Is this too much to keep my cat alive? Or: Am I being selfish?

phoebeismyheart

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Hello Cat Site people,

How do we know when we're asking too much of our feline companions? I am sure I'm not the only one struggling with this question. I really just want to know what other cat caretakers would do in the same circumstances.

Here's the run down:

Phoebe's exact age is unknown. She has been with me for 18 love-filled years. She was mostly full grown by the time we found each other, so a good guess is that she is 18-20 years old. She's a beautiful, affectionate calico- to me and a select few other people anyway! She lives up to the calico feisty nature in every way when it comes to anyone or anything she does not like.

Her aging started to show about 4 years ago. It was discovered then that she has hyperthyroid which we now manage with oral methimazole. We're still working on getting the dosage right. It's been very tricky and it keeps either sending her into hyPOthyroidism or not fully alleviating the hyPERthyroidism.

She also, not surprisingly, has chronic kidney disease. Her kidney values are very much influenced by where the thyroid pendulum has swung at any given time, as anyone with a hyperthyroid/CKD cat probably can relate to. When her thyroid is over-active her kidneys get more blood flow and values look better. When the medication sends her into hypothyroid, the kidneys get less blood flow and blood values look like they are tanking.

A year ago, another health issue began: seizures. Our vets have not been able to determine a cause of the seizures. She gets gabapentin everyday, twice a day, to prevent seizures. She still has about 1 seizure every 1-2 months even with the gabapentin.

Her blood pressure also went through the roof last year with the hyperthyroid/CKD and she began screaming all night in agitation. So now she also gets blood pressure medication.

On Monday of this week I noticed that she was drooling pus. Sure enough, she has an abscessed tooth now too. Given her conditions, the vet (and I agree here) said that sedation to remove the tooth is not an option. She would most likely not wake up.

The vet said that instead, we would most likely have to "pulse" antibiotics off and on to keep the infection down, thus alleviating the pus and pain.

So she is now on an antibiotic too.

This means in the morning I give her orally- methimazole, gabapentin, antibiotic.

In the evening I give her- methimazole, amlodipine (blood pressure med), gabapentin, and antibiotic.

(She also gets phosphorus binder mixed in her food.)

I'm told by the vets that these are all "treatable" problems. How many treatable problems add up to a miserable life for her though? I don't know if she has any quality in life.  She does not like getting medicine but she tolerates it. She does continue to eat despite her bad tooth, presently. She also still sits at the window.

But she also seems very "out of it"  and confused lately. I don't know if that's from tooth pain, all the medication, or merely her age.

Cat Site People, what would you do? Keep on this course and see how bad things get? When do I say "enough is enough"? I don't know if she's in pain. How I wish I could ask her wishes. :(
 

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I do understand where you are coming from, having just gotten dental work on my 17-year old to remove some very bad teeth.  She had been on antibiotics (clavamox) to control it for some time.  In my case, the vet was sure she would make it through the dental fine, but I was worried she would not.  After arranging for her to get good pain medicataion (not Ansior, which can only be used 3 days, and not Metacam, which is also an NSAID and worried me) but buprenex, which she had tolerated well in the past and could be  used every 12 hours for five days (and isnt a pill but a liquid given in a tiny drop 0.1 ml under the tongue), I went ahead with it.  I figured if she did not wake up, at least she would have gone peacefully in her sleep with no pain, and if she did wake up, the nasty teeth would be gone.  It has been a month since her dental work and she is doing just fine.  She sleeps a lot and doesn't do much else, but she purrs and likes to be petted and doesn't paw at her mouth any more except when she gets food stuck in what remaining teeth she has.

I can't tell you what choices to make for your cat, and of course it helped me that my vet thought she would be fine with the anesthesia because pre-op blood work showed everything in normal range, and her weight was perfect for her size.  Yes I was a nervous wreck, and I am still struggling with the bill (my vet is patient but I do need to raise some money I still owe them) but I am totally happy that I got it done, even if it just buys her a few more months of comfort. 

I'm not sure what antibiotic you have your cat on but with the clavamox, she HATES the liquid version that vets have, and her mouth was sore so pilling her was not a good choice, BUT I would dissolve the clavamox pills in a tiny bit of water, and once I could see it was completely dissolved, I mixed in cream or  goat's milk, and then I would give it to her with a syringe and she didn't mind.  We "pulsed antibiotics" for about a year before I finally got the courage to get her bad teeth removed.  Maybe if you used this antibiotic in this form, it would be more tolerable for your old girl.  My vet was amazed by how well it worked.
 
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lorie d.

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Two things I consider when I have to make this decision are the general quality of life the cat has and whether the cat seems to be suffering.  My cat Snowball lived to be 17, was in end stage kidney failure, and was having problems functioning in general.  When I looked into Snowball's  eyes , I could see that he was miserable and that being alive had become horrible for him, so I made the decision to let him go.
 
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phoebeismyheart

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That's the part that is so hard for me: I don't trust my own senses about Phoebe. I'm afraid my decisions are controlled by my grief and pending grief. :(

Like, right now she is on my lap, purring and I think: Of course she wants to keep living! Then other times I see her pacing around seeming confused and I think: The poor dear doesn't even know where she is. :(
 

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I so want to answer this with words of wisdom and clarity, except in decisions like this....  there really is neither.    This score card helped me with my decision:

Quality of Life Score Card

My kitty went under anesthesia when she was 19 for a teeth cleaning and impromptu biopsy of a growth I didn't know she had.   Her blood work was good and she was strong.  At the time, she was on thyroid medication.  She woke up.  But all pets are different.   

You have to do what is fair to your fur baby and knowing her quality of life, will help in that decision.  
 
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phoebeismyheart

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Clavamox is exactly what she's on. All the medications she gets are liquid suspensions. Since I am already syringing 3 others into her mouth, I'm just doing the same now with the Clavamox.

Hiding medicine in anything has never worked with her except for the phosphorus binder (I'm told it is completely tasteless so that makes sense).

If she didn't have so many other things going on, I'm sure we could pull the tooth and it would be fine. I'm not ready to accept the risk of putting her under IF she could be comfortable without removing the tooth. It's that IF that is so worrying and upsetting.

I have no idea if I'm just forcing her to suffer.
 
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phoebeismyheart

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It sounded to me like it is the seizures on top of everything else that has the vet unwilling to put her under.

Thank you for your kind words and the Quality of Life Score Card.
 
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phoebeismyheart

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Just one last thought: It makes this even harder when I am getting one perspective from the vets and another from friends and family.

Friends and family seem to think I'm doing far too much to keep her alive and comfortable and I should say goodbye before it gets worse.

Vets seem to think since it's all treatable that this is perfectly acceptable to have a cat on this much medication and that I should do everything possible to keep her alive as long as I can.

I have had a heart-to-heart with my vet and he accepted that my goal is NOT to keep her alive as long as possible but to keep her as comfortable and happy as possible. I also told him that I have aging parents to worry about and help as well as my cat.

She truly is my heart and we've been through, oh, just so MUCH together. I send out wishes every night that I'll know what to do. So far, I'm still conflicted.
 

kittens mom

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Hello Cat Site people,

How do we know when we're asking too much of our feline companions? I am sure I'm not the only one struggling with this question. I really just want to know what other cat caretakers would do in the same circumstances.

Here's the run down:

Phoebe's exact age is unknown. She has been with me for 18 love-filled years. She was mostly full grown by the time we found each other, so a good guess is that she is 18-20 years old. She's a beautiful, affectionate calico- to me and a select few other people anyway! She lives up to the calico feisty nature in every way when it comes to anyone or anything she does not like.

Her aging started to show about 4 years ago. It was discovered then that she has hyperthyroid which we now manage with oral methimazole. We're still working on getting the dosage right. It's been very tricky and it keeps either sending her into hyPOthyroidism or not fully alleviating the hyPERthyroidism.

She also, not surprisingly, has chronic kidney disease. Her kidney values are very much influenced by where the thyroid pendulum has swung at any given time, as anyone with a hyperthyroid/CKD cat probably can relate to. When her thyroid is over-active her kidneys get more blood flow and values look better. When the medication sends her into hypothyroid, the kidneys get less blood flow and blood values look like they are tanking.

A year ago, another health issue began: seizures. Our vets have not been able to determine a cause of the seizures. She gets gabapentin everyday, twice a day, to prevent seizures. She still has about 1 seizure every 1-2 months even with the gabapentin.

Her blood pressure also went through the roof last year with the hyperthyroid/CKD and she began screaming all night in agitation. So now she also gets blood pressure medication.

On Monday of this week I noticed that she was drooling pus. Sure enough, she has an abscessed tooth now too. Given her conditions, the vet (and I agree here) said that sedation to remove the tooth is not an option. She would most likely not wake up.

The vet said that instead, we would most likely have to "pulse" antibiotics off and on to keep the infection down, thus alleviating the pus and pain.

So she is now on an antibiotic too.

This means in the morning I give her orally- methimazole, gabapentin, antibiotic.

In the evening I give her- methimazole, amlodipine (blood pressure med), gabapentin, and antibiotic.

(She also gets phosphorus binder mixed in her food.)

I'm told by the vets that these are all "treatable" problems. How many treatable problems add up to a miserable life for her though? I don't know if she has any quality in life.  She does not like getting medicine but she tolerates it. She does continue to eat despite her bad tooth, presently. She also still sits at the window.

But she also seems very "out of it"  and confused lately. I don't know if that's from tooth pain, all the medication, or merely her age.

Cat Site People, what would you do? Keep on this course and see how bad things get? When do I say "enough is enough"? I don't know if she's in pain. How I wish I could ask her wishes. :(
Would it be possible to have several of the medications compounded together. Dermagel ?

I think you have to compare her life to someone who would be her age. Maybe not running and jumping but sitting in the rocking chair enjoying watching life around her. Is she eating, using the litter box, keeping herself reasonably groomed. There is the common thinking that better too soon that too late. It sounds like she still has reasonable quality of life for a 19-20 year old cat.
 

kittens mom

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Just one last thought: It makes this even harder when I am getting one perspective from the vets and another from friends and family.

Friends and family seem to think I'm doing far too much to keep her alive and comfortable and I should say goodbye before it gets worse.

Vets seem to think since it's all treatable that this is perfectly acceptable to have a cat on this much medication and that I should do everything possible to keep her alive as long as I can.

I have had a heart-to-heart with my vet and he accepted that my goal is NOT to keep her alive as long as possible but to keep her as comfortable and happy as possible. I also told him that I have aging parents to worry about and help as well as my cat.

She truly is my heart and we've been through, oh, just so MUCH together. I send out wishes every night that I'll know what to do. So far, I'm still conflicted.
If the medication is working then it is not too much medication. It's when it stops working. She's earned her time in a sunny window.
 

sweetdz99

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Honestly, you can NOT listen to friends and family because no one knows  truly what is best for YOUR cat other than YOU.  That being said...   You already accept the fact that  you will have to say goodbye.  Is that today? Tomorrow? Who knows. Maybe.  

I can only speak from my experience so please don't take this other than me telling you what I did.   This will be the short version because I am at work and I don't have make up here to fix my face!

My Kiara was 19 when she passed away.  She was strong, healthy, moved around well, ate, peed, pooped.. everything she was supposed to be.  She stopped eating.  I thought it was food.  Changed that, that didn't work.  Boiled chicken for her.. boom.  She ate.  She was still losing weight and then stopped eating again so I brought her in.  She was a little dehydrated, they gave her fluids, she was much better.  Blood work came back with hyperthyroidism.   She now had to take this pill two times a day.  A pill.  Kiara? Ha! She was evil.. there was no way.  So after days of wrapping her in a towel, or double teaming her or triple teaming her.. i finally got it.  A crushed pill in spray cheese and/or sour cream.  done.  She was eating again.  Perfect.  Everything was easy.  Then she stopped.  She kept pawing at her mouth and gagging like something was in her tooth.  She had done this before so i thought she needed cleaning.  Since we just had blood work... they showed no reason for her not to be able to go under.. so I scheduled the cleaning.  During the cleaning he found a mass...  took a chunk of it, stitched it up and finished the cleaning.    ** i would have NEVER had the cleaning done if they saw that mass before hand.  I want to kick myself still for that.  Here she was dying of freaking cancer and I am force feeding pills for hyperthyroidism, getting her teeth cleaned  instead of cuddling her on her final days**  ahem.. back to my story.    So now.. here she is with a sore mouth, stitches and cancer.  Great. I stopped the thyroid.  what was the point.  I forced fed her food.. which she only fought me minimally on because she was starving.  I syringe fed her food twice a day along with pedialyte.  It was messy.. I was always sweating after but i loved her.  Of course I would do those things for her.   She was on pain meds twice a day...  soon that wouldn't be enough.  She drooled and there was blood in the drool sometimes.  She was thirsty but couldn't drink normally  because the mass pushed her tongue to the side...  so I would splash the water on the corner of her mouth while she drank.  She would hide most of the day if I wasn't home but was with me when i was.  I begged her every single day for a sign.  A sign that she wanted to go... or a sign that she wanted to stay...  but then I was also pleading with her for one more night.   She was my light.  My everything good.  Our love for each other was amazing. ...  I was conflicted like you.  I would ask anyone who would listen  What should I do?  And pray they would say "she is still ok" ...   our last night together i knew it was time because the afternoon before, she didn't get up to greet me.  She laid on the couch and looked at me.  A look in her eye that told me "mama, I am so tired.  I love you and I don't want to go so just tell me you will be alright and help me cross over"  it was the most heat wrenching and relieving look at the same time.  I told her that we would go tomorrow and she slept on me the whole night.  

No one can tell you what to do.  I think I waited too long for my baby but our situations are different.  You have to listen to your heart.
 

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When one of my cats had a stroke hubby and I were really struggling to make a decision.  What really helped us to see things more clearly was to sit down with a piece of paper and write things out.  We made a list of all the things our Claude loved to do that were important to his quality of life.  We then made a list of what he could and could not do that were important to his quality of life.  This really made use understand just how much he was suffering and made us realize we really needed to make a decision quickly not to allow him to continue suffering.  You will never be ready to say good bye to your baby.  Writing this list out together really helped us make the decision together.  It was still very painful but we knew it was time to say good bye and it did not matter if we were not ready.  Claude's quality of life was gone now and we needed to release him from his pain and suffering.  We did take one night to say goodbye and spoil him at home.  We also gave our other cats a chance to say goodbye.  

Claude was 15 when he passed away and had been part of my life since the day he was born. There is no easy way to figure out when it is time but deep down you will know even if you are not ready.

I hope this helps you too.
 
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lcat4

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My 18-1/2 year old cat recently had a similar situation. He has mid-kidney disease with restrictive cardiomyopathy which presents like a murmur. He's needed a dental for a couple years now, but my vet has said it was too dangerous. Last month he started drooling and his lower jaw started swelling. He was miserable. He hates and does not do well with Clavamox, so we treated with Baytril for two weeks. The swelling subsided. Off meds, the swelling came back, and this time bloody pus broke through his skin at the jaw. Back on Baytril. I told the vet either we do a dental or this cat will die of sepsis.

With my vet's suggestion, I went to a dental vet. That's all he does. My vet said he'd be quicker and be better to handle an emergency. He required an echocardiogram and bloodwork. He altered his anesthesia procedures appropriately. He removed 7 teeth, and flushed the infection. He said the bone condition was terrible because of the infection. He prescribed Clindamycin (Clindamed by Bimeda) which is specifically geared towards jaw bone infections. My cat took it for 3 weeks. We go back in 2 weeks (after meds) to make sure the infection has resolved.

I can't speak to your specific senario. I don't have knowledge of cat seizures or the dangers that presents. I do know my vet said no way, too dangerous, and I now have a much happier cat after the dental.

At the very least, you might discuss changing the antibiotic with your vet. As said, my cat HATES Clavamox, and even though he wasn't happy about a syringe going in his mouth, the Clindamed did not end up foaming and splattered on the walls. So my take, it must not be that bad tasting. And it is geared to bone infections. The antiobiotic will not cure the abscess, your cat will probably still experience tooth pain, but perhaps the infection will be controlled.

As to when to let go, it sounds like you have a good frame of mind. My cat's brother was quite sick with cancer. We did everything we could to extend his life/keep him comfortable. For six months, everyone said to put him down. I woke up one day and knew it was time. You'll know.

Best wishes to you and Phoebe.
 
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Caspers Human

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Viability scores and moral support are all important but it is still hard, if not impossible, to know "when."

I'll answer a question with a question:  Is she still "your cat?"

Is she that happy, loving ball of fur you befriended and fell in love with?

Does she eat, sleep and play like the cat you always knew and loved?

Of, course, we need to ask whether she is in pain or discomfort and whether there are medicines or treatments that will help.

But when you get right down to the bottom of it, you've got to ask yourself...

If Phoebe still "Phoebe?"

Answer that question and you'll know when it's time.
 
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