How much illness is too much?

Hi there.
Would like some guidance/what would you do, type advice.
Situation, my mum and fathers cat. I do not live there, though have in the past and grown up with our cat as well so to speak. So my parents who are both retired, want my say in it though they live with him. I also act as the bridge between vet and them - as sometimes they can't comprehend all the information at once - so after a vet visit I list it out bit by bit for them. If that makes sense. They love their pets and have two elderly dogs aswell.

So our cat - he is turning 16 in a couple of months.
Since birth he has had a heart murmur that was stable enough to let it be.
The last couple of years he's had a slight limp, and cataracts that the vet wasn't too concerned about at the time.

Couple of months ago he had a sudden decline in weight, began going toilet inside, and his fur coat was a bit of a mess (lack of grooming due to lack of energy).
Took him to the vet and they diagnosed him with diabetes. He was given insulin and told he'd be checked again later to see if its helped. On top of this, the vet noticed he would need dental surgery, but at that stage just to leave it so we could monitor his diabetes.

This week specifically I noticed his limp had worsened, and he was less patient with everyone (other dogs, even petting), he was booked into the vets anyway as it was now time to check on his diagnosis.
He has gained a bit of weight, which is good, but the rest of the news isn't.
He needs dental surgery asap as he has developed an ulcer.
His heart murmur has worsened and needs to be treated.
His front leg does not feel good he has arthritis most likely, and his back legs aren't either like he doesn't want to put much weight on them (this is new).
His cataracts have also worsened.
The blood from his diabetes is not stable either, so the vet will change the insulin dosage.
During the vet visit, it was noticed an area of his stomach is particularly sore, so another issue might be happening too.

The trouble is with so much going wrong, how long do you continue for?
We realize that the diabetes is still not under control (as evident from the blood test this week) and this may be causing everything else to worsen. The vet said it might take some time and experimentation to stabilize his diabetes's.
The vet said we can throw everything we can in terms of treatment and he may live comfortably for 1 or 2 years more, but nothing will get better/heal so to speak, and some of his condition may get worse.

That all said... right now he needs the dental work done.
With his heart being like it is it puts him at high risk with dental surgery too. We need to do bloods, a chest x-ray and a heart trace first to see what pressure his heart might be under with surgery, though he is already high risk given age and what's happening.
And also we need to see whats wrong with this area of his stomach.

He sleeps most of the time, and he will play a little with his favourite toy (he has had since birth), and eats fine.
My mum is the one who cares for him, gives him his insulin injection (she is terrified of needles but got over her fear to help him).

But is it fair to keep him going, put him through the dental surgery, knowing he'll have these issues which will not get better, just get stable or potentially get worse?
Yet, I also dont want to feel like we are giving up on him.
My parents are under the impression he's just in pain and are prepared to put him down in a couple of days (our vet visit was today so they are having a sleep over it.) But I did explain that with all the treatment then maybe his pain will be managed. But with the uncertainty it is hard. They recognize he is 15 and on those golden years of life path too.
Any advice, or what would you do, or anyone gone through similar?

 

Hi and welcome to you, your parents and your kitty.
It is great your Mum looks after him.
Diabetes is a very treatable disease and cats can live for many years with it if it is treated and most die in the end from other causes, not the diabetes.

With the dental, he will probably feel so much better after it is done and you will have much more of a chance of regulating the blood glucose levels afterwards.

With his back legs, it sounds as if he may have a bit of diabetic neuropathy which is very common in diabetic cats who are unregulated. It improves once the blood glucose levels are more under control. Also MethylB12 tablets can be given for it. They we bought online or at health food stores, not from the vet....more about them later if you are interested.

If he is in any pain, it is probably only pain he is in is from his teeth which can be fixed with a dental. If he does have pain from arthritis there are medications to treat that.

Do you think your mother would test the blood glucose levels at home? We all do that here so we can adjust the insulin as needed and to keep out kitties safe. A good percentage of us are retired so age is no barrier to testing.......in fact being retired has its advantages as we don’t have to rush off to work!
To be able to test you need to buy a human meter which you can buy from a pharmacy..........which country do you live in?...,,you call your mother Mum so I’m guessing it’s not the US? We can help you get started and your Mum might like to start posting on here for help and advice.....it’s a very knowledgeable supportive group of people.
Your vet may say it is not necessary to test the BGs (blood glucose)....many vets don’t support it.....but it’s the best and safest way to help your kitty and to keep him safe, and you do not need your vets permission to home test.

I can’t comment on the heart murmur as I have no experience with them but I’ll tag @Wendy&Neko who can help you with that.

Can you tell us what type of insulin you are using and what dose please?
Also what food are you feeding. We recommend feeding a canned/wet diet with carbohydrates 10% or less for diabetic cats.
Keep asking questions...we are very happy to help you.
Bron

 

I agree with Bron. Don't wait on the dental. No doubt the dental problems are the cause of the extra high bg. Pain and infection raise numbers. Infection also puts the cat at greater risk of developing ketones. My cat had had three dentals done since becoming diabetic. She also has a heart murmur so has to do the x ray, echo cardiogram and all that. She's always pulled through fine.

Arthritis can be treated.... Ask about adequan shots. They can be life changing. I don't think my cat would be walking now without them.

The back legs sound like neuropathy. This will resolve with better bg control (through home testing) and b12 methylcobalamin. I like zobaline which can be bought in amazon. It packs a lot of mg in a small pill that is crushed over the food and mixed in. Really easy to give.

My cat had a lot of different things going on. She's 17. Diagnosed with diabetes 4.5 years ago. Had several dental issues (had all her back teeth pulled), then three years ago a tumor on her pituitary that makes her diabetes a high dose condition (acromegaly). The acro also causes boney growth in her elbows.... Thus the adequan shots. Two years ago stated developing ckd, for which we now give sub q fluids, and a year ago hyperthyroidism. We keep going because she's a happy girl.... And as long as she has a lot more good days then bad, and happy and purring, we will take things as they come.

 

While all of the conditions are likely treatable and manageable, the real question is, are your parents willing and able to do what is necessary to give this cat what it needs?
Can they give daily medicines, test his blood, bring him in for vet visits as often as needed, phone consults with the vet as things change and arise? Can they do what is necessary to keep him living a pain-free and reasonably good life? If they want to, but the reality is that it will probably be more than they can handle, and the cat will continue to be in pain and distress, then maybe it is time to let go. If they can and will give him the now-intensive care he needs, then give him a chance to live some more good years.

 

My girl also had diabetes due to acromegaly, like Janet's girl. It also caused quite severe arthritis and she got kidney disease. On top of that was a heart murmur which later became a heart condition and she was diagnosed with small cell lymphoma at the same time. She did have a few dentals before the heart disease, and she had an echocardiogram first to make sure her heart could handle the dentals. After the heart got worse, she could not have anaesthesia. All those conditions did mean extra medications and I had to be organized about what I was giving when. I did get her into see an internal medicine vet which helped me manage all the conditions. In spite of all Neko's conditions, she still had some really good times. She even took a "holiday" with us, travelling by car and ferry to stay in a hotel with us.

 

Hi everyone, thank you so much for your replies.
We are not in US, live in a small continent. No one has told us about having our own testing kit, I am waiting for the vet to ring back to clarify a couple of questions but I can ask about that too.
To have his dental surgery he needs a few tests done first to see if his heart will take it, though he is already high risk with age and what is already going on. He would need further tests to discover how bad his heart murmur, and arthritis prior to treating each of them. As well as a ultrasound of his stomach now.

He was put on a small dosage of insulin to start with for fear of the effect on his heart murmur (and this was before his murmur got worse too). So he is on 1.5ml. The vet wanted to increase it by 2ml next. Its baby steps till we get his diabetes stabilized. And in the meantime his other conditions may get worse...

He had been on Orijen Six Fish.
A few months ago is when the vet told us to change to Hills Science Diet Prescription W/D Multi-Benefit Dry,
and mum adds wet food.

The last words from the vet yesterday was “he is in a very bad way” - which maybe also due to this now noticed stomach issue.
The vet said “this is a big commitment, we only have two choices go all in, or euthanise.”
Either get all the tests done, put him through a risky surgery for his teeth, and try different medicines through trial and error - which puts more strain on his heart. While we hadn’t mentioned money the vet did, she said we could be looking at a couple thousand dollars this month to start the track.

My parents are coming to terms with it all, they are thinking it might be nicer for him to ease his suffering now, rather then put him through so much when the vet can't even guarantee he'll make it. He hates the vet of course and will need regular visits too. He's pretty miserable right now.
It would be so different if there was a 'yes this will work and he'll be better' answer, or 'yes surgery will be safe' but we can't have any of those. Its just a 'he's high risk cause of age, and worse risk with his heart' and a 'he might live one more year or two comfortably if we find the right dosage' ... but its a 'might' you know? And before that we have to put him through surgery and discover whats wrong with his stomach.
Is it better to let him go now while he still has a bit of life and can be still a bit happy. Then wait till he can barely move.
I just wonder we put him through so many tests, and it may still not work out. He sleeps most of the time, and has a fraction of play time. Is it nicer to have his life end on a high note now? But then waiting until they are at their worse... (that may make this decision easier because you can truly feel you did everything) but is it fair to wait till they reach suffering stage?

Its tough!
Thank you all for your stories and advice!

 

I hope you mean Units of insulin, not ml?

 

Yes, units sorry, its definitely not mls.
Gracie, yes this is a very big consideration as well. My parents are looking on how they can keep the treatment going, as well as listening to the vets advice. We've had three separate opinions from different vets now. Spent hours of research, and have talked to many people so they can understand and assess the the situation, and what is kinder for him.
Again thank you very much everyone for taking the time to read and reply to this thread.

 

I find vets are a bit quick for my liking in suggesting euthanasia. Cats can live quite happily with diabetes.
Their coat can look a bit of a mess due to the diabetes...sometimes dandruff. But that’s a minor thing. A brush now and then helps.
Arthritis can be treated with medication and the heart issue could well be able to be treated with medication.
And the dental would make him feel better Im sure.

I had 2 cats live to 21 and 22 so while 15 is a good age, many cats live a lot longer.
It’s really up to you and your parents what you decide.
I think your parents could look after him as far as the injections and medications are concerned. Just because someone is older doesn’t mean they are not capable of doing things. We have many many older people here who look after their diabetic kitties.
All the best..
Bron

 

Its not about age, please dont get me wrong.
But my parents have their own significant health conditions (one does have cancer) and the medicine they are on can sometimes effect their thought process. I attend each vet session because they can't take on every fact at once and may forget something important, or may not think to ask further questions. I didn't want to go into this as it is just one part of the situation, not the whole. And my parents are also still independent and quite capable of a lot of course.

Our cat will now require such needs (the vet today said he will soon go blind), and to be closely monitored that they may miss the slightest indication of a change in behaviour, or a dose of insulin or a tablet – not through purposely neglect or anything, they love him, but through accident with everything going on with them.
I tried to think through logistics of taking him to my house. But he has lived his whole life at my mums. I also live down a long drive way with several cats (he has never liked other cats), and I have a young dog who he hates (despite the fact she keeps her distance from him when we visit).

But that is just one part of it, the rest is really how long it may take to get his diabetes stabilized, how much he suffers in this meantime, and whether we can help these other situations that some have worsened and some have appeared over these past couple of weeks. It really has been a time of weighing up whats best for him, while considering options and hearing from others.

 

I know it’s hard. You must do what you think is best for him. It’s never an easy decision as we all love our kitties.

 

Hi Ange,

This food is obscenely high in carbohydrates. According to Hill's website, the dry matter carbs are 36.9%. This, in turn, would highly likely be driving your parents' cat's blood glucose higher. (My Saoirse was prescribed this food at time of Dx and was unregulated even on a dose of 3IU Caninsulin every 12 hours. When she switched to a low carb wet food her insulin dose dropped to 0.25IU almost immediately and her BG levels improved dramatically.)

If your parents were able to learn to home test, you could then consider transitioning him safely to a lower carb food and that could well see a big improvement in his BG levels BUT the insulin dose is likely to need to be reduced in line with the reduction in carb load, otherwise BG might go too low. More about safely transitioning a cat already receiving insulin here:

catinfo.org - Feline Diabetes

Which insulin is the cat (name?) is being treated with?


Mogs
.

 

Oh, you are in such a hard place. And only you can think through what's best.

I would join others in suggesting that you go ahead with the dental work and see how things stand after that. Next would be to move, with appropriate transitioning, to a lower-carb wet food.

All my best wishes.

 

Hey, thank you for your suggestions.
After another consultation with a vet, my parents have decided it would be best to let him go.
I really do want to thank all of you for taking your time, I have had many sleepless nights and reached out everywhere to get as much information and stories, to pass on to them as possible. They do not use computers. We've had a few consultations this week and each one has given similar prognosis. They haven't taken this decision lightly either. But we'll be with him.
Thank you again everyone, and I wish you the very best of your kitties!