Want to see more senior patients? Hit the ‘whys’

Move over puppies and kittens: Senior care is where the heart is, says Mary Gardner, DVM, founder of Lap of Love Veterinary Hospice. On Central Line: The AAHA Podcast she talks AAHA’s new guidelines and what every practice should do to improve its euthanasia protocol.

By Katie Berlin

If you work in veterinary medicine, you’re probably used to seeing one cute animal after another while you’re scrolling through social media. Puppies, kittens, and active young pets are everywhere—sleeping on your friend’s couch, at your clinic for their first vet visit, promoting pet insurance, or targeting you as a willing consumer of dog clothes and cat food brands.

But if you’re anything like me, it’s the senior pets that always make you stop scrolling.

Puppies are undeniably adorable. But can they compete with a photo of a sweet old man dog tilting his gray muzzle up and wagging his tail as a shelter employee comes in to clean his kennel? A YouTube video of a kitten is cute—but a TikTok of a young man playing the piano for the geriatric tabby cat who watched him grow up? Irresistible.

The 2023 AAHA Senior Care Guidelines for Dogs and Cats, released earlier this month, encourage veterinary teams to consider the whole story when they care for seniors. Guidelines task force member Mary Gardner, DVM, author, speaker, and co-founder of Lap of Love Veterinary Hospice, points out that in truly holistic senior care, a pet’s family and home environment are as important as the medicine—maybe even more important—and it’s by embracing these pets and their stories that we can craft the best care possible for as long as they’re here with us.

On her episode of Central Line: The AAHA Podcast, Dr. Mary shared her passion for “the weak and the wobbly, the skinny and the stinky, and the families that love them.”

Catch the full episode, “Gems from the Guidelines: Telling the Story of Senior Care,” on YouTube, anywhere you get your podcasts, or at aaha.org/podcast.

Access The 2023 AAHA Senior Care Guidelines for Dogs and Cats at aaha.org/senior-care.

Katie Berlin: Every senior pet comes with a story, right?

Mary Gardner: Yes. And we talk a lot about this in the guidelines. [Senior care] needs to be individualized care and what the family can handle—because it’s not just linear; it’s not just about medicine. It’s about care and caregiving and caregiver burden, and what they can manage in the house, and how their house is set up. It’s 90% environment and emotions, and 10% is the medicine—and if we just hyper-focus on the medicine, we’re going to miss a big part of that caring process.

KB: Taking the time to listen to those stories, giving them that space to tell you what their life is like, will really help you know what recommendations are going to stick and which ones are just not appropriate.

MG: I always say: You have to ask them, “What’s important to you about your care? Or “What are the two biggest struggles that you have?” Because as vets, we may be thinking of two problems—it might be incontinence and the horrible teeth that the pet has—but if they say, “Every night my cat is howling at 2 o’clock because of cognitive dysfunction,” you better try to help that before you try to fix the other things not on their list of priorities. I think that’s really important—to find out what their priorities are—because when you’re caring for a senior pet, it is so different.

KB: So [we’ve been] talking about people who know that their senior pet needs care. But you have found that so many of the pets that you go to their homes to euthanize have not actually been to a vet in the last year to receive treatment.

MG: . . . Yes. So one of the things I preach when I’m lecturing is about websites:  . . . If they’re not coming in, they’re not going to get your information when they get there. I challenge everybody to go look at their websites and tell me what their senior or geriatric pages are about. And if it just says, “We recommend coming in for twice yearly exams . . .,” which is great, and we recommend that in our guidelines, it’s not going to bring people in. We have to hit the whys.

So why is somebody searching? They’re searching because their dog has mobility issues, their cat has incontinence, their dog is crying at night and panting and pacing. So we have to get the top 10 things that are affecting our senior pets and write a story about them, and have management tools and products to recommend and [explain] why should they come in to see you.

And people will remember data 22 times more when you wrap it around a story. I just want to encourage clinics to really adapt some of their marketing to the seniors . . . I’ve got so many birthday videos and pictures from people, they’re like, “Maple just had her 16th birthday; here’s her picture with her party hat on.”

KB: The entire team gets really involved in these stories, and sometimes the team sees that pet more than the veterinarian does. Like those cats that show up for subcutaneous fluids three times a week or whatever . . . What are teams already doing that we consistently under-value and should really bring to the forefront and reward in terms of senior care?

MG: I think it is the little things. When you see somebody taking the time to walk slower with that pet. Did you know that the number one smell of a pet that lights their pleasure center of their brain is the smell of their owner? So if you see a technician or a [CSR] say, “Hey, do you have a t-shirt? Bring a t-shirt, I’ll make sure it stays in the cage with them.” If you see them be better at postoperative care, because that’s where the danger is. Highlight that and share that story and say, “Hey, Dr. Katie did this with this pet. But here’s our technician Jack, and this is what he did.”

Share the success stories and why we don’t have problems with anesthesia and things like that, and who’s doing gentle handling. These guys are brittle, and I see them getting held so rough. There are rock stars out there; highlight [the little things they do]. There are so many hidden treasures in our clinics.

KB: You’d have a hard time figuring out what is the most important aspect of senior care, because it’s such a holistic thing when it’s done well. What is one thing that anybody listening, no matter their role in the practice, could do differently when they go into work tomorrow, when it comes to senior care?

MG: You know, so many people ask me to do talks on compassion fatigue, and I say: I can’t do that because I don’t have compassion fatigue. I have compassion overload. Do I have drive fatigue? Yes. Do I have partner (spouse) fatigue? Yes. But for me, compassion has a couple of ingredients, and the first one is recognition of the suffering that I see. The second is wanting to change that. The third is not being attached to the outcome.

I think it’s really important for us not to get so attached to the outcome, because that will bring us compassion fatigue. When it comes to euthanasia, what everybody can remember tomorrow for the next euthanasia that they do is: They may not be in charge of why they’re euthanizing, but they can be in charge of how. And if you do that well, you will pillow your head at night, and that’s what I encourage everybody to do. Improve one thing in their euthanasia protocol, whether it’s what they say at the entrance or the exit, the sedation protocol or whatever it may be—I promise you, the euthanasias will be better each time.




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