09/22/17

Death, too, is part of life cycle

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By HOLLY WOLTZ

I live, breathe and eat being a veterinarian. I see a pet on a leash, and I check its gait. I see a grey whiskered dog and think of senior issues. I overhear a conversation about a pet’s illness, and I want to add my two cents.

Work is hard. Work is fun, and every day brings challenges. However, I had no idea when I signed up for this job, the sheer number of euthanasias and sadness I would face.

All pets die, and we know this when we adopt them into our lives. We are angels of death to so many, and this is a very, very important part of our lives.

The veterinary profession is unique when it comes to being comfortable with death. Like many aspiring veterinarians, I thought euthanasia would be the hardest part of my job, but it isn’t – not by a long shot.

MDs don’t get it. In the human world, euthanasia is a grave sin even when someone is suffering from a terminal illness.

“Futile care” occurs when a physician cracks the chest of an elderly patient in multi-organ failure who has just arrested, or the oncologist details a complicated journey for a deadly metastatic cancer.

The older you get, the more likely you are to die in a hospital. According to the Centers of Disease Control, 73 percent of people over the age of 65 die as inpatients.

It sounds like a horrible way to go. I hope that statistic changes as more states enact the Death with Dignity Act, and I add more years.

Almost every day I counsel clients as to “When is the right time to let go?” I have changed my criteria for euthanasia over the years and now answer that question with “Consider 6 things that your pet loves to do. If they are no longer able to do at least half of them, then it is time to let go.” This helps, but it is still far from simple.

Every situation and every family is different. I think relief from suffering is a moral obligation, and that it is better to end life too soon than too late. Euthanasia is truly a gift of love.

Never was this more apparent than last week. You might recognize this family because I’ve already written about Buddy.

I shared Buddy, a magnificent Golden Retriever, with Dr. Sybil Davis (a certified rehabilitation specialist).

When I first referred him to her 4 years ago, he could barely walk from a myriad of problems. In 6 months, he was walking and feeling great again.

His family simply refused to give up on him. He’s been a “frequent flyer” patient for both of us over the years.

This visit was different, and when I stepped into the examination room, I knew he was in trouble. He could barely stand and his breathing was labored.

Although Buddy lived in a family of three, he was really the son’s dog. They grew up together, and Alec brought Buddy in for visits. I always thought of Norman Rockwell’s paintings of boys and children whenever I saw them!

After diagnostics and quiet conversation, it was clearly time to let go, but we would not be rushed in making this decision. End of life should be kind – to the owner, as well as the animal.

I tried to walk the emotional landscape that accompanies the decision to euthanize. Do we refer, try hospice care, sleep on this decision for a day or two and reconsider? Could we give Buddy more days of good living? And, if we euthanize, what do we do afterward?

The whole family was present with Buddy, and the parents deferred the decision to Alec. He knew. I could see it in his eyes, but it was too hard to verbalize.

In his heart, he knew that Buddy had finally worn out. What a wonderful young man to put his dog first, and I know his parents were proud of him.

Buddy didn’t know what was happening. All he knew was a sense of tranquility from sedation, a quiet comfortable room and his family surrounding him. He died with grace and dignity, quickly with no pain. It was a gift from his best friend.

I am sometimes overwhelmed by these last moments, but I am also thankful that I can be a part of them. Without great love, there cannot be grief.

Thank you, Alec, for making the right decision, and thank you, Buddy, for the memories.

Complete Article HERE!

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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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09/9/17

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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08/23/17

Hospice service helps care for geriatric pets

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Stacie Alves and Dr Julia Spade administer acupuncture and laser therapy to a dog with arthritis. Last Wishes has assisted more than 5,000 families with their pet’s care since November 2012. Earlier this year, the organization opened the first compassionate comfort care center for pets in Houston. The center features comfort rooms that are used for hospice and pain management consultations, therapeutic laser, acupuncture, and compassionate sedation-euthanasia.

By Vagney Bradley

People and their pets can build a strong bond together, and losing a pet can be difficult. When a pet becomes terminally ill, Last Wishes, Houston’s first pet hospice service, steps in to take care of a geriatric pet, from moment of diagnosis through death and aftercare.

Dr. Christie Cornelius is the owner and veterinarian of Last Wishes. She also co-owns Earthman Last Wishes, Texas’ first water-based cremation service for pets. Cornelius and her associate, Dr. Julia Spade, will become the first two veterinarians in the state of Texas to become certified in Veterinary Hospice and palliative care in October.

“I started imagining a better way to offer end of life services after a few years of general practice. I saw how difficult it was for pet owners to bring in their painful or otherwise ailing companions into an unfamiliar, sterile, noisy, scary environment for euthanasia,” Cornelius said.

“I started offering home services through a feline practice I was working for at the time and found it extremely rewarding to be able to provide a peaceful passing for a pet in their own environment, surrounded by loved ones. As the years went by, I convinced myself there was a real need and desire for this type of service in our community.”

In 2012, Cornelius branched out and started Last Wishes while working full time at another veterinary clinic.

Last Wishes has assisted more than 5,000 families with their pet’s care since November 2012. Earlier this year, the organization opened the first compassionate comfort care center for pets in Houston. The center features comfort rooms that are used for hospice and pain management consultations, therapeutic laser, acupuncture, and compassionate sedation-euthanasia.

Cornelius’ goal is to help educate the community about pet hospice, comfort care, pain management, and gentle water-based aftercare services for pets.

Dr Christie Cornelius and assistant Betty Rose Bryant perform an exam on a dog.

Some of the common conditions the organization works with includes, but are not limited to, cancer, heart disease, liver disease, osteoarthritis, organ failure, cardiovascular and neurological disease, and vestibular disease.

“Last Wishes is unique in that we want to make the most of the time that every pet has left with their family. Our doctors and staff don’t just focus on making euthanasia as comfortable as possible when it is ultimately needed,” Spade said. “Our expertise in multiple forms of hospice techniques allows us to consider what is truly beneficial for each case and help strengthen the bond between the pet and their family.”

The majority of services are done in the comfort of the family’s home and in the pet’s environment. Services at the center include consultations, acupuncture, laser, sedation-euthanasia, pet loss support groups, and aftercare. Last Wishes also provides pet loss support groups and continuing education.

“We have established a network of providers, such as our very own grief counselor, pet sitters, pet groomers, and volunteers set up to meet all of our patients and family’s needs when it comes to providing care for an ailing pet diagnosed with a terminal disease,” Cornelius said. “In addition, we sponsor twice monthly pet loss groups and host a private Facebook pet loss support page.”

Additionally, the organization assists disadvantaged families and individuals with their pet’s end of life care through the Last Wishes Fund, a non-profit organization funded by public donations.

Last Wishes provides provide a folder of pet loss/grief information for each family, a clay paw print memorial keepsake, and gentle transport of the pet for aftercare services from the client’s home.

“It is such an honor to be invited into the homes and lives of the families of Houston,” said Jennifer Rames, Last Wishes office manager. “While euthanasia is never easy, we feel honored to provide our services so that these precious furry family members can pass with dignity, in the place they feel safest and happiest, and surrounded by the people who love them the most.”

Cornelius and grief counselor, Marilyn Ladin, are developing a pet loss support program. The program offers in-person and online individual and group therapy.

“Our goal is to heal some long-broken hearts,” Cornelius said. “We also aspire to help other veterinarians and veterinary staff struggling with compassion fatigue, depression, and anxiety among other issues. Too many of our colleagues are causing their own deaths.”

This month Last Wishes plans to unveil of a public pet memorial gardens in Cypress. The garden will include four gardens and handmade stepping stones as a tribute to the pets the organization has helped. The memorial will also feature a special Rainbow Bridge. Families will have access to the garden on Sunday mornings as an opportunity to visit their pet in a peaceful and natural setting.

Complete Article HERE!

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08/17/17

Medical Aid in Dying: What My Dog Taught Me

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by

He was sick, but it wasn’t like he was going to die anytime soon. A year ago, my dog Sierra sustained a neurological insult that left him delirious, unable to walk straight and almost entirely blind and deaf. Still, he enjoyed our loving touch, snuggling against my thigh as I watched a movie or falling asleep in my arms while being held. I struggled with these thoughts as the vet pushed the pink, fluid-filled syringe into his vein. He collapsed into my arms and let out a groan, as he had many times before. But this time, he did not get up.

I said goodbye and left him to join my parents standing in the waiting room. My father looked up at me, “Is it done?” I nodded, and suddenly, we all broke into tears. We embraced each other and talked about what a good dog he was. We told each other it was the right thing to do, that it was time. But was it? Why now?

I couldn’t help but think we were being selfish. Objectively, nothing much had changed since his suspected stroke, albeit he was undoubtedly more of a burden. We were constantly cleaning up after him, redirecting him when he got caught in a corner and paying for vet visits and medications. But the bottom line was that he still found enjoyment in life. Was the choice to put him down for our wellbeing or for his?

Health professionals and loved ones struggle with these same questions when caring for those nearing the end of life. Sierra’s decline came at a poignant time, one in which many are fighting for the right to choose death in the face of terminal illness or suffering. Currently, five states allow those with a terminal illness and a prognosis of less than six months to end their life with the help of a physician, also known as “medical aid in dying.” Canada legalized physician-assisted death in 2016, joining a small number of countries that have laws enabling this practice.

The principle behind these laws is relatively simple. People want to die with dignity, and in the process of fighting for the right to do so, they’ve ironically improved end-of-life care. As a free nation that claims to be a leader in health care, why have we not adopted this practice? While poking fun at “the land of the free,” Jim Jeffries, an Australian comedian known for his outsider political commentary, pointed out that “assisted suicide for the sick … is the biggest freedom of them all.”

Opposition to physician-assisted death comes from both the public and from within the medical profession itself. Deeply rooted societal ideals, values and norms fuel the debate. From day one, physicians take an oath to “do no harm.” Common sense tells us that healthcare professionals are supposed to help heal the sick, not to “help” them die. Furthermore, for some patients, taking one’s life goes against their religious values and/or our fundamental values as human beings. Also, many families find that loved ones nearing the end of life are often incapable of making well informed decisions due to fear, depression or the effects of disease on their mind. And so we choose life, even when death seems so near.

Despite the moral controversy, attempts have been made at giving patients the right to take control of their own death in the United States. Numerous court cases have brought the legality of this practice into light culminating in the 2006 Supreme Court case Gonzales v. Oregon. Under this ruling, the federal government failed to prohibit physicians in Oregon from prescribing drugs to help patients die, opening the door for states to legalize medical aid in dying. Organizations such as the Death with Dignity National Center have taken it upon themselves to both educate the public on end-of-life options and to advocate for physician-assisted death. Even so, there has been little done to legalize this practice in federal law.

Lawmakers took a step in the right direction during discussions about health care reform and the implementation of the Affordable Care Act (ACA). The misleadingly-termed “death panels” were a way to incentivize physicians to have discussions about end-of-life care with their patients. Unfortunately, this section of the ACA was thrown out due to political controversy. Finally, in 2015, the Centers for Medicare and Medicaid services approved regulations that allow qualified healthcare professionals to be reimbursed for providing advance care planning to patients. Still, moral and legal barriers persist, preventing patients from making the decision that is right for them.

Looking back, I am grateful that Sierra left us when he did. Choosing to put him down was not easy, but afterwards, I came to an important realization. By choosing death at that moment, we determined when, where and how he died. We chose a period when our family was home together so that we could spend quality time with each other in his last moments. This pronounced the end of our living relationship, giving us a sense of completion. We made sure that he died with us, in a peaceful environment, around those he loved instead of alone on the kitchen floor. He was able to leave the world peacefully and quietly without the suffering of a drawn out painful death that would taint our memory of his long and happy life. Sometimes, I wonder if the groan he let out at the end was a sigh of relief, a goodbye or even a thank you.

Complete Article HERE!

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07/21/17

Till the last good day: 3 pillars of palliative care

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Every dying pet deserves a plan. Consider these inspiring case studies and tips that illustrate the power you have in veterinary medicine to help pets live longer—with a better quality of life—for days, week or months on their path to a peaceful death.

By Robin Downing, DVM

Soft, gray muzzles. Opaque eyes, still filled with the warmth that sparks memories of their spritely puppyhood (or kittenhood). Your sweet senior patients still have the hearts of the joyful youths who once bounded into the exam room with wet, sloppy kisses and bright eyes. But as their bodies have changed, their needs have too.

It’s true that pets are living longer—into their teens and even 20s—and better than ever, thanks to the efforts of our veterinary healthcare teams. And the evolving preventive-care practices that help them live longer mean these pets may face serious illnesses at the end of their lives: end-stage chronic kidney disease, chronic congestive heart failure and cancer—currently the leading cause of nonaccidental pet death.

Instead of the sudden hit-by-car deaths, we now see slow, steady declines into the end of life. This monumental change in pet life expectancy demands a change in how we manage aging patients. We must prepare for the patient’s end of life long before it arrives, thinking through how we will address the special needs of these special patients.

Fortunately, the recently crafted 2016 End-of-Life Care Guidelines from AAHA and the International Association for Animal Hospice and Palliative Care provide a roadmap for teams to follow.

Pillar No. 1: You’re caring for pets and people

End-of-life care constitutes a critical stage in a pet’s life, and the compassion and decision-making that happens is at least as important as the accumulated lifetime of care before. Our collaborative relationship with clients takes on a new dimension and urgency in the face of the pet’s changing medical needs as well as the pet owners’ anticipatory grief (read about that here) and other powerful emotions.

Pet palliative and end-of-life care focuses on alleviating patient discomfort and controlling clinical signs while addressing the client’s emotional, social and spiritual needs. When we care for these patients, our fundamental concerns are pain management, hygiene, nutrition, mobility and safety in the home. The next tier of care focuses on the pet’s mental state and engagement with human family members as well as interactions with other household pets. Finally, the veterinary team needs to help clients appreciate the pet’s will to live and to participate in its own care—for example, its willingness to take pain-relieving medications or to be handled for wound care.

Pillar No. 2: You’re helping craft end-of-life care plans

The success of a palliative-care plan hinges on the same principles as any other care plan. The difference: the palliative-care patient meets one or more of these criteria:

  • The pet has been diagnosed with a life-limiting disease
  • The client has declined curative treatment
  • Curative treatment has failed
  • The pet’s quality of life is harmed by clinical signs of chronic degenerative disease
  • The pet is experiencing progressive illness with complications.

These are pets with special needs, and their care plans will reflect elements not typically included in the care plans we create for other patients. An integrated approach to end-of-life care addresses the pet’s needs and the client’s needs, including financial realities. (Check out “Needs care, no $$” for more on talking through financial limitations.) This requires open communication to foster collaboration between your team and your clients. Any end-of-life care plan will fail miserably if the client is unable (or unwilling) to execute it. All care plans must also consider the pet’s willingness to participate in its own care. We can’t create a care plan that the pet resents enough that it damages the precious family-pet relationship.

The needs of pets reaching the end of their lives change over time, so keep an open mind about how a care plan will evolve. Only by scheduling regular patient reassessments and revising the care plan can we continue to provide the care pets need and deserve.

Pillar No. 3: You’re checking in on patients—even at home

In today’s world of high tech and social media, clients are comfortable operating in the virtual world. It’s now a practical option to remotely monitor dogs and cats approaching the end of their lives. While many canine patients enjoy car rides, as they age and become infirm, travel may become challenging for them. Entering and exiting the vehicle may become difficult enough that very large dogs may become impossible to transport. Small dogs who are losing their sight or hearing may feel disoriented if removed from their home environment. And cats are notorious for resenting car transport, unless they are conditioned to it early in their lives.

Rather than adding more fear, anxiety and stress to the lives of pets and pet owners, it makes sense to create strategies for remote monitoring.

One strategy is for a trusted veterinary team member to make regularly scheduled house calls to evaluate the pet in its natural environment. This person can be a veterinarian (if needed) or a well-trained and experienced veterinary nurse. These reassessments should include a hands-on pain assessment as well as a meaningful dialogue with the client about how the pet’s doing. A veterinary nurse could take advantage of video streaming to interact in real time with the appropriate individual back at the practice to modify feeding, pain medication dosing and other aspects of the care plan.

And remember, using video in real time can connect clients and pets directly to the practice. The pet owner can ask questions and answer important questions from the veterinarian. These FaceTime or Skype calls or Google Hangouts are an opportunity to review medications and feeding. Best of all, a veterinarian can see firsthand the pet’s environment and movement through regular activities.

Your veterinary team is poised to offer comfort and care as the days fade and pets reach the sunset of their lives. So make a plan to offer these pets and their parents comfort and support until their last good day—and beyond. To learn more about how your team can offer support through the hospice and euthanasia process, see the dvm360 Leadership challenge: Pet pain and death.

Complete Article HERE!

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06/14/17

When a Pet Dies, Helping Children Through the ‘Worst Day of Their Lives’

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Reading age-appropriate books about a pet’s death, like this one for ages 4 to 8, may be helpful in getting a child over the grief.

The loss of a pet is often a child’s first experience with death. Understanding the unique ways that children view pets and respond to their passing can help parents to ease the grieving process.

Joshua Russell, an assistant professor of environmental science at Canisius College in Buffalo, who has studied the effects of pet loss in children, explained that for many children, pets are more than just animals. “Many kids describe their pets as siblings or best friends with whom they have strong connections,” he said.

In a study of 12 children ages 6 to 13 who had lost a pet, published in the journal Environmental Education Research, Dr. Russell found that even years after the pet’s death, some children still described the loss as “the worst day of their lives.” He also discovered that children come up with unique ways to rationalize their pet’s passing and that the way a pet dies influences how children grieve.

“Children, in particular, have a distinct sense of existential fairness around whether or not an animal lived until an appropriate age,” Dr. Russell said.

Like adults, children more readily accepted their pet’s death when it was expected in some way. For example, children were less affected when they knew in advance that the animal would have a short life span. They seemed to know that a fish or hamster, for instance, would not live as long as a dog or cat. When an animal was sick, they generally agreed that euthanasia relieved the pet of its suffering. If an animal is terminally ill, parents can help prepare the child by talking about the impending loss, as well as the feelings of sadness it will evoke.

This book is written for children ages 8 to 13.

Yet when pets died in tragic and unexpected ways, the loss was harder for the child to accept. “When a pet dies suddenly, it highlights the unpredictability of the world. It tells children that the people and animals they love can die without warning,” said Abigail Marks, a clinical psychologist in San Francisco who specializes in childhood grief.

Of course, a child’s age and developmental level affect how he or she understands death, and a child’s grief looks very different from an adult’s. Children do not always cry or immediately show emotion. But this does not mean they are not deeply affected by the loss.

“Kids under the age of 5 will have a hard time understanding that the pet is gone forever because it’s difficult for them to grasp the concept of death,” said Jessica Harvey, a psychotherapist in San Francisco who specializes in pet grief.

One way young children may express their grief is through play. After the loss of a pet, they may pretend, for example, that a stuffed cat or dog became ill and passed away. Parents can help their children through the grieving process by actively participating in this type of imaginary play.

Reading age-appropriate books about pet death may also be helpful. “Goodbye, Brecken,” by David Lupton, for children ages 4 to 8; “Kate, the Ghost Dog: Coping With the Death of a Pet,” by Wayne L. Wilson, for ages 8 to 13; and “Memories of You,” by Erainna Winnett, for ages 7 to 12, are some examples.

School-age children will often have questions about the animal’s death, and the back-and-forth that ensues may open up larger conversations about love, loss and what happens after we die. When telling a school-age child about a pet’s death, Dr. Marks recommends being honest about what happened. Doing so lets a child know that it is not taboo to talk about death or painful feelings, which can set the stage to process other sorts of loss in the future. Parents should also validate any emotions that arise as the child mourns.

She said that a child’s grief would ebb and flow; they may cry one minute and then resume playing or talking about other things the next minute. Parents should be more concerned if a child has nightmares, increased anxiety or difficulty sleeping. If these symptoms persist, psychological counseling may help.

…and of course, our personal favorite.

Dr. Marks said it was also important for parents to follow their child’s lead. “If they are asking about the details of the pet’s death, it’s a sign that they want to talk about it,” she said. “They are looking for your comfort.”

For many children, it is also important to have a goodbye ritual. “Rituals around death are some of the most meaningful ways we have of recognizing someone’s life, but these ceremonies aren’t societally defined for pet death,” Dr. Marks said. Families can create their own rituals, like having a small memorial service, scattering the pet’s ashes, planting a remembrance tree or creating a photo album.

“This is a way to process the loss and to honor the role that the pet had in your family,” Dr. Marks said.

Complete Article HERE!

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