You will notice
that many of these symptoms are identical to those seen throughout the
course of the disease: this is what makes it hard to tell when your cat is
approaching the end of his or her life. The primary differences between
the symptoms of treatable CKD and the final hours are the severity of the
symptoms and the fact that they no longer seem to respond well or at all
If you haven't
already tried treatment - if your cat has just been diagnosed and is on a
IV drip at the vet's, for example - you should definitely consider trying the
various treatments available for a reasonable length of time before making
the irrevocable decision to euthanise your cat. This particularly
applies if your cat has high BUN/urea and creatinine, but has only just been
diagnosed. In such a case, these values may be reflecting an acute situation
such as a
kidney infection (commonly undetectable) or severe dehydration. In
many cases the
values will reduce dramatically with treatment. I therefore usually recommend
treating a newly diagnosed cat for at least two weeks before making any
irrevocable decisions. Please check the
Symptoms and Treatments page to find more information on possible
treatable causes of the various symptoms.
With those very
important provisos, here are the main signs that are commonly seen when a cat
is close to dying from CKD. Please, please do not take them as gospel, as
incontrovertible evidence that your cat's time has come. This is your cat,
you know him or her best, and if you are not sure if the time has come for
your cat to cross, and your vet is confident that your cat is not in pain
(CKD is not normally painful),
then it is better to wait until you feel more comfortable with your
decision. Of course, it may be that you are deluding yourself because you
simply cannot face the thought of losing your cat, which is
understandable. This is why your vet's opinion can be helpful: ask your
vet what he or she would do if this was his or her own cat, and factor
this response into your decision, but do not base your decision wholly on
your vet's opinion. Generally speaking, little or no harm is done through
waiting a day or so before deciding on euthanasia, and you will probably
feel more at peace with helping your cat to cross if you have time to say
goodbye, and time to come to terms with the fact that this is most
Possible Signs of the Final Hours
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Very High Urea
(BUN) and Creatinine Levels
These are not
in themselves a reason for euthanasia because many cats who are newly
diagnosed, or cats who
crash, have very high levels but pull through.
If your cat was
diagnosed some time ago, you may well
decide not to put your cat through the stress of additional bloodwork. If
your cat has just been diagnosed, I would ask for bloodwork to be run so
you can see how things look.
If the end is
near, it is quite likely that urea will be
over 55 (US: 150) and creatinine over 650 (US: 7.0), and - this is a key
point - do not fall after treatment. If your cat has just been diagnosed,
high levels such as this are by no means unusual and may not fall
speaking, urea and creatinine will continue to rise inexorably in ESRD. If
your cat suddenly experiences a hike in blood values, as opposed to a
gradual worsening, it may mean an infection of some kind is present, and
it would be worth trying treatment to see if this
helps. Similarly, a sudden increase or an increase for no apparent
reason may be a sign of high blood pressure, in which case you might wish
to get blood pressure measured and try medication before choosing
If your cat has been receiving sub-Qs but bloodwork is
worsening, you may wish to consider trying IV for a few days, in case it
helps to reduce the values to a level manageable with sub-Qs once again.
If you have not yet tried treatments such as IV or sub-Qs at all, as is
sometimes the case with cats who are only diagnosed when they crash, you
should give your cat a reasonable shot at these treatments. When Thomas
was first diagnosed, his numbers were off the scale and he was on IV for
four solid days and nights, yet his numbers did not improve; but nevertheless, after
treating his anaemia and using sub-Qs for a few weeks, he improved
greatly. However, in humans giving IV to a truly end stage person can
be risky, because it may cause
pulmonary oedema, and the same may apply to
Really high levels can cause inflammation of the
brain and seizures. Having said that, Thomas did enjoy a few weeks of good
quality life (including eating well and going for walks) with values close
to or above these numbers, and he is by no means the only CKD cat to do
this. Treat the cat, not the numbers.
Just to confuse
matters, in end stage CKD, creatinine levels may fall (although this is
pretty rare). This occurs because creatinine is a by-product of muscle,
and towards the end CKD cats may lose a lot of muscle, and therefore
cannot produce as much creatinine.
University of Georgia College of Veterinary Medicine
explains more about changes in creatinine (scroll down to
Variations in Creatinine Concentration).
High levels of
phosphorus may accelerate the progression of CKD and may also make the cat
feel poorly. It is usually pretty easy to control phosphorus levels, and
you should see a difference a week or two after taking steps to do so.
Towards the end though, you may find that, despite
feeding a low phosphorus food and giving large amounts of phosphorus
binder, your cat's phosphorus levels just keep on rising. Your cat will
probably become weaker as a result, and may have diarrhoea.
Please read up
on the importance of phosphorus control
CKD cats have low levels of potassium, in advanced cases the potassium
levels often increase as the kidneys' ability to excrete potassium decreases. If
potassium levels become really elevated, the cat can suffer seizures and
occasionally even a heart attack. You can read more about potassium
Urination (Oliguria) and Inability to Urinate (Anuria)
Most CKD cats
urinate profusely. In ESRD, however, the cat may produce less and less
urine, and in the worst case may eventually be unable to urinate at all.
Although this is relatively uncommon, because apart from anything else
most people have their cats euthanised before this stage is reached, both
Tanya and Thomas became unable to urinate and this came on very quickly
It is sometimes possible to "kick
start" the kidneys with
a diuretic such as
(Lasix or Salix), but in both Tanya's and Thomas's cases we felt, based on
our vet's advice, that this was pointless. It was this inability to
urinate that made us decide for each of them that the time had come for
them to cross, since being unable to urinate is extremely uncomfortable,
and things were simply not going to get better.
CKD cats are
urinary tract infections, which may result in the cat visiting the
litter tray and producing little or no urine. So do not assume the end is
near simply because you see this symptom, have your cat checked by the
an inability to urinate may be caused by a blockage or a kidney stone, so
you may wish to ask your vet if this is a possibility in your cat's case.
See Kidney Stones
for more information.
Pet Place has some information about
anuria in cats.
Just to confuse
matters, some ESRD cats develop the opposite problem and become completely
incontinent, urinating wherever they are lying. Often these cats do not
have the strength to move, and end up lying in their own urine or faeces
or both, which can be very distressing to the cat, since cats are
usually very fastidious. Do have your vet check to exclude the possibility
of a urinary tract or bowel infection, which might respond to treatment.
Very Strong Bad
CKD bad breath smell may appear or worsen as your cat gradually
deteriorates. We got Thomas's breath under control after he first crashed, but over the last two weeks of his life his breath got
worse and worse, despite his sub-Qs and other treatments. This tends to be
a sign that the toxin levels are increasing in the cat's body, although
occasionally bad breath may be caused by an abscessed tooth or gum disease.
The bad breath
smell may seem to emanate from the cat's body; this is because the toxins
are no longer being excreted properly, so are building up in the
develop when a cat first crashes, and can often be brought under control
once treatment is commenced. With ESRD, however, very severe ulcers, often
covering the entire mouth and even the throat, may develop, often quite
suddenly, and be unresponsive to slippery elm bark powder, although sucralfate (Antepsin or Carafate, see
may bring some relief.
Most CKD cats
vomiting at least occasionally
and it can usually be managed. You may find that the vomiting
just worsens to the point where you are unable to control it well enough,
and the cat's quality of life is severely compromised as a result. In
Thomas's case, this came on extremely suddenly, he hardly ever vomited but
the day before he died, he suddenly began projectile vomiting, which simply did not respond to treatment.
Appetite/Refusal to Eat or Drink
If a cat is
truly dying, the digestive process will cease to function and the cat will
not need food. Perhaps because of this, vets often seem
to tell people that if their cat will not eat, it is time to say goodbye.
almost all CKD
cats will stop eating or drinking at some point, and it can
therefore be very hard to know when this symptom takes on a more sinister
meaning. If you haven't tried to treat this symptom, please do so before
fearing that the end is near -
food is an essential part of the treatment plan, and a cat can improve
dramatically after taking in some nourishment. This is particularly
true of cats who have been having treatment at the vet's, where they may
be stressed and not eat.
There are various
causes of inappetance in CKD cats, so you need to be sure you've looked
into any of these which are present and treated them as appropriate. Cats
who don't drink are often dehydrated, so look into correcting that too.
Even when imbalances are under control, cats may have got out of the habit
of eating, so read
Cat To Eat page for more information on ways to get food into your
With Thomas, this
was a very dramatic symptom since he ate almost the whole time during his
illness, even when his creatinine level was over 7, until the day before he died, when it was simply impossible for him
to eat - if we had forced him, he would have vomited it right up. This was
because his digestive system was shutting down.
However, our Indie had very little
appetite for several weeks after a dental, yet she made a full recovery.
So it is important not to look at this symptom in isolation.
Walk and General Weakness
are often caused by either low potassium, high phosphorus, anaemia or
metabolic acidosis, all of which are treatable in principle; and, more
rarely, by a blood clot to the leg, for which the prognosis is less favourable.
If you haven't already done so, do try some treatments, but in ESRD, these
conditions may simply no longer respond to treatment.
section has a full description of the meatloaf position. Many CKD cats sit
in this position when they are crashing, but may recover with treatment,
so this symptom alone is not reason to panic. However, if the cat assumes
this position despite treatment, or in conjunction with other signs
discussed here, it may be cause for concern.
These can be
caused by very high levels of urea/creatinine, by high levels of potassium,
by high blood pressure, by calcium imbalances or by anaemia. If you are able to treat the
condition causing the seizures successfully, the seizures may not return.
This is usually
caused by high blood pressure causing the retinas to detach; in some
cases, treating the high blood pressure can mean the retinas successfully
re-attach, so try treating it first. Blindness alone is not a reason for euthanasia in my opinion,
cats navigate by smell rather than by sight, and are simply not as
psychologically affected by blindness as humans are (see
Hypertension). Blindness in
conjunction with some of the other symptoms described in this section,
however, may be grounds for saying goodbye.
take this as a sign from their cat that it is time to let him or her go.
This can certainly be a useful sign, particularly if you and your cat have
a very close bond, but be careful not to read too much into it, certainly
not without trying treatments first - dull, sunken eyes are often a
symptom of dehydration.
I personally did feel that I could see in Tanya's eyes that she had had
enough; but then I saw the same look in Thomas's eyes when he first crashed,
and he pulled through, which has left me wondering what more aggressive
treatments might have achieved for Tanya.
If you get this sign after trying many treatments, it is obviously more
reliable than if you have tried none.
Many CKD cats
prefer to be in a quiet place, such as in a closet or high up on a shelf,
so again, this alone is not always a reliable sign that the end is nigh.
In conjunction with other signs described here though, this may be
Some cats seem
to be unable to get comfortable, and keep moving from place to place,
never staying in one for long. Tanya exhibited this symptom on her last
Weight and/or Muscle Loss
By his last
couple of days, it seemed like Thomas was losing weight and muscle tone virtually by
the hour, despite still eating several times a day. We did notice this ourselves
of course, but it was
really brought home to us by the vet. She had not seen him for a few days,
and when I took him in the day before he died because of his sudden
terrible vomiting, she was really shocked by how thin he had become. This
had happened despite the fact that Thomas always continued to eat fairly
well: he simply did not have any reserves left to draw on. By the time
Tanya died, she weighed three pounds.
Many people are
delighted when their CKD cat gains weight, but if this happens quickly it
may mean fluid is building up because the cat's body is no longer able to
regulate body fluids. In many cases, this can eventually lead to
congestive heart failure.
The cat may
start to spend more and more time sleeping (which tends to be common in
older cats anyway) and may sometimes take time to respond and be difficult
to rouse; the cat's temperature may be falling as the cat's body shuts
down (other possible causes for a low temperature are
which may be treatable ). Eventually in some cases - if the end is near - the cat may slip
into a coma.
The cat may become confused and seem not to really "be there".
This can be a result of the toxins in the bloodstream, although there may
also be an element of
This may be
caused by the toxins in the body or by high potassium levels. Thomas began
to twitch on his last day. Of course, you should first try to treat any
possible causes of twitching as outlined in the
Symptoms and Treatments.
Heart Failure (CHF)
are relatively common in CKD cats, as discussed on the
Heart Disease page. These can often be managed with medication,
but the treatment for the heart condition tends to put additional strain
on the kidneys, and vice versa. In the worst case,
the cat may develop congestive heart failure (CHF), whereby fluids in the
cat's body leak out of veins and build up in the lungs (pulmonary oedema),
around the lungs (pleural effusion) or in the abdomen (ascites).
It is possible
to remove this fluid, either through the use of diuretics or physically
("tapping"), but once congestive
heart failure has developed, the outlook is relatively poor. Although some
people have managed to keep a cat with congestive heart failure going for
several months, this is unusual, and for most cats the prognosis is
usually only a few weeks. It partly depends on how often the cat needs to
have the fluid tapped: obviously a need for tapping every two days is
wholly different to a need for tapping every two weeks or once every
month. A cat in CHF is usually not able to absorb sub-Q fluids well, if at all,
which means the kidney values tend to worsen; it is basically a vicious
circle. In severe CHF, if the fluids are not drained off, the cat
effectively drowns from the fluid in the lungs, so it is important to keep
a close eye on the cat in case of distress.
tends to fall as death approaches, though you will probably not be able to
tell that this is happening.
Anaemia in CKD
cats is usually non-regenerative anaemia caused by the fact that the
kidneys are failing, and generally speaking it does not kick in until the
CKD is relatively advanced. Mild anaemia is unlikely to cause major
problems, and even with severe anaemia you may be able to treat it very
successfully with rhEpo (Europe: Eprex; USA: Epogen or Procrit), or blood transfusions
to give you a
breathing space; but in some cases treatment may be started too late for
it to help.
In general, however, unless your cat is already in an advanced
stage of renal failure at diagnosis (when there may not be sufficient time
to start treatment before it becomes critical), or develops problems with rhEpo or blood transfusions, there is no reason why a CKD cat should
die of CKD-related anaemia - but it is critical to keep an eye on PCV and
treat anaemia pro-actively if it appears. There is more information on
anaemia on the Anaemia
Improvement Before a Crash
have experienced this phenomenon, myself included. Tanya kept herself to
herself the last couple of weeks, hardly ate anything and generally looked
very delicate. The night before she died, she suddenly appeared in the
kitchen and ate a massive bowl of her favourite food of her own accord,
having refused to eat without a lot of encouragement for weeks, and even
then she had only nibbled. She then proceeded to spend the evening with us
for the first time in weeks.
Of course, when
she crashed the next day, this made it all the harder to accept because
she had been doing so well only the day before; but my vet reassured us
that this does sometimes happen. At any rate, once we were over the shock,
we were at least left with a nice memory of Tanya's final evening with the
It is natural for cats to hide when they do not feel well: it is a
way to protect themselves from predators. Some cats near the end may take
this a step further, and may actually run away from home and hide if they
are allowed outdoors. Even an indoor cat who normally never has any
interest in going outside may take the opportunity to escape if one
presents itself. Again, this is instinct, the cat is trying to find a
place away from predators, but unfortunately it may also mean that his or
her humans cannot find him/her, and that the cat dies a lonely and perhaps
uncomfortable death. For the cat who does survive and return home, the
lack of food and fluids during the absence can make an already sick cat
this with Thomas: he normally went out alone, but on his last morning we
took him out on a lead to give him a last chance to smell his garden. He
tried to run away, and would have succeeded if he hadn't been on the lead.
Since it is
terribly distressing not knowing what has happened to your beloved cat, I
recommend not allowing your cat out alone if you suspect the end
is near. By all means take him/her outside on a lead, but please do not
make the mistake of thinking your cat is too weak to move, you could get a
very nasty surprise.
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Even if every
single one of the symptoms described above were present, you still might
not feel ready to let your cat go. That is perfectly understandable: it is
one of the hardest decisions you will ever have to make. Plus, if you have
been devoting much of your time to helping your cat, it can be very hard
to accept that you can no longer do anything to help him or her - the
feeling of helplessness is an awful one, so we cling to the hope that we
just need to find the one magic treatment that might help. But the day is
going to come when there is nothing left to try.
When Tanya was
ill, I felt that I would never be able to bear having her put to sleep. The only way I
was able to do it when the time came was when I finally accepted that neither Tanya nor
Thomas was ever going to get any better than they were at that moment;
that we had tried everything in our arsenal but our weapons were no longer
working; and that waiting any longer would therefore ultimately be for my sake, not
for theirs. How much more could I ask of them? Ultimately you cannot avoid
death; but often it is possible to avoid suffering. Once I began to look at it from the perspective of what was
right for them and what would spare them pain, it was still by no means an
easy decision, but I did at least feel it was inevitable, because I simply
could not stand by and watch them suffer when it was within my power to
prevent that. By not acting, I would not be prolonging their lives, I
would be prolonging their deaths. Ask yourself, how much more can I ask of
him or her?
A friend sent
me a quotation shortly after Thomas died. It said that a good death was
not about when or how; it was about knowing love. This comforted me
greatly, because, for all my mistakes, my cats did know love.
When Is It Time?
If you do
decide to euthanise, the decision as to timing is often no easier. Some
well-meaning people may tell you that that your cat will let you know when
it is time to leave, that you will look in his/her eyes and "just
is comforting to think that your cat may effectively take the decision out
of your hands in this way, you have to accept that it is just as likely
that this will not happen. It might possibly be easier with a CKD cat to
look in his or her eyes and "know" that it is time, in that you
are probably giving your cat so much care and attention that you will know
when something is wrong; but that doesn't translate as always knowing when
it is time. I looked into Tanya's eyes and felt it was time; but then
later on I saw that exact same look in Thomas's eyes - and he pulled
through. So I know from personal experience that "looking into your
cat's eyes" is an unreliable indicator. I have also heard from people
who have been told they will "just know" and who are so
worried about looking into their cat's eyes for "the signs",
that they neglect to enjoy their time with their cat. So by all means,
hope for a sign; but do not count on receiving one.
At the same
time, always remember that nobody knows your cat like you do: if you feel
pressurised into making the irrevocable decision, perhaps by your vet or family, this
may distress you afterwards; so again, try to decide in advance what are
the criteria you personally would use for making the decision.
Talk to your
cat. Your cat is an adult, and should be treated as such. Cats do not fear
death as we do, they live in the moment. On the day
before Ollie died, he was not eating much and seemed a little restless. In
the afternoon he sat on a chair opposite me. I gave him a cuddle and I
told him that we loved him very much, that we were so glad he had come to
live with us and we hoped to have much longer together, but we knew things
were tough for him and that we would understand if he had to leave us soon
and he mustn't fight on our account. Two hours later he collapsed and I
rushed him to the vet, where treatment overnight didn't work so we said
goodbye. I often wonder if our little chat gave him permission to go.
If you feel
your cat is towards the end but not quite there yet, or if it is a holiday
weekend and you cannot reach your vet, your goal changes from prolonging
life to providing supportive care
focused on your cat's comfort and quality of life. This would include the basics to keep
your cat comfortable, such as
sub-Qs or treatment for mouth ulcers, but don't bother with other
treatments such as vitamins or phosphorus binders. If the end is truly
nigh, the cat will probably not want to eat, so do not assist feed, but
keep food and water available.
The American Association of Feline Practitioners has a brochure
about hospice care, with information on criteria to consider in relation
to quality of life issues, and where to find pet hospice services in the
The International Association for Animal Hospice and
Palliative Care offers
information and support.
Euthanasia Versus a Natural
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Whether To Choose
The first thing
you need to think about is whether you agree with the concept of
euthanasia. Some people think it is fundamentally wrong, and would not
contemplate it in any circumstances; while others view it as the last act
of kindness you can perform for a beloved friend. If you do not yet belong to
either category, you need to give this subject some thought.
If you do feel
you would consider euthanasia when the time comes, it can be helpful to decide in advance, perhaps in conjunction with your
vet, the criteria which will lead you personally to seriously contemplate
euthanasia. This is not easy because different cats have different
tolerance levels (and so do their humans); and many of the symptoms of
CKD, which might lead some people who are unaware of the latest treatment
options to consider euthanasia, can in fact be
You may hope
that your cat will cross unaided, or you may choose to let your cat die
naturally. My personal view is that helping your cat to cross is the final
act of love and kindness which you can do for them; but some people simply
cannot find it in themselves to do it, or believe it is wrong for moral
reasons. If you fall into one of these categories, that is your
prerogative and your wishes should be respected.
Some CKD cats do cross peacefully, in their
sleep, and yours may perhaps be one of them; but this is not
guaranteed. Therefore, if you are planning to let your cat die unaided,
please ensure that you are able to
contact a vet at any time should you
change your mind
if your cat appears to be in discomfort and decide that you want your vet to intervene after all. This should not be too difficult in the UK, where vets are
obliged to provide a 24/7 service, so you should be able to contact a vet
at any time, day or night. People in other countries may have to find an
emergency clinic if they need help out of office hours.
If you do decide
you want to utilise euthanasia when the time comes, I would suggest an
approach something along the lines of:
if your cat
is in pain, or about to be in pain;
if your cat
has very little quality of life, however you personally define that.
Areas for consideration might include whether your cat is incontinent;
whether your cat is able to rest comfortably; whether your cat still
enjoys interacting with your family. Obviously treatment might resolve
some of these issues, so what also matters is:
if there is
in your and your vet's opinion very little or no chance of curing or
controlling this pain or discomfort and regaining quality of life;
euthanasia. Dr Alice Villalobos has developed a
Quality of Life Scale (2004) Canine and Feline Geriatric Oncology Honoring the Human-Animal
Bond, Blackwell Publishing, Table 10.1, released 2006, which can be
helpful in determining whether it is time to say goodbye.
reading the foregoing, you may feel unsure about what to do. If you are
not yet sure, in most cases waiting a few more hours or
occasionally days does not condemn a CKD car to agony, but can at least help
to get used to the idea and to know that you have done all we could.
Thomas home to spend his last night with his family before he was put to
sleep the next day. He had become sick really fast, so this gave me time
to get over the shock and to be sure it was hopeless and to accept that
there was nothing to be gained for him from making him stick around (as I
mention above, if I had made him stay with us for a longer period, I would
have been prolonging his death, not prolonging his life). But having that
time together did help me, and I like to think he was not too
uncomfortable whilst we said our goodbyes.
However, if you
look at the list of symptoms you may see towards the end (see
you will see that some of them are more tolerable than others. I would not recommend waiting too long if a cat is suffering
from congestive heart failure, problems
breathing, cases of
PKD in which
the cysts have ruptured (this is rare), or
seizures where you cannot
find and treat the cause. If your cat can no longer urinate, you should act
promptly. If you are at all unsure, call your vet. Saying goodbye a few
hours earlier than you planned may be easier for you to cope with
afterwards than worrying that your cat might have suffered even for a
You should consider visiting
People's Losses page, which contains some personal histories
bravely provided by several people who describe
what happened during their cat's final hours, and in most cases why they
then decided to use euthanasia. These histories are very hard to read, but
offer a unique insight.
The Pet Center has a very sensitively written section about
Feline Advisory Bureau has a leaflet on euthanasia.
Clarkston Animal Medical Center
has information on making the decision and what happens during
If you do opt
for euthanasia, I recommend arranging in advance that your vet will come to
your home if possible when the time has come - this is often less traumatic for both you and your
cat, though some people think they will be haunted by the experience if
their cat crosses at home, which is a valid point.
Most UK vets are
prepared to come to your home, usually with a vet nurse to assist, though
you may have to wait until they have finished their day's consultations,
and you will probably have to pay more.
It can be much harder to find a vet who makes house calls in the USA
Association of Housecall and Mobile Veterinarians will help you
search for one.
Westoba Canadian Business Directory
has details of house call vets in Alberta, Canada. If you live in
Lap of Love
may be able to provide at home euthanasia.
Our vet kindly came to
our home at 9.30 p.m. on a Sunday evening to euthanise Tanya - it was a
terrible experience, but that act of kindness made it a little easier to
bear. Thomas was also put to sleep at home. This meant I could sob in
private, and also that I did not have to drive home; I really don't think
it would have been safe for me to drive in my state of grief.
If you do have
to go to the vet's, try to arrange for somebody you trust to drive you,
and aim to get the last appointment of the session if possible so you do
not feel rushed and fewer people will be in the waiting room.
It is also
worth deciding in advance whether you wish to be with your cat when he/she
is put to sleep. Again, this is a very personal decision. Some people
feel they owe it to their cat to be present; others simply cannot bear the
idea. Both of these approaches are perfectly valid. Personally, I
felt I had to be there because I felt the presence of somebody they knew
and loved would comfort and reassure my cats.
Many people are
very scared by the thought of euthanasia. Quite apart from the emotional
trauma associated with the procedure, there can also be a fear of the
unknown in terms of what to expect from a practical perspective: how is
euthanasia done, what exactly happens to the cat etc.
The basic aim
of euthanasia is to stop the cat's heart in a painless way. In order to
achieve this, an overdose of an anaesthetic, pentobarbital sodium or pentobarbitone sodium, is given by injection. If you have ever had a
general anaesthetic, I would imagine that the sensation of dropping off to
sleep is similar for the cat, since an anaesthetic is used in both cases.
must be given directly into a vein, and most vets will inject into the
front leg. The vet has to shave or trim the cat's leg in order to see the
vein clearly. Some vets insert a catheter, a tube through which they will
feed the anaesthetic but my vet's method is to just insert the fine needle
with the anaesthetic directly, which I preferred. Sometimes with CKD cats
it is hard to find a vein because the cat is dehydrated or the veins have
some cats may fight the process, so if the vet expects this, a sedative
may be given first. If you have a cat who hates vet visits, you may wish
to ask your vet to do this. In the USA it is quite common for the vet to
give the cat a sedative anyway before they give the euthanasia injection.
This is intended to relax the cat, and often the vet will then give you
some quiet time together, perhaps twenty minutes or so, to say goodbye to
your cat. Your cat may be relaxed but awake following a sedative, but some
cats may become very sleepy and not particularly responsive to you. My
British vet does not use sedatives because she says they can sting. I have
had euthanasia performed both with and without sedatives, and do not think
the sedative bothered Harpsie, but nor do I think putting my other cats to
sleep without sedatives caused any problems.
When it comes
to the euthanasia injection, some vets choose to give a small amount of
anaesthetic in order to send the cat to sleep, then they add a bit more in
order to stop the heart. My vet just gave one amount. It usually takes
effect very quickly.
Occasionally a vet may inject the cat directly in the
heart, which I personally would find very distressing. I would suggest
that you should not agree to this unless all other methods have failed; it
should certainly not be the method of first choice but may on rare
occasions be necessary if the cat has very low blood pressure. If you
do agree to this, insist that a sedative is given first.
Usually the cat
will look as if he or she is falling asleep, and then he or she will
gradually breathe more and more lightly until eventually the breathing
stops completely: this only takes a few seconds.
Most cats cross
peacefully. Unfortunately there is no guarantee.
It was very gentle and
gradual with both Tanya and Thomas, and we didn't find it scary.
checks the cat's eyes and heart and pronounces the cat dead. You may
notice a few little sighs even after your vet has pronounced your cat
dead; this can be extremely upsetting if you are not expecting it, but
fortunately our vet had warned us about this possibility, which is known
as agonal breathing. Tanya and Thomas
did indeed give one or two little sighs; this was just a physiological
effect of the muscles relaxing, not proper breathing. Very
occasionally your cat may suffer what appears to be a nosebleed - this is
also caused by agonal breathing, and simply means that some capillaries or
other larger blood vessels in the lungs have ruptured. This does not hurt
the cat because it happens after death. Tanya also
began pulling tongues, it was really just her tongue relaxing, and we
actually found it rather cute since she often pulled tongues when she was
stroking both Tanya and Thomas the whole time as they crossed. You need to
be aware that, just as there can be involuntary breathing movements after
death, so other muscles relax, including the bladder and the bowels. As a
result a cat may empty his/her bladder and/or bowels after death. For this
reason it is best to have a thick towel and/or incontinence pad on your
knee if your cat crosses while on your knee.
cats' eyes stay open after death. They look empty though, compared to the
depth in a cat's eyes before death.
It may help you
to spend some time with your cat after he or she has crossed. To be
honest, I found this necessary in order to be absolutely sure that they
had definitely crossed. It had been
hard to groom Tanya for a while before her death because she was so thin,
but I promised her she would be beautifully groomed after she had crossed.
I kept that promise to her. You may find it comforting to clip a lock of
hair as a memento, or to take a paw print. If you have other animals, you may wish to let
them view the body, because it may help them understand what has happened.
You may have a
vet who cries along with you, or your vet may appear to remain detached.
My vet never cries during euthanasia, because she wants to focus on her
job of helping the cat to cross as peacefully as possible; but she told me
that all her team do find it distressing and often need some emotional
support from their colleagues afterwards. So if your vet doesn't cry, please don't assume he or
she doesn't care; and please do not let this stop you crying yourself if
that is what you want to do.
Happens During a Natural Death
people decide to let their cat cross unaided, This may be for religious or
similar reasons, where people feel they do not have the right to choose
death for their cat, or it may be simply because they cannot face
making the decision.
If you decide
to do this, if possible allow your cat to be in a comfortable place of
his/her choosing. With cats who
cross naturally, you will still see some of the signs outlined above, such
as strong body odour; reduction in body temperature and possibly coma; hiding; incontinence; and twitching and possibly seizures. Some cats will
simply gradually fall into a coma, become unresponsive, and die a gentle death. However, other
CKD cats may have seizures and a heart
attack. Dying may be swift and painless, or it may be drawn-out and
uncomfortable; it may even be painful, particularly if your cat is in
congestive heart failure as well, when s/he will basically drown from the
fluids in the lungs. Unfortunately, it is impossible to predict
which cats will die in which way.
your cat's caretaker, it is your responsibility to decide what you want to
do. I do respect the fact that individuals have the right to make choices
for their own cats; but before you make up your mind, I think it is
important that you appreciate how unpleasant crossing naturally can
sometimes be. Below is the story of a CKD caregiver who would prefer to
remain anonymous. If you've already
definitely decided on euthanasia, do yourself a favour and skip this. In
the interests of balance, there is also the story of a CKD cat, Roady, who
crossed unaided in a peaceful manner.
died of CKD in my arms, without benefit of euthanasia, on January 4, 2002.
Not because I made a deliberate choice to have it that way but because the
vet didn't make it in time to ease his passing.
"My cat's last hours were not pretty to witness. His deterioration
was extremely rapid. He went from being weak but functional, to
being almost completely helpless, in a matter of hours. At one point
he managed to get himself up on a cat perch to sleep, but woke up later
needing to urinate. I had been in the room with him keeping an eye
on him, but sadly I wasn't in the room at that moment; I heard a crash and
ran back in to find that he'd tried to get off the perch to
make it to his litterbox but had been too weak, and he fell, hard, about
four feet to the floor. I found him laying there, stunned, leaking
urine and unable to get up. This was about two hours before he died.
I left frantic messages for my vet, who was scheduled to come the next day
to euthanize him, but she didn't get the messages in time to be of any
help. I put my cat on my sofa and sat next to
him. He lay there for two hours, too weak to do anything but
breathe, until he was overtaken with convulsions. He kept convulsing
in my arms for nearly thirty minutes (while my neighbor was driving us to
an emergency vet) until he finally took his final breath and left me.
I talked to him the entire time, telling him that I loved him and was
there with him, but I know he didn't hear me or even know that I was
"There was nothing peaceful about his death, nothing to make me come away
feeling like we'd shared anything noble or beautiful. I would have
far, far rather been able to hold him in my arms while the vet helped him
to a truly peaceful passing, before matters deteriorated to the point they
did. I would have rather spared him what he had to endure on the
last day of his life."
slipped peacefully away at 3:03 a.m. California time this morning.
"About 8:00 last
evening he came to me and wanted to be with me on the couch. My wife went
to bed about 11. She brought us a big fluffy towel and the
heating pad in case we got cold. I wrapped him loosely in the towel and
him in my arms. We stayed that way, until he passed. He gave a little
crackling meow, his bladder let loose and he was gone. There was no pain.
"Mine and Roady's final time together was the best and most private.
Something we would not have had, had I opted to take him somewhere to be
put to sleep.
"I knew Roady,
knew his wishes, knew in my heart that his crossing would be
without pain and it was."
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This again is
unfortunately something which you really need to think about in advance if
you can. Although we had previously decided to bury Tanya in our garden,
we had not given any thought to a suitable container so we were faced with
a real problem when she died.
Resting Place Options
your cat in your garden;
your cat in a pet cemetery;
your cat cremated and the ashes returned to you;
your cat cremated and not have the ashes returned to you.
Thomas was also
buried in the garden. Unfortunately, after we had buried him, I had a
dreadful urge to dig him up again just to make sure he was definitely
dead. I didn't, of course, but the urge was very strong, signalling my
unwillingness to accept that he really had gone.
choose to have your cat cremated, your vet will normally arrange for
your cat to be collected from the vet's premises and taken to a
special animal crematorium. You need to be aware that quite
often several cats will be cremated at once, so if you ask for the
ashes back, you will be receiving either mixed ashes, or possibly none
of your cat at all will be there.
If you wish, you can ask for an individual cremation (known as a separate retort), which usually costs more.
Some places will allow you to attend this if you wish.
If you choose to have the ashes returned to you, they will usually be in a
sealed plastic bag within a plain, simple container. Many people choose to
buy a nicer urn or some other type of holder.
Experiences with Cremation
We lost Harpsie in the USA, so since we lived in an apartment at the
time, we had no choice but to have him cremated.
I was dreading it. Many people had told me it
would probably give me a sense of peace and completion, which I thought
highly unlikely. I hated the thought of burning his lovely fur and beautiful
face in particular, even though all the humans in my family opt for
We chose to attend the cremation, which I gather is unusual. But we are
always present when we bury our cats, and we didn't want to do any less for
Harpsie. Plus I wanted the reassurance of knowing they had got the
So we set off to the oldest pet cemetery in the USA,
Hartsdale Pet Crematory (founded 1895). It was in a
beautiful tree-filled setting, and there was
torrential rain, which we didn't mind, it fitted our mood better.
Of course I sobbed my heart out but people were right, it was cathartic. We
were given plenty of time in a private room for a personal goodbye with
Harpsie. I'd been told that Harpsie might look a little
different, but I'm pleased to say he looked
exactly as he did when we took him up to the vet
the day after he crossed. They placed him in a
little casket for the viewing, with a little white satin pillow for his
adorable little head, and a little cat-sized white satin blanket. We
were able to hold and cuddle and stroke him, until we felt ready (after a
fashion) to part with his little furry body.
We placed two red roses in with him, and then watched as he was
carried respectfully to the crematorium. We watched the man (who was very
kind and considerate) place Harpsie in it, then we went inside the main
building to choose an urn.
We opted for a pale cream marble
chest with a few pinkish-red swirls - the
base colour is a similar colour to Harpsie. We felt this was very
fitting because when Harpsie was a kitten he loved sleeping
with his head resting on the marble hearth.
We then went for a walk and the heavens opened, so we got soaked to
the skin. We returned an hour later to collect Harpsie in his new form. It
was curiously moving.
We brought His Handsomeness home, and he now rests in his
chest under his portrait.
And whilst we of course still wish that cute little face, body
and personality were still with us, we do feel a
sense of completion that he is home at last.
In almost all cases I would suggest that burying your cat or having the
ashes returned to you can give you some small form of comfort, as if your
cat has come home to you. You may choose a pretty urn to hold the ashes,
or mark the grave in some way: we have planted a rose on the graves of
each of our cats, and placed a brass memorial notice on the wall nearby.
companies sell urns and caskets, although I do not know anything about them
(they are listed in alphabetical order):
a stone marker for under US$15.
sells a variety of urns.
Peace sells a number of urns and memorials.
Casket Gallery sells wooden urns and
photo-urns, and granite headstones.
Eturnity Urns makes handmade glass urns.
Pets sells burial markers and cremation
Pet Urns and Caskets sell wooden urns and
Paws 2 Heaven
sells a variety of pet remembrance items, with 10% of purchase price going
to a shelter or rescue group of your choice.
Rays of Joy sells stained glass urns.
Memorials sell a variety of urns,
markers and statues.
Pets in Paradise
offers a variety of urns and markers in the UK.
Remembered offers urns, crosses
and headstones in the UK.
love beyond the world cannot be separated from it.
kill what never dies.
Nor can spirits
ever be divided, that love and live in the same divine principle, the root
and record of their friendship.
If absence be
not death, neither is theirs.
Death is but
crossing the world, as friends do the seas;
They live in one
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This page last updated: 24 January 2012
Links on this page last checked: 27 April 2012