Animal Rescue Families in Bremerton found her thirty pounds underweight, with an open gash wound on her head, along with numerous other lacerations. Unable to lift her head to eat, she required hand feeding. She was rehabilitated for three months by local rescue group Collar of Hope, and renamed Aisha, which translates as “She who lives.”

Adopted by Helen Anne in November of 2011, Aisha settled into her Lake City home, and thrived in her new environment. Lounging in the sunny backyard with Helen Anne’s three doting chickens became her new favorite activity. It seemed the perfect happy ending for Aisha, who remains a friendly, loving dog, despite her traumatic past. Sadly, in April 2013, Aisha was diagnosed with synovial sarcoma, a cancer originating in Aisha’s left hind leg. It was determined that Aisha would not be able to withstand surgery to amputate the leg.

Helen Anne struggled with the news, but with the support of her veterinarian, she was able to accept that there would be no curing Aisha, only maintaining her quality of life. Aware of hospice care (also referred to as “palliative” or “comfort” care), but lost as to what this entailed, Helen Anne sought the assistance of greater Seattle-based organization, The AHELP Project (Animal Hospice End of Life Palliative Care Project; ahelpproject.org). Through referrals from AHELP’s professional networks, she was able to find in-home hospice care services for Aisha.

The therapies a dog receives as part of hospice care aren’t intended to be curative. Rather, they aim to reduce pain and stress and contribute to a comfortable, loving environment. Helen Anne says this takes a team. Hers includes a hospice-focused house call veterinarian, whose services include acupuncture. When pet sitting services are needed, animal massage therapist Lori Theis stays with Aisha in Helen Anne’s home. Fully committed to Aisha’s care, Helen Anne also provides Aisha with a fine tuned balance of medication and supplements, such as salmon oil and herbs, which have produced positive results.

It’s common for pet owners to be unprepared initially for the decisions they face with a pet’s terminal illness, says Michelle Nichols, a co-founder and Executive Director of AHELP. Unaware that palliative care options exist, many families are under the mistaken belief that when curative treatments don’t succeed, euthanasia must soon follow. Michelle recommends being up front about your wishes for your dog with your vet, service providers, and family, because it’s still rare to find people well versed in animal hospice practices.

Families providing hospice care for their dog may encounter roadblocks along the way. “Sometimes the struggle is that they run out of funds, or the caregiver’s busy schedules prevent them from being home to care for their pet. Other times, caregivers simply need respite. That whole quality of life quandary for both the pet and their person is all encompassing,” says Michelle. AHELP provides counseling and support as families wade through their options and find the solutions that resonate with them.

Lola Ball, author of When Your Dog Has Cancer: Making the Right Decisions for You and Your Dog, was blindsided when her 9-year-old chocolate Lab, Porter, was diagnosed with cancer in January, 2008. Because the cancer had metastasized, Lola’s vet advised against aggressive treatments such as surgery and chemotherapy, which would only reduce Porter’s quality of life. Lola turned to hospice care instead. “My number one goal was that he would never be in pain, that he had a good life, and that he was happy. His tail still wagged, and he loved to go for walks even if they were really, really short. He just loved being with us at home and I knew that as long as those things were happening, that everything was okay,” says Lola. On March 4, 2008, Porter died peacefully at home, with Lola beside him.

Lola recommends having a contingency plan in place if your dog’s health declines further and your veterinarian feels that death is very near. “It’s really about being observant and in tune with your dog. That is how you’ll recognize whether they’re in pain or not. If you’re in a cancer situation, I recommend a hospice toolkit. Have a variety of medications that you know how to administer along with tools such as massage. This will help you manage your dog’s condition in the event that it’s a weekend or the middle of the night, and your vet isn’t available.” Lola recommends learning the symptoms commonly observed throughout the stages of the natural dying process, which she covers in her book.

If hospice caregivers feel they can no longer manage their dog’s pain, or otherwise maintain quality of life, they may decide to turn to euthanasia, whether it’s in-home or at their vet’s office. It’s important to find a practitioner well in advance, says Lola, and ensure that he or she will be available on short notice. If you choose in-home euthanasia, discuss contact information and travel time in advance so that when the time comes, your dog will not be left waiting in distress. Lola emphasizes that the decisions regarding a pet’s death are deeply personal. “I don’t think we can have judgment on anyone who is dealing with canine cancer because every situation is unique, and as long as you’re keeping the best interests of your dog and your family at the forefront, you will be making the right decision.”

People are often curious as to why Helen Anne considered adopting a senior dog, with the high risk of health complications. When asked, her response is simple. “If I was old, neglected, and had no home, I would want someone to take care of me.” Senior dogs possess a certain wisdom, she says, and her time with Aisha has taught her about resilience, forgiveness, and living in the present. There was much anxiety wrapped up in trying to find a cure, and finally letting go of that freed her to focus on making Aisha happy.

“Whether you’re talking about animals or humans, sometimes there is only so much you can do. When the prognosis is that things are never going to get any better, you can decide to take whatever time you have, and make it great,” says Helen Anne. “Aisha doesn’t show any signs of pain or discomfort. Her ears still perk up when I come home, she wags her tail, and she gets excited when there are treats. I think if you can give that gift to a dog in her final days, it’s a beautiful thing.”

Editor's Note: Since this article was published, Aisha passed away peacefully in the loving arms of Helen Anne. In an email to CityDog, Helen Anne writes, "Aisha profoundly opened my heart in ways that were unknown to me. She was a blessing. She was a wise old soul who touched so many people's hearts. I am grateful for her coming into my life. Although our time together was brief, she got to know love, comfort and safety in her last two years and for that, I find comfort. She was brave, noble and had a quiet knowing about her that will stay with me for the rest of my life." Rest in peace, Aisha.