Hospice & Palliative Care:
About Tiny: We got him when he was 10 weeks old and weighed only 20 ounces. He’s a pure bred Siamese who was bred for his personality, not his show quality. He is the constant companion of my 93 year old mother. He loves people and does not like to be alone. He is playful, talkative and cuddly. His blue eyes are the window to his world. You can see all of his emotions in that beautiful face – mostly love. Every day I thank OAH for giving me back my precious baby boy.
“Tiny Blue” Ariemma
Tiny Blue is a 12 yo, MN Siamese currently in the CARES program. He has chronic IBD, chronic pancreatitis, and pancreatic cystic changes. He also has chronic azotemia, a II/VI heart murmur, and unregulated diabetes mellitus. Tiny Blue came into the hospital on emergency in December 2012 for a hypoglycemic seizure. He responded to treatment and went home a few days later. Since his transport to and from the hospital is difficult and due to the nature of the constant changes in his medical condition requiring frequent nurse monitoring, Tiny Blue was considered for the CARES program for palliative care.
Tiny Blue’s first home visit started shortly after his emergency visit. His blood glucose and medications for nausea were monitored. His coat was dull and rough and he appeared a bit dehydrated and lethargic. His caretaker claimed that he was “back to normal” later that night.
Tiny Blue did great the whole next week and he looked brighter than the week before. His vitals were normal, his activity level and appetite had resumed, and his skin coat was smooth and shiny.
Tiny Blue’s current CARES plan is to continue medications and nursing visits as needed. His caretaker checks in with his CARES team and has discussed his quality of life in terms of any current regressions and current status. Moving forward, this case simply goes week by week based upon his clinical signs.
Pokey’s life expectancy was thought to be about 2 – 3 months; however, he lived 8 months after the first diagnosis of his illness. The CARES technicians visited him every one to two weeks and closely monitored Pokey’s vital signs, pain scores, nutrition, and his overall quality of life. Dr. Troyer also visited him about three times over the period and updated Pokey’s ICP (Individualized Care Plan) after each visit. We adjusted Pokey’s medications several times as his tumor grew bigger and his medical demands changed.
Difficult breathing was one of the expected clinical signs with Pokey’s medical condition, but we were also concerned about his brain involvement (function). We did not know the extent of the influence of the tumor on the brain. It was possible that he would seizure or his temperament would change for the worse (such as aggression). We prepared his caretaker by educating her and answering any questions she had. We also provided her with an emergency CARES kit, which was put together especially for Pokey. It included some medications Pokey could use in case of an emergency. Having such kit on hand eased his caretaker’s concerns.
Pokey deteriorated gradually over the eight months, but he had always been loved by his caretaker. His caretaker did everything she could do for him. He passed away at home as his caretaker wished. We believe he was happy until the end.
Days perhaps weeks pass while amazing medical miracles fulfill your wish and your pet is finally released to go home…. But sometimes disease or disability has transformed your pet from the able companion you knew, to a compromised patient. The prognosis may mean time will be needed to recover, or time may only be being given to say “goodbye”.
In either case taking your “new” pet home alone can be frightening… Every expression of ill health becomes terrifying: should you go back to the hospital, is another medication needed, is your pet getting worse, is whatever is happening “okay”, should you be doing more for your pet… These are questions that will come up 24/7 and usually not when your pet’s doctor happens to be on call. The fear and strain of navigating these waters alone can be debilitating.
Sadly I have been a sailor in these dark waters too many times before, but no more. This year while traversing a very critical life and death period with my baby girl Tucker, I found the CARES program at Oradell Animal Hospital. Tucker is a yellow lab who amazingly just celebrated her 13th birthday this past June. A few months earlier none of us thought she would live to see that birthday, and if not for her extraordinary medical team and her incredible CARES technicians, she would not have.
Tucker was diagnosed with metastatic mast cell cancer in 2010 and has been through several iterations of chemo protocols to keep her disease controlled. In December she developed laryngeal paralysis and required emergency surgery. Fate was not kind, and she aspirated under anesthesia and developed pneumonia. It was weeks of touch and go, but my girl is a fighter. But just as she was getting a clean bill of health for the pneumonia, her cancer came out of remission, and this time with a vengeance.
The cancer ravaged her body and she became so anemic that she couldn’t walk; she needed frequent medical care and close monitoring but was too frail to withstand trips to the hospital. Dr. Heather Troyer heads up the CARES program at Oradell Animal Hospital and she immediately set up a dedicated team of technicians and a palliative home care plan for Tucker. In addition to being able to schedule visits at my house as needed for supportive care including: checking vitals, administration of IV fluids, blood draws, physical rehabilitation for her weakened muscles, and other supportive medications and care, I also received a dedicated phone line which allows me to reach Tucker’s techs 24 hours a day, 7 days a week. It is like having an animal hospital in your pocket. No more long nights navigating waters of indecision. My CARES techs know Tucker’s case intimately (all the techs in the program do). They will either have the answer or get the answer amazingly fast as Dr Troyer is never more than a phone call away from them.
I can not say enough about the incredible people involved in CARES or the tremendous difference they have made in my life and in Tucker’s. I am eternally grateful to them and to Oradell Animal Hospital for supporting the existence of such a rare type of patient care service.
Today Tucker is doing well and can make it in to see Dr T for her exams, but she still remains in the CARES program and connected to her techs. Both Tucker and I trust them completely and will want them with us as Tucker’s journey through both her cancer and old age continues and evolves. They are a vital part of her medical team.
Tucker and I would like to express our deepest gratitude to Dr. Heather Troyer, Liz Stewart, Naomi Constant, Doreena, Kelly, Michelle, and all the other techs behind the scenes for what you do, and the grace with which you do it.
All our Thanks,
Barb Urquhart and of course,
Tucker the Wonderpup