End of life decisions- continuing care?

[Pouncecat1]

My cat had a scary episode last night. He staggered, lost control of his bowels and I was certain he was going to drop dead. But after a minute or two he recovered after having some rapid breathing. The rest of the night went well and he seems normal this morning. He slept next to me through the night and seemed okay.

i debated rushing him to the vet, but my concern was that the stress would do him in. He is in failing health. 16.5 years old. He has hyperthyroidism, early kidney disease, something is causing elevated liver enzymes, and he has a very rapid heart rate. I suspect what I saw was some sort of heart disease or mini stroke.

I spoke to the vet a week ago and the vet suggested an ultrasound to see what is causing the liver issue or we could do x rays to check for masses. But if he has cancer that probably won't change anything as far as treatment.

Now if this is a heart issue there are medications for that. I'm just not sure I should keep throwing treatments at him. Like we could do blood thinners or blood pressure medication, but again he is old and I don't want to have him suffer just because I have drugs that can possibly prolong his life (or not).

He eats well, but has been vomiting puddles of water, sometimes pees inappropriately, and his hind end is very sensitive. His coat looks terrible. But he has seemed happy except when you touch his hind end. He is active but a little more clingy and attention seeking. He has lost some weight despite my best efforts. I am well aware the end is near.

Part of me thinks I could at least try further treatment, but i find myself reluctant to rush him in and face more bad news and a potentially bigger vet bill. This breaks my heart to even think these things..but i just have a feeling that the end is coming. I have felt it for months. This is our last year together.

 

[FeebysOwner]

Hi. For the most part, it sounds like whatever health issues that have already been diagnosed are being treated relatively successfully. And, he doesn't sound, from what you have described, like he is on his 'death-bed'. If what he has going on now is treatable, it would be hard for me not to pursue it to find out. If and when you do the x-rays, ask about arthritis. His hind end sensitivity could be from that, and there are some options for reducing discomfort in that area as well.

Should this actually be your last year together, do you want to be able to say you did all you could for him - or, do you want to be wondering whether or not you could have treated him and had him with you longer? I am not trying to 'guilt' you - all I am doing is telling you my personal opinion if I were in your position with Feeby (15+ yo). Everyone is different in how they view these situations, but the bottom line is that you really need to follow your own heart/gut.

 

[mrsgreenjeens]

I'm assuming you are successfully treating him for the thyroid issue, and you have the kidney disease under control, or are monitoring it? My last kidney cat lost a lot of weight, and she also had liver issues from an unknown reason. We did not want to do an ultrasound, because no matter the results, we were not going to go to heroic measures treat a chronically ill cat. The Vet said we might be talking surgery for issues with the liver. We did put her on Denamarin for her liver, and also gave her Vitamin E (per her Vet), and whenver her enzymes crept up, she would get an antibiotic and they would lower somewhat for awhile, then we would rinse and repeat. She ALSO had an episode as you described that we thought might be a mini stroke and actually fell into her fountain. Freaked all of us out, including our other two cats, who started hissing and generally acting like they didn't know what to do. We, too, thought it was "the end", but we dried her off and gave her lots of love and she seemed fine. Never happened again and she lived for at least another year, if not more.

My question for you is, do you know WHY she has an elevated heart rate? Has this been explored? My old girl did NOT have that issue, but she did develop a murmur at the end, possibly from all the sub-q fluids she was getting for her late stage kidney disease . I don't know. She never had one until her very last Vet visit. Of course, I'm guessing you are not doing sub-qs with early stage kidney disease.

OH, and I totally agree that she probably has arthritis and depending on how bad it is, some OTC meds might help with that. Usually Cosequin or Dasaquin can help, but sounds like she might need some pain meds. Now that can be tricky with kidney disease, but you need to weigh the benefits of quality of life with quantity of life. I would have a frank discussion with your Vet about the racing heartrate and her pain and go from there. Personally I would NOT do the xray or ultra sound if you would not treat anyway, but ask your Vet if they think it could be something benign that could be treated easily.

And one more thing. The vomiting puddles of water might be from the kidney disease. That might be over acidity as her kidney's are unable to filter everything as they should. Often Pepcid A/C can help with that. You might ask your Vet about it.

 

[Pouncecat1]

I took him to the vet. They took a blood pressure and it was extremely low. The vet says he has heart disease and we can either take him home or go to the specialist and get a cardiac ultrasound. I opted to take him home.

I'm frustrated with the vet because he was just there 2 weeks ago because I had a feeling he was going downhill. The vet techs could not get a blood pressure on him at that time and told me to come back, after I waited for 2 hours in the hot car. I had bloodwork done at that time and it looked good minus the elevated liver enzymes. Either the vet missed his heart murmur at that time, or he suddenly developed one in the last 2 weeks.

I'm debating on taking him to a specialist, but they charge $160 for the appointment and $600 for the ultrasound. And if it turns out to be bad news... I just went through this with my cancer cat with no good outcome.

But he is home and seems okay for now. I got out some chicken as a special treat for his supper. Just praying he makes it through the weekend okay.

 

[Pouncecat1]

The vet thinks the liver and kidney issues are due to his heart disease. Since she doesn't know what is wrong, she didn't recommend any medications.

 

[adering]

My cat had a scary episode last night. He staggered, lost control of his bowels and I was certain he was going to drop dead. But after a minute or two he recovered after having some rapid breathing. The rest of the night went well and he seems normal this morning. He slept next to me through the night and seemed okay.

i debated rushing him to the vet, but my concern was that the stress would do him in. He is in failing health. 16.5 years old. He has hyperthyroidism, early kidney disease, something is causing elevated liver enzymes, and he has a very rapid heart rate. I suspect what I saw was some sort of heart disease or mini stroke.

I spoke to the vet a week ago and the vet suggested an ultrasound to see what is causing the liver issue or we could do x rays to check for masses. But if he has cancer that probably won't change anything as far as treatment.

Now if this is a heart issue there are medications for that. I'm just not sure I should keep throwing treatments at him. Like we could do blood thinners or blood pressure medication, but again he is old and I don't want to have him suffer just because I have drugs that can possibly prolong his life (or not).

He eats well, but has been vomiting puddles of water, sometimes pees inappropriately, and his hind end is very sensitive. His coat looks terrible. But he has seemed happy except when you touch his hind end. He is active but a little more clingy and attention seeking. He has lost some weight despite my best efforts. I am well aware the end is near.

Part of me thinks I could at least try further treatment, but i find myself reluctant to rush him in and face more bad news and a potentially bigger vet bill. This breaks my heart to even think these things..but i just have a feeling that the end is coming. I have felt it for months. This is our last year together.

For every pet that does not die naturally, there is a theoretical point in time that is "the right time" to either stop intervention or to have the animal killed by a vet. You will never pick that time exactly. So don't beating yourself up about that. As a responsible owner, your obligation is to figure out when the animal is about to cross from "too early" to "too late." Does the cat still have enjoyment? It pisses all over itself, but is it in pain?
You are not required to drag out its life to the last extremity if that means indignity and suffering for the animal.
My first cat developed a sublingual tumor when she was 13. And the vet went over the options. I could have her tongue removed, and a feeding tube inserted, and the cat would probably last about another six months and be miserable every minute of the time because it wouldn't understand what had been done to it, and the tumor would simply come back. At the time the vet examined the cat, he said that she was probably in some discomfort due to the tumor. I chose to have her killed before she began to suffer because that seemed like the better option compared to waiting until she was in great pain and then feeling guilt about having made her suffer because I couldn't face what was coming. I loved that cat dearly. And because I loved her, I picked the choice that benefited her rather than me. You'll do the same. It isn't about the money. You love your cat, and you will make the right choice when the time comes. And you will feel terrible.
But you shouldn't.

 

[mrsgreenjeens]

It makes sense now why his heart rate is so fast. My husband has the same issue. (low blood pressure/fast heart rate, and no, he does NOT have any heart issues!) But he does have thyroid issues, as does your guy. And if the thyroid meds aren't correct and result in hyPO thyroidism, my understanding is that can effect the heart rate. How is your boy's T4? Also, how are all his other numbers? You said 2 weeks ago they looked good, so I'm guessing no anemia, etc?

Did you talk to the Vet about Pepcid A/C for the vomiting? How about anything for the arthritis? I'm thinking the inapropriate peeing might even be from pain entering the litterbox . So now that your Vet thinks it's a heart issue, does she feel everything else will be resolved if he starts on the appropriate heart meds? (of course understanding this is her theory, not fact) ..is it YOU who thought possibly cancer, or your Vet?

As you mull over your options about seeing a cardiologist, here is an article on blood pressure in dogs and cats. It covers both high and low BP:

Why Is My Dog Or Cat's Blood Pressure High or Low?

Maybe you could have the initial consultation with the cardiologist and take it from there?

 

[Pouncecat1]

He was comfortable all night last night, ate his breakfast okay, has been wandering around my room and he just climbed on the bed. Since he doesn't appear in any distress, i see no reason to rush him back in. Given we don't know the severity of his heart problem, I'm just going to keep monitoring him and hope for the best. He does seem slightly lethargic, but he still hums at me when I say his name and purrs while I pet him. He climbed up on the bookshelf today and is starting to look more like himself.

I think he may have had a reaction to the supplement the vet suggested for his liver (and that may be what started all of this). The supplement is called Sam-e. I read some reviews in people and apparently it can cause heart palpitations. The day of the incident was the first day I tried him on it.

If he does have heart disease, there is no reversing it according to what I've read. We are lucky he is doing as well as he is. I've decided against going too far with treatment. What matters is his comfort levels now. If he does well until Friday, I will try to get him in to see the vet I trust, as that is when my usual vet gets back from vacation.

I've also read that blood pressure readings are notoriously difficult in cats. If the vet techs did the reading and not the vet, I'm not certain I would put much faith in it. According to the vet, he should be fainting from low blood pressure and I really haven't seen anything like that with him.

I'm grateful we have this time left together to say our goodbyes. I can't put a number on how much longer he will have left, but I spent this entire weekend with him. The bad weather makes me it easy for me to put off work and snuggle up with him. I did notice his eyes looked better today- they were the opposite of dilated, now they look more normal.

His last bloodwork was pretty normal, except for the Liver enzymes.

 

[mrsgreenjeens]

Second opinions from a trusted Vet are always a good idea. So glad he seems to be getting back to his old self

 

[Ravensong]

I am so sorry you are going through this. Sounds a lot like what my girl is dealing with. She's always had a heart murmur, but I suspect she may be having some additional issues with her heart since we started dealing with all the other stuff.

I am in a place where I'm trying to make decisions about how to manage everything that is going on with her. I had decided several months ago that I wasn't going to pursue further testing (US, CT scan, scope, etc...) because I didn't want to put her through chemo or radiation if they found what they suspect. I've been trying to treat symptoms, to make her more comfortable.

I'm grateful we have this time left together to say our goodbyes. I can't put a number on how much longer he will have left, but I spent this entire weekend with him.

Yes! I've been spending the vast majority of my time with both of my girls since I quit my job in March. So very grateful for that.