Thanks to everyone who sends well wishes to Lady Emeraude—I’ve no doubt that’s what helps her feel well. I’m following her progress so that others who may be facing the same situations and decisions can see they are not alone, and perhaps find more information to discuss with their veterinarian in caring for a geriatric cat. At this point in caring for a cat in Emeraude’s condition many minor symptoms show up that may be issues on their own or results of other larger conditions. Because she’s too weak to undergo major testing we are treating symptoms with as much information as we can obtain from blood tests and observations, and just making sure she is as comfortable as possible. While this is always a goal, Emmie is now in palliative care.
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We’re feeling okay, just a little tired. Emeraude recovered fairly well from her collapse in November, but with marked anemia and an enlarged heart she would not be fully well again. All diagnoses were really guesses because further testing would be needed to determine her exact condition, such as an echocardiogram to determine the level of her heart disease, and a bone marrow biopsy to determine whether the anemia and collapse were as a result of one of several forms of leukemia. Because she was not in the condition to undergo tests like these at that time, nor even as she felt slightly better, a test like a bone marrow biopsy would do more harm than good and even an echocardiogram could stress her beyond her comfort level, we can’t get a true diagnosis but I can still provide all the palliative care available to me.
She slowly declined, eating less, being less vocal and less active and having increasing trouble in the litter box. Observation is extremely important at this point, and noting for instance not only how much she eats but how she eats—a little at a time, trouble chewing or swallowing, particular foods that may give her trouble, and even checking her respiration and gum coloring after she has eaten are all details that provide clues to what she’s feeling, but decided how to treat what I was seeing was puzzling for me this time because of the unknown details of Emmie’s heart condition.
Hydration is often an issue with cats at this age, and whether they don’t drink enough to stay hydrated or they drink a lot but don’t metabolize the fluids normally because of a heart or kidney insufficiency, simply keeping them hydrated can go a long way toward general wellness. I had learned this not only through care for my older cats but also monitoring care for my mother in her last years—all the body’s organs, from internal organs to blood to even skin, need enough fluid to be able to do their part in keeping a body functioning, medications have a greater effect and even food is more fully digested and gives greater nutrition.
I’m well-acquainted with providing supportive or therapeutic care by helping them with three important functions: hydration, and intake and output. If I can keep them eating and eliminating comfortably that goes a long way toward their comfort, and proper hydration is often key to both; often it’s all that can be done. I’ve administered many doses of sub-cutaneous fluids after discussing it with my veterinarian, but with the level of Emmie’s heart condition and the fact she’d collapsed just weeks before I was concerned I might stress her to the point of collapse again, or overburden her heart with fluids it couldn’t manage, though she didn’t mind a good bit of water added to her food. Because of the sensitivity of her formerly broken jaw she doesn’t react well and I hesitate to pill her by mouth, and many of the other comfort measures such as a stool softener and Pepcid couldn’t easily be hidden in her food. I felt I needed more information.
My regular veterinarian makes house calls and is always available by phone so I discussed things with her. When Emmie really seemed to be failing two weeks ago, though, and I thought I might even need to have her put to sleep, my regular veterinarian was away. I decided to call the hospice veterinarian who works in our area.
We did a full panel of blood tests which showed Emmie is not hyperthyroid as most of us had guessed she might be, and that her red blood cell count had increased from 16% to 25% so her anemia was improving, but her white blood cell count was still very high and her heart function was still an issue. She had also lost a full pound from her emergency visit in November. We could, again, check for leukemia and explore her heart disease, but it was still not advisable in her condition. She has an enlarged heart, and most likely chronic lymphatic leukemia.
So we are following a course of supportive measures that she is currently enjoying: prescription canned recovery food that is high in carbohydrates and rich in protein and minerals as well as her regular favorite foods, a probiotic to help her digest it, weekly B12 injections, daily dose of Pepcid and stool softener Miralax dissolved in her food along with lots of water.
Her blood tests show that she is immunosuppressed enough that she is at risk of infection with anything that comes along, and we also decided to start her on a small dose of prednisone as a part of treatment for the anemia, so she is also on an antibiotic.
Emmie is adjusting well to this and is feeling better. She adores the prescription food and actually sings for it, even with everything mixed into it—she eats it all up and licks the bowl, which she didn’t even do for her favorite Fancy Feast flavors. She’s fine in the litterbox, and while she’s not too energetic, she’s still pleasant and social and very very affectionate.
I check and note her respiration and heart rate once a day as well though her incessant loud purring makes this a little difficult, but who could complain about that? In all, she’s pretty relaxed and comfortable, and that’s about all we can ask for right now.
Of course, feeling like she’s part of the household is very important. I visit her frequently and usually stay with her for a while after I’ve fed her, but she loves her pets any time I stop in. I leave the door closed while she’s eating and while I have food out for her, but I also let the other cats in while she’s eating now and then, and put the food away so the door can be open to the bathroom where she stays. She no longer wanders over to the studio when we are in there, but she seems to enjoy us being near. The boys are never far away, and it’s not just her food they are interested in!
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