Struggling with whether to euthanize

albertina

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Hi everyone, it’s my first time posting here. I’m from Singapore so the terms/situation I use/describe below may differ from the American context.

The reason I am here is because I’m really struggling with making a decision on whether to euthanize my foster cat, Baby, and if so, when would be the right time.

Baby is a community cat (a stray that lives in my neighbourhood) whom I helped to feed. I decided to foster her back in December 2022 because she had 2 wounds that would not heal and the vet I brought her to said she would need to be kept indoors and wear a cone until her wounds healed. I was supposed to release her back outdoors after her wounds had healed. Her wounds have healed but she had one medical problem after another and is thus still with me—first, she had constipation and had to have enemas and be hospitalised. The vet said she might have megacolon and put her on Cisapride and Miralax. She possibly has to be on this for life. Next, we discovered she was FIV and FeLV positive and would be better off as an indoor cat. Baby also had an existing problem before I took her in. She has urinary and fecal incontinence. The vets I’ve seen (3 of them) said her incontinence is likely caused by a tail pull injury and would likely be for life. And recently, in January 2023, we discover she has non-regenerative anemia.

I have never owned any cats prior to Baby. I was not mentally, emotionally, physically, and financially prepared for the complications and the effort Baby’s care would require when I first took her in for what I thought were just 2 superficial wounds.

I still don’t have answers as to what’s causing Baby’s non-regenerative anemia despite having spent thousands of dollars on vets. The vet initially thought FeLV, but her PCR came back negative for FeLV though they said the disease could be hiding in her bone marrow. We also did an anemia panel but that didn’t provide any conclusive results. We did an ultrasound and she has some pockets of fluid in front of her bladder, an enlarged spleen, and what looks like lymph nodes near her spleen. The vet has said that to further investigate, we would need to do either fine needle aspirates or biopsies of the pockets of fluid, the lymph nodes around her spleen, and her bone marrow. But Baby is not currently stable enough to undergo sedation and/or anaesthesia.

Her blood work doesn’t look good. Her blood counts are dropping despite receiving darbepoetin, vitamin B12, and iron shots to try and get them up.

Baby is still eating well with the aid of mirtazapine (an appetite stimulant). She is also on prednisolone (steroids) which would also give her more of an appetite.

I don’t know what’s normal for Baby since I have no experience with cats and since I got her when she was already sick. But Baby has never been interested in playing. She still does enjoy pets and will purr occasionally when given affection. She spends most of the day sleeping, but is quite active at night (mostly crying for food, sleeping, or occasionally scratching on her scratch board). She still does groom herself though perhaps its frequency and duration has decreased.

Baby has incontinence but does still use the litter box. Nonetheless her incontinence makes it hard for me to gauge her litter box habits. But it seems her litter box usage is becoming less frequent. Now, she mostly pees and defecates on the pee pad she is sleeping or lying on.

I am exhausted, emotionally, physically, and financially from caring for Baby with her incontinence and medical issues. I believe this is made worse because I wasn’t prepared at the start.

I asked 2 vets if there is a cure for Baby, but they weren’t very direct with their answers. They said some cats with her symptoms can live on prednisolone long term.

I am sharing all this as I’m torn. Emotionally, physically, and financially, I am spent. And when I am exhausted, I think it would be best to euthanise her.

But she still looks alive, still wants to eat (though this might be because of the medications she’s on) and seems quite bright (bearing in mind I don’t have a gauge for what is normal for cats nor her). She is also quite young. The vets estimate she is about 4–5 years old.

I’m really struggling with whether to put her to sleep, and if so, when would the right time be. Although I am emotionally spent, I still do love her very much. And more than dying, I fear seeing her suffer and decline. I don’t have the strength to see that. And I sometimes work myself into a panic attack when I see her breathe differently or when she has mysterious bleeding from her mouth. (Bleeding always stops by the time I get her to the vet and they cannot tell what might have caused it.) Yet I wonder if maybe she can overcome whatever she has and I am robbing her life by putting her to sleep.

Does anyone have any advice that can help me make these difficult decisions?

Thank you for your help.
 
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albertina

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One of the vets did recommend euthanasia right from the start when we discovered Baby had non-regenerative anemia, but I was not open to that at that time without knowing what condition Baby had. Though we still don’t have a diagnosis, if there isn’t a cure for her condition, I’m open to euthanasia.
 

NekoM

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Wow. I’m not surprised your exhausted that’s a lot to go through in two months! Any cat that’s diagnosed with anemia will automatically be tested for kidney disease. What did the Vets say about her renal health?
 
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albertina

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Wow. I’m not surprised your exhausted that’s a lot to go through in two months! Any cat that’s diagnosed with anemia will automatically be tested for kidney disease. What did the Vets say about her renal health?
Her SDMA score is high, but the rest of the kidney values are normal. They did see some abnormalities in the ultrasound, but again further investigation will require GA or sedation which Baby isn’t a candidate for right now.
 

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I, myself, would just keep her comfortable until you see her suffering. Keep her on the prednisone and any drugs she needs, and ask about putting her on DMG, a supplement to boost her immune system. You can get it on any Pet Med Site and most big shopping stores. i get mine online at Walmart and amazon. see if she should be on a daily 1/4 tsp. dose of Miralax (human) for her constipation. my cats had severe anemia, and an almost nonexistent white blood cell count, and were diagnosed with leukemia. One was given 'days' to live, and is happy and sassy almost 4 years later! i tempt mine to eat when they are sick with Delectable Lickables in the stew flavors., I also put their supplements in it.
I really feel for you, you took on much more than you counted on. you have already done much more than most. The bad thing is you will have tremendous guilt no matter which way you go because it is a part of grieving. i would go by how she acts. I wouldn't go too deep into any more tests, consider her terminal and just make her last days full of love. When they are diagnosed with something that cannot be cured, further testing just stresses them more. When you know she doesn't want to go on anymore, then make that decision to end her pain. Go by what your own eyes tell you. If she is crying and hiding, obviously in pain, then it is time. You may have to bring about a little suffering to get her to that point, but you will know for sure. my thoughts and prayers are with you both, just try to enjoy and comfort that little girl right now, don't put her through anymore. i'm so sorry.......
 
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albertina

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I, myself, would just keep her comfortable until you see her suffering. Keep her on the prednisone and any drugs she needs, and ask about putting her on DMG, a supplement to boost her immune system. You can get it on any Pet Med Site and most big shopping stores. i get mine online at Walmart and amazon. see if she should be on a daily 1/4 tsp. dose of Miralax (human) for her constipation. my cats had severe anemia, and an almost nonexistent white blood cell count, and were diagnosed with leukemia. One was given 'days' to live, and is happy and sassy almost 4 years later! i tempt mine to eat when they are sick with Delectable Lickables in the stew flavors., I also put their supplements in it.
I really feel for you, you took on much more than you counted on. you have already done much more than most. The bad thing is you will have tremendous guilt no matter which way you go because it is a part of grieving. i would go by how she acts. I wouldn't go too deep into any more tests, consider her terminal and just make her last days full of love. When they are diagnosed with something that cannot be cured, further testing just stresses them more. When you know she doesn't want to go on anymore, then make that decision to end her pain. Go by what your own eyes tell you. If she is crying and hiding, obviously in pain, then it is time. You may have to bring about a little suffering to get her to that point, but you will know for sure. my thoughts and prayers are with you both, just try to enjoy and comfort that little girl right now, don't put her through anymore. i'm so sorry.......
Thank you very much for your perspective. I actually learned about DMG from your posts on this site. I consulted my vet and she said it was ok to give so Baby is on DMG. She’s also on 1/8 or 1/4 teaspoon of Miralax depending on the consistency of her stool.

What you have said makes a lot of sense. And I will try and keep that in mind. I am a worrier and quite negative sometimes so I can work myself into a frenzy and lose sight of the big picture when I get anxious. Thank you for your sound advice that has helped to ground me.
 

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but again further investigation will require GA or sedation which Baby isn’t a candidate for right now.
It really doesn’t, thankfully for such a devastating disease it’s easy to diagnose from a physical examination, blood/urine test and a simple X-ray. Anemia is a symptom of Kidney disease and not a cause, Another symptom is dehydration caused by vomit, urine and water loss that can pass through the urinary and GI tract. In a situation like this it’s likely baby would be treated for kidney disease which should help all the diagnosed symptoms your dealing with. However here’s the good news - because she hasn’t been diagnosed for megacolon you can cut back on the Cisapride and miralax and most of these symptoms will likely go away and with luck euthanasia may not be a concern.
 
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albertina

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It really doesn’t, thankfully for such a devastating disease it’s easy to diagnose from a physical examination, blood/urine test and a simple X-ray. Anemia is a symptom of Kidney disease and not a cause, Another symptom is dehydration caused by vomit, urine and water loss that can pass through the urinary and GI tract. In a situation like this it’s likely baby would be treated for kidney disease which should help all the diagnosed symptoms your dealing with. However here’s the good news - because she hasn’t been diagnosed for megacolon you can cut back on the Cisapride and miralax and most of these symptoms will likely go away and with luck euthanasia may not be a concern.
I will check with the vets why she isn’t being treated for kidney disease. But it seems they don’t think this is the cause of the anemia based on the kidney values (besides the SDMA). One of the vets did say she has megacolon but also said diagnosis can be subjective so again it’s not very clear if she has or does not have megacolon. I have tried to cut back on Cisapride and Miralax in the past but she would be backed up with poop again. At this juncture, this isn’t something I want to experiment with because I don’t want to add another problem to what she is already experiencing. I’m trying to keep her as stable as possible and to hopefully address her non-regenerative anemia.
 

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I will check with the vets why she isn’t being treated for kidney disease. But it seems they don’t think this is the cause of the anemia based on the kidney values (besides the SDMA). One of the vets did say she has megacolon but also said diagnosis can be subjective so again it’s not very clear if she has or does not have megacolon. I have tried to cut back on Cisapride and Miralax in the past but she would be backed up with poop again. At this juncture, this isn’t something I want to experiment with because I don’t want to add another problem to what she is already experiencing. I’m trying to keep her as stable as possible and to hopefully address her non-regenerative anemia.
Just curious, but what is her gum color like? Are they pink and healthy looking or pale/whitish?
I am so sorry for all you and Baby are going through. I think it's so sweet that you took her in due to her sores to help them heal and she's been with you ever since getting excellent care. Whatever happens, she knows she is loved and cared for.
 
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albertina

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Just curious, but what is her gum color like? Are they pink and healthy looking or pale/whitish?
I am so sorry for all you and Baby are going through. I think it's so sweet that you took her in due to her sores to help them heal and she's been with you ever since getting excellent care. Whatever happens, she knows she is loved and cared for.
Her gum colour is on the pale/whitish side. Thank you for your kind words and for the kind words of all who have replied. They have provided me some comfort and needed strength.
 

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I will check with the vets why she isn’t being treated for kidney disease. But it seems they don’t think this is the cause of the anemia based on the kidney values (besides the SDMA). One of the vets did say she has megacolon but also said diagnosis can be subjective so again it’s not very clear if she has or does not have megacolon. I have tried to cut back on Cisapride and Miralax in the past but she would be backed up with poop again. At this juncture, this isn’t something I want to experiment with because I don’t want to add another problem to what she is already experiencing. I’m trying to keep her as stable as possible and to hopefully address her non-regenerative anemia.
I get it. You probably should call your vet, the extreme diarrhea and incontinence your describing signals critical dehydration, basically your heading to both Renal and GI functions shutting down within days.
 
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albertina

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I get it. You probably should call your vet, the extreme diarrhea and incontinence your describing signals critical dehydration, basically your heading to both Renal and GI functions shutting down within days.
Hmm, I’m not sure where you are getting extreme diarrhoea and incontinence. Baby doesn’t have diarrhoea. She has incontinence but she has had it way before I took her in and the vets have said it’s likely due to a tail-pull injury. Nonetheless, I do have a vet visit coming up this week and will check in about kidney disease with them.
 
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albertina

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Thank you so much for your support. Baby vomited the food she ate last night and has gone to hide. She isn’t a cat who hides much so I’m trying not to panic. I’m not forcing her out. Just sitting close by so she knows I’m there if she needs me.
 
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albertina

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I’ve contacted the vet to ask if I need to bring her in and if they have a slot for me. Hopefully it’s nothing serious and just a one off. Please send us good vibes!
 
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