The Importance of a Meaningful Goodbye

By Rev. Eliza Blanchard 

Interfaith Spiritual Advisor

 

Why do final goodbyes hurt so much? 

It is tempting to avoid them, sneak out the back way. Goodbyes mean that an end to what we cherished is real. We fear what others will think if we make “such a fuss” over a pet. We are afraid we’ll give way to our deepest grief.  We’ve never lost one so dear, so how does this work?

There are lots of reasons why we just don’t want to think about the end.

As a minister, I’ve worked with many grieving people as they struggle to create a farewell for loved ones. With some guidance most people find the experience hard but helpful. At New England Pet Hospice and Home Care, I’ve also helped folks at the end of life or with funerals and memorials for their beloved animal companions. They too find the experience enriching, especially as they recall their favorite moments with their friends, and realize that their love is not gone, that it endures always.

In my experience making the most complete goodbye helps.

Why? Because goodbyes are a way to honor the dead, to hold our feelings about our beloved, and to celebrate the gift that relationship is. In saying goodbye, we give meaning to mortality, and we gain wisdom about the meaning of life.

 

Fully saying good-bye creates meaning 
 

Because it gives a shape to a heart-breaking welter of emotions. For many, creating a complete good-bye is like telling a satisfying story: what I’m calling a “complete goodbye” includes a beginning (how we got here), a middle (what the journey’s been like, and what have been the highlights), and an end (what this precious life meant and why this being will be missed). This may feel formal, and that’s exactly right - a form gives shape to our sorrow and our loss. And a shape helps us hold onto what’s valuable about having those feelings. Honoring the relationship and being thankful for the positive things may even help resolve the mixed feelings, which can include guilt or failure, some mourners have.

Whatever tradition you come from or love can be a source for readings, blessings, music, and rituals you might include; it depends on how formal a farewell you want. Most importantly, your own words, tears, and stories are the most important elements of a goodbye to one you love.

 

                                                                                           
      

 

Resources:

• Douglas, Barbara Rosenfeld. Gently Into the Night: A Guide to Creating Your Pet’s Memorial Service. www.heartsoulpet.com, 2012
• Kowalski, Gary. Goodbye, Friend: Healing Wisdom for Anyone Who Has Ever Lost a Pet. Stillpoint Publishing: Walpole, New Hampshire. 1997.Greene,
• Lorri A, and Jacquelyn Landis. Saying Good-bye to the Pet You Love. New Harbinger Publications, Inc.:Oakland, CA. 2002.

WANT TO USE THIS ARTICLE IN YOUR EZINE OR WEB SITE? You can, as long as you include this complete blurb with it: “New England Pet Hospice & Home Care supports those caring for ill, elderly and special needs animals at home following the human hospice and palliative care models of interdisciplinary care. Learn more and get your FREE subscription to Wag & Purr: Your Guide to Comfort Care for Pets at www.NewEnglandPetHospice.com"

Side Effects of Chemotherapy

by Michelle Spencer
Veterinary Technician, Oncology Specialist

 

In this article, we discuss common side effects of chemotherapeutic agents and how your veterinary team can work to combat them.

When deciding whether or not to treat your pet’s cancer with chemotherapy, it is very important to keep two things in mind:

·       Quality of life is the driving force behind veterinary oncology
·       Cancer treatment is fluid and there is room for assessment at each step in the road

The occurrence and severity of side effects from chemotherapy in veterinary medicine are significantly less than those found in human medicine. To understand this discrepancy, it helps to look at the goals in veterinary oncology vs. those in human oncology. Veterinary oncology focuses on quality of life, while human oncology tends to focus on quantity of life. For that reason, chemotherapy dosing, schedules and protocols are less intensive in veterinary medicine, often resulting in less severe side effects. Research shows that less than 5% of veterinary oncology patients experience severe side effects requiring hospitalization.¹ Most side effects can be managed at home with oral medications and generally last only a few days.

Common Side Effects

Most chemotherapeutic agents work by killing or inhibiting the growth of rapidly dividing cells. However, most agents do not have the ability to discriminate between cancer cells and other healthy, rapidly dividing cells within a pet’s body. It is the destruction of these healthy cells that tends to cause the most common side effects.

Gastrointestinal

Healthy cells in a pet’s GI tract turnover frequently, about every 3-5 days. Because chemotherapy can kill these rapidly dividing cells, your pet my experience GI side effects 3-5 days after treatment  including vomiting, diarrhea and inappetence. Most of these side effects are self limiting and resolve within a couple of days. However, should your pet experience vomiting multiple times per day, vomiting multiple days in a row, prolonged inappetence, prolonged diarrhea or bloody or tarry diarrhea, notify your veterinarian immediately.

If your pet experiences an episode of vomiting,  you will likely be asked to pull food and water away from your pet for 12 hours and then slowly reintroduce it. Your pet may be given antiemetics such as Cerenia, Zofran or Reglan. These will help to combat nausea and vomiting and can usually be taken at home.

If your pet experiences a minor bout of diarrhea, an antidiarrheal such as Flagyl may be given at home. For more severe cases, your pet may need rehydration and injectable medications at your clinic.

Discuss episodes of inappetence with your oncologist. Occasional bouts may be cured by enhancing your pet’s meals with chicken broth, tuna juice, etc. Chronic inappetence should be examined and may be cured with oral medications such as mirtazapine.

Some agents such as piroxicam may cause gastric ulcers. Your veterinarian can give you medications such as carafate to help prevent ulcers by coating the GI tract with a protective barrier.

Bone Marrow Suppression

Your pet’s bone marrow is responsible for the production of blood cells. Because it is a site of rapidly dividing cells, it is a prime target for the effects of chemotherapy treatment. Most side effects arise when your pet’s bone marrow is unable to produce enough platelets (thrombocytopenia) or neutrophils (neutropenia). A lack of platelets can reduce the ability of your pet’s blood to clot properly. This can result in uncontrolled bleeding. A lack of neutrophils reduces your pet’s ability to fight infection. Common indications of infection are lethargy and a fever above 103°. If your pet is neutropenic, but otherwise feeling well, a prophylactic course of antibiotics may be prescribed. Should your pet develop an infection in their blood stream (sepsis), they will be hospitalized for intensive supportive care such as IV antibiotics and fluids. Sepsis is a dangerous situation and should not be taken lightly.

Because of the lifespan of these cells and the rate at which the bone marrow produces replacements, your pet is most likely to experience a drop in platelets or neutrophils about 5-10 days post treatment. During this time, you will be asked to bring your pet to the clinic for a Complete Blood Count to thoroughly evaluate these and other blood cells. This test is extremely important, and should not be missed.

Less Common Side Effects

Alopecia

Though hair loss is much less common in cats and dogs than humans, some breeds may lose hair, especially eyebrows and whiskers, during treatment. Non-shedding breeds are at greater risk for hair loss. Hair growth generally returns, but hair texture and color may differ.

Cardiotoxicity

Some agents, such as doxorubicin, may cause irreversible changes to a pet’s heart. A risk vs. benefit discussion should take place with your oncologist prior to treatment. If your pet is treated with an agent known to cause cardiotoxicity, expect them to have frequent ultrasounds of their heart (echocardiograms).

Allergic Reactions

Some pets may experience an allergic reaction to a chemotherapeutic agent. Though the most common culprit tends to be l-asparaginase, it is possible to have a reaction to any drug. These reactions can range from minor to severe, though the latter is quite rare. Normally, they can be treated with a few minor injections and some monitoring at your clinic. If you expect that your pet is experiencing an allergic reaction, call your clinic or visit an emergency hospital immediately.

Prior to treatment, discuss possible side effects of chemotherapy with your veterinary oncologist. Together, you can proactively formulate an action plan to provide your pet with relief.

Thank you for joining us for our third installment on companion animal cancer. In our next article, we will discuss veterinary radiation oncology and how it can benefit your pet.

¹Clinical Oncology Service,  Veterinary Hospital of the University of Pennsylvania (VHUP)

 

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What Happens After Death?

By Rev. Eliza Blanchard, Interfaith Spiritual Advisor

 

Sometimes I’m asked what happens to the soul of a pet when it dies. I don’t discriminate between species in life or in death: we all want to know where our best beloveds are, that they are free of pain,that they are safe, happy, loved.  

I assure people that their animal companions are loved, that they will always be loved, and that I’m as sure as I am of anything in this world that they are free from all suffering. Where those spirits are, I say, I don’t know. I can’t prove that there is a heaven, an afterlife, or rebirth. Many people believe that life leads to one of those states of being. Some believe that heaven is reserved for humans, while others believe their pet has joined other family members there. And for some, the death of a beloved challenges belief, bringing forth confusion or doubt.

Having doubts is normal, especially when mourning. We wonder why illness exists, why loved ones suffer, or why loved ones die. We may even fight mortality, reject it, or get angry at Whomever made such a world. Often such questions lead us to examine our values, review what’s important, and what commands our devotion. Here is an opportunity to seek out a trusted, friend, clergy, or counselor – someone to listen thoughtfully and reflect with you.
 

Our struggles can help us renew meaning.

I am sometimes asked what I believe about the souls of animals. I believe that - as physics teaches us - the energy doesn’t disappear. It can live on in and through us, as abiding spirits, as heavenly companions, as stardust, or as new beings born in another country. If you have lost a beloved pet, take the time to imagine where such a vibrant spirit is right now. Where did that vibrancy and affection get channeled? How might it move through the universe? Where might it find a home? How do you stay attuned to it? It is through that connection that our love is everlasting.

Know and cherish is the extra-ordinariness of life and the humility imposed by mortality. Bow to the mystery of existence. I believe in our powers of reason and in the greater understanding that science often leads us to.
 

Beyond the limits of reason is where
our deepest questions lie.

What I have witnessed many times is that

Love is the Answer.
 

 

Rev. Eliza Blanchard serves as Interfaith Spiritual Advisor to New England Pet Hospice & Home Care.  An ordained Unitarian-Universalist Minister, Eliza helps those of all faiths as well as those who follow no particular religious tradition find hope, meaning, and peace while caring for and mourning the loss of our beloved animal companions. 

 

WANT TO USE THIS ARTICLE IN YOUR EZINE OR WEB SITE? You can, as long as you include this complete blurb with it: “New England Pet Hospice & Home Care supports those caring for ill, elderly and special needs animals at home following the human hospice and palliative care models of interdisciplinary care. Learn more and get your FREE subscription to Wag & Purr: Your Guide to Comfort Care for Pets at www.NewEnglandPetHospice.com"

What You NEED to Know About Cancer Treatments

By Michelle Spencer, Veterinary Technician, Oncology Specialist

 

Welcome to our series on companion animal cancer. In the previous article, we discussed events that typically occur after your pet has been diagnosed with cancer. In this article, we answer some questions about chemotherapy treatments and present tips on how to find the best oncology team for your pet.
 

Choosing a treatment facility

Veterinary oncology is still a growing field. In some cases, usually due to geographical or financial concerns, your choices may be limited. If you do have the opportunity to choose from more than one treatment facility, ask yourself a few questions:

• Is your doctor a board certified Veterinary Oncologist?
• How far away is their office? How well does your pet handle the trip? Will you be able to travel there weekly, monthly, etc? Do they have hours that will accommodate your schedule?
• Do they offer financial plans, counseling, assistance?
• Will your pet remain with you during treatments? Will you drop your pet off for the day for treatment?

 

Chemotherapy

The word itself makes you cringe. But, remember, the goal of cancer treatment in pets is to control or eradicate cancer cells while preserving a good quality of life. Cancer treatment is fluid and there is room for assessment at each step in the road.

Some cancers normally respond very well to chemotherapy, while others do not. Your veterinary oncologist will be your most reliable source of information on this subject and will guide you through the decision making process.

Chemotherapy typically comes in the form of pills or liquid injectables. Intravenous, intramuscular and subcutaneous injections must be given at your veterinary office by qualified doctors and technicians. Some injections take just minutes, while others are delivered over a period of hours. At some clinics, you may be allowed to stay with your pet if they are receiving a short injection. Intravenous chemotherapy can be dangerous if it leaks outside of a vein, so it is best for your pet to remain calm and still during treatment. If your presence seems to excite your pet, the staff may ask you to wait outside for a bit while the treatment is in progress. In rare instances, some pets may require medication to help them relax during the injection.

If your pet is receiving a treatment that is given over a number of hours, you will be asked to leave them at the facility during that time. Normally, in such cases, there are rules and regulations in place to keep both you and your pet safe during lengthy chemotherapy infusions.  For instance, only a qualified staff member can attend to urine, feces and vomit should they occur during an infusion.

Chemotherapy treatments tend to follow a proven protocol or schedule. You should be presented with a schedule prior to treatment. The schedule should also include information about when certain blood tests must be run. While these blood tests normally do not indicate the cancers response, they will provide critical information about how your pet’s organs are handling treatment and alert you to infections.

Some pets may also qualify for a clinical trial. Normally, your veterinarian will present this option to you if they think it may be appropriate for your pet. Occasionally, some companies will provide you with free or discounted medications for participating in their trial.

Speaking with your veterinarian about the common and not so common side effects of chemotherapy and the proper precautions needed when cleaning up after a pet who has recently received a chemotherapy treatment, is a very important step. These issues will be addressed further in an upcoming article.

In our next article, we will discuss common side effects of chemotherapy agents, and the medications used to treat them. 

 

WANT TO USE THIS ARTICLE IN YOUR EZINE OR WEB SITE? You can, as long as you include this complete blurb with it: “New England Pet Hospice & Home Care supports those caring for ill, elderly and special needs animals at home following the human hospice and palliative care models of interdisciplinary care. Learn more and get your FREE subscription to Wag & Purr: Your Guide to Comfort Care for Pets at www.NewEnglandPetHospice.com"

OUCH! That Hurts - Identifying Pain

By Amanda Brown, Certified Veterinary Technician

A newly diagnosed illness can be very traumatic for both the family involved and the animal.  Pain management is key in the success of healing and well being for the ill or dying.  Often times we are not aware that our beloved pet is in any amount of pain until they begin exhibiting signs of abnormal behaviors or signs of discomfort.   Instinctively, animals will disguise pain to avoid becoming prey in the wild, so it is not until the pain has become so severe to the animal that we notice changes in their behavior. You, as the pet owner, are most equipped in determining whether noticeable routines and functioning of the animal are related to pain or social manners.

Pain triggers a series of physiological changes that increase stress.  These changes can affect all major body functions and may trigger abnormal body responses.  These modifications to normal body function can decrease the body’s immune system and its ability to work effectively.  For example, potential side effects of stress in animals include loss of appetite; increased heart rate; delayed wound healing; and/or a sudden onset of infection.

According to the AAHA Pain Management Guidelines for Dogs and Cats these are common signs of pain:

GENERAL SIGNS	SPECIFIC SIGNS
Loss of normal behavior	Decreased appetite, decreased activity, lethargic, decreased grooming (cats)
Expression of abnormal behaviors	Inappropriate elimination, vocalization, aggression, decreased interaction with other pets or family members, altered posture, restlessness, hiding (especially in cats)
Reaction to touch	Increased body tension or flinching, injured area and touch of regions may illicit reaction
Physiologic parameters	Elevations in heart rate, respiratory rate, body temperature, and blood pressure; pupil dilation

 

No animal should need to prove that they are in pain, which is why we as veterinary professionals have developed what we call a Multimodal approach to pain management. Multimodal Pain Management (MPM) is a tactic that takes advantage of the synergistic affects obtained by combining two or more classes of drugs to alter more than one phase of the pain pathway.

MPM is the best way to approach pain management, and provides comfort not only to the animal, but the pet owner as well.  Observation, touch, and knowledge of how pain can be displayed combined with how to defeat pain, will now make dealing with an otherwise disheartening situation easier.

The AAHA Pain Management Guidelines also note the following overlooked causes of pain:

 

Learning to recognize pain in your pet is one of the most important things you can do for him or her. Pain indicates injury, illness, and decline. Picking up on it early can make a very big difference in your pet's comfort and prognosis.

If you think your pet may be in pain, talk to your vet about options for treating it.  Sometimes the only way we can determine if an animal is in pain is to treat for pain and see what happens. You may be surprised! Your couch potato may become more active, your grumpy old man may become more friendly, and that occasional hitch in her giddy-up may lessen or disappear.
 

WANT TO USE THIS ARTICLE IN YOUR EZINE OR WEB SITE? You can, as long as you include this complete blurb with it: “New England Pet Hospice & Home Care supports those caring for ill, elderly and special needs animals at home following the human hospice and palliative care models of interdisciplinary care. Learn more and get your FREE subscription to Wag & Purr: Your Guide to Comfort Care for Pets at www.NewEnglandPetHospice.com"

Diagnosis Cancer: Now What?

By Michelle Spencer, Veterinary Technician

Welcome to our series on companion animal cancer. In this article, we address what normally happens after your pet has been diagnosed. In future articles, we will address the ins-and-outs of conventional treatments, alternative treatments and palliative care.

A diagnosis of cancer in your pet can be terrifying. But remember, you are not alone. Your veterinary team and New England Pet Hospice & Home Care are here to support you every step of the way.
 

Step One: Staging

Staging is the act of running a series of medical tests to obtain additional information.  Staging allows your veterinarian to see the extent of cancer spread throughout your pet’s body and to assess your pet’s ability to handle certain treatments.

 Three types of medical tests are typically run during the staging process:

Imaging: The mode of imaging chosen will depend upon the type and location of the cancer. It may include x-rays, an ultrasound, an MRI or a CT scan. Imaging  shows not only the spread of cancer, but also the integrity of internal organs. For instance, while an echocardiogram may not show spread of cancer to the heart, it may show an abnormality in the heart muscle, which may affect the your pet’s tolerance for treatment. In that case, special precautions may need to be taken or another treatment option chosen.

Blood Work/Urinalysis: Typically, a Complete Blood Count (“CBC”), Serum Chemistry and Urinalysis will be run. These tests are not used to diagnose cancer (except certain blood cancers) but provide information about the cancer’s behavior, any infection and how well your pet’s organs are functioning. For instance, while a pet’s liver may look healthy on an ultrasound, an abnormal blood test measuring liver function may reveal an issue.

Additional Cytology (cell investigation): Your veterinarian may need to look at additional cells under the microscope to get more information about your pet’s disease. This may involve a needle aspirate (a quick and simple procedure under local anesthesia), a biopsy or even surgery.
 

Step Two: Treatment Options

After gathering further information about your pet’s disease, your veterinarian will present you with treatment options.

Some cancers respond very well to conventional treatments, such as chemotherapy and/or radiation therapy, while others simply do not. Your veterinary medical oncologist and veterinary radiation oncologist are the best sources of information about treatment options, but always keep in mind:

1. The goal of cancer treatment in pets is to control or eradicate the cancer cells while preserving a good quality of life. Your veterinary oncologist relies on you to assess your pet’s daily quality of life at home and communicate that information often. Remember, quality of life is the driving force behind veterinary oncology, and you are your pet’s voice.

  

2. You and your pet are not trapped. Cancer treatment is fluid and there is room for assessment at each step in the road. If, for instance, you begin treatment and your pet experiences side effects, you, along with your veterinarian, may decide that you will no longer use that type of medicine or even that you no longer wish to proceed with that form of treatment. On the flip side, you may cautiously begin treatment and, after seeing a positive reaction, decide that it’s appropriate for your pet to continue or pursue more aggressive treatment.   Remember, you always have choices.

Making decisions about whether and what type of treatment to pursue can seem overwhelming.  In  the next issue of Wag & Purr, we will talk about how to make decisions in times of crisis and confusion that will feel right to you both in the moment and when you look back on them.
 

Michelle Spencer is a Veterinary Technician with New England Pet Hospice & Home Care.  Michelle has been a Veterinary Technician for 12 years, much of it devoted to the field of oncology, including more than five years at New England Veterinary Oncology Group as a Medical Oncology Technician, at Dana-Farber Cancer Institute as a Clinical Research Coordinator, and more than 5 years at Massachusetts Veterinary Referral Hospital as a Critical Care Technician. 

WANT TO USE THIS ARTICLE IN YOUR EZINE OR WEB SITE? You can, as long as you include this complete blurb with it: “New England Pet Hospice & Home Care supports those caring for ill, elderly and special needs animals at home following the human hospice and palliative care models of interdisciplinary care. Learn more and get your FREE subscription to Wag & Purr: Your Guide to Comfort Care for Pets at www.NewEnglandPetHospice.com"

The Rainbow Bridge and a Glass of Water

Two days ago, I was on a pet loss bulletin board and someone posed this dilemma:

 “Here’s the problem I have with the whole Rainbow Bridge thing – what if my husband dies first? Does my dog go with him to heaven?  So when I get there, no one I waiting for me? Or does he wait for me to get there and my husband has to be without him until I get there? And what about my childhood dog? Is he with my parents – or waiting for me and my sister?”

[If you have no idea what the Rainbow Bridge is, the thumbnail sketch: some believe, literally or figuratively, when an animal passes, it waits in a big field by a rainbow bridge for its human to pass away. When the human dies, human and animal are reunited in this “pre-heaven” and cross the rainbow bridge to the afterlife together.  It’s a lovely poem by an unknown author that can be read in its entirety here.]

     I have been thinking about this person’s comment (and the many similar ones that were posted as follow up messages) ever since.

     I think of it this way: our bodies and those of our animals are merely containers for our essence/soul/spirit/energy/love/whatever you want to call it.  Like water in a glass, when we are stuck in the container, we can only be in one place at a time and only in one very rigid form.

     But release the water from the glass and what happens?  It transforms.  It is still the same water, but can be many places at once. It can be many different forms, from tiny droplets to giant puddles. It flows, separates and reconnects. It is here, but also there. It is many things while still being the same thing.  And I believe the same is true of our spirit when it is released from the confinements of our physical body.

     So if you ask me, do I personally think you will be reunited with your beloved animals when you pass from this life?  I will say yes.  They are waiting for you – and also for every one else who touched their life and whose life they touched.  They will go with you and they will wait for the others - at the very same time. They don’t have to choose and no one has to make that journey alone.

     At least, that’s what I think. There are many ideas about what, if anything, comes next and the truth is, none of us really knows. It’s not about finding the one Truth, but about finding our own truth.

What do you think?