How do you know when it's time?

I come to you all for guidance and support in trying to determine when it's time for Howie to cross the bridge. He has really slowed down on eating, refusing to eat even half the food I put out in front of him. I don't even know if he's getting all the medicine I mix in it or if he's getting enough for insulin.i switched flavors of food a couple weeks ago as he seemed to be getting bored with his other ones. His little body has been through so much....diabetes, acromegaly, pancreatitis, arthritis, and now what we believe is SCL. He's lost 3 pounds since June. He is listless, paces around a lot in patterns that don't make sense, cant really groom because of his arthritis, doesn't want to be held or lay on my lap, doesnt play or do mucg but lay in his bed, and makes some strange meowing noises out if the blue. I know there is a QoL scale but that is just so scientific. I see glimmers of hope when he rarely chases or follows my other cat around or comes to visit when I'm watching TV or even just wags his tail.

I know this isn't about me, it's about Howie. I'm heartbroken and feel guilty and selfish for not wanting to get up even earlier now to make sure he gets some food because I have to follow him around with his plate and hold it in front of him to eat while my other cat is locked away. Even in 45 minutes, he's not eating a half can of food. There is no one but me to take care of him and i just started a new job 7 weeks ago so cant be showing up late. He does like baby food and Tiki Stix but I know he can't live on those items.

I appreciate all thoughts, ideas, and suggestions (please be kind). I've only had him for 4 years as he was a senior cat when I got him, but I feel like I've had him my entire life with what we've been through together. He is my soul cat.

 

I found this post helped me with Neko: Making "The Decision": Help to know when and how especially tracking the good times and bad times and how much of each, and since then this one has been useful. Feline Pain Scale Also worth a discussion with his vet who knows him.

Small cell lymphoma is treatable, but with Neko there were so many other things going on at the time to cause her to be inappetant so I'm not sure how effective the treatment was. Make sure he's getting ondansetron 3-4 times a day, and a good amount for his weight. I would also reduce his dose of insulin again, so the amount of food is not so much a worry. He's gotten to the 60's on this dose at least 3 times and you don't want to leave him alone with a dose taking him that low and iffy appetite. Is there MC he likes? I also upped Neko's carbs a bit so I didn't have to worry as much about how much she ate. Also try for higher fat foods so he's getting calories in him.

Thinking of you in this difficult time. Our acros take a big place in our hearts.

 

I'm so sorry. This is always a difficult time. The llnk Wendy posted is helpful. I know with Gabby, she told me. Little by little, the multi-organ failure was taking her. She just looked at me and I knew. And she knew that I knew and I promised her she would never suffer. Cats will tell you. We just need to be smart enough to listen no matter how much it hurts us.

 

He is on Chlorumbucil but I wonder if it is worth it at this point if he just isn't eating like he should be. He's on 2 ondansetron a day. Do I double his dose each time he gets it? I'm not home enough to give it every 6-8 hrs consistently. Should I give Cerenia? He's not vomiting or appearing nauseous. I appreciate your thoughts on his insulin dose and food. He just gets FF when he needs MC food but I can't give that consistently as the gums in it upset his tummy. I just got a shipment of his Weruva food, of course! Do I Judy give up on low phosphorous food to get higher fat and higher carb? Food is such the big question mark. I did find a diabetic friendly high calorie supplement powder I mix in his food which he tolerates. Thank you, Wendy!

 

I would up ondansetron to 3 times a day on work days and non work days. AM, PM when you get home and before bed if a work day. It doesn't last that long in the cat. Though you can actually buy injectible version that does last longer than the pills. What is his ondansetron dose now and how much does he weigh? It can be given up to 4 times per day, and 0.5-1.0 mg/kg of cat. I gave it about an hour before giving chlorambucil and several days after. Neko was also on Cerenia. They target different nausea receptors so it's oK to give both.

Is he on prednisolone or budesonide as well? Neko couldn't do pred due to her heart, but the budesonide helped and didn't impact her BG. Which is the least of your worries as this point.

You should be able to find low carb, higher fat and moderate protein food. And that is lower phosphorus. Worst case, you add a binder.

 

How often are you giving it? My Mario has SCL and was originally on a schedule of M-W-F ad felt bat the day after administration, Then he was chanfe to a larger dose every two weeks. He acted so much better on that schedule;

 

He's on Chlorumbucil once every other week. I'm going on Day 5 after administration and his appetite is still not good and he doesn't finish his food. I figured it would last a few days but not this long.

 

I get home only about 1.5 hours before his dinner meal (if I'm on time). I can't really switch meal times around as I have to be at work so early with my new job. But I could give him another one before bed which is usually about 3.5-4 hours after his dinner meal. His Ondansetron is the generic version from Chewy and its 4mg. He currently weights 10 pounds +/- a few ounces. He gets two/day (at pre-shot testing times before meals) currently for his pancreatitis. He is on Budesonide as well as Gabepentin (compounded liquid).

 

Side effects of chlorambucil can last that long. Neko took 5-6 days before she felt better. She started on every other day dosing and it was way worse. She had no good days with that. EVery two weeks is much better. What is his chlorambucil dose?

For ondansetron, I'd do one in the AM, one when you get home after work, and another before bed.

 

It is 10 mg/ml and he gets .6ml every other week. I will make the switch in times for his ondansetron. Thank you for all your help! I hope he crosses this hump soon as I've spent 2 hrs tonight trying to get him to eat and another hour this AM.

 

For his size, he should be getting approximately 5.5 mg of chlorambucil, so about right. Are you giving it as a liquid? That's not recommended as it is a carcinogen and too much chance of getting liquid on you. You can get it compounded into capsules or chew treats to the amount you need.

 

Hi Tracy. I’m so sad about Howie. I know you love him a lot; your special pandemic boy.

How was his SCL diagnosed?

I don’t have any advice to give that you haven’t already been given — except that I might just let him eat what he likes (baby food and Tiki Stix — not to the exclusion of all other food, of course) and not worry so much about it. You can try to make any necessary adjustments. He should be allowed to enjoy eating to the extent that he can.

May I ask what the diabetic-friendly high calorie powder is that you found?

 

Wedgewood said nothing about not getting it compounded as a liquid, although it came with a ton of warnings. The same ones that come with Cabergoline that is also compounded as a liquid.

As of today, my vet and I decided to take him off Chlorumbucil. The side effect of low appetite does not give him a quality of life he deserves. He is at least 16 and I don't want to fight with him trying to get him to eat. This may not be everyone's idea of a good decision, but I feel OK about it. Thank you again for all the advice and help!

 

I get it. At one point, when it was getting close to time, I took Neko off of chlorambucil too. It just wasn't worth it given the amount of nausea.

 

Thanks, Suzanne! I found Carnivore Critical Care from Oxbow Health. I buy the 70mg bag from Amazon every 2 weeks. Someone suggested it on here and he doesn't mind it mixed in his food!

As I just mentioned to Wendy, my vet and I took him off Chlorumbucil as of today. I just can't watch him wither away because he doesn't have an appetite. Hopefully he'll regain his desire to eat within a few more days. I ordered him some higher fat and moderate carb food in hopes that helps him maintain his weight for the time I have left with him. He is my soul kittie.

 

Thank you for letting me know that. Helps me feel better about my decision. Should I keep him on Budesonide still? I honestly don't know what it's for! I just got a new bottle of course!

 

I kept on with the budesonide. It helped inflammation of the bowel walls as it's a steroid - before she was vomiting more.

 

Thanks for the tip. I may try that with my cat Ginger. I think the decision about the chlorambucil was a good one. He was really struggling. Let us know if his appetite picks up and if the new food helps. I will keep you both in my thoughts and prayers.

 

Have you tried CBD oil? I give it to my 20 yr. old to help increase his appetite and reduce nausea. There's also evidence that it can help with anxiety and pain management.

https://www.veterinarians.org/cbd-for-cats/

 

I havent! Where do you purchase yours? It's worth exploring!

 

There are lots of online places but after much headache-inducing research I went with Holistapet and have been using it for several years. It's organic, third-party lab tested and guaranteed to have no THC. A couple months ago I ran out and got some human CBD oil from our local cannabis store. If you go that route, make sure it doesn't contain THC which is toxic to animals.

One thing that baffled me at the beginning was what strength to get and how to dose it. Holistapet has a handy dosing chart but as CBD oil is very safe the dose can be adjusted as needed. For example, I have the 600 mg strength and Finnegan does well with 3-4 drops once or twice a day. He's old but still half feral and can be pretty spicy so I mix it with a little food to avoid fighting over putting a dropper in his mouth. When he had a dental in December, the techs who took his blood (and lost a little of their own) were surprised at how feisty he was for a skinny old man cat.

https://www.holistapet.com/products/cbd-oil-for-cats