EDITOR’S NOTE
Nearly all veterinarians have managed terminally ill patients for which aggressive treatment or euthanasia, for a variety of reasons, is not an option for the owner. Veterinary hospice provides an alternative therapeutic modality to support quality of life.

The following case exemplifies how hospice services can be customized for optimum end-of-life care.

History
Tazz, an 11-year-old castrated Maltese, began experiencing slight hematuria. Although CBC and biochemistry test results were normal, ultrasonography of the bladder revealed a mass. Biopsy confirmed transitional cell carcinoma (TCC). In general, surgery can be unhelpful in most TCC cases because of the extent of disease at diagnosis. Chemotherapy with mitoxantrone at 5 mg/m2 IV q3wk can be helpful in combination with piroxicam. These options were declined by Tazz’s owners because of Tazz’s age, history of difficult anesthetic recoveries, and severe dislike of
veterinary clinics.

Piroxicam was prescribed at 0.3 mg/kg PO q24h. However, Tazz also had a history of pancreatitis and a sensitive digestive system and began to have NSAID-related hematemesis 3 weeks later.  Piroxicam was ceased and tramadol begun at 2.5 mg/kg PO up to q6h, in addition to famotidine at 1 mg/kg q12–12h and sucralfate at 500 mg PO q8–12h. Although Tazz had good quality of life on this regimen for over a year, his owners requested in-home hospice care to maintain his comfort until he passed naturally or euthanasia was elected.


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