Senior cat, is it time?

I am the proud momma to an 18 year old tabby cat named Skunk.  He has FIV, diabetes, and was recently diagnosed with advanced chronic kidney disease.  The disease can be managed, and some cats can live for years with it.  I've been trying everything I can.  I give him 60 mlsubcutaneous fluids twice a day, and am giving him a B12 and iron supplement, maralax for the constipation and a phosphorous binder since he refuses to eat a kidney healthy diet.  He is super picky so I can't add anything to his food or he won't eat it, so I've been mixing his powdered medicines with water or chicken broth and syringing them in his mouth.  He will only eat Friskies canned food, but even then, he only eats a tablespoon or two at a time, if at all.  His latest labs show he is pretty anemic and it doesn't appear his body is even trying to make new red blood cells.  My vet recommends a blood transfusion and ESAs, but he doesn't do it.  He referred me to a specialist, but the costs are at minimum $700 to $800.  No matter how creative I am with it, my budget just doesn't have it.  Skunk is pretty unhappy with the fluids and medicines.  He only gets up to drink water or go to the bathroom, and pretty much stays in one spot 24/7, except when I put him on my lap.  He used to be a chin snuggler but refuses to do that now.  He will very quietly purr sometimes when I'm petting him.  His current qualify of life is not good, but I keep thinking there's hope if I can just find the right combination of medicines.  The kidneys do so much that there are so many things to always be watching for (potassium, calcium, sodium, phosphorous, anemia, constipation, nausea, loss of appetite, dehydration, BUN, creatanine, etc.)  But there's also the part of me that says it's time to let go, that all I'm doing is torturing my poor sweet cat.  I don't know what to do so really, I'm just asking for thoughts from others.  What would you do?

I'm meeting with my vet in the morning to discuss next steps so any thoughts are welcome.

Hi S skunksmom Sorry that no one has replied yet. This is always such a hard subject and quality of life is what we want for our loving companions. I'm glad that you are consulting with your vet tomorrow but also trust yourself on this. You know your kitty the best and if you feel like your sweet baby has potential for more good quality life then see what the options are. I know someone wise on TCS said something to the effect of are we prolonging our cats life or prolonging their death. A good question to be included with others when thinking about the end of life pet care.

to you for having to go through this! We are glad you are here and this community is so supportive and loving that you will have a shoulder to cry on and an ear to listen to whatever decision you make.

-Tina

i can only tell you what i would do and i would make that final appointment. to me, quality of life trumps quantity anyday. i've been a nurse a very long time and i've seen people kept alive because their families couldn't let them go--even if it was against their wishes and i just hope that never happens to me. your cat has very little, if any, quality of life and at 18 it's a very slim chance it will get better. i would give him that final act of love and kindness.

This is always a tough thing to think about.  I just recently lost a kidney cat, after three years of poking and proding her, giving her Pepcid A/C for acid issues, Mirtazipine for her appetite, Sub-q fluids, begging her to eat, trying every wet food known to man, etc.  I fed her 7 - 9 times a day as she would eat a very small amount at each sitting.  Believe me, I know where you are coming from, except my girl didn't have FIV or diabetes.

There were times when my hubby and I though we should let her go, then she would rally and we'd think..."no, not yet".  But you have to ask yourself, does your old guy have more bad days than good?  When that happens, then it's time to think about letting him go, for sure.  The greatest gift you can gift is releasing them if they are suffering. 

Here is a quality of life scale that may help in your decision:  http://www.allpetsmacomb.com/qualityoflife.html

One thing that my hubby and I found helpful was to actually write things out. Make a list of all the things your cat enjoys that are important to his quality of life. Then make a list of the things he can no longer do. Sometimes seeing things written down makes them clearer then trying to think them through in your head. We did this when we were struggling with the decision for one of our cats years ago.

You know Skunk the best and you will know when it is time even though no one is ever ready to say goodbye. I am sorry you are faced with making this difficult decision.

Hi SkunksMom and welcome to the forum !

How fortunate both of you are...Skunk, to have coped with three major chronic conditions, any one of which, alone, might have taken him years ago, yet he has reached the age of 18 - and you, to have been able to successfully manage all of those complications.

I'm not long away from a ~6 month period when I provided palliative care to one of my cats, so I can empathize with some of what you're dealing with.

If I were to try to put myself in your shoes, I'd base my decision (to pursue treatment or to release him) on the cat's quality of life before he developed anemia. You are the only one who is able to and has a right to determine that. If you could eliminate the anemia, turn the clock back so-to-speak, would you be comfortable allowing him to carry on as he was back then? (I did not consider/include the daily meds routines - which nobody likes - when I was making my own QOL assessments - these were the small price we both paid for an otherwise good life.) From my understanding of both transfusions and treating with ESAs, these are not at all difficult for the cat.

On pursuing treatments, the first thing that hits me is that it's not necessary to use a Veterinary specialist for transfusions nor ESAs....so, because cost is the first hurdle/consideration, I would be searching for the less expensive option:  a competent (preferably feline) Veterinarian who is experienced with and can provide these services. I think I'd start by looking for a cat-only clinic, and I would want a seasoned Veterinarian....owners of such clinics usually fall into that category. There you could get a cost estimate for initial exam, a transfusion and starting you off with the first drug dosings. You can give the subsequent doses yourself but there will be periodic bloodwork costs. A 'ballpark' cost estimate should not be difficult to assemble. (One of the ESAs is fairly expensive - there are ways to minimize it -  the others not so much)

There's a very good CKD online community that could help get you through these new treatments.

In the meantime, there are some things that can be done to keep him comfortable, at the very bottom of this page: http://felinecrf.org/anaemia.htm#anaemia_treatments

If you want reliable, plain-English information on ESAs, try this: http://felinecrf.org/esas.htm

The online group is here: https://tanyackd.groups.io/g/support

I hope something there may help.

Thanks for all your replies.  The CKD online community is fantastic with so much information.  I have spent a lot of time today calling around to area vets to try to find one who does blood transfusions and/or has CKD experience but have come up empty.  I live in a pretty rural area so have an abundance of general veterinary practices, but nothing covering this apparently.  My appt with my vet is at 3:30 today.  Skunk is getting worse by day so we either have to turn it around right away, or it's time to let him go.  I can't keep making him suffer while I hope to find the magic solution, and can't remember the last time he had a good day.  

SkunksMom said:

 
Thanks for all your replies.  The CKD online community is fantastic with so much information.  I have spent a lot of time today calling around to area vets to try to find one who does blood transfusions and/or has CKD experience but have come up empty.  I live in a pretty rural area so have an abundance of general veterinary practices, but nothing covering this apparently.  My appt with my vet is at 3:30 today.  Skunk is getting worse by day so we either have to turn it around right away, or it's time to let him go.  I can't keep making him suffer while I hope to find the magic solution, and can't remember the last time he had a good day.  

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Sweetie, if you cannot remember the last time he had a good day, I think you have your answer.  It is utterly heartbreaking, but such an act of love to take away their suffering.  I am not trying to dash any hope and perhaps your vet will have another option, but Skunk may be letting you know his little body is worn out.  Whatever you decide, you have our support.  Big hug and a kiss on Skunk's little head.  So sorry!

I think the most loving promise we make to our pets is the commitment to give them not only a good life, but also a good death, no matter how much it breaks our hearts. Deciding when or if it's time is, in my opinion, the single most difficult part of sharing a life with a cat. Whatever the outcome, you're in the thick of that decision right now, and it's horrible and painful. It's clear you love your little guy dearly, and my heart goes out to you as you navigate the process.

I'm making one last effort to try to get a good combination together.  If it doesn't work, then I'll let him go.  We're adding B12 shots that I can give him at home for his anemia, and adding an appetite stimulant, an antacid, and switching out his phosphorous binder to one without calcium.  He still turns up his nose at anything besides friskies shreds with gravy, but I want to try other foods anyway since they're not the healthiest for him.  Anyone have any suggestions?  He really doesn't like pate. 

SkunksMom said:

 
I'm making one last effort to try to get a good combination together.  If it doesn't work, then I'll let him go.  We're adding B12 shots that I can give him at home for his anemia, and adding an appetite stimulant, an antacid, and switching out his phosphorous binder to one without calcium.  He still turns up his nose at anything besides friskies shreds with gravy, but I want to try other foods anyway since they're not the healthiest for him.  Anyone have any suggestions?  He really doesn't like pate. 

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Honey, right now, I would think that whatever he will eat is the healthiest thing for him.  If he bounces back, then you can make dietary decisions.  Just my two cents, and I am overjoyed that your vet came up with other options!  Go Skunk!  Very happy for you and Skunk both, and I pray this will help him live many more years.

Oh, I'm definitely not taking his friskies away!  Just going to offer a variety to see if anything else catches his attention.  Any food is better than none at this point!

I would be shocked if there is a person on this site who hasn't done the food shuffling routine.  They can be SO picky!  And they don't seem to like the foods that are best for them.  I can't tell you the countless dollars I've wasted on very expensive foods.  They'd rather go hungry.  I feed wet food, and I feed grain-free and that's about as good as it gets so far.  If Skunk doesn't like pate and he's eating Friskies with gravy anyway, he would probably like the Fancy Feast with gravy.  That's like kitty crack.  The gravy versions contain wheat gluten, but so does Friskies, and Fancy Feastt would offer him more flavor options.  Sometimes just getting actual food into them is a major achievement.  I so hope that he starts eating and enjoying it and bounces back quickly.  This little guy will be in my prayers.  

Towards the end, one of the only things I could tempt my cat with was chicken livers. She loved them. We would buy them frozen in a little box from the grocery store and I would parcel them out into an ice cube tray. I'm not sure how much you want to mess with Skunk's diet, but if you're looking for alternatives, it's worth a try. Please know, though, that this was over ten years ago, before I knew anything about feeding raw food to cats, and I have no idea whether offering chicken livers is medically advisable. And giving too many at a time resulted in diarrhea for my kitty.

She also would sometimes eat baby food chicken -- the pureed stuff. She was very partial to Gerber's, as I recall.

I've got my fingers crossed for you guys!

Sirentist said:

 
Towards the end, one of the only things I could tempt my cat with was chicken livers. She loved them.........giving too many at a time resulted in diarrhea for my kitty.

I have no idea whether offering chicken livers is medically advisable

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I really value the Tanya's CKD site. I almost always refer to it as 'The Oracle of all-things-kidney cat'. Well, 'The Oracle' speaks about chicken livers, too:

 Bacteria thrive on iron. Therefore if a cat has an infection or inflammation, the cat's body will sequester iron (i.e. iron is stored away rather than released into the bloodstream) so as not to feed the bacteria. This means that the cat's body will be unable to use any iron you give. In most cases, the infection or inflammation will only be short-term, and the cat will be able to manage without a supplement. Sequestering does not happen with heme iron (iron from meat), so if your cat definitely needs iron, you could ask your vet about feeding a small amount of chicken liver (one or two tablespoons, once or twice a week). Most cats seem to like liver, and although you should not give liver too often or in large quantities because it contains very high levels of Vitamin A and is also high in phosphorus, the above dosage should be safe, but do discuss with your vet.

http://www.felinecrf.org/anaemia.htm#iron_supplements

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Who knew there is iron.....but....there's also heme iron ?

I gave Skunk his B12 shot and the appetite stimulant, and he is eating like crazy!  He's also talking to me again, and loving on me!  Plus, for the first time in weeks, he is leaving his spot in front of the window and walking around, other than to water or the litter box.  It is a very remarkable improvement.  I'm trying not to get my hopes up, but I am happy to see all this!

White Shadow said:

 
I really value the Tanya's CKD site. I almost always refer to it as 'The Oracle of all-things-kidney cat'. Well, 'The Oracle' speaks about chicken livers, too:

Who knew there is iron.....but....there's also heme iron ?

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I know, I had no idea!  I looked for chicken livers at my local grocery store, but they only had beef livers.  I'll have to broaden my search.

SkunksMom said:

 
I gave Skunk his B12 shot and the appetite stimulant, and he is eating like crazy!  He's also talking to me again, and loving on me!  Plus, for the first time in weeks, he is leaving his spot in front of the window and walking around, other than to water or the litter box.  It is a very remarkable improvement.  I'm trying not to get my hopes up, but I am happy to see all this!

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This is GREAT news!  And absolutely amazing considering how he was before the vet visit.  I am SO happy about this.  For an 18-year-old boy with the health problems he has, this is nothing short of a miracle.  

If there are any asian markets near you they should sell chicken livers hearts and all that good stuff lol. Goodluck