Norfolk vet helps owners say goodbye to loved pets

Posted by Big Rat on Campus on Feb 17, 2014 in Rat Answers | Subscribe

The veterinarian rubs Cheyenne’s large, limp head and tries to get her to eat. The Great Dane likely will be dead within the hour. Her last meal should be a treat.

Cheyenne’s silvery white body sprawls across her bedding, which has been pulled out onto the wooden deck of her owners’ Norfolk home.

The 13-year-old dog can no longer walk well, and arthritic pain and neurological deterioration have made her gait unstable. She has developed a canine version of dementia and often is disoriented, confused and anxious. She has been incontinent, and no longer responds to medicine.

Her owner, Carol Keiser, a nurse practitioner, knew it was time to let her go and wanted it to be as peaceful and comfortable as possible. So she called Tyler Carmack, a veterinarian who has made a business of providing end-of-life care to animals.

Lady, another of Keiser’s great danes, sniffs the vet.

“OK, Lady, here you go,’ Carmack says, giving her a bit of food. “But it’s not about you today.”

Carmack gets up and walks to her bag to begin her final prep. Keiser kneels next to Cheyenne. The owner lifts her dog’s head, touching it with her own. The wind shakes the leaves overhead and stirs pine needles across the deck.

The only sounds are Keiser’s soft sobs.

“You’re the best in the whole world,” she whispers to Cheyenne. “You’re going to go to sleep now.”

Carmack, who started Hampton Roads Veterinary Hospice in 2011, is often told that hers must be the saddest job in the world. She disagrees. What she does, she says, is more of a privilege.

Carmack, 32, grew up with a virtual zoo of cats, rats, rabbits, ducks and fish, and she knows what it’s like to lose a pet. As a vet, however, she likes to get into the skin of the animals, and think about what pain and dying are like for them.

“We all want them to live forever, and that’s not the way the world is,” Carmack said, before her visit to Keiser’s home.

When deciding whether the time has come, she considers the quality of a pet’s life, not its quantity in years.

She started traveling to people’s homes to offer pet hospice care and euthanasia because she knows that some people become as attached to their dogs and cats as others do to children.

If dying humans prefer to spend their last days in the comfort of home, why should it be different for animals? Why shouldn’t Cheyenne take her last breaths on the deck where she’d galloped a thousand times, with her playmate Lady nearby and the sounds of nature that were her daily music?

But shortly after Carmack began her business, she realized that it wasn’t only about the animals.

Owners needed comfort, too.

 

It’s a drizzly cold Tuesday night, and five people have shown up at Hampton’s main library. Boxes of tissues are spread out among the tables and semicircle of chairs.

The is the Peninsula gathering of the Pet Loss Support Group that Carmack began in early 2012. The meetings alternate monthly between Hampton and Virginia Beach and allow owners to work through their grief.

This night, Carmack has asked a yoga instructor to teach breathing and relaxation exercises to help participants relieve stress and anxiety. The group, however, just wants to talk.

Someone says they’d read that 90 percent of owners ignore their pet’s symptoms of pain and disease until it’s too late to provide care that might make the dying process less painful.

One woman cries about how non-pet owners don’t understand the pain and sometimes casually toss out, “Just get another pet.”

Several in the group talk about regret and pangs of guilt. How they’d spent thousands of dollars to extend the lives of their pets when they should have allowed them to go earlier. How they’d purposely overlooked symptoms.

One man says he was selfish.

Carmack nods and listens.

One woman discusses how her dog fell one day and started having problems standing and climbing stairs.

The woman didn’t realize the extent of her pet’s injuries “because I was picking her up and carrying her up the stairs…. I didn’t mind carrying her up and down – what’s 7 pounds?”

Then she pauses and looks at Carmack.

“But how do I know if she wanted to be carried?”

Carmack closes the meeting by offering advice, telling those gathered to reach out to friends or each other during times of despair. Find people who understand that losing a pet is like losing a child.

Someone asks Carmack how she deals with death on a constant basis.

“The nice thing is going into a house, and my patients are usually past ready,” Carmack says, “and they think they don’t have to keep up the front for the family anymore.”

A couple of the group members dab their noses with a tissue.

“They can just go on now,” Carmack says, “and go to sleep.”

 

Carmack graduated from Cox High in Virginia Beach, then attended North Carolina State University as an undergrad, followed by its veterinary school.

She worked in emergency care, and it was there that she realized families were not preparing themselves for the final struggles of their pets, as people often do with humans.

“These medical decisions are very personal, emotional and confusing for pet owners and their families,” Carmack said.

“I liked explaining and the counseling, but in that case you’re having to explain and have them understand it in 15, 20 minutes.”

She moved back to Virginia Beach a few years ago with the idea of an on-call business that promoted hospice care, which allows pets comfort, such as acupuncture, during their last weeks or months, and families more time to digest what is happening.

Often, it is just hand-holding on Carmack’s part, getting family members to talk about the end. Or educating them on the death cycle.

Carmack helps them to gauge the point at which they will be willing to think of euthanasia: Is it when their pet stops eating, or becomes incontinent? Or once the animal turns easily agitated and confused and becomes a danger to the family?

The idea of pet hospice care caught on quickly. Carmack opened her business on Nov. 1, 2011, and got her first call for help at 8 that morning.

Now about 70 percent of her business is home euthanasia, which she performs about 50 to 60 times a month. Another 20 percent of her work is hospice, and the rest is acupuncture.

Carmack has doctors on call to help out when she needs to take a day off or travel, but she sleeps with her cellphone by her bed.

When she counsels people, Carmack also shares her own story. Santa brought her a gray-and-white kitten when she was 6. Socks, as she called the cat, was her best bud for years.

Then, while Carmack was away at college, the animal became ill and her mom told her she should come home.

“It was hard to see her sick,” Carmack remembered, “but it was worse knowing that she’d probably been that sick for a long time.”

 

Cheyenne lies motionless as Keiser weeps.

From her bag, Carmack removes a syringe, tourniquet, razor, disposable pad and box of clay.

The veterinarian stoops at the rear of the dog and slowly lifts Cheyenne’s legs and tucks the pad underneath, in case there’s some incontinence.

Carmack shaves off a small square of fur on the Great Dane’s leg, then applies the tourniquet to find a vein. She attaches a catheter. She had already given Cheyenne a sedative to make Cheyenne drowsy.

Cheyenne’s eyes flutter, then close.

Into the tubing, Carmack inserts a solution that will end the dog’s suffering.

Keiser wraps her arms around Cheyenne. A few minutes later, Carmack takes a stethoscope and reaches under the owner’s arms to check for a heartbeat.

She finds none.

Carmack puts her own arm around Keiser and whispers in her ear.

Keiser holds onto Cheyenne as the veterinarian takes the right paw and presses it into the clay to make an imprint. She will leave it for Keiser.

Three women with a stretcher arrive and lift Cheyenne to take her away. Carmack removes the dog’s collar and gives it to Keiser.

Keiser grabs Carmack in a big hug and breaks down while thanking her.

“I’m just glad we were able to help her at home,” the vet says. “You call me if you need me.”

Denise M. Watson, 757-446-2504, denise.watson@pilotonline.com

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Article source: http://hamptonroads.com/node/706784

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