Archive | October, 2012

A Visit

16 Oct

It is visiting day and Abby comes to sit at my feet.  She sticks her head out, eager to wear the ‘Pets and Friends’ bandana and get started.  We hop in the car and head to the hospice.  Normally on leash she walks beside or slightly behind me, but as we leave the car and head along the sidewalk she is out front leading the way.

We enter the building and head to reception.  Abby wriggles a greeting to the receptionist who voices an enthusiastic hello and rubs Abby’s ears.  We chat briefly and then stop in to see the volunteer coordinator who gives Abby a rub and chatty hello.  As we head out into the hall, the chaplain meets us.  Two residents have died in the night and he has been dealing with the families, one of which has taken the death particularly hard.  The chaplain kneels down to pat Abby and I tell her to stay while I duck into the lunch room to grab my name tag from a drawer.  When I return, Abby’s tail is sweeping broadly and she is ‘smiling’ at the chaplain and he is smiling in return.  He stands and enters his office as we head down the hall.  We stop in to touch bases with the Director of Care who is just hanging up the phone.  It is a busy day what with the two deaths and consequently the two open beds to fill.  She leaves her chair to greet Abby and enjoys a very brief hiatus in her day.  She tells me which of the residents have died.  One had always been eager to have Abby visit and I will miss our time together.

We head down to the nursing station and say a brief hello.  They are settling back into the routine of the day after losing two of their patients.  I pull out the ‘volunteer book’ in which we volunteers record the details of our visits.  The notes give the volunteers a running non-medical history of each of the residents – preferred topics of conversation, who is eager for visits, who is not and who is fading.  I chat with the nurses to decide who may be up for a visit and then together Abby and I move down the hall.

I give a little rap on the door and stick my head in.  B is sitting quietly atop the bedclothes on her bed.  She is wearing sweat pants, a tee shirt and a lovely hand knit sweater.  She is seventy-two and has fought a long losing battle with cancer.  She sees Abby and her face lights up.  Abby wriggles her greeting and I lift her up onto the bed.  They give each other full attention and then after a couple of minutes Abby lays down with her head on B’s lap.   As B and I chat, her right hand fondles Abby’s ears continuously.  A few minutes later, some of B’s friends arrive and we all chat about ‘dogs’ for a while.  Abby and I leave B with her friends and duck into the next room.

D is almost gone.  We have been visiting him for over a month now and at the beginning he delighted in having visitors.  His wife and son have gone to catch a quick late lunch and will be returning shortly.  He smiles weakly as we enter and Abby quickly settles onto the bed.  He is heavily medicated for pain and abruptly drifts off to sleep.  Abby joins him in sleep and she begins to snore.  We went for a long walk this morning and she has some catching up to do.  A few minutes pass and D awakens picking up mid-sentence where he left off our conversation.  He strokes Abby’s back and I talk about a fishing trip I recently went on with my cousin.  D was a fisherman here on the west coast and he enjoys tales of the sea.  Five minutes later he has drifted off again.  This cycle of wakefulness and sleep continues until his family return.  They are relieved to find us at his bedside and find comfort in knowing that he has not been alone.

As we walk down the hall, a young Asian woman steps out from her mother’s room.  “The nurses told me you were here.  My name is W and I was hoping you two could stop in and see my mum.  We have a dog at home and she misses her tremendously.  My mum doesn’t speak English though.”  We enter the woman’s room and when she sees me her face shows a flash of concern.  As her daughter explains our presence, her mother catches sight of Abby and a lovely smile spreads across her face.  Up on the bed, Abby soaks up the attention both women lavish upon her.  They are chatting now in Cantonese spattering the conversation with laughter.  Abby then sits up on her haunches like a Meerkat.  “That means scratch my tummy please.”  They oblige and giggle as Abby’s eyes slide shut in contentment.  “Does she do any tricks?” asks the daughter.  I nod and lift Abby to the floor.  “Point your finger at her and say BANG!”  W raises her arm and shoots Abby who immediately drops like a stone onto her back.  More laughter.  A nurse comes in, curious about all the joyful noise.  Abby flips back onto her feet, expectant for a treat.  I pull one from my pocket and give it to W who offers it to Abby.  More chatting ensues till the nurse hears a bell chime from another room.

After a few more short visits, we stop back at the nurse’s station and fill in our record of visits, then we offer our goodbyes to the staff and head home.  It has been a good afternoon.

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Death Anxiety

13 Oct

After discovering a lifeless bird or cat at the roadside a young child may ask of her parent why the animal is dead.  Then after processing the answer will follow up with “Will I die?”  Later as teenagers, we may engage in risk taking behaviours such as drug taking or drinking and driving – as if testing the boundaries of our existence.  At some point we will encounter the reality of death as a friend or grandparent dies.  Throughout our adult life we commonly ignore the existence of the door ‘over there’ without actually acknowledging that some day we will be passing through it.  The door may become exquisitely clear as when your parent or child dies but then we quickly hasten to conclude our death is a long way away at some time far in the future.  Pay it no attention and it isn’t really there seems to be a common mind set.  We even build elaborate mental processes to soften the reality.  Many religions have us simply passing out of this life into another.  Regardless of what happens to us as and when we die, there is a thread of anxiety about death that runs throughout our living years.  For some this anxiety becomes very profound after being diagnosed with a life threatening illness.  This anxiety may then be heightened when the physician recommends that the patient be transferred to a palliative care ward or a hospice.

Regardless of the reason, caregivers in palliative situations all have agendas when dealing with patients.  Director’s of care are actively engaged in coordinating the medical services patients receive, physicians treat outstanding medical issues, nurses tackle the day-to-day personal care, chaplains seek to address religious concerns while family and friends visit with issues related to personal relationships.  In each of these cases the intent is to assist the patient, yet everyone in some way is asking for something from the person approaching death.  Be it information on pain levels, bowel function, drug reactions, crises of conscience or legal matters, the patient is asked to give of themselves.  Many of these interactions do little to reduce death anxiety.

The Hospice Education Institute is a U.S. based non-profit organization whose mission is to inform, educate and support the delivery of hospice programs.  They suggest that there are five principal methods for addressing patient anxiety in palliative care settings.  They are counseling, visualization, cognitive methods, drug therapy and relaxation therapy.  Palliative pets can play a role in this last category.  For animal lovers approaching the end of life, contact with the familiar positive interactions with pets helps to normalize the hospice environment.  In the case of a palliative pet and the volunteer that brings the animal to the hospice, the role is simply to give of themselves.

On numerous volunteer visits when entering a hospice room with Abby, the first expression I have seen on the face of the patient is one of concern.  I can almost hear them thinking.  ‘An unknown person is entering my space.  What do they want?  Why are they here?  What now?’  However, when they see the dog, a smile spreads across their face and they are suddenly eager to engage.  As the hospice coordinator of volunteers at the hospice where I attend is often wont to say, ‘There is no I in volunteer’ and the role of the volunteer and the palliative pet is simply to give without thoughts of outcomes and expectations.  And that is what dogs do.  In bringing the familiar to the room, the dog brings comfort and relaxation.  Conversations initially focus on the dog, the patient’s pets present and past.  Later, as trust is established, the conversations often become more wide reaching, all at the pleasure of the patient.  The opportunity for a patient to physically engage an animal whose essence is just ‘to be’ is the key factor in reducing anxiety during a visit from a palliative pet.  As discussed in the Health Effects blog at this site, pets have been clinically shown to reduce stress and anxiety levels.  In my experience, unlike watching a television program or listening to a radio which act more like distractions from mental and emotional states, the act of stroking a dog quietly resting on the bed engages the mind of the dying to live in the moment and carefully explore the reality of what remains of their lives.

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Pet Health Effects

3 Oct

There is a growing body of scientific evidence that conclusively affirms the numerous positive health effects attributed to human-animal interactions.  Interacting with a pet has been shown to decrease anxiety and to activate the sympathetic nervous system in humans.  Other studies have shown increased survival rates in individuals who had suffered a myocardial infarction (heart attack).  In an article published in Companion Animals in Human Health, Friedman and Thomas examined a group of coronary artery disease sufferers who had experienced a heart attack.  One year survival data conclusively found that those individuals who owned a dog were significantly less likely to have died in the one year duration of the study.  Given that most dog owners take their animal out for regular walks and hikes, it is not surprising that not only is the dog being exercised but so is the owner.  Interestingly, a positive benefit was not found for cat owners.  While one might initially suppose that owning a dog was related to differing physical characteristics of the patients than non-owners, such was not the case.  The dog owners were not found to be ‘healthier’ sick people at the beginning of the study and the positive benefit was found to be solely attributed to dog ownership.

In the April 2010 edition of the scientific journal Acta Medica Okayama, the authors investigated the effects of service dogs on health-related quality of life issues.   In the study, the researchers utilized a detailed survey that evaluated various health indicators of persons with significant disabilities such as spinal cord injury or multiple sclerosis.  The experimental group lived with a therapy dog and those in the control group did not.  The results show that persons living with therapy animals have reduced physical and mental stresses and higher self esteem.

Susan Swartz writing for The Press Democrat interviewed health professionals who have found that dogs have become an essential part of their practice.  Dogs are now a key piece in fully engaging teens and war vets in counseling sessions where the animals act as conversation starters and safe surrogate companions.

Anxiety is a common emotion for persons entering a hospice.  For those that are mentally competent, they are fully aware that this is the last stop on the train of life.  Even those who hold devoutly religious beliefs, the knowledge that their life is rapidly coming to an end can induce fear and apprehension.  In my experience, the very act of entering a room with a palliative pet tends to normalize the environment, especially for a new resident.  The relief on the patients face and through their bodies is immediately evident and those that are comfortable with dogs very quickly engage with the animal before fully engaging with me, the dog’s leader who after all is just another stranger in this new strange environment.  The animal’s presence immediately elicits physical contact and calming repetitive stroking of the dog straight away precipitates a relaxed interaction.   Even for those patients with advanced dementia, palliative pets can generate positive responses.  In my experience physical contact with a dog can trigger some deep rooted reaction in an otherwise socially unresponsive dementia patient.  Whether this response is innate or memory-based is unclear but I have witnessed otherwise unengaged patients who have been physically challenging to care givers become calm and relaxed in the presence of and contact with a palliative pet.

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