Palliative Treatment - Would I Do It Again?

Depression Mental Health Random Thoughts

Cartoon illustration of Flip, a tabby cat. This tabby cat is peach colored with yellow stripes, on a blue background.

It's been over a year since I sent My Cat's Battle with Oral Squamous Cell Carcinoma out into the world. So many of you read that post in a moment of deep sorrow. Many of you reached out to me via email or left a comment on the post. As heart wrenching as it's been to read about your beloved pets, I hope that my words have been able to provide some relief in such an intense moment of pain. I know Flip would want it that way, and I continue to welcome your stories and questions.

Recently, a reader emailed me about my experience with palliative radiation and asked me why I might not do it again. I thought long and hard about my answer to them. It took a long time to craft my response because it is so unknown. Would I put my other cat, Sweet Pea, through palliative radiation (or some other treatment for a terminal illness) again? The blurry, gray answer is, I'm not so sure.

Here's why.

While pursuing palliative radiation certainly bought me time with Flip, it did not cure her. She still passed away from SCC, as I was told she would. So the question ultimately is – do you want or need more time with your pet?

There is no wrong answer. I needed more time with Flip when I received her abrupt diagnosis back in April 2020. I had never lost anyone close to me and losing one of my two beloved cats was more than I could bear. At the time, I was emotionally unavailable (and still am, but I'm working on it) and could not fathom how I would get through losing Flip. To me, if I didn't pursue treatment, the alternative was to pick up strong painkillers and make her comfortable at home. Maybe she'd last a month or two.

At the time, I couldn't do that. Putting Flip through palliative radiation made me feel like I was fighting for her, even though the doctors told me she would not survive. I'm glad I did it. The extra time proved invaluable and Flip was a good candidate for radiation. The treatment did shrink her tumor, albeit temporarily.

Losing Flip rocked my world. I felt something deep inside of my psyche shift when she was gone. I felt tiny cracks form in my rock solid facade. Those cracks have grown in the last two years. I've learned how to open up, although it's still really hard for me. I've learned to treasure every moment with my other senior cat, Sweet Pea. And most importantly, I now know the loss of Flip didn't send me spiraling into a depression that I couldn't climb out of.

Knowing that makes me more confident in my ability to handle another loss. Take my cat Sweet Pea as an example. She will be 17 in May and has been plagued with asthma and a curved thoracic since birth. She was the runt of the litter and I picked her especially for me, back the hot summer of 2005. A young, 20 year old Adrianne holds a tiny white kitten, Sweet Pea.

A young me (age 20) with Sweet Pea in 2005, right after I brought her home.

 

Sweet Pea has had a Flovent inhaler that she uses periodically since 2011. She's had pancreatitus and several ultrasounds. She takes Prednisolone daily now to combat the inflammation in her lungs.

Tuesday, I discovered she has a large, mediastinal cyst next to her lungs that makes her breathing labored.

 

While nowhere near as devastating of a diagnosis as SCC, a mediastinal cyst isn't the greatest news. It can't be drained because it will fill back up. It makes it harder for her to breathe. The only real option is surgery, which would be highly invasive, involve a week's stay at the hospital and cost $8-$10k. 

For me, today, this week....the answer to surgery is no. 

I'm not so sure I would have said no a few years ago. Before losing Flip, I was terrified of losing my cats (hell, I still am to some degree). But now I accept it as a sad reality of pet ownership. Before Flip, death didn't seem real.

Now I know how real death is and how incredibly hard it is to watch a pet suffer. I'd be remiss to say that I didn't see Flip suffer – I absolutely did. From the constant drooling, inability to eat and lethargic manner, I watched SCC suck the life out of my cat. Would it have been easier to forgo treatment and manage her pain instead? I would have lost her sooner but I may have seen less suffering. 

A cartoon of Sweet Pea, a white cat on a yellow background.

Sweet Pea is not like Flip. She's always been more fragile and as she ages, I find myself wanting the best quality of life for her as she lives out her golden years. An invasive surgery would traumatize her. It would remove the cyst, enabling her to breathe better, but with her respiratory history, it's incredibly risky. She could die on the table and even if she didn't, the recovery would be painful and long.

For now, I've decided to do nothing for the cyst, except continue Pea's regimen of Prednisolone and occasional Albuterol. I spend the first hour of every day with her. It's always the same. I wake up, brew myself a cup of [now decaf] coffee, and like clockwork, she crawls into my lap. We sit this way for a minimum of twenty minutes, but it's gone as long as two hours. Every single day, without fail, for the last two years.

These are the moments I cherish most. These moments will make it easier for me to say goodbye, even if I have to do it unexpectedly.

 

Losing Flip forced me to prepare for the loss of Sweet Pea. And I have been, every day since Flip left this Earth. I spend deliberate time with Sweet Pea and I am grateful for those moments. I'm present in those moments, and fully aware that one day, I won't have those moments with her anymore.

I feel more mentally prepared now for loss than I did then. It won't be any easier. But now, I'm more inclined to look at the realities of treatment and not assume my cat is in the 1% of those that will survive.

I feel like I'm rambling – maybe because I am. Maybe because I really won't know what to do until I'm in another situation. At this moment, I can only describe the shift within me that makes loss sad, but not unbearable.

I told that recent reader to consider a few things when deciding if they should choose palliative treatment for their own kitty. Consider:

  • Your mental state and ability to handle loss (be honest with yourself here, there is no wrong answer)
  • Your cat's tolerance for stress / vets / travel to appointments / recovery
  • Your cat's general demeanor (are they a fighter?)
  • Is your cat's condition terminal? Would treatment give them a chance at life?
  • Would treatment make their life worse?

I cannot stress enough how there are no right or wrong answers here. As a pet owner, YOU are the one who knows your pet better than anyone else. You've been tasked with caring for them as they live out their life – you have the responsibility and duty and honor of deciding how to proceed when tragedy strikes. Ultimately, you are the only one who can decide what is best for them, and whatever you decide will be the right thing.

I hope this post helps those of you struggling to decide what to do with a pet whose been recently diagnosed with a disease. It's such a big thing to go through and it's not just about how it affects the pet, it's about how it affects you, too. 

I will continue to write about this topic when it feels relevant. That reader's question (and my long response to them) made me feel like this topic was worth exploring further. Thanks for reading.

If you have any questions for me or just want to vent or share your story, do not hesitate to email me at hey@ponnopozz.com. I will respond to each and every message. Note: sometimes your emails go to spam and I find them a week or two later. I will respond no matter what, but if the message goes to spam, there will be a delay.

Feel free to comment on this post, as well. I read all comments and approve them, but I cannot respond to individual comments due to a limitation with my blog. For direct communication with me, please email.



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