Palliative care for pets with terminal illness

A few days ago, I received a call for advice.

A man was facing a dilemma. He was told his dog has cancer and is terminal.  His vet advised him to have his dog put down.

The man didn’t really know what it meant so he asked me if “putting down” meant killing. It was a simple question and the answer is “yes”. Putting down is killing. Call it “putting down”, “letting go”, “mercy killing” or whatever terms you feel more comfortable with, ultimately it is the act of ending a living being’s life.

He didn’t like the idea of killing his dog, he told me. So he asked for options. I suggested palliative care and he hadn’t heard about this before (his vet also did not give him this option). Finally, he asked for vets, so on a personal basis, since I’ve just gone through palliative care with Rosie, I gave him the names of two vets whom I had personally found to be compassionate, who respected and supported my decision to opt for palliative care for Rosie and who were willing to advise me professionally on this.

I wish to write more about this, though.

I consider myself “lucky”. I won’t call it anything else. I was plain lucky that with the guidance of compassionate vets, I was able to turn Rosie around from not eating to having a hearty appetite during the last 40 days of her life. We already knew her illness was terminal. In fact, on Day One itself, one of the vets already suggested euthanasia, but he knew I would not agree to that. Rosie was still eating (though being hand-fed), she was curious and alert, was walking, jumping and behaving like a normal cat. The only difference was that she had terminal liver disease and was jaundiced.

We do not know how or when she contracted the disease. Rosie was FIV+ and lived as a street cat for a year before we moved here and she adopted us. Being used to the life as a street cat, she still went to the playground every morning for food from her previous feeder. The vet said it must have taken a long time for the disease to progress to what it was when the jaundice was visible and her lack of appetite became apparent.

The rest of what happened day-to-day during Rosie’s last 40 days, those who followed the blog, would remember. Rosie started eating again and appeared to be as normal as any other cat. But then, her abdomen started swelling due to the increasing blockages in her liver. Nothing could be done to reverse that. Rosie had four vets to help her (allopathic medicine, TCM and acupuncture), yet nothing more could be done. The supplements helped a lot, but I knew the end was near. However, Rosie was steadfast and so strong – she took it all in her stride. She continued eating heartily (I think it’s all thanks to the supplements, steroids and of course, everyone’s kind prayers too). She only went down suddenly on the last day, after the visit to the vet. All in, her final decline took about 7 hours. Then, she was gone.

I was lucky, Rosie was lucky – that there was no prolonged suffering.

Everyone has to die of something one day. We can only hope death will be quick and peaceful.

In the 40 days that I nursed Rosie (not much “nursing”, actually, as Rosie remained active and well), I recalled the days I nursed Wendy (the rescued dog with distemper). I recall how much moral support I received from blog readers (thank you!), but at the same time, I was chastised by a few for not opting to have Wendy put down. I remember the harsh words – that I was cruel. Although I nursed Wendy every day, I was deemed cruel for not having Wendy killed – ironical, isn’t it? But the thing is, I was Wendy’s primary caregiver and every day when I fed her, I looked into her eyes and I did not see suffering. I only saw strength, calm and peace. Armchair critics who called me cruel had not visited Wendy at all. They just assumed Wendy was suffering just because she had grown very thin. My question to them was: How do you know Wendy is suffering? Have you even been to see her once? Have you talked to Wendy? Even if you have, do you know what she wants? For sure?

Then, came the rest who bombarded me using religion. Now, that was hitting below the belt, really. They were angry with me for not opting for euthanasia so they blamed my religion. They said I was Buddhist and the first precept is “To abstain from killing” (more accurately, to abstain from striking down a breathing being) and so they said I was afraid of breaking the first precept. Some said I was afraid of “bad karma” – I take great offence to that. In the first place, “karma” in the Buddhist context refers to one’s intention (AN 6.63). If one’s decision is borne out of compassion, then how is that ever “bad karma”?  Secondly, I’ll tell everyone this much: the word “karma” (in Sanskrit, or “kamma” in Pali) has been so badly misused and abused, especially by Buddhists who don’t even bother to study the ancient texts. If anyone wants to use the word “kamma” in a Buddhist context, I implore you, first, to please read the Acinteyya Sutta (AN 4.77 – also known as the Acintita Sutta) on the Unconjecturables, then you talk. I have no quarrels with the word “karma” being used loosely, though.

I have kept quiet all these years, but I would like to say my piece now. I may be guided by my religion but I do have a brain and heart of my own. You may not like my actions, but please don’t blame it on my religion. I act on my own, from my brain and my heart. I do what I think is right and I do it to the best of my capacity. Religious texts are 2600 years old and the texts have to be interpreted in context. While I study them, I still function from my brain and my heart. I am not a blind follower.

If I may be allowed to continue a little bit, precepts in the Buddhist context are different from “commandments”.  Precepts are meant as guidelines, as training rules. A much greater yardstick is compassion. Every decision that we make, let it be one that is compassionate and wise. If someone feels that euthanasia is the most compassionate and wise decision for an animal, then, it is. No one should say what is right or wrong. This is a decision that the caregiver makes and is comfortable with. Similarly, if someone opts to give palliative care for a terminal animal, why is that so wrong?

So, coming back to Wendy’s case, Wendy seemed so calm, peaceful and strong. I felt I didn’t have the right to make that call because I didn’t know what she wanted. I have always taken the stand that if euthanasia was legal in Malaysia for humans and if a human of sound mind wanted to have himself euthanised, I would definitely respect his wishes. For that matter, if I were terminally ill and am no longer able to function, I’ll want to be euthanised as well so that I won’t be a burden to my caregivers. But we are humans and we can make a decision for ourselves. That is the difference – a human can make a decision for himself and convey that decision to other humans, but we will never know what an animal wants – that was the difficulty that I faced with Wendy at the time. Although Wendy grew very thin towards the end, but she remained very alert. And at peace. A day before she passed away, she was still drinking the chicken essence that I fed her.

Vixey was terminal too. She had brain trauma when she was a little kitten and I was already told she would not live long. Vixey was a pygmy kitten. I knew I’d have to eventually give Vixey palliative care. Towards the end, Vixey’s kidneys and bladder failed. She was also a very, very strong and brave kitten. She was only 2 years old at the time (a pygmy kitten’s lifespan is about 3 years).  I gave her palliative care and she was so considerate, she would run all the way out to the garden to defecate (she was having diarrhoea all the time). Vixey was strong right until the end. Even the day before she passed away, she was still as strong as ever – complaining about the drip in her paw.

Mac (our dog) had multiple organ failure towards the end of his life. The vet said there was nothing else to do – either euthanise or give palliative care with painkillers. We opted for the latter. Mac had a good 10 days of palliative care where he was cheerful, active and eating well. Then, he passed on peacefully one morning.

Vixey and Mac’s stories: https://myanimalcare.org/wp-content/uploads/2011/04/See-You-at-Rainbow-Bridge-e-book.pdf

Remirth (my childhood dog) had stomach cancer towards the end of her life. Euthanasia was unheard of at the time. Everyone would just nurse their pets till the very end. Remirth passed away peacefully surrounded by our whole family.

Remirth’s story: https://myanimalcare.org/wp-content/uploads/2011/04/Pawprints-on-My-Heart-e-book.pdf

Bobby passed away of old age. Very peacefully, in his sleep. We wish all our pets (and humans) will be gifted with the chance to pass away peacefully.

A friend wrote to me last week. We discussed many things and one of the things we talked about was nursing terminal animals. He shared that recently, he had taken over a sick kitten from a group of rescuers. The kitten had nose cancer and the cancer was spreading fast. However, due to his committed and loving care, the kitten was eating, cheerful and even playing. The vet recommended that the kitten be put down, but my friend didn’t see any reason to do that since the kitten was happy and was still interacting with him. Then, came the rescuers – they bombarded him for “prolonging the suffering” of the kitten and insisted that he must get the kitten euthanised. And he said this to me: “I felt it was unreasonable for them to make such demands especially in matters of life and death. And the most vocals ones only saw him months ago while I was the one who clean, fed and look after him for several months before he passed away.”

Sounds familiar, right?  And this friend doesn’t live in Malaysia. So it certainly isn’t a Malaysian thing either.

I told him I totally empathised with him as I faced the same “bombardment” when I nursed Wendy too. Wendy was my rescue and yet, I was bombarded by other rescuers who had not even seen Wendy before.

Giving palliative care to anyone, human or animal, is not an easy task. We know there is no cure anymore and the person or animal is dying. There is nothing to look forward to. There is only death waiting to happen. Yet, because we value life, we do our best to make the person or animal feel as comfortable as possible, with dignity and respect, as best we can, until the time comes for him/her to go.

For those who wish to opt for palliative care, here is an article that might help you give the very best for your pet:

http://www.dogster.com/lifestyle/5-ways-to-make-palliative-care-for-your-terminal-dog-palliative-plus (applies to cats and other pets too)

The article above is shared by another friend who has recently also nursed a few terminal animals to the very end.

And to be fair, here’s another point of view: http://www.pet-loss.net/quality.shtml

Whatever we decide for the animals under our care, let the decision be made with compassion, respect and wisdom. We owe them that much.

And let us not bombard each other just because we may disagree with another’s decision. Our animal-lover community is small enough, let us stick together and support each other. Please.

Rosie and me.
(6 days before she passed away)

Rosie, sitting on my lap in the car, in the afternoon, back from the vet’s.
She passed away that evening.

8 comments to Palliative care for pets with terminal illness

  • Lay Peng

    A very big thank you to Sister for sharing this knowledge. It makes me more understand.

  • Dear Dr Chan, there must be so much pain running deep in you. It never grows easy to bid farewell to our pets no matter how many times it has to repeat in our lives. Take courage. Take care.

    • chankahyein

      Dear Weiee, Thank you very much. The pain of losing a loved one will heal with time. The good memories will remain and the painful ones, hopefully, will fade a little. Such is this imperfect life. We just have to accept it as it is.

  • At our clinic we have at least once a month a new case that requires palliative care. It’s highly important that people are made aware of early what kind of commitment this requires and to guide them medically towards the course of events that will likely unfold.
    Besides apprpirate home care, sufficient, multilayered pain management is of imperative importance. That’s why wworking with professional and committed medical people is really important. After all, neither human nor pet should go through this alone…

  • Btw, I (as a vet) and our clinic staff completely disagree on pressuring any caring pet guardian to “PTS”. That’s wrong on many levels. In our experience not a single carer would let a pet suffer without doing EVERYTHING to ease the pets discomfort and to provide utmost compassionate care until the pet moves on when his/her time is “right”. At Asia Paws we are committed to support caring pet guardians. Not push them one way or the other. Sadly, vet schools teach generally a quite different approach (as per your experience)

  • Yong Pui Fun

    A good and compassionate vet to go to is Dr. Susanna Hoffherr Santhiram of AsiaPaws.
    She is a western trained vet with special training in animal acupuncture.

  • fith

    I’ve been following your blog for quite some time now and I’ve always admired your passion in helping animals. And of course your very supportive family too.
    What you did for Rosie always amazed me. And I think, you are the best Rosie could ever ask. I have learnt a lot from you and looking forward to learn more in future. I hope some bad words would never deter you. Thank you.

    • chankahyein

      Thank you very much, Fith. Critics will continue saying what they want to say, but I hope they will realise that our animal-lover community is already so small, it is more important that we support each other despite differences in opinion, than to lambaste each other when everyone is already trying her/his best to help animals in our own ways. No, their words will not deter me, but being human, I also need to say my piece, sometimes. Thank you for your moral support. It is most appreciated. 🙂