By Dr. Andy Roark | vetstreet.com

ThinkstockJust last week, while I was performing euthanasia for a critically ill patient, the pet’s owner looked at me and said, “I bet this is the hardest part of your job.” That gave me pause.

For me, putting animals to sleep is not one of the hardest parts of being a veterinarian. That’s because euthanasia is often a blessing and gift to a suffering animal. In my experience, the hardest part of being a veterinarian is telling owners that their beloved pet has a terminal illness and will soon be leaving this world. The emotions that pass across their faces, even if they have suspected the worst for some time, are heart-wrenching.

Related: Euthanasia — Why Some Pet Owners Choose to Stay and Some Choose to Go

It’s Never Easy

I still remember the first person I had to share this terrible news with. He was a nice, middle-aged man with two small children and an 8-year-old Rottweiler named Stone. Stone was a member of the family, and when he started to limp, his owner brought him straight in to be checked out. Stone was a wonderful dog at home, but he was not a fan of the veterinary clinic. My best dog treats did nothing to warm his heart, and when I manipulated his painful left shoulder, well… that ended our chances of being best friends.

Even though Stone was not an admirer of mine, I liked him, and I really liked his owner. That made it so much harder to discuss his diagnosis: osteosarcoma. Osteosarcoma is a painful bone tumor that responds poorly to treatment. In some cases, treatments involving limb amputation and/or radiation therapy can be beneficial. In Stone’s case, these options were not feasible.

Together, Stone’s owner and I decided to provide him with the best palliative care we could, and we promised each other that we would not let Stone suffer. When the time came, we would do the right — if tough — thing and put him to sleep rather than allow him to live in increasing pain.

Stone’s owner was the first person I ever had an end-of-life discussion with, and he was also the first person to ask me a question I have heard hundreds of times since: “How will I know when it’s time?”

The most recent person to ask me this question was my own mother. Her Miniature Schnauzer has battled long-term health problems and was recently diagnosed with diabetes. Unfortunately, she initially responded poorly to treatment. She lost her love of food, began soiling her bed and was generally acting pitiful.

How to Decide

Over the past few years, I’ve heard a lot of veterinarians give wonderful advice to people who are wondering when it is time to give their pets the gift of a peaceful passing. Here are four of the best pieces of advice I’ve heard, and they are the same ones I passed on to my own mother for her consideration.

Every pet, illness and situation is different. There is no single rule that can be followed for when it is time to help your best friend “cross the rainbow bridge.” Getting input from your veterinarian on the specific medical conditions that your loved one may face is vital for doing what is best for your pet. You may also benefit from having a caring friend who is not as emotionally involved in the situation as you are to help you gain perspective and really “see” what is happening with your pet.

Related: The Hardest Decision a Pet Owner Has To Make

Remember that pets live in the moment. One of the most wonderful things about animals is how they embrace the present. Every time I walk into my house, my faithful Vizsla throws a one-dog ticker tape parade. The fact that I have entered the house thousands of times before, or that I will leave again in a few hours, means nothing. All that matters to him is the joy that he feels right now.

When our pets are suffering, they don’t reflect on all the great days they have had before, or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes. And their eyes are what matter.

Ask yourself important questions. Sometimes, articulating or writing down your thoughts can make the right path more apparent. Some questions that help pet owners struggling with this decision include:

• Why do I think it might be time to euthanize?
• What are my fears and concerns about euthanizing?
• Whose interests, besides those of my pet, am I taking into account?
• What are the concerns of the people around me?
• Am I making this decision because it is best for my pet, or because it is best for me because I’m not ready to let go?

Measure their quality of life. This is no more than trying to determine how good or bad our pet’s life is at this moment. Trying to assess this can be difficult, but there are some ways you can try and evaluate it. Let’s take a look at a few of my favorites in the next section.

Is Life a Joy or a Drag?

Our pets may not be able to talk to us and tell us how they are doing, but if we pay close attention, there are many clues that can help us answer that question.

The Rule of “Five Good Things”: Pick the top five things that your pet loves to do. Write them down. When he or she can no longer do three or more of them, quality of life has been impacted to a level where many veterinarians would recommend euthanasia.

Good Days vs. Bad: When pets have “good days and bad days,” it can be difficult to see how their condition is progressing over time. Actually tracking the days when your pet is feeling good as well as the days when he or she is not feeling well can be helpful. A check mark for good days and an X for bad days on your calendar can help you determine when a loved one is having more bad days than good.

HHHHHMM: Doctor Alice Villalobos is a well-known veterinary oncologist. Her “HHHHHMM” Quality of Life Scale is another useful tool. The five H’s and two M’s are: Hurt, Hunger, Hydration, Happiness, Hygiene (the ability to keep the pet clean from bodily waste), Mobility and More (as in, more good days than bad). Dr. Villalobos recommends grading each category on a scale of 1–10 (with 1 being poorest quality of life and 10 being best). If the majority of categories are ranked as 5 or above, continuing with supportive care is acceptable.

Pet Hospice Journal: Keeping a journal of your pet’s condition, behavior, appetite, etc., can be extremely valuable in evaluating quality of life over time.

A Tale of Two “Endings”

Thankfully, my mother’s Schnauzer, Zoe, eventually responded to her therapy. As a perpetual optimist, I like to think that she may be with us for some time to come. Still, the reality of having older pets is that we must be vigilant in their care and aware that every day is a gift.

In the case of my long-ago patient, Stone, with whom I first walked this path, I am glad to say that he did not suffer unnecessarily with osteosarcoma. His owner made a good decision, and Stone crossed the rainbow bridge while in the loving arms of his people. He was remembered by them as a strong, loving protector of the children in his family, and I will always remember his owner for having the strength and wisdom I hope we’ll all have when the time comes to say that final goodbye.

More on Vetstreet.com:

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Occasionally, the decision making that surrounds euthanizing a pet is pretty straightforward. In cases of massive trauma, severe illness or unrelenting pain that cannot be managed, the path seems clear. In other cases, however, it can be hard to know what to do.

The feeling that “it’s time” can be more obvious in some situations than in others. But no matter how clear-cut the case may seem, a decision to euthanize a beloved pet often still involves a slew of conflicting thoughts and emotions. Making reasoned choices for our pets in such situations is often agonizing — and maybe that is as it should be. It is no small thing to end a life, and each instance must be approached with care and deep respect.

It Is Never Easy

Clients often talk about their struggle to find the “right” time. (Veterinarians face this same issue themselves with regard to their own animals.) Few people want to “jump the gun” and end a life too soon. On the other hand, most of us would be horrified if we waited too long and our pets suffered needlessly. So how do we navigate euthanasia decision making more easily? When the information we have seems clear, but we just can’t wrap our minds around making a decision, what do we do? And what do we do if a veterinarian (or well-meaning friend) suggests euthanasia as something to consider when it hasn’t even been on our radar to begin with? That can be an emotional shocker.

Deciding to euthanize a pet is never easy. This is particularly true when finances, time constraints, physical limitations to providing care, unexpected events, or a need to prioritize the care of our human family trumps our desire to care for our animals.  We can feel tremendous guilt, helplessness and sometimes even resentment toward the things and people that we think are standing in the way of what we’d like to do. Sometimes life is so busy it seems there just isn’t time to stop — to take the time we really need to face up to the decisions we must make. And then sometimes it seems there simply are no good choices, no matter how much time we may have.

How to Make Sense of the Difficult

Having people who can listen to your concerns and questions, and help you sort through things as objectively as possible, can be invaluable. This can then leave room for tackling the equally important emotional issues attached to losing a loved one — in this case, an animal companion.

Your veterinarian can help you with the medical questions and also support you by acknowledging how tough these decisions are. But sometimes the questions related to our emotional attachment are the ones that can be the most important to address because, if not, these emotional factors can be the things that blind us to the reality of our pets’ conditions.

Hard as it may be, we have to acknowledge the realities of our situation. There are “quality-of-life scales” out there that have been popularized, but none of these have been scientifically evaluated or validated. So while they can give us ideas about what we need to consider when we walk down this path, they should not be used as cookie cutter guides for our euthanasia decisions. There is too much individual variation in circumstances. For most people, there are things other than the pet’s actual medical condition that must be considered. From financial resources to time available to care for an ill pet or the physical limitations of caring for a disabled pet — there are often multiple bits of information to process.

Guilt can confuse things even further. In an ideal world, we would all have enough money and time and the right floor plan and the physical strength sufficient to provide any level of home care needed. For some animals — for instance, my own cat — even administering oral medications is not possible. It’s not ideal, but it is real, and it is the reality of our individual situations that is the foundation for making reasoned decisions about what to do with a seriously ill or dying pet.

A Second Pair of Eyes

Subtle changes (weight loss, arthritis, increases in water drinking, etc.) can be so gradual as to be unnoticeable to us, since we are around our pets daily. Even significant declines in health may not be recognized by you — but may be by a caring friend or by your veterinarian. The observations of others can help us see the reality of a situation more clearly, especially when it comes to pain and loss of function. Be open to this input; resist the urge to block it out because it might be something painful you don’t want to hear. Listen to the assessment of your veterinary team or friend, and weigh what you’re seeing with the information you’re being given. Two of the most common quality-of-life issues that clients often struggle to recognize in their pets are pain and nausea. Your veterinarian can help you more fully understand what is going on with your pet.

Rely on Your Team

Medicine is all about teamwork. Establishing relationships of trust and understanding with your veterinary medical team can help you feel more comfortable with the advice that is being given. It is important that you understand all of the factors that influence a recommendation from your veterinarian.

• Write down questions you may have as they come up, so you can remember to get them answered.
• Ask for clarification about anything you don’t fully understand.
• Consider scheduling an appointment to speak with your veterinarian about euthanasia without your pet present, so there is less distraction.
• Have a friend accompany you to take notes, or ask your veterinarian if you can record the conversation so you can review it later to make sure that you heard — and processed — everything.
• Be honest about your concerns, questions and confusion.
• Get a second opinion if you think extra information or another set of eyes might make things clearer for you.
• Speak with a counselor if there are emotional or psychological factors that could be keeping you from being able to make decisions or fully accept what you are being told.

Acknowledge Your Loss

Part of letting go is recognizing what it is we stand to lose. There are, of course, physical benefits of pet ownership. And maybe, more important, our pets seem to provide many things we, as humans, crave yet are not able to provide to one another: unconditional acceptance and love, unwavering support and unqualified appreciation for who we are. Losing this type of love and connection can be the worst loss some will ever experience. Take time to honor the unique relationship that you will be losing.

At times, the last, best gift of love we can offer our beloved animal companions is release from torment. If your primary focus is truly your pet and their comfort, and your decision is made from a heart of love, you will make the right choice.

Grief over the death of a beloved pet can be devastating

DREAMSTIME

The traumatic loss of a pet under sudden and violent circumstances can leave an owner feeling powerless.

And dear readers, so many of you have written to me about closeness to pets and grief after their loss. Please send me any resources or ideas you can offer to help this writer heal.

5 of 5 people found the following review helpful:
5.0 out of 5 stars You can’t read this story without a tissue., October 28, 2002
By A Customer
This review is from: Jasper’s Day (Hardcover)
This is a touching story about a boy Riley who wants to make his retriever Jasper’s last day very special. Together the family celebrates what a great companion Jasper has been by visiting many of the places that have been special to him. I would read this story along with my child. Although sad, it is a sweet story of a family’s love and respect for a dog they certainly viewed as a member of the family.

44 of 44 people found the following review helpful:
5.0 out of 5 stars Getting Help with the Grief, October 8, 2001
By
“pattiel“
This review is from: The Loss of a Pet : New Revised and Expanded Edition (Paperback)
Three weeks ago, we lost our 8-year old Boxer, Taylor, to Lymphosarcoma. We took her to the very best Oncologists(several of them), spent thousands of dollars in trying to keep her with us for as long as possible, but in the end we knew it was time for us to let go.

Not having children, the pain of losing such a loving animal was beyond my expectation of grief. When I researched the list of books on pet loss, I was looking for facts on how to deal with this agony and pain. Dr. Sife’s introduction and chapters on this subject matter was a validation that what me and my husband were feeling and going through were normal.

Dr. Sife’s case histories throughout the book were very helpful in applying what other people have experienced and what we were going through.

For anyone who has recently lost a pet and is looking for some insight on the feelings they are experiencing, I highly recommend this book. He is very factual. If you are looking for a spiritual or religious aspect, this is not the book. Although Dr. Sife does touch on this subject in a chapter, the basis for the book is the psychological aspects of losing a member of your family.

Cold Noses at the Pearly Gates is an incredibly well researched book offering true and lasting peace for individuals coping with pet loss. The author’s concern for his readers is made evident throughout the book. He wants you to know you are not alone and that the Word of God offers you hope in your grief and salvation through Jesus Christ. I would recommend it to all animal lovers. — Terry Wilson, Faith Writer’s Book Reviewer, February 2007

I read this fabulous book. It is brilliantly written, sensitive, heartwarming and uplifting. It will bring you hope and comfort. — Susan Peterson, Hollywood Producer

Thank you for your book and for the gracious inscription. — White House, First Lady Laura Bush letter of April 9, 2004

By Janice Kennedy, Ottawa Citizen June 4, 2011

Every now and then, that tiny microcosm that is our personal space in this world stops dead in its tracks. And everything else –politics, world events, even riproaring Stanley Cup finals –fades for a bit.

So it was for me this week in the loss of my pal Molly, the sweet yellow Lab who was less dog than cherished family member for the last 13-plus years. She died on Monday, as gently and peacefully as we could have hoped, thanks to the professionalism of a skilled and sensitive young vet. And while Molly’s departure means nothing to the larger world, it means the world to my family and me. Which testifies to the beauty and disturbingly deep grace of pets in human lives.

Some people should stop reading right here. This column –the first without my “secretary” Molly stretched out behind me on the floor of my home office, waiting for me to reach back and give her one of her hundred daily ruffles –is really for pet people. Non-pet people, who will find it clichéd, cannot know the truth pet people have always known: that teary farewells to beloved animals are unapologetically clichéd –because love is cliched.

And we do love our pets. We love them so much that we even do the hardest thing of all, releasing them from the hurt that has finally become too much, the last months of increasingly crippling arthritis, the pain that no longer responds to medication.

When we had to do this for our previous dog, our vet suggested that it was a gift to be able to end beloved animals’ suffering, easing them gently into a final sleep. And it’s true.

But it doesn’t feel much like a gift. It feels like loss and guilt and great emptiness. The house is unnaturally quiet now, devoid of that life that was always there, always waiting whenever we walked through the door.

As one involved in the material and emotional mechanisms of dog ownership for nearly four decades, minus a few gaps between pooches, I’m finding a dog-less house an empty place indeed.

Molly’s sudden absence is so huge it’s palpable, measured on a scale of negatives. No more warm and constant companion in whatever room I’m in. No need to have that small piece of cheese waiting at lunchtime, those three tiny squares of toast in the morning, those little treats of dinnertime meat lovingly put aside. Molly no longer walks by my side in the nearby field she loved, searching for her doggie pals. No longer do we have to worry about her stealing socks and napkins, or poking around in visitors’ purses (“Labrador retriever” being a euphemism for “kleptomaniac”), looking to score breath mints, grocery lists or, if she was lucky, used Kleenex.

That old lady’s “oof” she made when she plopped down beside me is no longer a household sound. No longer can I expect that beautiful face to peek around some corner, checking my whereabouts.

The absence of her face is the hardest thing. It still looked youthful –aged white fur masked by her natural blond-and-white –a perkylooking face at odds with the cruel realities of her body’s advanced age. That made her leaving especially tough, as did her softness, her sweetness.

She didn’t lack spirit –she was full of fun and mischief, especially in her youth –but there was never any malice in her, any meanness.

There was simply an intensity of devoted love.

This is not something easily explained to those who have never lived with dogs, who doubt that animals behave in any way other than the generically instinctive. But here is the true (and instinctive) knowledge of dog owners: their pets’ devotion is a gloriously real thing, the gift of a Creator who was smiling the day he made dogs.

Molly would have thrown herself in front of a truck for us or fought off the fiercest intruder. (OK, maybe not that, since she didn’t actually know what an intruder was. Everyone who came to our home, from visitors to furnace guys, was a potential new friend.) She had, yes, a generous heart.

She had a big personality. For that, I owe my wonderful Molly more than the love that was so easy. I owe her memory respect, for what she was and what she brought to the world around her, never mind how small.

People who have never shared their lives with pets will not comprehend this. I don’t expect them to understand the compelling spiritual validity of tributes to non-human creatures who have added to the world’s measure of joy. If those people have read this far, I suspect they are saying: “Oh come on, already. Get a grip. She was just a dog.”

But she wasn’t.

Janice Kennedy writes here Saturdays. E-mail: 4janicekennedy@gmail. com

© Copyright © The Ottawa Citizen
Read more: http://www.ottawacitizen.com/life/passing+Molly/4892643/story.html#ixzz1ONRpQTZI

Pet Loss: 3 Steps to Making use of Photography and Creativity to Ease Grief   by Greg Walcott

in Business (submitted 2011-05-28)

About the Author

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For a comprehensive list of counselors in the USA

the Asso­ci­a­tion For Pet Loss and Bereave­ment (APLB)  has an excel­lent website that we recommend: www.aplb.org

Chicago VMA
630–325-1600  630–325-1600

Cornell University
607–253-3932  607–253-3932

University of Illinois
217–244-CARE (2273) or 877–394-CARE  877–394-CARE  (2273)

Michigan State University
517–432-2696  517–432-2696

P&G Pet Care, Pet Loss Support Hotline
888–332-7738  888–332-7738

The Ohio State University
614–292-1823  614–292-1823

Tufts University
508–839-7966  508–839-7966

Virginia-Maryland Regional College of Veterinary Medicine
540–231-8038  540–231-8038

Washington State University
509–335-5704  509–335-5704  or 866–266-8635  866–266-8635