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Thursday, May 23, 2013

Euthanizing Chronically Affected Cats?

I've been bad about addressing some of the emails I've received in the last couple of months as I've had lots of other things to blog about.  But it's about time to rectify that, so the next several blogs will deal with questions from readers.  Here is the first, which I have edited somewhat because of the very long email....

Prior to September of 2012, I had four healthy felines of varying weights, ages and breeds. At the end of September we adopted a 6month old tabby kitten from a local shelter.......While living in the shelter, he had been on a diet of Iams and were told that if we switched him to a different type of cat food, he could experience diarrhea.
We did switch him to the Purina we were feeding the rest of the kitties and immediately noticed diarrhea. Assuming it was due to the food, we figured it would pass in a couple of days and thought nothing more. After two weeks, we took him back to the vet and they looked him over, said it was the food and to have him fast for 24 hours then switch him back to Iams.
We did this and by now all of the kitties were experiencing diarrhea. Again, we were under the impression this was from the food brand switch and that it would pass. Another week passed and I took the kitten back in to be examined where it was discovered he had Giardia.

[Over the next 4 months there were a total of four treatments involving panacur, metronidazole, and amoxicillin]

 
I took another fecal sample to the vet since there is no absence of diarrhea. The vet informed me that the Giardia is not present but that they found coccidia. The cats were dosed and given a single dose of Baycox and I was instructed to redose them again in ten days.  The diarrhea has yet to stop and while we still have one more dose to administer, I have run out of treatment funds to carry on in this manner should the second dose of Baycox fail.

While I realize these infections are not necessarily life threatening, they are highly contagious to other felines (as I devastatingly found out while trying to place a rescue cat into my home to love and take care of). This is not a matter of 'I won't' treat them, as I have been cleaning up cat diarrhea from five cats for three months. This is a matter of 'there is no forseeable end to justify the means'. I can no longer afford to pay thirty dollars a week in litter, fifty a week in medications and another thirty odd dollars weekly in cleaning supplies.

At this point I'm not even sure if I could afford to euthanize them but taking them back to a shelter where the infection occurred doesn't sound like an responsible ethical decision either. The cats may be treated there but odds are they won't be cured and will infect others. Or they will be ignored and possibly (unlikely due to age) be adopted and foisted upon the next unsuspecting adoption owners who would harm an animal for having uncontrollable litterbox issues or toss them outside to fend for themselves as so many animals are down here in southern Texas.

As a vet, listening to these proceedings and seeing invoiced bills showing these steps have been taken with no results, would you euthanize the felines in question?

This is definitely a difficult situation and I sympathize.  I would agree that it sounds like an infectious cause due to the spread to your existing cats.  What surprises me is that this is still going on.  Giardia should be eradicated and then some from the extensive treatment they have been on.  Coccidia also usually responds to therapy.  However, an interesting thing about coccidia is that it can be a normal organism in the intestine and tends to reproduce rapidly when there is digestive upset such as from other infections or unclean conditions.  I would suspect that the coccidia were opportunistic and took advantage of the other problems to grow and reproduce.  So the current problem may not actually be Giardia or coccidia.

There is another possibility here.  An organism called Tritrichomonas can sometimes infect cats and is notorious for being resistant to most antiprotozoal and antibiotic treatments.  There is not a simple test for it and it may not be readily visible on a typical fecal examination.  I've found it before in cases very similar to this one.  One of my old professors, Dr. Jody Gookin at North Carolina State University, has had some efficacy with ronidazole, but this drug can be toxic to humans and needs to be given with extreme care.  The diarrhea can persist for years otherwise.

Besides investigating this option there may be some help from probiotics and specialized gastrointestinal diets.  However, those may be of limited benefit with this many cats affected.

Back to the main question....should these cats be euthanized? 

I find that a very difficult decision.  Everything in me screams out that this is not the kind of case where we want to put them to sleep.  On the other hand I'm a very practical person and realize that life isn't always ideal.  This is more than simple diarrhea, it's months and months of a chronic problem that can't be resolved.  While it sounds like the cats are otherwise in good condition, there is a risk that this will not always be the case. 

Personally I would take additional steps.  I would consider fecal cultures and have a diagnostic lab look specifically for Tritrichomonas.  I would also look at treatment for this organism.  If none of that helps, it may be warranted to seek the help of an internal medicine specialist.  But I know that in this case the funds have run out so none of these recommendations may be realistic.  With that in mind I would look at options such as Care Credit or a charitable organization to puruse the case. 

If none of that is possible or if there is still not a resolution, then I would consider humane euthanasia.  Yes, that stinks, makes me hurt thinking about it, and is a less than ideal decision.  But I can understand the extensive care and expense involved here and know that a client like this isn't making the decision lightly or due purely to inconvenience.  I have to look at what is the better option for the pet:  live with diarrhea and possibly be forced outside or be abandoned, or peaceful euthanasia. 

It's a very tough decision and I'm glad this isn't my personal case.

2 comments:

  1. It sounds like a frustrating case for all involved! Is it large or small intestinal diarrhea?

    I would call the cat food company to report the problem - maybe that lot of food had an issue.

    To save money, you can always mix all fecal samples together and submit as one sample :)

    I agree with Dr. Bern that I would do the Tritrich InPouch culture test and go from there. Make sure they are off of antibiotics for several days before doing the Tritrich test. It sounds like it may be a Tritrichomonas infection, which can be hard to treat due to serious side effects from the treatment but then at least you'd know what you were dealing with. Sometimes a wet mount -- just a fresh fecal sample with some saline on a slide -- under a microscope can be enough to detect these buggers but usually the culture is necessary.

    I'm not sure I could physically do the euthanasia if someone presented me with these cats :( I have a feeling my kitty family would increase from four to nine...;-P

    Could it be worth checking back at the shelter again to see if they've diagnosed anything there recently? There certainly could be an outbreak there that they haven't made public (for many reasons).

    Bland diet can be helpful too -- just cooked chicken if they'll eat it. Can also add metamucil to pre-existing diet...another cheap option.

    I just went through this with two kittens and after 6 months and $1000 of diagnostics and treatments, we got them resolved by changing diets (fourth diet we tried). Fresh in my mind! :)

    Please keep us posted!
    Katie Johnson, DVM

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  2. A terrible choice indeed. It makes me appreciate the value of quarantining incoming pets when introducing to an established and healthy household. It is one reason I won't foster pets to reduce risk to my own.
    Great advice.
    My sympathies and hope this can be resolved
    Fi

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