Palliative Medicine and Hospice

What does Arms of Aloha do?

We provide pets with comfort and peace in their final years, months, weeeks, or moments by providing chronic pain management, palliative care, hospice care, home euthanasia, and cremation services. We also support the human family members by guiding them through their grief journey.

In order to focus on this important aspect of medicine, we do not do wellness visits, surgery, or vaccinations, nor do we provide emergency/urgent care. If your pet needs to be diagnosed or treated for an illness or injury, you should visit your pet's primary veterinarian or contact one of the emergency clinics on Oahu.

Questions about Palliative Care

What is palliative care?

The World Health Organization defines palliative care as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." You can read more here.

Some people will also use the term hospice care, which is essentially the same as palliative care in a patient with less than six months to live.

You can read more about our palliative and hospice care program on our palliative care page.

What interventions can you offer to help keep my pet comfortable?

There are many ways we can help your pet be as comfortable and happy as possible in the face of a chronic or life limiting illness. Our doctor is trained in advanced techniques for control of pain and other symptoms that can interfere with quality of life. Your options will depend on your particular situation and may include use of medications, physical medicine, environmental modifications, assistive devices and more. Our job is to serve as a guide as you decide what will help your pet the most, then get the ball rolling with the interventions you choose.

Do you provide nursing care for my pet?

Generally, family members do the day-to-day care such as administering medications or performing certain home treatments. We can train you in techniques that you are unfamiliar with. If you need professional help with daily care, we can make referrals to a trusted provider.

How do I enroll my pet in palliative care or hospice?

You can get started by scheduling a home consultation with us. Our doctor will meet with you and perform a complete assessment of your pet's physical condition and your home environment, then help you decide on a care plan.

How should I prepare for a consult?

Please try to minimize distractions during the visit as much as you can. It is best not to schedule other contractors or service providers to come to your home at the same time. We respectfully ask that you do not accept non-urgent phone calls during your appointment. It is also helpful to have everyone who is important in your pet’s life present for a consult. However, it is often the case that loved ones cannot be present for an appointment, and we welcome them to participate via phone or video chat.

What does a palliative care consultation cost?

Together we will explore beyond the medical facts and help you address your pet's emotional, physical, and social needs, then we'll work together to create a personalized care plan that works for you and your pet. You'll receive educational materials so you know what to expect, and learn what to do in an emergency. Consults start at $325.

Questions about Home Euthanasia

I'm having trouble determining when it's time to euthanize my pet.

We totally understand. This is tough stuff! The fact that you are struggling with this decision is completely normal (and very common) - it is also a sign that you care very much about your pet.

The idea of a single "right" time is a bit of a myth. As a respected colleague of Dr. Naun's put it, there is a window between "too soon" and "too late" and the best we can do is try to land somewhere in there based on the information we have at the time.

Any decision you make will have pros and cons associated with it, but if you are coming from a place of love, you really can't go wrong. Your pet would expect nothing more of you than that.

All that said, many people who reach out to us are wondering how to assess their pet's quality of life. We have some resources that may be helpful for that. There are a number of scales and assessment tools around the web - the most well known probably being the Quality of Life Scale developed by Dr. Alice Villalobos.

Although scales can sometimes oversimplify the complicated issues around end of life decisions and don't account for the context in which the pet lives, they serve as a good jumping off point so that you know what to be watching for.

If you are still needing guidance, we suggest you reach out to us by email or phone to discuss your particular situation, or set up a palliative care consultation with our doctor so that we can help you explore these issues in depth.

How do I make an appointment for euthanasia?

We know this is a difficult step to take and we try to make it as simple as possible. You can call us at 808-435-3006 or use our online scheduler here.

Do you require an exam for a home euthanasia?

We only perform a full physical exam at your request, or if you need an opinion on whether it is the right time for euthanasia. We understand that families who care enough about their pet to engage our services are not seeking it for “convenience” reasons. We do maintain the right to decline a euthanasia if it is deemed inappropriate (this is exceedingly rare), and we absolutely promise to treat every client with kindness and respect and help families find alternatives if needed.

How should I prepare for a home euthanasia appointment?

We encourage you to think about where you and your pet might like to spend your final moments together and who should be there, either in person or via phone or video chat. We are quite flexible and will honor any reasonable request. You can also print a Quiet Please Sign (you'll be given a link prior to your appointment) and post it at the entrance to your home if you’re concerned about unexpected visitors or deliveries.

Do I need to withhold food before a euthanasia appointment?

No, feeding your pet is fine and encouraged if they still have an appetite. For your pet’s comfort, we recommend avoiding excessively large amounts of rich treats that could cause stomach upset.

What happens during a euthanasia?

The doctor will give a deep sedative to ensure your pet is relaxed and calm. This is followed by the euthanasia drug, which is simply a big dose of anesthetic. They’ll fall into a deep sleep, then their breathing reflex will stop, and then their heart will stop. They won’t feel a thing and we’ve found it’s almost always very peaceful when we do it this way. The doctor will make sure to explain every step before it happens and answer your questions so that you’re comfortable with what’s going on.

How long will a home euthanasia appointment take?

Most appointments take about 45 minutes to an hour, although sometimes they are as short as thirty minutes. We allot an hour and a half for each appointment in case the pet or family needs some extra time for any reason.

Can I give treats during the euthanasia appontment?

Yes, in fact it is encouraged if your pet is still interested in food - you may even want to give special or "forbidden" foods if that would be enjoyable for you and your pet. It is fine for them to have food up until the point they are too sleepy to eat.

Do animals feel pain when euthanized?

Euthanasia is not painful. The medication used is a general anesthetic that induces deep sleep, but a large enough dose is used to stop the pet's breathing and then the heartbeat. Because it's an anesthetic that works on the brain, the pet cannot be aware of what is happening at that point.

In addition, at Arms of Aloha we first give heavy sedation or full anesthesia before the euthanasia is performed. Pain and anti-anxiety medications are incorporated into this step, ensuring your pet will be as comfortable as possible through the process.

If you have ever had surgery, falling asleep for the euthanasia feels exactly the same as it does when you receive anesthesia for a surgical procecdure, and is not frightening or painful.

Will my pet release their bowels or urinate during the euthanasia?

This happens in a small percentage of patients. We bring waterproof blankets and puppy pads to protect your furniture, flooring, or lap just in case.

Can you do a euthanasia outside?

Yes, we can accommodate appointments outdoors, weather permitting. We do have a few suggestions for considering your comfort as well as your pet's:

• The process will take at least 30 minutes, and it can get very warm in direct sunlight. A tent or other barrier can provide shade, or we can provide an umbrella.
• If the ground is slightly wet, we do have water resistant blankets for seating. If it's really saturated this may be uncomfortable for the family.
• Flies may be an issue in some locations and can be an annoyance. A fan can help with this. We've found essential oils are a mild deterrent. A screen tent would be the ideal solution if that's possible.
• Depending on the location and season, mosquitoes can also be a source of discomfort to family members in the early evening hours.

These are relatively minor issues that can be overcome with a bit of planning. If you have any questions or want advice for making an outdoor setting as comfortable as possible, feel free to ask us.

Can we do the euthanasia appointment somewhere other than our home?

Some of our most beautiful appointments have taken place somewhere that has special meaning to the pet and family. Although most people still choose home, you have some other options. Popular choices include:

• A park or other gathering place
• The beach
• Another loved one's home

General guidelines are that if the appointment will take place on someone's else's private property, you need to get their permission first. The University of Hawaii forbids commercial activity from taking place in common areas on university land. You may also want to consider your privacy e.g. by choosing a less busy time of day or a location that isn't heavily visited. If you have any questions about the appropriateness of a location or want suggestions, feel free to ask us.

Who can be at the euthanasia appointment?

Anyone you think you and your pet would like to be there. Some people choose to have quite a few friends and family members present. This is completely up to you.

Should I allow my other pets to be present?

This depends on the personality of your other pet(s) and the bond that they share with the pet who is passing away. In most cases, it is best to allow other pets to be present, but to leave a door open (literally or figuratively) so that they may leave if they choose to. Each animal is a unique individual and will respond to the situation differently – maybe by keeping a distance or by wanting to be right there. It is best to respect their wishes and allow them to pay their respects in their own way.

Should my children be present?

We encourage you to discuss this with your older (school age) children if, as is often the case, they are close to your pet. It is normal for children and teens to become overwhelmed and not want to stay in the room. Perhaps the kindest thing that we can do is respect and validate their choices and feelings, and allow them the space to leave or stay as they wish. Very young children are welcome to be present, although you may want to consider whether this will mean additional stress or distraction for you. Having an additional caregiver on hand may be helpful.

What does a home euthanasia cost?

The cost of a Compassionate Home Euthanasia will vary depending on the time of day, the size of your pet and your preferences for aftercare. Regardless of your choices, we will treat your pet as one of our own, and our service always includes a complimentary clay paw print and door to door transportation for your loved one's remains. Euthanasia starts at $500. You can call us for details or get a quote on this page.

Questions about Cremation and Aftercare

What are my aftercare options?

The most common choices are home burial or cremation. If you want your pet cremated, you can optionally have their ashes saved and returned to you. If you decide not to get your pet's ashes back, the crematory will scatter them in Kaneohe Bay. If you want to know more details or additional cremation options, plesae visit this page. There are even more details and ideas for honoring your loved one here.

I need to have my pet cremated. What do I need to do?

Just let us know. The final cost of your appointment will depend on your specific wishes. If you choose cremation, the doctor will take your pet to the crematory, and if you would like to have their ashes back, we will hand deliver them to you.

We also offer cremation as a standalone service. You can learn more and see prices here.

How will you get my dog to the car?

If we are taking care of cremation for you, the doctor can carry smaller pets (up to thirty pounds or so) to the car, although you can do it yourself if you prefer. For larger dogs, we have stretchers to make the process easier.

If there isn't someone in the home who can help with the stretcher, or if your dog is over 85 lbs, an assistant can also attend the appointment by prior arrangement when available.

What if I want to spend some time with my pet before you take them for cremation?

Our doctor will typically give you a few minutes alone together, but you can ask for more time if you wish. Your appointment is scheduled for an hour and a half total, and you are welcome to use some of that extra time for grieving if you need to.

If you need longer, we may be able to come back at a later time to retrieve your pet for an extra charge. We would recommend no longer than 24 hours later. Because of the extra logistics, please let us know in advance if you want this option.

Where will my pet be cremated?

We work with the trusted professionals at Oahu Pet Crematory in Kailua, which has been providing pet cremation services for over twenty years. You can learn more about them here.

Can I be present for the cremation?

Oahu Pet Crematory does offer this option for an additional charge. We can help facilitate the arrangements for you. Private Viewing Cremations must be scheduled in advance and avaiability is limited, so please let us know as soon as possible so that we can best honor your wishes.

How do I get my pet's ashes back?

We take care of the cremation process for you from beginning to end. Once we have your loved one's ashes back from the crematory, we will get in touch to arrange hand delivery to a location that is convenient for you (that is usually your home but can also be at your place of work or another location).

Is there a discount if I pick up my pet's ashes at your office instead of having them delivered?

The additional charge for getting your pet's ashes back covers the cost of the segregated cremation. Hand delivery is a complimentary service, although you are welcome to come pick up your loved one at our office if you prefer.

How soon will I get my pet's ashes back?

We usually get ashes back to the family in ten days or less, often sooner. We will be in touch when his/her ashes are ready to make arrangements.

How do I know it’s my pet’s ashes that I get back?

To be completely truthful, this is a matter of trust. The crematory we use is very professional and caring and has been in business for more than 20 years. We have walked through their process with them and have 100% confidence in their ability to make sure you truly get only your own pet's ashes back.

What will the urn I receive look like?

The standard return is a mahogany wooden box. You can also choose a biodegradable urn suitable for pets up to 50 lbs at no additional charge. Your urn will come wrapped in a blue velvet pouch.

If you would like something more customized or engraved, check out our catalog.

Can I use a different urn?

Yes, absolutely. You can order a custom urn from our catalog or purchase one elsewhere. If you order from us, we'll make sure you get the right size, but if selecting an urn elsewhere you should allow for at least one cubic inch of space per pound of body weight. If your pet lost a lot of weight due to illness, we recommend using their healthy weight as your guide.

If you already have your own urn, you can send it along with the doctor to the crematory and we'll take care of the rest. If you order an urn from us, we'll take care of transfering the ashes to your custom piece before delivery. If you take the standard urn and decide to switch to something else later, we can help you make the transfer if you drop by our office during business hours (please call to make sure someone will be there first).

If you decide to transfer your pet's ashes yourself, it's not difficult. The lid fits snugly but is easily removed, and the ashes inside are wrapped securely in a plastic baggie and tissue paper.

Can I scatter my pet's ashes or bury them at sea?

Yes you may, but it is a good idea to check for any local zoning ordinances or regulations before proceeding, especially on public lands. You can learn more here. Generally, you are fine scattering or burying ashes on your own private land. You should always obtain permission of the landowner if you plan to spread ashes on property that is not your own.

If you are planning on scattering ashes at sea, the Clean Water Act requires that ashes be scattered at least three nautical miles from shore. If the container is not biodegradable, it should be taken back to shore and disposed of separately. We offer biodegradable containers at no extra charge and scatter tubes for a small fee.

If you are interested in having a professional charter for your scattering, we recommend Hawaii Ash Scatterings. They can help you arrange everything from clergy services to photography to make your ceremony truly special.

Can you divide my pet's ashes?

Certainly. Just let us know exactly what you want and we will take care of it for you.

What happens to my pet's ashes if I don't want them back?

Your pet's ashes will be scattered in Kaneohe Bay by the crematory.

Can I bury my pet's remains?

In some situations, you may be able to, although there are several guidelines you need to be mindful of.

• You must first get permission from the City and County Zoning Department (roh.info@honolulu.gov, or call 768-3809), as well as your homeowner's association if you have one.
• Burial must take place on land that you own, or with permission of the landowner. Burial on public lands is not permitted.
• It may be illegal to bury remains in bodies of water or watersheds that feed the drinking water supply.The burial site, regardless of location, must be above the water table. Also consult your utility companies about the location of underground lines or pipes before you dig.
• Digging and/or the natural breakdown of fresh organic matter may be harmful to a tree's root system, which generally extends about as far as the outer leaves and branches of its canopy.
• The grave should be at least four feet deep to provide protection from wildlife, other pets, or weather conditions. This is often impossible in Hawaii. Alternatively, cover the burial site with a heavy, solid barrier, such as large rocks, for a minimum of 6-9 months.
• Remains that are unearthed can be harmful or even fatal if consumed due to the presence of the euthanasia medications in the body. This could expose you to liability if a protected wildlife species is harmed.
• You can wait up to 24-36 hours before burial. You may wish to protect the body from insects with blankets or mosquito netting and provide an absorbent material underneath the hindquarters and head. Chemical changes in the muscles will occur 3-4 hours (sometimes earlier) after death and will prevent further repositioning. Odors are usually not a problem within this time frame, but essential oils such as lavender or peppermint can help, and will also deter insects.

Questions about Logistics

What kinds of animals do you treat?

We treat primarily dogs and cats. We may be able to help out other types of smaller house pets such as rabbits, guinea pigs and rats, and depending on the circumstances, pet birds. We do not service livestock, but if you need a recommendation, feel free to give us a call.

Can I bring my pet to your office?

We do not have a brick-and-mortar clinic where we see patients. All appointments take place in your pet’s home. We will go anywhere on Oahu.

Where do you make house calls?

We serve the entire island of Oahu.

Do you have military base access?

Our doctor does not have base access and will need to be sponsored. Procedures have been changing frequently and vary between locations, so we suggest you check directly with the appropriate authorities at your military installation.

In general, MCBH/MCAS and JBPHHH/Pearl Harbor-Hickham will require someone to sponsor us in person; Schofield has not had such a requirement. Procedures are often different depending on the day and time, so again you should check directly to avoid unexpected hassles.

Do you offer weekend or evening appointments?

Yes, we can see home euthanasias after hours, depending on our doctor’s availability. You can browse the schedule here. Appointments after 5 pm Mon – Sat or anytime on Sunday are an additional $125. Please ask for an estimate or use our online estimator for more information.

Palliative care consultations are offered Monday - Friday between 10 am and 4 pm.

How much lead time do you need to schedule a home euthanasia?

Generally speaking, most of the time we can get to you within a day or two. During busy periods and around weekends/holidays it may be longer. Depending on the schedule and your location, we may be able to accommodate same day requests if the situation is urgent. If you need a same day appointment, please call with your request instead of sending an email or scheduling online.

My pet does not like visitors. What can I do?

Please let us know before the appointment, so that we can brainstorm to minimize the stress associated with our visit.

When is payment due?

Payment is due at the time of service. If you need financing options, we work through third party providers CareCredit and Scratchpay.

Do I need to pay in advance for services?

For euthanasias, we will send an invoice in advance of your appointment (it comes at 10:00 am on the day of the visit, or if you are scheduled prior to 11:30 am, it will come the day before. You can conveniently pay online if you wish but it is not necessary.

Palliative care consultations must be paid in full 48 hours prior to the scheduled itme.

When during the appointment will I pay for services? Can you bill me?

With pre-approval we offer financing options through Scratchpay and CareCredit. Palliative care consultations are paid in advance. At home euthanasia appointments, if you have not already paid in advance, most people will choose to take care of billing when the doctor arrives, but we can wait until the end of the visit if you prefer.

What are my payment options?

You can pay one of five ways. We accept cash, all major credit cards, Venmo, the CareCredit credit card, and financing through Scratchpay.

We regret that we cannot accept personal checks.

Do you offer Military or Senior discounts?

We know how difficult it is to be worried about finances during an already stressful time. In order to keep costs reasonable and deliver top-notch service to all our patients and their families, we are unable to offer discounts.

Who will be coming to my home?

Our veterinarian, Dr. Carolyn Naun, does all home visits, whether for euthanasia or for consultations. You can learn more about her here.

If you chose cremation and extra help is needed bringing your pet to the doctor's car, an assistant can also attend by prior arrangement.

Does my vet need to refer my pet to you for services?

This is not necessary - you can contact us directly to get started. For palliative care, it is helpful to have your pet's medical records prior to the consultation. If you are continuing to receive care from your regular vet, we can collaborate to make sure everyone is on the same page.

Questions about Grief and Loss

Should I hide my feelings to be "strong" for my dying pet?

It's OK that you're sad or upset - this is a life-changing event, after all. Our animal companions are extremely attuned to our emotions and it's unlikely that investing energy in being "brave" to spare their feelings will work. Do whatever comforts you - and if that means maintaining a "stiff upper lip," then that's OK, too.

How will my other pets react to the death?

Like people, animals may grieve, and like people, each individual may have their own unique way of expressing grief. In our experience, the family pets are less upset during a euthanasia than the human family members, but they do seem to understand what is happening. Some animals may appear to be indifferent or not want to be near the dying pet. We recommend respecting your pets' wishes in this regard and not force them to interact if they don't want to.

The most common behavior change after the death of a sibling pet is a decrease in appetite for a few days. Some animals will "search" for their companion, although it is thought this behavior is less common if they are present or nearby for the death. They may seek reassurance or affection from human caregivers during the grieving period.

The kindest thing you can do for a bereaved pet is to stick as closely as you can to their normal routines. This gives them a sense of security and stability.

Most pets will be back to their usual selves after a week or two, but if behavior changes and especially loss of appetite last any longer, we recommend a checkup with their vet to rule out a medical cause.

How should I talk to a child about euthanasia and death?

A child's understanding of death will depend on their life experiences and stage of development. We recommend reading this article for advice about guiding children through their loss. Other excellent resources are this story from NPR and The Dougy Center's website.