Pain is the leading reason human patients seek chiropractic care. It is logical to adapt the techniques of chiropractic for application to animal pain. It is important to understand the difference between biped and quadruped spinal biomechanics in order to provide healing and not harm. Comprehensive training is required by the veterinarian who will apply chiropractic as a treatment technique. The veterinary technician plays a critical role in treating animal patients with chiropractic. It is important for the technician to have an understanding of the principles and practices of veterinary chiropractic in order to fulfill that role.

The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.

As our most popular companion animals, dogs and cats are often lumped together for their management and general care. There are major differences in the development of dogs and cats that reflect differences in their evolution and domestic history. Dogs have been domesticated much longer than cats. The developmental stages of the dog and cat can be summarized as neonate, transitional, socialization, juvenile, adolescent, adult, and geriatric. During transitional roughly week-long stage, the eyes and ear canals of the puppies and kittens open. Socialization period is a time of great learning for puppies and kittens. The juvenile stage is one of continued physical, mental, and emotional growth for the puppy and kitten. Social maturation is when the baby animal becomes an adult and has adult responses to stimuli. Veterinary and aging experts are divided as to when cats and dogs become old and geriatric. Learning is the process by which a behavior is acquired, omitted, or changed as a result of experience. This chapter discusses classical conditioning, operant conditioning, counterconditioning, and desensitization. Classical conditioning is about associations between stimulus and emotion, physiological, or secretion response. Operant conditioning is based on cause and effect learning. Unlike classical conditioning, which is learning by association, operant conditioning is learning based on consequences. Counterconditioning is the process of changing an existing classically conditioned response, and replacing it with a new response to the same stimulus. Classical counterconditioning is the change of an emotional response. Operant counterconditioning is teaching the animal to perform a desired behavior in the presence of a important stimulus. Desensitization (DS) is a process where a stimulus is presented repeatedly in a controlled and gradual fashion. DS is a useful behavior modification tool and is used in conjunction with counterconditioning to change an animal's emotional and behavioral responses to stimuli. Pets are part of the lives of many people. Many families have pets so children can learn about life, empathy, and responsibility. Attention to how life stage changes may affect a pet means changes in management of the pet can be implemented to minimize disruption. A frequent stress for families is moving to a new house and this is a high-risk time for pets to be lost or injured. Pets and owners will be stressed so extra vigilance about gates, doors, and keeping pets on leashes when outside can all reduce accidents. For many pet owners, introducing a new partner to their pet can be stressful. Pets and interactions with animals are good for the development of children but are not without risk of injury. Mobile babies can frighten pets. Children gain a lot from interactions with pets. Some couples co-parent their pet after their relationship has broken down. For a pet owner to know when their pet's “tune-up” is needed is a first step to transparent and compliant care. A user's manual must be easy to read and broken up into sections that reflect the growth and development of the pet similar to automobile's care reflecting mileage. The manual should have sections for the more common nonveterinary pet care needs where questions might arise — nutrition, grooming, behavior, and insurance. The real benefit of computers is the ability to integrate the pet's name, breed, and breed-specific information very easily. This manual could be a great marketing tool as well. Compliance is an area of great frustration in practice. In many cases, compliance comes up short because of the lack of transparency and the ultimate surprise that occurs from visit to visit. Veterinary healthcare is not free but pets are considered family members or companions by most owners, consistently across all income levels, and not every family can afford care. Since the early 1970s, veterinary practices have focused, rightly, on maximizing revenues and demonstrating high value to the pet owner. Veterinary medical education has focused increasingly on specialized care, deemphasizing routine or wellness care in favor of advanced diagnostics and procedures that are unaffordable for many pet owners. Practices that serve low-income communities can be financially successful by offering every client treatment options priced with appropriate margins, but with at least some at more affordable prices. Cost containment is critical to success when providing veterinary services to low-income families in order to maximize the potential for acceptance of recommendations and to create a viable business. Low-income families want to be responsible pet owners, and understand they need to provide veterinary care for their pets. A major barrier to pets receiving veterinary care is the fear, anxiety, and stress (FAS) they suffer when visiting the veterinary hospital. Fear Free is based on the belief that veterinary practice can be a positive experience for the patient, the client, and the veterinary team if attention is paid to the FAS of the pets in our care. The previsit questionnaire and emotional medical record are opportunities to remind the client how best to transport the pet to the hospital. Fear Free can provide a competitive advantage to a veterinarian or practice over internet resources, pet store employees, and social media. Veterinarians and all veterinary practice team members need to be familiar with the signs of FAS in pets. Emotional health and well-being need to be diagnosed, and treated to the same extent as physical health and well-being. Visiting the veterinary clinic is a stressful time for both clients and patients. Cooperative veterinary care training is at the very center of pet-specific handling. Cooperative care training is focused on husbandry tasks the patient will need to comply with for its healthcare. Cooperative care training relies on consent work but also requires the animal have some foundation skills as well. Teaching a consent behavior is the first step in true cooperative care. Training a consent behavior is all about building a history of reinforcement for this behaviour. Targeting is a useful skill making it easy to move an animal into position without tugging or coaxing. Cooperative care behavior will require shaping, bridging, counterconditioning, and desensitization. Cooperative veterinary care starts with teaching a consent behavior the animal can use to communicate readiness to participate. Husbandry behavior should be trained through positive reinforcement. Many interactions and routine procedures can be made more animal friendly with simple changes. Vaccinations can be given in such a way as to reduce pain and routine procedures can be practiced, making them familiar for the pet. Cooperative care is a model from zoos and marine parks that encourages training of the animals to facilitate their own examination and healthcare which is becoming more familiar to veterinary clinics seeing companion animals. Creating a clinic that focuses on the animal's and client's experience has benefits for the animals, staff, and clients. Stressed and anxious pets display their distress differently. Animals may use aggressive behavior, struggle, or repeatedly jump up seeking reassurance. Veterinary clinics can be frightening for animals. Owner perceptions of how their animals feel at the clinic may cause them to delay presenting their pet to the clinic. Many routine procedures can be made more animal friendly with simple, low, or no cost changes. Behavioral problems are both very common in pets and incredibly frustrating for owners. Behavioral screening and counseling are essential components of every veterinary visit. The client's understanding of the importance of preventive healthcare is most easily influenced during early pet ownership. A team approach is best for behavioral counseling, allowing the hospital to maximize the team's comfort level and education. One of the common ways to positively influence the bond between the pet and owner is to encourage age appropriate socialization and obedience training. Behavioral screening and counseling should be part of all veterinary exams. Early socialization, positive training techniques, and environmental enrichment are key to maximizing companion animal welfare. Low-stress handling techniques encourage positive behaviors during veterinary visits. A strong human–animal bond with their pets leads to better, more satisfied clients, who contribute more significantly to ethical financial growth for the hospital. The recognition of behavior problems and mental health in animals is growing among the veterinary industry. The normal behavior of species generally seen at the veterinary clinic should be common knowledge for all staff. Mental illnesses in companion animals and other species kept in farms, laboratories, zoological collections, marine parks, and aquaria are recognized by veterinary behavior specialists. The types of mental health problems diagnosed in patients include anxiety disorders that may present as aggression directed at familiar people and/or animals, aggression directed toward unfamiliar people and/or animals, separation anxiety and distress, marking and house soiling, phobias, and Generalized Anxiety Disorder. Obsessive compulsive disorders and cognitive decline syndrome may also be seen. Depression is also recognized but rarely presented. Developmental disorders of young animals are also becoming recognized. Behavioral counseling, whether for undesirable or abnormal behaviors, begins with a thorough history, physical exam, and diagnostic testing. Once the medical and/or primarily behavioral causes for the problem have been diagnosed, treatment can ensue with appropriate therapy. Behavioral therapy may include owner education, environmental modification, behavioral modification, neuropharmacology, nutritional intervention, and/or auxiliary products. Environment enrichment is key to reducing boredomrelated negative behaviours. Consistency is key to the success of any behavioral intervention. Client education to increase compliance and motivation will improve the chances of success. Behavioral consultation and therapy can be an amazing economic driver for clinics who value and charge for them appropriately, are motivated to create programs that are client friendly, and utilize a team approach to delivery. Thorough behavioral counseling requires a full history, physical exam, discussion of environment, diagnosis, therapeutic plan, and follow-up to ensure compliance. New puppies and kittens are welcome additions to veterinary practice because they represent new life as well as the opportunity to forge lifelong veterinarian–client–patient relationships (VCPRs). Key considerations for every new puppy and kitten include, but are not limited to, breed-related predispositions to disease, behavior, diet, parasite control, and vaccination protocol. Each consultation is an opportunity to develop a unique VCPR and to address pet-specific care. To provide this level of care, veterinarians must cover the following areas: breed, behavior, diet, reproductive health, parasite control, and vaccinations. Small-breed puppies should be watched closely for eruption of permanent dentition so that, if necessary, dental corrections can be paired with sterilization surgery to avoid multiple anesthetic events. Pet-specific care requires an initial investment of time to take a thorough history, elicit the client's perspective, and individualize recommendations. Many people enjoy the company of their cats but may not understand what cats need. Cats are considered hypercarnivores by ecologists and have an essential requirement for meat. All cats benefit if their owners understand more about cats in general and their cat in particular. The information needs to be reinforced by all the healthcare team at every visit. There is a huge amount of information and pseudoinformation available on feeding a cat. There is a wealth of information on how to feed and maintain the health of kittens without mothers. Cats are always more cooperative with their owner around. Feline-Friendly Care aims to keep the owner safe and the cat calm, so allowing the owner to be present during the sampling procedure is recommended in most situations. Encourage owners to provide sufficient resources distributed in the area available for their cats to help reduce conflicts. Pet owners fear pain and suffering for their beloved animal family members. Pet owners want their beloved animal family members to live as long as possible, and they are rightly concerned about the potential for pain to undermine their pets’ quality of life. Pet owners want the veterinary team to partner with them for the benefit of their pets. An important key to pet pain prevention and keeping pets lean is to keep them active. The veterinary team can and should play a role in guiding pet owners about appropriate activity for particular dogs and cats. Once pain and inflammation from osteoarthritis are present, an appropriate multimodal pain management strategy must be designed and implemented in order to break the pain cycle, and allow the pet to engage in regular activities. Conditioning for lifelong health, wellness, and activity is best begun early in a pet's life. Obesity in dogs and cats is one of the most common diseases encountered in small animal veterinary practice, affecting approximately 20–40% of all pets. The recognition, diagnosis, and treatment require the veterinary team to focus on the individual patient's needs, develop a comprehensive communication strategy, and offer sustainable treatment options. The concept of weight bias and personal bias has been well documented in human medical literature. The foundation of obesity treatment in dogs and cats remains caloric restriction and increased caloric expenditure through physical activity. The American Medical Association encourages physicians to use a “person-first language” approach to obesity. The next step in diagnosing and treating obesity is to obtain a nutritional history. One of the biggest challenges in obtaining an accurate nutritional history is uncovering the number of treats and food rewards given. Vital signs are patient-specific measurements used in both clinical practice and triage to assess the status of an individual's whole-body health. Tracking changes in BP at each veterinary visit is prudent so as to diagnose disease early and initiate medical management before significant target organ damage (TOD), direct blood pressure (BP) measurement involves placing an arterial line in the patient. Systolic BP, diastolic BP, and mean arterial pressure are measured continuously. Indirect BP measurement, using Doppler or oscillometric monitoring, is more practical. Systemic hypertension may be primary or secondary. Routine BP screening among apparently healthy patients is key to establishing their baselines so that deviations from the norm can be noted and evaluated in light of trends. Screening for hypertension is important to patient wellness; being proactive catches disease early. Early recognition of systemic hypertension allows the clinician to initiate treatment before TOD is irreversible. An important aspect of senior care involves monitoring body condition and providing nutritional consultation. In most pets, base metabolism rate (BMR) decreases with age, yet with older cats, BMR can increase. Cognitive decline (dementia) is common in aging dogs and cats, and their QOL can be greatly impacted. If signs are detected early in the process, management can help keep the changes minimized and help pet owners adjust accordingly. Older pets have a higher incidence of dental disease, primarily because the teeth and periodontal tissues have been there longer to accumulate problems. As in human medicine, a patient's care can be enhanced if they have an advocate that can monitor their care and health parameters. Helping pets age well is an important part of veterinary care. Simple tips can help owners make adjustments to their pet's environment to encourage movement and mental activity – important for aging gracefully. There are several changes seen in the body as it ages. Weight loss and change in body composition are seen in older dogs and cats. Higher body condition scores (BCS) have been linked with longer survival rates when faced with serious health problems such as neoplasia or cardiac insufficiency. Body weight and BCS should be assessed and recorded across the pet's life. Decreases in BCS below healthy need to be investigated. It is common for animals well into their teens to be presented to companion animal practices. Aging in companion animals mostly parallels aging in people with the expected decline in sensory abilities along with more complicated medical problems. Cognitive decline is due to normal aging, while cognitive impairment is a loss of learned responses and other cognitive skills due to damage to the brain. In elderly dogs and cats, it leads to cognitive decline syndrome (CDS). CDS parallels dementia and Alzheimer's disease (AD) in humans. There are several theories as to what causes CDS. Some animals have the changes in the brain associated with AD in humans and it is thought that it may be the same disease process occurring. Treatment of CDS aims to improve clinical signs and slow progression of the disease to improve the welfare of the pet and owner and delay the onset of dementia. Quality of life (QOL) is a term we use to describe the qualitative, less clinically measurable components of a pet's condition. Helping clients to understand how to read their pet's behavior to determine their QOL can not only facilitate conversations about whether it is time to consider euthanasia, but it can also prompt treatment discussions about pain management or other palliative care. Helping everyone to see and hear what a pet is communicating can be critical as a family considers euthanasia and deals with grief at the end of life. An important part of a caregiver's education at their pet's end of life is understanding what this specific death might look like if they delay euthanasia too long.

The guidelines discuss the components of a systematic approach to nutritional management of dogs and cats. A nutritional assessment, including a body condition score and muscle condition score, is a screening evaluation that should ideally be performed at every examination. Individualized nutritional recommendations, based on the nutritional assessment, should be designed to achieve and maintain an appropriate body weight and meet nutritional requirements. Communicating nutritional recommendations to clients is a challenging aspect of nutritional management because pet owners may interpret the practice team's guidance as advocacy for a particular pet food brand or a judgment of the client's ability to properly care for the pet or of the owner's own nutritional status. The guidelines discuss approaches for effective, nonjudgmental communication of dietary recommendations to clients and strategies to increase acceptance of and adherence to veterinary nutrition recommendations. Other pet nutrition topics of current interest include recommendations for particular pet life stages, breeds, and disease conditions; risk factors for nutritional deficiencies and obesity; and considerations for home-prepared diets.

The guidelines discuss the components of a systematic approach to nutritional management of dogs and cats. A nutritional assessment, including a body condition score and muscle condition score, is a screening evaluation that should ideally be performed at every examination. Individualized nutritional recommendations, based on the nutritional assessment, should be designed to achieve and maintain an appropriate body weight and meet nutritional requirements. Communicating nutritional recommendations to clients is a challenging aspect of nutritional management because pet owners may interpret the practice team’s guidance as advocacy for a particular pet food brand or a judgment of the client’s ability to properly care for the pet or of the owner’s own nutritional status. The guidelines discuss approaches for effective, nonjudgmental communication of dietary recommendations to clients and strategies to increase acceptance of and adherence to veterinary nutrition recommendations. Other pet nutrition topics of current interest include recommendations for particular pet life stages, breeds, and disease conditions; risk factors for nutritional deficiencies and obesity; and considerations for home-prepared diets. (J Am Anim Hosp Assoc 2021; 57:153–178. DOI 10.5326/JAAHA-MS-7232) AFFILIATIONS From Red Bank Veterinary Hospital, Tinton Falls, New Jersey (M.G.C.); Academy of Veterinary Nutrition Technicians, Lafayette, Indiana (K.M.B.); Department of Population Medicine (J.B.C.) and Hill’s Pet Nutrition Primary Healthcare Centre (T.D.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada; The Downing Center for Animal Pain Management, LLC, Windsor, Colorado (R.D.); Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee (M.M.); and Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio (V.P.). CONTRIBUTING REVIEWERS Angela Rollins, DVM, PhD, DACVN, Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee Megan Shepherd, DVM, PhD, DACVN, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia Correspondence: marthagcline@gmail.com (M.G.C.) * These guidelines are supported by generous educational grants from Hill’s Pet Nutrition, Inc., Purina® Pro Plan® Veterinary Diets, and Royal Canin®. They were subjected to a formal peer-review process. † M. G. Cline is the chair of the AAHA Nutrition and Weight Management Guidelines Task Force. x T. Durzi is the representative for the Primary Care Veterinary Educators. These guidelines were prepared by a Task Force of experts convened by the American Animal Hospital Association (AAHA) and were subjected to a formal peer-review process. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience. AAFCO (Association of American Feed Control Officials); ACVN (American College of Veterinary Nutrition); BCS (body condition score); BF% (body fat percentage); BW (body weight); CKD (chronic kidney disease); DCM (dilated cardiomyopathy); DEXA (dual-energy X-ray absorptiometry); DHF (diet history form); HPP (high-pressure processing); MER (maintenance energy requirement); MCS (muscle condition score); RER (resting energy requirement); WSAVA (World Small Animal Veterinary Association); USDA (United States Department of Agriculture) The AAHA website (aaha.org/nutrition) contains supporting information and resources for practice teams. a 2021 by American Animal Hospital Association JAAHA.ORG 153

This chapter discusses the development and evolution of veterinary palliative medicine and hospice care, evaluation and maintenance of the quality of life in end of life care, foundational principles of clinical bioethics, bioethical principles, and the systematic approach to the practicalities of end of life care. As soon as a life-limiting disease is diagnosed, it is appropriate to open a dialogue with the pet owner about the anticipated arc of the disease process on the way to the end of the pet's life. It is important to consider the effects of pet end of life care on the family's quality of life. In Principles of Biomedical Ethics, Tom L. Beauchamp and James F. Childress describe four foundational principles that may serve as an analytical framework for the formulation of rules guiding medical decision making. They are: respect for autonomy, nonmaleficence, beneficence, and justice.

The objective of this 90-day pilot clinical trial was to assess the impact of a full-spectrum product containing hemp extract and hemp seed oil on dogs with chronic mal-adaptive pain. A total of 37 dogs diagnosed with chronic maladaptive pain primarily as a result of osteoarthritis were enrolled in the study. The dogs were given an initial physical examination that included systematic pain palpation, mapping of pain patterns, informal gait analysis, metabolic profile, and owner interview. The same palpa-tions and mappings were performed during each biweekly assessment to identify trends, chart progress, and inform dose adjustments. The metabolic parameters were repeated at the end of the study. Of the 32 dogs that completed the study, 30 dogs demonstrated improved pain support. Of the 23 dogs in the study that were taking gabapentin at the time of enrollment, 10 dogs were able to discontinue the gabapentin, and an additional 11 dogs were able to have their daily dose reduced with the addition of the cannabi-diol (CBD) oil. Conclusion: The addition of a hemp-derived CBD oil appears to positively affect dogs with chronic maladaptive pain by decreasing their pain, thereby improving their mobility and quality of life. The reduction in gabapentin dose may be the result of changes in analgesia and/or sedation with the addition of the hemp oil extract.

"Translating the Human Clinical Ethics Consultation Committee Model for Veterinary Applications." The American Journal of Bioethics, 18(2), pp. 54–55

End-of-life (EOL) care and decisionmaking embody the critical final stage in a pet's life and are as important and meaningful as the sum of the clinical care provided for all prior life stages. EOL care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client. Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support. Veterinarians should not allow an EOL patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place. Animal hospice care addresses the patient's unique emotional and social needs as well as the physical needs traditionally treated in clinical practice. An EOL treatment plan should consist of client education; evaluating the caregiver's needs and goals for the pet; and a collaborative, personalized, written treatment plan involving the clinical staff and client. Primary care practices should have a dedicated team to implement palliative and hospice care for EOL patients. How the healthcare team responds to a client's grief after the loss of a pet can be a key factor in the client's continued loyalty to the practice. Referral to professional grief-support counseling can be a helpful option in this regard.

Pain is an unpleasant and emotional experience associated with actual or potential tissue damage. The current method of caring for a person with multiple issues and problems is a "multidisciplinary" approach; however, the disadvantages of a multidisciplinary approach are many. A more desirable alternative is an "interdisciplinary" approach. Interdisciplinary care is predicated on professionals communicating with one another about a single patient and designing care that is in the overall best interest of the patient. This paper describes the formation of the International Veterinary Academy of Pain Management, whose objective is to promote the interdisciplinary approach to animal pain management.

Traditional Chinese veterinary medicine (TCVM) has been practiced for thousands of years. TCVM focuses on keeping the mind and body in balance as imbalance leads to illness and disease. TCVM is categorized into five branches that include diet and food, exercise -Qi-gong, Tui-Na, acupuncture, and herbal medicine. A diagnosis in TCVM is reached by differentiating patterns — those of the patient's constitution and of disease or imbalance. The diagnostic systems used include yin-yang, eight principles, zang-fu organs, four levels, six stages, san jiao, and pathogenic factors. In both the human and veterinary field of study, myofascial trigger points (MTrPs) cause pain. Palpation after clinical evaluation is currently the only method used in veterinary medicine to definitively diagnose MTrPs. While it is important for veterinary technicians to understand the principles and practices of veterinary chiropractic, it is not appropriate for technicians to perform animal chiropractic adjustments.

Chiropractic is a medical discipline based on spinal manipulation. A central tenet of chiropractic medicine is that pathology of the spine leads to nervous system dysfunction through the formation of a “vertebral subluxation complex (VSC)”. The VSC describes a spinal segment that is restricted from moving throughout its normal range of motion (ROM). A primary care practitioner, by carefully palpating the patient for pain, can identify patients that would potentially benefit from chiropractic evaluation and adjustment. Before any adjustments occur, the canine patient must be thoroughly evaluated to make as complete a diagnosis as possible. The same principles that apply to diagnosing and adjusting dogs apply to cats as well. This means decreasing significant pain before adjusting to provide the best outcome and experience for the patient. Chiropractic care provides a reasonable strategy for enhancing the effects of pharmacological pain management strategies.

In providing palliative care and hospice in a veterinary outpatient primary care setting it is important to manage all aspects of the patient's needs as well as the primary disease process, and to understand that veterinary palliative care and hospice do not require a special degree or board certification. They only require compassion for the terminally ill patient and the human family members, a commitment to keeping patients united with their families for as long as they are comfortable, and a willingness to keep a comprehensive perspective on the patient's changing needs as death nears.

Hygiene, comfort, and safety during pet palliative care and hospice are usually straightforward. The veterinary health care team must coordinate care to ensure that the pet and the family are fully informed and engaged in the process. End-of-life issues, euthanasia, and death are typically not everyday concerns for the pet owner. Pet owners and veterinary patients rely on the veterinary health care team to help create the structure within which the pet will die. The veterinary team can give the family-pet unit the gift of structure and multifaceted comfort. The veterinary profession must take seriously this unique niche of care.

Veterinary patients in palliative and hospice care have progressive and often degenerative diseases that can cause pain as well as loss of function and decreased quality of life. These patients can often benefit from the application of physical medicine and rehabilitation techniques to maximize comfort and function. Physical medicine and rehabilitation are most effective as adjuncts to pharmacologic pain management. Physical medicine and rehabilitation can decrease the doses of analgesics required to keep these patients comfortable. The blend of physical and pharmacologic medicine allows an optimum balance between maximum comfort and maximum mentation.