Euthanasia Alternative: Pet Hospice

Up until just a few years ago, people had one treatment option for their terminally ill pets–euthanasia–and the average veterinarian thought it better to get it over with sooner rather than later. But if Eleonora Babayants had listened to the veterinarian who advised her to put her dog Lima to sleep immediately, she and Lima would have lost out on their additional three years together. Instead of euthanasia, Babayants elected to care for Lima at home, using a relatively new program for dying pets called “pet hospice.” Pet hospice allows a dying animal to live out the rest of its life at home, pain free and surrounded by its loved ones.

“Human hospice and pet hospice are very similar ideas, because pet hospice is modeled on human hospice programs,” says Kathryn Marocchino, president and founder of Nikki Hospice Foundation for pets, a nonprofit organization that links sympathetic veterinarians with pet owners and provides education and advocacy concerning pet hospice. “The basic tenet is that you live each day until you die, and you make the best of it. And in both humans and animals, making the best of it revolves around pain management,” she says.

Veterinarians who are willing to work with individual clients to provide pet hospice at home can help train owners to deal with many of the day-to-day tasks that make caring for a dying pet so difficult. These include keeping the pet out of pain, teaching owners how to administer medications at home, even shots and IVs, instructing owners on how to keep wounds clean and prevent bedsores, and providing other suggestions to keep the pet comfortable.

“The pet owner needs a vet who is willing to support the owner with anything that may arise when taking care of a dying pet,” Babayants says. “In the case of my vet, she was willing to provide the hospice care for me.” She said, “If it gets to the point where I need to come to the house and help, I will.” Babayants says that although it was a bit intimidating for her, she learned how to give Lima fluids under the skin, administered shots, and learned what signs to look for to keep the dog out of pain. “The owner has to be willing to learn these basic medical techniques, but with the support of a vet who is willing to help, I found I could do anything I needed to,” Babayants says.

Another option for pet hospice care is frequent in-home visits from people trained in end-of-life care, like the veterinary students who participate in the Colorado State University’s College of Veterinary Medicine and Biomedical Sciences Pet Hospice program. From a medical point of view, it can be difficult and scary to have a terminally ill pet at home, according to Co-Team Manager of CSU’s program, Christie Long, “especially if they require a lot of support, like administering fluids for rehydration, giving medications, keeping feeding tubes clean. It’s so stressful for a sick animal to be brought into the clinic, so we can have a much less stressed patient if we can keep the pet comfortable at home.”

CSU’s hospice service is one of the only formal programs in the country to offer structured in-home hospice care, free of charge, but many other veterinarians are willingto work with owners on an individual basis to provide hospice care to pets. Nikki Hospice Foundation for pets offers no in-home services itself, but it offers referrals to a network of willing pet hospice veterinarians across the country.

When to say goodbye
Sometimes pet owners are so subjectively devoted to the idea of keeping their pets alive that they can’t see when it’s time to let go. According to Long, it’s the responsibility of the hospice team to carefully assess the animal’s pain level and encourage owners to make the decision to euthanize when the pet can’t be kept pain free. “One of our standards for accepting a pet into the hospice program is if the animal can be made comfortable at home, because we don’t want to assist you with keeping an animal alive who’s in pain,” Long says. “And sometimes, when the animal no longer can be kept out of pain and has no quality of life, then euthanasia can often be the best gift.” While the CSU team will never force euthanasia, they will withdraw from a case if they feel the animal is suffering needlessly and they can’t persuade the owner to choose euthanasia.

The Nikki Hospice Foundation for pets takes a slightly different approach, advocating for the owners’ right to choose how and when their pet dies, including the right to refuse euthanasia altogether. Marocchino founded the organization out of her own grief at finding no end-of-life assistance when her beloved cat, Nikki, was dying of acute feline kidney failure. Marocchino had taken Nikki to an emergency animal clinic, where vets pressured her to euthanize Nikki on the spot.

Instead of putting Nikki to sleep immediately, Marocchino took her to the University of California Davis, where they also recommended euthanizing the cat. “I had trained as a human hospice volunteer the year before, and so I kept asking if we couldn’t do some kind of home hospice care,” Marocchino says. “I was looking for pain management at home, but there just wasn’t anything they could offer me. So in the end, we made the decision to euthanize her there at UC Davis, on a cold steel table.” Marocchino, extremely traumatized by the event, walked away deciding then and there to help found a pet hospice foundation so that no one would ever have to go through what she had just suffered.

Despite the organization’s stance on freedom to choose euthanasia or not, Marocchino is clear that she personally believes the owner should let go when a pet cannot be kept pain free. “The point isn’t to just extend the animal’s life, it’s only if you can take advantage of that quality time,” Marocchino explains. “If the pet can’t be kept out of pain, or if it’s comatose, then it’s time to let go.” But the main point she makes is that the choice must lie solely with the pet owner–not with the veterinarian or even the hospice providers.

Grief, but no regrets
When you talk to owners who have gone the hospice route, they share one clear trait: They have no regrets. Nancy Haugen, an assistant clinical professor at the University of California at San Francisco School of Medicine, who chose in-home care over euthanasia for her dog, Brinn, says pet hospice allowed her to focus on her dog’s needs and encouraged her to follow her own intuition for his care. “When you can just focus on your own instincts, and on the animal’s instincts, that ends up creating a situation where there’s no regrets,” Haugen says. “Pet hospice gives us permission to trust a really old primitive part of us, and to trust the nature of the dog or cat. It allows a powerful end-of-life experience where there’s sorrow and grief, which is very natural, instead of trauma and regret.”

When Babayants chose the challenging path of pet hospice for her dog, Lima, she had no idea what she was getting herself into. But with the help of her regular veterinarian, Babayants was able to keep Lima comfortable so they could enjoy their final time together. “She had a very happy three years, she didn’t suffer, she ate, she went for long walks,” Babayants says. “The best doctors in the whole world, when they tell you how long your pet has to live, can’t really know for sure. We would have lost those three years together if I’d just put Lima to sleep. When she passed away, I was in terrible grief, but I never felt any regret.”

For more information:
Nikki Hospice Foundation
CSU’s Pet Hospice Program
The American Association of Human-Animal Bond Veterinarians

Power Up Your Diet For 2009

Are you or a loved one feeling fatigued after the holidays? While part of it may be from all the celebrating, part of that dragging feeling may be coming from your diet.

It's easy to let a healthy diet slip away during the holidays, but it is equally important to take stock of what you are eating and make sure you are getting a healthy balance of nutrients. Vegetarians may feel particularly sluggish and fatigued if they are not getting enough iron in their diets.

Foods rich in iron include beans, lentils, iron-fortified cereals, dark green leafy vegetables, dried fruit, nuts and seeds. Make sure you get enough iron to power you through the new year! For today's Action, try a tasty recipe for iron-rich lentil almond burgers.

While I'm not a huge fan of vegetarian or vegan meals (I have a tolerance factor of zero for icky foods), these vegetarian burgers are just the thing to have on hand if you’re rushing around or have company for the holidays. Keep them in the fridge or freezer, and pull them out to have on buns or on their own with sliced tomatoes and relish. Or try them with roasted potatoes and roasted broccoli.

INGREDIENTS
6 cups water
1 cup brown lentils or green French lentils (see note)
2 tablespoons extra-virgin olive oil, divided
3/4 cup finely chopped carrot
1/3 cup finely chopped shallots (about 2 medium)
1/3 cup finely chopped celery (about 1 stalk)
1/4 cup sliced almonds
1 teaspoon chopped fresh thyme
1/2 teaspoon salt
1/4 teaspoon freshly ground pepper
1 large egg yolk, lightly beaten (or flaxseed substitute)
1 tablespoon lemon juice

1. Bring water to a boil in a large saucepan. Stir in lentils, reduce heat to medium-low and simmer until very tender and beginning to break down, about 25 minutes for brown lentils or 30 minutes for green lentils. Drain in a fine-mesh sieve.

2. Meanwhile, heat 1 tablespoon oil in a large skillet over medium heat. Add carrot, shallots and celery and cook, stirring, until softened, about 3 minutes. Add almonds, thyme, salt and pepper; continue cooking until the almonds are lightly browned, about 2 minutes. Transfer the mixture to a food processor; add 1 cup of the cooked lentils. Pulse several times, scraping down the sides once or twice, until the mixture is coarsely ground.

3. Transfer to a large bowl; stir in the remaining lentils. Let cool for 10 minutes. Mix in egg yolk (or flaxseed) and lemon juice. Cover and refrigerate for 1 hour.

4. Form the lentil mixture into 5 patties. Heat the remaining 1 tablespoon oil in a large non-stick skillet, preferably cast-iron, over medium-high heat. Add the patties and cook for 3 to 4 minutes. Turn gently and continue to cook until lightly browned and heated through, 3 to 4 minutes more. Serve immediately, or allow to cool then freeze.

Note: French green lentils are smaller and firmer than brown lentils. They cook more quickly, too, in about 20 minutes. They can be found in natural-foods stores and some larger supermarkets.

Nutrition per serving: 228 calories; 9 g fat (1 g saturated fat, 6g mono unsaturated fat); 41 mg cholesterol; 27 g carbohydrates; 11 g protein; 7 g fiber; 276 mg sodium; 467 mg potassium.

Nutrtion Bonus: Folate (53% daily value), Vitamin A (50% dv), Fiber (40% dv), Iron (20% dv), Potassium (16% dv).

1 Carbohydrate Servings.

Exchanges: 1 1/2 starch, 1 very lean meat, 2 fat (mono).

YELLOW PEPPER RELISH
A colorful relish for the burgers, this is also great stirred into nonfat yogurt for a vegetable dip or combined with light mayonnaise for a zippy salad dressing.

INGREDIENTS
3 cups water
3 yellow bell peppers, seeded
2 medium onions, peeled
1/3 cup maple syrup
1/3 cup cider vinegar
1 1/2 tablespoons frozen pineapple juice concentrate
1/4 teaspoon salt
1 serrano chile or jalapeno pepper, seeded and minced (optional)

1. Put water on to boil in a medium saucepan.

2. Meanwhile, shred peppers and onions with the large-hole side of a box grater into a large bowl. Finely chop any remaining pieces of onion or pepper and add them to the bowl. Cover with the boiling water and set aside for 10 minutes. Drain in a large colander for 5 minutes (don’t squeeze out any moisture).

3. Place the shredded vegetables, sugar, vinegar, pineapple juice concentrate, salt and chile (or jalapeno), if using, in a large saucepan. Bring to a simmer over medium-high heat, stirring occasionally. Reduce heat to medium-low and gently simmer until thickened and tender, 25 to 30 minutes. If the mixture gets too dry before the peppers are tender, add water, 2 tablespoons at a time. Refrigerate, uncovered, until chilled, about 2 hours.

Visit EatingWell.com for free quick and easy healthy recipe collections!

Reform American Health Care

Target: U.S. House of Representatives
Sponsored by: IOUSA: The Movie

Did you know that Americans spend more on health care than any other country? Costs have been rising significantly faster than economic or personal income growth for the past 40 years, and the trend is continuing at an unsustainable rate. In fact, it is the worst long-term crisis facing the nation, and it demands a solution.

If we don't address these rising costs now, our entire safety net could disappear, including Medicare and Social Security. Even worse, cost burdens and our $9.5 trillion national debt make it almost impossible to invest in new programs that make us healthier and more secure.

Annually, the U.S. health care industry spends an amount equal to the entire gross domestic product of France and Spain combined, so reform is going to be complicated and challenging. But it needs to happen sooner rather than later, and the first step is asking hard questions about health care in America.

Waiting to reform the health care system will just push the problem onto our children and grandchildren, and that is irresponsible and immoral. Ask Congress to seriously face health care reform today.

Sign the petition!

Signature goal: 25,000

Current signatures: 2,370

Clean and Green Exercise

Originally posted by Annie B Bond. Excerpted from "Wake Up and Smell the Planet" (Skipstone, 2007), by Grist.org.

Even eco-types like us can be couch potatoes (though the couch is formaldehyde-free and our potatoes are organic and locally grown). But when the clock says 5:03 p.m. and the stress of your last meeting lingers on, nothing beats the satisfaction of a sweat-inducing, tension-releasing workout. (Well, that or a good stiff bourbon.) Still, popular modes of exercise come with their own set of environmental concerns, so educate yourself before dropping to give us 20 at the end of your busy day.

For the Fleet of Feet
Those of you whose post-work exercise routine includes an invigorating run may want to consider the implications of inhaling deeply—especially if you live and jog in an urban area.

Your chief outdoor foe is likely ozone, created when the chemicals in car exhaust and other emissions react to sunlight. It lurks mostly during the day, usually hitting its peak in the late afternoon and early evening, and lessens quickly as the sun goes down. Since traffic is usually lighter at night, and factories are likely to be spewing less, it’s likely that nighttime air is cleaner than daytime air. Of course it all depends on weather, geography, traffic intensity, the type of pollution, and so on. Some particulate matter can stick around for weeks, but in general pollution weakens with time.

If your schedule—or safety concerns—don’t allow for nighttime jogging, you still have options. Just pay attention to the local air-quality forecasts and keep a close eye on your body’s reactions as you run, especially if you have asthma or another respiratory condition. Try not to run on days or nights when the air quality is especially bad. If you simply can’t miss a day, ease up a bit: Walk instead of jog, jog instead of sprint.

As for other alternatives, you could create a gym with your friends by combining collective equipment. Or think about joining a local sports league—you get to exercise and socialize all at once. (And whether you win or lose, there’s always a reason to hoist an organic beer or two afterward.)

Low-Impact Exercise

• Walk or bike to work.
• Run up and down the steps of your local museum (just try not to sing the “Rocky” theme song.)
• Work in your garden.
• Do sit-ups while watching Animal Planet.
• Clean out your garage.
• Take your dog for a long walk.
• Chase your kids around the yard.

Advanced Workout

• Bike home from the market with panniers full of fresh food.
• Volunteer to lift sacks of bulk grains at your grocery (you never know).
• Join a group that clears trails in local hiking areas.
• Bench press your composting bin.
• Plant trees with a local arbor organization.
• Push a Hummer into a Prius car lot. Bonus workout: Engage in the ensuing scuffle (don’t forget to guard your face)!

Come On In, the Water’s … Probably Okay

We know some of you go to great lengths to achieve a weekly quota of laps at the pool. Perhaps you’ve noticed the scent of chlorine wafting off your skin for hours afterward and thought, “I stink of chemicals and my hair is turning brittle and green. Could this be harmful?” Well, perk up those swimmer’s ears as we dive into what we know about pools.

Chlorine is used to remove harmful contaminants from water, mostly because it’s
cheap (and because anyone who’s swum in a kid-populated pool is thankful for its mighty
pathogen-zapping powers). But when chlorine reacts with organic matter such as dirt and dandruff, a whole new family of chemicals results: Trihalomethanes (THMs), which hang around in the water and the surrounding air. Their concentration depends on water temperature and the amount of chlorine in the pool.

When swimming in chlorinated water, you have an elevated exposure to this group of chemicals, though the actual risks from such exposure are currently unknown. How long do THMs persist in the body? In the case of the most notorious, chloroform, the answer appears to be: not very long. The U.S. Occupational Safety and Health Administration has set allowable workplace chloroform levels for the standard work week at 50 parts per million. Most pool air will be at that level or higher, but you are only in the pool for an hour or so.

If swimming is your exercise of choice (and if you don’t do it all day long, every day), the associated chemicals aren’t likely to do you in. Be aware that outdoor pools and indoor pools with high ceilings are considered safer than those in low-ceilinged or otherwise tight quarters. Rest assured that swimming is great exercise—and you look totally hot in that Speedo.