Monday, January 28, 2008

Helen's Dead Cat Walking

About two years ago, my cat Chester was diagnosed with acute chronic kidney disease. An x-ray showed one kidney shriveled and gone and the other fast losing ground. He’d lost several pounds, had no appetite, and would’ve died within a week or two had the vet not offered a treatment whereby he gets subcutaneous (under skin) fluids three times per week. She said with the fluids flushing toxins out his body he might live another year to a year and a half.

Always the softy, I agreed to do the treatments. Knowing that driving him into the vet’s office three times a week would not be an option, I learned to administer the fluids myself. He also needs canned food, which involves separating him from my other two cats because they still need dry food at least once a day for their teeth. Oh, and I give him a quarter of a stomach tablet each night because the kidney disease causes excess acid. I figured I could do just about anything for a year and a half, right?

Well, it’s now been two years since his original diagnosis and Chester has not only gained several pounds (he’s a fifteen plus pound bad boy) he show no signs of succumbing to kidney failure any time soon. After a check-up last Friday, the vet thought I could drop his treatments down to twice a week and she wanted to do a blood test to determine the values of various indicators of kidney disease.

This brought up an emotional dilemma. If his condition had worsened, I knew there would be additional medical treatments available. Without getting into the tedious details, suffice it to say it’s an additional expense and involves more care-taking. I’m feeling as though I have to draw a line somewhere, sometime.

And there’s the rub. I have to draw the line.

Don’t get me wrong. I’m not complaining. For the most part, I’m glad I’ve been able to do what I can to extend Chester’s life and what I do is nothing compared to what many people go through in pet care. Chester’s quality of life has been wonderful, and, by looking at him, no one would guess this cat was supposedly dying. But two years ago, in making the decision to provide this medical treatment, I didn’t realize I would be setting myself up for having to, at some point, decide to stop.

This is probably too heavy a topic for a Monday morning, sorry, and I realize I’m talking about an animal, but people run into the same issue with loved ones who happen to be human every day. How far should medical practices go in saving a life? Is every life worth saving? When/where do we draw the line? Should we be the ones drawing the lines? And why does death, something inevitable for all of us, seem like such a terrible thing?


Playground Monitor said...

This is a hot button with me and my husband. Ultimately the decision to draw the line should be made by the person (if they're capable), their designated family member(s) (if they're not) and the doctors. The government should stay out of it. My husband and I both have advanced health care directives to deal with this.

Every life has value. But is it right to continue a life that has no quality -- one that puts an enormous emotional strain on a family? My grandma was in this situation -- terminally ill from cancer and in terrific pain. My grandpa wanted to keep her alive; my mom and uncle wanted them to let her go. After consulting with the doctor they told him they were prepared to have my grandfather declared incompetent if that's what it took to let Grandma go. The doc sided with them and they just kept her pain-free until she slipped away quietly.

I'm not sure death is what we fear so much as suffering. That's what I fear -- being in awful pain, watching my family have to deal with all of it.

Hugs to you and Chester. We had to get rid of our last cat back before Thanksgiving and she actually looked a lot like Chester, just a tad fluffier. It was tough but I knew it had to be done.

Michele Hauf said...

Oh, Chester looks like my Toast. So cute. And maybe he's one life # 7 or 8, eh?

I found out about a month before Xmas that my best kitty, Sebastian has feline leukemia. He's 15, and I believe going deaf and a little senile (he cries out loudly all day long). We got the special food and had to have the other cat vacinated so he wouldn't get it.

And we struggled with the same stuff you're struggling with. When to just let go? And is an animal any less deserving of kindness and care than a human? The hubby is one of those guys that'll sooner take it out back and put it out of its misery than clean up another pee spot on the floor (He's in continent, too. Sigh...) But all I can think is, if you're aging father started peeing around the house, would you put him out of his misery too?

It is a challenge when it's an animal and not a human. I think they give us such unconditional love that it's worth doing the best we can for them, but with limits. Medical for animals is spendy. Keep them comfortable, but perhaps they are meant to age naturally, and with as little medical intervention?

And death seem terrible, but I realize it's not. Yet, if you have children I wonder if losing a pet can be harder than a close aunt or uncle?

Michele Hauf said...

Oh dear, after re-reading my post, I hope everyone gets that it's the cat who is incontinent, and not the hubby. :-)

Cindy Gerard said...

Oh Helen. You've hit on an issue that many of us have dealt with or will be dealing with at some point in the future. MY DH and I are animal lovers to the max. We went to great lengths to keep our old Brittany, who had a heart condition, and our Pointer who had some mysterious condition that was never diagnosed, alive - which also involved a lot of money. But the deciding factor that overrode all else was: what was their quality of life? If we and the vets decided we had reached the point where there was no good quality, then that was the line we did not cross. And when we reached it, as we did with both old dogs, we did the right thing and had to vet come to the house to put them down. It's never been easy but it's been right.
And while those were both difficult and weighty decisions, the bottom line was, they were animals and the perspective was always there.
A little over 2 years ago when my mother, who struggled with heart and kidney disease for years started talking about discontinuing dialysis, which would mean discontinuing her life, the entire family was faced with the horrible truth that all the medical marvels in the world that had been keeping her alive could not cure the one thing we all need to thrive - the will to live.
She was tired. She was sick. She had fought the good fight for years and much of that fight was fought for us because she knew we did not want to lose her. It was very difficult letting her go but as we look back, we realize that hanging on was for us, not for her. For Mom, death was not a terrible thing. It was release, it was rest, it was comfort. And, in retrospect, supporting her in her decision and letting her go was the best gift we could have given her.
Thanks for making me think about that and allowing me to reaffirm that we did the right thing.

Anonymous said...

Helen, your cat is so lucky to have you! You have taken on a huge task to keep him alive.

Our family had to deal with something like this in November. Our dear sheltie, Angus, was 11 and seemed to suddenly slow down. One day, when he was laying next to me, I noticed that his heart beat was very irregular. We took him to the vet and wound up having blood work & an ultrasound done of his heart. He had a large tumor in his chest. We decided to have a biopsy done and it showed a noncancerous tumor.

Then we had to decide if we should have the tumor removed. The operation was expensive and involved opening up his chest. This dog meant so much to us, so we had the operation done. HE died shortly after surgery from uncontrollable bleeding. It was a risk of this type of surgery, but what a blow.

I fI had to do it all over again, I still would take the chance to save our special dog.

Having an animal is a big responsibility.

Helen Brenna said...

Sorry, guys. Something unexpected came up and I won't be back until this afternoon to read comments.

Betina Krahn said...

Helen, your dilemma is familiar and wrenching: when to let go of a beloved four-legged family friend. It's so hard to love them and have them as companions for so many years and then to lose them.

Some, however, are more dear than others. My guy schnauzer is half human. His little sister schnauzer is 100% dog. He's almost five years older than her and when he goes, I don't know what we'll do with her-- she may be a mess.

As to how this relates to humans-- Cindy, your words about your mom really touched me. I've had to deal with this three times in the last dozen years and it never gets easier. Each life has its own value and each person has their own standards for what makes a productive and satisfying life. I'm convinced that my dad didn't want to go on. He stated several times during his last days that he didn't think he'd ever leave the hospital. I got a cold chill every time he said it, and it turned out to be true. He never came home again. But I think he was ready to go and not overly sad about it.

Death seems like such a terrible thing to us because we don't know what's beyond this life and because we who are left behind have to live with the loss and absence of warmth. You're right Helen, it's not so much the death that we fear, it's the suffering and not being in control that terrifies us. I didn't think I'd be able to watch someone I loved die, but I've done it twice now and both times it was a moving and sacred experience. It also took much of my own fear of death away. It's part of life.

Personally, I want to go of an instantaneous heart-attack after a day of shopping like crazy and eating fabulous Italian food!

lois greiman said...

Helen, I'm sending hugs. That is so hard. I put down my beloved mare last March. We'd been together for 28 years. It still brings tears to my eyes thinking about it. But I think quality of life is everything. It's a terribly difficult decision, but life in constant pain is no life at all, and I realllly hope when I get to that point I can make the decision to quit.

Blessings to you and Chester.

Debra Dixon said...

Hugs, Helen!

How old is Chester?

We're big animal lovers and I once had a cat with type of subcutaneous tumor that if you could ever get *all* of it out of the muscle/skin the cat would be perfectly fine. But this particular tumor had the tiniest tendrils that invaded surrounding area, Even with big margins it was always hard to know if they'd gotten it all.

The alternative--if you didn't get it all--was to continue to grab it every time it popped back up and try and prevent it from ever attaching to a bone or growing into an organ.

The vet said, you know, most people just don't find these on cats when the tumor is this small (pea sized). "Usually we don't see the owner until they've got a robin's egg. You've got a better than fair chance of getting it all this surgery."

5 surgeries later we were running out of muscle/skin to stretch back together. But it bought us 2.5 years and we gave up two weeks of pain for 6 months of complete quality of life and a chance to "beat" it.

Well, there came the day when they said, it's hit bone, we're done. :/ So, we made him comfortable. We weren't taking a rib out.

I think you know when you've hit that balance of quality of life and treatment. It's not easy.

And we all have a different *ability* to provide care that requires enormous amounts of time and/or money.

What was the question? LOL! Well, whatever, hugs for you and Chester.

byrdloves2read said...

Love the pictures of Chester. He looks like my old cat, Frodo, who lived for 19 years.

I had to do that subcutaneous fluid to our dog but it was twice a day. I did it for about a month. That awful decision of when to quit was mine and it came when she whined and whimpered as I inserted that big, old needle. Sigh. I just couldn't inflict more pain on her just to keep her with us longer. It didn't seem fair to her. So our vet came to the house and gave her the final shot while I held her in the living room. It was a gentle, stress-free passing for our beloved pet.

I just hope when I get to that point in my life, there will be someone who can do it for me (and it will be legal).

Christie Ridgway said...

Hugs to Chester and family. We're cherishing every day with our beloved 13 year old yellow lab. The sons know that we're going to have to make a difficult decision at some point. The youngest seems to understand that well, the's going to be very, very difficult for him. Harlow (best dog in the world) was happy and extremely active until last June. Then he lost his hearing and slows down more each day. His sister belonged to my in-laws and she died last November (in a "good" way, if we can say there is such a thing. She just fell over and died.)

We assess his quality of life every day. When he's in pain, then we'll have to make that call to the vet. But today, he's still excited when it's mailman time, because our great carrier brings him two dog biscuits every day.

It's the little things...

Susan Kay Law said...

We were lucky with our last dog; the decision was obvious, and very sudden. But it was great to be spared the second guessing. He had a great life up to the last few hours.

I just keep my fingers crossed than any future decisions will be as obvious.


Anonymous said...

Ah, Helen, I feel for you, girl. I gave my cat Mousie subcutaneous fluid for the last two years of her life (she lived to be 21). She didn’t get better, though. She got steadily worse until, one night, a mere shadow of her former self, she died in her sleep— thus saving me the pain of having to make the decision to stop.

I did better with my Calico, Peachie. At 18, she developed a mysterious respiratory problem that defied diagnosis. We tried nasal spray (ever tried to do that to a cat?), antibiotics, steroids… One day she was lying in the basket on my desk, her breath rasping in and out as she struggled to breathe. I finally said, “Screw it. This isn’t fair to her.” I bundled her up, then and there, and took her to the vet to have her put down. It was one of the hardest things I’ve ever had to do but I’d do it again in a minute. After the vet gave her the sedative, she took the first easy breath she’d taken in months and started purring. And then she slipped peacefully away. It was the right thing to do and—to this day—I wish I’d been strong enough to do it for Mousie.

I will be strong enough to do it for my dog Xena when the time comes. She’s old and arthritic and has Cushing’s disease. Right now, she’s doing fine. But I’ve promised her that when the pain is no longer controllable and she has more bad days than good, I’m going to let her go.

I think the body (animal and human) eventually gets to a point where it just plain wears out and medical intervention is only a stop-gap. The trick, I guess, is knowing when that point has been reached.

Helen Brenna said...

Marilyn, hugs to you on recently losing your cat. So sorry to have brought up a touchy subject, folks.

Michele, I treated a cat with leukemia years ago. I think the move to this 2 story house with the long set of stairs is what finally killed him. He just got pooped out climbing them all the time.

And I do think, unless the relative is very close to the family, losing a pet is harder on kids. We had to put our dog, Mia, down 7 years ago and it's still one of my daughter's most traumatic days.

Oh, Cindy, you hit on the toughest situation of all with what you went through with your mom. I can't imagine how tough that must have been. It shows, though, that most of us probably don't fear our own deaths as much as we fear for how our kids would deal with us being gone, or how much we'll miss the ones we love.

Anonymous, hugs to you too! So sorry you lost Angus, but you can be satisfied you did what you could. Love the name, btw. Very cute.

Betina, I'm with you on the wanting to go fast and furiously. Long and lingering can be so devastating to those around us.

Oh, Lois, horses. My, they love for so long. I'm sure you were so attached to your mare. Hugs again.

I feel terrible for having brought this up. Sorry, again.

Deb, Chester is only 12, so he was only 10 when diagnosed. All those surgeries are hard on a family as well as the pet. I've gotten to the point I almost freak when I see one of those white plastic cones to place over the pet's neck so they can't get at their stitches. Hate those things!!

Byrd, twice a day! That's a lot and I'm not surprised it only took a month. Chester tolerates the needle really well, but I have to keep finding new areas. The back of his neck is developing scar tissue from all the punctures. I took the pics, btw, just this morning, so you can see how healthy he still looks. Stinker!

That so sweet, Christie that your mail carrier brings dog biscuits!

Susie, I guess that's what I'm hoping for ... an easy decision when the time comes.

Wow, Candace, I don't know that I've heard of an older cat than 21. That's amazing. It's hard to know when the right time is, isn't it. They can't tell us.

Thanks, guys, for all your hugs and such.

Chester sends his own meow too!

Helen Brenna said...

Sorry, that last post was so so long!

Debra Dixon said...

I think the first time you have to make the decision for a pet you wait much too long. I can look back over the years and tell you that it had never gotten any easier but I feel like I've made a better decision each time. I've learned and applied that knowledge to the next pet. Been able to draw a clearer line between what I'm doing for me and what I'm doing for them.

I can begin to separate the selfish denial from the pet's best interest.

Kathleen Eagle said...

Wow. This is a tough one. Theoretically, I don't believe in keeping an animal alive when it has a debilitating medical condition. There's something unnatural about it when they don't understand, and I think we have a tendency to take these measures when we've begun to think of them as human. I don't think we should cause animals to suffer, and when they're in our care, we shouldn't allow them to suffer. If we can't do anything about it, we should let them go.

People have caused such misery for domesticated animals simply by breeding them for "desirable" traits to suit our whims. Mind you, I'm not opposed to farming, ranching, breeding animals for human consumption, companionship, sport, etc. But man is not the most humane critter on the planet. I say, don't cause or allow *prolonged* suffering. People can choose and express their choices. Animals can't.

Does that sound awful?

However, one of the most difficult things I've ever been through was putting our beloved 13-yr-old Aussie down. He had cancer.

Kathleen Eagle said...

About our Aussie...
Cisco was our daughter's dog. She suffered horribly with migraines, and he saw her through her painful times. When he was about 3 he chased a rabbit through the woods on one of the hottest, most humid days in MN history, flopped down and couldn't get up. It was a holiday, so we had to take him to the ER. They kept him overnight, but when he still wasn't doing well the next day the vet said they might be able to save him at the U of M--big vet program where they keep rescued greyhounds for blood transfusions. The vet there said that he had maybe a 30% chance. It's a matter of reversing a process (set off by overheating) of blood cells desroying instead of making platelets.

I asked the vet what he would do. He said if it were his dog he'd have to put him down because it was going to cost $1500-2000 which he couldn't afford. I asked whether the procedure would, if successful, restore the do's health. He said that it would. Then he left me alone to discuss it with the dog. Mind you, Cisco was on his feet looking at me in that special dog way, his red eyes (pitikiation? I can say it but don't know how to spell it) the main symptom of the canablization that was going on in his blood. We decided--my not-human puppy and me--that I'd pay if he'd play. (I called home to consult, of course, and the vote was unanimous.) Pay, play, and pray. Cisco came through. The vet was elated. He said the readings had gotten well below his 30%-chance range before the condition reversed. I saw the greyhounds out for play during one of our visits, and I thanked them.

One more story coming up...

Kathleen Eagle said...

Helen, my 16-yr-old Abysinian kitty had kidney problems, too, and we (okay, daughter Elizabeth) did the subcutanean water treatments. Coco hated it. After about a year of it he stopped eating, and we put him down. I wouldn't have kept it going that long--he got pretty skinny, didn't do nearly as well as Chester-- but Elizabeth insisted. She was married by that time, and when she came over, Coco would hide. He had a good long life even with the occasional neutered male bladder infection issues. He was on the special diet most of the time, as is the cat I have now. Next time I'm going female. (Although dh says no more cats.)

Helen Brenna said...

Deb, that's so true about getting better with the decision making with each pet. It's still an agonizing decision, and that's the part I'm whining about, but it does get a bit more clear cut.

No, Kathy, what you said makes total sense, but I've never thought of it that way before. They can't understand. So far Chester is tolerating the fluids well. He gets a lot of scratches while he's sitting there with a needle under his skin and has only gotten antsy a couple times. I think if he kept running away, I'd have to rethink it.

That's a nice story about Cisco, Kathy, but a female cats still have issues, sweetie! And they can be nasty. Hiss!