Coping with Loss Pt. 1: Diagnosis and Care
| Print | By Carol Frischmann | June 9, 2009 2:01 PM

Coping with Loss Pt. 1: Diagnosis and Care

Learning that your pet has a terminal illness can be devastating for a family. Working with a veterinarian you trust to confirm the diagnosis is the first step.

Diagnosis

Veterinarian Merry Crimi urges, "Be sure your vet makes an accurate diagnosis, and not just a best guess. Laboratory tests, x-rays, ultrasounds and biopsies can confirm diagnosis of a terminal illness. Be sure you understand how your veterinarian reached his conclusion, and ask how the disease most often progresses."

The outcome of a terminal illness is death. "Common terminal illnesses include inoperable brain cancer, end stage kidney, and heart failure - diseases where surgery or medicines cannot be effective," says Crimi.

A second opinion

If you do not feel the spectrum of options given to you is reasonable or you don't have a trusting relationship with the staff that has seen your pet, seek a second opinion. Another opinion may offer some options you hadn't considered.

Pet companions may feel awkward about asking for a second opinion. Most veterinarians can appreciate that for important decisions, a companion might want another set of eyes and ears. A caring veterinarian will not make it difficult for you to get more information or consult with another professional.

Hospice for terminally ill pets

When the diagnosis is terminal and your pet will not survive more than six months, Crimi and the American Animal Hospital Association (AAHA) recommend hospice care. Rather than a place, hospice care is a philosophy that focuses on relief of a pet's pain and its emotional comfort rather than the delay of death. To prevent the anxiety of hospital visits and allow maximum time together, hospice enables companions to provide pet care at home. In addition, increased attention and physical contact may bring you closer as you adjust to your pet's progressive disease and say goodbye in your own way. Hospice can make a pet's death a kinder, more intimate experience for both of you.

How to hospice

The first step in hospice care is to find a veterinarian comfortable with hospice philosophy. (Many veterinarians practice hospice care, but are unfamiliar with the term.)

Veterinarians and technicians teach you how to administer medication, feed, clean and monitor your pet's pain and general health according to a plan that changes as the pet's needs change.

In hospice care, you give medication on a regular schedule, rather than in response to pain, so your pet remains comfortable.

You may not be at ease with handling injections, intravenous medications, blood, or feces, so work with your veterinarian to develop a treatment plan within your comfort level. Sometimes medications can be given orally or rectally instead of intravenously, or the sight of blood can be minimized using careful bandaging.

Crimi suggests families ask what to expect, especially the details of the physical effects of the disease, to reduce their fear.

As pet owners adjust to their role as caretaker, they sometimes handle more than they thought. If the pet's illness becomes overwhelming, the veterinary staff is available to help.

Hospice allows pets to feel safe and loved and gives pet owners an opportunity to say good-bye at their own pace, transforming frightening circumstances and loss of a beloved friend into a life-affirming opportunity.

Coping with Loss Pt. 2: Pet's Passing

The word euthanasia, meaning good death, makes people wince. Ending a pet's life is a difficult and personal choice. Families caring for a suffering pet can get help in deciding whether and when to make this choice, and support afterwards.

Partners helping you choose

Although your veterinarian is in the best judge of your pet's physical condition; you are the best judge of your pet's quality of life. "This is a decision you should consider together," says Dr. Merry Crimi. "When you have an animal healthcare provider who considers you, your pet and your pet's disease a unique situation, you can be confident you are working with a good partner."

Your pet is also a partner in the process. "Animals usually give signs their quality of life is gone and all that's left is suffering," says Crimi. "They won't eat or respond well, and don't interact in the ways they always have. If you see these signs, your pet is communicating with you."

Weighing the signs

Talk with your vet about the course of the illness. Have you passed the milestones you discussed as indicators it was time to make this decision? Robin Downing, DVM, in her book "Pets Living with Cancer," suggests finding a very specific answer to this question: At what point is the pet's quality of life unacceptable? Is it when the pet can't control elimination? When it can't stand or walk? When it is disoriented and does not know where it is? When its pain is out of control?

Crimi cautions that your idea of the right boundary may change during the course of your pet's illness. Nevertheless, she agrees that talking about boundaries early is a good approach.

Enid Traisman, MSW and Certified Grief Counselor suggests pet companions keep in mind a pet's experience of his terminal illness changes each day. The pet care provider's situation also changes. "Caretakers," she says, "can make a new decision each day based on the day's experience."

"The act of euthanasia can become a companion's final gift of comfort to an animal in a great deal of pain," says Downing. Crimi agrees, and adds, "These are individual choices best made inside a strong partnership of veterinarian, companion, and pet."

Pet loss support group

Traisman, directs the DoveLewis Pet Loss Support Group for pet companions anticipating pet death and the euthanasia decision, as well as those whose pets have died. Group members share support and information with each other. Sessions benefit companions making the decision by identifying companions' fears and concerns, planning for last photos, paw prints and fur clippings, considering how to make the pet's end of life meaningful for the pet and for the rest of the family.

When you are ready

Some veterinarians will come to your home. For personal reasons, you may prefer to take your pet to the veterinarian's office. Either way, most veterinarians will give you the option of being with your pet at the time of euthanasia. Typically, veterinarians give a first injection that makes your pet drowsy. A second injection suppresses respiration and heartbeat.

Any choice is difficult

Exploring all aspects of the decision with your veterinarian and with others whom you trust is very important. Keep in mind, however, that in the end, the decision belongs to you and you alone.

Questions to consider

Is your pet still happy with a zest for life, terminally ill and in pain, or critically injured with no hope of recovery?

Is your pet living with dignity?

Can you afford the time, money, and emotional strain of care required?

Will more tests, treatments or surgery make your pet better?

Do you consider euthanasia an act of compassion?

Are there signs from your pet that she has given up?

Are you keeping your pet alive to meet your needs rather than his?

Coping with Loss Pt. 3: Recovery and Grieving

Grieving and recovery from the loss of a pet applies to the entire family: adults, children and other pets. "A pet's death hurts so much because pets are a source of unconditional love and appreciation. When a pet dies, we lose a part of ourselves," says Enid Traisman,M.S.W., C.T, C.F.S., and Director, DoveLewis Pet Loss Support Group.

Making loss a healthy experience

The main task is to make the loss a healthy experience through understanding, grieving and memorializing. Traisman says, "Normal reactions include crying, dry mouth, inability to concentrate, no appetite or overeating, sleep disturbance, lack of motivation and an empty, hollow feeling."

With children, directness is important. Explain that your pet died, instead of using confusing terms "gone away" or "put to sleep." Then, share your beliefs about the soul or spirit of pets. For example, "The spirit of our pet is with God," or "Our pet's spirit is a warm feeling in our hearts." Expect that everything may remind your child of the pet, and your child may worry about others they love dying.

Grieving is important. Draw, write, or talk together about your pet. Memorialize your pet making a memory box with mementos. Plant a tree or write a goodbye letter. Traisman reminds us that children process thoughts and feelings by "doing." "Helping your child say goodbye to a pet is giving him an important life tool - a model for dealing with death or other significant losses."

Animal grief

What we know about animals' ability to grieve is not extensive. Jacqueline Neilson, DVM, DACVB is one of 46 U.S. veterinarians also holding a degree from the American College of Veterinary Behaviorists. Neilson says she usually receives calls for an appointment within a day or two of one pet's death. Within two or three days, the survivor pet is adjusting. After a three-week interval, the survivor is himself again.

Dr. Merry Crimi says survivor pets' behavior depends on the bond with the deceased animal. "Pets often appear to search for the absent pet. The remaining pet may mope, look un-well, or be less active for a month or so."

Neilson adds, "Dogs are a highly social species. When they lose part of their group, they notice. Whether they grieve in the same way people grieve, it's hard to know."

"Without a doubt, there is a sense of loss," Neilson says. "The absent pet filled a role in the dog's life. If the absent pet initiated eating, play and the voyage outside through the dog door, the remaining pet is rudderless. He needs time to learn to initiate these activities on his own. This change in the remaining pet's behavior can look like what we see in depressed people."

What's a companion to do?

The owner can provide much beneficial guidance to the remaining pet. Initiating the activities the companion used to initiate will comfort the survivor. In addition, be sure your pet is not isolated. Initiate play. Take your dog outside. Be present in the room while your dog eats.

"Dogs are highly adaptive creatures," Neilson says. "It is unlikely that dogs dwell on yesterday or tomorrow. This serves them well when their pack members die.

Coping

All members of the family will adapt. Important is to keep active, to talk about your absent pet and to talk with others who have suffered a similar loss. To find a pet loss group in your area, contact your local humane society or consult The Argus Institute.


Author Carol Frischmann has said goodbye to many pets including cats, dogs, fish, horses and lizards. A Doberman pinscher and three parrots supervise Carol's writing,
including her most recent books, "Conures" and "Attracting and Feeding Backyard Birds," available through her website, www.thiswildlife.com, or your local bookstore.

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