Palliative Or End Of Life Care For Our Pets

Every season serves a purpose. Even or especially the last one we walk with our best friends. A season of profound lessons. Of accepting “there is nothing we can do” about the disease. But knowing “there is always something we can do” to make our best friends feel more comfortable. And pain-free.


what is palliative care?

As our animal friends approach their golden years (some in their younger days), they may develop terminal illnesses like kidney failure, heart disease or cancer.  When we understand that the condition is not treatable or the decision is made not to treat it – yet our pet still has “that light in her eyes” – then we talk about palliative care.

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Some animals are not good candidates for surgery or chemotherapy. Palliative care provides an alternative to premature euthanasia.

The primary aim of palliative care is to provide comfort to the terminally ill. Relieve pain for the dying. Maximise quality of life in the final days. Until death occurs naturally or humane euthanasia becomes necessary.

It is about a moral duty to offer compassionate comfort care but not prolong the suffering of animals who are in pain or experiencing poor quality of life.

It is about learning to provide home care, manage chronic wounds, administer oral and injectable medications, supplements, fluids and special diets (if necessary).

It is about knowing when to start and realising it is time to stop.

managing pain

Pain is debilitating. Chronic pain can create a “stress response” associated with elevations of cortisol, reducing your pet’s immune response, leading to infections and slower healing.

In palliative care, we manage pain with various drugs (e.g. steroids, opioids, non-steroidal anti-inflammatory drugs) and holistic therapies (e.g. acupuncture, massage, physiotherapy, hydrotherapy).

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Consider acupuncture to relieve pain from old-age conditions like osteoarthritis. Acupuncture may also relieve nausea which may then improve your pet’s appetite.

How do i know if my pet is in pain?

Firstly, animals tend to hide their pain – an instinctive survival advantage. Secondly, they cannot verbally communicate their pain. We have to watch our pets closely to detect any changes in behaviour. They may be in pain if they are:

  • unusually quiet or withdrawn
  • restless, pacing around or trembling
  • hiding and avoiding human interaction
  • whining or whimpering
  • biting or snapping when touched
  • licking or biting a body part excessively
  • limping or exhibiting stiff body movements
  • having difficulty lying down or sleeping
  • refusing food

** Read more about MANAGING PAIN.

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A “preemptive” approach to pain – using analgesics before the onset of pain – is most effective. Animals who receive post-surgery pain control heal faster & eat sooner than those who don’t.

my pet is not eating, what can i do?

We tend to get upset when our pets will not eat. And the immediate urge is to force feed them so they do not go hungry or lose weight. But this might make them even more averse to eating.

Most of the time, our pets are feeling pain or nausea which makes them withdraw from food. It takes a combination of appetite stimulants, medications to relieve pain and nausea, and novel ideas to tempt them to eat.

  • If you are feeding dry kibbles, start by soaking kibbles in water or broth to soften it or mixing in canned food to make it more appealing and easier to eat (especially for senior pets with dental problems)
  • Warm up the food to make it smell tastier
  • Feed small amounts throughout the day instead of one big meal
  • Offer strong-smelling foods like cheese or tuna or even small amounts of burgers and bacon if your main aim is to have your pet eat something (always consult your vet about appropriate diet for your pet’s condition)
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Feeding tubes are very useful for animals who are ill & have lost their appetite, or are keen to eat but have difficulties swallowing or keeping food down. For chronically ill animals, discuss with your vet if force-feeding or tube-feeding will actually improve quality of life.

my pet is not drinking enough water

Dehydrated animals will lose elasticity in their skin. Their gums become pale and dry, the saliva is thick and sticky. They are listless and their eyes may appear sunken. If not corrected quickly, the condition becomes life-threatening.

  • Flavouring the water with some broth may tempt your pets to drink more
  • Syringe-feed fluids at regular intervals throughout the day
  • Hydrate your pet subcutaneously, especially for animals who are losing water from frequent urination, diarrhea or vomiting. 
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Some cats & dogs prefer to drink from automatic water fountains

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Your vet can teach you how to administer subcutaneous fluids at home & depending on the medical condition, advise if fluid administration will make your pet feel better or worse.

stay as active as possible

When our pets are ill, they tend to rest a lot more. However, light regular activity is important to keep them mobile, increase circulation and prevent pressure/bed sores.

Engaging in day to day activities also keeps them mentally alert. So continue short play sessions and go on leisurely walks if your pets are up to it. Drive them to the parks and beaches or simply enjoy the car rides. Pick up yummy treats along the way!

Some basic lifestyle changes can offer relief for pets suffering from chronic pain which affects mobility:

  • Control weight and incorporate light exercises (e.g. hydrotherapy) to decrease joint stress and improve muscular support of the joints.
  • Provide easy access to litter boxes or garden for elimination (e.g. gently-sloped ramp)
  • Raise food and water bowls to a comfortable level (e.g. place bowls on non-slip stools)
  • Provide non-slip floor surfaces to help your arthritic pets get up and walk more easily (e.g. yoga mats)
  • Provide comfortable but firm beds for your arthritic pets
  • Use body harnesses, slings, wheel chairs or carts for animals who have trouble getting around

keep clean and comfortable 

Maintain your pets’ grooming routine to keep them clean and happy. Use pee pads or diapers if they are incontinent. Brush their fur and clean their face and body daily with a warm damp cloth, especially for cats who have stopped grooming themselves regularly.

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Prepare comfortable sleeping spots in quiet areas & keep them clean & dry (especially if your pets are incontinent). Surround your pets with their favourite blankets & toys.

prevention is really better than cure

Very often, we only take our pets to the vet when signs of illness become obvious. Sometimes, that can be a little too late. As our pets enter their senior years, frequent health screenings can help us detect age-related diseases at an early stage.

** Read more about HEALTH SCREENING FOR OUR PETS.

when to let go – choosing Euthanasia

There is a period of time between the first thought of euthanasia and actually choosing it. When we are unsure if it is the right thing to do (for moral or religious reasons). When we wonder if we should wait awhile longer because he looks brighter today. When we simply need time for closure with our beloved pets who have shared our life for the past 15 years.

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We all know one day death will come. But perhaps, we are not prepared for how dying looks like.

We may say that based on medical tests and reports, your vet knows best when is the right time to euthanise. We may also say that based on years of living so closely with your animal friends, who knows better than you?

Because we are so emotionally bonded with our pets and fearful of the flood of grief that follows, it helps to have a daily record of their activities so we can be objective in deciding when it is time to end life.

When our animal friend is no longer responsive to his surroundings nor recognise us. When she refuses to drink or eat, even her most favourite food. When they are constantly crying in pain. When breathing becomes laboured. When they seem anxious and confused. When the bad days outnumber the good.

You see, living longer does not always mean living better. As much as we want our best friends to have a good life, it is just as important for them to have a good death. Love them enough to give them that.

Sparky Says “Thank You Dr Tricia Ling”

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Our beloved Shetland Sheepdog, Sparky, has been going to AMK Veterinary Surgery (now known as Mount Pleasant Vet Centre, Mandai)  since he was a puppy. When he was 13 years old, we met Dr Tricia Ling.

Dr Tricia is the most proactive, detailed and compassionate vet we’ve seen all these years. Instead of the usual and nonchalant “it is normal” or “it is like that” from other vets, Dr Tricia really spent time explaining her findings and showing us theoretical visuals to compare with Sparky’s.

My husband and I truly appreciate the patience and care Dr. Tricia and her team of vet techs had given to Sparky. He passed yesterday. Nevertheless, we sincerely felt he was in good hands.

We are grateful to Dr Tricia Ling and her team.

Laura and Sparky

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Bambalina Says “Thank You Dr Anthony Goh”

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“Thank you my friends from far and near for your kind words of condolences. Our sincere heartfelt appreciation and thanks to Dr Anthony Goh and his fabulous team from Mount Pleasant (Gelenggang) for taking care of our girl.

Bambalina crossed the Rainbow Bridge to Heaven on Friday night (18 March). She gave us 10 years of Heaven on Earth.

We shall always cherish her love and memories and she will remain in our hearts and minds forever .”

Skorpio Boy (Pack Leader), Nancy Neo (Pug Leader) and Ravi Velu (Pug Man)

Remembering Porsche

Since I was a kid, I loved animals. At the age of 18, I adopted my first dog, Porsche, from a breeder. She was the outcast as she was oversized and had a terrible skin condition.

I always believe in adopting. There are too many abandoned, homeless, sick pets out there waiting for good homes.

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When I got home, Porsche would always welcome me at the door. To be greeted by her was the highlight of my day. Whenever I can, I would bring her out to see the world. 

Last Christmas, Porsche started limping. We thought she might have a sprain or dislocated her shoulders. Radiographs were inconclusive and she got better with anti-inflammatory medications. But by Chinese New Year, she was limping badly again. This time, we discovered a lump near the shoulder. Tests were suggestive of bone cancer, possibly osteosarcoma. She was just 8 years old.

Osteosarcoma develops deep within the bone and is a very painful tumour. As the bone is destroyed, it tends to break with minor injury. Osteosarcoma spreads rapidly, especially to the lungs.

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Porsche’s cancer had spread to the lymph nodes. We decided to let her live her last days happily, with no amputation or chemotherapy. Pain medication made her condition easier to bear.

As days went by, Porsche became anaemic and started displaying symptoms of fluid retention (swelling around her neck).  She could not walk and would lie on the floor, calling out for us when she was uncomfortable or needed to pee or poo. I had to flip her over every few hours to prevent pressure sores.

One night, Porsche passed on peacefully in her sleep.

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Porsche taught me about love & loyalty. No matter what happened, I knew she loved me. She was my best buddy, my family.

Now when I come home everyday, I would take a look at Porsche’s urn and greet her. Just like how she used to greet me, it is now my turn to do the same.

Thank you for staying by my side till your last breath. I could never ask for a better friend than you. I love you, Porsche.

Tok Jia Hui, Mount Pleasant Veterinary Centre (Gelenggang)

9 Things Your Deceased Pet Wants You To Know

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“Your pet wants you to have no regret & no sadness. They want you to know that these were their choices and you honored them perfectly. They want you to be happy again.”

Excerpt from the beautiful article: “9 Things Your Deceased Pet Wants You To Know” by Susan Petruno.

1. There’s nothing that could have been done differently.
Everything that needed to happen, did. Your pet wants you to know there is absolutely nothing you, or anyone, could have done differently to save them. You did everything exactly right.

2. They chose you as their parent.
Your dog, your cat, your bird – chose you, as the one who would make them feel the most loved and bring them the most comfort and joy while they were here. And you did. Your pet wants you know that you are the perfect parent.

3. They understand your sadness but would rather see you happy.
Remember how, when they were alive, they would snuggle up next to you, sitting by your side (or on top of you), whenever you were feeling sad or feeling bad? They wanted to make you feel better *just like you thought* and they wished they could do something to make you happy then. And they still do, even now.

They don’t want their exit to have brought pain, in fact, no one does. But they understand that this is part of the process. They want you to remember the happy, love filled and joyous times you spent together. And look back upon them with gratitude and thanks.

4. They know you love them and hope you know they love you back.
Your pet doesn’t want you to wonder if they knew how much you loved them, they do. It is said that grief is the final gift of love given from one to another, and the depth of that grief is a measure of the strength of the love between the bond.

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“Porsche taught me about love & loyalty. No matter what happened, I knew she loved me. She was my best buddy, my family.” ~ Jia Hui

5. They’re still right by your side.
You aren’t alone. They aren’t gone forever – they’re still right by your side. And they always will be, if you let them.

6. They still want to do things with you.
They’re still here, in spirit form, and they still enjoy your company and want to do the things you always did together. All you have to do to invite them along, is pat the couch beside you and encourage them to jump up, or give them the okay to hop out of the car and accompany you on the hike.

7. They don’t want you to regret the way that they died.
If you had to carry your dog into the vet to be put to sleep, your dog does not want you to regret this choice. It was their choice too, to be in your arms as they took their final breaths.

Your pet wants you to have no regret and no sadness. They want you to know that these were their choices and you honored them perfectly. 

8. They know you often loved them more than you loved yourself.
Even if you didn’t have proper food to eat, they know you somehow managed to buy them food and treats. Your pet knows you often showered them in more love than you ever showed yourself. This is exactly why you were the perfect choice as their parent, and they want to thank you for loving them even at times when it seemed so hard to love anything at all. 

9. They loved you more than they loved themselves.
You were always supportive, always loving, and always doting, even at times when you thought you weren’t. Your pet loved you, and loves you, more than they ever loved themselves.

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Till We Meet Again, Condo!

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When this boy was rescued by Pei Jiun and Rosalind, no one thought he would survive the next few weeks. He had chronic kidney failure, Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV). 

But lived on he did. Way past everyone’s expectations. Since last August, he had been staying at Mount Pleasant Animal Medical Centre (Farrer), under the care of Dr Ang Yilin and team.

This is our little tribute to a little fighter. His name is Condo. 

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Condo was found in a condominium, hence his name.

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Condo was really a good boy – big heart, fine manners, got on well with everyone, including Big Man the resident dog!

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Sometimes….just sometimes…Condo did feel a bit embarrassed by the dog’s eagerness to please. Or rather, eat.

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Happy moments that linger in the hearts of the team at Mount Pleasant (Farrer).

Condo left us on Wednesday, 1 July 2015.

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“Dear Dr Ang & team, thank you so much for showering Condo with love, care & compassion for the last months of his life. I could not ask for a better team to see him through this. I have no doubts he spent his happiest moments with you all. Thank you for your kindness.” ~ Pei Jiun

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“It was a sad day as we bade farewell to one of our longterm patients & boarders, Condo cat. He showed us what a true fighter he was, having battled kidney failure for the past 2 years, enduring needles daily for the past 10 months. We salute his carers, Pei Jiun, who willingly took on the hefty medical bills of a stray cat & Aunty Rosalind who travelled back & forth to get Condo his medications & brought him his favorite steamed fish. Thank you for trusting us to take care of him. RIP Condo. You will always be in our hearts.” ~ Dr Ang Yilin & all at Mount Pleasant Animal Medical Centre (Farrer)

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They say “Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day that says, I will try again tomorrow.”

Thank you for teaching us to be brave. To be grateful to all who help us along the way. And no matter what we are going through, to try again tomorrow.

Enjoy the boxes, toys, steamed fish and catnip up in heaven, Condo. We will meet again.

Remembering Lico

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A pitiful sight. But Lico was still loving and sweet as usual.

Cryptococcosis is an infectious disease caused by the fungus Cryptococcosis neoformans. The disease is contracted by inhaling infectious particles (e.g. from bird droppings, soil, decaying vegetation).

In animals with a suppressed immune system, the organisms can spread from the nasal passages or lungs to other organs, and progress to develop severe diseases. 

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Lico was an old cat and also living with Feline Immunodeficiency Virus (FIV) which made her highly vulnerable to Cryptococcosis. The disease is not transmittable to humans or other animals.

Symptoms of Cryptococcosis include:

  • weight loss
  • lethargy
  • sneezing
  • nasal discharge
  • nasal mass
  • skin lesions on head
  • eye disease (e.g. haemorrhage in the retina,  inflammation of the eye)
  • central nervous system abnormalities (e.g. head tilt, incoordination, circling and seizures)
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The fungus may cause Meningitis, an infection and inflammation of the meninges (membranes that cover the brain). Left untreated, Meningitis can be fatal.

Diagnosis of Cryptococcosis is obtained by fine needle aspiration and cytology or tissue biopsy. A blood test called the latex agglutination test identities the actual fungal antigen.

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A fine needle aspirate of the mass was taken for microscopic examination.

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The fungal cells are rounded yeasts with a thick mucoid capsule.

As cryptococcus is a fungus, treatment requires the use of anti-fungal medications which include fluconazole, ketoconazole and itraconazole. 

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Lico’s final visit to Dr Girisha at Mount Pleasant Veterinary Centre (Changi).

The prognosis for cats with Cryptococcosis is relatively good. However, Lico was old and weakened from FIV. She was also losing weight for the past 6 months although blood tests were normal. The original swelling above her eye was very mild but ballooned rapidly within 2 weeks. All the while, her appetite was good.

Lico did not recover. She crossed the rainbow bridge at 15 years old. A good age for a rescued community cat.

Well-loved. Fondly remembered. And always beautiful in our eyes.