Am I being selfish and unkind?

Our little old boy (now 16 and a half) was diagnosed with
hyperthyroidism last January. Unfortunately, he also had underlying
CRF and when he was given medication for the hyperT his kidneys
couldn`t take it. We tried different drugs and dosages, but each time
he started vomiting and his BUN and creatinin levels rose alarmingly.
Reluctantly, we took the decision to stop treating the hyperT, and
just give him Fortekor to help his kidneys. Amazingly he is still
with us, although he has lost over half his body weight and looks
dreadful. Up until recently he was eating a fairly reasonable amount
and his weight loss slowed down. We have been giving him Hills A/D
almost exclusively, mainly because that was all he would eat, and also
I because I thought that as his appetite was small, the A/D would
provide enough calories to maintain him. However, his appetite has
now dropped away and although he seems to want to eat, nothing I give
him tempts him. The vet says that he is undoubtedly feeling nauseous,
and from the way he turns his head away when he sniffs my latest
offering, I think this must be the case. Anabolic and cortico steroid
injections haven`t helped and he is now very weak and tends to totter
when he walks. He will take a few steps and then sit down, and this
morning he lost his balance on our hard kitchen floor and fell over.
He got up very quickly, though, and he does still have the strength to
jump on to our knee for a cuddle. I look at him and think that it is
time to say goodbye, but he is still chirpy and doesn`t seem depressed
as if he is in pain - he is just very, very tired. It doesn`t seem
right that I wait until he is in pain, and yet, if he is still
enjoying his little comforts, as he seems to be, it doesn`t seem right
to put him down too soon.

I am in such a quandary that I would welcome your views, please.

Kate

Kate wrote:
Our little old boy (now 16 and a half) was diagnosed with
hyperthyroidism last January. Unfortunately, he also had underlying
CRF and when he was given medication for the hyperT his kidneys
couldn`t take it. We tried different drugs and dosages, but each time
he started vomiting and his BUN and creatinin levels rose alarmingly.
Reluctantly, we took the decision to stop treating the hyperT, and
just give him Fortekor to help his kidneys. Amazingly he is still
with us, although he has lost over half his body weight and looks
dreadful. Up until recently he was eating a fairly reasonable amount
and his weight loss slowed down. We have been giving him Hills A/D
almost exclusively, mainly because that was all he would eat, and also
I because I thought that as his appetite was small, the A/D would
provide enough calories to maintain him. However, his appetite has
now dropped away and although he seems to want to eat, nothing I give
him tempts him. The vet says that he is undoubtedly feeling nauseous,
and from the way he turns his head away when he sniffs my latest
offering, I think this must be the case. Anabolic and cortico steroid
injections haven`t helped and he is now very weak and tends to totter
when he walks. He will take a few steps and then sit down, and this
morning he lost his balance on our hard kitchen floor and fell over.
He got up very quickly, though, and he does still have the strength to
jump on to our knee for a cuddle. I look at him and think that it is
time to say goodbye, but he is still chirpy and doesn`t seem depressed
as if he is in pain - he is just very, very tired. It doesn`t seem
right that I wait until he is in pain, and yet, if he is still
enjoying his little comforts, as he seems to be, it doesn`t seem right
to put him down too soon.

I am in such a quandary that I would welcome your views, please.

Kate

I am sorry about your boy. How lucky you are to have had him so long.
Nobody can really advise you about the right time to euthanize though.
You're the only one who can judge what his quality of life really is.
Just remember, that cats can mask pain very well, when you try to judge
how comfortable his existence is now. One indicator is that they will
start hiding when they are really suffering.
Best of luck to you. I know how hard it must be.

Sherry

"Kate" wrote in message
...
Our little old boy (now 16 and a half) was diagnosed with
hyperthyroidism last January. Unfortunately, he also had underlying
CRF and when he was given medication for the hyperT his kidneys
couldn`t take it. We tried different drugs and dosages, but each time
he started vomiting and his BUN and creatinin levels rose alarmingly.
Reluctantly, we took the decision to stop treating the hyperT,

Hyper-T/CRF is very difficult combination to manage- but it can be done-
been there. I don't think you should stop treating his hyperthyroidism
because that could kill him sooner than CRF- i.e., develop congestive heart
failure associated with thyrotoxic heart disease.

You said you tried different doses of methimazole. Did you try very small
sub-therapeutic doses such as 1.25 mg? A gradual decrease in serum T4 will
result in a more gradual change in renal blood flow- which will allow better
autoregulation of the kidneys. IOW, his BUN/Cr will not rise dramatically
or abruptly. The slower and more gradual the better the results. The
dosing schedule I followed was: 1.25 mg/once a day for 3-5 days; then 1.25
mg/twice a day for 5 days; then 1.25 mg AM/2.5 mg PM for 3-5 days. If he
tolerates that dose then 2.5 mg/twice a day. If his therapeutic dose is
greater than 5 mg/day, increase the dose by 1.25 mg AM for 3-5 days then by
1.25 mg PM.

You may not be able to control both diseases but you should be able to
strike a delicate balance between an "acceptable" level of hyperthyroidism
and an "acceptable" level of azotemia. The smaller and slower the
increases the better the chances of striking an "acceptable" balance of both
diseases.

If you're dosing him with methimazole, you might want to cut the pill in
half and put it in a #2 or #3 gelcap. Methimazole is very bitter and causes
many cats to lose their appetite. Encasing the pill in a gelcap will mask
the taste and smell and has no effect on absorption. Methimazole is also
available in a transdermal gel that's applied to inner earflap (pinna).

Also, you should be able to reduce his azotemia by feeding a food with a
lower protein content (g/d-k/d) since the by-products of protein catabolism
significantly contributes to the BUN. You should be able to stimulate his
appetite enough to eat g/d with cyproheptadine (Periactin). The usual dose
for cats is 2 mg (1/2 tab) twice a day- but CRF cats eliminate the drug
slower than cats with healthy kidneys- so, your vet will probably adjust the
dose based on response.

Managing these diseases simultaneously can be difficult and frustrating--
but it can be done. Seems to me that you'd welcome the extra effort to save
your little guy.

Keep the faith.

Best of luck,

Phil.

Thank you for replying, Phil. Back in January I did post here asking
for advice when Toby was first diagnosed, and you were kind enough to
suggest the regime you recommend below. We did try all of your
suggestions, including the sub-therapeutic dose of methimazole.
Unfortunately, even with that tiny dose, Toby vomited. We tried him on
the k/d diet, but he wouldn`t eat it and the vet told me that not
eating was worse than eating the "wrong" thing. I think the fact that
he wasn`t diagnosed early enough may have caused his kidneys to become
used to the high blood throughput for too long. Thinking back, I am
pretty sure that Toby had hyperT in September 2004, but the vet we
went to then did not pick up on it. It was only when he continued to
lose weight (the only symptom, BTW) and I sought a second opinion that
he was diagnosed.

I shall certainly ask our vet about the appetite stimulant you
mentioned. Anabolic steroid injections did help for a few weeks and
his weight stabilised, but then they seemed to lose their efficacy and
the weight loss began again. I think that now he is almost at the
lowest limit he can be before organs start packing up; he has a very
large frame and in his prime weighed in at just over 6 kg of muscle
and bone. He is now down to 2.9 kg. He has surprised us all several
times this last 9 months or so by perking up ("bouncing back" is going
too far!) but I fear that we have now gone passed the point of no
return. I know that cats a very good at masking pain, as Sherry said,
but although I believe he cannot be comfortable, especially if he is
nauseous, he isn`t vomiting and doesn`t crouch hunched up and looking
miserable, so perhaps I can postpone the inevitable for a little
longer. But is it selfish and unkind of me to wait until he _is_ in
pain and miserable? That`s my dilemma.

Thanks for listening.

Kate

"Phil P." wrote in message
...

"Kate" wrote in message
...
Our little old boy (now 16 and a half) was diagnosed with
hyperthyroidism last January. Unfortunately, he also had
underlying
CRF and when he was given medication for the hyperT his kidneys
couldn`t take it. We tried different drugs and dosages, but each
time
he started vomiting and his BUN and creatinin levels rose
alarmingly.
Reluctantly, we took the decision to stop treating the hyperT,

Hyper-T/CRF is very difficult combination to manage- but it can be
done-
been there. I don't think you should stop treating his
hyperthyroidism
because that could kill him sooner than CRF- i.e., develop
congestive heart
failure associated with thyrotoxic heart disease.

You said you tried different doses of methimazole. Did you try
very small
sub-therapeutic doses such as 1.25 mg? A gradual decrease in serum
T4 will
result in a more gradual change in renal blood flow- which will
allow better
autoregulation of the kidneys. IOW, his BUN/Cr will not rise
dramatically
or abruptly. The slower and more gradual the better the results.
The
dosing schedule I followed was: 1.25 mg/once a day for 3-5 days;
then 1.25
mg/twice a day for 5 days; then 1.25 mg AM/2.5 mg PM for 3-5 days.
If he
tolerates that dose then 2.5 mg/twice a day. If his therapeutic
dose is
greater than 5 mg/day, increase the dose by 1.25 mg AM for 3-5 days
then by
1.25 mg PM.

You may not be able to control both diseases but you should be able
to
strike a delicate balance between an "acceptable" level of
hyperthyroidism
and an "acceptable" level of azotemia. The smaller and slower the
increases the better the chances of striking an "acceptable" balance
of both
diseases.

If you're dosing him with methimazole, you might want to cut the
pill in
half and put it in a #2 or #3 gelcap. Methimazole is very bitter and
causes
many cats to lose their appetite. Encasing the pill in a gelcap
will mask
the taste and smell and has no effect on absorption. Methimazole is
also
available in a transdermal gel that's applied to inner earflap
(pinna).

Also, you should be able to reduce his azotemia by feeding a food
with a
lower protein content (g/d-k/d) since the by-products of protein
catabolism
significantly contributes to the BUN. You should be able to
stimulate his
appetite enough to eat g/d with cyproheptadine (Periactin). The
usual dose
for cats is 2 mg (1/2 tab) twice a day- but CRF cats eliminate the
drug
slower than cats with healthy kidneys- so, your vet will probably
adjust the
dose based on response.

Managing these diseases simultaneously can be difficult and
frustrating--
but it can be done. Seems to me that you'd welcome the extra effort
to save
your little guy.

Keep the faith.

Best of luck,

Phil.

"Kate" wrote

But is it selfish and unkind of me to wait until he _is_ in
pain and miserable? That`s my dilemma.



Kate,

I just wanted to say that I feel for you, and have been through this. I
waited too long, and now really regret this. By the time I made the decision
to ease my 20-year-old cat's suffering, she was skin and bones, incontinent
and could barely lift her head. I know she suffered and cannot justify my
failure to save her from suffering earlier. I just loved her so much I was
in denial about how bad off she was. That said, it was the hardest decision
I have ever made--and it is one nobody could make for me. Next time I will
err on the side of being a little early rather than late. But it will never
be easy. Good luck to you.

Kate wrote:
Our little old boy (now 16 and a half) was diagnosed with
hyperthyroidism last January.

snip

Here's a link that might help:

http://angelshavenhere.homestead.com...edecision.html

My heart goes out to you,

-L.

I also have erred on the side of too early as opposed to too late.
Gail
"cybercat" wrote in message
...

"Kate" wrote

But is it selfish and unkind of me to wait until he _is_ in
pain and miserable? That`s my dilemma.



Kate,

I just wanted to say that I feel for you, and have been through this. I
waited too long, and now really regret this. By the time I made the
decision
to ease my 20-year-old cat's suffering, she was skin and bones,
incontinent
and could barely lift her head. I know she suffered and cannot justify my
failure to save her from suffering earlier. I just loved her so much I was
in denial about how bad off she was. That said, it was the hardest
decision
I have ever made--and it is one nobody could make for me. Next time I will
err on the side of being a little early rather than late. But it will
never
be easy. Good luck to you.

"Gail" wrote in message
ink.net...
I also have erred on the side of too early as opposed to too late.

I'm sorry. That would be really terrible.

cybercat wrote:
"Gail" wrote in message
ink.net...
I also have erred on the side of too early as opposed to too late.

I'm sorry. That would be really terrible.

My experience is that it's really one or the other. It would be almost
impossible to gauge it just right, you just can't know for *sure.* I
think with my last cat who had to be euthanized, Cory, that it was sort
of close (I hope). He certainly wasn't crying in pain and he was
eating a tiny bit but he had lost quite a bit of weight, and barfed
alot despite reglan and other meds. He was tired, weak, stiff. His
eyes were glassy. He wasn't hiding yet but he was distancing himself,
I could tell. He wasn't making eye contact anymore and being petted
didn't interest him much.

I'm sorry, Kate, for your decision. It's so hard to have the power to
decide when but it is also certainly a gift you have to give.

Candace

Candace wrote:
cybercat wrote:
"Gail" wrote in message
ink.net...
I also have erred on the side of too early as opposed to too late.

I'm sorry. That would be really terrible.

My experience is that it's really one or the other. It would be almost
impossible to gauge it just right, you just can't know for *sure.* I
think with my last cat who had to be euthanized, Cory, that it was sort
of close (I hope). He certainly wasn't crying in pain and he was
eating a tiny bit but he had lost quite a bit of weight, and barfed
alot despite reglan and other meds. He was tired, weak, stiff. His
eyes were glassy. He wasn't hiding yet but he was distancing himself,
I could tell. He wasn't making eye contact anymore and being petted
didn't interest him much.

It was definitely time, then. Far, far too many people wait too long.
I saw it time and time again at the vet. It made me wish somebody
would pull a Kevorkian. I have posted the story before about the lady
who dragged her cat back and forth to the vet all day on his last day
simply because she was too selfish to let him go. Finally the poor
thing expired in his carrier late in the day on his 3rd or 4th trip
back into the vet. What a horrible way to spend your last day, IMO.

I would rather err on the side of "too early" than too late. I talked
at length with my vet about this before I euthanized my dog last March.
I know I did the right thing but it still haunts me. I even discussed
it with her afterwards, to make sure I didn't do it "too early". She
said, "What would you have done differently?" I said, "Maybe waited a
week or two more, waited until she had another really bad day...", and
she said, "...and how much more suffering would that have been,
possibly?" In the end, I am glad I did it when I did. She was still
herself, still had some spark, still was the kind old soul she had
always been. If I had waited until that "spark" which made her special
was gone, I don't think I could have foirgiven myself.
-L.