Animals In Print
The On-Line Newsletter
From 26 November 2003 Issue
Cats/Chronic Renal Failure
Emotional Roller Coaster
The progression of feline CRF has been compared to an emotional roller coaster ride by those who have gone through it, and, indeed it is. As time goes on, the sloping hills become steeper and closer together. There are up days and down days.
Taking care of a CRF cat can be emotionally stressful, extremely frustrating and time consuming for all involved. Your cupboards may be full of food your cat won't eat. You may wonder how much you are hurting the cat by giving sub-Q fluids. When the time comes for medication and then even more medication, you may agonize over how much more the cat can possibly bear. Our experience with Avatar has taught us that cats can, indeed, put up with quite a bit. After two and a half years of sub-Q fluids and two years of three pills twice a day and the loss of more than a third of his body weight, he remained the lovable, affectionate cat he had always been.
In spite of your best efforts, your cat may become withdrawn and depressed. The first few times this happened to Avatar, we tried to steel ourselves for the worst. Each time, though, he bounced back (at least part way) and stayed at the new 'plateau' for weeks or even months. Each crisis plunged us into gloom. Each minor recovery elated us. Watching Avatar groom himself for a few minutes after recovering from one of his bad spells brightened our whole week. At first we considered each additional month as a gift, then each week and finally each day. Our efforts were focused on quality of time rather than quantity.
The effects of caring for a CRF cat will eventually hit and you may feel exhausted and, occasionally, even angry at the cat. These are normal feelings. A caregiver's life is not easy. Be sure to take some time for yourself.
Friends and relatives may insinuate that you are quite mad to have chosen such a course of action. Only a true cat person will understand completely. The loss of respect from those who are judgmental is a small thing. The love you receive from your cat is unconditional and will more than compensate for any small-minded opinions from others.
The financial impact can be substantial if the cat is able to maintain a reasonable quality of life for a long period of time. This is particularly true if you have sub-Q injections done at the veterinarian's office (as we did) rather than doing them yourself. Medication can also be expensive. If you are financially able to afford the expense, then it is well worth continuing on. We put off buying a new car for more than a year. If you examine the situation, you come to the realization that your money is buying life. What else could be so precious?
Loss of Mobility-Curtailment of Activities
Caring for a CRF cat can mean no extended periods of time away from home at all unless arrangements are made with a competent person to care for your cat while you're gone. When the condition is advanced, the cat will require some sort of special attention almost every day. This is not meant to imply that caring for a CRF cat is a constant vigil, but regular sub-Q fluids or regular medication regimens definitely limit your freedom of action. Since CRF cats urinate frequently and in greater volume, the litter box must be changed more often. If you must go away, you will have to make arrangements for someone to administer the sub-Q fluids and/or medications in your absence. This is not a casual cat-sitting situation. Check with the technicians at your veterinarian's office. Perhaps one of them would like to earn some extra money on the side and be willing to come to your home daily, if necessary, to care for your cat while you're away.
The Burden of Making the Final Decision
Eventually, either you or your cat will have to decide that the time has come to put an end to your efforts to prolong the cat's life. Since most cats in CRF rarely show signs of agony, or even severe discomfort until the very end, trying to judge the way the cat feels will become a constant preoccupation. You can expect to project your own anxiety onto the cat and try to read the cat's actions and expressions through the filter of your own distress. Most people who have made that final decision say that the cat let them know when the time had come. They are unable to explain exactly how this worked. In any case, the close relationship between a CRF cat and his caregiver does lead to a level of communication that is more profound than the usual cat-human interaction. As a caregiver, you will become attuned to tiny variations in the cat's attitude and health, so it is not unreasonable to assume that you will know when further efforts will be more deleterious than helpful.
Although you may anticipate an enormous amount of guilt over making the final decision, you should keep in mind that some people have, in retrospect, experienced guilt at having prolonged an uncomfortable existence for too long. If your efforts on your cat's behalf are based on love, it's unlikely that you will make a serious error in judgment when the final decision must be made. There is no quantifiable measurement of the optimum time to end a life. It will be tough enough just to make the decision without agonizing over it after the fact.
With Avatar, we tried to set markers to take the burden of making the final decision away from us. For example, we told ourselves that when his weight dwindled to a certain point or when he became too weak to jump onto his favorite perch, the decision would be made for us. In the end, though, the burden fell entirely on us. After closely watching the progression of his CRF for so long, we knew that Avatar would not be able to weather another crisis. The choice became one of waiting until he was suffering or acting to prevent that suffering. We opted for the latter.
Talk with your veterinarian in advance about euthanasia so that you are fully informed and can make decisions early. It is a difficult choice, but one that must be made when your cat is in end-stage CRF. When the time actually comes, you will be emotionally overwhelmed and that's not a good time to try to make rational decisions. Your veterinarian will explain what options are available. You may or may not want to be present during the procedure. If you do, some veterinarians will consent to come to your home. Ask your veterinarian about giving a tranquilizer to the cat prior to the intravenous injection to reduce stress.
Funeral rituals are for the benefit of the living. This holds true for the loss of any loved one. Doing right by the deceased is a way of getting your own life in order and dealing with the loss. You will need to decide on either cremation or burial. In the first case, you must also decide if you want a private cremation (your cat only) or a communal cremation (several pets) and make your wishes known to your veterinarian. Private cremation is slightly more expensive but ensures that you will have your own cat's cremains returned to you, if you so desire. If you decide to have your cat buried, know in advance where pet cemeteries are located in your area and gather information on memorial stones and pet coffins. As with communal cremation, a communal burial may also be a suitable alternative. Cremains may also be buried. You also may decide to have a favorite toy or blanket buried or cremated with your cat.
The loss of a beloved cat can be devastating and the deep pain and grief may last a long time. No one can take the hurt away for you. But celebrating your cat's life may help. Remember your cat with a memorial garden. A photo collage can be comforting. Write down memories of the good times you had with your cat. Have a portrait done of your cat from a favorite photograph. Make a scrapbook full of memories and pictures of your cat. If your cat has been buried in a pet cemetery, visit occasionally.
A number of pet-loss hotlines are available for counseling and support. Click here to find links to pet loss pages and Rainbow Bridge. Seek out friends who have gone through the same thing and can understand and sympathize. Although no cat can ever replace yours, eventually you may want to have another join your home and this is probably the best therapy of all.
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