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What is Animal Hospice?

March 12, 2013 3 comments

Definition

Merriam-Webster(.com) defines hospice as, “a facility or program designed to provide a caring environment for meeting the physical and emotional needs of the terminally ill.”  The definition of animal hospice will often depend on who you ask and what they have to offer you.  To compare to animal hospice, break down the (human) definition into ints components:

16yo dog, Oscar

  • a facility or program
  • to provide a caring environment
  • meeting the physical and emotional needs
  • terminally ill

All of the above can be met when supporting our pets with animal hospice.

Facility or Program

Hospice is a philosophy and care plan more than a place.  While human hospice facilities exist for patients in hospice that are medically too fragile to stay home, may families utilize skilled nursing facilities with the added support of a hospice support team that come to the facility.  As of this writing, there are no known animal hospice facilities to board and provide 24/7 care.  There are veterinary clinics, including 24 hour clinics that support hospice services compliment the hospitalization.  Animal sanctuaries may also support animal hospice.  As these require the pet parent to give up their pet, it is not considered a hospice facility as a resource for care.

A caring environment

For humans, hospice often happens at home.  For an elder man, not recovering well after a heart attack, hospice is in the hospital.  For a woman in a care facility for her dementia, hospice is in the facility.  It is important to note that hospice can happen anywhere.  In this regard, the animals are no different.  In most cases, hospice for our pets will happen at home.  If a dog is hospitalized when his cancer creeps into his lungs, hospice can happen at the vet clinic.  When a cat is hit by a car and a veterinarian can get her comfortable until the kids get out of school to come say goodbye via in-home euthanasia, this is also animal hospice.

Meeting the physical and emotional needs

The physical and emotional needs of the animal being met is the activity that one might consider hospice on a logistical level.  This is also the part of the definition that defines a team.  At Animal RN, we believe that animal hospice starts first with pain management and identification.   Once pain is addressed, then we can get into details on the hospice plan and creating a team to help support the individual.  By utilizing a team, families are able to provide quality, loving care while saving money and assuring comfort.  The emotional needs component is a wonderful variable that changes from one family to the next.  What we know from work with humans and our experience is that joy is an important part of life.  As we age, what brings us joy shifts.  That joy is what makes the effort of hospice so worth it.  Its not about extending life, its about living.  As one woman described her experience with her dog in hospice, its not about adding time, its about the time being precious.

Terminally ill

The diagnosis or suspicion of a terminal illness is the difference between animal hospice and palliation.  Hospice means we have the diagnosis or a high likely-hood determined by a veterinarian.  To simplify, palliation is the application of the hospice philosophy without a confirmed terminal diagnosis or limited (6 month) prognosis.

For most people, the terminology doesn’t matter.  Call it what you want, so long as your taking outstanding care of the animal.  The terminology may play a bigger role in the future as pet insurance and more veterinarians get involved in animal hospice and palliation.

At Animal RN, our definition of animal hospice and how we support it everyday is so much deeper and more involved than the dissection of this one definition.  To find out more, subscribe to this blog or check out our website http://www.animalrn.com.

Buyer beware: Animal Hospice or Hoax

July 30, 2012 1 comment

I recall that first family that brought me to the understanding that what we were doing was animal hospice.  I remember the hours spent scouring the internet, calling strange veterinarians on the phone. I was looking for a sympathetic ear, a peer to encourage, mentor or otherwise be a resource for me as I tried so desperately to support this family.

Photo of Bella in hospice

Thankfully, this dog, Bella was not in pain.  She still needed creative care as we supported her to live 5 years past the veterinarians suggested euthanasia.  She didn’t just live, she really loved in those days.  That girl and her person had their best times in that phase of her life.  Her veterinarian was willing to support them on this journey – as she wasn’t in pain, he just didn’t know how.

Bless them for knowing that I didn’t know how either.  Some true, basic nursing and common sense modifications for her home area and routine were all this girl really needed.  I spent hours with her.  When she was sleeping, I would read.  I read about pain management and how to identify pain.  I read about dying naturally and what that could look like.  I read about the spiritual side of transitioning, the stories of human hospice workers and oncology nurses.    Every waking thought was about how to support this family, what might come next and how to make sure Bella stayed comfortable and what to do if she didn’t.

As I look around today and see veterinarians, technicians, pet sitters, dog walkers, groomers and many others entering the animal hospice arena, I am cautiously optimistic.  On one hand, I am thrilled.  Together we can really love and support families when hospice is indicated.  What a brave and beautiful army.  The caution comes from the dark side of any monetized industry.  Pet parents beware.  Yes, please seek help with your animal hospice support.  This can’t, shouldn’t, and doesn’t have to be done alone.

Due diligence  is especially important as some try to jump on the buzz words and bandwagons to make a quick buck.  Ask questions.  Ask for references.  Get specific stories.  Years of experience is a great help, but how can we check those that have the right heart and intention that are new?

Help us create a great list of questions for people to screen their hospice support team.  What would you ask to determine if someone is qualified to help you with your cat or dog?

A family’s review: In-home Euthanasia for their Dog

July 15, 2012 2 comments

A real review of a euthanasia at home.  The focus is on the experience and interaction with the veterinary clinic and staff.

Legend: (=) neutral experience, (-) negative experience, (+) positive experience

  • (=) Dr. and staff were late to leave hospital.  Could have been a positive if communicated.  Since the family was treasuring every second, they started to worry when they were not there or communicating there adjusted arrival – this intereupted their time with the dog.  The  family appreciated the extra time.
  • (=) The Dr got lost on the way.  Again,  no problem as the family appreciated extra time.  Directions were clarified when they called for them.  The lack of communication and the blaming for the directions on the phone were the only reason this was not seen as a blessing.
  • (-) Overall, the family made comments after the fact to other areas and past experiences with the clinic.  The team not communicating regularly enough regarding status, leaving family on pins and needles anticipating their arrival.  As a result the family questioned past experiences with the clinic and their future use of the clinic.
  • (-) The Dr and staff member pulled up in a mercedes sedan – no possibility of transporting the 80# dog back to the clinic for the requested private cremation, no communication or arrangements made with the family for them to handle dead body transportation.
  • (-) On their eventual arrival, the Dr got out of the car loudly complaining about how whoever gave the directions was wrong and telling us what they should have been.  This was communicated to a liasion that met the team at the driveway and after subdueing them, led them to the family expresssing their desire to be calm and quiet and peaceful around the dog.
  • (-) On the short walk to the family and dog, the Dr again complained to 2 others regarding the directions, again loudly as nearing the dying dog and his grieving family.
  • (-) When the Dr and staff member joined the dog and family they proceeded with small chat and self focused conversation, disrupting the tone and dishonoring the moment the family had carefully created for themselves.
  • (=) The Dr explained the process of the euthanasia and approximately what to expect.  Explanation was sufficient at best.  Having had a better explanation previously from a third party they did not feel unaware.
  • (-) During the short process, the staff member had to go back to the car for additional supplies.  The family considered something might be going wrong or unexpected in the process, raising concern for the comfort of the dog.
  • (-) The Dr and staff member left.  They left before discussing or helping with the logistics of moving the dog from the yard where he was euthanized to a vehicle for transportation for cremation as arranged with the clinic.
  • (-) The Dr left before verifying their clinic would be open after hours for cremation drop off.  The family had to make an additional call to the clinic in this raw moment to make sure they could take the dog after being left with him.  Since the clinic did not answer the first call, they called another clinic to see if they would be open and available to help with their dog.  This disrupted the beauty and peace of the moment after the euthanasia.
  • (-) When arriving at the clinic with thee dog, no one was ready or available to help. The family had called in advance and were expected.  The car had to moved 3 times to accomodate the clinics request for getting the dog inside and the family members had to  carry his limp body.
  • (-) The assistant asked the family member if they could put the dog in a garbage bag before removing from the car.  This process surprised the family member and while he acted strong said “sure,”  it was clear he would rather not have known this logistical piece.
  • (-)When confirming we’d like a paw print, the staff member sounded surprised.  The receptionist had confirmed that paw prints were standard when making the initial inquiry for the euthanasia house call and cremation arrangements.  The family member almost took back the request to be accomodating, but couldn’t part with the memorial.

Overall score: 2 neutral,  12 negative and 0 positive

Have you had an experience that should have or could have been almost a nice way to say goodbye that was tainted?  Share in the comments your story – how can we improve the experience?

2-Speed Dogs, a lesson in comfortable mobility

June 14, 2012 2 comments

The name started with my first dog.  He would walk so much faster in the sun, then slow to a snails pace in the shade.  It was such a dramatic shift in his speed and his desire to walk, he earned the nickname “2-speed.”  image dog resting in shade

As I worked more and more with seniors animals, I noticed my “2-speed” was not alone.  Some dogs would walk slower going away from the house and double time-it on the way back.

One of my loudest messages as a senior pet care provider is to honor your animal.  I’m not talking about letting a young dog rule the roost.  This is about when you sleep wrong and you kink your neck, you don’t turn it to the left that day.  Listen to your body.  In this case, we’re passing that respect on to our senior pets.  If they seem to be having a slower day, let them.  Its OK to have a less than 100% day.  By honoring what our pets bodies are telling them, we can help them have comfort and quality in their life.

2-speeds are the exception to this rule, sometimes.  Maybe.  My dog wasn’t tired of the walk, he wasn’t even super hot.  He was a wise, older animal who had figured out his joy was not found exercising, especially in the sun.

I honored him by changing the times of day we walked.  I made sure it was cool.  He would still act tortured to be out on a walk.  I didn’t see any gait changes or subtle signs of pain in him, but wanted to respect him in this phase of life.  I then shortened our walks, they were almost to nothing.  We added in swimming to help him move with relief on his joints.

Maintaining comfortable mobility is a major quality of life component in comfort care for hospice animals.  Mobility is a longevity and comfort staple.  All the 2-speeds to date have taught me that animals, like people, don’t always want to do what’s best for them.  Caring for them well sometimes means taking that walk, even if its shorter.

Imagine an old man whose doctor asked him to walk once a day for his health and his wife may sometimes have to…encourage him to take that walk.  Serve your pets well.  Keep them comfortably mobile and honor them, as opposed to being swindled by these wonderful souls.

Have you had a 2-speed in your life?  I’d love to hear about them!  Use the comments below to share your story.

Animal Hospice: What if my pet dies at home naturally?

January 24, 2012 Leave a comment

One of the complications of great veterinary care and the option of animal hospice care at home, is the possibility that our pets will die at home, naturally.

On one hand we all wish for that wonderful, peaceful passing. Our pet will close his eyes and never open them again. And then what? It is our responsibility to have these things thought out before they happen, or at least to know who to call.

A good home care plan includes always being a few steps ahead of things. This includes uncomfortable conversations and decisions including:

  • Burial versus Cremation
  • Urn returned to you or not
  • Customized urn or standard
  • Single pet urn or multi pet urn
  • Bury at a home you may not live in forever or bury at a cemetery
  • Do you want a paw print, a nose print, fur clippings, or collars
  • Memorials with cremains (ashes)
  • Who will take him to be cremated
  • Do I need help with a burial
  • Is the body going to smell

These are all important questions. Questions that if not answered in advance will limit your options. There are other important questions around memorializing your pet well and the logistics of a deceased pet. Don’t allow yourself to get surprised by the desired outcome, be prepared. Contact Robyn Kesnow, RVT at Animal RN for a list of questions to consider and bring to your local pet care team for support.
robyn@animalrn.com

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Utilizing Animal Hospice Does Not Rule Out Euthanasia

October 25, 2011 1 comment

Implementing an animal hospice plan does not exclude euthanasia.

I found a huge misconception around animal hospice when I was recently asked to present on animal hospice at a Senior Dog Social.  The training facility had blocked out an hour every Saturday in the month to bring in presenters to interact with senior dogs and their people in a slower paced, senior friendly setting.  Topics ranged from games and life enrichment with senior dogs to nutrition and support for aging bodies.   Prior to my arrival, the guests hadn’t been told anything other than the topic for the week would be animal hospice.  They weren’t informed what they would get out of the session, what type of information to expect, nothing other than the doom and gloom topic of animal hospice.

Lets just say that this shifted my presentation game plan.  Who wants to go hear about animals dying?  Who wants to face their dearest buddy’s mortality?  I sure wouldn’t, I would be off finding something more fun and more about living to do with my dog that day.  The unfortunate thing is learning about hospice and palliative care is ALL about living and living well.  I’m going in, already prepared to really surprise people with beautiful news and information to support their pets as they age.

I started off the session asking the attendees about their thoughts and impressions regarding animal hospice.  What I expected to hear were concerns regarding monitoring comfort and measuring pain.  I expected questions regarding quality of life, perhaps concerns regarding transference (imposing our ideas onto our pets).  I was sure someone would bring up the general question, what is animal hospice.  What I heard instead was a clear, matter-of-fact statement from a woman that hospice was not for everyone or every situation.  OK.  I absolutely agree with that; I asked her to elaborate and explain.

The woman went on to tell the story of her most recently deceased dog.  She explained in great detail the caregiving and supportive care she provided once the terminal cancer diagnosis came.  She told us how she labored to find the best information, nutrition changes, modifications to the home, pain management and ultimately a well choreographed and honorable euthanasia at home.  She went on to talk about the ways the family enriched her dog’s life during the last few months, weeks and days of his life.  Careful thought and planning went into when and how to help him cross the rainbow bridge.  The woman’s body language changed as she shifted from recounting was was obviously a great memory and a time she was very proud of to an assertion of why animal hospice would not have been a great fit for her dog.

She believed animal hospice meant dying without the aid of euthanasia.  She thought her dog would suffer if allowed to live to a natural death, she was very sure of her support for her dog and the lack of suffering.  As things got more complicated and more difficult to assure comfort, they made the arrangements for euthanasia and memorializing her dear dog.

It was my great pleasure to clarify and congratulate her on a well managed hospice plan.  Animal hospice does not mean that euthanasia will or will not be a part of your family’s plan.  Animal hospice is a philosophy around how you care for, live with and love your pets.  For Animal RN, we don’t even assert a timeline on it.  We believe while we have a prognosis to give us an idea, while we can ascertain with our experience approximately how long a pet may have here with us, we do not know it was the last 6 months until that animal passes.  At Animal RN, we don’t focus on the dates and longevity, we focus on today and making sure today is a day without pain, without suffering.  Today should be a gift, filled with love and joy.

When supporting animal hospice, Animal RN includes education around natural death (death without chemical or medical assistance).  This does not exclude euthanasia for families.  As our pets age well, the chance they die on their own increases; Animal RN believes it is our responsibility to be prepared for that possibility, regardless of choice of natural death versus euthanasia.

Precious Time and a Perfect Day:

October 3, 2011 1 comment

One of the things I constantly find myself trying to describe as I work with very senior pets and their people is what I call precious time.  We are constantly looking at, debating and monitoring quality of life for our pets as they near the end of this journey, this life.  I often hear how families don’t want to “prolong life” their main concern is to not allow their pet to suffer.  Of course, we’re all on the same page here.  Suffering is not an option and one of the most valuable benefits to working with Animal RN is the peace of mind knowing that you have objective, educated and respectful support to monitor and help bring insight to what’s going on medically/ physically your pet during this time.  

It just so happens that by offering what we call palliative support, there is more time.  The purpose of the care is not to lengthen the time, but to offer comfort and quality to whatever time there is.  What I find indescribable is the precious time that comes during palliation.  I believe it comes from a variety of factors.  The animal is more comfortable, and can be present and enjoy his world and his environment and people.  The people are aware of the mortality of their furry family and also are able to be more present and more engaged in the relationship.  When these 2 beings find themselves together, present and enjoying the moment – this is precious time.  It doesn’t matter if it’s for minutes, hours, days or weeks; something happens and there becomes and understanding.  So many people describe to me the most prolific connections, the most clear and powerful goodbyes.  I wonder what their thinking as they tell me these tear jerking stories and I’m smiling and nodding.  I’m smiling because they are now a part of the club.  The only way to know this feeling, this connection is to have experienced it first hand.  This is why I fight for animal hospice.  This isn’t about euthanizing versus dying naturally; this is about living in a moment.  Perhaps one day, we will be able to find and embrace our pets and our relationship with them earlier in their lives.  It is yet another lesson we can learn from our furry friends.

Jon Katz, a well-known author has a new book out, since his own dog Orson died.  Please enjoy this excerpt from “Going Home” sharing the “perfect day” with his dog.

It is possible to take something beautiful and lasting out of the heart-wrenching experience of seeing the animal you love move inexorably toward death. Nobody can take the grief away, nor should anyone try, but our love for animals is nothing but a gift, and it keeps on giving, even when they go home.

A man named Harry, an Iraq war veteran and tennis coach from Minnesota, hit upon a simple and profound idea to transform this otherwise sad experience into a blessed one.

It was a gray morning when the vet told Harry that his dog Duke’s heart was failing and that it wouldn’t be long before he died. Harry was not surprised, but still, the news depressed him. Listening to the vet, Harry later told me, he’d gotten an idea, one he thought would pay tribute to his life with Duke and give him something to feel besides sadness and loss.

“Tomorrow, I’m going to give you a Perfect Day,” he said quietly to Duke as they left the vet’s office. He would take the day off from work and create a sweet memory with his dog. It would be a special day, filled with all the things Duke loved most, as close to perfect as Harry could make it. He would take his Canon PowerShot along to capture some images of the day, to preserve the memories.

Duke was a border collie/shepherd mix. He had always been a lively, energetic dog and would herd anything that moved. Walks, work, food, Frisbees, red balls—these were the things Duke loved, along with chasing balloons and popping them.

Harry went shopping for supplies, and when he came back Duke was napping on his dog bed. He went over, lay down next to the dog, and hugged him. “Pal,” he whispered, “tomorrow is for you, your Perfect Day.” He was embarrassed to tell his wife, Debbie, about the plan, but she sensed what was going on and gave the two of them the space they needed. It was her belief that the dog, more than anything else, helped Harry heal from the trauma of Iraq. He couldn’t look at Duke without smiling, and when he had first come home, he hadn’t smiled too often.

At eight the next morning, Harry got up. Duke was lying on his bed, which was next to Harry and Debbie’s. The dog rose a bit slowly, then followed Harry down the stairs and into the kitchen. Harry opened the refrigerator and took out a hamburger patty and two strips of bacon, cooked the night before. He put them on a plate and into the microwave.

Duke was riveted. When the plate came out—Harry touched it to make sure it was warm but not hot—he dumped the meat into Duke’s bowl, along with his heart pills. It was as if Duke couldn’t believe his eyes. He was almost never given people food. Looking up at Harry, as if asking permission, he waited until Harry nodded and said, “OK, boy,” before inhaling the food.

A feeling of sadness came over Harry as he thought about how Duke would soon be gone. He wandered into the living room and lay down on the couch. Duke came over and curled up next to him. Harry began to sob, softly, then more deeply and loudly; Duke gently licked his face.

After a few minutes, Harry rose to get dressed. Although he worried about straining the dog’s heart, he let Duke follow him up the stairs. On this day, Duke could do anything he wanted. No corrections. He sat on the bedroom floor and watched Harry put his clothes on. When Harry said “Sneakers,” Duke labored to get up onto his feet, walked over to the closet, and brought Harry his white running shoes. Harry had enjoyed training his dog to bring him his sneakers, and Duke seemed to love it too.

Harry went back downstairs, followed by Duke. He picked up a bag from the pantry and walked out into the yard. Inside the bag were two dozen high-bounce red balls. One at a time, he threw them and bounced them off the back fence. Duke tore after one gleefully, then another, catching some, narrowly missing others as they whizzed past his head.

When Duke started to pant, Harry stopped.

Next they went to the town pond. Harry sat by the water’s edge while Duke waded in, paddled around, swam back, shook himself off, then repeated the routine about a dozen times. Every few minutes Harry tossed the dog a liver treat. It practically rained the small and pungent treats. Once again, Duke looked as if he could hardly believe his good fortune.

They came back to the house and napped. After lunch, Harry took Duke to the vast state park outside of town. He picked a flat, gentle trail, and the two of them walked a couple of miles. Eventually, they came to a stone abutment with a beautiful view. Harry walked over to the edge and sat down. Duke clambered out and curled up beside him. It was a gorgeous afternoon, and the wind ruffled the dog’s hair. Duke held his nose up to the wind, picking up the scents of the earth.

God, I love this creature, Harry thought. I never feel this peaceful, this much at ease. It is something to remember, to honor.

They sat together for nearly an hour, enjoying a bond of complete understanding and affection. If only the world could stay like this, Harry thought, this simple, this good.

Harry knew that Duke was tired, so they took their time walking back, stopping frequently to rest. A few years earlier, Duke could have hiked all day, and sometimes they did that together. But not anymore.

When they got home, Harry cooked Duke some prime sirloin, then chopped it up. The dog was beside himself, looking up at Harry as he ate, expecting the food to be taken away. That evening, Harry put one of his favorite Clint Eastwood movies into the DVD player and Duke hopped up onto the couch, put his head in Harry’s lap, and went to sleep. When the movie was over, Harry carried the dog up the stairs and laid him down on his bed.

Several weeks after the Perfect Day, when Harry came home from work, Duke was not there by the door to greet him, and he knew he was gone. He went into the living room to find Duke dead. He knelt by his dog, closed his eyes, and said a prayer. Then he dug a deep hole in the backyard and buried Duke there, along with some bones, his collar, and some of his beloved red balls.

Of all the photos Harry took on the Perfect Day, the one he loved the best was of Duke sitting out on the stone ledge in the state park, taking in the sights and smells.

Now every morning before he goes to work, he flips open his cellphone and smiles at the picture of Duke, looking for all the world like a king surveying his territory.

Harry passed on the idea of the Perfect Day to friends and other dog owners struggling to come to terms with their own pets’ failing health. Many have since shared with him the stories of their dog’s Perfect Day. It makes him happy to think about Duke’s legacy—all those Perfect Days for all those other great dogs leaving our world behind.

Excerpt from Slate.com. Photography from Robyn Kessler Photography

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