Is there any hope?

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Rose L

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Hi All,
My 15 yr old cat has numerous health conditions, and we are now considering euthanasia, but it is breaking my heart and I still have some uncertainty on whether we could/ should do more, or whether we are just prolonging his suffering.

He has diabetes, chronic pancreatitis, and back about a month and a half ago he was diagnosed with a UTI. It was treated with an injectable antibiotic Convenia, did not go away, and in fact spread to his kidneys and we were back in a few weeksand put on a course of Veraflox, but he continued to get worse. He was also put into surgery and got a feeding tube at this time for his excessive weight loss. He was found to have other conditions as well- Chorinic Kidney Disease, and severe GI disease which unfortunately we had no idea about. By the ultrasound, the vet thought the CKD was probably in an earlier stage, but his kidney values were also elevated due to the acute infection.

Unfortunately he has continued to get worse in spite of the antibiotics and the feeding tube. On many days he leaks fecal matter, and he is continuing to pee beside our bed. He was rechecked at one point with an ultrasound (after the first week of antibiotics) and they said the bladder still looked enflamed, and that they would have expected more improvement by now. So, they put him on a take-home set of injectable antibiotics called Enrofloxacin.
He is also now on a steroid for his severe GI issues including fecal leakage. He is on Metroclopramide as well.

Unfortunately, he has just continued downhill, he cries at night (is now on Gabapentin and is more comfortable though, so this happens much less), he does not eat or drink on his own (but through the feeding tube)...except he sometimes cries in front of his water bowl but won't drink it. For some reason he licks up water from our shower?

We are giving him a bit of intravenous fluid. He vomited 2 days ago. He has a watery-dischargey eye on the side of the feeding tube- not sure why. He sometimes trembles a bit as he breathes. He overall looks like he feels miserable...stays curled up in the fetal position most of the day with head in blankets....

Called the vet's today and asked if we should come in for our scheduled follow-up tomorrow for more tests, or if there was no point as he clearly is deteriorating.
They implied that it was very unlikely that much could be added or changed to his care with the follow up, so I felt like it was probably pointless.

They said there was a very small chance that they might find a new bacteria in his bladder (2 weeks ago it was just the e-coli which should have been sensitive to the antibiotics prescribed- but they have not worked). She said there is a very small chance that it would be something different, but even so most bacterias she could think of should have been killed off by the antibiotic provided, so it is unlikely he could get something to turn things around at this point. She implied she thought his kidneys were likely failing.
She also kind of said that she thinks we tried everything reasonable and that euthanasia wouldn't be a bad decision.

Still I feel terrible. Is there more we should be doing? Or do I just need to accept that all his systems are shutting down and he has so many conditions that he just can't recover?
 
Hi All,
My 15 yr old cat has numerous health conditions, and we are now considering euthanasia, but it is breaking my heart and I still have some uncertainty on whether we could/ should do more, or whether we are just prolonging his suffering.

He has diabetes, chronic pancreatitis, and back about a month and a half ago he was diagnosed with a UTI. It was treated with an injectable antibiotic Convenia, did not go away, and in fact spread to his kidneys and we were back in a few weeksand put on a course of Veraflox, but he continued to get worse. He was also put into surgery and got a feeding tube at this time for his excessive weight loss. He was found to have other conditions as well- Chorinic Kidney Disease, and severe GI disease which unfortunately we had no idea about. By the ultrasound, the vet thought the CKD was probably in an earlier stage, but his kidney values were also elevated due to the acute infection.

Unfortunately he has continued to get worse in spite of the antibiotics and the feeding tube. On many days he leaks fecal matter, and he is continuing to pee beside our bed. He was rechecked at one point with an ultrasound (after the first week of antibiotics) and they said the bladder still looked enflamed, and that they would have expected more improvement by now. So, they put him on a take-home set of injectable antibiotics called Enrofloxacin.
He is also now on a steroid for his severe GI issues including fecal leakage. He is on Metroclopramide as well.

Unfortunately, he has just continued downhill, he cries at night (is now on Gabapentin and is more comfortable though, so this happens much less), he does not eat or drink on his own (but through the feeding tube)...except he sometimes cries in front of his water bowl but won't drink it. For some reason he licks up water from our shower?

We are giving him a bit of intravenous fluid. He vomited 2 days ago. He has a watery-dischargey eye on the side of the feeding tube- not sure why. He sometimes trembles a bit as he breathes. He overall looks like he feels miserable...stays curled up in the fetal position most of the day with head in blankets....

Called the vet's today and asked if we should come in for our scheduled follow-up tomorrow for more tests, or if there was no point as he clearly is deteriorating.
They implied that it was very unlikely that much could be added or changed to his care with the follow up, so I felt like it was probably pointless.

They said there was a very small chance that they might find a new bacteria in his bladder (2 weeks ago it was just the e-coli which should have been sensitive to the antibiotics prescribed- but they have not worked). She said there is a very small chance that it would be something different, but even so most bacterias she could think of should have been killed off by the antibiotic provided, so it is unlikely he could get something to turn things around at this point. She implied she thought his kidneys were likely failing.
She also kind of said that she thinks we tried everything reasonable and that euthanasia wouldn't be a bad decision.

Still I feel terrible. Is there more we should be doing? Or do I just need to accept that all his systems are shutting down and he has so many conditions that he just can't recover?
@Bron and Sheba (GA)
 
Hi and welcome to the forum. I am so sorry you are in this position.
First of all the original antibiotic, convenia, given is really not suitable for a UTI. But vets still give it because it is convenient.
Did the vet do a culture and sensitivity for the UTI? That is the only way you can find out what the bacteria is and what it is sensitive to. Otherwise it is guesswork.

It sounds as if your kitty is nauseated and needs to be on ondansetron or cerenia. I would try and get ondansetron first. The vet will have to write a script for you and you will need to get it at a human pharmacy. It is very effective against nausea in cats. I know he has been given Metroclopramide but I think the ondansetron would be much better for him. Controlling the nausea is often a game changer.

It does sound as if he is not being managed well to be honest. I would push for them to ensure they are giving the correct antibiotic for the uti.
With all this going on, I’m not surprised his kidney values are out of kilter.
My cat Sheba had diabetes, pancreatitis and early CRD and it was manageable.
What insulin and dose is he getting?
Have you tested for ketones in the urine?
Do you test the blood glucose?
Have they done blood tests to see if he still has an infection? A raised white cell count would indicate there is still an infection for example.
Do you think you could get his blood results so far and post them here? To do that you would copy and paste it. If the vet has the lab exults, they can email them to you. .you paid for them and are entitled to have them. We have people here who can have a look at them for you and maybe make some suggestions.

If you are uncomfortable and unhappy with euthanasia, don’t do it. Vets often seem to suggest this when they run out of ideas. You are not the first person to arrive here in this situation. I am going to tag @Suzanne & Darcy to see if she has some other ideas.
Hang in there and we will try and help you :bighug::bighug::bighug:
 
EDITS: he is on Cerenia (1/4 pill a day) plus another antibiotic in addition called Metronidazole for his GI issues (and supposedly to also help with any UTI issues as well as his main antibiotic- Enrofloxacin- for that).

Thank you so much for your kind reply. I will ask them for all his test results and post here. I forgot to put the Cerenia in my post, but he is on that. I am pretty sure they did a urine culture, but I will ask for the results. THey just told me it was e-coli in his urine. He has been seeing a specialist "hospitalist" too. He was tested for ketones at his last 2 visits. None were present. The first vet who saw him at the emerg care center a month ago thought his continued symptoms were due to ketoacidosis and wanted to hospitalize him for 10 grand (I did an earlier post about it), but he didn't even have any ketones in his urine when I took him back in. Instead he had all these other problems and the continued UTI.

I do feel like some things have been mixed up with his ccare...long story. For one thing, for his tube feedings they have put him on Purina Essentialcare Senior formula for cats...but the vet tech mentioned that it was a urinary food...which it is not. I now think they meant to prescribe the OTHER purina urinary care one...so he has been on the wrong food for 2 weeks. Not sure if this would make a big difference though.

I have a really hard time coming to terms with euthanasia...but I also have waited too long for a pet in the past and their natural death was not pleasant...so I don't know. I'll try to get back with his test results. Maybe I should pursue additional testing? But if the vet was right that it wouldn't really change anything, then I don't want to put him through another vet visit at the end of his life... I am so torn. This is the worst.
 
Sorry, and I forgot to add, he is currently on .5 units of glargine...it was recently changed. He was on a Libre monitor but it randomly stopped working. His blood glucose is quite variable with everything else going on with him right now.
 
Here are your2 previous posts

https://www.felinediabetes.com/FDMB...derly-cat-10-000-vet-stay-recommended.294549/
https://www.felinediabetes.com/FDMB...t-estimate-advice-needed.294573/#post-3211178

With the tube feeding, the Hills a/d canned food is very good. I'm not a fan of the prescription foods but this one is good for sick cats and is easy to tube feed.
I'm also going to tag @Wendy&Neko to see if she has any suggestions. She and Suzanne probably wont be around until tomorrow now as it is late in the US and Canada.
I would still ask about the ondansetron as it is better for nausea than cerenia.
And I would check that they did a sensitivity with the UTI as no antibiotic is any good unless it is sensitive to the ecoli which can be hard to eradicate.
 
My heart goes out to you. I would join the groups.io group for chronic kidney disease as soon as possible and make an introductory post.
Metaclopramide isn’t a good choice for nausea. The Ondansetron (Zofran) that others have recommended is a much better choice for nausea and Cerenia is good for vomiting if that is a concern. Cerenia can also be beneficial for pancreatitis. If he has a kidney infection he will need 4-6 weeks of an appropriate antibiotic to clear it. The Baytril you are using should be effective against E. Coli. I would ask to see the lab results from the urine culture.

Has his blood pressure been checked? I have had cats who cried/howled a lot at night and it was a result of high blood pressure. That is a known symptom.

What is the steroid being used and what is the dose? I assume it is Prednisolone (not prednisone). What did the ultrasound report say? It would perhaps be helpful if we could read it. Where is the inflammation?

You said you are giving IV fluids. Did you mean to say sub-q fluid (subcutaneous fluids given under the skin)? What type of fluid and how much?

I am so sorry about this situation with your cat. I totally understand how you feel right now. It is heartbreaking.
 
Thank you everyone so much for the replies <3

Yes, I meant Sub-q fluids. He hasn't had blood pressure checked. I will ask for the ultrasound report as well. God, this is heartbreaking, and I do feel anger like they should have been able to give me something to cure his infection, right? Or is that not always possible when their immune systems are compromised from concurrent conditions?

He is getting worse. He now is losing control of his hind legs. He just sits in front of his water bowl not drinking. Paced a bit in the night, then went back to fetal position. His eyes are very sunken. His nose and eye is very stuffed on the side of his feeding tube.
I am worried he might have a partial blockage of his urinary tract (or perhaps just the infection still). He is releasing pee every now and then, but it isn't a lot (and he used to pee a lot with his diabetes).

Here were his most recent results from 2 weeks ago :

From October 15th: Vetscreen w/SDMA Total Protein 83 52-88 g/L Albumin 35 25-39 g/L Globulin 48 23-53 g/L Albumin/Globulin Ratio 0.7 0.35-1.5 Ratio AST(SGOT) 17 10-100 U/L ALT (SGPT) 16 10-100 U/L Alkaline Phosphatase 15 6-102 U/L Bilirubin,Total 1.7 0.0-6.8 umol/L BUN 38.5 (HIGH) 5.0-12.9 mmol/L Creatinine 349 (HIGH) 53-212 umol/L SDMA 46.0 (HIGH) <15.0 ug/dL An increased SDMA (>20.0 ug/dL in cats and >16.0 ug/dL in dogs) should be interpreted in light of the patient's history, clinical presentation and hydration status. Additional diagnostic testing may be warranted to differentiate acute kidney injury versus chronic kidney disease and/or identify the presence of underlying conditions that can cause a significant increase in SDMA. Refer to the Antech SDMA algorithm for guidance regarding further diagnostics, treatment and/or monitoring. It is recommended to recheck SDMA and creatinine in 2-4 weeks to assess for persistence or trends in SDMA, and interpret in light of the creatinine. To access the SDMA algorithm, please visit: https://tinyurl.com/4ypuxfuw Bun/Creatinine Ratio 110 Ratio Phosphorus 2.61 0.77-2.65 mmol/L Glucose 8.5 3.5-9.4 mmol/L Calcium 2.50 2.05-2.70 mmol/L Sodium 142 (LOW) 145-158 mmol/L Potassium 5.4 3.4-5.6 mmol/L Sodium/Potassium Ratio 26 (LOW) 32-41 Ratio Chloride 112 104-128 mmol/L Cholesterol 8.60 (HIGH) 1.94-5.70 mmol/L CPK 73 56-529 U/L
 
I am going to third the recommendation of getting a script for ondansetron to help with nausea. Many of the symptoms you describe sound like that is an issue.
he is on Cerenia (1/4 pill a day)
How much does he weight and what size is the Cerenia pill? It is dosed by weight and pills come in different sizes. Many vets under dose this medication.

Losing control of hind legs could be a side effect of diabetes called neuropathy. It is treatable, more about it here: Feline Diabetic Neuropathy
plus another antibiotic in addition called Metronidazole for his GI issues
Metronidazole/aka Flagyl has the nasty side effect of impacting his GI system. When a kitty is getting an antibiotic, you should also look at giving a good probiotic to help return his good flora. Give the two a couple hours apart. Visbiome or Proviable may help.

Was his thyroid levels checked, ie. T4? Hyperthyroidism can also cause howling.
 
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