My old soldier Cally
Although Princess dominated the cat medical news for a while, my attention was never off my eldest cat and old friend Cally. At 21 she is kept going by veterinary magic and a stubborn personality, but the nature of her end is starting to become clear. This is another "organise my thoughts" post. Blogging is handy for this sort of thing.
For many years now Cally has received monthly injections of Cartophen for her arthritis, which is partly due to age and partly from a car accident more than 15 years ago which left her a bit stiff. Clearly she's responded well to the medication. She was also receiving the anti-inflammatory liquid Metacam from us as needed until last year when the dosage to keep her comfortable also made her nauseous. I've been around cats and cat vomit long enough to tell the difference between furball-related vomit (even sans fur) and deeper illness vomit. It's pretty simple really - the more digested the contents the worse. Foam is also bad. Lots of clear liquid also bad. But I digress.
When we reached the end of Metacam's usefulness we switched to the opiate-based liquid painkiller Tramal, also marketed as Tramadol for humans. It's exactly the same stuff as given to humans, right down to the peppermint flavouring. This is because it hasn't been in use long enough or received sufficient funding to be manufactured in cat-friendly mouse flavour. Cats hate peppermint, and every time we dose her with it she drools copiously to avoid tasting or swallowing it. To maximise her dosage we use a very fine syringe for the 0.06ml dose, shove it as far back in her throat as possible, then hold her head up and mouth shut to encourage her to swallow the first rush of drool. Then we release her head and mop up the first few minutes of drool. Dr Laura says few owners are able to keep up this regimen (mostly through squeamishness) and frankly I don't blame them. It's not a nice thing to have to do to a pet on a weekly+ basis.
Being an opiate, the Tramal does not take Cally's pain away, but it does make her high. Boy does it make her high. I was put on the stuff when I had shingles and it was a horrible experience of wrongness, and everyone I've ever asked who's had it also reports the same. I'm hoping Cally doesn't experience the same kind of existential angst, but the drug certainly has a significant impact on her. She becomes restless and hyper-vigilant, and if she were human I'd say paranoid. She sees ghosts everywhere. Her eyes are circles and fully dilated. She gets very little sleep and doesn't even lie down for much of the first day or so. I don't know if she becomes itchy about the ears but she rubs her head aggressively against anything sharp, but preferably my fingers. I remove a lot of fur on these days, and use the opportunity to comb and groom her when she's not feeling the pain.
After the first day or so of this she starts to slow down, and then settles in to sleep it off. She goes through a phase of shaking as she comes down, and I have to resist the urge to give her another hit right then. If I do then she starts to build up tolerance and then starts vomiting without getting the benefit of the drug. So I've learned to let her dry out a bit and must wait until she's showing signs of the original discomfort before giving her the next dose. In this way I've managed to keep her at the same dose for a long time with no signs of developing tolerance or indeed intolerance. I'm told I'm doing the right thing.
I don't let her get too low before I deliver the next dose, and so far that's been possible to maintain. She still shows interest in the world, her appetite is good (perhaps too good, as she's now showing signs of a thyroid condition), her whiskers perk at me, she's quietly smoochy, and will even exchange pokes with the kittens. When she's high she'll even run around a bit and poke at interesting objects, albeit for short amounts only.
But there are times when she really does get creaky, when she does seem too tired to go on, when it takes a few tries to get up on the bed or the coffee table, when she's had enough of Buffy poking her tail. With Princess gone Buffy has focused a lot more of her playful teasing on Cally, and sometimes it's a bit much. She still has the power to glare at the kittens and make them back off, but I can see it costs her to do it. On really bad days her eyes sink, she trembles, and she purrs too loudly. She eats more, drinks more, and uses the tray more these days, but since she's losing weight at the same time none of this is good news. She had no love for Princess, but I'm sure the change in the cat population has caused her some kind of additional stress.
My task now is to read the balance between her health issues and the mental and physical costs of treatment versus the gains that treatment can give her. I don't count being high as a benefit - she's alert and mobile, but I can't help but feel it's stressful for her too. The best is the quiet time that comes after, when she's calmer but still feeling relief, or on warmer or dry days when her aches and pains aren't so bad and she can get in some quality window sill time. She still purrs when I scratch her chin. But one day the bad days will outnumber the good, and unless something happens to change this pattern it's up to me to keep score every day, and make the call every day.
I love that old psychopath. More so than any other, Cally is my cat.
Argh.