End stage kidney disease-when to euthanize

[msaimee]

I'm a regular participant on the Strays and Ferals forum, and this is my first time posting here.

My 15 year-old cat, Chablis, has had hyperthyroidism and on again off again kidney issues for about 4 years. Two years ago his labs indicated middle stage CRF, but then a year later, his labs were normal. The past week he's been more lethargic and isolative, dehydrated, and lacking appetite. I started giving him SubQ fluids daily since last Thursday and he seemed to perk up a bit. He's been eating only tuna and Greenie treats. I took him to the vet yesterday and his Creatine is 6.6 and BUN 118mg, which indicates stage 4 kidney failure. The vet gave me the option to euthanize him or have him hospitalized for IV fluids. I don't want to hospitalize him because I don't want to traumatize him with the separation and put him through that-I went through that with another cat who had kidney failure and it did not work out well and I have a lot of guilt about his last days in the hospital.  I also didn't feel it was the right day to euthanize him because he was still eating a bit, sitting at the window, and laying beside me on the bed so I didn't think he'd given up yet. So I decided to continue giving him SubQ fluids and start Azodyl to give him some more time and see if by chance he would bounce back from this. Today he's not wanting to eat much except a few bites of Greenies. I bought some baby food and will try to entice him with that later. I guess if he stops eating on his own, that's the sign that's it's time to euthanize him? The vet said that he might have a few more weeks. I hope I made the right decision not euthanizing him yesterday and I hope I know when the time will be right. I don't suppose cats ever just pass peacefully on their own with kidney failure? Has anyone else cat a cat with such a high Creatine level who survived for months afterwards?   

 

[ondine]

I've not had a cat this ill before.  The only time I've had to make this hard decision was with a feral cat who was too sick to recover and who did not have a place to go.

I am so sorry for this situation you're in.  I wish I had advice.  All I can offer is that you will know when the time is right.  Your previous experience has given you information about how not to do this.

My prayers are with you and Chablis.  He's had a good long life because of you!

 

[shadowsrescue]

I have not dealt with kidney disease or CRF at all so I cannot help with that.  Yet I agree with Ondine, that you will know when the time is right.  It's a very very difficult decision, but one that you just get that gut feeling.

I am so sorry that you are dealing with Chablis and his illness.  Cherish the wonderful memories and make his last days/weeks/months comfortable and special.  Take lots of pictures of him too. 

My thoughts and prayers are with you during this difficult time.

 

[Norachan]

Hi @MsAimee  I'm sorry to hear you are going through this. I've never cared for a cat with kidney issues either. The only similar experience I've had was caring for Harvey, a former feral who suffered from FIV and other related health problems.

As you said, dealing with feral cats is different to dealing with cats who've had a lot of interaction with humans. They just don't deal with being handled as well as other cats do and you have to take their stress levels and the adverse effect this can have into account.

With Harvey the vet warned me on the last 2 visits to the clinic that he was getting near the end. When it got to the point that I had to syringe feeding, which he hated, and carry him to the litter box and he spent all day curled up in a quiet corner I knew it was time to let him go. Another cat may have tolerated being syringe fed much better and maybe kept going for a few more months, but I didn't think it was fair to keep putting him through what was obviously an upsetting process for him in the hope that we'd have a little longer together.

I think you'll know when it's time. 

Thank you for all you've done for him.

 

[melaq]

I remember when I had to euthanize my little boy cat. He was such an adorable, cuddly little brother to my other two cats. But he developed diabetes and I spent about a year trying to manage it on my own. In the end, no matter what I did, it didn't seem to help, and he had taken to hiding in the basement alone, not eating and wetting himself. I brought him to the hospital when he didn't even have the energy to lift his head. 

It's nice to say that "you'll just know", but to be honest, I'm still carrying so much guilt about it, and it was hard for me to get over it.   I know you don't want to see Chablis suffer. I guess if he doesn't become responsive at all, then maybe you can think of it.  

I hope all the best for you and kitty.  

 

[betsygee]

I think you made the right decision to not hospitalize him for the fluids.  I did that with one of mine last year.  He rallied for the weekend that he was there, and we hoped it might give him some more time, but when he got home, it wasn't sustainable.  We kept him as comfortable as possible as long as he was eating but once he curled up by the litter box, didn't move and didn't want to eat or use the box, we knew it was time.

I'm so sorry.  It's so hard to go through, and there's no 100% right answer.  

 

[catwoman707]

I also agree that it is not in his (or your) best interest to hospitalize him, I think the best is for you to give it what you can and hope for a bit of time with him, it's okay to syringe feed if he doesn't fight it, but no sense in his being miserable if so, you wouldn't want him hiding from you dreading the feeding sessions either.

As long as you can entice him with anything in the world he will eat, go for it.

Heat the chicken baby food as it smells so much better to them, anything he will eat, it doesn't matter now if it's a diet of temptation treats, if it gives him enough calories to sustain his life, I'd do that gladly.

It sounds like the time will come due to his eating. If he stops wanting to eat completely, lays in a sleeping position all of the time, doesn't care to interact anymore, he is ready to go.

Whether it be tmrw or next month, let his behavior tell you when. He will be thankful.

Something that has always felt rather comforting, is remembering that cats dont look at death the way we do, when we delay it, we have already started to mourn them, how much they mean to us, how empty our lives and homes will be, all of the years you've spent together, gosh, 15 years, he has been through alot of life with you.

So if you can completely separate your feelings in the decision of when he would want to make his exit, you will be giving him a very kind gift. 

Oh, btw, currently my girl Simone, who is likely 15 has been recently diagnosed with hyperthyroidism and moderate CKD. She has only been on methamizole for a month, topical gel on her ear.

Just today I spoke with her vet, asking if we need to lower the dose, as she is now a bit too low key, depressed in a way. She agreed.

I know I will be facing the same road you are now someday, but hoping for at least a few more good years if I'm lucky.

 

[furmummy]

So sorry you are going through this.  It is never easy, and the questions if we are doing the right thing weigh heavily.

A friend of mine went through this a couple of years ago. They had a CRF cat who also had a ton of other issues. And, they had also had a dog years earlier who had cancer.

She always felt that she should have helped her doggy friend over the bridge sooner. She carried quite a bit of guilt over that.

As kitty deteriorated, and made a come back, and deteriorated again... it was agony for her loving parents.  And I kept saying, "You will KNOW when the time

is right because she will TELL you".  And my friend kept asking, but what if I don't hear her, or if I misunderstand??

But when Love is there, there will be no misunderstanding... Reading your post, it is obvious how much love is there, and how you want the best for your friend.

For my friend, it had a natural unfolding and when they made the decision, there was no ambivalence. It was HARD, but the time was right and they knew it.

And it was perfect and beautiful in some way as it was the most difficult thing they have ever done.

You will have the same feeling. Your kitty will tell you. She will let you know when it is time. You will know, without second guessing yourself. Just give up the struggle and flow...

Oy. My heart goes out to you. So hard and so very painful...

(((((Hugss))))))))

 

[cat pal]

What a horrendous place for you and your cat to be, it may or may not be of comfort to know there are others who have been there and understand just how difficult it is to read this disease, just as it is difficult to read a stoic cat who is critically ill. I lost my beloved (stray) Nina, pictured in my avatar, May 30 2014 to kidney failure. She was an adult when I found her, in very bad shape, but eventually all her injury, weakness, illness healed except her kidneys, ultrasound showed they were very malformed. She lived years beyond our expectations, I kept track of her kidney values and weight every 3 months, always thought we would catch a downward trend and begin fluids and appropriate measures but never had the chance. Of course I should have seen the subtle signs, in retrospect I do, but I was caring for another sick cat in the household and all my attention was there. I didn't understand how sick Nina was until she was gravely ill and for this I haven't forgiven myself, I've just moved forward. I finally caught on one day when she was having diarrhea, moved oh so slowly, hung out in the bathroom which for some reason in her past life she had always feared, and was making some vocalizations that I can only describe as distressed purring.  She was hospitalized for two days in an attempt to hydrate her, balance electrolytes, bring her skyrocketing numbers down. We were beyond deciding IF she would be hospitalized, the question was whether hospital treatments would be enough to save her. They weren't. She deteriorated very quickly, and even in those very final stages I was still deluded into believing she would pull through, looking back at her condition I don't know how I could have believed this.

The most chilling sign, which said it all, the color in her bright blue eyes was completely gone, replaced with black. They say you'll know when it's time, that cats with CRF don't suffer until the very end. I will always have to live with the fact I didn't know until it was past time, and I believe this cat suffered in her last hours, though the vet said she wasn't suffering and I could take her home overnight to say good-bye. I had finally realized that the kindest thing I could do at that moment was to stop trying to keep her here and to help her to go. Consider yourself as having an advantage and a better chance of knowing when it's time before I did, because you are aware of the gravity of your cat's condition, you know his numbers. Could you bring him in for a full day of IV fluids, and another creatinine BUN check, even if you don't want to leave him overnight? It might do him a lot of good.  A worsening still of the numbers, or no improvement might be your sign. If he stops eating that to me would be a definite sign. When they reach the point of assist feeding, of being too weak to make it to the litter box, of not interacting, to me that is past time, because these are signs of distress. Maybe Chablis will bounce back, I sincerely hope he does, just as I hope you and all CRF cat people are better than I was at recognizing "the signs" -

take care

 

[msaimee]

Thank you all for your advice and support. Chablis is doing better now that he's been on subcutaneous fluids for a week. The other day the vet said to increase it to 200ml in the morning and 100ml at night for a week to see if there's any improvement. This morning he is well enough to see the subq bag and run downstairs away from me at a pretty quick speed, so that is a good sign. His appetite is low, but he does pick at the dry food and Greenies, and I hand feed him tuna and baby food so he is getting food in him. Last night he slept on the bed with me and seems to be appreciating all the special attention he's getting in a household of 5 cats. The vet suggested I return him after a week of the increased fluids to have labs done again to see if there's been any change. Vet trips are very stressful for him--the vet is a half hour drive away, and he pees the carrier--so I may not want to put him through another set of labs at this point, and I'm thinking that it will be his behavior, not the lab results, that will guide me.

Here is my question right now. How long do I sustain him by giving him this large amount of subq fluids every day. The vet suggested that if his labs don't improve after a week to either hospitalize him or consider euthanasia, but it's hard to set that time frame. I know that eventually I will have to cut back the fluids, but what happens if he deteriorates again? What do I do if the subq fluids are what is keeping him functioning? I think I could look into finding discounted fluid bags on Amazon or ebay--it will get expensive to go through a bag every 3-4 days.  I don't mind giving it to him every day, and he's really good about it--I also have to give him thyroid medicine twice every day will a pill gun, which he accepts. I agree that if he stops eating altogether, that will be a sign that it's time to let him go. I guess this will be a one day at a time situation, and there are so many questions to consider.

Catpal, I had a similar experience with a cat 4 years ago. He was a  rescued stray Siamese, Angel. He must have ingested something toxic in my home because went into acute kidney failure. I noticed his lethargy  for a few days and should have taken him to a vet then, but didn't think he was that bad, I thought he was just out of sorts for some reason. It was around the holiday time and I was working extra shifts.  By the time I took him to the ER vet, 3 days later, on Thanksgiving night after work, he was in end stage kidney failure and non-responsive. The vet should have told me to euthanize him, but led me to believe he had a chance if I hospitalized him for a few days with IV. I regret that decision to this day. He was horribly depressed in that place, non-responsive, kept moving off the heating pad, wouldn't eat, and his last hours on earth were spent in a strange, frightening place with barking dogs and crying animals. After about 36 hours, I asked them to euthanize him.  I've been carrying guilt around about how I handled that entire situation. But I've also felt his loving presence with me at times, too. I believe our pets understand we do out best for them and don't want us to hang onto guilt when they pass. Chablis is not yet at the point that Angel was, he is still having some quality of life, and hopefully I'll make a better set of decisions this time around.

I adopted Chablis 15 years ago when I was drinking too much Chablis. I thought it would be nice to have another cat, so I called a woman from a Penny Saver ad. She brought the Siamese kitten over my house. The next morning I re-considered my decision to have another cat, and wanted to return him, but she didn't answer my calls. It turned out that he was horribly malnourished and infested with tape worms. He nearly died after I took him to a quack vet who told me he was too tiny to be given a de-wormer. When I took him to another vet, they gave him fluids and a de-wormer, and he eliminated several 6 inch worms in the carrier on the way home. It took months to get him to a normal size. He's been the best  drunk "mistake" I ever made. He's been the nurturing papa cat to every stray and feral cat I've taken into my home over the past 15 years. I hope to do the best for him in his final days. Chablis is the cat on the left.

Leo&Chablis.png

• msaimee
• Jul 23, 2015

 

[shadowsrescue]

You and Chablis are in my thoughts.  Give him lots of loving. 

I think I would wait to and taking him back to the vet.  It is so stressful on him.  Just wait and see how it goes.  Keep letting him eat whatever he will eat. 

 

[2bcat]

Some thoughts from having a cat with same conditions:  I'm trying to remember what lab numbers I saw, I don't think her kidney numbers ever got that high.  So, I guess that means it's sort of uncharted territory for me as well.  We were syringe feeding at the end, mainly BECAUSE her lab numbers were not that high and she was still getting to the litter box and interacting with us somewhat and having a reasonable amount of energy.  If I had to look back and re-evaluate then maybe it was a little long that we did the syringe feeding.  But if we missed by a week or so in figuring it out, I am trying to live with that.  She passed suddenly from a heart complication from what we were able to ascertain.

Anyway, FWIW, I don't think you're wrong choosing both not to hospitalize and not to euthanize right then.  I see no reason to believe those were the only two choices at this time.  Judging from what you've described he has perked up a bit.  You will have to address the eating, but I do believe that not eating alone is not a sign.  CKD cats often have stomach upset and possibly other issues that will cause them not to eat long before it's truly time IMO.  And there are meds that can be given to ease the stomach upset, including simple Pepcid at small doses among other things.

I suspect it would help if you get info from a lot more people who have dealt directly with some of these things, by reading at http://felinecrf.org/ and perhaps joining one of the support groups.  I don't remember how those work any more but there are at least two "groups" (Yahoo groups or similar) that are dedicated to support discussion for feline kidney disease.

The amounts of fluid sound really high to me.  But fluid treatment with CKD is not usually temporary; that is something you would keep doing.  The dose may change, and I wouldn't think you would continue at 300ml/day indefinitely.  Usually it is considered important that all the fluid from the last dose is gone before doing another dose, especially one that large.  But fluid keeping him functioning, that is quite possible.  You can source fluids by the case at reasonable prices, usually.  Sometimes a regular pharmacy can order it or you can just order it online.  I would think jumping to check the kidney numbers again after just one week is a stretch.  Although, thinking back, I think we must have done a recheck as well after starting fluids, as I seem to recall that we thought the numbers improved with the fluid.  (It's not a fresh memory; this is all from a couple years ago.)  I don't think it was that soon though; I think it was a few weeks with fluid at home before we checked levels again.

I hope that helps a little.  Hang in there.

 

[msaimee]

The 300ml dose of fluids hasn't been too high because it vanishes from under his skin within a few hours, and he's still drinking a bowl of water in addition (which is better than the 3 bowls of water a day he'd been drinking prior to the subq fluids). I'm going to cut down to 200ml to see if that is enough for him. He's moving around more and hanging out with my other cats more, so I think the fluids are helping. I'm going to focus on spending as much time with him as I can and just take it day by day. Thanks for all your advice and support, and I'll keep you posted.

 

[msaimee]

Well tomorrow it will have been a week since I took Chablis to the vet. I'm giving him fewer fluids--about 150ml a day--and force feeding him high calorie vitamin paste and some baby food. He eats some Greenie treats on his own but has lost his taste for tuna. He's still using the litter box to pee-I don't know if he's pooping (I have 4 other cats indoors and can't tell who does what). He still moves around and can jump on the couch, but he spends most of the time sleeping. His eyes are always just half way open when he's awake. He responds to petting and cuddling with a slight purr. He groomed his face earlier today. I just wish I knew if he is in pain. I know he's uncomfortable, but I can't tell if his quality of life is still good to him. I think he's appreciated the attention he's gotten the past week from me and his buddy cat, Leo, so I'm glad didn't euthanize him last week. People say I'll know when it's his time, but I just don't know. I want to hold onto him for as long as I can, but don't want him to suffer.  I guess it's a matter of one day at a time.      

 

[LotsOfFur]

Sending you (hugs) and comfort to you and your beautiful Chablis.

 

[jdollprincess]

I'm so sorry your going through this. I lost 2 cats back in April to CKD and it was awful. One of them was only 8 years old. He was acting pretty normal even when his creatinine was at 10. When it reached 12 I decided to try iv fluids for 4 days since the 400mls of subqs he was getting daily just wasn't bringing his numbers down. Even the vet thought it was odd how normal he seemed with such high numbers. Unfortunately the iv fluids didn't work as well as I hoped but I brought him home since he was still eating pretty well. Two weeks later he started drooling really bad and I opened his mouth and his gums were covered in ulcers. At that point my vet recommended euthanasia since the only thing that would get rid of the ulcers was getting his kidney values down and there was nothing left to do short of a kidney transplant. I decided to let him go since I knew he was in pain. It was really hard though because even with the ulcers and the 12.4 creatinine he was still active and eating. I think all cats must be different on how well they cope with loss of kidney function. My other cat mittens was 16 and her creatinine was 6.9 when I let her go. She was extremely weak in her hind end, barely eating, and she would just sit for hours beside the water dish.

I know Chablis hasn't been eating well. Do you have him on any meds for excess stomach acid or nausea? With numbers that high he most likely has an upset stomach and I'm surprised your vet didn't prescribe anything for it. As soon as my cats were diagnosed my vet had me start Pepcid and as their numbers went up we added cerenia. I would definitely call your vet immediately and ask if you could try an anti nausea medicine. It could make him feel a lot better and want to eat. I also used an appetite stimulant on mittens on days her appetite seemed low. As far as the fluids go, call around to your local pharmacies to see if they can order fluids for you. I was going through a bag every 3 days and luckily the mediciane shop was able to order me a case of 12 for $92. I ordered the administration sets and needles online.

 

[Norachan]

I'm glad to hear he is still with you, but I'm sorry I don't have any words of wisdom that might help you here. Just taking it one day at a time seems like the best thing you can do right now.

Hugs to you both.

 

[betsygee]

 
Well tomorrow it will have been a week since I took Chablis to the vet. I'm giving him fewer fluids--about 150ml a day--and force feeding him high calorie vitamin paste and some baby food. He eats some Greenie treats on his own but has lost his taste for tuna. He's still using the litter box to pee-I don't know if he's pooping (I have 4 other cats indoors and can't tell who does what). He still moves around and can jump on the couch, but he spends most of the time sleeping. His eyes are always just half way open when he's awake. He responds to petting and cuddling with a slight purr. He groomed his face earlier today. I just wish I knew if he is in pain. I know he's uncomfortable, but I can't tell if his quality of life is still good to him. I think he's appreciated the attention he's gotten the past week from me and his buddy cat, Leo, so I'm glad didn't euthanize him last week. People say I'll know when it's his time, but I just don't know. I want to hold onto him for as long as I can, but don't want him to suffer.  I guess it's a matter of one day at a time.      

It is one day at a time, and trust yourself--you will know when it's time. 

 

[shadowsrescue]

Give Chablis extra love.  My thoughts are with you during this difficult time.  I know from going through the end with Sadie that you will know when the time is right.  I kept asking myself, how I would know and when the time came, I just knew it was the right time.  It didn't make it any easier, but I was certain I was doing the right thing. 

Please keep us updated and know we are all thinking of you and sweet Chablis.

 

[msaimee]

An update for Chablis. He's been doing better, much better than 2 weeks ago when he was spending all day laying inside a closet. I think the daily regiment of subq fluids (I'm giving 100ml a day), kidney medication Azodyl, and force feeding him high calorie, vitamin paste is having a good effect. He's moving around a lot more and getting up and down the stairs at a pretty quick pace. He's still picky with food, eating mostly Greenie treats, but at least he's eating. I ordered 6 more bags of lactated ringer online which my vet ok'd. I'm having a hard time finding inexpensive Azodyl--it's very pricey, and it has to be shipped cold. I'm wondering if giving him one dose a day instead of two will be effective? At this point I'm hoping to have him around for a few more months instead of the days or weeks I thought I had even a week ago. I guess most people would have just had him euthanized, but he's been such a good cat that I want to give him some more time. He is enjoying the extra attention he's getting, I'm sure of that. Thanks for all your support and kind wishes.