Struggling with whether to euthanize

[Antonio65]

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.

I rescued a feral cat a three of years ago, she was sick, very sick, thin and weak. She was diagnosed with non-regenrative anemia. The vet also did a bone marrow sample to test it and they confirmed that the anemia couldn't be fixed. They proposed the euthanasia for the cat, because she was declining and unrecoverable.
I told them I was agianst it, and that they should have tried harder, whatever they could do.
And they did, and with a long therapy with just prednisolone (a really inexpensive drug) for several months, the cat fully recovered, and now she's a wonderful healthy cat... alive!

I have the feeling that vets tend to suggest the euthanasia very easily when they have to deal with feral or stray cats.

You say that SDMA is high, but the other renal values are ok. I think that SDMA overrules the other levels, so I believe that Baby has a renal condition, and this could explain the anemia too, along with a bone marrow issue.

My advice is to keep caring for Baby as long as she feels quite well, and still eats and loves you.
When time comes, she will let you know.
You're doing a wonderful job!

 

[louisstools]

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

There are a variety of "quality of life" charts/calculators that can help you visualize the metrics around Baby's quality of life. Your vet might also have one they recommend. Your vet is also a good resource for that question because, due to the magic of proximity and their education and experience, they can see Baby and evaluate her.

I had to go through this decision in late 2021 with my cancer boy. I had two takeaways. First, from all the formal research and antidotal reports from pet owners and vets, the vast majority of people who make this decision make it too late. So if you're going to err, err on the side of too early because that is the humane thing to do.

Second, you're going to second guess yourself and feel like cat poop regardless of the decision you make so try and make this a metrics and evidence based decision as possible. Use the quality of life charts, vets recommendations (take actual notes on what they say), write out your reasoning. I suggest all this extra work so that when you do second guess yourself and start to beat yourself up you have tangible data and materials to go through to calm you down.

 

[di and bob]

I will pray for your sweet little girl......

 

[albertina]

Update on Baby
I checked with the vet today why Baby wasn’t treated for kidney disease. They told me she actually is. The darbepoetin jabs she had been having were meant to treat kidney-related anemia. Darbepoetin is the cousin of epoetin which is normally used for kidney-related anemia.

However, he also explained that Baby has so many medical issues that kidney disease was not the main focus. This is because the SDMA value is an indicator for risk of future kidney disease. Her normal kidney values urinalysis showed that she didn’t have kidney disease at the moment. Considering all the other medical issues she had, it was not a priority to treat for kidney disease.

Baby’s blood counts have risen so the prednisolone is working and we will continue with this medication and retest her blood again next week. This will probably be tapered to a lower frequency later.

Baby had been bleeding from the mouth on and off for the past few months. She has an indolent ulcer and the vet said she could bleed to death from that. I searched online and didn’t see anything like that. So I am a bit dubious about what he said. He also said the ulcer could have contributed or caused her anemia. He suggested we use laser to get rid of it now that Baby’s blood work is relatively good though there is still risk with putting her under GA. Again, I searched online and don’t see any mention of indolent ulcer being a cause/contribution to anemia so I am somewhat sceptical. I also don’t see laser mentioned much in the treatment of this, but it seems like a newer form of treatment and seems quite painless, quick, and has relatively few side effects so I am tempted to try it for Baby.

Baby injured her right hind leg today and it’s swollen. The vet has advised to just let her rest it as the medication for it could interfere with prednisolone so he doesn’t want to give it to her. He said the prednisolone has some anti-inflammatory properties as well and should help a little together with rest.

All in all, a mixed bag of good and bad news, but mostly good, I think!

 

[albertina]

I will pray for your sweet little girl......

Thank you so much. You have been a source of comfort and support more than you probably know.

 

[albertina]

There are a variety of "quality of life" charts/calculators that can help you visualize the metrics around Baby's quality of life. Your vet might also have one they recommend. Your vet is also a good resource for that question because, due to the magic of proximity and their education and experience, they can see Baby and evaluate her.

I had to go through this decision in late 2021 with my cancer boy. I had two takeaways. First, from all the formal research and antidotal reports from pet owners and vets, the vast majority of people who make this decision make it too late. So if you're going to err, err on the side of too early because that is the humane thing to do.

Second, you're going to second guess yourself and feel like cat poop regardless of the decision you make so try and make this a metrics and evidence based decision as possible. Use the quality of life charts, vets recommendations (take actual notes on what they say), write out your reasoning. I suggest all this extra work so that when you do second guess yourself and start to beat yourself up you have tangible data and materials to go through to calm you down.

Thank you for your suggestions. I will do a bit of research on the various quality of life charts. Vets here tend to shy away from mentioning euthanasia because I think generally people here still prefer a “natural” death. I will try and have a frank discussion with my vet though. I think if I ask point blank, he will provide some guidance although he tends to avoid telling me whether he thinks euthanasia is a reasonable option at this stage.

 

[albertina]

I rescued a feral cat a three of years ago, she was sick, very sick, thin and weak. She was diagnosed with non-regenrative anemia. The vet also did a bone marrow sample to test it and they confirmed that the anemia couldn't be fixed. They proposed the euthanasia for the cat, because she was declining and unrecoverable.
I told them I was agianst it, and that they should have tried harder, whatever they could do.
And they did, and with a long therapy with just prednisolone (a really inexpensive drug) for several months, the cat fully recovered, and now she's a wonderful healthy cat... alive!

I have the feeling that vets tend to suggest the euthanasia very easily when they have to deal with feral or stray cats.

You say that SDMA is high, but the other renal values are ok. I think that SDMA overrules the other levels, so I believe that Baby has a renal condition, and this could explain the anemia too, along with a bone marrow issue.

My advice is to keep caring for Baby as long as she feels quite well, and still eats and loves you.
When time comes, she will let you know.
You're doing a wonderful job!

Thanks for your encouragement as well as advice. I did check with the vet about kidney disease and the answer I received is in an update i just posted on Baby. I do trust my vet’s judgement on this. Kidney disease will probably be something we have to address in the future for Baby but not necessarily right now.

 

[Alldara]

A albertina Any bleeding when you have anemia will contribute to further anemia. That's why your vet wants to manage it. Also an infection there could become dangerous.


I'll just add in, some of the charts don't have it but it's okay and good even to consider yourself when deciding on euthanasia as well. Your health still matters so the amount of financial and emotional support you have to care for yourself will impact your decision and should impact your decision. Especially when the diagnosis is terminal and the cat is wearing down. Once you are certain that this level of care is permanent, will get no better and in fact will only get worse, you'll need to imagine the point on the chart where your resources start to go lower than the care the cat needs, that will be your 'limit' where you get euthanasia (among considering the quality of the cat's life and if they are enjoying things still).

Some people consider keeping them comfortable until they die naturally the right thing to do.
Some people consider euthanasia the right thing to do.
I try to consider the cat's level of care that they enjoy. Most cats will have a point where they don't like the level of care needed anymore. They may begin to hide from care.

 

[albertina]

A albertina Any bleeding when you have anemia will contribute to further anemia. That's why your vet wants to manage it. Also an infection there could become dangerous.


I'll just add in, some of the charts don't have it but it's okay and good even to consider yourself when deciding on euthanasia as well. Your health still matters so the amount of financial and emotional support you have to care for yourself will impact your decision and should impact your decision. Especially when the diagnosis is terminal and the cat is wearing down. Once you are certain that this level of care is permanent, will get no better and in fact will only get worse, you'll need to imagine the point on the chart where your resources start to go lower than the care the cat needs, that will be your 'limit' where you get euthanasia (among considering the quality of the cat's life and if they are enjoying things still).

Some people consider keeping them comfortable until they die naturally the right thing to do.
Some people consider euthanasia the right thing to do.
I try to consider the cat's level of care that they enjoy. Most cats will have a point where they don't like the level of care needed anymore. They may begin to hide from care.

Thank you for this. The point about bleeding causing more anemia and why my vet wants to manage it makes a lot of sense.

I had never really considered myself and my resources as a factor in deciding about euthanasia but this along with considering the level of care the cat enjoys is very practical advice. Baby has been very vocal of late about going to the vet. I think she hates going, but she is still allowing me to give her medications and still allowing me to put her in her carrier to go to the vet. I think she is getting tired of being poked and prodded but may not yet be at her limit. I am trying to minimise vet visits while still getting her the care she needs. I will definitely keep the level of care she enjoys as one of my considerations in making this difficult decision. She is improving now so I don’t have to decide now but I should probably start thinking about when euthanasia would be an option for us.

 

[Alldara]

A albertina Yes I don't think you need to consider yet. But you are beginning to learn her limits so that's great.

Antonio65 Gave a very good example too, that makes me very hopeful for continuing improvement for your situation.

Plus you received many other resources from other people. So there's much hope for your cat.

You can't help if you're running on empty. So I bring up that consideration for people. Because it also helps to consider what type of help you need to continue. For example my neighbour has come to help me before to care for my cat, and I've helped to care for her dog. With that support, it keeps you going. I've also helped many elderly neighbours trim their cats claws and such to limit expenses and vet visits for them. Plus this online community is full of education and emotional support.

 

[Norachan]

Any bleeding when you have anemia will contribute to further anemia. That's why your vet wants to manage it. Also an infection there could become dangerous.

FIV+ cats tend to suffer from mouth infections, which makes it difficult for them to eat, which exacerbates any other health problems they are having. If the laser surgery sounds like a simple way to treat the ulcer and it's within your budget I'd follow your vet's advice and have that done.

I'm in Japan. My vet is a Buddhist and is very reluctant to euthanise any animal. Even when I've had cats with end stage cancer or renal failure he's taught me how to give SubQ fluids and pain medication and insisted it's better to keep the cat as comfortable as possible and allow them to pass at home.

Whether to euthanise or not depends very much on the culture of the country you are in, so that's something else you need to keep in mind.

In my experience, if a cat with a terminal illness is still willing to eat it shows they still have some quality of life. When they stop eating and just sleep all the time it's a sign that there's nothing more to be done for them.

 

[iPappy]

FIV+ cats tend to suffer from mouth infections, which makes it difficult for them to eat, which exacerbates any other health problems they are having. If the laser surgery sounds like a simple way to treat the ulcer and it's within your budget I'd follow your vet's advice and have that done.

I'm in Japan. My vet is a Buddhist and is very reluctant to euthanise any animal. Even when I've had cats with end stage cancer or renal failure he's taught me how to give SubQ fluids and pain medication and insisted it's better to keep the cat as comfortable as possible and allow them to pass at home.

Whether to euthanise or not depends very much on the culture of the country you are in, so that's something else you need to keep in mind.

In my experience, if a cat with a terminal illness is still willing to eat it shows they still have some quality of life. When they stop eating and just sleep all the time it's a sign that there's nothing more to be done for them.

Both vets that saw Tag didn't jump to euthanasia as long as some quality of life was still there. The vet who actually did come to the house had talked to me a week before, because it was obvious he wasn't going to come out of it, and, her words, "but it's killing you." But he was still eating, and still would give me his trademark "bright eyes" when I'd approach with his food until those last 2 days.
With mine, not eating all together is a big sign. So is how they act with me. If they were always affectionate, attentive, and engaging with me and no longer want anything to do with me, that's a big sign.
But luckily, it doesn't sound like Baby is there yet.

 

[albertina]

A albertina Yes I don't think you need to consider yet. But you are beginning to learn her limits so that's great.

Antonio65 Gave a very good example too, that makes me very hopeful for continuing improvement for your situation.

Plus you received many other resources from other people. So there's much hope for your cat.

You can't help if you're running on empty. So I bring up that consideration for people. Because it also helps to consider what type of help you need to continue. For example my neighbour has come to help me before to care for my cat, and I've helped to care for her dog. With that support, it keeps you going. I've also helped many elderly neighbours trim their cats claws and such to limit expenses and vet visits for them. Plus this online community is full of education and emotional support.

Yes, I do feel we are in a better place now than when I first posted. Baby is improving and her health is starting to stabilise I think. This will allow me to recoup somewhat in terms of resources both tangible and intangible.

I don’t really get a lot of help with looking after Baby as I decided to take her in myself and feel I should be responsible for most of her care since it was my decision. With that said, I do need to learn to ask for help. When I have whether in real life or in a forum like this, I’ve found people are mostly willing to help. I need to learn to take care of myself as well so I don’t burn out and get to the stage where I just want to give up on everything.

I have received a lot of help from all of you here whether in terms of practical advice or emotional support. I am immensely grateful for that. I’m just a stranger on the internet and all of you did not need to help, but you all did.

 

[albertina]

FIV+ cats tend to suffer from mouth infections, which makes it difficult for them to eat, which exacerbates any other health problems they are having. If the laser surgery sounds like a simple way to treat the ulcer and it's within your budget I'd follow your vet's advice and have that done.

I'm in Japan. My vet is a Buddhist and is very reluctant to euthanise any animal. Even when I've had cats with end stage cancer or renal failure he's taught me how to give SubQ fluids and pain medication and insisted it's better to keep the cat as comfortable as possible and allow them to pass at home.

Whether to euthanise or not depends very much on the culture of the country you are in, so that's something else you need to keep in mind.

In my experience, if a cat with a terminal illness is still willing to eat it shows they still have some quality of life. When they stop eating and just sleep all the time it's a sign that there's nothing more to be done for them.

Yea, I’ve booked Baby in for the laser surgery and am working out the cost with the vet who’s trying to give it to me as cheaply as possible.

Yes, I agree euthanasia is a very controversial subject and depends a lot on the culture of the country. I realise I probably am a little different in my views on euthanasia compared to my culture.

My main concern is that Baby doesn’t suffer. I would hate for her to not be able to breathe, for example. Or to waste away without food, or to be in pain. To me, this sort of suffering is unnecessary. But, Baby is currently not anywhere near these scenarios. Although, earlier on, I really thought she might be. I have some time to properly think about her care and to think ahead about end of life when that time comes.

Thank you for sharing your thoughts!

 

[albertina]

Both vets that saw Tag didn't jump to euthanasia as long as some quality of life was still there. The vet who actually did come to the house had talked to me a week before, because it was obvious he wasn't going to come out of it, and, her words, "but it's killing you." But he was still eating, and still would give me his trademark "bright eyes" when I'd approach with his food until those last 2 days.
With mine, not eating all together is a big sign. So is how they act with me. If they were always affectionate, attentive, and engaging with me and no longer want anything to do with me, that's a big sign.
But luckily, it doesn't sound like Baby is there yet.

Tag sounds like a lovely cat.

Yes, I believe Baby still has quality of life. She is still eating and is still responsive to me and the environment.

I’m just curious, but when cats near the end, do steroids and appetite stimulants not work to get them to eat?

 

[NekoM]

Update on Baby
I checked with the vet today why Baby wasn’t treated for kidney disease. They told me she actually is. The darbepoetin jabs she had been having were meant to treat kidney-related anemia. Darbepoetin is the cousin of epoetin which is normally used for kidney-related anemia.

Apologies for being tough on you, this clarification was what I was pushing for. With something like this you need the full picture to see how it all connects!

 

[albertina]

Apologies for being tough on you, this clarification was what I was pushing for. With something like this you need the full picture to see how it all connects!

No worries, I understand where you are coming from. I was probably reacting the way I did because I was just tired and overwhelmed at that point. I apologise for that too. I do appreciate your advice and for sharing your knowledge and caring about Baby.

 

[fionasmom]

It is possible that in an extremely ill animal that appetite stimulants will not help. However, I have seen the opposite occur, resulting in a ravenous, but deceptive appetite.

You have really tried to do your best for Baby for all the time that she has been with you and in your life.

 

[albertina]

It is possible that in an extremely ill animal that appetite stimulants will not help. However, I have seen the opposite occur, resulting in a ravenous, but deceptive appetite.

You have really tried to do your best for Baby for all the time that she has been with you and in your life.

Thank you for answering my question and for saying that I have tried to do my best. I needed to hear that.

 

[iPappy]

Tag sounds like a lovely cat.

Yes, I believe Baby still has quality of life. She is still eating and is still responsive to me and the environment.

I’m just curious, but when cats near the end, do steroids and appetite stimulants not work to get them to eat?

The vet gave appetite stimulants for one of my cats when he was barely eating at all and we didn't know why, and they worked...kind of. He'd pick at his food more but he never really dove in like I had hoped, but at that stage (we later found out) he was very much full of cancer.
Another cat was on steroids, and it did increase his appetite but not really excessively like I've heard others say. But he was on those a full year before he passed, and he was known to be a finicky eater to begin with and towards the end he was being finicky but I never assumed it was because he was terminally ill. I just wish they could talk.