If the way in which you approach quality-of-life discussions is putting too much pressure on either you or the client, Mary Gardner, DVM, has good news: There’s a better way.

Instead of having the client fully rely on your professional expertise (as if the decision is always black and white) or telling the client to let you know when they’re “ready” (whatever that means), the cofounder of Lap of Love Veterinary Hospice advocates for breaking the conversation down into thoughtful categories that will allow for a more equal distribution of the decision-making load.

Here’s what she covers with the pet owner when assessing a pet’s quality of life:

“Look at the disease or ailment the pet is facing, because depending on that, the quality of life could change,” says Dr. Gardner. For example, the conversation around a dog in heart failure will be different than for a dog with arthritis. “What they experience—even the way they die—will be different,” she explains. In other words, discussing the pet’s quality of death is an important part of the conversation as well.

 Every animal is different, so we have to look at the pet’s personality and how it’s handling its ailments, says Dr. Gardner. Some questions to explore: How does the pet handle pain? Anxiety? How does it respond to the types of tools and treatments it would require (e.g. harnesses, subcutaneous fluids)?

 Every client is different, too, so you’ll need to get a sense of how they’re handling their pet’s ailments and whether or not they’re willing and able to manage the treatment regimen as well. For example, Dr. Gardner says some owners aren’t willing to administer subcutaneous fluids or strap their pet into a harness every time they need to go outside. “And some families want to say goodbye sooner rather than later,” she adds. That means you’ll need to find out if your client would rather euthanize their pet a week too soon or a day too late.

Don’t avoid the elephant in the room, even if it makes you cringe. A caring-but-cash-strapped client may even feel relieved to hear you bring it up and treat it as a valid part of the discussion. “But remember, it’s not just about the money. The other budgets to consider are time, physical and emotional. If an owner is tapped out of any of the four budgets, I support their decision to say good bye,” says Dr. Gardner.

In the figurative and literal end, the decision of when to euthanize will still be difficult. But by bringing together both the expert in veterinary medicine (you) and the expert on the pet (your client), that decision should be better informed and hopefully less burdensome to everyone involved.

Editor's note: This article is based on a dvm360.com video featuring Mary Gardner, DVM. 

Sarah Mouton Dowdy, a former associate content specialist for dvm360.com, is a freelance writer and editor in Kansas City, Missouri.

Articles

Lap of Love Veterinary Hospice cofounder Dr. Mary Gardner breaks the daunting discussion into thoughtful categories that ideally result in a more informed, less burdensome decision.



The anatomy of a better quality-of-life conversation

Like many veterinarians, I give “the flea talk” several times a day. In fact, most of us could probably do it in our sleep. Educating our clients on the importance of year-round parasite protection can be a frustrating and drawn-out process, especially when dealing with what I like to call "flea denial." 

As someone with a science background, I tend to reference science when talking with clients. I tell them about the 

2011 AAHA/AVMA Preventive Healthcare Guidelines

 for cats and dogs, which clearly state that every dog and cat should receive “year-round broad-spectrum parasite control with efficacy against heartworms, intestinal parasites, and fleas.” The guidelines also recommend a customized plan for tick control based on risk assessment.

Most of us have had a client say, “I don’t need to give preventives in the winter months.” I live and practice in rural Missouri, where the winters can be cold and long, but I see patients infested with fleas 365 days a year.

I can talk about the AAHA guidelines or go over the flea life cycle with clients until I’m blue in the face, but it seems to have little impact on whether they decide to protect their pets against parasites year-round. I try to reinforce that clients who only administer preventives on a seasonal basis are playing Russian roulette with their pet’s health, but despite my best efforts I still have clients like Mrs. Shay in the poem below. 

Doc Stroupe came into her clinic one morning,

outside clouds were gray and rain was pouring.

Dogs barked, cats meowed, cages shut with a clang.

Doc glanced at the schedule, and then the phone rang.



"Her skin is red, and she itches and scratches.

She even has hair coming off in patches!"

"Certainly, Mrs. Shay. Can you bring her at ten?

"I'll see you at ten. Thank you, goodbye."

The next couple of hours were kind of a haze

of trying to finish the neuters and spays.

she remembered her appointment with the dog with an itch.



She walked into the exam room and saw the Maltese.

"Yes, Doc. I simply don't know what to do,"

as she crossed her arms and tapped her shoe.

"She itches and scratches all day and all night!

When I give her a bath, she tries to bite!"



Doc Stroupe paused and asked with some trepidation,

"Does Louise happen to be on flea medication?"

Mrs. Shay replied, "No, but I know it's not fleas!

Now hurry and look at my dog, if you please."

Doc Stroupe saw the skin, and thought with a smile,

this is a classic case of flea denial.


Mrs. Shay was distressed and dismayed to learn,

that Louise had the Bermuda shorts skin pattern.

As Doc ran a flea comb through the dog's hair,

she saw tiny fleas jumping here and there.


"Fleas can't be the problem. There's only two or three,"

"Adult fleas are only part of it, Mrs. Shay—

You must know that when there's two or three,

Louise has fleas—she could no longer deny.

"If keeping fleas off your pet is your intention,

Louise needs year-round flea prevention.”



Louise looked up at her owner with pitiful eyes.

Mrs. Shay knew she must help to stop her dog's cries.

Doc Stroupe went over which products work best.

Soon they would be rid of this nasty pest.



As Mrs. Shay left with a supply of flea pills,

Doc Stroupe felt great about her education skills.

Months later, when Doc did her reminder call,

Mrs. Shay said, "I'm good on meds for a few months. It's almost fall."

as she sat at her desk, and did a facepalm.

Dr. Jessica Stroupe is a practice owner and mixed animal veterinarian in Missouri. A 2012 graduate of the University of Missouri College of Veterinary Medicine, she enjoys using poetry to commiserate in a humorous way with her colleagues about life as a vet. When she’s not working, she enjoys spending time with her husband and sons, running and weight lifting.

Talking about fleas and other parasites with your veterinary clients can be exasperating when your advice goes unheeded, but veterinarian Jessica Stroupe finds humor in her frustration about what she calls "flea denial."


'Louise Has Fleas': A poem about the frustrations of flea denial


The restrictions of having a valid veterinarian-client-patient-relationship (VCPR) significantly impact how we're going to be able to deliver telemedicine services, says practice manager Bash Halow, LVT, CVPM. That’s why he offers telemedicine as a free service to get clients in the door for an in-person visit.

“I’ve decided to introduce telemedicine as a not-charged-for service at our practices, as an introduction to talk to clients—in general terms—about what’s going on with their pet and using that to bring them in for the exam we need,” he said in an interview with dvm360.

A valid VCPR includes a physical exam, and for good reason, says Halow, adding that using telemedicine as a replacement for that hands-on exam is very risky.

Watch the video below to learn more about how (and why) Halow uses telemedicine at the practices he manages.

Veterinary practice manager Bash Halow offers strategies on how to use telemedicine as a way to fortify the veterinarian-client-patient relationship.

Scared to use telemedicine at your veterinary practice? Don't be

The American Association of Feline Practitioners (AAFP) is inviting the veterinary community to attend its first-ever 

, which will focus primarily on feline anesthesia and behavior.

The e-conference will be held Monday, April 6 from 11:00 a.m. to 4:30 p.m. EDT to accommodate busy veterinary professionals who may be unable to leave their practice.

Despite the online-only format, the conference will still offer the same real-time experiences found at a traditional conference, including networking, Q&As and engaging discussions with other attendees, all made possible through a chat functionality. Attendees will also earn four RACE-approved CE credits.

The first half of the virtual conference will be led by Sheilah Robertson, BVMS (Hons), PhD, DAVCAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS, senior medical director for Lap of Love Veterinary Hospice—a network of over 100 veterinarians that specialize in end-of-life care and in-home euthanasia.

The schedule for Dr. Robertson’s talk is as follows:

11:00 a.m.—Anesthesia for Senior & Super-Senior Cats

12:00 p.m.—Anesthesia and Analgesia: Real World, Real Cases

The second half of the conference will be led by Sarah Heath, BVSc, DECAWBM, CCAB, MRCVS, a veterinary specialist in behavioral medicine and an external lecturer in small animal behavioral medicine at Liverpool University.

The schedule for Dr. Heath’s lectures is as follows:

2:00 p.m.—Inter-Cat Tension in Multi-Cat Households

3:00 p.m.—Behavioral Considerations in Feline Obesity & Weight Loss

This virtual conference, hosted by the American Association of Feline Practitioners, will allow veterinary professionals to participate from the comfort of their desks or on the go.



AAFP to hold inaugural e-conference in April 

Hey, veterinary professionals. We know you’re busy. That’s why we’ve made it even easier for you to get the latest veterinary news.

Click the video below to view the top 3 stories of the week in 60 seconds:

Last week, Antech Diagnostics announced the development of the 

first diagnostic test for canine inflammatory bowel disease.

The Purina Institute has announced the imminent launch of 

 the first and only cat food that can reduce allergens in cat hair and dander.

 explains how hypothermia occurs, the negative effects it has on the body, 

 how to prevent it during anesthetic events.

Videos

Want to be in the know? Check out the veterinary news highlights from this week.

News in a minute: First canine IBD blood test, game-changing feline diet, hypothermia doodle

Research shows that loneliness and social isolation can induce negative health effects that rival those of obesity and smoking. In a 

 from global health insurer Cigna, nearly half of Americans reported feeling alone, isolated or left out at least some of the time. An argument can be made that today’s so-called “loneliness epidemic” is a serious threat to public health.

But Mars Petcare and the Human Animal Bond Research Institute (HABRI) believe that help for many people who feel alone, socially disconnected or isolated can come in the four-legged form through human-animal interaction (HAI) and pet ownership.

Consortium on Social Isolation and Companion Animals

Recognizing the potential of companion animals to make a real difference in human mental health, in 2018 the retail giant and the nonprofit collaborated with practitioners and researchers from human and animal healthcare to form the Consortium on Social Isolation and Companion Animals, with four overarching goals:

Identify the potential of HAI to assuage social isolation in people.

Pinpoint hurdles that some individuals may face in realizing the benefits of HAI.

Propose best practices and practical solutions to address those hurdles.

Last year, the consortium convened experts in public health, research, psychology, gerontology and veterinary medicine for the first-ever Summit on Social Isolation and Companion Animals to tackle these goals, particularly as they relate to older adults and the mentally impaired.

 released this week by the consortium underscores the importance of social interaction in mental health and presents the results of a 2,000-person survey of both pet owners and non–pet owners throughout the United States. What they found may not be surprising to veterinary professionals:

80% of pet owners say their pet makes them feel less lonely.

54% of pet owners say their pet helps them connect with other people.

85% of all respondents believe that interaction with companion animals can help combat loneliness.

76% of all respondents agree that interacting with animals can alleviate social isolation.

“Pet ownership produces better heart health, and we have evidence that it improves mental health, but there’s an epidemic of loneliness in our society,” HABRI Executive Director Steven Feldman told 

. “We wanted to take a hard look at how having a pet and HAI can impact such a big societal challenge.”

From the Summit came three primary recommendations to ensure that animals are taken into consideration when addressing the loneliness epidemic.

Research is needed to help qualify best practices for whom and under what circumstances companion animals may be effective to help alleviate loneliness.

“We are working to facilitate and increase the amount of research in this area,” Angela Hughes, DVM, PhD, senior manager of Global Scientific Advocacy Relations at Mars Petcare, told 

, “because we understand that not every situation is going to be a perfect one for pet interaction.”

Instead of considering whether there is a pet in the home, future HAI research should take into account the quality of pet–human interaction and the degree to which individuals are attached to their pets. Future research should also evaluate the practice of animal-assisted intervention (AAI) to create evidence-based protocols that can be shared with all programs.

 Many barriers prevent older adults and the mentally impaired from participating in HAI. According to Feldman, this is an area where veterinarians play an important role.

“One of the barriers is making sure that as people age, they can keep their pets,” he says. “Veterinarians with older clients can help those clients keep their pets healthy as they age even as they move into continuing care facilities.”

But it’s also vital to recognize when pet ownership may 

be the solution. “Do they not have the ability to personally care for a pet?” Dr. Hughes asks. “Maybe an interaction with a therapy animal would be more beneficial instead of them being responsible for that pet all the time.”

Amplify uptake of ‘gold standard’ programs.

 The third recommendation is to support and help advance best practices in HAI. When it comes to therapy animals, for example, what are best practices to keep these pets healthy and make sure their welfare is looked after?

“Perhaps a doctor can prescribe a pet to a client who is suffering from social isolation and loneliness,” Dr. Hughes explains. “But we have to ask what’s the right pet and the right situation? We’re trying to help provide good guidelines and best practices.”

This report is just a starting point to help establish the role of pets and companion animals in helping to alleviate social isolation around the world. While some hurdles were identified at the summit, and best practices were proposed to help address these hurdles, researchers acknowledge that much more work remains.

Over the next five years, HABRI and Mars Petcare have committed to working to achieve these three goals in an effort to spark real change in society.

“Ultimately, we believe in the power of pets to help solve this pressing epidemic of loneliness and isolation,” Dr. Hughes says. “That’s why we feel like this roadmap is going to facilitate the role of HAI and pet ownership in addressing it.”

A new report from Mars and the Human Animal Bond Research Institute explains how interaction with animals can help many people feel less alone and socially isolated, and provides recommendations for keeping companion animals safe and healthy in the process.