I want to share some insightful notes from Kimberly Fox, a pet caregiver who is providing pet hospice care for Rennie, her 12-year-old, 90-pound golden retriever. Rennie developed a rapidly growing mass involving his entire right pelvis. His case was considered inoperable bone cancer after a surgical consult. Kimberly was shocked. The Golden Retriever Club of America reports that 67 percent of large males and 57 percent of large females die of cancer. The scenario for Rennie is not unusual. What is very special about Rennie's case is that we are being given a most personal perspective by a devoted pet caregiver. She is making comments on needed and wanted professional service, which is evolving in veterinary medicine as a viable option for pet caregivers who feel inclined to care for their best friend until the end. Dr. Rachel Jones of Marina Pet Clinic referred Kimberly and Rennie to our new Pawspice care service at the Crossroads Emergency Care Clinic in Norwalk, Calif. Kimberly felt the need for expertise in management of the end of life care issues that were facing Rennie. She came in for consultation, pain management and palliative care. We were able to provide a helping hand to make Rennie's final days more comfortable and joyful for him and his family members. If we can understand Kimberly's feelings, we will understand Pawspice. This is her letter. Alpha Decision For me, the most successful and appropriate way to view my loving relationship to my dog is as alpha leader to pack member. This is the most appropriate relationship to keep the dog happy, relaxed and behaving well. And if I'm prepared to take that role seriously, then end-of-life decision making takes on a certain point of view. In the wild, as alpha, I would naturally and appropriately abandon my sick pack member, not without regret, but with the larger understanding that this is what's best for the overall good of the pack. It's literally nature's way harsh but, in the wild, realistic. But I'm not a wild dog making this alpha decision. I'm a human alpha, so my options are greater and, in a way, more complex. Rennie is an older dog dying of cancer. He was basically very peppy and healthy until he seemed to crash in a health crisis we discovered was brought on by inoperable cancer. No Suffering He's at an appropriate age to die, based on normal life expectancy for his breed, so I don't think heroic measures to extend his life are appropriate. However, I also don't think allowing him to suffer as the cancer takes over his body is appropriate either. So before coming to Dr. Villalobos's team, I was at a fork in the road. [My choices were to] put him down at a point when he is still interested in interaction with his pack, he's still eating well and still has most of his normal functional control. Or see if we can take a little more time monitoring the disease's progress while working to keep Rennie comfortable until we hit that tipping point where the cancer is having a bigger negative effect on his life than being with the pack, thanks to palliative care. I was very relieved to learn that there is medical technology and a protocol to provide effective palliative pain relief for Rennie. As a dog owner who has the money and time to take the dog hospice journey, I believe it provides a graceful way to see Rennie out of this life mainly for me. I can't say, honestly, how much Rennie wills to live at this point, except to read the signs of his daily behavior. But I know it helps me to have this transitional time. He's been a part of my family since he was 10 weeks old, and I treasure the time I have with him. It's extremely emotional to lose such a beautiful member of our family. So I deeply appreciate the pawspice approach where I can responsibly meet his needs for pain relief, while I work through my own emotional process of letting him go. I'm watching him very carefully, because I don't want to extend his suffering unnecessarily. But with the pawspice protocol, I feel I can actively relieve his suffering and participate in helping him enjoy a little more time with the pack while the cancer moves in and takes over. The pawspice approach doesn't ultimately relieve me of my responsibility to make the decision to end his life with euthanasia, if that's more merciful. A Bit More Time But it does allow me to capture just a little more time, as Dr. Villalobos says, an extended goodbye where I can take a few more weeks to deeply appreciate the special role Rennie has played in our lives. It's the difficult dharma (lesson) of dogs: that they are so loving and loyal and so short-lived, compared to most human relationships. They're also very "in the moment." So the truth is, my responsibility for his life is far more emotional for me than for him. He's just here, now. The pawspice approach gives me a little more processing time, a little more time to show my gratitude for his gift of Creature Being in my family and I hope I'm helping him go out easy, too. Kimberly Fox Culver City, Calif. Dr. Villalobos is a member of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics. She may be contacted at dralicev@aol.com. <HOME>
