How do I know when a cat is at end of life?

May 22, 2022 10:05 AM

My cat developed probable pneumonia this week and is current receiving intensive treatment at a vet hospital (including antibiotics, nebulizer treatments, residing in an oxygen cage). How can I think about whether this is an end-of-life situation vs a temporary bump in the road?

On Friday, Mr. Butters stopped eating and was lethargic with labored/intercostal breathing. I took him to his regular vet where they did chest x-rays and found what was probably pneumonia. They sent me home with antibiotics.

Overnight he was very lethargic, not using his litter box (very unusual for him) and not eating or drinking (also very unusual - he's a hefty boy who enjoys his meals and treats). Saturday I took him to the emergency/after hours vet repeated the x-ray and found increased area of opacity (i.e., worsening from the day before) put him in an oxygen cage, started albuterol nebulizers and antibiotics with a plan to stay overnight. I called this morning and they said he has not been able to wean off oxygen overnight and is still not eating. The plan is for him to likely spend another night at the vet trying to wean off the oxygen cage and start eating.

I'm trying to figure out how much treatment is "reasonable" and when we start to talk about this being an end-of-life situation. He was a formerly hale and healthy cat (if a bit overweight). He had an unusual bout of runny nose and sneezing a couple of weeks ago, but that resolved on its own. His age was reported by the shelter to be 11 when I adopted him 6 years ago, which would make him currently 17. However, vets have repeatedly expressed disbelief at his supposed age, noting that his body and teeth do not look like those of an super senior cat.

I know that humans often require multiple days of oxygen to recover from pneumonia, but I'm not sure what is reasonable for a cat especially given his potentially advanced age. Cost is not an overwhelming factor but its also not a non-factor, and I'd hate to spend thousands and thousands of dollars just for him to suffer for several days alone in an oxygen cage. Somewhat complicating things is that I am going across the country for several days on Tuesday for work. My 19-year-old son will be at home, but managing the potential end-of-life for a family pet seems like a lot to hand him.

I'm pretty strongly inclined to facilitate a peaceful ending rather than attempting heroic measures based on previous experience and since animals cannot consent to treatment and can't understand treatment goals or when an uncomfortable situation will end. I also don't want to prematurely end treatment for a treatable condition.

Have you had a cat have this kind of ailment and treatment? How long did treatment last? How did it end up? How do I approach this discussion with the vet (who is not my regular vet, who I do not know, and have only been able to talk to via phone)? If I start talking about whether this is an end-of-life situation do I look like a heartless monster?

posted by jeoc to Pets & Animals (22 answers total)

Response by poster: I think a big part of what I'm struggling with is that he was a totally healthy butthole knocking stuff off my desk and now seems so shockingly, suddenly critically ill. So if you have experience with a cat taking that kind of turn it would be helpful to hear about it and the outcome.
posted by jeoc at 10:08 AM on May 22, 2022

This is an excellent question for your vet. I asked this exact question to a vet for a dog, and got an answer that helped us make the right decision when the time came. /
posted by Geckwoistmeinauto at 10:27 AM on May 22, 2022 [4 favorites]

Best answer: My 12 year old cat had a very quick downturn in heath, with labored breathing, and he ended up spending 5 days at the emergency vet in an oxygen cage (ended up being diagnosed asthma/chronic bronchitis). It was a tough decision given the cost but I decided I would do what I could as long as there was a possibility for him to recover fully. He had to spend the rest of his life on a low dose of steroids, but had a very good quality of life for the remainder of his life and I felt like it was the right decision.

A year after that though, he had another sudden downturn in health and was diagnosed with a rare cancer in his chest. I still feel like I made the right decision though during his first health crisis.

Cats are very skilled at hiding when they are sick which often looks like a very fast downturn and it can be tough to accept that a cat that seemed perfectly healthy was actually near the end. It should be clearer in a day or two whether your cat is improving or declining, I would give him a day to improve (or not) and make your decision on Monday.

Wishing you and him the best, this is such a hard thing to go through.
posted by matcha action at 10:51 AM on May 22, 2022 [2 favorites]

My dog was 13 with diabetes and congestive heart failure when he ended up in an oxygen cage for pneumonia. It prodded me to ask his attending vet (he was at a hospital) "if this were your dog, what would you do?" We made the choice to let him go.

But for only pneumonia? I'd (upon preview, what matcha action said) give him a day or two before asking that question.

I'm sorry. This is difficult and anyone who has loved a little creature knows you're not a heartless monster.
posted by kimberussell at 10:58 AM on May 22, 2022 [2 favorites]

I had a kitty who came down with a very stubborn & uncomfortable inflammation in her sinus. Kitty was older and the treatment was expensive, uncertain, uncomfortable, and inconvenient, but I just had a sense that she wanted to beat it and that she could beat it. The next time she got sick I didn't have that sense. This is to say that if your instinct is telling you something I think it's ok to listen to it because you know him. Give it as much time as feels right. I know this is still pretty vague but that was my experience. I know this is a very difficult time & I hope he starts feeling better soon.
posted by bleep at 10:59 AM on May 22, 2022 [1 favorite]

Best answer: I’m so sorry you’re dealing with this - I am going through this right now, too. I was prepared to say goodbye to my 9-year-old cat this weekend, as she had oral surgery a week and a half ago and has been declining ever since (has had a consistent fever, was barely eating, now not eating at all, spends all her time hiding under furniture in the basement, have been making almost daily trips to the vet for IV fluids and medication injections because she won’t swallow anything). On Wednesday she started showing scary neurological symptoms, and that was the point where I came to terms with this being the end. On Friday I talked to the vet about comfort care, and we made a timeline for euthanasia. But later that day one of the vets suggested we try a cheap, rare disease treatment before calling it quits, and now we’re in limbo. I’m only OK with the limbo because she’s on fentanyl, so I know she’s getting some pain management.

It was $1200 for the surgery and another $1200 in office visit/treatments, and I keep googling “is my cat dying” because she is so sick and I don’t know what to do. If I were you, I’d try to talk to your normal vet and the hospital vet about timelines and prognosis, and then see what has the best gut feeling.
posted by Maarika at 11:08 AM on May 22, 2022 [2 favorites]

Best answer: awwww what a cutie :(

when my previous kitty took a fairly abrupt decline (with kidney disease) I ask the vet if they could let me know when it was appropriate to consider ending things. she gave me a straight answer and I was able to make the right choice for my kitty. everyone at the vet was so kind and gentle through the whole process.

I hope your baby pulls through, but if its time to say goodbye, know that you are sparing Mr Butters an extended period of suffering.
posted by supermedusa at 11:15 AM on May 22, 2022 [1 favorite]

Best answer: I wouldn't worry about whether your vet thinks your a heartless monster - they are used to interacting with all sorts of pet owners, and it isn't their job to judge your decisions. It is their job to advise you.

I would ask your vet the following questions: "If he hasn't improved in 24hrs, how likely is it that another 24hrs will make a difference? If he doesn't improve after 48hrs, how likely will he improve after that? What are the long-term health implications of this treatment?" If the vet thinks another 24hrs will likely lead to a full recovery, that's one thing - if the chance is only 10%, that's another matter. I've never had a cat with pneumonia, so I have no idea there.

I once had the option to spend roughly $1000 to just get a diagnosis for an elderly cat, and was told that the result of the diagnosis would most likely either be an incurable disease or a costly surgery. It wasn't an easy choice, but I decided it was time to say goodbye - there are so many cats that get euthanized each year because nobody will adopt them - I figured my resources were better spent saving one of those with more of a life ahead of them than my elderly cat who likely didn't have much time left. I know that might come off as a heartless calculation to some, but to me it's less clear cut.
posted by coffeecat at 11:28 AM on May 22, 2022 [7 favorites]

Mr Butters is a beautiful boy. I'm sorry you're going through this. I had a 10-year-old cat who, seemingly overnight (but obviously asymptomatic for a while), developed severe anaemia, to the point where there were so few red blood cells that she couldn't get enough oxygen. A couple of treatments to try to restore her blood count didn't work, you can't transfuse a cat, and so I asked my vet (a friend and neighbour) what he would do if it was Stanley, his cat. He said without hesitation that there was one more treatment they could try but if that didn't work, then it was time to let her go. Trust your vet and ask them to be straight with you.
posted by essexjan at 11:32 AM on May 22, 2022

Agree with everyone saying the vet can help you here. A 17-year-old cat who appears much younger might have a good prognosis, but also maybe not. Asking what the likely trajectory is is a very reasonable question and the vet has seen hundreds of cases just like Mr. Butters. I have an old lady the same age and she is prone to allergies and wheezing. She had a downturn (not pneumonia), took some antibiotics, and was back to her old self. The vet recommended Cerenia as a maintenance drug and it's done wonders reducing inflammation, wheezing, etc. Good luck as you navigate this -- it's hard.
posted by *s at 11:40 AM on May 22, 2022 [2 favorites]

Best answer: Last year our 12 year old cat suddenly went from totally active and normal to serious pneumonia. We took her to the vet for daily fluids, feeding, antibiotics, steroids. It seemed impossible that a cat who had been so healthy all her life could go downhill so quickly, but she didn't respond to treatment. Covid protocols kept us from being at her appointments in person, which made it harder to get a good feel for her condition and communicate properly with the vet. After a few days of treatment she got worse and went into respiratory distress (which was awful and terrifying) and we had to rush her to the emergency vet. In the end, we hoped just to be able to have her stable enough off the oxygen to take her home for euthanasia, but it wasn't possible. They let us in to be with her at the end, but she was sad and scared and if I could do it over we should have made the choice earlier.

I hope very much that things turn out differently for Mr. Butters and you.
posted by LadyOscar at 12:45 PM on May 22, 2022

I agree that it's a good question for your vet. Our current cat arrived at the local no-kill shelter with pneumonia and other (treatable) health problems, and after a slow-but-successful treatment has had years of health with no apparent consequences. There's no guarantee either way, of course, but the vet may have a sense of your cat's likely prognosis.
posted by tchemgrrl at 1:31 PM on May 22, 2022 [1 favorite]

Best answer: So if you have experience with a cat taking that kind of turn it would be helpful to hear about it and the outcome.

I won't get into all the details because it's... frankly sad and I'm still not really "over" it, but I had a cat that went from healthy to very ill, very quickly. The vet (who was a total stranger to us) was honest with us about our options and supportive of all of our decision-making.

The thing I want to share is that no matter what you do, it will probably feel like the wrong thing, at least in the beginning. There are rarely easy decisions here, and I wish you the best in navigating it.
posted by sm1tten at 2:03 PM on May 22, 2022 [6 favorites]

I don't think we're the right people to ask.

The thing is, you fundamentally want medical information. You seem like you would have a pretty clear idea of what to do if you knew your cat's prognosis: You would continue treatment if you knew his condition was treatable and he would recover, but you would end treatment if you knew that he wouldn't recover.

What you're wrestling with is that your cat's prognosis isn't certain. The best person to talk to about that prognosis is the vet, who has the medical expertise and experience to tell you what's likely to happen next. It still probably won't be certain (nothing medical is, especially with an older pet), but they can probably give you a better idea of probabilities.

We can tell you about what happened with our pets, but that doesn't mean that's what will happen with your pet. We literally don't know what your pet's medical situation is beyond what you've told us here, and we don't have the expertise to take what you've told us and give you a prognosis.

A good vet will not judge you for asking; they won't think you're a heartless monster. In fact, a good vet will want you to ask, because it tells them you're ready for a potentially difficult but necessary conversation. They will have had many of these conversations with many other pet owners. So please, ask your vet.
posted by Kutsuwamushi at 6:48 PM on May 22, 2022 [3 favorites]

"Somewhat complicating things is that I am going across the country for several days on Tuesday for work. My 19-year-old son will be at home, but managing the potential end-of-life for a family pet seems like a lot to hand him."

Many vets offer boarding, especially for pets that need to be given medications. I would arrange for your cat to board with your vet (ideal) or another vet (if your vet doesn't board pets) and continue receiving antibiotics, oxygen, and other care as necessary until you return home from your work trip.

That way your cat is receiving skilled care, you aren't rushed to make a decision, and your son isn't saddled with the responsibility of keeping a sick cat alive or the guilt of the cat dying on him while you are away.

Don't euthanize your cat prematurely because of your upcoming work trip. You will torture yourself for the rest of your life wondering if you made a bad decision because of schedule pressures.
posted by Jacqueline at 7:44 PM on May 22, 2022 [2 favorites]

In fact, a good vet will want you to ask, because it tells them you're ready for a potentially difficult but necessary conversation.

There are otherwise good vets who are not great at this conversation, but you only learn that from (sad) experience.

This is not a situation where your cat is at home dealing with a chronic illness and you've exhausted the recommended options and make a day-by-day quality of life assessment to determine when it's time. It's an emergency situation where you've had two days of ongoing treatment that the vet presumably has experience with. So I'd go with coffeecat's line of questioning about probabilities and long-term implications.
posted by holgate at 10:13 PM on May 22, 2022

Best answer: To add to the great things written above, on thing I’ve learned from a vet is that when a cat stops eating, it can be a very serious sign, and it can be very hard to get a cat to start eating again. If your kitty persists in not eating, that is likely to be another sign that the situation is not promising.
posted by StrawberryPie at 10:48 PM on May 22, 2022

Best answer: Mr Butters' near relation is (sitting?) purring/snoring on my office chair as I reply. And who on the weekend managed to vomit in three different places on the stairs

Your adult cat came from a shelter 6 years ago - so for most of his life he was not under your care - which means that his health may be compromised in a myriad of small but enduring ways from that time. You actually don't have a complete basis to assess his underlying health

Mr Butters is not eating and he was formerly plump. Your cat is a cat who likes food and who is taking no joy in this activity now. For me, that is an indication that quality of life is taking a sharp downturn. If there is no interest in food over the next day or so, I would not put him through more stress

In a previous AskMeFi, the comment was, "You regularly regret leaving it until too late; you rarely regret too early."
posted by Barbara Spitzer at 1:19 AM on May 23, 2022

I would again urge you not to make a decision based on what internet commenters think about your cat's prognosis. Please talk to your vet.

We're good for framing difficult decisions, but not good at giving medical advice. I'm seeing a lot of statements that this-or-that symptom means your cat has a poor prognosis, but we really don't know. For example, cats can and do sometimes lose their appetites when they're sick and then get better, just like humans, so while lack of appetite can be a sign of end-of-life decline it isn't always.
posted by Kutsuwamushi at 10:41 AM on May 23, 2022 [3 favorites]

Response by poster: Sad update: he ultimately wasn’t able to get off of oxygen and the vet suggested it may be his time. Hearing peoples’ stories was helpful.

The suggestion to board with the vet was particularly good and that was the plan if he looked like he was going to recover.
posted by jeoc at 6:56 PM on May 23, 2022 [1 favorite]

Aw, I'm sorry. It looks like Mr. Butters had a good life with you.
posted by oneirodynia at 3:01 PM on May 24, 2022 [1 favorite]

I’m so sorry, jeoc.
posted by kimberussell at 4:20 AM on May 27, 2022 [1 favorite]