Do not underestimate the caregiver-burden

11

In general, pet owners with chronically or terminally ill pets often suffer from high levels of burden, stress and anxiety which might lower their level of functioning and quality of life. Research in the field has shown that the caregiver burden can produce immense stress on the person, which even could impede his/her health and psychological condition. It is important for the veterinarian as well as for the caregiver to be aware of this burden and arrange the end-of-life care in such a way that your furry friend - as well as you! - are as comfortable as possible.

Resource
→ petcaregiverburden.com

Challenges facing the dog owner

11.1

Once your dog has been diagnosed with cancer, your and your dog’s life may change dramatically. These changes can be difficult to deal with, and can put strains on you, your family and friends. It is normal that you develop many different and sometimes confusing feelings.

You may worry about your time schedule (job obligations), family, or your daily or weekly habits. It is also common to worry about the treatment and side effects, hospital stays, regular visits to the veterinarian and medical bills.

Your veterinarian can answer your questions about diagnosis, treatment, therapy and how your home might have to be adapted to your dog’s terminal illness. You may find out the approximate costs of the treatment and follow-up therapies. You might also want to talk about your worries and feelings with relatives, friends. You will find it helpful to discuss your concerns with other dog owners who have had the same experience. Talking is healing!

Internet sites such as ours – www.aliceribbon.ch – might give you ideas on what to expect and how to get started.

Your healthcare team is also in an excellent position to suggest resources for financial aid (insurance), transportation to the clinic, home dog-sitting, or emotional support which you can use during, and after, your end-of-life care.

Don’t be afraid to take on help!

The financial burden

11.2

Once a cancer diagnosis is determined, among the important considerations is cost.

Consulting with your vet or oncologist will certainly help get you an approximate figure, but he or she may be hesitant to nail down a specific figure since it’s impossible to predict just how your dog will respond to treatment. There are many other factors that can affect the eventual final costs. There are cancer treatments which can be done at a couple of hundred Euro a month, and others that start to add up into the thousands before the end of the treatment.

In chapter 7 and 8 on screening, treatments and therapies, the Animal Oncology and Imaging Center, Hünenberg in Switzerland has kindly given some rough estimates on prices. While they are only estimates and only valid for 2017, they will give you a good idea of what you might have to expect.

Animal insurance is an important option and may cover your dog’s cancer treatment (wholly or partially)—but be aware that rules concerning pre-existing conditions will generally prevent you from getting coverage once your dog has been diagnosed. So it is imperative to get animal insurance as soon as you have acquired your dog!! (see chapter 14).

A stitch in time saves nine!!

According to the National Canine Cancer Foundation USA,

the cost of the initial visit to confirm a cancer diagnosis can be upwards of $200.
Major surgery to remove a cancerous tumour deep inside the body, or one that will require reconstruction, can start at $1,500.
Chemotherapy treatments might range from $200 to $2,000, depending upon the type and severity of the cancer.
Radiation therapy can range from $2,000 to $6,000 or higher.
Additional medication—such as pain relievers or antibiotics—could cost another $30 to $50 per month for an indefinite period.

Resource and further reading
→ What to Do When Your Dog is Diagnosed with Cancer: Treatment, Prognosis, and Costs

Please find below the estimated average costs in Switzerland for the year 2017

Resourrce
→ comparis.ch

The time schedule burden

11.3

A terminally ill dog can be surprisingly challenging not only emotionally but also in terms of logistics and time burden. Hospice care requires an active commitment and constant supervision from the caregiver.

Remember that taking care of your pet means above all taking care of yourself. How else can you have the energy to help your furry friend?

When your dog is not able to get out of the house anymore, you will have to consider staying home more often to take care of your dog. This might put a strain on your family or partner. They might become frustrated, accusing you of neglecting them to be with your dog.

You might have to consider that during your dog’s end-of-life care you will very likely have to continue your work outside the home. Will your employer grant you paid leave if you take time off from work?

There might be a sense of a disruption in ‘normal life’.

Things you might be expected to do during the end-of-life care

11.3.1

1

Keeping a daily medical record
of your dog’s condition, changes in eating/eliminating patterns; dates of treatments and side effects is an invaluable tool in determining the eventual course of treatment.
In this difficult time, even someone with an excellent memory cannot be expected to accurately recall everything. Writing it down provides a permanent and very important record.
2

Keeping a daily medication schedule
What doses of which medications were administered, at what time each day, etc.
3

Evaluating your dog’s pain
assessing his quality-of-life on a daily basis and giving pain-relieving medication accordingly.
4

Preparing a special diet
often a whole-food diet especially designed for cancer patients (see chapter 10).
5

Transporting your dog to the veterinarian
for regular follow-up visits and examinations.
6

Transporting your dog to the clinic for treatments
Daily trips to the clinic if you’ve opted for radiation treatment.
7

Transporting your dog to the clinic for chemotherapy
Once every 3 weeks if you have opted for chemotherapy via injection.
8

Offering a heightened level of care
As your pet eventually loses some body functions: can’t walk anymore, can’t relieve himself alone, can’t eat solid food, etc.
9

Help your dog in walking and relieving himself
Your dog might develop a mobility issue. Nevertheless, it is important to keep him moving and engaged with the world for as long as possible. So you might have to help him in walking with the help of a towel under his chest.
10

Performing simple medical tasks
Such as bandage changes, cleaning subcutaneous fluids, administering medications, or providing maintenance on a feeding tube if our dog can’t eat anymore.
11

Starting to think about saying good bye
if you want to accompany your dog into his natural death (assisted by medication to make his last days or hours peaceful at home) or, if you feel it more appropriate, to wait for the time for euthanasia (in-home or at the veterinarian’s office).
A personal comment: 50% of pet owners regret or suffer from their decision to have their furry friend euthanized, and this adds to the stress and suffering of the caregiver.
12

Starting to think about burial or cremation services.

Resource
→ My Pet Has Cancer - 8 Must Know Tips For Comfort And Care

The psychological burden

11.4

Studies on the phenomenon of “caregiver burden” have shown that pet caregivers suffer in the same way that people caring for human family members do.

The strain of caring for terminally ill humans or pets follows the same pattern—sleepless nights, endless medical visits, losing out on a social life, financial stress and so much more. It can lead to lower quality of life, anxiety and depression.

Dr. Spitznagel (USA), who initiated the research in this field, started a blog called petcaregiverburden.com that focuses on the science of caregiver burdens in people caring for pets.

His research team’s goal is to help people decrease the stress of the situation and to make the most of the time they still have to spend with their pet.

This knowledge may help veterinarians understand and more effectively handle client distress in the context of managing the challenges of caregiving for a sick companion animal.

Signs of caregiver stress

11.4.1

As a caregiver, you may be so focused on your loved one that you don't realize that your own health and well-being are suffering. Watch for these signs of caregiver stress:

Feeling overwhelmed or constantly worried
Feeling tired most of the time
Sleeping too much, or too little
Gaining or losing a lot of weight
Becoming easily irritated or angry
Losing interest in activities you used to enjoy
Feeling sad
Having frequent headaches, bodily pain or other physical problems
Abusing alcohol or drugs, including prescription medications

Too much stress, especially over a long time, can harm your health. As a caregiver, you're more likely to experience symptoms of depression or anxiety. In addition, you may not get enough sleep or physical activity, or not eat a balanced diet — which increases your risk of medical problems.

Strategies for dealing with caregiver stress

11.4.2

The emotional and physical demands involved with caregiving can strain even the strongest person. That's why it's so important to take advantage of the many resources and tools available to help you provide care for your loved one. Remember, if you don't take care of yourself, you won't be able to care for anyone else.

To help manage caregiver stress:

Be informed about the disease
Having a good understanding of the disease, its trajectory and the skills needed for the care of the pet will minimize the stress and suffering of the caregiver.
Keep a diary
Write a diary of your dog’s conditions, his psychological state, social interactions, your thoughts and concerns, joys and sorrows. You might want to accompany it with pictures and/or videos. In this difficult time, writing down everything provides a permanent and very important record to look at later. It will be your and your dog’s common legacy and the souvenir of an emotionally very dense and special period of your life together with your furry partner. This might also help you to reassure yourself that you have done all humanly possible to help your friend.
Accept help.
Be prepared to ask others to help you, and let the helper choose what he or she would like to do for you. For instance, one person might be willing to take your other dogs / your children for a walk a couple of times a week. Someone else might offer to pick up groceries or cook for you.
Focus on what you are able to provide.
It's normal to feel guilty sometimes, but understand that no one is a "perfect" caregiver. Believe that you are doing the best you can and making the best decisions you can at any given time.
Set realistic goals.
Break large tasks into smaller steps that you can do one at a time. Prioritize, make lists where you can tick off the entries and establish a daily routine. Begin to say no to requests or extra work that are draining your energy.
Get connected.
Ask your veterinarian or find out on the internet about caregiving resources in your town. Caregiving services could be such as pet transportation, in-home pet-sitting for a couple of hours and shopping home-delivery.
It is important for caregivers to take time for the things they enjoy while occasionally finding a sitter for their sick pet. Many people, however, are afraid that if “I'm not there, something will happen”, which only adds to their stress.
Seek support from your friends.
Continue staying well-connected with family and friends who can offer non-judgmental emotional support. Set aside time each week for connecting, even if it's just a walk or a cup of coffee with a friend.
Set personal health goals.
For example, set a goal to establish a good sleep routine or to find time to be physically active on most days of the week. It's also crucial to fuel your body with healthy foods and plenty of water.
See your doctor.
Make sure to tell your doctor that you're a caregiver of a pet with a terminal illness. Don't hesitate to mention any concerns or symptoms you might have.

Resources
→ Caregiver stress: Tips for taking care of yourself
→ Caregiver burden in owners of a sick companion animal: a cross-sectional observational study

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