Animal hospice care: vet support

Since I’ve started writing about my experience of caring for my dying dog Louie until his natural death, people have been contacting me, feeling encouraged and inspired by what I have shared. Some of these people were in distress when they spoke to me because it had been suggested to them by their vet, family or friends to euthanise their animal who was old and dying yet they wanted to let their animal live out their life – however short or long it would still last. They were relieved to hear that hospice care is an option for animals too, not just humans. With permission, I am telling you about three of these stories.

Mimy, a Chihuahua X Pomeranian, had lived a healthy and happy life for more than 15 years and other than a knee surgery several years back never needed to see a vet. As she was ageing, Mimy was going blind but adjusted to losing her vision easily, as long as her humans didn’t move around the furniture.

One day Mimy started vomiting and and the vet she was taken to gave her an anti-nausea injection which helped. However, she lost her ability to bark and eat, so her human took her to another vet who did blood tests and an x-ray. While Mimy was at the vet, her human was notified of a food recall, a certain batch was contaminated and had caused cases of megaesophagus, a disorder in which the esophagus dilates and loses motility. This condition has a poor prognosis. Regrettably, Mimy had been fed from that batch. The vet’s diagnosis though was brain injury and he suggested euthanasia. The x-rays had only shown a slight variation of the esophagus and they didn’t think anything was wrong there. Mimy’s human researched the condition further and found the Australian Canine Megaesophagus Facebook group a great source of knowledge and support for her.

Mimy was syringe fed for about five weeks and lost quite a bit of weight. So they went to see yet another vet who suggested to either seeing a specialist or else euthanising her. After everything this little old canine lady had been through, her mum didn’t want to put her through more tests but neither did the other option sit right with her. This is when a friend shared my blog articles and she contacted me.

When we spoke it was unclear if there was help for Mimy or if the time had come to keep her comfortable and allow her to die at her own pace. I suggested a consultation with my holistic vet, Dr Pearson from Paws to Heal, which turned out to be extremely helpful and confirmed that this dog was suffering from megaesophagus. With the help of homeopathy Mimy was able to start eating on her own again and regained weight! Equally important, Mimy’s human felt warm, caring vet support for allowing her dog to live out her life.

In the last few days of her life – as is common when dying – Mimy’s appetite decreased and she stopped eating altogether. The day before she died she received a Bowen therapy treatment which helped her feel very peaceful, so much so that she slept through the whole night, something she hadn’t done since all her troubles started. On her last day, Mimy had periods of unrest, feeling a bit agitated. This is also a normal part of dying. There were some of her favourite people visiting and she cuddled in each one’s arms in turn until her mum noticed that Mimy wasn’t breathing anymore. She had died quietly, in the arms of love.

Reflecting on the experience, Mimy’s human says that she never thought she would be up to this big job of caring for Mimy in the last three months of her life. Not usually a very patient person, her dog taught her to stop hurrying and just relax with her, accepting her pace and needs. Though it was a challenging time, Mimy’s human feels deeply grateful for having lived through it.

Caring for a dying animal is not taught at veterinary schools. Therefore, the great majority of pets are euthanised. Vets often refer to Quality of Life (QOL) charts when recommending euthanasia. QOL charts are based on the belief that the usual signs of the normal dying process (such as weight loss) are unacceptable. GRACE Animal Hospice Consortium put together a Quality of Dying (QOD) checklist designed to determine acceptable quality of life to continue the normal dying process while receiving comfort care. Vets who are unfamiliar with and unaware of animal hospice care usually jump to the conclusion that a pet owner just can’t let go when they suggest euthanasia and meet opposition. This situation can escalate into becoming an animal welfare concern from the vet’s point of view causing immense stress to the owner who deeply cares for their animal and is looking for professional support. Ginger tabby cat Trotty’s story is one such case.

More than twelve years ago, Trotty turned up on his human’s doorstep one day. Inquiries revealed that he was about 4 years old and due to ill health his previous person was no longer able to look after him and had planned to surrender him to an animal shelter. It seems Trotty took finding a home into his own paws and was warmly welcomed at his chosen new residence.

Late last year, Trotty became lethargic and withdrawn and didn’t eat. A blood test revealed that his red blood cells were haywire. The vet said it could be a sign of cancer and suggested euthanasia. When Trotty’s human didn’t agree to the suggested course of action and wanted to leave the clinic, the vet attempted to block his exit. An hour later, the police arrived at his house, insisting he take Trotty to a vet to be put down. He did not follow their request either but at this point felt very shaken. Growing up, his family had always had cats, sometimes as many as four or five at a time, and all but one lived out their lives and died unassisted. The only one who was euthanised was Smokey, a huge gray fluffy long-haired cat, after he had suffered a stroke. So, euthanasia was the exception, not the norm.

A week later, there was a visit from an Animal Welfare Officer. She took one look at Trotty doing so well again and the caring home he lived in and closed the case.

Two days after the traumatic vet visit Trotty had come back around again, regaining his appetite and interacting with the human and other feline family members like he always had and maintained this demeanour until his death. In the last six weeks of his life he started to loose weight and stopped eating two days before his passing which happened when his human was not at home. The signs of dying were there and it wasn’t a big surprise when one day he returned from work finding Trotty dead. This was six months after it had been advised to euthanise him. Six months of a life well lived.

Trotty’s human decided to make known in an email to the head of the vet clinic how distressed he felt about the conduct of the consulting vet. Here is the last paragraph of the response he received.

“Vets will never call an inspector under the animal welfare act for anything they feel is trivial but the important information is if they, in their opinion, suspect circumstances where the act could be breached, our professional code of conduct instructs us we must act. The entire focus is on the welfare of the animal concerned. It is not a situation where we are trying to police behaviour but we are required to hand over information so that an inspector can investigate the circumstances . It is a situation that is extremely rare in a professional career and in my case, I have not had to do this myself. It is a situation that is stressful for everyone and I am sorry if we have added to your stress as you have outlined. We as a clinic have learned from this experience and will take on board the feedback from you to improve our service in the future.”

I am sharing this story with you to raise awareness. Villainising can happen so fast and does not serve creating openness for the road less traveled. I’d like to see a change in veterinary care regarding end of life understanding and policies. There is a link to the current medicalised view of human ageing and dying. Bestseller “Being Mortal – Medicine and What Matters in the End” by surgeon Atul Gawande is an insightful book on the topic and provides a historic chronology showing how ageing and dying became all about medical interventions and management. The introduction of his book starts with the following paragraph.

“I learned a lot of things in medical school, but mortality wasn’t one of them. Although I was given a dry, leathery corpse to dissect in my first term, that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”

It must be similar for veterinarians. And yet, it is a different ball game altogether. Human life is sacred, so much so that almost everywhere in the world it’s considered murder to assist a person to die who wishes to do so. Ending the life of a pet through euthanasia on the other hand is frequently thought of as a selfless act of kindness. Euthanasia for a dying animal has its place when comfort care can’t be provided, be that because pain control is unsatisfactory or because the carer is unable to do so. When it is possible, however, those who choose it should not have to fear being judged negligent, selfish or cruel.

You can always spot the pioneers by the arrows in their backs.

William H. Calvin

It’s a vulnerable place to be in, questioning beliefs and practices, entering the non-conformist zone. When Chloe’s human read my first Facebook post on providing hospice care for my dog Louie who was paralysed after a stroke, she was wondering what in the world I was doing. As she followed our story, she became curious, intrigued by how it unfolded and the insights and experiences I shared. She has never felt comfortable with vets suggesting euthanasia though has made the choice to do so when she sensed that her dogs had asked her for it.

When her 14-year old Lab Chloe had a vet check because she had not been herself lately, it was discovered that she had a large tumour in her lungs. The vet recommended putting Chloe to sleep right there and then. Though Chloe clearly wasn’t feeling her best, her human saw that she still wanted to live regardless. She took her home, put her on a cancer starving diet, added beneficial herbal supplements and remedied any breathing difficulties that Chloe sometimes had with the use of essential oils. Within a day, Chloe perked up visibly. She participated in everyday life again.

The vet that had seen Chloe, disagreed with the choices made for her. She contacted Chloe’s human daily, asking to bring her dog back into the clinic again as she was concerned for her welfare. Getting in and out of the car for a vet visit was stressful for Chloe and her human decided that it would be an unnecessary strain for her, especially considering she was doing so well. She provided a daily report on Chloe’s health to the vet. To dissipate the growing tension, I suggested to Chloe’s human to get in touch with a holistic vet and transfer her dog’s vet care to them which she did. What a relief it was to finally receive vet care support in line with her inclinations and understanding, and have the original vet backing off with well-meaning but ill placed concerns.

“Have you ever noticed that we allow our [pets] to be well, and then when it’s the end of their life, we allow them to be dead, but we don’t allow a transition process between the two?
The last stage of living is called dying. Some deaths are quick and immediate, and others are slower, sometimes taking several months, or even a year. Every being’s dying process will be unique. The good news is that the body does innately know how to shut down and die. It does not need help, but rather, our support for a normal, natural process called dying. Hospice honors that innate wisdom, neither speeding death up, nor slowing it down.
If we’ve never seen a dying process before, it can easily scare us. Education on the stages of dying can be a tremendous help. Having the support of others who have witnessed and allowed a dying process can also be very helpful.”

Mary Walby from Horse Hospice

A few hours after Chloe’s human consulted with the holistic vet, Chloe’s well-being suddenly took a dive, she was very restless and her symptoms required certain specific remedies that were not immediately available, the vet not being local. When I heard about it and checked if I by chance had them, I discovered that I did and decided I would drop them off. When I arrived over an hour later, Chloe’s human was in a state of overwhelm and I decided to stay for a little while. She was feeling vulnerable and unsure, in need of understanding and support.

I sensed that Chloe was relieved that someone was present to bolster her human. We gave Chloe the first remedy but after observing no change in her symptoms, started to wonder if she was actually in the active dying process. We continued providing comfort to her through massage and acupressure and by just being there with her. Chloe had soldiered on all afternoon and evening and now she was simply tired. She wanted to go outside and wandered around a bit. Her legs got wobbly, she stumbled and sank to the ground. That was a bit of a scary moment for Chloe’s human. We were there with her as she lay under the starlit sky, gave a few more breaths and then reclaimed her angel wings.

After a little while, we went inside to warm up by the fire. Stories of previous losses spilled out of Chloe’s mum as what had just happened started to sink in. Though it had been on the cards that Chloe could die, it all still happened a bit fast. Her human had not given thought to what to do with Chloe’s dead body. We talked through the options and a decision was made. Chloe’s mum was really nervous and very reluctant about going outside again to see to Chloe’s remains. She thought it would be too much to bear and that she couldn’t do it. I suggested to pick some essential oils to anoint her darling dog’s earthly dwelling. Focusing on that task seemed to make things more doable. When the oils were chosen – frankincense, myrrh, rose and a few others – we went outside.

The drops of oil fell onto the beloved body like sacred tears and opened the door into a holy space beyond fear. There, memories of Chloe were shared as we gently rubbed in the oil, there were tears and there was laughter. It was a dropping into the heart, the heart of the moment. Covering the dead body of a pet can be so distressing. I remember when Louie died and we put him into his shroud. A part inside me just screamed, “no, no, no,” couldn’t bear losing sight, making the loss so much more real. Chloe’s mum too struggled with this moment. We covered the body in the sheet slowly, at a pace that was doable.

Consider each day a miracle – which indeed it is, when you consider the number of unexpected things that could happen in each second of our fragile existences.

Paulo Coelho

Dying is not only a physical event but also a metaphysical one. You could call it just a string of coincidences that happened on the day of Chloe’s death. But what if she was aware of its imminence and guided this whole affair to this outcome? I felt in awe and so honoured to be part of it. Chloe’s human felt immensely grateful for my presence, to not have to face the unknown alone. A dying pet is nothing to be afraid of. If we learn what natural dying looks like and have the support we need, it is a very deep, soul-nourishing, connecting, heart-opening, mystic experience.

Animal hospice care is an unknown concept to most vets. If you are considering accompanying the dying process of your pet when they have reached the end of their life, discuss this option with your vet to find out where they stand and if they are interested in educating themselves on the topic to be by your side should you need them when the time comes. This is best done before you are in the situation so that you can look for a different vet should yours not be comfortable with the idea.

“Not every person and circumstance can do hospice. We all have limitations. When you reach them, it is ok to honor them. If you need to euthanize your [pet], please do.” (Quote by Mary Walby from Horse Hospice)