End of Life and Quality of Life

Jul 7, 2013 by     11 Comments    Posted under: Personal Opinion, Tips & Advice

I would like to thank everyone for their kind wishes and moral support for Cosmo. If you would like to read more about him please click here for part one and here for part two.

He just turned 12 years old last week and has started acting very needy.  He has been screaming for attention at all hours of the day.  This is a little different than his normal behavior.  I petted him under the chin and noticed that he had small bumps that were not there a week ago.  His lymph node on the right shoulder is now enlarged.

I am planning on taking samples to prove that it is the return of the cancer.  I feel certain that is.

I am now at the crossroads of how do I proceed.  This is obviously a very aggressive cancer since it returned only 3 months after treatment.

Do I take him back for more surgery and treatment?  That option does not make sense since he has been through so much by this time and it will last less time than the previous.

Do I treat him as “hospice”?  I give him pain medication waiting until he stops eating and his quality of life is terrible.

I do not want him to reach the point of terrible quality of life.  I will need to make my decision of the correct time.  I have always told people that they will know the time.  I wish not to be selfish and keep him alive for my sake or for that of others.  This is a family decision.

He has been such a good friend and want to be respectful and say good bye before he is suffering.

Many thanks for everyone’s support and kindness.

Dr Marcus Brown

Dr. Brown, founder of the NOVA Cat Clinic and co-founder of the NOVA Cat Clinic, received his Doctor of Veterinary Medicine degree in 1986 from the University of Illinois. Currently the medical director for Alley Cat Allies and is an active supporter in local, state and national feline organizations such as: American Veterinary Dental Society, American Association of Feline Practitioners, American Veterinary Medical Association and American Animal Hospital Association. Dr. Brown also contributed the creation of the Association of Feline Practitioners’ 2009 Wellness Guidelines for Feline Practitioners.

Dr. Brown enjoys continuing education and regularly attends seminars and conferences across the country focusing on the advancement in feline veterinary care. Dr. Brown also utilizes on-line discussion groups and veterinary networks to assist the clinic in maintaining the highest level of care and providing the newest treatments available in feline medicine.

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  • Holly

    So sorry. Let him tell you when it is time. They tell us, if we are willing to listen.

    • Marcus Brown Dvm

      Thank you Holly,
      I will try to listen and be sure to honor when he is ready.

  • Kitty Dybdall

    I think all of us *think* we will know when it is time for our furry friends…but it is not that easy. With my Collie/Shepherd mix she declined with arthritis and I remember saying/thinking “If she only had something definitely like cancer…then I’d know. Then it would be definite. The next dog I had, a Golden Retreiver developed liver cancer at 12+…and you know what? it was still difficult to know when. When the scan showed her entire liver was engulfed and she was having some ascities, the vet said it was couple of weeks to a month or so. She was feeling relatively well and so I decided to give her “princess for a day” day and she got all kinds of yummy treats (fresh cooked chicken and rice, hot dogs, and beef and rice), we went to the lake for a long walk in the crunchy leaves and lots of sniffing…and then it was time. My vet does in home euthansia, so it was low stress and peaceful. There is honestly no good time, but I gave her the best day I could while she was still feeling good enough to enjoy it. That was the best I could do for her.

    • Marcus Brown Dvm

      Thank you for sharing Kitty. Both Cosmo and I appreciate your kindness and support

      • Jo Ann Williams

        Having lost all three of my cats to illness 2 years ago, I have walked in your shoes and I know it is terrible. Thanks God you have the power to make a humane decision to end his life when you know it is time. And I am confident you will know when that time comes
        Jo Ann

  • Kitty Dybdall

    p.s. Safe and happy travels Cosmo.

  • Michael Ray

    Hello Dr. Brown,
    Great Dialogue. I think the decision differs for everyone. But the love each owner has for their kitty will give them strength and wisdom. If a loving caring owner thinks the kitty is tired, it is probably time to go. But up until then, we wanna try everything to help that seems within reason. No bad choices really, just different. But no one wants to wait too long either…
    May his love and his soul vision through the eyes guide your tough times ahead. Best Wishes and kiss his head for me!
    Scruffy Cat

  • Mary Ann Horn

    Sweet Cosmo. When I was in the office not long ago, he came over and greeted Frieda, who is also 12 now. As you may know, I’ve been going through the same debate with Frieda, especially after my last major out-of-town trip, during which she suddenly starting showing clear weakness on her left side. Right now, I’m lucky, since she actually gained weight in the last couple of weeks and is reacting a little more normally on the left. It is so hard–you don’t want to lose them, but you don’t want them to suffer either.

  • Nancy Checklick

    I was so happy to see Cosmo just last week. I thanked him for helping me learn how to take care of my own kitty better.
    I think your decision, when it’s time, won’t be as burdensome because Cosmo will tell you when, he’ll let you know it’s okay. You have a very special relationship and communication. Cosmo will help you through this too. He’s that kind of amazing kitty.
    We love you both,
    Nancy & Norman

  • Jo

    Dr. Brown,
    Thank you for the informative articles regarding Cosmo. It is wonderful and rather unusual to see articles written regarding feline cancers from the perspective of a vet writing about his/her own cat!

    I have a 16 yr old spayed female with mammary cancer (she is also solid black!). We caught it early apparently as a deep biopsy, followed by a somewhat radical lumpectomy (but not full blown unilateral mastectomy) 3 months later by her regular vet, has resulted in her still living a year later. She’s not been on any meds or supplements all that time except for CurcuVet SA-50 TID.

    But I am now feeling a chain of very small lumps on one side.

    Your article helped convince me that another surgery is not justified. The last one was pretty painful for her and it was a good 2 wks for her to recover.

    Can you please give us your thoughts on when an owner or vet should begin prednisolone as a palliative drug? What signs or symptoms would warrant the start of prednisolone? Are you looking for signs of pain? Vomiting? Tumor eruptions through the skin? Please let us know. I don’t want to start it too early as she needs a strong immune system to help her fight the metastasis.

    • Marcus Brown Dvm

      A year is terrific post surgery. For most breast cancers in cats, surgery is the best option. They unfortunately are usually very aggressive. There are different types and it does depend on the type she had/has.
      Prednisolone may not be helpful for her type of cancer. This is something that you should discuss with your veterinarian.
      Pain management may be needed and the choice of treatment should be tailored to her needs. Prednisolone may be contraindicated depending on the type of pain medication.
      It looks like you have done a great job with her care. Nursing care is underrated and it appears that you have done extremely well.