“She’s very old, and she just doesn’t seem to be going so well…”
I could see that. She was simply skin and bones, and her whole body had locked up with arthritis- she could hardly move her head, as she watched me with calm and knowing, wise old eyes. Her mum unfolded the story of her life for me as I sat amongst piles of books, sipping a cup of peppermint tea, quietly listening.
“She will be 17 in a month or so, and she still seems engaged and happy, though I know she must be in pain, and the smell from her mouth is nearly enough to knock you out. She’s still eating though. She is drinking a lot more water than she used to, she seems to be always at the water bowl these days.” The old cat’s mum looked at me, paused for a second, collected herself. “We just don’t know what to do – is it cruel to keep her going? She’s been with for so long, since we rescued her as a little scrap of a kitten.”
“Let me have a look at her, and then we can talk about all of that,” I reassured her.
I picked her up, light as a feather. Bones, bones, bones, sticking out everywhere, not an ounce of fat on her body, coat all dull and stark, matted and unkempt from her shoulders back (this was a far as she could reach to groom, due to her arthritis). I gently palpated her tummy, and found her kidneys – as I expected, they were much smaller than they should have been, and hard and knobbly. Then I took a look at her mouth. A cesspit of tartar and gingivitis greeted me; the stench nearly made my eyes water. All her teeth were rotten, a huge build up of calculus, with a nasty suppurating infection oozing all around the teeth.
“She has fairly advanced kidney failure, severe arthritis, and her teeth…. Well, her mouth is simply awful -”
“I know her teeth are terrible, but the other vet we went to said she was too old to have an anaesthetic,” she broke in, obviously worried.
“Yes- there is a risk there, and I have seen some old cats in kidney failure get suddenly worse after having a dental, because the anesthetic does drop their blood pressure, and this can cause the kidneys to finally stop working, if they are close to the edge. However, with an old lady like this one, who must be in so much pain with her teeth, not to mention the strain that this chronic infection would be causing her, I really think that it’s best to accept the risk and deal with the teeth.”
Her mum took a deep breath, and looked at me.
“So – I’d like to refer you to a friend of mine. I can’t do this sort of work on a home visit, you need a hospital. She will need to have IV fluids to support her through the op, and then we’ll just have to see how she goes. There’s a chance it could be the end of her, but her quality of life is so awful with a mouth like this that I think you simply have to accept the risk.”
“Ok then, I’ll do it, and hope,” she told me, bravely.
I filled out a referral letter, and rang the hospital. Before I left, it was all set in train. I came back to see her again a week later.
“She was really flat for two days after the op, but she’s back on her feet, and eating. The other vet had to take nearly all her teeth out, and they were so bound into her jaw, the only way was to drill them out. She came home with some pain relief, and she seems much happier on that. Could she keep having some?”
“Well – cats are hard when it comes to pain relief. They metabolise drugs differently than we do, or dogs. And the only longer term pain relief I can offer you for her (the same one she’s been on post op) can be hard on her kidneys. So we are a bit between a rock and a hard place,” I said.
Her mum’s face fell. “Oh dear… I just want her to be comfortable, you know. I know she doesn’t have too much longer to go, and I hate the thought of her suffering at all.”
“I totally understand. And since she has such severe arthritis, and is obviously happier with the pain relief, then we could treat this as a palliative care option. It’s certainly fair enough to keep her on the pain relief long term, and just see how she goes. Then, if her kidneys give out, we can gently help her go.”
I warned her that she might only last a few weeks, or months. That old cat went along for another 6 months before her kidneys finally gave up the ghost, in spite of her treatment flying in the face of best practice. But that’s what palliative care is about, for me. There comes a point when quality of life outweighs risks of adverse side effects. When I went back to put her to sleep, she was weak, hardly able to get up and move about, but her eyes were still bright with intelligence and wisdom, and she purred away like a rattly old car as I gave her the sedative. For her, the risk of the surgery and the pain relief paid the dividend of another 6 months with a hugely better quality of life. Such a gallant old cat!