Senior cat with IBD: How do you know it's time?

dulcemir

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I am writing this because my baby boy, my first born, hasn't been eating for about two days. He's also been throwing up consistently for the past two weeks.

He was diagnosed with IBD in October 2020. He's been living with it for almost two years. It's been up and down. We're currently on injectable dexamethasone, 1.5 cc. The doctor says this is sort of the end of the road, in terms of treatment. If his IBD no longer responds to this steroid, we don't have a ton of other options.

He's had great months, and he has had bad weeks. Last November, I thought I had to put him down because he was drooling uncontrollably and not eating, but he recovered and did well for the next few months. From March to May or so, he even gained weight—about a pound.

He's now losing weight rapidly. He doesn't seem really lively anymore. He's about 16.5 years now. I don't want him to be miserable, but I also don't want to do anything brash because I'm exhausted with many years of care for him (even not traveling because I've been committed to taking care of him).

I just want to know when I will know it's time. I know there should be more good days than bad days. Right now, it's about even in the past two weeks. He was responsive and asked for food this morning. I gave him some, but he didn't eat much. He didn't ask for food at all tonight and has been lethargic.

IBD is terrible, awful. I don't wish it on anyone or any cat. I'm just so sad and tired.
 

catloverfromwayback

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All my sympathy. My elder girl has (we think) IBD, but a very mild form.

It’s always the thing one asks oneself - did I let them go too soon? I asked that with Maddie (my avatar) when she had what turned out to be cancer, initially misdiagnosed as IBD. She didn’t eat and vomited up any medicine, after frothing at the mouth fighting it. Now I regret putting her through that time, whenI knew it was palliative care at most.

I would say, ask yourself if you want your darling to be having more bad days than good, when you know it is the end of the road approaching. There’s no easy answer. You will feel the pain of his loss - but imo it is better not to keep them hanging on, hoping against hope, at this stage.

I am so sorry.
 

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First, I'm so sorry. I'm keeping you in my thoughts and heart, because I know how hard this is.

For me, I knew when Isabel (18 years old.) stopped eating that night that something was wrong. She had just kind of 'flopped' off the counter that day too, then laid in a daze for 20 minutes until she shook it off. I assumed that she was going through a seizure, but the vet was closed and we don't have an emergency vet near us =( Through out the night, I checked on her. I gave her pets, encouraged her to drink and eat, brush her. She'd every so often take bites, but seemed off. She'd hold her mouth open a bit and I could tell something was wrong. When morning came and she still hadn't eaten, I decided to rush her to the vet (which I was already gonna do, but I decided to go asap.)

She peed herself when I put her down to let the other cats say goodbye to her, just in case. I was still holding out hope that the vet could help her, you know?

When I got to the vet, I point blank asked him if it was time and he said yes. My vet doesn't BS me. He tells me the truth, doesn't sugar coat. He told me, nicely, that her organs were starting to shut down and whether I chose to put her down or not, she'd pass within the day.

I followed my gut when I saw how bad she was, and that was, I suppose, how I knew... even if I needed that confirmation from the vet. It didn't help with the guilt and wondering, but it did give me the courage I guess to go through with putting her down. It's NEVER EVER an easy thing to do and if I'm being honest with you, I wish I had put her down sooner, before she'd ever fallen off the counter or got to the point where she felt that bad. I feel terrible that I held on so long, but I know why I did - saying goodbye is so hard. And the wondering is so awful.

Communicate with a vet you trust, talk to them, get opinions on your boys state. Having a vet you really trust through this is very very helpful.

I'm so sorry again =( There is a spot for you and your boy in my nightly prayers tonight. Thinking of you both.
 

catloverfromwayback

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First, I'm so sorry. I'm keeping you in my thoughts and heart, because I know how hard this is.

For me, I knew when Isabel (18 years old.) stopped eating that night that something was wrong. She had just kind of 'flopped' off the counter that day too, then laid in a daze for 20 minutes until she shook it off. I assumed that she was going through a seizure, but the vet was closed and we don't have an emergency vet near us =( Through out the night, I checked on her. I gave her pets, encouraged her to drink and eat, brush her. She'd every so often take bites, but seemed off. She'd hold her mouth open a bit and I could tell something was wrong. When morning came and she still hadn't eaten, I decided to rush her to the vet (which I was already gonna do, but I decided to go asap.)

She peed herself when I put her down to let the other cats say goodbye to her, just in case. I was still holding out hope that the vet could help her, you know?

When I got to the vet, I point blank asked him if it was time and he said yes. My vet doesn't BS me. He tells me the truth, doesn't sugar coat. He told me, nicely, that her organs were starting to shut down and whether I chose to put her down or not, she'd pass within the day.

I followed my gut when I saw how bad she was, and that was, I suppose, how I knew... even if I needed that confirmation from the vet. It didn't help with the guilt and wondering, but it did give me the courage I guess to go through with putting her down. It's NEVER EVER an easy thing to do and if I'm being honest with you, I wish I had put her down sooner, before she'd ever fallen off the counter or got to the point where she felt that bad. I feel terrible that I held on so long, but I know why I did - saying goodbye is so hard. And the wondering is so awful.

Communicate with a vet you trust, talk to them, get opinions on your boys state. Having a vet you really trust through this is very very helpful.

I'm so sorry again =( There is a spot for you and your boy in my nightly prayers tonight. Thinking of you both.
I feel for you with Isabel’s passing. My Caitlin died of heart failure in my lap as we were driving to the vet to have her put to sleep. It was barely two weeks since she’d been diagnosed with terminal cancer.
 

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I understand what you're feeling. My boy has suspected ibd 3 biopsies indicate the normal finding of ibd or lymphoma. This began with pancreatitis last June and were now on the normal course of trial and error.The journey is horrible. The question of when/if is debilitating. It is said " better a day early than a day late" but the heart would usually disagree. If you feel your baby is having equal bad and good days the question becomes how long do you continue to fight? We are there too. I keep trying to find a way to give him more good days. That'll determine my actions I suppose. His whole look has changed and it breaks my heart.
There is only your gut to guide you I think. I understand the hope and the fight.
God Bless you both
 

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Here's are some considerations of gauging your cat's quality of life: Quality of Life and End of Life Care - Cat Friendly Homes

If you feel that it's worth trying other treatments, you can seek out a second vet opinion. You can go to a different vet hospital or ask your vet to consult with a veterinary school or other vet hospital.
 
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dulcemir

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Update. Thanks, dear friends and kitty lovers, for sharing your thoughts. I have an update to share with you all, although I'm not sure this really resolves anything. Just looking for a few thoughts and suggestions for next steps, based on your own experience with a senior kitty living with IBD.

Went to the vet. I took my boy to an emergency vet on Wednesday night. They gave him the following:
  • Subcutaneous fluids
  • Maropitant (Cerenia) injection 10mg/mL/mL
  • Famotidine (gen) injection 10mg/mL/mL
  • Vitamin B12 (gen) injection 3000mcg/mL/mL
  • Metoclopramide (gen) injection 1mg/mL/mL
  • They also gave me liquid metoclopramide, with instructions to give 1 mL per day every 8 hours to tame the nausea.
I passed on getting an X-ray or additional bloodwork; I don't think those would've revealed anything new since my cat got his bloodwork in late May. Both the doctor and I suspected that his IBD is aggressive and is not as responsive to his dexamethasone injections.

Since the vet visit. The treatment he got at the vet seemed to temporarily relieve what I perceived was his pain, and he has not vomited since.

Still not eating. He hasn't eaten much, however. He has eaten a bit—bites here and there, sometimes a little tablespoon of wet food drenched in tuna water—but it has not been significant. I'm not sure if the lack of eating is the result of associating food with nausea or if he doesn't have an appetite at all. I have given him Mirataz to try to stimulate his appetite, but it doesn't seem to work. (The Mirataz is expired, but I can't imagine that its effectiveness would be reduced by that much, but let me know if I'm wrong!)

Behavior tells me he's hungry, but actions tell me otherwise. He has requested food and yowled, but once I give him his food, he turns away. I wonder if his hunger cues are hitting, but he can't stomach the food because he doesn't feel well.

Next steps; is he starving? I don't want my boy to starve to death. But I also want to do everything I can to make him feel good enough to eat.

Has anyone experienced this? And if so, what was your plan of action?

I suspect I'm at the end of my efforts, but I want to exhaust every possible option I have before considering euthanasia. :(

Here's a pic of him this evening at sunset.
 

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catloverfromwayback

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Update. Thanks, dear friends and kitty lovers, for sharing your thoughts. I have an update to share with you all, although I'm not sure this really resolves anything. Just looking for a few thoughts and suggestions for next steps, based on your own experience with a senior kitty living with IBD.

Went to the vet. I took my boy to an emergency vet on Wednesday night. They gave him the following:
  • Subcutaneous fluids
  • Maropitant (Cerenia) injection 10mg/mL/mL
  • Famotidine (gen) injection 10mg/mL/mL
  • Vitamin B12 (gen) injection 3000mcg/mL/mL
  • Metoclopramide (gen) injection 1mg/mL/mL
  • They also gave me liquid metoclopramide, with instructions to give 1 mL per day every 8 hours to tame the nausea.
I passed on getting an X-ray or additional bloodwork; I don't think those would've revealed anything new since my cat got his bloodwork in late May. Both the doctor and I suspected that his IBD is aggressive and is not as responsive to his dexamethasone injections.

Since the vet visit. The treatment he got at the vet seemed to temporarily relieve what I perceived was his pain, and he has not vomited since.

Still not eating. He hasn't eaten much, however. He has eaten a bit—bites here and there, sometimes a little tablespoon of wet food drenched in tuna water—but it has not been significant. I'm not sure if the lack of eating is the result of associating food with nausea or if he doesn't have an appetite at all. I have given him Mirataz to try to stimulate his appetite, but it doesn't seem to work. (The Mirataz is expired, but I can't imagine that its effectiveness would be reduced by that much, but let me know if I'm wrong!)

Behavior tells me he's hungry, but actions tell me otherwise. He has requested food and yowled, but once I give him his food, he turns away. I wonder if his hunger cues are hitting, but he can't stomach the food because he doesn't feel well.

Next steps; is he starving? I don't want my boy to starve to death. But I also want to do everything I can to make him feel good enough to eat.

Has anyone experienced this? And if so, what was your plan of action?

I suspect I'm at the end of my efforts, but I want to exhaust every possible option I have before considering euthanasia. :(

Here's a pic of him this evening at sunset.
Did the vet offer any opinion about whether it’s time?
 

Allyocean

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He's beautiful! I
I'm sorry you are going through this. I too have been dealing with IBD. My boy is 12 as of this week.
He was in the same state a few weeks ago. With a 2mg budesonide, sub q , b12 etc etc for 2 weeks every 2 hour hand feeding, he's now having a good week. Daresay great. And just budesonide 1x day.
If this doesn't hold we will move forward with chloabucil in conjunction with budesonide. I opted not to get a fourth ultrasound or biopsy. The chloabucil is used for aggressive ibd and small cell lymphoma.
I'm not sure where you are in this horrible journey. But I'm praying you find the right combination to give him the life all kitties deserve.
 
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dulcemir

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Did the vet offer any opinion about whether it’s time?
His main vet is on leave until the end of the month, but the backup vet did mention that if he's still not eating, I could consider (1) hospitalizing him or (2) euthanasia. Hospitalization would involve giving him IV fluids and a possible feeding tube, but, to be honest, I don't want to go that route because I don't want to leave him overnight just to prolong his life for a few days or weeks if he's suffering.
 

Krienze

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May I ask what you're feeding him?

With Isabel, I found when she'd go on her mini hunger strikes, lickable treats and foods were the best way to go. And she rarely snubbed fancy feast. At that point you know, I didn't care what she ate as long as she ate so I tried wet treats and foods to see what she'd peak interest in. Maybe a wet food/lickable might help?
 

catloverfromwayback

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His main vet is on leave until the end of the month, but the backup vet did mention that if he's still not eating, I could consider (1) hospitalizing him or (2) euthanasia. Hospitalization would involve giving him IV fluids and a possible feeding tube, but, to be honest, I don't want to go that route because I don't want to leave him overnight just to prolong his life for a few days or weeks if he's suffering.
Hospitalisation does sound like putting him through a lot of stress for no good outcome to me. I’m so sorry.
 
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dulcemir

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I'm giving Max buprenorphine for pain. Not sure if you've tried that. My guess is you've tried everything possible. I'm so sorry
I haven't tried buprenorphine for pain yet. He doesn't seem in pain yet (no ears back, just sleeping, mostly), but by the time he gets there, I think I would've made a decision. :(
 
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dulcemir

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May I ask what you're feeding him?

With Isabel, I found when she'd go on her mini hunger strikes, lickable treats and foods were the best way to go. And she rarely snubbed fancy feast. At that point you know, I didn't care what she ate as long as she ate so I tried wet treats and foods to see what she'd peak interest in. Maybe a wet food/lickable might help?
He not eating much right now, only Fancy Feast flaked tuna treats. I've tried Churu, all kinds of wet food, even his favorite Greenies, but he's not taking anything. :(
 
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dulcemir

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Hospitalisation does sound like putting him through a lot of stress for no good outcome to me. I’m so sorry.
Thank you, kind friend. My partner and friends also told me that hospitalizing him, even for temporary relief, doesn't sound like a great option, especially if it involves overnight stays and being alone in an unfamiliar place. Unless it gives him months and months of additional good quality of life, I'd rather not put him through the stress, indeed.
 

catloverfromwayback

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Thank you, kind friend. My partner and friends also told me that hospitalizing him, even for temporary relief, doesn't sound like a great option, especially if it involves overnight stays and being alone in an unfamiliar place. Unless it gives him months and months of additional good quality of life, I'd rather not put him through the stress, indeed.
Yes, and unless you can get a definite answer from the vet(s) that it will help him that much, which obviously they can’t give, it sounds like a risk too hard on him to take.
 
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dulcemir

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An update for you all. I slept on the sofa last night so I could be around for my boy. He yowled throughout the night to ask for food, but I didn't want to wake up to give him any because I was so tired.

This morning, I did give him some Fancy Feast slurry, and he lapped it all up.

I also gave him Fancy Feast flaked tuna, and he ate all 10 packets.

At this point, I'm just grateful that he'll eat anything, even if it's fish.

I'm going to the pet store later to pick up more slurry-type treats to get his appetite going again, with hopes that he can keep his food down.

Do you have any recommendations that've worked wonders for you with an advanced-staged IBD kitty?
 
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