Cat near the end. need advice

I know in the end I have to make this decision, but I need some advice for people who have been through this.

My cat Gamos is 20 years old and in renal failure. The vet said not to bother bringing him anymore and that he probably only has a few weeks left and that when he stopped eating it was time. 

Gamos is eating almost nothing, except a little bit of yogurt and wet food. He gets SubQ fluids every night but I can see he is getting worse. He has trouble walking and can't jump. He also barely uses the litter box and often pees on his blanket.. My husband thinks we should send him out on a high note and we agreed to make an appointment for next Sunday (I'm off Friday so I can spend the day with him.)

My issue is that Gamos is still there mentally most of the time. He's very bad in the morning, but in the evening he perks up and even walks around a bit and demands food. 

I keep going back and forth. When he's bad, I'm okay with putting him to sleep but when he's good he's my boy again but I'm at an impasse. I don't want him to suffer, but I can't bare the thought of putting him to sleep before its time. 

Any advice?

My heart goes out to you--you have a very difficult situation to address.  Here's a couple of links to some information, much of it is clinical evaluation. Because no one can tell you when it is time  except for your kitty Gamos- but you have to be very very mindful of what his eyes are telling you as cats are experts at hiding their pain.  I had to say goodbye to my precious girl Tiger a year ago; she had pancreatic cancer. In the end, she appeared to be getting better, but it was more me not being able to see the situation fro what it really was.  On her last day she crawled into my lap for an amazing 2 hour purring session at 4:30AM on a Sunday morning. But when I carried her upstairs to go make her breakfast, her eyes told me she was ready to cross the Rainbow Bridge.  I felt horrible, but rushed her immediately to the ER vet as it was a Sunday morning. A good friend told me that Tiger was waiting for me to be okay with her leaving me.  And at first that made me feel horrible for not recognizing the pain she had to be in, but a year later I know my friend was right. (except for the part about me being "okay with it", I'm still not okay with it but I am forced to accept it. One piece of advice I wish I had listened to was that it is better to say goodbye a day early, than a day too late.  I almost waited until it was too late-  I'm just glad that she didn't pass while she was at home because that to me would have been the absolute worst case scenario.  You and your kitty will be in my heart and prayers.

http://www.lapoflove.com/Pet_Quality_of_Life_Scale.pdf

http://lapoflove.com/Pet_Quality_of_Life_Scale_DrMcVety.pdf

Also, don't miss this excellent post by Gareth in Crossing the Rainbow Bridge:

http://www.thecatsite.com/t/237066/when-the-moment-comes

My heart aches for you.

When there are more bad days than good days. When they do not respond to you and stare off into space. When they no longer do the things that they enjoy.

also I noticed that you are doing subfluids=did they send you home with anything for nausea? That could be why he isn't eating. Ask the vet about Pepcid and Cerenia. they can write you a script and you can either pill or give injections. No this isn't a cure BUT this will keep him more comfortable until its time. Its not fixing the problem but kidney kitties often have upset tummies and want to eat but can't.

Last week we sent our old girl on to the Bridge after a month long illness with cancer and kidney issues. we kept her comfortable with fluids, Cerenia and Pepcid. It really helped keep her comfortable until we had the ultrasound to find out how bad the cancer was, unfortunately we couldn't do any more for her-that night they sent her home with injection of steroids to help pain management as her tumor was wrapped around the adrenal gland and kidney then it branched out into the small and large intestines. Unfortunately all her organs were enlarged/enflamed which explained the no eating for 2 weeks. We just didn't know how bad it was until the ultrasound. The good news is we kept her comfortable while we were trying to figure out what was wrong. I thought it was a bad bout of pancreatitis. But that was only one problem.

I would ask your vet about giving Pepcid for acid and Cerenia for any nausea then you can decide when to send him on.

There is a link that I found helpful that is a rating of each issue. you can go through and see what things are manageable and what isn't to help gage when is it time?

The hardest part for me was she was purring and interacting with us right up to the last moment but I knew the cancer was making her feel so sick and it was just going to get bigger. So after her bugging me and purring and not eating that night-I decided she suffered enough. If it was just kidney issues then that would have been a different treatment plan.

Only you know your cat more than anyone else. If you can feel comfortable medicating and helping your kitty enjoy life then that's what you do until they give you that look. Floey gave me that look the day before during the ultrasound-I saw that look in her eyes after we got the results of all the issues.

See into his eyes and see what you see. I am so sorry you have to make this decision.

http://www.allpetsmacomb.com/qualityoflife.html

All Pets Veterinary Clinic

QUALITY OF LIFE AND THE DECISION TO EUTHANIZE

The decision to pursue additional medical treatments or consider euthanasia for a sick
or chronically ill pet is a hard decision to make for many pet owners. This handout
has been designed to help you consider the quality of life of your pet and to help make
you aware of some of the additional options that exist if it is not the right time for
euthanasia. Answer each of the questions in each section with a yes or no.

PAIN

Pain control is essential. Many animals do not complain in obvious, visible ways
when they hurt. Many animals will hide their discomfort. Consider the following:
____My pet hurts.
____My pet limps. (If it didn�t hurt, they wouldn�t limp.)
____My pet pants frequently, even at rest.
____My pet�s respirations are forced, exaggerated, or otherwise not normal.
____My pet licks repeatedly at one site on his/her body or at a site of a cancer/tumor.
____My pet guards or protects and area of his/her boddy and may snap if that area is
approached or touched.
____My animal�s posture is abnormal or different than normal.
____My pet shakes or trembles sometimes during rest.
____My pet is on pain medication and it doesn�t work.

Possible interventions for yes answers: start pain medication, change pain medications,
combinations of pain medications from different drug classes, surgical intervention,
non-traditional medicine (acupuncture, etc.), treat the underlying disease/condition.


APPETITE

Appetite is one of the most obvious signs of wellness. Most animals are normally
vigorous eaters. Consider the following:
____My pet doesn�t eat his/her normal food anymore.
____My pet picks at his/her food now but never used to do this.
____My pet walks over to his/her food and looks at it but won�t eat or walks away from
the food.
____My pet doesn�t even want �good stuff� (treats, human foods, snacks) anymore.
____My pet acts nauseated or vomits.
____My pet is losing weight.

Possible interventions for yes answers: hand feeding, heating food, adding moisture
by soaking food or using canned varieties, careful addition of human foods, syringe
feeding, stomach tube placement, medications for appetite stimulation, medications
for nausea.


HYDRATION

Hydration status is equally important as appetite. Without adequate water consumption,
your pet can become dehydrated. Dehydration can contribute to weakness and not feeling well.
Consider the following:
____My pet doesn�t drink as much as he/she used to.
____My pet frequently has dry, sticky gums.
____My pet is vomiting or has diarrhea (fluid loss can also contribute to dehydration).

Possible interventions for yes answers: add moisture to the diet, subcutaneous fluid
administration, medications to control vomiting or diarrhea.


HYGIENE

Animals that don�t feel well, especially cats, do not have the energy to maintain
normal hair and skin. Consider the following:
____My cat doesn�t groom herself any more.
____My pets hair is matted, greasy, rough looking, dull, or foul smelling.
____My pet has stool pasted around his/her rectum or in his/her hair.
____My pet smells like urine or has skin irritation from urine.
____My pet has pressure sores/wounds that won�t heal.

Possible interventions for yes answers: regular brushing and grooming, frequent bedding
changes, adequate padding for areas where the pet spends a lot of time, appropriate
wound care, treat the underlying disease/condition.


ACTIVITY/MOBILITY

Changes in normal activity can be due to mobility problems, pain, illness, or aging
(arthritis). Consider the following:
____My pet cannot get up without assistance.
____My pet had a hard time getting around and/or limps.
____My pet lays in one place all day long.
____My pet does not want to play ball, go for walks, or do the things he/she used to do.
____My pet falls frequently.

Possible interventions for yes answers: pain medication addition or adjustment, physical therapy.


HAPPINESS/MENTAL STATUS

Another important area of consideration is the pet�s mental status and happiness. Consider
the following:
____My pet does not express joy and interest in life.
____My pet does not respond to the people that he/she used to respond to.
____My pet does not want to play with toys or do other things that he/she used to enjoy.
____My pet seems dull, not alert, or depressed.


GENERAL BEHAVIOR PATTERNS

Changes in normal behavioral patterns are often a key indicator of how well and animal
feels. Consider the following:
____My pet is hiding or sleeping in odd places.
____My pet doesn�t greet me when I come home and he/she used to.
____My pet is overly clingy and is following me around and he/she never used to do this.
____My other pets are treating this pet differently�they are overly attentive or ignoring
him/her completely.
____My pet doesn�t care about what is going on around him/her.


OWNER PERCEPTIONS

Many times an owner is aware that their pet is suffering but does not want to give up
on their pet. Consider the following:
____I wouldn�t want to live if I were in a similar situation.
____I would be painful if I were in a similar situation.
____I have made appointments for euthanasia for this pet cancelled or didn�t show up.
____I am holding onto this pet for some sentimental reason. (ex. the pet belonged to
a now deceased family member, the pet helped me through a hard time in my life, etc.)
____ My pet is having more bad days than good days.


Count the number of yes and no answers that you have marked. ____Yes ____No

Unfortunately, there isn�t a simple point system or scale that will tell you exactly
what do for your pet. However, the more yes answers you have, the more likely it is
that your pet has a poor quality of life. This list has been significantly expanded
and altered from an article on quality of life. The original scale uses 50% as a cutoff.
If this information is extrapolated, it would imply that more than 21 yes answers means
your pet has a diminished quality of life. If this is the case, you have two options:
1. Make major changes to try to improve your pet�s quality of life (like some of the
things listed above) or 2. Euthanize your pet to relieve his/her suffering.

Please do not hesitate to contact us to further discuss this handout and your pet�s
specific situation.


The information provided is for educational purposes only and is not
intended to take the place of your regular veterinarian. Please do not hesitate
to contact your regular veterinarian if you have questions regarding your pet.


Very loosely adapted from Quality of Life Scale, Veterinary Practice News, June 2006, pg. 24.

I just want to tell you how sorry I am. Our sweet baby Francie is only six but we are struggling with putting her to sleep after continual reoccurrence of chyle in her lungs and the possibility of developing fibrosis in the lungs.

I used to facilitate a support group for people who has lost their pets.  I heard many stories over the years, most were wonderful, filled with love to warm the heart.  There was one story that still haunts me; a woman who obviously waited too long, she could not let go, and I think her vet did her and her cat a huge disservice to not let her know that perhaps it was time.  In the end, she waited too long.

It is better to make a thoughtful decision,than to make one in a crisis.  That would not be good for you, or for Gamos.  I think about  how I want to leave this life; peacefully, being held by those I love and who love me.

*PRAYERS*  I have been in this situation with loved ones many, many times, as recently as on 29 June, when we said goodbye to our beloved Rani, who was 19 years and almost 2 months.  In my opinion, this is a deeply personal decision and I do not believe anyone is truly qualified to tell you what to do, except your CAT.  It is said that cats will let their caregivers know when it is time for them to leave, and I have had this happen before.  As to what to do, that, too, is an entirely personal decision and not one to be made lightly; I would suggest sitting quietly with your cat and letting any messages come through intuitively.  Hopefully you understand and can agree with this.