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Things you can do well before EOL

Most of the info on this page is for terminally ill pets, but one thing it's really nice to do any time in their life is make a rubber paw cast, which is much more comforting than anything made from their dead paw. I took a mold and made a rubber cast of Reese's paw while he was still alive, and it's been helpful to hold whenever I miss him (which is basically all the time). The moment I made it is seared into my mind forever, so I'm glad I had time to make it while he was alive.

DIY paw casting

Use a nontoxic substance, ideally one that will set very quickly so your pet doesn't get too impatient. Some common options:

Tanya Ruffin has a helpful blog post on using Amazing Mold Putty to make a rubber stamp of your pet's paw. I found a kit box at my local art store.

End-of-life (EOL) planning

For a chronically ill pet, I recommend making an end-of-life plan as the end nears, even if your loved one is not quite yet in a terminal stage of their disease. End of life decisions can potentially involve enormous amounts of money and can be incredibly stressful and overwhelming.

You can always change your exact decisions when the time comes, but it removes a huge emotional load if you know what to expect *before* you're sobbing uncontrollably into a towel and being asked to sign hospital forms, make horrible decisions on the spot, and pay surprise medical bills you may or may not have budgeted for.

People who have already experienced a loved one's prolonged EOL may have a slightly less difficult time making euthanasia decisions to help their pet not suffer. I had never gone through this before, and was in a uniquely desperate zone where Reese was functionally my only family member, so I gave up nearly two years of my life to nurse him and would have done literally anything for him that wasn't going to actively increase his suffering. However, I decided to draw the line at full-body cancer treatments when he was already very fragile anyway from multi-organ failure.

I sobbed a lot while researching this information, so I hope that collecting it all into one place can make things a little bit easier for someone else out there.

Preparing yourself

No matter what decisions you make, it is good to have at least one person on call, who is willing to be with you and drive you to the hospital for the difficult parts. Do NOT attempt to drive while sobbing uncontrollably.

I have commonly heard from dogs' humans that "they just knew when it was time", but reports from cats' humans appear to be mixed. I speculate that this may be related to differences in inappetence between cats and dogs. Cats seem to be able to lose their appetite for a much higher variety of medical reasons that have nothing to do with their desire to live.

Tanya's Guide has a very well written end-of-life page. If you are able to stomach it, I think this page does a very good job helping you understand what to expect, both logistically and emotionally. Obviously, this may not be for everyone, but I found it extremely helpful to feel in solidarity with internet strangers who have gone through the same kind of heartwrenching grief and loss and know that I was not alone.

Preparing to let go

One helpful piece of advice I got was to have a conversation with your loved one when you are ready to let go. Although they may not understand all your words, they understand your body language, and saying the words can sometimes help *you* express your body language, which is probably dampened by your human societal conditioning.

Things were hard with Reese because he had so many ups and downs and there was never a time where it seemed like he was "ready", even when he was extremely weakened and things were very difficult for him. It was clear that he loved being with me and that would never change, but he passed a few days after I told him that I was ready to let go if it was too hard for him to keep staying alive for me.

Expensive decisions

If you are reading this page well in advance of the end, it will definitely go much easier if you are able to build up or crowdfund at least $2000-3000 in your pet emergency fund, though I know that is a luxury many people cannot afford. Depending where you live, it could cost several hundred dollars just for home euthanasia and cremation.

I hope this page will at least help you figure out what services you are able to afford so you can emotionally prepare for these difficult decisions.

Getting help with EOL planning

Blue Pearl hospice care offers virtual quality-of-life consultations, ranging from $95-195. They can help you understand your remaining medical options, how to make the hard decisions, and EOL planning.

It is also possible to find pet "death doulas", who can help you with EOL planning and emotional aftercare. Think of them as a buddy who can help you through the process if you don't have friends you feel comfortable asking to help. Their services tend to be less expensive since they are not veterinarians. Here is one pet death doula's resource page.

It feels expensive, but an unhurried end-of-life consultation is really worth it for a dear loved one. My Blue Pearl consult helped me make better medical decisions, saved me a lot of agony wondering if I was making the right decisions, and definitely saved me money in turning down desperate end-of-life medical procedures that wouldn't have helped Reese live longer anyway.

It lightened my burden a great deal to get expert help making a plan for Reese, learn about his remaining medical options, maximize our last little bit of time together, and know that I was really doing the best I possibly could for him.

Possible end scenarios

Do Not Resuscitate?

If your pet's heart unexpectedly stops at the hospital, resuscitation and life support can cost around $300-2000. You will be asked to pre-approve your preference as soon as you drop them off at the hospital so they can act ASAP if anything happens. (I did not realize they would ask me to make this decision on the spot and subsequently had a breakdown in the parking lot.)

For a healthier cat, you might choose resuscitation. Every single ER staff I saw toward the end of Reese's life all recommended I check Do Not Resuscitate for him. They said that CPR can be traumatic and has a very low success probability for a cat who is already in very bad health, that I would only be slightly prolonging the inevitable. One of the aides also had an EOL pet and said they would select DNR for their own terminally ill furbaby, which finally convinced me.

Even though I was resolved to be with him in his last moments if at all possible, I accepted DNR near the end when he was extremely frail and the mere act of CPR might have killed him anyway.

I didn't find out about VEG (Veterinary Emergency Group) until after Reese passed. If there is a VEG near you, I highly recommend going to them for all your ER needs, because they let you stay with your pet the whole time. One of my new cats gets triggered and hissy about nearly every normal vet experience, but was totally fine at VEG except for the moment the needle was going in her, because they let me sit with her and cuddle her the whole time we were waiting for the vet to see us. The VEG staff probably spent more time soothing my new cats than talking to me during intake, which was amazing. The more industrial pet ER closer to my house was unbelievably stressful for Reese, and he often had to sit alone and scared in holding cages for many hours at a time, which was an actual medical concern with his EOL heart condition.

Euthanasia

There is extremely wide cost variance in end-of-life services, depending on the cost of living in your area. Here are the costs I found in the U.S.

Vets may push strongly for euthanasia toward the end because it is very hard to predict how prolonged or painful a natural death will be.

If choosing the last day, you may like to plan to help your loved one do all the things they like best that they are still able to do.

Natural death

Tanya's Guide has a very well written page called "The Final Hours". If you are able to stomach it, I think this page does a very good job helping you understand what to expect, both logistically and emotionally. Obviously, this may not be for everyone, but I found it extremely helpful to feel in solidarity with internet strangers who have gone through the same kind of heartwrenching grief and loss and know that I was not alone.

Tanya's Guide describes a phenomenon called "rallying" where a terminally ill creature will suddenly seem to recover and feel much better in the hours just before their death. After doing badly for about five weeks, Reese suddenly rallied and even played with his toys for the first time since getting really sick, and we had one last good afternoon snuggling together.

I didn't recognize that this was "rallying", and was so thrilled by him feeling better that I was unwilling to schedule euthanasia that day. He declined over a few hours and then suddenly began to convulse -- I quickly put him in his carrier and rushed him to the emergency hospital in five minutes, but I think he was already dead as I was lifting him into the carrier. Although unpleasant, it was at least over very quickly for him. Unfortunately, there is no way to guarantee that a natural death will be quick.

Some hospice care organizations, such as Blue Pearl, may be able to prescribe terminally ill pets an emergency sedative that you can inject at home in case they start to die painfully and you are not able to get them to emergency euthanasia in time to prevent prolonged suffering.

There are a number of reasons why I felt emotionally unable to pick a home euthanasia date for Reese and he ended up dying a natural death, but now that I have gone through it once, I think I would choose home euthanasia for a terminally ill pet in the future. Reese's natural death was not peaceful at all, and there is no guarantee that your pet will pass away peacefully in their sleep.

Immediate aftermath

If you want, the vet can give you privacy to hold the body and grieve for a while. It is ok to be a complete mess during all of this.

I howled and screamed at the top of my lungs for over half an hour until the body began to grow cold, and then I went home and sobbed for a few more months in a row. The experience was absolutely awful, but also a necessary part of my grieving process. I do feel like holding the body helped me come to terms with the fact that he was truly gone and there was nothing more I could do for him. A dead body feels unmistakably different than a sleeping living being.

What happens to the body

If they pass away at home, you can either take their body to a nearby pet hospital or contact a pet hospice care for body pickup service (which may be expensive). You may also choose to bury the body yourself if you have a place to do it.

Cremation

Cremation services can be arranged for at a pet hospital or via pet hospice care.

Costs are generally the same for all pets under ~20 lbs. If you have a dog or other animal over that weight, cremation costs will vary by size. Some pet crematories may not be able to manage bodies over 100 lbs, or may charge a very high cost, so try to find this out so you're not surprised when the time comes.

Thoughts: I personally chose communal cremation since it is not important to me to hold onto the ashes, but everyone may have different reasons & preferences.

Paw print

Pet hospitals and EOL services usually offer an ink paw print and/or a 3d clay paw impression when your pet has passed.

Thoughts: If you want a paw impression, I would strongly recommend DIYing one while they are still alive -- the paw print will be associated with a better memory for you that way. I do have an ink print from the hospital that I kind of hate because I know it was made from his stiff dead paw.

Aftermath logistics

See my page on dealing with the aftermath of pet loss.