CRF kitty, made an appt to PTS. Second guessing.

[wasabipea]

Long story short, I had posted in the "introducing a new cat" forum not too long ago, I brought in a 7 month old cat to try to alleviate some of my 18 yr old, Roni's, depression after losing her brother of 18 years to cancer. they had been together every day for 18 yrs.

Roni was diagnosed with CRF 5 yrs ago, but her numbers were so slightly elevated that even without any real treatment, they didn't get much higher. A few days ago, I dind't know if it was the depression she was in from losing Len, but I took her into the vets and her numbers have increased. While not substantially, much more than in the past. Creatinine was 3.8 and BUN was maybe 68.

I've seen numbers much worse, and I'm torn whether to try heroic measures, sub-Q fluids for a week and see what happens. She got 100cc last night and this morning I could still see the spot where the fluids gravitated to this AM - I don't think she is absorbing them. Plus she isn't on my lap anymore (she used to be that everything I had a lap free, she was on it and purring), she is barely eating, and looks generally miserable. Sleeps most of the time. She still has a cold wet nose, but when I go to pet her she tolerates me instead of getting Super Happy like in the past. and she has been peeing outside the box, but that has been an off and on issue for a long time.

Some of the behavior could be from the loss of her brother, some could be from the new cat - who is now totally separated from her in it's own room.

I made the appt to put her down for tomorrow night. I'm confused to whether I'm doing the right thing. She is 18 and my vet calls her the "miracle kitty" because she has bounced back from deaths door so many times. My heart hearts for her, and I don't want her to suffer anymore, and be the happy kitty she once was. I know the kidney numbers aren't that high, but do I want to put her thru the stress of "heroic measures" just to buy a little more time, for selfish reasons?

Since losing my boycat, Len, and I got in a bad car accident and now her problems... all in the same month. I'm not thinking straight. I guess it's better to let them go peacefully earlier than in pain later. But I'm so very confused and questioning my judgement.

I'm probably going to get more confused posting this, I know. She is so unhappy.

 

[stephenq]

Hi @Wasabipea

I wouldn't call Sub Q fluids heroic, i'd call them a very normal and tried and true method of keep a CRF cat feeling good for a period of time.  I would discuss with your vet if you've given the fluids enough of a chance before you make the final decision.  And your cat can see if the fluids are being well absorbed.

 

[wasabipea]

Hi again StephenQ:

I know they aren't really heroic, but taking her in every day for 7-14 days adds to the stress she's been under, I refuse to hospitalize her (I had a cat die once during hospitalization, and I never got over it). She is on amltryptene(sp?) So many other meds are not compatiple.

When I got home from work, she looked pretty good and I thought I would likely postpone PTS for a bit and see if a week of fluid therapy would get her numbers to the point where she was comfortable and happy. I thought I saw that light and "will to live" in her eyes.

Its gone now. I can't get her to eat anything, she lapped at some tuna juice, but threw it up.

I think I have to suck it up and factor in her quality of life, and remind myself this is about her and not me.

And she is absorbing the fluids so- so. This morning I could still see the pocket of fluid in her leg from last night, I didn't notice tonight.

It's those little moments of her being her old self that keep me from putting her to rest. She doesn't look ready, at moments that matter, then she looks suffering again.

Sorry I'm rambling. Just needed someone to bounce this off of.
Thanks for listening.

 

[furmonster mom]

It's so hard to let them go, but follow your gut instinct.  If she is ready, then don't second guess yourself.   

It's always hard, but they have much shorter lives than we do naturally, so it's not fair to try and prolong it further to the point of misery.

I've always done PTS at home.  I'm grateful to have a vet that will come to my home, where I can make sure they go quietly and comfortably in familiar surroundings.

 

[mycatwasthebest]

@StephenQ...I thought subqs could be administered at home...right?

am I wrong @catwoman707?

 

[mycatwasthebest]

Hi Wpea/OP- please put Sub q in the search box---you will see you can do it at home-no need for traumatic vet visits!

 

[betsygee]

I'm so sorry you're going through this.  I have an 18 year old who had to go on subq fluids a few months ago.  We do it at home every third day.  Sometimes he will have a big lump in his leg that looks like the fluid isn't being absorbed.  But then after some time, it is gone.  It's more work, but it's working for him.  I'm sure he has a good quality of life for now.

My first cat went through the same thing.  The subq didn't work as well for her.  She continued to decline, wasn't eating, and ultimately we made the decision to euthanize her.  

I agree with @StephenQ  about discussing with your vet how long to try the subq before deciding whether it's working or not and then you'll feel better about your decision. Ultimately, you've known this kitty for 18 years and know her best.  

Again, I'm sorry you're going through this.  It's never easy.

 

[carolina]

@StephenQ
...I thought subqs could be administered at home...right?

am I wrong @catwoman707
?

SubQ can absolutely be given at home..... Very easily and comfortably.... The OP's vet can teach her how to do it and supply whatever is necessary

 

[stephenq]

It's true that sub Q fluids can be given at home and generally easily, and many people and vets like to give it between the shoulder blade where you can get a nice pocket of fluid, but @Wasabipea's cat Roni may be in a serious decline and based on her description this may be the time to rally around the OP's growing realization that the time may have come.  Her vet will advise her best, 18 years is a long life, and our final obligation is to ease our companion's passage at the end.  Roni may still rally, but our OP is in a better position than any of us to decide what is best.

@Wasabipea we are with you if you want to give it more time, and we are here for you if the time has come.

 

[wasabipea]

Thanks everyone for your supportive posts. They tried to teach me to do subQ at home a couple of years ago when she was in crisis, and I was a big wuss and couldn't do it. I'm going to have to suck it up and learn though. The needle is so big though, how hard is it to break the skin?

I've given injections to my mother, but it was a tiny needle - skin only.

She won't eat, not even baby food or cold cuts. Yesterday am I thought she was telling me it was time (only 2-3 days on subQ) but last night she looked better and this morning I was greeted in bed with her favorite thing to do - say good morning while I'm still in bed). I was greeted with this face (yes,she is 18).

photo-16.JPG

• wasabipea
• May 30, 2014

I'm going to give subQ a bit longer, try to learn today and get over my fear, and see where the next couple of days leads. Look at those eyes, she's not ready. I'm OK with the PTS when she has given up, or her condition deteriorates to the point where quality of life is gone.

I would like to have the euthanasia done at home, but my regular vet does not do that. There is a woman who will, but -call me selfish I want her paw print in clay. I'm not sure the home vet does that.

Thanks again. Any tips or advice on how to get over my reluctance to administer subQ would be much appreciated. It won't buy much time with her age, but even a week at this point would be a treasure... even though she hasn't been the same cat since she lost hr brother, her personality changed quite a bit.

 

[betsygee]

Oh, what a beautiful girl!!!  We have an 11 year old in a similar position now.  The vet suggested we give it a month on the subq and then make a decision.  The first couple of weeks were awful.  I've given subq before and am giving it now to our 18 year old, but Molly's skin is so thin, it was very difficult.  I had to take her back to the vet and have them do it because I was sticking the needle all the way through to the other side....    I watched carefully the second time and the vet tech picked a bunch of skin and rolled it between her finger and thumb.  I realized she was picking up more skin than I had been and so she was able to get the needle in easier.  I just did it last night and it was the easier time so far.  Luckily for me, Molly likes treats so I distracted her with a couple of treats, picked up a good amount of skin on the back of her neck and got the needle in without her noticing too much.

Re food--Molly wasn't eating, either.  The vet said basically buy one small can of several different kinds of foods and just try them.  I finally found one that she's eating for now.  It's one day at a time.

Re the paw print in clay, you can do that ahead of time.  I bought kits at our local craft store and have made little stepping stones for three of our cats.  I want to do Molly's soon, while she's still with us.

Perhaps your vet can show you again how to administer the subq.  I never thought I'd be able to do it, either, but I did.  I'm doing it for two cats now.  Molly may not make it, but I'll know we gave it our best shot.  I think you will know, as you said, when her quality of life is not good and it's time--and your mind will be more at ease when it's time.  You're doing all you can for her.  My thoughts are with you both.  

 

[wasabipea]

That's a good idea, doing the paw print ahead of time. Maybe I'll ask if they can do one tonight.
she won't eat anything, not even tuna. The vet is fairly insistent that once they stop eating, that's it.
Should i try to force feed for a day or two to see if her appetite returns? I really don't know when to call it a day. She doesn't look good now, I postponed the euthanasia for today, but it may still happen this weekend.

I would really like a paw print, I treasure her brother, Lenny's. I only wish i has cut a lock of his fur, but at least i pulled what was out of the brush.

 

[betsygee]

Re eating, they're all so different, and it's so hard to know.  Molly quit eating, too.  I syringe fed her several times over a 24 hour period but figured if she didn't start on her own after that, it would be time.  And then the next day, I blended some pate in the blender with a bit of water and she lapped it up.  That seemed to get her started again. She's not eating much, but it's something. And I don't know how long it will last, it's day to day with her, like with your kitty. 

 

[cocheezie]

re: sub-q fluids. I have a skinny cat who is getting 100ml sub-q fluids at home every day. I also had difficulty at the beginning with poking through the skin. I'd pull up her skin and the two sides would stick together making the tenting area very small,  and making it hard not to poke the needle right through. The solution that worked for me (and has worked every time since) was to gather up a big chunk of skin, hold the needle very close to where I wanted it to go, then ease the tent of skin backwards onto the needle (instead of pushing the needle forwards).

On occasion, I've had to use the neck end of the tent rather than the body end of the tent. (i.e., needle goes into shoulder tent pointing towards tail rather than pointing towards head).

I'm sorry you and your cat is going through this.

 

[wasabipea]

Roni is small too, maybe 7.5 lbs, so she only gets about 100cc also. When i was watching and trying to understand the process, there seems to be a decent sized pocket to work with. I think a couple of years ago when i tried to learn, they said the same thing about pulling her skin onto the needle, rather than sticking her. Since she is also small, I'm concerned about the needle going all the way thru too.

I always thought force feeding was too extreme a measure and unfair. But now that I'm in the position, and only plan for short term to see if she eats on her own again, so be it. After her brother got PTS, she went into a deep depression and would only eat one fancy feast appetizer food that is not fortified and not meant for primary food. Now she won't eat that, so I syringe that hi Cal gel ( like Nutrical) for the time being, and up until today she was eating baby food. Now she doesn't want that.

So many factors at play here which makes this confusing:

-- She lost her brother a few weeks ago, and they were together for 18 yrs every day.
-- She naturally got depressed but started to bounce back after maybe a week.
-- Then she quickly declined again, and me thinking it was because she was lonely, brought a 7 mo old kitten (so sweet ans submissive) into the house. They didn't get introduced properly because the little one is like a Wallenda kitty and barricades, etc mean nothing to her.I'm trying to keep them totally separated for now, but I let the little one out to roam - supervised-in the evenings

So I can't figure out whether she is giving up over grief,whether it is her time anyway (so close to her brother who i still cry every day over - universe, I'm unhappy with you right now), whether the kitten being in the house backfired and made her give up
My heart is telling me that the loss of her brother took the fight out of her.

I don't want to PTS before I know I did everything I could - since aggressive cancer took her brother very unexpectedly and there was nothing that could be done - but I'm not thinking straight because I'm still mourning him... which is why I'm asking for your real life tales.

My vet has seen her troubles over the years, but she always rallies back, and I think they are trying to influence me to let her go. I really don't know what to do.

And Betsygee, I'm so sorry you are going thru this too, pm me if you ever need to chat or a shoulder

 

[peaches08]

A couple of tips for subcutaneous fluid administration.  1.  Stick the cat quickly.  Slow sticks of a needle cause needle drag and is very uncomfortable.  2.  Warm the fluids in a sink of hot water, leaving the drip chamber/tubing outside of the water.  Once warmed, run the cold fluid out of the line and then inject into the subcutaneous space.

My CRF cat actually enjoyed her subcutaneous fluid therapy.  She'd roll over onto her side and enjoy the warmth.  She was also good for her assisted feedings (force feedings) up until she was euthanized.  I only did them for about 2 months, then her kidneys stopped working at all.  As much as it hurt to let her go, I could do so knowing that I had tried everything possible for her.   Some cats, the forced feedings are too stressful and not worth it for anyone involved.  Only you can make that decision.

 

[betsygee]

Oh, I'm so sorry, you're going through an awful lot at once.  If you try, or have already tried, a couple of things, like the subq or syringe feeding and it doesn't make a difference, you'll know you tried everything you could and it's time to let her go.   It must be so hard to think about, so soon after losing her brother.  

Force feeding has its place, but it's not always appropriate. I tried it on my first kitty for a couple of days and it was clear it wouldn't do any good.  It was her time.

Each cat and situation is different--you know Roni best, and seem to be pretty in tune with her.  If her vets have known her through various episodes, they probably know her pretty well, too, and are giving you the best advice they can.

 

[aoi chan]

I don't know what meds you are giving her, but maybe she is nauseous which can cause inappetance in cats. Ondansetron is given for nausea and Cerenia is more for vomiting. I don't believe that not eating would be a reason to let her go.

Have seen some videos on YouTube where they show you how to administer SubQ fluids? Make sure she has absorbed all of the fluids before administering fluids again. You won't want to overhydrate.

I won't have anything nice to say about bringing a kitten into this whole situation so I'll leave that as that.

 

[superpooper]

You can do the print at home with her still alive. I did this when my 13 year old lab cross was dying last year. I bought a block of white baking clay at Michaels, rolled it out as per the directions, and squished her foot into it and threw it in the oven. I made several of them, one for each my sisters and I.

 

[stephenq]

If she's gone a couple of days it may be hard to re-start her, liver illnesses take hold when cat's stop eating but she must get nutrients so syringe feeding may be your only way unless you had the vet put in a feeding tube, and that might be considered heroic, depends on your POV.  Feeding through a tube is actually super easy, easier than syringe feeding.

For sub Q fluids, yes the needle looks big but the tip is beveled, its super sharp and they don't feel it. The trick is not to be slow about it, but find your entry point and GO. :-). It helps to have someone holding the cat.

Your girl is beautiful!!!!!