CINCINNATI — Sooner or later, pet owners have to say goodbye. You could say it’s the bill we receive for the years of love and the profound emotional benefits of pet ownership.
As services for pets have grown to where virtually any major medical specialty available to humans is now practiced by small-animal veterinarians – including orthopedics, neurology, cardiology, oncology, even ophthalmology – there is one developing field that helps guardians as well as pets: end-of-life care, or hospice.
Emily Miller is one veterinarian who offers hospice and in-home euthanasia for pets in the Cincinnati area. Miller, who works daytimes at Lebanon Small Animal Clinic, offers consultation in the evenings and weekends on issues including mobility, pain-management, understanding disease progression and, ultimately, when it may be time to say goodbye.
Miller began her career at the Farm Sanctuary in Watkins Glen, New York. She started as a summer intern as a student at the University of Colorado, and then returned after graduation to work for two years as manager of the sanctuary’s health-care team.
“I was in New York (state) and I was taking care of all these animals,” she said. “I was the manager of the health-care team, and I decided that I really needed to go to vet school to understand the disease processes and then also the big word is the ‘pharmacodynamics,’ or how the medicine worked to treat these ailments that I was seeing. So that was what started it.”
Initially Miller thought she’d care for large animals, but there are few jobs in large-animal medicine that see a patient through to a natural death.
“I thought that’s what I was going to do (large animal care), but I wanted to only do it in a rescue setting. … I don’t eat animal products so it would be a conflict of interest” were she to work in an agricultural capacity.
Miller said it was her day-to-day work at the Lebanon clinic that led to her interest in hospice and at-home euthanasia: “I got this job (in Lebanon) and I had no idea how many beloved family members that we would be saying goodbye to and I felt this need to provide something more than a euthanasia in the clinic. … and I just thought, you know, I want to be able to do this in peoples’ home and have them honor their pet and give them a more peaceful goodbye.
“And then, at the same time, my dogs at home started getting – they went from seniors to geriatrics and just seeing the changes in them and educating myself in how to make their lives the best,” she said, she really began to focus on end-of-life-care for pets.
Figuring Out When the Time Is Right
She defines pet hospice as “focusing on keeping the pet comfortable and maintaining a good quality of life until it’s time for them to have a humane euthanasia.”
And when is it the right time?
"Everybody's different, and we all have a certain amount of time that we can give to that pet, a certain amount of money that we can put toward that pet and a certain amount of emotional energy that can go that pet and it’s not the same for everybody, so I never would say, 'Oh, it's too early,' because maybe for me I could have maintained a good quality of life for that dog, but for somebody else who has three kids and a full-time job and that pet’s not getting the attention that they need, then it's not a good quality of life for that pet."
Recently, Miller purchased a franchise with Lap of Love, a Florida-based company, with about 40 outposts across the country. Lap of Love provided a business template, practical protocols, and medical-community support.
Miller said her consultations run from advice on how to make a home more comfortable for a movement-reduced pet (i.e., platforms or pet steps) to pain-killers and when to make the toughest decision.
“It’s focusing on keeping the pet comfortable and maintaining a good quality of life until it’s time for them to have a humane euthanasia,” she said. “It’s knowing that there is no cure, but we’re going to try to do everything we can to keep them comfortable, until the medication is no longer adequate.”
As an example, Miller recounted a recent patient, a 9-year-old dog that was suffering from bone cancer. She identified what the dog loved to do still and then assessed when the time might be right for the owners to make a decision for euthanasia.
“We talked about when she no longer wants to eat or she no longer wants to do her favorite things like go outside and sniff in the yard. And we also talked about her physical appearance, like what her muscle mass is, her coat, is she panting? And then they were much better prepared when it came to that time when they called and said, ‘Okay, it’s time for us to say goodbye.’”
In this case, Miller was involved in the late stages of a patient’s life. But other times a pet’s owners have managed on their own – to this point.
“Sometimes,” Miller said, “I go out for a consultation and the owners just need to hear that its time to say goodbye. ... There are a lot of tears but also lots of laughter. The pet parents share wonderful memories of when their pets were healthy. They talk about their pets favorite things and the silly things they do. I leave with a heavy heart but always grateful that I was there to help end their pet's suffering.”