What Can I Do for a Cat with Several Major Medical Problems?


Hi there. My husband and I are in a sudden pickle. My cat, Homie, is 17 years old. He had his annual a month ago and had low RBCs. We brought him back in two weeks later to recheck and it was normal. But the following week he became lethargic and wasn’t really eating or drinking. He has gum disease and has an appointment in a couple of weeks.

I thought he had a toothache, so I brought him in. My vet thought she found a mass on an Xray, so we had to bring him to a hospital. It ended up being an enlarged bladder. He has been living with chronic renal failure, treated with aluminum for the phosphorus, which has been keeping him within normal range. They did a physical and what they called a “quick” chest ultrasound. No echo, no ECG, no Xrays yet. But they found he has A Fib and suspected hypertrophic cardiomyopathy L sided from the quick ultrasound, and congestive heart failure. He had pleural effusion and they drained 50ml via thoracentesis. The fluid tested positive for suspected lymphoma.

So I went from thinking he has a toothache to having to decide what to do about his life. I am just crushed. They recommend an echo, ECG, chest Xrays, and cardio consult with bloodwork to determine the extent of the heart disease and an abdominal ultrasound to stage the cancer. Then they think they’ll give him one dose of L-spar palliatively and prednisone if his heart can handle it. Probably also some heart meds depending on how bad the disease is.

He’s at home now, lying on the floor. His back legs are wobbly and sometimes he falls over but he can still walk, though he is mostly lying down. He seems awake, which makes me nervous that he’s uncomfortable. He holds his urine until we bring him to the litter box. He only eats a couple of licks/bites and a little water.

I’m praying he’s not in pain while we figure out what the heck to do. My husband and I are on different sides. I want to treat; he thinks it’s cruel. I don’t want to be selfish. What would you recommend? The cat is almost deaf but not in any pain in his ears. He still needs to have a couple of teeth out … HELP!! When I read all of this I can hardly believe it.

I am very sorry to read your sad story. From what you have written, it is clear that Homie has several major medical problems. The ones you mention include kidney failure (also known as CRF), heart disease (a-fib, hypertrophic cardiomyopathy, CHF), cancer (lymphoma causing pleural effusion), anemia (low RBCs), and dental disease.

In a situation like this it unfortunately is necessary to prioritize the issues. Although I generally am a strong proponent of dental care, Homie is not a good anesthetic candidate and extractions simply aren’t feasible. The anemia is likely secondary to the other problems. If it becomes a clinical problem, it may be addressable with injections of EPO. I doubt that will be necessary.

The three remaining problems are, unfortunately, a difficult combination. Fluid therapy is the most effective treatment for kidney failure, but it can lead to complications of heart disease. Medications that treat heart disease can exacerbate kidney failure. And many of the medications used to treat lymphoma (most notably prednisolone — which is the backbone of every lymphoma chemotherapy protocol) have the potential to exacerbate both heart disease and kidney failure.

If you choose to run the recommended tests, I will not think you’re unreasonable. However, if I live long enough to find myself in Homie’s situation, I hope to avoid being chewed up by the medical-industrial complex. As hard as it is to say, I think Homie is a very good candidate for hospice care. Unfortunately, he is fighting a losing battle on many fronts. It will not be possible to cure his many problems, so the kindest option may be not putting him through further testing or treatments.

Many vets now incorporate hospice (which includes not only palliative medical care for pets, but also support for grieving family members) into their practices. I recommend that you consider contacting one of them.

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