Permission to Grieve, Part I

From www.sharingandhealing.org

When we talk to clients facing heart-wrenching decisions, we frequently hear apologies about their tears or distress. I always reply that, of course, it is okay and that there’s no need to apologize. However, my response never seems to do justice to just how acceptable and expected it is for them to be feeling so overwhelmed. Losing a pet can be devastating, and facing end-of-life decisions can be agonizing. The apologies I hear often bring to mind an old memory of a gentleman in a pet loss support group who gently said to an apologizing woman overwhelmed with grief and tears:

“You know, when you are drowning in a swamp full of alligators, nobody expects you to get out of there with grace.”

When faced with profound losses and devastating decisions, feeling overwhelmed is an incredibly normal and natural response – you are doing what you can to survive this moment. That man said it better than I’ve ever been able to, and his echoing words consistently remind me that a grieving heart needs compassion, patience and permission to grieve.

Burying your grief or pushing it aside won’t make the pain disappear or the process move more quickly. It seems that we often feel that if we’re attending to our grief, we’re somehow dwelling on our loss or failing to move on. In fact, it is usually just the opposite. Consider how we approach our physical ailments. If you break your leg, you give your body time to rest and heal. You may know that you will someday walk or even run again, but for now, you care for your body and listen to what it needs. It can help to envision your grief in much the same way.

Unfortunately, the grief we feel following the loss of a pet still lacks the social acceptance that other forms of grief are awarded, and we often have to claim our own time and space to grieve. It takes an extra step of courage and self-awareness to ask to take the day from work, to call a family member or friend to come watch your kids for an afternoon, or to simply allow yourself to cry when you feel the need to. As difficult as it can be to give yourself permission, it’s important to remember that your needs are worthy of the same patience and compassion you give those you love.

We have written before about how crying can help us physically express our grief.  Tears, however, seem to be one of the most common things people feel the need to prevent or apologize for. Often, our worst fear is breaking down into tears at work, at a social gathering, or even in front of our children. Giving yourself permission to process and honor your grief involves listening to your body and working with the emotions you are feeling, rather than burying them or setting them aside for later.  And sometimes people find that even just consciously giving themselves permission to feel overwhelmed and to express their sadness lifts a burden off their heart.

Remember, our society does not always support healthy grieving processes; most of us are conditioned to ignore, move on, and “get over it”. Once we step outside of those expectations, it’s easier to give ourselves the freedom and space to grieve, heal and grow. Sometimes we need help walking this path and claiming the space we need, and we may also need to give ourselves permission to look outside ourselves for help from family, friends, support groups or professionals.

Next week: Permission to Grieve, Part II (Permission to Heal)

Posted in Grieving the loss of a pet | 26 Comments

A Good Cry

Built to cry…

The grief that accompanies the loss of a beloved companion animal is profound and the pain of that loss can be felt emotionally, spiritually, and physically.  Grief is a grueling physical experience and shedding tears is one of the ways our body supports us in processing and healing from loss.

Sadness and grief are the emotions that help us with loss.  When a significant loss is sustained there is a buildup of emotion that, if we allow it, is expressed physically through crying.  That release often helps us “process” the experience we are facing and among other things, can help us to recover some mental balance.

Scientific research supports the belief that crying is good for our health.  Generally, it is agreed that there is a buildup of toxic stress hormones that are released into our bodies prior to crying.  Stress hormones negatively affect virtually every system in our bodies.  We know that tears contain these hormones and help to cleanse our bodies of them.  Thus, crying is a natural and essential biological function that results in the elimination of stress hormones associated with stress-related health problems. Crying relieves stress, lowers blood pressure, removes toxic stress hormones, and also helps to remove manganese, a mineral which is responsible for negative effects on mood.

Neuroscientist and tear researcher, Dr. William H. Frey explains that, “crying is not only a human response to sorrow, it’s a healthy one.  Crying is a natural way to reduce emotional stress that, left unchecked, has negative effects on the body, including increasing the risk of cardiovascular disease and other stress related disorders”.

The “water” in you…

The human body is 60% water and our blood is 83% water.  Metaphorically speaking, it may be useful to think of the water in our body as our “body of water” and in that way consider its function, the ways it flows, or is dammed.  When we experience a shock to our system, such as the death of a loved one, we become tense.  Stress hormones build up in our bodies and we may even get a lump in our throat.  All of these create a sense of blockage – damming our energy and waters.  Tears restore flow, allowing our water and energy to move freely – opening our waterways, connecting us to our healing waters…. cleansing us.

In her book, The Language of Emotions: What Your Feelings Are Trying To Tell You, Karla McLaren explains that, “many of us, because we’ve had such poor socialization around sadness, think that sadness is only about loss, it’s not.  Sadness is also about restoring flow, ease, and relaxation…. Because when you finally let go of things that just don’t work, you’ll suddenly have room for things that do.”  McLaren says that the questions to ask of sadness are, “What must be released? And what must be rejuvenated?

In the case of grief and its accompanying sadness, we do not have a choice about whether or not to let our loved one go, their life has come to a close.  Sadness and tears help us with the very difficult task of letting go of the things that can no longer be held on to, restoring the flow of our “healing waters”, and creating space for us to move into what comes next.

Posted in Grieving the loss of a pet | 6 Comments

Waiting for a Sign

dog cloudThe fact is we don’t know a whole lot about how animals communicate, but we certainly know that they do. It’s possible there is a lot more communication happening between us and our animals than we are sometimes aware of, or give ourselves (or them) credit for. It’s an opportunity to develop our emotional intelligence and also to shift our attention to both the verbal and non-verbal ways that we communicate.

Interspecies communication is mysterious at best, and yet we know that we communicate with our animals every day and that they communicate with us. But how do we do it? And how much is understood? Communication takes on profound importance when we are companioning our beloved animal through illness and death. They can’t tell us where it hurts, what makes them most comfortable, or what their wishes are as they make their way through this final transition.

We wish to honor our pet’s dying process while wanting also to alleviate their suffering. We understand our obligation to them as guardians and the responsibility of taking care of them in their final days and moments, and yet we also know them as unique individuals with desires and thoughts of their own. People often say that they are “waiting for a sign” from their dear one, something that lets them know that the time has come.

Remembering that the two of you have been communicating throughout your relationship and that you are the ultimate authority on how that has occurred is a place to begin. Take a moment to reflect on the specific ways you and your pet “talk” with one another. In your minds’ eye take yourself through a typical day – it often begins with waking up, going “potty” and having some breakfast. Even in those brief moments it is easy to determine that there are so very many examples of communication and it is helpful to take a mental note of all of the ways that occurs. Yawns and “kisses”, a look, attentive posture, wags, purrs, going to the door. We look at them questioning and they look at us confirming. We ask them if they have to go potty and they confirm… they do!

We learn to understand a great deal about what our pet is communicating to us and we develop a sense of “knowing” them in an intuitive way. When things are going fine and there is little at stake, we have no trouble trusting that intuition. We have this ability with people, too, and we don’t question it much, but with humans we can verify its accuracy verbally.  However, when we are faced with the seriousness of illness and death and the fear that often accompanies such a situation, we sometimes find that end-of-life discussion just too painful to talk about and too heartbreaking to “listen” to.  In those very difficult moments when so much is at stake, we sometimes forget or lose track of our intuition and our ability to communicate the way we normally do. It is just much more difficult to center ourselves and connect with our dear animal in times of crisis and pain.

Plan to take some private, reflective time to talk with your pet. In preparation, try to make sure that you will not be disturbed. Find a comfortable place to sit with your pet and take a few deep, centering breaths. As you begin to talk, be open to the ways you are experiencing the communication and attentive to the ways you are “hearing” from your pet. These may be thoughts, emotions, body sensations, images, and intuitions. Take note of what you are hearing, remembering also to let there be silence or gaps in what you are saying in order to make room for “hearing”.  You can say as much or as little as makes sense to you.

Things to talk about:

-what they have done for you / what they have meant to you

-what you are grateful for

-what you would like to apologize for

-what you know about their condition and that it is not going to get better

-that euthanasia is an option for them

-what you are struggling with

-what you have questions about

-that you are waiting for them to give you a sign

-that even though you will be very sad when they are gone, that you will be OK, and that it is OK for them to go.

We don’t necessarily know that our pets understand all of the words that we say, but is it not possible that they “hear” some part of what we are expressing to them from our hearts?  When we gather ourselves to give expression to our thoughts and feelings there is power in it.

Click here for a FREE printable version of this article:  Waiting For a Sign

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MN Pets is Different

A few years ago, I faced terminal diseases with each of our family’s two rescued beagles. We chose to experience the euthanasia of Hiro and Asia at home. Losing our pets was so difficult but being at home made it more peaceful for them and more private and meaningful for us. These experiences convinced me that difficult times could be made easier by offering clients a choice of euthanasia at home and inspired me to create MN Pets.

You will find that home euthanasia is very different from a clinical experience. We have had the honor of helping many people and their beloved pets by supporting them through a pet’s euthanasia in the comforting familiarity of their own home. That first-hand experience has made us uniquely capable of creating a relaxed and meaningful experience for you and your beloved pet. Our goal is to help create positive memories for you and other family members as well as to help provide the most peaceful final moments together for you and your beloved companion.

How are we different?

Local
Our veterinarians have helped thousands of pets right here in Minnesota.  We personally know many of the veterinarians who are your pet’s “regular veterinarian” and have close relationships with many clinics in the Twin Cities.

Focus
We focus exclusively on home euthanasia services and do not provide other services.  Our day is scheduled to provide ample time with each pet.  We have unique experience with euthanasia in the home setting and have developed special protocols to ensure comfort and support for pets and family members.

Relaxing Sedative
This medication helps your pet ease slowly into a pain-free, completely relaxed rest. We find that it comforts family members to slow down the process and observe their pet transition from an awake to a sleeping state.

Simplicity
When your pet is sleeping, we administer the medication to painlessly end your pet’s life. It takes effect within a minute or so and quietly slows body functions. There is no conscious awareness of this for your pet. We believe simplicity brings peacefulness and so we don’t bring an assistant or go through placing an IV.

Experience
Our compassionate veterinarians have many years of experience in the field of veterinary medicine.  We have all practiced in small animal clinics.  Each of us has chosen to focus our career on helping pets at the end of life. We are able to guide families through the process of euthanasia, answer questions and include family members, including children and other pets in a way that is meaningful for them.

Support
We also employ a licensed family therapist with specific training as a grief counselor and end-of-life issues related to the human-animal bond. She is available to our clients who would like support with end-of-life decision making, grief support, and for families who would like information about how to talk with children about death and dying. She also supports the education of our doctor staff on grief support skills and other topics.

Availability
Because Minnesota Pets has four licensed veterinarians we are broadly available to our clients. We have appointments available every day of the week, on weekends, and in the evening, for example. We understand that timing at end-of-life is unpredictable and to that end we do our very best to schedule ‘day of’ appointments when the need is imminent.

Compassion and Comfort
Home is a naturally comfortable, stress-free environment for you and your pet. No travel in the car is necessary and there are no stainless steel tables. There is no trembling, no fear, and no anxiety. We work at a relaxed pace and plan to spend up to an hour at your home. Your pet is comfortably bundled in a cozy blanket for transportation.

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Medications We Use

We hear lots of questions about the medications we use.  Below is a simple explanation of our medications and why our doctors believe they are a good choice.  All the medications we use are specifically designed for veterinary medicine.

Sedative

We believe your pet should be as relaxed and pain-free as possible during our visit.  We administer a sedative and wait until they are comfortable before proceeding.  The sedative is a simple under-the-skin injection.

Cats receive a sedative containing up to four different medications that all work well together: one or two tranquilizers, an anti-anxiety medication and a narcotic pain reliever.  We use a tiny needle for comfort and the medication is usually given over the shoulders or in the lower half of the body. Each of our doctors has a favorite technique which works well for them. The sedative can take anywhere from 3-15 minutes to take effect, depending on the cat’s medical condition and the body’s readiness to absorb and respond to the medications.  It will produce a very relaxed, sleepy state.

Dogs receive a sedative mixture, too.  They receive one or two tranquilizers and a narcotic pain reliever that work well together to produce a sleepy, relaxed state in about 10-15 minutes.  This medication is also delivered with a small needle to facilitate comfort for the pet and is usually given over the shoulders, though anywhere will work just fine.  If your dog is eating and enjoys treats, it is a lovely idea to save something special for the time the sedation is administered. We’ve found that peanut butter, ice cream, cream cheese or small meaty dog treats are great distractions.

The sedative is not full anesthesia, but it is very close.  Your pet will be relaxed and comfortable, will want to lie down, and will be almost completely unaware of what is happening in the room.  Their reflexes will still be present and a very loud noise or stimulating movement would be able to slightly awaken them.  It is common to see leg movements as if dreaming.  Breathing usually slows down but some dogs will occasionally pant for a moment or two.  Our doctor’s presence and touch will not be something that bothers your pet and they likely will not be aware of anything our doctor is doing.  The narcotic is a powerful pain reliever and it is unlikely that they feel any  remaining sensation of discomfort from their condition.

Euthanasia medication

The euthanasia medication we use is the gold standard of care in veterinary medicine. In other words, this medication is the best available.  It quickly and smoothly helps the pet to pass away, usually within about a minute or so. Pet owners sometimes ask if this medication works by paralyzing the body and this is not so.  It is an anesthetic combined with another medication (one that is sometimes used to prevent seizures) and together they constitute a significant dose of anesthesia, enough to stop the body’s living processes.  This is not a painful or scary event for a pet, especially for one who is already deeply relaxed.  In fact, the pet will lose consciousness completely within just a moment or two of receiving the medication. Other body processes, including the heart beat, will then begin to slow down and finally stop.

We don’t usually see many outward signs of the medication’s effects.  We may see a slight lift of the tail or stretch of the body. We sometimes see a brief increase in respiration. We see little else outwardly and we believe this is due to the very relaxed state they are in when they receive the medication.  There is no evidence that the pet feels any discomfort or distress while this medication is being administered.  Our clients report their impressions that this experience appears to be a very peaceful and gentle process for their pet.

Questions or Concerns

We welcome you to share your specific questions or concerns with our support team at (612) 354-8500.  We want you to feel comfortable and informed about what will happen during the appointment.

Special note: For the sake of safety, we won’t list drug names or doses here but you are welcome to ask the veterinarian during the visit.

Posted in Preparing for your pet's appointment | 6 Comments

A Day Too Late

“I tell all my puppy adopters, one day too early is so much better than one day too late.”

Sage advice from a recent client’s mother who was joining us for the appointment of her grown daughter’s beloved cat.  Mom went on to share the story of the loss of one of her dogs several years earlier and how awful she felt remembering that event and knowing that one day sooner for his appointment would have been so much better.  I got the sense that she carried that regret with her throughout the years and was eager to lend advice to others so they’d avoid the same fate.

I often struggle with how to help clients whose pets have a grave prognosis.  We’ve all heard this term before in the movies or on TV.  Veterinarians use this term to describe a disease that inevitably results in a very likely poor outcome, often death.

There are certain diseases that tend to put themselves into the grave category more than others.  Top of the list are the various cancers we see often in pets, such as hemangiosarcoma (blood vessel cancer), osteosarcoma (bone cancer), and others.

As I consult with pet owners on the phone, I sometimes get the sense as I listen to their narrative that they are struggling with making the decision too soon.  They are waiting for signs more compelling than the current ones, so they will know for sure.  They ask if we’re available in the middle of the night or on short notice.  The message I’m hearing is that they are waiting for an event that signals unmistakably the pet has reached the end of their natural life.  In other words, what they may not realize is that they are often waiting for a crisis event.

Home euthanasia services are wonderful but don’t lend themselves well to crisis situations.  Practical reasons preclude us from being there at a moment’s notice, day or night.  We don’t live next door, we have other patients, and we are unavailable in the middle of the night.  It simply means that if a crisis were to occur (intractable pain, seizing, difficulty breathing, bone fracture) your options may be more limited in terms of what services are available to assist you and your pet.  Just about the only option on very short notice is the emergency clinic, staffed by wonderful people certainly, but not the same as being at home.

When your pet has a grave prognosis, careful planning and coming to terms with the finality of your pet’s disease are helpful first steps.  Ask your pet’s veterinarian questions to fully understand the disease and its likely progression.  It is prudent and caring to plan for your pet’s passing in a way that allows them to do so in the most comfortable, safe, and relaxed way possible.  It is important to remember that the disease is responsible for the “why” and “when” of your pet’s death, and that you are acting responsibly and in their best interest to determine the best case for the “where” and “how”.

Our veterinarians and pet loss counselor are available to help you discuss your pet’s unique condition and to help you think about the best way to plan. Click here to contact us.

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Featured on TV News

We were pleased to be recently featured on a television news program about our services.  In the story you can hear from one of our recent clients as she describes her journey of saying goodbye to her beloved dog.  Like many of our clients she struggled with the decision and ultimately decided that euthanasia at home was the best choice for her pet.

You can watch the video here.

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Laughter Through Tears

As you can imagine, most of our appointments involve a lot of tears and moments of sadness and reflection.  As veterinarians whose careers are devoted to assisting with end-of-life care, this is something we expect and have become very comfortable with.  Individuals and family members feel the intensity of the moment, recognizing the gravity of saying goodbye to a four-legged loved one.

Often our conversation gets around to memories of the day the pet came home, how they picked them out of the wiggling mass of wagging tails or memories of quieter moments at the breakfast table or on the many hundreds of walks taken together.  All of these stories are special and celebrate the unique bond we have with our beloved companions.  I love these stories, as they bring a lightness to the moment and a brief respite from the intense feelings of grief.  Usually the memories bring a smile to everyone’s faces and (perhaps surprisingly) laughter is a part of many of our visits.

One day in particular stands out in my memory.  The couple and I were out on the lawn with their beautiful girl, an elderly yellow lab.  We were enjoying the end of a beautiful summer day, and as is so often the case in MN, were fighting off some mosquitoes.  No bother, we’re tough Minnesotans and their wish was for their girl to pass in the cool grass outside, where she was most comfortable.  I fully supported their choice as we often work outside where pets are comfortable.  Her mom and dad were deeply saddened at the thought of saying goodbye to her.  She was suffering from severe orthopedic difficulties and I supported their choice for her as well.  She needed to be released from her pain and suffering.

As we sat and talked, waiting for the sedative to relax her, the mosquitoes became more and more intrusive.  It was no longer just a slap here or there, it was full-on assault.  We tried to remain serious as befit the moment but somewhere a giggle snuck through.  First one, then each of us snickering and trying not to.  Something like that experience in church when you were a kid and your sibling says something funny to try to get you in trouble and you’re trying so hard not to laugh but you can’t help it.  The giggles turned to guffaws and finally to full-on belly laughs.  The tears were rolling down our cheeks and we couldn’t do a thing about it.  It was difficult to tell if mom and dad’s tears were tears of joy or sadness and at that point it didn’t matter.  We experienced one of the sweetest, most exquisite feelings: laughter through tears.  Their dog, without intention, gave one last gift to the people who loved her so dearly, momentarily releasing them from the intensity of their grief on that beautiful summer night.

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Quality of Life, Part I

Quality of life is a term we often hear when a pet is nearing the end of their life or experiencing an illness.  There are several ways to assess quality of life but it is very important to remember that you and your family are the experts when it comes to your pet.  Discussing quality of life issues with other people who love your pet can be very helpful.  Including children in discussions can be particularly helpful to them as they process what is happening to their dear pet.

Here is an exercise you could do yourself or with your family that will help you assess the quality of life your pet is experiencing.  Many people whose pets are nearing the end of their lives ask:  “How do I know whether I am contributing to maintaining quality of life or whether I am prolonging suffering?” It is a complex question and in order to begin to understand it better consider creating a checklist.

Think back to a time when your pet was perfectly healthy and in the prime of his/her life.  Try to recall what a typical day was like for them then and make a list of things they could do or enjoyed doing.  What was the very first interaction you would have with your pet in the morning?  Did she jump on to the bed to wake you?  Can she still do that?  Then did she ask to go out to potty?  And is she still able to do that?  What did she like to have for breakfast? Go through an entire day (until bedtime) making note of all the things your pet could do or liked to do.

After you have completed your list return to each entry and consider whether your pet can still do or enjoys doing each thing.  Cross those things off the list that your pet can no longer do or enjoy.

If many of the things on your list are crossed off, then you may begin to see that your pet’s quality of life is diminished.  Doing this exercise may illuminate or allow you to have a more objective perspective on what challenges you and your pet are facing at the end of life.  It will likely bring to mind some pertinent questions to bring to a conversation with your veterinarian—keep a record of those questions.

It is also often helpful to keep a daily journal about the quality of the day your pet has had with you.  Here is a link to a “daily diary” page that we like.

Quality of Life, Part II addresses pain, one special component of quality of life.

Click here for a FREE printable version of this article:  Quality of Life, Part 1

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Bandit’s Grief

Every once in a while, something really unusual happens and I feel like I’ve witnessed something extraordinary.

One of my patients this week was a lovely black lab mix named Indy who had reached the end of her journey with cancer.  Her loving family chose to help end her suffering in the gentlest way they knew, with a home euthanasia.  Her passing was peaceful and I could see that they were relieved to see her at rest.

Indy’s best friend at home was a healthy, beautiful setter named Bandit (pictured here).  He was young and energetic and in the interest of helping Indy be as relaxed as possible, Bandit spent the appointment in another room.  After Indy passed away, her owners wisely decided to give Bandit the opportunity to see her.

I strongly support allowing other pets in the household to be present during the appointment or to spend a few minutes with the deceased pet.  Pets are then able to process the loss.  It is one of the great benefits of home euthanasia appointments and does seem to help the grieving process, allowing pets to put to rest any mystery about what happened to their companion.  They don’t linger over things too long.  Most have a sniff or two and move on.  They aren’t burdened with the thoughts of what loss means, as we often are.

Bandit was different.  At first he did the usual sort of sniffing around and checking things out.  He walked from one to the other of us, greeting us.  He then cautiously sniffed Indy near her face and then a little near her elimination.  That’s normal as many pets recognize indoor urination as unusual for their companions.  He went back to her face and sniffed again, longer this time and tail nervously wagging.

Then he did something I’ve not observed before in my many experiences with pets at the time of loss.  He pawed at her a bit.  Then he lay down next to her with his face right next to hers.  He made a quiet sound I can’t describe.  He lay there, moments passing, while we watched, mesmerized.  I couldn’t help wonder what thoughts were going through Bandit’s mind.  I try not to attribute human emotions to pets – I feel I may interpret incorrectly and it seems unfair in some way to diminish the uniqueness of their experience in the world.  But allowing my anthropomorphising-self to have a guess, I’d say he was confused.  Where is she?  Can I get her to wake up?  After a few moments passed he got up and again made the rounds to each of us, licking tears and providing comfort (whether he meant to or not).

And then he was done.  No more of those same behaviors around Indy.  He walked around the room calmly and confidently and lay down, legs extended in the air, clearly asking for belly rubs.

Had he made sense of things, in his own way?  I think so.

Posted in Grieving the loss of a pet | 5 Comments