09/12/17

How to care for your pets after you die — and what you should never do

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According to the 2017-2018 National Pet Owners Survey, 68 percent of U.S. households, or about 85 million families, own a pet. For many, these animals are not just companions, but beloved family members. From providing comfort in times of trouble to greeting us at the front door, it’s hard to imagine life without their unconditional love.

Nevertheless, whether you’re the proud owner of a miniature box turtle or mammoth Irish Wolfhound, owners have an obligation to ensure that their four legged friends are cared for when they’re no longer around.

But Erach F. Screwvala, an estate-planning attorney with Screwvala LLC, says that he’s noticed a rising trend in asset base management: unusual pet provisions.

Recently, one NYC woman made headlines when she left $300,000 of her $3 million estate to her two cats. The Manhattan lawyer says that though it’s not uncommon to see vast sums allocated to furry friends, you don’t need to allot such sky high funds for adequate care.

“Amounts higher than this are more common in the celebrity world – for example, Oprah Winfrey supposedly has put aside $30 million for her dogs in her will,” Screwvala said. “If such large bequests are desired, it is critical to provide for distribution of any excess amounts after the death of the pets to avoid burdensome probate proceedings to distribute any remaining money.”

In outlining pet provisions for a well-crafted estate plan, Screwvala suggests taking one of three routes: listing a beneficiary, establishing a pet trust, or finding a trustworthy organization to look after your sweet Fluffy or Fido.

First, a beneficiary will inherit your pet when you pass away; preferably, you can leave them money to provide for the animal. Next, if you desire more control, a pet trust, ideally as part of a revocable living trust, is recommended. While this plan is more expensive to set up, it provides certainty that the pet will be cared for precisely how you want, Screwvala said. It is critical to provide sufficient funds for a pet trust, so that the trustee has ample funds to execute your wishes. This is particularly true with animals that have longer life expectancies, like horses, he adds.

Lastly, finding a specialized animal care organization is a viable option to leave your furry friend in good hands. Make sure that you make arrangements in advance, as many groups will have specific guidelines, Screwvala notes. In his years as an estate planning attorney, Screwvala has encountered many bizarre requests for pet provisions.

“One that really sticks out in my mind was when I was asked to include a diamond dog collar and walking leash. Although, this was a rather peculiar request, it was definitely a wise move, as you can imagine a genuine diamond collar is incredibly valuable!” he said. “However, if the dog collar was encrusted with laboratory grown diamonds I would advise against because synthetic diamonds are of no inherent value.”

Additional requests have included a wardrobe of designer animal outfits and provisions for a custom-made wooden casket for a cat, Screwvala said. While such specific requests certainly gave the owners of those animals peace of mind, establishing your estate plan with straightforward pet provisions is beneficial to all.

“The most important thing people should leave is enough money to ensure that their pet is properly cared for after they pass away,” Screwvala said. He suggests avoiding overtly ridiculous food provisions (filet mignon steak only!) or anything else that might be difficult for the caretaker to fulfill.

Ultimately, one of the smartest moves you can make is connecting with an experienced estate planning attorney who understands your local laws, Screwvala says. This expertise is critical: in some states, provisions for pet care in wills are honorary, meaning that they can be ignored by your heirs.

“They don’t need $300,000, but a loving caretaker, regular veterinarian care, and a couple square meals a day will do wonders!” he said.

Complete Article HERE!

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09/11/17

Doctors want to give their cancer patients every chance. But are they pushing off hard talks too long?

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Biff Flanagan, an esophogeal cancer patient, stands with his wife Patricia at their home in Sa Diego, CA on Wednesday, August 30, 2017. Mr.Flanagan received an experimental immuotherapy cancer treatment for his cancer.

By Bob Tedeschi

A new generation of immune-boosting therapies has been hailed as nothing short of revolutionary, shrinking tumors and extending lives. When late-stage cancer patients run out of other options, some doctors are increasingly nudging them to give immunotherapy a try.

But that advice is now coming with unintended consequences. Doctors who counsel immunotherapy, experts say, are postponing conversations about palliative care and end-of-life wishes with their patients — sometimes, until it’s too late.

“In the oncology community, there’s this concept of ‘no one should die without a dose of immunotherapy,’” said Dr. Eric Roeland, an oncologist and palliative care specialist at University of California, San Diego. “And it’s almost in lieu of having discussions about advance-care planning, so they’re kicking the can down the street.”

Palliative care and oncology teams have long been wary of each another. For many oncologists, palliative care teams are the specialists to call in only when curative treatments have been exhausted. For many palliative care specialists, oncologists are the doctors who prescribe treatments without regard to quality-of-life considerations.

But the new collision between immunotherapy and palliative care experts comes at an inopportune moment for health care providers, who have in recent years promoted palliative care as a way to increase patient satisfaction while reducing costs associated with hospitalizations and emergency room visits.

Dr. Cardinale Smith, an oncologist and palliative care specialist at Mount Sinai Hospital in New York, said she has seen a handful of patients who tried immunotherapy treatments after failing chemotherapy, and who were later admitted to the hospital in poor condition. Almost all of them died there, without having been asked about where, and under what conditions, they might prefer to die.

“These conversations are not occurring because of the hope that this will be the miracle treatment,” Smith said. “Unfortunately, on the part of the oncologist, treatments like immunotherapy have become our new Hail Mary.”

Immunotherapies work for only around 15 to 20 percent of cancer patients who receive them.

They have been approved by the Food and Drug Administration for Hodgkin lymphoma and certain cancers of the lung, skin, blood, kidney, bladder, and head and neck — but not for common cancers like prostates and most cancers of the colon and breast. A new type of immunotherapy, CAR-T, was approved earlier this week for leukemia.

But even for those cancers, oncologists and patients sometimes refuse to acknowledge clear signs that immunotherapies are failing, said Dr. Sandip Patel, a cancer specialist and immunotherapy researcher at the University of California, San Diego.

Patel said he now engages home-based palliative care specialists, who can provide supportive care while a patient’s health is relatively stable. “Then, at least when they transition to hospice, it’s not as much of a free fall out of the traditional health system, and if they’re one of the patients who respond to the therapy, great.”

He lamented the fact that patients who fail immunotherapy treatments spend more time in hospitals than with their families at home. “The flip side is, if I had a cancer with a 15 percent response rate, and if the benefit might be longer-term, I’d try it,” he said. “Who wouldn’t buy a ticket to a lottery of that importance?”

But not all patients have a clear idea of what that lottery ticket might cost them. Carrie Clemons’s father, Billy Clemons, who is 68 and is a former Texas state representative, last year stopped responding to chemotherapy for renal cell cancer that first struck him in 2002. His doctors recommended the immunotherapy Opdivo, which had recently been approved for his cancer.

At the time, he was symptom-free from his cancer, though scans showed it had spread to his lungs and some lymph nodes.

Two infusions of the drug, Clemons said, were followed by “eight months of hell,” during which her father became incontinent and had to use a wheelchair, lost his eyesight and most of his hearing and speech, and endured multiple weeks of intubation and care in the ICU. When his heart stopped beating, he needed to be resuscitated.

While immunotherapies trigger debilitating side effects much less frequently than chemotherapy, they can spur potentially life-threatening conditions, depending on the cancer type and the treatment approach. Fewer than 5 percent of patients overall face serious side effects, for instance, but more than one-third of melanoma patients who receive a combination of immunotherapy drugs can experience such conditions. The upside: Half of those melanoma patients will see their cancer shrink for at least two years.

Clemons’s doctors at Houston’s MD Anderson attributed the reaction to a runaway immune system that essentially attacked his central nervous system. To reverse it, he needed weeks of therapy to replace his plasma with that of donors, to clear away his blood’s overly active antibodies.

He slowly improved, though, to the point where only some slight vision impairment remains, and doctors recently declared his cancer in remission.

Although the family is thrilled at the outcome, Clemons said, they had little idea when they began that such side effects were possible, and doctors never engaged the palliative care team to either discuss side effects or help manage them.

She wouldn’t have known to ask about such care. “I always just equated palliative care with hospice,” she said.

Hospitals overall have made some headway in integrating oncology and palliative care specialists, with more oncologists referring patients to palliative specialists to help them ease side effects of treatments and achieve quality-of-life goals.But Roeland, the doctor at the University of California, and others say the integration is less smooth when it comes to cutting-edge cancer treatments.

Palliative care teams have not been able to keep abreast of the breakneck pace of cancer treatments, so they may not be offering up-to-date counsel to patients who ask about possibly life-changing therapies.

Meanwhile, most of the growth in palliative care medicine has happened among clinicians who work in hospitals, where they generally see only those who have done poorly on immunotherapies, for instance.

“They’re not seeing the super-responders,” Roeland said. “So their first reaction usually is, ‘Why would you do that?’”

Biff Flanagan, an esophogeal cancer patient, on a walk with his wife Patricia at their home in San Diego, CA on Wednesday, August 30, 2017. Mr.Flanagan received an experimental immuotherapy cancer treatment for his cancer.

Roeland understands more than most the seductive qualities of an eleventh-hour immunotherapy gambit. He had given up hope of curing Bernard “Biff” Flanagan, 78, of his esophageal cancer in late 2015, and referred Flanagan to hospice care to help him manage his extreme weight loss, fatigue, and the emotional distress he felt from not being able to swallow.

But Flanagan, who speaks with the gruff, seen-it-all humor one might expect from a career FBI agent in LA, wanted to keep seeking a cure.

Roeland said he knew that many hundreds of clinical trials were testing the therapies on other cancers, so he did some digging. A paper from a recent cancer conference showed that some people with squamous cell esophageal cancer responded to immunotherapy. He could arrange to get the drug through the Bristol Myers Squibb, for free.

He presented the idea to Flanagan and his wife, Patricia, with the caveats that it might not work, and could come with possibly significant side effects.

Flanagan jumped at the chance. Patricia, a former professional photographer, was less enthused.

“I ran into her later in the coffee shop,” Roeland said. “She looked at me like. ‘What the hell are we doing here? He doesn’t have a good quality of life.’ I’m feeling guilty now.”

Roughly six weeks into the treatment, Flanagan’s energy was returning, and he found himself at the fridge. “I grabbed a glass of OJ, knocked it down, swallowed it no problem,” he said. “And it was like a miracle. I had another one.”

Now Flanagan has no symptoms, and he experienced only the briefest side effect: a skin rash that abated with ointment. Patricia recently helped him dispose of the morphine and other medications the hospice team had given them.

“If he’d died in the hospital, I would’ve felt terrible,” she said. “If I were in his place at that point, I’d have tried to arrange to die at home at my own choosing, but Biff just didn’t have as strong feelings about that as I had.

“I had little hope that he was going to recover, but it’s just been amazing. He really is living the life he’s always lived.”

Roeland said that for the experience “is so immensely rewarding that it drives an oncology practice. It can be 1 in 100 that happens like that, and you say, well, is it worth it?”

Complete Article HERE!

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09/10/17

The Prophet and Secrets To A Good Death

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I stared at her blood results for a few seconds too long. I felt crushed, my shoulders sagged and I realised that my face had given it all away.

By

The patient couldn’t speak now, but she motioned to my pen. I handed it to her with her own notes – a mistake in retrospect. I need not have worried as she was in no fit state to read. She scribbled on words that broke my heart.

“Doctor, I’m dying aren’t I?”

I whispered back “Yes.”

She nodded; a large tear fell down the side of her face. I tried hard to stop my own tears falling too.

I wasn’t emotional because she was dying, as a doctor you unfortunately get used to death very quickly. No, I was upset because of how she was dying. She was in pain, she was struggling to take breaths, and her family had not yet arrived in their own car as the ambulance had managed to cut through traffic and they hadn’t.

I held her hand as her breaths became shallower, only stepping away when her husband and children finally made it to her bedside just as she slipped away.

It’s difficult to argue that this was a good death. This lady had spent her last moments surrounded by strangers, in a cold and uncomfortable emergency room bed and with the cacophony of hospital equipment as the last sounds in her ears. Her relatives had to give rushed goodbyes.

A bad death

Scenes like this play out every single minute of every single day across the world. In fact, for something we’ve been doing since the beginning of time and despite all the advancements in medical science – the human race is remarkably bad at dying.

The odds are that most of us reading this article will pass away in a manner that leaves much to be desired. [1] We may be taken to a hospital even though there was little to no benefit in doing so, passing away in an ambulance or an emergency room with tubes stuck down our throats and needles in our arms while medics surround us decide what the next move will be and how they’ll break the news to our shocked families, even if all the signs had been pointing towards this for months or even years.

Death is difficult enough without the often-preventable complications that make it more painful and stressful than it needs to be. Even though we don’t talk about it much, there is such a thing as having a “good death.” [2]

What is a “good death”?

A “good death” – the very term seems like the ultimate oxymoron. After all, what can be good about death? It’s the ultimate in bad news. In fact, on a scale of bad things that can happen to someone, death seems likely to be the worst.

Yet, as anyone who has come across death on a regular basis will tell you, there are such things as good and bad deaths. An entire medical speciality called Palliative Care was created to facilitate the former.

From an Islamic perspective a good death is one in which the person dies with Allah being pleased with him or her, or engaged in an action or at a time that is considered pious. [3], [4] While we can never know who is in possession of divine favour, we do know that the Prophet mentioned certain times, modes and places of deaths as having special significance. For example, I remember vividly recalling that family members of Hujjaj, who died in the horrific tunnel collapse of 1990, were comforted by the fact that their relatives died on holy land whilst on the pilgrimage.

However, the commonly held Muslim view of a good death is lacking. It almost entirely revolves around the unknowable relationship between the deceased and Allah, while neglecting more practical temporal aspects. For the purposes of this essay, I want to explore the practical side of a “good death” and show that this is actually part of a neglected Prophetic tradition that we can and should revive.

A good death is described as any passing in which an individual dies as peacefully as possible, in accordance with their wishes and according to their own ethical, cultural or religious standards. [5] This includes dying free of pain, in a location of their preference (usually divided into one of the 3 H’s – home, hospital or hospice) and surrounded by their loved ones rather than medical and nursing staff.

It doesn’t sound complicated does it?

Yet, every single day, the majority of people die in just the opposite way.

So, how do we achieve a good death?

I went looking for inspiration from Islamic history and found answers hidden in plain sight. The clues are scattered throughout the life of the Prophet himself, like scattered pearls of wisdom waiting for us to put them together into a coherent whole.

You can divide the steps required into 6 steps:

  1. Thinking and talking about death

There are many ways of achieving a good death, but they all have the same first step. We need to be prepared to think about it, but in a way that empowers rather than paralyzes us. We need to make it less of a taboo.

The Prophet was the master of this. He used to think about death often and asked us to do the same, but was never accused of being morbid. He taught us, “Remember often, the destroyer of pleasures.” [6]

By bringing talking about death back into polite conversation and into the family life, we remove it from being solely the domain of the mosque and imam. It may mean taking the kids to a funeral or talking to your parents about the funeral arrangements for a recently departed grandparent. Whatever entry point you use, remembering death will help you plan about it.

  1. The warning shot

A warning shot is the first difficult discussion that people have about an impending death. This is when bad news is delivered in a step-wise process so that the impact is less severe on those affected.

Doctors are trained to do this by lowering the tone of their voice, getting the patient worried by asking if they would like to have someone there with them and to generally appear gravely concerned. We then impart the warning shot – usually something as simple as “I’m afraid I have bad news” – and give time for the patient to absorb this before delivering the bad news. [7]

This occurred quite obviously in retrospect with Allah giving the Prophet several warning shots with increasing clarity that his life was drawing to a close. First, Jibreel went through the Quran with the Prophet twice instead of the usual once during their Ramadan reviews. Beyond this, Allah revealed that religion had been “perfected” thereby making the role of the Prophet complete.

In turn, the Prophet passed on these warning shots to us, his community at various opportunities including at Hajj Al Wida and in his khutbas at Masjid Nabawi.

Warning shots are important. They allow us to prepare for the worst-case scenario, rather than live in hope and find ourselves woefully unprepared when the time comes.

  1. Choosing where and how you would like to be cared for in your final illness

The location where one dies is obviously not something everyone has the luxury of choosing. However, for most natural deaths, this is something important and despite most people preferring to die at home, this is not achieved.

The sad truth is that, again, we will spend more time thinking about the hotel room that we stayed in 5 nights in during a holiday years ago than where we would like to see out our final days.

The Prophet was concerned about where he would be during his final illness. He asked rhetorically, “Where shall I stay tomorrow?” multiple times until his wives understood that he wanted to choose where he wanted to stay rather than switching rooms every evening as was his usual custom. He chose for himself the room of Aisha  [8]

A good death isn’t necessarily a pain free one, but it certainly is one in which unnecessary suffering is avoided if the patient wishes. Again, the medical profession has advanced far enough that no one should suffer unduly in his or her final moments, but because patients are unaware as to what is available to them, they continue to suffer. [9]

  1. How should your funeral be conducted?

The rulings on Muslim funerals are fairly specific. So specific, in fact, that we make the mistake of thinking that there isn’t room for personalisation. There clearly is, even if it is limited. Everything from choosing whom you would like to lead your Janazah prayer, at which mosque and who should lower you into the ground can often give people a sense of peace and familiarity with a daunting reality.

The Prophet did the same. He had asked that his body be washed using water from the well of Ghars, presumably because he liked the sweet taste of the water there. Amr ibn Al As asked to be buried with fragments of the Prophets nails in his mouth and under his eyelids. Ottoman Sultans would occasionally be buried with pieces of the Kaaba kiswa on them.

As long as it remains within the boundaries of accepted tradition, it can be comforting to know that you had some say in how your funeral would be conducted.

  1. Where should you be buried?

This is an important decision and for most of us, it won’t matter much because – well, we won’t have to worry about it. However, there is a strong indication that where someone is buried does matter almost as much as where they lived in life. Many a necropolis has sprung up around the tomb of a pious man or a companion of the Prophet like Jannat Al Mualla in Makkah, Eyup Sultan in Istanbul and Bab Al Saghir in Damascus. [10]

It was the cause of much consternation to the sahaaba that they did not know where to bury the Prophet . The relief that was felt by all, when it was discovered that the Prophet had mentioned to Abu Bakr that all Messengers are buried where they die, is palpable. Take a moment to reflect on that conversation. In a mark of how difficult the conversation is, even the Prophet (SAW) didn’t directly tell Abu Bakr where he would like to be buried, but instead made a general statement about all Prophets. This way, he got his point across to his close friend but minimised the heartache.

  1. How should your estate be divided after death?

Inheritance laws in Islam are strictly governed and regulated leaving limited scope for people to go wrong. But unfortunately, most Muslims living in non-Muslim countries, do not have formal wills written up. This means that their estates are at risk of being divided according to the law of the land they die in.

The Prophet was concerned about what would happen to his estate after he died, but his estate was not just the physical objects he left behind. It included the spiritual legacy of the Islamic faith. Therefore, he repeatedly mentioned for Muslims to guard the prayer and to look after the ladies of their house. [11] Not only that, it was clear that he went as far as he could towards nominating Abu Bakr to lead us after his death without actually commanding it.

While you should definitely prepare a will for your physical possessions, also consider your legacy beyond that. Who should educate your children? What advice do we have for them when they grow up? What should happen to our collection of books? Which charities would you like some of your endowments to go to and for what cause?

Your life is so much more than just the money and materials that gets divided up after you die. If you are lucky, those who survive you may try and keep your legacy alive. They would find it much easier if you gave them some directions beforehand.

Conclusion

In the end, the best way to attain a good death is to live a good life – a. A life that is lived in the service of others for the sake of Allah, a life in which there is real meaning and purpose and a life in which death is remembered.

As a Muslim, I know that a good death is one in which Allah is pleased with the person dying. As a doctor, I know a good death is one in which the patient is comfortable and surrounded by their family, not me. As a human being, I know a good death is one that comes after having added value to the lives of my fellow human beings. These are not mutually exclusive and the life of the Prophet (SAW) gives evidence for being able to combine all three.

As the old poem goes, we all have a rendezvous with death. Why not make it a good one?

Complete Article HERE!

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09/9/17

A pet’s death: How to cope with your grief, loneliness

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By Michael Joe Murphy

Own a pet? Eighty-five million American households do — at least 43 million of them with dogs, an estimated 36 million with cats — beloved friends, companions, often considered family members. Photos of pets being rescued from Hurricane Harvey are a reminder of how much we treasure them. As we cherish them no less than our closest human companions, the loss of a pet often brings intense pain. For advice on coping with that grief, and the difficult decisions facing owners upon the loss of a pet, the Orlando Sentinel Editorial Board sought out Dr. Ron Del Moro, a licensed mental-health counselor with the University of Florida’s Veterinary Hospitals.

Q: What can a pet owner expect to feel over the loss of a pet?

A: I am not sure what one may expect, as there are an infinite range of emotions that losing a loved one can produce. The key for people experiencing loss is to allow oneself to feel whatever comes up without judging it. Many people I work with feel a deep loss when their pet dies. Extreme sadness, loneliness, and guilt are some of the most common emotions I see.

Q: What can a person do about those feelings?

A: One of the best things to do is not to judge our feelings (or the feelings of someone else going through it). We all deal with loss and grief differently; there really is no right or wrong. With that said, I feel that guilt and anger, though common, are misplaced and can be unhealthy. Often these emotions are masking deeper feelings of sadness.

The key is get support wherever we can. It is healthy to feel our emotions and be able to talk it through with people we trust (including a mental-health professional).

An individual’s way of grieving will differ from the way other people grieve. One’s grieving process also will differ in intensity and duration in the losses one experiences throughout your lifetime. Following are a few of the many ways that grief can be expressed and healing enhanced:

• Open expression of emotions such as crying, conversations about loss, etc.

• Drawing, writing poetry, or other artistic expressions

• Internal processing, thinking about the loss, trying to make sense of it, often done during activities such as meditation, exercising, bike riding.

• Dedicating time to animal organizations.

• Committing to make positive changes in your own life.

• Making scrap books or photograph albums of your pet.

• Keeping a written documentation of your feelings/journaling.

Again, there are infinite healthy ways to cope with loss and grief; it is very much a unique individual process.

Q: When is the right time to euthanize a pet?

A: Again, I cannot make that call. Only a veterinarian and the owner can answer this question, hopefully together. I don’t know when the “right” time is, and I would like to think that euthanasia is an appropriate and humane step to take to end pain and suffering when there is a low likelihood that our loved one is going to feel better. I often think quality of life is a key factor in this very personal decision. It hurts to see animals suffer without hope of healing.

Q: Should an owner stay during euthanasia?

A: Again, this is an extremely personal decision; there is no right or wrong. I always tell people, try to avoid “shoulding” on yourself and others. I recommend that people to take time and think about this decision and discuss it with family and/or your veterinarian.

Q: What should owners do next? What should they tell their children?

A: Everyone handles grief differently, there is no one right way. Individuals need to ask themselves “what do I need.” This can be a difficult question to answer, and we may not be able to get what they need even if they figure it out, but we have a much better chance of getting what we need when we know what is needed. Talking to supportive people, engaging in activities that allow us to be present in the moment and staying out of our thoughts is a good place to start.

In regard to talking children, it is up to the family and their spiritual beliefs. It is an opportunity to have a conversation with them about what death is. Telling kids that their loved one is “getting put to sleep” can give children a negative association with sleep, and I recommend against it.

Q: Will pets that lose an animal as a companion grieve?

A: I am not an animal expert and really don’t know. It seems that the other pets do miss their companion and experience a loss, but I cannot say this with much validity.

Reactions of Other Pets in the Home

If you have other pets in your home, you might find that they appear to be grieving the loss of the one who died. This is not at all unusual as the loss of a human or animal family member will change the structure and dynamics of the family. Also, pets that have lived together can become just as bonded to each other as we become to them.

Therefore, many animals will experience a transitional and readjustment period as a reaction to the missing pet. If your pets are experiencing physical symptoms or behaviors that have you concerned, or if these symptoms last more than a couple of days to a week, a visit to your veterinarian is warranted to rule out illness or disease.

The following are some behaviors of surviving pets that have been reported by people:

• Searching behavior

• Increase or decrease in vocalization

• Changes in the amount of attention the pet wants

• Taking on behaviors of the pet that died even if this never occurred before, such as:

• Sleeping where the other pet slept

• Playing with toys that belonged to the pet that died

• Rubbing or rolling where the other pet rubbed or rolled

• Other unique activities the deceased pet engaged in

• Changes in appetite

• Changes in mood

• Personality changes such as quiet or shy pets becoming more outgoing and assertive, or outgoing pets becoming more quiet.

What You Can Do to Help Your Pets Through Their Grieving Process.

• Observe them closely for changes

• Do not change their basic routine or the structure of their day any more than is absolutely necessary. For example, feeding, grooming, and sleeping time should remain as close as possible to the way it was in the past. Remember, changes in your pet’s routine will only add to confusion.

• Respect your pet’s desire for “hands on” attention such as holding, cuddling and petting. Many people report wanting to get closer to remaining pets in the home but find that the pets do not always welcome more attention, especially if it is something they are not used to. Try not to push unwanted attention onto them. However, if remaining pets are seeking more close attention, then try to find the time to give it.

• Provide more opportunities for exercise and play — this will be good for both of you.

• Reward calm, relaxed or other desirable behavior.

• Try leaving a TV or radio on while you are gone.

• Understand that animals are very good at picking up on their human’s mood and some of your pet’s reactions could be a result of your stress or anxiety. Many people find it helpful to not cry or show extreme sadness in front of their pets.

Should You Get Another Animal as a Companion for Your Pet?

This is one of those questions for which you are the best person to answer. You know your pets better than anyone else and are most likely the one who knows best if another pet will make your current pet or pets feel better.

Some things you might want to consider when making this decision are:

• Is your pet very social?

• Is your pet used to having other animals around?

• Would another pet help your current pet to get more activity and exercise?

• If your current pet is now an only pet, how much time will it be spending alone if there is not another animal in the house?

• Are you and other family members ready to commit to and reinvest in another pet?

Things to Remember

• Some animals will show no signs of grief after the death of another pet in the house.

• Even for pets, grief is an individual process that will affect each one in a different way.

• Your pet’s reaction to the loss should improve as the days/weeks go by. If this does not happen or if anorexia (loss of appetite) occurs, then you should contact your veterinarian.

Q: Should a grieving pet owner get a replacement right away?

A: Again, this is a very personal decision without a right or wrong answer.

Q: Is there anything else in your experience that people frequently ask or encounter? How do you recommend they deal with it?

A: Be kind to yourself and allow the cycles of grief to run its course. It can take weeks, months, and even longer. Get support and take care of yourself best you can.

Below is an excerpt from our pet loss support page that I helped create:

Self-Care During the Grieving Process

Grief can affect every aspect of your being. Therefore, your emotional, physical, cognitive, social, and spiritual needs must be nurtured in order to work through grief and to heal.

The following are some suggestions on how you might begin the process of self-care. You may find that improving in one aspect makes you feel better in others, or that certain behaviors help in more than one area. This is because they cannot really be separated; each is somewhat dependent on the others and all are crucial in healing and maintaining your general good health.

Emotional

Emotional care involves expressing and acknowledging your pain.

• Talk with someone who understands the relationship you had with your pet and how much you are hurting

• Write down your feelings in a journal or in a letter to your loved-one

• Create a scrapbook or photograph album of your pet

• Use your artistic abilities such as drawing, painting, or sculpting to express your feelings.

Physical

Physical care is done to keep your body healthy.

Grief can deplete your energy and make you extremely susceptible to illness and disease.

• Eat healthy foods

• Exercise

• Avoid using alcohol or drugs as a means of “feeling better”

• Try to get enough sleep.

Cognitive

Cognitive functioning can be extremely impaired by grief.

Try stimulating yourself intellectually to improve your memory, concentration, and other cognitive abilities.

• Read books and other information that will help you to understand what you are going through

• Talk with others who have been through a similar experience and learn what was helpful for them

• Social contacts and establishing a support network are extremely important to help us not feel so alone.

• Find a healthy balance between the time you need alone and being with others

• Join a pet-loss support group

• Although not everyone will understand your grief, having a couple of close friends or family members who are supportive will help tremendously.

Spiritual

Spiritual care involves doing things that you enjoy, that connect you with nature, and being kind to yourself. Some people refer to this as working in your “heart zone.”

Spiritual care can, but does not have to, include your religious beliefs or your philosophy on life.

• Take a long walk

• Take a long bath or shower

• Light a candle in memory of your pet

• Get a massage, facial, pedicure, or anything that makes you feel good about yourself

• Think about your philosophy of an afterlife for animals and talk with others who believe similarly to you

• Call a friend you haven’t spoken with for a long time

• Do something kind for someone else

• Meditate

• Do something kind for other animals or for an animal cause.

Complete Article HERE!

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09/8/17

4 Things I Learned About Grief, Loss, and Healing After My Dad’s Death

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By Susie Moore

Give time, time.” —Martha Beck

 
My dad died when I was 19, when he was almost 60. He was a writer like me. He was also an addict. It was expected (he had a bad heart and no plans to surrender his vices), but it was still a shock when it actually happened. Sometimes it feels like 14 years ago. Sometimes it feels like it all happened so recently—especially when he visits me in dreams.

When I reflect upon my what I’ve learned about loss, grief, and life in the years since, these are four truths I know for sure:

1. Love is stronger than death.

I still have a father. He lives within me and my sister and in our memories. When I make an English roast dinner, drive a car (he taught me how), play Scrabble or cards, read the classics, watch English television, and even sit down to write, I feel his presence. The first time I held the book I’d authored in my hands, I felt him say, “I told you so! You did it.”

When someone leaves your life, all that’s gone is his or her physical form. That notion has been tremendously comforting to me.

2. Spending real time with loved ones is important.

I visit my mum in the U.K. twice per year. Life is busy, yes. But making time for the people you love matters. Spend time with your parents (and everyone who’s important to you). And try not to spend all the time you’re with them on your phone.

Ask them questions. What did they think about the world when they were your age? What were they doing? What year were they the happiest? What are their favorite memories of you? Write it down too! You’ll revisit those stories many times in your life.

3. Just because someone looks OK doesn’t mean they are OK.

After losing her husband suddenly last year, Sheryl Sandberg said, “Don’t ask someone who’s grieving, ‘How are you?’ Ask, ‘How are you today?’”

Emotions for someone who’s grieving are a roller coaster—they can go from laughter to tears in seconds. There is no right or wrong way to grieve, and we should never judge anyone who is experiencing grief. The process is deeply personal. I don’t talk about my father unless it’s with my family or I’m speaking to someone going through a similar experience. I don’t want sympathy or questions. This is my way of handling things, and that’s OK.

4. Death can inspire you to live life to its fullest.

If I live to my dad’s age (and I hope to live much longer than that), my life is already more than halfway through. This sounds scary, but to me, it’s motivating. Death gives life meaning. When I contemplate my own imminent death one day, I feel courageous, fearless, and powerful. You’re allowed to feel this way too. The hardest lessons bring the greatest freedoms.

I think of my dad every day—especially when something funny happens. And I talk to him every time I achieve a significant milestone. I admit: I’m jealous when I see other people with their dads. And that’s OK too. I practice compassion for my own emotions, which I consider the highest form of self-care.

My grief has changed shape over the years, but it’s true what they say about time. My physical pangs of suffering are fewer now. And in moments of questioning, the most healing thing I can think to do is live a life he would be proud of. Because we’ll always be in it together.

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09/7/17

Meaningful Planning for Final Arrangements

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By Melanie Ball

Some people wait to reach a certain age or receive a serious diagnosis before they start planning their final wishes.

Luckily, when we lost Dad to mesothelioma, we didn’t have much planning to do. Ever the family overseer, my father preplanned his memorial services.

He prepared for everything, including financial planning.

I am only now realizing the gracefulness of Dad’s consideration of our family during our time of grief. We were all a mess when he passed, and his prior decisions relieved some of the stress at a time when his guidance was most needed.

Exploring final arrangements ahead of time can relieve families of unnecessary anxiety during a time of emotional need. Preplanning also presents an opportunity for a person to make their own choices regarding their final wishes.

Dad found peace of mind by guiding our family through the difficult process of saying goodbye.

Developing a Plan Early Reduces Stress Later

Most folks don’t know much about the funeral process until they face the loss of a loved one.

Lack of planning often leads distraught family members toward emotion-based final arrangement decisions. The shock of loss can cloud one’s judgment.

Exploring aspects of final services in advance is a helpful step toward developing a solid plan.

For many, the most alarming part of final arrangement planning is the cost. Financial concerns may guide much of the decision-making process.

The National Funeral Directors Association is a reputable organization of more than 10,000 funeral homes in 49 states. In 2014, the NFDA estimated the median cost of a traditional funeral with burial at more than $8000.

Such a price tag may surprise bereaved families.

An expensive funeral doesn’t necessarily equate to a meaningful service.

A thoughtful service is a reflection of the memorialized person. Preplanning ahead of time allows families to create a memorial that truly embodies the essence of a loved one’s life.

Remembering them with honor and dignity is the goal of most funeral planning.

Be Aware of Different Types of Services

Most families consider spiritual beliefs, family and cultural traditions, and of course, the costs when making their final decisions.

Knowing what types of memorial services are offered is a good starting point for most people. It is also important to understand legal and ethical elements that may influence final decision making.

Each state governs funeral practices differently, but the Federal Trade Commission (FTC) provides national regulations that guide funeral providers.

There are many options available, so it helps to have a clear, universal definition of services. The FTC has an important role in clarifying the options available for customers across the nation.

According to the FTC, there are several basic types of services provided in most states, including:

  • Traditional Full-Service: Traditional funeral services are the most expensive type of memorial. This type of funeral includes a viewing or “wake,” a formal funeral service, hearse transportation and a graveside memorial. Often services take place on two separate days.)
  • Direct Burial: Direct burials exclude a formal viewing, hearse transportation and certain services provided the funeral home. There are fewer necessary goods which brings the cost down significantly. This type of service usually shortens the time between passing and burial.)
  • Direct Cremation: Services that involve direct cremation generally omit the formal viewing. After processing, the remains are placed in a container called an urn which is usually present at a memorial service where families join together. Cremation is much more affordable than traditional services.

Planning final arrangements can be a bit overwhelming. Understanding the basic services available can ease the decision-making process.

Protections Provided by the Funeral Rule

Federal guidelines are designed to protect customers shopping for funeral products and services. The FTC’s Funeral Rule offers peace of mind to many shoppers.

While each state passes their own laws regarding legal funeral practices, the state laws coincide with these federal guidelines.

Among the many protections in the Funeral Rule:

  • Customers can shop with funeral homes and only pay for the goods and services they want to buy, rather than choosing from lavish packages that lump products together. Families can save money by only buying the goods they need.
  • When seeking a price quote, shoppers don’t have to show up at the establishment in person. Service providers must give customers a price quote over the phone, if they inquire. This is especially helpful for families planning under time constraints.
  • People who meet with funeral home professionals to discuss plans are provided with a General Price List. This document clearly states the prices of all goods and services available from the provider. Seeing the listed price can help people make cost-conscious choices.
  • Sometimes the cemetery or crematory has separate requirements which families should know before signing a funeral arrangement contract. The provider must inform the customer with a list of those requirements in advance of purchase.
  • With some services such as cremation, caskets are not necessary. The customer may choose to use an alternate or less elaborate container. Other shoppers may choose to order a casket from a different provider. Funeral homes must allow people to order them from other companies, rather than exclusively selling their own products.

Making final arrangements is a difficult process under the best of circumstances.

During times of emotional despair, discernment escapes most of us. I’m not sure my mother was capable of planning Dad’s services in the days immediately following his death.

It was a tough time for our family, and I learned from my father’s thoughtfulness. Taking care of my family in the future is just as important as taking care of them now.

Making arrangements for our final goodbyes is a way I can comfort them when they confront life without me.

Complete Article HERE!

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09/6/17

Confronting Death and Dharma at Brooklyn’s Green-Wood Cemetery

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Can we shift our perspective on the reality of loss?

By Lauren Krauze

When I arrived at the main gate of Brooklyn’s Green-Wood Cemetery, I was greeted by two talkative green birds hopping and flapping about in the grass. I was surprised; the birds seemed bright and exotic compared with the pigeons, jays, and sparrows I normally see. I later learned that these playful birds are monk parakeets—a very fitting name given that I was attending an event called Death and Dharma, a lecture and meditation series co-presented by the Brooklyn Zen Center and Green-Wood Cemetery.

Green-Wood’s high, rolling hills and shady lawns offered a cool and quiet respite from the heat and hum of downtown Brooklyn. A group of about 40 people gathered on the grass near the cemetery’s Modern Chapel, a serene space for meditating and contemplating death and dying.

“Death is a fundamental question. It’s sometimes called ‘the big question,’” said Rev. Francisco (Paco) Genkoji Lugoviña, the founder and guiding teacher at the Hudson River Peacemaker Center. “There are lots of questions, actually, and no real answers. However, at age 78, I try to live each day with as much involvement and obedience to what emerges and go with it.”

Joining Lugoviña was Rev. Daiken Nelson, the founder and guiding teacher at the Pamsula Zen Center in Harlem. Nelson and Lugoviña are both teachers and priests in the White Plum Lineage of Taizan Maezumi Roshi and the Zen Peacemaker Order. As a pair that often teaches together, they were invited to share their insights with the Brooklyn Zen Center community.

“In the West, and particularly in the U.S., people don’t deal with death until they have to,” Nelson said. “They don’t think about it until someone they know passes away. I think it’s important to at least think about it before that happens and try to realize that it’s everyone’s fate.”

While the discussion was rich with teachings, stories, and koans from the Zen tradition, Nelson and Lugoviña also created space for people to briefly talk about their own relationships with death and dying. At the start of the discussion, they asked individuals to share one or two words that reflected their thoughts on the topic. While many people expressed a cautious wonder and curiosity about the topic, others shared words like “fear,” “uncertainty,” and “dark.”

Lugoviña didn’t seem very surprised. As a Zen teacher, he said that he often ventures into this very territory, especially in his conversations with people struggling with anxiety, depression, and suicidal thoughts. He also relayed a poignant story about his grandson, who passed away at age 23 after a methadone overdose. That experience taught him to reevaluate his intellectual understanding about death and shift toward a deep experience of gratitude.

“A friend of mine once told me she that she used to count her life by the number of summers she had left,” he said. “I think that’s a very poetic way to look at what we value in our lives and cherish what’s important to us.”

In a short work titled “Vulnerability,” acclaimed poet David Whyte writes, “The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance.” Nelson echoed this by imparting a teaching about impermanence and what can come of embracing the transient nature of experience.

“What I’ve been working with in my own practice is accepting whatever is arising,” he said. “We can learn to accept our inevitable passing, the passing of others, and the passing of this moment. Realizing something is just how it is—that it’s ‘just this,’ without it having to be any different—can give rise to freedom.”

At Green-Wood, humble gravestones and elaborate mausoleums dot the landscape, crowding some of the hills and valleys. The root of the word monument is the Latin word monere, which means “to remind.” These markers remind the living of the deceased’s name, life, and family, but for Nelson, the monuments reflect a more complicated reality that attempts to honor both the teachings of impermanence and the reality of human connection and loss.

“Once we are born, we exist, and then we spend our lives going to great lengths to express that in the world,” he said. “We spend a great deal of time and energy thinking about this self, or the ideas we have about awareness, consciousness, our connections with others, acceptance, and impermanence. Then people die, and afterwards, we want to live in the memory of them, whether it’s through their accomplishments, their stories, or things we build to honor them.”

He then introduced a teaching from Bankei, a 9th century Chinese Zen master. While recovering from a serious illness as a young man, Bankei realized his existence was nothing more than a moment-by-moment experience. He framed his realization about life as “the unborn.”

“He taught us that nothing is ever born and nothing ever dies,” Nelson said. “Life is a moment-by-moment arising and falling away. So, he said, don’t get born. Don’t fall into identification as me or you, as young or old, as a woman or a man. Even our habits are not part of our original being. Everything is unborn. Why not abide in that?”

He then looked around and chuckled.

“What better place to talk about the unborn than a cemetery?”

Many of us laughed, too. Later, during meditation, I tried to focus on the sounds and sensations I was experiencing: the gentle breeze rolling off the back of my neck, the cool grass under my feet, the soft breathing of my friends around me. At one point several birds cried out, asserting their place in the world before settling in for the evening.

I began to realize that it is possible to sit in a cemetery—a place so deeply associated with death and loss—and feel very much alive. I also understood this as something I can practice on a regular basis; when I find myself sinking into mental, physical, or emotional places of decay, I can work to more directly experience my own vitality as I honor the complicated thoughts of fear and doubt swirling within me.

By the end of meditation, the sun had dipped below the Upper New York Bay. In the lingering warmth of the afternoon, I found myself wondering how many more summers I have left. In that same moment, however, I was able to shift my perspective and realize: I am here, right now, breath-filled and conscious and capable of so much. As my friends and I walked out of the cemetery, I took comfort in their singsong voices echoing in the open twilight sky. I also noticed a pigeon’s glowing red feet, the cemetery security guard’s half-smile, and the first fireflies brave enough to shine their lanterns and welcome the night.

Complete Article HERE!

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