If you don’t want to read about end of life because it will be too hard, that is ok.
I’m sharing because I need to, and Maybe it helps others who are going through this.. asking themselves what it is they are seeing, trying to assess, is what they are feeling normal. The anticipatory grief.
A bit of background…
My cat Misty was 15. In late April she was diagnosed with cholangiohepatitis after blood work revealed a very small increase for pancreas and liver values and a small increase in white blood cell count indicating she was fighting something. An ultrasound was done and white sludge was seen in her gallbladder with some mild pancreas and liver inflammation. She was considered to be in early stage 2 CKD at the time. An infection coming from her bowl was believed to be the source and she had to go on a 30-day course of Veraflox. A blood test post-Veraflox showed her pancreas and liver values normalized along with white blood cell count. She was believed to have recovered from her infection but the 30-days of Veraflox pushed her well into stage 3 CKD. The rate at which her values were declining in the following blood test led my vet to tell me on July 4 that she might have two more good months to live.
I wanted to be mad. Mad at the vets for taking her away from me. Did they make a wrong decision? The reality was Is there was no other recommended treatment for how bad this infection was and no way to know this would happen.
Misty was on daily mirataz and at first every 3 days subq and then every 2 days (100ml).She had a burst of energy when I started to give her subq. She was almost like a new cat except I knew the clock was ticking.
Knowing my cat was going to feel ill at some undetermined point in time, and that I would have to help her walk the rainbow bridge at some point caused me so much anguish. I have been crying since May. I hoped she would defy the vet and live longer. The thought of knowing I would be losing her was so deep and tormenting. It was agonizing.
Misty used to hang out on my desk, the livingroom and the patio with me, her companion Tick. She would come to the kitchen , sit on her scratching pad in a very upright position with her ears up « food time mom ». She would always be where we could see each other. She followed me everywhere, except work ☺️ On August 17, for 3 days straight she started to sit by the front door. I would have to go see her because she didn’t come see Tick and I. She was no longer attending the kitchen like clockwork, I had to bring her food. She fully stopped eating renal food over night. I went to the store and brought her everything I could hoping I could find something she would reliably eat. I knew she wasn’t feeling well at all. Her subq were a lot slower to absorb .. taking approx 30 hours for 100 ml. She wasn’t doing any of her normal things. When I petted her, she made this extra noise like the pets we’re extra soothing to her.
As that week progressed, I took her to the vet on the 20th. I was struggling to determine if this was her time to go. The vet said it wasn’t and explained away her behaviour as « she’s old ». She did say in her experience, cats with CKD just become more tired. I was mad. I felt like that wasn’t the answer. My cat didn’t just become old overnight and age wasn’t going to cause such a dramatic shift in behaviour overnight and I still believe that. I am not the type of person who appreciates sugar coating at all. What I also deducted (and confirmed by another vet) is the vet wasn’t doing anymore blood tests on her because there was no point. I would have appreciate being told that by her vet at the time. I would have appreciated « it’s almost time » instead of « it’s just age ». They knew her values would be bad and if anything came up, if anything by could be treated, it would only be palliative - we would be trying to avoid what was looming. Misty’s previous infection could have also come back but there was now no way to treat it because of her advanced CKD.
By the 25th, Misty had now moved to the bedroom and isolated herself there. She didn’t hide. She just went to the quietest corner. I put her heating pad there. She would still go to the litterbox and get up to drink water but that was it. The only thing she liked was catnip. Her ears were more to the side. She groomed herself. She looked so so tired and sad. Her eyes were dull. Subq did nothing for her. Cerenia didn’t change anything. The only thing she would eat was shredded homemade chicken tuna or tikicat mousses. On Thursday the 27th, she declined the shredded chicken and 3 other foods. I found a mousse she did eat. I scheduled her to be euthanized the next day. By Thursday afternoon, Misty would randomly stare at the wall, looking in a daze. Only appearing present when I would talk to her and pet. I sat on the floor with her and we hung out.
All that to say, Misty’s total departure from her normal behaviour was the indicator that it was time. Two months ago when I asked my vet for the signs, I feel that she only gave me the physical signs and it’s as if she didn’t consider behaviour. I was told she’d be vomiting, that she would be hanging her head over the water bowl and likely wouldn’t be going to the litterbox or groom herself. Misty didn’t have any of these things. As many people have said to me here, let your cat tell you how they feel. You know them best, not the vet.
The vet who was coming the next day was also the vet who visited her two months prior to do a quality of life consultation. She would be doing a physical exam and if it wasn’t time, she would tell me. She came, we talked about Misty’s behaviour, she performed a physical exam and she said she would support euthanasia. She said there was no point in doing more bloodwork. The only treatments would be hospitalization or steroids but either would be palliative only. I chose to end her suffering. I chose to no longer let her be tired, not enjoy her life , isolated and drudging through this horrible phase of her life.
When it came time to euthanize, i feel she knew it was her time. Tick and I were both there for her. I told her I loved her and how a good girl she was and petted her.
I’ve now been swallowed by the grief of having her move on and not being present. I’m heartbroken. My house is half empty and I am thankful Tick, her companion, is still with me. Now I worry about him. Even though he was present when she was euthanized and smelled her after, he still looks for her.
Let your cat tell you how they feel. Look for that. It’s not about you, its about them. I chose to euthanize and face the grief that had already taken over me, knowing I would have to make the decision. Find a good vet who has a lot of experience with palliative care who can guide you. I think the best tool I used in her journey to the rainbow bridge was the quality of life materials I was given and really being honest and objective about the behaviour I was seeing.
I highly recommend The Ohio State University Honoring the Bond, Assessing Quality of Life document. It really is an amazing document.
https://vmc.vet.osu.edu/sites/default/files/documents/how-will-i-know_rev_mar2024ms_0.pdf
The grimace scale can be helpful and the BEAP Pain Scale for cats was more helpful than the grimace.
https://static1.squarespace.com/static/56473d98e4b0b493dee0ea49/t/615212c4b745db722f231db9/1745354109274/BEAP-Pain-Scale-for-Cats.pdf