Promoting quality of life in an elderly cat

[KJIA]

My beautiful ragdoll, Juliette, is 17 years old. She has been relatively healthy throughout her life, aside from a few dental extractions in her later years and some likely arthritis. However, her age is beginning to become fairly apparent. She is my first and only cat I have ever owned, and I want to do the best I can at ensuring her quality of life in her senior years. If anyone would share their experiences in caring for an elderly cat, senior cat enrichment, or ideas to promote comfort, I would love to hear your thoughts.

Unfortunately, we are beginning to deal with some health issues. Earlier this year, Juliette was diagnosed with hyperthyroidism after I noticed her losing weight despite a large increase in eating/drinking. Our vet has prescribed mediation for the hyperthyroidism, and while her thyroid hormones, appetite, and thirst have returned to normal, she not not regained any weight. I have read from many that although medication was helpful, many didn't notice their cat fully bounce back and regain weight until radioiodine (I-131) therapy, which can cure the hyperthyroidism.

We recently went to a consultation appointment at a veterinary hospital to learn more about the radioiodine therapy. During the appointment, I learned that due to the radioactivity I would need to isolate Juliette after the treatment and minimize my contact with her for six weeks, which I'm sure would be very hard on her. Additionally, the hospital would perform a thyroid scan before treatment to determine the correct dose to administer her. Although the scan is not invasive and the hospital vet did not agree that anesthesia was necessary, they said it was unfortunately the hospital's policy. Obviously, anesthesia for a 17 year old cat is also a confounding concern. The hospital suggested a blood test, urine test, echocardiogram, and ultrasound to determine her risk. We came back with numerous findings including IRIS stage II chronic kidney disease, intervertebral disc disease, mild thickening of part of the small intestine, and small liver nodules. The hospital vet recommended we begin a diet specific for kidney disease, although did not elaborate further. The confusing part was they approved us to be added to the radioiodine therapy schedule, but when I pressed about the anesthesia concerns they kept reiterating how many risk factors Juliette has against her. I know we can't predict the future and I wouldn't expect them to tell me that everyone will be 100% fine, but approving us (indicating they were comfortable with proceeding) but then to scare me with all the things against her seemed contradicting. They would only say she has many risk factors, but no indication of whether this is 5% risk or 95% risk. Is the vet comfortable with a patient like us, or if it were their own cat would they think it was too dangerous? I left the appointment feeling pretty disheartened about our new (and many) diagnoses and how to know what is the best decision.

I am going to try to find a new primary vet for Juliette to discuss these many issues with. Our primary vet of many years retired. The clinic was bought out by a new vet, which we continued to see, but I haven't been as happy with them in their ability to communicate (not informing me teeth were extracted during a cleaning), maintain records (such as known medication allergies), and listening to my concerns (hyperthyroidism can mask kidney disease and when I insisted on bloodwork I was told her kidneys were fine). For now I would like to focus on determining an appropriate diet for her kidney disease and easing her arthritis and intervertebral disc disease, so that her quality of life is maintained and she is as comfortable as possible. We are on the schedule for radioiodine therapy, but luckily it is not for two months yet, so I have time to think if it is really the right option for us. I am less concerned with the small areas of thickened small intestine and liver nodules, as it was explained this was a common occurrence in older cats and usually benign.

And that brings us to the end of our story! I would love to hear anyone's experiences with any of these diseases, making decisions to provide the most comfort and quality of life for an elderly cat, or particulars on choosing a vet for a senior cat. I am very sad with the idea that we may not have too much time left together, but I want to do my best that the time left is happy and comfortable for her.

Thank you!

 

[FeebysOwner]

Hi. That is a lot going on, and I am sure I cannot possibly address every issue. I have a 19+ yo cat who was diagnosed over 3 years ago with hyper-T. She was - and still is - on Felimazole for that. I was not comfortable with going directly into the radioiodine therapy. Shortly after that, she was diagnosed with CKD, so that changed things a bit for me. She also has arthritis, along with some spinal fused invertebrate disks, high BP, and it would seem intestinal lymphoma as well, the latter of which we are not treating.

Regarding the radioiodine therapy and the testing that has been advised for your cat to go through, it all sounds good. But there are very many variables regarding after care - up to and including time spent isolated after the treatment and associated care. Most of the vets are overly cautious about what needs to be done, and many on this site will tell you so. Some restrictions are regional requirements, other are affiliated with vet preference. You might want to peruse through the web site that I have provided a link to below. It isn't an easy web site to navigate, tbh. Animal Endocrine Clinic | Where science and compassion cure

Also, you may want to spend some time getting familiar with this site as well - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It is excellent for its information but can be intimidating and overwhelming when starting out - HOWEVER, it is well worth diving past that. I refer to this site often.

Regarding arthritis, you have OTC options like Cosequin, Dasuquin, Glyco Flex, among others. There are also prescription injections such as Adequan and Solensia for arthritic pain too.

I know I have covered a lot but yet only scratched the surface. I hope this information is helpful, and that you will find beneficial input from others as well. It takes time to digest all the things you need to know, so don't fret about the learning curve.

 

[silent meowlook]

Hi. My cat is hyperthyroid with asthma, nodules in the lungs, IBD, lymphoma, a mass in her intestines, and suspected kidney disease, and a heart murmer. Seems like there is more but I can’t think of it right now.

I chose not to do the I-131 treatment because she would have to stay in the hospital for 3 days. I also don’t trust anyone, and honestly like the fact that I can keep her on the higher side of her T4 to help with her kidney disease.

It is very important that you have your kitty’s blood pressure checked. Both the hyperthyroidism and the kidney disease can cause hypertension.

I am not a vet. If I Owned your cat, I would find a feline only veterinarian and set your cat up with them as your primary. Cat only veterinarians are usually much more experienced and knowledgeable about cats.

I personally would not want to stress my cat with having to be hospitalized and I definitely would not do anesthesia. The other thing that concerns me is who is going to be caring for your cat at night in the hospital?

Things may have changed since I was working in a hospital where they did the
I-131treatment. Back in 2005 - 2010, where I worked, at a specialty hospital, the cats were kept in a closed off room where only one tech and one doctor could enter. They would leave at the end of the day and the cats would be alone from 6pm till 8 am. Even though there was overnight staff, only the one tech could care for those cats.

I am sure things have changed since then, but if you do decide to go ahead with it, make sure you ask all the questions you can and don’t assume anything.

My cat has been on methimazole about 3 years and is doing fine with it. I have known many cats that live quality lives on it as well for many years.

 

[heatherwillard0614]

I guess another thing to consider is her age is her system strong enough for the treatment for one and 2 how would she do being confined for so long.. stress and depression are a possibility especially if she goes from always being with you to being by herself for 6 weeks..

You have had concerns that they really didn't answer they have pulled your little lady's teeth without consulting you there are a lot of things raising a red flag for me just in your one post... I personally would not start any treatment plan with your current vet. I would also find a feline only vet.

If you can't find a feline only vet I would still find a different practice to take her to if she were my cat. IMO with everything that you have said I wouldn't trust your current vet with my cat at all. Thus is my personal opinion.

Please whatever you do make sure you make informed decisions have every question and concern answered. Do not go through with anything unless all concerns are discussed.

 

[nurseangel]

Hi, it's heartwarming to know how much you care for your cat. My elderly cat, Daisy, has CHF. We have determined to make her life as comfortable and has as possible. We give her the treats she loves most, within moderation, and try to buy her strawberries at least once a week. (She loves them.) Her favorite thing is her heating pad, she now has a choice of two in case one of the others steals a bed. When you mentioned arthritis, this is the first thing I thought of. If the vet okays something, we try to make it happen.

DH had an office cat who had benign tumor behind his eardrum. We purchased his favorite food, but he simply would not eat for the veterinary staff, and due to other health complications, he had to stay for a few weeks. DH visited every day, and we would go back in the evenings to feed him again. IMHO, lots of extra spoiling helps out a lot, if your cat feels up to it. I had another cat with malignant cancer, and it distressed me that she didn't want anyone to be near her. I often put things into a human perspective, and people with terminal cancer sometimes don't want to be touched.

God bless and please keep us posted.

 

[fionasmom]

There is a great deal of good advice here and I am only going to add that Fiona herself was on Felimazole for three years, starting when she was 13. She did well on it despite the fact that it had to be disguised in food. During her younger years, she was a slightly overweight little girl who lost weight once she was dxed with hyperthroidism. She never regained substantial weight even on the medication.

The thyroid scintigraphy, which is the scan that you are probably referring to (?), is discussed by Dr. Petersen under the Nuclear Imaging portion of his website which FeebysOwner provided earlier. It is considered important in the use of the radioactive treatment and he states that this procedure should never be done without it. However, I certainly get your concern about the anesthesia and the isolation.

Don't hesitate to stand there until your questions are answered. You are not getting any of these treatments for free and that in itself means that you need to know whatever concerns you. Ask for percentages. What is it...a 5% or 95% chance? Ask what they would do with their own pet, even though some doctors hate that question and some are fine with it. Ask about restrictions with care and access to her on the part of the vet staff when she is isolated. Mention what S silent meowlook brought up and ask how "alone" she will be during this time.

 

[happilyretired]

My first cat was diagnosed as hyperthyroid when she was about 17. My vet at the time advised NOT treating her at all, as the regular testing of hormone levels would be too stressful for her. This was about 25 years ago, and I'm sure treatments have changed since then. She remained comfortable, and it was only the lack of quality of life [general deterioration of old age] that caused the vet and I to opt to send her to the Rainbow Bridge when she was 20.

However, I lost two subsequent cats to CKD, and that was an awful experience for all of us. Tanya's website is invaluable in navigating this situation. If I had a cat now with multiple problems, and CKD is one of them, that would be my focus for helping the cat be as comfortable as possible with this terminal disease. One of my guys lived 11 years after diagnosis; the other lasted only 24 months. It's almost impossible to know how CKD will progress in any individual cat, but I would not put a CKD cat through ANY significant procedure, even one considered life saving. I realize this is only my opinion because of these two cats, but the last days of CKD that I experienced with both of them were heart rending.

 

[KJIA]

Thank you all for your suggestions. I think I've settled that we'll continue the hyperthyroid medication instead of opting for the I-131 treatment with anesthesia. We do use the Cosequin supplement and I have built steps for her to help her reach her favorite places, but I like the suggestion of a heating pad so I will look into that. I tried getting her a memory foam bed awhile back, but typical kitty, she prefers her smooshed cardboard box. Maybe a heating pad would be more to her liking.

Thanks for pointing me to Tanya's website for CKD information. I will definitely read through it little by little so I can have all my questions when we see our new vet. I really appreciate everyone's feedback. It really helps me feel better with everyone's kindness and reassurance.

 

[Mac and Cats]

I have two cats with CKD and hyperthyroid (both treated with the pill). One has been diagnosed with both almost 3 years ago for both and the other about a year or maybe almost two years. One also has possible IBD/Small cell lymphoma and he takes 2.5mg of Prednesolone daily, he also has a small heart murmur. The other also has asthma and severe arthritis. So, I can relate to having a cat with many issues. Neither eat the prescription CKD food regularly as they aren't huge fans of it. I do try to get them to eat food with the lowest phosphrous level that they will willingly eat. It's hard for me to do the phos-bind (phosphorus blocker) because I've read you shouldn't give it to them within 2 hours of pills or within two hours of giving them kidney food as there is something in it that counteracts eachother and it can also block the absorption of medications. Plus, our vet doesn't know anything about the binders and that makes me extremely hesitant. We do have a secondary vet and I'm going to ask them about it at our next visit to see if they have experience with it. I looked into the I-131 treatment for the one with IBD/SCL before our other cat was diagnosed. Once the other was diagnosed, it became, well how do I decide who gets it? We can't really afford to even do one, much less both. Both are doing well with our current treatments. The cat with the arthritis has been doing monthly Solensia shots for about 9 months now and it has totally changed her life. She's more active, moving around, actually moving around the house (as opposed to staying in one spot during the day). Has your vet talked to you about Solensia? Is it something you can consider? For me, it's about $82 a month (sometimes we go 5 weeks), we do not have an office visit fee for that.

I also had another cat that lived to be 18 and was on a CKD diet for 5-ish years. He did really great until about the last 6 months of his life. The only other issue he had was a heart murmur and arthritis, but Solensia was not available during his lifetime. I think all of the things you mentioned are manageable, but I know how overwhelming it is to be slapped with in the face all at once. If your kitty isn't a fan of the prescription food, here is another database that might help you. Good luck to you and this site is a great resource for information and support!

 

[neely]

During the appointment, I learned that due to the radioactivity I would need to isolate Juliette after the treatment and minimize my contact with her for six weeks, which I'm sure would be very hard on her. We came back with numerous findings including IRIS stage II chronic kidney disease, intervertebral disc disease, mild thickening of part of the small intestine, and small liver nodules.

I'm sorry to hear about Juliette but glad you posted here to ask questions and get other member's advice. I wanted to address the above two sentences since our cat who was also diagnosed with H-T started out on Methimazole and then had the I-131 radioactive iodine treatment.

First, you do not have to minimize contact once she comes home for six weeks. It is only necessary for two weeks. We also did not have to quarantine our cat to a separate room in the house but just try to stay within 3 1/2 feet or arm's length away. He could not sleep with us during the two weeks but otherwise had our full attention. Yes, it was not ideal but the end result was worth it for us. This was almost two years ago and fortunately his T-4 levels have remained in the normal range.

Second, from a lay person's perspective it does not sound like Juliette is the best candidate for the I-131 given her other health issues. We went to a veterinary university medical specialty center and they were very specific about not performing the I-131 if the cat is not a good candidate. We had all the appropriate tests to determine this done by our feline only vet and she consulted with the radiologist at the specialty hospital.

Third, and very important, your cat does not need to be anesthetized for the procedure but rather lightly sedated. Our cat is a brachycephalic breed and we learned from past experience a long time ago that they need a specific type of anesthesia for this reason. I would have been deeply concerned if he would have had to go under anesthesia.

Last I wanted to let you know in our situation we were extremely pleased with the specialty hospital and the staff. There was someone with him around the clock who not only gave us updates but told us we could call as often as we wanted. I think you have to take into account Juliette's age and pre-existing health concerns. I know this is not an easy decision but one which you should take time to evaluate. I wish you and her the very best of luck and if you have any other concerns we would be more than happy to address them with you.