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Tough Decisions Ahead

I've had my cat Cocoa for almost 18 years now. I've had her since she was a kitten. Recently, she hasn't had the best health.

Over the past 1 1/2 years, I've watched her develop several medical conditions:

1. She lost a majority of her eyesight due to high blood pressure. During that time, she was taking blood pressure medication twice daily and also had steroid drops in one of her eyes to reduce inflammation.

2. She has been on the blood pressure medication twice daily routinely for over a year now.

3. She got a lesion in her eye, probably due to running into something around the apartment. She had antibiotic drops to heal that injury.

4. She developed a bladder infection and took antibiotic pills daily.

5. Throughout all of these diagnoses, she's had blood drawn several times, urine samples taken several times, x-rays taken, blood pressure checks, and lots of poking and prodding.

Within the past 2 weeks, Matt discovered blood in her urine throughout the apartment. I brought her in and determined she had another infection. The vet put her on more antibiotics and did a recheck 10 days later. At that appointment, she determined that the infection was gone, but that blood was still in her urine. Blood was drawn to check for hyperthyroidism, which may be presenting itself through this infection. The vet said she'd call me on Monday with the results. If her thyroid was normal, it could mean she has a bladder stone or a blood clot.

On Sunday, I found that she was urinating throughout the apartment again, some of which was bloody. I called immediately this morning to get the test results and determine the next plan of action. Her thyroid was normal, so I had to decide about further testing.

At the appointment this morning, the vet first recommended to get an x-ray to look for a bladder stone. If one was found, it would require surgery of around $1,000. Given her age, I told her that wouldn't be an option. Not only is it expensive, but at this point in her life, I don't think I want to put her through the stress of surgery with everything else she's had going on. She absolutely hates going to the vet.

The x-ray would not show a blood clot. Instead, we'd have to get an ultrasound. However, the technician is not there on a regular basis, so we wouldn't know when that would be able to be done. If she had a blood clot, it's likely due to her high blood pressure. There didn't seem to be much to do for that except to medicate.

The vet also mentioned that there's an off chance she could also have some sort of syndrome that causes her to have blood in her urine. She mentioned a cat that had nothing medically wrong with it, but it just had blood in the urine 5 days every few weeks.

The vet, given her history and symptoms, seemed to believe it was most likely a blood clot. So, I opted to put her on antibiotics once again and some pain medication to help her be more comfortable.

I'm feeling like I may have to reach a big decision sometime soon, and part of me feels guilty. I've been very stressed about her the past 1 1/2 years with all of her medical issues. Matt and I will be moving in a few weeks, and I'm admittedly really worried about moving her. She'll be stressed trying to learn the new layout without her eyesight, and if her bladder condition doesn't improve, she could damage the carpeting. That, and I'll have the added stress of worrying about her constantly. I'm also admittedly worried about paying the medical expenses, though I acknowledge that's admittedly selfish.

I don't know how much her conditions are decreasing her quality of life, but I do know that it has decreased recently as I remember her in her younger, more active years. I don't know how that compares to my worry about her and my lack of desire to pay for major medical expenses. I feel very guilty at the thought of putting her down when I don't know if I'm stealing good weeks, months, or years from her life. But then again, I have no way of knowing if she is even currently comfortable and happy.

As I monitor her symptoms this next week or so, I think I'll have some important decisions to make. For those of you who are pet owners and/or have dealt with aging pets, your advice (on either side of the argument) is appreciated.

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( 23 comments — Leave a comment )
maladroitkat
Feb. 8th, 2010 07:36 pm (UTC)
I'm not sure what to tell you . . . Honestly, the kindest thing you could probably do for her at this point is have her put to sleep. It doesn't make the decision any easier though.
paninogirl
Feb. 8th, 2010 07:49 pm (UTC)
No, it doesn't. But, I've been emailing my supervisor as I do some work from home, who recently put her dog to sleep, and she said this:

Everything you are doing sounds to me like you are taking really good care of her. I made the same decision about Scully. I could have done expensive tests and procedures in her last months, but I already knew I didn't want to put her through any surgeries. So I just kept her as comfortable as possible. Just know you don't have to make any major decisions today. Take one day at a time and you'll know when it's right.

When I look back at Scully's life now I can really see how her last few months weren't the best and it would have been OK for me to ease her pain and put her to sleep anytime in that period. She, like Cocoa, had a long happy life and one more week, month, or year doesn't matter to them. They live in the present so if their present is filled with trips to the vet, drugs, and discomfort then I really truly believe it's OK to let her go anytime. I couldn't see it as well until I was on this side of it.

What I realized with Scully is that had I to do it over again, I wouldn't have wanted to wait until she was dying. It was clear, but it was so so awful and I do wish she hadn't gone through those last hours. I also realized though that death and dying aren't ever easy, or pain free, or pretty. So whatever you decide will be OK. It will be hard, but it will be OK. It's really hard to accept losing pets but realizing that is how they are made ... to be here just a fraction of our lives helped me accept it.


So, if her symptoms don't seem to improve with this next round of medication, or it only helps things temporarily, it may be time to say goodbye before the move.
xiphias
Feb. 8th, 2010 08:16 pm (UTC)
Eighteen years is a good run for a cat.

At this point, the only thing you can do is, basically, "listen" to your cat. Most of the time, cats find ways to let you know when they're done.

You're definitely at the "palliative care only" stage here. You are not going to cure anything she currently has. What you are doing is only making sure that she is as comfortable as she can be, for as long as it is reasonable, AND that she wants to be around.

There may come a point where, even if she'd rather be around for a little longer, you just can't medically do it. And there may come a point where, even if you COULD keep her around for a little longer, she'll make it clear that she's ready.

It's a LOT easier when the second thing happens, and, fortunately, it's a little more common.

It's not easy, though, even then. Even when your kitty lets you know that it's time, it's still among the hardest things you'll ever do.

I think that the easiest thing that could possibly happen would be for the kitty to decide it's time, to curl up, and die peacefully on her own terms. But that happens very rarely.

So.

Pay attention to your kitty, and, when she lets you know it's time for her to die, take her into the vet, and hold her in your arms while she's euthanized. That's what we did with our Boopsie, and I'm still crying when I think about it. And it was years ago.

But it's part of our responsibility to our animals.
paninogirl
Feb. 9th, 2010 03:28 pm (UTC)
Thanks so much for your kind, thoughtful post.

I think the most difficult thing I'm trying to figure out if whether or not she's letting me know she's ready to go. I've been monitoring her more closely with this latest bout of medical issues, and there is definitely a change. If she's not uncomfortably urinating everywhere (which has gotten better since I started her on meds again), she's either pacing the apartment or spending long hours curled up in her cat bed. She hasn't really even been meowing in the middle of the night to "ask" for food or coming toward the couch to paw at it to let us know she wants attention. She's keeping more to herself.

I don't know if that means she's ready to go, though. But, I don't think I want to wait until it gets worse and she literally is dying painfully. I'm thinking I'll spend as much time with her between now and the weekend, keep her comfortable with medication, and put her to sleep before I head on vacation to Florida. I'd like to spare her that stress of us being gone as well.
lietya
Feb. 8th, 2010 09:01 pm (UTC)
I do agree with everyone who says that she had a long, happy life, she doesn't fear death or even think about it (unlike us) and you'll probably get a sense of when it's time... even if that time isn't now.

However, I can't come up with much advice because we are currently going through something very similar (life-threatening bladder infection, upcoming surgery, vet costs at $5000 and climbing) for a five-year-old cat - whose age changes the cost/benefit analysis a lot. All I can offer is all the sympathy in the world for you right now. And the confession that if he were 18 years old, I don't think we'd put him through all of this intervention, either.

*hugs*
paninogirl
Feb. 9th, 2010 03:35 pm (UTC)
You're probably right; I imagine she doesn't think about death like we (and especially I) do. I think the hardest part for me is not feeling like I'm robbing her of any good time left and not feeling guilty for making the decision for her.

I think I would be in a similar situation to you if my cat was much younger. But, I've had many good years with her since I was 11 and she was a kitten, so I know she had a good life.
lietya
Feb. 9th, 2010 03:46 pm (UTC)
I can pretty much guarantee that because she neither thinks about nor expects any "good time" beyond the moment, she won't be robbed. She'll be happy and enjoying her life right up until the moment that she peacefully leaves it with no regrets. It's one of the blessings of an animal's life philosophy.

Those of us who are left behind are the ones who suffer and grieve.

Not to mention that statistically, if she'd lived wild rather than as your beloved kitty, she probably wouldn't have had about 13-15 years of that time. You gifted her that, along with love and care. Never feel guilty for robbing her of anything - you gave her everything!

(We did put a different cat to sleep years ago, but in that case it was also fairly straightforward; her prognosis was so poor that otherwise we would have had to let her die in pain within a few days. So I do know how hard it is to feel like you made that decision for them... even in a situation where it's *clear* it hurts and it's impossibly difficult.)

Edit to add : having done it, I should mention that putting a cat to sleep really is - peaceful. They just drift off, and they don't know that they won't wake up. There's no fear or pain or even worry. It's humans who agonize about dying, because they can anticipate it; Cocoa will only know that that you're nearby and loving her as she falls asleep. (It's also really, really quick. Like, less than a minute. They get a sedative first to guarantee that they won't notice, and then the injection.) It's weird to say, but I ended up wishing we could have offered the same sort of graceful, peaceful death to my grandmother!

Edited at 2010-02-09 03:54 pm (UTC)
paninogirl
Feb. 10th, 2010 02:41 am (UTC)
I think the hardest part of all of this has been that I perceive Cocoa's feelings and reactions like a human's. However, I am sure that she is not thinking about death; she is just trying to live comfortably day by day.

Considering that she spends most of her day sleeping either in her cat bed or near the heater, compared to what she used to do even a few years ago, I know that things aren't as great as they used to be.

Thanks for telling me what to expect. I know I'm going to be a bawling mess (I came home from work today, picked her up, and immediately broke down into tears), so it's good to know what will happen.

I agree; there would be some serenity in knowing you could ease your pain in a similar way we can ease our pets' pain.
xiphias
Feb. 10th, 2010 03:17 am (UTC)
Of course you're going to be a bawling mess. When we walked out of the room where they put Boopsie to sleep, and they took her body away to be cremated and the ashes mailed to us later, I walked out of the room, and made it to the hall, and just started sobbing uncontrollably. I just fell apart. We'd been wise enough to bring the friend that we would have left Boopsie with with us, so she could say goodbye, too, and SHE ended up having to drive -- I just couldn't.

And I just randomly burst into sobs for the next week.

And I STILL feel sad when I think about it.

And all that is good. I'm GLAD of all that. Because Boopsie's memory deserves it.
calliedl
Feb. 9th, 2010 04:07 am (UTC)
It sounds like you are doing everything possible, though I'm sure it doesn't feel like enough for your cat who you love. I do think that there gets to be a point where letting them go is more kind than keeping them, but I don't know how to determine that point. I'd have a horrible time in the same situation--I know it will come some day, but I hope that it's a long way down the kitty road.

I'll be thinking about you!
paninogirl
Feb. 9th, 2010 03:44 pm (UTC)
I think I'm understanding that point right now. She doesn't have much of her sight, so maneuvering in a new apartment would be very stressful for her. That, combined with her already existing medical conditions, would put her through stress that would only be done because I'm afraid to put her down. As many people are telling me, it's best to let her go before things get much worse than to be selfish and hold onto her until she's painfully dying.

I hope this decision is a long time coming for you, Dominique! I've been very emotional as I've been working through this decision.
(Anonymous)
Feb. 9th, 2010 12:44 pm (UTC)
So Hard
This is so hard, Rachel. It seems as though you're going through a situation similar to what I did with Reggie -- your cat's health is declining rapidly due to age at the same time that your life is becoming more stressful. I understand your guilt and confusion about your motives for euthanizing Cocoa.

In my mind, it comes down to this: Cocoa has had a LONG, loving life with you. At this point, her quality of life has diminished greatly. I think the move to the new apartment would be very disruptive and stressful for her. I think the kindest thing you could do is euthanize her. It is a terribly hard thing to go through (for you), but, unfortunately, it's part of being a responsible pet owner.

I would recommend holding her while she passes. Again, it sounds awful, but I think it will give her some comfort, and you will feel the weight of life taken from her little shoulders.

I'll also add that I haven't felt guilty about euthanizing Reggie. I know it was the right thing to do. In fact, I feel relief, because I know he is not in any discomfort at all. Surprisingly, it seems I went through most of my grief before he was gone. I still miss him, but I think we're both at peace.

I hope this helps. You're in my thoughts through all of this.

-Lauri
paninogirl
Feb. 9th, 2010 03:46 pm (UTC)
Re: So Hard
Thanks, Lauri. Given you went through this recently, I was hoping I'd get some advice from you. I have been very worried about moving her, as well as her diminishing health. While nothing seems immediately life-threatening at this point, I don't want her to suffer any more than she already may be.

As difficult as it is, I think putting her down before the move is the best thing I can do for her. And, as everyone has mentioned, it is the most responsible thing to do as her owner.
ethel
Feb. 9th, 2010 03:57 pm (UTC)
Rachel, I've had a lot of experience with end-of-life decisions, both personally with my own beloved pets, and during my time at the emergency clinic. If I can be a resource in any way, I would be honored to help you.

Euthanasia is such a hard decision. I remember with my childhood dog Casey...she started to slowly get sicker and sicker. One day she would vomit blood on the carpet and we'd think, "it's time," and the next she'd be playing like a puppy and it would throw a cloud of doubt over what had been a difficult but relievingly clear decision just 24 hours prior. After we did euthanize her, we too realized that we could have said goodbye at any point over the last few months, and it would have perhaps been more humane to let her go. In hindsight we could see with more clarity that it was because we loved her so much that we did not want to let her go, we did not want to rob a single day of her future, and we just couldn't say goodbye. It's hard to think about even now, 14 years later. I have tears running down my cheeks as I think about it, and how much we loved her, and how much I miss her still today.

In my first clinic, in my first month, a client faced with this same decision asked my favorite coworker how you really know that "it's time." I will never forget Amy's advice to her, because her words rang so true in my heart, and I have told them to many friends over the years and have in turn provided some level of help and comfort to many. I would like to share them with you now.

Make a list of five of the things that your pet likes to do the most. I sometimes mentally review this list with Wilma....for her it would probably be eating treats, jumping up and down in joy when she sees me or Seth, chasing cats and rabbits and frogs, eating canned food, and trying to climb up onto someone's lap for a snuggle. When Wilma can no longer do two of these five things either from physical disability or lack of interest, or she can only do them with difficulty or great prodding, then I know it's time to think about letting her go.

The reasons this advice rang so true with me are many. First, it's been my experience, both personally and professionally, that when people are hit with this decision, that they often benefit from a course of action that is objective rather than subjective. It's so difficult when your voice whispers in your ear one way or the other until you question your judgment so much that you don't know what is the right thing to do. Taking a step back can often be beneficial

Second, it helps to put one in a good frame of reference by thinking of all the great things about their pet, about all the things they have had and all the love that's been shared, instead of all the things they now cannot do. Even when I get sad about thinking about letting Wilma go (which will come sooner than I will ever, ever want) when I think about her chasing frogs at my parents' place, I always smile. That's my Wilma, and it always will be, even when I have to say goodbye.

But most importantly, it brings the focus to the pet, and what the pet needs and wants, and away from one's love and fears and the inevitable second-guessing. When Wilma grows so infirmed that can no longer or barely do almost half the things that give her the most joy out of anything in the entire world, then I will know that her quality of life is compromised, and that no matter how much I love her, it's time to give her the final, most loving gift I can ever give her.

So that is my one and only piece of advice to you, Rachel. Make that list for Cocoa. It will be a list of love.
paninogirl
Feb. 10th, 2010 02:46 am (UTC)
Thank you so much for this, Laurie. I absolutely needed to hear this advice, as it makes it easier to make the right (but difficult) decision. I plan to make that list tonight.
tiern_meister
Feb. 9th, 2010 05:13 pm (UTC)
Rachel-
I just read your post and I am running late for work so I don't have time to type everything I want to say. Since I just went through this with my Maya I know what you are feeling and how your heart is aching. I will make a longer post tonight when I get home. I'm thinking about you and Cocoa! :)
paninogirl
Feb. 10th, 2010 02:47 am (UTC)
Thanks for your thoughts, Tierney. I appreciate them. :)
tiern_meister
Feb. 10th, 2010 02:52 am (UTC)
OK, I am going to add more...

First of all, I want to say that Ethel's idea of thinking of the top 5 things your pet loves to do is a fantastic idea. After reading it I chose to do that same thing with Maya (even though we already put her to sleep). It totally reassured me that we made the correct decision to put her to sleep. We put her to sleep on a Friday because our vet wasn't going to be in on the weekend. We didn't want to risk one of her tumors bursting over the weekend and either having her die in excruciating pain, or have to rush her to the animal ER where they don't know her or us.
A recommendation I have is take a picture of Cocoa from 6 months ago. Then really compare what you currently see to what you see in the picture. I look at pictures of Maya 2 months before she died and she still had all of her life in her face and eyes. Pictures that I have of her the week of her death look nothing like her. She doesn't have her "smile" or her personality in her eyes. She looked tired and ready to go. I think that it is something that you as her owner can see. You know Cocoa best and you know how she is feeling.
In my personal opinion, I think it may be time to say goodbye. I think that Cocoa will have a very difficult time adjusting to your new place, and what if something were to happen while you were on vacation? I am sure that when it's Cocoa's time you will want to be there holding her. I would hate for you to go out of town only to receive a call that she has passed or needs to be put to sleep immediately. Do not feel selfish for taking these factors into consideration. Cocoa has lived an amazing life in a loving home. You have given her a great gift and she loves you for that.

Whatever you decide I'm here for you! Your in my thoughts! :)
paninogirl
Feb. 10th, 2010 03:04 am (UTC)
Thanks, Tierney. :) It seems most of the pictures I've taken of her in the past 6 months have been of her sleeping in some cute way. That is how she spends a majority of her days...

I did reply to the comment from xiphias below this one about my plan to bring her in early next week before my vacation for the exact reasons you mentioned. The move will be stressful, I don't want to worry about her on vacation, and I want to be there with her during her last moments.

I'm glad you found Laurie's comments helpful in thinking of Maya. She's truly awesome and incredibly knowledgeable about animals, so I'm glad I'm not the only one benefitting from her wisdom in this post.
xiphias
Feb. 9th, 2010 06:15 pm (UTC)
It's totally fair to consider the stress of moving as part of your consideration of when it's time to euthanize Cocoa. When Boopsie was reaching the end of her life, we were getting ready for a several-week trip. We have a very good friend who deeply cares for animals with whom we would have left her, if necessary, with the understanding that, if our friend decided it was time, SHE could make the decision to put Boopsie to sleep.

As it turned out, we put Boopsie to sleep several weeks before the trip, and I'm happy it turned out that way. We weren't worrying about her on the trip; we got to be there when it happened. And we didn't have to take that into consideration for our decision as to when -- it was clearly time.

But, frankly, we WOULD have considered it. If Boopsie was in the maybe-yes-maybe-no stage before we left, we would have had her euthanized, so that she wouldn't have had to go through the stress of moving to our friend's house. Boopsie LOVED our friend, don't get me wrong, and, when she was healthier, she loved staying there, but even that would have been an unfair burden on our kitty.

So don't feel guilty or conflicted about taking the move into account in making your decision. It's a legitimate factor in your kitty's quality of life.
paninogirl
Feb. 10th, 2010 02:54 am (UTC)
Thank you so much for these added words. I feel that Cocoa may be in the maybe-yes-maybe-no category at the moment, as all of her health issues are (seemingly) treatable. Now, however, they are becoming more numerous.

We have a 4-day trip planned next weekend. While the neighbor comes down to feed her medicated food twice a day and gives her a little TLC during these vacation times, it won't be the same as us being here. Also, if something were to happen to her during that time, I wouldn't want to not be there with her. We then move 2 weeks later. So, I'm looking at early next week to bring her in. It will give me enough time to give her some final TLC (my goal is to make her purr at least once a day, because then I know she truly is happy) and mentally prepare myself a bit more for this sad but important decision. Dragging it on after my vacation would just be out of fear on my part. And, I know I would worry about her on the trip, and I'd like to avoid that.

Thanks for helping ease some of my guilt.
princemuchao
Feb. 9th, 2010 09:47 pm (UTC)
I hate to say it, but if Hunter was in the same situation I think I would let him go. I dread the day I have to make that decision... he is the best cat I have ever had, and will ever have.

Whatever you decide, try not to feel guilty - you know her better than anyone and I'm sure that the decision you reach will be the correct one for her/your situation.

Just because veterinary technology has advanced to the point where they can extend lifespans so far past natural age, it doesn't follow that a cat has the same reasons to struggle through the pain of old age that human beings do.
paninogirl
Feb. 10th, 2010 02:59 am (UTC)
I'm honored that you took some time to write a response, Scott, especially since I don't see you on LJ much. :)

Hunter is such a sweetheart, and looks so much like Cocoa. I definitely have a sweet spot for him and completely understand how upset you'd be over losing him. Given you'd put him down in my situation, knowing how much you love him, helps me come to terms with my decision. I'm actually surprised at how many people are encouraging the plan. But, it's probably because I've never been through it with an animal I've been so close to and because I'm so emotionally involved in my current circumstances.

You are right; I shouldn't continue her struggles just because medicine and technology will allow her to. Thanks for helping me put things into perspective.
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