Brandon -- Saying Goodbye To An Extraordinary Cat

We let Brandon go on Monday. The poor little guy spent the last few years of his life juggling a complex set of chronic health problems including blindness, high blood pressure, heart disease, kidney disease and extreme sinusitis. These he managed -- allowing us to medicate him and administer fluids -- but recently an earlier cancer (parathyroid carcinoma) came out of remission –causing large masses to grow near his larynx and chest -- and his chronic kidney disease progressed into kidney failure. Because of Brandon’s heart disease, neither could be aggressively treated and so we began hospice care for him.

Brandon was an unbelievable cat that touched everyone he met. He loved sitting on laps – even of people he barely knew -- and would eagerly share the lap with another cat. In his healthier days, he routinely sprinted and jogged before going to bed each night. His best “cat friend” was Onyx who was over twice his size. Almost every day you would see them extensively grooming each other and then play-boxing – Onyx sitting down and Brandon standing on his hind legs to be at the same height. Onyx would usually let Brandon win and then cuddle with him for a long nap. They reminded us of the “lion and the lamb”.

After becoming totally blind in 2007 we provided Brandon with a large cage to live in so he could easily locate his food and water dishes, litter box and bed. We’d bring him out for lap time and attention whenever we could and he adjusted well to this limited life style. Brandon had all the attributes of the Burmese breed including the “bulldog” body that is sometimes described as a “brick covered with silk”. He was a very unique cat and we miss him dearly.

Deciding when to end hospice care and euthanize a beloved cat is never an easy decision. Euthanasia – derived from the Greek words “eu” and “thanatus” meaning “good death” is the humane ending of the life of one who is terminally ill and in untreatable pain. Making the decision to euthanize starts with those guidelines, but sometimes applying them is easier said than done. Veterinary exams and lab tests can diagnose a terminal illness, but how do you identify “untreatable pain”? Cats can’t tell you about their pain and because they’re genetically-wired to be hunters, they actively work at hiding it. Because of our focus on elderly cats we’ve helped a number of cats get to the Rainbow Bridge and have our own set of guidelines to evaluate end-of-life pain. Here are some of the ones we use to determine when euthanasia may be kinder for the cat than continued hospice care.

• Is the cat eating? Food is important to maintaining life quality – and is a good indicator of how the cat feels. So long as the cat eats regularly you can be assured they’re not in great pain. As their illness progresses, their appetite may diminish, but by sitting with them while they eat and providing tastier foods (baby food, canned gourmet food) you can often whet their appetite. And that’s okay – so long as they’re eating. Weigh the cat frequently to make sure they’re eating enough to maintain a reasonable body weight. Sudden weight loss can surprise you – as they may not be eating as much as you think. When the cat totally refuses food – or is only ingesting small amounts -- it may be time to consider euthanasia.

• Is the cat taking in enough fluid? A healthy cat gets adequate fluid from eating food and drinking water, but if a cat is sick they may need supportive fluid therapy. This is easy to do at home and helps keep them comfortable during their final days. If the cat becomes dehydrated they’ll feel poorly and their quality of life quickly declines.

• Is the cat breathing abnormally? Panting, irregular breathing patterns, and open-mouth breathing are signs of distress that may need immediate attention.

• Is the cat sleeping comfortably? If the cat is constantly curled tight in a ball or sleeping in dark hiding places this could be a sign of discomfort or pain. Take the cat in for evaluation and to determine if pain medications are appropriate.

• Does the cat accept your attention? It’s never a good sign when a cat that enjoys your companionship prefers to be alone. Seek veterinary help in evaluating the change in behavior as it could signal pain or discomfort.

Using signs like these helps you translate cat behavior into a measure of life quality. They are only signs, though, and can be misleading. If you suspect your cat is in pain and that it’s time to consider euthanasia, set up an appointment with your veterinarian to get their input. They have the training and knowledge necessary to grasp the hope or futility of continuing hospice care. They cannot (and should not) make the euthanasia decision for you. As your cat’s human representative, you are the one to make the final decision.

In Brandon’s case my sense was that he was failing, but he had so many chronic health problems applying the above pain guidelines was hard. For instance he had always made breathing noises because of his sinusitis, but Monday they seemed more intense. And his cheeks were moving in and out which I had never noticed him doing before. I thought he was eating, but he’d lost 9 ounces over 3 weeks so the actual amount of food must have been minimal. He’d been on SQ fluids for years so we knew he was getting fluids yet the water dish in his cage didn’t need filling as often as before so he was drinking less. He still enjoyed lap time, but Monday morning Brandon never settled in--standing most of the time –not sleeping as he normally would.

We said our goodbyes– just in case -- and then took Brandon in for a veterinary evaluation – knowing he may not return home afterward. We learned that the cheek-breathing was a form of open-mouth breathing and that’s not good. A mouth exam showed he had “kidney breath”– and that there was at least one open sore in his mouth. These are both signs of final stage kidney disease. The greenish color of his nasal discharge (from his chronic sinusitis) suggested a new bacterial infection. The growths at his larynx and chest had grown more as well. Euthanasia at this point seemed appropriate but we could continue to hospice him, if we started him on antibiotics and pain medication.

It was a difficult decision – but we understood, Brandon’s condition would only continue to worsen. He’d need pain medicine for the rest of his life because the mouth sores wouldn’t heal unless we ramped up the amount of fluids we gave him to help his kidneys. We knew we couldn’t do that because his heart wasn’t strong enough – we had already tried and it caused chronic coughing. So, as difficult as it was, we knew it was time to let him go. Brandon’s quality of life was going south quickly and nothing could be done to improve it. So --with a heavy heart, we chose the next best thing for Brandon – giving him a good death. May he rest in peace and be waiting to greet us on the Rainbow Bridge.