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Monday, April 24, 2017

Sedating a pet for euthanasia brings the concept of 'a good death' full circle

By my own admission, I focus on end-of-life and the process of death with both humans and companion animals a lot. As one who has come to specialize in caring for senior and geriatric pets -- especially dogs -- I find myself walking alongside families as they navigate these periods of life with their pets. I’m okay with that, and I do it because I have a desire to. Pets, just like humans deserve to die with as much comfort and support as possible.


Though I had a few experiences with client’s pets meeting the end of the lives in the year’s past, in 2011 I had a deep dive into the lives of two other families. As a freelance writer for AnnArbor.com, I covered their journeys with end-of-life care and home euthanasia, which were both facilitated by local house call veterinarian Dr. Cathy Theisen. The power and intimacy of those conversations is still not lost on me.


Before too long, I’d be in the midst of death much more closely and with rapid-fire succession. I would see my father through his end, as cancer had its cruel way with him. A year later, one of my dogs would meet the same fate after some hospicing and by 2015 and 2016, I was immersed in the hospice and end-of-life care with my two remaining pets, who were in advanced age, with the help of Dr. Theisen and Dr. Monica Turenne. Those experiences don’t count the many that I've been, to varying degrees in the midst of with charges and their families (yes, the humans, too).



Inexplicably, I haven't felt the urge to run in the opposite direction during any of it. Quite the contrary, in fact. I’ve become very familiar and yes, more comfortable with death, even seeking out educational opportunities to help me navigate death and dying in a professional capacity; I’ve leaned into it, for lack of a better phrase, knowing that if I want to work with animals and their families, it’s a profound and normal part of the calling. I’ve been fortunate enough to be surrounded by professionals who have paved a compassionate path. Shying away when the topic of euthanasia comes up doesn’t seem natural to me. The Greek etymology of that word: eu = “good” and thanatos = “death” may seem like an oxymoron to most, and I understand.


My intention of giving my own pets a peaceful passing, whenever that was to be, was months in the making and by all accounts, a positive encounter. And I was all-too-aware that euthanasia might be a part of that. There was help from both doctors and other professionals to ensure that my pets and I were advocated for.


But that’s not so with everyone. And why that’s the case, is complicated.  


In my writing and my hands-on encounters, there hasn’t been another topic that has incurred as much controversy and emotion as euthanasia. And because of my experience, it’s easy for me to understand why. It’s due in part to the notion that concluding that euthanasia is the best option in a given situation -- when all of the physical, emotional, medical, financial resources (or any combination thereof) at our disposal have been exhausted -- is by all means, a huge one. It’s a sensibility of, ‘here we are’. When faced with the limitations that exist, a family might feel like they’re giving up, falling short. (They’re not.) Coming to that crossroads, let me tell you: it’s the most mind-numbing, raw experience you’ll face with a pet.


Past experiences with euthanasia often color one’s decisions about what they want for their pet; they can be empowered by them, they can feel like they’d want to do things a little differently or even be paralyzed by them. The absence of having previously traveled the path of losing a pet doesn’t often offer a buffer of comfort. That can feel like diving into the deep end of the ocean -- at midnight.


One person’s experience with the process of euthanasia highlights a common situation:


After my last pet died -- they were euthanized at the vet’s office -- I know that I couldn’t go through that again. It was too traumatic, for them, and for me. They were stressed, afraid, and yes, feeling the effects of their end-of-life because the drugs were no longer enough. Getting to the clinic was hard, but even worse, was seeing the tension and pain and fear in their face as they passed. I don’t understand, isn’t euthanasia supposed to be humane? It wasn’t what I had in mind for a death that was orchestrated and meant to be easier. I don’t think I’d choose that again. I’d rather they’d died at home and on their own than have to go through that.


Sadly, I’ve heard this kind of thing more than a few times. Folks may keep mum about this when it comes to veterinary staff, but they feel comfortable confiding in me. That is not something that I want families feeling like is their only option, going it alone. And the members of the veterinary community that I know feel the same way. Having a family try to manage a pet in end-of-life without them being medically supported (adequate pain management and getting answers to questions about what is happening, most importantly) isn’t good for the pet, nor the family for obvious reasons. And it surely damages the human/animal bond.


Having the option to have euthanasia performed at home where the pet is familiar and comfortable is a boon and can of course mitigate the problems that arise when trying to transport them to the vet, and house call and hospice vets routinely provide this in their practice. Ditto for some vets that practice in a clinical setting. With all three, planning in advance is necessary of course. I do realize that not everyone is comfortable with the scenario of a pet dying at home. So that, and in other cases where the possibility of a crisis situation availing itself and necessitating euthanasia in a clinic, making the transport of the pet as low-stress as possible is key. Having a plan in place -- one that has been crafted with a vet -- to achieve this is a must.


But aside from having all of that lined up, there is one detail that is, without question, crucial in facilitating a peaceful transition and mitigating at least some of the poor experiences that I mentioned above. It’s the simple act of a pet being sedated for euthanasia.


Sedation is two-fold: it’s not only for the pet’s well-being, but the family attending their companion animal as they are helped along by the vet. Within a few minutes of being given the sedative, the pet drifts into a deep sleep, which I can tell you is inherently a calming segue, an intensely comforting state of being not only for the pet, but for the humans. I’ll share that Gretchen’s passing was especially resonant. She gently closed her eyes after being given the sedative, then settled into the deepest sleep I’d seen her enjoy in months. Then she began to snore -- not just in her tired old dog fashion, but in a way that signaled to me that she had attained a level of comfort that hadn’t been possible in the weeks before then due to her failing body. My instinct was to reach out to her, to pet her carefully, gently because of her advanced osteoarthritis and then I realized something overwhelmingly profound -- I could pet her without any worry of causing her pain. I found myself petting her the way I used to do before her tender joints made it prohibitive. Then, without another thought, I crawled into her bed, cradled myself around her, hugging her, talking to her, listening to her breathe, saying my final goodbye, sobbing tears of comfort and joyful exhaustion and soaking up every ounce of physical contact that was most certainly the gift of gifts from the Universe that I never thought I’d ever have, and dared not ask for.


But only sedation made that possible. It brought the concept of “a good death” full circle, and in itself is an act of advocacy for both the pet and the family. Not every vet sedates a pet for euthanasia, unfortunately. If it were not something that would have been standard with my hospice vet, I would have advocated for myself and Gretchen that she be provided it no matter where that road might have led.


So, as I gently offer, “...be sure to talk about sedation” to those in my midst as they indicate they see that euthanasia needs to be a bigger part of the conversation with their vet, I say the same to you.  

Lorrie Shaw is a freelance writer and owner of Professional Pet Sitting. She has been a featured guest on the Pawprint Animal Rescue Podcast, talking about her career working with companion animals and writing about her experiences. Shoot her an email, contact her at 734-904-7279 or follow her adventures on Twitter.

Tuesday, April 11, 2017

Predictability, the right tools and simple rules promote a sense of safety for senior or infirm pets and their humans

One of the first things that I notice when meeting a family with an older pet, or one receiving palliative/hospice care, are the ways that the humans have implemented ideas to address the animal's changing needs. It's typically a combination of things designed to enhance mobility, prevent any falls and comfortable rest. I'm always happy to see the creative and thoughtful strategies that families use to accommodate their pets with time-tested tricks, and even some terrific new products on the market.


Safety first, is the mantra when it comes to our pets, but something that is too often overlooked—and vital nonetheless—is the need to ensure the safety of the persons handling and interacting with the pet. I’m happy to say that in all of my years caring for pets professionally, especially geriatric companion animals and those in end-of-life, I’ve not been bitten. But it’s not luck: I’ve employed safe rules of engagement.
The truth is that animals that are living with pain (numbers that are often underestimated, in my experience), those that are not feeling well or have issues with mobility quite often are apprehensive about interacting with us, especially when we need to assist them in some way. Chronic pain wears on animals just as it does humans, both physically and mentally. It doesn't feel good, and the prospect of being in more discomfort or not having the autonomy to move independently and at a pace they can manage is daunting.  The same holds true for pets with diminished vision or hearing; having either or both of those senses dulled or expired impacts the way that they might be able to respond if approached in away that is incompatible with what they're comfortable with. And when that's the case, pets react in really the only ways they can: they give a clear warning when put in situation that's challenging—usually with a look, a growl, even a quick snap—or in a worst case scenario, yes, a bite. For that reason, it seems important to reiterate the need to interact with our pets in a safe, mindful manner always.


Additionally, the assistance the we give is physical in nature, and no matter the size of the pet, keeping our bodies safe from injury (both from bites and from lifting/assisting) is imperative.


The basics


It seems important to begin by saying that understanding where a pet's comfort zone is, what causes them tension or unease is a great place to begin to both be most helpful to them, and for us to stay safe.


Be aware of proper lifting and transferring techniques. Using tools like harnesses and slings for dogs can help facilitate ease of assistance, provide stability. You can create a sling from re-purposed materials, but harnesses like the RuffWear WebMaster and the Help-Em Up are especially great because since they have handles attached, one need not have physical contact with the pet. This is a plus, as many arthritic dogs can be a little guarded about being touched, even a helpful way.


Create a safe environment for pets with diminishing mobility. This might mean moving dog beds (preferably orthopedic!) to a main floor area so that they are not only easily accessible but so pets need not use stairs. By placing rubber-backed area rugs on non-carpeted floors, pets can have sure footing on these surfaces. Consider adding baby gates to limit access to areas like basement stairs, a second story, or other areas where a pet has trouble negotiating movement. By implementing these strategies, we reduce the necessity of having to help a pet up from a fall because they've lost their footing, which is an area of less-than-ideal interactions that gets overlooked.


Understand how changes in cognition, hearing or vision can affect how a pet responds in various situations. A pet's senses can be dulled with age, so it's easy to imagine how that affects their perception of what's happening around them. This is especially important when people and other animals are close by. Giving a pet that's hard-of-hearing a little warning that you’re approaching with a wave of a hand, a click of a light or by not approaching them from a direction where they're not looking is mindful.

Pets with visual impairments benefit from an audible heads-up, like a verbal cue or a quick whistle before being approached.



It's also important to remember that some medications can leave pets a little sleepy, so that can affect their ability to respond.

Changes in cognition can affect how a pet may process being touched and/or approached.

In my experience, geriatric pets can be quite fuzzy-headed upon waking, and it can last for a while longer on some days, so they always need extra time to get rid of the cobwebs. Speaking of sleeping, it goes without saying that approaching a dozing pet too closely or touching them carelessly isn’t wise, but this is especially true with older pets or those traversing illnesses and end-of-life. When trying to rouse one of my charges, I’ll often give a couple of raps on the wall where they are sleeping and call their name calmly but audibly.




Other considerations in safety


The younger members of a family aren't as sophisticated about recognizing signs of uneasiness or stress in pets of any age, and so it’s vital that there is open conversation with children who are in the midst of family pets about using extra-special care when around older or infirm pets. Click here for a great source of info by Dr. Sophia Yin.

As a caregiver, I stress these strategies to clients as we talk about my caring for their most vulnerable family members not only for their safety, but mine. Though I adhere to low-stress interaction techniques and those that don't promote fear, as one who is new in the pet's life, they're often less-than-comfortable with my needing to physically handle them in ways that they might not feel so much so about with a trusted member of their tribe.

By implementing these rules of promoting safety and favorable interaction with each human that comes into contact with a pet with these special needs, there's a sense of predictability, and that is critical for their overall well-being.

Lorrie Shaw is a freelance writer and owner of Professional Pet Sitting. She has been a featured guest on the Pawprint Animal Rescue Podcast, talking about her career working with companion animals and writing about her experiences. Shoot her an email, contact her at 734-904-7279 or follow her adventures on Twitter.

Wednesday, April 5, 2017

Low-stress strategies for sub-q fluid administration in cats at home are a win/win

Subcutaneous fluid therapy is something that a veterinarian may prescribe being done at home for cats. And while it's fairly easy and straightforward to in theory, when you get home and have to set about doing it on your own, it's not uncommon to feel all thumbs because your furry friend isn't as cooperative as you might like. 

Though conventional wisdom might have one think that doing fluids in a comfy, relaxed space, like on the couch in the living room makes sense, it certainly does if things are working well. But if that's not the case, one of the things that I suggest is that families consider doing fluids in a smaller space, like a bathroom. In the video below, I offer more tips that can help your cat be more amenable to getting fluids at home, promoting more success for the long term. 



Lorrie Shaw is a freelance writer and owner of Professional Pet Sitting. She has been a featured guest on the Pawprint Animal Rescue Podcast, talking about her career working with companion animals and writing about her experiences. Shoot her an email, contact her at 734-904-7279 or follow her adventures on Twitter.