I can feel the fatigue and sadness in your letter and just had to respond. As someone who's "been there" with a sweet and gentle cat, I utterly relate to what you've written. It is a very, very difficult situation. It sounds as if you and the doctor are doing everything you can, and I wish there were something more optimisitic I could say. I suppose on the positive side, at least the nitro paste is pretty easy to use. Are you applying it "bare" or covering it with some sort of tape? (I was a critical care/E.R tech and we always used a piece of cloth Zonas tape upon which we wrote the date and time of application, which can be very helpful at home, as well. It helps you keep track of your meds, especially when there are so many, helps keep the kitty from flinging it off by head-shaking and minimizes your exposure to the nitro, which you could absorb through your skin.)
But the real question I think you are asking is about quality-of-life. Am I correct? It is terribly distressing to be in one mode where you are watching, monitoring, and hovering over your beloved kitty, looking for some signs of hope, but more often than not, becoming more worried as new symptoms develop. Then there is the whole sad business of administering the meds...it struck me as ironic that the medications I was shoving down my poor Yuki in an effort to make her more comfortable and hopefully extend not just the length of her remaining time but the quality as well--seemed to be making her worse. I don't know if it was the meds themselves and possible side-effects or the sheer exhaustion she seemed to experience post-treatment. She hated pills; I tried slurries and liquids, and had varying success with those, but still, what it came down to was the heartache I felt when I'd approach her and pet her--how she loved that! --only to have to haul out the magic box of stuff she just hated. She'd be breathless and tired after I administered the meds, no matter how gently I did it. Then she'd go stand in her "unhappy spot" in the hallway, with her back turned to me for a little while. I can still see her there, and if she'd been a cartoon, then the balloon would have said, "Traitor!"
But what to do?
Eventually--and that "eventually" actually came quite suddenly one morning following a very happy evening where she lay on my chest, kneading and purring with so much gusto, I thought she'd burst--Yuki's condition became critical. Of course, I'd been jousting with the idea of "letting her go" off and on over the course of her illness, but on this particular morning, I just knew. I knew that no matter what we did in terms of medical treatment, that the likelihood of her being around in a week--let alone a month or a year--were probably nil. I just knew it. There was no way this could continue. I knew she'd gone into acute congestive heart failure, and I was losing her. I jumped in the shower, preparing myself to get her to the hospital for what would either become a life-support situation, or euthanasia. My thoughts were quite clear in spite of my rushing around.
However, a sense came over me as I wrapped a towel around myself: a sense that it was already over. I don't know how I knew, but I did...when I turned the corner after leaving the bathroom, I found her motionless, peaceful, quiet. That's how swiftly she went. What a generous soul she possessed! Yuki had spared me the final decision. I was very fortunate to have had that wonderful evening with her only about 12 hours earlier. I knew she'd had quality to her life because she'd been happy just that recently. Now don't get me wrong: I bawled my eyes out and I cried a LOT in the weeks and months to follow.
And I am very much aware that most caregivers of cats with HCM don't have such a "clean ending" to the story. But it's just not possible to predict some of these things. Knowing what I know now, I guess my advice is, to talk with your vet, or even with yourself, and get an idea of how much time Caramel has left. I know that no one can say for sure, but if you approach it from the "do you see him being here in (a year/month/week)" type fashion, you may get a better picture of what to anticipate and that may assist you in whatever decision you make.
It has been seven months since Yuki passed away. I know that she'd be in kitty heaven now no matter what course of action I'd chosen. There's something about knowing this that comforts me. Not long after Yuki's death, a little kitten came to me in a state of distress--he had an injury that his owner could not afford to treat. He was such a friendly little guy, I was instantly smitten. The owner relinquished custody of this kitten and now he and I were face-to-face...and somehow, I knew Yuki would approve. He came home with me, I nursed him back to health, and since then, "home" has not been the same! He is a thunderbolt, a rocket, a clown, a loverboy, a brat, a prankster, my other cat's best friend/accomplice and at times, the bane of his existence. He is now eight months old, and a long, lanky, loveable buffoon and I cannot imagine life without him. He poured sunshine over my heart when it was heavy with grief. I saved his life, and in many ways, so did Yuki. Sometimes I feel as if I can almost see her gazing at me through his big blue eyes in one of his moments of sweetness and calm. (Yuki was also a Siamese cross with gentle blue eyes.) The heart doesn't forget, but it does heal.
This is not meant to tell you to do something or not do it, but simply to let you know that things eventually get better, no matter how rocky it is now or in the near future.
Cheryl, I hope this helps in some way. Please know that there are many people here who care very much about you and your beloved Caramel and we are all here for you.
[Non-text portions of this message have been removed]