September 14th, 2012
|07:33 am - The ethical dilemmas of daughter and cat-carer|
Some of you might remember that 2 or 3 years ago I was looking after my parents' cat while they were on holiday, and it was pretty clear to me that it had diabetes, which they would not acknowledge. I started him on insulin without asking their permission. I thought they might not be able to cope with the injection regime. However, once I had taken the initiative, they picked up the routine, and the cat has survived to its current great age. It's very scrawny but hanging on.
Anyway, I've got him again, and once again there is clearly something very wrong. This time it's his right eye, which is badly infected. I am thinking this is a side-effect of the circulatory problems associated with diabetes.
Immediately I saw the cat I was thinking 'Why don't you acknowledge this problem?' It's obvious something is badly wrong. Anyway as soon as I had 'custody' of the cat, I whipped him off to my own vet. She says his eye is so bad that she would probably remove it except that he wouldn't survive anaesthetic. But as far as I can tell he is not suffering. I don't think he can feel it. There seem to be none of the tell-tell signs of pain; he's purring loudly, lets me touch the eye without flinching, and eating three or four big meals a day. Therefore I am starting antibiotics and anti-inflammatory to try to save the eye without surgery.
Eating 3 or 4 big meals a day? - bonus vet advice - he is also hyperthyroid. The vet says balancing treatments for hyperthyroidism and diabetes would be 'demanding'. If I start him on a big thyroid work-up while they are away I am committing my parents to a great deal of stress. I know I underestimated them before, but I don't think they could cope. Unlike the diabetes I don't feel his thyroid problem is harming his quality of life - if you saw him, he's a happy but very very old cat. The vet says without radical treatment his life expectancy is - well, pretty short.
So, my proposal is to not to start on a third regime on top of the insulin and eye treatment (both of which I have imposed on them without asking) but to simply let my mum and dad know the diagnosis. Then they can decide what to do. I think the only alternative would be to - I don't know - claim custody of the cat, refuse to give him back, and start some massive intervention. I think it's better to let them look after him at their home, where he is with people he has known all his life, and will probably pass away quite peacefully and quite soon.
Even without your not-actually-my-cat ethical dilemma, it sounds very much like the right course of action is optimistic - but not aggressive - treatment of the eye and making life as good as possible for his remaining time.
Yes. If he was in pain it would be a whole other dilemma. Glad I don't have to worry about that.
At the moment, I'd agree; most vets don't advocate massive intervention with an old cat anyway. He certainly isn't in pain if he's eating like a horse (though the purring isn't a reliable guide, they can do that when stressed). I'd want to keep an eye on things, but don't know how close you are physically?
Yes, I do remember that about purring now you mention it, but just overall I don't get a bad feeling from him at all. I will keep an eye, but to be honest I think we are in the end part of the old chap's life now.
Agreed. He's not suffering, he's just got little time left.
Glad there's a bit of a consensus. The eye is horrendous - makes me glad we have antibiotics now. I guess at one time animals and people just had to endure that kind of awful thing.
It looks as if the cat has reached a stage in its life where everything's breaking down. If it's not one thing, it will be another thing.
And I think it's a good point that trying to do a massive intervention will be stressful to your parents as well as to the cat.
Yes, that's it. I think if I went to them with a fait accompli: 'Hey mum and dad you have to do all this stuff every day to keep your cat alive' they would feel obliged to do it, and they are both struggling with their own medical issues. I don't want to do that to them.
|Date:||September 14th, 2012 08:54 am (UTC)|| |
People don't always notice things in plain sight, because they creep up. Then an outsider comes in and its obvious. It's the "Only a Mother" affect.
This is a generous remark, which reminds me I am being a little bit exasperated with my parents, but as you say, from their perspective this has crept up slowly on them.
How old is the cat? How sad that it's suffering.
Cats are very tough. If they show pain or unhappiness they are generally at death's door, so demeanor and/or purring are not reliable indicators.
But you've already been to the vet and have gotten good advice, it sounds like.
My husband is always really blasé about our cats' various illnesses and never wants to take them to the vet. I think it's because he doesn't want them to be sick and wants to magic it away by ignoring it. Drives me crazy, since I always end up being the one who deals with it.
Edited at 2012-09-14 01:12 pm (UTC)
It's hard to know how old because they got him as a rescued street-cat donkey's years ago. I think my choices boil down to antibiotics or an operation which might kill him. I'll only put him into surgery if he get very miserable.
|Date:||September 14th, 2012 03:26 pm (UTC)|| |
It sounds to me as if you are doing your best by both the cat and your parents. I hope the cat continues happy, and indeed pass away peacefully, should that be coming soon, as seems very likely.
Thanks I keep giving him treats just in case
I'm not sure how the vet can be certain the cat is hyperthyroid without a blood test (I took Tabitha in when she stopped eating, and mine said it could be any one of four things, but the blood test showed she was hyperthyroid).
In our case pills (which I grind up and mash into their food) made a huge difference, though Tabitha also had surgery once the pills had made her strong enough to stand up to an operation. Rosie wasn't as ill in the first place, though as I said the other day her count is currently higher than Tabby's because she's on pills but never had surgery.
But I don't think it would make much difference if this cat is likely to die soon anyway; Bella (my cats' mother) was also hyperthyroid, and the pills improved that, but she died a few months later for other reasons.
She did say it would need bloodwork to be sure, but she felt around and reckoned his thyroid was enlarged so that made her confident - I don't know enough to judge. I think the difficulty with handling it with medication is the diabetes. Again, I can only go by what she said.
We had this sort of problem with my parents' cat. It is a horrible dilemma, but if the cat is not in pain then his quality of life is unlikely to be improved by radical medical intervention.
I hope he isn't in pain anyway
As various other people have said, it sounds as if the cat has reached the age and state of decrepitude where the best option for *him* is to keep him comfortable for whatever time he's got left, even if that means essentially palliative care. The palliative care option also seem to me to be the best for your parents, both in terms of their physical capacity, and their emotional stamina -- an easy, comfortable death for their pet at home with the people he loves will be easier for them to cope with.
Yes, I think so, thank you
|Date:||September 15th, 2012 02:52 am (UTC)|| |
Tough, isn't it? I do agree with everyone who suggests a gentle path, even if it means he has less time...
Yes, thank you, he seems pretty much relaxed about it all right now
You've had lots of supportive comments, and here's one more. Based on what you say about the cat and about your parents (and only you know them all well enough to judge) I think you're doing the right thing. *hugs*
Thanks, I phoned my dad in the end, and he is happy for me to make a decision if the time comes
Please let him die in a familiar environment surrounded by his people.
Don't worry, that will happen in any case. He is comfortable with me, because I have looked after him off an on for years, probably ten years now, and he treats a visit here like a holiday of his own. He's lying in a patch of sun next to me as I type this. The absolute worst that would happen is he doesn't make it two weeks to the end of their holiday.
My only dilemma is whether to start a program of treatment which might prolong his life, but commit my frail parents to a regime they may not be able to cope with
|Date:||September 22nd, 2012 12:11 am (UTC)|| |
Good plan, IMO. If the cat were in pain, it would be a different kettle of fish.
No disrespect intended to your folks, but I hope your parents aren't going to get another pet after the current one passes away (which I hope will be a long and painfree time in the future, unlikely though that might be). What if the cat had been suffering? Doesn't sound like they would have noticed, which is not ideal.
Glad you're looking out for the wee beastie.
I think you are right, and that's part of what makes it doubly sad. My mum has had a cat almost all her life, and I think that is the last for her. It wouldn't be fair on the cat.