15 July 2014

Cats and Medicine: When is it not worth it?

I got into a bit of an argument with someone recently over giving cats medicine.  This owner was doing everything possible to help her cat and was following all the vet recommendations with the result that the cat was on 8 different medications daily plus fluids.  I commented that sometimes we need to focus on the quality of life and not just the quantity.  I further explained that for some cats, no medication is best even if that is not the 'right' medical decision.

This was then translated by someone else to mean I didn't love my cats nor did I see them as part of my family.

And that struck me as wrong... Somehow I managed to bite my tongue, but just barely...  From my perspective, there are several scenarios and each one must be treated differently.

  1. Willing cat with fixable problem.
  2. Willing cat with stable problem.
  3. Willing cat with terminal problem.
  4. Unwilling cat with fixable problem.
  5. Unwilling cat with stable problem.
  6. Unwilling cat with terminal problem.
Bodhi peeking out of a crinkle bag
By willing cat, I mean a cat that does not fight the pilling, syringing, etc.  The cat may not enjoy it, but he doesn't put up much resistance.  For these cats in group 1 or 2, yes, medicating them makes sense. They either get better or they stay the same.  For example, Bodhi got an URI and he got antibiotics, which, since he's a kitten, he thought the pink medicine was okay.  With Anya, she needs occasional eye drops for her herpes and in general she's fine with them.  The medicating of these two cats did not or does not upset them or otherwise bother them.  A willing cat with a terminal problem I think comes down to the owner's willingness, the amount of discomfort for the cat, and honestly, the attitude of the cat -- if all parties are willing, then fine.  My dear Maggie was like this -- she had cancer which had metastasized and was a very compliant patient who wasn't ready to die.  Some cats will endure receiving a large number of pills and liquids without any problem.

By unwilling cat, I include those cats that fight the medication process. (I'm not talking feral cats -- that's a whole other set of problems.) For an unwilling cat with a fixable problem, most of the time it does make sense to treat the cat.  There will be a period of stress with giving the medication for a few days to a couple of weeks, but then the cat is fine and back to health.  For example, Wendy had a scratch on her eye.  She is nearly impossible to pill or put eye ointment on, but for 5-7 days, she got it because I knew in the bigger picture, she would get better.

Now here is where I start getting in trouble.  I personally don't think it's worth it for the cat in the big picture to force medication on him if he is dying and there is no hope.  To me, that is creating not only extra stress in his life, but creating a living hell for his last few days or weeks.  Yes, do small things to keep the cat comfortable, but that is it.  If the cat is so uncomfortable without medication, then perhaps euthanizing the cat is the best choice.  My angel Bertie hated the medications, had not hope of recovering, and so, as hard it was, I let him go.

The big question is the unwilling cat with a stable problem.  Again, I usually get in trouble for my ideas about this.  I would work on helping the cat adjust to the process, give it a sufficient amount of time, and if the cat adjusted great, and if not... well, I guess I would try to decide if my interventions are helping or hurting.  Clancy has CRF among other things and when it comes to pilling, injection, or doing much with him, it usually ends with me bleeding.  But over months, I have gotten him to take a herbal pill by using pill pockets.  Giving him sub-Q fluids is still exciting, but we are getting it done although maybe not as frequently as we should.

If I'm not in trouble enough... I also include in 'unwilling cats' those cats that may not fight the medicating, but which you can see are upset and literally depressed by the whole experience.  Robbie is probably soon to be in this category.  He has the pre-cursors to intestinal lymphoma.  There is a well-tested treatment that might buy him more time.  He would need a biopsy (not just a needle biopsy either).  He would need to go to a vet 1-2 times a week.  He would need blood tests every 3-4 weeks.  He would...  The list goes on.  And I can tell you, his spirit would die -- he might live longer, but he would die inside.  He is terrified of cat trips and vet offices.  He gets depressed after each trip to a vet.  So, dragging him to a vet weekly would be nothing short of torture in my book.  I love him and would like him around for longer, but I can't do this to him.

There's two basic points I'm trying to make in all this.
  • Just because we can do something medically for a cat may not mean it is actually right to do it for the cat. 
  • Perhaps by not doing something to the cat, the owner is actually loving the cat more by respecting the cat.

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