Welcome . . .
to the world's largest Golden-inspired website! Since 1997 we have strived to help others strengthen and proactively lengthen the bond. Our 501(c)(3) nonprofit additionally provides cancer treatment grants for working dogs and funds research in comparative oncology.

A Personal Struggle
Our Golden Oliver led the way when our site came online in 1997. And, his valiant struggle and loss to lymphoma helped us channel our efforts in more healthful and holistic ways (learn more about how to do that at our important Polluted Pets page). Yet, even with reduced vaccinations, filtered water, a chemically-clean environment, organic foods, and more, we did not escape a fibrosarcoma diagnosis with our Golden Darcy in 2005. Their images, along with other Goldens who have lost such battles, are honored above.

Veterinary Hospice: An Evolving Field

According to Guy Hancock, DVM, MEd, at the American Association of Human-Animal Bond Veterinarians, "Hospice is a system which provides compassionate comfort care to patients at the end of their lives and also supports their families in the bereavement process. It includes comprehensive nursing care as well as psychosocial and spiritual care for the patient and family. Hospice is built on the nursing model, in contrast to the medical model of care. Hospice is not about heroic medical interventions that prevent quality of life in a pointless attempt to prolong it."

About 100 veterinarians nationwide offer end-of-life support as part of their regular services, compassionately viewing dying as the final stage of living. A few clinics, including the Argus Institute at Colorado State University in Fort Collins, are dedicated solely to end-of-life treatment for animals. Dr. Nancy Ruffing, a mobile hospice veterinarian in Pittsburgh, Pennsylvania, feels that "Owners have to have some type of a mental plan for what to do at the end of life, but you have to look at your pet critically when they're having a good day so you can recognize the subtle differences on a bad day. You really have to be in tune with your pet, and that starts at the beginning." Amy Souza's article, Veterinary Hospice: Ways to nurture our pets at the end of life, speaks well to the delicate issues in this emergent area.

"There's a Catch-22 right now, and that is we don't have very many people who see themselves as providers in this area, and there are a lot of potential users of animal hospice who have no idea that it exists," says Dr. Amir Shanan, who has offered veterinary hospice for more than 10 years in his Chicago general practice. "Pet owners don't ask about hospice services, and veterinarians don't offer information because, they say, pet owners aren't asking about it."

Part of the reason is that neither general-practice vets nor the general public know exactly how to define pet hospice. The confusion stems, in part, from the term itself, because "hospice" also refers to a standard of care provided to dying humans. Pet hospice takes many forms, however: a couple like the Millers tending to their dying pet, veterinarians who travel to people's homes, or even a physical location where animals live out their final days. In the broadest sense, hospice is a philosophy of caring for a dying animal in a loving, appropriate manner, while also supporting the pet's family.

Many people agree that the best place for a pet to die is at home, surrounded by familiar sights and smells and the people who love them. Veterinarians focused on hospice or end-of-life care aim to make the time before death comfortable for animals by teaching people how to administer medications and fluids, and helping them decide when euthanasia is warranted. ...

Making Tough Choices
As animal guardians, we must make choices for our pets, but on the whole, the veterinary profession - while excellent at offering medically oriented solutions - is not well equipped to help people make end-of-life decisions. These decisions are fraught with emotions and bring up all sorts of practical, ethical and existential questions. What value do we place on life? Does that extend to animals as well as humans? What constitutes suffering? How do we know when euthanasia is warranted?

The Argus Institute at Colorado State University's veterinary teaching hospital has on-site counselors who are available around the clock to assist people facing difficult medical decisions about their pets. Dr. Jane Shaw directs the institute and teaches veterinary communication at the school. Students often ask her what to do if someone doesn't want to euthanize a pet. "We ask questions of the client and can discover whatever barriers are there," Shaw says. "There's a subset of clients, mostly because of spiritual reasons, for whom euthanasia is not an option. For other people who desire a natural death for their pet, we walk them through what that death might look like. In many disease conditions, the death is not peaceful, and we have to have pretty frank conversations about that. Euthanasia is a controlled process and, done appropriately, is peaceful. Natural death is completely unknown, and that makes some vets uncomfortable. They're worried about the animal's welfare and the client's welfare." ...

To end life or let life end?

"There is intense debate in the community around what is hospice for animals," says Marocchino, who helped organize a pet hospice symposium in 2008. "Hospice to vets means, 'I will do everything to help you, but I have a quality of life scale, and when the dog reaches a certain number, it's time for euthanasia.'"

At the symposium, Marocchino says only two veterinarians in attendance had ever witnessed the natural death of an animal. This fact suggests to her that euthanasia is used too frequently and too readily by veterinarians. "They're not giving death a chance," Marocchino says. "Euthanasia should be a last resort."

The majority of people working in pet hospice, however, do believe that euthanasia is a necessary - and humane - tool. Some of them worry that the larger veterinary community, and the general public, will misinterpret the term "pet hospice," believing that death without euthanasia is a fundamental tenet.

"Hospice is not about replacement of euthanasia," says Dr. Robin Downing, owner of the Downing Center for Animal Pain Management in Windsor, Colorado. "In 23 years of practicing oncology, I have a fairly high conviction that the number of animals who die a natural death is few and far between. Most animals reach a point where they are actively in distress, and we have an obligation to let them leave while they still know who they are and who their family is. The only time a client has expressed regret to me is the regret that they waited too long."

The subject of death prompts strong feelings in most humans, and there are no easy answers for doctors or people with pets when confronting an animal's final days. As the veterinary hospice field grows, it is crucial that practitioners remain open to divergent opinions and values, says Shanan, who this year co-founded the International Association for Animal Hospice and Palliative Care. "We must humbly accept that the subjective experience of dying is a great mystery," Shanan says. "Also, we are acting as proxy for the wishes of a patient who is not of our species. It is very easy to err no matter what guiding principle we choose to follow." ...

Dr. Jaime Glasser, who graciously Live-Tweeted (Sept 5-7, 2009) from the Second International Symposium on Veterinary Hospice Care at UC Davis, shared the following insights:

  • Sharen Meyers LCSW: Hospice in a nutshell is to Live until you Die. And, Human Hospice needs Vet Hospice to get back to the center of our calling.
  • A few speakers have all said we may deliver euthanasia to our pets to alleviate our own fear of suffering and not the pet's suffering.
  • Dr. Ella Bittel: Hospice Care can walk people through the grieving process so that when death of a pet occurs, gratitude and love remain.
  • It is SO important to decide what you want done in the case of your Pet's death BEFORE they are ill and where YOU are going to get support.
  • I learned today that we can not fault any decisions we have made in the past without the knowledge we have today.
  • Dr. Tom Wilson: In Hospice when we accept death, fear and powerlessness are replaced with a continuum of care, and a strength emerges.
  • Dr. Tom Wilson: Hospice needs to be a part of a whole system of wellness, and we must reevaluate our health model. We must recognize all animals as conscious beings, and recognize our kinship with all life.
  • Dr. Tom Wilson: We can not forget that we need to accept death and dance to the end of the song with our animals as they live to enrich our lives. When we dance to the end of the song with our pets, when death is eminent, we will have sorrow but no regret.
  • Dr. Anthony Smith: In Hospice we have to have empathy, not sympathy.
  • Dr. Tina Ellenbogen uses Intra-Peritoneal injections for home euthanasia so the pet dies slowly, gently in the owner's arms.
  • Dr. Ella Bittel: Are we supposed to Euthanize an animal just IN CASE they are uncomfortable? What if they want to live?
  • Coleen Ellis, who founded the first Pet's Only Funeral Home in the US, believes we need rituals to allow us to grieve the loss of our pet, and is determined to educate our society that Pet Loss needs to be validated.
  • We are reminded to not assume what we mean by Hospice Care or Natural Death is the same for everyone.
  • Veterinarians want to relieve suffering but need to know Euthanasia is not the only solution. Hospice Care is best done WITH a Vet's help.
  • As Veterinarians we do not have a good education in death, hospice or the grieving process. Veterinary Hospice Care may actually lead us to accept death as a part of life and teach us how to live our lives better.

The newly created 2008 International Association for Animal Hospice and Palliative Care (IAAHPC) is an interdisciplinary organization dedicated to promoting comfort oriented nursing and medical care for companion animals as they near the end of their life and as they die. It was founded by Amir Shanan, DVM, who also founded the incredible Compassionate Veterinary Care practice. His Hospice Care work provides services, primarily at home, that minimize the suffering of pets during the end stages of their lives, and to provide information and support that minimize the suffering experienced by these pets' owners and families. Learn more below about what constitutes Hospice Care with Dr. Shanan.

Please check out our comprehensive listing of hospice related resources:

     Dr. Hancock's Veterinary Hospice Concepts & Applications
     AVMA Guidelines for Veterinary Hospice Care
     Dr. Ella Bittel's Spirits in Transition
     Dr. Villalobos Pet "Pawspice" Home Care Tips
     Dr. Villalobos Quality of Life Scale

     Dr. Anthony Smith: Compassionate Care FAQ
     Informative Articles on Animal Hospice
     Informative Books on Death and Hospice Care
     Learning How to Say Goodbye
Dr. Wolfelt: Center for Loss and Life Transition
Informative Books on Hospice Care and Death
Angel's Gate Animal Hospice Guidelines
Taking a Bite out of Cancer
Sanctuaries & Veterinarians Offering Hospice: State Listing

Hospice Readings, Prayers & Spiritual Resources
(North Texas) Animal Chaplain Services
Animal Hospice Blogging & Twittering
Praying for Love: Personal Beliefs & Pet Love Connection


Dr. Hancock's Veterinary Hospice Concepts and Applications (Link)
The first difficulty to be faced by veterinarians is making a prognosis that the patient is terminal. The human hospice guideline of a life expectancy of 6 months or less is probably too long for many veterinary situations. Using the ratio of average human years to dog years, 6 months is equivalent to approximately 1 month. While hospice care would certainly be appropriate during the final month of life, it may be appropriate for much longer in some cases.

The veterinarian must first recognize that the patient is terminal and that hospice care is a better alternative then further heroic attempts at cure. This step is complicated by the veterinarian's emotional investment in the case's good outcome, which may make it more difficult to admit the true circumstances as early as is optimal. In addition to determining the appropriate time to make a switch to hospice care, a second problem is that there is no veterinary hospice to which a referral can be made. The same veterinarian must re-evaluate the patient care plan from an entirely different perspective.

Once the veterinarian determines that hospice care should be considered, the primary caregivers (owners) must then be informed about the choice. In some cases this will come as a relief to clients who have already recognized the impending death of their pet. Other clients may not yet be ready to face reality or give up hope for a cure.

Helping reluctant clients choose between ever intensifying medical treatment, hospice care or euthanasia is a difficult task calling for much sensitivity and care. It is important to thoroughly explore with the client all the options and their medical and financial consequences as a part of this preparation. It may be necessary to give the client time to think about the options and discuss them with family members before making a decision.

A particularly useful idea is to have the client think through the issues and describe their preferences long before they are faced with the real decision. This might be termed "pre-need" counseling, and veterinarians might encourage clients to complete a form similar to the advanced directive now required at human hospital admission.

In terms of providing comprehensive hospice care, the veterinarian is most prepared to fill the role of medical director. Pain management and relief of signs are the major emphasis. Hospice care is becoming a specialty in human medicine, which indicates the potential for advancement and new knowledge about treatment techniques.

The veterinarian, veterinary technician and clients should jointly develop a plan of care to address relief of pain and management of signs. Clients should be made aware of various techniques which might be employed, and their limitations. They should be advised of signs indicating pain, side effects of the medical conditions and treatments, and anticipated complications as the patient's condition declines. Clients may need to decide if euthanasia is still an option, how the pet's remains will be treated after death, and other details of care and memorialization.

Home nursing care and respite care can be provided by veterinary technicians and hospital personnel, but veterinarians are probably not the best providers for the other aspects of hospice care. Psychosocial services to the immediate family should be provided by people with credentials in that field. An ideal veterinary hospice care team would include employees and volunteers from the local human hospice. Spiritual counseling is another critical aspect of hospice care, and should be available to a veterinary hospice patient's family members. The unexpected death of a much beloved pet can cause intense personal grief and could precipitate a spiritual crisis as well. There are two cautions to consider: first, the care must be provided by a team that is well coordinated and has good communication. Secondly, the spiritual and psychosocial counselors on the team need to be selected for both their professional competence and also their sensitivity to the human animal bond. A blind referral to an insensitive counselor could do more harm than good.


Dr. Ella Bittel's Spirits in Transition
Spirits in Transition was created by Ella Bittel, an Holistic Veterinarian who is on the board of directors of the International Association for Animal Hospice and Palliative Care (IAAHPC) and on the advisory board for the Nikki Hospice Foundation for Pets (NHFP).

When her dog companion of 17 years, Momo, reached the end of her life, Dr. Bittel came to realize that none of her training in traditional or complementary veterinary care had provided any information on how to support a companion animal dying naturally. This, of course, reflects our society's desire to want to refrain from thinking about those topics of death and dying. Then left unprepared and somewhat helpless, the common result is to employ euthanasia when the end approaches.

Dr. Bittel's experiences with Momo passing naturally, and feeling that just like birth, the dying process is of inherent value and an important part of an individual's journey, led her to engage in animal hospice and create a weekend seminar and online classes for those desirous of such end-of life care. She also hopes to build a worldwide network where people caring for a dying animal can find support from those who share their passion for hospice care.

Get Insight on these Frequently Asked Questions from Dr. Bittel:
       1. I am not sure if my animal is suffering—how can I tell?
       2. My animal no longer wants to eat. What should I do?
       3. My animal does not want to drink anymore. What should I do?


Dr. Villalobos Pet "Pawspice" Home Care Tips for your Terminal Pet
Dr. Alice E. Villalobos, winner of the 1999 Bustad Companion Animal Veterinarian-of-the-Year Award, was a founding member of the Veterinary Cancer Society and 2005-2006 president of the American Association of Human-Animal Bond Veterinarians. She has been in the forefront of the veterinary hospice movement, coining the term Pawspice to represent the animal equivalent of hospice, seeing it as a viable alternative when pet owners are coping with the problems and pain of their terminally ill pets. As noted in the article, Pawspice an option for pets facing the end, Dr. Villalobos does not see euthanasia as the sole option, and believes clients become panicked when their veterinarians have instructed them that this is their only option. She would like to see palliation being a bigger word in a veterinarian's practice, especially with terminal patients. "Palliation — that's what pawspice really is all about: to make things better. I like the word palliation because it has pal in front of it. We're doing something for our pal to make things better."

Dr. Villalobos' Quality of Life Care Program includes:
Consultations: Individualized Quality of Life Care Program that considers both the pet care giver's level of ability and participation, while addressing the pet's comfort and medical needs.
Chemotherapy: Administration of the most current chemotherapeutic agents and protocols.
Medications: All necessary medical therapy with treatments such as blood transfusions, electrolyte imbalance replacement, steroids, antibiotics and hormone therapy.
Nursing Care Instruction for Pet Caregivers: Detailed instruction to pet care givers including administration of subcutaneous fluids, injections, application of pain control patches and all aspects of at home nursing care.
Effective Pain Management: Pain control through means such as use of oral medications, injections and patches.
Adequate Nutrition: Optimum caloric intake and nutrition through immuno-nutrition supplements, feeding tubes and excellent quality food sources.
Adequate Hydration: Fluid intake through increased fluid consumption or subcutaneous fluids.
Hygiene: Proper cleanliness through bathing, brushing, applying diapers and antibiotics for tumors.
Mobility: Maintaining muscle mass and healthy joints through walking, assisted swimming, harnesses, slings and physical therapy.
Contentment: Joy, mental stimulation, and interaction with their family through socialization, grooming and activities.

Conceptualized Hospice for a Pet's Last Days: Pet "Pawspice" — Home Care Tips for your Terminal Pet
By Alice E. Villalobos, DVM 

As pets get older, the bond between them and their human caregivers grows stronger. In this millennium, cancer will touch one in every three people and over half of their senior pets. Organ failure will claim the lives of the other half of senior pets. It is time to rethink how the profession will help pet owners face the final days with a terminally ill best friend. Most pet owners have preconceived notions about cancer and its treatment. Obvious biases and ingrained feelings regarding cancer may cause a negative approach towards its treatment in geriatric pets. Case by case, veterinarians and their professional staff must overcome the defeatist attitude about cancer therapy by dispelling negative notions, one by one.

If the pet’s illness can’t be treated due to financial constraints or a logistical problem, it is still a matter of good professional service to compassionately provide advice and home care giving instructions. When a treated pet’s cancer has recurred, if it is resistant to further treatment or if the pet is in the terminal stages of cancer, in home hospice care is a wonderful next step that keeps pet and caregiver comfortably close to their nest. A well conceptualized, creative, palliative pet hospice (Pawspice) for pet owners may be the very best care that medicine can offer to support the people pet bond. Veterinarians and their staff can kindly and respectfully help sustain a quality life for the terminal pet during the last days of the people-pet bond

When a pet is injured, gets sick, gets old, or has arthritis the question of home care comes up. How much care is a pet owner willing to provide to an ailing pet? From this author’s personal experience with treating cancer patients in California for 30 years, it can be stated with authority that the answer to this question is very personal and it may have no limits. Each pet owner has unique personal life style and tolerance considerations. After an initial consultation with the primary veterinarian and a thorough consultation with a specialist regarding options for curative treatment or palliation, the owner will struggle with finances, logistics, love, guilt and grief. Then they either accept the challenge to treat their pet’s illness or decline therapy. It is crucial that veterinarians refrain from being judgmental at this touchy time. It is kind to continue educating and offering options that may be more palatable for the owner to incorporate into their routine. It is also important to refrain from suggesting or insisting on euthanasia as the next best option if the pet is not treated as initially recommended. Let the pet owner know that pain relief and ways to make the pet more comfortable is available while they are trying to make a decision regarding therapy. Many clients have complained that the initial veterinarian was too quick to recommend euthanasia, or that the veterinarian seemed to insist things be done as an “all or none” method because the pet’s prognosis was poor for recovery or it was suffering or its disease was incurable.

Some pet owners feel that they would be unable to handle the thought of giving daily injections of insulin to a diabetic pet or giving a daily injection of fluids under the skin to a pet with failing kidneys. The idea of using a feeding tube for nutrition during recovery from lipidosis, or after an oral surgery or during radiation treatments to the oral cavity may sound like heroics to one person and make perfect sense to another. It is truly important to always speak to the caregiver in a tender, unhurried fashion as that person is most likely under a tremendous amount of personal, financial and emotional stress.

Home care for a pet that can't walk or eliminate is a task certain pet owners have chosen to tackle with the help of Pampers, pet wheel chairs, egg crate mattresses and ramps. Families will even acquire portable oxygen tanks for pets with compromised respiration. Some people react with fear of medical procedures and needles. Others have great interest in learning how to administer to their pets for convenience and needed financial savings. The most important ingredient to look for in oneself, in the staff and in the pet owner is willingness. Hold a staff meeting and ask the question if being a compassionate veterinary care giving facility is truly O.K. with the nursing staff. Put one special staff member as the appointed support person for a certain pet and its owner. Ask the client to direct phone calls and concerns to their designated staff member or support team. Staff can handle most of the home care problems and the doctor can see the pet on regular rechecks to answer major questions such as changes in prescription medications.

The nation is very impressed with the concern and care that the Hospice across America program has provided for people who are dying. Veterinarians can win the loyalty of their clients by emulating the philosophy of the Hospice in honor of that special bond that connects people to their pets. This may help keep our profession more celebrated in the eyes of the public. Unlike the Hospice Movement for people, the veterinary profession won’t be able to send in technicians with free bereavement counselors, hospital beds, oxygen, free meals and wheel chairs. However; from exam room consultations, veterinarians and staff can gracefully provide the education needed for the efficient home care of ailing pets. Education that facilitates the control of pain and the art of providing good nutritional and hydration support gives the caregiver ability to care with expertise. They have more time to let go slowly and carefully. Many tender private moments of quiet emotion and sweet conversation are shared between the caregiver and the dying pet.

The most important factors to educate home caregivers to confidently monitor are: quality of life, minimal pain, adequate nutrition, hydration and respiration and detection of sepsis. With training from the veterinary staff, home care may be almost like being in the hospital. Ask the question, “If this pet owner were trained to take the pet’s temperature, administer subcutaneous fluids and provide the proper medications and sufficient food , can this pet have some well being and live longer at home?” If the owner is instructed to create some frequent, routine fun (doing the pet’s favorite things), the pet may even cheer up and look forward to the events. Ask the pet owner if he/she is satisfied with the arrangement. It is also important to determine with oneself and the staff if it feels rewarding or at least satisfactory to help preserve the bond between this person and this pet. If these ingredients are present, then pet hospice (Pawspice) is a good experience for all involved.

Ask the pet owner if they have experienced the amazing help that the American home hospice care movement has provided for a terminally ill friend or family member.

Despite the lack of financial support from national fund raising campaigns, the veterinary profession can emulate the concern and care exemplified by the hospice concept. Veterinarians can win client loyalty by respecting and preserving the special bond that connects clients to their pets and keeps this profession so celebrated. If the veterinary team helps peacefully to control pain and to provide nutrition in a hospice way, client-caregivers gain confidence. They also gain courage for themselves.

Practical Ideas for Some Specific Disease Conditions
Renal failure patients fed special modified diets such as Hill’s K/D or Select Balance, Modified Diet, may survive well if supplemented with educated home care which includes: subcutaneous fluids, Tumil-K, Pepcid, Amphogel, tissue salts, vitamins, fatty acids (safflower oil or fish oils). Regularly scheduled recheck profiles can monitor renal function, acidosis and anemia. Epogen may be used to bring low PCV levels back up to normal. One cat in this author’s practice survived six happy years at home on daily subcutaneous fluids passing away at age 22.

Diabetic pets who belong to reluctant, needle-shy owners need the option of their veterinarian feeling comfortable about offering oral hypoglycemic medication. One can expect good clinical results with oral medication in one third of diabetics that have no ketones in the urine. Clients feel that their veterinarian is trying to help the pet while prioritizing their own concerns. If hyperglycemia is not controlled with oral medication, the owner may be more inclined to try injectable insulin as a second choice.

Anorectic pets often need to be hand fed. People need to learn the proper technique to best hand feed their ill pet. Cats like their food warmed to body temperature. Squamous cell carcinoma of the tongue in cats renders the tongue stiff and useless and causes early starvation despite efforts to eat. When a pet can’t or won’t eat, the placement of a percutaneous esophageal feeding tube may be performed under a short anesthetic with minimal risk. The procedure has been described by Rawlings, JAAHA, 1993, 29: 562-530. After the esophagosotmy feeding tube is in place, the pet needs to be fed successfully a few times in the hospital. It is essential that a discharge appointment be scheduled for a demonstration on how and what to feed the pet. If a helpful nurse, whom the owner may call for further instructions, gives this demonstration, the client is more at ease during the first few days with the feeding tube. The diet and supplements for feeding must be spelled out to avoid clogging the tube and to ensure the pet is getting enough calories and liquid to maintain body weight. If the tube gets clogged, instruct the owner to use Coca-Cola to dissolve the clog. Create a schedule that spells out the morning and evening times for medications, chemotherapy, amounts of fluid, feeding volumes and supplements on a written daily calendar. This written schedule helps to clarify the day’s work order for the home caregiver.

Nasal cancer patients with facial deformity and night stridor may be palliated with combinations of NSAIDS such as piroxicam or carprofen and evening sedation with burtorphanol.

Osteosarcoma cases that are not amputated can be palliated with walking casts to prevent pathological fractures, ramps to get in and out of the car, into the house and on the bed. The use of piroxicam at 0.3mg/Kg once daily for pain control may actually yield a rare remission on a sporadic basis as shown by Knapp and workers at Perdue. Carprofen with caution about hepatotoxiciy in debilitated dogs may also help control pain. The cautious use of Fentanyl patches may also be very helpful for in home end of life pain control.

Degenerative myelopathy or paralysis often includes a wide range of resourceful home care items such as the above mentioned ramps along with slings, chest and rump lifts, canvass suspension hammocks, wheel carts, etc. Foot covers that are made with cloth or canvas help to prevent abnormal wearing and ulcers of the metatarsals, pads and metacarpals.

Decubital ulcers are avoided in recumbent animals if thoughtful planning ahead includes pads, waterbeds and egg crate mattresses, all with washable covers. Frequent and complete cleaning of the pet’s coat and skin is important if the pet is soiling itself with urine or feces. If the pet is out doors, extreme caution must be taken to prevent fly strike and maggots especially for the long hair breeds.

Transitional cell carcinoma cases will live many months on therapy. It helps to put diapers or Pampers when the pet is in the house and keep the bed close to the doggie door. This helps the family to endure the problems of stranguria and pollakiuria. If the hematuria is severe enough to cause extreme blood loss, measures to control the blood loss are in order. Mix a 1% solution of formalin with a vial of the topical ear solution, Synotic, which contains DMSO, and instill into the bladder with a urinary catheter. Keep the mixture in the bladder for 10 to 15 minutes and then void and flush out the clots. This palliative procedure may reduce the hematuria for 7-10 days and it may be repeated as needed.

Brain tumor patients that are having seizures may be able to stay at home with confidence and with fewer emergency visits if given instructions to use injectable diazepam introduced into the rectum as a suppository for seizure control.

Severe vomiting may be controlled with Zofran injections. On one rare occasion, this author dispensed injectable atropine to help a Great Dane that had unresponsive vomiting and salivation and a low budget owner. Care should be taken to provide liquid tears while using atropine in this fashion, especially in breeds susceptible to KCS.

Severe pain may be controlled with injectable nalbuphine. This drug offers pain control without the typical sedation effects that accompany most powerful pain medications. Nalbuphine doses range from 0.5-1mg/kg SQ. every 3-4 hours in dogs and 0.2-0.5mg/kg in cats SQ. every 3-6 hours as needed. This pain medication is not under the controlled substance regulations and may be of great value in pain control at home for end of life care patients.

“Chemoprevention” may be presented as palliative care for pawspice candidates. According to Dr. Philip Bergman of M.D. Anderson Memorial Cancer Center, chemoprevention involves the use of natural or synthetic compounds that may reverse or suppress the process of carcinogenesis, metastasis and recurrence. Nutritional advice and a nutraceutical supplementation program that underscores cancer prevention for treated, untreated or terminally ill cases may be professionally supervised. This service creates further client confidence that the primary care veterinarian is helping as much as possible. Animals that have received surgery or chemotherapy or radiation therapy that are still considered to be at great risk for recurrence are definite candidates for the pawspice concept because they are actually expected to die from their disease within 4-12 months. Dogs with osteosarcoma, hemangiosarcoma, adenocarcinoma, lymphoma and cats with breast cancer, vaccine associated sarcoma, lymphoma, IBD, FeLV and FIV all fall into this category.

Technician house calls may be set up for those who are unable to deal with administering injections and fluids to the ill pet. The reception staff can be made aware of which pets are on Pawspice programs so as to be sensitive to the owner’s calls.

Pet Loss Group Sessions can be very helpful for the most affected individuals.

We recommend that the family read the new AAHA book, Pets Living With Cancer: A Pet Owner's Resource by Robin Downing, D.V.M.

Networking is also a big help. Give the phone number of another client who is providing the same type of Pawspice care so they can have the opportunity to share their experience with the newcomer. Dr. Kathleen Carson and Christine Grey, both from this author’s facility, actively participate in a Chat Room for Chronic Renal Failure cats on AOL (America on Line). This informative chat room opens every Sunday evening at 5:00 p.m. Pacific Standard Time. Tell clients to look for the private chat room, “CRF”.

This type of net working is very helpful and is a staff time saver.

Day care for ill pets can be provided by the primary care veterinarian. This service may be the key to sustaining a Pawspice for the working pet owner. Convenient delivery and pickup times that revolve around the owner’s schedule may be prearranged.

Euthanasia for the Pawspice Pet
Many pet owners want their beloved pet to pass away at home. Unfortunately for them, the slow decline of a sick pet may be too difficult for the family to accompany all the way to the end of the pet’s life.

There are many questions such as, “How will I know when the time comes?” The answer to this question rests with the pet. Advise the family that their pet will give a sign such as unrelenting vomiting, diarrhea, crying, a moribund state or more bad days than good days. When the time approaches for the pet to be humanely euthanized, the emotional pain for the family may be softened if they know that the procedure can be performed at any time of the day or night. Arrangements must be made that cover the patient’s care 24 hours a day. Referrals for house calls, night calls and after hour emergency room facilities need to be set so that the decision time for euthanasia is made on behalf of the pet, not the doctor’s office hours. When the time comes for the emotional pain of euthanasia, caregivers who are in a Pawspice program are enabled to make the best decision for the pet. If they are going to bring the dying pet to a facility for euthanasia, instruct them to bring the pet’s favorite blanket and a candle and family or friends and other pets to share in the final goodbye. It helps create a gentle atmosphere if the overhead lights can be softened. One suggestion is to turn off overhead lights and leave the x-ray viewer lights on in the exam room. The candles can also be lighted at this time.

The next step is to sedate the pet in the presence of the owner. This lets people relax while the pet gently falls into sedation. A deep intramuscular injection of dormacetin or butorphanol-ace in the presence of the owner is given. This allows that big first step to be an easy step for the family to see their beloved pet falling into a relaxed sleep. At this time it is kind to ask if each person in the room wants to stay for the final injection. Many families are content to leave their pet in the sedated state with complete trust that the next step is painless and fast. If family members are present towel may be placed over the pet’s body covering the chest area up to the neck. At this time it is this author’s preference to give the final euthanasia solution I.C. while the family lovingly strokes the pet’s head. Many institutions prefer I.V. euthanasia with I.V. catheters preplaced. However, it seems somewhat traumatic to take near death pets away from their grief stricken owners into the backroom in order to place indwelling catheters, which may involve a struggle. Most near death pets are often anemic, hypovolemic or hypotensive. If catheter placement causes any struggle or discomfort in the last few minutes of life for the near death pet, it is honestly too difficult for this author, let alone caring staff members, to repeatedly witness, even if the owner is not present.

After the family members are gently assured that their pet’s heart has stopped beating, it is appropriate and thoughtful to encourage them to stay and view the deceased pet. Compare this special time to the custom of having a little wake as they do for human family members. This author feels that there is not enough reverence, service, ceremony or support offered to the family on the occasion of death of the family pet by the veterinary profession in general. As recognition of the overriding importance of the bond that holds clients to veterinarians becomes common place across the country, more hospitals will set aside softly lighted rooms for pet wakes upon the occasion of a pet’s passing. This is the time to read poems and talk compassionately about how important and sweet this dear beloved pet was. It is highly recommend that the caregiver and children write a few words about who this pet was and what was their special relationship all about. Often a small lock of hair can be placed it in a windowed envelope with the date and the pet’s name and given to the family as a souvenir. This author likes to read Rainbow Bridge and a few poems from ANGEL PAWPRINTS, the wonderful anthology of pet memorials edited by Laurel E. Hunt, available from Darrowby Press, 3510 Thorndale Rd., Pasadena, CA, 91107. This book can be left in the room so the family may have private time to read poems and grieve alone with their deceased pet. Every five or ten minutes, it is wise to check in on the family and see if they need any assistance. We again recommend that writing a story or a few paragraphs about the pet would be helpful in the grieving and closure process. This is also the time for making a plaster imprint of the pet’s paw (available from the Argus Center at CSU).

Post Euthanasia Follow Up
We send one or two sympathy cards with staff notes and signatures. It makes sense to ask for pictures of the pet and encourage the bereaved clients to get back into the love cycle again and adopt a homeless pet. A genuine invitation for the pet owners to come back and visit with cookies and pictures is extended.

A call to the family a week later to ask how things are going help the bereft family. If they are troubled, a very helpful tip can be given that encourages tears and grief feelings to be limited to 30 minutes a day preferably in the morning or the evening. It is good to tell person that they are missed and to encourage them to hurry back into the people-pet bond and adopt another loveable pet as soon as they feel up to it.

Sir Walter Scott: On a Pet’s Life Span
A favorite short poem by Sir Walter Scott can be read to caregivers when they start a “Doggie Pawspice.” It is taken from Laurel Hunt’s book. With one changed word it can include cats and other species of pets. “I have sometimes thought of the final cause of dogs (pets) having such short lives and I am quite satisfied it is in compassion to the human race; for if we suffer so much in loving a dog (pet) after an acquaintance of ten or twelve years, what would it be if they were to live double that time?”

Bergman, P., Chemoprevention, Proceedings of the 1999 ACVIM Forum in Chicago.
Choen, S. P. and C. E. Fudin, eds. “Animal Illness and Human Emotion.” Problems in Veterinary Medicine, 3, No. 1 (March 1991).
Downing, R., Pets Living With Cancer: a Pet Owner’s Resource, AAHA Press, April 2000.
Hoskins, J., Feline ‘Triad Disease” Poses Triple Threat, D.V.M. Newsmagazine, February 2000, p.4S-7S.
Hunt, L.E., Angel Paw Prints: An Anthology of Pet Memorials, Darrowby Press, 1998.
Lagoni, L., Morehead, D., Butler, C., The Bond-Centered Practice: The Future of Veterinary Care, Proceedings of the 1999 ACVIM Forum in Chicago.
Ogilvie, G.K., Hospice and Bond Centered Practice: The Future of Veterinary Care, Proceedings of the 1999 ACVIM Forum in Chicago.
Ogilvie, G.K., Moore, A.S., Managing the Veterinary Cancer Patient: A Practice Manual, Veterinary Learning Systems, 1995.
Rawlings, JAAHA, 1993, 29: 562-530, Percutaneous Placement of a Midcervical Esophagostomy Tube: New Technique and Representative Cases.
Villalobos, A. E., Oncology Outlook, Those Stubborn Cats That Won’t Eat, August 1999.
Villalobos, A. E., Oncology Outlook, Pet Hospice Nurses the Bond, VPN, September 1999.
Villalobos, A. E., Oncology Outlook, On Bladder and Prostate Cancer, VPN, January 2000.
Villalobos, A. E., Oncology Outlook, Chemoprevention: Can Food Fight Cancer? VPN, March 2000, p. 48.



Dr. Villalobos Quality of Life (HHHHHMM) Scale
Veterinarians are often asked to assess the various aspects that determine the overall quality of life in terminally ill pets. Most older companion animals have one or more concurrent disease conditions that worsen with time. One third of our pet population is overweight and or obese. When pets become burdened with illness or cancer and related treatment issues, their pre-existing conditions complicate the prognosis for survival or may limit options for effective treatment.

The attending doctor is frequently asked, “When is the right time to euthanize my beloved pet? How will I know?” You can respond with something like this, “ One day it will gel. You will know when it is the right time because your pet will tell you with a look or a gesture, a sign or a series of bad days.” A quality of life scale may help everyone, especially those who are in denial, to look at issues that are difficult to face. Caretakers can use the proposed Quality of Life Scale to ask themselves if they are able to provide enough help to maintain an ailing pet properly.

More and more clients are requesting in home health care help for their ailing pets. We must remaining sensitive to the caregiver’s wishes and provide end of life care such as pet hospice or “Pawspice.” More information on Pawspice care will be presented at the 2:30PM -3:30 PM session.
Animal patients have specific needs and desires that should be recognized and respected.

Veterinarians must rise to accept the challenge of meeting these basic needs and desires for terminal patients. If we can create or restore a satisfactory level for our ailing companion animals, then we are justified in preserving the life of the ill pet during its steady decline toward death. The goal in setting up the Quality of Life Scale is to provide an easy guideline for assessment of the pet so that family members can maintain a rewarding relationship and nurture the human animal bond. This Quality of Life scale offers some objectivity while remaining sensitive to the caregiver’s wishes. It will relieve guilt feelings and engender the support of the veterinary team to actively help in the care and decision-making for end of life, Pawspice patients.

The basic needs and desires innate to quality of life for terminal geriatric cancer patients should not and cannot in good consciousness be ignored (McMillan 2005). It is up to the veterinary professionals and to the pet’s individual caretaker to design an end of life program. The program needs to address each factor that deals with quality of life openly and honestly. We can be very proactive in helping pets achieve an improved score on their evaluations. The scale for each factor runs from one to ten. 10 is the best and highest quality rating for each factor. There are 7 basic factors in this proposed scale. A score of 70 would therefore be perfect. (If the terminal geriatric cancer patient scores at least 5 on each issue, the quality of life is considered reasonably good.)

Use this proposed list of basic desires or factors. These factors are presumed to be essential for quality of life. There may be additional factors for individual cases which may impact the decision for the family. Each factor needs to be monitored by both the attending doctor and caretaker with careful attention. The proposed list can be named “HHHHHMM,” The 5 H’s and the 2 M’s are easy to remember. The list includes the problems that every Pawspice program should strive to satisfy: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad days. A score above 5 on most of these Quality of Life Issues is acceptable in maintaining a Pawspice program. Each pet’s situation needs to be customized, and each pet owner needs to be recognized as an individual who needs a kind, supportive coaching approach to come to terms with the decision to end a best friend’s life.

Pet caregivers can use this Quality of Life Scale to determine the success of Pawspice care. Score patients using a scale of 1 to 10. Click here for a handy PDF copy.



H: 0 - 10 HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary?
No hurt: adequate pain control is first and foremost on the scale. This includes the pet’s ability to breath properly. Most people do not realize that not being able to breath is ranked at the top of the pain scale in human medicine. So attention to the pet’s ability to breathe properly is a top priority. Cases with pulmonary effusion need thoracocentesis on an as needed basis. Pet owners need to be trained to monitor the pet’s respirations and comfort level and to identify labored breathing so they won’t wait too long to provide relief. Some families are willing to provide oxygen therapy at home for their ailing pets. The veterinarian can prescribe oxygen through a medical supply house. Pain control may include oral, transdermal and injectable medications and be given preemptively.
H: 0 - 10 HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
No hunger: if adequate nutrition is not being taken in by the pet willingly or by hand or coaxing or force feeding, then placement of a feeding tube needs to be considered. Cats do very well with esophageal feeding tubes. Malnutrition develops quickly in sick animals when the caretaker is not educated enough to know how much their pet needs to eat to maintain body weight. Instruct owners to use a blender or liquid diets to help their best friend maintain proper nutritional and caloric intake. Many pets will live much longer if offered wholesome, flavorful foods that are varied. My own Great Pyrenees, Alaska, went from a life of consuming only dry food to canned food to hamburger, fresh baked turkey, to chicken, to various types of sausages, to venison (thanks to Dr. Jack Stephens), pastrami, cheeses of all types and gourmet cut and marinated meats. She liked parmesan cheese, smoke flavor, Alfredo sauce and cheddar cheese soup mixed into her food along with lots of encouragement and coaxing and hand feeding. It takes patience and gentle concentrated coaxing to get some Pawspice pets to eat. It is hard not to be disappointed when such specially prepared food is rejected. Just come back with another offering with a different flavor a little later and that meal may be more appealing to the patient.
H: 0 - 10 HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
No hydration problems. Educate the pet owner about adequate fluid intake per pound (10 ml per pound per day) and to assess for hydration by the pinch method. Subcutaneous (SQ) fluids are a wonderful way to supplement the fluid intake of ailing pets. It may take a few demonstration sessions for a pet owner to learn how to administer SQ fluids. This helpful procedure saves the client a lot of money and keeps the pet on a much healthier status. Giving SQ fluids can make a huge difference in quality of life during pawspice.
H: 0 - 10 HYGIENE - The patient should be brushed and cleaned, particularly after elimination. Avoid pressure scores and keep all wounds clean.
Good Hygiene is a must! Can the pet be kept brushed and cleaned? Is the coat matted? Is the pet situated properly so that it won’t have to lie in its own soil after eliminations? Pets, especially cats with oral cancer can’t keep themselves clean, so they get demoralized quickly. The odor associated with necrotic, oral tumors can be offensive and cause social rejection by family members. Instruct the pet owner to use antibiotics to help reduce foul smelling infections. Dampen a sponge with a much-diluted solution of lemon juice and hydrogen peroxide and gently stroke the face, paws and legs of the patient. This action is similar to a “mother tongue” and helps to clean the fur while soothing the unkempt cat. Dogs love this type of facial and paw grooming too!
H: 0 - 10 HAPPINESS - Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?
Happiness is important for both caregiver and receiver. Ask yourself if the patient has desires wants and needs (Comstock 2001). Are these being met? Is the pet able to experience any joy or mental stimulation? It is easy to see that our pets communicate with their eyes. They know what is going on via their senses and mental telepathy. Is the ailing pet willing to interact with the family and be responsive to things going on around him? Is the aging cat able to purr and enjoy being on the bed or in one’s lap? Is there a response to a bit of catnip? Can the cat bat at toys or look and follow a laser light? Can the ailing pet enjoy the upbeat greetings and petting of loving family members? Can the pet’s bed be moved close to the family’s activities and not left in an isolated or neglected area? Is the pet depressed, lonely, anxious, bored or afraid? Do you have a routine fun time that the pet looks forward to? Mobility--- Score 0-10.
M: 0 - 10 MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk?  Is the pet having seizures or stumbling?  (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
Mobility is relative. Ask, is the pet able to get up and move around enough to satisfy normal desires? Does the pet feel like going out for a walk? Is the pet showing CNS signs, seizures or stumbling? Can the pet be taken outdoors or helped into the litter box to eliminate with assistance? Will a harness, a sling, or cart help? Is medication helping?

The answer to the mobility question has viable and variable scenarios. The scale score for mobility is acceptable anywhere from 0-10. I have met some utilitarian pet owners who are way too rigid for their requirements in mobility of their pets. For instance, they are regretfully but willing to sacrifice their pet’s life rather than elect amputation of a limb. Some pet owners have the honest yet teleological feeling that amputation is mutilation and not fair to the pet. Instead, they allow the pet to bear a painful limb for months before euthanasia. Then there are cases like the 12 year-old, male, 90 pound, Golden Retriever, Krash Pancino of Orange County. Krash’s mobility was compromised when he entered our pawspice program with osteosarcoma of his left distal radius. His history precluded amputation because of severe degenerative joint and disk disease and degenerative myelitis. Krash had severe osteoarthritis of both his knees along with moderate to severe DJD from bilateral hip dysplasia. Krash’s cancer leg was splinted for visits to dog park and at playtime to offset a potential pathological fracture. His Pawspice was happy full of joy and love that lasted for 3 months.

Dr. Robin Downing wrote thoughtfully about the mobility issue for Murphy in her book, Pets Living With Cancer, A Pet Owner’s Resource. She wrote, “ Because Murphy is such a big dog---150 pounds and very tall---her ability to get up and down and to walk under her own power are very important benchmarks in my personal “bottom line.” She would be impossible to pick up and carry around. For the same reason---her size---her ability to control her urine and stool output is important.”

In my opinion, the mobility scale can have a variable score from 0 to 10. The need for mobility seems dependent on the species and breed. Cats and small lap dogs can and do enjoy life with much less need for handling their own mobility than large and giant breed dogs. If the pet is compromised and is only able to lie in bed, is there a schedule to change the position of the pet and rotate the body at least as often as every two hours? Can the pet’s bed be moved around the house to keep the pet entertained and in the family’s company? Atelectasis and decubital ulcers must be avoided. The nursing care of large immobile dogs is very demanding. Is the bedding material soft enough? Can an egg crate mattress be used and set up properly to avoid decubital ulcers? Is there a role for a pet mobility cart or an Evans standing cart? These items really make a difference in the Quality of Life for the pet that has limited mobility yet is still alert and responsive.
M: 0 - 10 MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
Ask if there are more good days than bad days. When there are too many bad days in a row, (or if the pet seems to be “turned off” to life), the quality of life is too compromised. Bad days are those filled with undesirable experiences such as: vomiting, nausea, diarrhea, frustration, falling down, seizures, etc. Bad days could be from a condition that worsens such as: cancer cachexia or the profound weakness from anemia, or from the discomfort caused by gradual tumor pressure or obstruction or a large, inoperable tumor in the abdomen This was the situation with my own dear 111⁄2 year -old Australian Shepherd, Alfie. He had a huge, undifferentiated mass that rapidly expanded his liver. If the two-way exchange needed to communicate and maintain a healthy human-animal bond is just not there, the pet owner must reconcile or be gently told that the end may be near.

It is very difficult for families to make the final decision to end a beloved pet’s life by euthanasia. Coming to a decision about ending a pet’s life is especially avoided when euthanasia is against the pet owner’s gut feelings or if it against their religious beliefs. Sometimes they are not sure about the quality of life issues at the very end. It can be made more clear to them if a standard scale for Quality of Life is explained and measured ahead of time and re-evaluated every couple of weeks or every few days or hours as the situation requires. If the pet is slowly passing on with a peaceful tranquility, then that may be a satisfactory situation.

What many pet caregivers really want is for their pet to pass on naturally at home, in their arms or in their own bed. That is okay as long as the pet is just weakening steadily and not ‘suffering to death’. We as veterinarians need to accept the fact that it is a very personal and natural wish when our clients request us to help their pet to die naturally at home. We are the ones they turn to for help and we have an oath “to use our scientific knowledge and skills for the benefit of society through the protection of animal health and the relief of animal suffering.” We can help our client’s pet loss needs and at the same time guarantee that the pet has a pain free passage by using the most powerful preemptive pain medications during the last days and hours.

As part of a Quality of Life Program, or Pawspice program, we should suggest the option of home euthanasia and refer the family to a kindly house call veterinarian. Hopefully, using this conceptualized user-friendly “HHHHHMM” scale for quality of life will facilitate the heart wrenching decision that euthanasia truly is. Hopefully your professional guidance and kindness can help relieve the angst and regret about a beloved pet’s death that often haunts pet owners for the rest of their lives.


A total >35 points is acceptable for a good pawspice

Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006. 



Dr. Anthony Smith: Compassionate Care FAQ
Anthony J. Smith, DVM, founded Rainbow Bridge Veterinary Services, one of the only veterinary practices in the world devoted exclusively to providing end-of-life care (hospice and euthanasia) to pets in their own homes.  Dr. Smith also serves as an adjunct professor in biology at Contra Costa College and is a renowned author with over 20 professional journal and textbook publications.


Informative Articles on Animal Hospice

  The Latham Foundation's Latham Letter Special (Full) Issue Fall 2008: Veterinary Hospice Care . . . Issue includes several great articles: The Emerging Field of Veterinary Hospice Care by Stacy Baar; First International Pet Hospice Symposium: Drawing the Circle of Care by Barbara Saunders; Veterinary Hospice Care: It’s History and Development by Kathryn D. Marocchino, Ph.D., FT; Quality of Life – Quality of Death by Ella Bittel, DVM; A Family Veterinarian’s Perspective on the Human-Animal Bond and Hospice Care-Giving by Richard Timmins, DVM; and, Companion Animal Hospice and Animal Communication by Jeri Ryan, Ph.D.
  Veterinary Hospice Care – Post Conference Reflections by Dr. Ella Bittel . . . Summarized in this article are considerations stimulated by the 1st International Symposium on Veterinary Hospice Care, from perspective of an involved observer, contemplating possibilities and challenges the veterinary profession is facing when opening up to hospice care for animals. Subjects covered include "Gap in Standard of Care", "Sister Human Hospice", "Re-evaluating the Plan of Care" and "Suffering and the Will to Live".
  Quality of Life Quality of Death by Dr. Ella Bittel . . . Article focused on distinguishing how different the needs of a dying individual are from those in the middle of life, and how we can support an animal throughout the end of its life. It also looks at how our personal and societal notions about quality of life and suffering influence our decisions, which have triggered us to treat our animal family members very differently from our human loved ones when a terminal diagnosis has been made.
  Leaving this Life, in Rhythm with Nature by Dr. Ella Bittel . . . Common misunderstandings present in our society lead people to euthanize their animals in reaction to normal signs that mark specific phases during the natural dying process.
  Embracing Death’s Journey with Our Animals by Dr. Ella Bittel . . . The death of her own dog, Momo, was the initial incidence that had Ella realize the extent to which in our society euthanasia has replaced knowledge about how to support an animal through its natural dying process.
  A Natural Transition by Denise Flaim . . . Help your dog die peacefully in her own home is the subtitle of this article which briefly summarizes some of the key points of how to provide quality of dying.
  Focusing On The End by Jessica Tremayne  . . . This article takes a look how in the veterinary profession the term "hospice" currently is being interpreted in various ways. While all focus on comfort or palliative care, there are great differences in how soon or often euthanasia gets implemented.
  Consultant on Call–Hospice: A Way to Care for Terminal Pets: Part 1 and Consultant on Call–Hospice: A Way to Care for Terminal Pets: Part 2 . . . North American Veterinary Conference (NAVC) Clinician's Brief, by Dr. Alice Villalobos, May 2009.
  Pet hospice movement gaining momentum . . . New umbrella organization starts a year after first symposium, JAVMA News, April 15, 2009.
  More veterinarians offer hospice care for pets . . . From pet hospice clinics to student-run programs, the veterinary profession continues to develop ways to care for terminally ill pets, JAVMA News, August 15, 2006.
  Protecting pet hospice . . . Growing popularity of pet hospices raises concerns of abuse, JAVMA News, December 15, 2007.
  Pet hospice helps owners cope with death . . . Southtown Star, August 10, 2009
  Pawspice an option for pets facing the end, JAVMA News, October 1, 2000
  Allowing Our Pets to Pass Away with Dignity . . . The Epoch Times, March 2, 2009
  Hospice helps pets die peacefully at home . . . Trend recognizes depth of human grieving for four-legged family members, The Denver Post, August 20, 2007.
  Hospice Care – Ending Life with Compassion, From the American Animal Hospital Association (AAHA), article giving a good overview of animal hospice philosophy and practical advice on how to plan for and create a hospice environment in your home.

Paws into Grace FREE Hospice Guide . . .  In this concise ebook from Paws into Grace, veterinarians and hospice experts Elizabeth Benson and Jessica Vogelsang answer the following questions and more: (1) What is pet hospice, exactly?; (2) Is my pet a candidate for hospice even if I don’t believe in euthanasia?; and, (3) How will I know if it’s the right time to say goodbye?




Informative Books on Hospice Care and Death
  More Than a Pet: A Holistic Guide to Animal Hospice, Compassionate Pet Death and Euthanasia, by Pat Bradley, DVM, 2009. Pat’s approach is loving, practical and nonjudgmental. She’s about helping you make decisions that work with your beliefs and values, so you can feel confident and at peace with the choices you make. In More Than a Pet, you’ll get valuable information that few authors detail.
  • The Introduction provides a discussion of death – and why no one ever talks about it.
  • Chapter 2 covers the anticipatory grief that arises when you realize your animal is approaching the end of his life.
  • Chapter 3 looks at the supplies you’ll need as you prepare your home for hospice.
  • Chapter 4 takes you step-by-step through the process of choosing an assisted or natural death.
  • Chapter 5 describes what to expect from a natural death.
  • Chapter 6 prepares you to talk to your veterinarian about assisted death.
  • Chapter 7 explains the assisted death (euthanasia) process.
  • Chapter 8 discusses whether you should be there for your animal’s death, and how to prepare yourself.
  • Chapter 9 provides information about being a hospice caregiver.
  • Chapter 10 is about remembering and memorializing your beloved animal companion.
  • Chapter 11 introduces you to the grieving process and what you may experience.
  • Chapter 12 for your family and friends, to help them help you in this emotional time.
  • The Appendix contains many resources, guides and checklists that you can print out for easy reference.

We just love lists, where details are provided simply, making them that much more helpful. Dr. Bradley obliges well in this regard, with the following:

  • The signs that death is approaching, so you know what to expect and can face this process with sense of calm and a feeling of peace – if you choose to do so.
  • A discussion on financial, legal and ethical issues.
  • 12 questions to ask your veterinarian before a euthanasia, which could prevent emotional and financial pain.
  • A detailed description of the euthanasia procedure, so you can approach it without fear.
  • A path to help you decide if you want to be there for your animal’s death – and how to prepare yourself.
  • 15 supplies you’ll need for to prepare for your animal’s death at home (and a resource guide of where to find them).
  • 14 questions to contemplate when choosing a compassionate death.
  • How to be there for your animal as a hospice caregiver – and how to keep yourself from burnout during this demanding time.
  • 10 things your friends can do to support you – including in a full chapter to print out and share with your friends and family.
  Blessing the BridgeWhat Animals Have To Teach Us About Death, by Rita Reynolds, New World Library, Novato, California, 2001. Like a hospice worker, author Rita M. Reynolds cares for sick and dying animals, helping them comfortably cross the threshold into death. This book has functional appeal and spiritual longevity. Reynolds shows us how to ritualize and soothe animals' deaths, while also offering us abiding wisdom about life on earth.
  Animals and the Afterlife, by Kim Sheridan, EnLighthouse Publishing, Escondido, California, 2003. Do animals have souls? What happens when they die? This book offers some amazing answers…
  The Tibetan Book of Living and Dying, by Sogyal Rinpoche, Harper Collins Publishers, New York, New York, 2002.  This perennial philosophy that is at once religious, scientific, and practical. Through extraordinary anecdotes and stories from religious traditions East and West, Rinpoche introduces the reader to the fundamentals of Tibetan Buddhism, moving gradually to the topics of death and dying. Death turns out to be less of a crisis and more of an opportunity.
  On Death and Dying, by Elisabeth Kubler-Ross, M.D., Simon & Schuster, New York, New York, 1969. This book can help us face, professionally and personally, the end of life.
  The Tunnel and the Light, by Elisabeth Kubler-Ross, M.D., Marlow & Co., New York, New York, 1999. Life-enhancing insights from the author of the classic On Death and Dying.
  The Handbook for Companioning the Mourner: Eleven Essential Principles, by Alan D. Wolfelt, Ph.D., April 2009. Partly a counseling model and partly an explanation of true empathy, this handbook explores the ways companionship eases grief. For caretakers who work with grieving people or for friends and family just hoping to stay close, 11 tenets are outlined for mourner-led care. These simple rules call for understanding another person's pain, listening with the heart rather than the head, not filling up every minute with words, respecting confusion and disorder, and relying on curiosity rather than expertise. Alan D. Wolfelt, PhD, is a grief counselor and the director of the Center for Loss and Life Transition. He is the author of Healing a Spouse's Grieving Heart, The Journey Through Grief, Transcending Divorce, and Understanding Your Grief.  




Dr. Wolfelt: Center of Loss and Life Transition
Alan D. Wolfelt, Ph.D., C.T. is an internationally noted author, educator and grief counselor. He serves as Director of the Center for Loss and Life Transition and is on the faculty at the University of Colorado Medical School's Department of Family Medicine. Dr. Wolfelt writes the "Children and Grief" column for Bereavement magazine and is the author of When Your Pet Dies: A Guide to Mourning, Remembering and Healing. Affirming a pet owner's struggle with grief when his or her pet dies, this book helps mourners understand why their feelings are so strong and helps them overcome the loss. Included are practical suggestions for mourning and ideas for remembering and memorializing one's pet. Among the issues covered are understanding the many emotions experienced after the death of a pet; understanding why grief for pets is unique; pet funerals and burial or cremation; celebrating and remembering the life of one's pet; coping with feelings about euthanasia; helping children understand the death of their pet; and things to keep in mind before getting another pet.

Best known for his model of "companioning" versus treating the bereaved, Dr. Wolfelt is committed to helping people mourn well so they can live well and love well. His 2009 book, The Handbook for Companioning the Mourner: Eleven Essential Principles, is partly a counseling model and partly an explanation of true empathy, exploring the ways companionship eases grief. For caretakers who work with grieving people or for friends and family just hoping to stay close, 11 tenets are outlined for mourner-led care. These simple rules call for understanding another person's pain, listening with the heart rather than the head, not filling up every minute with words, respecting confusion and disorder, and relying on curiosity rather than expertise. We love his Companioning vs. Treating model, also available to print as a PDF:

  1. Companioning is about honoring the spirit; it is not about focusing on the intellect.
  2. Companioning is about curiosity; it is not about expertise.
  3. Companioning is about learning from others; it is not about leading.
  4. Companioning is about walking alongside; it is not about leading.
  5. Companioning is about being still; it is not about frantic movement forward.
  6. Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words.
  7. Companioning is about listening with the heart; it is not about analyzing with the head.
  8. Companioning is about bearing witness to the struggles of others; it is not about directing those struggles.
  9. Companioning is about being present to another person's pain; it is not about taking away the pain.
  10. Companioning is about respecting disorder and confusion; it is not about imposing order and logic.
  11. Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

Dr. Wolfelt recently created a Pet Loss Companioning Certification Program. This retreat is co-taught by Dr. Wolfelt (Day One Facilitator) and Coleen Ellis, Founder of Pet Angel Memorial Center and Two Hearts Pet Loss Center (Day Two, Three, and Four Facilitator). This learning retreat explores a variety of sub-topics related to pet loss, such as, the Six central needs of mourning; Dimensions of response to pet loss; Application of "companioning" philosophy of caregiving; Special need of children; and, Development of pet loss support groups. Dates: 2010 February 1 - 4, 2010 and February 7 - 10, 2011.

Grief: General These thoughtful articles provide guidance and direction for anyone touched by grief.

For Hospices and Other CaregiversThe following articles are designed to help caregivers take care of themselves as well as those who are suffering from loss.

Funerals, Memorials, Cremation and Related TopicsThe days following the death of a loved one can be filled with sadness and confusion. The following articles can help you understand the importance of the rituals surrounding death.

Helping Yourself with GriefSomeone you love has died. You are now faced with the difficult, but important, need to mourn. Mourning is the open expression of your thoughts and feelings regarding the death and the person who died. It is an essential part of healing. The following articles provide many practical suggestions to help you move toward healing in your unique grief journey.

Helping Others with GriefA friend has experienced the death of someone loved. How can you help? The following articles provide many practical suggestions for helping others with grief:

For and About Grieving Children and TeenagersChildren and teenagers have special needs following the death of a friend or family member. The following articles provide wonderful insight in helping children and teens understand and express their grief.




Angel's Gate Animal Hospice Guidelines (Click here for PDF version)

1. Be present and be in the moment with me. In the moment of now we will write the final chapter of my life. Your presence is everything. Listen to me with your heart. 
2. I have a right to compassionate, considerate, respectful care. Choose for me a veterinarian who will honor me physically, emotionally and spiritually. One who will listen to you because you are my advocate and no one loves me as you do. Choose a veterinarian who will offer her or his wisdom so that you can make informed decisions regarding my care.
3.  Keep me free from pain and symptoms so that I may enjoy my day and the precious time I have left with you. Seek to understand the different types of pain I may have. Look for enthusiasm in my eyes as a gage. Celebrate my life with me till the very end!    
4. Keep me well nourished so that my body will have the fortitude that it needs to fight disease and energy to function. Offer me my favorite foods to entice me to eat but honor my decision, should I choose not to eat.    
5. Keep me well hydrated; for this will keep me in balance with the universe.    
6. Keep me warm and comfortable. I will need to be bathed more frequentlymaybe several times a day. My favorite bed and blanket gives me security and lets me feel safe. I want to smell fresh air and to feel the warmth of the sun on my face. I want to hear the softness of your voice reassuring me of my importance in your life.    
7. Let me stay active and continue to be a part of the family I love so dearly. I want to go for rides in the car, and long walks on the beach, and snuggle with you on the couch while we watch TV. Keep fun in our day.    
8. Touch me. Your loving hands have fed me, played with me, comforted me and now give me strength. Linger just a little longer as you scratch my ear. Your touch lets me know you are there and gives me assurance that you care.    
9. Give me permission to leaveI need to hear those words from you. I need to know you will be OK. Let me go. Know it is my time even if it seems like it is too soon. Support me as I take my final breath.    
10.  If there comes a time when you know that I am suffering please euthanize me. I trust that you will always make the right decision for me for I am the blood of your heart. Be with meI want you to be my last vision.    
11. As there has been great joy in our life together now let there be joy in my passing. Cherish and be thankful for our happy moments together. Promise to keep my memory alive in all you do everyday.



 Animal Hospice Blogging & Twittering





We just love acronyms and found much learning power in them when teaching graduate psychology and education courses. And, when such mnemonics are paired with sensible and helpful insights, it becomes a win-win for us all.

Take control of the situation by arming yourself with the most up to date information you can. Ask for printed materials or information from the professionals you meet. Obtain resources to help you understand your dog's specific disease and treatment options. And, finally work together with your dog's health care team so that you understand the reliability and validity of all the information you've gathered.
a team of compassionate, and trusted specialists. This may include: a conventional veterinarian, a certified veterinary oncologist, a certified radiation oncologist, and/or a holistic veterinarian certified in areas such as homeopathy, nutrition, Chinese herbs, acupuncture, chiropractic, and massage therapy. Do not be afraid to get a second opinion before selecting your best course of action.
eep a running record from day one, writing everything down in a specially designated notebook on: treatments utilized, medications along with your dog's response, progress on combating treatment side effects, supplements that are added, and changes in habits and behaviors. Write down any questions you may have before each visit is made to your dog's doctor. Take notes during discussions with your dog's specialists. And, don't be embarrassed to repeat information back to ensure that you truly understand what was said.
ncorporate good nutrition and a homemade cancer diet as this will play an integral role in your dog's survival. Organic ingredients are the best! Use supplements to boost the immune system or address adverse treatment effects. Also, introduce changes to diet or supplements slowly in order to be sure that its effect is a positive, rather than stressful or compromising, one.
the hazardous effects of our chemically-laden environment. Use only filtered water. Do not use any chemical agents to clean your carpets, floors or surfaces. Only use vinegar, mild soap, and water. Do not use any pesticides on the lawn or in the house. Also, do not expose your dog to environmental toxins or second-hand smoke.
strength from your family and friends. Bring a partner or friend with you when you talk to specialists involved in your dog's care. And, make sure that all discussions that you have involves everyone who loves your dog, including family members and children. Guarantee an acceptance of what is shared so that everyone feels comfortable in asking questions and expressing their feelings and opinions.

Anticipate that there will be many ups and downs during this new chapter in your life. Plan for emergencies by keeping an assortment of medications on hand and having various mobility aids available (e.g., Bottoms Up Leash, Folding Pet Ramp, Pet Stairs).

Be kind and gentle and compassionate to yourself. Know that you are doing the best you can do, and that your dog knows that. Let go of judgment about what you can and cannot do. Your dog will be okay either way. Simply forgive yourself, love yourself, and care for yourself. 
the integrity of your dog's physical body and immune system. That means, absolutely no vaccinations or caustic flea applications! And, protect your dog's lymph nodes by using an Easy Walk Harness which places no strain on a dog's body. Only use a light-weighted collar for ID purposes, having it hang slightly from the neck, rather than being tightly affixed around it.
comfort in knowing that here are no incorrect decisions. And, do not worry about what others may think about your treatment choices. Just trust in your judgment, knowing that you are the only person who fully understands your dog's emotional, social, and physical being. With all your knowledge in hand, you need only listen to your heart in order to make the right decisions.
life. It is a precious gift. And, be sure to remember this. Every day is a good day that allows you and your furry love to remain together.

Click here for Taking a Bite out of Cancer PDF


Sanctuaries & Veterinarians Offering Hospice Care
Please note that the following listings are provided merely for convenience, not as an endorsement. This resource assumes that the inquirer will fully and properly investigate the credentials and practice of a given veterinarian from whom they seek care for the animals for which they are guardian(s).l

If your state is not listed, contact the Nikki Hospice Foundation for Pets for further assistance in locating a veterinarian who offers hospice care in your area [707-557-8595 or].





Pine Country Animal ClinicPatti Blackmore, DVM (Payson)




Pat Bradley, DVM, LPC (Conway)
Holistic Veterinarian and Licensed Professional Counselor, Author of More Than a Pet: A Holistic Guide to Animal Hospice, Compassionate Pet Death and Euthanasia



A Chance for Bliss Animal Sanctuary (Penryn)
Animal Emergency Centre, Tracy Reis, DVM (Studio City)
AnimalRN—In-home Hospice Nurse for Animals, Robyn Kesnow, RVT (Santa Rosa)
Bittersweet Animal Hospice and Grief Recovery (Marin County)
Brighthaven Holistic Animal Retreat (Sebastopol)
Paul Burton, DVM (Retired), Redding, 530-223-3843
Paws into Grace - Hospice Care & Home Euthanasia (San Diego)
Kristi Freeman, DVM (San Diego)
Home Sweet Home Veterinary Housecalls, Dawn Ziegler, DVM, San Diego, 619-226-7297
Linda Mar Veterinary Hospital, Ilana Strubel, DVM (Pacifica)
Mendocino Animal Hospital, Charlotte Burns, DVM, Sara Rice, VMD (Ukiah)
Nikki Hospice Foundation for Pets (Vallejo)
Pawspice, Alice E. Villalobos, DVM (Hermosa Beach)
Rainbow Bridge Vet Services, Anthony J. Smith, DVM
Cheryl Scott, DVM, MPVM, One Medicine Program, UC Davis School of Veterinary Medicine
Silverado Veterinary Hospital, Mara Bleviss, Julia Campbell, Shelley Flowers, Paul O. Hess, Peter Morse, DVMs (Napa)
Sundust & Ferdie Animal Hospice, Frazier Park, 661-245-7387
VCA Benicia Veterinary Hospital, Jill Sperry, DVM (Benicia)




Colorado State University College of Veterinary Medicine and Biomedical Sciences (CSU) Pet Hospice (Fort Collins area)
Denver Integrative Veterinary Service, Catherine A. (Katie) Jones, DVM (Denver area)
PAALS for Life (People And Animals Living Synergistically) (Castle Rock)




Coastal Valley Veterinary Services, E. Jennifer Hall, DVM  (Middlesex & New London counties)
Katherine Skiff Kane, DVM, Cornwall Bridge, 860-672-4948
Quarry Ridge Animal Hospital Health & Hospice Home Services, Dr. Ridley (Ridgefield)




For Paws Hospice (Pinellas County)
Guy Hancock, DVM, MEd, Sentient, LLC (St. Petersburg)
Lap of Love, Dani McVety, DVM (All of Tampa Bay, Hillsborough, Pinellas & Pasco counties)
Suncoast Veterinary Care Center, Deborah L. Sullivan, DVM (Lutz)




Compassionate Care Veterinary Service, Karen A. Jordan, DVM (Metro Atlanta area)
Georgia Veterinary Specialists (Sandy Springs)
RVT Pet Care (Atlanta)



Kindred Spirit, Kindred Care, LLC, Shannon Fujimoto Nakaya, DVM (Island of Hawaii)



Compassionate Veterinary Care, Amir Shanan, DVM, Compassion for Pets President (Lincoln Park, Chicago)
Near North Animal Hospital, Jennifer L. Henderson, DVM (Chicago)



Eric Clough, VMD (Retired), Kennebunk, 207-985-1563



Compassionate Veterinary Housecalls, Winsome Eu, DVM, CVA, CVH (Columbia & surrounding areas)
Healthy Pet Mobile Vet, Rachel Wander, DVM (mainly Frederick & Montgomery counties; also Howard & Carroll counties)
Dr. Jennifer Ramelmeier, Veterinary Holistic (House call & Phone Consult) Services, Clarksville, 410-531-9213
Veterinary Home Health Services, Mary Lynn Selzer, DVM (Salisbury)




Angell Animal Medical Center, Lisa Moses, DVM, DACVIM, CVMA (Boston, Jamaica Plain)
At Home Veterinary, Jeremy Gransky, DVM (Boston and Metro West area)
Back Bay Veterinary Clinic (Boston)




Casey Nash, DVM, Grand Haven Animal Hospital, Grand Haven, 616-846-6700
Paws Mobile Veterinary Service,  Kathryn VanKoevering DVM (Saline)
Unleashed Mobile Veterinary Services, Kari Nugent, DVM (Detroit area)




Home for Life Animal Sanctuary (St. Croix Valley)
Sanctuary Animal Refuge And Hospice (Brownton)



Country View Animal Clinic's "Pawspice Program" (Cedar Hill)
The Pet Doctor, Marcy Hammerle, DVM (Ofallon)




Eric Clough, VMD, Merrimack, 603-424-9922
Founded Merrimack Veterinary Hospital and is co-founder of The New Hampshire Foundation for Companion Animal Care, Inc., a public non-profit for indigent pet owners.




Kindred Spirits Animal Sanctuary Eldercare & Hospice (Santa Fe)




Angel's Gate Hospice & Rehabilitation Center for Animals (Fort Salonga)
Henrietta Animal Hospital, Michelle Brownstein, MS, DVM (Henrietta)
Hope Veterinary Clinic, Kristine A. Young, DVM and colleagues (Brooklyn)
Lancaster Small Animal Hospital, Susan Mineo, DVM, Stacie Minnier Thomas, DVM (Bowmansville)




Animal Hospital East (Asheville)
Hidden Valley Animal Hospital, Brian Lapham, DVM (Raleigh)
Shearer Pet Health Services Office of Pet Rehabilitation, Pain Management & Hospice Care, Tami S. Shearer, DVM, 2009 President, AAH-ABV (Dillsboro)




Gentle Journey Veterinary Hospice, Nancy A. Ruffing, DVM (Pittsburgh)




Canyon Lake Veterinary Hospital Animal Hospice Program (Rapid City)




Buttercup's Pet Hospice, Anne Stanland, DVM, and Peg Beehan, LCSW (Nashville, Middle Tennessee)




Cats Love Housecalls, Cecilia Burnside, DVM (Austin)
Beyond the Rainbow Pet Hospice & Memorial Center, Inc. (Fort Worth: 877-630-PETS)




Alternatives Veterinary Services, Marjorie M. Lewter, DVM (New Castle area)
Ballston Animal Hospital (Arlington)
Blessing the Bridge Animal Peace Garden, Rita Reynolds (Batesville)
Charlottesville End-of-Life Veterinary Care, Liz Palmer, DVM, County vet offers a kind of pet hospice (Charlottesville)
House Paws In-Home Veterinary Care, Leah Node, DVM (Fairfax County area)
Leesburg Veterinary Hospital: Sasha’s Heart Pawspice and Palliative Care, Krisi Erwin, DVM, CVA (Leesburg)
Veterinary Holistic & Rehabilitation Center, Kim Danoff, DVM (Vienna)




Tina Ellenbogen, DVM, Mobile Veterinary Services (Bothell)




Cat Care Clinic (Madison)
Countrycare Animal Complex, Karen Strickfaden, DVM (Green Bay)
Healing Heart Pet Hospice (Appleton)


This article contains copyrighted material, the use of which has not always been specifically authorized by the copyright owner. I am making such material available in my efforts to provide background knowledge on areas related to canine cancer. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this article is distributed without profit for educational purposes.