By Dr. Becker
A Heart for Older and Special Needs Pets
Dr. Bittel has a very special place in her heart for older animals and those who are dying. As a veterinary acupuncturist, she treats mostly senior animals with mobility issues and other age-related conditions. Acupuncture is extremely beneficial for those patients. Special needs animals, who require a different level of care to treat issues like incontinence that are unresponsive to conventional treatments, are also amongst her very favorite patients.
During her veterinary studies in Germany, Dr. Bittel worked in a residential facility for disabled people for six years. The work she did there taught her not to be reactive to what her eyes saw or how someone looked. Instead, she learned to tune into a person’s spirit, their interests in life, and all the things about them that were completely independent of their physical abilities. She believes her experience with disabled people set the stage for her career as a holistic practitioner for animals.
Spirits in Transition
Dr. Bittel has a website called Spirits in Transition, which is focused on hospice care for animals. She became interested in hospice when her heart dog, Momo, died at the age of 17. Momo was a large dog, so Dr. Bittel feels fortunate that her beloved companion lived such a long and high-quality life. With the support of acupuncture, Momo enjoyed full mobility right up to the end.
During the last few weeks of Momo’s life, like so many of us with dying pets, Dr. Bittel tried to anticipate the best time to euthanize her – simply because she had always assumed she would need to euthanize. She tried to check in with both the dog’s spirit and her own – “When is the right time? When should I do it? Is this something she wants now?”
But Momo never gave the signal that, “Yes, this is the time”. When she entered the active dying process, Dr. Bittel didn’t recognize the signs because no one had prepared her for what to expect. She thought to herself, “This is the time that I have to euthanize.” So with the help of a friend, she loaded her into the car. After about five minutes in the car, Momo died in Dr. Bittel’s arms.
Besides wishing she had not loaded her into the car during the last minutes of life, Dr. Bittel felt generally okay with the way in which Momo died, but she was left with some questions. A year later, it finally hit her. She realized the only question she asked Momo was, “Do you want to be helped to overcome this situation (be euthanized)?” She never asked Momo if she just wanted her to be there with her during the normal dying process. It never occurred to her to ask her dog that question.
The realization was a bit shocking to Dr. Bittel. She never considered the idea of letting an animal die a natural death, and she realized the same was true for most in the veterinary profession. It was a real wakeup call for her, and prompted her to support clients with interest in hospice care for their animals. Some years later, she created educational resources for people who want to provide the same level of care to dying animals that humans receive at the end of life, and also began sharing her experience in presentations at veterinary conferences.
Spirits in Transition was created in 2006, and it provides an animal hospice helpline for people who aren’t sure what to do in a given situation. Often callers have lots of questions even when their pet is still in a good situation, and unfortunately, most veterinarians aren’t prepared or trained to respond to end-of-life concerns.
Hospice Can Help Create Good Memories of Your Pet’s Final Days
Veterinary students in Germany and the U.S. generally don’t receive training on hospice care. They don’t learn how to help an animal die in it’s own good time or how to respond in a helpful manner to the needs of the pet’s owner or caregiver. It’s such an important aspect of veterinary care, and it’s not part of the curriculum. Death is as natural as birth, but vet students don’t learn about end-of-life care.
The result is that often, veterinarians don’t know what to do for animals at the end of their lives, or their human families. Pet owners, often overwhelmed with emotion, look to their vet for guidance. Many people have deep regrets after agreeing to euthanize a pet. They wish there was another way and the associated feelings stay with them forever unless they’re able to work through them.
The final moments we have with our pets stay with us forever. There’s no going back; there’s no do-over. Dr. Bittel believes that’s why it’s so important to create a good memory, and hospice care can help with that. Clients have told her that hospice allowed their grieving process to begin while their pet was still alive. For some reason, it is easier for family members to process grief while still in the presence of the pet. And when the animal is gone, there is of course more grieving, but caregivers are often surprised to realize they feel less heartache than they anticipated, or than they’ve experienced at the passing of other pets.
Dr. Bittel’s clients also often tell her, after a pet has received hospice care and passed, that they feel much more prepared for the dying process of a human loved one – and even their own death. Hospice helps many people, including children, process extremely deep-seated feelings and needs around the subject of death.
Preparing for Your Pet’s Death – Why It’s So Important
A child’s first exposure to death is often the passing of a pet. Dr. Bittel knows that how the parents handle the situation is extremely significant. Many parents feel the need to shield their children from what they view as a potentially damaging or scary experience. But the reality is that children are quite capable of dealing with death if they have appropriate support. In fact, kids are often so much more connected to the natural rhythms of life that they provide support for the parent.
Several of the first hosts of the Spirits in Transition weekend seminars Dr. Bittel conducted, were people who, as children, were prevented by their parents from experiencing the end of a pet’s life. There was a feeling of incompleteness that remained a major influence in their lives.
At the seminar, they watched a video capturing the last 48 hours of a dog dying in its own time while receiving hospice care at home. Seeing it brought completion and a sense of peace to those who had not been allowed to witness the death of their own pet.
Just the thought of a beloved pet dying is overwhelming for many people. As they watch their pet get older, or develop an age-related illness, or begin the dying process, they are overcome with fear. I asked Dr. Bittel to offer some guidance on learning to cope with our feelings of fear, so that we can remain good guardians and do our jobs serving our animals until they’ve made a complete transition.
Dr. Bittel actually developed most of her educational resources to do exactly that – to help animal caregivers address their fears around their impending loss. Her goal was to offer practical advice in how to support the animal, and when we know how to deal with a particular situation, the knowledge alone reduces our fear. Dr. Bittel puts it this way:
“We are served well when we spend some time contemplating our own mortality and our animal’s mortality, and deal with the emotions around that.”
In her seminars and online classes she also includes body techniques that can help with fear. Her strongest recommendation for anyone with an animal family member is to prepare while the pet is still well.
Dr. Bittel feels that there’s no right or wrong when it comes to lovingly choosing what to do at the end of a pet’s life. No one can guarantee a pet owner who wants to avoid making a euthanasia decision, that by doing everything possible in terms of hospice care it will be possible to maintain the animal’s comfort sufficiently for the pet to die naturally (though it is possible to achieve in the majority of the cases). There also is no way to predict exactly how the dying process will proceed, because it’s different for each animal.
At-Home Euthanasia Should Be Part of the Planning Process
As Dr. Bittel does with her clients, the Spirits in Transition helpline also emphasizes the significance of the ability to have an at-home euthanasia performed in case it becomes obvious that disturbing symptoms can no longer be adequately controlled. The veterinary profession has some catching up to do in this area, as there’s a lot we can do similar to what is done in human hospice to successfully manage end-of-life symptoms.
But without that knowledge, or in situations where the level of care required can’t be given for some reason, the 24/7 in-home euthanasia option should be in place so that the animal’s caregiver isn’t forced to schedule it ahead of time. It’s not a matter of saying, “On Friday at 3:00 pm is the right time.” It’s more a matter of deciding whether a changing situation can be managed in the best interests of the animal.
There are also pet parents for whom hospice care simply isn’t an option. It isn’t right for everyone. Dr. Bittel’s goal is to make it available for those who want it so they don’t feel abandoned at a time when they most need support.
Sitting Quietly by as Your Pet Transitions
In my practice, most of the pets who are transitioning are very much at peace with the process. To them, exiting the world is just as natural as coming into it. So the animal is dying, and is fine with it. The guardian, however, is not. Often, my job is to help the caregiver recognize that her pet is fine. In response, I hear things like, “What do you mean he’s fine? He’s dying!” And I reply, “Yes, he’s dying beautifully and perfectly and doing a great job. Your pet is doing a great job of dying.”
But it can be very confusing to pet owners. We often don’t keep in mind that the only creature we’re in control of is ourselves, and sometimes the best gift we can give ourselves and our pet is to let go of the need to control every possible outcome. While the pet is doing a great job of transitioning from life to death, sadly, the guardian is often experiencing feelings of failure, frustration, inadequacy, and guilt.
There are times in life when there’s nothing we can or should be doing, despite our sense that we should be doing something. It could be that what we should do is simply sit quietly with a pet who is dying. It’s a uniquely human trait that we feel we must be hovering and doing, hovering and doing.
Animals have the innate ability to beautifully manage their own energy. Given the opportunity, animals are grounded out all the time. They’re in balance. But it’s so hard for pet owners to be at peace with the notion that their animal will be okay as he transitions, and that their job in supporting and helping their pet may not be an active one. It may be entirely passive – just sitting quietly with their pet.
Dr. Bittel’s experience is that pet caregivers are comfortable as long as they know what to do. But when the time comes to do nothing – when there’s nothing left to do and the dying process is unfolding in its own way and smoothly, being present with the animal is what’s important. It’s about just being with your pet without bringing anything but love into the space. Allow the process to unfold without clinging to the moment, and without feeling torn up by grief at the moment your pet is ready to transition.
If You Let It, Your Pet’s Death Can Be a Gift of Peace and Solace
One of the great benefits of hospice care is that people often come to a place where they realize it’s okay. It’s okay that this life ends now. Sometimes there’s even relief, because the burden is considerable for those who have cared for an animal with a complicated illness. It’s really not the dying process that’s the problem — it’s the terminal illness. Inevitably, there comes a point when the illness no longer plays a role. The dying process unfolds, and there’s really very little to do.
What helps as the process unfolds is to minimize influences in the environment, including noise. Often in human hospice, a TV will be on loudly in a dying patient’s room. If the TV is on for the patient, because he or she is calmed by it, that’s one thing. But if the TV is on to distract the other people in the room from their fear of what’s happening, it’s not a good thing.
Preparing in the best way we can for the end helps us with our perception of death. The passing of a pet can help us gather peace around us. It’s the final gift your dying pet can give you when you allow yourself to be fully present.
Dr. Bittel has heard stories of animals that have not been able to transition until the human caregiver is able to at least temporarily resolve emotional distress. One reason for such distress could be that the dying process often takes longer than people anticipate. Many people haven’t experienced a real-life dying process, and don’t realize that a TV show or movie portrayal of death is not typical of a normal dying process.
Dr. Bittel would like us to step beyond the idea that death should go faster – it should be over quickly. “If we can just be with it, it is a really great opportunity for us,” she says.