Expert: Jessica - 10/4/2011

Question
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Overwhelming Guilt: Did I neglect and inadvertently kill our cat?

He started getting skinny in April and I took him to the vet.  He had to have a tooth pulled at that time and the vet advised me to keep an eye on another tooth and try brushing with baking powder.  I tried brushing them with cat toothpaste, but I couldn’t really reach well enough into his mouth to do an effective job.  In hindsight I probably should have taken him back to the vet, but the cat had resumed eating and looked like he was feeling back to normal.  Back then I told the vet I was interested in getting a professional cleaning and he discouraged me.  He said most dentists charge $400, put the cat the sleep for the procedure, and all you really get for that is the same result as brushing at home with baking soda and he encouraged DIY instead. Had I thought tooth issues would be the cause of his death I would have insisted on professional cleaning.  I regret not brushing his teeth with baking soda as directed.

With the one tooth pulled and a round of antibiotics the cat seemed to be getting back to normal.  He was eating and seemed to be gaining weight back.  Then he seemed to come down with allergies and chewed his back fur down to the skin.  I bathed and Advantage flea-treated him and put Vetricin on his skin and his fur grew back.  He hadn’t really put all of his weight back on, but with his skin was no longer itching he seemed at ease.  He slept a lot, but I don’t think he was sleeping more than usual, the expression on his face looked content and calm.  Like our other cats, he vomited sometimes after eating.  I thought that was pretty typical for cats, and I didn’t think he was throwing up his kibble more than before or more than the other cats.  Later it sort of seemed like he threw up more frequently, but I wasn’t sure.  Did I hurt him by not realizing sooner I should have switched him to canned food?

About September it dawned on me he was indeed throwing up more than usual because he was getting skinny again.  I switched him to canned food and he seemed to eat more and throw up less.  I thought he was gaining weight.  But then one weekend in mid-September he stopped eating his canned food.  Being unemployed, I could not afford after hours emergency medical care for him.  I had to wait two weekend days until Monday morning to take him to his regular vet (continuing to try to hand-feed him whatever little bit he would take.)  He had a second tooth pulled and antibiotics and a nose drop prescribed to allow the puss that had gone up from his upper fang into his nasal passage.  (Gentamicin Sulfate .3% solution.)  The vet said he might not want to eat that night, but by the next day should start feeling better and eating.  

I gave the antibiotics, but now I don’t know if my mind is playing tricks on me or whether I only gave him one dose per day or the prescribed two.  I thought I gave him two each day, but when I try to recollect exactly now I cannot remember.  I feel like an idiot for not writing it down.  I don’t write my own prescriptions down, I just make a point of taking them the same time on the clock every day.  I could have sworn I gave him all the dosages with the exception of one day that I’ll talk about in a minute.  Could missing, say, 2 out of 8 dosage times in the course of four days have hurt him?  That number is the worst case scenario.  I really don’t know any more.  

Tuesday, the second day of oral antibiotics, he looked like he was starting to feel better except he was still reluctant to eat. I encouraged him to eat his moist food by hand feeding and he had a small amount.  So from Monday to Wednesday I was going through this nursing process.  Thursday and Friday I had a short-term job and lasting 12 hours each day and missed giving him his morning dosage on Thursday.  I thought my boyfriend would give the medicine.  I gave the evening dose.  He had both doses Friday.  Friday evening and night I thought we were still on-track to be able to nurse him back to health but his breathing became labored in the middle of the night.  I was scared he was going to die.  I removed the dried mucus that had formed since the last cleaning just a couple hours earlier from his nostrils but that only helped a tiny bit.  I tried to get him to breath through his mouth, but he would only breath through his plugged nose.  Over the course of maybe 2 a.m. to 8 a.m. I put in maybe three more drops per nostril (in total) to try to open them up.  Did I harm him by giving more than 1 recommended drop per nostril?  I took him back to the vet first thing in the morning where he got IV fluids, B-12 shot for severe anemia, and antibiotics.  The vet said “stop the drops RIGHT NOW… there are two holes there.”  English is his second language so I don’t know what holes he meant, but I gave him no more drops after that.  His tone scared me.  He didn’t come right out and say “you should not have exceeded 1 drop per day,” so I don’t know whether by "right now" he simply meant now if the day you stop giving the drops or whether he meant I messed up by giving too many drops.  I only gave the extra drops because I genuinely feared he was going to die at that time and didn’t know what else to do.  

When I walked in to that appointment, the first thing the vet noticed was a lump on my cat’s lower abdomen sort of in his groin area or on the belly near where the thigh connects to the trunk.  He palpated it and showed me that it was huge (about 75% the size of an egg.)  He asked whether the cat was vomiting blood or unable to go to the bathroom or anything of that sort.  I said no to those things, but that he vomited his food.  I don’t understand why that lump was not detected on the prior visit just a few days earlier.  I had not only discussed the tooth with the vet on the prior visit, I said the cat was feeling bad in general, not eating, getting skinny PLUS the last time we were there he recommended maybe having to pull the tooth down the road.  On that prior visit, the vet went straight for pulling the tooth.  Maybe he should have given the cat an actual “check-up” and maybe I should have realized that and insisted upon it.  In this present visit, he said we’ll see if we can get the kitty through this episode and deal with the lump later.  Maybe it is a swollen lymph node.  

After that most recent vet visit, I got the cat home and tried many times to feed and water him and give him Nutri-Cal gel, he took tiny bits at a time but at least he took them.  At one point I poured out dry kibble for the other cats and I was so encourage when this cat literally ran over to the bowl.  I gave him his canned food and he ate with gusto.  I thought we were out of the woods.  He even groomed himself which is something he had not done for the past few days.  He was looking good from around 6 p.m. to as late as 2 or 3 a.m when we all had drifted in and out of sleep from 11 p.m. or so on.  

Then my boyfriend had people over really late and woke the cat and I up at about 4 a.m.  He and I argued about this in front of the cat.  Then when I awoke at about 10 a.m. the cat had left my bedside and was sitting on the lower shelf of a table.  He had been hanging out there more frequently over the past week and I was scared by the fact that he would face the wall while under there.  But he was facing outward that time, so I thought maybe he was just relaxing there.  Except his expression on his face looked like he didn’t feel good.  Should I have stayed up from 4 a.m. all night long to hand feed and water him?  Did he get dehydrated or lose too many calories?  But didn’t he need to sleep for a while too?  I thought I had given all I could for the day (Saturday going into Sunday.)  He had just been infused with fluids that Saturday and I gave him droppers of water all throughout the day.  I got the 1.5 teaspoons of NutriCal into him, and got him to eat some hand-fed food several times throughout the day.  If he looked that close to death shouldn’t the vet have recommended hospitalization or said how gravely ill the cat was?  

So now it was a Sunday and it was clear he was gravely ill.  I started calling around to see if I could locate any sort of emergency vet I could afford.  It started becoming clear that he was dying because he was really unsteady on his feet and got a confused look in his eyes.  He died within hours.  It was so confusing because it had just looked like he was on the upswing.  Less than twelve hours before he had been “doing his feet” on the cat scratcher and looking so much better.

I am racked with guilt.  I wonder whether it was because I didn’t take him back to the vet sooner (after the April visit) over the tooth issue that may have killed him.  I wonder if the tumor in his stomach did.  Or was it a combination?  What percent possibility is it that had I taken better action he would be alive?  Where did I go wrong and what should I have done instead?
Also, in the previous vet visit I told the vet the cat had a lump on his stomach.  The vet didn’t even feel his stomach and told me that it’s just a pad of fat that develops on older kitties just don’t touch it or allow people to play with it and it will be fine.  The lump was in a different location, it’s not the puffy bulge of belly that I was referring to, so I’m not suggesting he was misdiagnosed.  But I DO wonder whether if the vet had taken the time to palpate the abdomen issue I brought to his attention whether he would have noticed the tumor.  

The other thing is that one of the times I was feeding the cat the NutriCal Saturday, he had another tooth fall out.  On the very most recent visit the vet spotted a different tooth (a back tooth) he thought might need to be removed, but that tooth was firm.  The tooth that came out was a lower fang.  Did he neglect to look at all the teeth?  Or could the tooth have just happened to loosen and fall out in a matter of hours.  Did it make a difference?  

In all, if I knew that this was just this cat’s “time” things would be a lot different.  But I feel like I failed to spot things like “how thin is too thin,” “when do you seek follow-up care when you just got back from the vet and believe the cat to have been given the okay” and I was just too stupid/ignorant/lazy/unobservant to realize I should have taken him back.  

I have had a lot of faith in this vet up until now and I don't know how to take what has happened.  I know I mentioned some critical things about him, possibly questioning whether he did the right thing, but I accept that he knows better than me.  For example, his eyes went right to that tumor which I had not even noticed.  He seems to just “know” immediately what’s wrong by looking at the animal.  He’s an old fashioned sort who works with a lot of people who do not have a lot of money.  For example, if an animal needs antibiotics, he does not insist that you get several hundred dollars of tests first that almost every other vet I have used in the past would have insisted.  But he’s not a “bargain basement” type in terms of skill, either, as far as I can tell.  He also has a loyal clientele that includes plenty of rich clients who really love his “country doctor… old fashioned general practitioner” type of care he gives.  While I was there, I heard him acknowledge to one patient that the owner needed greater care than what his office was equipped to provide and referred them to a larger animal hospital.  So I don't think he would hesitate to refer me elsewhere if my cat needed something greater than what he could provide.  I think he views his practice as “ministering” to people and animals.  I do question whether taking the cat to a more state-of-the-art clinic would result in him being alive now.  But if I did I know the bill would probably be at least $500 if not into the thousand or more mark and then it gets into whether I can even pay that much.  But if someone gave me a choice "the cat or $2000?" I would find a way to pay for it or finance it.  I wonder if the vet made a mistake or two along the way.  I wonder if I should continue taking my other cats to him.  

I also wonder if my boyfriend and I arguing in front of the cat killed his will to live.  I was so upset because not only was the 4 a.m. arrival of his party totally disruptive to me and the sleeping cat, the party included a total stranger who looked like a street person which I felt was an outrageous risk to put our household in.  I told him to get the people to leave but it took a while to get them totally out of the yard.  I read him the riot act for pulling this move, especially with a sick cat.  I really regret the manner in which we fought in front of the cat.  I should have saved it for another time.  I was just so upset.  I hate myself.  I hate my current situation.  

My confidence in my ability to care for animals is completely shaken.  We have three other cats.  I never thought of myself as a “cat person” and these are, technically, my boyfriend’s cats.  He took in a pregnant stray.  But, I have come to love them as my own.  He was unable to take them to the vet because, thank God, he has a job during vet business hours.  I paid for this care even though I am really broke and had to withdraw money from my old employer-funded retirement account and take a bunch of penalties just to be able to afford to get by.  I used to work full-time, but now it’s hand-to-mouth.  I have my own tooth that is decaying and requires a root canal and crown that I have had to put off because I cannot afford it yet.  If this had only happened while I had a job… and if only I had been more observant, our precious cat could still be alive.  It’s like the symptoms flew just under my radar.  Like I knew it wasn’t “ideal” and was taking steps to help him, when in actuality it was grave and I didn’t take the right steps or take them quickly enough.  I’m also upset that my boyfriend didn’t say the cat is looking like it needs to see the vet ASAP.

Please tell me what I did and didn’t do wrong and what do I do to not repeat missing the ball with my remaining cats.  Our precious cat was 12.5 years old.  He was content for almost all of those years.  I am scared I caused him discomfort for an unknown period of time toward the end of his life.  My vet said his cat, and Abyssinian, is 27 years old.  I wish there was some way to know how long my cat, a domestic shorthaired black cat, “should” have lived.

There is a reason I have never obtained a pet on my own.  I am scared of letting them down.  I have, however, become the default caretaker of other people’s pets when they slack off (this has happened with other animals from other family members.)  I love the animals that have come into my care through whatever circumstances and I do my best with them.  Even with my own health, I admit I have a tendency to muscle through illnesses and wait longer than I probably should to seek care.  It’s like my threshold for what is still “normal” is lower than average… I really don’t know.  Maybe I am being too critical.  My animal’s wellbeing is at least as high a priority to me as my own, if not higher.  This cat I have been talking about slept with me and cuddled with me for almost every night I knew him.  Up until close to the end, I thought he was happy and in good shape.  I hope I treated him right.  I loved him so much and sorely miss him.  I feel sick over perhaps exercising poor judgment.  I just don’t know how I could feel so well-intentioned on the inside and yet feel like I totally failed him in my actions.

Answer
Hi Jane,

First, I'm so sorry about the loss of your kitty. He was obviously very special to you. I know the guilty feelings you're going through, the "shoulda', woulda', coulda's". It's easy to feel as though we let down a beloved pet when we can't save them. In reality, nothing could be further from the truth. It sounds like this kitty met the sad fate of cancer, something NO ONE can cure. YOU did not fall short here. You provided this cat with love and care from the time you met him, and that is all a cat could ever hope for. Although we would all love to have cats that live to be 27, remember that he didn't have any idea how long he was supposed to live. He didn't know he was dying "young". He just took each day as it came and didn't fear death, as we do.

I don't think you were negligent. You depended on a professional to tell you why your kitty was losing weight. You depended on him to do a thorough job and catch ANY possible reasons why. I understand that he assumed you were dealing with a tooth issue after the first bad tooth was found, but too many things can change in a matter of months, especially in older cats. I feel very strongly a thorough exam should have been performed at each visit. The cancer still may not have been caught on palpation - this is not a hard and fast diagnostic. Two vets can palpate an abdomen one week apart, and one can feel a fairly large mass, and the other will completely miss it. However, I DO feel the vet relied too heavily on his assumption that the cat's weight loss was all to do with his teeth, and very likely missed what was going on elsewhere in the body. I have one animal hospital that operates this way. They address only what I complain about. So after years of watching how different vets work, I have learned to speak up - "Did you check his ears? Did you feel his belly?" I tend to stick with them for situations where I know the problem (say, a cut on the foot), and in cases where I don't already have a good idea what's going on, I head to a vet hospital that I know gives very thorough exams (although they are more expensive).

Truthfully, in your situation, the bottom line is that cancer is quite untreatable in cats. And even if they had caught the tumor early on, I don't think the final outcome would have been very different. I think the tooth problems were likely the secondary issue, and the cancer was likely the underlying cause of the weight loss all along. Cancer is difficult for us to come to terms with because cats hide the signs of it until they are literally days or hours from death in so many cases. We see them losing weight sometimes, but they don't really seem sick until they are very terminally ill. And suddenly, we find out they have untreatable cancer. Most tumors located in the abdominal area are lymphoma, and this has a remission time of about 8 months when treated with a full chemo protocol (though survival time varies greatly, it is not generally considered curable). I treated two cats. The cost was about $3000 for the first few months (each), and neither survived longer than 4 months.

As for the spat you and your boyfriend had, it is true that keeping stress to an absolute minimum around sick cats is strongly recommended. I would urge him not to have any parties or unfamiliar company over if any of the cats are in fragile shape. And as you are aware, cats are very sensitive to human emotions, and arguing around them does cause them distress, so when this can be avoided, it's best to do so. But I don't believe your kitty simply lost his will to live as a result of your argument. Our bodies give out on all of us eventually, and sadly, the time had come when his body could no longer support life.

In the future, if you feel like a cat isn't at 100%, try to get them to a vet to be sure they're okay. We just do the best that we can. Because of the communication barrier between species, we can't know if something's not feeling just right with them. We can't expect ourselves to be psychic and know the instant something is wrong all the time. Just try to be in tune with them, and if you DO recognize something's not right, have them checked out. If what the vet says to you doesn't make sense, ask questions, get a little pushy, or get a second opinion.

Best wishes,
Jessica