Originally posted by the New York Times here. Written by Ana Homayoun
They say cats have nine lives, but my dog, Mason, seemed to have almost that many in the last two and a half years of his life. He cheated death time and again, and I believe it was largely because he had excellent end-of-life health care.
A decade ago, someone in my situation might have opted for euthanasia with the idea that it would put an end to his suffering. But the palliative and hospice care approach I took not only eased his pain but also gave him more days happily enjoying life.
The first crisis came in 2015 when he was given a prognosis of less than a year to live with a diagnosis of congestive heart failure. I followed my veterinarian’s care instructions — avoiding food with sodium, dispensing medications twice daily, making sure he had lots of rest and adequate exercise — but I was missing writing deadlines for my latest book and generally feeling awful.
One afternoon, my mother handed me a copy of Atul Gawande’s “Being Mortal: Medicine and What Matters in the End.”
“I know most people read this book when they think about caring for their parents,” she said gently. “But I really think you should read it about caring for your dog.”
By then, Mason was 12 years old and had been with me for nearly all of my adult life. I had moved several times, started a business, navigated friendships and relationships, finished graduate school, and written my first two books with him by my side. I felt a sense of responsibility that he was well cared for in his final days.
It’s no secret that pets are an integral part of many American households. According to the 2017-18 National Pet Owners Survey conducted by the American Pet Products Association, 68 percent of American households — or about 85 million families — have a pet, and 60.2 million of those households have dogs. Doggie day cares, pet spas, organic food, non-BPA toys and training programs have become commonplace. The survey found that Americans spent approximately $69.51 billion on their pets in 2017.
But we don’t spend much of it on health insurance. End-of-life care can be expensive for humans and pets, and one of the reasons Mason received such excellent care was because I had luckily purchased a pet insurance policy years earlier on the recommendation of a friend who had cared for several aging dogs.
Though relatively uncommon in the United States and Canada, pet insurance is a mainstay for many European pet owners. The first known pet insurance policy was written in Sweden in 1890 by Claes Virgin. According to Sweden’s National Veterinary Institute, nearly 80 percent of dog owners in Sweden have pet insurance.
But in the United States, only about 3 percent of families have it. According to data from the North American Pet Health Insurance Association, 2.1 million pets were insured in the United States and Canada in 2017, up 17 percent from the previous year.
The policy I had for Mason, which my friend suggested, was from a company called Trupanion. It covered 90 percent of his treatments, not including examinations and prescriptions. The company’s chief veterinary officer, Dr. Steve Weinrauch, was a practicing vet in England before moving to the United States with his wife, a Scottish veterinarian, and he said he noticed a marked difference in the way people approached veterinary care in Europe versus the United States. In Britain, most of the pets he saw had medical insurance and their owners readily agreed to the treatments he suggested.
In the United States, he found that pet owners who were just as caring would sometimes delay treatment or try conservative rather than proactive treatments because of cost, and then would be upset when their pet’s condition did not improve or greatly deteriorated.
It may seem extravagant to purchase pet insurance at a time when many humans can’t afford health insurance in the United States, and I didn’t openly admit to many people that I’d done so. But I was surprised to find that it covered a wide range of care, including acupuncture, fluid therapy, chemotherapy, blood work, CT scans, M.R.I.s and physical therapy — not all of which Mason needed.
“The pet is almost the same as the child to a lot of people,” said Dr. Diane Roberts, a San Francisco Bay Area veterinarian and medical director of SAGE Centers for Veterinary Specialty and Emergency Care, where Mason received treatment.
Conversations around end-of-life care, palliative care and hospice treatment have a growing place in veterinary care. For years, euthanasia after a terminal diagnosis was somewhat common, but today, according to Dr. Roberts, pet owners “keep their pets comfortable for longer. They are more willing to give meds and care than they were 20 years ago.”
According to the website of the International Association for Animal Hospice and Palliative Care, founded in 2009, “Hospice exists in the belief that patients in the last phases of life deserve this care so that they might live as fully and comfortably as possible.” For pets, hospice care mainly includes pain management and comfort care that focuses on maintaining quality of life. Hospice and palliative care can prolong a pet’s life with the option of euthanasia if it is determined to be the humane course of action.
“Being Mortal” shifted my own fears around end-of-life and death into a focus on living a good life, with lessons I applied to my own life as well as to that of my aging dog. I began to focus on comfort and quality of life rather than drastic medical interventions.
Pretty soon, we had a morning routine of going to a nearby park or beach, a treat once reserved for weekends or days off. Mason began perking up from the back seat whenever he realized we were blocks away, enthusiastically putting his paws on the center console.
And then, Mason surprised everyone. Twelve months after his diagnosis, Mason’s enlarged heart had returned to a relatively normal size, and his heart murmur, though still pronounced, was not cause for great concern. His veterinarian said Mason was one of approximately 2 percent of dogs he’d seen whose condition actually reversed and improved since diagnosis. The combination of medications he was given for heart failure — pimobendan, Lasix and enalapril — seemed to work well, and over time his dosage was reduced.
Over the next year and a half, Mason moved through heart failure, intervertebral disc disease, bladder cancer and kidney failure with awe-inspiring fortitude. Once, after a four-day hospitalization for kidney failure, the doctors wrote on his discharge papers how they had explained to me that we were likely in a hospice situation. Five days later, he was prancing at the park and begging for extra treats, leaving everyone dumbfounded.
Because of Mason’s remarkable resilience, it was hard for me to know when his time was really near. About a week before he died, he became more fragile and more resistant to leaving home, getting up only to move between dog beds or to go to the bathroom. I had read a great deal about signs that a dog is dying, but it was really Shanti Zinzi, the veterinary assistant who administered Mason’s fluid therapy, who provided the most invaluable guidance, texting and emailing and providing in-home care — all covered by pet insurance — to make sure he was resting comfortably, and I put a plan in place in case his condition worsened.
In the end, Mason died quietly and peacefully on his own at home one Wednesday afternoon. His end-of-life care reminded me of the importance of living well.
“Unfortunately,” Dr. Weinrauch said of pets, “none of them can live long enough.”
Ana Homayoun is the author of three books, most recently, “Social Media Wellness: Helping Tweens and Teens Thrive in an Unbalanced Digital World.”
Euthanasia: Making the Decision
Posted on August 25, 2016 at American Humane
While some pets die of old age in the comfort of their own home, many others become seriously ill, get injured in some way or experience a significantly diminished quality of life as they grow very old. In these situations, it may be necessary for you to consider having your pet euthanized in order to spare it from pain and suffering. Here are some suggestions for dealing with this difficult decision, as well as some information about the euthanasia procedure itself.
KNOWING WHEN IT’S TIME
Talk to your veterinarian. He or she is the best-qualified person to help guide you through this difficult process. In some cases, your veterinarian may be able to tell you definitively that it is time to euthanize your pet, but in other cases, you may ultimately need to make the decision based on your observances of your pet’s behavior and attitude. Here are some signs that may indicate your pet is suffering or no longer enjoying a good quality of life:
Once you have made this very difficult decision, you will also need to decide how and where you and your family will say the final goodbye.
WHAT TO EXPECT
Making the decision to say goodbye to a beloved pet is stressful, and your anxiety can often be exacerbated if you do not know what to expect during the euthanasia procedure.
BURIAL AND CREMATION OPTIONS
Your veterinarian can offer you a variety of options for your pet’s final resting place.
End of Life Care
Posted on ASPCA.org
Coping with the impending loss of a pet is one of the most difficult experiences a pet parent will face. Whether your furry friend is approaching his golden years or has been diagnosed with a terminal illness, it’s important to calmly guide the end-of-life experience and minimize any discomfort or distress. As your pet’s health declines, you may elect to care for your pet at home—with the supervision of a veterinarian—or you may decide to end his suffering with euthanasia.
Read on to find out how to help make your pet’s final days peaceful and dignified.
Is Your Pet In Pain?
When cats and dogs are suffering, they may not show outward signs that we normally associate with pain like whimpering or crying. Sometimes an animal will continue to eat or drink in spite of pain or disorientation. Some physiological and behavioral signs that your pet might be experiencing pain include excessive panting or gasping for breath, reclusiveness, reluctance to move and food pickiness.
Caring for an Elderly Pet
The most important thing you can do for your elderly pet is to minimize any pain or distress she’s experiencing.
Pet Hospice Care
Pet hospice care, also known as palliative care, is an option if your pet is suffering from a terminal illness and a cure is not possible. The goal is to make a pet’s final days or weeks more pleasant with the proper use of pain medications, dietary strategies and human interaction. Pet hospice is not a place, but a personal choice and philosophy based on the principle that death is a part of life and can be dignified. When considering hospice care, pet parents should very careful not to prolong the suffering of pets who are in pain or experiencing poor quality of life.
A participating veterinarian will teach pet parents how to provide intensive home care to keep an ill pet as comfortable as possible. Hospice care requires an active commitment and constant supervision from pet parents, who work with their veterinary team to make sure their pet’s life ends comfortably. If you decide hospice care is the right course for you and your pet, you will become your pet’s primary nurse and caregiver, as well as the link between your pet and the veterinary team. Consult with your primary veterinarian and see if she recommends hospice care for your pet based on his specific needs.
Euthanasia provides a painless, peaceful end for a pet who would otherwise continue to suffer. Your veterinarian has special training to provide your pet with a humane and gentle death. During the procedure, your vet will inject your pet with a sedative followed by a special medication. The animal experiences no awareness of the end of life—the process is akin to undergoing general anesthesia for a surgical procedure and takes about 10 to 20 seconds.
Your veterinarian is the best person to advise you on when the time is right to euthanize—information from medical tests is often more accurate than what a pet owner can observe, and pet owners often delay the moment of euthanasia in anticipation of grief. Observing and keeping an accurate record of your pet in his daily activities can help you to decide. If you observe that moments of discomfort outweigh his capacity to enjoy life, it is time to euthanize, even if your pet still experiences pleasure in eating or socializing. If your pet is in pain, your main goal should be to minimize his suffering.
What to Do If Your Pet Has Died at Home
If your pet is under the care of a veterinarian at the time of his or her passing, he or she can guide you through next steps. However, if your pet dies in your home, there are options to consider. Whether you simply want the body to be removed from your home, or you wish to permanently memorialize your pet in some special way, the choice is yours.
Pet Cremation and Burial
It is very common for pet owners to have their deceased pets cremated. You need to decide if you wish to keep your pet's ashes as a remembrance. If so, you will want to arrange an individual (or private) cremation, meaning that your pet will be cremated alone. Businesses that offer individual cremation commonly offer home pick-up/delivery of remains as part of their service packages.
Depending on local laws, it may be legal to bury an animal on your own property. It is typically illegal to bury an animal on public lands such as parks. If you desire burial for your pet but do not have land of your own, check to see if there is a pet cemetery or memorial park in your area.
If you wish to simply have your pet’s body removed from your home, consult your local government to find out if your sanitation department picks up animal remains.
Dealing with Pet Loss
There are many forms of grief that are completely normal in the wake of the loss of a beloved pet. For support dealing with the loss of a pet, call our Pet Loss Hotline at (877) GRIEF-10.
When You Love An Old Dog, Managing Care Can Be A Challenge
by PREETI N. MALANI
Posted on February 25, 2017 on NPR.org
The notion of dog years stems from the common belief that one year for a dog equals seven years for a human. Although canine aging is more nuanced than a simple formula, any dog lover knows that dogs' lives pass far too quickly.
Even so, America's 70 million dogs, like their human companions, are living longer, on average, because of better medical care and nutrition. Caring for elderly dogs can be heart-wrenching. Many pet owners struggle to understand when to pursue aggressive care and when to stop and help a beloved pet pass on.
"Older patients are the biggest challenge veterinarians face," says Dr. Alicia Karas, an assistant professor of veterinary medicine at Tufts University. She argues for a holistic approach to older dogs, saying that "too often we focus on the affected body part or the results of an X-ray, not how an animal walks into the exam room."
Pain tops the list of common health concerns for older dogs, with causes ranging from the routine, such as arthritis, to the more serious, such as cancer. As in humans, pain management can be complicated by other conditions. A dog with weak kidneys, for instance, may not be able to take canine-specific pain medicine.
Karas looks beyond drugs to treat pain, sometimes recommending massage, therapeutic ultrasound and rehabilitation.
The benefits of a good rehabilitation program can be far-reaching. Older dogs may not make it outside for long walks, says Karas, but with rehabilitation, "three times a week the dog gets out and sees people who pet and love him."
Older dogs, like their aging owners, may experience memory loss. "When we work up a pet for urinating in the house, we tend to focus on the kidneys, bladder and endocrine reasons," she says. But it may be a case of "simply forgetting to go to the bathroom," she explains. Anxiety is closely linked to impaired memory, and even minor changes in the household can be hard on older dogs.
While specialized care may seem ideal, Dr. Stephen Steep, a veterinarian in Oxford, Mich., tries to present a menu of options and to set realistic expectations of what can and can't be done. "Here are some things you can do. If cost is not an issue, this is an option," he says. "Here is another less aggressive option." But the pet's comfort is paramount, and Steep says he always considers whether or not a particular decision will improve quality of life.
When it comes to end-of-life discussions, Steep recognizes they're inherently difficult. He likes to start with open-ended questions, noting that many owners aren't aware of subtle changes. "How is your dog's appetite?" he asks. "Is your dog sleeping through the night? How is he doing on long walks?"
Although Steep believes most owners understand there is a limit to their pet's life, he feels people don't always realize how old their pets really are. He tries to help them accept aging as a normal process, not a disease.
"People want to have dog pass away at home in their sleep, but that is rarely the case," Steep says. "You get into a situation where the pet cannot go outside to urinate or defecate. He may be gasping for air due to heart failure or incapacitated due to memory loss."
Still, some people just can't let go. When Steep gets the sense that someone is pushing too hard, he tries to emphasize the pet's comfort. "I'll pull them into clinical activities like checking heart rates, monitoring water intake, to try and open their eyes," Steep explains.
Most owners come to the realization that their dog is at the end of its life.
Although Karas recognizes the moral distress created by end-of-life decisions, she acknowledges the importance of euthanasia. "When I have no other options, I have a tool to alleviate suffering."
When Andrew Shepherd's 14-year-old English setter, Madison, developed seizures, he focused on maintaining her quality of life. Given her age and the lack of any obvious discomfort, Shepherd decided against an extensive work-up and instead focused on the dog's symptoms, a decision their veterinarian supported.
During the following months, the seizures become more frequent, lasted longer and the dog appeared to be in pain. "She would yelp," Shepherd recalls. "It was clearly not a pleasant experience."
One day Madison suffered a protracted seizure while traveling in the back seat of Shepherd's car. For him, this was the tipping point. "We couldn't sacrifice her quality of life just to keep her around," Shepherd explains. After that, it was about selecting the right moment to let Madison go.
Their final night together was a celebration of Madison's life. The family comforted their dog, took pictures, shared their favorite Madison stories and made a list of all the nicknames they had for her.
Shepherd recalls crying as he took Madison to the veterinarian's office for the last time. "Normally she hated going to the vet, but this time she didn't fight at all," he says. "She knew it was time."
Dr. Preeti N. Malani is a professor of medicine at the University of Michigan in Ann Arbor. You can follow her on Twitter: @PreetiNMalani.
by Berit Brogaard D.M.Sci., Ph.D
Posted Feb 24, 2014 on Psychology Today
Whether animals can experience romantic love is unknown. But there is some evidence that they are capable of experiencing the same range of emotions as we can. The brains of many mammals are surprisingly similar to the human brain. Take as an example the brain of a cat. A cat’s brain is small compared to ours, occupying only about one percent of their body mass compared to about two percent in an average human. But size doesn't always matter. Neanderthals, the hominids that went extinct more than twenty thousand years ago, had bigger brains than Homo sapiens, but they probably weren’t smarter than the Homo sapiens that beat them in the survival game. Surface folding and brain structure matter more than brain size. The brains of cats have an amazing surface folding and a structure that is about ninety percent similar to ours. This suggests that they could indeed be capable of experiencing romantic love. But we will probably never know for sure.
There is one thing we do know though: Your dog or cat doesn’t regard you merely as a food dispenser. Pets as well as zoo animals form strong attachments to their caregivers. As attachment is a form of love, animals are indeed capable of loving their caregivers.
Dogs have been reported to love their masters so deeply that they mourn their death for many years. Such was the case of Greyfriars Bobby, a Skye terrier in Edinburgh, Scotland. He served as Constable John Gray’s companion, until Gray’s death in 1858. After Gray’s funeral, Bobby was spotted sitting on top of his master’s grave in Greyfriars Kirkyard. The loyal police hound is reported to have spent every night at his master’s grave until his death fourteen years later.
The attachment of dogs to their owners has been confirmed in a study conducted by Daniel Mills, a British specialist in clinical animal behavior. The study used an adaptation of Ainsworth’s strange situation paradigm, in which the researchers observed the reaction of dogs and cats in response to their owners and strangers. He found that securely attached dogs tended to behave similarly to infants when their owners left, whereas cats tended not to do that. If anything, cats tended to have more of an avoidant attachment style, often ignoring their owners and happily greeting strangers. These results, of course, do not show that cats are incapable of attachment. While cats no doubt tend to have a more avoidant attachment style than dogs, most of us know from anecdotal evidence that there can be enormous differences in how attached cats are to their owners. My own two cats, Bertrand Russell and Roderick Chisholm (named after philosophers like my other cats) are undoubtedly anxiously attached, clinging tenaciously to me to the point of annoyance.
While it seems relatively uncontroversial that dogs can be attached to their owners, and that the owners assume the role of caregiver, there is also evidence that dogs can temporarily take over the role of caregiver. Dogs seem to be attuned to the emotions of their owners and are able to act as a loyal companion in times of need. In a study published in the September 2012 issue of Animal Cognition, University of London researchers found that dogs were more inclined to approach a crying person than someone who was talking or humming, and that they responded to crying with submissive behavior. According to the researchers, this contrast indicates that the dogs’ response to weeping wasn’t simply the result of curiosity but was based on a primitive understanding of human distress. These findings indicate that when a dog comforts his sorrowful owner, the caregiver-recipient roles are sometimes reversed. The dog temporarily becomes the caregiver, which suggests a more sophisticated attachment pattern in dogs than in infants.
These results have also been confirmed with brain scans. Gregory Berns, a neuroscientist at Emory University, used fMRI neuroimaging to test the brains of dogs. This is not simple feat. fMRI scans only work if the participants lie completely still, which dogs normally aren’t capable of. However, Berns trained his dogs to lie still in the tight compartment of the scanner, which made the brain imaging feasible. The results were astonishing. Berns’ lab team found increased activity in regions of their brain associated with attachment, empathy and a theory of mind in response to their owners. A theory of mind is a belief system about what others think and want that is continually updated. So, dogs apparently wonder what their owners are thinking about.
Animals also seem capable of experiencing attachment love for each other. The awe-inspiring story of Tika and Kobuk, two malamutes who had been companions for years, testifies to this. Together the two dogs had bred and raised eight litters of puppies. But Kobuk was a bit of a bully. He would eat Tika’s food and shove her away if he got the chance. He would also attempt to steal away any attention people gave her. But the bullying came to a complete hold when Tika developed cancer in her leg. Kobuk’s behavior changed entirely. He let Tika sleep on the bed, while he rested on the floor. He groomed her face and neck and would not leave her side. Tika’s leg eventually had to be amputated. In the beginning it was quite a challenge for Tika to walk on three legs. When she stumbled and fell Kobuk would try to help her. He even saved Tika’s life when she was going into shock during her recovery from the amputation. Kobuk was barking to wake up the owner, who rushed Tika to the hospital. Thanks to Kobuk’s attention and love, Tika survived. Kobuk continued to care for Tika while she was still recovering. But once Tika had fully recovered and had learned to walk on three legs, Kobuk was back to his old behavior.
Animals also sometimes form attachment relationships with members of other non-human species. The BBC documentary Animal Odd Couples features several unusual attachment relationships, among others that between Anthony, a giant lion, and Riley, a little coyote. When Anthony and Riley were brought to “Keepers of the Wild” animal sanctuary, they were only about a month old. They immediately bonded. They enjoyed playing and grooming each other. When they arrived at the sanctuary, they were the same size but that quickly changed. The lion rapidly outgrew the little coyote. Despite their extremely different physique, their early bond continued into adulthood.
Attachment love is not restricted to mammals. In his book Mind of the Raven biologist Bernd Heinrich argues that since ravens have long-term mates, they must feel a form of attachment for each other. Otherwise it is difficult to explain what keeps the couple together for a lifetime. Although not all birds mate for life, many do. Brant geese are no exception. The BBC documentary features a male Brant goose who has chosen a forty-five-year-old female Aldabra tortoise as his soul mate. He chases away anyone who tries to get near her, ensuring that she gets to eat her crisp lettuce without any interference. The hefty female tortoise contently puts up with his protection and care, in fact she truly seems to enjoy it. A truly kooky couple.
Brit has written over 100 peer-reviewed articles, some three hundred popular articles on neuroscience and health issues and three books: Transient Truths (Oxford), On Romantic Love (2015) and The Superhuman Mind (2015). She is currently finishing a third book with Oxford entitled Seeing and Saying. Her work has been featured in various public media, including Nightline, ABC News, the Huffington Post, Fox News, MSNBC, Daily Mail, Modesto Bee, and Mumbai Mirror. She is also an editor of the international peer-reviewed philosophy journal Erkenntnis, is the 100th President of the Southern Society for Philosophy and Psychology and was the first female President of the Central States Philosophical Association.
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