A feisty 17-year-old on the back porch looking through a screen for "mom" during this last "favorite summer"

Photo by the Farsakian family

End of life decisions are, sadly, a part of owning a pet. To euthanize or not to euthanize due to medical problems, quality of life, and (unfortunately) the cost of extreme medical care are all issues which must be weighed by responsible pet owners. Also, whether an owner decides to euthanize a beloved pet or opt for medical care, we should be careful not judge them for the choices they make.

In an ongoing series regarding end of life decisions, we will be discussing individual cases that will include success stories, some examples of grieving families who made a compassionate decision to euthanize, as well as ways many have come to terms with the loss of a beloved pet. It is our hope that there are lessons we can learn about the importance of pets in our lives, as well as ways we can nurture the animals we love, whether it be extensive medical intervention or a compassionate and caring end in the arms of someone who loved them.

This is the story of a family that went to extreme measures to extend the life of their beloved pet. For them, it was just not yet time for her to go. Although they recognize they extended their cat’s life for a short period of time (after all, Nini was more than 17 years old), they opted for a surgical removal of a tumor to improve quality of life, if even temporarily.

A well-loved 17-year-old cat
Nini the cat has been a valued member of the Farsakian family for 17 years. Nini was a young, but full grown, cat when Stuart picked her as the family pet for his second birthday present (Stuart is 19 now).

Like too many animals, prior to her adoption by the Farsakians, Nini had been abandoned or was feral, and had spent the first winter of her life out in the cold, even losing part of her ear to frostbite. According to mom, Melissa Farsakian, due to such rough beginnings, Nini has “never forgotten where she came from and has made sure that we understand that she has appreciated every day that she has spent with our family.”

Bad news from the vet
So, of course it was with heavy hearts the Farsakian family received a poor prognosis from their veterinarian, Dr. Janet Figarra: “Nini was a 17-year-old domestic shorthair that presented during her examination as very pale and weak with an enormous mass palpable in her cranial abdomen.”

While the family requested the Ann Arbor Animal Hospital to remove the mass with the hope it would extend Nini’s quality of life, Dr. Figarra was skeptical as to whether Nini’s mass could be removed and was also questioning whether Nini would survive surgery in her frail condition.

According to Dr. Figarra, “We decided to have an abdominal ultrasound performed to try to determine degree of organ involvement. We also took digital radiographs of her thorax to look for evidence of metastasis (the spread of a disease-producing agency, such as cancer cells, from the initial or primary site of disease to another part of the body). The ultrasound suggested that the mass was exclusive to one liver lobe. We then discussed pros and cons of surgery before electing to proceed.

"For Nini, specific indications to pursue surgery were many. Although she could only take small meals, she continued to be interested in food. Her shortness of breath and her reduced mobility appeared to be directly related to the tumor. She was profoundly anemic but she was continuing to make new red blood cells (a regenerative anemia) suggesting that she would be able to normalize red cell numbers once the source of bleeding was removed.

"If the tumor was in a single liver lobe as it appeared on ultrasound, liver lobectomy could increase Nini’s length and quality of life,” Dr. Figarra added.

A family’s decision
Reasons to pursue hospice rather than surgery were also considered. Nini was fairly comfortable and surgery would mean a period of increased discomfort during recovery.

There were high risks with anesthesia in such a debilitated cat. She would need a blood transfusion and careful monitoring of heart rate, respirations and blood pressure during surgery.

The veterinary staff was concerned that they may not be able to remove enough of the tumor to significantly improve Nini’s quality of life due to adhesions or spread of the tumor to nearby organs. Finally, the cost of surgery was also weighed versus the potential benefits.

Nini already had reduced quality of life and, without intervention, her veterinarian’s best hope was for a couple more weeks. Her family was committed to doing everything possible to extend Nini’s life. They decided for surgery.

The outcome
Nini’s surgery went well, and she recovered from the anesthesia nicely. Tissue samples were submitted for analysis to determine the type of tumor and the prognosis. Moving ahead with the surgery was very rewarding for all involved, and the Animal Hospital, like any other veterinary clinic, was thrilled to have made such a positive impact on Nini and her family.

According to Melissa, “We understand that the tumor has come back from histology about as bad as it could be and that at best we may have bought her a little time. That’s okay; we knew before we did this that this outcome was a possibility, and it was important to us to at least make her as comfortable as possible. We had no idea how far back she could come.

"I might venture to say that she was even a little sassy. She deserves to be. She has nurtured our son Stuart and our whole family, she has raised two dogs and several kittens (the most recent of which came feral from the ditch in front of our house), and we knew she was not ready to go yet. She has paid her dues many times over. Watching her sun herself on the deck and run out to, much less run in from the woods, proves to us we made the right decision.”

“Our family is so humbled to have Nini back with us in the condition she is in. I looked up today to see her running toward the house from the woods in our back yard. She was confident, strong and unbelievably happy. It took me aback just to see it. Even when Nini could barely move and barely breathe she never complained, she never became short with any of us including the sprite kitten that she had to deal with. She is wise and loving, and we are a better family for having her.”

It is a nightly ritual to share sharp cheddar cheese with our animal family. They don't get much of it but a few tastes each. It keeps us all bonded. Molly is in the foreground. Nini is on the stool not-so-patiently waiting her turn. Beauty Girl is on my husband Steve's shoulders. Both cats ride there. Levi is in the back patiently waiting his turn for his bite. They share, nurture each other and nurture us.

Photo by the Farsakian family

“Her favorite summer”
After spending the summer doing the things she loved best (sunning in the yard, being with the family), Nini passed away peacefully at home about a month ago. Her digestive track eventually failed with the growing tumor, so the vet prescribed pain meds to keep her comfortable ,and she gently went to sleep.

Melissa says she does not regret the surgery, which gave Nini about six additional months of life. The extra time gave both Nini and the family a chance to say goodbye. “

God in his grace knows what we need,” says Melissa. Around the time Nini fell ill, “He gave us a feral kitten in a ditch who learned a lot from Nini.” While Molly (the dog) served as a mother figure to Nala (the kitten), it was the “granny,” Nini, who taught Nala the kitten how to be a cat.

"Until one has loved an animal, a part of one's soul remains unawakened. " (Anatole France).

David Caddell is the hospital director at the Ann Arbor Animal Hospital. David can be reached at 734-662-4474 or dcaddell@AnnArborAnimalHospital.com.