Tuesday, 28 October 2014

Massage for Palliative Care in the Older Dog

It has been widely researched that massage and aromatherapy can help with palliative care in humans (see appendix for examples of scholarly articles). Most seem to concur that there is a statistically significant reduction in anxiety after massage, with or without essential oils, and levels of anxiety are reduced. They conclude that massage can improve physical and psychological symptoms, as well as overall quality of life. In several palliative care units massage therapy is offered as a complementary treatment for pain, discomfort, and emotional distress working in conjunction with the health care multi-disciplinary team. 

In dogs there is less scholarly research regarding massage & palliative care but it is available (see appendix for examples). Dr Jessica Pierce states that using several different therapies, drugs and complementary therapies, can create a synergistic response which is more effective than a single therapy alone. Robin Downing states most dogs find massage to be very comforting and adds that massage can be performed by a trained provider, but many massage techniques can also be taught for use at home. 

Alice Villalobos, DVM, former President of the American Association of Human Animal Bond Veterinarians (AAHABV), and founding member of the Veterinary Cancer Society, refers to hospice care in dogs as “pawspice”. 

The event that set me thinking about palliative care and dogs was that I received two referrals the other week from a vet about a couple of elderly dogs. One was terminally ill with kidney failure, the other had suddenly started to struggle to walk. They were aged 14 and 13 years respectively and long-loved members of their families. Clearly I was not going to be able to make them puppies again but my aim was to help them with any muscle and joint aches and stiffness so they could hopefully be pain free to fight any other issues going on in their body – holistically helping them to heal themselves. 

This took me back to my very first case study – an elderly dog who was also referred to me by the same vet. The dog was an old lady with progressive stiffness in her hind legs. She also had a cruciate injury on her right back leg but the veterinarian had recommended letting it heal itself rather than putting this elderly dog through potentially life-threatening surgery. Her owners had taken the dog to hydrotherapy and now wanted to try more targeted massage and myotherapy. When I first met her she was severely hunched and clearly in pain. During the first treatment the owners and I were surprised at how she simply lay down for me making ‘happy vocalisations’ with no protest at all. Effleurage around her neck, pectorals, front legs, back and hind legs resulted in the dog actually turning round and planting a big kiss on me which both the owners thought was amazing as this was the first time we had met. 

After the first session I was sent a picture of a very relaxed dog sleeping happily for the rest of the day. When I walked through the door for the second session she immediately lay on the floor ready for the massage. Her owners said she had been ‘full of beans’ all week and was really looking forward to going out for her walks. In fact she was rather over-enthusiastic so they were taking it slowly as advised. It was also encouraging to see that they had also been doing the homework I had given them and that their dog was now actually coming to them and asking for it – she had turned into another massage diva. I can’t stress enough how giving owners the tools to help their own dog in return helps them too. 

I had several sessions with this dog and her owners regularly brought her to meet us at local dog shows. 18 months later she still remembered that seeing me meant she should lie down for her massage. 

Flash forward a couple of years to my latest ‘oldie’ referrals. The first was a very poorly dog who was suffering with kidney failure. My aim for the session was, at the very least, to help reduce the stresses, strains and stiffness that had built up in his limbs due to his immobility from his illness. Massage can help maintain the circulatory system, boost the immune system and relax the tired muscles. This should also help to quieten their mind allowing them to stretch out safely and concentrate on healing internally so they can continue in a dignified way for as long as possible. There is a double bonus too as the owner can also relax during the treatment session as they give the care of their dog over to me for a while. 

As often happens on the first appointment, the dog was slightly unsure of what was happening but quickly lay down and let me perform a series of gentle warming massage strokes to his whole body and joints. In addition the dog has taken to lying in a bed that was clearly two sizes too small, possibly for security. So his hind limbs had become very shortened and bent. As he stretched for me during the session I was able to gently extend his legs ensuring his tendons did not become shortened. The owner and I also used a bit of stealth to replace his small bed with one that was more his size while he was sleeping off the massage so that the issue would not recur. There is no fooling some dogs though, even elderly ones. When he approached his new bed he looked at it suspiciously, looked at us, then flopped down in eventual resignation. But he was able to stretch out so the dirty looks from him was worth it to us. We made a plan to visit this dog every couple of days to continue with the relaxing massage. As the week went on, his eyes were becoming brighter and he bounded to the door to greet me. 

We even introduced music into the therapy session. The dog had a ‘tune’ which the owner always used to sing to him at night. I downloaded that tune onto my phone and played it while giving him his massage. I’m sure he recognised his tune but even if he didn’t, the owner and I were singing along in a relaxed way. (Listen to "Harry" by Catherine Howe and try not to shed a tear with me.  I'll be a blithering wreck when that comes on shuffle as I'm walking Sam & Sarah)

I had given the owner a short routine to use on the dog before his first walk and during the day. She felt that empowered her in the palliative care of her dog, helping him to maintain his dignity and gave her something to do rather than simply watch him fade away. 

Senior referral number two was a dog who had become lame very quickly. The vet had diagnosed neurological degeneration and there was noticeable muscle wastage over his rear end. This dear dog decided immediately that he loved massage and lay down stretched out on his huge comfy bed for me. He even rolled over after 30 minutes so I could work on his other side – no prompting needed. We made a plan to visit this dog weekly at first to ease his muscular aches and pains and once more I gave the owners a short routine that to perform daily. 

As I have stated in other articles, I would advocate that massage is not just for prevention or injury but has many uses. One being as a useful adjunct to more traditional treatments in palliative care helping to reduce pain, improve circulation and relax muscles. Psychologically it also helps to calm, and comfort the dog thus helping to relieve any anxiety. It has been shown to be of benefit in humans so should be equally effective in our dogs. Combining a regular routine from the owner with a longer maintenance session from the professional could help maintain and even improve their quality of life. The regular routine doesn’t need to be a long session - the session I gave both sets of owners would only be about 5 to 10 minutes - but enough to give both them and their cherished dog a few hours peace. 

For advice on methods for treating elderly dogs, please contact me from the achypaw.com website. 

Appendix

The American Massage Therapy Association. (Sept 2009). ‘Massage Therapy Can Improve the Quality of Life for Those in Hospice and Palliative Care’. http://www.amtamassage.org/statement5.html [accessed 28th October 2014] 

Pierce. J. (2012) ‘Palliative Care for Pets’. http://www.seniorsresourceguide.com/articles/art01240.html [accessed 28th October 2014] 

Rodier. L. (March 2010). Canine Hospice Care Options : Veterinary hospice care considerations for your canine companion. http://www.whole-dog-journal.com/issues/13_3/features/Hospice-Care-For-Dogs_16206-1.html [accessed 28th October 2014] 

VCA Animal Hospital based on material written by: Robin Downing ‘Palliative Care for Dogs’. http://www.vcahospitals.com/main/pet-health-information/article/animal-health/palliative-care-for-dogs/8179 [accessed 28th October 2014] 

Wilkinson, S. et al (1999). ‘An evaluation of aromatherapy massage in palliative care’. Palliative Medicine. 5 pp 409-417

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