Pet Hospice Complication

all4mom2

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As I've posted before, I'm attempting to let my nearly 17-year-old kitty with a suspected brain tumor (presumed secondary to nasal/sinus) transition at home. To accommodate his needs in the face of growing neurologic deficits, I began helping him walk by using a sling or just holding him up, put him in diapers for incontinence (which, surprisingly, he didn't seem to mind), and began hand-feeding him. In time, he became too uncoordinated to eat and drink on his own (intention tremor and, the vet thinks, some facial paralysis due to cranial nerve involvement), so I progressed to administering sub-q fluids at home for hydration and hand-feeding using a syringe and catheter tip for nutrition. I'll be the first to admit I probably should have euthanized him at this point, but I didn't, although all of my previous pets have been; I simply couldn't seem to do it with this special pet. At any rate, that went pretty smoothly for a while -- I finally learned to manage the needle, and he happily ate the softened meals I squirted into his mouth, until a day or two ago, when he became bringing it up again. It seems he can't hold down his food anymore or digest it (it came up the next morning in the same "noodle" shape it went down in the night before). Rather than subject him to that anymore, I've just stopped feeding him, but am continuing fluids. He basically sleeps ALL the time now, and I expect him to pass naturally within a day or two. He was always thin (runt of the litter), but as this illness has progressed, he's eaten less and less as he's slept more and more and is by now emaciated. I'm worried that standard euthanasia may not even be possible at this point as a result (if his veins have collapsed) and the vet would have to resort to the "heart stick" method. I also don't know if I should continue the sub-q fluids if he's actually in the dying process; on the one hand, it may plump up his veins so I could now consider euthanasia, but on the other, if his organs are shutting down (including the heart), couldn't it result in pulmonary edema? I'm administering 100 ml's per day. I expected (and vet confirmed) that death from brain tumor wouldn't necessarily be painful - he's never seemed to be in pain - and that he'd just fall asleep and not wake up; possibly a seizure, which also wouldn't be painful for him. If he were to pass from malnutrition now that he's not eating at all, the expected end was a heart arrythmia and a sudden and again painless death. But none of these things have happened. I seem to have painted myself into a corner. I definitely will NOT attempt this again, but now I need to know what to do from this point onward for the best death. It's all been very peaceful so far, but I'm so afraid of something going wrong and causing pain...

Help!
 
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sivyaleah

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mrsgreenjeens

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I think you really need to discuss your questions with your Vet. I suppose you could take him in for euthanasia and if his veins were collapsed, THEY could administer sub-qs to see if they plumped up enough. Or just call them and ask if they ARE collapsed, is there any other way other than the heart stick method, which I would think you absolutely do NOT want to do unless he is unconscious. I wonder if they could use some form of gas to knock him out (like ether)...remember ether? That way they wouldn't have to inject the sedative into a vein.

Anyway, perhaps your Vet can brainstorm with you on this to help your sweet boy cross over peacefully. I'm so sorry you (and he) are going through this :hugs:
 
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all4mom2

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That was my question, or one of them; I feel he's so close to death now that euthanasia may not even work properly -- or be worth it, if he's basically asleep. It may be the brain tumor or the lack of nutrition. I'm not sure (I'm keeping him hydrated). What best to do?

I'm honestly kind of ashamed that I let it get to this point... It seems we either have to kill them prematurely or risk this situation. I sincerely believed he would have passed on his own by now.

Again, he doesn't seem to be suffering (he's asleep), but still.
 

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I would stop the fluids. That’s what happens with human hospice patients. Fluids prolong the process.

If you choose to have him euthanized, he can be sedated with a tiny injection in the muscle and then given the final injection either via vein, or heart. My Felix was handled that way two weeks ago. He was completely unresponsive from the sedation.

I am sorry your kitty is so sick.
 
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all4mom2

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Thank you. That's the kind of practical advice I need (I'm gathering this thread isn't too popular because there's some judgement there, and perhaps rightfully so; I might have messed up). I was still supplying fluids because that's the one thing I CAN still do for him (I can't make him keep food down) and to withhold them felt like murder, the same way euthanizing him would feel. Also because I read that starvation isn't really painful (I do extended fasting myself), but dehydration is. However, as I say, he's mostly out of it now, so maybe it doesn't matter. I did discuss all the various euthanasia options with this vet and even asked about gas, but he sort of shrugged it off like it wasn't an option. Again, I appreciate your helpful response. I still don't know what to do, but will withhold his fluids.
 

catmom2wires

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You might see if there is a hospice vet who will come to your house. Sometimes seeking a new opinion brings new options.

My friend was in a similar situation and his little girl did die naturally. The last moments were not the best, and he is still a bit haunted by it. I would try and avoid that possible scenario.
 
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all4mom2

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There is no "hospice vet" around here. I live in Podunk. It's either euthanasia or a natural death. The latter DOES seem to happen to other people -- but not to me, apparently! My baby - who is a Velcro kitty - must not want to leave me any more than I want to lose him.
 

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Thank you. That's the kind of practical advice I need (I'm gathering this thread isn't too popular because there's some judgement there, and perhaps rightfully so; I might have messed up). I was still supplying fluids because that's the one thing I CAN still do for him (I can't make him keep food down) and to withhold them felt like murder, the same way euthanizing him would feel. Also because I read that starvation isn't really painful (I do extended fasting myself), but dehydration is. However, as I say, he's mostly out of it now, so maybe it doesn't matter. I did discuss all the various euthanasia options with this vet and even asked about gas, but he sort of shrugged it off like it wasn't an option. Again, I appreciate your helpful response. I still don't know what to do, but will withhold his fluids.
I don't think there's any judgment here. I can reckon that not many have replied to you because it is something so very particular and personal, that nobody thinks has the right to give out judgements and hence they stay silent, and also because not many of us have found themselves in such a terrible situation.

I should be the last one to talk, because I dragged the story of my cat for so a long time, I prolonged her life (and sufference and pain, maybe) for maybe too long.
In a hindsight I think I did prolong her life beyond what is humanely acceptable, and though I realize I might have messed up like you think you did, I would do the same thing all over again.

I'm so sorry you are finding yourself in such a dire situation, this reminds me of what I had to go through with my cat. Should I have to let her go now and peacefully, or can I drag her forever?
I kept syringe feeding her till the end, I kept her hydrated till the end, and I only gave up and surrendered when she couldn't stand it anymore.

Those moments still haunt me nearly five years later, and still have doubts whether I did things right. So I fully understand you.

The only thing I can say to you is to keep supporting him with fluids, not let him die dehydrated, it would be terrible for him and you. Give him anything that can relieve his pains and discomfort, stay close to him as much as possible, let him feel you're there. He may seem unconscious, but he will feel you and he will pass happier.

I hope everything will happen smoothly.
My thoughts are with you.
 

mrsgreenjeens

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And if you think he's hanging on for you since he's a "velcro kitty", tell him it's ok to go. Seriously. Even though you think he may not hear you, the thoughts may get through to him. Let him know you'll be ok and that he's free to go anytime. :hugs:
 
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all4mom2

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So that's one vote FOR fluids and one AGAINST. Instinctively, I feel better giving him the fluids, as dehydrating must be terrible. Can anyone else chime in with their knowledge or experience on this question?

I have told him it's okay to go and be with his buddy who passed on a couple of years ago (he's been crying, searching, and mourning for him ever since), but no-go. He always was a determined little thing!

Funny; I'm "haunted" by all the other deaths via euthanasia. It seems most, while of course they miss their pets, don't think twice about it, but I always felt tremendous guilt. Now it seems I'm doomed to feel guilt no matter which way it goes! I read so many accounts online of pets dying suddenly or having passed unexpectedly in their sleep, but that's not to be for me; I always have to make these agonizing life-or-death decisions.

It's almost enough to make you not want another pet knowing it always comes to this!
 

catmom2wires

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Dehydration is not painful. Overloading failed kidneys (which is usually what stops working before the heart) is.
 
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all4mom2

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Dehydration is not painful. Overloading failed kidneys (which is usually what stops working before the heart) is.
If it's what they do in people hospice and it's not painful, why do they always ply them with morphine?
 

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Morphine is used for pain control most often. Not only for the disease process, but also because lying immobile becomes painful after a few days, especially for the elderly who may have poor skin and little cushioning.

Morphine is also used for those with breathing issues. It reduces the feeling of “air hunger” so the patient does not feel he or she is fighting for breath or smothering. My mom died with heart failure 5 years ago and used nebulized morphine and was in no discomfort.

Morphine is less often used for anxiety. There are better drugs for that, though, so it is used less often for that.
 

Antonio65

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I believe that feeling dehydrated must be one of the worst things ever.

It's not true that people don't think twice about putting to sleep their pets. It's always a painful decision to take, and as you can read in my previous message, I dragged my cat for a very long while, way longer than my vets told me I should have done.
Because I couldn't do that, I just couldn't.

But one day my cat told me she was ready and wanted to go. It was her choice, she was ready, I let her go...

My other cat passed in her sleep, at night. And though she took the burden of the euthanasia away from me, I will never forgive myself for not being with her in that moment. I will take that guilt with me forever.
 
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all4mom2

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It's also used for VSED (the voluntary cessation of eating and drinking); these usually aren't debilitated bed-bound elderly patients, but I've read it's to ease the pain and/or discomfort of dehydration... But I also don't want to overload his circulation should his organs begin to fail, so I still don't know what to do about it! It's only 100 ml's a day...
 
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all4mom2

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What I mean is that most sincerely believe vet euthanasia (sooner rather than later) is absolutely the right thing to do and so don't feel they've "murdered" their pet, but rather done them a huge favor, especially if the vet leads them to think that. I can't say I have.
 

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A vet once told me they absolutely cannot lead a person to think that euthanasia is the thing to do. It's against their deontology.
They can only remember you that there's this possibility, but they can't advise you against one thing or the other.

I had to take this step several times form my home kitties and a few of my ferals, and it's always been a tremendous pain in the heart, so heavy and strong that sometimes I wondered how I survived it. I never took that decision lighthearted, I always pondered all possibilities, and decided in favor of the euthanasia only when all options were ruled out.

Keep in mind that, even for vets, the euthanasia is a huge shock and stress. A few of them told me that they do prefer to perform it at the end of their shift, because they might have a hard time finishing the working day after that.

If your cat isn't in pain, he isn't suffering or struggling, I would advise you to wait for the nature to do its course.
But do call a vet if you see that things are getting unbearable for him.

I'm deeply sorry ☹
 
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all4mom2

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Thank you for your replies.

He honestly has not seemed to be in distress at any point. The only time he acted upset was when he couldn't walk properly where he wanted to go and kept falling over, but I found ways to help him, and he was good again.

Then he started a repetitious chewing motion, and I realized he was hungry, as he couldn't get enough food in on his own, so I began syringe feeding. Since he began throwing up and being unable to keep it down, he hasn't repeated that behavior or seemed hungry.

Now, of course, he sleeps almost all the time and purrs and wags his tail when I pick him up before falling asleep again in my arms. He is HIDEOUSLY thin (not only fat loss; also muscle wasting), but doesn't seem to be in any pain or distress.

I'm just worried about -- and trying to avoid -- this taking a sudden turn for the worse.
 
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mrsgreenjeens

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How is he this morning? Still with you? Have you asked your Vet if they think withholding fluids would cause any pain for him or make him uncomfortable in his current state?

I have read it's not painful, but that's in humans and I don't honestly know if they were given sedatives or not.
 
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