When Do You Know It's Time?

[huxleysmom]

my cat Huxley has had a real hard time this week. He has IBD and is going through a bad flare up. He is very lethargic, sleeps all day or lays on his side when he is awake or just stays in the loaf position with his paws awkwardly under him. He refuses to play and generally looks miserable. He is pooping again (which is an improvement), but is now refusing to eat much. I can't pill him so this makes things difficult as he takes his medication crushed in his food. I am probably going to have to board him at the vet for a few days for them to get him back on his feet. This isn't the first bad flare up. I have had Huxley for 7 months now, and he has had 3 of those episodes already. The last few days have been extremely hard for me as I am starting to think about his future. I hate myself for starting to think about this. I do not want to give up on him, but I also do not want him to end up living a life in pain, having lost tons of weight because he can't eat, and having to constantly take him to the vet for more treatments like regular enemas or leaving him there to care for because I can't administer him the meds he needs. I know for a fact that I will not be making this horrible decision when it is too late. I will not let him suffer simply because I want to keep him with me a little longer, but I am afraid to make that decision too early. How do I know it's time when the time finally comes? How many bad days? How many flare ups? He has no concept of time so when he is feeling horrible, he does not know something better may come along. I am really struggling with guilt over even thinking about this now, but from what I have read on this site and other IBD supprt group, the end is almost always the same and poor kitties have to be put out of their misery by their owners.
I am so conflicted with all of this. Is it worth continuing fighting knowing that bad flare ups will come again, most likely more and more frequently? Or is it me simply giving up too early and not fighting enough for him? Today I just feel lost and defeated.

 

[arouetta]

I just faced the decision to put my cat to sleep. The biggest influence in my decision was to ask myself if I would want to live the way she was living. The answer was no in my case. I would not want to live with the medical interventions she needed.

That's my best advice. Imagine living the same life he is living, the pain, the medical interventions, the good times, everything. And ask yourself if you would continue the medical treatments and stay alive like that, or if you would end life-saving measures. Once you have that answer, the decision should be clear. Not easy, never easy, but there should be clarity.

 

[LotsOfFur]

First, I'm really sorry that you and Huxley are having to deal with this. From what I understand from your post it sounds like Huxley is suffering with IBD w/ constipation; correct?

How old is Huxley? I read that he's only been with you for 7 months... do you know more about his health history you might be able to share?

What food do you currently feed him and what medications is he currently on? (I apologize for all the questions, it can really help with the advice and answers others can provide)

As for the question of when do you know it's time to let them go... Quality of life is a huge part of the answer in my opinion and when the bad days out number the good ones. That is very simplistic and generic but some place to start.

You may be able to turn a corner with Huxley with the right combo of food and meds. There are several members who have battled IBS with their kitties and were able to provide many quality years to their lives. Hopefully they will see your thread and chime in.

~Tina

 

[maggie101]

My 16 yr old has IBD/PANCREATITUS/LIVER INFLAMMATION. She has been on flavored liquid medacine that I put in her food for over a year she is boney skinny but alive. She will even wrestle with my cats and chase them. She has had a couple of flare ups. My vet gives her a steroid shot when that happens. Last pic is before she was sick. 11 to 5 pds!

 

[valentine319]

So when is it time? For me I've got a really odd sense I know it's coming. I'm not sure it's true with every person. I start mourning because no matter what the vet says I feel something is really wrong.

So if you don't know or are questioning if you're just thinking of it because you see no light? Quality of the cat's life. Are you doing everything you can but the cat is miserable and in pain. The next thing I'm going to say is my personal belief. If you're feeding your cat but ibd is so bad they're actually starving. It's when their body is failing and they are suffering. They can eat but not get any nutrients. Suffering that you can't come up with any solution.

I get being exhausted and seeing no light. I believe the time to end it is when there's very little quality of life left.

 

[huxleysmom]

Thank you for your response. Huxley has IBD, stomatitis (though it is controlled for now), several severe allergies, constipation and now possible pancreatitis.
He is almost 6 years old. I adopted him on New Year's Eve. When I got him, the vet from the shelter thought it was only food allergies, and he had been put on a prescription medication and was fine. I had read on his file that he jad puked a few times and was tested for pancreatitis, but it had come back negative). I was very weary of his health before i adopted him and asked the shelter as well as the vet who had been treating him if he was a healthy cat, and they told me yes. Clearly, he is not. The poor thing.

He is currently on Pred (5mg a day every day), 1/4 Pepcid once a day and Miralax 1/8tsp a day.

He has been experiencing yet another flare up (last one was in June), but this time is doing a lot of lying around on his side, sleeping all day and also going from wanting to be left alone, to wanting to be on my lap all the time.

The vet told me to go up to 1/2 pepcid and add Cerenia too. She said if that wasn't working, we'd try pain meds (can't remember the name). She thinks he could also have pancreatitis.

Thr problem is he has stopped eating and I give him his meds in his food. I cannot pill him. He spits it all back out and then fears me for days.
Because of his mutliple allergies, it has been very hard to find something he can a) eat and b) not have severe allergic reactions to. The only thing I have found is Hound and Gatos pork wet food and Hills Science sensitive stomach dry (though it is full of grains and I would like to wean him off of that if possible).

I have lost count of how many times we have been to the vet, how many combinations and dosage of meds we have tried and it's always the same result. He gets well for a few weeks though we have never managed to get rid of the nausea, then one day the same thing starts again. Worsening of nausea, lethargy, no more eating... he has been maintaining his weight so that's a start. I have also added Slippery Elm and it seemed to help the last couple of days with his constipation, but now he won't eat.
I am going to bring him to the bet again and maybe have them board him. Maybe do the complete blood work they recommended last time and hopefully they can get him past this bump.
I just wonder if this is going to be what his life is like, a few ok weeks followed by a few weeks of pain and misery over and over again, is this really worth it gor him?

First, I'm really sorry that you and Huxley are having to deal with this. From what I understand from your post it sounds like Huxley is suffering with IBD w/ constipation; correct?

How old is Huxley? I read that he's only been with you for 7 months... do you know more about his health history you might be able to share?

What food do you currently feed him and what medications is he currently on? (I apologize for all the questions, it can really help with the advice and answers others can provide)

As for the question of when do you know it's time to let them go... Quality of life is a huge part of the answer in my opinion and when the bad days out number the good ones. That is very simplistic and generic but some place to start.

You may be able to turn a corner with Huxley with the right combo of food and meds. There are several members who have battled IBS with their kitties and were able to provide many quality years to their lives. Hopefully they will see your thread and chime in.

~Tina

 

[huxleysmom]

Thank you. I think that's exactly what I am going through: seeing no light. He is the one in pain right now, but I am the one struggling to keep going.

So when is it time? For me I've got a really odd sense I know it's coming. I'm not sure it's true with every person. I start mourning because no matter what the vet says I feel something is really wrong.

So if you don't know or are questioning if you're just thinking of it because you see no light? Quality of the cat's life. Are you doing everything you can but the cat is miserable and in pain. The next thing I'm going to say is my personal belief. If you're feeding your cat but ibd is so bad they're actually starving. It's when their body is failing and they are suffering. They can eat but not get any nutrients. Suffering that you can't come up with any solution.

I get being exhausted and seeing no light. I believe the time to end it is when there's very little quality of life left.

 

[huxleysmom]

View attachment 191153 View attachment 191153 My 16 yr old has IBD/PANCREATITUS/LIVER INFLAMMATION. She has been on flavored liquid medacine that I put in her food for over a year she is boney skinny but alive. She will even wrestle with my cats and chase them. She has had a couple of flare ups. My vet gives her a steroid shot when that happens. Last pic is before she was sick. 11 to 5 pds!

Poor thing. It looks like she is still enjoying her life though. Huxley is on daily pred, but has been sleeping the majority of the last 3 days. When he is awake, he moves very little, won't play or eat. Just lies there.

 

[babiesmom5]

So when is it time? When you have done everything reasonably possible...and there is no chance of improvement. I'm not sure Huxley is there yet.

To my knowledge, Huxley has a "presumed diagnosis" of IBD, but not a definitive one. In a post back in June, I suggested Huxley get an ultrasound, but you were going abroad soon. Did you get one? If not, I would start there.

A GI Ultrasound can see intestinal thickening...and in what part. It can also reveal fluid accumulation, enlarged lymph nodes, liver, pancreas enlargement, tumors, inflammation and more. While it cannot diagnose like a biopsy, a good radiologist can suggest what is more likely or less likely, thus providing your Vet with important information to develop a treatment plan.

Huxley may well have pancreatitis, no doubt exacerbated by the uncontrolled inflammation. He will probably require hospitalization. If he can be stabilized, a treatment plan to decrease the inflammation will be needed. This usually requires a steroid. Inflammation did not develop overnight, so it will take time to beat back. Vets usually start with a high dose, then scale back to minimal dose required to keep inflammation at bay.

You say you can't pill. Have you tried using a pill gun? I put the steroid (and any other medication) in a #3 chicken flavored capsule and down the hatch it goes. Also, steroids can be compounded into a flavored treat. You can pick chicken, fish, or chicken liver flavor. A 10 mg steroid comes in a very small scored square that you cut in half or quarters depending upon the dose. My cat gobbles it and wants more!

I think the quality of Huxley's life could be improved IF you can get him stabilized and get the raging inflammation under control. IBD can be like a roller coaster, but with proper control, a cat can live a very good quality of life.

I would at least give Huxley a chance. Hopefully suggestions above will help.

 

[maggie101]

If she is given pain meds it is liquid. Much easier. Just squirt it on the side of her mouth. Lying on the side and drooling with eyes partly closed is one sign she's in pain. Also hiding and lying on her tummy stiff

 

[maggie101]

She was never hospitalized. She did have an ultrasound. A biopsy can be fatal for some cats so I skipped that. I give her fruity flavored liquid medacine. A compound pharmacy can flavor it. Pill popper did not work for me. I would have a vet assistant do it

 

[huxleysmom]

What happened when I left certainly didn't help. I think the second woman who was supposed to take care of him at best was not thorough with making sure he got his medicstion and at worse even possibly left him with dry food for an overnight trip somewhere. I was so angry when I come back to find him like that. Worse part is when I asked her what happened, she said all was well when she was here and maybe he is just punishing me for leaving him. I am going to ask the vet today to take him in and do at least the full blood plannel they were tking about. I don't know if they can do the ultrasound there, but I will ask. I know he has not been getting his medicine correctly over the last weeks and that's probably created this situation, or at least not made it any better as he had a flare up in June. However, he has been on steroids (5mg a day ) for months prior to that. Maybe it is not a high enough dose. I'm not sure, but I think it's time for him to be treated at the vets office and have some testing done.
As far as medicating is concerned, Huxley's multiple allergies make it more dofficult as I cannot get them compounded in treats (he doesn't eat treats anyway) or liquid. I could try the pill gun though. Do the pills have to be put in a gel capsule?

So when is it time? When you have done everything reasonably possible...and there is no chance of improvement. I'm not sure Huxley is there yet.

To my knowledge, Huxley has a "presumed diagnosis" of IBD, but not a definitive one. In a post back in June, I suggested Huxley get an ultrasound, but you were going abroad soon. Did you get one? If not, I would start there.

A GI Ultrasound can see intestinal thickening...and in what part. It can also reveal fluid accumulation, enlarged lymph nodes, liver, pancreas enlargement, tumors, inflammation and more. While it cannot diagnose like a biopsy, a good radiologist can suggest what is more likely or less likely, thus providing your Vet with important information to develop a treatment plan.

Huxley may well have pancreatitis, no doubt exacerbated by the uncontrolled inflammation. He will probably require hospitalization. If he can be stabilized, a treatment plan to decrease the inflammation will be needed. This usually requires a steroid. Inflammation did not develop overnight, so it will take time to beat back. Vets usually start with a high dose, then scale back to minimal dose required to keep inflammation at bay.

You say you can't pill. Have you tried using a pill gun? I put the steroid (and any other medication) in a #3 chicken flavored capsule and down the hatch it goes. Also, steroids can be compounded into a flavored treat. You can pick chicken, fish, or chicken liver flavor. A 10 mg steroid comes in a very small scored square that you cut in half or quarters depending upon the dose. My cat gobbles it and wants more!

I think the quality of Huxley's life could be improved IF you can get him stabilized and get the raging inflammation under control. IBD can be like a roller coaster, but with proper control, a cat can live a very good quality of life.

I would at least give Huxley a chance. Hopefully suggestions above will help.

 

[maggie101]

Most vets do not do an ultrasound. An internal medacine doc can. He knows more about the cat's intestines

 

[babiesmom5]

Poor Huxley is in a bad way right now in my opinion largely due to negligent care while you were away. Shame on them! He probably did not get his medication properly, thus allowing the inflammation to flare out of control...possibly causing pancreatitis.

I would definitely get him to the Vet ASAP. Once enzymes escape from the pancreas and begin digesting it (necrotizing) it is like a train heading down the track...hard to stop. Early intervention is essential!

In my opinion, and I am not a Vet, just based on dealing with 5 IBD kitties, 5 mg Prednisolone is not enough at this time. With the inflammation raging out of control, I would predict it is going to take an initial higher dose (perhaps 5 mg twice a day) for a period to get it under control before scaling back. Your Vet can advise.

The pills do not have to be put in a capsule, but I find they slide down easier in one...less likely to stick in the throat or cat to taste them. The #3 Chicken flavored ones I use work well. You might check them out at www.capsuline.com. They are $7.99 for 100 and they ship fast. I also like these capsules because you can put one or more meds in them, especially good if you have to cut a med into halves or quarters with rough edges. I pre-load them so they are ready to go.

 

[huxleysmom]

She better hope I don't bump into her or I may not be able to control myself! I had left specific instructions that if she couldn't handle feeding him or if she noticed he stopped taking his meds, she was to immediately take him to the vet to be boarded. Clearly even that was too much work for her.

Poor Huxley is in a bad way right now in my opinion largely due to negligent care while you were away. Shame on them! He probably did not get his medication properly, thus allowing the inflammation to flare out of control...possibly causing pancreatitis.

I would definitely get him to the Vet ASAP. Once enzymes escape from the pancreas and begin digesting it (necrotizing) it is like a train heading down the track...hard to stop. Early intervention is essential!

In my opinion, and I am not a Vet, just based on dealing with 5 IBD kitties, 5 mg Prednisolone is not enough at this time. With the inflammation raging out of control, I would predict it is going to take an initial higher dose (perhaps 5 mg twice a day) for a period to get it under control before scaling back. Your Vet can advise.

The pills do not have to be put in a capsule, but I find they slide down easier in one...less likely to stick in the throat or cat to taste them. The #3 Chicken flavored ones I use work well. You might check them out at www.capsuline.com. They are $7.99 for 100 and they ship fast. I also like these capsules because you can put one or more meds in them, especially good if you have to cut a med into halves or quarters with rough edges. I pre-load them so they are ready to go.

 

[huxleysmom]

I just heard back from the vet. I am going to bring him in and they will keep him for a few days. They are going to give him sub-q fluids, a steroid shot, pain meds and whatever they feel is necessary to get him over this rough patch. At the same time we'll try to get him on an all wet diet only. I would love to get him off the dry. I'll also make an appointment for an ultra sound with consult to see what is really happening. Hopefully this'll give us answers. I asked the vet if she thought that this was what his life was going to be like from now on and she seems to think tha we should be able to manage it and give him a good life. Hopefully, she is right.

 

[babiesmom5]

I think you are on the right track and it is good the Vet is going to keep Huxley a few days to get him over this temporary rough patch.

Yes, an all wet diet is very important. No dry--only leads to problems. This transition can best be achieved when the cat is feeling well and hungry. To this end, before Huxley is discharged, you might want to inquire about an appetite stimulant, anti-nausea medication and also about upping the steroid dosage. With an all wet diet, it is not as calorically dense as dry food; thus, you have to really push to get required calories in them. AND put lost weight back on them Also with IBD, they have reduced nutrient absorption due to thickening of the intestines. But it CAN be done!

It is good you have made an appointment for an ultrasound. This will be revealing.

I think your Vet was right about Huxley's prognosis.

 

[huxleysmom]

I hope we'll be able to transition him to all wet. He has been very stubborn about it though. He also can't really have big portions in one go and with being out of the house at work for 10 hours a day it may make it difficult, but we'll see what happens. I'll talk to the vet about an appetite stimulant. I just hope they will actually try to do it. When I checked him in, there was no notes about trying to wean him off of dry so they were going to talk to the vet about it to confirm. I'll call tomorrow to confirm they are. She's given him a steroid shot, so i don't know if he'll also be taking pred daily as well on top of that, at least for now. It seems like a lot, but then again I am not a vet. I hope she is right about his prognosis. I am not prepared to give up on him yet. This week has just been emotionally draining, it's not time yet for him, but this is forcing me to think and evaluate what I think quality of life means for him and prepare myself to the fact that one day, and maybe no as far from now as I would want (he is only 6 years old after all and I thought I would have a good 10 years with him at least before having to think about this) I'll have to make that decision for him.

One day at a time for now I guess. First goal: get him past this.

I think you are on the right track and it is good the Vet is going to keep Huxley a few days to get him over this temporary rough patch.

Yes, an all wet diet is very important. No dry--only leads to problems. This transition can best be achieved when the cat is feeling well and hungry. To this end, before Huxley is discharged, you might want to inquire about an appetite stimulant, anti-nausea medication and also about upping the steroid dosage. With an all wet diet, it is not as calorically dense as dry food; thus, you have to really push to get required calories in them. AND put lost weight back on them Also with IBD, they have reduced nutrient absorption due to thickening of the intestines. But it CAN be done!

It is good you have made an appointment for an ultrasound. This will be revealing.

I think your Vet was right about Huxley's prognosis.

 

[huxleysmom]

I got an update from the vet's office just now. He seems to have eaten a good amount today so is getting better. His vet will give me a more detailed update tomorrow and will let me know when I can take him home. Feeling a little relieved.

 

[babiesmom5]

This is a very positive optimistic sign! It's when the Vet does everything to "prop them up" one day, even two days in a row and it does not work. Not good.

Now if Huxley can just continue this upward projectory. Fingers crossed!