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What is your client thinking?
Labour and love for Mr Pink
  1. Louise Locock

Abstract

Louise Locock describes the challenges and rewards of caring for her cat with chronic kidney disease

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What you need to know

  • Managing a cat with chronic kidney disease can be a huge amount of work for clients. Regularly ask them how they are coping and signpost them to resources that can offer additional support (see below), including any service your practice may provide for boarding chronically ill pets.

  • Consider collecting management tips and useful resources from owners of cats with chronic kidney disease and sharing these on practice notice boards, Facebook posts or in newsletters.

  • Louise found Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease (www.felinecrf.org) helpful for a mix of practical information and emotional support written by another owner.

  • International Cat Care (www.icatcare.org) and Vet Professionals (www.vetprofessionals.com) also provide good owner resources.

I’ve owned many cats over the years, but Mr Pink was special. The intensity of the relationship and degree of noisy communication was exceptional. Siamese don’t accept passive, independent cat status – one of Mr Pink’s many nicknames was Dog. They are in your face; they search your expression with their deep blue eyes; they won’t take no for an answer; they make themselves the centre of attention. Mr Pink was the family clown.

Thank you, Mr Pink … I miss you, and it was worth every moment. But I don’t miss the work

In February 2015, I was in the USA when our cat-sitter messaged us that Mr Pink was not looking great and she’d take him to the vet. Things spiralled; having had mild kidney disease for some time, suddenly his creatinine spiked to nearly 900. Our vet knew we were away and took advice from a specialist cat clinic. To our amazement, after eight days of IV fluids, he went home, his creatinine and urea almost down to previous levels. A friend gave him daily subcutaneous fluids and medications to keep him going until we got home. I returned thinking he probably had a few months at most, and was willing to take on the extra care for the short time we thought he had left.

Two years, eight months later and he has just been put down. Long periods of stability were interspersed with small declines and occasional crises. Daily fluids crept up to twice daily, then three times. Water bowls distributed around the house multiplied. He started to lose interest in his renal biscuits; we introduced appetite stimulants and phosphate binders to expensive tinned food. By the end we just gave him whatever he wanted, even if it was going to shorten his life.

In his last six months, constipation set in. We eventually found a laxative that kept the worst of it at bay. Even so, he developed a tendency to vomit whenever he was straining, and sometimes dragged faeces around the floor. In the last couple of weeks he occasionally didn’t make it to the litter tray. We woke one night to hear him weeing on our bedroom carpet, so we added an extra litter tray in our bedroom. Then I found him weeing on the floor right next to another tray. Like everything else we just learned to accommodate it. Finally, his weight started dropping a little faster, and he became steadily more bony. We added steroids, which only helped for a bit, and so we made the decision to have him put to sleep.

So was this cruel? And why did we keep going so long? Leaving aside the enormous cost, his care became a huge amount of work, which crept up on us. Giving subcutaneous fluids, initially so daunting, became routine for both him and us; 30 seconds every now and then seemed a small price to pay to prolong his life. It was a constant process. It made holidays difficult; I am lucky I had a friend willing to do the necessary. No cattery we have found will do this, and you can’t ask a neighbour to just pop in and inject your cat three times a day. It was also an emotional burden, worrying every day whether his condition was changing, whether we were doing the right thing each time we added a new intervention, and whether he was still enjoying life.

Mr Pink was much-loved, and his death symbolises the end of an era. Did we judge the tipping point between survival and welfare right? I will never know. Thank you, Mr Pink, for being the finest, funniest, loudest and most loving cat of my life. I miss you, and it was worth every moment. But I don’t miss the work.

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