Help on chronic disease in elderly kitty

I am feeling very stressed from my 15 y.o. kitty's chronic illnesses.   I request your support.

My kitty Blue developed IBS a year or so ago.  It has by now progressed to pancreatitis.  The last few days I have been wondering if now we are moving into senility territory, or drug reactions.

Her meds are prednisone for the last year.  Recently the vet added weekly B12 shots, twice/day antibiotic, and an every other day anti-emetic.  The vet also tried to show me how to give her hydration by i.v. to be done if she quit eating.  By the size of that needle, I didn't want to do it, although giving B12 shots is easy (much smaller needle).   So I have decided that if she needs i.v. hydration (stops eating for 2 days) I will take her to the vet.  Maybe I'll eventually learn how to do it, but it scares me.

Three days ago I was petting her alot because that seems the only activity that she is interested in any more.  I guess I forgot about the over-stimulation thing, or the fact that I was petting her tummy.  Suddenly, she got agressive, even violent.  I backed off some 4 feet and she was so irate/agitated that she came running across the room and bit my ankle!  I was so shocked!  She had never, ever attacked me.  We had a deeply close relationship until the last few weeks.  I had always been 150% kind to her (except giving her her meds, which she hated).   I was so shocked I cried for an hr.  Now I'm so afraid she will lash out at me at any moment.

Although I have had a lot of contemplation over the whole thing and realize she is ill and that aggression is a sign of illness, or at the worst, just frustration over pills being poked and squirted at her every day, it still really hurt that she would attack me viciously.  

Meanwhile, I asked myself what all this is teaching me (my religion is reincarnation) and I felt that I am learning about caretaking the deeply ill and I am learning about service, and that is my attitude: I am her caretaker...my job is to take the very best care of her, selflessly.  This is my journey right now and my job is to meet the challenge.

Anyhow, today was Saturday and I was home observing her deeply.  She did not sleep a wink the whole day, but just stared sadly into space.  A couple of times I saw her stretch and roll like a normal cat.  She got up and ate and walked around.  She purred when petted, but mainly she just sat in her cat bed and stared at me, at nothing, the whole day long.  I had her on a pain oral injection today because I am wondering if she is in a lot of pain and maybe the pain meds will help.  My impression is it is helping.

She just now walked into the room and licked her paw.   So she is not ready to go yet, but she sure seems unhappy, and I even wonder if she is becoming senile because I feel like I have lost the emotional connection we had...it is like she is not really there anymore or we are not connecting anymore.  We were once so close, such soul mates.

This is so hard.  It is stressing me out.

I'm trying to emotionally remove myself in sort of a clinical manner.  I think I am too emotionally involved.  I know this is what medical professionals have to do.  I'm not having much luck, so I came here for support.

Of course I have started the thoughts about putting her down, but I think we're not there yet.  The vet told me she is not dying.  But she said that before the senility symptoms appeared.  I guess I need to tell the vet the latest developments.

Anyhow, any thoughts or advice anyone has will be appreciated.

I am so sorry to hear that you and Blue are going through difficult times. It sounds like she is receiving good care. Everything you mention is very common for those diseases. I think you are talking about giving subcutaneous fluids at home. Some members here have done it regularly for their cats as well, and there are some tips for making it easier on the both of you. It really doesn't have to be as bad as you fear. I will try to find those references for you.

As for the aggression, it may have been a sign of pain since pancreatitis is known to be painful I hope the pain med (sounds like buprenex?) will help. Being a caretaker of an ill pet is very emotionally draining and can be physically exhausting, so please make sure you are taking care of yourself as well. Many hugs for you and many healing vibes for Blue.

Thanks so much Bval.   This is so hard, I needed to vent.   I take your point that I need to take care of me too.  

Thanks for listening and responding.  This all makes me realize I need to talk to the vet some more about all these concerns.  I don't want to inflict my pain onto all of you....I guess I just reached one of those points of desperation, but as we all know, you pull yourself together and carry on.

When you mention that she is not herself, she just stares into space, no connection with you right now, could that be the pain meds effecting her?  When I take pain meds, I get kind of "spacey".  Maybe she really isn't "there".  I don't know what medication she is on, but it could very well be effecting her that way

As far as the attack on you,  how has she been since?  Did she seem to regret what she did?  Did she immediately try to make up to you?  she hasn't attached you since, has she? 

Some symptoms of senility are a lack of grooming, disorientation, loss of hunger, loss of bowel function, and increased irritability.  Does she display these symptoms?  (other than the irritability, which can certainly be explained with all the pilling and whatnot, as you mentioned)

It is definitely difficult when you have a chronically ill senior cat.  I had a kidney cat who passed away last year.  He had kidney disease for 3 years, and for those 3 years I was his nurse, and we did give him his sub-q fluids at home (luckily, my hubby WAS an ER nurse, so he was pretty familiar with needles  and IV set-ups, etc., but he was still frantic about sticking our furbaby with one)  Anyway, one day when I was begging Sven to eat, he finally just turned his back on me, and I looked deep into his eyes and asked if this was the day he wanted to leave us, and he started to purr extremely loud, and I knew he was talking to me and telling me "yes".  All the previous times when I asked him that, he would dig into his food as  his way of telling me he wasn't quite ready   Not sure why I am telling you this...guess just letting you know that since you two were once so close, you may be able to connect again.  Just talk to her, she may talk right back to you and tell you what she wants. 

Don't forget to really take care of the cat bite too.  I think the statistics are 100% infection for cat bites on humans .  My hubby ended up the hospital for 5 days from a cat bite from one of our other cats when he accidentally grabbed her as she was making a run for it out the back door (once a feral, always a feral I guess )

I, too, wonder if the pain meds are just making her zone out. The aggression could be from one of several things, from being sick to not enjoying being medicated. The few times I have dealt with ill kitties, none of them were aggressive. They didn't have the energy to be aggressive, so I guess it's at least good your kitty has the strength to attack. My male kitty that I had to put down earlier this year was not aggressive toward me, but he completely gave mt the cold shoulder for his last few days of life. He just laid in his kitty bed day and night, not moving...unless I petted him for too long, in which case he took two or three steps and laid back down on the floor. It was tough because he was always an affectionate kitty and while I knew he was avoiding me because he was sick, it was impossible to not get emotional over it.
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But the difference is my kitty was dying from end stage cancer and yours, while in the throes of chronic illness, does not seem to be at death's door. Has Blue been acting continuously aggressive since that first incident, or was that a one-time thing? Maybe she was just in a foul mood. My Kippy gets overstimulated very easily and he'll bite and scratch and hiss when he's had enough physical contact...but since he has no front teeth, his bites don't do any damage. Nonetheless, it sounds like you are providing Blue with wonderful care and our kitties will let us know when they are ready to leave us. Blue sounds cranky, but also sounds like she has some spunk left. If she purrs when you pet her, I think that's a good sign - a cat that is done living will not purr or roll around or groom itself. I think all I can suggest is to keep doing what you're doing, pet and snuggle with Blue when she will allow it, and stay in contact with your vet in case something changes.

I am so sorry to read of your recent experience and concerns for Blue.

If Blue's sudden aggression was a one off incident and has not occurred again I am thinking it was most likely due to sudden pain, and she was probably as shocked and frightened by what she did as you were.  It is also very difficult to sustain a close and trusting bond with a cat when you are having to so regularly medicate and impose unpleasant / painful procedures on them and I am sure that what ever the cause of the recent incident this will not help either of you.  If you have noticed other significant changes in her personality that would not be easily and consistently be explained by her known health issues or her medication (esp the pain meds) then it would be useful to document these and describe thoroughly to your vet so they can think about whether there is something else going on.  You did not say whether your skin was broken in the attack but if it was I share the concerns of your other posters and hope that you have sought attention for this as cat bites are very likely to become seriously infected. (It is usually pretty obvious shortly afterwards though).

 I lost 2 elderly cats, one 7 years ago at almost 18, and the other 3 years ago aged nearly 22.  I had wondered if both of them had started to develop dementia before I made the decision it was time for them to leave me.  As they aged they both developed increased dependency behaviours, seeking reassurance and  'crying' when they didn't know where I was.  The older sister also became quite scruffy looking and didn't groom much but as she was very arthritic I figured it was more due to her pain and limited range of movement. On further observation in fact they had both gradually become blind: they were still very good at navigating around their home as long as everything was tidy and in its place. What then persuaded me they were both still alert was that they did learn new arrangements very quickly and still coped with little changes without distress.  

The sister I parted from first had chronic bladder inflammation but suddenly became what I can only describe as 'switched off' one day. It was very dramatic as one moment she was running about and climbing on the furniture and the next she was lying on the sofa just staring in  to space and not responding to me touching her, didn't seem to know how to move or anything. She was very passive and not distressed though which was good.  (She was vet phobic and didn't go there unless she was critically ill). She couldn't stand up or anything. When I finally got her to an experienced vet 3 days later (it was Christmas & limited cover) they said she had little tumours all over her retinas and she probably had tumours in her brain with one suddenly pressing on a significant part of her brain - shutting her down other than very basic body functions.  I do not think this is what you are seeing in Blue - it was very obvious my little cat was no longer in her body.

The sister that stayed with me for another 4 years was frail but tolerated her pain and limited movements well. She let me know when she was ready to go after her mobility deteriorated so much it was difficult for her to balance and walk without her sight. She looked so tired and sad, and everything looked like such an effort for her. Her cattitude had gone. Once I had called the vet she just wanted to be with me gently stroking her and I am sure she knew that I had arranged to take her for our goodbyes at that point.  

I hope you are able to have a positive discussion with your vet and that they know both of you well so they can help you in your decisions, undertake any examinations you all agree necessary, and to find a way to support you in what ever decisions are made. Most of all I hope you feel you are able to feel a return of that emotional connection - her spirit will be there somewhere just waiting for you to feel where.

Oh thank you all so much for your support.  You cat-moms/dads are the most caring people!

To answer you all at once, yes, it was the buprenorphine not senility!   Because today I gave her none and she's back to her old sweet self.  And I am being careful not to touch her tummy.   I do believe now that I hurt the pancreas when I rubbed her tummy.  Somewhere on the internet is a picture of an inflamed feline pancreas and it looks terrible...bright red and inflamed.  I asked my vet if that is what they really look like and she said yes....so no wonder she is in pain.   I tried to relieve the pain by giving her the buprenorphine but apparently it was too much, and apparently she had what you call a parodoxical reaction....the exact opposite reaction that most creatures get.  While most of us get sedated by opioids, some individuals get the opposite.  Blue got absolute insomnia and agitation and restlessness.

Yes, these kinds of chronic illnesses are very stressful for the caretaker.  I have been her nurse for over a year and I have a full time job and other things going on, and so it is stressful.  Also I am very sensitive and feel like she is the best friend I ever had so it breaks my heart to go through this.

I did some meditation today for stress-relief and also had dinner with friends who have pets and discussed it with them.  I realize too, that some things we can help with, but not control, and so you hand over what you cannot control to a higher power.

I will call the vet on Monday to see what she thinks of all this.  My friends suggested there might be another pain-killer that will work better with her.  I am also being very careful to watch for over-stimulation....to pet her gently and for short periods and avoid the tummy area.  

She only attacked me that one time, which was 3 days ago.  She did "apologize" in a cat way...come to me for affection and lick me and so forth.  I actually was very hurt (emotionally) for 24 hrs, when I have bent over backwards for a year to be a good nursemaid, but I got over it and so we "made up."  I certainly do sympathize with her that she hates my giving her pills but I do it anyway.  There's just a scratch where she bit me, so that's ok, but believe me she scared the **** out of me at the time, because she came at me like a mountain lion whose cubs were in danger!

Now I think she is NOT senile, just a chronically ill kitty.  It's the up and down of IBS and pancreatitis that gets me.  I have heard others say it about these 2 disease:  they are horrible diseases, shape-shifting diseases.  They keep you on edge because you never know what symptom is next, or whether the cat goes into remission for awhile.

The vet says I only need to do sub-q if she stops eating for 2 days.  No problem there...she is eating daily.  The vet told me she is NOT near death, but I still often think I will walk in on a dead or dying cat, because my last cat died very suddenly and I think I have a kind of PTSD from the last cat's death.  This is my last cat.  I am 64 and it is hard enough taking care of my own stuff.  I can't imagine going through this again in 15 years when I am 80.

But I LOVE cats, so may become a foster cat-mom for the shelters to get my cat fix until I am too old to manage elder cat care.

Thanks MrsGreenJeans...I liked your story...it sure is hard to know when the time has come.  We are not there yet at all, but I just hate to think she's in pain.

RuneKeeper, I think you are right: there's alot of life yet left in Blue.  I just have to manage my feeling of stress from it all, so I can hang in here with her through the end.

Thanks MServant for telling me your stories.  Very interesting.  I now think Blue is not senile, but just suffering sometimes.  Her mood and behavior changes quite a bit during the course of the day and day to day.

Today she is back to her old loving self and I saw her sleeping finally.  I was gone most of the day to see friends and I am glad...I needed a break and some relaxation from care taking.  

Although it is not good that Blue is in such pain I am relieved that you have concluded her changes the other day were related to her medication, and that you are looking in to possible alternative medications to help her. I hope you are both recovering and restoring your relationship with plenty of pampering. And of course your pampering includes being kind to yourself and making the most of outings with friends.    

Hi bluesmom and welcome to TCS !

bluesmom said:

I will call the vet on Monday to see what she thinks of all this.  My friends suggested there might be another pain-killer that will work better with her.

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That 'other painkiller' comment is one that rang the alarm bells with me.......

There is another class of drug that has been around for some time in cat medicine.....that has proven to be very dangerous and harmful to cats....and, yet, is often prescribed.

It is the Non-Steroidal Anti-Inflammatory, or NSAID.

Now, because you're a nurse in the human medicine field, I'm sure you're aware of NSAIDs.

What you may not know, is that cats, unlike humans (and, even other mammals) CAN NOT METABOLIZE NSAIDs. Cats have not evolved with the necessary liver enzymes to process them.*

So, NSAIDs go directly into the bloodstream and are filtered by the kidneys...AND they are nephrotoxic - they destroy kidney cells.

On top of this, it takes a lengthy period of time for NSAIDs to be cleared from a cat's system, so the drug continues to circulate and continues to do its damage. (Cats poisoned by NSAIDs require 4-5+ days on IV drip to completely clear the drug.)

Again, because you're a nurse, you're going to understand (better than the average person) that a cat who is 15 will already have expended a good part of her reserve kidney capacity, those nephrons 'waiting in the wings', ready to be called to action when needed.**

The most common Veterinary NSAID for cats is meloxicam ("Metacam", or other -coms or -cams) and it's available in both oral and injectible forms. The newest product in this class is "Onsior".

Many people have had the messages "NO Metacam - No Other NSAID" put on/into their cats' Vet files.

Besides buprenorphine, there are two other safe pain meds for cats that I'm aware of and have 'seen' used. And, like bup, both are opiods: Tramadol, in tablet form and Fenatyl, a "pain patch". Buprenorphine seems to be the simplest.

If she appears 'zoned out', you can certainly titrate the dosage. I usually use less than prescribed. I find it's effective about six hours.

I suspect that the aggression you had from her was a one-time incident - and I think you've pinpointed the triggers for that.

There is a specialized online group for people with cats with pancreatitis. They have been around for many years and will be on top of current treatments. From my experience with other such groups, I believe that I'd be a member there if I were in your position. You'll find them here: Feline Pancreatitis Support    Just click on the purple +Join Group button

Hope something there may help!

*   Quote:

Cats have a deficiency certain enzymes, glucuronyl transferases, which are responsible for glucuronidation, and hence their reduced ability to metabolise certain drugs such as aspirin, benzoic acid, serotonin^[5], acetaminophen (paracetamol)^[6] and meloxicam

http://vetbook.org/wiki/cat/index.php/Glucuronidation

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**   Quote:

...kidney failure develops more slowly, usually in older cats, and is the result of the gradual loss of nephrons, the functional unit of the kidney (healthy cat kidneys have hundreds of thousands of them).

Nephrons can’t regenerate themselves. Once one is damaged and no longer working, it is gone forever and can’t be replaced. Many things cause the loss of nephrons: a bout of acute kidney failure can knock out a whole bunch at one time, but everyday wear and tear builds up too. Some cats may also be born with fewer nephrons than is normal. So you can see how over time a cat could essentially "run out" of nephrons.

http://www.petmd.com/blogs/thedaily...idney_disease_a_vets_perspective#.Uhj6Kn-tIuc
 

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Here are a couple of optios to consider:
1) Accupunture for pets; and/or
2) electromagnetic therapy - just recommended by the vet who doea accupunture to avoid heavy pain killers and their effects -- seems to be helping - just recently started.

I found accupunture for my cat very helpful.

Good luck..you are both starting on a rough journey together--- .listen to each other and at times just look into your kitty's eyes and tell how much you care..no words needed..find your path and be brave..she will need you to be..and you will find your way by looking at het.