The last, and hardest, decision

Miscellaneous and Personal Stuff I Must Share
1

Now? Not yet? How much longer?

My cat Freddie Mercury (“Merc”), a senior former stray, has intestinal lymphoma that the vet can now feel with palpation. He’s eating a lot, frequent little meals of the always available wet and sometimes dry food, yet getting thinner; from an adoption weight of 10-point pounds he’s down to 6-something. I suspect the lymphoma is blocking his body from absorbing the nutrients from what he eats, and so he is hungry, hungry, yet can’t be sated.

Merc’s fur still has some shine, but it’s become rougher, a staring coat, with random little tufts sticking out here and there. His energy level is low, his walk is less steady; he’s looking and feeling bony now, and his head is looking too big for his body.

And yet… And yet he still goes about his usual daily old-cat routines, still (with the help of a step) getting up on the bed with me for standing belly skritches before napping by my feet, still purrs. The intensity is way down from his adoption baseline but there’s still some enjoyment left in his life.

But how much, really? I know animals don’t suffer with the same looking-back regrets we humans do, don’t bitterly compare the agility and endurance of our youth with the uncomfortable constraints of declining health and age. But is there still enough left of life in him now to ask him to go on? Do I wait until the burden of his existence so far outweighs whatever shreds of it he has left, or let him go before his life reaches that point?

I owned my Thoroughbred Ben from age 10 to 30, and put him down when he was clearly failing, but still enjoying his life enough to be a happy horse. I made the mistake many years ago of trying to keep a beloved cat alive too long, past the point where it would be a mercy to let him go, have always regretted my selfishness, and have made and kept my promise to all my animals since then: better a week too early than a day too late, a sentiment my vets agree with.

So now I find myself slithering along that razor’s edge, adrift in that uncertain murk of now? Later? How soon? Too late? And I still don’t know.

2

You can’t read his mind, but I’d suggest letting him stay around as long as his happiness is evident, or at least greater than his suffering.

3

We have an old cat who might have lymphoma, although she’s lived long enough past the initial diagnosis that the vet thinks it might be irritable bowel disease, or something else. She has trouble eating, and can’t eat much at once. She begs for food constantly. (We leave dry food out, but we have three healthy young cats who vacuum up any wet food she doesn’t immediately eat.) She’s skin and bones. Her fur is scraggly. She has arthritis. She’s deaf and senile.

We treat her with steroids and gabapentin (a pain killer.)

We were just talking about her yesterday. She still seems to enjoy life, at least some of the time. She enjoys being fed. She sometimes enjoys our company. She yowls before taking a nap, but we think that might just be so she can hear herself. (Deaf). She doesn’t sound like she’s crying out in pain.

I keep thinking she will drop dead, or get worse in some obvious way. But she actually seems a little better than a year ago, before we started treating her.

It’s hard. I don’t think your cat, or ours, has quite reached the point when it would be best to put them down. But I’m not sure.

4

Though my old animal is a dog, I’m in much the same situation. I’ve bookmarked this article and go over it from time to time. I hope it’s helpful.

5

Just went through something similar a few months back. In my case it was a little easier - intestinal lymphoma, probably yes (not 100% confirmed, but it wasn’t worth doing a biopsy given his other issues). Declining weight, worsening coat condition, yes. Hypertensive, some mild arthritis, borderline hyperthyroidal, hypertrophic cardiomyopathy w/ murmur that made it impossible to sedate to clean his crappy teeth. But the topper was bladder cancer that was steadily filling his bladder space and he was just way too old for operating to buy him any happy time. As the oncologist I consulted noted, he had just about every old man cat disease short of diabetes.

He was medicated (various) for palliative care and still ate fine, would have brief moments of playfulness, would still occasionally seek affection. But when his trips to the litterbox got to the point where they were more than once an hour to express a tiny bit of bloody urine and I saw him stumble a couple of times, it became a pretty “easy” if painful decision. Probably should have done it a week earlier :slightly_frowning_face:. Nineteen and a half, pretty good run for a cat.

Anyway you can try vitamin b injections if you aren’t already to help with the nutrient malabsorption if your vet thinks it might help. But I would always just try to judge when their behavior seems to alter enough that they are clearly struggling a bit. Hiding in darker spots, avoiding contact more, won’t engage in play, etc.

But cats are tough, it’s always such a guessing game the way they hide symptoms. Best of luck and condolences.

6

Very good advice.

Our Pete-loaf had feline leukemia when we got him from the shelter.

He was a majestic 16 pounds for a while after we neutered him and he had access to all the food he wanted.

After 2+ years though, the illness started showing. He lost interest in food. He’d still come when he heard the treats rattling but he rarely ate anything. He’d still purr for us, but he just did not feel well. He was down to 11 pounds. He had one spot on his side that he’d licked raw for most of the time we had him, and that shoulder became very atrophied (I assume there was some kind tumor there). We tried everything we could to get him to eat including Valium and anabolic steroids (cat got better drugs than I ever have!!). Nothing helped.

We made the hard, hard decision. That was nearly 30 years ago and I still get sniffly.

7

Thanks, all. Merc’s last bloodwork was pretty much normal (for an old guy) for renal, thyroid, etc., leaving the lymphoma as a diagnosis of exclusion. We decided no point in confirming it with an ultrasound, and the current palpable thickening seems to indicate we made the right decision.

Merc is getting a daily dose of prednisone as palliative care, using a gel I rub inside his ear rather than having to force a daily pill down his throat. His teeth need cleaning but of course that’s right out. I think we still have some time left, but it’s weeks at best, and I’m staying alert for clear signs I might be waiting too long.

Here’s a crappy photo I just grabbed from my crappy point-and-shoot.

8

When I was trying to make this decision for my dog, the vet’s advice was, “better a week early than a day late”. It’s all about minimizing suffering for the animal.

9

That’s what we thought about Rachel, our old lady. That was nearly a year ago. She’s no worse than she was, probably a little better. She definitely gained some weight after we started her on steroids.

And now i have to go make up some pills for her. She gets ~2/7 of a standard capsule each day.

10

He’s pretty boy with his white whiskers black coat. All I can say is over the 40 plus years we’ve had pets is that we knew when the time was right. You seem to know from experience, and I think you will make the right decision for Merc. He’s had a good life with you, and is a loved and lucky cat. It’s hard to lose them or let them go.

11

Exactly. My vet and I agree wholeheartedly on that. The trouble is, which week is early enough but not too early?

With my old horse Ben, I’d decided in the spring to let him enjoy one more summer in his current wonderful home, then let him go in the fall, say October, rather than put him through another New England winter, but his health issues began visibly deteriorating enough that we moved up his euthanasia to August. He was his usual happy self, munching his last treat (couldn’t see well for cataracts, moving somewhat stiffly, but still looking 15 years younger) as the needle went in. I’m glad I chose to have him put down then rather than trying to squeeze out any more time.

12

I believe the steroid Merc’s on has helped to make him more comfortable and extended his life somewhat, but he’s still lost weight since his previous vet visit. When I pick him up now there’s hardly anything in my hands, and that’s fairly sudden, and the coat deterioration seems to be accelerating.

13

What does the vet say? I’m surprised they won’t come out and say “It’s time.” if it’s actually time.

14

I’m dealing with the same issue. I have five rescue cats between the ages of maybe 11 - 14. I knew at the times I got them that it was a bad idea to have so many get old at the same time I’m getting old but here we are.

Seven (13?) was diagnosed with diabetes and kidney disease a few weeks ago. She is getting insulin twice a day and going to the vet for sub-q fluids twice a week. She is very stressed about this and not getting better yet. She had glucose curve testing done at the vet Monday and the vet upped her dose of insulin. I hope this works. She is still peeing 5 or 6 times a day and whines when she approaches her water bowl. The vet doesn’t know why she does that, she shouldn’t be in pain but it breaks my heart. I don’t want her to live the rest of her life stressed out.

I had to take Summer (14?) to the emergency clinic Saturday before last when she suddenly had trouble walking. There was no definitive diagnosis and we saw her vet a few days later. They gave me options for testing that could run over a thousand dollars. They gave her an antibiotic shot and one for arthritis but I declined additional testing because she was walking and acting normal at that point. Over the weekend I noticed that one of her eyes has halfway rolled up. But, again, she is acting normal. I think maybe she is having mini-strokes. I’m watching her closely but I’ve considered that she might suddenly take a turn for the worst. I’ve got the number for the mobile vet ready to go if that happens. I want her to peacefully die on her spot on the couch. That’s actually the plan for both of them.

The last few weeks have been exhausting. I’m so worried that I’m about to lose them both. I want to do everything I can for them. But I’m not sure that I am up to the challenge. I have my own health issues that are making all this difficult but I don’t want to use that as an excuse and I feel bad for even thinking about that. Not to mention the money issue. I have it but it’s not unlimited. Everything about this sucks. Hugs to everyone else going through it.

15

IME vets will rarely say precisely, though I’ve had one do it; but they will generally give some indication.

I’ve had several cats die gently at home, over the years; I think I made the right decision in those cases. I’ve taken others for that last ride, knowing it was the last ride; and one who I thought I’d be bringing home for a while longer until the vet. examined him and said no. I think those were also the right decisions. I misjudged one badly, but so did the vet; he got very suddenly much worse, and I took him in as soon as it happened; but that was a matter of being off by an hour, not by a week. (He had a tumor near his spinal cord, which grew into it.)

If the cat’s still eating, and still purring when petted, and not hiding, I’d be inclined to wait longer; though I’d also consult with the vet. But you’re the one who’s looking at him and holding him. Often they’ll tell you.

16

The vet I deal with most often for my cats trusts my judgment, given how many years and animals we’ve been working with together. I know one vet in the practice more than once would tactfully try to persuade a long-time client to let her cat go, but that person was the kind that can’t bear to say goodbye and keep their animals going well after they should have been released. I can think of three horses, for example, boarded where I was horsekeeping, whose owners refused to let them go despite how much they had deteriorated.

My vet and I trust each other’s judgment. If she said let’s do it now, we’d do it now. When I say it’s time, she’ll agree.

17

It’s a personal decision. We talked to our vet, and he gave us a lot of things to consider, but nothing definitive.

Our vet explicitly said we should consider what we are up to doing. Your life matters, too.

I’ve kept animals longer than some here would advocate. I prefer to wait until they no longer want to live. That means that we’ve only had a vet put down one. Another we would have, if the cat had started actively dying during business hours, but he was dead by morning. And a third died peacefully in a bed of leaves, in view of the bird feeder, where she liked to sit. The proximate cause was probably hypothermia, which (according to humans who have been rescued) is a peaceful way to go.

The only death i wish I’d hurried along was my mother’s. She spent 4 days painfully dying, and if it had been legal, i would have put her down after the first few hours. It was her explicit wish that she not suffer and that we not prolong her life, a wish she made decades before the fact and reiterated frequently as her health failed towards the end. I still feel guilty about not being able to honor that wish.

But i don’t prolong the lives of my sick pets, unless they have prospects of actually recovering. No invasive treatments, no treatments they hate. My sister declined to be my mother’s medical proxy because she has kept several pets too long. I think that’s the bright line you want to avoid.

But my mom had lost most of her interest in living months before the end. Maybe my cat has, too. But i can’t ask her. I don’t know. Personally, I’d prefer to err on the side of knowing it’s time. But i don’t pretend to know that I’m right about that.

I think any point between “having trouble with its daily functioning” and “obviously in great pain and/or dying” is justifiable. And it depends on part on the animal, the person, and the circumstances. It’s just hard.

18

Given your feelings, i suspect it’s time to say goodbye to your cat. He’s probably in pain. He’s suffering from unslakeable hunger. But you might ask him what he prefers. It’s hard to ask a cat, but sometimes they answer.

19

Oh, god, my mother spent her last few years actively wanting to die given all her health issues, and if it were in my power I would have released her long before hospice finally eased her end.

ETA: I don’t know how, if at all, this affects my thinking, but I don’t believe in an afterlife; that this life is all anyone gets and we should make it as comfortable and happy for us and those around us as we can, and let go of life when it’s no longer worth living.

20

We waited too long with our first cat. She had (it turns out) an undiagnosed tumor in her throat that kept her from getting any food down, so she wasted away. When her legs failed, we had someone come to the house. We swore never to let an animal get to that point again, which usually means you second-guess your decision for euthanasia. That was the case with our second cat, who had a brain lesion. She kept pacing in circles and was clearly not the cat we had come to love, so we had her put down. I still feel like we may have betrayed her, but that’s assigning human feelings to an animal. Her death was painless and needed. So it’s a crap shoot. Were I the OP, I would take the step and live with any guilt. You’ve given Merc a good life and rescued him from a certain early and unpleasant death and should now give him the dignity of a painless passing.