I need to know if euthanasia was best for my cat (pancreatitis, fatty liver, blocked bile duct)

john2564

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My wife and I made the tough decision to euthanize our 11+ year old cat yesterday and I've been searching the internet trying to find information that supports the info we were given by a couple of vets so that we can be sure we did the right thing.

I apologize for the long post but I'm really hoping that people that are knowledgeable about cats or that may have had a similar experience might chime in and offer us advise about whether we did the right thing.

Here is the detailed story:

In September the cat was diagnosed with a thyroid problem and was put on 2.5mg of methimazole twice a day. She improved within about a month, became more active, coat improved, etc. We were thrilled.

About two weeks ago we noticed that she had lost a lot of weight (she was 10.5 lbs at her last check up, and maybe 12 lbs before the thyroid diagnosis) and was acting funny, sitting and staring off into space, mentally disconnected etc.

We took her to the vet and she weighed in at 8lbs (-2lbs in about a month) and the vet noticed that she was jaundiced. He said that it was probably cancer, however a quick search on my phone revealed that methimazole can cause jaundice, so at the time I was sure it was a reaction to the drug. We discontinued methimazole last Wednesday.

She ate her last food willingly last Friday, and we fed her with a syringe on Saturday and Sunday. We took her to an emergency vet on Sunday to get a second opinion and possibly to have a feeding tube inserted because she was fighting us over the syringe feeding and vomiting. The emergency vet gave us meds to combat nausea and an appetite stimulant and we continued to syringe feed per until Monday when we took her to our regular vet.

Our regular vet did a bunch of additional tests and confirmed that she had hepatic lipidosis (fatty liver) and agreed to insert a feeding tube on Tuesday. The vet also performed an ultrasound and found an inflamed bile duct.

The vet informed us that she had a 50% chance of getting over the fatty liver, and that after she was over it she needed surgery to correct the bile duct issue, and that the overall chance of survival would be 30%. They wanted to do additional tests but were vague about what they would be, mentioning xrays, an additional ultrasound and a cat scan to try and figure out what the bile duct problem was. Since we were told that she would not survive the surgery until she improved, we figured that additional tests were not worth it if we couldn't have the corrective surgery done anyway. We declined to do the tests and resolved ourselves to getting her healthy enough to be able to have the surgery.

I did a bunch of research and found that the survival rate for fatty liver was approximately 90% if the cat was properly cared for, which my wife and I were prepared to do.

The cat spent the entire day at the vet on Tuesday and Wednesday receiving food via the feeding tube, a bunch of drugs and subcutaneous fluids.

On Thursday (Thanksgiving) my wife and I spent the entire day feeding her 20-25ml of food every two hours. After each feeding the cat would get very depressed and was obviously uncomfortable. She was drooling constantly and clear liquid would come out of her nose for a while after feeding. She would also grunt and her breathing became noisy. I thought maybe we were feeding too much but I checked the internet and confirmed that we were giving the right amount, if not less.

We gave her subcutaneous fluids (200ml) twice as directed by the vet, and within about 15 minutes of both treatments she urinated wherever she was and immediately laid down in it. At this point we had to confine her to our bathroom because she was hiding from us wherever she could and urinating all over the place.

My wife and I decided to go back to the vet yesterday with the intention of pursuing the additional tests to try and find out what the issue with her bile duct was. At this point we did not want to put her through weeks of tube feeding if she wasn't going to survive the corrective surgery anyway.

Our vet had already spoken to the surgeon (we talked to her on Thanksgiving, she was so helpful) when we arrived at her office on Friday, and the surgeon advised us to skip the additional tests and go straight into surgery.

We were given a price of $3500 for the surgery and $1000 for post-op care, and were told that she had a 50% chance of survival, and that the surgery may not even correct the issue. The vet did some blood work and determined that the cat had improved in some areas and deteriorated in others. Her total bilirubin level had gone up (indicating her liver had gotten worse) and she had low blood pressure and her blood was very thick. She had also lost another pound (in 4 days) and was down to only 7lbs.

Our vet said she didn't feel like she had a good chance of surviving an operation, and that she would not survive if she didn't have the surgery. If she survived the surgery and it corrected the issue, we STILL had to tube feed her for 4-6 more weeks to correct the fatty liver.

We didn't want her to die during the surgery or post-op because we wouldn't be there for her and she would have been afraid. I'm afraid this was a selfish decision.

We also didn't want her to come out of the surgery only to go through 4-6 weeks of tube feeding to find out that we couldn't correct the fatty liver and still lose her, which would have made the last 2 months of her life very uncomfortable.

Ultimately we decided to have her euthanized. It was very hard on both of us but with the information given to us by the vet and the surgeon her total chance of recovery would have been around 25% and would have required 2+ months of recovery time and tube feeding.

The vet offered to do an autopsy free of charge and we accepted. She worked until 8:30 last night to perform the procedure and called to inform us of what she had found.

The vet said that all of the internal organs were very jaundiced, the pancreas was 3-5 times normal size, the bile duct had a bunch of abnormalities and was inflamed, and the gallbladder was inflamed. Additionally a lymph node in the area was enlarged and contained abnormal bacteria. She did save a tissue sample and offered to send it somewhere else to be examined but we declined.

I asked the vet directly if we had done the right thing and she said yes, and I asked directly if the cat could have been saved, and she said it was doubtful. I was relieved by this information, however I decided to search the internet for confirmation in case she was just being reassuring.

Ultimately based on the autopsy it is clear the cat had pancreatitis which had caused the inflammation in the bile duct and gallbladder, and hepatic lipidosis (fatty liver) had been caused by decreased appetite secondary to the pancreatitis.

I found two sources that confirmed that pancreatitis and fatty liver combined had a "poor" prognosis or about a 20% chance of survival, however I found many more sources that claimed that both problems were correctable and that the prognosis was "good".

It is killing me to think that we made a rash decision in putting the cat down. If anyone has any information or a personal experience they can share that can help my wife and I believe that what we did was best for the cat we would really appreciate it.

Ultimately my specific question is, if we had done the surgery, and the pancreatitis was discovered, and the cat survived the surgery, what are the chances that the cat could have been brought back to full health?

From what I have read on the internet the only way to cure such a severe case of pancreatitis is to withhold food for 3-5 days to keep the pancreas from producing enzymes.  Given the fatty liver condition, it is doubtful the cat would have survived this fasting.  We would have had to cure the fatty liver problem first, however with the blocked bile duct I don't believe this was possible.  Can anyone confirm the accuracy of this?
 

tulosai

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Hi 
 I am sorry you have come to the forums at such a sad and difficult time.

Honestly, I don't know the answers to your 'medical' questions.  I'm not a vet, and I fortunately haven't had to deal with these specific  issues myself yet.

I will say that, based on what you have posted you have an honest, caring, and knowledgeable vet.  I think you should feel good about following her advice, and I don't think you have any reason to doubt her when she says you did the right thing and that it is doubtful your pet could have been saved.

I know from personal experience that deciding to put a cat down is one of the most painful and difficult (if not the most painful and difficult) decisions there is.  Even when it is completely  obvious that it was the right choice, to everyone, it is very normal to still second guess yourself and grieve about the decision.  However, you have to keep in mind that your kitty was in pain and that she didn't understand why.  It sounds to me like she was ready to go, and that you and your vet both saw this.  While nothing I or anyone else can say will probably make you feel better right now, I really do believe that your cat is in a better place and that she is thankful to you for having been strong enough to make this decision for her.

When you feel ready, please feel free to explore our Rainbow Bridge forum 
 and post stories about your kitty there.  I can tell that she was very special and very loved. 
 
 
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AbbysMom

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Hello and welcome to The Cat Site. :). I'm sorry you've found us under these circumstances and I am so sorry for the loss of your cat. :(. I do not have specific experience with what your cat went through, but I did have to have my cat to sleep within a week of noticing symptoms and never got a diagnosis.

No matter when you put a cat to sleep, you will question yourself after. It's normal. :(. You made the best decision you could for your cat, without putting your own feelings into it, based on all the information you were given. As an outsider reading your story it sounds like you made the right decision. Your cat sounded miserable and sounds like she was not improving, but only getting worse. Your decision doesn't sound all that rash, but it is always an awful decision to make. I'm sorry it came to that.

We do have members that have experience in both fatty liver and pancreatitis and I'm sure they will be along in a bit to give you more technical answers.
 

cprcheetah

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I had a cat named Ducky who was hyperthyroid, she got Fatty Liver Disease and never recovered, it was horrible.  It sounds though that you did make the right decision for your kitty, although it is definitely a hard one.
 

aprilprey

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I am so sorry you guys went through this - my sympathies.  I euthanized my thyroid-diseased cat in March - RIP Houdini.

Now onto your original question: I cannot give you a "researched based" answer; that is, a detailed response that critiques what your vet told you.  I can only relay what our philosophy is regarding invasive treatments for our cats.

In other words: if a diagnosis for one of our cats spells numerous invasive procedures with a low to middling probability of a long term cure - we plan on declining and letting nature take its course, ensuring the cat is as comfortable as possible, then doing the right thing when they are clearly no longer enjoying life.  Quality over quantity, I guess.   A very individual, personal decision.

I am doubtful that, had you not euthanized kitty, that she would have had a very comfortable, high quality life.  I am not a vet so please take this as a purely layperson's view.

In other words: to my eyes, reading this, you did the right thing.  In fact, I have more doubts myself about waiting too long!  Each time I have to do "the deed", I vow to do it earlier next time - sounds crazy, huh?  In fact, Houdini did not go through even a fraction of the treatments your kitty went through.  So to compare our two situations: if you guys feel that you jumped the gun, well, then, I jumped way more than a gun!  I jumped as the gun was being loaded, so to speak. 

In closing, again, my sympathies.  To this person here, you did the right thing.
 

denice

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You will question your decision that is normal.  I have a cat that did survive fatty liver but he didn't have pancreatitis and the blocked bile duct.  He had an IBD flare that went into fatty liver disease. It's amazing how quickly they can go into fatty liver.  I do believe that it would've been very difficult for her to survive because of the mutually exclusive treatments.  Feeding, preferably even overfeeding, is the treatment for fatty liver.  Underfeeding is the preferred treatment for severe pancreatitis.  She also would not have been a good candidate for general anesthesia because of the liver disease.  I don't think it would have been possible to get her completely over the fatty liver before surgery because that on it's own has a long recovery period.

Just from what you have said I think you made the right decision.  I am very sorry for your loss.
 
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laurag

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To me it sounds like you and your wife did everything you could, but that she had so many issues going on that likely she wouldn't have survived. The vet doing the necropsy after her death may reassure you of this. However, I totally understand that euthanizing a pet comes with huge regrets and questions of whether there could have been more you could do. You miss your friend and it feels terrible to have to make that decision.

Fatty liver alone is something that can be cured. The fact that she was losing weight and had the other conditions as well probably meant that she was suffering quite a bit. You carefully considered her needs, and whether or not it would work. To me it sounds like you did make the right decision to spare her the pain of surgery. Recovering from that would have been pretty hard and given that she was so sick already, it would have been harder.
 

sillywabbit

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I am so sorry for your loss. But you did what you thought was best. With the advancements in veterinary medicine, it seems to me that A lot of vets have gotten out of doing the right thing by our pets and tend to guilt owners into horrendously expensive treatments that really do nothing but prolong suffering. But this isn't about money: it's about quality of life.

I would have done the same thing, and would feel exactly as you do today. Nothing worse than prolonging your sweet kitty out of grief over missing them. I've done that, and still suffer guilt for not putting my cat to sleep til she was out of her mind with fear and pain, just because I was 24 and had just buried both parents and didn't want to lose my best friend.

Remember the happy times, your kitty still loves you, wherever she is.
 

lovelost

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I am going through the same painful examination of my choice right now.  I put my almost 20 year old cat to sleep two days ago.  I am not sure if my story helps you, but hearing yours helped me so I thought I would share as well.

Valentine had CRF and probably hid the symptoms for a week or so, but the onset seemed sudden to us.  We were a bit distracted because our 12 year old dog injured her back and needed a lot of attention, and we had a number of other concerns right then, so we missed some of the more subtle warnings.  Here is what happened:

Last Friday, I realized she looked a bit puny and so I doted on her and decided to take her to the vet on Monday for a check up.  

On Sunday, she looked worse and didn't eat her morning treats. I should have rushed her to the emergency vet, but I didn't panic like I should have.  

Monday, she started vomiting clear liquid.  I took her to the vet early in the day and was told she had CRF.  By this time she looked awful and she had lost a lot more weight.  She had begun to stagger just a little bit. Her CUN numbers weren't that high, but they were high and her potassium was very low.  The vet said she had kidney disease and gave her subcutaneous fluids. potassium, and antinausia medicine. They sent me home with special food, pepcid and a potassium supplement and I was to bring her back the next day for more fluids. There was encouragement that it could be managed. Valentine seemed to feel a little better.

Tuesday morning, she seemed about the same, but she was home alone for hours because I had to work.  She ate a little of the special food they gave me. At 5:30, I took her back to the vet for fluids and noticed a poo smell as we were leaving.  There was a little blood on her anus and she had not cleaned herself well. Something I know she hated.  The vet said that she probably had very hard stools so to check her kitty litter and call back.  I checked her kitty litter and there was a large pool of runny dark reddish matter. There was no improvement in her eating or her general attitude after the fluids.

Wednesday morning, she looked awful.  She could barely support herself, especially with her back legs.  I needed to go to work, as I do most days, but couldn't just leave her there alone until time for her fluids at 5:30.  I took her straight into the vet and left her there for the first time ever.  I knew she wasn't improving.  I went to work for a total of 30 minutes, wept inappropriately in front of coworkers,  and returned to the vet.  They did another blood test and her numbers were significantly worse despite the fluids.  I wanted to save her from suffering starvation, fear, pain, the indignity of not being able to control her own waste, especially if she was just going to die anyway. I asked the vet what she would do and she said she thought it was time to put her to sleep.  It had only been 3 days.

I took her home with me and spent the day with her.  She never ate, she could barely stand to drink and so I would hold her little emaciated back end up while she did.  She was willing to go to heroic efforts to reach her kitty littler when necessary, though I helped her with that, too. I kept her warm and I hope I made her feel safe and loved.  When my husband came home, we returned to the vet together and were with her until she was gone.  I don't think she had more than a half second to be afraid.

These end of life decisions are a terrible responsibility that pet parents acquire when they adopt a pet and we all just have to do our best.  Putting my beloved cat to sleep 3 days after I found out she was sick was the hardest thing I have ever done and I can't stop second guessing myself.  Objectively, people I know who love animals and understand animal physiology say with confidence that I gave her a gift by not putting her through more heroic treatments, but what if?  And I miss her horribly.   I keep finding all these stories about people who were able to mange their cats CRF and just freaking out, but when I read them I realize that their cat was younger, responded well to treatment, and they caught it earlier or, that by manage, they mean they kept them alive for 8 months or so, but they had several relapses and were constantly being prodded and poked or hospitalized. Valentine would have hated that.

The most consoling words I have received are from someone who has had to make the decision so many more times.  She said that the only time you actually know for sure when the right time to let them go is comes when you wait too long, watch them suffer more than they should, and regret it.  Better a week to soon then a day too late.  

You did what your vet thought was best and you saved her months of pain
 
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