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Wednesday, November 15, 2017

Picking battles, understanding limits while a pet is in hospice can be transformative

Recently, I was meeting with a family to get up to speed on their dog’s hospice care plan. They had lost another dog, Sal -- one that they had adopted well into his senior years -- only a couple of years earlier, and that experience was still quite fresh in their memory. In the time since their sweet boy, Timo, had developed a life-limiting illness, we’ve set time aside to talk about the changes that have been occurring, how the family is feeling about what’s happening, how well they feel they’re all managing and bouncing ideas around about comfort care and safety.

“I really wish that I could do more for Timo,” said my client, someone who I might add isn’t shy about administering care, no matter how challenging or messy the task is.

“I get the feeling that you mean a little more than what you’re saying,” I replied.


This, after getting the update on my charge’s updated prescription regimen and hearing how he gave the clear indication that he wouldn’t be accepting of acupuncture. He also doesn’t tolerate taking one of his medications well, so, as with many hospice pets, we give the medications he needs in order of importance, and administer what he’ll reasonably allow and revisit what he won’t a little while later in hopes that we’re successful -- basically, picking our battles.

“Yes,” she went on to say, with a big sigh. “I just wish I could give him all of the medications everyday. Sal was so good about it; Timo is a different story, and he’s not faring as well as he could.”

One thing that I’m certain of in my work is that navigating animal hospice isn’t routine, nor perfect.

There’s the notion of having ideal days, rough days, really good days, great days, even, but it’s never perfect. Having that realization come at you when you’re hospicing a pet, especially when you’ve tended to another so recently can make for a daunting journey. And when things had gone well in one’s previous experiences with animal hospice, it can conjure up some complicated, unexpected feelings -- including frustration and guilt -- emotions that we when we need to free from when trying to focus on providing that level of care.

The truth is that we need our pet’s cooperation, their permission, really, to carry out a hospice care plan, among other things.

Some companion animals are extremely easy going, like Sal was, others not as much. It seems important to note that no two pets are alike, nor are their disease trajectories, even if they seem similar. Case in point: two like-aged cats with renal insufficiency can fare differently based on any additional diagnoses that they have, like diabetes, hyperthyroidism -- not to mention their personalities. A medical issue seems easy enough to contend with, right? It’s there, it is what it is, no wrestling with it. It’s more tangible, rigid, cut and dry. But a pet’s willingness to consent or cooperate with allowing care, veterinary exams, taking medication requires flexibility; we can try and work with that, we can cajole them.

Or can we?

Well, most of the time. Sometimes. In some cases, never. And there’s the rub.

Sure, we can be creative with compounded medications and with disguising pills and capsules, and that works well, but sometimes, we just need to honor what our pet is telling us and back off a bit, maybe try again later. Perhaps the pet prefers someone else to handle that particular duty.

We can forgo some treatments, even supportive care like subcutaneous fluids, and try other, less effective strategies that a pet will accept or that we’re able to manage.

We can, if it’s too stressful for the pet or the humans, go with a house call veterinarian instead of going to a vet clinic.

With some pets, hospicing them -- nor treating them reliably for any medical condition -- isn’t an option at all because they won’t allow anyone to handle them, something that becomes more necessary as things progress. We can only do what they will accept, and what we’re able.

Something else to think about is how we as family members might be different in handling the duties of providing palliation or hospice care the second or third time around. We’re not the same person as before. It’s important to ask ourselves: Are we as physically able to manage it? Do we have the time needed to devote to it? Mentally, do we feel equipped? Are the financial resources in place? Are we trying to manage the care of a human loved one who needs it right now as well? Is everyone in the household on board with managing the plan?

That’s only part of what affects how a palliative and hospice care plan can be seen through. Ensuring that the pet and the humans at the core are feeling honored and supported by the professionals involved (veterinarians, pet sitters and even a pet’s trainer or behaviorist) is also vital through the process. So is understanding that circumstances can change at any time and affect the way that the plan is carried out. I’ve seen time and time again that much of the strife that is felt by families comes with the ever-changing landscape that comes before a pet dies, and it can be amplified by comparing this experience with previous ones, especially if the latter was one that was more manageable.

I’m not going to say don’t feel guilty or don’t let the fact that your pet isn’t accepting of treatment upset you, because that’s our nature to have emotions like that in those situations. What I will offer is this: give yourself a moment to take a step back along with a deep breath, and understand that you are doing the very best that you can on any given day with the resources that you have and what your companion animal will allow. You might be surprised that in giving yourself the permission, the courage to do that, you can transform this time of life with your pet.


Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care support. She is also a Certified Pet Loss and Grief Companion and a member of The Association for Pet Loss and Bereavement as well as the International Association of Animal Hospice and Palliative Care and Pet Sitter International. She tweets at @psa2.

Tuesday, November 7, 2017

Disrupted sleep cycles can be a result of and a clue into how much stressful events affect dogs

“Bumble has been behaving oddly the past few weeks, and I’ve been concerned about that, given that she’s so young and has been healthy. She’s been urinating in the house, and at times seems so touchy. You know her pretty well -- any ideas??”


This was an email that I got a few weeks ago, and the question, well, it’s not all that unusual.


I decided to call Bumble’s human, rather than email back, since it seemed like the best way to get to a solution. We chatted for a bit, talking about what was going on in her family’s life, and then I asked some more questions that ranged from if there were any changes in the dog’s appetite, her water intake, bowel movements, any disinterest in her usual favored things or activities, apprehension with other pets -- any small detail. A couple of things had accompanied the inappropriate elimination, including some sleep changes and being withdrawn at times. She even snapped at the vet staff -- something that was very uncharacteristic of her, as she loves going to the vet -- to have an exam to get to the bottom of any possible health issue behind the behavior changes. Plowing forward, I helped Bumble’s human whittle down things even more: was there a pattern to these things happening? When did they start? Does the intensity increase at any time?


In the end, we figured out that, after an unfavorable interaction with another dog that occurred weeks before (Bumble was bitten and required a few stitches and an antibiotic for a bite wound to her leg), she hadn’t been herself -- that’s the time that the behavioral changes started. Putting everything together, it all made sense. But one thing -- the sleep changes -- were especially telling.


A recent study on how stressful experiences affect a dog’s sleep drive home this point. Researchers from the Family Dog Project wanted to see if stress affects sleep, and just how much. The results, which were derived from observing 16 dogs, divided into two groups (one-half having a good interaction, the other an unfavorable one) over a period of days. You can learn more about the study by clicking here.


We know that sleep is important for a lot of things, and during all stages of life. It’s especially vital when we are trying to heal from an injury (as in Bumble’s case) or navigating a stressful period. A secondary issue that Bumble’s family faced is that they were losing sleep because of Bumble’s tendency to be restless at night.


After implementing some strategies that I suggested (with her vet’s input, blessing and oversight) to help Bumble manage the after-effects of the traumatic event that she encountered, the sweet pooch was able to settle into a more normal routine and get back on track.


The takeaway: when a pet is expressing behaviors that are new to us, and troubling or less-than-we-expect from them, we can’t opine that they are doing so out of spite, or anger or other very-human reaction. Pets are great communicators, and if we are paying close attention to the details, we can often get to the root of what is going on. We also can’t discount the importance of sleep, for every member of the family.


Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care and is also a Certified Pet Loss and Grief Companion. She's a member of Doggone Safe (where she completed the Speak Dog Certificate Program), as well as the International Association of Animal Hospice and Palliative Care, Pet Sitter International and Pet Professional Guild. She tweets at @psa2.

Monday, October 30, 2017

Indifference, lack of support from others after losing a pet can stem from hidden stories

That flush of emotion -- one that can encompass anything from sadness, a void, a breathlessness even confusingly accompanied by a catch of vibrant joy after recalling a fond memory -- is sometimes familiar, at other times, surprisingly less so, equally gripping and can hit any time. It’s that emotion that comes with the grief after the loss of a loved one. Loss that is recent, anticipated or is one that has had a chance to cure a bit with time or tending. The accompanying grief that inextricably links us as part of the human experience can just as easily isolate those that it’s touching if it doesn’t really register on the radar of loved ones, friends, those that we work alongside, the world-at-large.


The interesting thing about loss and grief is that neither seek approval from anyone. The pair swoop in without being summoned, and we’ve no choice but to go along with them when they arrive. There’s really no point in which grief from loss -- especially loss sprouted from death, loss has many roots -- is equidistant to any time frame or stage of life. In fact, there is no timeline at all for it, despite what some think.



Having experienced this myself and in accompanying others through their grief, there’s no doubt that this is an especially challenging misconception to hurdle in our interactions with others after losing a pet. It seems that it’s easier to understand the loss itself to be so gutting -- it’s so black and white, so tangible -- but it’s that lack of approval that grief seeks that seems to trip people, the grieving and those around them, up. Grief is cloudy, so murky, subjective even. Because grief isn’t always recognizable, because of some of our less-than-healthy relationships to it, fears about what it is or isn’t and most importantly, how it should proceed, it can be the default when around a grieving person to say well-meaning-but-off-the-mark things, to even have a dismissive attitude or worse. I recall one woman, who I know to be impossibly caring quip, "Well, we all have to go sometime..." after my dog, Bruiser died from cancer. This was odd, coming from her but later, I came to understand the flippancy of her comment better.


There’s so much chatter about what not to say to someone who is grieving a pet, what to say to them, and a lot of it is helpful information. In their defense, it can be tough for someone who doesn’t “get it” or hasn’t been afforded the luxury to, to get it right. And, in my experience, those grieving the loss of a pet often don’t feel empowered to own their process, to express what they need.


Do you see the gap there?


Instead, when we’re grieving, the advice we often hear is to stay away from those who aren’t as understanding or supportive as we’d like, at least for a little while. And that’s fine in theory, but the fact is that in practice it’s more tricky; we have professional and familial ties to others, not to mention that in general, life doesn’t stop and avoidance isn’t a good strategy. To soften those uncomfortable interactions for ourselves, we often defer to the other person. Sure, that can be a quick way to get through a moment, but time after time after time, it can wear on us -- and it really doesn’t make future interactions easier as we grieve.


What I’ve discovered in years of writing about the human-animal bond (and more importantly, listening to reader comments), working with families with pets and as a pet loss and grief companion, the idea that often, in our own haze of grief, the ones with the most indifference, the purveyors of biting, off-the-mark comments are the ones who are hurting as much as we are. Yes, sometimes, our grief tears off the proverbial scabs of their own disenfranchised, buried, and silent grief. Like the ones that belonged to the aforementioned woman, as I learned.


Does that mean that we stuff our grief? I offer, a resounding no! -- quite the contrary. Instead, tread thoughtfully, mindfully through your grief process during interactions with others.


Don’t be afraid to say to another person when you’re having a tough moment, hour, or day that when they are having difficulty in navigating something important to them, that you hope that you’re extending the kind of consideration they need to do that better. Be fearless in articulating how your grief is very much a testament to the relationship to your pet -- another living being that you spent each day with -- and that their confusion about it can make it tough to relate, but surely they’ve a close relationship that’s been impacted by death and that must resonate on some level. The comments with regard to euthanasia can be especially cutting, and it’s no wonder: in my experience, it’s the single most sensitive issue surrounding a companion animal’s end-of-life, especially for those who have avoided it, had a poor euthanasia experience, or if there is a sudden illness or accident necessitating it. It’s always fitting to express with sensitivity, the notion that yes, having a veterinarian’s help to helping your pet go to peace might be or is or was necessary, and that you’re grateful that your final act of love for them was an option.     


Is everyone that you encounter wrestling with their own buried grief with a pet as you make your way through your own? No. But I will say that our culture doesn’t have the healthiest relationship when it comes to loss and grief. And pets have a way of drawing us humans closer to that edge of profound emotion than anything else on earth with their ability to form social bonds and life cycles that move far too quickly from curious, young creatures to the mature sages that we envy. And the latter, no matter our feelings about pets, magnifies our collective uneasiness with mortality. So again, be unapologetic and brave about your grief after losing a pet, and bear in mind that the person who seems to be the least supportive of it may actually draw the support and resilience that they sorely need to reconcile their own sense of loss in your doing so.





Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care support. She is also a Certified Pet Loss and Grief Companion and a member of The Association for Pet Loss and Bereavement as well as the International Association of Animal Hospice and Palliative Care and Pet Sitter International. She tweets at @psa2.

Tuesday, October 24, 2017

Halloween safety with pets can be successful with mindfulness and a little preparation

For weeks, aisles have been lined with Halloween candy, decorations, costumes and the like. It's a fun time of year, and, in most households, things are looking and feeling a bit
more festive. Pets have a natural curiosity about all this new stuff, but it can also make them a bit uneasy. It's important to remember that the things that we humans view as fun can be especially frightening to pets. Costumes, faces painted with make-up and life-sized decorations can startle pets and cause them to behave unpredictably, so introducing Halloween to any pet with mindfulness and a slow pace is important.

By keeping a few things in mind, you can keep your furry friends safe and keep the fun going this time of year.
  • One of the most common activities, carving pumpkins, is a long-held tradition for adults and kids alike. Keep jack-o-lanterns that are lit with candles away from all pets.
  • The days preceding and following Halloween often yield pranks — and some are not-so-playful. In fact, they can be cruel, particularly towards pets, and especially black cats. Don't leave pets outside and unattended during this period.
  • Strings of lights are popular these days in both indoor and outdoor displays during Halloween. Be sure to always keep cords and wires bundled and out of reach. Watch for decorative plastic pieces that cover the lights. These can look especially inviting to pets, much like their chew toys. Artificial spiders and spiderwebs are enticing, too. Consider them carefully before using.
  • With oodles of trick-or-treaters ringing your doorbell, it can be a difficult time for some pets to manage. The noise, the costumes and little ones can be disconcerting for pets. Avoid problems like anxiety and excessive barking by giving your pet a safe, cordoned-off area to stay in during this time. Try a spare room with white noise or a radio playing to buffer the sound at the door, and use a Feliway diffuser or spray for cats, and an Adaptil diffuser or spray for dogs.
  • Halloween candy is particularly inviting to pets — some even have penchant for the sweet stuff. Take special care when there is candy around to keep it locked up and away from pets, perhaps in an upper cupboard with a door on it. Dogs and cats are very crafty and can reach counter tops, tables and stove tops. Chocolate is especially toxic to animals, as it contains a component called theobromine.
  • Also, xylitol, a sugar substitute found in sugarless gums, candies and other sweet treats poses a special threat to dogs: it's absorbed rapidly into their bloodstream, releases a large amount of insulin, causing extreme hypoglycemia (low blood sugar) and can lead to liver failure and even death. Use special care with packs of gum in your purse or in your car's console.
  •  Call the ASPCA Animal Poison Control Center (APCC) at (888) 426-4435 if you suspect your pet has ingested a harmful substance. They can help guide you, and if you need to have your pet see a veterinarian locally, the APCC can start a case file that can be transferred to that vet. Have your credit card handy, as there is a fee of $65 to do so and is well worth it. Though not a substitute in an emergency, you can also download their mobile app by clicking here.
  • Candy wrappers can be a special problem. Foil and cellophane can be fun for pets to play with but can pose serious tummy issues, even a blockage.
  • Does your pet like the activity that Halloween brings? Bandanas are a suitable, simple way to have a pet look festive. For the truly adventuresome, it's fun for pets to dress up in made-for-them costumes. But, be sure that they fit properly, that your pet can breathe in the costume and that movement isn't impeded. Consider giving the costume a trial run before the festivities begin to ensure your pet really feels comfortable and that there is no risk of allergy. Avoiding costumes that have small pieces that could be pulled off and choked on is a must, especially for those curious young canines. Bear in mind that some pets are not fond of playing dress up, so if that's the case, be mindful and skip the costume. 

Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care and is also a Certified Pet Loss and Grief Companion. She's a member of Doggone Safe (where she completed the Speak Dog Certificate Program), as well as the International Association of Animal Hospice and Palliative Care, Pet Sitter International and Pet Professional Guild. She tweets at @psa2.

Saturday, October 14, 2017

Grief with pet loss—often met with shaming—is very much a bigger part of the human experience

Many years ago, I walked through my first professional experience with death. Being in the midst of a family who was navigating their pet’s decline in health and then the process of being humanely euthanized gave me a very different vantage point of death than I’d ever imagined I’d have. I also knew that I wasn’t as equipped as I could be; experience and time solved that in the coming years. Since that first experience, I’d seen even more than one might expect as a caregiver for pets: countless unexpected deaths, even more terminal diagnoses, age-related decline that had become too complex for the veterinary hospice care plan and medications to manage -- even a couple of pets who died in my care. I consider myself honored to have been a part of that as well as sitting vigil with families during a pet’s final hours, and having asked questions on behalf of a family while Face Timing with them during an unexpected emergency vet visit when they were at a loss for words after hearing news they didn’t want to hear, all the while scratching their dog’s backside because it comforted them, the one at the center of everything.    

It’s been a vicarious education that I never expected but with every opportunity, I felt compelled to run toward.  


One thing that every one of those situations has in common is grief.


The grief of families, of their extended circle. Not not just a blanket of anguish, no sir. It’s bereavement that ranges from the kind one feels when they get news and though the outcome of it is certainly dire, the path leaves much to the imagination -- a very active one, at times -- of grim anticipation. The fresh grief that leaves us numb, raw when that most unwelcome event swoops in, yes, that. The grieving that occurs when the dust settles just a little, and everyone goes back to their respective lives and one is left to be with that disquieting sense of everything is different. There’s the anguish that one feels when looking back and lamenting that if there was more money in the savings account, additional treatment could’ve been an option, if the pet would have only been amenable to accepting treatment. Oh, lest we forget about that kind of grief that leads others to quip, ‘...it’s just a dog -- you can get another to replace them, right?’


Regardless if the grief is fresh, long-set in, disenfranchised, anticipatory or blended with guilt, it’s not easy to endure. And, as I’ve seen time and time again, they’re not unified experiences, despite what well-meaning people will tell you. No one can attest, ‘I know how you feel,’ as our respective relationships with our pets are unique and complex than imaginable. The deaths of our pets are also, as one friend recently pointed out, so deeply felt because we share so much more time with them than other humans -- even say, our parents.


There are as many forms of grief as there are ways to grieve. Whether our pet dies as a result from a sudden illness, an accident, a terminal disease or age-related decline, it seems important to note that those factors often determine how the grief manifests and how we walk through it.


And it’s not something that we get over, our grief associated with losing a pet or anyone for that matter: we get through it. I tend to think our grief is quite a testament to how much our bonds have evolved with our companion animals, and in some cases, what those relationships represent. For some, it’s straight up ‘hey, this is the best relationship that I’ve ever had with another living thing’, while for many, it’s a pivotal cradle-to-grave partnership. For others, that pet represents a bond with another human loved one who might have been that dog, cat, bird, or snake’s owner before they died, and the pet is that living link to said person and now that the pet is in need of extra care -- whether it’s a manageable health crisis, an accident, hospice or even death -- this event has an impact beyond measure. Each of these scenarios, each relationship reflects so much about our lives beyond pets.


So, know that your grief is valid; it’s valued (and yes, valuable), relatable, teachable and having it in your lap is very much a part of the human experience as we know it today.


There’s no right way to grieve. We just do it, our way, and there needn’t be any shame in grieving. We’ve enough on our proverbial plates to contend with in grief to be subjected to being judged on grieving our pets or for how long or how we express it on any given day.  And there’s no shame in taking the time that we need, nor seeking support in navigating the process.

Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care support. She is also a Certified Pet Loss and Grief Companion and a member of The Association for Pet Loss and Bereavement as well as the International Association of Animal Hospice and Palliative Care, Pet Sitter International and Pet Professional Guild. She tweets at @psa2.

Monday, October 9, 2017

Thank you for not walking your dog

Upon meeting with a family of a happy Labrador mix a few weeks ago, the busy mom of two toddlers sheepishly mused, "I don't walk her as much as I should. I don't seem to have as much time these days, with the kids and all..." 

"No need to apologize," I responded. "You have this ginormous fenced backyard, she's occupied with playing fetch and squirrel-chasing. Let's not neglect the fact that she can run around free."

The truth is, walking said pooch is not all that fun. And by her human's admission, she's right—some of it has to do with poor skills on the part of the dog. But in my experience with her, outings are often fraught with challenges because of stuff going on in their neighborhood. The former could be remedied, but I know all too well how much work it is to try and smooth out. And for a busy young family, the bandwidth isn't there. And even if they could manage the training, there's the external stimuli and other dogs that have inadequate tools to cope and the humans with them that lack even more knowledge to create an ideal environment. Yes, it can be really hard to train our canine friends and then proof them in every challenging environment they'll face and expect the results we desire. 

I don't have a problem saying that I find dog walks a bit overrated. Sacrilege, right? Not so fast. 

Sure, dog walks can be fun, great exercise and terrific enrichment for our canine friends. But they are devoid of all of that for some dogs. So, what's the point? I ask. Walks are not the only form of exercise, fun or enrichment and I'm not sure who decided that walks were a must-do. There are plenty of other options to get dogs outside and burn off some energy, get some much-needed exercise or sniff around and use stimulate their brains. 

I've several canine charges that find walks challenging, and I accommodate that. Maybe that means only going for walks when their neighborhoods aren't so busy. It means avoiding one street because there's that one house where the well-meaning owners decided to go with an electric fence and their dog often makes their way to the street anyway and we'll have unwelcome interaction. Sometimes I go to Plan B, and stick with what's enriching, fun and what the dog can handle. Because when a dog needs to get outside and enjoy themselves, it should be a fun, favorable endeavor, not a daily struggle for both ends of the leash.

If you've a fenced yard, why not have a vigorous game of fetch? A ball, a Frisbee, a favored stuffed toy, heck! a stick will do just fine. Give your dog pal a play bow and give chase—they love that. Hide-and-seek is great fun, of course, as is a game of Find It. modeled after an Easter egg hunt, I hide a couple of a dogs favorite toys in the yard (alternatively I'll use a few favorite dog treats) and then open the door to let them hunt all the while encouraging them, 'find it!'. These games are great because they incorporate not only activity, but something far more important: engagement with their trusted humans. Dogs love—and need—this kind of interaction with us. It builds and maintains the human-animal bond and shared experience. It's also good for us humans. I can attest that I'll use any excuse to be silly and laugh. 

Don't have a fenced yard? Consider asking a friend or neighbor if you can borrow theirs while they're not around. Visiting a dog park during low-volume periods can be a boon; check out times of day when there's no one around and take advantage of that. One of the things that I love to do for dogs with no fence is to clip a long lead to their harness and head to a park or natural area when there is a low-volume of foot traffic around. Giving a dog the chance to sniff, to have autonomy, to make decisions about how long they'll be exploring and lingering over an area is tops. Here's a video demonstrating how useful a long lead can be. 

There's no need to allow others to shame you into forcing your dog into situations that they struggle in, even if it seems as benign as taking a walk. I can assure you that a leashed walk with a dog can be one of the most stressful situations for both dog and human. Of course, it's fine to work on leash manners on a regular basis when your dog is receptive to it, but if they really have trouble, as a professional, let me assure you I'll never throw shade on you when you decide to forgo it and stick with activities that your pet feels safe engaging in. 


Lorrie Shaw is owner of Professional Pet Sitting, where she specializes in ancillary pet palliative and pet hospice care and is also a Certified Pet Loss and Grief Companion. She's a member of Doggone Safe (where she completed the Speak Dog Certificate Program), as well as the International Association of Animal Hospice and Palliative Care, Pet Sitter International and Pet Professional Guild. She tweets at @psa2.





Tuesday, September 19, 2017

The lasting resonance of using "against medical advice" in vet medicine can complicate a family's already difficult decision

Instead of a traditional blog post, I'm offering up a vlog entry this week. I highlight a situation I've seen in my work in pet sitting and especially as one that has come to specialize in pet palliative and pet hospice care.

As pet professionals, our jobs, especially when a family is facing a grim diagnosis, can be very challenging, there's no doubt. This is especially true for veterinary doctors, vet techs (nurses) and support staff. And as professionals, how we use the words at our disposal is as important as the skills and knowledge that we've attained. We can't forget that.



Lorrie Shaw is a freelance writer and owner of Professional Pet Sitting. She has been featured guest on the Community Cats Podcast, talking about how experienced pet sitters can be a valuable asset for families with pets, as well as in the animal rescue, veterinary and animal hospice communities. Shoot her an email, contact her at 734-904-7279 or follow her adventures on Twitter