Plz help, should my 19 year old cat get surgery or palliative care for pyometra?

- cat's age: 19 years - sex/Neuter status: Female(ignore that it says male on one of the pictures it was an error), intact (not spayed, but tubal-ligated(not by my choice)) - breed: Medium-sized domestic cat (mixed breed) - body weight: 2 kg (4.4 lbs) *Short History:* Previous diagnosis of pyometra and benign liver cysts in 2017/2018. Episodes over the years of vomiting, inappetence, and lethargy resolved with fluids and antibiotics. *Clinical Signs:* - Vomiting (brown, puddle-sized) - Inappetence (resolved with treatment) - Lethargy (resolved with treatment) - Weight loss (underweight) - Poor grooming - Loss of playfulness *Length of Time:* Gradual decline since 5-6 years, with episodes of vomiting and lethargy. Recent worsening of symptoms My cat emma was tubal-ligated (not spayed) by previous owners, idk what they were thinking. In 2017/18, she was diagnosed with pyometra and benign liver cysts. I didn’t pursue surgery Bec I was a teen at the time and parents were opposed to it. Since her diagnosis, she has experienced a couple episodes of intense vomiting, inappetence, and lethargy, which were resolved with fluids and antibiotics. However, her overall decline has been gradual. Around 16 years old, she lost interest in play and now sleeps most of the day, only perking up during feeding time. Also she's underweight (2kg), has poor grooming, and resists being brushed or bathed, and her abdomen is swollen sometimes. Despite this, she maintains a good appetite, uses her litter box, and can jump small heights. My concern is whether to focus on palliative care or consider surgery, given the risks associated with her age, slightly elevated liver enzymes, and limited veterinary care in my country. The brown color and puddle-sized vomit suggest liver disease, and I worry that the pyometra may be worsening her liver function. My issue is, since she seems to get better with antibiotics and fluids, should I just focus on palliative care instead of surgery? I’m so scared of the risks, especially as I live in a third world country where vet care isn’t as advanced as in the west. There’s also her liver. Her liver enzymes are slightly elevated, but the fact that it’s not a lot makes me feel like it’s not serious liver disease and the cysts are not the main cause of her vomiting and stuff. However the vomit is usually brown and the size of a puddle which indicates liver disease. I have a feeling the pyometra is making the liver function worse, which leads me to consider surgery bec maybe she’ll be fine with just the liver cysts as her liver levels are not too high. But I’d be lying if I said this stuff doesn’t make me deathly scared of her recovery process after surgery.  I don’t want to prolong her life for her to suffer for weeks on weeks, and then have her liver get significantly worse. To be honest, there are also some practical issues holding me back. The cost of surgery, her food, transport for vet visits, and potential emergencies is just too much to handle all at once. I'd have to ask friends for help, which idk if I wanna do especially since idk the prognosis. Also I still live with my parents(normal in my country) and rely them for transport altho i could uber, but they're already against me caring for my cat. Dealing with them on top of my own anxiety is just too much to handle right now. I’m torn. Do I: 1. Take a chance on surgery and the potential difficult recovery 2. Keep her comfy with meds and fluids until things get bad enough for euthanasia? 3. Let her go now, before things get worse? I don’t want to prolong her life, I just don’t want her to suffer. I’m worried about the recovery and future liver issues. I’ve attached her x ray and blood test results from last year, and the from this year in June when she was having one of her episodes-I assume the levels must be worse during these times as opposed to when she’s feeling better.

Hello - I am so sorry that you are in this position and am going to make some potentially brutal statements, but please bear with me.  First, however,  I'm afraid that we do not give second opinions on this site.  I have not been authorised to do so by your vet, and do not know the case as well as they know it.  Now:  You offer three options and appear to understand the pros and cons of them, but it may be worth encapsulating each of these options into the nitty gritty:  1) how much does it cost?  This is important.  Financially, health-care decisions have to be made on a cost-potential benefit basis every day.  In the UK, we do not see this for humans because the nature of the NHS drives financial decisions behind closed doors.  However, financial cost is always relevant and it is important to get a  handle on it. Furthermore, the costs are not only financial:  The same can be said in terms of emotional cost to yourself and the animal, and any sickness / pain being suffered.  Please write down:  What is the cost of each option?  2).  What potential benefits are on offer?   For example, in a 19 year old cat, we seem unlikely to be extending excellent quality of life for a prolonged period because the life expectancy of cats in the UK is below this age.  What would it look like if the operation / doing nothing / medical treatment went 'well'?  What sort of experience would this be for the patient?  What is your gut instinct about how this balances against the benefits?   e.g. for euthanasia, peace of mind and comfort for the patient would be the best outcome.  For surgery, buying a certain amount of good time.   3) ie. How likely are we to see the 'good' outcome?  Is recovery an unlikely scenario, or a very likely scenario etc    4) What is the worst case outcome?...................................         Having thought these four questions through and discussed this, there are frequently no right or wrong answers.  The correct answer for one family is not necessarily the correct decision for another.  For me, it sounds as though life is incredibly difficult right now; that the status quo doesn't appear to be working.  Living in a state of indecision in such conditions as you are facing, is stressful (i.e. high cost to you) and may not be helping the patient.  There is no perfect choice here, just a choice of imperfect ones.  For me, the indecision is the most stressful and least helpful thing and that any way in which your vet approves of you moving forward, is OK.  I hope that something there helps.

Please note that I haven't offered any medical questions;  I do not think that this is a medical question; you have your vet for that.  Please do be kind to yourself at this difficult time.  The RALPH site online offers support for owners when life gets tough and remember - that there is no ideal answer, and that whatever works for  you and the patient, within your vets recommendations, is okay.