Help! Difficult Decision, need advice now

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smokeymay

Member Since 2012
The vet called this morning. There is no sign of life. She's on antibiotics, IV, he says she's too weak to go home. I told him to try an anti nauseant shot. He will, dunno how long that takes to kick in. But he wants to see me this morning, possibly to put her to sleep. Yesterday her creatinine levels were at 6, suddenly up from 2 a few weeks ago. I've heard that cats can bounce back though, but the vet thinks she won't. She also has diabetes, which is well controlled right now, and pancreatitis. I don't want her to suffer but I want her to live and I don't want to make a bad decision if she still has any hope. Does anyone know of cats who appeared to be dying and after a few days of IV bounced back? What on Earth should I do? I anticipate leaving soon--please, any advice appreciated.

Smokey's mommy
 
Perhaps you can get a second opinion from another vet at the practice.

Is she in pain or is the pain controlled well? If she isnt in pain, I dont see any reason why you cant wait on the decision and continue the IV to see what happens...

Good luck, will be thinking of you!
 
I agree that (if the cost of the treatment isn't prohibitive) pain would be the deciding factor for me. If the pain were well controlled, I take more time to make my decision than I would if I knew my kitty was in pain. It's so hard when they are suffering. I don't want to "decide" too soon and kill my friend prematurely (made that decision once on something that turned out to be treatable and have never really forgiven myself) but I don't want to drag out their suffering when they aren't going to get better.

So I guess I don't have any advice...just sympathy for your situation. It's hard to see our loved ones so sick.
If she's comfortable, I'd give her some time. If she's suffering?...I wouldn't want to suffer...

Best wishes and prayers for you and yours in this agonizing situation.
 
I don't know if she is in pain or not. The vet didn't think so, but no way to know for sure. The vet said if he sent her home it would be the type of thing where we'd have to look over and check to see if she was still alive or not. Yeah I would rather wait, but, also am afraid she could end up dying.... alone. There is no 2nd vet at the practice. There is an excellent animal hospital nearby but they charge a fortune and may very well tell us the same thing.... the cat may be too weak to move to there. I'll ask the vet about waiting.

The main thing for her is she is really weak, hasn't really eaten since Saturday night and it's Tuesday. But she only started IV yesterday night, and received sub Q fluids at vet only Thursday and Monday. Now it will be daily.... I don't want her to starve to death though. Oh, my poor little angel. I've only had her 6.5 years and it's before her time. I feel like there has to be a way for her to rally, despite what the vet said.
 
I'm so sorry Smokey and you are going through this.

If, in fact Smokey has pancreatitis, it's an incredibly painful condition. At the very least, ask the vet to try an injection of buprenorphine to see if your cat acts better. If any cat or human is in pain, they don't want to move or eat.

The vet can provide nourishment, usually dextrose, via an IV drip. This will mean blood glucose numbers will go up but that's the least of the issues. The vet can also assist (i.e., syringe) feed. Your cat should not be starving while at the vet. Insulin can be used to offset any rise in BG values. The vet has to get food into your cat otherwise you are courting hepatic lipidosis developing which is a complication you just don't need right now.
 
Thanks guys.... yesterday I took the throw blanket off my bed that she loved to sleep on and put it in her cage at the vet's, and also took some toys (which she didn't particularly play with, but liked to watch me toss them and run after them lol... her only favorite toy is "mommy."). So hopefully she can smell me and the smells of home.
 
I've seen some pretty miraculous recoveries take place "here" in the past year and a half, and the optimist in me says it is never too late. When you get there, if the vet says that he feels it is "her time", ask if you can spend some time alone with her. And do ask about if she's in pain.

I'm a big believer in "following your gut", and I think if you can spend some private moments with her, you'll know what to do. I'll be praying for you and for her.
Listen to what your inner voice is telling you when it's just you and her.

Hugs,
Carl
 
If she isn't eating what about seeing what the vet's thoughts are on an e-tube? In the couple years that I have been on this board I have seen some amazing recoveries with the use of an E-tube to get nourishment into the kitty.

It is never an easy decision ...my thoughts and prayers are with you. Give Smokey scritches from all her friends here and tell her we are pulling for her.

Mel, Maxwell, Autumn & The Fur Gang
 
Thanks so much guys.

Even though the vet feels this is it, I have decided that if she remains as is right now, I won't put her to sleep. I went to visit her, and she looked all comfy in mommy's super soft throw blanket that was her favorite blanket I took from my bed. She's weak and tired, but was glad to see me and put her head into my hand for pets.

The vet said he doesn't think she is in pain. But, there's no way to know for sure. Pancreatitis can cause pain, and she's quiet and not meowing, and cats are quiet when in pain. I could request a pain med, but, dunno with side effects if that can make her feel worse. Overall she looked peaceful. I'm sure she's uncomfortable because she can't really stand up to maneuver. I picked her up to put her in the litterbox, and she didn't realize she wasn't in all the way and peed a little prematurely. I tried to wipe her off as best I could. But at least discomfort doesn't equal great suffering. I hope against hope that somehow she will improve after a few days of IV. If things get to a point where she is suffering then I would give her a peaceful end. But the way she is now, a bit out of it, and tired, I think mostly she's just resting and not thinking I abandoned her. I think her blankie from my house gives her great comfort. If she goes in her sleep that would be okay too. But hoping she'll stay alive and rebound. For the past month, she's been crashing and rebounding.... this crash is just worse and longer lasting than the others. She did show interest in food and water, but couldn't bring herself to eat it. I will ask about an e tube. I cancelled work today so I could spend more time with her.
 
I'm so sorry to hear your baby is sick. I am praying she will bounce back .
Even though she's out of it I'm sure she was happy you were able to see her.
I agree, go with your gut feeling.
I am sending you both virtual hugs and prayers.
 
Thanks so much guys! I went to see her throughout the day (took off from work) and tonight. She ate tonight!!!! The vet wasn't sure it's enough to save her, but it's a good sign, it has to be. She's still really weak and lethargic, but now I know I'm right not to give up on her. I'm visiting her tomorrow and will keep you all updated. C'mon, Smokey girl, you can do this, and you have everyone pulling for you and sending you such good thoughts!
 
Thanks for the update! Great to hear that she ate something. Looking forward to more good news :smile:

Carl
 
I've heard it is really hard to tell if a cat is in pain because they hide it so well. Sometimes, you just have to give them a little pain medication to see if they don't seem to feel better with it. I would ask the vet if he thinks a little pain medication should be given to see if it helps her.
 
I agree with Dyana, kitties are wonderful at keeping how much they hurt away from us. That and a small amt of Bupe wont hurt her any and may even help.
 
So happy to hear she ate a little...you might try the next time you go visit her to take some of her favorite foods/treats with you and see if she will eat for you. A lot times even if they won't eat for the vet they will eat for their peoples. Even if you have to finger feed her, it might just jump start her into eating better.

Come on Smokey girl you can do this...we are all pulling for you!

Mel, Maxwell, Autumn & The Fur Gang
 
For the poster that mentioned it (sorry forgot your name) what's Bupe?

Thanks guys, went to see her today. She was drinking on her own, not eating. Ate for me though. 20 pellets of dry food and a decent amount of baby food. I wish I can stay all day so I can get her to eat more regularly, but am restricted to vet's hours. I asked vet for pain meds before, but he says he doesn't think she is in pain... but I'm sure if I pushed it I could get him to give it. When I asked he did say that with pancreatitis there would be a tender spot if I pet her, etc... so at least we know that the pain isn't the acute pancreatitis pain, if she is in pain.

I asked him to give her a stomach emptier. A few weeks ago, he found her stomach to be enlarged. He said pancreatitis can cause that. She had responded to the stomach emptier, and her stomach went back down to normal size. Since she has shown a pattern of 2 or 3 well days followed by not eating/drinking, I was thinking it could be that her stomach keeps not emptying from pancreatitis. So that is my hope to hold onto, because that can eventually resolve. The vet said the stomach emptier wouldn't hurt her but he doesn't think it is going to help at this stage. I am praying that this isn't pure kidney disease, and is reversible (at least to an earlier stage) and is simply being temporarily exacerbated by all her other issues.... pancreatitis, being severely underweight due to DKA recovery (it's been over a month now). I'm hoping that somehow we can hit the right meds and fix her. Vet says her long term prognosis isn't good. I'm hoping so hard he is wrong. My Smokey is a spunky gal, and strong and brave.

Thanks for pulling for Smokey. She needs all the good wishes she can get.
 
PS Smokey's phosphorus levels are quite high, and this is troubling because she hadn't eaten in 1.5 days when measured at vet's. Vet says we use phosphorus binders when she eats. So, the fact that her phosphorus levels were high when she hadn't eaten and was crashing... does that mean she has no chance? I'm so devastated for her. Does anyone know about this? ANy advice appreciated.
 
Bupe is a transdermal pain medication usually given on the ear or it can be given as a shot if needed. It is ofton used for cancer or Pancreatitis. My sister calls it "Ear Goop" as thats the form she uses with her Kitty Tasha for the oral cancer she has. I cant think of the actual name of the medication right now, sorry.
 
Thanks guys,

I'm about to visit her now, and am only allowed one hour. I'm worried because she only eats when I'm there and it can take almost an hour to get her to start eating. Not sure if the vet will allow visiting this weekend as it's a holiday weekend.... but hope so. I'm starting to shift my attention to "getting her well enough to come home with me for one day" so that she doesn't think I gave her up. But her legs are so weak she can't move or stand so I don't know if that can ever happen. Ideally I'd like to give her until Monday but also don't want her to suffer. She's rebounded in the past from her crashes but this time she's not... she's stable for now but not improving. It's been about 60 hours of IV time for her so far. My heart is breaking. I'm starting to see the reality in front of me, though I still wildly hope that somehow she'll be miraculously cured.
 
Saying my prayers for your beloved Smokey and hoping that she will be able to come home with you. Have they checked her potassium level and also her HCT? Usually IV fluids are given for a max of 3 days before they start to affect her hematocrit level. Is she anemic? As for Bupe, pancreatitis is painful and pain can put them off of food also. Another thought is KFC........for some reason cats love their chicken and will gobble it down. No good time of the year for this to happen but so much worse around the holidays and vets being closed, etc. If there is nothing left the vet can do and IV fluids are finished, you could bring her home and do sub-Q's, give her meds she needs, and she might even perk up more being home and not being left alone during this time of year.
 
God my heart goes out to you. I'm still praying for that Christmas miracle...But also for guidance and peace, with whatever comes your way.
God bless,
jeanne
 
I know they checked her potassium and phosphorus levels... I think she is getting some potassium.

When I saw her today she didn't eat or drink and seemed just to want to give up. I told her I will do whatever she wants. However towards the end she perked up a bit and the vet mentioned she may have been hypoglycemic. So I don't want that to affect my decision. But I left it that I will call tomorrow, set up a time, assess her, and, if she is still not eating/drinking and doing worse then I'd put her to sleep. I'm not ready for that, because she is so young. I feel so incredibly guilty for taking her off insulin when it seemed like she didn't need it. That seemed to cause this downward spiral, and she can end up paying with her life. Everyone says how I went above and beyond for her, that they have never seen a cat so loved, so spoiled, such a special bond between her and her human friend. I feel incredible guilt. It would be something if she turned around tomorrow, but based on what I saw today it looks bleak. She's been on IV since Tuesday night I believe, so it's been 2.5 days. I want more than anything to take her home and let her be comfortable. But she can't even move or stand up, her paws and legs are too weak. I can't disconnect her from her fluids. How I wish I could see her more on what could be the last day of her life. My heart is broken and I can never be whole again.
 
My heart is breaking for you at you have to go through this. It's never easy but know she loves you as much as you love her and she knows that everything you did you did because you wanted what was best for her.

Still praying that she comes around

Jen
 
thanks jen. hope, to answer your other question, the vet says she is a bit anaemic but not terribly. the two things i know are way up are the phosphorus levels and the creatinine. and phosphorus binders won't be given unless she is actually eating enough to make it worth it. I feel so helpless, knowing what is wrong and being powerless to act. I love her so so much and am at home now, imagining all the things that may never happen again without her. I can't bear it.
 
Cats that are experiencing kidney problems experience a loss of appetite. Your kitty needs to be on low phosphorus foods or a phosphorus binder needs to be added to her food. Water is also an important factor in bringing down kidney values. Dr. Lisa has a list of low phos. foods.

Dr. Lisa has information on CRF on her site but Tonya's Site is the go-to place of info on renal issues. It's the FDMB board for kidney concerns.

Also, the vet "thinks" your cat was hypoglycemic? He didn't test? That's ridiculous. They should be running lab values pretty regularly. If the vet isn't doing so, while it may be more expensive, you need to get your cat to a better, more comprehensive care facility. You want an internal medicine specialist who will be running lab values regularly.
 
It sounds like you need to be with your kitty. If they wont let you, sit in the waiting room till they do. Someone there has to have a heart.
jmo.
jeanne
 
Hi,

To answer your posts, the vet does run regular blood sugar tests. He had planned to close at 12 today but let me stay an extra hour. He was going to run a blood sugar test but was waiting til I left so as to give me the most time with her. Other than her behavior, given that she's on IV but not eating/drinking, it is an educated guess that the 1 unit of insulin was making her low (she'd had a reading of 80 at peak a day or two ago as I recall).

I am fortunate in that the vet lives where he works. So he will be checking on my cat at regular intervals, even throughout the night. When my childhood cat took a sudden turn for the worse a few years ago, he stayed up all night with him. At a hospital, while their hours may be longer, in the past they only let me stay around 20 minutes. With this vet, I've gotten to visit as much as 3x/day on his longer days, and when I had only one visit per day, it's often been for 2-3 hours.

Phosphorus binders only really work when given with food.... they bind to the phosphorus in food, but as I understand they will not take out phosphorus already in the cat's system. They also have side effects. My cat has only eaten twice in the past two days, when I was there, and not enough food. Thanks for the site, I will check it out. For awhile I was asking all similar types of q's, like did they test for this, and that, etc.... but given that my cat has been crashing every 2 or 3 days for the past 1.5 months, and had pulled out of it before, but isn't right now, and her kidney/phosphorus values are going way up, the feeling is that she is beyond the point where she can be helped. I will continue asking questions, but so far the vet has answered pretty well and had tested whatever I asked him about... I could pull my cat out and take her to a hospital to get a second opinion, but chances are it will cost thousands to hear the same thing (I've alraedy spent thousands on her since her DKA), and also, she is just so frail that I can barely pick her up.... I am afraid she wouldn't survive the car ride, and she may think she is going home, only to be driven to the ER and then back to the vet to be put to sleep. :( That seems like a lot to ask of her. My feeling is that the IV either will flush her kidneys out or it won't.... and if it doesn't, she's in serious kidney failure and nothing can really help that.

My heart is tugged knowing she is where she is right now, without her mommy. I'm just hoping tomorrow she'll do well enough that I can hold off til Monday before making any decisions. Sometimes I wonder at my motivation because I may be being selfish given that she is not comfortable. I want to do right by her, and it's so overwhelming, because it's damned if I do, damned if I don't. I'd asked about a feeding tube, but the vet said he'd be very concerned she may not survive the procedure at this point, she's so delicate.
 
Thanks guys. I'm all over the map. I don't want her to suffer, but on the other hand, there are cats in crises like these that do recover but take time. Even if the vet is right, even if she is destined to keep crashing, I'd much prefer her to make it through this and spend her last few days at home (with me trying daily Sub Q fluids and etc). Then if she crashes we can take a quick trip to the vet and let her go (b/c keeping her alive to crash every other day is cruel). Letting her go like this, with her feeling possible abandonment, not being surrounded by her family, feels too terrible to bear. She has a whole history of abandonment (lost her first mom after 6 years, stayed with someone else for 6 months, now has lived with me for 6.5 years but she's always afraid of losing me). So I won't rush into this, even if she doesn't eat tomorrow, either. It's so difficult, but I want to pull for her to make it through this crisis at least.
 
Just wanted to send you some more hugs and support. cat_pet_icon The love and support you are giving your kitty, well I so hope and pray she improves so you will have more time together. She's been blessed these last six years to have found you. Hope she is home with you very soon.
 
Thanks. I'm about to visit. Just holding my breath for her to be okay or to show some improvement or start eating.....
 
She was like a different cat today. When I first walked in she was alert and able to stand up on her paws a bit. However then she zonked out with her head in the water bowl, but overall her legs were a bit stronger, and, unlike yesterday, she was able to hold up her own head. The vet told me that after 3.5 days on IV, her values hadn't changed. Creatinine above 6, and phosphorus high, slightly higher than before. I'm still convinced she can potentially get better. If she passes away while in the vet's care I only hope it is in her sleep and peaceful. I hope that she can come home, or that if she remains at the vet when the time comes to cross I can be there with her. She looked devastated when I left today (she woke up when she heard the cage door closing). I just wish her phosphorus levels would drop so she'd feel better.... but nothing to do about it when the cat isn't eating. My poor little baby.... I think she was 5 lbs after DKA and has lost weight since. Mommy wants to make her well.
 
Oh PS When I spoke to the vet, I asked if he'd taken her blood pressure. He does not have BP equipment at his office and if I want that checked I would have to take her elsewhere. He had listened to her heart throughout this ordeal and found nothing unusual, and does not believe her to have hypertension based on presentation of symptoms. However I know that cats with these conditions are prone to it.... not sure where to take her to have this done, and also how often should a CRF/diabetic/pancreatatic cat have their blood pressure checked?
 
Straw-grasping here: peritoneal dialysis to try to remove some of the toxins?
 
Thanks, will ask my vet. I tried googling it, and seems it has a very high mortality rate.... will ask vet though.

I keep praying that I'm doing the right thing. It's so hard that the cat can't tell you what they are feeling. My cat can barely use her legs, often sleeps with her head in the water bowl, isnt' really eating or drinking, weighs 5 lbs or maybe even less now..... yet she has moments where she's alert, and she always loves me being there. Is all this fighting worth it for her mommy time? Is it worth it if she passes away and I'm not there? Is it worth it for her to feel all this misery if she gets to go home... but only lasts a day or two there? What if she can rebound from this and go on to enjoy a few more weeks or months of life? Can I handle the roller coaster? WIll I be too emotional and frighten my cat? She loves me with all her heart; I am the center of her universe and she's not letting go of me yet. So all I can do is pray that she wants to be alive and that she can at least come home with me, however long that is. I'm scared for the Holidays, cause I can't visit her as often. My poor little angel.
 
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