15 year old cat developing numerous health problems. Concerned for quality of life. Time to let her rest?

[impacted]

My 15 year old cat has been developing numerous health problems over the last few years. After each of these procedures, she bounces back, but this year it seems like something is coming up every few months. I'm starting to really question her quality of life.

Sept 2020 - Dental cleaning & extractions

Oct 2021 - Abdominal obstruction removed

Aug 2022 - Diagnosed diabetic. I work remotely, test often, and got her regulated with the help of online communities. Takes 9 unit of insulin to regulate her compared to most cats needing just 1 or 2 units. The very high dosage indicates acromegaly which can lead to enlarged organs.

February 2023 - Constipated. 4 enemas do not work. Takes 2 sessions of being knocked out and manual extraction. Doctor prescribes Miralax (stool softener) and Cisapride (stimulates colon movement). She pukes up the Cisapride but I get her regulated with Miralax and pumpkin puree.

May 2023 - Starts straining to pee randomly. Goes to box numerous times within a short time and only dribbles come out. Sometimes it's blood tinged. The vet rules out UTI, prescribes an anti biotic anyways, and says it's likely idiopathic cystitis. This continues randomly on and off.

September 2023 - Vomits for hours and stops eating for a week. Vet says XRays show thickened intestines but no blockage. We determine she is not able to tolerate Miralax anymore. Even minimal doses every few days trigger a negative response. Take her off of Miralax and her pooping patterns normal. Additionally, doctor says her kidney values are highly elevated but does not expand on what this means. I'm assuming early kidney disease?

November 2023 - Gets constipated out of nowhere over the course of a week. Enema didn't work and vet wants to conduct another manual extraction under anesthesia. Hasn't eaten much over the week until appetite stimulant administered.

Am I heartless for wanting to cancel the manual extraction and finally put her to rest instead? The money is not an issue. While constipation is treatable, I truly am concerned about her quality of life. I pay for this procedure and then it's a few weeks of feeling good before weeks of sickness. It seems like it's getting to the point where she is having more bad than good days. In addition, over the last year, she is no longer able to groom well and doesn't tolerate my brushing her well. She has to receive gabapentin and a shave because she get mats that smell like death. Part of me is doubting this is the right call because she's still out socializing, watches the birds some, and has an okay appetite overall.

 

[Furballsmom]

Hello, I read through your post twice, and I see your point. Things are rough for her and don't seem to be improving to any large degree or for any great length of time now.

Am I heartless for wanting to cancel the manual extraction and finally put her to rest instead?

I don't know if this article below will help or make much difference, but to answer your question, no, I don't think you are heartless, in fact quite the opposite.

When Is It Time?: Making The Difficult Decision On Euthanasia - TheCatSite

 

[FeebysOwner]

Hi. There is a good possibility that many of her issues could be tied to kidney disease. Find out what her kidney numbers are so you know how highly elevated they are. Kidney disease can attribute to constipation and present urinary tract issues too - dehydration being the primary reason. Dehydration, along with kidney disease, and what sounds like an irritated bowel (intestinal wall thickening) could also be behind her vomiting.

What kind of diet is she on?
What do you mean by Miralax triggering a negative response when given every few days?
Has the vet offered another diabetic treatment that might be more successful? There is more than one option.

Disclaimer: I have a 19+yo cat with multiple health issues and even though she gets around less than your cat, I will continue to treat her in whatever manner that I can because I see interest in her to continue to live. Your cat sounds even more so interested than mine. So, that is where my head is at, just so you know.

Have you ever considered having your cat seen by a specialty group - one that has internal med vets along with specialists in areas such as endocrinology? They might be able to offer some ideas that a general vet cannot. Any tests and vet notes can be shared with them to help reduce redundant costs. I guess, if it were me, I would go down this route to see what they have to offer before you make your final decision.

 

[impacted]

Dehydration, along with kidney disease, and what sounds like an irritated bowel (intestinal wall thickening) could also be behind her vomiting.

What do you mean by Miralax triggering a negative response when given every few days?

She is only vomiting when Miralax is administered, even if it's a small dose every few days instead of daily

 

[impacted]

What kind of diet is she on?

Purina Beyond pate. It's low carb wet food.

Has the vet offered another diabetic treatment that might be more successful? There is more than one option.

She is regulated on the insulin she has, so I'm just wondering why this is relevant. The problem is that the high dose requirements indicate feline acromegaly which contributes to enlarged organs.
.

Disclaimer: I have a 19+yo cat with multiple health issues and even though she gets around less than your cat, I will continue to treat her in whatever manner that I can because I see interest in her to continue to live. Your cat sounds even more so interested than mine. So, that is where my head is at, just so you know.

Thank you for the perspective. I've been going back and worth. Whenever I start thinking it's her time, she starts acting like she wants to continue.

Have you ever considered having your cat seen by a specialty group - one that has internal med vets along with specialists in areas such as endocrinology? They might be able to offer some ideas that a general vet cannot. Any tests and vet notes can be shared with them to help reduce redundant costs. I guess, if it were me, I would go down this route to see what they have to offer before you make your final decision.

I should look into this. None in my city, but I'm a couple hours away from multiple large cities where we can probably get better help.

 

[FeebysOwner]

She is regulated on the insulin she has, so I'm just wondering why this is relevant. The problem is that the high dose requirements indicate feline acromegaly which contributes to enlarged organs.

Admittedly, I know little about diabetes and insulin treatments. All I know is there are more than one option out there and perhaps others than what you are currently using wouldn't either require as high of a dose or would not attribute to acromegaly. One of the reasons for pursuing a vet endocrinologist.

Any chance your cat could take lactulose instead of Miralax? It isn't as plain tasting but might be an option if you haven't already tried it. That might be another thing the specialty group could help with.

 

[white shadow]

Hi I impacted !

About this:

I..test often, and got her regulated with the help of online communities.

Was one of those "The Feline Diabetes Message Board".....(this one) ?
.

 

[silent meowlook]

Hi. I am sorry you are struggling with your cats health issues.
I can’t tell you when it is time to let go or not. That is all on you, since you have to live with the decision. Which, usually leads to thoughts of “ Did I wait too long and let her suffer?” Or “ Did I do this to soon and not try everything I could?”. No matter what, it is a tough choice to make and one that sticks with you.

What I do when faced with a decision like this is, get a second opinion. I would suggest you find a feline only hospital near you, if you can, and go there and see what their veterinarian says. Then make a decision based on both vets findings. That is what I would do. But of course she is your cat and I truly believe you probably know what the right thing to do is.

9 units of insulin is crazy. What kind of insulin? Had they ever tried her on Lantus Glargine? If acromegaly was suspected, did they test? Did her face look different to you? It is very rare in cats. I have seen it a couple of times and the cats seem to have these very large faces. Not heads, just their faces seem large.
Anyway, I wish you peace in whatever you decide to do and I hope your cat magically gets better, but of course that doesn’t happen usually. I wish it did.

 

[impacted]

Hi I impacted !

About this:


Was one of those "The Feline Diabetes Message Board".....(this one) ?
.

Yep

 

[impacted]

9 units of insulin is crazy. What kind of insulin? Had they ever tried her on Lantus Glargine? If acromegaly was suspected, did they test? Did her face look different to you? It is very rare in cats. I have seen it a couple of times and the cats seem to have these very large faces. Not heads, just their faces seem large.

Prozinc. Vet doesn't seem too concerned about switching or further testing because she is regulated. I'm not in a populous place that attracts much talent/specialists, so there seems to be a knowledge gap. For example, the vets don't seem to understand the established scientific fact that cats experience stress related hyperglycemia and that glucose readings at the clinic are unreliable. Thankfully, I've learned a lot about the disease and acro from the Feline Diabetes community. A large face can be an indicator but it's a misconception that physical deformities must exist. The high insulin requirements make it more likely than not.

 

[silent meowlook]

I still wouldn’t think that without trying the lantus first. But if you don’t have access to it you are kind of stuck with what the vets prescribe. Some cats just don’t respond to the other insulins.