Hospice As Part of A Team

In many ways, veterinary hospice is greatly informed by, and based on, human hospice medicine.  We learn from our human colleagues, we adapt their priorities and focuses, and we strive to practice as they do, supporting comfort and quality of life for both the patient and the family.

There is one way, though, in which those of us who work with animals – and our patients – are luckier than our human counterparts.  In human medicine (in the United States, at least), a patient must choose between pursuing curative care and entering hospice; they can’t receive the benefits of hospice care while still receiving traditional medical treatment for their condition.  Our pets, thankfully, do not need to make this decision – a pet patient can begin hospice and palliative care while still also being treated by general practice vets and/or specialists, and often benefits significantly from this decision.

Hospice care functions best when it’s part of an integrative approach that includes a team of professionals to give the best, and most well-rounded, support to both the pet and the people caring for them.  Far from replacing your regular veterinarian, a hospice veterinarian is joining them, and adding to the resources you have at hand.

This teamwork can take many shapes.  Some pets have multiple chronic health conditions, some of which may be better managed at home by a hospice veterinarian while others are more easily handled with in-clinic care.  A pet diagnosed with a potentially manageable but progressive condition may benefit from seeing both a specialist (such as an oncologist or internal medicine specialist) to help manage the primary disease as well as a hospice veterinarian to make sure that, in the course of treatment, quality of life is still prioritized and the family gets the support they need.  And even for families who decide to avoid any further office visits, general practice vets are still part of the team, providing historical information, helping with medications, and being available for support.

Hospice cases are often complex, and demand a lot from the people caring for the beings in need.  Hospice’s greatest purpose, ultimately, is to make sure that you have the best possible team supporting you and your loved one along this journey.

Maggie

We lost our sweet, silly, crazy, dearly beloved Jack Russell terrier, Maggie, on August 15, 2018. She was 19 years old.  Although our hearts are broken, we are grateful for so many things: We had been working with Becky to manage Maggie’s arthritis and other age-related issues for nearly a year before she died, so we had a plan in place for what we wanted when the time came to say goodbye to her. She had a good last day at home, with treats, yard walks, and visits from friends. We had the whole day to say goodbye to her. It was beyond comforting to have Becky there to help our little girl pass peacefully, with us by her side.

 
We got Maggie when she was 3 months old. She was a typical Jack Russell terrier in her puppyhood: smart, willful, and overflowing with energy. Although she wasn’t always a fan of other dogs, she made many canine friends in the neighborhood over the years (and even a feline one), and had TONS of human admirers. She was beloved by her dog walkers, her vets, our family and friends, and most especially by us. It seems impossible that she’s gone. Her joie de vivre, even in her senior years when her sight, hearing, and mobility declined, seemed to imply (as Becky said) that she’d outlive us all. It’s hard to be without her. I know she’ll never leave my heart, but I miss her physical presence every day. There will never be another quite like her. Run over the bridge like the crazy 3-month-old puppy you were when we first got you, Maggie. We love you so much, always.

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Kya

Today we remember and celebrate Kya, a sweet, beautiful girl, with these lovely words written by her family.

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Kya – August 14, 2018

A Siberian husky with eyes of blue

In our family she was the heart.

And on that sunny summer afternoon

From our family she did depart.

 

A coat of black, gray and white she had

The prettiest face, like no other.

To me she answered to “Come see Mom”

And to Tom it was “Come see Dad.”

 

The daily walks @6am she would take

Her and Dad alone together.

All around the neighborhood they went

No matter what the weather.

 

A well-behaved girl that she was

Who brought smiles, laughter and love.

Blessed were we to have her with us

Now she watches over us from above.

 

The time had come for her to leave

Her presence we will miss as we grieve.

The time will come again in a while

When we remember her with a smile.

 

Kya – Our Pet, Our Friend, Our “Little Girl”

Becoming An Apprentice

One of the most important things to me, as a hospice practitioner, is continuing to learn and find ways to better support my patients and clients.  Veterinary hospice is a field that is always growing and changing, and I want to make sure that I do my best to stay educated about ways to provide comfort and care in this critical time.

Because of this, I am incredibly excited to announce that I’ve been accepted into an Apprenticeship in Western Herbal Medicine, starting this fall!  This is an eight-month-long program, focusing on in-depth learning about veterinary herbal medicine, with a focus on traditional western plants.

So often, when we’re facing a terminal diagnosis, families want to turn to resources beyond mainstream medicine.  The primary challenge in doing this is a lack of education – about what herbs and supplements are safe and effective, how to properly dose them to be most beneficial, what their interactions with other treatments and other health conditions may be, and how to choose the right brand and formulation (since these products are not regulated by any government office).  By studying this subject in depth, I hope to learn how to use these plant-based treatments to help give my patients the best possible quality of life, as well as answer questions from their caregivers who are looking for complementary and alternative paths to support their beloved pets.

My apprenticeship will begin this September, and I can’t wait to share what I learn with my clients – and if you are a pet caregiver who is interested in herbal medicine for your pet, definitely discuss it with your veterinarian!  These treatments are frequently very helpful, but they still need to be approached with education and care to make sure that we’re helping our patients in a safe, knowledgeable way.

What Happens After – Home Care

We’ve come to my third and final post about caring for your pet after they pass; this is also the hardest to write because it’s one of the most sensitive topics to confront.  One of the most surprisingly difficult challenges we frequently face at the end of a pet’s life, these days, is helping a family that wants to bury their beloved pet themselves.  As our lives become more and more urban, what may have once been a simple and commonplace decision has become increasingly complicated.  If this is a path that you want to take, it is important to communicate clearly and in advance with your veterinary team.

As simple and comforting as a home burial for your pet may seem, there are many factors to consider, both legal and practical – I am going to go over the most basic and common of them here, but the most important thing to know is that the laws and requirements can vary widely by location; make sure to talk to your veterinary team, and to plan in advance.  With that in mind, if you want to lay your pet to rest yourself, here are the details that you need to keep in mind.  Be aware, I am going to speak in detail about care of remains here.

-You cannot legally bury your pet on public property.  While every jurisdiction may have its own laws about burial on private property, it is never legal to bury animals on public property, such as parks or reserve lands.

-The legality of burying pets on private property varies depending on local laws.  In Massachusetts, at least, this can vary by city and township.  If you wish to perform a home burial, you will need to contact your city’s town hall to determine whether this is legal in your area.  You will also need to contact DigSafe to make sure that the area you are planning to use is away from power, gas, and water lines.

-The physical effort of burying a pet at home can also be significant.  While our pets are often smaller than we are (but not always!), we still need to make sure to lay them to rest deeply enough to make sure that they remain safe and undisturbed.   This means making sure that their final resting place is at least 4 to 6 feet deep, and that they are covered by at least 3-4 feet of earth.

-If an animal is helped to pass by euthanasia, this process involves an injection of lethal medication.  This means that any other animal that gets access to your pet after they pass will also ingest these fatal medications.  Therefore, for any pet that passes by euthanasia, it is vitally important that they either be laid to rest in a casket or under a layer of rock as well as earth to prevent any risk of predation.

-The time of year can also affect your ability to perform a home burial – if the ground is frozen, it may be challenging to dig a resting place for your beloved pet.

Home burial is, for many families, a beloved tradition and a cherished honor, and it can be very important to hold onto this way to maintain a connection to your pet after they pass.  If that is true for you, then I absolutely encourage you to work with your veterinary team to plan in advance and help arrange a way to make this happen as smoothly as possible.

If it turns out that your township has laws preventing home burial, or that other circumstances prevent this from being a valid option,  your hospice veterinarian may be able to help you come up with alternatives.  Burial at a pet cemetery, cremation and burial of ashes, or creation of a memorial garden may all be options for having a physical location to visit and honor your pet’s memory.  The most important thing to remember is that you do not need to navigate this maze alone in your grief.  Your veterinary team is here to support you, and help you create the best possible end-of-life experience for you an your beloved pet.

Gizmo

Today AC&C remembers and celebrates Gizmo, a sweet and handsome little man who graced his family with his loving presence for many years.  He will be remembered with love and joy, and he will be greatly missed.

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What Happens After – Further Options

In my last post I talked about the most common ways to care for our beloved pets after they pass.  I’m going to continue that conversation here, by talking about some of the less-common paths that a family can choose to follow in choosing their pet’s aftercare.

Every family, and every person, is unique in their relationship with death and in their choices with regards to body care.  There is no one right or wrong path, and so many factors shape our beliefs, our wishes, and our decisions in this sphere – our previous experiences and those of the people around us, our faith, our culture, our bond with our pet and with other people in our chosen family, our thoughts and philosophy about the environment, and hopes and plans for the future.  The most important things to keep in mind are that your wishes are worthy of respect, within the limits of the law, and that communication with your veterinarian is critical.  If you have very specific wishes regarding your pet’s care after they pass, the earlier you are able to let your veterinary team know, the more likely they will be able to either help you accommodate them or, if they are not able, help you find someone who is able to realize these wishes.

With that said, what are some of the more specialized options available?

-Witnessed Cremation – I talked about private cremation in my last post.  Most crematories will also offer, for families that choose this path, an option for the family to be present and witness the procedure.  For some caregivers this can be a very sacred act of honoring their pet and bearing witness to their final transition from this life.

-Aquamation – Also known as “green cremation,” or alkaline hydrolysis.  This is a procedure where the remains are reduced to ash by chemical breakdown, rather than by heat.  It is often a choice pursued by caregivers who are concerned about the environmental impact of both burial and standard cremation.  At this time, aquamation is not available in Massachusetts, but it is legal in Vermont and Connecticut; if this is a path you wish to pursue it is important to discuss it with your vet early in the process of end-of-life planning.

-Taxidermy – This can be an option for people who want to physically retain either all or part of their pet.  The most important thing that I can stress, if this is a path that you choose, is to make sure that you find an artist who is experienced, skilled, and reliable; in Massachusetts the person in question also needs to be licensed by the state.

If you want to keep the likeness of your pet but do not want to pursue taxidermy, there are also businesses that will make plush replicas of your pet, such as Cuddle Clones or Grief Pets; these may be a way to keep a physical embodiment of your beloved pet without preserving their body.

Any list of options that I can make is going to be limited, of course, by my own experiences – ultimately, if you have a question, an idea, or a wish for your pet’s care after they pass, please discuss it with your veterinary care team.  They will do their best to work with you to find the best possible way to honor your wishes, and to care for your beloved pet with respect and compassion.

What Happens After – Choices

So far, my writing here has focused on caring for ailing pets, preparing for their passing, and caring for ourselves as we approach this journey.  There’s one subject that I haven’t touched on yet, though, and it’s a difficult one to talk about, but also incredibly important, so I’m going to focus on it for the next few posts.

It’s hard to think about caring for our beloved pets after they pass, but unfortunately it’s something that every caregiver needs to face eventually.  Many people have no idea what their options are when it comes to aftercare, and being confronted with this painful question for the first time when you’re also dealing with the immediate grief of having just lost your pet can make it even more traumatic.  Nothing is more tragic than regretting a decision made in haste, without the necessary information, time, and thoughtfulness to choose the best path to honor both your wishes and your bond with your pet.

With that in mind, I’m going to talk here about the most common paths available to care for your pets after they pass.  I’ll go into detail about specific choices, and some less common paths, in a future post, but it’s vitally important that all pet caregivers be informed about the choices available to them on this subject.

Here in Massachusetts there are a few pet cemeteries that veterinarians work with.  Many people have questions about such facilities; don’t be afraid to ask your veterinarian about the pet cemetery that they work with.  Your vet should be able to tell you the name of the facility, as well as discuss their practices, and answer any questions that you have about your pet’s care.  You can also visit their grounds yourself, if you want to see where your pet will be cared for and meet the staff – this can be a good way to address any concerns, as well as a beautiful way to honor the pets already cared for there.

Almost all pet cemeteries offer the following care options:

-Private burial:  Most cemeteries have beautiful grounds where you can have your pet laid to rest in their own private plot.  Because this does involve more preparation, as well as ongoing care, if this is what you wish for your pet you should discuss this with your veterinarian earlier in the course of your hospice relationship.  They should be able to help you get in touch with the appropriate staff at the pet cemetery, in order to make the necessary plans.

-Burial with other pets: If you are a member of a faith that does not permit cremation, or if such is not appealing to you, this can be a respectful way to lay your pet to rest without the concerns of arranging for a private burial.

-Cremation with other pets: When a pet is cared for in this fashion, their ashes are generally laid to rest on the cemetery grounds.  If you do not wish to have your pet returned to you, this can be a very thoughtful, respectful way to care for them.  Many crematories also allow for small personal items (letters, pictures, favorite toys, or blankets) to be cremated with the pet, which can be a beautiful final ritual or memorial.

-Private cremation: In this situation, the pet is cremated alone, and the ashes are returned to the family.  As above, most crematories allow the family to send personal items with the pets; they also can have many options for vessels to hold the ashes.  You can discuss this with your vet or the crematory staff, either before or after  – if you’re not emotionally ready for such questions at the time of passing, ashes can always be transferred later.  This may be a touching way to honor a pet’s memory, on their birthday or the anniversary of their passing.   Many crematories also offer scheduled private cremation, if you wish to be present.

The most important thing to keep in mind, when facing this decision, is that in every situation your pet will be handled with compassion, respect, and dignity.  Both your veterinarian and the staff of the facility that they use will treat your pet as the beloved being they are, whatever path you choose for their care.   If you have any questions about aftercare – about what’s involved, what your choices are, or how to handle the situation in the best manner for your and your pet’s wishes, please reach out to your veterinarian.  By considering these questions in advance, when it does come time to face your pet’s passing you can focus on the emotions of the moment instead of worrying about additional decision-making.