Decision making over veterinary bills in treating old cats

For me, it’s a balancing act between assessing how comfortable a cat is and will be, the benefits and risks of surgery or treatment, the quality of the remainder of the cat’s life and lastly the cost of treatment. Decisions, decisions, decisions….

Photo by Christina Rutz

Photo by Christina Rutz

For all cat caretakers, there comes a time when veterinary bills are liable to mount. This is when your cat is old and starts getting ill more frequently.

In the US, it is estimated that just 0.3% to 1% of the cat population is insured against veterinary bills¹. This is a very low figure. It appears that most people don’t want to add to their regular outgoings. They’d rather take a chance and hope that their cat remains healthy. However, at the geriatric stage of a cat’s life the usual feline illnesses such as kidney disease, hyperthyroidism, cancers, heart disease etc. start to click in and so do the decisions about what to do.

Do you spend lots of money on vet treatment or do you decide that it is time to euthanise? Your vet might advise you wisely but, ultimately, the decision is the cat caretaker’s and often it’s not about money. On the contrary, it’s mainly about emotion, love and loss.

The relationship between caretaker and cat has deepened over the past 4 decades. The bond is stronger and letting go is harder. Fifty to one hundred years ago you’d probably find that people were more willing to have their cat PTS when old rather than fork out on expensive treatments. It may have been the norm.

Treatments have improved, there are many more options and greater expectations. Veterinary surgeons can do wonderful things nowadays at a wonderful price. The decisions are more complicated.

Obviously, what a person spends on vet bills depends a lot on how much money the person has but I’d bet that a lot more people with lots of money are more willing to have their cat euthanised than relatively poor people. It is not about money. It is about a person’s connection and relationship with her cat(s).

Some cat caretakers would spend their last dime on medical treatment for their cat. They’d go bust before they stopped trying to prolong the life of their cat.

However, this can be foolhardy and dare I say it, selfish. The decision to treat the illnesses that beset the lives of elderly cats must include a discussion about the quality of life a cat can achieve with treatment. We are into the same sort of discussion we have in the press about euthanasia of people with terminal illnesses.

It is my belief that the vast majority of people believe that sensible and sensitive use of euthanasia is preferable to prolonging life when the quality is extremely poor.

So, putting aside the cost of treatment of an old cat who is seriously ill, the decision comes down to deciding what is best for our cat, which includes deciding if she in pain and what sort of quality of life is left for her. The decision should not be clouded by self-interest and what is best for the cat’s caretaker. In short, the decision should be governed by unconditional love and it should be as objective as possible.

There is no doubt that at this time an excellent veterinarian who has a lot of experience under his belt is invaluable. This is because the balance between quality of life and euthanasia depends on the information provided by your vet. I’d lean on him/her and ask tough questions. It is hard to know if a cat is in pain. A good vet can assess that much better than us. How long will your cat live even if given the best and most expensive treatment? Do you want her to live for 9 more months because (a) you don’t want to lose her or (b) because she will have a decent 9 months of life ahead of her?

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Decision making over veterinary bills in treating old cats — 29 Comments

  1. This is great – very to the point. I agree – there can be a level of selfishness – but it’s a fine balance and the decisions are plentiful and hard, and the final decision as you say – has to be for the right reasons. I have not been confronted with this.

    I am just a beginner in cat caretaking. I have dealt with ilness and even had a sick cat die on me but never had to make a final decision. It must be very hard. All I care about is that my cat get’s what she wants. If she wants to live I would like to know or be able to tell and I would do anything I could to make it possible. If, as I have seen, after a point she doesn’t want to live and would rather go in a corner and die, then it’s time. Of course there is a huge and murky middle area where you aren’t sure if or what she (or he, my cats are all girls) wants.

    Nonetheless – given the emotion involved it might be hard to know if you are seeing clearly or not to make that decision but I suppose if you are close to your cat you will know.

    I haven’t the experience that many other people here have had with losing cats so I can’t really comment any more. It must be very hard. I will find it very hard when the time comes. With Red I didn’t have that choice.

    • The worst part is the feeling of guilt at being the person with the power to say to end a cat’s life, even though it’s the kindest thing you can do.
      I relive all the times we’ve had to have very old cats PTS over the 40 years we’ve had cats, but it’s something cat loving caretakers just have to do at times.

    • Thanks Marc. I am pleased you agree what I wrote at least in principle.

      I disagree that you are a beginner because I am sure that you will make the correct decisions through instinct and intelligence.

      Having to make a decision to euthanise a cat you have loved for her/his entire life is very hard. It is hard to make a sensible decision because, as you say, there is a lot of emotion clouding the decision making process.

      I found that I was leaning towards playing safe and not wanting to do it for reasons connected to me, not my cat.

      Looking back I think I delayed too long and put her through unnecessary discomfort and pain.

      It was the first time for me so it was a learning curve but there is a lot of time to make the decision, usually, so one can process it and ask oneself tough questions.

      The fact that cats live shorter lives than ours is probably the single biggest problem of cat caretaking. It is a sort of hell at the end.

      The moment came when I decided: she looked at me after I had given her her food and told me she could no longer eat. It was as if she was asking me. I felt she was asking me.

  2. This is a time when we must put an old, ill cat’s needs first and ask ourselves if she has quality of life or not. If she hasn’t, then hard as it is, we have to make the decision to free her from pain, it’s the kindest thing we can ever do for a suffering animal.
    All the money in the world can’t reverse old age and terminal illness, we have to be very careful a vet isn’t stringing us along with various treatments because many nowadays have to reach targets for their employer, tests and drugs being two where a lot of money is made.
    Yes take advice from a trusted vet but at the end of the day we know our own cats far better than any vet and we know when the time is right to say goodbye to a much loved cat for her sake.
    We have money put aside for our cats needs but if it wasn’t enough then we’d eat bread and jam for every meal rather than they went without what treatment they needed IF it was in their best interests.

    • Yes you make that good point Ruth that we have to deal with it in a businesslike manner for our cat’s sake. It is about doing the “right thing”. I found I had to wait for a clear sign before I acted.

      • Yes we have to be strong for our cat’s sake, even though we crumble afterwards, but it’s the hardest thing EVER!

  3. Sadly for me, this is a timely article. I hope to get feedback from my POC friends. My Bigfoot seems to be in early renal failure. At least, that is what the doctor suspects. His only real symptom is a tremendous increase in water consumption. The doctor compares the need for increased water as in a bucket with hole in it. It is impossible to fill. Another symptom was a light colored, almost gray, poop, if you will pardon the expression. Again, the vet wasn’t impressed. Of course, reading on the internet only causes more worry for me.
    I agree that it is difficult to tell if a cat is in pain. But I still believe I will know better than a vet. He doesn’t seem to be uncomfortable but he does ask for hours of soothing. Usually at 2:am.
    He has had blood tests twice in six months. The first test showed most everything normal except for a “slight” rise in the kidney number. I didn’t say that well, but I think you understand. His more recent test showed that number slightly more elevated. Still, according to the doctor, not alarming. His thyroid is fine.
    I was not sleeping well, listening to him get up very half hour to lap up water for long stretches of time. Finally, I had a long conversation with the vet on the phone. She said it isn’t necessary to keep a vigil. He could go on like this for one or two years. And, that there isn’t really any good treatment for cats kidney problems.
    Ruth AKA wrote in a comment to me some time ago, perhaps years, that the water drinking could be a sign of kidney problems.
    I should also note, Bigfoot will only eat dry food. I’m sure he was raised on the worst kibble, then left on the street to wander into my life. Probably already an old cat. I’ve never been able to get him to eat anything wet. He is so skinny. Only 8 1/2 pounds. That is two pounds lighter than four years ago. The other signs of his age is he doesn’t groom himself anymore. He has fairly long fur, so I keep him brushed and washed with a warm damp cloth. And he sleeps 22 hours a day. His purr is like a rattle. He is still affectionate and seeks out company by calling out from his perch.
    I will miss him very much when he goes, but I don’t need him to stay for me. I cannot bare for him to be in any pain or discomfort. I think that is my job to discern. I see death as a part of the circle of life. But it is up to me to see that the quality of his life, short as it might be, be the best it can be.
    I find it odd that there is little treatment for renal decline. I ask for your input please.

    • It sounds as if Bigfoot is in the early stages of renal failure and hopefully you may have him around for a good while yet. Our Felix lived a long time after he was diagnosed, the vet gave him regular injections of vitamin B12 which helped him. He drank a lot of water and sometimes had projectile vomit as time went on, but he still had good quality of life.
      We had him PTS when he started having fits, only mild at first and they left him incredibly thirsty that’s all, not distressed. But one Sunday he had a really bad one and the vet came out and PTS, we could tell he had had enough.
      Bigfoot still wants your company Dorothy so he’s not feeling very bad or distressed, old cats do sleep a lot so I wouldn’t worry about that. Ask your vet about vitamin B12 and just keep a close eye on him. You WILL know when it’s time to say goodbye! It’s an awful time to live through knowing what is coming, but try to treasure every moment with him, I’m so sad for you.

      • Thank you Ruth. Comforting to know it is the early stage. I did read about the seizures being the advanced symptoms. I’m not looking forward to that. I’ll treasure every minute with him. There is such a stark contrast between him, Marvin and the to back yard characters. My life is filled with cat joy, with a bit of sorrow thrown in.

    • So sorry Dorothy, I didn’t realise Bigfoot is an older cat or that he is not well, it’s such an awful time when you know that something is lurking there but hopefully you’ll have lots of time together yet, you will know when life starts to get too much for him. I think we all torture ourselves these days looking symptoms up on the Internet and we come away frightened and upset at things we see that might not even be relevant. I say “Enjoy the now and don’t spoil it by worrying about later” (but I don’t always practice what I preach.)

    • His only real symptom is a tremendous increase in water consumption.

      Liquid goes straight trough cats with renal failure – drink lots, pee lots (these are the words of my vet who is excellent). These symptoms are exactly the same as Binnie’s towards the end of her life but don’t take that as a sign. I am just reporting my experiences.

      I don’t know how old Bigfoot is. He has lost some weight and his purr has changed.

      To me it sounds like he is an old boy. For me (a layperson) he has classic signs of kidney failure at an advanced age and this is very common. But I am just comparing him to what I experienced.

      I’d wait and watch. I believe one knows when it it time to euthanise. My Binnie looked at me one day and she would not eat. That was my moment to act – the look in her eyes and the inability to eat and she was underweight and looked miserable. Also her vet had given me an indication that I could ask her to euthanise her. But I am not saying it is always like that.

      I am very sad to hear about Bigfoot, DW. He is part of our lives here on PoC. We love him like one of our own.

      Please keep asking if something changes and all the best.

      • Thank you Michael and Barbara. Yes, waiting and watching. There isn’t much else to do…sweet boy will let me know. I suspect he could be even more than 15 years of age. I do wish I knew. It would help. If this is the natural course of an aged cat, knowing how old he is would be helpful emotionally.

        I so appreciate the support.

        • I sense you have a great approach to this. I have a feeling he is more than 15 and also that you will know what to do. You will know because you are in tune with him and understand him.

    • He’s beautiful. With kidney, it’s just a wait and see. A lot of cats live 3-5 years with very few symptoms other than H2O consumption. Trust your gut. You’ll know.

      I may not be the best person to talk about this, since I tried heroic measures (even CPR) to keep my Chester with me after he was diagnosed with kidney failure. But, he was fairly young. I suffered over my decisions a lot, but have made peace.

  4. Making the decision to put an animal to sleep is horrendous but it’s the last kindness we can do and it’s a real test of our love for our cats if we can put everything aside except the cat’s needs, what is best for the cat in every way is more important than anything. Do what is necessary then fall apart afterwards, that’s what we’ve done in the past. Having said all that expense would never be an issue or consideration to me in deciding if a cat was to be treated or PTS, if it was a case of money would fund a cure then I would borrow myself up to the ears to pay for treatment. I despise those people whose first thought if their cat/dog is ill is to “get it put down” and get another one, to them pets are mere possessions, like electric kettles and toasters where it’s cheaper to replace them than to repair them.

    • You’re very sensible Babz. It is tough to make a good decision. It is a very grey area. There is no real clear guidance. It is down to oneself and gut feel.

      • Sensible in good times but like everyone else I’m devastated when the time comes for a decision like this, the last day of Felix’s life was so sad he was so tired and we could tell he was almost ready to go and then in the evening he had a fit, we were lucky that a vet would come on a house visit on a Sunday evening rather than him be ill all night, but when it was done I just held him and howled like an animal myself

  5. DW- My heart aches for you… and it aches for anyone facing this most difficult decision to let a beloved pet (all pets) go when it is time to say “Goodbye”.

    When we open our hearts to a kitty- or any pet for that matter- we must, at the very precise moment- open to the fact that we will be grieving their loss. But the ability to love and receive their love is an awesome gift that never can be taken for granted.

    I have had to make that decision far too many times. It is gut wrenching for us- but it is equally gut-wrenching to watch our beloved cats suffer and feel helpless to alleviate their pain and bring back that quality of life that they so enjoyed for whatever amount of time we have had the good fortune to have spent with them.

    Both Sir Hubble Pinkerton and Dr. Hush Puppy are in the “first stages” of renal disease. Our vet tests urine and blood every three months. They are 13 1/2 and 14 years old. The Oriental breeds are very prone to kidney failure sadly to say..

    When the time comes to start treatment for them, we will be very aggressive and watch them very closely. Administering sub-Q fluids can help tremendously- I had a cat in renal failure many years ago, and was not eating, was vomiting- the whole scenario. My vet at the time suggested that I learn how to administer sub-Q fluids. I was terrified at the prospect but soon learned how to do it, and we had another 18 months of very high quality life with this little Lilac point meezer. When the fluids no longer gave her that great quality of life and it was obvious that she was suffering- we said goodbye to her at home-It was peaceful and quiet and I knew that we had done the right thing- (would that this option was available for humans who suffer so greatly)…

    It sounds like you have a very wise and compassionate veterinarian- which is so important- to help guide you.

    I truly believe that our cats tell us when it is time… for that final act of love.. and Michael is so right- that is the unconditional love that we must give them.

    We must open to listening to them and grant them that wish. It is oh so so hard to do…

    • I think you summed it up, Jo.

      our cats tell us when it is time

      It sounds mystical and magically but it isn’t. It comes from a deep understanding between cat and human and after many years of communicating without a common language, one understands one’s cat and that request to take her to the vet one last time.

    • Thank you for the beautifully written comment Jo. I was told that administering fluids was an option when it comes to that. Knowing your little one kept on going for another 18 months is great encouragement to take that option. I do pinch his skin to see if he is dehydrated. So far, he is holding on to some of the water he drinks.

      Last year I had to make the decision for my 90 lb. 13 year old dog. I knew exactly when it was time. The vet came to the house to do the deed. Daisy was content and seemed relieved when the needle went in. The house was empty without her, but in many ways it was a relief. Waiting and wondering is the hard part.

      I have to trust that I will know what to do.

      Thank you again.

  6. I shall keep treating Mr Minns for hyperthyroid & diabetes (a tricky combination to control) for as long as Mr Minns is happy. That’s always been my yardstick – quality of life. My vet knows that when I say “I think we’ve reached the end of the road …” that I’ve assessed my cat’s welfare and not my bank balance.

      • When you can read cat body language, you understand when that time is approaching. When a condition is inoperable or untreatable and only a restricted life lies ahead, it’s unfair to impose restrictions on a cat that won’t willingly accept them.

        I’ve learnt to recognise some of the “approaching the end” signs and have listed them (and other euthanasia criteria) in some of my articles online.

        Old age and euthanasia is something I’ve written about extensively. I was one of the first to have articles published on these topics in the UK (Feline Advisory Bureau) and in Australia and I also wrote the original old age/euthanasia decision leaflet for Cats Protection.

        The links on old age, euthanasia and bereavement are at the foot of my general & health care index:
        http://www.messybeast.com/healthcare-index.htm

  7. thats so true, such a hard thing to do and decide and i believe cassy did that by meowing so loud and constantly although i hoped she would be ok am thankful she lasted four more days before it happened again.

    • Cassy was ready to go Kylee.
      Sometimes very old or very ill cats who know they haven’t got long left, meow loud and long, it’s a heartbreaking lonely sound.
      Our Ebony did this for a few days around dawn, before she died but she still had her quality of life all day, it was only when she stopped eating and visited her favourite haunts she hadn’t been to lately, we knew she was weary of life.
      We decided to have the vet call and possibly PTS next day if she still wouldn’t eat, but meanwhile she chose to go herself that day.
      She lay down and went into a deep sleep, waited until my sister Babz was home from work and we were all together, to take her last breath and die peacefully.
      It was very sad, but such a relief that she chose her own time and spared us the awful decision.
      R.I.P all the beautiful cats everyone here has loved and lost x

      • Thanks so much Ruth it was reassuring to know that it was her time it certainly makes the process easier im coming to accept it alot more. I know its early days but im so sure she is in rainbow heaven playing with all our kitties happily. Im just happy i managed to find her when i did.

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