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Sunday, April 3, 2016

Kidney Failure And Cancer. Treat or Not?

I recently got this email from Amanda.....

I would greatly appreciate it if you would be willing to give me your opinion on my situation.

Now the funds are not the main reason, I will find the money if needed but my husband says our beloved Sammy is his best friend and wouldn't want him to suffer for one more day than necessary.

My 10 year old cat has a huge (orange size) mass in his stomach about where the left kidney would be.  I have only had blood test done and he is in renal failure.  Doctors want to take x-rays and do a ultra sound to see if the mass can be operated on or to see if he has cancer and if it has spread to his lungs or other organs.  Then we would see if he has cancer or if the mass could even be operated on because of how large it is.  Mind you my cat is a medium size 12lb cat with a  orange size tumor in his stomach, which cannot be comfortable for him.

I noticed a decline in his play around 6 months ago but I contributed that to us just moving to a new place.  He is thirsty all the time and practically lives in the bathroom now cause he always wants water from the faucet.  Every time we go to the bathroom he's in there asking for us to turn on the water.  He plays less and less with me and doesn't like to be touched at all around his stomach area.

So I'm at a crossroads.  Do I do the x-rays and ultrasound to see if its cancer or to see if it can be operated on?  But either way my husband doesn't want to put our cat through any surgery.  The mass is so large I couldn't even imagine how much they would have to cut him open just to remove it.  This is horrible to think about putting him through this just so he could live a few more years for my own selfish reasons...  Or am I'm being stupid and not going through with it cause he could have a few more years?

Any advise would be greatly appreciated.  I don't believe he is suffering too bad yet but I do believe that he is not his regular self, he is always drinking water, he is always peeing, he has some good days and some bad ones.  But if I could stop his suffering I will, I just don't know when the best time would be.  My heart is breaking just the thought of having to put him down or even having to have him operated on and him dying on the operating table.

There is never an easy decision in situations like this.  Even if you know it's the best thing for your pet you still feel bad about ending their life (no matter how peaceful it may be).  I'll help as best as I can, but ultimately this is a decision between you and your own vet.

The first thing that concerns me about your story is the fact that he is in renal failure.  An animal has to lose 2/3 of its kidney function before you will see any abnormalities and 3/4 of kidney function before the pet acts sick.  The kidneys don't regenerate, which is why there is so much redundancy.  Once parts of the kidney is damaged, it stays that way.  We can do great with only 50% of our kidneys, which is why we can donate one and not need any treatment.  But we can't function with much less than that.

If a cat is showing signs of renal failure this essentially means that one kidney is completely non-functional and the other one is only half working.  If you remove the non-functioning kidney you still have the problems with the remaining one.  If only one kidney was damaged due to cancer and the other one was normal, you actually wouldn't see blood abnormalities, and you could remove the bad kidney without problems.

So just with the lab tests alone this sounds like a bad situation that wouldn't respond well to therapy and would be a high surgery risk.

If you wanted to pursue diagnostics you could probably start with just either chest x-rays or an ultrasound, not necessarily both.  If tumors show up on chest radiographs the cancer has spread and surgery isn't going to help.  If an abdominal ultrasound shows both kidneys affected (which I would suspect) or tumors throughout the abdomen, surgery isn't going to be a solution.  Sometimes it's worthwhile doing additional diagnostic tests for the peace of mind of absolutely knowing that there aren't any other options.

Based on what you've shared, Amanda, I would not hold out hope that surgery would help.  However, definitely talk to your own vet about that, as I don't know other details of the case.  This is a situation where I wouldn't rely only on my advice since I'm not close to the case.  Your vet may know some aspects that I don't and that may change the decision.

If surgery isn't an option due to cost, inability to help, or simply not wanting to do it, then you have to look at overall quality of life.  I've often believed that it's better to euthanize one day too early rather than one day too late.  If you know what the eventual outcome will be in a terminal case, I don't like waiting until the pet is actually starting to suffer.  If I know that they will be suffering at some point, I want to help them pass on before the suffering starts.  But that's not a clear-cut point in many cases, and it's often a very subjective decision.

This past week I saw a cat who was being treated for hyperthyroidism.  We had her on medication for several months, even increasing the dosage beyond the typically recommended amount, but we still couldn't get her thyroid levels down to normal levels.  She wasn't herself, was continuing to slowly lose weight, and overall was unregulated.  The only other option was to refer her to a specialist for radioactive iodine therapy.  While this is a great treatment it is very expensive and therefore out of reach for many cat owners.  These clients simply couldn't afford this option, so we were left in a tough situation.  Medical therapy wasn't working, the cat was slowly worsening, and they couldn't go to the next step.  As hard as it was for them, they decided that the best thing for their beloved cat was to euthanize her.

Amanda, I don't know if any of this helped, but it may give you some different thoughts.  Go over this with your own vet and look at what is going to be best for your family and pet.

1 comment:

  1. Great article. I have been owned by dogs my whole life. All I can say is you "know" when they no longer have joy in life. You "know" in your soul that they are miserable and no longer can live a life without pain. You will know when it's time. It's very peaceful. You hold them in your arms and they gently go to sleep. They go to sleep loved. I hope I am so lucky to go to sleep in the arms of someone who loves me.

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