Thursday, February 22, 2018

Optimal sleep is a simple way to bolster a pet's palliative or hospice care plan

Ask most people what they could use more of and they'll say, 'sleep'. 

Oh yes, we value it so much and know that we need it to be our best selves. So why is it that so many of us strut around like its a badge of honor to exclaim how little sleep we've had and how productive we are [or think we are]? It's understandable, really, given the current societal climate: if you're not busy most of your waking hours and intrude on those hours when you can rest optimally, you're a loser. That, coupled with a world that's perpetually 'open for business', it's hard to honor our inherent need for sleep, and not just some shut eye, I'm talking about restful, valuable sleep. The truth is, we humans aren't the only ones that need sleep; animals are dependent on it. A new series, "The Secret World of Animal Sleep" on the Smithsonian Earth website, details those parts of the lives of the animal world. 

As a companion animal death doula, and as someone who interacts with senior and geriatric pets regularly, it's hard not to notice that some families have a tendency to impart their own attitudes about rest and sleep onto their pets. Though I see it less often with cats—the assumption that cats sleep their lives away isn't lost on any of us—I'll often hear families lament that their dogs seem to sleep a lot. The truth is, they do, and it's not just growing puppies! 

Older pets, those who are ill or recovering from illness or injury and yes in their twilight or are approaching their end need adequate rest. That said, the standard isn't one-size-fits all. After surgery or an illness of course, it's understandable that recovery takes a lot out of anyone so that's easier to take notice of. What can be more difficult to recognize is when the need tends to build slowly with advanced age and any complicating illness or disease trajectory, as it tends to be more gradual. That, and we might forget how much some daily life and events take out of them: that car ride to relative's house for a fun visit, having a contractor working at the house—even a new arrival like a baby or another pet. 

One of things that I've seen unfold time and time again is a scenario that can get easily overlooked: the need for predictability and routine with our companion animals. It's not all that uncommon on my Monday and Tuesday rounds to find older or hospice pets exhausted, crabby and out-of-sorts. (I also note higher incidences of digestive upset and nausea, but I digress.) For many families, they're away at work and school on weekdays but then on weekends, there's more hustle and bustle around the house, disrupting a pet's usual rest periods, plus there's more inclusion. One astute family pointed this out years ago as their Dalmatian eased into twilight and it's been a barometer I've gratefully employed ever since in my work. 

The point is, any fluctuation in schedule or health status uses physical and mental energy, which can deplete energy stores, so more rest is necessary to cope. And it seems important to remind that things take longer to recover from as age advances.

One thing that I gather from my conversations with families is that it can be a tough pill to swallow, noticing those changes that occur with the age or possible illness of a pet and our need to then admit that's the case. Sometimes, we ignore what we see, so please know it's a normal response to those gut-wrenching realizations but it's something we can and need to hurdle.

What's important to remember is that adequate rest is one of the most helpful, supportive and nurturing things we can offer our pets as they demonstrate to us they're slowly winding down.

In fact, as I've seen in my time in animal hospice, pets tend to fare better when they've been afforded adequate rest balanced with other aspects of a palliative care plan that's tailored to their needs. One of the questions that I ask families with pets receiving enhanced palliative care or in hospice when we meet is, 'How well are they resting? Are they sleeping comfortably? Are you sleeping?'

So, how can we best help our pets roll with the punches during this time? It's pretty simple. The notion of setting the tone for comfort and a sense of safety along with ensuring that there is time set aside for rest affords them the autonomy to do so.

A bed that accommodates their physical comfort, especially when it comes to arthritis is a great start, along with choosing an area of the home that they feel most comfortable in. Having an amount of privacy that suits them (some pets need to be alone) and an optimal level of quiet helps, too. In fact, a few of my families have found it necessary to give their pet a room of their own, preferably one with a door, to rest undisturbed. This not only achieves a peaceful space in terms of noise, privacy and temperature—the latter can be critical for some animals—but in a household with multiple pets, it's not uncommon for the infirm pet to be bullied or fussed with a bit by one or more others so this offers some protection when things can't be supervised. (I see this more so with cats.) 

Balancing out factors like this can optimize the most important of all, time. Understanding what does work for your pet in terms of how much quality sleep they are requiring, and adjusting for stress, seasonal changes (I find that heat and humidity in the summer and wintertime's snow and cold affects energy levels) and changes in their condition and any accompanying anxiety. Some days, you'll notice that your animal friend is demonstrating that they're up for more engagement and that's terrific! Just know that they'll likely need more rest afterwards, so make room for that.

It's a simple idea, but a good solid rest sets up how the coming hours and even days unfold, and using a more encompassed approach with facilitating sleep can yield more good days and help soften the bumpy ones. An equally great benefit of seeing to it that your pet has the kind of rest that they need is that you'll have a better chance of sleeping well, too—something that we need to be our best for everyone in our life, and also helps support that all important human-animal bond well into a pet's end of life. 

As always, I urge my families to take what they derive from the conversations that we have about sleep and other concerns and talk to their veterinarian about additional options that are appropriate and safe for their companion animal. This can include veterinary-formulated nutraceuticals, herbs, supplements, acupuncture and even pharmaceuticals. 

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.

Wednesday, February 7, 2018

Rituals as storytelling can help the grief process after the loss of a pet

We have few things in our collective culture that serve as markers in life. You know, those things that say that we've reached points in our respective journeys that are significant. In the broadest sense, aside from cementing our relationship with another human like with a wedding, the birth or welcoming of a new child or serving our country during war -- and for some in our culture, those situations never occur -- there really is little else that we feel compelled to mark as a rite of passage, aside from some cases, religious ones. 

Rituals and traditions are a natural part of the events that we do honor, and in our culture, I can see that we need more of that. Reclaiming rites of yore and establishing new ones would be especially helpful in navigating the bumpier times, enable us more solidly connect to members of the proverbial clubs that we're (sometimes unintentionally) initiated into and to navigate that new territory. Rituals demand that we engage in the act of noticing -- something that Ellen Langer has pioneered the discussion of -- as well as find the language (verbally and visually) to articulate meaning. They incorporate movement, too, which is especially important in rituals attached to loss. (Moving our bodies helps us move our minds and hearts through the mourning process.) They also help facilitate the very important mental movement from grief into mourning and that mystery of 'what will life be like going forward?'. It's all very much about storytelling, the core of ritual. 

Aside from helping to attach a sense of physicality to important events in our lives, rituals are closely tied to the idea of time. When we're grieving and mourning, our sense of time often feels skewed, and ritual helps us gain some equilibrium with it. It's also acts as a tether to the past, reminds of the present and helps us remember that there's a future. Rituals and traditions summon a sense of timelessness. 

Painful events, and there are many of them -- a death of a loved one, the loss of a job, losing a breast, a move cross-country from a place one feels bonded to, a relationship that dissolves, selling a business -- are tough because we don't know who we're supposed to be, other than strong enough to navigate it. So, in hushed tones, we slog through the emotions that invariably arise. Yet they're all part of our story, our collective stories. And we grieve to varying degrees when these things happen, even if we don't realize it, and then we mourn. We mourn the familiarity, the comfort, the identity what is attached to it has given us. There is that unsettling sense of uncertainty that accompanies it all. After all, there's the idea of a 'new you' unfolding.

But often, we don't ritualize losses, outside of a funeral for a human member of our tribe. And what happens when a pet dies? We often feel too shamed to express our grief then, let alone give that life event a marker. The truth is that we need to do that even more then. We need to acknowledge and honor our story with that pet with ourselves, discover the verbal and visual language to articulate it and for those who've earned the right to hear it, we need to share the story with them. This kind of storytelling not only enables us to express our own path of loss, grief and mourning, it invites others to convey theirs. The latter can be an incredibly rich and full experience as well. 

The ways that we ritualize the passing of our pet can be as vast and unique as our lives with them. 

Loss offers an opportunity to express emotions in unexpected ways

One family shared their recent experience of using ritual after Nico, their 17 year-old cat, passed away after complications from chronic kidney disease.

A sense of emptiness, even discombobulation is a common feeling amongst those I work with in Pet Loss and Grief Companioning.

Photo credit: Meghan Storey


"...there was just this sadness and also a kind of surreal-ness," said Meghan Storey, one of Nico's humans. The day after the family's vet helped her along, Storey walked into the house from work for the first time without her cat being there. The new normal became starkly visible.

"Like, logically you know what's happened. You were there. You brought her to the vet, you left without her... but it still doesn't seem to make sense. Yesterday there was a cat here, today there's an empty space. I walked in the door to this empty table and I'm guessing I cried. I felt this need to acknowledge that Nico had been here. It would seem wrong to just come in and make dinner like it was an ordinary day. This little furry life had come and gone and intersected with mine for quite a few years, and she had a beautiful spirit, and I couldn't just carry on like she hadn't existed."

I was kept me up to date on how things were going with Nico, and was in the loop as bigger decisions were made on her behalf. It wasn't easy time. But a couple days after Nico died, I got an email that exuded a radiance, a sense of peace. Remembering what she saw with regard to the death and funeral traditions belonging to one of her best friend's family, who happen to be Vietnamese Buddhist, an idea organically formed in Storey's mind. In the Vietnamese Buddhist tradition, setting up a small adorned shrine in the home with photos of the deceased loved ones is common, as is burning incense. And these loved ones are acknowledged on a regular basis, sometimes setting out favorite foods and other things that they loved.

She explained, "And so, I set to work putting together my own little tribute to Nico. I lit a few sticks of incense and a candle. I put out little dishes of different foods that she liked, and treats, and some milk and water. A couple of her toys. And it really helped. I felt like I was honouring her."

Photo credit: Meghan Storey
With Nico's ashes home where they belong, the ritual continues.

"Since then, I have been lighting a little candle for Nico most nights. I was comforted when we received Nico's ashes, and then the sympathy card with her paw print from the vet. I've set up a very small shrine on our mantle. That's just my way of remembering that Nico was here, and letting her know that we loved her and that her sweet little spirit is welcome to hang out here any time it wants."


Do what's meaningful and comfortable for you 

I had done a lot of intentional work beforehand to prepare for the passing of both my pets, who did so 8 months apart. They had benefit of going to peace at home, so I wasted no time in beginning the ritual practices, and in fact, I recommend it. My vet made clay impressions of their paws after they transitioned. I spent some hours alone with them at home to allow myself some time to feel any recoil from the day and clipped locks of fur from their vessels to be made into memorial art pieces and jewelry. After transporting them to the facility, the staff helped me tend to them, situating their vessels in their final resting boxes just so in preparation for private cremation. Spending that last bit of time with them, tending to them was incredibly powerful and cathartic, and though it's not something everyone would feel comfortable doing, I did and it's really good that the option is there for others. 

The things I did on those days, and what Nico's family did for themselves incorporated important elements: tangible objects, words, movement and meaningful, intentional activity that make rituals what they are. 

I've no doubt that because of the rituals, I was able to remember more details from those days, something that I really wanted to do, knowing how much of a blur they can be in the fog of grief.

I did other things, like set up small tribute tables for each of them, incorporating things that remind me of them or that belonged to them. I donated any leftover veterinary medications and pet food to local animal organizations. 


There was more stuff that I did, and still do as an active ritual, years later.

I keep a plush soccer ball of Gretchen's on my bed amongst the throw pillows and I see and pick it up and bop it around every morning or when I'm stressed. She loved sports balls of any kind, but especially soccer balls. In her geriatric years, she preferred softer options for her old teeth and one day at IKEA, I saw the perfect choice. Happiness ensued! I plant catnip every summer because I know Silver loved finding it in the yard -- it still makes me laugh to recall finding him ripping it out of its spot if I wasn't paying attention. 

Rituals spur the memories that we need to remind us, and in their own way are a form of effortless storytelling. And storytelling is something that we really need to get us through the bumpy periods in our lives, and to remind us to make each and everyday matter.



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.