Old cat and kidney disease?

[skimomma]

I have a 20yo cat that is shockingly healthy for her age aside from being deaf.  However, we recently noticed her drinking a LOT more water and therefore also urinating much larger volumes.  It may have been going on for some time because different people clean the litter boxes, we have multiple cats, and there is a natural spring that runs through our basement that the cats typically drink so they almost never touch their actual water bowl.  I spent the last few days following her every time she went into the basement to confirm that it was indeed her that was intaking so much more water.  Anyway, I got her the first vet available appointment, which is a full week from now.  I would like to be well-prepared when we go.  I'd like to be very clear on what we are and are not willing to do.

If it is indeed kidney disease/failure, it is probably pretty advanced given her age and that everything I've read says that by the time they are drinking that much water, it is likely advanced.  What, if anything, can be done to treat at this stage?   

We had a pretty bad experience at the end of our last cat's life.  She was also very old at 22 years.  They did not actually know what was wrong with her, other than being 22, but had us doing all kinds of invasive things in what I now realize was a misguided attempt to appease us.  It is clear that the vet we go to will assume that one wants to do anything possible to prolong life unless told otherwise.  Whereas I (incorrectly) assumed that the vet would advise us as to when we should consider euthanasia.  I regret that we prolonged that cat's misery.  A less timid and sensitive cat might have been a good candidate for that path, but that cat was quite miserable with everything we were directed to do and I don't believe it was in her best interest.

This cat is not at all timid and borders on feral.  She was a stray and was not at all socialized when we ended up taking her in at about 3 years of age.  She has mellowed to some degree over the years but she still hates to be picked up and only very rarely wants attention on her terms.  We could not even pet her for the first 5 years we had her and her vet file has a caution sticker on it.  She will bite and scratch at the slightest provocation.  It takes three people to clip her nails and the last time she got vaccinations, we had to sedate her.  All this meaning that there is very little she will "agree to" when it comes to "bugging her."  We can probably get her to take meds inside treats but anything involving needles or manhandling will make her very unhappy.  I do not want another situation in which we make the last days (or even years) of a pet's life miserable again. OTOH, if there are non-invasive ways to prolong discomfort and/or life, we are eager to do it.  I just don't always feel like I get a clear message from our vet. 

Thoughts?  Anyone been here?  How can I be very clear when speaking with the vet?

[sassenach]

I’m a people nurse so take this all with a grain of salt, but kidney failure leads to less pee, not more. I would be more suspicious for uti or diabetes. We are very much natural life/death pet owners. We don’t do invasive treatments or testing. I think going in with that mindset will help you to know what to say yes or no to. UTI is an easy fix and probably a good place to start. Hope it’s something simple!

[GailV]

Cats do drink more/pee more with kidney disease (CKD). A cat UTI has different symptoms. I'm not familiar with feline diabetes.

Step one in CKD is generally giving a prescription food that is balanced with low phosphorus. Other cats shouldn't eat this. If needed you can use a supplement that I think binds the phosphorus. Some people do things like learn to give subcutaneous water.

We had an older cat who started drinking lots of water, peeing a lot (the one in my avatar)... we had the bloodwork done and his various levels were so very high ... and he lasted for YEARS after that. The vet was surprised, because all indications were that he should drop dead, but he just kept going along living his life (Covid lock down happened in the midst of this, and his favorite person in the world suddenly reappeared from college and was in her room 24/7 doing her classes, and he parked on her lap, which really revived him a lot).

He didn't like the prescription food so we gave up on that quickly. Never tried any other supplements that were specific for kidney disease. Used some other supplements that were just for general health for older cats, like B12, which he liked. The biggest issue was that we couldn't have his teeth cleaned, which he really needed, because he couldn't be put under anesthesia. Over time the pain of his teeth made it hard for him to eat, which led to his deterioration.

I thought this website had lots of good info on cats and kidney disease: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

[Pawz4me]

32 minutes ago, skimomma said:

We can probably get her to take meds inside treats but anything involving needles or manhandling will make her very unhappy.  I do not want another situation in which we make the last days (or even years) of a pet's life miserable again. OTOH, if there are non-invasive ways to prolong discomfort and/or life, we are eager to do it.  I just don't always feel like I get a clear message from our vet. 

Thoughts?  Anyone been here?  How can I be very clear when speaking with the vet?

I'd practice saying the things in the first paragraph above. Say "quality of life, not quantity" a lot. Some vets are much better about this than others.

[Katy]

Call in advance and ask the person that answers to write in the file that you’re suspicious of advanced kidney disease, and you want to verify that and talk about pain, end of life care, and euthanasia. You do not want to selfishly prolong life if the formerly feral cat is in pain. 

[livetoread]

I've told our vet with several pets that we consider this a hospice situation where we want to make our pet comfortable and would fix easy things but aren't willing to put them through invasive testing or treatment. We aren't looking to prolong its life beyond easy fixes, just make the remaining time better. 

I had an old cat with advanced kidney disease. She lived about a year with no additional treatment since she hated the kidney food and hated going to the vet so much she'd pee on the table in fear. She did well until suddenly she didn't - she was eating very little and was lethargic. I had her kidneys tested more time to be sure and she was definitely in kidney failure so we put her to sleep the next day. Administering fluids at home is something one can do with cooperative cats to prolong their time and perk them up, but we knew she wouldn't be cooperative and we would all be traumatized by the effort.

ETA it's my understanding that it generally isn't painful for them. They feel nauseous and then just more tired. Our vet described it as feeling hungover. If there are complicating issues though, of course all bets are off.

Edited April 13, 2023 by livetoread

[skimomma]

26 minutes ago, GailV said:

Cats do drink more/pee more with kidney disease (CKD). A cat UTI has different symptoms. I'm not familiar with feline diabetes.

Step one in CKD is generally giving a prescription food that is balanced with low phosphorus. Other cats shouldn't eat this. If needed you can use a supplement that I think binds the phosphorus. Some people do things like learn to give subcutaneous water.

We had an older cat who started drinking lots of water, peeing a lot (the one in my avatar)... we had the bloodwork done and his various levels were so very high ... and he lasted for YEARS after that. The vet was surprised, because all indications were that he should drop dead, but he just kept going along living his life (Covid lock down happened in the midst of this, and his favorite person in the world suddenly reappeared from college and was in her room 24/7 doing her classes, and he parked on her lap, which really revived him a lot).

He didn't like the prescription food so we gave up on that quickly. Never tried any other supplements that were specific for kidney disease. Used some other supplements that were just for general health for older cats, like B12, which he liked. The biggest issue was that we couldn't have his teeth cleaned, which he really needed, because he couldn't be put under anesthesia. Over time the pain of his teeth made it hard for him to eat, which led to his deterioration.

I thought this website had lots of good info on cats and kidney disease: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

Thanks for all of this!  I am encouraged that you had such a good outcome.  This kitty will not eat the prescription food, which is something I forgot to mention in the OP.  She is quite set in her ways.  She can tolerate a cat treat here and there, but rapidly throws up anything other than the food she regularly eats.  She eats a raw food diet and I will need to see what that means as far as phosphorous.  We have had a handful of times over the last few years in which we ran out of her regular food and tried to give her high-quality grain-free canned food and she instantly puked it up each time.  And there is no way on earth I would even attempt to admin subcutaneous water.  That was one of the things we did with our last cat, who as far more tolerant of being manhandled by us, and it was heart-breaking.  I will not do that again.

[skimomma]

4 minutes ago, livetoread said:

I've told our vet with several pets that we consider this a hospice situation where we want to make our pet comfortable and would fix easy things but aren't willing to put them through invasive testing or treatment. We aren't looking to prolong its life beyond easy fixes, just make the remaining time better. 

I had an old cat with advanced kidney disease. She lived about a year with no additional treatment since she hated the kidney food and hated going to the vet so much she'd pee on the table in fear. She did well until suddenly she didn't - she was eating very little and was lethargic. I had her kidneys tested more time to be sure and she was definitely in kidney failure so we put her to sleep the next day. Administering fluids at home is something one can do with cooperative cats to prolong their time and perk them up, but we knew she wouldn't be cooperative and we would all be traumatized by the effort.

I even mentally battled with taking her to the vet at all but feel I should at least verify it is indeed CKD and not something that could be easily treated.  I wrote down "hospice situation" as a talking point.  I don't even want super invasive tests but I believe they can confirm CKD with a blood test and we can go from there.  There is no collecting urine with this cat either.  She will simply not pee in anything that is not her normal litter.  last time we tried the plastic bead things, she peed next to the box and never in it....after holding her pee in protest for 2 days  Sigh.

I appreciate hearing that others in this situation did not force the prescription food.  I am not even sure I would attempt to try it given her usual reaction to anything not-her-normal-food at her age.  I also appreciate knowing what to look for when we get closer to the end.  Right now, you would have no idea anything is wrong with her other than the drinking and peeing.  She is currently up high on a shelf attempting to destroy a plant while occasionally shooting me looks of disapproval.....both of which are her usual happy-space activities.

[Kanin]

My 18 year old cat has kidney disease. She won't eat the prescription food, so I just said forget it. I also decided not to do subcutaneous fluids. I'd be keeping her around longer for ME, not for her. When the vet told me about the kidney disease, I thought she would be on a quick road downhill, but she's been doing just fine. 

[livetoread]

It's hard when you know there are things that would prolong her life and feel like as a responsible pet owner, you should do them. But that's all you are doing - prolonging the life of an old cat - and the life needs to be a good life. For us, buying a few more months wasn't worth inflicting the stress. She was set in her ways about her food and it's more important that they eat something rather than hunger strike over food they don't like. Keeping weight on is often tough anyway since they can feel a bit nauseous, and even a couple of days of not eating can throw them into rapid deterioration. So yeah, feed her what she likes and know you are doing the right thing.

I did want to make sure it wasn't something else or something easily fixed, so we wanted the diagnosis and numbers, but I didn't keep bringing her back for followup after we knew she had the disease. The vet wanted to monitor her numbers, but when I asked whether we could just go by symptoms rather than the numbers since coming was so stressful for the cat, she readily agreed. Then, when our cat took her final nosedive, I took her in to make sure again that she was in actual failure then. Knowing it was, we put her to sleep.

 

[GailV]

Oh yeah, the vet sent me home with all the "special litter" which we never did use. I forgot that was even a thing! 

I would absolutely skip the prescription food.  In the end we were feeding Winth whatever he wanted (we used commercial wet food), plus as many treats as he wanted (he loved hearing the grill fire up and would come out to the patio to get a bit of chicken or trout). 

The extra-drinking-and-peeing phase lasted for years for us. Now our remaining cat is starting the same symptoms, and the most I'm doing is making sure her dental work is all done promptly before that can no longer be done. The vet has noted that her various blood levels are elevated, but not yet in the danger zone. She's 17.(Her asthma will probably be what weakens her the most - we use an inhaler twice a day which is yet another example of medical things I never thought I'd be doing with a cat)

[Kanin]

Just now, livetoread said:

I did want to make sure it wasn't something else or something easily fixed, so we wanted the diagnosis and numbers, but I didn't keep bringing her back for followup after we knew she had the disease. The vet wanted to monitor her numbers, but when I asked whether we could just go by symptoms rather than the numbers since coming was so stressful for the cat, she readily agreed. Then, when our cat took her final nosedive, I took her in to make sure again that she was in actual failure then. Knowing it was, we put her to sleep.

 

If I was a vet, I'd prefer my patients to take this approach, I think.

[skimomma]

10 minutes ago, GailV said:

we use an inhaler twice a day which is yet another example of medical things I never thought I'd be doing with a cat

Lol!  I cannot imagine trying that with my half-feral demon cat!

[Storygirl]

We had one elderly cat with kidney disease. Another with diabetes. And now we have a young cat with urinary tract disease (very unusual -- we have an appointment with a specialist).

Diabetes -- cat will be extremely thirsty and will therefore urinate a lot. Common if cat is overweight. We had to give our cat insulin shots twice (I think) daily. He spend several periods of time (overnight) at the vet for them to get his dosage correct when first diagnosed. After about a year, we put him down, because he stopped using his box, and we were putting our house on the market, and he obviously felt terrible whenever we weren't home to give him his shots on time.

Kidney disease -- We had to add water to her food to increase her liquid intake. We kept her for about a year after diagnosis and decided not to give her any special treatment, because she was already 15. The vet recommended injecting water under her skin twice a week at $20 per time, and we decided not to do that. When Kitty stopped eating, we took her back in, and she had lost three pounds. She started as a 7 pound cat, so that was extreme, and we hadn't realized. The vet said she was likely in a lot of pain 100% of the time. We took her home to say good bye and then had her euthenized a few days later.

If I had to do that over again, I would have put her down at the first diagnosis, but it was our first experience with kidney disease, and I didn't know. I'm sorry that we let her suffer. She was affectionate until the end, so we didn't realize the pain she was in.

UTI -- our cat has a unique condition, so may not apply. But symptoms include straining to urinate but producing little. Sometimes he will huddle by the litter box but not go in. He avoids the litter box and pees elsewhere. He likes to do this in empty laundry baskets, so we have an easy way to collect samples for him. Sometimes he would pee a lot, just because it had built up, I think. He licks himself down there a lot. When he has an infection (he gets repeat infections), he sometimes will hunch himself up and growl, and we can tell he is in pain. Our cat sometimes produces bloody urine, because he has struvites (stones in his urine that injure him inside).

Kidney disease can be diagnosed through blood testing. At our vet, it is a "senior" blood screening and costs more  -- maybe $170.

I will be honest. With your 20 year old kitty, I would be prepared to tell the vet that it's time to let her go. We had to do this with our diabetic cat, and it was hard to not have THEM be the ones to say it was time. I felt like I was betraying my cat, even though I knew it was the right thing. It's easier (though not easy, of course) for the vet to encourage the decision. I think you could say that  -- "It would help me to know that you support a decision that this is the end."

[Spy Car]

1 hour ago, skimomma said:

Thanks for all of this!  I am encouraged that you had such a good outcome.  This kitty will not eat the prescription food, which is something I forgot to mention in the OP.  She is quite set in her ways.  She can tolerate a cat treat here and there, but rapidly throws up anything other than the food she regularly eats.  She eats a raw food diet and I will need to see what that means as far as phosphorous.  We have had a handful of times over the last few years in which we ran out of her regular food and tried to give her high-quality grain-free canned food and she instantly puked it up each time.  And there is no way on earth I would even attempt to admin subcutaneous water.  That was one of the things we did with our last cat, who as far more tolerant of being manhandled by us, and it was heart-breaking.  I will not do that again.

I'm fairly new to cats and their health issues, but have trying to do a crash course. A grain of salt should be applied to my counsel.

I was going to link the Tanya's website that was linked by @GailV above. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

My understanding of common responses depends on the "stage" of the CKD (chronic kidney disease). The "old way of thinking" was to reduce protein in early stages of kidney disease, that seems to have done more harm than good. 

There are non-prescription canned foods that have lower phosphorus than typical, without moving into the low-quality (and expensive) prescription foods that many cats refuse to eat in any case.

Many people do feed raw to CKD cats keep up good health and some turn to phosphorus blockers as a way to effectively lower the absorption of phosphorus in the body, especially in late-stage kidney disease.

Tanya's is a very widely used resource.

I wish I could offer more. 

Best wishes,

Bill

 

 

Edited April 13, 2023 by Spy Car

[Faith-manor]

I am sorry. We had to put our beloved cat down from CKD. She was 18 and had simply lived past her organs wearing out. The vet said she was a week or less away from real suffering and pain. We didn't want her to go through that. It might be time to brace yourself for tough decisions. I say that as someone whose beloved dog nearly died Monday, and who went into the vet yesterday thinking pup was probably going to have to be put down. I was NOT emotionally prepared. Thankfully, he is home currently snuggled in and sleeping on my lap. I know I have to get myself more at peace with the possibility of letting him go though.

[skimomma]

Thanks everyone!  I feel like I am well-prepared of the vet visit.

It appears that the raw cat food company we use does have a low-phosphorous kidney-health version available with a prescription.  That might be a possibility and I will bring it up with my vet.  I don't know that my cat would tolerate even that type of switch but it is worth a try.  The way we feed the cats makes it impossible to make 100% sure cats are not eating each others' food.  Anyone know if low-phosphorous food would be harmful to a healthy cat?

All this assuming it is indeed CKD.  It seems pretty classic and while I cannot rule out diabetes, the cat is not overweight so it seems unlikely.

[skimomma]

1 minute ago, Faith-manor said:

I am sorry. We had to put our beloved cat down from CKD. She was 18 and had simply lived past her organs wearing out. The vet said she was a week or less away from real suffering and pain. We didn't want her to go through that. It might be time to brace yourself for tough decisions. I say that as someone whose beloved dog nearly died Monday, and who went into the vet yesterday thinking pup was probably going to have to be put down. I was NOT emotionally prepared. Thankfully, he is home currently snuggled in and sleeping on my lap. I know I have to get myself more at peace with the possibility of letting him go though.

Luckily (or not), one gets to the mentally-prepared point any time a cat lives past 20 years.  That is why I am a little miffed at our vet after the 22yo cat experience.  It's not like we thought a 22yo cat was going to have a whole lot of time under any circumstances.  Any rational person is going to understand that there would be no magic cures.  I just didn't have the experience or words to make clear that we were only interested in hospice measures.  Nor did I understand that the vet was recommending we do things that were not purely palliative.  Which is why I want to be better informed before we go this time.

Other than the water-drinking and pee-increase, she does not seem unhealthy or uncomfortable at all right now.  She is jumping up on things, getting into trouble, drawing blood for fun, begging for people-food treats, sunning herself, and generally being 100% normal.  She just bit me (again) because I had to put the lid on her catnip wall-ball thing and she seemed to really enjoy it.  So I think we have time.  Knowing what I have learned so far, I would not even go to the vet other than to just be sure it is CKD rather than something else that could be more addressable. 

[Garga]

3 hours ago, skimomma said:

I have a 20yo cat that is shockingly healthy for her age aside from being deaf.  However, we recently noticed her drinking a LOT more water and therefore also urinating much larger volumes.  It may have been going on for some time because different people clean the litter boxes, we have multiple cats, and there is a natural spring that runs through our basement that the cats typically drink so they almost never touch their actual water bowl.  I spent the last few days following her every time she went into the basement to confirm that it was indeed her that was intaking so much more water.  Anyway, I got her the first vet available appointment, which is a full week from now.  I would like to be well-prepared when we go.  I'd like to be very clear on what we are and are not willing to do.

If it is indeed kidney disease/failure, it is probably pretty advanced given her age and that everything I've read says that by the time they are drinking that much water, it is likely advanced.  What, if anything, can be done to treat at this stage?   

We had a pretty bad experience at the end of our last cat's life.  She was also very old at 22 years.  They did not actually know what was wrong with her, other than being 22, but had us doing all kinds of invasive things in what I now realize was a misguided attempt to appease us.  It is clear that the vet we go to will assume that one wants to do anything possible to prolong life unless told otherwise.  Whereas I (incorrectly) assumed that the vet would advise us as to when we should consider euthanasia.  I regret that we prolonged that cat's misery.  A less timid and sensitive cat might have been a good candidate for that path, but that cat was quite miserable with everything we were directed to do and I don't believe it was in her best interest.

This cat is not at all timid and borders on feral.  She was a stray and was not at all socialized when we ended up taking her in at about 3 years of age.  She has mellowed to some degree over the years but she still hates to be picked up and only very rarely wants attention on her terms.  We could not even pet her for the first 5 years we had her and her vet file has a caution sticker on it.  She will bite and scratch at the slightest provocation.  It takes three people to clip her nails and the last time she got vaccinations, we had to sedate her.  All this meaning that there is very little she will "agree to" when it comes to "bugging her."  We can probably get her to take meds inside treats but anything involving needles or manhandling will make her very unhappy.  I do not want another situation in which we make the last days (or even years) of a pet's life miserable again. OTOH, if there are non-invasive ways to prolong discomfort and/or life, we are eager to do it.  I just don't always feel like I get a clear message from our vet. 

Thoughts?  Anyone been here?  How can I be very clear when speaking with the vet?

Your story is mine regarding an old cat that the vet kept trying to treat and I didn’t realize we should let go. I thought the vet would offer it as an option, but realized that they don’t. You have to be the one to ask to have the cat put down, or for the care to be hospice. I thought it was horribly insensitive that they didn’t offer, “We can treat the condition, offer hospice care, or offer to put the cat down.” Instead, I had to be the one to bring it up and I could barely get the words past my throat. It would have been much more merciful to me as a pet owner to be able to say, “The last option,” or “The second option,” instead of having to say, “I think it’s time to put him down.” Urgh.

As you have vowed, I will never go the route of treating something that ought not be treated for an older cat and putting them through miserable medical procedures.

I like what someone said above about using the word Hospice. 

1 hour ago, Storygirl said:

We had one elderly cat with kidney disease. Another with diabetes. And now we have a young cat with urinary tract disease (very unusual -- we have an appointment with a specialist).

Diabetes -- cat will be extremely thirsty and will therefore urinate a lot. Common if cat is overweight. We had to give our cat insulin shots twice (I think) daily. He spend several periods of time (overnight) at the vet for them to get his dosage correct when first diagnosed. After about a year, we put him down, because he stopped using his box, and we were putting our house on the market, and he obviously felt terrible whenever we weren't home to give him his shots on time.

Kidney disease -- We had to add water to her food to increase her liquid intake. We kept her for about a year after diagnosis and decided not to give her any special treatment, because she was already 15. The vet recommended injecting water under her skin twice a week at $20 per time, and we decided not to do that. When Kitty stopped eating, we took her back in, and she had lost three pounds. She started as a 7 pound cat, so that was extreme, and we hadn't realized. The vet said she was likely in a lot of pain 100% of the time. We took her home to say good bye and then had her euthenized a few days later.

If I had to do that over again, I would have put her down at the first diagnosis, but it was our first experience with kidney disease, and I didn't know. I'm sorry that we let her suffer. She was affectionate until the end, so we didn't realize the pain she was in.

UTI -- our cat has a unique condition, so may not apply. But symptoms include straining to urinate but producing little. Sometimes he will huddle by the litter box but not go in. He avoids the litter box and pees elsewhere. He likes to do this in empty laundry baskets, so we have an easy way to collect samples for him. Sometimes he would pee a lot, just because it had built up, I think. He licks himself down there a lot. When he has an infection (he gets repeat infections), he sometimes will hunch himself up and growl, and we can tell he is in pain. Our cat sometimes produces bloody urine, because he has struvites (stones in his urine that injure him inside).

Kidney disease can be diagnosed through blood testing. At our vet, it is a "senior" blood screening and costs more  -- maybe $170.

I will be honest. With your 20 year old kitty, I would be prepared to tell the vet that it's time to let her go. We had to do this with our diabetic cat, and it was hard to not have THEM be the ones to say it was time. I felt like I was betraying my cat, even though I knew it was the right thing. It's easier (though not easy, of course) for the vet to encourage the decision. I think you could say that  -- "It would help me to know that you support a decision that this is the end."

D-Mannose works on people and cats to treat UTIs. You can dissolve it in a dropperful of water and squirt it in the cat’s mouth. You can do this as a preventive measure—a little bit every day, to avoid UTIs.  It’s sold as a supplement in powdered form online and I think in stores like WalMart.

https://www.amazon.com/NOW-Foods-733739028099-D-Mannose-6-Ounce/dp/B00JWKDF6A/ref=sxts_rp_s_a_1_0?content-id=amzn1.sym.eff26b9b-e255-411b-a40d-eccb21f93fe4%3Aamzn1.sym.eff26b9b-e255-411b-a40d-eccb21f93fe4&crid=1AUBTDDRO6IWE&cv_ct_cx=dmannose&keywords=dmannose&pd_rd_i=B00JWKDF6A&pd_rd_r=00ace62e-76ed-4d5e-8a2c-0020581b770e&pd_rd_w=IDCW0&pd_rd_wg=CG1p6&pf_rd_p=eff26b9b-e255-411b-a40d-eccb21f93fe4&pf_rd_r=16JB5B28P4C3TW8CVRRY&qid=1681401902&sbo=RZvfv%2F%2FHxDF%2BO5021pAnSA%3D%3D&sprefix=dmannose%2Caps%2C145&sr=1-1-5985efba-8948-4f09-9122-d605505c9d1e&th=1

Go to the comments, scroll up a bit to the “questions” and above the “questions” type in “cat” to find posts about people using it for their cats. It’s cheap, easy, and there are no nasty anti-biotic side effects.  They might have soft poo for a few days as their body adjusts if you decide to give him the DMannnose daily.

Edited April 13, 2023 by Garga

[ktgrok]

Former vet tech.

Just be upfront with the staff and the vet. Simply say, we love her but she's not the kind of cat that tolerates being handled, let alone stuck with anything or medicated. We might be able to put medication in food/treats, but that's really it. And most of all, we want to focus on quality of life, not quantity. At 20 she's earned the right to have her last days be peaceful, not stressful, so that's what we want to focus on. Given that, what would you suggest? 

Depending on what things are found, it is also VERY appropriate and helpful to say, "what kinds of things should we consider, or be looking for, to know when is the right time to consider euthanasia, given her situation?"

Trust me, there is no quicker way for a vet to be labeled heartless and cruel and smeared on reviews and social media than to tell someone unwilling to consider euthanasia that they should put the pet down. So due to concerns over their own livelihood they have to be cautious and try to feel people out about it. Add in that they are usually never going to be sued for malpractice for advising treatments, but can be sued for NOT advising a treatment. There are articles in every state/local/national veterinary newsletter with legal advice to that effect, and warning vets/staff not to try to "xray the owner's wallet" and fail to offer treatment just because you assume the person can't or won't be able/willing to pay for it. It's a tricky line to walk, both legally and emotionally. No one wants to be sued, no one wants a client to start screaming "YOU WANT TO KILL MY CAT! YOU HEARTLESS MONSTER!" And both those things DO occur. People get WEIRD about their pets. (me included)

So truly, being up front and honest about the direction you want to go, limits both financial and practical, etc are WELCOME by any good vet. It takes that stress off of them as to how to walk that line. They will NOT think you are a bad pet owner for being practical about end of life issues - truly they won't. You got this cat to 20 yrs old, obviously you are an amazing pet owner! And they realize that. 

[ktgrok]

1 hour ago, skimomma said:

 Any rational person is going to understand that there would be no magic cures.  I just didn't have the experience or words to make clear that we were only interested in hospice measures.  

You might be amazed at the percentage of people that are completely IRRATIONAL that vets deal with. It's....sort of amazing. Pet owners can be downright WEIRD and they get even MORE irrational when pets are older and seriously ill. 

Add in that owners are unsure how to communicate a willingness to be less than aggressive with care, AND that vets often get into vet medicine because their people skills are not their strongest - so they are perhaps less able to pick up on nuance or unspoken things, AND the threat of lawsuits...it can be a mess of miscommunication. 

Some vets are better with end of life stuff than others. The clinic I worked at the longest, in South Florida, had a reputation for being one of the best for end of life stuff. Not really something you brag about...but it was true. We were very open about options, we flat out ASKED what direction people were leaning, what they could and would do or not do, and we had a separate room we called "the comfort room" that was just for euthanasias and discussions of end of life. Had a love seat, no exam table, bookshelves, a pretty faux skylight, tissues, etc. And since it wasn't used for regular appointments there was no rush to move people out for the next patient, AND the next time they came in, with a different pet, they didn't have to worry about being in the same room where they lost their loved one. 

But it just isn't something focused on in vet school, and like I said, a lot of people working int he field have better animal communication skills than they do people communication skills. 

[Clarita]

I have no insight into kidney disease in cats. I'm just here to mention that if you are looking at hospice care for your cat, some vets provide in-home care (they travel to your house for hospice care). That may be a really good option to ask about and look into. They will also provide euthanasia at your home which is just much better for everyone involved. 

I don't know if it is appropriate to ask the current vet about this option, but know that this option could be available should your cat need routine long term care or euthanasia. 

[Garga]

@ktgrok Thank you for explaining all that about vets and the dance they have to do around end of life conversations. I was so unhappy that I had to ask for them to put down my cat instead of it being one of an offering of choices, but I can see how the vet might have feared I’d freak out if they said anything. 

I love it that your old vet office had a room for end of life that was different from the examination room. I had to have a kitty put down. It was years later that I happened to be in that same examination room with a different kitty and I walked in and burst into tears. Years later! 

 

Edited April 13, 2023 by Garga

[ktgrok]

Just now, Clarita said:

I have no insight into kidney disease in cats. I'm just here to mention that if you are looking at hospice care for your cat, some vets provide in-home care (they travel to your house for hospice care). That may be a really good option to ask about and look into. They will also provide euthanasia at your home which is just much better for everyone involved. 

I don't know if it is appropriate to ask the current vet about this option, but know that this option could be available should your cat need routine long term care or euthanasia. 

It is 100% appropriate if it is something someone is interested in! Often the regular vet will keep business cards or at least have the contact info for vets who perform this service. I know the one my son worked at last year often referred people to it. The regular vet just really can't, most of the time, do house calls as their clinic model is set up to need them to do a certain number of appointments per day - they are paying clinic staff to be there for in clinic appointments. For them to take a staff member with them, pack up stuff that normally is in clinic, travel to the home, handle the process without rushing it, listen to the owner's grief and give them time with the deceased, then transfer the deceased pet to the vehicle, travel back, transfer deceased pet to the clinic from the vehicle in a way that doesn't disturb other clients in the parking area, etc just takes a BIG chunk of time, one that can't even be predicted as you never know how long it will all take, and that means basically blocking off a lot of time for them and the rest of the staff. 

Someone who runs a mobile service already has all the equipment needed in their vehicle, is not paying for the overhead of a clinic building or staff so can take more time, and will transport the deceased pet directly to the place of cremation. It just is a better process if you want in home euthanasia. And yes, many pets and people are more comfortable with this. We had the option with our last dog we put down but 1. we knew the dog LOVED car rides and going places so one last trip seemed only fair and 2. he wasnt' afraid of the vet clinic and 3. my DH didn't want the memory of saying goodbye to be tied to a place in our house he would see over and over. Didn't make sense for us. But for others if the pet is stressed by car rides or vet visits, it totally makes sense and is a fantastic option. No decent clinic vet would begrudge you for asking for a recommendation to someone to do this. Besides, from a dollars and cents view vets do NOT make money on euthanasias. It's not priced as a money maker, and as I said, takes a lot more time than many other visits, so it isn't like they are worried they will lose out on a fee or something. Not that they WOULD care about that over the animal, but in case people were wondering. 

[ktgrok]

2 minutes ago, Garga said:

@ktgrok Thank you for explaining all that about vets and the dance they have to do around end of life conversations. I was so unhappy that I had to ask for them to put down my cat instead of it being one of an offering of choices, but I can see how the vet might have feared I’d freak out if they said anything. 

I love it that your old vet office had a room for end of life that was different from the examination room. I had to have a kitty put down. It was years later that I happened to be in that same examination room with a different kitty and I walked in and burst into tears. Years later! 

 

FYI, before we had that room we tried to remember not to put people back in the same room. But if we forgot (and years later we certainly would have forgotten) we had no issue if someone said they didn't want to go in that room, and briefly explained why. We had that happen a few times and we totally understood. I mean, we love our pets too and get it. 

[skimomma]

@ktgrok I really appreciate the insight into the struggles vets deal with.  I had not really considered that some people would be offended or upset by being counseled about euthanasia.  I have written down your suggested wording and will use it!  I especially appreciate the "does not tolerate being handled" bit.  This has always been a challenge with this cat when a vet suggests we do something that I know 100% will not fly.  I feel kind of like a wimp but there are some things this cat will not allow and others that I could force but would decrease her (and my) quality of life.

Unfortunately there are no mobile vet services of any kind in my area.  Not even for euthanasia, aside from large farm animals.  We very much wanted this for our last cat as she was in a lot of pain, it was raging winter, and she is terrified of the car.  On top of allowing her to live in pain for much longer than we should have, I also live with the guilt that her last hour was total terror and misery for her....having to go from house to car, then car to vet office in a raging blizzard, yowling in the car the entire drive, seeing dogs (AKA the scariest thing ever) in the waiting room, and finally strangers manhandling her.  It was awful and certainly not peaceful.  It still makes me tear up.  I would have paid the entire day's worth of appointments to allow her to pass in her own comfortable home.  But that was not an option.

We have a big shortage of vet services in our area and the only reason I got an appointment one week from now was that a a friend offered to give me her slot that was for a non-emergency visit.  Otherwise, it would be weeks, in not months, for me to even get her in.  When our kitten had an eye infection that was going from bad to worse, I was told the first available appointment was 6 weeks away and if that was too long we should consider driving to the closest mid-sized city, two hours away, to have her seen.  We live in a geographical oddity that makes access to all kinds of things abnormal.  So I feel very lucky to get in at all and know I have one shot to get all of my questions answered.

[El...]

My cat tried to die on me a month ago. She's doing ok now, amazingly! Long story, she was in pain, and a new pain shot had her back to her usual, crabby self. 

Anyway, I had to directly ask the vet, what are the arrangements I need to consider for euthanasia? I had to say the word. Asking about "hospice care" didn't trigger that conversation. I had to be specific. And after giving me all the details, my sweet vet offered me a hug... and that made me cry right there in the office! 

I can imagine the crazy she has to work with. 

[GailV]

4 hours ago, ktgrok said:

 

 AND that vets often get into vet medicine because their people skills are not their strongest - so they are perhaps less able to pick up on nuance or unspoken things,

OMG you have just totally changed my perspective on the lead vet at the clinic we go to. She's amazing insofar as pet-health knowledge -- I chose this practice because of that! She's great about explaining the various levels of care depending on how much $$ and time you want to spend on your pet. But she really sucks in other ways, and you just laid it out in a way that I suddenly "see" things so much more clearly.

I've started specifically requesting a different vet. I tell the front desk it's because vet#2 has history with this cat and the asthma - one of her cats had asthma, blah blah blah. But mostly it's because I've been so POed at the lead vet and some of the things she blurts out. And now I feel okay about that decision.

 

[ktgrok]

44 minutes ago, GailV said:

OMG you have just totally changed my perspective on the lead vet at the clinic we go to. She's amazing insofar as pet-health knowledge -- I chose this practice because of that! She's great about explaining the various levels of care depending on how much $$ and time you want to spend on your pet. But she really sucks in other ways, and you just laid it out in a way that I suddenly "see" things so much more clearly.

I've started specifically requesting a different vet. I tell the front desk it's because vet#2 has history with this cat and the asthma - one of her cats had asthma, blah blah blah. But mostly it's because I've been so POed at the lead vet and some of the things she blurts out. And now I feel okay about that decision.

 

Yup. It is a known issue in the vet world that people go INTO the field because they want to work with animals, and don't like dealing with people. Except....animals are not the clients. They are the patient, but not the client. People are the client. You HAVE to deal with the people. And that is SO hard for so many of them. I mean, it's WHY many of them go to vet school instead of human medicine. It's something that if discussed a LOT in vet circles, because it is such a known problem. But...the ones who are good with animals are the ones you WANT dealing with your pet. So it's hard. Ideally you have at least a few people on staff who have better people skills. (but keeping good staff is also hard when the owner has bad people skills...a whole OTHER issue). 

My boss I had the longest really struggled with the people skills in some areas...but she DID try really hard. She went to conferences and workshops on being a better leader, communication, etc. And hired people that balanced her out. But yeah, the one before her was way worse. Best was a husband and wife team - she had the soft skills he lacked, and they had I think 5 kids? So maybe that helped teach them how to work with people better?

[Quarter Note]

10 hours ago, skimomma said:

However, we recently noticed her drinking a LOT more water and therefore also urinating much larger volumes.  

 

7 hours ago, skimomma said:

while I cannot rule out diabetes

Just so you know, what you described, suddenly drinking a lot more water and then urinating much more, was the first sign that my sweet kitty (years ago) had diabetes, and she wasn't overweight.  Just be prepared.  I was able to keep her for quite a while after her diagnosis with twice daily insulin shots, though.

Best wishes to you and your cat at her appointment.  I'm so glad that you don't have to wait more than a week to see the vet.

[Quarter Note]

6 hours ago, ktgrok said:

...we had a separate room we called "the comfort room" that was just for euthanasias and discussions of end of life. Had a love seat, no exam table, bookshelves, a pretty faux skylight, tissues, etc. And since it wasn't used for regular appointments there was no rush to move people out for the next patient, AND the next time they came in, with a different pet, they didn't have to worry about being in the same room where they lost their loved one. 

This is so beautiful.  What a considerate, thoughtful vet clinic that must have been.  I'm glad you had the opportunity to work there!

[ktgrok]

3 hours ago, Quarter Note said:

This is so beautiful.  What a considerate, thoughtful vet clinic that must have been.  I'm glad you had the opportunity to work there!

It was. She was very dedicated - the vet had one step son but he was older when she married his father so not really "her" kid in the same way. The clinic WAS her baby. She was an amazing boss in many ways, personally lent me money once, let my son hang out in a back room after school when we were having an issue with aftercare, paid to fly me and other staff members on a couple of vacations, paid for a lot of ongoing staff training, etc. She is very dediated still, I should say. I just moved, lol. I worked there more than a decade though, which is VERY unusual in the world of vet staff.