February 17, 2007

Pet Hospice: what's best for the cat?

The Appointment in Samarra
as retold by W. Somerset Maugham [1933]

There was a merchant in Baghdad who sent his servant to market to buy provisions and in a little while the servant came back, white and trembling, and said, Master, just now when I was in the marketplace I was jostled by a woman in the crowd and when I turned I saw it was Death that jostled me. She looked at me and made a threatening gesture, now, lend me your horse, and I will ride away from this city and avoid my fate. I will go to Samarra and there Death will not find me. The merchant lent him his horse, and the servant mounted it, and he dug his spurs in its flanks and as fast as the horse could gallop he went. Then the merchant went down to the marketplace and he saw me standing in the crowd and he came to me and said, Why did you make a threatening gesture to my servant when you saw him this morning? That was not a threatening gesture, I said, it was only a start of surprise. I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.

A month has passed since I euthanized Aimee. Not a day goes by that I do not question my judgment.

Was I hasty, pressed by my feelings of inadequacy to cope with "come what may?" Was her diarrhea a symptom of organ failure or a sign that she was responding to the homeopathic remedy I'd given? Was she really "suffering," or was my decision to take her life, only a merciful end to my misery?

Cause, effect, continuum, our choices shape destiny and ultimately the fate of our animals. I want to believe that there are no right and wrong choices in the universal scheme of things. Just choice and the consequences we get to live with.

I am a great one to make a well-informed, practical, even wise decision on an intelligent basis. Then I beat myself up because I'm not emotionally detached or tempered enough to accept the consequences.

Today is one of those days. What was I thinking?

I chose to eschew what I considered "heroic" extremes, i.e., subjecting Aimee and myself to the roller-coaster of managing diabetes mellitus in a cat.

Based on research, we were facing many trips to the vet and many hundreds of dollars in diagnostic tests just to regulate blood glucose. Add to this the time and costs of daily glucose monitoring and insulin injections, the financial requirements were overwhelming.

Stuart and I are struggling to pay for our own health care, dental expenses and medicine. Plus we have another pet with chronic conditions that require time and expense.

Aimee, a 14 year old calico cat, drew the short straw.

Next, I changed her diet to a Innova Evo, a high protein, low carbohydrate food also high in phosphorus. There was a 50-50 chance, that diet alone would regulate her blood sugar. On the other hand, the high phosphorous content in it could accelerate renal failure.

Flip a fucking coin. Something was going to get her.

We researched better balanced commercial canned foods. She'd eat heartily for a while, then sniff, turn up nose and tail and refuse today what was yesterday's treat.

I offered B.A.R.F - biologically appropriate raw food - which some people believe to be a far healthier alternative for cats. She could not be persuaded that raw was for her. I could not risk tipping her into hepatic lipidosis by withholding food until she ate it.

Ultimately, I fed Aimee whatever she would eat.

I chose her homeopathic remedies.

In April, I thoughtlessly let her lick clean a bowl I used for sugar-free banana pudding. Sugar-free, right? It sent her into a 100% carbohydrate overloaded tailspin.

Aimee stopped eating. Her coat was raggedy. And she was showing clear signs of diabetic neurapathy - her back legs were weak so she almost walking on her hocks, her head was cocked at an angle and her skin was rolling in little spasms.

I gave her 1 pellet of Phos 30C. Then I contacted a homeopathic vet for support. The remedy and consulting Dr. Betsy pulled Aimee through the crisis.

In about a month, she had returned to a new normal, weight stable, appetite good. I added Vitamin B12 - methylcobolamine to her diet. I followed up with Thuja 1M to clear away the effects of vaccinosis. This caused an aggravation of kitty acne she'd had since she was a kitten. In another few weeks, I gave her Uran Nit 6C, which is often helpful when a diabetic continues to emaciate despite a healthy appetite.

By August it looked like the homeopathy had turned her around.

Kitty acne on her mask was clear. Aimee ate several small meals a day and seemed content. She did all normal cat things including sunning herself a good part of every day and sitting outside in the evening. She may have been vomiting before her first meal; I don't know. She awakened me at 5am; I put her outside. She still had a little chlamydia in the right eye and I cleaned ear mites out of her right ear. The cocked head, unsteady gait and bent back legs - neurapthy - all but disappeared.

And so it went, weeks of honeymoon, punctuated by days of crisis, right through Christmas and into the New Year.

Why didn't I just turn over the case to a qualified homeopath?

One path was to fight to keep her alive. The other was to let her die.

When my Daddy didn't want a dog, he dropped it off at the "dog pound" and never looked back.

"That wasn't a good dog," he rationalized.

I go to the opposite end of the spectrum.

I didn't want this cat, but I didn't have the heart to take her to the Humane Society for euthanasia as an unwanted pet or ask a vet to put her down. So I spent the entire last year of her life - and mine - in conflict, "in decision."

What a coward.

I questioned my choice many times during this last 12 months. When my guilt and shame overwhelmed me, Stuart reminded me of one overarching question: what is best for this animal?

There comes a point in the management of chronic disease, when the cost of treatment can become more than its benefit. In the advanced stages of terminal diseases such as cancer, kidney failure or neurological disorders, some treatments cause pain or make pets ill without any hope of curing their disease. This is the best veterinary science can offer. Even gentle homeopathy has limits.

At this point, one must make a decision about which is more important for one's pet: quality of life or quantity of life. Pet owners have the option of stopping aggressive treatment and letting their pets end their life comfortably in the intimate, caring surroundings of their own home.

Pet hospice is a philosophy that promotes an alternative to death in an impersonal, clinical hospital environment. It functions on the principle that death is a part of life and terminal illness and death can be experienced with dignity, as an animal rests at home with its loving family.

Was it better to put her through the tortures - and vaguaries - of modern science? Health up and down. In and out of the vet's office. Occasional hospitalizations for dehydration. She would have gained a few years, maybe, but at what cost?

Was it better to devote myself to making her as comfortable as possible, given her disease progression, until the time came that she no longer enjoyed a good quality of cat life?

Frankly, all I see with the former are dollar signs. I'm not that altruistic. So I chose to balance what I believed to be in the quality of my cat's living with the limits of my time, money and temperament.

Given my history of pet rescue, this proved to be a most uncomfortable decision. Now I have a daily log of her demise. And I am haunted by lingering images of how ill she became over time, and tortured by guilt and shame. I could have done more, should have done more to intervene.

All year, I said over and over, "if I can give her a good year, I will be satisfied."

I did. I'm not.

Such is the nature of second guessing one's decisions. No matter which path one takes, the other will look better in retrospect. In the end, there is no right path or wrong path, there is just a path. And it ends in the grave.

In between, you have to do what you can live with.

Further Reading:

Feeding Your Cat: Know the Basics of Feline Nutrition

Feline Diabetes

Feline Diabetes Message Board

Feline Diabetes and Diet: the High Carbohydrate Culprit

Hospice Care: Ending Life with Compassion

Blessing the Bridge What Animals Teach Us About Death and Dying

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