Wednesday, January 23, 2019

The loss of a pet due to sudden or traumatic death invites grief that can be more confusing to navigate

"We did everything we were supposed to. We did everything right..."

This is a resonant refrain that I hear from my families after their pet dies unexpectedly, often as they glance over to the boxes of heartworm and flea preventative that they fetched just days before but will now go unused in their household. The emotions that begin sputtering out are understandable and expected: confusion, anger, 'it's not fair', a generous helping of 'WTF?', all often mixed with guilt. 

Death is a common companion in my work. Often working with senior and geriatric pets and their families, it's usually a time of life for them when I'm ushered in; there is a pet's age-related decline or life limiting diagnosis, or it could be that in-home care is just more fitting for their respective emotional needs. 

But in truth, I work with companion animals of all ages, and I can tell you that when a pet who has been deemed to be the picture of health receives a terminal diagnosis or dies suddenly, that's an entirely different scenario when considering the human-animal bond. I've been in the midst of my share of families whose have lost their pet unexpectedly—in fact one close friend had this unfold just a few weeks ago—and for them its an experience that has its own share of complicated emotions, which in turn further tangles the grief that accompanies the loss. 

Having close proximity to this as someone who is in the trenches, I've learned what can be expected: anything. And despite what is frequently expressed by the person who is grieving their pet's sudden death, they always seem surprised by what their disbelief is doing to them, but even more so by their anger and lack of trust directed inward, like a knife. The former seems sensible to them when a death comes out of nowhere, but perhaps in the quest to derive some tangibility about it all, these thoughts can filter in: 

What did I not pick up on? 

That day weeks ago when Buster seemed a little 'off'... that had to be a clue that something was wrong, yes? 

If I'd not made the choice to go on that trip, or to have them cared for by XYZ on XYZ day, this event might not have happened. 

These thoughts invade our sense of us really knowing our pets, or worse yet, they destabilize us further by smashing our perception that we should have had an unreasonable sixth- or seventh sense about things that are often hard as Hell if not impossible to recognize if a pet is ill. And then there that trusting our own judgement about things, about other people's capabilities, about our lack of a crystal ball. Oh, that pesky fly that is guilt and shame, tagging along, buzzing about. 

There's no doubt that loved ones, friends and co-workers feel inept at navigating the rules of engagement in interacting with the person who is grieving, and when it's a sudden loss that's even more so. This is especially true if there was some aspect of trauma anchored to the pet's death. That's not surprising: in our tendency to be death- and grief-phobic, not to mention how tone deaf we are to those who have experienced trauma it can be easy to steer away from those grieving or to do so ourselves when we're in the depths because we feel like we're not being heard. It's not unusual for those of us who work with pets and/or the field of grief and loss to bear witness to a family's expressions of anger, shock, guilt, second-guessing, along with the sadness and longing for the pet they've lost.  And those emotions often bear the scars of somehow feeling misplaced or inflated. As I commonly hear from Companioning clients, 'I thought there was something wrong with me because these emotions are still here, or that I have had them at all.' 

I assure them that this is expected, all of these emotions, and that there is no timeline. After all, grief is not a pathology. It's normal, and it comes with having bonds with others, including those with animals. Grief (and trauma) are entities that very much need to breathe and move. When we're knee, waist or neck deep in them, our instinct is such that we recognize that they need attention even though we may feel it's easier to stuff them down. Grief invariably wins the wrestling match, and storytelling, practiced as a personal ritual or verbally with others, gives it an outlet.

When we're grieving the loss of a pet, especially if it's a sudden loss and/or it encompasses a traumatic event, it's not at all unusual to tell and re-tell the story of the event and its initial aftermath to others, yet another assurance I offer to families I work with. (In 'The Year of Magical Thinking', Joan Didion recounts how she found herself doing this after the sudden death of her husband.) Storytelling, something we seem to be hard wired for, is a way for us to make sense of everything with regard to the event, to grasp and wrestle with it, to time-keep, to cope. We need to tell our story, whether it's recounting the event or having the opportunity to express how we're feeling on any given day. We need others to listen to it. The crucial part of this of course isn't so much to just get it out, but to tell our story to those who have earned the right to hear it, and to have them hear us do more storytelling over the course of our grieving process. The problem is that not everyone has earned that right. And only we get to determine who those people are. 

Carving out where those safe spaces are can be daunting in the fog of these events, as the shock of it all is alone enough to disorient us. It can be as much so for those around us who want to be supportive or at the very least do-no-harm. But ours is not a culture that, for the most part, has a healthy relationship with grief or sadness and the like. I'll add that it's also one that has developed an even unhealthier aversion to feeling (or acting) anything but happy and sunny on a daily basis. For some of our peers, when they see our pain, it can trigger their own from a past experience with loss that they've lacked the tools to cope with. It seems important to mention the group of people who have an over-eager desire to intervene—which in itself can be overwhelming for us—as they tend to be intent on prescribing how we can best navigate our grief journey. This, despite our not having given consent for them to weigh in, and as is often the case, we feel the least empowered to advocate for ourselves while in this state.

Those around us tend to fall into one or more of the aforementioned categories, and knowing that can be super-helpful in understanding any [mis]communication from someone in our orbit and identifying those peers that are worthy of hearing our stories. I find that mostly, it just comes down to the other person not knowing how to proceed and that's even more the case after the death of a pet that wasn't expected. That's when communicating as clearly as we are able about what our needs are (and maybe more importantly, what we don't need) and asserting our boundaries when necessary is essential.

Lorrie Shaw is an Animal Hospice Palliative Care Practitioner & holds a certificate in Pet Loss & Grief Companioning. She is 
CXO of Telos Companion Animal Services, LLC. She tweets at @psa2.

Tuesday, January 1, 2019

Trigger-stacking and other causes of aggression in geriatric pets can move the conversation toward euthanasia

"Let's schedule a consultation well before any trip you've in mind to meet and get a feel for whether or not we're all a fit," I always implore once a family and I have a chance to make that initial connection by email or phone. 

They can also be assured that I'll be asking a lot of questions about their pet's health and behavior, as well as a history on both had how they've changed as they've aged or how their co-morbidities have progressed. I also do periodic re-assessments with my existing families with pets in fragile health or advanced age.

Because of my experience, it's not uncommon for families with pets with special needs—usually geriatric pets—because of their health and behavioral considerations to reach out for help with their care. It could be that they'll be traveling or need a hand while they're at work to tend to little or big things that contribute to the pet's comfort and well-being, not to mention the family's peace of mind.

You'll notice that I noted health and behavioral considerations. Those two things are very much united when we're talking about geriatric pets receiving palliative or hospice care. In fact, they're criteria, or need to be, when families receive a life limiting diagnosis for their pet, or when age-related decline has necessitated conversations about how to best help them. We have a lot of options for treating disease, or crafting a palliative or hospice care plan—but how that is carried out is another matter. Not only does the family need to be able to manage it, but so does the pet. I recall saying on one podcast that I guested on, "...we need the pet's permission and cooperation... they need choice [on whether or not to participate]." 

Pets are great communicators. My professional training, which includes a designation of dog bite safety educator and Certified Fear Fear Free Professional–pet sitter, I've not only learned to hone in on what a pet is telling me or those around them, but to use strategies to interact and care for them that match their changing physical, emotional and behavioral needs. A pet's sensory deficits (like vision and/or hearing), physical decline, pain level, how well they’ve slept and rested on a given day and any cognitive dysfunction can impact their ability to manage tolerating a treatment plan and being interacted with to have it in place. The same is true if a pet is touch averse or has behavioral challenges. I spend time talking with families about all of this, as well as how their absence alone can impact the pet's ability to cope, not to mention being in my care for any length of time. 

As I said, during a consultation, I have a lot of questions. I require a pet’s complete medical record, a veterinary wellness exam visit including bloodwork, urinalysis and an evaluation for pain, using a pain scale. Everything about their care plan is sussed out, including medications, and things like how easily they rest and eat among other things. In essence, it's vital that the pet be stable enough to be in my care. While all of that is the criteria that I use on my end, I also assess the companion animal from a behavioral and emotional standpoint, and gain an understanding of what’s in place for mental and environmental enrichment. If the pet had a history with a trainer or vet behaviorist, I require the written behavioral management protocol to be sent as well. 

It’s not uncommon that after reviewing everything that I recommend that a family connect with a credentialed trainer that I feel comfortable with who adheres to humane, positive reinforcement methods. This can be a huge help to the family to be more cognizant of their pet’s behavioral and emotional limitations. 

I'm not ashamed to say that there countless families that hear me say, 'I don't think that your pet will do well in my care, or in your absence at all' or 'I get the feeling that your dog could manage your being away for a long weekend, but ten days... no. That's too long.' I always offer facts to support what I mean so that I can advocate for the pet and myself, and I stick to my guns.

The truth is, when a pet enters the phase of palliative or hospice care, it's not only about daily management of a medical treatment or comfort care plan. It's about them having stability, predictability, and routine and I'll assert that is the core foundation of it all. Their emotional and behavioral well-being depends on that. So does my ability to promote safe interactions between me and the pet, something that can be more challenging as a pet moves through this phase of life.

And sometimes, I'm not confident that safe interactions between myself and the pet will be possible, and it is likely to be things that one might typically disregard. It can because the kinds of interactions that the pet requires to stay adherent to the treatment plan and feeling good, like being medicated, make them uneasy. Hygiene and needing help with that can be problematic for a pet. If a dog needs help physically getting around or help up from their bed or assistance getting up if their legs give out when they're walking (even with a sling) because of the all-too-common hind limb weakness, that can put me in a dangerous situation. Being out of routine and in the care of a less-familiar person can contribute, just like a family's absence can. Anxiety can increase during this phase of life or even present itself for the first time. All of these scenarios can stress the pet and lead to a nip or a serious bite. I clearly and compassionately articulate that, and give specific details why, because it's more common than not that what I'm seeing that the pet is demonstrating is that they are having trouble with trusted and known caregivers performing those tasks, too. 

And that means the human-animal bond with the family is at risk of being negatively impacted. 

The stuff that I've talked about already is a good example of what we in the pet care and training industry refer to as 'trigger-stacking'. Though, in this phase of life new triggers are often revealed simply because the pet's health needs require more frequent interactions and handling. I’m happy to report that there are nutraceuticals, supplements and prescription meds (a primary vet or vet behaviorist are best positioned to make recommendations for prescribing) and behavioral management protocols (a credentialed trainer or vet behaviorist team can guide this) that can be a big help in helping the pet manage better. 

This all brings me to a topic that I'm asked to weigh in on periodically: whether or not humane euthanasia should be considered for a pet that is experiencing behavioral changes, namely aggression, that make for a very slippery slope when it comes to their well-being and safety, and the humans around them. It's hard to ignore how even the most seemingly benign interactions that a pet requires can become triggers for them. In some cases, the techniques used to navigate through interactions can be modified to suit a pet's new boundaries, but when that's not possible or a pet's stress and anxiety can not be assuaged, or a bite occurs, exploring the decision of humane euthanasia becomes a very real thing for families. 

Though I urge families to discuss this with their veterinarian—the only one who can guide them through this decision and process—I offer some perspective, mostly by the way of my listening, really hearing the family. If a caregiver brings this up, it’s likely they are struggling significantly. For anyone who has done it or done their best to avoid it, it's hard enough to have that deeper conversation with their veterinarian about euthanasia when one is considering a pet's physical and medical decline and their inability to manage physically and emotionally (this goes for the humans too). And introduce the topic because there's a question that a behavioral element affects anyone's safety, it completely changes the landscape of the situation. I assure you that the emotions that a family struggles with regarding humane euthanasia are ten-fold when the conversation is broached because of a question of a pet's behavioral stability, and oh, do they have a lasting effect. 

The truth is that in most cases, I've seen that behavioral changes, yes, even aggression, are often heavily influenced by factors like a pet's ongoing pain or other factors. There are diseases that are known to affect a pet's behavior (like diabetes, hyperthyroidism and hypothyroidism, the latter often linked to laryngeal paralysis and accompanying hind limb weakness in dogs), and even Canine or Feline Cognitive Dysfunction. These are very much medical conditions, and can in themselves contribute to trigger-stacking. And as time goes by, medical conditions of any kind can become less manageable, especially if a pet's ability to participate in their prescribed treatment plans, including taking medication, becomes more difficult for them.

I say all of this not in an effort to minimize how much a pet's behavioral stability can impact the decision about whether euthanasia needs to be a part of a conversation. I do so to highlight the weight of how medical conditions—diagnosed or not—influence a pet's overall ability to cope, physically, emotionally and most of all, behaviorally, even to the point of aggression. And in looking at a situation from this vantage point, it helps to see that perhaps the decision to euthanize is less about viewing a pet as an aggressive animal who's behavior is jeopardizing the well-being of themselves or others, but how the progression of medical issues has impacted their ability to cope and be the calm, loving pet they've always been. In any case, it's important that we are not expecting more of a pet than they are willing or able to give, and to respect their boundaries, especially when they move the proverbial line that tells us where they are. That's the greatest show of compassion that we can give them, and ourselves.

With over 20 years of experience in pet care, Lorrie Shaw is an Animal Hospice Palliative Care Practitioner, Certified Fear Free Professional–pet sitter and CXO of Telos Companion Animal Services, LLC. She welcomes your contact through