Introduction

This section is about living with CRF on a daily basis, both from an emotional and a practical perspective. The fact that CRF is ultimately terminal can be very hard to cope with. You may also be worried about how much to put your cat through, bearing in mind your cat's personality and the costs involved - looking after a CRF cat may sometimes require a lot of your time, energy and money. However, in most cases people and cats do learn to cope, and seeing how your cat improves makes it well worth it in most cases.

If you're not sure how much you and your cat can cope with, I would suggest that you opt for a trial period of, say, one month, during which you treat your cat to the best of your ability, and according to your financial limitations, and then review the situation. With luck your cat will be stable and happy and you will both be getting into a routine that works for you both.

Even so, occasionally things will get on top of you, particularly if you have little or no support at home. Some people cope better than others, depending upon their own personality or how well their cat is doing; but everybody living with CRF needs some level of support at some stage of the disease.

This section covers the following topics:

1. What is the emotional rollercoaster?

2. Emotional issues and support

• support from those close to you

• support from your vet

• on-line support

• support from yourself

3. Practical Issues and Support

• minimising the financial burden

• financial support in the USA

• balancing commitments

• going away on holiday or business

4. Quality of life/personal limits

• Mary Helen's experiences with Snicklefritz

5. Other family cats

6. Worrying about the future (anticipatory grief)

7. Creating memories

8. One last thing...

1.   What is the Emotional Rollercoaster?

The emotional rollercoaster refers to the mixed emotions you will feel as you care for your CRF cat. When your cat is doing well, you will feel good but will probably also be wondering how long it will last; and when your cat is poorly, you will feel emotionally drained and very frightened. These ups and downs are referred to on the CRF lists as the emotional rollercoaster.  

2.   Emotional Issues and Support

Support from Those Close to You

Many people around you will not understand why you are so upset about your cat's illness. You will probably also lose count, as I did, of the number of people who tell you that you are foolish to spend your money treating your cat. If possible, try to explain to those around you why it matters to you that your cat is terminally ill; but if they are unable to understand, then save your energy and try not to take it too personally. Really, these people are to be pitied because they obviously have never experienced the special bond that you have with your cat. If all else fails, tell them you need to feel you have done your absolute best to help your cat in order to minimise any guilt you might feel later on; many people will be able to understand if you phrase it that way. Then do not raise the subject again, but instead seek support elsewhere.

Support from your Vet

If you and your vet have a good rapport and are able to work as a team, it can make a world of difference to how you cope with CRF. Conversely, if your vet is not prepared to work with you at giving your cat a chance, it is an extra burden, making you feel like your cat's fate ultimately rests in your hands. It may be that you are never going to see eye to eye, in which case you need to find another vet; but it might equally well be a simple misunderstanding. British vets are very conscious of the quality of life issue, and may misinterpret your attempts to give your cat a chance and to make him/her more comfortable as you being incapable of letting go, no matter how ill your cat is. Do be prepared to listen to your vet's opinions and medical  knowledge, they have an important role to play in helping you to make decisions about your cat's wellbeing. At the same time, your vet must understand and respect that this is your cat and your opinions are valid too. Try to make it very clear to your vet that you have your cat's interests at heart, not your own, that you will let go when the time comes (if indeed you will), but that you feel that time is not yet here. Essentially you have to learn how to be your cat's advocate - the Special Needs Pets website has a helpful section about how to do this and how to work effectively with your vet. 

On-line Support

The single best piece of advice I can offer to those on the CRF rollercoaster is to join  the Feline CRF Information List. It is overwhelming to find other people prepared to rejoice along with you on your up days and to support you on the down days, and it really can make all the difference to how you cope on a daily basis. As an added bonus, you can obtain practical advice on problems that arise from people who have already experienced the same problems and who know what works in handling them. 

Support from Yourself

No matter how much support you do or do not have, you will probably have days when you feel overwhelmed, when you really do not think you can cope anymore, or when you feel you don't want to live this way anymore. And you know what? - it is perfectly fine to feel that way. After all, you are caring for a chronically ill family member, and facing the eventual loss of a treasured friend, a major emotional trauma. Accept that you may feel this way, and that it is fine to do so; and just get through the bad days the best you can. Above all, be kind to yourself - take a hot bath, buy yourself a book or whatever, and most importantly, give your cat a big hug and tell yourself that having to live with CRF is much, much superior to the alternative.  Consider using the Bach Flower Remedies (see Holistic Treatments) for yourself on days like this. But don't forget, your cat can pick up on your mood, so try also to focus on the fact that you do still have your cat with you, and try to enjoy his or her presence.  

Vetcentric has an article about coping with the stresses of caring for a sick cat.

Special Needs Pets discusses how caregivers need care too.

3.   Practical Issues and Support

Minimising the Financial Burden

Veterinary treatment is not cheap - and why should it be, after all vets have trained for many years and have a lot of overheads. If your cat is insured, then this will be much less of a worry for you. I strongly recommend insuring your non-CRF cats (I do not know of any insurance company that would take on a cat post-diagnosis) in order to remove this strain in the future. You can either obtain commercial insurance or self-insure (save money every month in a savings account for a rainy day). If you do insure your cat, make sure you use a company which provides cover for life; some companies will only pay for a condition for a maximum of twelve months, which is of limited use for a cat with a chronic disease like CRF.

In the USA it is possible to buy the necessary supplies from on-line pharmacies at much reduced prices, but this is less easy to do in the UK, although Obtaining Supplies Cheaply has links to a couple of such suppliers (and to Canadian and US suppliers too). If your cat is not insured and you are unable to obtain cheap supplies, but your cat is doing well on treatments, politely ask your vet if he/she could possibly give you a reduction for ongoing treatments, or perhaps provide some of the supplies you need at cost, either regularly or occasionally. Please note that your vet is doing you a favour if he or she agrees to your request, you have no automatic right to this. Also, if you can afford the upfront outlay, consider buying in bulk: once we knew Thomas was stable we bought his supplies for two months at a time from our vet and it worked out much cheaper for us. 

Financial Support

In the USA or Canada, some veterinary clinics accept a payment scheme known as Care Credit. This is essentially a credit card just for veterinary fees, which offers a variety of payment options, from interest free periods to extended payment plans. Unfortunately it did not have a very good report from the Better Business Bureau (though it has improved recently and is now rated B), but if you already have a standard credit card, you might prefer to use that.

The American Animal Hospital Association may be able to offer assistance of up to US$500 a year to people in the USA who qualify.

In Memory of Magic may also be able to offer assistance to people in the USA on a low income via its special CRF fund for CRF cats.

United Animal Nations offers assistance with veterinary emergencies to people on low incomes.

The Feline Veterinary Emergency Assistance Programme may be able to help those on low incomes in case of emergency.

Help a Pet offers a similar service.

The Pet Fund offers fundings to those with pets in need, though there is a waiting list of up to twelve weeks.

Balancing Other Commitments

Most people have to earn their living in some way, which will probably limit the amount of time that they can spend with their CRF cat. This can be particularly distressing if your cat is having a bad time yet you have to go into work or care for your children or elderly relatives. Try not to feel guilty about the conflicting demands on your time. If possible, take some time off work or find somebody who can take your children out of the house for a few hours if your cat is very poorly but do not beat yourself up if this is not possible. Try to make your cat comfortable and if possible arrange for somebody to call in and check on the cat's wellbeing - if you are at work, a phone call at lunchtime to tell you your cat is bearing up can be enormously comforting. 

Going Away on Holiday or Business

Another practical problem can arise if you are due to go on holiday or if your work requires that you travel on business. You may decide not to go on holiday while your cat has CRF but bear in mind that your cat could live for several years with this disease. In the USA and Canada it is possible to book petsitters who are happy to give your cat fluids and medications each day, but at this stage fluids are largely unknown in the UK so most petsitters would not be able to do this. You might be able to persuade a family member or a friend to learn how to treat your cat and to step into your shoes while you are away if your cat is relatively stable; or a local cattery may be able to assist. You could also ask at your vet's: often one of the vet nurses (vet techs) will be happy to come in twice a day to check your cat, give sub-Qs and medications and deal with food and littertrays in order to boost their income. If all else fails, consider booking your cat into your vet's - a least your cat will get the necessary medications while you are away and the staff in most veterinary surgeries will also stroke the cats and play with them if they are well enough and if time permits. And if you do go away, please try to enjoy your break: if you return with recharged batteries, it can give you the boost you need to carry on and your cat will benefit.  

Petsitters International can help you locate a petsitter in a number of countries.

National Association of Professional Pet Sitter can help you find a petsitter in the USA.

4.   Quality of Life and Personal Limits

You will probably be very concerned about your cat's quality of life; but please do not forget your own quality of life in the process. CRF is a very hard disease to live with, and if you feel you must be a saint in the process it can be even harder.  

You may experience immense frustration e.g. if your cat is urinating inappropriately. Whilst your frustration is probably aimed more at the disease than at your cat, it is possible that occasionally you will find yourself taking this stress out on your cat by shouting at him or her. This is obviously not something to be proud of, and you should try to avoid this kind of behaviour; but it is at least understandable. Please do try your best not to take your stress and frustration out on your cat, but if it does happen, try to put some space between you for a while until you regain some perspective; and tell yourself that your cat will remember many years of loving care rather than one moment of weakness. 

We all have our own personal limits in other ways too. Just as some people have more emotional resources than others, so some people have more money than others. If you can easily find the money to pay for your cat's treatment, that is one less stress for you; or you may not have too much money but are happy to go without other things in order to pay for your cat's treatment. It becomes more complicated though if you have others to consider apart from your cat; or if you simply do not have much money. It might theoretically be possible, for example, to take out a loan to pay for your cat's care; but not everybody can bear the strain of making loan repayments for months or years to come. 

There is no shame in acknowledging your own personal limitations in all these areas, and trying to accept them. This does not mean you love your cat any less, just that you have other demands on your financial and emotional resources, and that you must juggle everything as best you can. You are only human and can only do your own personal best - as long as you do that, you have nothing to reproach yourself for.

Mary Helen and Snicklefritz

Here is Mary Helen's story of how she decided what was important to her and her elderly CRF cat, Snicklefritz. This was in response to someone who asked why people keep cats with CRF alive when there is no cure for the disease. Your own criteria may be different but I think Mary Helen's words help us to realise that cats do not worry about their own health the way we worry for them.

"Snicklefritz wanted to live, and it was my job to support that until she was ready to leave. Because she could not speak English, it was up to me to work with the vet to carry out her wishes. Really very simple.

My father is in kidney failure and he doesn't always feel great, but he is preparing for dialysis and transplant screening, because he's willing to endure those "extreme measures" so that he can continue to live. Why should
our cats be different?

Snicklefritz was 22 years old and age had taken its toll, but her will to live was strong. Her eyesight had dimmed over the years and she no longer looked out the windows, but just because her world had gotten smaller didn't mean she didn't treasure her little niche.

She was arthritic and didn't walk and jump like she had, but that didn't keep her from enjoying her plush cat bed right in the middle of the living room, the center of the action, where she could watch and enjoy as family life with a toddler swirled around her. She happily slept with crayon drawings, stuffed animals, all kinds of crazy things tucked into her bed by my daughter, to the point where sometimes her happy purrrring face and the tip of her tale were all that you could see. She didn't need to walk much, her loving presence filled our house and people came to her.

She reigned supreme in her little fiefdom, and she was not about to give that up until she was ready. I'm not saying she liked the medicines, the vet trips, the fluids. But even though her life was very limited physically, she was happy loving us and being loved, and it was enough for her.

My mother lives out of state and had heard the saga of Snicklefritz's decline. She loved Snickle dearly and had gently suggested a couple of times that perhaps it was time to let her go. Well, my mother came to visit and watched as my darling 3.5-pound, arthritic old girl carefully and slowly walked across the room. With tears in her eyes, Mom looked at me and said it was like watching the walking dead.

And then, Snickle taught my mom a lesson. In her classic Snickle-way, she taught my mother an important thing about life. Never cranky, never scolding, always full of joy and love...

She went over and somehow managed to hop up to Mom's lap by herself. And she settled down and began to purrr her HUGE happy purr. And she looked up at my mother's face and gave her that slow wink of contentment and love.

Snickle may not have had much of a life, but it was enough. She might have felt pretty lousy, but it was worth it to be able to be with those that she loved.

She was 22 and wasn't going to be cavorting about like a kitten, CRF or not. But she was older and wiser and needed different things to make her happy. A soft bed, a loving family, that was what mattered to her at the end. She made a tremendous effort to say "goodbye" to us in her final illness and then she let go and stopped fighting. It was time, and although I miss her more than I can describe, I know that she was ready to go.

I think we can focus too much on what our cats have lost through their illness and not enough on what remains. Simple things like warm sunshine and time with our loved ones are the essence of joy...

My daughter was privileged to know Snicklefritz until she was almost 3.5 years old and was nursed through her second surgery by that old, frail kitty that loved with a passion and a strength that belied her tiny, arthritic body. We have greatly mourned the loss of our beloved feline companion, but we have also learned so much about the strength of love. And I know that my daughter knows that I would care for her with the same love and patience that I gave Snickle, even when it was not easy, even when I felt I could barely go on. And I learned that about myself as well..."

5.   Other Family Cats

Many people have more than one cat, and can find that this makes dealing with CRF even harder. You may find it tricky trying to feed your CRF cat a different food to the others (see Which Foods to Feed for more on this). You may feel guilty for giving so much of your time to the cat who is ill, perhaps feel you are neglecting your healthy cats. Your healthy cats will probably sense that something is not right, and may start to act differently. This is fairly common when the sick cat has been hospitalised and returns home - the other cats may hiss and spit and not accept the sick cat. This is usually only because the sick cat smells differently, and of the hospital to boot: if you can make all the cats smell alike, perhaps by rubbing each cat with a piece of your clothing or dabbing them on the nape of their neck with a tiny amount of vanilla, this behaviour usually disappears.

If you can, try to find a little time each day for your healthy cats - it can be very comforting spending time with a cat who doesn't need much care, and of course it is good for the cat too. But if you simply cannot find the time, do not worry too much, you can always spend time with your healthy cats later on, but your CRF cat's needs must take priority for now.   

6.  Worrying About the Future (Anticipatory Grief)

There is something called anticipatory grief, which is when you worry about and grieve over losing someone you love before they have actually gone. Sometimes when you are caring for a terminally ill cat, you worry so much about what is around the corner, and how you will cope, that you forget to enjoy the time you have together now. You may begin to focus more on your cat's illness than on your cat, forgetting that this is still the cat you know and love, even though his or her behaviour may be a little different. I did this all the time with Tanya, (though I was a little better with Thomas). I spent much of my time sobbing, as I envisaged life without Tanya, and I forgot to focus on the fact that right at that moment we were still together.

You may also find yourself trying to distance yourself emotionally from your cat, in a sub-conscious effort to spare yourself pain when he or she dies. But it doesn't work, you are going to feel pain at that time so you may as well try to enjoy your time together now, in fact try to savour every moment, enjoying your cat's uniqueness.

When Harpsie was diagnosed with terminal cancer, and the vet said he might only have a week or two to live, I made a conscious decision that I was going to do my best not to do anticipatory grieving. I figured if we didn't have much time left, I was going to savour and cherish every moment, and anyway, there would be plenty of time for tears later. So each day I would get up, and be glad Harpsie was still there, and if he'd eat breakfast (I was very lucky that he did keep eating) and his breathing was no worse (he had secondary lung cancer), and he seemed reasonably comfortable, I'd say to myself "I don't think today is the day", and then I'd focus on enjoying his company.

Of course I would get bad moments if he became subdued later in the day or something like that, and sometimes I'd get upset anyway, because the thought of losing him was so horrible. But I did largely avoid anticipatory grief, and I'm so very glad I did. I now have memories of our last two weeks together of him eating as I held the plate for him, of little chats where I told him how much I love him, rather than of me sobbing into his fur coat all the time (though I did this sometimes, of course). So do try if at all possible to just live in the moment and not worry too much about tomorrow. But of course there's nothing wrong with expressing your sorrow and fear sometimes too, bottling it up is not good for you.

Anticipatory grief often includes bargaining. When Harpsie was diagnosed with terminal cancer, my bargain was "OK, I accept I have to lose him, but I would at least like to be allowed to keep him until June please". In fact, we had to have Harpsie put to sleep on 23 May because of breathing difficulties ( he had secondary lung cancer). My bargain was not a bargain at all, because the situation was completely beyond my control - Harpsie's cancer progressed at a rate that had nothing to do with me. The Pet loss link below does have some information on the types of bargains which are more likely to be helpful to you.

I know all this is easier said than done, but this quotation might help you to live in the moment:

"There are persons who shape their lives by the fear of death, and persons
who shape their lives by the joy of life. The former live dying; the latter
die living".

Horace Kallen

Pet-loss net has a helpful article about what it calls "pre-bereavement", or coming to terms with the fact that your cat has a terminal illness.

The Association for Pet Loss and Bereavement has a weekly online chatroom available on Thursday evenings (US eastern time) to help people deal with anticipatory grief.

7.  Creating Memories

It can often be very helpful to create memories of your cat, in the form of photographs, video recordings, collecting locks of hair etc. - whatever appeals to you. My husband arranged for portraits of Tanya and Harpsie to be painted for me as a birthday present one month before Tanya was diagnosed, and I find them enormously comforting now both of them are gone.

I had also happened to start videoing Tanya a few weeks before her diagnosis, and I continued to film her even when she was ill. Before she died, I felt sure I would never be able to watch the videos after she was gone; but in fact, only a few days after she died, I felt the urge to watch them, and I sat there, with tears streaming down my face, yet at the same time finding the images tremendously comforting. I had begun to worry that I had kept her with me for too long, but watching the video taken only two weeks before she died, when she actually looked relatively well and happy despite being very thin, reassured me about her quality of life during those last few weeks; while seeing her before her diagnosis enabled me to remember her at her best. I still watch those videos even now, and they never fail to lift my spirits. Of course, I also have videos of Thomas, which are equally cherished.   

8.  One Last Thing...

Please try to remember that living with CRF is not always doom and gloom. The first few weeks after Thomas crashed when we were trying to stabilise him were certainly very hard emotionally, with us wondering every week if he would last another week; but after the first few weeks it was really quite simple. Giving him his medications took only 10 minutes a day and for the rest of the time he acted like a healthy cat, eating, sunbathing, grooming himself - and it delighted us to see it. When you reach some level of stability like this, then it really does make the emotional rollercoaster worthwhile.  In addition, many people on the Feline CRF Information list find that their bond with their cat is deepened as a result of the joint effort in fighting CRF. 

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