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How to Approach the End-of-Life Decision for Your Pet After A Cancer Diagnosis

Nov 15, 2021

Pet cancer visited our home for the first time the summer between my second and third years of vet school. Tuna, my beloved 5-year-old cat, was diagnosed with high grade, B cell intestinal lymphoma. As a veterinary student, I knew it was “the bad one.” We were swiftly referred to the oncology service and told that while chemo would extend Tuna’s life by a few months, that it would likely not be possible to save her. We were shocked, grief-stricken and lost. Even with two years of veterinary medical education under my belt, nothing prepares you for a life-limiting diagnosis of a beloved pet.

To read Tuna’s full story, visit Dr. Mavi’s article: Pet Cancer Awareness Month: A Veterinarian’s Story with Their Beloved Pet

With November being National Pet Cancer Awareness month, I think about that experience with Tuna and have come to recognize she gave me an incredible gift. I already had an inkling that hospice and end-of-life care would be my path but up until that point, I hadn’t experienced the rollercoaster of emotion, nursing care, second guessing, guilt and grief that comes with walking the end-of-life path with my own pet. Tuna was, as the expression goes, my first rodeo. She gave me the gift of first-hand experience caring for a pet with a terminal diagnosis. My journey with her remains the most formative chapter of my training and she helps me daily to understand and support families in similar situations with their beloved pets.

Here at Caring Pathways, there are many cancers our end-of-life care veterinarians see commonly for euthanasia appointments. Different cancers progress and affect our pets in different ways, and the following are general guidelines to help pet families monitor their pets and make plans for their peaceful passage at the appropriate time.

To ensure good quality of life, any pet with a cancer diagnosis MUST have the following:

Pain Control

Some cancers are considered more painful than others but all malignant cancer has the potential to cause pain. Osteosarcoma, nasal and oral tumors are just a few that are considered to be extremely painful. Pain can be difficult to assess in animals but common signs of pain include panting when it’s not hot, restlessness, not sleeping at night, whining, limping and changes in posture or behavior.Talk to your primary veterinarian, oncologist or schedule an in-home assessment with a Caring Pathways veterinarian to make sure your pet’s pain is well controlled.

The Ability to Breathe Easily

In pet hospice, the inability to breathe easily is considered equal to, if not worse than, severe, unmitigated pain. Tumors may arise from the lungs themselves or appear as metastases from cancer elsewhere in the body. Hemangiosarcoma is an aggressive tumor of blood vessels but it can also cause respiratory distress via a sudden, large bleed into the abdomen or chest cavity. Likewise, nasal and oral tumors, or any tumor that impacts the airway at any point has the potential to compromise your pet’s ability to breathe. Talk to your vet about how to monitor your pet’s breathing. Count the number of breaths in 15 seconds when she is resting comfortably and multiply by 4 to calculate her breaths per minute. This number should be less than 30 at rest. Another sign of respiratory difficulty includes unwillingness to sleep on one’s side. Pets may adopt a sternal posture instead, lying on their chest vertically.

Freedom from Nausea

I’ll never forget Tuna’s wet chin as she started to fall asleep with her pre-euthanasia sedation. It only showed up on that final day, but it was due to hypersalivation, a sign that her intestinal lymphoma was making her very nauseated. Cancer outside the GI tract can also cause your pet to feel nauseated. If you notice your pet is becoming inappetent, drooling or smacking their lips, talk to your veterinarian or schedule a consult with Caring Pathways. We may be able to help you control your pets nausea with medications and make suggestions for palatable, easy to digest foods.

The Ability to Relax and Sleep Comfortably

Pacing, nighttime restlessness, the inability to settle and get comfortable are serious signs your pet may be experiencing pain, difficulty breathing, discomfort, anxiety or some combination. Talk to your vet about increasing your pet’s medication to help them get a good night’s sleep. If your pet is having difficulty breathing or exhibiting restlessness despite pain control, it may be time to help them make their peaceful transition.

Avoiding the Crisis, if Possible

Any pet with a cancer diagnosis may experience a sharp decline at any point. Some cancers grow and spread quickly, causing pain, hemorrhage, taking up precious space in lungs or causing sudden discomfort, disorientation and anxiety. The question we hear most frequently in pet hospice is, “How do you know when it’s time?” The short answer to that question is that you don’t know because there simply isn’t a clear, perfect time. That said, we generally urge families to consider saying goodbye to pets with a terminal diagnosis sooner rather than later. Keep a journal of your pet’s good and bad days and be vigilant that the standard of a good day does not start to slide downhill. Think of the “right time” to schedule a euthanasia as being more of a window of time. I have euthanized pets fairly early in their cancer diagnosis because families felt they had waited too long with previous pets and they wanted to let their pet go when they were still feeling relatively okay. I myself feel I waited “too long” with Tuna, but I don’t beat myself up because we did our best and her sudden decline took us by surprise, as it does for so many families, and we acted as quickly as we could to help her transition. All families agree that they do not want their pets to suffer and most want to avoid taking their pet to the ER for euthanasia.

At Caring Pathways, we are here to support you and your pet on their end-of-life journey, including after a cancer diagnosis. There are many quality of life assessment tools on our website and if you are seeking guidance from a veterinarian, consider scheduling a TeleAdvice Appointment or an In-Home Consultation Appointment. In the meantime, remember to care for yourself too as your pet’s caregiver, celebrate and cherish every day that remains with your pet, and you can never have too many photos or videos of your loved one.

Written by: Dr. Mavi Graves, Caring Pathways Veterinarian

Dr. Mavi moved back to Colorado to attend vet school at CSU. While at CSU, she served as a manager of the student volunteer pet hospice program and that’s when she discovered end-of-life care as her veterinary calling. Dr. Mavi feels that the end-of-life journey is an incredibly sacred and meaningful time to serve pet families and she feels strongly about the importance of letting pets pass away at home. It is an honor to facilitate gentle and peaceful euthanasia experiences and to that end, Dr. Mavi has earned her Fear-Free Certification. She is also working towards acupuncture certification and strives for excellence and personal betterment in supporting pet owners through what may be one of the most difficult days of their lives.

Mavi Graves
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