Archive for the ‘Pain Management’ Category

Caring for Our Pets and Ourselves at the End of Their Lives

Monday, November 3rd, 2014

Photo credit: Blair O’Neil

If ever you’ve lost a beloved pet, or you are close to losing one, I think this piece will resonate with you. My friend, Susan Shannon, who lives and works in California, is the author. She is an animal minister and chaplain who truly understands relationships between people and their pets. She has given me permission to share the following article with you. If you are moved by what Susan has written, please voice your comments. I know she will appreciate them.

Helping Your Pet Let Go

Chances are, your beloved furry soul mate pet knew before you did that the time to say goodbye was approaching. That doesn’t make it any easier of course. Our pets absorb our thoughts, feelings and emotions in ways we as humans are just beginning to understand. It is quite possible that your thoughts about your pet’s old age, sickness, injury, etc are getting in the way of them being able to let go.

Our pets often tune into our sadness, conflicted grief, worry and concern and internalize it as if they are the cause of your sadness. True, they are, but not because they are “bad.” It is important for us to “send” them the thought-images that whatever the cause of their impairment is, that it is not their fault. They are reaching the end of their life in this body, but they need to be assured that the joy they have given you continues and WILL continue even after their spirit is released. Talk to them outwardly and inwardly to let them know that this is a natural process and that leaving their body does not mean their spirit will be abandoned by you.

This asks a lot of us humans-and this is a good skill that we, as chaplains and ministers, will have a lot of opportunities to practice. When we are involved in care-giving our pet animals OR humans, it is helpful to bring an altruistic awareness to everything we do for them. When we are administering medication, think, “May this elixir transform all elements of suffering and pain into the pure ground of being” or something in that realm of thinking. Compare the energy behind this positive affirmation to the energy of “I am so full of sadness and sorrow that I have to force you to take this.” or, “Here goes another $5.00 pill.” or something like that. Your pet feels the emotional charge in everything you do or feel.

Keep this altruistic line of thought when you are cleaning their excrement, too. Animals have pride-often, when incontinence strikes, they are ashamed and might even expect to be punished. This can be a real challenge to the humans, but you can let them know that this is part of the bond you made when you took them under your stewardship. This is a sign that their bodies are getting ready to let go, and that soon their spirits will be set free from this kind of substance. Be gentle with them when you clean them, tell them it is ok, and try to practice equanimity.

The Journey Ahead: Theirs and Yours

It is wise to have more than one “conversation” with your pet about the journey ahead. Let them know that they will be released from their body into a realm of light and love. Let them know that when that happens their home in your heart will become the most constant place of connection-that you and them will always be together then, that there will no longer be separation. Let them know that once they are released from this body, this body which has served them well and given both of you much enjoyment, that they will experience a freedom that you will celebrate. During these conversations it is helpful to let the animal know how and when you will remember them, such as visits to places you loved, other dog friends, rides in the car, cuddling on the couch, etc.

Our animals want to know that we will be cared for too. Let them know how you will fill your time once they are gone. Show them, through your thought-pictures, what you will do: working in the garden, walking, jogging, biking, playing music, whatever it is that feeds you, let them know that you will continue to engage in these activities. Help them understand that you will be healthy, that you will be engaged, that yes, you will be sad for a little while but that when you are sad at their loss you will talk to them and keep their spirits warm in the present tense of your grief and loss.

Be Ready, Be Aware: Complicated Grief and Exploring Your Own Theology

If you have recently lost someone dear to you, if you were raised with the idea that “boys don’t cry” or “the funeral is over so get over it” or “euthanasia is murder” or any similar code of thought, you might have a very difficult time with initiating your pet’s transition. Be aware that all of this is normal, and utilize whatever resources (see above for some sources) to find your solid ground here.

Your own personal theology about death, or your lack of personal theology around death will factor into your feelings. This is a good time to explore whatever that is or isn’t in the current context of letting your pet go.

Compassionate Release

You can let your pet know that “compassionate release” or euthanasia is an act of love and the highest intention of commitment as a human being in your decision to free them from the suffering of their body. If you plan on ritualizing the passage, you can also let them know what each stage of the ritual means to you and to them. Focus on the release from form to the formless, and give formless an introduction as a place we all come from, go back to, and to some degree, live in on a daily basis. As their spirit transitions, you might feel them hovering around the space you shared with them. If so, acknowledge them, but let them know that they have your full permission to soar the heights of the spirit realm in true joy and freedom, and that you will still be joined with them, even more so, when they are beyond time and space into the formless realms. Your love, your light, your joy, will always be with them-and theirs with you!

Plan Ahead

As you contemplate the time to let your pet go, offer yourself deep discernment around what is best for you. Do you want to keep your pet at home for this transition? If so, get referrals for vets who do home visits. Many vets will offer a deep, respectful compassionate presence as they release your pet in your own home. You might want to keep the body for a while afterwards for your own prayers or for closure with respect to other family members who might need to see the pet before burial or cremation.

If you are doing the euthanasia at home, it is important to make arrangements to either bury your pet, bring the body to a pet crematorium, or have the vet take the body or come back to pick up the body after you have closure. Think ahead. Get all your ducks in a row before choosing the date and time so that when the moment comes, you can be totally present with all that is on the day.

When The Hour Has Come

When the time has come for your pet’s final vet appointment, do what you can to be at peace. Some people make a special bed for their beloved. Some give them their favorite foods if they can still eat. If you have personal deities or teachers who you feel would be good spirit guides for your pet’s transition, you can make a little altar near the bed. It is good to keep in mind though that these things are more for your own peace. For your pet, YOU are their guide, their deity, their protector. Their needs are very few at this point.

Some people have soft, gentle music playing. Again, that is fine, but know that this is more for you. As your animal’s consciousness goes from being tranquilized to finally leaving its body, sometimes it is best to have silence. As the vet administers the sedative before the terminal injection, if possible, allow your palm to gently hover above your pet’s forehead, drawing the attention and focus of the life force there, in the third eye area, then moving and holding your hand above the animal’s crown chakra area before the second injection. You don’t need to touch the animal-the energy from your palm is enough. You can silently pray to the God/Goddesses you find strength in to guide your pet home, visualizing them around your beloved. In this way you can assist the consciousness leaving the body through the highest energy center.

Honor What YOU Need

Everyone has their own style and needs when dealing with grief and loss. Be true to what YOU need. Some people benefit by cleaning up all of their pet’s toys, leash, bed, bowls, litter boxes, even vacuuming the whole house before the body is taken away. After the body is gone from your house, it might be good to leave the house for a night, or at least the day. Ritualize what you do next, with the focus on self-care. This is what your pet would want. Let the honest tears fall, and allow them to continue as much as they want, but take care of yourself. Do something physical, do something distracting, sit in meditation, take a bath, just do what nurtures YOU.

For others, keeping the remembrances of their pets in the home can help with closure, in which case they might WANT to keep their pet’s toys etc. around. There is no right or wrong with what you need.

Afterwards

Yes, there will be tears. Yes, there will be sadness, loss, grief, perhaps even remorse or guilt. Losing a beloved pet can be even more traumatic than losing beloved humans. After all, they loved you unconditionally. Don’t let anyone minimize your grief. This is really important. “Get over it, it was just an animal.” is one of the most misinformed lines ever. Use care with whomever you turn to for companionship during this time. If you have a friend who has gone through this process, he/she might be a good start. If you need to talk about your grief further, it is helpful to find some local pet-grief/loss groups. If that is not available, there are a number of “rainbow bridge” pet loss on-line forums.

In conclusion, helping you and your pet travel this journey of the soul is a blessing for sure, but is also a painful realization of the impermanence of all our relationships. You can help their spirit release from their body by letting them know that you will never be separate in your heart, and by showing them that you will take good care of yourselves after they are gone. This is a lifelong practice that will serve you well in the transitions of all your relationships, human or animal. Remember to be gentle, hold your intention of love and thanks gently but firmly, and fully recognize the teachings our beloved four-leggeds have to give us by opening your heart more to the many ways the Divine works. In this way you are embracing the true gifts of Animal Ministry.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Great News on the Canine Cancer Front

Sunday, November 17th, 2013

In honor of November’s National Pet Cancer Awareness Month I would like to share some “hot off the press” wonderfully optimistic news with you. Dr. Nicola Mason from the University of Pennsylvania School of Veterinary Medicine has been researching a new way to treat osteosarcoma, an aggressive and fatal form of bone cancer that has an affinity for growing within the leg bones of large and giant- breed dogs.

Until now, treatment of osteosarcoma has consisted primarily of amputation (removal) of the affected leg with or without chemotherapy. In spite of such aggressive treatment, inevitably tiny clusters of cancer cells eventually grow into metastatic tumors that ultimately become life-ending. Approximately 60% of dogs die within one year of the diagnosis.

A new approach

Dr. Mason’s innovative approach to treating dogs with osteosarcoma involves “cancer immunotherapy” in which the patient’s own immune system is triggered to target and kill tumor cells. In order to use a dog’s immune system to treat osteosarcoma Dr. Mason devised a vaccine consisting of bacteria that have been modified to express a protein called Her2/neu. This protein is known as a “growth factor receptor” and is found on a variety of different cancer cells, including some canine osteosarcoma cells. You may have heard of Her2/neu before because it is commonly associated with breast cancer cells in women. The concept behind the vaccine is as follows: The bacteria stimulates the dog’s “immune system soldiers” to seek out and destroy the bacteria along with cells that express Her2/neu (osteosarcoma cells).

Outcomes to date

Thus far, Dr. Mason has treated 12 dogs with osteosarcoma following amputation and chemotherapy. The dogs received the vaccine once weekly for three weeks. Side effects of the vaccine were minimal. All that was observed was a mild, brief fever following vaccine administration.

The preliminary results have been immensely encouraging. The first vaccinated dog, Sasha has a survival time of 570 days thus far. Two other dogs vaccinated at the beginning of the study are alive and cancer free more than 500 days post diagnosis. Other dogs who were vaccinated more recently are still doing well. These are truly fantastic results.

What comes next?

Some dogs with osteosarcoma are not good candidates for amputation primarily because of neurological or musculoskeletal issues in their other limbs. Treatment options for these dogs are aimed at reducing the pain associated with the tumor. Dr. Mason plans to begin including some of these nonsurgical candidates in her osteosarcoma vaccine study.

Additionally, Dr. Mason is contemplating learning if what she has developed would be an effective means for prevention of osteosarcoma. Certain breeds (Rottweilers, Irish Wolfhounds, Great Danes, Saint Bernards, Doberman Pinschers, and Greyhounds, to name a few) are particularly predisposed to osteosarcoma. It will be fascinating to learn if the osteosarcoma vaccine will effectively prevent this horrific disease in high-risk individuals.

The research results gathered thus far represent a monumental success in cancer treatment and provide significant hope for a disease previously associated with a grim prognosis. Kudos to Dr. Mason for her stunning work! If your dog has osteosarcoma and you are interested in participating in Dr. Mason’s studies, contact her at 215-898-3996 or by e-mail at nmason@vet.upenn.edu.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Hospice Care for Pets

Sunday, July 8th, 2012

Photo Credit: © Tonya Perme

Over the years I’ve counseled many thousands of clients as they’ve struggled with end-of-life decision making for their pets. For many of those years, clients who expressed opposition to humane euthanasia for moral, philosophical, emotional, or religious reasons created quite a conundrum for me: my professional obligation to ease patient suffering seemed incompatible with their convictions. Fortunately, over time, I’ve become wiser, and have embraced the means to reconcile what is best for the patient when euthanasia doesn’t feel like the best or the right choice. The resolution for this moral/ethical dilemma is hospice care, also referred to as palliative care. In fact, nowadays, I discuss both hospice care and euthanasia as reasonable options whenever helping a client figure out what makes the most sense when their beloved pet’s life draws to an end.

Just as in human medicine, veterinary hospice care is selected for patients with terminal illness. And just as in human medicine, veterinary hospice care emphasizes physical and psychological comfort for the patient along with emotional support for the family caring for their loved one.

The venue for veterinary hospice is within the home with family members and friends providing the bulk of care. Typical tasks include turning from side to side, assistance with urination and bowel movements, carrying, frequent bathing, preparation of special diets, and administration of medications and supplemental fluids. Hospice can be a monumental task as round-the clock care is usually necessary. And for larger immobile dogs, a team effort is necessary for lifting and moving, and to keep them clean and free of bed sores. Terminally ill pets are quite capable of “lingering” so it is not uncommon for hospice care to last for weeks or even months.

Health care professionals- veterinarians and veterinary technicians- pay visits as frequently as needed to ensure that that the patient is relaxed and pain free, provide moral support for family members, and coach care providers on various tasks including how best to recognize symptoms of pain and anxiety.

While providing hospice care can be emotionally and physically draining, it can be a richly rewarding endeavor, especially when pain and suffering are well managed. This period of “closure” can create precious memories that feed and nurture the soul, giving everyone involved the strength to withstand that final goodbye.

If you are interested in hospice care for your pet, be sure to spend some time selecting the veterinarian to guide you on your journey. He or she should be a super compassionate person with a large arsenal of pain management options and a willingness to come to your home as often as needed. Be aware that some hospice vets firmly believe in “until natural death do us part” whereas others support their client’s choice for euthanasia should it arise during the course of hospice care. When hiring a veterinarian to assist you with hospice care for your pet, be sure to sort this issue out in advance.

To learn more about hospice care for pets I encourage you to check out The Nikki Hospice Foundation. Their Third International Symposium on Veterinary Hospice Care will be held later this month (July 20-22) at the University of California, Davis. This is a conference geared for veterinarians and nonveterinarians alike. If you are interested in increasing your knowledge about hospice care for pets, this is the place to be!

Another awesome resource is the International Association of Animal Hospice and Palliative Care . Their annual conference will take place in Denver in early November. Can’t make it to Denver? Take advantage of the webinars offered by this terrific organization.

Have you ever been involved in hospice care for a pet? If so, I would love to hear your impressions.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Pain Management 101

Friday, September 4th, 2009

My husband and I just returned from a wonderful stay at a dog-friendly campground. We encountered just about as many dogs as we did people! We made some new friends including Buddy, Sierra, Milo, Otis, Judd, Lexie, and Homer (please don’t ask me to recall the names of their humans). Our next-door neighbors were Milo and Otis, two middle-aged black Labradors. When these goofy brothers weren’t off on family hikes they spent their time meandering about with sticks in their mouths and checking our campsite in case we managed to “misplace” any food items. By day three, I observed them to be exploring less and lying around more. I also noticed that Milo was favoring a front leg and Otis was showing discomfort in his hind end. When I mentioned my observations to our neighbors (I cannot seem to keep my mouth shut in such situations), they told me that Milo and Otis both have arthritis and their stiffness and soreness was predictable in response to their increased activity level. They routinely gave them pain medication (the equivalent of aspirin or ibuprofen for us) as soon as arthritis symptoms became apparent. In fact, they had administered their first dosage that morning. These poor folks had no idea that such innocent comments would prompt a mini-lecture from the likes of me! Here is what I explained:

Whether for ourselves or for our pets, the ideal time to treat predictable pain is before it begins. Investigational studies have documented that pain can induce a “kindling effect”. In other words, low-grade pain has the potential to self-ignite into a flare-up of pain that is more severe, therefore more difficult to control with medication. Far better to take proactive measures (medication, acupuncture, rehabilitation therapy, glucosamine, chondroitin sulfate, etc.) before the onset of predictable or anticipated pain than it is to attempt to douse the discomfort once it has already “caught fire”. It’s also important to keep in mind that many dogs, particularly those with stoic demeanors, may not demonstrate any overt symptoms until their pain has progressed well beyond what would be considered mild.

I suspect that my new friends Milo and Otis will be far more comfortable on their future camping trips! I must confess here- I also counseled their humans on the benefits of weight loss (both dogs were chubby) as a means of benefiting their arthritis pain. Those poor people certainly got more than they bargained for! Does your dog predictably become stiff or sore following increased activity? If so, please share what you do to prevent the discomfort.

Now, here’s wishing you and your four-legged best friend good health! 

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller. 

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Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross