UPDATE Post 23: He's gone. Guilt of not doing enough...PU kitty back in the hospital with a blockage and finances running low

[barnesthenoble]

I’m at a loss and really struggling. My sweet Sylvester (I think my heart cat, honestly…I love them all but this fellow is so special) has had a hell of a year. We started off with removing a possibly cancerous toe (results inconclusive, of course) in January. Then it got infected so he was in a cone for six weeks (he’s FIV+). A week after the cone came off he blocked for the first time. A month later he kicked off a series of four blockages in a row that lead to a PU surgery in early May. In mid June he got a UTI. He’s been doing well since then but on Tuesday started showing some signs of possible discomfort, and by last night was in a full on FIC flare. Today he’s back in the hospital again with another blockage. I’m waiting to hear back from the vet on what they find on the urinalysis and how the catheterization went.

I am absolutely heartbroken and terrified and feeling guilty. I’m over $12k in vet bills for him alone since December, not to mention the horses and other cats. I have maxed out cards, sold saddles, etc etc to pay for this. I don’t have any more financial rabbits to pull out of hats. I don’t think I can come up with another $4k if he needs a PU revision.

I’m feeling incredibly guilty. He’s on wet food with extra water and 2x/d gabapentin, but maybe there was more I could do. More supplements. Subq fluids. Be home more. Kept the space tidier. Kept the space less tidy. Trazodone? Prozac? He lives in my bedroom away from the other cats since he doesn’t like them. He has a window, Feliway diffuser, cat tree, bed to hang out under, water fountain. There are some other things maybe I could try, other supplements, a calming collar, trying to spend more time with him during the day (hard when I work…). I went on a 5 day vacation at the end of August. A good friend that he knows well stayed over so his routine was uninterrupted but evidently he was stressed.

I feel like a failure. I’m terrified to lose him but I just don’t know what other choice I’ll have if he keeps reblocking. At some point (honestly, I’m past the point) the level of debt becomes irresponsible. And am I just torturing him to buy him more time? Is it fair to try different drugs that keep him various levels of sedate? Even if I had the money, is a PU revision, more meds, etc in his best interest?

Sorry, I’m just rambling at this point. I’m waiting for a phone call and dreading the future. Just needed to write it all out somewhere because to most of the folks I know, he’s “just a cat.”

[shiloh]

Oh lord you poor thing. He’s NOT “just a cat.” He is your pal, your family and your furry bff.

I wish I could send you some $$ but I am strapped for cash myself. Have your vet try him on some kitty Prozac - that surely helped my kitty who was literally one step away from having that same surgery. He kept getting blocked and was ultimately diagnosed with idiopathic mucous plugs and crystals. He finally had to be cut off dry food forever because it turned out on his last trip to the vet (which cost me $$$) that that was the cause of all his issues. He has and is doing much better. Try that as well.

Also, try CARE credit and do a google search on some other charities. Also try local TNR folk - I have a couple in my area that will help with medical bills as well.

I am jingling for you and Sylvester!

[3PonyFarm]

Don’t feel guilty. You are doing the best you can. He is lucky to have you.

[OverandOnward]

@barnesthenoble

I’m at a loss and really struggling. My sweet Sylvester (I think my heart cat, honestly…I love them all but this fellow is so special) has had a hell of a year. We started off with removing a possibly cancerous toe (results inconclusive, of course) in January. Then it got infected so he was in a cone for six weeks (he’s FIV+). A week after the cone came off he blocked for the first time. A month later he kicked off a series of four blockages in a row that lead to a PU surgery in early May. In mid June he got a UTI. He’s been doing well since then but on Tuesday started showing some signs of possible discomfort, and by last night was in a full on FIC flare. Today he’s back in the hospital again with another blockage. I’m waiting to hear back from the vet on what they find on the urinalysis and how the catheterization went.

I am absolutely heartbroken and terrified and feeling guilty. I’m over $12k in vet bills for him alone since December, not to mention the horses and other cats. I have maxed out cards, sold saddles, etc etc to pay for this. I don’t have any more financial rabbits to pull out of hats. I don’t think I can come up with another $4k if he needs a PU revision.

I’m feeling incredibly guilty. He’s on wet food with extra water and 2x/d gabapentin, but maybe there was more I could do. More supplements. Subq fluids. Be home more. Kept the space tidier. Kept the space less tidy. Trazodone? Prozac? He lives in my bedroom away from the other cats since he doesn’t like them. He has a window, Feliway diffuser, cat tree, bed to hang out under, water fountain. There are some other things maybe I could try, other supplements, a calming collar, trying to spend more time with him during the day (hard when I work…). I went on a 5 day vacation at the end of August. A good friend that he knows well stayed over so his routine was uninterrupted but evidently he was stressed.

I feel like a failure. I’m terrified to lose him but I just don’t know what other choice I’ll have if he keeps reblocking. At some point (honestly, I’m past the point) the level of debt becomes irresponsible. And am I just torturing him to buy him more time? Is it fair to try different drugs that keep him various levels of sedate? Even if I had the money, is a PU revision, more meds, etc in his best interest?

Sorry, I’m just rambling at this point. I’m waiting for a phone call and dreading the future. Just needed to write it all out somewhere because to most of the folks I know, he’s “just a cat.”

• Sylvester is not ‘just a cat’. He’s YOUR cat. He’s fulfilling a vital role in your life – and his, too! As your cat.
• You are not a failure. You’ve already done far more than most owner would do. As I’m sure many have told you.
• ‘Doing more’ is not something I’d see as helpful, because you have already done so very, very much. Just IMO.

I had a vet - a feline specialist - give me some wise advice. “Is your cat happy? On a daily basis, does your cat enjoy being a cat?”

This is just my point of view, if it doesn’t mesh with yours, you can discard it …

When those things are no longer true, and the problems are not fixable, it’s ok to let them cross the bridge and be relieved of the burdens of life.

I can’t answer for you and your cat, of course. I totally understand how the question eats away at you. Have been down this road (similar roads) with more than one animal, as many on this board have done.

Our culture has far, far too much emphasis on doing every medical thing to prolong life, even when nature has another answer. It’s not just unhealthy for those of us facing loss. It’s profoundly unhealthy (even abusive in some situations, in my personal opinion) for the patient who is ready for relief.

Again, I don’t know if this applies to you and your cat. But if you come to a similar conclusion about your precious pet, then it is ok to let go, if the time has come. Animals are so much wiser and more accepting of nature’s direction for them than we are. If that is the situation, your cat will appreciate the relief, rather than blaming you, something animals don’t do. Animals don’t know about lifespan or age. Just how they feel right now.

Do not feel that because you’ve invested so much in trying to save him that you have to keep doing so. That’s a ‘sunk cost’ fallacy. You’ve done the very best for him. That effort has helped assess the answers.

If the vets do bring your cat back to health of course I celebrate with you. But your thread title and initial post sounds like your concerns and questions are valid.

Blessings on you and your precious kitty. Hoping for the best for both of you, whatever that is.

[barnesthenoble]

@shiloh

Have your vet try him on some kitty Prozac - that surely helped my kitty who was literally one step away from having that same surgery. He kept getting blocked and was ultimately diagnosed with idiopathic mucous plugs and crystals. He finally had to be cut off dry food forever because it turned out on his last trip to the vet (which cost me $$$) that that was the cause of all his issues. He has and is doing much better. Try that as well.

Also, try CARE credit and do a google search on some other charities. Also try local TNR folk - I have a couple in my area that will help with medical bills as well.

Thank you! I never received a call from the ER vet but it’s a busy university hospital so I am hoping no news is good news. It’s still terrifying, however.

He’s been completely off dry food four about three years now, since we had a spate of urinary issues with a different kitty who refused to eat wet food if dry was even in the house. That’s what’s made this so hard–he only eats wet food, he gets extra water (and only filtered, mineral-free bottled water to avoid any crystal issues), he’s on gabapentin, he’s been getting (admittedly not as frequently as he should, but every two weeks) Adequan to help his bladder lining, he has a water fountain, a Feliway diffuser, toys, scratchers, a cat tree, a window with a tree right outside to watch birds, etc. I will definitely talk to the vet about prozac or trazodone, but I’m nervous that I could lose him to another blockage while we try to pin down dosages. But I may lose him either way.

Unfortunately I’ve got Carecredit maxed out with his various vet bills. I’ll need to look into some charities or other possible funding sources. Even if I can find the money I’m battling with the decision of whether it would be fair to him if he needs to have a PU revision, etc. If the first one didn’t heal well (he was difficult, rolling around, jumping around the kennel, ripping off his cone, etc), there’s no guarantee the second one will. But at the same time, there’s the part of my brain saying I’m not giving him a chance if I don’t do it. The unfair part of my brain, which I recognize, but…it’s a hard one to fight.

@OverandOnward

• ‘Doing more’ is not something I’d see as helpful, because you have already done so very, very much. Just IMO.

I had a vet - a feline specialist - give me some wise advice. “Is your cat happy? On a daily basis, does your cat enjoy being a cat?”

…

I can’t answer for you and your cat, of course. I totally understand how the question eats away at you. Have been down this road (similar roads) with more than one animal, as many on this board have done.

Our culture has far, far too much emphasis on doing every medical thing to prolong life, even when nature has another answer. It’s not just unhealthy for those of us facing loss. It’s profoundly unhealthy (even abusive in some situations, in my personal opinion) for the patient who is ready for relief.

Thank you. This is a value that I do hold very dear–better a day too soon than a moment too late–and I’ve watched other folks put their animals through hell throwing the treatment book at them, not recognizing the animals were suffering. I try to ask, and am currently asking, myself what is fair to the animal. Am I prolonging life at the expense of prolonging suffering? I don’t have this same level of difficulty with the horses, I think in large part because their quality of life seems more…measurable. I have a harder time with the small animals, for some reason, and I don’t know why.

I think, when he feels good, Sylvester seems to enjoy his life. He’s cuddly and playful. He sleeps under the covers, spooned up against me, with his head on my pillow. When my alarm goes off in the morning, if I don’t get up soon enough to give him breakfast, he starts knocking things off the nightstand to wake me up. He chirps at birds and chases his tail and demands his churus. But then nights like last night and days like today, I feel like I’m torturing him–he’s obviously uncomfortable, in pain, stressed, and there’s nothing I can do to comfort him. And based on the last year, more times than not (5 out of 6), the issue ends up being a blockage, not a flare I can nurse him through. Which adds incredible expense and, more importantly, stress.

If he comes through this one and we find supportive care that can prevent another block, I’ll be elated. But I’m terrified that won’t be the case, that he’s going to come home and block again in short order. At which point I will be forced financially, but also I think ethically, to euthanize him. It will break me but I just can’t prolong his suffering, even if the money weren’t an issue.

The horrible part of this is that it feels so random. If it were cancer, or some other disease, some sort of inevitably terminal situation where the treatment is often only buying time of questionable quality, that would be one thing…but these are theoretically preventable and treatable occurrences, even if the reality is that they aren’t really preventable and are inevitable due to some biological wiring in him that we don’t know enough to understand. It’s so hard to combat the voice in my head that says I have failed him by not preventing his stress and figuring out the root cause and solving the issue. So hard.

But I also need to remember your words–that animals don’t blame, and he won’t hold it against me if I have to let him go. That’s a good and important reminder. I’ve given him what I hope are a wonderful six years–he showed up in our driveway one night, skinny and intact and limping, and I never planned to keep him but fell in love and never looked back. I have to remind myself that even if it all comes to an end soon, I gave him the absolute best six years of life that I possibly could. Forever wouldn’t be long enough for me, but I wouldn’t trade these last years for the world, either.

[OverandOnward]

@barnesthenoble that is a moving and insightful view of your situation with this dear kitty.

It’s good to see that you have one of the most important things I think that we all need in situations like this, and that is a clear set of decision criteria. It doesn’t mean that we have to stay hard with that criteria, it can be adjusted, but just to have a guide.

Sometimes, when people come to COTH with the “what should I do?” post, maybe what they really need is a big hug and “it’s OK to let this animal go”. If and when you decide that it’s time, it’s OK. You will be doing the right thing for him.

He found a place in your heart forever. That is not going away.

All good thoughts for you and Sylvester!

[MunchingonHay]

@barnesthenoble

I’m feeling incredibly guilty. He’s on wet food with extra water and 2x/d gabapentin, but maybe there was more I could do. He lives in my bedroom away from the other cats since he doesn’t like them. He has a window, Feliway diffuser, cat tree, bed to hang out under, water fountain. There are some other things maybe I could try, other supplements, a calming collar, trying to spend more time with him during the day (hard when I work…)…

Can I come and be your cat. You are doing so good by him. You have gone above and beyond to help Slyvester be comfortable. you are NOT a failure. You are doing the best you can.

@barnesthenoble

At which point I will be forced financially, but also I think ethically, to euthanize him. It will break me but I just can’t prolong his suffering, even if the money weren’t an issue.

Sometimes we have to feel the hurt harder so our pets are not in any pain.

You are a great kitty momma.

[Alex_and_Bodie_s_Mom]

@barnesthenoble

Just needed to write it all out somewhere because to most of the folks I know, he’s “just a cat.”

First, there’s no such thing as “just a cat” - he’s YOUR cat.

Second, do not feel guilty because I honestly don’t see what else you could be doing for him! Sure, maybe subQs once a week to keep him flushed, but if the vet didn’t recommend it, why would you think about it? It’s something to consider going forward though, maybe, and they’re not difficult to give at home.

Third - I had a cat with massive blockages that came out of nowhere. We never figured out what was triggering them, and there’s a chance you might never truly figure out the cause of Sylvester’s, either. Given that he’s FIV+, it might be an underlying condition that you’re not aware of.

Massive hugs to you. I’ve been at the place where there simply isn’t anything else to try. And it sucks. You’ve done - and are doing - everything you can for him. Sometimes, that’s all we can do.

[reefy]

No critter that we love with our whole heart and that brings us joy is just a whatever. I’m sorry he’s having such a hard time - I have tux boy kitty and he is a whole 'nother level of love, even though I have loved dearly every cat that I’ve had the honor of caring for. I’ll be thinking good thoughts for you! He’s a lucky little dude to know such love

[ohmyheck]

What a beautiful sweet boy.

Please don’t allow yourself to carry any guilt if you decide to say goodbye. You’ve been an absolute hero to this kitty. He understands (they know) that everything you do for him comes from a place of profound love.

Warm hugs and all the best to you going forward.

[shiloh]

OMG - you really are doing everything for Sylvester! He’s being treated better than most human patients.
But - yes, there is a line. And I think you know you are there already. If you feel you need to let him go, then let him go. It’s a misery and the hardest thing to do but you really have done everything short of waving a magic wand. If you let him go, don’t feel guilty - you did enough, you did what you could. And more.

you are both lucky to have each other.

[rubygirl1968]

He is a beautiful boy and definitely not a just a cat. I can’t add anything more than the other great advice you got in this thread but I’m thinking of you both.

You’re doing, and have done, everything possible.

(((hugs)))

[4horses]

I’m so sorry you are in this position. I lost my best cat to cancer. I was spending roughly $1200 a year trying to keep him comfortable with his severe allergies and then tried chemo drugs which gave him one more year with us. It never seemed like I did enough but I will say he was a happy cat despite everything.

My cat that I have now has been diagnosed with FELV. He has insurance but the antiviral medication I wanted to try him on is experimental and expensive. My vet refused to write a script for it because it hasn’t been tested enough even though the people that have managed to get it have reported very positive results. Now I’m trying to find a different vet that might be willing to allow us to try the drug, but part of me wonders whether I’m wasting my time… if I can’t afford the drug anyway? The company does offer the medication for free if it’s unaffordable but that is for human patients. It certainly seems like the odds are stacked against us. But maybe there’s no point, if no vets are willing to prescribe it…

We have the technology now to save animals that under normal circumstances wouldn’t survive. The question is, if it’s affordable and whether it makes sense to continue? I don’t know how to answer this. My cat looks absolutely beautiful and healthy. It’s hard for me to accept there’s nothing more we can do… that I should just let nature take its course. My mind says if he’s dying anyway there’s nothing to lose by trying treatment… either the drug will work, or he’ll have side effects and have to go off of it. I feel like we should try. Meanwhile my vet is too worried about the liability.

If it’s any consolation, we outlive our pets and will eventually have to say goodbye to them no matter what… I just wish we could have more time. My cat is only a year and 9 months old. It seems so unfair…

Is there something else you can sell to come up with the money?

One of my friends says “they have lived a good long life and that’s the best you can do.” She’s better at saying no when asked to prolong treatment, then I will ever be.

My dog went into kidney failure and needed dialysis. The vet said even he couldn’t afford it on his pets. He said we can do this but it’s unaffordable for most. It wouldn’t have helped anyway. Necropsy showed his condition was terminal and treatment wouldn’t have helped.

Is your cat likely to recover even with treatment? My aunt’s elderly cat was having blood in it’s urine and had bladder cancer, unfortunately.

[barnesthenoble]

Thank you all so, SO much for the kind words of support and wisdom. They mean more than you know. There was a reason I came to COTH when I felt so unmoored and I truly don’t think there is a higher concentration of kind, compassionate, and educated animal owners anywhere else on the internet.

Sweet Sylvester is home. The good news is that the surgeons looked at his PU site and don’t think a revision is warranted, which is one load off since that would have been the biggest financial hurdle as well as the hardest thing to nurse him through again. The bad news is that he still blocked even with the PU. Now we work on stress management and tinkering with medications like fluoxetine or trazodone. He’s doing well at home so far, super stressed for the first hour but settled down once the gabapentin and being home kicked in. Trying to resist the urge to spend every waking hour with him, which isn’t super feasible since I have horses and other cats and need to do things like eat and run errands.

Thank you again for the support, suggestions, and reassurance that I’m not being ridiculous or unfair to him if I have to call it sometime soon. I’m hoping we can get him through this flare up without a recurrence ever again, but I also know the odds aren’t necessarily in my favor so I am going to take it one day at a time and do the best I can.

[4horses]

What worked for my cat with the allergy issues (who also had urinary issues as well), was to get ph strips and test his urinary ph. His ph on regular cat food was an 8.0 and even on Hills prescription urinary food, his ph was too high. I switched to Royal Canin which was better but he was allergic to it. Finally ended up on a home cooked diet with methionine tablets to acidify his urine. He had struvite crystals.

Definitely get the ph strips and see what his urinary ph is doing. You can also get a microscope off ebay- don’t get the plastic ones, but they have some decent ones used. It’s not difficult to put a urine sample under there and look for crystals.

[shiloh]

I am so glad to hear this good news about Sylvester. Give him a kiss and a treat from me. And give yourself a break - you need it.

[Bearx2]

Your post brought me to tears because I have been in your situation before and it absolutely sucks. You have done and continue to do everything in your power to keep your buddy safe and comfortable. Please don’t beat yourself up, you will know when it’s time to call it and you can be sure he feels the love you have for him.

[OzarksRider]

Have you tried Methigel? It’s supposed to lower the urine pH to prevent stones and crystals from forming. It’s cheap and it doesn’t require a prescription. I gave this to one of my cats that had frequent cystitis, and it seemed to help.

[barnesthenoble]

Just wanted to say thanks again to everyone, and give a bit of an update. Sylvester is home and seems to be doing well. We had a scare a week ago Saturday night where I was concerned he’d blocked again, took him to the ER and they determined it wasn’t a blockage, he had a very small bladder so it was likely inflammation or a UTI. The vet was so incredibly sweet, she’d already unblocked him twice this year and waived the emergency fee. I took him to our regular vet first thing that Monday. Ran bloodwork, urinalysis, etc and started him on a longer round of pain meds and some anti-inflammatories.

Good news, absolutely no evidence of crystals, concentration was good, pH was good. Some blood in urine and lots of wbc and bacteria. The culture came back on Friday showing a UTI of corynebacterium (no species provided), which of course none of my vets have seen before. Naturally. There also isn’t any specificity testing to help us decide which abx to use. Between us all we did some reading on PubMed and one of the vets spoke with her husband, who is an infectious disease pharmacist iirc. Decided on 8 days of a high dose of Clavamox. We’re four days in and he seems to be doing well, knock on wood. Other than objecting to the banana flavored meds, for which I don’t blame him, he’s eating and cuddling and peeing (thank god). We’ll do another culture (to the tune of $350, when did it get so expensive?!?!) after the abx are done to see if we knocked it.

Of course I found all sorts of horrific things on pubmed about bladder surgery for encrusted infections with corynebacterium, etc. Hoping that’s not the case, but we’ll cross that bridge if we get to it. So far he does seem to be more comfortable urinating so, here’s hoping…

Thank you all again for the support. It means more than I can possibly express.

[barnesthenoble]

And for cat tax!