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QUESTION: First of all I know that the question I'm posing is pretty difficult if not impossible for anyone, especially anyone that does not know or has not treated my pet to answer but I would appreciate some unbiased input because the decision that I am facing is so very difficult for me.
My question is about our 17 (or at least she will be on June 12) year old Himalayan cat, Baby.  Baby has a few health problems which is no surprise considering her age.  In January of 2014 she was diagnosed with pancreatitis which we have kept in check with 2.5 mg of prednisone administered twice a week.  Also a blood panel done around November of 2013 indicated she was in very early stage kidney failure.   She is not as fast or limber as she used to be and I suspect she has some arthritis as well.  Despite all of these conditions Baby was a pretty happy little camper with a good appetite (probably helped by the prednisone) and enjoyed a good life.  At least up until early April this year when I started noticing that Baby seemed a bit lethargic and was not eating much.  She was still interested in food and would come out when she heard cans being open and bowls being refilled but she would just kind of sit there and stare into space while our other cat ate then walk away.  After a few days of this I became concerned and took her to the vet on April 7.  The vet confirmed what I suspected which was that Baby had some pretty bad dental issues going on.  Her weight had dropped from 3.2 kg to 2.43 kg and the gums around two of her upper back teeth were very inflamed.  She gave Baby a shot of antibiotics which she said might take a couple of days to kick in but would last two weeks.  She also gave us syringes filled with buprenorphine to administer once or twice a day for pain relief.  Given Baby’s advanced age and fragile condition we agreed that there was not much else we could do.  The treatment plan was to give her the antibiotics every four weeks to keep the infection in check and hope that maybe she would lose the infected teeth although the vet pulled on the teeth to see if they were loose but apparently they weren’t.  She also mentioned that in cat’s her age this could be oral cancer.
We took Baby home and it was a few days before she showed any sort of improvement.  I was very worried about Baby and had to hand feed her for a few days and sometimes even then she would not eat.  However by about April 12th Baby was eating on her own again.  She really perked up and was acting like her normal self.  I was so happy - the only thing that concerned me was that the eye on the side of her face with the infection seemed really runny.  I called the vet around April 24th and asked if we should give her another shot of antibiotics but she suggested that we should wait because she wanted to avoid Baby developing an immunity to them and instead suggested that we give her eye drops.  We tried the eye drops a few times but Baby really hated them and it really didn’t seem to help plus around this time she started sneezing a fair bit and I just thought poor kitty, along with everything else she also caught a cold.
We took Baby back to the vet on May 4th to get her second antibiotic shot.  The vet said the inflammation was down and Baby’s weight had gone up to 2.88 kg.    Baby seemed to be on the mend and I was happy that she seemingly had dodged another bullet.  The only thing concerning me was that she kept on making this weird sneeze/snorting sound occasionally.  We went away over night on May 9th.  When we returned on the afternoon of May 10th I noticed there was something on a chair Baby likes to snuggle up on.  It was a couple of teeth!  I was pretty happy because I thought great - now that she’s actually lost these two bad teeth the infection will go away and she’ll be fine.  Indeed, she did seem fine - she continued to eat on her own and acted normal in every single way except for one thing.  I would notice blood around her mouth every day.  It was not steady but every day there would be a new little stain.  I figured this was just from the tooth loss and it would go away.  It didn’t so I became concerned and took her back to the vet on May 13th.  This was a different vet at the same clinic.  He looked in her mouth and said it was quite “nasty and inflamed”.  He said that it could be oral cancer and advised us to keep an eye on her and bring her back in a week.
Baby continued to eat and act normal but the bleeding persisted - some days more than others but there always seemed to be a little bloody drool around her chin.  When we took her back on May 21 the vet looked in her mouth and said that the inflammation had subsided a fair bit but that given the wound in her gums he was fairly certain it was oral cancer.  He said that we could get a biopsy to confirm but at the time I thought “what’s the point?”.  Even if we could confirm we weren’t about to put her through any invasive treatments just to prolong her life a little, if at all.  I’m now kind of regretting this decision.  At least if I was certain it was oral cancer it would make the decision of putting her to sleep a little easier… maybe.  Anyway, the vet gave her another shot of antibiotics - I guess given her prognosis he was not concerned about her developing an immunity to them - and sent us home with more pain meds.
Of course I was crushed by the diagnosis.  In some respects however, if I had not heard it I would think that Baby was doing pretty good, except for the bleeding which has yet to go away.  She has a bit more trouble eating since she lost the teeth.  She kind of shakes her head to one side after she eats and paws at the air a little.  The sneeze/snorting continues as well - it is by no means constant but I hear do it from time to time on a daily basis.  Other than that she eats and seems to enjoy life but is a little more subdued.  I choked this up to the pain meds which can cause a bit of sedation.
She had a really good couple of days this past Wednesday and Thursday but yesterday she really seemed to crash.  Spent a good part of the day holed up in the place she goes to when she’s not feeling well and did not eat much.  I think I let this one bad day spook me.  My husband and I talked about it and we decided it was time.  We want the vet to come to the house to put her to sleep rather than take her into the office but they want 3 days notice for a house call.  I guess yesterday I was in the mindset that I did not want her to suffer waiting for a house call and I did not want to put her through another vet visit.  We called and made arrangement to have the vet come out this Monday to put her to sleep.
This morning she was purring on my pillow when I woke up.  She’s been eating and drinking and doing her normal routine.  I did not even notice any blood on her chin until just a little while ago after she’d eaten.  So now I am torn again.  I’m wondering if she even does have cancer since we never got it checked out.  My husband says even if she does not have cancer it doesn’t matter - she has some sort of wound in her mouth that is still bleeding almost 3weeks since she lost those teeth and there isn’t a whole lot we can do about it.  I know that I will have to say good bye to her eventually and we are so lucky to have had her this long but I am having a real hard time letting go.  Part of me thinks we should get the biopsy if it is not too invasive, part of me thinks we should cancel the house call for Monday and just monitor her some more but then part of me thinks I am being selfish and it is better for her life to end while she is not suffering too much plus I worry about the three day house call wait.  Even if we don’t cancel the house call I am going to have the vet do one last check in her mouth before we put her down.  I know it could  just be wishful thinking but part of me still hopes that it was just bad teeth not cancer and she is just taking a long time to heal.  The situation is making me so crazy and so sad.  I don’t want to lose my little buddy but at the same time I want to do what’s best for her.  What do you think?

Quality of Life Chart
Quality of Life Chart  
ANSWER: Hi Sharon,
I know that this is the most difficult situation you can face. As a vet tech, I have been guilty of waiting too long because I know how to prolong things, and that's not a good thing.

It's torturous to keep second-guessing yourself so I am going to give you a guide to compare how Baby is doing on any given day or overall.

Basically it boils down to one thing Sharon, her quality of Life. At 17, chances that she has some sort of oral cancer are really high, and that the teeth she lost fell out due to it spreading in her mouth. Right now she is eating, and has an occasional bad day.

There are two major signs to watch for:
First, she will stop eating all together, and you cannot coax her at all to eat. That's when she is ready. it's natural for them to prepare themselves for death by not eating.  
Secondly, she has more bad days then good days.

I am not there so I cannot tell you that she is ready or not ready. Usually, you can see it in their eyes after they stop eating. They will give you a "look" and that will be when it's time. I know this is very, very painful and the only thing that got me through losing my last two pets was holding on to the fact that they were at peace and no longer in pain. One cat had kidney failure at 15 and my dear sweet Annie Mouse, my last dog, I had to put down because she developed cancer in her leg that spread to her lungs. It was so very hard for me to do, but once it was done I was relieved.

Don't beat yourself up over your choice, whatever you decide, because she knows that you love her and are doing what's right for her. You must hold on to that.

Read the guide then watch her and make your choice based on what you see in 24 hours. If you waited another month that would be too long, but waiting until next week to decide is not.

My prayers are with you during this very painful decision Sharon. I am grateful your husband is there. I did this alone.

I will attach the guide so you can print it. This chart was written by a veterinarian that does hospice for pets, so just ignore the rating scale on the side. The middle is what's important.
Please let me know things go.  


---------- FOLLOW-UP ----------

QUESTION: Thanks for advice Jana and for replying so quickly.  I didn't think that I would get an answer before Monday but I told my husband at least it helped to write everything down.  And it really, really helps to know that someone is out there and cares.  I spent a lot of time petting Baby yesterday and crying and holding on to fantastical thoughts that maybe she could pull through this.  But yesterday evening I sat myself down and forced myself to think things through.  I began to realize that I should be grateful that Baby has been in our lives for so long.  We have had four other cats and Baby has outlived them all - one by over ten years.  She has dodged bullets in the past especially the one in January 2014.  We thought we would be putting her down then and we got to keep her for over 16 more months.  We have already had our bonus time and Baby got to enjoy a fantastic year where she got to do all the things she loved and be showered with love and affection. She has had a really, really good life and a long one too.  I know she doesn't have much time left.  Even if she were able to pull through the dental problems or somehow hold on despite them, I see her at the water dish more and more.  She was already getting pretty skinny before any of the dental stuff happened and I suspect it won't be too long before her kidneys begin to fail.  I truly believe you are correct when you say a month would be too long.  At present she still eats but I think it is getting more and more difficult for her.  And although she still comes out and engages with us she has begun to spend more and more time in her hiding places and we have upped her pain meds to twice a day. I don't want to wait until she is not eating and has totally isolated herself before putting her out of her misery.  She is a smart lovely little being and I'd rather let her go a little too soon than wait until all that she is has vanished. My husband said I could cancel the appointment tomorrow if I want to but if I do I should make damn sure that I have some sort of criteria to know when to make it again. Maybe Baby could make it through another week or two before she stopped eating all together and hid in the closet all day.  But last night I came to the conclusion that an extra week or two would be more for me than her and I would still be miserable anyway.  And more importantly I don't want to leave it until Baby is in total misery too. I told myself I've got to be brave and do what has to be done so I won’t be cancelling the appointment.  She was on my pillow purring for a bit this morning and I hope she will be tomorrow too but right now I'm trying to accept that it will be the last time.  It is so hard to let them go. I appreciate you being out there to listen and care.  Thank you.

Thank you for the chart - I will print it and keep it because I am sure this is not the last time I will have to make this terrible decision, but hopefully not for a long, long, time.  We have another kitty - a 10 year old shelter rescue mixed breed. I'm sure having her to hug will help get me through the coming days.

ANSWER: Hi Sharon,
Before I had my beloved soul-mate dog Cameo put down I laid on the floor with her all day crying. I just couldn't stop. And all she did was lick my face over and over and over.

I will never forget that. I was devastated losing her, but I had adopted a rescue who was 9 weeks old and when Cameo died Annie Mouse was 7 yrs old. I had her another 7 years and she was a huge comfort to me and we became very close.

I now have no dogs since I lost the last one in 2011, but I have three cats. I think that after I lost my mom in 2006 it became easier for me to let anyone go knowing that they were no longer suffering. Yes I suffered, but not as badly as I had in the past.

I know tomorrow will be a very hard day for you and your husband, but treat your self gently and keep holding on to knowing that you gave Baby a gift.

You gave her the gift of ending her pain. The love is always there and I feel like they are often with us, closer than you know.

My prayers are with you all tomorrow.

---------- FOLLOW-UP ----------

QUESTION: Hi again Jana.  I truly am so sorry to keep bugging you like this and I promise it will be the last time.  It is just that in some ways it is easier to pour out my heart to a complete stranger rather than those that are close by although I have tried to reach out to them as well.  And for the most part they have been very kind.
The doctor came yesterday afternoon and gave Baby her final needle.  This last weekend with her was very intense.  Part of me thinks it would be so much better not to know when our cherished pets were going to leave this world.  I knew exactly when it was going to happen and the anticipatory grief and counting down the hours was excruciating.  I could not help but think “this will be the last Baby does this”, or “this will be the last time for that…”.   Over the weekend Baby continued eating on her own and she looked comfortable when she was at rest.  She drank a lot too, actually way more than normal and I kind of wonder what was up with that.  We made sure she got her pain meds every 12 hours or so.  I had brought her litter box upstairs so that she would not have to take the long walk down the stairs to the basement.  She used the upstairs box on Friday and Saturday but after that she made the long trek downstairs.  I could tell because she usually would only pee in the corners of the box and most of the time it would get outside the box.  She was always such an independent little girl.  Anyway, all of this makes me feel so guilty, like maybe we should have given her a few more days or weeks.  But on the other hand she definitely was not as active and not engaging with us as much as even last week.  She only went outside briefly on Sunday morning and my husband could not coax her out again after that.  Usually she would meow at him several times a day to go out.  I stayed up late on Friday and Sunday night so that she could sit on her little chair in front of the screen door and enjoy the night air.  She loved that.  She came and sat beside me on Sunday night while I was at my desk.  That was another one of her usual spots.  She used to jump up on the desk and bug me while I was working or playing on-line.  As she got older she could not quite make the leap so I put a little chair beside mine and that is where she would curl up and keep me company, of course in between coming up on the desk trying to get in between me and the key board!  She sat with me a bit on Sunday night and she was even purring on my pillow at least part of the night and yesterday morning until she got me out of bed.  My husband said she then came out to the front hall and waited for him to open the front door and put her chair in front of the screen one.   She sat there for a bit, had a bite to eat and then she spent the rest of the morning (except for one more snack) in her little hiding spot in the closet.  We could not coax her out so I just sat on the couch and watched her sleep.  She looked pretty peaceful.  I wish she could have just drifted away right there because I am so troubled by her final moments and that is why I am writing to you today.  Maybe as a vet tech you could tell me more about the euthanasia process and what our pets experience as they go through it.
When I called the clinic on Friday they had asked me which vet I would prefer came out.  There is one lady vet that is my favourite and I asked for her or the new girl that first saw Baby when we brought her in at the beginning of April.  They could not come yesterday but the male vet was available so I agreed.  If truth be told he would have been my last choice.  But, he was the vet that had seen Baby the last two times we had taken her to the clinic and I did not want to chicken out after having finally made the agonizing decision so I agreed.  Really second guessing my decision now.  I am sure they said a vet tech would come out with him and I remember 10 years ago when the lady vet came to put another kitty to sleep there was a vet tech with her.  But when the doctor came yesterday he was alone.  He explained the process - of course I was a basket case by then and am not 100% certain of what he said but he did say something to the effect that he would give Baby a needle in her stomach and although it would take a little while for the drug to take effect she would lose consciousness soon after and then her breathing would gradually stop.  He said that sometimes it could take up to 20 minutes but that the patient would be unconscious for most of it.  He said that they find with cats this is a better way to go about it because often when they give the needle intravenously they have to shave the cat and the whole process can be very upsetting for the cat.  Okay I thought, you are the expert, although I did not remember the last time we had to do this being too traumatic for our other cat.  I think the lady doc had first given our cat some sort of sedative before starting the intravenous process and after that it was pretty quick and peaceful… at least that is the way I remember it.
Anyway, Baby did not like getting the needle in her stomach - who would? - she yelped and growled a little then tried to get away.  I had to gently hold her so she would stay in the little box we had her in.  Then she started doing the sneeze/snorting thing over and over again.  Not sure but I think the sneeze/snort stuff was part of the pathology of her disease - maybe her nasal cavity being partially blocked with a tumor or maybe blood from her tooth wound welling up there?  Dan mentioned that he observed her doing it when her head was down eating.  It did seem to mostly only coincide with the eating process.  Anyway, I found this very unsettling.  I don’t know how long it took.  It probably was only 30 seconds or less but to me it felt like an eternity before she finally settled down and started to drift off into unconsciousness.  The doctor calmly said something about her trying to get her breath but I wasn’t paying all the much attention to what he was saying.  I stroked her until she finally took her last breath.  It took about ten minutes before she finally stopped breathing.  I hope her last moments were not filled with pain or terror but I feel like they may have been and I feel so responsible.  I feel like maybe I should have waited until the vet I wanted was available or asked for the same process as with our other cat.  I did not know any better at the time but somehow I feel like I let Baby down when she needed me the most.  The thought of it really haunts me.  Afterwards I asked Dan if it bothered him and although he said it was a bit unsettling to see her trying to breathe like that he is unwavering in his belief that we did the right thing.  He tells me over and over again and I’m sure his patience is starting to wear pretty thin.  But I can’t help beating myself up over it - wondering if we had her put down too soon or too late or if there was a better way to do it.  I know I should not dwell on the final moments, days or even weeks of her life.  They are such a small part of what otherwise was a very good and very long life but they are so immediate it is all I can focus on at the moment.  I so hope she did not suffer too much in her final moments.  The whole point of having the vet come to our house was to make it easier for her.  I did not want her to die trembling and shaking in fear on some cold metal examination table.  Part of me feels like I should go talk to the vet about my feeling but then I think what good can come of it?  I’ll probably just make him feel bad or he’ll think I’m a nut job and besides it is all over and done with now.  It is not like it was a dress rehearsal and we will get another chance to get it right.  Still….
This morning I woke up to the birds singing at the usual time and so missed Baby giving me little head butts and purring in my ear.  I hope I always remember her little morning ritual, it was such a nice way to start every day.  I feel a lot of emptiness today.  Baby had become the focal point of our entire household and now that she is gone I feel at loose ends.  I had purposely put off stuff that needs to be done around the house and yard to keep myself busy after she was gone so hopefully that will help.  I know I have a long process of grieving ahead of me but I think I can get through it if I can get rid of this burden of guilt.  I hope you can give me some advice on how to get past it and on with my journey. Thanks again for your patience, Jana.

Answer
Oh Sharon,
I totally understand the guilt. We all live with it for the first week or so. The second guesses- "Did I do the right thing? Did I wait too long/ not long enough."

I relived the final moments of each of my pets deaths over and over as I sobbed into my pillow. I don't know why we do this, maybe it's guilt, maybe it's just an overwhelming sorrow and maybe that because that was their very last moment with us-we cling to it desperately like a log as we are pushed into a river of tears and sorrow.

It hurts deeply for a few weeks. I remember when I laid on the floor and my Annie Mouse took her last breath- I thought to myself, "I just want the next few weeks of pain to be over with now."
But I had to go through it as you also must. My worst times were in the morning, and at night as well. The routine of feeding etc, has been interrupted. In my case, I had no more dogs so I did the first thing I could think of. I picked up her bed, her bowls, her toys, anything that was hers, and I took them and put them into my storage unit. I didn't even want her collar to be where I could see it.

You will also have moments over the coming months that the pain will come back like a knife- but it will pass.

You mentioned that you have other cats. Love on them as much as you can, it really helps. I looked at my cats as links that went back years to my litter of 5 cats I had for 19 years to both of my dogs. I have a 13 year old now that is a link to them and a young cat that will be her link when she is gone. I also have a 15-16 yr old that I adopted from my son.
Busy yourself with your projects and the other cats and you will find that time does lesson the pain and being busy makes that time go by faster.

Nothing will stop this grieving process and I know you know that you just have to work through it. She didn't suffer at the end. She was asleep and it just became a permanent one. The method the vet used is a bit odd but what he said was true- it's much more traumatic shaving her leg etc. Without a tech there he couldn't have done it. The snorting and sneezing was from the disease in her mouth. I had one cat that had oral cancer and he sounded like a freight train when he tried to eat. I waited too long with him as well. I felt terrible about it but after he was gone I knew it was the right thing.   

In my personal and professional opinion you did what so many other pet owners don't do- you did this at the right time. She was only going to go downhill from here. You didn't let her linger and suffer. You gave her the gift of her dignity and ended her pain. You said you had upped her pain pills. If you had stopped all her medication she would have stopped eating right away.

After she started getting terrible diarrhea,  I realized the prednisone I had been giving my beloved Cameo was keeping her appetite up artificially and that it was doing more harm then good. I stopped giving it and she refused to eat - and to me that's a signal that they are ready. I knew then that it was time. But looking back on the photos I took of her the week before I realized I had selfishly waited too long. She was very thin and you could see she was in pain. I beat myself up over that for months.

So you have nothing to be sorry for Sharon. You weren't selfish and you were the best owner and friend Baby could ever have had.

Sleep well knowing that you did the right thing at the right time for her. The pain lessens, as you know from the past. But for here and now be grateful that she is at peace and running free somewhere over that Rainbow Bridge. Sometimes the gratitude helps with our own pain.

I have no problem with you writing to me about this in here. I hope I have been of some help.
Take care of yourself and your other babies. They still need you.  

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Jana Connell RVT, CVT

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PLEASE READ BEFORE SUBMITTING TO ME: I am NOT a vet and do NOT diagnose diseases. That is only for a licensed Veterinarian to do. I will give you suggestions and steer you toward calling your vet for help. You can call the vet's office and talk to the technician there or the vet at times. Don't be afraid to call them! If you have a serious issue with your pet please post it to one of the veterinarians in here- I will tell you the same thing in my answer. IF your pet is injured or in an emergency situation, CALL YOUR VET- Do not wait and post in here. Just call the vet's office and get them in to see the vet right away. Critical treatment time is lost if you seek answers here when you should have your precious pet at the vets!! Don't sit at home waiting for an answer when your pet is critically ill or injured!! I can answer most questions about small animal and wildlife care as well as small animal nutrition. I can also answer questions about all phases of dental care for small animals. I DO NOT answer questions about birds (unless it is wildlife or songbirds) or HAMSTERS/GERBILS/CHINS/GUINEA PIGS/REPTILES/FROGS/RABBITS/PET BIRDS OF ANY KIND so please submit these questions to the appropriate sections. I, as well as other experts in here, do NOT do homework questions- that is for YOU to do! Please respect these rules for all of us. Thanks!

Experience

I have over 42 years experience in the field of veterinary medicine. I specialized in small animals and did wildlife rehab for over 25 years, mostly raptors, squirrels and opossums. I am a Small Animal Nutritional Consultant with 6 certificates from Hills Pet Foods, CNM and Purina. I also specialized in Small Animal Dentistry which is a field I truly love. I also Teach Veterinary Technology to working technicians who are studying to take their California Tests to become Licensed Technicians. They have to take both the VTNE (Veterinary Technician National Exam) and the California boards.

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Audubon,World Wildlife Federation, American Society of Veterinary Dental Technicians.

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http://askthevettech.com/

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Licensed with California and Oregon, RVT and CVT. Certified Veterinary Dental Technician Have over 1500 logged hours of Continuing Education Credits(that means I keep up to date!).

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Nominated for Expert of the Month for the last 5 years.

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