Toffee’s Legacy: Saying Good-bye through Hospice Care

By Scott Boyd

Toffee

Toffee was born 28 October 1998, and adopted with her “sister” Taylor by Barbara and Scott on 05 January 2008 from AireCanada Airedale Rescue Network. Toffee underwent Regenerative Stem Cell Therapy on 20 May 2011, with Dr. Todd Scott of the Crestwood Veterinary Centre in Edmonton. In early January 2012, she was diagnosed with canine cognitive dysfunction syndrome (CDS). Although the signs appeared gradually and had been somewhat managed through medication, an overwhelming majority of her symptoms worsened to the point where she formally entered hospice care passing away on 11 February, 2012.


Why this feature for AireCanada?
If you are reading this, whether or not you have companion animals, are a volunteer, or veterinary professional, we likely share the values of compassion, respect and empathy. We may also share the need for education to enhance quality of life: ours and our companion Airedales.

When Barbara, Dr. Scott and I first discussed regenerative stem cell therapy for Toffee, we read whatever we could find to inform and educate ourselves. There wasn’t much, so it didn’t take long, but, as a service to AireCanada and others, we offered Toffee’s Adventure: Healing with regenerative stem cell therapy as a means to inform and educate others about this new and potentially beneficial treatment.

In adopting three older Airedales we knew that there were some inescapable truths we would face. We also thought we had educated ourselves to provide appropriate care. In many ways we were well prepared, but in one, preparing for their end of life, we found ourselves largely ignorant. What we hope to provide in this report is information and resources for that end point in the continuum of life that we discovered through our hospice care of Toffee. Fortunately there is much more information available on canine elder-care and hospice than on regenerative stem cell therapy, but we’ll present those resources, along with some anecdotes, in one feature for your easier access.

Acknowledgements
Everyone who worked on this report would like to thank to Maureen Scott, AireCanada Airedale Rescue Network, for giving us the opportunity to present this information for those taking care of elderly Airedales. Thanks too, to Joni Bulat and Joe Miller, Molly, Denise Bohaychuk, and Taylor and Ruby for selflessly providing hospice and respite care for Toffee, Barbara and me, as well as editorial support. Taylor gives thanks to Marie-Andree Lachapelle and Gary Poliquin, foster family, for grief healing support.

Why hospice care for Toffee?

Who hasn’t been touched by loved ones in human elder-care or hospice? In Canada, especially, elder-care is well established within the health care construct. Even though relatively new to Canada, hospice care, is becoming more widely accepted by families experiencing end-of-life care for their loved ones. However, end-of-life care, and death in general, remain very difficult subjects to discuss for North Americans; perhaps even more so when it comes to animal companions.

Barbara and I, although completely unprepared, knew one thing, “good death” (euthanasia) as a first option for any of our ‘grrrls’ was not an option for us. Our reasons were personal but, perhaps much like us, you’ll know intuitively when you face the question, and you will.
We had been recently touched by human hospice. What we didn’t know by choosing animal hospice care was just how little information, resources and support exists in Canada. Regardless, we would not have chosen any other path with Toffee, nor will we likely with Taylor or Ruby.

Hospice care is a very specific type of end-of-life care that supports the patient and family and always entails palliative care to allow terminally ill patients to live out their lives as fully and comfortably as possible. Hospice follows a number of basic principles that distinguish it from other care given to animals at the end of life:

Hospice recognizes that death is a natural part of the cycle of life, not a failed medical event, and does not have to be feared or avoided; the focus is “intensive caring instead of intensive care,” without prolonging or hastening death.

Source: When is End-of-life Care for Animals Truly Hospice?, Ella E. Bittel (Holistic Veterinarian) and James C. Armer, DVM, ( in The Latham Letter, Fall 2011).

Caring for Aging Airedales

OMG…read, ask questions, and speak to those with elderly dogs because there is so much more information available about caring for puppies and adults than there ever will be for older dogs, which seems to parallel our society’s perhaps similar lack of interest in older humans. Interestingly, if you delve into the “hospice” websites in this feature you’ll see resources closely linked between human hospice and animal hospice.

As with humans, defining “old” and the aging process for dogs is filled with mysteries, misconceptions and myths. Some myths are so prevalent they are taken for “common sense” and, for the elderly Airedale, could actually speed the aging, or an associated disease process. For example, there is no one definition for “old dog” (it is breed specific). There is also no legal meaning in Canada and America for “senior” dog food. The label can mean whatever the manufacturer wants it to mean. Some “senior” dog foods actually have higher sodium content than adult dog foods so, for the older Airedale with heart disease, eating this food would make it harder for her to cope with the disease.

Do you know where to find statements of Nutritional Adequacy on commercial dog foods let alone what the statements mean? To find out, visit the Competition Bureau of Canada at http://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/01229.html

It goes without saying that there are many things to consider with caring for an aging dog and it cannot be stressed enough that preparation and prevention are key to a proactive approach. Keeping one’s dog healthy for life involves some specific work on our part, and a comprehensive wellness plan developed in collaboration with our consulting veterinary professionals.

Recently published books for your reference:

Good Old Dog, Expert Advice for Keeping Your Aging Dog Happy, Healthy and Comfortable, Faculty of the Cummings School of Veterinary Medicine at Tufts University, Edited by Nicholas Dodman, BVMS, with Lawrence Linder, MA, (Houghton Mifflin Harcourt, 2010).
Caring for your Aging Dog: A Quality-of-Life Guide for Your Dog’s Senior Years, Janice Borzendowski, (Sterling Publishing Co., Inc., 2007).
Hound Health Handbook, Betsy Brevitz, DVM, (Workman Publishing Company, Inc., 2004).
Senior Dogs for Dummies, Susan McCullough (Wiley Publishing, Inc.2004).
Complete Care for Your Aging Dog, Amy D. Shojai, (New American Library, 2003).

Web sites for your “favourites”:

Aging, and Geriatric Supports and Resources for Lay-person and Veterinary Professional:

  • · Canadian Veterinary Medicine Association (CVMA)

http://canadianveterinarians.net/  and from the CVMA website http://www.animalhealthcare.ca/

  • · American Society for the Prevention of Cruelty to Animals

http://www.aspca.org/Home/Pet-care/dog-care.aspx

  • · American Veterinary Medicine Association

http://www.avma.org/animal_health/DogsRule/default.asp

  • · American Association of Human-Animal Bond Veterinarians

http://aahabv.org/

  • · Old Dog Paws

http://www.olddogpaws.com/

A Final Gift.

Barbara and I had experienced pet loss before, but I know we were not fully aware of, or prepared for, the challenges and rewards of hospice care.  We were fortunate to have a supportive veterinarian in Dr. Scott, even though he had not experienced hospice care himself.  He provided the objectivity we needed to help us assess and decide on the subjective and personal quality-of-life issues that would lead to end-of-life decisions we could live with.

Recruiting Toffee’s Hospice Team.

Recruiting Dr. Scott was only the first step in forming Toffee’s Hospice Team. Had we had more time we would have secured the services of a house-call-making (mobile) Veterinarian or Animal Health Technician.  Why a mobile veterinary professional?  For one, the patient’s home is the hospice. So, while she may still need the specialized medical care provided in a clinic, she may not be able to be safely (or conveniently during clinic hours) transported.  That said, we anticipate a little resistance from those in veterinary medicine to make house-calls, as the current norm seems to be, “bring the animal to us”, during office hours or to an after-hours emergency clinic.  Unlike in America, Canada does not have an association or registry for vets and technicians who make house calls. It appears it is the responsibility of the human care-giver to find and/or entice a veterinary professional to go against the current norm, but they are available  One has to ask around. Again planning and preparation are paramount.

Another option to consider for the delivery of specific medical services in the hospice, if a mobile veterinary professional is not available, is to have the vet and/or tech instruct the human care-giver.  Anyone with a diabetic dog will have likely learned how to administer insulin, so to be taught how to assess and chart vital signs, to monitor pain and provide relief, to monitor eating and drinking, to monitor bladder and bowel function, and to know the signs of impending death can all be learned by the committed care-giver.

In our case, Dr. Scott was prepared to train us and/or provide house-call support.  To his credit, and our surprise, he admitted his inexperience with hospice care and his willingness to assist Toffee and us as best he could.  We concluded a planning meeting with him by confirming the best means of correspondence given his work and personal schedules and Toffee’s anticipated urgent needs.

Even if I wasn’t the lone care-giver and Barbara wasn’t working in Regina during hospice, we would have recruited others to Toffee’s Hospice Team.  She loved attention, like most Airedales, so to have “visits” from her friends and family for intensive caring we knew would be important to her during her hospice.  These “visits” also included giving Taylor and Ruby some special attention, such as going for a walk, grooming, reading to them and making special meals.  For primary care-givers, having respite is crucial to maintaining balance, focus and calm.

For Toffee’s Hospice Team I recruited family members who I considered secure in providing intensive caring for Toffee, were secure in being alone with Toffee given her condition, and were able to “visit” regularly in order to provide consistency for Toffee and myself.  As you might expect these requirements narrow the field considerably, even if one has a large pool to draw from.  I didn’t receive a “yes” from every person I asked, and I didn’t expect to.  I knew the demands and commitment required and I explained them to each person beforehand.  Some who were unable to join the Hospice Team, joined a Support Team and brought prepared meals, which I was grateful. There was one day that I just ate oranges, chiefly because they were easy to prepare and could be enjoyed at Toffee’s bedside.

If one has the luxury of time as a result of their planning ahead, there are online courses available for hospice care-givers (Spirits in Transition, Nikki Hospice Foundation, and International Association of Animal Hospice and Palliative Care).  Through this training an orientation for your dog’s hospice team could be prepared and delivered.  Even if your Team is knowledgeable about hospice, I would recommend an orientation for them in order that they and your dog become comfortable with each other and the surroundings.

Preparing Toffee’s Hospice.

Each hospice setting will be unique.  Given Toffee’s condition we had to remove any bump, slip and trip hazards, block stairs, and create circular spaces out of square rooms.  We set up her “safe place”, which included favourite beds, blankets, toys and scents.  It wasn’t immediately obvious to me, until I did some online research, just how important familiar scents are to keeping an animal in hospice calm and peaceful.  One article even suggested using female pheromones on bedding to remind the patient of “mother” and “safe”.  I was never able to locate a source for such pheromones, so I used Rescue Remedy and ensured Toffee had all of her favourites around her.  I also had beds set up for Taylor and Ruby adjacent to Toffee’s should they choose to lay down beside her.

In Toffee’s “safe place” I set up a station for “charting”, storing her medications, and a laptop computer for online searches and corresponding with Toffee’s Team. I also discretely kept my bedding there as I would often nap beside Toffee, which was comforting in one obvious regard, but not so in another.

During my online search for information I read that some animals in hospice develop new anxieties, or that existing ones are exacerbated.  Toffee did show some separation anxiety previously, but I did not expect this anxiety to be exacerbated by her seeing my eyes close when I slept so close to her. I wanted to tattoo pupils on my eyelids so we could both get some rest.  I finally trained myself to sleep with my hand, or one of her toys, over my eyes as a solution.

I also read that blankets and toys covering your dog at this stage can feel like dead weights, cause over-heating and thus may be very uncomfortable. So I would make a tent for Toffee using her toys and blanket.  She appeared quite comfortable and by checking with my hand on her body, not too hot or too cold.

Toffee initially took her meals with the other grrrls, but when she got to the stage of only taking food by hand, I had to create a separate feeding area.  When she was no longer able to move unassisted , but was still hungry and thirsty, I had to corral Taylor and Ruby to keep them from joining us.  I knew they wanted to help Toffee, but eating her food and drinking her water would have been a problem.  Having the otherwise active and able-bodied grrrls did present a challenge sometimes, but the challenge was far outweighed by their support and companionship.

Oh how I wish I would have thought of this sooner for Toffee…grippy socks.  The floors in our house include a combination of hardwood, linoleum and tile. Even for young Airedale feet this can pose a problem. For older, unsteady legs the slippery flooring is a real concern.  I had put down area rugs in Toffee’s “safe place”, but much of the lino and hardwood was exposed and, unfortunately, clean-up from her indoor bathroom activities was taking precedence over mobility.

But one day Joni suggested I get pairs of children’s socks with grips on the soles…grippy socks!  Toffee loved them, though I don’t think she really cared for the high-rise style.  She was no longer slipping and was able to move with confidence on her own. We did have to monitor her for over-heating and fatigue, as we know dogs regulate their body heat through their mouths and feet.  Thank you Joni, and thank you grippy socks!

Because we live in an urban area and the Grrrls were known in the ‘hood, I circulated a notice to neighbours of Toffee’s Hospice, which included signs of her condition, i.e., reversed sleep-wake cycle and night-time walks, changes in traffic patterns to our home, people other than me walking Taylor and/or Ruby, and a copy of a  Special-Needs or Hospice Certificate* completed by Dr. Scott and indicating that Toffee was in Hospice under his care.

One neighbor even came by to thank me, wish us well, and share his story of losing his dog.  I was grateful for his response. Prior to circulating the notice another neighbor passed an unsolicited comment when he saw Toffee and I out for a walk one afternoon (she walked slowly and frequently stumbled, but was walking nonetheless I thought). Another neighbor took it upon themselves to file a noise complaint (OMG…two terriers in a new home situation with new people walking them).  Words to the wise, don’t expect that long-standing neighbours will necessarily be understanding of your situation.

To alert folks not aware of Toffee’s Hospice, i.e., Canada Post, unexpected guests, etc. I posted, in addition to the original Hospice Certificate, notices on front and back doors indicating: home serving as hospice, doorbells disconnected, please knock, and calm and quiet guests welcome.

Toffee’s Legacy.

Saturday, the day of Toffee’s passing, was as traumatic as it was sudden. We were still forming her Team and had nothing prepared for her body or memorial, which only added to our grief.  Toffee’s Legacy is, in one part, a step forward in our healing, and in another, helping inform fellow care-givers.

Hospice may or may not be for you and your companion.  It is heart- and gut-wrenching, requires planning and preparation, and time and resources.  BUT it does provide an intimacy and an opportunity for sharing and expressing that human-animal bond one would never have any other time.

Websites for your review:

Supports, Resources, Training, and Guidelines for Lay-person and Veterinary Professional:

  • · Spirits in Transition (* available here for download)

http://www.spiritsintransition.org/

  • · The Nikki Hospice Foundation for Pets

http://www.pethospice.org/

  • · International Association of Animal Hospice and Palliative Care

http://iaahpc.org/

  • · BrightHaven Healing Arts Centre for Animals

http://brighthaven.org/

  • · Angel’s Gate Hospice for Animals

http://www.angelsgate.org/index.htm

  • · American Veterinary Medicine Association (AVMA)

http://www.avma.org/animal_health/DogsRule/default.asp

  • · American Association of Human-Animal Bond Veterinarians

http://aahabv.org/index.php/end-of-life-hospice-care

  • · The Latham Foundation for the Promotion of Humane Education

http://www.latham.org/

  • · Special Needs Pets

http://www.specialneedspets.org/

 

Grief Healing Discussion and Support Groups:

  • · Hospice of the Valley Grief Healing Discussion Group

http://www.hovforum.ipbhost.com/

  • · Special Needs Pets

http://www.specialneedspets.org/

  • · Pet Loss Canada

http://petlosscanada.com/

  • · Pet Loss Resources: Canada

http://www.pet-loss.net/resources/Canada.shtml

  • · American Humane Association Pet Loss Program

http://www.americanhumane.org/interaction/programs/humane-education/pet-loss/

 

Recently published books for your reference library:

  • · The Dog on the Bed A Canine Alphabet, , Richard Teleky, (Fitzhenry & Whiteside, 2011).
  • · Pet Parents:A Journey Through Unconditional Love and Grief, Coleen Ellis, (iUniverse.com 2011).
  • · The Legacy of Beezer and Boome: Lessons on Living and Dying from My Canine Brothers, David Koktavy, (B Brothers Press, 2010).
  • · The Art of Racing in the Rain, Garth Stein, (Harper Perennial, 2008).

 

In Memory of Toffee

3 thoughts on “Toffee’s Legacy: Saying Good-bye through Hospice Care

  1. AireCanada would like to thank Scott Boyd and his team of hospice caregivers who helped Toffee along on her final journey. He has done a wonderful job of compiling the resources he used to provide hospice care for Toffee. We all hope that his research will help others who are contemplating this sort of care for their senior dogs of any breed.

  2. I am reading Toffee’s Legacy with a great lump in my throat. Too infrequently do we pay tribute to the profound and everlasting gift of such journeys as Toffee’s. We are so lost in our own grief and fear of loss that unwittingly we may fail the very soul depending upon us for that final transition. Thank you to each of you, Toffee’s Team, for offering insight and foresight to end-of-life care, even whilst your own hearts were split into a thousand fragments. All blessings attend you ….

    With gratitude, Sue Forrester, Australia

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