Written by Shannon Fujimoto Nakaya, DVM
I encounter many people who proclaim, "When the dog can no longer walk, that's it." There is a lot of empathy for pets who can't get up to relieve themselves -- namely poop and pee -- independently; it is a predicament that many people hope to avoid for themselves. Perhaps those of us who work in the health care profession have, by necessity, different views on these bodily functions; but bodily functions happen -- poop happens and pee happens -- and the goal is to have them happen as comfortably and as tidily as possible. There are tips, techniques, pads, beds, lifting devices, wipes, and shampoos that can minimize clean up and make getting through these necessary bodily functions as efficiently as possible and allow us to enjoy more time on more pleasant matters.
Like people, some pets will be more accepting of being helped than others. If losing mobility is an acute development, where the pet was independently getting up on its own and suddenly cannot, the initial adjustment is sometimes harder. However, even in these cases, the first week is usually the hardest, after which most pets adapt, learn, and get used to new routines (often times, more easily than humans do). Most pets are adapatable about receiving help for matters of personal hygiene. In fact, some of them seem to develop quite an enjoyment for being pampered like a prince or princess, having someone freshen their bedding, bring them snacks and a beverage, give them a massage, sit and tell them how special they are . . . who needs legs?
Maintaining hygiene is absolutely essential for the non-ambulatory pet. They MUST be kept clean and dry at the level of their skin. Fur coats can hold on to a lot of moisture and damp skin will be much more vulnerable to urine burns and bed sores. These can occur rapidly, be difficult to resolve, and lead to pain and life-threatening infections. They are not pretty and should not be part of the graceful aging, graceful exit plan.
Some pets remain aware of their bodily needs and communicate when they "need to go." Others cannot. Strategically placed diaper pads can catch most of the bodily excretions; however, the patient still needs to be checked to make sure that the diapers wicked the fluids away from their body. Fitted diapers can catch eliminations more accurately, which can be helpful, particularly in patients who squirm off their beds (although sometimes these patients squirm out of their diapers as well). Fitted diapers hold eliminations against the body necessitating wiping and drying the patient during diaper changes.
In pets with long coats, it is sometimes easier to strategically trim or shave fur from private parts and hind legs. It allows for easier bathing and faster drying. It also allows for monitoring the health of the skin more readily.
Bathing may just become a regular part of your pet's life. It is really helpful to have a detachable shower head or a hose with a warm water connection. Older and debiltated pets often get chilled more easily than younger ones. Cold water can just be shocking and unpleasant to them and they will express their displeasure, where as warm water showers are really not so bad and generally well tolerated. Having a rack or a stretcher or a plank that can keep your pet positioned in a slight angle (front end elevated a few inches higher than its hind end) during it's showers will keep the entire animal from getting soaked if hind end needs bathing. Rather than wetting, then shampooing in a full lather, then rinsing and rinsing and rinsing, I try to keep bathing to something that gets the patient clean in just a few minutes. I put just a squirt of shampoo into a bucket and fill the bucket with warm water creating a bubble bath that smells clean and is not really soapy. If the patient is really soiled, I'll use two or three buckets of this "bubble bath" until the patient is clean. In any case, the rinse cycle is eliminated. In cases where he patient can hold it's front end, I'll sit it's hind end in a bucket of warm sudsy water and wash it that way. The more water you absorb with towels, the faster the patient will be dry and the less time spent with the blow drier. Dry towels absorb more water; I use two to three towels to dry a corgi.
Baby powder can help with that last little bit of dampness.
Bedding should be (1) soft enough to prevent bed sores or pressure sores, and (2) washable or easy to clean in case there are accidents. There are a variety of orthopedic foam beds for pets. Foam is nice and soft and conforming, but can be very difficult to clean if peed on, especially the larger, finer, thicker pieces of foam. If the foam bed you've chosen does not come with a waterproof cover, a vinyl tablecloth or a piece of vinyl from the fabric store will give you that layer of protection. Even if it does come with a waterproof cover, having a second "back up" cover or an extra layer of protection might be a good idea. Plastic bags work in a crunch, but they puncture more easily and are much more slippery and crinkly than a piece of heavy duty vinyl.
While you are the fabric store, you might also purchase some fleece. This is one of my favorite materials for bedding. If you aren't concerned about the color or print, you can usually find something that no one can imagine wearing at a very discounted price. It can be cut and/or folded to whatever size works best for your needs and the edges do not require finishing. I use it to on top of other bedding. I also used it as bedding -- a dozen layers of fleece provides very decent padding that is entirely washable in a regular washing machine. And fleece dries very quickly.
Laundry tips: Scoop up as much of the soilds as possible. Rinse out the visible stuff. If urine soaked, put it under running water for a few minutes for dilution. Or soak in a bucket of water. Use your regular detergent and add a cup of white vinegar to your wash -- it works like magic to neutralize the bad odors and the laundry will not smell like a pickle. (Thank you to Virginia Maxwell for sharing this best ever laundry tip.)
Inflatable air mattresses can provide decent padding and are easy to clean.
Even when your non-ambulatory pet has the most comfortable and conforming bed, it is important to change it's position, or shift if from side to side, every few hours. Particularly when a patient is lying on one side, the lung lobes on the bottom side do not fully expand. There will also be poorer blood circulation on the bottom side. It is standard protocol to rotate recumbent (not capable of getting up on its own) hospital patients from left side down to right side down every 1 to 2 hours.
All of this is easier when your animal companion happens to be 10 pounds rather than 100 pounds. I've known more than one senior pug that happily got toted around in a padded rubbermaid container. I've also cared for large and giant dog, some of them bigger and heavier than me. It is possible if you're up for a good work out and have a strong back. Some of the assistive devices described in the earlier chapter on mobility are really helpful when working with larger dogs.
Non ambulatory patients can be more sensitive to changes in the surrounding air temperature. Feeling their feet and ears will give you some indication about whether they are feeling hot or chilled. A non-ambulatory patient should never be placed directly on or under a heating pad. It is safer to put the pad under a couple of layers of blanket and let the heat rise.
Access to water needs to be insured. Water bowls should be broad-based or attached to a stable base so that they can't tip over. Sometimes it's just easier to offer the patient water every few hours.
Often times, people seem heistant to touch the elderly, whether they are elderly humans or animals. Many elderly animals appreciate light touches, especially from those they are familiar with and trust. Running a finger or a soft toothbrush gently along the contours of your animal companion's face and ears or a gentle rub down over it's entire body can stimulates microcirculation and the release of endorphins (self-made chemicals that make us feel good). Internationally reknowned animal expert, author, and teacher Linda Tellington-Jones has thousands of cases recorded in books, videos, and classes showing how gentle touches TTouch can impact animals (and humans) physically and mentally.
Caring for a non-ambulatory patient requires total commitment. It is not possible to make this commitment alone and have a job or another responsibility that takes you away for hours at a time. It is not fair to an animal companion to make this commitment part way because being stuck lying in your own waste for hours on end is not natural or desirable for any animal. Alowing it to happen to a beloved companion falls somewhere between neglect and cruel and unusual punishment.
Given a choice, few would choose to be non-ambulatory and dependent on others to perform necessary bodily functions and maintain hygiene. But as a well-respected mentor once pointed out, if this animal companion were my grandfather, I could not kill him just because he needed help getting out of bed and going to the bathroom. So long as her dog remained otherwise physically and mentally well, she was committed to lifting, carrying, bathing, and pampering. And none who saw them could ever say it was a tortured existence. It was a journey graceful aging, dealing with what we don't have and appreciating what we do. There are some animals, like some people, who are ferociously protective of their independence, and might choose death over care and dependency. For better and for worse, we can make that choice on behalf of our animal companions. It can be a weighty decision (more about this in my other book, Kindred Spirit Kindred Care: Making Decisions On Behalf of Our Animal Companions), but this is one of the situations where it seems more humane to make a choice one way or the other than to allow our animal companions to wallow in our indecisiveness.