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Grief — & Relief: Consulting a Hospice Veterinarian

Frankie: He's not talking

Frankie: Sending mixed messages

There’s a comforting old saw that, to me, deserves to go the way of the myth of unconditional love: Your pet “will tell you when it’s time.”

Frankie has dementia and he’s blind but he’s fairly healthy. He lets me know when he wants to go outside to relieve himself but he can’t always find his water bowl without my help. He’s sometimes affectionate but he’s no longer aware when other people enter the house; his days of barking to “protect” me are long passed.

So what exactly is Frankie telling me? If anything, he’s sending me mixed messages, ones that I can’t decode.

It’s tough enough to watch your pet’s aging and illness; the last thing you need is the burden of trying to read the tea leaves to determine whether your pet wants to leave this world. Consider the natural language barriers — even those of us who have become reasonably familiar with dog signals can’t always understand the special dialects — and the fact that animals often hide their pain.

Not every pet “will tell you when its time” — and not every owner will be able to listen. Many of us need the help of a human who is an expert in this arena.

What Exactly Is a Hospice Vet?

Last week I did an interview with Dr. Janet Tobiassen-Crosby for About.com Veterinary Medicine; it was posted Monday as Hospice Help: Guidance for Knowing When It’s Time to Say Good-Bye. I was thrilled to have the opportunity to talk about my experience on a widely read forum; I’ve gotten quite evangelical on this topic.

There are a few things I’d like to add.

  • You don’t send your pet away with animal hospice. The term “hospice” for humans often means going to a separate facility to get medical care for a terminal illness, though home care is also an alternative. In animal hospice, your pet almost always remains at home getting care from their people with the help of a veterinary professional or professionals.
  • So called “euthanasia vets” often deal with life as well as death.  Many of us are aware that there are veterinarians who will come to your home to perform euthanasia so your pet can pass peacefully in familiar surroundings — in some cases, it’s your regular vet — but there is very little information about practitioners who also have an even more important role: as life counselors. In many cases, after a consult with a hospice vet, owners will learn that they have more time to spend with their pets as long as a pain- or stress-relief program is created. In other cases, such as mine, owners discover that they need to let go.

This discovery made me very very sad — and it was a huge relief to no longer spend my time trying to figure out what to do. In case I missed the point of what she was saying — “he seems to be frightened and confused much of the time; he’s not aware of his surroundings” — my vet, Dr. Sheila Kirt of Home At Last, was specific: “I probably would have said good-bye by now.”

I believe Dr. Kirt saw Frankie at his worst — more out of it than usual because we awoke him from a deep sleep — so, although that statement gave me a few guilt pangs, I don’t feel like I have subjected Frankie to undue distress (and now I’m devoting several weeks to making up for any discomfort I might have allowed him to experience). At the same time, I heard her message, loud and clear, and not from Frankie: “It’s time.”

Where Do You Find Such a Vet?

As I said in my interview with About.com, I found Dr. Kirt through a friend who had used her services and recommended them highly. I asked her how other people find her and she said, “Like you did: Word of mouth. Often, vets recommend me.”

There is an organization called the International Association of Animal Hospice Care and Palliative Care that lists some individual veterinarians with this type of practice (though not Dr. Kirt’s). I found the description of hospice on the site rather confusing: it does not make clear that your pet stays at home and it makes it sound like you have to hire an entire team of veterinarians — which could be very expensive. I don’t know what the actual cost of a palliative care program is; I haven’t investigated it. I paid a one-time consultation fee of $150 for a home observation and examination — money that couldn’t have been better spent. Forgive me if I sound like an American Express commercial but “Peace of mind? Priceless.”

So I would suggest you ask your vet and  look on the internet — and then get a personal referral in addition. You do not want a person in your house who is not good at this. You want someone who is kind but firm, who picks up on and respects your beliefs (in my case, my loathing of the Rainbow Bridge; of course it helps that I sent her my post on the topic in advance) but does not let them interfere with common sense — or the laws of the land.

Someone who confirms that your pet is adorable but does not let that deter her in advising you to let him go.

 Update: I wrote here about what was right for me; many others have had different experiences. See Your Turn: How Did You Know When “It Was Time”?

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27 Comments

  1. Posted October 16, 2013 at 3:07 pm | Permalink

    I feel like most of the time, I’ve been able to be a good judge as to when to let our dogs go in the past, perhaps with the exception of Lilac. She had dementia as well, but was very healthy otherwise. Her dementia was at its worst at night and we went through over two years of not sleeping through the night with her. She was so advanced in years and such a wily character, it was hard for me to divine when she was ready to go. Honestly, I kept praying that she would just go to sleep and not wake up so I didn’t have to make the decision, but after a pretty bad week for her (and us, too) I realized that it was time to let our old lady go. I think that no matter what you believe, it’s never easy to let them go, but it shouldn’t be. Life is sacred, especially one that you’ve grown to love!
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    • Edie Jarolim
      Posted October 16, 2013 at 3:17 pm | Permalink

      It’s such a tough decision but I’m sure you’re right, that you knew what you knew. Perhaps dementia is a special case because the dogs otherwise seem to be doing well (like there is an “otherwise” when you’re up half the night!). I admit I have no basis for personal comparison since Frankie is my first dog; I just know others who have agonized and would have benefited from an outside opinion.

  2. Jenny
    Posted October 17, 2013 at 6:53 am | Permalink

    Thank you so much for sharing your story. It is hard. Everyone says, “quality of life,” but that is so hard to judge when there are good days and bad days, and animals hide physical pain making it even harder to evaluate. I never knew that veterinary hospice existed. I’m years away from needing such a service, but when my kitties start showing their age, I’m glad to know there may be specialists who can help me with palliative care or a final decision.

    • Edie Jarolim
      Posted October 17, 2013 at 7:03 am | Permalink

      Yes — the good days are the killers. They make you second guess yourself, say “Maybe I’m wrong.” I’m still feeling that way, even with the help of the hospice vet. I’m glad I could help.

  3. Mary Commins
    Posted October 17, 2013 at 8:02 am | Permalink

    I am calling BS on this “vet”! I have never had second thoughts about when it was time. If you know your animal, you’ll know when the bad days outweigh the good days and when they are in too much pain to bear. This is a “vet” who has never met your pet before and makes such a personal decision for you???? I KNOW my pets. I know when they tell me its time. This entire article is written for people who have pets but are so not in tune with them that they need a stranger to tell them to euth them. My personal vet would never make that decision for me. He gives his opinion when asked for it, but leaves the final decision to those who know nd love that animal the most. Which should be the guardians.

    • Edie Jarolim
      Posted October 17, 2013 at 8:05 am | Permalink

      As I wrote in today’s post I was a bit hasty. I wrote about my experience and no one else’s. The same vet as I consulted also helped two of my friends, but everyone has a different experience. And I am extremely in tune with my dog but with CCD things are more complicated.

    • Posted October 17, 2013 at 4:53 pm | Permalink

      Dr. Kirt and those in her field are there as an advocate for the dog. There are times when a pet parent cannot or will not recognize the pain and suffering the animal is enduring. The pet parent is too close, projecting their own feelings onto the dog. I’ve seen it too often where a pet parent cannot accept that an animal has given everything they have. It’s obvious that the dog is tired and ready to go, but the parent’s vision is clouded by what THEY want and need, not what’s best for the animal.

      Hospice vets aren’t there to demand that you let your pet go. Their role is to advise you of the medical condition of your pet, explain pain levels and help you make a decision. Notice I didn’t say the right decision. Ultimately, the decision belongs with the pet parent but they should welcome informed opinions about what’s best for their family member.

      • Edie Jarolim
        Posted October 17, 2013 at 4:57 pm | Permalink

        Thanks for this informed analysis. That’s exactly how I felt, that Dr. Kirt was Frankie’s advocate.

  4. Marlene
    Posted October 17, 2013 at 8:18 am | Permalink

    I would just like to add that hospice for humans also means that people can remain in their homes and die peacefully at home. People do not have to go to a facility to die, though they have that option if that is what they or their families want.

    • Edie Jarolim
      Posted October 17, 2013 at 8:23 am | Permalink

      Yes, you’re right, Marlene — I will make that clearer.

  5. Posted October 17, 2013 at 8:57 am | Permalink

    Thank you for sharing.

  6. Posted October 17, 2013 at 9:06 am | Permalink

    I think knowing “when it is time” is probably more about us coming to terms with the realization that it is time to let go. Having a complete stranger come to my home and tell me my pet is ready to leave this earth in one respect would be helpful. They have no emotional ties to my pet and can be objective. On the other hand, if I’m not ready to hear those words then how does that really help? I do have a really good relationship with my vets, and they tell it like it is. They know me well enough to know that I don’t want my pets to suffer. They’ll tell me what to start watching out for. I’ve not ever had a pet with dementia so I don’t know how I would handle that. The pets of mine that I’ve made the decision over had illnesses with clear signs of physical deterioration. Having said that, it was still difficult to know if it was the right time. The way I try to look at it is if the pet starts having more bad days than good days, then it’s time to start making plans. We have the ability to end their suffering. If they were humans, they literally would be in hospice care for months or years on end, doped up on morphine until their body officially gave up on its own. How’s that for quality of life?
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    • Edie Jarolim
      Posted October 17, 2013 at 9:19 am | Permalink

      It’s interesting. One of the vets in my practice, the one who suggested I get Frankie’s teeth pulled by a specialist, would probably never have suggested to me that he was ready and it would never have occurred to me to ask her; she’s not a person I could talk to. I think if I hadn’t known on some level that it was time, or at least feared it was, I wouldn’t have contacted the hospice vet. So I think there was some gut instinct at play — the instinct to ask an outsider.

  7. Barbara
    Posted October 17, 2013 at 9:28 am | Permalink

    I have very mixed feelings about this. I have let many, many animals “go” over the years; however, within the past year, something changed. I met a communicator who has done wonders for all my animals with herbal and essential oil remedies. My dog “told her” that animals don’t want us to make that decision. Regardless of their pain and illness, they are stoic and always have hope. I also read this same comment on FB about a stray that two young men rescued and consulted a communicator about this. Animals would rather go on their own time than have a vet euthanize them. My communicator had never heard this before but did have the experience with her own elderly dog who finally allowed her to help him cross over. Apparently, when euthanized before their time, the animals don’t cross over immediately but stay in this realm for some time and this is disconcerting to them. Take this message for “what it’s worth” — it’s simply another point of view with which you can choose to agree or disagree (I don’t care — I’m merely presenting some interesting information).

    • Edie Jarolim
      Posted October 17, 2013 at 9:30 am | Permalink

      I appreciate it. That’s why I opened up this forum — to hear different points of view.

  8. Alicia Robinson
    Posted October 17, 2013 at 11:26 am | Permalink

    Why are earth would you even fathom the idea that euthanasia is not killing by any means? We all suffer until the end. Nobody believes that euthanasia is an acceptable act for humans. Watching and losing someone we love is a terrible experience, but that comes along with the territory, whenever we allow ourselves to experience love. Killing a life because it is an”acceptable” practice does not make it alright by any means. Ending a life and telling someone it is okay to do, to let them go is even worse. I suffer from great physical disabilities that cause me immeasurable pain. Still, no one has ever tried to put me down because they didn’t want to see me suffering anymore. love is joy, love is pain, but life is more important than anyone single being can even understand. Ever think that maybe an animal barely clings to life in this world for a reason? You are no different than murderers who are trying to justify your own sick perverted ways of thinking! Then, you even have the gall to make money at it! SHAME ON YOU!!!

    • Edie Jarolim
      Posted October 17, 2013 at 11:38 am | Permalink

      My mother had a doctor who was kind enough to give her enough morphine to ease her out of the world when she had terminal liver cancer, for which I am eternally grateful. It is what she wished. I respect your wishes to do something different with your life, and I am sorry for your pain, but I certainly do not feel any shame.

    • Posted October 17, 2013 at 4:48 pm | Permalink

      I don’t know how you feel you can speak for everyone on the planet, but I do believe in euthanasia for people — just so you have this for future reference — I think we should be able to decide when to call it quits when morphine can’t pierce the pain. I don’t believe in suffering til the end as any kind of badge of courage. Just saying…
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      • Edie Jarolim
        Posted October 17, 2013 at 4:54 pm | Permalink

        Thanks for the support, Mary. Yes, I think it would be a kindness to have that option for humans too. That would be my choice — if I had one.

    • Karen
      Posted November 7, 2013 at 2:10 pm | Permalink

      Alicia Robinson: I’m so very sorry that you have physical ailments. But, you obviously have never loved someone with terminal cancer. A cancer that takes away every shred of dignity that one has left. A cancer that even morphine can not control the pain. A cancer that wraps itself around the person’s spine, until they no longer have the use of their lower body, in any fashion. A cancer that slowly at times, and quickly at other times, causes internal blood loss. And you have never had that loved one, upon seeing this same thing happen to their siblings, beg you, to not let them die that way. Don’t judge other people. You don’t have that right.

  9. Tara
    Posted October 17, 2013 at 4:08 pm | Permalink

    During the evening hours of July 15th of this year, I noticed that Tinker tried to poo, nothing. I called the ER Vet and they told me to give him some mineral oil and that he should go within 2 hours, he laid by my chair, still nothing. At 3:30 am, my husband and I were at their office. An all body x-ray showed nothing in his stomach, his prostrate was enlarged, his heart was enlarged and had a growth in this belly. Tinker showed up in my doorstep on the morning of July 4, 1999, I figured his was between 4 and 6 months old. He was my baby. The ER vet said he would leave it to my regular vet to treat him. Could have punched him. At 9 am on the 16th, I had Tinker at his regular vet. His heart wasn’t just enlarged it was 4x times the size it should be. They started him on heart meds and 20 mgs of Lasix 2x day. I gave him wet food to get him to eat and eat he did. That was Tuesday. On Wednesday he ate, and pee’d cause of the Lasix. On Thursday, I noticed he wasn’t right. The heart med said to call if you noticed a change in your pet, if they were taking the heart med and Lasix, I called and was told to come right in. He didn’t seem to be getting rid of the fluid, and on his left side was a ribbon of fluid. This was around 2:30 pm. Dr. Gibson was so wonderful in talking to me, explaing what was going on. Tinker’s feet were cold, his body temp was down, his breathing was labored. I listened to all she had to say through tears, that she didn’t think he’d make it to the weekend and that if I wanted to bring him home and come back Friday, that would be ok, that I didn’t want to see him hurting for breath. I brought my baby home, to talk to my husband. All I could do was cry, I finally told him what Dr. Gibson said. About 4:15 pm, after holding Tinker like a baby for over an hour, I asked him to take us back to the vet. The people knew when we came in why I was back. Dr. Gibson came in to talk to us, to explain what she would do, I was holding him not wanting to let go, she gave him the first shot, I held him till it was time for her to give him the second shot. When she brought him back afterwards, she told me that they had made a paw print and would send it to me. Everyone in the outter part of the office knew when I came out what had happened. My husband dug a place for Tinker, when he came to get him, it was all I could do to let him have him. Had it not been for the kindness that Dr. Gibson expressed to me that day, I wouldn’t have been able to do what I did.

    There are some vets who are like Dr. Gibson and some who, well there are no nice words to describe how cold they are. Instead of charging us an outrageous amount for the shots, that many vets would have, the cost was $20.

    All I can say, they tell you, and if they can’t you have to make that decision, and there are times you just know when. I still grieve today and will for a very long time.

    • Edie Jarolim
      Posted October 17, 2013 at 4:14 pm | Permalink

      I’m very sorry for your loss. I’m glad that, at the end, you had a kind vet to ease Tinker out of this world.

  10. karen
    Posted October 17, 2013 at 6:09 pm | Permalink

    My beautiful young ridgeback died a horrible excruciating death while my vet and I tried to save him over several days. We didn’t know what was wrong, that he had been poisoned He finally died in my arms waiting for the vet to come and euthanize him. I regret so much that we put him through it ,that we didn’t put him out of his misery days earlier but we were so hopeful that he would be okay because he was so young. I will never make that mistake again of letting one of my babies suffer like that. Euthanasia of animals in pain(not to be confused with shelters killing healthy animals) is a blessing.

  11. Posted October 17, 2013 at 10:16 pm | Permalink

    It’s such an individual choice – choice being the operative word, with regard to our responsibilities as stewards and caretakers of our animals – . Being able to relieve suffering is a godsend.

    Having been there with dogs who I had to put to sleep, I felt that I was able to communicate to them what was happening so they did not feel ‘lost.’ One dog I couldn’t be with, I did later feel had experienced unnecessary confusion upon passing, so I don’t particularly agree that pets should have to go ‘naturally’ if proper attention is paid.

    After Ellie, my oldest, alpha female dog passed away last year, I was most concerned that the two younger male dogs would feel abandoned and lost, and they did for a short while. Within a week, we found and rescued a litter of puppies and that drew them out of their funk immediately, having to be ‘parents’ suddenly for a bunch of young pups. The puppies filled that vacuum she had left. It was a little ‘uncanny’.
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  12. lYNDA nAUSEDA
    Posted October 18, 2013 at 4:08 am | Permalink

    Marty this is where you guys come in.When its time to let my fury family go Im pretty sure but I need that extra push of reality to help me.Lucky for me I have kind and compassionate vets who dont push extra expensive treatments to prolong for the sake of their own pockets.I always want a straight shooter when it comes to my vet.Its SO difficult but I feel our pets job to help us love again and through their passing opens the heart for another orphan .

  13. heidi
    Posted November 7, 2013 at 1:18 pm | Permalink

    Im struggling with this at the moment. I have a chi that we think has a brain tumor. Hes always had seizures and has done well on Pheno. One day several months ago he got stuck walking in a tight circle he couldnt get out of. he couldnt turn to the left. we made the decision to put him on Prednisone. It worked and for a few months he was back to his normal.

    now he is in decline, he has good days and bad. just when i think its time, he rallies and can come almost back to normal for a few days. then the pattern starts again. its been a roller coaster of emotions. he still eats and drinks, takes himself out, is engaged but sometimes uncoordinated. My vet thinks he will lose mobility all together and thats when its time. Its so hard because mentally hes totally with us.

  14. franny
    Posted November 7, 2013 at 4:12 pm | Permalink

    I have had to let two of my elderly dear ones leave the earth this year and it was devastating. I am one of the lucky ones though, as the vet who cared for Rowan came to the house once we knew it was time and he gave Rowan a beautiful and pain free passing. I knew it was time and so did Row.
    With Rock it was a bit different. Rock was diagnosed with CHF and atrial fib about two years ago. At that time the cardiologist gave him 6 months to a year. We went home with meds to ease the CHF and we had great days and not so great days. On our last regular visit my vet indicated that he was progressing in the disease process and at some point soon we would turn a corner, and that we would know that as it happened. A month later we seemed to reach that corner and we decided to visit the vet once more to get a sense of where we were. Upon seeing Rock our dear vet said, ” we have come to the corner”. Not words I wanted to hear, but seeing Rock struggling to breath and so unhappy, we simply did the best possible thing for him and let him sail away, knowing we surrounded him with our good energies and our love.

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