Azure Holland, Author at Azure Holland

WHAT TO EXPECT WHEN YOUR PET HAS A CHRONIC DISEASE Dr. Janelle’s Guide for Pet Parents

Hearing that your beloved cat or dog has a chronic disease can feel overwhelming. Whether it’s diabetes, kidney disease, arthritis, or a heart condition, the news often comes with a mix of emotions—confusion, fear, guilt, and love.

The good news? With proper care, many pets live happy, comfortable lives even with chronic conditions. Here’s what to expect and how to prepare.

ADJUSTING TO LONG-TERM CARE

Chronic diseases require ongoing management, which may include:

Medication (pills, injections, topicals)
Prescription diets
Frequent vet visits and lab monitoring
At-home care (e.g., glucose checks, mobility support)

This can feel like a big change, but most pet parents find a routine. With time, it becomes second nature.

COSTS AND PLANNING

Chronic care can be a financial commitment. Consider:

Pet insurance or veterinary credit plans
Monthly budgets for meds, food, and checkups
Emergency funds for flare-ups or complications

Planning ahead helps reduce stress and ensures consistent care.

UNDERSTANDING QUALITY OF LIFE

Keep checking in on how your pet is doing. Ask:

Are they eating and drinking?
Are they in pain?
Do they still enjoy walks, toys, or cuddles?

Your vet can help assess and adjust care to improve comfort and well-being. I find it is helpful to keep a journal. Do not discount how other pets in the household interact. Sometimes they can be a signal that things are changing and to consider end of life options.

PREPARING FOR END-OF-LIFE DECISIONS

This is the hardest part of the journey

Signs that your pet may be nearing the end include:

Unrelenting pain
Loss of appetite or mobility
Difficulty breathing
Disinterest in life
Decreased appetite or having to encourage them more to eat

Using a quality-of-life scale can guide your decision. We have one available here https://azureholland.com/pet-quality-of-life-guide/. It is common for your pet to have ups and downs. Measuring how many more down days than up days can guide you as well.

Euthanasia, while heartbreaking, is sometimes the kindest option. It’s a final act of love—to give your pet a peaceful goodbye when suffering outweighs joy. Talk to your vet and contact us in advance so you can understand all the details. You’re not alone.

EMOTIONAL SUPPORT

Caring for a chronically ill pet can take an emotional toll. It’s normal to feel sadness, guilt, or fatigue. Lean on support groups (online,local), friends, family, and your veterinary team. Visit our grief resources https://azureholland.com/grief-resources/

Your pet feels your love and care—and that matters more than anything.

CELEBRATE THE GOOD DAYS

Even with a chronic condition, pets can have many good days—playing, snuggling, or just relaxing in their favorite spot. Keep a journal, take pictures, enjoy every moment. Chronic illness is only part of their story—not the whole.

IN SUMMARY:

A chronic diagnosis is not the end. With love, structure, and support, your pet can still live a life full of warmth and joy. And when the time comes to say goodbye, you can do so with peace, knowing you gave them everything they needed—right to the end.

Improving End-of-Life Care for Pets: A Collaborative Approach with Dr. Azure Holland

This week, I had the privilege of visiting two incredible veterinary hospitals—Animal Hospital of Brier Creek and Paws at Play Veterinary Hospital. During my time there, I had in-depth discussions with their teams about providing better end-of-life care for pets. As someone who is deeply passionate about this aspect of veterinary care, it was both heartwarming and humbling to share insights and offer guidance to help these hospitals navigate the challenging yet essential process of helping families make tough decisions when it’s time to say goodbye to their beloved pets.

At the heart of what my team and I do at Azure Holland is helping families decide when it’s time for their pet to pass on peacefully. It’s an emotional and challenging decision, but with the right support, tools, and language, families can feel confident that they are making the best choice for their pet’s well-being. We explored how veterinary teams can better communicate this decision-making process with pet parents, helping them understand their options and the benefits of making end-of-life care a compassionate experience.

While at these two hospitals, I had the opportunity to coach the staff on enhancing the end-of-life experience within their facilities. From fostering open, empathetic conversations to improving the physical environment, there are many ways we can ensure that the final moments are as peaceful and dignified as possible for both the pet and their family. These small changes in approach can make a big difference in the overall experience, ensuring that families leave feeling supported and at peace with their decision.

One of the key aspects that sets Azure Holland apart is our commitment to providing the highest level of care within the home environment. We believe that pets and their families deserve a comfortable, familiar, and loving space during such an intimate time. Our team works to ensure that the pet’s final moments are peaceful, pain-free, and surrounded by the love of their family. By offering this in-home care, we help families avoid the stress and uncertainty of a hospital setting during this emotionally intense time.

We are always looking for ways to collaborate with veterinary hospitals to ensure that pets and families receive the best possible end-of-life care. If you’re a veterinary professional looking to improve your hospital’s end-of-life approach, we’d love to get to know your team and provide training on the language, tools, and techniques that can help make this difficult time easier for families to navigate. Together, we can offer compassionate care and support to every family that entrusts us with their pets.

End-of-life decisions are never easy, but they are a natural part of every pet’s journey. At Azure Holland, we are committed to walking alongside families through this process with understanding, compassion, and care. If you’re interested in learning more about our services or would like to partner with us to enhance your hospital’s end-of-life care, please don’t hesitate to reach out. Together, we can make these final moments as peaceful and loving as possible.

How Do I Know When It’s Time?

AS PET PARENTS, we don’t want our fur babies to suffer at the end of their lives. We also don’t want to cut any precious moments short. There is no more agonizing pain than having to put a baby to sleep because often, to end their suffering we must face ours. It’s the choice to ease the suffering of a dear friend, offering them this final act of love. For us, it’s knowing we did everything we could for them until the very end.

So how do I reconcile my head and my heart? Head and heart are often not aligned at the end of a pet’s life. Emotions can be running very strongly and clouding any real rational thought around the decision. I coach families through end-of-life decisions and try to bring an objective lens to the situation. Grounding yourself in facts around your pet’s health may support you through the ultimate decision to help them cross the rainbow bridge.

The Quality of Life Guide on the website is the first place I send pet parents. Working through this assessment gives an objective number to the pets QOL. I have found that having each member of the household do their own assessment can lead to constructive conversation around the pet’s health. If you live alone, you may consider anyone that knows your pet and can help with a QOL assessment. The number obtained in the QOL guide is not a hard fast determinant, but a snapshot in time and a way to help assess things moving forward. The QOL assessment includes considering pain, hunger, hydration, hygiene, happiness, mobility, and more good days than bad.

If you or someone you know is having a tough time deciding when it’s time, my team and I are here to help. We provide both general consults virtually, and comprehensive end of life care visits within your home. Each visit is tailored to be as unique as the bond between you and your pet.

We understand the pain and heartbreak this decision brings.

Thank you for taking time today to begin exploring this emotional topic.

Dr. Azure Holland has been reappointed by NC Governor Roy Cooper

Update: August 2024, Dr. Holland has been elected and reelected President of the board July 2022, 2023, 2024 and reappointed by Gov Cooper July 2023.

Raleigh, NC – On July 1, 2018 Dr. Azure Holland, owner of Azure Holland Mobile Veterinary Service was appointed by North Carolina Governor, Roy Cooper to the North Carolina Veterinary Medical Board.

The North Carolina Veterinary Medical Board (NCVMB), a state regulatory and consumer protection agency, was created in 1903 by an act of the State Legislature. Their mission is to safeguard the health, safety and welfare of the people and animals of North Carolina.

The Board is responsible for governing the practice of veterinary medicine. Its primary responsibilities are examination of applicants, issuing and renewing licenses/registrations, formal complaints, practice name approvals, and inspections of all veterinary practices throughout the State.

The Board consists of eight (8) members; these members are appointed by the Governor, the Speaker of the House, President Pro Tempore, and the Commissioner of Agriculture.

“It is such an honor to be appointed and I look forward to serving the people and animals of North Carolina.” Dr. Azure Holland

About Dr. Azure Holland
Dr. Azure Holland is from Bailey – a small town in Eastern North Carolina. She graduated from North Carolina State University with a B.S. in Animal Science and attended the University of Tennessee Veterinary School, graduating in 2007. Dr. Holland has been in private practice in the Triangle area since that time.

About Azure Holland Mobile Veterinary Service
Azure Holland Mobile Veterinary Service focuses only on in home pet euthanasia and veterinary hospice. We believe this is the most compassionate option for pets because it offers the comfort and familiarity of home for dogs or cats as well as privacy for families. Because comfort, familiarity, and family mean everything. Once you have made the difficult decision to let your pet pass on peacefully, our doctors can provide the kindest and most compassionate way to say goodbye.

Monster

My sweet Monster crossed the Rainbow Bridge in January of 2023. One thing that gave me comfort was that she truly had a wonderful, long life. At 22 years old, she was with me for almost half of my life. Monster was a fan of hugs. When I’d come in the room, she’d put her paws out for me to pick her up. I still miss that! Monster was also a fan of sneaking into my closet and stealing a glove or a sock and bringing it to me. She would meow so loud that I used to think she was hurt, but I believe she thought she was bringing me a gift. Dr. Holland let Monster take one of my socks with her. I’m so grateful to Dr. Holland for the kindness and compassion she showed when Monster passed away.

Thank you,

Suzie M.

Are In-Home services more expensive?

Regularly I am asked this question so I wanted to address it on my blog knowing that it is a sensitive topic. I have practiced at both an animal hospital and my mobile service that provides home euthanasia for dogs and cats in the Triangle and surrounding areas. I feel that both of my unique professional experiences gives me good insight on this issue.

My house call visits typically last on average around 2 hours. This can vary depending on how much the pet parents and I talk, and the overall experience that the family is wanting. I am trained in pet loss guidance and I like to spend the first part of the visit just talking and getting to know the pet and the pet parents as well as going over the procedure in detail and answering any questions. My goal is to have the family feel as comfortable as possible. With my mobile veterinary service I never overbook myself. When I show up to help a family I am 100% focused on their needs and the needs of the pet. If the family chooses to, I also take care of all the aftercare arrangements including meeting with the crematorium provider after the in-home appointment.

Hospitals are often loud and busy places. Typically the clinician is handling multiple fur babies and has much less time to meet with the families and discuss the procedure or offer pet loss guidance. I know from speaking with families who decided to say goodbye to their beloved pet in hospitals that they often felt rushed to say goodbye and wished they had chosen a more intimate setting. I know from the experience of working in both practices that in-home euthanasia is not for everyone, just as saying goodbye within a hospital setting is not for everyone. Cost does play a role in whether some families decide to say goodbye to their pets at home. I’m proud to offer a compassionate alternative to pet parents so they have more choices when it is time to say goodbye.

Loss and Grief with Dr. Holland

The loss of your dog or cat is one of the hardest things that a pet parent has to navigate. Throughout this journey of the final life stage, there are an array of emotions that can come up. I have had to say goodbye to beloved fur babies and the grief has been intense. Here are some things that have come up in me as I have traveled along the path of grief and loss and to finally finding happiness again.

Is it crazy for this to hurt so much?

No. The grief that I have felt for a beloved pet passing surpasses anything that I have felt for another human in their passing. Pets are often the center of the home and the focus of our love and attention. They comfort us and they know us fully, including our habits and secrets. They are often our “mini-me’s” and it’s only natural that with a relationship that strong and meaningful that we could have a powerful amount of grief.

Here are the 6 stages of grief and how they may show up in the process of losing a pet:

Shock and disbelief- the first responses to the loss of a beloved pet. This can last anywhere from a few hours to several days.
Anger, alienation and distancing- anger can come up in many forms. Often there is anger about the disease that took your baby, or at the Dr. that wasn’t able to save them. Anger when carried to an extreme level can keep you from moving through the healing process and fully experiencing grief.
Denial- having trouble accepting that your fur baby is really gone. Typically this stage is very quick and is rooted in fantasy.
Guilt- the more that you loved your baby, the more likely you are to experience guilt. Experiencing guilt on some level is very natural as we rethink the final life stage of your fur baby and the decisions made for care at the end.
Depression- It is normal to feel depression with intense mourning. With the loss of all my babies and in particular my kitty Mantis, the depression was pretty marked. I would wake up in the morning and ask myself, “Will I ever be happy again?”. I was already in therapy at the time Mantis passed and I used sessions to process this incredible loss. *If the depression becomes too intense or prolonged than one should seek help from a trained professional
Resolution- a time for spiritual healing. In this final stage, we move through the grief and are able to hold onto the memories and the love of our beloved while moving forward with life’s activities.

How can I process my feelings?

The most therapeutic thing we can do is lean into our emotions and pain. In order to get through the other side of grief, we have to feel deeply and sit with the heartbreak and anguish of the loss. Bottling it up and pretending we are ok will only delay the healing process. I have found it especially helpful to speak with my trusted therapist or friends that are pet people. Getting the feelings out is the most important part of the healing process. Crying is one of the most cleansing and cathartic things that we can do for the soul. Other ways to process and move grief through your body: exercise, dance, meditation, journaling, etc. Express yourself and try not to hold it in.

I have been lucky to be surrounded by other pet people during my grieving process. If you don’t have pet people in your inner circle, seek them out. This type of understanding can be so very helpful in your healing journey.

Some practical suggestions:

Find other sympathetic and supportive people to lean on to get your feelings out in a safe environment.

Allow emotions to flow, don’t bottle them up.

It’s never too late to say something to your beloved deceased pet. Write a letter to them sharing how much you love recounting the special memories that you have.

Dedicate or donate something in your pet’s name. Knowing that they are helping other fur babies is a way for them to continue on.

Establish new routines at home. Pets, more than anything in our lives, are rooted in our living patterns. Don’t be scared to shake things up!

Hold some sort of private service or memorial for your pet. This can be as simple or as involved as you wish.

Attend a pet loss or bereavement support group. Allow yourself to share fully and experience the grief in a safe space.

If/When you are ready to bring a new fur baby into your life, tell them stories of your beloved one who passed.

My pet has been given a terminal diagnosis, what now?

The process that a family goes through to reach the decision of euthanasia for a beloved family pet can be one of the toughest things they ever have to go through. What can make the decision even harder is knowing your pet has a terminal diagnosis and seeing that he or she seems fine – today. Depending on the diagnosis, many pets can quickly end up in an emergency situation that may be painful or extremely stressful on the pet and pet parent. Having your veterinarian provide you with as much information as possible about the diagnosis and what to expect in a timeline format can help families prepare for the ultimate loving decision of euthanasia.

So how do families decide what to do? This decision is personal and every individual approaches and deals with death differently. I always recommend to pet parents to envision how they want to say goodbye. I’ve come to people’s homes where the pet is still doing fairly well and the family was able to take the pet on a final walk, take some pictures, and feed a special meal. In these situations the families saw the appointment as a celebration of life and they wanted saying goodbye to be on a very uplifting experience. Other families that I have helped wait until there is a change in the quality of life of their pet such as the pet not eating or walking. There is not a wrong answer, just what feels right in your heart. I am honored to help pets and families with these difficult choices. My mobile practice covers the Triangle. In my experience as a veterinarian, home euthanasia offers a very loving alternative to brining your pet into a hospital. It also offers a more private and stress free environment for the pet and pet parent.

Azure

When is hospice right for my pet?

I get asked about pet hospice when I meet with families so I hope to help explain a little more. Pet hospice is often thought of in the same way we think of human hospice, that is, to provide comfort during the final phases of life. When I help families with pet hospice the Triangle, I am meeting with them and their pet and assessing the current care needs to provide comfort. Some families are not ready to say good bye yet or wish for the pet to pass over the rainbow bridge naturally. I will provide a short term care plan that may include fluids or nutrition, etc. I spend time with the family and instruct them on what to expect during this time and the different ways they can make their pet more comfortable. Pet hospice is also about education so that my families will understand the process and what they can do at home.

Azure

Why Home Euthanasia for Your Pet?

I’ve found in brick and mortar practices, that euthanasia appointments can feel very impersonal and often take place in cold sterile exam rooms. Families are also forced to start the grieving process in a public setting. In a regular hospital setting, the Doctor often cannot devote 100% of their attention to the pet or the family with rarely time to offer any bereavement guidance. I’ve seen pets come to the hospital for euthanasia who have just endured a terrifying car ride and are now faced with being in a hospital where stress or painful procedures may have happened in the past. Hospitals are busy places with other patients coming in and out and many other people waiting and busy staff. My experience has shown me there is a much better way to honor and say goodbye to the family members who have been so loyal and loving to us.

When I go to a home, I am completely focused on the pet and the family. I do everything I can to make this very hard situation just a little bit easier for the pet and it’s loved ones. I spend time with the pet and also focus on the pet parents and what they are going through. The whole process is very gentle. The pet gets to be at home surrounded by familiarity and love. Sometimes owners will give treats before the sedation, or have a special toy there to comfort their beloved pet. I try to tailor each experience for the pet and family. Some families choose to say goodbye under a tree outside, some families invite their friends over to send their pet off with good wishes, and still others choose to curl up with their pet on the sofa and spend the last few minutes together as they have spent most of their lives. I feel honored to have been there for my clients who have let me into their families and if I can be of any assistance to you, please reach out.

Azure