Dear Most Esteemed and Knowledgeable Kitties:
Miss Emma is approximately 18. I adopted her from Feline Rescue in St. Paul, Minnesota, about seven years ago. She had apparently been abandoned. Emma has advancing kidney disease and has started fighting the subcutaneous fluid treatments I need to give her. She's eating, but now only baby food mixed with a little canned KD [prescription food for cats with kidney disease]. She only eats about 1-2 tablespoons at a time but will eat frequently. It's difficult to know when her quality of life no longer exists. Just because she's eating a little doesn't mean she's "happy." What would you suggest? Thanks!

~Judy

Siouxsie: Judy, this is one of the hardest decisions a cat caretaker can make. Mama knows this all too well, since she has had to do this before, too.

Thomas: Sometimes it can be easy to see when it's time to say good-bye. When it's clear that a cat is suffering -- in obvious pain, unable to eat, feeling miserable -- you know in your heart that the kindest thing to do is to let her go.

Dahlia: But in your case, the situation is not as clear. Miss Emma is fighting the subcutaneous fluid treatments that she needs in order to stay reasonably healthy, which would indicate that she's tired of fighting her disease. But she's still eating, so that indicates that on some level she wants to keep living.

Siouxsie: In order to get more clarity, you'll need to look beyond the obvious.

Thomas: You didn't talk about Miss Emma's activity level or her behavior in your letter. Sometimes these less obvious signs can tell you more about how she's feeling.

Dahlia: Is Miss Emma still able to enjoy things she did when she was younger and healthier? Does she still play with her toys? Does she enjoy being petted and held, or does that cause her pain? Does she enjoy napping in sun puddles and being where she can enjoy human company, or does she spend a lot of time hiding?

Siouxsie: If her general quality of life seems to be good, and the main problem is that Miss Emma is fighting the fluid therapy, there are things that can be done to make the experience more pleasant for her and easier for you.

Thomas: If you warm the fluids to body temperature (98 to 100 degrees), the treatment will be much more comfortable. Also, you may want to slow the rate of administration of those fluids.

Dahlia: Amy D. Shojai, in her book Complete Care for Your Aging Cat (which is a must-read for anyone who lives with a senior cat), tells a story of a woman whose cat had kidney failure and needed subcutaneous fluids. The cat hated the daily needling and fought the treatment like crazy. The woman was heartbroken because the treatment her cat needed to stay healthy was so traumatic. But her vet was able to install a subcutaneous catheter, so that instead of having to poke the cat every day to administer the fluids, all the woman had to do was hook up the fluids to the catheter.

Siouxsie: And once the cat had the catheter installed and the fluids were warmed to body temperature, the treatments were so much easier! The cat didn't fight the treatment, and she immediately started getting her appetite and energy back.

Thomas: So, Judy, maybe you can ask your vet about a subcutaneous catheter. If your vet thinks Miss Emma would benefit from this and can still maintain a good quality of life as long as she keeps getting the treatments, you could give her a whole new lease on life.

Dahlia: You can find some good online resources for information about chronic renal failure (CRF) in cats. The Feline CRF website is one. The About.com Cats Forum has articles and resources about many specific cat-related issues, and there are a number of online support groups for people who care for cats with kidney disease.

Siouxsie: So, Judy, if the issue is just that Miss Emma doesn't like the sub-q fluids, there may be ways to make the treatment easier.

Thomas: But realistically, you know you have a cat with a disease that's not going to get better. At some point, the bad days are going to outnumber the good days. And when that time comes, the kindest, most loving and courageous thing you can do is to say good-bye to Miss Emma and help her life to end with minimal suffering.

Dahlia: Nobody likes euthanizing cats. It's hard on veterinarians, too. Your vet has come to love Miss Emma on some level; it's only natural. People don't become vets because they're indifferent to animals, after all!

Siouxsie: Your vet can give you a realistic assessment of where Miss Emma is in the course of her disease. He or she has probably told you what you can expect in terms of symptoms and behavior as Miss Emma's disease progresses. But you're the one who knows her best, and ultimately you're the one who will have to make the Big Decision.

Thomas: We'd recommend that you take some time to talk with your vet, if you haven't already. It's not unusual for caretakers of chronically ill pets to be confused about when it's time to say good-bye, and part of the work a vet does is to help caretakers understand the disease and its effect on the cat.

Dahlia: Your vet probably won't tell you whether or not you should have Miss Emma euthanized, but as a professional and a person who sees your cat less frequently than you do, he or she may pick up on indications of how the disease has progressed that you may not see as clearly. He or she may have ideas that could help Miss Emma feel better, too.

Siouxsie: You might also ask your vet about the euthanasia procedure. Mama says she found it helpful to know what's involved so that it wouldn't come as a shock to watch it happen.

Thomas: If you would prefer to have Miss Emma spend her final hours at home rather than enduring that last trip to the clinic, ask your veterinarian if he or she will do a house call for euthanasia. Some vets will.

Dahlia: Our vet said she would do a house call for our final vet visit, should any of us need that. Mama hopes we all live a long, long time and just go to sleep one day and never wake up. But she knows that may not happen, and she knows she'd prefer us to spend our last moments together in a familiar, comfortable place.

Siouxsie: If you want to have Miss Emma cremated or buried after her death, talk to your vet about that, too. Your vet can assist you with cremation arrangements if you want to do that.

Thomas: It's probably better to begin making post-mortem arrangements in advance. You know Miss Emma will die, but you don't know when. In the throes of immediate grief, it's very difficult to cope with these kind of decisions.

Dahlia: Mama says that the hardest part of saying hello to an animal friend is knowing that someday you'll have to say good-bye. But it's all the love and joy between hello and good-bye that make the pain of that heartbreaking grief worthwhile.

Siouxsie: You don't need to worry that Miss Emma is afraid of death or will be upset at you for helping to end her suffering. Cats don't fear death. We live in the moment, and generally in every moment we find peace and happiness.

Thomas: But when each moment of our life is a moment of pain and sickness, we can't be happy, we can't do the things we love, and all we want is for the suffering to stop. When the time comes that she's suffering more than she's at peace, she will let you know. The most poignant indication is The Look. Believe me, you'll know it when you see it.

Dahlia: And know that when you accept and abide by her wishes, Miss Emma will thank you from wherever cats' souls go for releasing her from her suffering. She might even send you another kitty friend when the time is right.

Siouxsie: We know that this is a hard situation, Judy, and we hope we've been able to give you some insight that will help you make this difficult decision.

Thomas: We can't tell you what to do. But we know that if you talk to your vet about treatment options and the progress of her disease, and if you listen to Miss Emma with an open heart, you'll know.

Dahlia: Thank you for rescuing Miss Emma and for giving her a wonderful, happy and safe life with you. It's especially wonderful that you rescued her as a senior cat. Not many senior cats find homes, but Miss Emma is living proof that you can enjoy years of love even if you adopt an older cat.

Got a question? Need some advice? E-mail us at advice@paws-and-effect.com. None of the material in this column is meant to be a substitute for regular veterinary care.