18y9m old cat with likely brain tumor. I can't decide what to do?

My girl has a suspected brain tumor. She has lost vision in her left eye and hearing in her left ear sometime within the last year. She also has bits of food on the left side of her mouth and gets a lot of food into her water. I took her to the emergency vet at the beginning of October as she seemed to be unable to use the litter box. They confirmed no blockage and that it was likely neurological. She was also limping intermittently and her left foot was sliding forward or out to the side a bit. I took her to a neurologist and they suspect a brain tumor. I should have let them do the mri but she has hcm so I wanted to wait for the echo which was scheduled soon after. They gave her prednisolone to help her symptoms- which it has. I have since gotten the echo and her hcm has not progressed and they said she is 'low risk' for anesthesia. She also has kidney disease but it is either stage 1 or early stage 2. I am getting new bloodwork done tomorrow. I can't decide whether to get the mri and see what the options are then or just continue on this path of palliative care. I have had her since she was a kitten so my heart is breaking. I am trying to not be selfish but I also have guilt no matter what I choose.   If I get the mri and proceed with surgery, that is of course invasive and surgery is a risk. If I do nothing I feel I am letting her die prematurely. Yes, she is old but she is a physically strong cat who is still agile and has a healthy weight / appetite, etc. I don't want her to die on the table but I also feel bad doing nothing. Since her other conditions are mild and being managed I feel she could live several more years. Especially when in my research I have found that there is a medication to stop the progression of hcm and also that kidney disease vaccine coming in 2025 that can prevent worsening of that. Also her kidneys are stable with the diet I give her.   I know it has to be *my* decision but I struggle with decisions in my every day life and something like this just feels impossible. It's been a month of mulling it over and I have not figured it out. 😢

Hello and Im so sorry to hear that you are in this unhappy place.   Nearly 19 years is an impressive age for a cat; if everything could be treated and revert to normal again, there realistically might not be a long life expectancy from here; most vets have occasionally seen a cat in the low 20s and very few cats are thought to have reached 25.   Brain surgery is a huge undertaking, both financially and physically, with a huge margin for error.  As a non- specialist vet I wouldn't consider performing it, but if an experienced specialist somewhere is prepared to offer the surgery in a cat of this age and fitness, they should give you a worst case and best case scenario of what they expect to happen afterwards.  This is not a decision that I can make for you.  From the balance of factors that you have described in a cat I loved very much, I suspect that I wouldn't be looking at radical surgery.  I might be taking one day at a time, trying to provide the best possible quality of life.  We usually counsel owners in advance to discuss what an acceptable quality of life looks like - at what point they would want to stop treatment and put the pet to sleep - in order that they recognise it when this situation arrives.  Otherwise we tend to become acclimatised to how our pet is; to see it as the new 'normal,' even when quality of life is very low.  End of life decisions are difficult, because you love your cat! There is no definite 'right time' because everyone has a different idea of what that looks like; secondly because of the high emotion involved.  Nobody wants to say goodbye to their cat; it is always easier to put the decision off, to say 'but I don't know yet!' or to wait for the next thing, than it is to make it.  But please, don't beat yourself up; a hesitancy to say goodbye to someone you love, is a normal, human reaction to greif and greif is not a weakness.  When the time comes and it is over, a lot of people feel better; the anticipation can be worse than the event itself.  There is a charity, the Ralph Site, you can access online who may be able to offer you more advice or even point you in the direction of counselling.  Whatever you decide and whenever you decide it, we wish you and your girl all the best.