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How do we say goodbye when it’s time for our dogs to leave us?

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If you follow us on Facebook, you know that we recently lost one of our family members, Gabrielle, a beautiful German Shepherd who was part of our family since 2005. As Gabi faltered and we tried to come to grips with the inevitable in March and April, I learned of a veterinarian, Dr. Carolyn Naun, who specializes in hospice care, pain management and home euthanasia for pets.

This was a new specialty to us, but it is an outstanding service. Dr. Naun, who owns and directs Arms of Aloha, is compassionate, sensitive and highly skilled. She came to our home and Gabi quietly went to sleep on her own bed, in her own home, slipping away peacefully.

Dr. Naun agreed to participate in a Q&A to help our clients and readers become acquainted with this specialty field. In addition to being a doctor of veterinary medicine, she is a certified hospice and palliative care veterinarian – a certification earned through the International Association for Animal Hospice and Palliative Care (IAAHPC), which was founded in 2009. The organization launched the animal hospice and palliative care certification program in 2016, and Dr. Naun was a member of the inaugural class of AHPC graduates, earning certification in 2017.

TRADEWINDS: How and when did you become interested and involved in this specialty field?

DR. NAUN: I worked in general veterinary practice for 15 years prior to opening Arms of Aloha. I had always sensed that something was missing from the traditional approach to end-of-life care for pets. Hospice is a very new field in veterinary medicine, and I personally began to be aware of it four or five years ago. Eventually, when I decided to open my own business, I felt that filling this niche was a natural choice.

TW: How would you summarize or describe the education and training required to become certified?

DR. NAUN: To become certified in animal hospice and palliative care, a veterinary professional takes 100 hours of rigorous, advanced training. They must then demonstrate their knowledge, experience, and competence in animal hospice by submitting two case reports and passing a comprehensive exam.  While certification is not necessary to practice hospice and palliative care, it reflects specialized skill in addressing the unique needs of animals at the end of life and their caregivers.

TW: You deal with people when they are at their most vulnerable, having to make some of the hardest decisions of their lives. How are you affected by this work? What are the rewards?

DR. NAUN: I consider it an honor and a privilege to help families during such an important and sacred time. It is incredibly uplifting work.

TW: You have additional team members with training in hospice and palliative care. Is this common?

DR. NAUN: The hospice team always consists of a veterinarian and the caregivers (family members who are primarily responsible for taking care of the pet and providing for their daily medical needs). The team can also include – as Arms of Aloha does – a veterinary technician and a grief support professional. We utilize both a chaplain and a licensed clinical social worker. Depending on the family’s wishes, other pet care professionals and loved ones can also be on the care team.  We are open to partnering with anyone the family wishes, and have worked with animal communicators, energy healers, pet sitters, physical therapists and acupuncturists, among many others.

The veterinarian directs the medical care, making diagnoses, prescribing treatments or medications, and offering medical advice to the caregivers as needed.

The veterinary technician checks in regularly with the patient and family, taking vitals, finding out how things are going between visits, and seeing if there is anything else that needs to be addressed. They coordinate closely with the veterinarian, often serving as a liaison between vet and caregivers. Our veterinary technician, Lucy, has extensive experience in emergency and critical care. She has been a certified veterinary technician (which is similar in training and expertise to a registered nurse) for almost 30 years.

Another professional, such as a counselor, social worker or chaplain, can offer emotional support to the caregivers. Having someone on the team who is solely dedicated to the family’s needs offers a balanced approach to patient care.

TW: How do you work with other veterinarians? Do you have collaborative relationships?

DR. NAUN: The pet’s regular veterinarian can be as involved in patient care as they and the caregivers wish. Often, the primary care veterinarian has known the pet for years and can offer a valuable perspective. As Arms of Aloha is not a brick-and-mortar practice, we depend on partnership with traditional clinics for some treatment modalities and diagnostic services.

Because AHPC is such a new field, I need to build individual relationships with community veterinarians to earn their trust and collaboration.

TW: Do caregivers ever have difficulty with the idea of someone “new” coming in toward the end of a pet’s life?

DR. NAUN: One of the hallmarks of a good hospice or home euthanasia professional is their ability to establish trust and rapport quickly. Strong communication skills and empathy are indispensable.

We often spend quite a bit of time talking with the family on the phone before we meet the pet.

TW: Your website says you work with clients to personalize the care and services they receive, including euthanasia. Can you provide an example or two of more unusual or interesting arrangements?

DR. NAUN: We are occasionally asked if we can perform euthanasia at the beach because going to the beach is so central to family life for many of our clients and patients. I have witnessed some very moving tributes to the departing pet; sometimes a family member will read a eulogy, sing or play an instrument. At one of my first home euthanasias, I was invited to walk down to the yard and attend the burial immediately afterward. We held hands around the grave and prayed. It was beautiful.

TW: Hospice care for humans is usually initiated when death is anticipated within about six months. When is it appropriate for caregivers to contact you?

DR. NAUN: The “six months” rule you mention applies to human hospice because it’s paid for by Medicare, and the agency requires a prognosis of six months or less in order to cover it.

Animal hospice, on the other hand, can help any pet with a chronic medical condition that affects their daily life. Even patients who are not terminally ill – such as pets who have chronic arthritis – can benefit from “comfort care” (known as palliative medicine) aimed at helping them live as fully as possible. Common conditions we see are cancers of all types, kidney failure, back problems (such as disk disease), and arthritis. We have even supported pets through chemotherapy.

The length of time patients spend in hospice care depends on their particular illness and condition. We have had a few patients who were actually discharged from hospice after two to three months because they got better! Our longest running patient has been with us for almost two years. More typically, most pets are with us for less than a month. We hope that as awareness of palliative medicine grows, we will be able to start helping pets and families earlier in the course of their illness. We would love to hear from families wanting to explore their options as soon as they get news of a serious diagnosis.

TW: Is there anything else that you think people should know?

DR. NAUN: Hospice is not giving up. It means embracing a commitment to the comfort, well-being and emotional health of the pet and his or her caregivers. Families can still pursue life-saving measures if they wish; in fact, palliative care can help relieve some of the symptoms associated with treatment as well as the disease itself.

We thank Dr. Naun for her time and willingness to share her insights. Even more, we thank her for the expertise and kindness she provided Gabi and our family on April 16.


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