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Toni wants to know if it's fair to treat her cat's hyperthyroidism and kidney disease, when he's already 20 years old. Our take: Yes, it is fair, but choose the palliative care option rather than the heroic "treat to save a life" care.

There’s a middle road between no care and curative care, and that road is called palliative care. Photo by JaneA Kelley

Dear Most Esteemed and Knowledgeable Kitties:

My cat has just been to the vet and the typical diagnosis for a cat of her advanced age. I’ve been through cats with hyperthyroidism before, one went untreated at 16 years old one received radio iodine treatment at 12 years old (still only lived to 13 1/2 with digestive problems.). I tend to want to just let this current kitty go untreated. At her age i don’t want to start running around forcing medication on her, medication which would likely exacerbate the kidney problems. That, coupled with destroying our relationship. I have no issues with euthanizing when I feel she may be suffering or time is close.  We all die, and i feel as if this would be akin to forcing a 95 year old human to go through chemo. Any thoughts?

~ Toni

Bella: Well, Toni, we certainly understand where you’re coming from. Our beloved Thomas developed hyperthyroidism and kidney disease when he got older, too, and Mama’s beliefs about how she was going to care for Thomas evolved as he aged.

Tara: Mama had some heart-to-heart talks with her veterinarian about what she could do to keep Thomas comfortable and about her beliefs around curative, heroic care for an old cat.

Bella: But, as Mama told the vet, “I know that not treating would also cause suffering, so I want to know what we can do together to make Thomas as well as possible without going to extreme lengths.”

Tara: While it may seem like the kinder thing to not treat a cat for hyperthyroidism and kidney disease, we think the best option for an elder kitty with chronic illnesses is palliative care.

Bella: Palliative care, also called comfort care, does not aim to cure the diseases. Instead, it aims to keep the cat as comfortable as possible until she lives out her natural days.

Tara: You mention that you see treating your cat as being akin to forcing a 95-year-old human to go through chemotherapy. We understand this viewpoint, and so does Mama. Mama doesn’t want to go through chemo when they’re (Mama is nonbinary, so “they” is grammatically correct!) 95 years old, but they’re not averse to comfort care, which includes things like managing pain and other discomforting symptoms such as nausea and anxiety.

Bella: You need to understand that a cat with untreated hyperthyroidism is suffering, for example. First of all, they’re always hungry because they’re burning through so many calories. Secondly, the raging thyroid hormones set off a cascade of physical symptoms such as rapid heart rate and blood pressure changes that can produce feelings of anxiety and being unwell. That’s one reason why cats with hyperthyroidism cry a lot: their bodies are so overstimulated and revved up that they can’t calm down and their nervous system can’t get a rest.

Tara: But hyperthyroidism and kidney disease are also synergistic, which means that each disease affects the other–something you probably know from having other cats who have had these illnesses. Hyperthyroidism tends to mask kidney disease by making it seem like the kidneys are working better to filter out toxins than they really are.

Bella: That’s one of the reasons why Thomas’s vet recommended against doing radioactive iodine therapy on him. If we cured him of hyperthyroidism, we might have made his kidney disease worse, and if we still had him on medications rather than curing him, we’d have the option of “letting him run a little hot” if we needed to, in order to keep his kidney function decent.

Tara: But we also had to treat Thomas’s kidney disease. Kidney disease also causes suffering because the buildup of toxins in the bloodstream can lead to nausea and a feeling of being generally unwell. That’s why some level of treatment of the kidney disease could help your cat to suffer less.

Bella: To make a long story short, Toni, we highly recommend that you talk to your vet about palliative care. Veterinarians are usually right on board with palliative care for older cats, and they’re more than willing to help you make sure your cat is as comfortable as possible until she draws her last breath.

Tara: Palliative care does include giving medications, but there are ways to give medications that won’t harm your bond with your cat and force suffering on your feline friend. For example, Thomas took his Felimzaole (thyroid medication) in Pill Pockets, so Mama never had to stick a pill down his throat. Many medications can also be compounded into tasty liquids that you can simply put on your cat’s food.

Bella: Palliative care may include giving subcutaneous (subQ) fluids in order to help your cat’s body excrete more toxins in her urine. There are lots of tips for making subQ fluid administration easy, the most important of which is to warm the fluids by soaking the fluid bag in hot water for about 10 minutes and squishing it around so the temperature is even throughout the bag. Run the fluids through the line until you get warm fluids, too.

Tara: The thing that’s most uncomfortable about subQ fluids is the cold liquid. Even the needle doesn’t hurt that much.

Bella: But if you decide you don’t want to give your cat fluids, we’d strongly recommend feeding wet or raw food only (it has more moisture) and leaving a full bowl or pot of water out for your cat to drink from. To tell the truth, Mama only gave Thomas fluids about once a week, and she always made sure he had plenty of water for the rest of the time.

Tara: So, Toni, you don’t have to do “all the things,” but we’d definitely recommend talking with your vet about ways you can keep your cat comfortable without harming the bond you two have.

Bella: Palliative care is a very valid option, and one that we strongly recommend. If you can minimize your cat’s pain and discomfort by finding alternate ways to administer medications, you’ll be able to keep your bond strong and you won’t be forcing your little old lady into heroic treatment.

Tara: We hope this helps, Toni. And please know that we’re not saying you’re hurting your cat or anything like that; we’re just trying to present you with an option between aggressive care and no care.

Bella: What about you other readers? How have you managed caring for old cats with chronic illnesses? What tricks did you use to make sure you weren’t hurting your cat by medicating them? Let us know in the comments!

Tara: And be nice to Toni! She really wants to do what’s in her cat’s best interest, and that’s why she wrote to us. If she didn’t care, she’d have just let her cat sit there and not even ask any questions about whether she could be doing something different.