It's Not About the Age. Medical Decision Making for Geriatric Cats

Medical decision making for your cat is often complicated, especially when your cat doesn’t have a definitive diagnosis. We all struggle with what-to-do and how-it-should-best-be-done. Then there’s the added issue of costs. What if a test could give you clear insight into what is sickening your cat but it’s a budget-buster? What if the test doesn’t give you helpful results and you’re left as confused as you were before-and broke on top of it?

What if it’s more challenging than that? What if your cat is elderly? Do you still make the same choices for them or do you give up and put them down?

I would go to the ends of the Earth for my cat Spencer. He recently turned 18, which is 88-years old in human years. At 16, Spencer had a large mass removed off the tip of his pancreas, even though one vet said maybe we should just let him live his remaining days without doing the surgery (assuming it was cancer-but the mass ended up being benign). Our surgeon said she could do it and get Spencer through the procedure and she did just that. It was a long, tough recovery, but Spencer made it and has had good quality of life.

Test results indicated that there were some cells that were “consistent” with neoplasia (cancer), but did that mean he had cancer? I had to decide if I would put him on chemo or try homeopathy instead. I’d only just started to learn about homeopathy and I was so well-entrenched with allopathic medicine I feared not going straight to chemo. I even ordered the medication and had a vet oncologist on Spencer’s case, but this cat is geriatric. Do I do chemo on him knowing the possible side effects?

©2017 Robin AF Olson. Spencer after recovered from surgery to remove a mass in his abdomen.

Then, as I was trying to decide what to do, Dr. Jeff Feinman, my holistic vet, sent me an article from the New Yorker magazine. It was a simply fascinating piece about cancer cells-how we all have those cells in our body, we even have metastatic cells, too, BUT we all do not have the “fertile ground” in us for those cells to run wild. That’s why two people with the same kind of cancer have two different results of that cancer. The article talked about two men with skin cancer. One man resolved the cancer with minimal treatment while the other required a great deal of chemo and eventually passed away.

So even if Spencer HAD cells that were consistent with neoplasia it did not mean he HAD CANCER throughout his body (which our oncologist agreed with). Clinically, Spencer was doing well. The oncologist then told me the chemo was a prophylactic measure.

“So he doesn’t really need chemo, then, right?”

“Right.”

The chemo is still in my refrigerator.

I chose to do homeopathy.

TWO YEARS LATER

I feel as though Spencer, who has chronic kidney disease, has had two bonus years after his difficult recovery from surgery. I never thought we would even get to this day and still enjoy his company. I should not be greedy wanting yet more time with him, but as I’ve learned in homeopathy, focusing on age is not the goal. Focus on how the cat is doing. How is his energy, his behavior, his appetite, his mood? If all of those things are going well, then that’s the focus, not a number. It’s possible he will keep going for some time to come.

©2019 Robin AF Olson. Spencer getting laser therapy.

Because Spencer “red zones” really fast at the vet, the most we can do with him is do an occasional blood test. Exams are out of the question. I’ve been taking him in for laser therapy on his legs and back, which he enjoys, but other than that, we can’t do much.

But something's wrong with Spencer—a lot of things. I’ve been noticing changes over the past year plus that I thought were age-related, but a light finally went off in my head and now I have tough choices to make.

Spencer’s had a number of issues: • Weakness to mild lameness • Turns his head when he eats • Appetite issues • Weight loss he lost a pound in the past year • Dirty ears • Staining on his paws • Unkempt coat • Coughing with a sneeze at the end of the coughing. • Low energy

Then I finally realized it was Spencer’s teeth. I asked Dr. Larry to look at Spencer’s mouth the last time Spencer was having laser done. Dr. Larry couldn’t look at more than one side of Spencer’s mouth before Spencer blew a gasket. It was enough for Dr. Larry to see PUS coming out of Spencer’s upper gums. He had a wicked mouth infection and was in dire need of a dental cleaning and probably tooth extractions.

Then I went back to my mental list of problems Spencer faced. Most of them could be related to his bad teeth. Immediately we put him on antibiotics (normally I am not a fan of them but in this case it was a must).

©2019 Robin AF Olson. Spencer a few days ago, enjoying a catnip banana, a sure sign of feeling better.

13 DAYS LATER

Within a few days Spencer stopped turning his head while he ate. I had already treated his ears with a steroidal liquid that cleaned them out nicely and the paw stains were going away.

Spencer began to eat a bit better and walk a bit better. I added pro-biotics to Spencer’s food many hours before medicating him to help protect his gut.

Once his mouth began to feel a bit better, Spencer began to groom himself again. His energy picked up a little bit. The big shocker was he stopped coughing.

I imagine that the infection in his mouth, effected his sinuses, which caused him to have post-nasal drip, which would make him cough/sneeze. It could also effect his ears. It could effect his kidneys. It could do so many things, but I hadn't considered even looking at Spencer's mouth because of his age. He's 18. I assumed that his changes were AGE RELATED, NOT SOMETHING ELSE. I wrongly assumed that you can't do a dental on a cat that old. He had a dental in 2016 so I thought maybe he was fine.

But it's clear what we have to do is not because of his age. It's being done tomorrow (9/5/19). Spencer HAS to have his mouth fixed or he will die a slow painful death from his horrible teeth. Of course I’m terrified that he will die from the stress of being at the vet, from being sedated, from something else they didn’t know about because they couldn’t do a proper x-ray or exam all these years.

I’ve had a few conversations with Dr. Larry and with Dr. Jeff. We’re going to gas-sedate Spencer, which is a slower sedation, but he can wake up a lot easier-no drunk walk, no hallucinations post-procedure. It won’t effect his kidneys so badly.

Dr. Larry has kindly cleared his schedule so he can focus on Spencer. Super-Deb, my friend and Vet tech, knows Spencer well. She’s worked with Dr. Larry for decades. This is the best team I can have to do this procedure. We have a game plan in place, but I'm scared, too.

Dr. Jeff has been advising me on which remedy to give Spencer before and after his dental procedure. He also agreed that the gas sedation would be the safest.

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Spencer wasn’t doing well a few days ago — after I stopped his antibiotics. I stopped them after nearly two weeks because he was fighting me more and more and he wasn't eating well. I’d given him homeopathy and I thought he was getting worse. He had a bad day yesterday, not eating well, very wobbly in his gait. I thought maybe we should do an ultrasound. Maybe Spencer’s mass grew back? Maybe he is full of cancer? I'm going crazy with "what ifs."

Then last night he started to perk up. This morning he ate more than he has in years. He seems brighter. He is walking better, faster, more steady on his paws. It HAS to be the homeopathy now that the antibiotics have pushed the infection back.

While Spencer still has a nasty mouth, perhaps I’ve shored him up as much as I can so he can handle what’s going to happen tomorrow. I’m trying not to think about getting a call to tell me he didn’t make it. I know I’m going to lose Spencer some day, but I hope that day won’t be any time soon.

Spencer is one of the first cat’s I ever fostered. He’s been with me for 17 years. He’s my shadow, my purry-pal. I can’t imagine my life without him in it. I can't stand the thought of it

But I also don’t want to be so fearful that I don’t help my cat when he needs it most. He will not have a "fun day" tomorrow. He needs a healthy mouth to have a chance at a better future. We have to try.

Whatever happens, I didn't let Spencer's age stop me from treating his issues. I just focus on how he's clinically doing and if my vets feel we can reasonably do the dental safely then that's what we will do. Your cat's age shouldn't stop you from providing vet care, especially because cats are living longer lives than ever.

And I hope Spencer is one of those cats (fingers and toes crossed).

©2019 Robin AF Olson. My sweet boy.