End stage, making a decision soon. Anything else to do?

13yo cat, various health issues, recently crashed. I posted a similar message in Tanya's support group, but posting here since we are going to the vet tomorrow and I may not come home with him.

Feb 11, 2026 (crash)
BUN: 191
Creatinine: 15
Phos: 15.8
SDMA: 53

This is his current/recent crash. His breath smelled HORRIBLE, like rotten eggs, and I could smell it from across the room. I thought his teeth were rotting out. He had gotten very lethargic and eventually stopped sleeping in bed with me. I couldn't get him to eat the renal diet for most of the past month, but did keep trying to give him aluminum hydroxide liquid (which he hated, I had more luck with Phos-Bind) and eventually just tried to keep him eating at all. I couldn't hospitalize for financial reasons, and given the limitations of his (more obvious now 3-4/6) heart murmur, the doctor prescribed 50ml subq fluids per day, more aggressive phosphorus intervention (100ml/day->225ml/day), daily famotidine, daily Cerenia, and he has also been on daily Mirataz. On Sunday, the vet called to check in and suggested taking his fluids up to 50ml 2x/day (100ml/day total) but to carefully monitor his respiratory rate for any signs of cardiac distress. I have now done this twice and he is tolerating it very well so far. His breath smell has significantly improved and no longer smells like rotten eggs, now it is more like normal fishy cat breath. He is still not eating much, so I am giving him whatever he will take, and a chicken breast slurry seems to be the best so far. I always add Phos-Bind and try to add B vitamins and anything else I can (HydraCare, Porus One, FortiFlora, B vitamins), but it's pretty hit or miss and he seems very sensitive to any change in scent.

So that is the current state of CKD treatments. However, he has some other complexities that factor in: he is FIV+ (former TNR), had a possible stroke last August which could have also been vestibular syndrome (I didn't get an MRI but he was examined by a neurologist and they said likely a stroke). According to tests has mild pancreatitis and he has really TERRIBLE teeth. Half of them have been removed, the rest have periodontal disease. I am worried that he has FORL/tooth resorption. He recently began grinding his teeth and now when he eats or drinks water he has to take breaks because he starts grinding his teeth or something like that. I cannot tell if it's actually jaw issues (TMJ? maybe his jaw catching? maybe it's arthritis?) and because of his delicate condition he cannot get a proper dental examination that would be able to identify actual tooth resorption. No elevated WBCs in lab results so I don't think there is an infection. My regular vet (along with another at the practice) have given him a superficial dental look and didn't see anything alarming, no lesions either. I am worried he is in pain, from his teeth and/or the pancreatitis, and that this is hastening his demise by preventing him from eating.

His current state is as follows. The positive: he is more alert, sleeping out in the open and no longer hiding in his cat igloo. He is still using the bathroom, especially peeing regularly (3-4x/day), but not pooping much. He looks more comfortable at the moment... he was restless and doing the pain crouch a lot last week, but now he is able to relax and sleep in a normal curled up cat shape, so I think his gastric (and maybe pancreatitis?) issues are improved. No vomiting, respiratory rate consistently 20-25 breaths/min. The negative: he seems a bit wobbly (but it's hard to tell, he has been a lil wobbly since the stroke), he still doesn't have much of an appetite or at least only has eyes for chicken and tuna, is losing weight, and isn't really grooming much, though I can't say that part is worse, just not improved.

Questions: Given where he started and where he's currently at, does it make sense to keep going? Is it even possible for him to recover from those numbers with supportive care at home? (Most of what I have seen says that these are numbers that require days of IV treatment.) Would it make sense to try a painkiller for potential tooth pain, given the risk of reducing his appetite? Is there anything else I could try? My vet is willing to work with me and would be flexible. I have pretty much every type of food/supplement you could imagine and at this point I'm willing to try anything.

Thanks for any wisdom you can offer.

Previous results/info:
Jan 15, 2026
BUN: 121
Creatinine: 7.6
Phos: 8.1
SDMA: 40

Aug 18, 2025
BUN: 39
Creatinine: 2.3
Phos: 8.1
SDMA: 15
RBC: 8.91
HCT: 40.2
HGB: 12.2

He also has mild anemia, results very similar between past two visits. I can add more results if desired, I am not sure what is relevant.