once a day.
Linville continued this regimen for another nine months or so until it became apparent that Coyote needed to be euthanized, a step Linville agreed to in order to cut short the cat’s last days of discomfort. Ultimately, though, Coyote’s life had been extended by at least 11 months beyond the day Bassett originally gave the diagnosis. Linville’s efforts had made all the difference.
Even though treating Coyote required daily attention, Linville says she would gladly do it again. “You brush and floss your teeth a couple of times a day,” Linville says by way of comparison. “To help keep alive an animal I dearly loved, this was not asking too much.”
For veterinary teams, the story of Coyote is instructive, showing not only that intensive home care can extend the life of even old and seriously ill pets, but also that owners increasingly are willing to take part in giving treatments.
“Pets are living longer than ever before, primarily due to the advancement of superior preventive care earlier in their lives as well as our own increasing ability to care for the needs of a pet in their older years,” says Mark Epstein, DVM, medical director of the AAHA-accredited Total Bond Veterinary Hospitals in Gastonia, N.C., and chair of an AAHA task force that is drafting veterinary care guidelines for senior companion animals.
“The role that pet owners play [with their senior-aged animals] cannot be understated,” Epstein says. “To a surprising degree, many of them want to get involved in a hands-on way with the treatment of their pets, and when that happens, it’s not only an asset for the veterinarian, it’s something that can greatly enhance the quality of life for a pet.”
“Clients in general are better informed and educated on pet issues today,” agrees Kim Morrow, DVM, co-owner of AAHA-accredited Magrane Pet Medical Center in Elkhart, Ind. “They are researching pet issues on their own, looking up things on the Internet and presenting us with the results of their research. They ask about things like medication and therapies and are generally interested in actually getting involved in the process, if they can.”
Many more aging pets
Experts estimate that aging pets make up more than a quarter of the nation’s pet population. According to a study conducted by the AVMA, at least 28% of the nation’s dogs and more than 25% of its cats are at least 8 years old, a benchmark commonly used to determine whether an animal can be classified as a senior. Applying those percentages to current pet-population statistics, this means more than 45 million pets in the United States likely would be classified as seniors.
Definitions vary as to when an animal should be viewed as aging. The AAHA senior care guidelines task force indicates that dogs and cats that are approximately 7 to 8 years of age should begin senior wellness screening exams and tests, though large-breed dogs may reach a screening threshold a year or two earlier (the guidelines are forthcoming in March 2005). Other veterinarians have adopted the formula developed by Fred L. Metzger, DVM, owner of the Metzger Animal Hospital in State College, Pa. He factors in both the probable age of a dog and its weight to determine its classification as an adult, a senior or a geriatric.
According to the Metzger Animal Hospital Age Analogy Chart, an adult dog is one that is between 6 and 8 years of age, but weighs less than 50 pounds. A dog that’s 6 to 8 years old, but weighs 50 to 90 pounds, is considered a senior. Geriatric dogs on Metzger’s chart — that is, the oldest dogs — are those that are at least 14 years of age, no matter how much they weigh (though a 10-year-old dog could be classified as geriatric if it weighs 66 pounds or more).
Metzger insists that by using a commonly accepted age-classification system, veterinarians have a greater chance of diagnosing diseases normally associated with aging animals during an earlier stage of their development.
A focus on improving care
Efforts to help pinpoint essential life stages in animals illustrate the profession’s preoccupation with improving not only care, but also diagnosis.
“Veterinary care today is so much more sophisticated than it was a generation or even a decade ago,” says Susan McCullough, author of the recently released Senior Dogs for Dummies (Wiley Publishing, 2004).
“A cancer diagnosis is no longer necessarily a death sentence for a dog, for example,” McCullough says. We can even detect diseases and problems with the same diagnostic tools that are being used for people.”
New and developing treatments specifically geared for older animals now include pain management, MRIs and chemotherapy, kidney transplants, acupuncture, herbal therapies and even the injection of disease-modifying agents. And many pet owners don’t balk at them, even when animals reach very advanced ages.
“I had a farmer from Abilene one day come in with a dog that was about 20 years old, and he told me that she had only three months more to live,” recalls Robert Munger, DVM, owner of the Animal Ophthalmology Clinic in northern Texas. “He was emphatic: ‘She has to be able to see, no matter how many months she has left. Do I make myself clear?’ ”
Love in the labor
Like Munger’s client, pet owners are forming increasingly strong emotional attachments with their animals. According to a 1998 Gallup Organization survey, pet owners regard their animals not only as part of the family, but also as better companions than some human members of their family.
Equally telling, Gallup reported the vast majority of dog owners thought their pets deserved skilled medical care, no matter how much it ultimately might cost.
That result is echoed in recent research like the 2003 AAHA compliance study, funded by a grant from Hill’s Pet Nutrition Inc., which found that 90% of pet owners want their veterinary practices to offer them all the best-quality care options. “This attitude runs across all socio-economic lines,” notes Epstein, whose practice treats animals owned by clients from both lower- and upper-income neighborhoods. “I’ve seen cases where a person with very limited means has said they would pay any amount to treat their pet.”
“Owners have plenty to contribute,” McCullough says. “I myself have had the very good fortune of having a veterinarian who is very willing to listen to my ideas on dog care and even disease diagnosis. She and other veterinarians have told me that they can supply technical expertise, but in the end, no one knows an individual dog better than the owner does.”
“I look at the willingness of clients to get involved as something that can only make the [care] situation better,” Munger says. “When we do something like cataract surgery, for example, I often find myself telling the clients that I’m more worried about them in the next 48 hours than I am about the dog, because they’re going to be the ones who’re most responsible for their pet’s care and recovery.”
Munger adds that the owner’s ability and willingness to deliver health care also is very important for a pet. “I like to get the patient back home and into their normal environment as soon as possible,” Munger explains. “They feel better, they heal better, and you want them to get back into their regular routine, eating and that sort of thing, in a relatively short period of time.”
Discuss the details
How veterinary teams teach clients the basics of at-home care may vary slightly among practices. But the basic concept of not leaving anything unexplained should be the guiding rule, Epstein says.
McCullough adds that good communication also involves telling clients whether or how the treatment will significantly improve the animal’s quality of life. This way, clients can determine the extent to which they want to become involved in home care.
“I think the veterinarian has a responsibility to make sure the owner understands what the results of such efforts are likely to be, as well as the degree of care involved in seeing to the needs of a pet with a chronic condition,” McCullough says.
“Take, for instance, owners who will be administering subcutaneous fluids every day or two to their cat that has chronic renal failure,” Epstein says. “[Our practice] will have printed instructions, but most important, we demonstrate one administration to the owners, talking and walking them through it.”
During a hands-on demonstration, the veterinarian or a team member ideally explains the function of the fluid bag, the administration set and the needles. The session also covers how the animal should be positioned, how the needle should be set and how the line can be opened and closed to calibrate the proper amount of fluids needed.
The emphasis, Epstein says, always must be on complete but easy-to-follow information. Printed instructions should detail the “schedule, amounts, what problems to look for, when to return for follow-up and how to contact us if clients have questions or problems.”
The same emphasis on detail applies during follow-through. “We keep in contact with the owner to find out on a regular basis not just how the pet is doing, but also how the clients are handling their new responsibilities,” Epstein says.
If the animal has a permanent condition, such as diabetes, which requires an insulin injection twice a day for the rest of its life, Epstein recommends what he calls a “care-pair program.” The client and patient are assigned to one particular staff person, who is then responsible for following up by phone or email, scheduling rechecks and answering basic questions.
Buffer against the risks
As owners become more involved in the care of their animals, chances do increase that something may go wrong, primarily because the owner may make a mistake or simply be negligent.
“That’s always a risk,” Morrow admits. “And it’s one of the reasons why I’m always very careful when I’m talking to clients about what they have to do to help their pet get better. It really boils down to communicating with the client.”
To minimize risk, Munger says, “You have to be aware of how you phrase instructions. Make it clear that if the client has any concerns or questions about anything at all, they should contact [the practice] as soon as possible, or in more extreme cases, take the animal to an emergency clinic.”
Incidental information also needs to be communicated carefully. “If [clients] say to you that they just don’t think they’re up to caring for their pet, you have to tell them that there are really only about two other options available,” Munger says. “They have to find someone who can provide the in-home care or the animal will have to remain hospitalized longer.”
Either way, Epstein believes that as more of the nation’s pets grow older, practice team members and owners increasingly will need to rely on pet owners to provide some extensive care for patients.
“We have better medications and therapies than ever before,” Epstein says. “But if we’re not effectively communicating with our clients — most of whom want to get involved in the care of their pets, especially as they age — then the technology can only take us so far.