when to say goodbye?

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allison and Bubbles

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Hi all...I am looking for a little advice/knowledge here for my 16 yr old kitty with stage 2 kidney disease...he is in quite a bit of pain...at least from all the signs I know of and he is having almost chronic nausea...he gets bupe for pain every 12 hrs and cerenia for nausea but in past two weeks he seems less interested in eating and in more discomfort ...I just do not think this can be attributed to kidney disease and I was told by my vet last night which nearly did me in that there is no point in doing an ultrasound as nothing can be done for him anyway because of his kidneys...? vet said he is not a candidate for surgery if needed...can anyone think of what may be causing his continued intermittent pain and nausea ? He is not arthritic nor constipated ...pees normally and poop looks normal and he still does have an appetite ...hes negative for pancreatitis (spec fpl done) but his amylase was elevated (1300)...I do not want him to suffer anymore and as much as it scares me I wonder if I have to let him go...oh xray was odd...showed enlarged bladder but that problem seemed to immediately be solved after urine was expelled ...help...
 
Allison I’m so sorry you’re going through this. I wish I had some answers for you. Maybe post his lab results and someone can see something the vet missed. I’ve heard that ondansetron is the best for nausea and can be used with cerenia for better relief I hope you find answers :bighug:
 
Hi Sharon14tothe rescue as always...i ove you!! ok i posted his labs on Tanya' ckd site...many ppl have looked at them and said nothing is standing out...I had a heck of a time posting them all by hand bc I do not know how cut and paste works...perhaps sometime in the remainder of my life I might actually learn this...I can try to do it typing out all by hand again if someone might be able to post it for me...I cant get zofran which is unbelievablely frustrating bc it could literally save him from fatty liver..he is down to eating small amts of food...basically I believe he suffers from not only nausea but an aversion now to food...I keep switching up his food...he is in a significant decline and I cannot get an ultrasound til Monday or Tues...his pain level is no longer under control either (all this in past five days or so)..vet said no pt in ultrasound anyway bc there is nothing they could do for him anyway (surgically )...his body is too weak...I am afraid I may have to let him go before the ultrasound. .I asked vet 48 hrs ago to put him on clavamox. .last sort of effort to possibly cure an underlying infection...his urynalysis came out fine 8 days ago...any thoughts? It is awful watching my little guy suffer...
 
Can you give the pain med every 8 hrs maybe even a slightly reduced dose each time. If he needs it he needs it.

I don't know what or why your giving. Olive was given gabapentin for discomfort every 8-12 hrs. Started with the 12 hrs but it wasn't working. Went to 8 hrs and worked like a charm. Decreased over time and she has been off it a month now. We have it handy should she need it again.
 
yes...the painkiller is an opiod...so it could be dangerous if I give him too much...
gabipentin I never tried...it blocks some types of pain caused by the nerve system...but I do know from human experience and ppl I have known that have taken it .... it can be quite effective ...but not nearly as effective as Buprenephrine ...thx for your caring...I am truly facing the awful decision...Mor Mor has hardly eaten in 24 hrs...this is new....he lost a pound in one week ...
 
yes...the painkiller is an opiod...so it could be dangerous if I give him too much...
gabipentin I never tried...it blocks some types of pain caused by the nerve system...but I do know from human experience and ppl I have known that have taken it .... it can be quite effective ...but not nearly as effective as Buprenephrine ...thx for your caring...I am truly facing the awful decision...Mor Mor has hardly eaten in 24 hrs...this is new....he lost a pound in one week ...

Smokey got 0.15 of Buprenorphine every 8 hrs. He started at 0.3.
 
what is a liver shake?...no i have not been syringe feeding...I have a/d...I could try that...it might help him feel better...but I am confused about whether or not you should syringe feed a kitty who is nauseated...he has been getting sub q fluids 100ccs every night and in past cppl days I have actually out of almost desperation giving him MORE sub q fluids in the morning as well ...I do not know id I should be doing that...trying anything to make him feel better...I am afraid I am not administering the Bup right...I cant put it on his gums...it goes everywhere...so I just give it to him orally and hope some of it gets absorbed through his gums....
 
I’ve never given Bupe, so I don’t have any ideas on how to help with that. For the liver shake, check out the link I posted above. You could just try some chicken liver warmed in the microwave, only a few seconds as it will explode if you overheat it and it’s a mess to clean.
 
what is a liver shake?...no i have not been syringe feeding...I have a/d...I could try that...it might help him feel better...but I am confused about whether or not you should syringe feed a kitty who is nauseated...he has been getting sub q fluids 100ccs every night and in past cppl days I have actually out of almost desperation giving him MORE sub q fluids in the morning as well ...I do not know id I should be doing that...trying anything to make him feel better...I am afraid I am not administering the Bup right...I cant put it on his gums...it goes everywhere...so I just give it to him orally and hope some of it gets absorbed through his gums....

With bup squirt in the side of his cheek or under tongue. If he has heart disease be careful of the amount of fluids you give.
 
ok thx sharon...I will try to find chicken liver here...I think that might really perk him up...the symptoms of hunger look similar to symptoms of pain...I have just realized this morning ...I am going to first try a/d ...thx again for your help and caring...no time is more difficult than this as we face the inevitable....
 
thanks Olive...I will try my best to keep it in his mouth before he swallows it...its a struggle bc he is also nauseated so I run the risk of him vomiting it up...its all a difficult balance it seems...
 
Hi Allison. When to let go is always hard and it just never gets easier. Cats and dogs will put up with incredible amounts of pain and just keep going without ever complaining. The problem with pain meds is that a human with a compound fracture can tell the nurse "Yes, that's better" and knows what to expect. But a cat that is suddenly stoned does not know what just hit him.
I don't want to abandon you but I also don't want to be the one idiot in the room that kills your cat when it could be something else. Even constipation can be quite painful. This is not about me but I have to say we have lost eight cats and a dog in three years and some were in pain so this is what we did.
Jasper was not in physical pain but because he could not make it to the litter box (he was living in our bedroom at that time) he had no dignity. That is a kind of pain and one day Cynthia and I just said "Why are we doing this to him".
Hannah was not in physical pain but had dementia so when a smart dog looks around and does not know where she is she had no pride and she knew that. Our vet opened on a Sunday morning for that.
Elmo was the smartest cat I've ever had but had liver and kidney disease. When he started sleeping in the shower we just let him be for a few days before his last car ride. He could have gone on for another three months but what was the point?
Sometimes I think if animals could talk they might say "I know you love me but right now you're not doing me any favours".
Jacob and Nigel both had cancer so we had them at home almost to the end. Using BUPE can be like playing with fire so we watched carefully for balance, eyesight, how the other cats reacted. They were both kept away from the stairs, the tub, toilet and sink and anything that could get knocked over and fall. I cannot remember the doses but we quadrupled Nigel's dose and he could still walk, knew where and who he was. Jacob was much the same but was terrified every time we came near him he'd be force fed his enormous diet of pills (he was misdiagnosed) so we just let him sleep under the bed for 48 hours.
Noah gets transdermal BUPE, I just tickle his ears twice a day. That is from a compounding pharmacy, it's expensive and the weekend is here so that might not be much help.
I cannot say "Oh if he's just howling you'll know it's time" because maybe a thorn is stuck in his pad. Too many "maybes"! Sometimes all that testing is for nothing, too many test results are open to interpretation. Even that is me giving you medical advice so I'm not saying "Do this, wink wink". You are the only one who knows and that Allison can be the loneliest feeling in the world.
Nigel was # 8 for us, I was so angry with God I almost put my hand through a window after that. That's when I got my PTSD diagnosis.
I'm not even going to re-read this post, it comes from my heart and not my head.
If anyone sees something I've said is wrong please correct me, this is not the time to be worried about how I feel. Everyone loves and cares about you Allison and your family. Be kind to yourself this weekend and the ones around you. :bighug: :bighug: :bighug:
 
whether from your head or heart or wherever...you said what I really needed to hear bc yes this IS the loneliest feeling...you are right...it is just Mor Mor and I and his life is in my hands...I dont like the way his life is going...he is on Bupe ...cerenia...mirt...and now clavamox (which was my last hope that maybe he has an underlying infection causing his pain and nausea)...it has been 48 hrs since he started it so it is too early to say ...his urynalysis came out fine but I know he could have a curable infection (kidney) that has not been diagnosed....there is no indications of this...normal temp...wbc count normal but it IS possible still....he is barely eating and he now growls when I pet his belly even though he is being still PLAYFUL which is shocking....which brings me to your other good point...animals will jusy keep going even in bad pain...and nausea...neither of which is any quality of life...I think very similarly to you...quality of life is everything and I have become so enveloped in Bubbles first ...now Mor Mor and I am afraid of losing sight of the big picture which is not hard to do when you become jaded ....I so appreciate what you have just said Dickson...He is scheduled for an ultrasound on Monday ...I am unsure just yet if I will go through with it... my vet does not recommend it...he feels Mor Mor is dying ...he has 30yrs experience ...thx for writing...you express your thoughts very well...
 
He is being still PLAYFUL!!!!
Hold everything. I've seen really sick cats eat and drink but being playful is not something a cat would lie about like a human ("Oh I'm fine"). His ultrasound is in 48 hours so between now and then keep track of when and how much he eats and drinks and pick through his litter for any blood or something that does not belong.
You're getting some mixed signals, "his urynalysis came out fine" which is confusing. Obviously something is going on but what?
Your vet recommends against the ultrasound? Why? I know Mor has had one or more already.
CJ is sicker than I am now so I need to follow the advice I gave you and take care of myself but I'll be on and off all weekend. :bighug:
 
:bighug::bighug::bighug: If he is playing I’d wonder why or how he feels so bad. I just gave Baby the oral bupe straight down the mouth, I had no idea it’s suppose to be on the gums?!? I think it may absorb there quicker but it still works straight to the tummy. Like any oral meds that goes there. I would try to syringe feed or maybe sprinkle parm cheese on his food. Baby likes it when she won’t eat. Give him anything but I’m sure you’ve tried...I just have Baby left & I understand being lonely for sure. We’re here for you - big hugs & please keep us posted.
 
I do not understand what is going on with Mor either...he at one point plays with his cat nip toy and appears happy and normal...an hour later he appears in pain...the signs are: his eyes seem fixed...he is unresponsive to being petted...he wont "open up his belly " and let me pet him there...he is listless ...at times purring way too loud with respiration rate too high...and wont eat favorite treats...these are the signs of his discomfort ...I have not tried parm chz yet!going to buy some today...his appetite is low but he is still eating enough to not be in danger of liver issues...yes bup cannot be absorbed through the GI tract...according to a well informed member here...I know I was very surprised to find this out as well...it is absorbed thru the gums and is not an easy task to master! kisses to Baby...I have a special feeling for her...not sure why...she is just so cute!
 
Aaaw she sends head bumps back to you both, you sweet one! I guess Baby didn’t get much bupe then! I’ll know next time. The cerenia should help the tummy... sending Mor lots of love! It does sound very strange but I think you will know when it’s time.
 
Even my own vet doesnt recommend bothering with an ultrasound...he says theres no point...so i asked for clavamox in case there is underlying infection going on...its been over 48 hrs...he is feeling good today...my hopes are high again...I am getting the ultrasound anyway ...I have to exhaust all possibilities that there might be something I can do to treat him ...no part of me is ready to let him go yet...so I know its not time...thx for your continued support Becky...
 
I have migraine meds that need to kept under the tongue until they melt, useless otherwise. Some antianxiety meds work the same way.
You said your appointment was Monday? By the time tomorrow morning comes around you'll only be 24 hours away from some kind of answer.
Does this mean MorMor has not been getting his BUPE the right way until now? Try either putting some on your pinky finger (with gloves) or smearing his gums with some BUPE in butter or cat food. Remember Allison, if you've been doing it "the wrong way" it's not about guilt. We just want Mor to be pain free and lucid and we'll see how Monday goes.
Is Monday a statutory holiday in the U.S.? Does that mean your appointment is at an emergency clinic?
 
Sorry, forgot this. It's always been my impression that ultrasounds can only see soft tissue; growths, cysts, lumps etc. On the other hand I was sent for one when I had a hernia, a tear in the abdominal wall, and both my surgeon and the tech said I was wasting my time. I don't understand, really frustrating.
 
yes it is very hard to comprehend how a liquid is to be somehow applied to Mor's gums...its a huuuge challenge just to get him to open his mouth....maybe a cutip might work ...if I put it on my finger it just gets spewed everywhere....
yes in about 24 to 48 hrs I may have some kind of answer....you know he had an enlarged bladder on the xray and his bladder was expelled immediately and he is peeing normally...so I do not know if it was some kind of temporary blockage but the vet has not suggested a recheck xray and I am going straight for the ultrasound...poor Mor is not well and he has some pretty bad days so this cannot continue.....I need some answers...I think we are a special group of folks here bc most ppl seem to just let their cats "get old" and then euthanize without any testing...I will spend two yrs paying off all these vet bills....
 
A Q-tip is a way better idea than mine. Some will stay soaked on the Q-tip so see if you can do it that way with a bit of the broth from some food.
I ended up with transdermal because Noah just hated the taste, it was the worst part of his day by far. The vet said that was really odd.
 
Why did my vet not tell me this? Bupe, I’m asking her next time we go. A person needs to know this! Oh good... yep I’d do the ultrasound too. Baby had x-rays last week & my vet could tell where the pancreas would be if it was inflamed. I didn’t know that either!? Good luck on Monday!
 
Hi Allison - i'm sorry to hear about your kitteh being so sick. These decisions are always hard.

I think quality of life is important. If we think our kitteh is just having a down period, then we double down on the time and attention, as well as the vet help. For chronic situations, we have decided to keep our kittehs as comfortable as possible until the time comes. It is always a tough decision though.

Thinking of you and your kitteh tonight.:bighug::bighug::bighug:
 
Hi Jeff...I see you here alot always in support of those who have had a loss...thanks for that and thx for your thoughts about my kitty...yes it is particularly difficult when kitty is declining...and especially when you do not know why...last night he had a bad night...he was in pain to the point where it was disrupting his breathing (not laboured ...just awkward looking if that makes sense)...he has daily "bouts" of pain and nausea. .tommorow is his ultrasound I hope...could be Tuesday...this situation can really make the owner ill too...I have barely slept in well over a month keeping watch over Mor Mor...this morning he is leaping around like a young boy being even playful...I gave him extra bupe last night at 4 am ...he was supposed to wait until 8 am this morning but I could not watch him in this pain....I think today I am going to take him to another vet if I can find one open...he needs better nausea and pain control and I felt the last visit with my vet wasnt great as the vet has sort of lost interest unfortunately..I think some vets give up on older kitties because of course they do not want them to suffer and when there are so few answers they just need to sort of give up...I kind of understand this as numerous things causing pain or discomfort can be going on in a 16 yr old kitty...but I simply can't give up when I see him rolling around in the sun and still enjoying life...maybe it is a matter of more good days vs. bad ones ....not sure how others make this call...thx for your continued attention and comfort towards those of us in these situations...
 
Yes, it could just be a matter of finding another vet and a modified treatment regimen. You are lucky to have him for 16 years. That is pretty old for a kitteh.

For us, it has not usually been easy to make the call. The last time was Scoobs in 2016. And we think it was poison that destroyed his intestines. But there was no way to live a normal life after that, so it was his time. It doesn't keep you from missing them though.

I also help with insulin and dosing guidance. Not so much in the past few months because of work.
 
yes I remember you saying you were not quite able to watch videos of Scoobs yet as it would be too hard on you...I completely understand...i lost Scallywag in jan 13 2015 and i have a huge over life sized photo of her ...the only picture on my wall...and I have to take her pic down often bc it is too hard to look at...I lost a kitty named Oafy june 8 2004...and i still have only looked at her album about ten times...I totally get it...
 
Scoobs was a brown tabby, and was an expert at leg lovin. He used to go for walks with Theresa and the droolers.

Our current 2 tabbies are Leo (black) and Little Dude (orange). Here is a picture from 1am this morning. They are luv bugs.

Leo is pretty stable at 3.0-4.0 units/dose, along with his chemo and pred. We are happy that Little Dude has become his daily companion.

Little Dude and Leo luv bugs - 05-27-2018 1am b.jpg
 
Stage 2 kidney disease is likely not the only issue. Was a Spec fPL run for pancreatitis? Have you been giving cerenia or ondansetron? If only one you could try the other or even both for nausea as they work differently. Sometimes they need syringe feeding to get them to want to eat. If giving a nausea medication you could try an appetite stimulant like cyproheptadine or even 1/4 regular Zyrtec. You can add warm water to the AD and syringe small amounts hourly about 30-45 minutes after the medication if he doesn’t eat on his own after getting them. You can combine the meds in a gel capsule and chase with a syringe of water. This doesn’t sound to me like he’s ready to check out if playing and socializing. Have you tried offering Gerbers ham baby food or one if the other flavors that are on,y meat? Sometimes my cats would eat it when they wouldn’t eat anything else. It’s also easy to finger feed or syringe without having to water it done. :bighug:
 
taking pics at one am...I can sure tell how much love you have for your cats...especially reading what you have done for Leo ( never considered chemo for a kitty as a real possibility)...you saved his life ...your cats got really lucky to have you as their keeper...thx for all your support...will keep you updated on little Mor Mor...☺
 
thx Tiff...my vet wont prescribe ondasteron...yes hes been tested for spec fpl...but that was six weeks ago and his amylase was elevated ..but not enough to the pt where vet concluded it would be pancreatitis....I do not know what to do except try everything I can think of and what u folks have suggested...thx for writing...I am truly exhausted
 
Amylase is not a good indicator of pancreatitis in cats. Chemo for cats is different than for people as the goal is remission rather than a cure. Some require a couple pills whereas if masses it’s usually injections which I did for Tiffany. I’m Elise. Some cats do actually get cured. It’s draining dealing with sick fur babies :bighug:
 
Tiff..do you know what bloodwork the vet bases his decision on to confirm pancreatitis? I have had it..in ppl it is lipase...I was told in cats it is amylase...I would really like to know bc if my kitty has pancreatitis ...it would possibly explain his intermittent pain episodes and nausea....
 
The test is Spec fPL. There’s a quick one that just gives a positive or negative. You don’t want that one. Antech has one called Precision PSL but I don’t think it’s so accurate either. I just got labs in my two 1 1/2 year olds to have a baseline and one was slightly above normal. She definitely doesn’t have it. IDEXX runs the right test. Only thing is diabetes , CKD and some other things can make the test read high but it’s all we’ve got testwise. I’m starting to think these tests are causing some cats to be labeled with pancreatitis that might not have it. JMHO though.
 
hmmm...yes I have questions about why his amylase was higher than normal...he did have the spec fpl test....but I am like you... still do not always believe bloodwork results as a way to find an accurate diagnosis...Mor goes in for an ultrasound tommorow....
 
Good luck at the ultrasound, let us know how it goes.

When I had to give bupe, I didn't both to get the cat to open its mouth. I just took the (needle-less) syringe, slowly snuck it in through the corner of the closed mouth and squirted it between the teeth and cheek.
 
Hi Sharon...I love this place...feels like I have friends here when ppl.remember Mor Mors ultrasound!! I am not going to get my hopes too high bc he has lost a pound in two weeks but nothing showed on the ultrasound !!..It was a vet not a specialist that viewed the ultrasound. .but the specialist will be viewing it today ...they suspect a kidney infection and the urine culture should come back soon...he has been on clavamox for four days but w dont see a huge improvement in pain level...but maybe the infection is not sensitive to clavamox....I honestly cant wipe this smile off my face as my hopes are just buried beneath the surface until I hear more from the vets office today...I also talked the vet into zofran for a weeks trial...but if the infection can clear up shouldn't need all this extra medication ...i hope....it is costing me 300 buks a month....so there is hope...and i owe it all to this group including you for encouraging the ultrasound....I honestly thought euthanasia was around the corner...thanks so much for asking about us!
How are you doing ? I did not forget what happened to your kitty ...
 
Hello to everyone who has followed this journey with me...I just sent a long message saying thank you for all your encouragement but looks like it did not get posted...so this one will be more like a blurb ....but oh what a good blurb it is!!
The ultrasound showed no masses at all and vet suspects from viewing the ultrasound (I think?) a kidney infection...isnt this kind of a likelihood bc he is ckd? I thought it would make him more suseptible to kidney infection but vet said no...I asked hi. for clavamox anyway in case there was an undiagnosed infection...so for five x
days he has been on clavamox...I cant say my hopes are through the roof though because he has lost a pound and a half in three weeks....urine culture comes back hopefully today and I talked vet into zofran in the meantime! yaaah....for small miracles...he needs better nausea control...so I want to thank you guys for encouraging me to go through with the ultrasound bc if you hadnt I probably would have come to another conclusion on my own and things would have definitely gone a different direction....I am praying he is treatable...but honestly he is very frail at the moment ...seems a bit weaker in past cppl days...thanks you all for caring...I love this group ...feels like you are my friends...would be so awesome to meet ppl in person or on skype somehow!!!cheers from Mor Mor and me!!
 
A new thread gets my vote. Sometimes people don't read all the way to the bottom of a thread they've seen before and with new threads every minute yours can sink to the bottom in just a few hours. You might get replies from members you've never seen before.
Elmo had kidney problems but that was a very long time ago, I can't remember his treatment. Yay MorMor!
 
Hello all...I got the bad news about Mor Mor last night ...he has advanced kidney failure and I need to put him to rest....see his picture below...
 
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Hi Sharon....the vet told me last might he has an "enlarged area of his kidney " which he called pyelonephritis....but his urine culture showed no signs of infection....he simply said your cat is dying of ckd...well thx so much like I didnt know that already....I am so pissed off at the the incompetence of vets....my cat is suffering clinically from pain and nausea...why would this vet use this terminolgy if no infection AT ALL was found in his culture...I really "lost it" on the vet last night....he is very nice and I need to apologize ....any thoughts?
 
I had not heard of pyelonephritis before, so I googled it. There are many sites explaining it, HERES one. It sounds like kidney infection needs 4-6 weeks of AB, and one article said specimen had to be taken from a certain place in the urinary tract:

Definitive diagnosis requires urine cultures obtained from the renal pelvis (funnel-like part of the ureter in the kidney) or parenchyma, or, as a last resort, histopathology from a renal biopsy.


Truthfully, I don’t know what to tell you Allison. I’m with you on the incompetence of vets. I’m dealing with that now with one of my civies. Almost $1000 worth of treatment and still not any better....:bighug::bighug:for both of us...
 
yes that is similar to what I read about how to tell if this is actually this particular infection...I think my vet was tired...it was after midnight ...but I mean hes still a vet and I can still think clearly when I am tired...so this time I am not inclined to give him many breaks....I think it is the final time for me to seek one more opinion...I do not want to let go of Mor if this is something treatable...omg...I cannot just go by this one vets opinion even tho i did trust him ...30 yrs experience I thought would be a good indication that this guy knows what he is talking about.... but inconsistancies leads anyone to not trust their vet....what is wrong with your kitty??
 
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