Liver Disease / Euthanize or Not

I have a 14.5 year-old tuxedo cat.   She's probably 15 lbs. and has always been on the larger size despite my feeding her properly (i.e. Hill's weight or C/D dry food as she had developed some crystals in her urine.)   She's not very active and even less so as she's aged as she's gotten sore. Early last fall, she began drinking and urinating noticeably more than usual but no other problems.   I hadn't gotten full bloodwork done on her in several years because she's a terror at the vet, even when given meds to calm her down but what little fluids could be taken indicated no issues beside the crystals. About 15 days ago, she stopped eating the dry Hill's food.   She had a canine tooth pulled long ago, had some tartar and chewed out of the side of her mouth, so I gave her wet food which she seemed to enjoy and thought maybe dental issues.  However, then she started to become less interested in that.   On Monday, I took her to be anesthetized for bloodwork.   They obtained it without anesthesia.   Her liver values are sky high and the doctor told me she'll die in less than a month.  She's down to refusing practically all food.   The primary symptom is no appetite.    She's keeping to herself a bit more but still getting around OK and hasn't lost weight yet or other related symptoms.   I plan to have her put down on Saturday and I'm very upset.   The vet says he's never seen a senior cat recover with liver values so high and no appetite. Just looking for a second opinion before I do this.   I'm not one to force feed animals and do extraordinary measures just to keep them alive.   Thoughts? Thanks very much in advance, and forgive me, but please don't make me feel guilty.   I'm really struggling.

Hello - I dont beleive that liver enzymes alone are a good reason for euthanasia, because some diseases that affect the liver - even to extreme amounts - are transient.  However, high liver enzymes, severe deydration and a cat that cannot tolerate medical treatment eg a drip might be a  different story.  This can only be decided on a case by case basis - I do not know this cat, so we can only reccommend a second opinion (we cannot supply these, as per site rules but also because  your vet knows infinitely more about your cat than I do - eg which liver enzymes are raised and by how much and what their current physical state is).  I wonder if an emergency referral to an internal medical specialist is a possibility?

The problem here sounds to be the challenge around taking blood, reaching a diagnosis and possibly delivering fluid therapy.  Your vet will have the best impression that they can get with the information that is available to them;  however it is hard to predict a case without being able to do tests or find the differential diagnoses, so there may be uncertainty.  I wonder whether pain or even thyroid disease may be having an impact on your cats' ability to allow treatment?  Good questions for your vet include:  Is there another vet eg a feline medical specialist, who could diagnose this cat - for example if you were to refer them?  Who would have the best chance?  And supposing that they could get blood, is there anything that could present like this that could be treated successfully - and if so. for what type of timescale?

Remember that I know nothing about this patient.  Referral has to be balanced against the mental welfare of the cat.  This is a decision for yourself and your vet.

Ps If you type 'euthanasia' and particularly 'put to sleep' into the blog, this is likely to bring up some articles that you may find useful.

My main concern is - if not euthanasia, then what? - because treatment and tests seem still to be necessary. Wishing you all the best with this difficult decision - whatever you decide.

Your assessment is correct.   I've often found there are two divergent theories on how to handle these situations.   First, do everything to keep the cat alive and second, be kind and reasonable and just let go, especially when they're old.  I go to a sort of 'blue collar vet' and so they largely side with the latter theory. Like most situations in life, I always seek a balance and today, that's a struggle.   My gut feeling is that this animal's condition is terminal and she'll go into a steep decline soon.  In a week's time, she went from having an OK appetite to consuming nothing more than water. The last time I had to do this, my cat had clearly reached the end of the line.   It hid in strange places and acted like a zombie.  This animal still purrs, it still comes to my calling at times.  It still noses around in the backyard, but it's enthusiasm is certainly diminished. I don't have the stomach for intrusive or invasive tests and I'm sure the cat doesn't either but it's just so difficult when they're behavior is somewhat normal.   When do you let go?   Now, I'm thinking out loud and not really giving you anything substantive to address.  I may opt for treatment and see how she responds with the understanding that a positive outlook and is highly unlikely. Thanks so much for 'listening' and doing what you do.

Sending best wishes and hope that everything from here is as pleasant as possible for you and her. Wishing you both all my best.