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Chronic Health Issues / Quality Of Life / "when?"

Friend's Friend

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Greetings, friends; I hope everyone is well.

I'm writing because there's a lot of external stuff going on in my personal life, which is making this situation all the more difficult, and I'm looking for a bit of guidance.

For those who've had cats with chronic illnesses that aren't, ostensibly, life-threatening . . . but which are obviously impacting their quality of life . . . and what treatments you've tried haven't helped (but you can't afford a revolving-door, "Let's see what sticks!" approach) . . .

How do you determine when your cat's quality of life has declined to the point where you might need to have The Talk with your vet?

Friend has hyperesthesia. My vet and I tried Gabapentin and Clomicalm, and neither worked well for him (the Clomicalm actually made him really constipated). Back in January or February, we decided to take a conservative approach to treatment--wherein my vet basically said, "Is he happy and healthy otherwise, when he's not having episodes? Then let's leave him be."

The issue is . . . his bad days have become worse. He has good days, too, but I'm starting to wonder about his quality of life. I don't even know how to assess that, at the end of the day--I mean, how do you draw a line and say, "This is enough?"

I've read all about making lists of your cat's five favorite things and using that as a benchmark and stuff, but . . . when he's having multiple episodes for a string of days in a row--even if he's totally fine when that's not happening--and even though he has strings of good days, too--well, it gets me to wondering.

And then . . . how do you bring that up to your vet?

Any constructive thoughts on this matter would be deeply appreciated. As I said, there are a lot of other external stresses in my life; I'm not going to make a call at this point--but some help and guidance from those who've been there would be good.

Thanks, all. <3
Dyl.
 

FeebysOwner

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Hi! I would say that it is highly likely your cat is feeling your stress and is reacting to it, which is increasing his episodes. This is not his fault, it is due to his condition, as stress plays a HUGE role in hyperesthesia. All cats react to how their owners are feeling, but probably even more so when stress is involved.

There is absolutely no reason to put down a cat over this condition. And, there are other options to try to help with his stress - such as CBD oil if you can get it where you are located. Serotonin enhancers might help, which neither Gabapentin or Clomicalm are (the latter helps the cat's body reabsorb natural serotonin being produced, but if the level being produced naturally isn't adequate, I don't know how effective Clomicalm would be).

It is truly a trial and error when it comes to finding help with this condition, as not all cats will respond to the same treatments and there is no way to know until one is tried and does or does not work. With any treatment, it may require as long as 3 months to see results.

I don't know what all your external stresses are, but it would be helpful to both you and your cat if you could find ways to relieve/decrease your own stress as well. I think if you could, after a bit you would see some difference in your cat too.

If you haven't read up much on hyperesthesia, here is an article you might find helpful.

Hyperesthesia in Cats
 
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Friend's Friend

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Thank you for the reply.

With all due respect, while I mentioned external stresses, my mental health / anxiety is actually halfway decent, considering the circumstances, and unfortunately I'm doing everything I can (in conjuncture with a therapist) to keep the pieces together. And obviously I would never blame my cat for this situation or his condition. I would really appreciate it if assumptions weren't made. I understand that the subject of an owner bringing up even the thought of euthanasia stirs up strong emotions, but I'm not here looking for judgment.

Incidentally, his bad days started before everything came crashing down in my own life. It's always been a rollercoaster. Perhaps it was my mistake for bringing up dealing with external issues; perhaps it gave the wrong impression that I'm overreacting due to my anxiety. That's not the case. This question has been rolling around in my head for a while, because contemplating treatments that are outside of my reach is useless. Giving Friend the best quality of life that I can is the point, and it's my responsibility, likewise, to begin to understand when that quality of life has been compromised.

As I said, I can't afford to try a bunch of different treatments to see what will work. I'm just going off of what my vet says, and her thoughts, when I brought my concerns about not being able to afford going down the rabbit hole medication-wise (or alternative treatment-wise) are that hyperesthesia really isn't understood, and she wouldn't want to put Friend through a trial-and-error process any more than I would. I'm sure there are other options out there--whether or not they're viable in my situation is another matter. I've done extensive research on hyperesthesia, and most of the information I've found is contradictory at best, so I'm inclined to believe my vet on this one.

Again--I'm not going to make a decision now, by any means. What I am concerned about, and what I came here seeking advice for, is understanding how to gauge when his quality of life has suffered to the point of needing to make that decision--and that's a question I will most likely have to address anyway (although hopefully several years down the road).
 
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FeebysOwner

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Sorry - I wasn't making any judgment, but if I came across that way to you I sincerely apologize.

And, yes, you are correct - when someone suggests euthanasia for a cat that is for all intents and purposes healthy but has a condition that can be treated, despite the difficulty in finding a treatment that works specifically for that cat - it does set off alarms with me - but it did not trigger judgement, just sadness.

Short of trying other treatments and/or environmental changes to see if something is successful, I have no idea what other options there are. It would seem you probably already know this with your extensive research on the subject.

Since you have a vet you trust, have you told her that the "let's leave him be" is not working and that he is getting worse - just to see what she might suggest next?
 
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Friend's Friend

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I'm so sorry for my prickles, friend. I know this topic raises a lot of alarm bells for people, and unfortunately, yes, I do know that there are folks out there who rush to euthanize their pets at the first sign of trouble, or who blame their pets, or any number of things. The truth is that even though this is all hypothetical, I'm having a tough time not beating myself up over it . . . which no doubt colored my reply to you. So for whatever I didn't communicate clearly, and for whatever snippiness seeped through on my part--I deeply apologize.

It's an unfortunate reality that sometimes the money runs out and you can't treat your pet in every way possible--even if that treatment would "cure" them, insofar as can be. I'm not happy about where Friend and I are, but . . . we're doing the best we can. I just want him to have more good days than bad, and it breaks my heart to see him suffering.

No, I haven't had a chance to contact my vet yet to chat about what's going on. That's on my to-do list.

Thank you so much for your kindness and understanding. <3
 

Jem

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Have you considered trying to find another home for him with someone who has the means to try and find the appropriate treatment?
You could start a crowd funding site...?
Perhaps your vet would be willing to look into if there are some medical trials or new research into hyperesthesia, something that Friend could participate in?
Perhaps there is another vet in your area who would be willing to work with you (when it comes to price). For example, my vet often gives donated medication from other clients (from pets who have passed) to those who may not have the means at the time. I have been a recipient to this myself when we were dealing with my cat with CHF, who was on 7 different heart meds at one point.

I honestly don't know how to gauge a cats quality of life with hyperesthesia or how to help you "think this thru" because this it is not a TYPICAL "he's suffering, and it's getting worse" situation. The symptoms can vary drastically, even day to day depending on the situation and especially because stress and anxiety seems to be the biggest common link with this condition, which is treatable (albeit complicated, to say the least, we ARE talking about cats!;)), I just don't know.
All of the information that I have read when I had to "make the decision" myself, all spoke about eating and drinking, using the litter box on their own, being able to groom themselves, participating in things they always liked, can they still get around, is there pain, are there more bad days than good...And you still need to gauge what IS a "bad day" vs. "the new norm". I'm sorry I'm not much help with your specific question.

I can tell you love Friend and want what's best for him, and in many cases, euthanasia is the kindest and most compassionate option, but I wanted to offer a few ideas that you might not have thought of that may help.
:heartshape:
 
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Friend's Friend

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Hello, friends. Thank you both. <3

Jem--thank you for your response. My vet is fantastic; she's seen us for free before (when what she saw us for would have cost in the hundreds of dollars) . . . She's done everything she can, I think. Even she's got a boss to answer to, at the end of the day. :/

You're quite right--every "guideline" I've come across has been in terms of tangibles, which makes situations like this all the more difficult. I'm hoping that my vet might have some thoughts on this . . . although I guess one of my concerns is that during our last call she said, "I think the problem might be you--I think you care too much." Meant as a caution against anthropomorphizing, I suppose--or projecting too much onto one's cat. She's a kind-hearted person and I think I know what she meant, but ouch(?). So now I worry that for some reason she won't take this as seriously, although I freely admit I'm probably over-thinking it.

Anyway . . . thanks again to both of you.
 

stephanietx

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I would definitely try the CBD oil which can really work to calm a kitty and might help lessen the severity of his bad days. Also, do you use any other calming agents such as Feliway in your home? That might also help.

I have a cat who is very sensitive to change, any little change that I don't think anything of. While he doesn't have FHS, he does have chronic stomach issues and asthma. I also have a kitty who has feline herpes and she is also very sensitive to changes to her routine. Cats are funny little creatures and are so very sensitive to us, even when we don't realize it.

Have you considered a second opinion or a cat only vet?
 

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We have a boy with hyperesthesia. I'm not sure how Friends episodes play out or how severe they are, but our cats episodes were dramatically reduced when we took any kind of dry or carbohydrate heavy foods out of his diet. Depending on Friends diet now, and his age and food preferences this might not be an option at this point. And even if it is, it might not help him like it helped ours but if it's something you think you could try, it might be worth a shot.
Preparing for the possibility of having that talk with the vet isn't pleasant. I have a hand ful of things I consider baseline before I consider it (minus a life threatening emergency where seconds matter), such as if they still take interest in things they always liked, if they still show interest in food, if they still use their litter box, do they self groom any, how do they react to me if I speak to them and pet them, etc. I need it to be 100% clear in my head that euthanasia for them wouldn't be "ending their life", it would simply be ending the remaining suffering since the life they knew and loved is completely gone from them.
I'm sorry you're dealing with this. But I do like his name, perfect name for a perfect companion :hellocomputer:
 
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Friend's Friend

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Thank you both so much! <3 Apologies for my delayed response . . .

In no particular order: does anyone know how to get ahold of CBD oil? My vet mentioned it but added "I'm not really supposed to tell you about it." (I know it doesn't have THC in it, so it's for the "chill" factor, not the high . . . but everything along those lines is illegal in my state, so I don't know if that'd play a part in why she said what she did.)

Re: food! Oh, food. Friend's on urinary tract food right now; I tried wet food only after his first urinary issues but he refused to eat it (brand / type made no difference). Poor guy lost three pounds in two months . . . so we're back to dry stuff now. If he didn't have a history of urinary issues I think I'd feel more comfortable tinkering with his diet, but since I know that he's been crystal-free for six months on this stuff . . . I guess I'm a little wary of toying with that too much.

As for a cat-only vet, unfortunately the only one near me doesn't have the best reviews, which has me uncertain of going to them.

1 bruce 1: thank you for the thoughts on "the talk". He's perfectly fine when he's not having episodes, but when his bad spells are multiple episodes a day for days in a row . . . I guess that just gets the question turning in my head . . . even though, of course, during good patches, I immediately revert back to, "How could I even wonder about that?" And I guess that's where situations like this can be so difficult--it's not always cut-and-dry. Part of why I came around here, actually, looking for advice. <3

But . . . anyway . . . thank you all for listening. <3 I really appreciate it.
 

FeebysOwner

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Re: food! Oh, food. Friend's on urinary tract food right now; I tried wet food only after his first urinary issues but he refused to eat it (brand / type made no difference). Poor guy lost three pounds in two months . . . so we're back to dry stuff now. If he didn't have a history of urinary issues I think I'd feel more comfortable tinkering with his diet, but since I know that he's been crystal-free for six months on this stuff . . . I guess I'm a little wary of toying with that too much.
Have you tried to add a little bit of water to his current dry food, just to see if he would eat it that way? If so, add a bit more, etc. If you can get him to tolerate some water mixed in, then you could later try the wet again.

I don't know if Friend's food is part of your concerns about him, so maybe this is really a non-issue regarding the food. I will tell you, Feeby has been on urinary care food for 10 years now after bladder surgery for stones - and it wasn't until a couple of years ago that I added wet food to her dry diet. Even now (knock on wood) she is stone free. She does, however, drink a fair amount of water each day.

Wish I could help with the CBD oil, but I have no experience with this and hope others that do will come along soon and help you out with where you might be able to find it.
 
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Friend's Friend

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Hey Feeby,

Nah, the food's a non-issue. ^_^ At least insofar as his hyperesthesia is concerned. It does add a hitch to the whole "Diet might help" situation, but I've also read of people for whom changing their cat's diet doesn't work, so . . . I'm in favor of keeping that even-keeled, and keeping him happy in at least one medical department. ;) I just consider it a blessing that the urinary tract food is even working, to be honest.

He drinks plenty of water as well--actually, it's funny: he'll refuse to drink except out of one specific bowl that isn't for him, but he likes it, so.

I hadn't thought of trying to accustom him to wet food textures by adding some to his dry food. Hm. I'll keep that in mind and see if he'll learn to tolerate it! :) Thanks, friend!
 

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Hey Feeby,

Nah, the food's a non-issue. ^_^ At least insofar as his hyperesthesia is concerned. It does add a hitch to the whole "Diet might help" situation, but I've also read of people for whom changing their cat's diet doesn't work, so . . . I'm in favor of keeping that even-keeled, and keeping him happy in at least one medical department. ;) I just consider it a blessing that the urinary tract food is even working, to be honest.

He drinks plenty of water as well--actually, it's funny: he'll refuse to drink except out of one specific bowl that isn't for him, but he likes it, so.

I hadn't thought of trying to accustom him to wet food textures by adding some to his dry food. Hm. I'll keep that in mind and see if he'll learn to tolerate it! :) Thanks, friend!
I miss the days when our boy was eating a home cooked diet, but he decided he didn't like it anymore and he's done so good on fancy feast that we're scared to change it up much. I think it's a decent brand, others do and others disagree but in the end, when their health is on the line like this, you don't want to rock the boat. I totally understand and agree with how you feel on this. Adding a bit of wet food like FeebysOwner FeebysOwner mentioned would be a great thing to try though.
On the CBD oil, there's been a recent explosion of CBD oil products that are just pretty much snake oil. I'd steer clear or the super cheaply priced stuff and if you can find a company that has a history of producing good, solid, reliable supplements and products I'd pursue it.
I'd be curious enough point blank to ask the vet what they mean. They might have seen animals on CBD oil that improved, but their corporation or company policy might tell the vets not to recommend it for whatever reasons.
Whatever happens, we're rooting for you and Friend :wave3:
 
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Friend's Friend

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Hello, 1 bruce 1. :)

Yeah, I'm really wary of purchasing through online retailers; the upshot of in-person contacts is that presumably if word-of-mouth is that they're good, then they're good. As for my vet's response . . . She works in a tiny private clinic--actually, she's the first vet to be hired besides the clinic's founder, and frankly it seems like a pretty chill place. I didn't get the impression that they would poo-poo a treatment if it's known to work, even if it's "unorthodox". (I mean, we used Clomicalm, and that's technically an off-label application . . .) I'd also be curious to hear her reasoning--my guess is that it probably falls under the umbrella of all that's technically illegal in my state (i.e. medicinal marijuana isn't legal yet).

Anyway--it's a good morning today! <3 Very grateful for that.

Thank you all, again. <3 It means a lot to be able to come here and just blab about all this.
 
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