Calling Patiodog and others of expertise! Death and the Geriatric Pussycat

Ah.

I understand now.

You are going to have to find a way to have that conversation with your vet, Deb.

I can email.

The answers are funny though...because her written English is way worse than her spoken! She's French.



This is their website:

http://www.glenosmondvet.com.au/


If you look through a bit you'll see the black clinic cat.

He's a wonder!!! I never even knew they had one because he was a highly traumatised kitten they took in (they try to re-home dumped kittens) who was apparently very timid for the first two years,

Now he has burst into amazing life!!! He greets you at the door.....escorts you to the counter, and smooches when you get there. He is always delighted to greet Miranda, and she to see him.

He bounces around as though he is on a pogo stick, and is bursting with character!

I really think it would be best to talk to her, if you possibly can, Deb.

So you have a proper 2-way dialogue about your concerns.

Most vets would be very obliging about doing that, particularly in circumstances like Miranda's.

But anyway, Deb, how is your darling Miranda going?

What is she up to?

Is she her feisty self? Is he still telling you what to do, what her particular requirements are?

Do you have any recent photographs? I'd like to see them if you'd like to share.

Please give her a good under the chin scritch from me.

She's slow but happy.

I had a funny incident the other day.

I made the decision some time back not to pass up on any opportunity to make her happy...so I tend to greet her with great enthusiasm when she turns up.

The other day I was on the sofa talking to a car yard on my mobile. During the conversation, Miranda hopped up for a smooch. Without thinking, I started talking to her...you know the usual "Hello my darling....how are YOU??!!"

The poor car guy was quite thrown until I explained the scenario...then started talking about how awful he felt when his family had to put down their 12 year old dog!

Well who else could she possibly think you were talking to, Deb?

She knows she is number 1 in the scheme of things!

There should be hospice for kitties. Miranda's lucky to have you as a mom and advocate. I agree that testing at this age serves no purpose. If the tests find something, the treatment's likely to be worse than the disease. I could see if she had an infection that could be easily treated, but that doesn't seem to be the case here.

The info I posted from the vetinfo site explains why the blood tests would be needed.

In Miranda's case, a lot depends on how far along her kidney disease/kidney failure has progressed.

Butterfly, thanks for your research, but as far as I can see I already know, and have known for years, all that your sites have to say.

In my experience it is damned obvious when the cat's quality of life begins to go down, and all that can be done for Miranda is being done.

I have no intention of allowing her to suffer death from kidney disease. She will be euthanased well before that.

ah, poor Bunny. Hard decisions to have to make.

I think you're absolutely doing the right thing - nothing unnecessary - comfort a priority.

You're a good BunnyMummy to Miranda.

(Bunny)

This is the part I was referring to that explains why the need for monitoring via blood tests:



The medications and IVs help control the build up of the toxins and help prolong her good quality of life.

She is HAVING medication and IVs.

I am not asking about whether she should have treatment, I am asking if frequent testing could actually make a meaningful DIFFERENCE to the meds she is already having. So far nothing has changed for 2 years despite testing, aside from more frequent IVs which I initiated quite independently of any testing because I could see she needed them.


Butterfly, I have nursed about 11 cats through this process and I am well aware of the effects of kidney disease.

You know what's hard?

There are actually quite effective treatments which prolong the whole thing!!!

Once upon a time by the time you knew Puss had kidney disease it was pretty much the end. Now they find it earlier and treat it and the whole "when?" thing goes on a lot longer!!! And you know they are dying for longer! I mean, you know an elderly animal has a shelf life anyway....but there's something a bit different about this.

I'm good at "when"....I've been solely responsible for lord knows how many animals since I was about 6....and have made the call numerous times.

I'll weep and wail and be very distressed, but it's all just part of the deal.

I understand that. You were asking if the frequent blood tests were needed. What I'm trying to say is that the monitoring via blood tests probably lets them increase/decrease the medication dose as needed to control the toxin build up...very similar to the frequent montioring of blood coagulation needed for tweaking coumaden levels in humans.

^Yes...but they HAVEN'T altered dose despite deterioration.

From another point of view you could be called compassionate.

Ruthful Roger

Potential benefits I can envision from regular testing:
1) As mentioned above, you can monitor values to predict when the kidneys are getting worse and euthanize before Miranda starts to show you that she's feeling worse.
2) You can monitor her for progressive anemia. Cats in renal failure often stop producing enough erythropoietin (EPO) to maintain their red blood cell cells, and become anemic.
3) You can monitor her phosphorus levels, which can rise with kidney disease and make her feel quite sick.

So what to do with this information?
1) I suspect that you're attentive enough to Miranda to know when her overall condition is getting worse and probably don't need the blood work to tell you this. Plus, daily fluctuations may make testing on a given day give an artificially dire or rosy picture.
2) The effects of chronic anemia can be very difficult for an owner to recognize, because onset is so slow and because the body is very good at adapting to anemia that develops over time. Still, anemia can cause weakness, fatigue, malaise, and hypertension, and may be correctable with administration of EPO.
3) High levels of phosphorus really do cause a great deal of suffering, and aluminum hydroxide can be given to bind circulating phosphorus and make the patient feel better. If phosphorus levels are getting high, though, you're probably going to recognize that Miranda's feeling worse and you can have her worked up at that time to see what's going on and whether it can be fixed or not.

So, long story short, in your particular situation the main benefit I see from regular testing is to recognize developing anemia -- which is only useful if you plan to treat it. That said, if you're going to track her red blood cells, you might as well also be taking a look at other relevant stuff -- creatinine, BUN, phosphorus, electrolytes, albumin -- that can be got from the same sample.



All that comes with the disclaimer that I don't actually treat chronic kidney disease with anything other than the permanent solution in my current line of work...

I love you.

Thank you. She IS such a naturally happy and stoic little thing that she could feel quite unwell without my knowing, I guess. That would be awful. Mind you, she is tucking into her food with glee still. I also go by the tail barometer.....

Really good: curved over her back like a little archer's bow when she talks to me. Haven't had that for a bit.

Good: Up at 90 degrees and tip curved over back...that's where we are.

Ok: Straight up.


Not good: Anything less than ninety degrees.


I also go by the chatter scale...the more chatter I get the better.

And the : How much stroking and smooching she wants scale,

Plus smiles...how many cat smiles (slow blinking of both eyes) I get when I talk to her.

How the hell are YOU????? Big Changes going ok?????

Thanks Butterflynet...

It really does sound like you're pretty attuned to what's going on with Miranda. I'd probably check the bloods if her appetite started to slip, otherwise leave her be, myself.

Big change is stalled, of course. I was finally informed the other day that they should be able to start looking for new vet by the end of next week. 6 weeks after I gave them 4 weeks' notice.

I mean, the steady income is nice, but everything else about the situation is fucked. But it is what it is. For whatever reason, my super left it in the mullet's court to get things done (they're trying to negotiate a contract with a university program to share salary as a part of a cooperative effort), and so of course it's being done slowly and ineptly. The super has offered to fill an LTE position for someone to come in and help with the workload; we'll see what happens with that. Most folks looking for relief work at the rate we'll be offering really aren't up to the surgical volume, and it usually takes a while to get a feel for how to manage cats and dogs as a herd.

Glad to hear that Miranda is still plugging along. Sounds like she's having quite the run. I hope you're doing well yourself...