Difficult Ethical Question On Euthanesia Of Beloved Cat, Help

[ara11]

My precious 11 year old took ill 4 days ago out of the blue. His diagnosis was compounded by his presenting disease that may have had nothing to do with the 2ndary one... I will never know.
I took him to family vet for vomiting 8 times. He was discharged hours later after an anti emetic and no vomiting. Once home he was drooling and hiding so we went to emergency clinic. He was tested and xrayed and given anti emetic and fluids and antibiotics for fever. The fluids were stopped when an ultra sound showed some vague questionable cardiac problems. After 2 days there the internist was so worried she felt he needed an ASAP echocardiogram at another facility where he was seen by a cardiologist who diagnosed CHF and mitral stenosis (rare in cats he said) and hypotension, also unusual with all that.
The shock is overwhelming and his prognosis is suddenly poor. (He offered euthanasia). He went from wonderful happy eating everything and being loving to a day of vomiting to a death sentence. They said the nausea and vomiting had nothing to do with the CHF-- but was he going along fine with that or did it become acute because he vomited? I have him home. He doesn't eat or drink and I shoot meds down his throat adding to his misery and freaking out . He is sitting outside on the porch and doesn't want to be inside with me. He does look outside. I don't want to keep him alive for me but I do want to if he wants to live. This wasn't an aging cat. This all JUST happened. Based on the cardiologist report, the other dr too now says we don't want him to suffer. He has no pain. They say he can throw a clot at any time and that would be painful. But it can be days or weeks or...
What do I do? Do I force meds down his throat so he can hopefully live or do I let him go? Will making him miserable with these meds add to his quality of life if he gets used to them? Will they help even tho they cant change his heart? They also said letting him not eat or drink is a horrible way to die (but he wont eat or drink unless I force feed him) . I am beside myself. I'm crying but what is he doing or thinking?
I would like to know what any of you in similar situations did? My other cat who also loved him has distanced herself from him and hisses at him now.

 

[nansiludie]

I am so sorry to hear about your cat turning ill so fast. Honestly, only you can make the choice as to whether you think he is ready. I will say this though, its never easy and you'll always second guess and think what if, if only, etc. But its human nature to do so. To want to keep someone with you as long as you can and love them and not lose them. When I am faced with this awful choice, I always ask myself, am I doing it for them or for me? I try to look at it from their view, are they eating, playing? Are they truly living or just staying alive? I've noticed over the years, animals don't fear death, they come to terms with it. They aren't like us in the sense they fear the afterlife. You say he's staying off by himself, seems he's come to terms with his mortality already.

If he was my cat, I don't think I would put him through all that treatment with no chance of him getting better or having better days ahead. I look at quality of life instead of quantity.

Sometimes it hurts so bad when we let them go early but I'd rather let them go early than have them suffer a single day. I couldn't do that to them. I just couldn't.

 

[Furballsmom]

The other cat is smelling all these different smells from him, and your concern as well. I'm so sorry this happened to you all!! N nansiludie brought up a lot of good points. My thoughts are with all of you!

 

[Margret]

I've just been looking up "mitral valve stenosis in cats" online, and it sounds quite dire. When it happens in humans it's generally caused by rheumatic fever (my mother-in-law had it, from that cause) and can be treated with a valve replacement; that doesn't seem to be available for cats and would be incredibly expensive if it were. Essentially, this is a terminal disease.

There are 2 kinds, mitral valve stenosis and supravalvular mitral stenosis (which is actually related to a fibrous membrane that's just above the mitral valve; they can be difficult to distinguish without actual surgery).

The reason this is so rare in cats is that cats can't get rheumatic fever, so they think that when it does occur it's congenital. This is also the reason it's generally seen in younger cats; I suspect that you've been lucky that it didn't show up before this. As far as I can tell, the CHF is probably caused by the mitral stenosis.

My father-in-law suffered from CHF and my mother-in-law from mitral stenosis, so I've seen the results of both these problems in humans, and in both cases the primary symptom I saw was a lack of energy.

It is extremely unusual for a vet to suggest euthanasia, unless the client has specifically asked about it. When they do, I see it as a red flag. I believe it probably translates "If this were my cat I'd be putting him to sleep." You may want to ask the vets this question: "If this were your cat what would you do, and why?"; I think that will get you the best answers. Be sure to include the "and why?" part, as that will get you the kind of information about what is ahead that you really need.

I do know that in humans heart problems can manifest as nausea or stomach pain; I don't know about cats.

When medications can actually do some good it's definitely worth giving them, despite the cat's natural antipathy to pills. But the question to ask about meds is whether they're actually extending life, or are they merely extending the death of your cat. And that is a question you'll have to answer for yourselves.

Paraphrase from one of the Liaden Universe novels, by Sharon Lee and Steve Miller:

I wish I could tell you that you'll always make the best decisions for the people who are in your care, but I can't, because it isn't true. What I can tell you is that you'll always do your best for them, and that when you make mistakes the people you love will forgive you.

I can also tell you that whatever decision you make, you can always come to TCS for love and support in the trying days ahead. We're a huge community of cat lovers, almost all of whom have had to make similar decisions at one time or another, so we understand how painful this is for you. We also understand that you can get through it, and heal from the trauma, and we'll be happy to help you do that. And we're very sorry that it's such a painful reason that brought you to us. Nevertheless, welcome to The Cat Site.



Margret

 

[denice]

I am so sorry and it is an awful choice. It sounds like two vets are in essence pushing euthanasia which is very unusual. I just had one of mine euthanized for a long running chronic condition and I brought up euthanasia when I made the appointment. The vet still offered an alternative with increased meds and blood work.

 

[duckpond]

I am so sorry that this has happened and that you are faced with this horrible choice! It is never easy, the best we can do for them is to make sure they don't suffer, if there is no real hope for recovery. I will keep you both in my thoughts!

 

[ailish]

I might want to know, maybe you do, why he is vomiting and not eating if it is not related to the cardiac problem. Is there a fix for that other than the drastic one of forcing medication? If that is reversible I might be tempted to see if he could resume eating naturally before I made any decision.

 

[ara11]

I've just been looking up "mitral valve stenosis in cats" online, and it sounds quite dire. When it happens in humans it's generally caused by rheumatic fever (my mother-in-law had it, from that cause) and can be treated with a valve replacement; that doesn't seem to be available for cats and would be incredibly expensive if it were. Essentially, this is a terminal disease.

There are 2 kinds, mitral valve stenosis and supravalvular mitral stenosis (which is actually related to a fibrous membrane that's just above the mitral valve; they can be difficult to distinguish without actual surgery).

The reason this is so rare in cats is that cats can't get rheumatic fever, so they think that when it does occur it's congenital. This is also the reason it's generally seen in younger cats; I suspect that you've been lucky that it didn't show up before this. As far as I can tell, the CHF is probably caused by the mitral stenosis.

My father-in-law suffered from CHF and my mother-in-law from mitral stenosis, so I've seen the results of both these problems in humans, and in both cases the primary symptom I saw was a lack of energy.

It is extremely unusual for a vet to suggest euthanasia, unless the client has specifically asked about it. When they do, I see it as a red flag. I believe it probably translates "If this were my cat I'd be putting him to sleep." You may want to ask the vets this question: "If this were your cat what would you do, and why?"; I think that will get you the best answers. Be sure to include the "and why?" part, as that will get you the kind of information about what is ahead that you really need.

I do know that in humans heart problems can manifest as nausea or stomach pain; I don't know about cats.

When medications can actually do some good it's definitely worth giving them, despite the cat's natural antipathy to pills. But the question to ask about meds is whether they're actually extending life, or are they merely extending the death of your cat. And that is a question you'll have to answer for yourselves.

Paraphrase from one of the Liaden Universe novels, by Sharon Lee and Steve Miller:


I can also tell you that whatever decision you make, you can always come to TCS for love and support in the trying days ahead. We're a huge community of cat lovers, almost all of whom have had to make similar decisions at one time or another, so we understand how painful this is for you. We also understand that you can get through it, and heal from the trauma, and we'll be happy to help you do that. And we're very sorry that it's such a painful reason that brought you to us. Nevertheless, welcome to The Cat Site.



Margret

Thank you and everyone for the thoughtful replies. Its good to have community who understands how much I LOVE this creature and only wan whats right for him. The drs offered me a choice of either trying to get meds into him or euthanasia. I chose bringing him home for meds which I am now not successful in giving. I went to my own vet this morning who was as surprised as I was about PUma's condition. He offered to help with the meds once a day (they are twice a day). So now we have this to do as well, which means putting him in his carrier (he cries) to go to vet for meds to relieve his heart. My vet thought we should try the meds.

 

[ara11]

I am so grateful to have you kind people responding. Don't think this doesn't mean a lot to me. and Puma

 

[Furballsmom]

We're sending oodles of good thoughts and prayers your way

 

[Margret]

Two possibilities on the meds:

1. Pill pockets, available in pet stores.
2. Pill shooters (like a syringe, sort of, except it holds a pill; you put the pill in, put the shooter in the cat's mouth, and eject the pill clear at the back, near the throat - get it from your vet).

How big are the pills?

Margret

 

[laura mae]

is there any chance that the medication can be compounded into a liquid? It may not be much easier, depending on the cat, but sometimes the compounding liquid is a viscosity and flavored so well the cat doesn't taste the medication.

I had a cat that was fairly hopeless for a different condition. She was a great kitty and I tried to save her life. The thing I regret most about her last month is making her take a lot of different medications in my attempt to save her.

 

[susan denning]

I like the liquid idea too. With one of my cats (Felix), liquid is about the only way I can get meds into him.

 

[Margret]

Hmm. I never thought about liquids. The only time I've ever tried to medicate a cat with a liquid I was lucky that I did it in the bathroom because the medication ended everywhere except inside the cat! I guess it depends on the cat and the flavor.

Margret

 

[ara11]

One pill has to be quartered (Lasix) and the other is an oblong tablet like Tylenol size. He also is to finish the liquid antibiotic just because they believe in the whole dose (like he will live long enough to get antibiotic resistance....)The vet can push this easily down his throat but I am having much more trouble. I am giving him a break tonight from meds (he has been in closet all day since morning meds without eating or drinking). I think 5 days on augmentin in enough when we didn't really find a bacterial infection but were treating empirically before the heart issue was uncovered.
I should also add that due the left atrial problem as well as CHF they saw potential for thromboembolism ("mist" noted- but I cant find what exactly that means) which the cardiologist aid could happen in an hour or days or weeks or... he was leaving it vague since I guess we cant predict but my anxiety ofcourse has me checking my baby constantly. If I think too much I get this sick feeling inside. A week ago today he was a playful snuggle bunny.

 

[nansiludie]

One pill has to be quartered (Lasix) and the other is an oblong tablet like Tylenol size. He also is to finish the liquid antibiotic just because they believe in the whole dose (like he will live long enough to get antibiotic resistance....)The vet can push this easily down his throat but I am having much more trouble. I am giving him a break tonight from meds (he has been in closet all day since morning meds without eating or drinking). I think 5 days on augmentin in enough when we didn't really find a bacterial infection but were treating empirically before the heart issue was uncovered.
I should also add that due the left atrial problem as well as CHF they saw potential for thromboembolism ("mist" noted- but I cant find what exactly that means) which the cardiologist aid could happen in an hour or days or weeks or... he was leaving it vague since I guess we cant predict but my anxiety ofcourse has me checking my baby constantly. If I think too much I get this sick feeling inside. A week ago today he was a playful snuggle bunny.

I was hoping for a better update.
Have you tried any salmon or tuna? Any smelly wet food? He needs to eat.

 

[ara11]

Thanks nansiludie, I have tried everything. He went up to dish this morning looked at it and didn't eat. Same with water. My vet said he wasn't dehydrated and not to worry about fluids. sounds odd but apparently he had a bit of fluid overload days ago. Vetmedin is the cardiac med he is on. A side effect was fatigue and nausea. Thus withholding his tonight dose might let him try to eat. I don't know. Thank you for thinking about him.
If I thought he wanted it, I would crawl in closet with him but I reason that he is in there because he wants privacy and solitude and darkness. The world shrinks when a loved one is very sick.

 

[ara11]

I might want to know, maybe you do, why he is vomiting and not eating if it is not related to the cardiac problem. Is there a fix for that other than the drastic one of forcing medication? If that is reversible I might be tempted to see if he could resume eating naturally before I made any decision.

Ailish, he vomited the first night I brought him in and had a fever and not since. This cardiac issue was discovered while they did a workup to be sure he had no intestinal blockage. His organs were fine, his heart wasn't. This fatal diagnosis was an incidental finding they said and the one thing might have nothing to do with the other.

 

[beckbjj]

FWIW, I have a technique that works for my hard-to-pill cat. I kneel down with him between my knees, and cross my ankles behind me so he can't back out. Then I put one hand across his upper chest and grasp and open his lower jaw with thumb and one finger, the other hand I hold the pill and use some fingers to open his upper jaw and my index finger goes down into his throat with the pill. He's truly horrible with pills but this has never failed because he's blocked in so he can't claw me from the front or squirm his way back.

Best of luck with your kitty! My two cents, I wouldn't euthanize him yet either, I'd definitely keep trying with meds.

 

[Furballsmom]

The world shrinks when a loved one is very sick.

yes, yes it does. My heart is wrapped around you both.