Siamese with severe cardiac problems

Question
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Followup To
Question -
My beloved 17 year old lilac point siamese cat Shadow was diagnosed with severe myocardial failure.  I originally took him into the vet a week ago because he was having so much pain in his mouth from his teeth.  The vet noticed that he was breathing hard and said we should take xrays it showed a build up of fluid.  He referred me to a specialist but I was unable to get in for a week and in the meantime he had me giving him furosemide to reduce the fluid build up and fluid injections (150cc under the skin) to stop him from getting dehydrated.  At our appt with the specialist yesterday they drained the fluid off his chest and gave me medications to stop blood clots and sent us home to see how he would do.  They told me to stop the iv fluids and to cut the furosemide in 1/2.  He has been going down hill every since.  His mouth hurts him so he cannot eat or even drink water.  I am hand feeding him with a syringe and I am getting food into him but he is not happy about it at all.  He keeps sneezing and is very weak.  The Vet told me that he wasn't in any pain (except his mouth) but I don't know what to do.  I would just like to be able to keep him comfortable and feeling the love we have for him until the end.  

Is there anything you can suggest that I might do to help him.  I love him so much.  This is so hard.

Thank you for your help
Answer -
Hi Sharon.  I am so sorry for your situation.  I can't bear the thought of this happening with my cats.  But it did happen to one.  He had Congestive Heart Failure and took several medications a day, including diuretics and anticoagulants, like yours.  After 3 days in the ICU, he came home.  But he had shown marked improvement and was eating again on his own.  He became strong again, but died suddenly of heart failure just three months later.

At any rate, anorexia is not a good sign.  If it's truly due to dental problems, then a pain reliever may help.  Ultimately, it would be best to have the problematic teeth pulled.  A cat with Congestive Heart Failure is at a higher risk than healthy cats during surgery, although there are several types of anesthesia that are good for use with cats with heart problems.  It's a scary thing to put a sick cat through surgery.  However, you really have to weigh the risks and the benefits.  If your kitty is refusing to eat, he is not going to survive.  Even if you manage to force feed him, his quality of life will be awful, and chronic pain itself often results in an quick death.  If Shadow was my kitty, and the vet truly felt his teeth were the problem, I can say for sure I would opt to have oral surgery performed on him.  It would be best to have the cardiologist do this.

If he is having gum or other soft tissue problems in addition to tooth problems, an anti-inflammatory medication could help.  Dexamethasone and Prednisone are two corticosteroids that many vets prescribe for the treatment of mouth inflammation.  Again, because of the CHF, treatment with steroids may be riskier than with healthy cats.  You should ask the cariologist if he or she feels the a corticosteroid would be worth the risk if it will increase his quality of life.

I wish I could give you some great news.  It's so hard to see beloved pets go through this.  I know you just want to find anything that can help him.  The best I can say is, make your decisions based on his quality of life.  While it is always hard for us to let go, there comes a time when it becomes unfair for the kitty to have to face the discomfort (even if there is no pain, difficulty breathing and severe weakness are just as tough) .  If he still refuses to eat after you've tried everything the vets recommend, he's telling you he doesn't want to try anymore, and the most loving decision you can make is to have him put to sleep peacefully.

Wishing you strength and peace with the decisions you make.

Jessica

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Thank you for your kind response - My Shadow is still with me but is fading.  The cardiologist told me to stop the lasix because he was dehydrating and go ahead and give him fluids.  I did and he has started drinking on his own but still not eating.  I have been able to get about a can of the a/d from the vet down him a day but he fights me.  Yesterday he wondered outside and layed in the sun for a while then came back inside and cuddled up with my rag doll cat that has been his best friend for the past 4 years.  I have been giving him some pain killer at night (a light dose) for his mouth pain and that seems to comfort him.  This morning when I went into my living room and sat down he jumped up into my chair with me like he used to.  He is still sneezing and doesn't have much energy and I believe has fluid in his lungs but does not seem to be in any pain.  I am also giving him an injection each day (from the cardiologist) to stop blood clots.  What are my chances of his passing away peacefully and painlessly on his own?  I don't want him to suffer at the end but I don't know that I am strong enought to have him put to sleep.  It seems like the final betrayal to me - everything in me wants to try and save him.

Thank you again for your help

Sharon

Answer
Sharon, I am so, so sorry that things are not improving.  All I can do here is reassure you that your feelings are normal.  None of us feel strong enough to make that awful decision.  And we all feel like it is betrayal.  That is our flawed conscience talking.  And they are feelings that don't at all reflect how our kitties perceive things.  This is one of the situations where we need to follow our minds, not our hearts.  

We all would do anything we could to save them.  But in my experience, chances are a cat with Congestive Heart Failure in this state is beyond saving.  Would it be more loving for you to swallow your pain for now, and bring him in to a vet where he will simply slip painlessly into a state of sleep, or would it be more loving to watch him whither away, day after day, allow him to dehydrate, starve, and eventually suffocate from fluid accumulation?  The most humane choice for him is to have him put to sleep.  I would also urge you to be with him in the vet's office when it happens.  Let your face be the last thing he sees.  Be strong for him.  It will be painful for you.  But don't let his last minutes be filled with unfamiliar faces and sounds.  Be there to hold him and talk to him.

Chances that he will pass away peacefully and painlessly from Congestive Heart Failure at this point are almost zero.  In fact, I believe he is showing signs of suffering now, by refusing to eat.  Cats are masters at hiding pain.  So while he may appear comfortable, you can imagine that fluid in the lungs is at least very stressful.  My vet explained to me with my cat with heart failure, that he was living in a state similar to having someone sit on his chest all the time, because the fluid was restricting his breathing so badly.  That's a very terrifying way to live.

One other thing that my vet said to me that has always stuck - it's better to let them go a day too early than a day too late.  And while it's devastating to put a cat to sleep, it's worse when you don't do it in time.  I can tell you that by experience.  I will never forgive myself for the ones that I made wait too long.  Their last hours are spent in agony.  I don't want to fill your mind with horrible thoughts, so I won't go into detail, but I must tell you it's absolute torture.

You will be strong enough.  Your love for him will not allow you to be weak when he's counting on you to be strong.  Be brave for him, just for a moment.  After that, you will have plenty of time to sort out your feelings.