The relationship between people and animals, often called the human-animal bond, is powerful and diverse and has been documented throughout history, across cultures, and in recent scientific research. 

Although people experience the human animal relationship most often with dogs, cats and other household pets, individuals also form bonds with wildlife, feral animals, even farm animals.  We magnify the effects of the bond even further when we bring registered therapy animals into nursing homes or children's reading programs to benefit others.  We train service animals to help people with disabilities, literally transforming their lives and providing increased independence.

I don't usually have to explain to my clients what the human-animal bond is - they are often experiencing the benefits as well as the painful emotional consequence of loving an animal as we face end of life concerns.

Recently I had the honor of being elected to the board of the American Association of Human-Animal Bond Veterinarians (AAH-ABV), an organization with the mission to advance the role of the veterinary medical community in nurturing positive human-animal interactions in society.

That seems like it should be a "no brainer" to most of us as veterinarians, but as scientists and physicians we are taught to fix things. In fact the veterinary oath makes no mention of people beyond using our skills "for the benefit of society". 

What we need to keep in mind, especially as companion animal veterinarians, is that the relationships pets have with their people has a huge impact on their health and welfare. Here are just a few examples:

• When we prescribe medications for pets that are difficult or impossible to administer at home, the pet suffers.  
• Too often behavior problems can result in resentment, physical separation, even abandonment of our four-legged family members.
• Frequently recurring dog bites - often terminal for the dog -  stem from poorly educated people or children and poorly socialized animals.  
• Overfeeding, obesity and the resulting health effects (arthritis, diabetes, etc) shorten the lives of our pets

In consulting with clients with patients in veterinary hospice, we weigh the benefits of any treatment with the potential risks, as well as the impact on the relationship.  A medication that we can mix with gravy may be okay, but if getting a pill down requires a struggle, we need to look at other alternatives. 

It's about the bond.  

Many people ask me if they should get a second dog as a companion to their older dog.  After all, it doesn't take twice as much work to take care of two right?  (Although remember, it does cost twice as much!) 

If you add the right second dog to the family and are a bit lucky, it can work well for all involved.  

To fight off worry about the future or regret about the past, I actively look for ways to live in the moment - when I get it right, it's an incredibly peaceful feeling.  I’m closest to that state of being when I am interacting with animals and it's one of the reasons I became a veterinarian, committed to a vocation that celebrates that interaction we have with our pets - the human-animal bond.

I grew up in a household full of animals, but my first dog, Missy, was a birthday present when I turned eight - she was a beagle, basset, terrier mix that my parents found in the classifieds.  She was my best friend and taught me so much about compassion and love, fun and 0vercoming fear.  She was there for me through the most difficult years of my life.  She died while I was in college and when I think back now, I almost don't remember my childhood before her.  I’ve had many other dogs and cats and other pets that I loved dearly, but my first dog will always hold a special place in my heart.

I saw one of my favorite sayings on a t-shirt the other day: "Be The Person Your Dog Thinks You Are."   What a worthy goal!  

There are so many treatment options in veterinary medicine these days - we can choose cancer radiation treatments, joint replacements, kidney transplants for our pets  - all quite successfully in the right cases.

But we as pet owners almost always outlive our pets, so we are repeatedly faced with making difficult decisions about their care and the lengths we will go to treat them.

So what do you do if you are facing a terminal disease for your pet, you have chosen not try to "cure" the disease and now you are seeing declining quality of life.  The decision on whether and when to choose euthanasia is a difficult and personal one.  You may be thinking you need to postpone it. Maybe you feel your pet still has more good days than bad.  Maybe you want to make it until the next college break, or the end of a deployment.  Maybe it's not a decision you are emotionally prepared to make.  Veterinary hospice may be something you are considering.

I've written about veterinary hospice in the past, and while more and more veterinarians are offering hospice care programs, the truth is many pet owners have been providing basic hospice care for some time - home cooking, help getting outside, cleaning up after daily accidents.  Doctors can prescribe pain control, appetite stimulants, fluids, etc., but whether your veterinarian gets involved or not, when you are providing end of life care for your pet, you need to think about three different budgets:

1. Your Financial Budget - you have choices about where to spend, but (almost) everyone has a point where they get uncomfortable.  Whether it's because it's impacting the overall finances, or others in the family have hit their limit, it's a finite resource.
2. Your Time Budget - providing end of life care is a significant commitment for the household as your pet needs more and more help getting around, going outside, staying clean.  Even with veterinary and nursing support, it's a commitment.
3. Your Emotional Budget - You've had years of love, fun, companionship and experiences.  Hospice care can be an amazing time to prepare to say goodbye, but it will not be easy for you.   The emotional toll of caring for your declining companion requires the biggest budget of the three.

Without enough money, time or emotional currency, you get into a deficit situation that can have a long term impact on your life - it can put at risk finances, relationships, employment.

When any one of the three runs out, it’s important to acknowledge it's time to do something differently.  As difficult as it will be to ask, find some help from a veterinarian, extra helping hands at home and/or a mental health professional.

You've got to balance the budget.