Sunday, March 18, 2012

Some resolution?

Melissa has a friend who, aside from being a massively talented and caring human being, communicates with animals.  I spent much of the day in a room with her friend, "L" and 100 cats.  Incredible, simply incredible.  (And it confirmed my recent realization that I like cats a whole lot better than most people.)  Anyway, for hours, I sat there, wishing that she would ask me if I would like her to talk to Scruffy.  (Of course, I know why she didn't/couldn't - it just would have been easier for me.)

Towards the end of the day - during which I had literally been amazed over and over again about what an unusual person L was - we were alone in the room, except for the bazillion cats.  And somehow, I heard myself ask her if she would talk to my Scruffy.  She came right over to where I was sitting, pulled up a chair, and laid her hand on my knee.  And closed her  eyes and sat in silence for some time.  And then she said, "He's here."  I was already crying.  And I didn't know if I could talk or ask questions, or if I was just supposed to wait and absorb what she/Scruffy said.  So, I just waited.  She said that he was pain-free.  No pain.  Several times.  I don't know.  I have to say here that during virtually all of the two months of Scruffy's leaving, I really didn't perceive that he was in significant pain.  I know, they hide it and all that, but he just didn't act any differently than he always had.  The oncologist, when he was first diagnosed, had given me a dozen syringes with buprenex in them, but he said that he didn't expect that there would be much overt pain.  No, I didn't ask how he knew that.  And I have liver disease - I know that it can cause excruciating pain, and I can't imagine that a big fat tumor sitting in your liver and a whole mess of them in your spleen couldn't hurt.  So, maybe I was deluded.  I don't know.

She said that he emphasized that his last week he had absolutely NO pain, and asked me if it was a particularly traumatic time.  And I was surprised - because, it had been a week that - except for the tumult of trying to make myself make the appointment for the final vet trip and the upset about not being able to get a Saturday appointment - was actually very peaceful and calm. Once I knew that it was time, I let him eat his beloved Fancy Feast without the stupid phosphorus binder, and without worrying about how low the phosphorus content was.  I didn't go to my mother's in the evenings.  And we spent so many hours just sitting in my chair, while I rubbed his ears and scratched his chin.  It was a sad but calm time.  I never thought that it was traumatic.  Oh, I hope he didn't.

And he agreed that he was ready to "go".  It was time.  It wouldn't have been good to have waited.  Which was probably true.  Although I am convinced that - having reread that vet article about animals dying at home - that he wasn't in shock or whatever horrible stuff they suffer during those last days.  His blood pressure was normal.  His gums weren't sticky and his skin was elastic - I gave him fluids two and sometimes three times a day, plus he drank a lot from the bathroom sink, although he still only peed twice a day.  He ate and ate, exactly like he always had, going from dish to dish and gobbling.  I couldn't find him to give him his fluids one night and he turned out to be on the top level of the cat tree - 8 feet up in the air, and he got there and down again on his own.  I don't know.  I don't know.   That said, I don't think I could have waited  much longer.  I certainly didn't want him to have any more chemotherapy treatments - and I had never given him the cytoxan pills I was supposed to.  (I can't even find the damned things now - I wanted to donate them to the Specialty Hospital for someone else to use.)  I couldn't have watched  if he'd been throwing up or too weak to move or not showed enjoyment of things that had always been important to him.  So,  yes, it was time, painful as that is to think about. And she said that Scruffy was grateful for all the stuff that I had done for him over the years, that he knew he had been lucky that I wanted to take care of him and get past all the awful diseases he'd had, one after another.  And I shouldn't feel guilty about not knowing that he was so sick.  Which, God knows, remains one of the things I just can't get over - how could he had had all those tumors and still have been exactly what he'd always been?  I can't understand it; no amount of feline staunchly hiding pain and discomfort makes sense to me here.  The fact that we only even found out that there was something wrong by accident, by coincidence. I can't deal with it.

Anyway, she said Scruffy was still "here", because he had to stay because I was in such pain and couldn't allow him to go.  She said that there is a Collective - a place where all the souls of cats who die go, and that when their souls join together, they have a huge power that is used to help other cats who are still here.  And that Scruffy wanted to go and be a part of the Collective, but first I had to let go of the "string" that I was holding him to me with.  He can't leave me while I am so sad about losing him.  He was always such a sweet, caring cat; that's not a surprise, I guess.  She said that there's no time limit for allowing him to move on, but that he's ready when I am.

A tiny, sad, sick little cat had picked me to hold her almost all afternoon.   While L was saying all this about the Collective and how Scruffy was waiting for me to allow him to move on, I suddenly became aware of stroking this sweet little black cat and of the sensation of feeling one tear rolling very slowly down my cheek and dropping on my shoulder.  I had a quick flashing image of an open book and a page being turned.  And a kind of semi-peaceful feeling - not that it was all resolved, or that I would never cry again or anything; just that it seemed like a portion of the sadness was fading.

And then L took her hand  and held it out in the air between us.  I reached out to hold it, just kind of instinctively, and she said, "He's here.  That's Scruffy. And he'll always be here."  And I thought, oh, let it be him.  I needed to think that he was there.  And that I could touch him just one more time.

It was an almost three hour drive to get home, and I cried virtually the entire trip.  Not violently sobbing or anything, just sadness.  Thinking about a thousand things, and about letting the Puffer go on to his next adventure.   Now I really think that, because of all of the thousands of hours and days that I spent actually doing stuff to take care of him - not just feeding and petting, but "treatment" things - somehow maybe part of my seeming inability to heal and accept his loss is a kind of "caretaker syndrome".   This last time, there was no happy ending.  Giving away all of his medications and the syringes and the eyedrops and the fluids and the cancer treatment stuff - was like giving away my identity as his "caretaker".  But, it's done and he's gone.  I need to be able to say "Fly free, Scruffy" and mean it.....

Saturday, March 10, 2012

Irrelevant Ramblings

I was just "closing" Scruffy's Feline Diabetes spreadsheet, and it occurred to me to wonder how far back his meter goes.  So, I checked.  May 3, 2008.  Just under a month after that magic time when he went OTJ on April 8, 2008.  In almost 8 years, he had only two glucometers - both One Touch UltraSmarts.  I guess I will be saving this last one, along with its ugly black case and the no-longer-manufactured-lancet device that was so much better than the newer one that replaced it.  I hope saving it doesn't jinx any of the ten remaining furry members of the family.....


Yesterday was the first time in the four days since Scruffy died that I left the house.  It sounds so dumb, but I couldn't bear to get a shower without him being there.  Since obviously I can't give up bathing altogether, I forced myself to do it, standing in the tub with the water streaming down on me, sobbing my eyes and my heart out.


Someone posted this week on the Feline Diabetes Message Board about the effect of steroids on FD.  I did want to record someplace - here, obviously - before I forget, that while the IV dexamethasone while he was hospitalized did significantly increase Scruffy's glucose level - into the mid-200's, generally, the prednisone that he took daily for the rest of his short life - about six weeks - really didn't do much of anything negative.  I don't know if it was related to the increased fluids (twice a day, instead of once).  In fact, the oncologist felt that continuing the prednisone , even though it was scheduled to be tapered off, might be helpful in reducing the inflammation in his failing kidneys and helping them to remove some of the excess calcium.   His diabetes was steroid-induced in the first place, but pred wasn't the crisis I expected it to be.  All in all, becoming an active diabetic again was pretty much a non-starter for my sweet boy.  His little pancreas had apparently actually healed quite successfully.  I guess we got one break in all this horror.....


My good friend Linda (of Linda and Wild Thing fame, if anyone reading this belonged to the Feline Diabetes Message Board) sent me this:

It just arrived today.  A grave marker, with Puffy's name on it.  It made me cry.  (I probably didn't need to say that, since everything still makes me cry.) I'm thinking about how I want to fix the grave now. The marker, and maybe some flowers.  And maybe one of those little white picket fences for the whole area under the apple tree where all of our cats are buried.  Thank you, Linda.


This showed up in my inbox the day after Scruffy died.

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Letting Your Dog or Cat Die at Home

March 07, 2012 / (21) comments

For the past two weeks, we’ve talked about signs that require a mandatory emergency veterinary visit. The reason why I’m harping on this is because I’ve seen or heard about a lot of pet pain and suffering as of late. This week, we’re going to discuss whether or not it’s appropriate to let your dog or cat die at home. The short answer? No.

I have a lot of friends and family who think it’s okay to let their pet die at home versus having to bring them to a veterinarian for humane euthanasia. You may think you’re sparing your pet the "stress of a veterinary visit," but in fact, your intentions (while well intended) are, to put it bluntly, wrong.

Let me be bold — for the sake of your pet’s quality of life — by stating that allowing your pet die at home often results in the double "S": Slowly Suffering.

If you surveyed veterinarians, I’m willing to bet that the majority wouldn’t let their cat or dog die electively on their own at home (unless it was for religious purposes, but that’s a whole different ball of wax). Our oath as veterinarians is to prevent suffering and, in my opinion, it is a gift that we are able to relieve suffering via a pain-free injection.

By letting your pet die at home, you may eliminate that hard "decision" of having to end your pet’s life … but it’s not always for the best. Making the decision to euthanize is a horrible, stressful, painful process, and I had to make it with my own dog back in July 2011, so trust me, I know how hard it is.

In human medicine, hospice care often involves a lot of analgesia — pain medication — that relieves any symptoms. This is traditionally in the form of intravenous, constant rate infusions (a.k.a. "CRIs") of morphine. The benefit of a constant flow of pain medicine into a vein? No pain. Unfortunately, the tradeoff for that CRI of pain medication is that your loved one is unconscious, sedated, can’t relate or respond to you, and has poor cognitive response because they are heavily sedated. That said, they are pain free, which is good.

In veterinary medicine, hospice care is just starting to take off (I’ll elaborate on this another time). When pet owners take their pets home knowing that their beloved pet has been diagnosed with end-stage disease, they don’t always have that option of intravenous morphine being constantly dripped into their pets’ veins. In fact, it’s important that a veterinarian counsel the pet owner on when the "right" time to humanely euthanize is appropriate. For me, it’s when their quality of life is affected: when they can’t get up, when they don’t want to eat, when they are hiding, when they cry out in pain or act really clingy, or when they stop acting like a joyful puppy or kitten.

The key thing to keep in mind is that you, as a pet owner, may not be able to pick up on the body’s sympathetic response to stress; in other words, how the body (your pet’s body) will always try to save itself. The body doesn’t want to die and will attempt to trigger key homeostatic mechanisms designed to try to keep itself alive. The body’s goal: to maintain its heart rate, blood flow, and blood pressure. When you let your pet die at home, it may seem "peaceful," but it’s not — with the exception of severe, acute hemorrhage (where the body bleeds out quickly and the patient loses consciousness).

When you have a pet with chronic anemia, chronic kidney failure, cancer, or other metabolic problems, they are typically very dehydrated and "in shock." Their heart rate is typically racing to try to maintain their blood pressure and oxygen delivery. It’s the equivalent of feeling light-headed, dizzy, oxygen starved, and too weak to get up, while having heart palpitations for the 1-2 days before you actually succumb to death. Not a fun way to go.

If you can imagine feeling really, really hung over, that’s you just being dehydrated after 12 hours of drinking. Imagine the headache, nausea, and light-headedness that your pet actually is succumbing to from days of not eating. Because they may not show signs of suffering (as their goal is to please you, right?), you may not pick up on these subtle hints of the "double S."

Any easier way to check? Check their pupil size. Depending on the lighting in the room, pupils are typically very dilated in the presence of shock and body stress.

I know this isn’t a topic people like to talk about, but I don’t like seeing pets dying at home. It’s painful. It’s slow. And, contrary to what you think, it really is a gift to be able to prevent your dog or cat from reaching that point of shock and dehydration before humanely putting them to sleep.

When in doubt, talk to your veterinarian. A lot of veterinarians will now go to homes to minimize transportation stress. I'm a firm advocate of this, as it’s much more peaceful for all involved.

Justine Lee

from the PetMDNewsletter

Did it make me feel any better?

Wednesday, March 7, 2012

Dangling from the Lifeline

Okay, I'm back again, but it's been less than 48 hours since Scruffy left, and I have 9 years of stuff saved up....

I woke up this morning - without opening my eyes - to the definite sensation of a cat laying across my thigh and a furry head resting in  my cupped hand.  Just like it was supposed to be!  At first, I thought it had to be my imagination, a longing to have Puffy back where he belongs, and then, reality returned.  Short, very soft smooth fur, and a big rumbling purr - definitely not my Scruffy.  It was Busy.  Who is a mildly interesting story on his own - he's around 12.  And he has spent his entire life here, since he was 4 months old, desperately wanting to be The Cat in Charge.  For some reason, probably because he's kind of a goofy cat, he never succeeds.  When Black Kitty died, and when Pickle died, poor Busy tried, it just didn't work.  Scruffy, on the other hand, was absolutely oblivious to the pecking order.  He wasn't interested in positioning himself for power.  He wanted to sit on my lap regularly, he wanted copious amounts of food on a nibbling schedule, and that was about it.  He knew who he was, lol; he didn't need to boss anyone else around.  He was willing to let Milkshake drape himself all over him, he didn't mind sharing a food dish, but otherwise, he was firmly fixated on maintaining his dignity.  And me.

Morning wake-up scritches

The snow has melted.  When the dirt over Scruffy's grave dries out a little, Rege is going to smooth it out and put the "turf" back in place.  I bought this kit at Michael's last year to make plaster steppingstones/markers. I got all sorts of accessories, too - bottles of dye to make them different colors, molds in varying shapes, an odd little plastic holder that is supposed to let you apply letters to the marker.  When I get the unused caskets off the kitchen table, I guess maybe I'll try my hand at marker-making.  Or not. I'm having a hard time concentrating.  And I haven't seen my mother in two weeks. Maybe marker-making will have to wait....

Scruffy's empty grave, before the snow

Knowing that Scruffy's time was limited - but not HOW limited, sadly - I have been taking tons of pictures.  Mostly they're the not wonderful, blurry type that are my unfortunate speciality.  I have very few close-ups that show how pretty his markings were.  And now I'm thinking, geez, I loved his big furry feet - and I don't have a single picture of them.  I did think about getting one of those footprint kits that other people's vets always seem to make as a memento.  Because he was spending a lot of time on the cat trees at the end, which put him right in front of my chair, I do have a bunch of pictures of the Ploofy Tail.  I loved his Ploofy Tail. It was so thick underneath the not-particularly-attractive long fur.  Not that he let me touch it very often.  Anyway, he had a kind of smooth bouncing way of walking, and the Ploofy Tail would wave in the breeze behind him.

The Ploofy Tail

Maybe I'm done here, after all.  I want to finish the medical stuff from the Specialty Hospital.  And maybe that will be enough.

I love and miss you, Puffy.  Come back and see me sometime soon, all right?  Just to let me know you're okay.


What I'd give to know what he's thinking about here.

Scruffy developed a taste for tea towards the end.  I wish I'd known years ago how much he liked lactose free milk, too.  :(


Tuesday, March 6, 2012

I'll have a cup of sorrow, with a teaspoon of regret and just a dollop of tears....

Well, I thought yesterday's post would be the last.  Somehow, I still have all these disjointed things flailing around in my mind, and this seems like the logical place to put them.  My apologies.

First, I have a clear comprehension that this was a CAT here we're talking about, and which I am mourning.  I realize that there are people who have lost human loved ones who would think my sadness reflects some sort of innate unbalance of sentiment.  Or something.  But, the reality is, yes, he was a cat, and yes, I've lost - just sat here and counted them on my fingers - eight other cats over the last forty years.  I guess the difference is, thanks to Scruffy and feline diabetes, I had developed the obviously false expectation that, if I did X, Y, and maybe Z and found people who had experience with whatever it was, disease processes would stop/back up, and life would go on.  Like, I could read and learn and DO stuff and the disease would pull up and say, "Whoa - I'm outta here.  You can have this scraggly little cat back."  I'd had the luck to get Scruffy through a whole variety of stuff that was particularly unpleasant for him - urinary blockages, diabetes, melanoma and laser eye surgery, and Milk's epilepsy bowed to my extreme good fortune after only a year of diddling around with medications.  So, in the back of my mind, there lurked this tiny little hope that maybe the cancer that had snuck up on us would disappear.  The problem was the kidney stuff - you only get so many nephrons, and Scruffy's were giving up the ghost at such a fever pitch that even my skill at deluding myself was overtaxed.

I'm thinking I should have seen one of the IM specialists. Right in the beginning.  At the first mention of elevated creatinine.   Choy-Foong told me about Aluminum Hydroxide and sent me hers; the Tanya CRF website had a list of foods and their phosphorus levels; Choy-Foong also sent me Meowzi's remaining azodyl capsules.  The euphoria of finding that the tumors were gone was so short-lived because I didn't understand that that didn't mean more cancer wasn't lurking in all the little nooks and crannies of his body.  Or that his kidneys - that I worried about the WHOLE time he was a vastly uncontrolled diabetic and they turned out to be fine - would never get the chance to just diddle along toward failure at a more normal pace.  There are people on the CRF boards whose cats have had CRD/F for nine years!  I would have been thrilled with even one year more.  Although, then I think, yeah, but I'd have to go through all this pain and sadness with Scruffy again - and I don't know if either of us could have tolerated it.

I woke up this morning, way earlier than I would have chosen, to find one tear meandering very inefficiently down my right cheek.  Like, even in my sleep, my heart is so disrupted that it's got a sort of leak.  I haven't had an actual decent night's sleep since Scruffy started chemotherapy; he woke me up a dozen times a night. He'd stand on my chest - I'm a really deep sleeper, normally - until I woke up, and then he'd head-butt my chin until I'd uncover both hands and rub his little ears.  His "eary-beeries".....  And then, he'd go back and flop down with his head in my hand again.  It was so endearing.  I'd give most anything to have him here to wake me up again.  Yeah, I know - it's been less than 24 hours, and numbness will set in. Eventually.

I have been instructed by Melissa that there is to be no expression of regret about the timing of Scruffy's demise.  (I was gonna type the other "d" word, only I couldn't.)  That it was the right time solely because it was the right time.  And then I think, well, yeah, but I bet I could have kept him alive for another week or so.  We'd already spent six weeks of nearly every minute involving doing something to, with, or for my sweet boy.  I had all the pills, I had the fluids, I had the doctor's appointments, blah, blah, blah.   Would he have been happy? Well, truthfully, yeah, I think he would have.  He didn't ask for much, and he never really quit eating with some enthusiasm, which, to my mind, is the key to survival for a cat in most circumstances. The thing that scared me was his dying - the actual dying - from kidney failure.  I was watching a Tom Selleck movie over the weekend, and he had a dog that wasn't doing well, and when he took it to the woman vet - she had NO personality - she said, without any discernible testing being done that I could see - that the dog had "kidney failure" and there was nothing that could be done and he should be "put down because the end wouldn't be pretty."  I had looked up on the Tanya website the section about The End.  There was a whole chart of horrible things, and of course, there was no way to know which one/ones Scruffy would get.  I was terrified that he'd end up in seizures in the middle of the night and there wouldn't be anything I could do to help him.  Or that he'd die when I wasn't home or something. So, yes, maybe deciding when it would happen and being able to make sure that there was no undue pain involved and that I could be there for him, even if he didn't know it - well, it made a kind of twisted, stomach-turning sense.  Occasionally, on the Feline Diabetes Message Board, people would come on and post about whether their cat was ready to "go."  And someone would say, in essence, "Well,  I know a lot of people who've said that they waited too long, but hardly anyone ever says they did it too soon."  I'm not sure about that.  Maybe I did it too soon.  Maybe Scruffy wasn't really getting weaker daily, or feeling nausea from the kidney failure that even ondansetron (doubled) couldn't stop.  I don't know.  Maybe there's no need to know.

And of course, once it's done, there's not much point in stewing about the might-have-beens.   The last two months with my Puffer, even with the sickness and the smell and the pilling and the dragging-to-the-hospital and the fear of chemotherapy, well, it was a time of such distinct and memorable pleasure. He was really a sweet little guy. He was perfectly willing to sit on my lap for hours and hours.  His whole life had been devoted to trailing around behind me, waiting for me to sit down so he could jump up on my lap.   He was always the first one in the kitchen when it was time to eat.  He even dragged himself downstairs to meet me at the garage twice in the last week of his life.   I didn't realize until he was hospitalized in January that I talk to him ALL the time.  Talked.  All day long, I was gibbering away to this poor little cat who probably would have been perfectly happy if I'd just shut up and scratched his ears and chin in silence.  I appreciated every single thing about him - and oh, how I regret how mad I was at him about all the rug-peeing.  I have a distinct memory of yelling at him one time, and he stood there, tiny little body all tensed, staring up at me, and then took off at top speed with his ploofy tail in the air. And he went  straight downstairs and pooped right beside the litter box.  Guess he showed me.....  And I kept meaning to make a video of him, loping along with his stomach swaying from side to side to race up the cat steps in the kitchen to eat on the window ledge.  It made me smile for the entire almost nine years I had him.  It still makes me smile, thinking about it, with more tears running down my face.  Time better hurry up and fix that leak.  There's not gonna be enough kleenex in the world.

My friend, Lorna, made this - it's wonderful.

Monday, March 5, 2012

My Scruffy is gone.

He woke me up about 5 AM.  He wanted to find a place on me to snuggle, but he was wobbly, and a little weak.  He ended up with his head on my shoulder, and the rest of him stretched out between my arm and my body.  He felt so thin and bony, not like the chubby little cat he'd always been.   He purred, and shivered, and occasionally twitched.  I flipped the afghan down over him - I have thought, ever since they shaved his stomach for the first ultrasound a couple weeks ago, that he's always cold.  Being anemic probably doesn't help either.  Anyway, he didn't want to be covered, and he wobbled over to the edge and got down.  He was back in a minute, though. We slept till 8:30.   Milk, and Burble, and OneBun, and Busy, and Duncan, and Scruffy and I.  It was so nice.  But somehow, it made me think that, oh, I don't know, that it was unfair to keep trying to save him when he was the one paying all the penalties or something.  I got up and filled the bathroom sink for him.  And then I gave him his own can of Salmon and Shrimp Fancy Feast, with no stupid aluminum hydroxide in it, and without worrying about whether he wanted to nibble on anyone else's food.  He ate happily on the cat tree - I wish that I'd thought of feeding him there before last week.  His falling off it last night was just an accident, because he'd been up higher and wasn't used to gauging the distance.   And then, I got a shower and he waited patiently on the floor of the bathroom until I was done.  I spent twenty minutes poking around in my yarn room trying to find something to bury him in.  I had bags and boxes and the two caskets that were the wrong size.  I picked out a nylon bag with a zipper and thought it would do.  But, the more I thought about it, the more I thought it wasn't any good.  I finally found a big fabric shopping bag like thing from JoAnne's.  It was big enough to hold the little blanket with the hearts on it that I wanted to wrap around him afterwards, and the blue pi, and his sweet little body.  It wasn't wonderful, but at least it was decided. The whole thing was like an out-of-body experience or something; I couldn't believe I was looking for something to bury my Scruffy in.

Fresh water!  (The sink's not pink, and the bare spot on his back is so I could see what I was doing when I gave him fluids.)

I gave him 50ml of fluids; I know that being dehydrated can interfere with the stuff they inject working.  He never fusses.  About anything.  He's got three scabs from old fluid needle holes - wonder why that happened?  I wanted to hold him.   We had two hours till the appointment, but he was insistent that he wanted to lay on the mat/his blue kitty pi by the bathroom.  I took two of his prozac pills.   I picked him up a couple of times, just to tell him how much I loved him. I brushed him carefully and got almost all the knots and food clumps out that he wouldn't let me touch before.  Funny, although his breath was really bad today, his fur didn't have such a strong urine-ish odor any more.  Dying kidney smells.  About 1:30, Rege came home.  I gave Scruffy another half can of FF - his very favorite, Gourmet Chicken, and he gobbled it down.  And then I wrapped him in the blue pi and a towel, and we left.

He always loved riding in the car and looking out the window.  When I was driving alone, and after I learned about cat safety from Dr. Lisa,  he didn't get to do that any more.  So, he poked his tiny little head out of the towel bundle and looked at the snow and the cars and the tears running down  my face.  I scratched his ears and his nose in the places he liked:  "I scratch your eary-beery, Puffy; I scratch your nosey-rosy."  Geez, have I always talked baby talk to this eminently clever and wise little cat?  I told him over and over how much I loved him and what a good cat he was and that I wanted him to always stay close to me.  He shivered periodically, even with the heater on.

In the morning, I had called the vet's office to pay for the euthanization - isn't that an awful word? - but there really isn't another word that's better, I suppose - so that we wouldn't have to stand around with my dead cat after it was all over.  And the technician - who is really sweet - offered to stay extra to be with me.  She said they expected to be busy, which wasn't good news.  And all the stuff about how I was doing the best thing I could for him.  I find it hard to believe that anyone could believe that that's true.  Not that I think anybody would say that with an evil intent or anything, just that killing a beloved cat doesn't exactly seem like a gift  to the cat.

Anyway, when we got there, there was thankfully no one in the waiting room and they said we could just go into the exam room.  (The one with no sink - I was gonna ask the vet if he'd empty Puffer's bladder because of the fluids and the bathroom water, but where would he do that?)  I put the towel I brought on the stainless steel table - I hate those damned tables, and the blue kitty pi.  I sat down to hold him and talk to him and rub his ears, and then the vet came in.  He said, "Are you sure you want to do this?"  And for one quick moment, it flashed through my mind that I could just stand up with Puffy in my arms and run right out the door.   But I didn't.  I wanted to hold him during the sedation shot - the first one, but the vet wanted him on the table.  So, we curled him up in the pi - he didn't fuss again, as usual.  And he gave him the shot in his scruff. Puffy meowed, and turned his head around, like he couldn't believe someone had done that.  And then he just put his head down on the edge of the pi.  He was breathing steadily, shallowly.  (I've been watching his breathing because the kidney failure/chemo papers the hospital gave me said to.)  The vet went out, and I just kept rubbing Scruffy's head and ears and whispering to him.  Dr. G came back in and checked him to see if he was sedated.  He was, he said.  He gave him one of those big pink shots in his back leg - I always told people not to use the front leg because he has that awful ingrown claw.  It didn't work, and he gave him another big pink shot.  I was reminded of poor little Britty a couple years ago, who had to have three of those shots before her dear little heart stopped beating.    And then he got out his stethoscope and listened and said, "Well, he's gone.  His heart is stopped."  But, I could see - well, I thought I could see, although it was clearly just wishful thinking, I guess - that he was breathing - his little bare stomach where they shaved him - I'm positive I saw it moving rhythmically.  And both Rege and Dr. G said it wasn't.  He wasn't breathing. My Puffy wasn't breathing.  It makes me gasp and sob and cry to even remember that minute and that realization.

So, we gathered up the towel and the kitty pi and the extra kitty pi I brought along and my poor sweet boy and put everything in the JoAnne's bag, and we went home.  We stopped at Burger King - my cat is dead in the back seat and I'm ordering a hamburger.  When we got home, we ate, and then Rege went out and practically had a coronary shoveling the icy mud over my Puffy's grave.  And that was it.  The end.  Almost nine years of loving that funny little cat, who was such an individual, so self-contained, so focused, so loving.  And now he's gone.

One last nap together
I never can finish a story.... So before we left, I couldn't find Milkshake anywhere.  Scruffy's been his special buddy, his fixation for years. Was it reciprocated?  I don't know, Scruffy wasn't one to go and hunt up anyone but me to snuggle up with.  But Milk - ah, Milk loved to spend hours curled up with Puffy.  So anyway, I couldn't find him before we left.  I called him and looked all over - no sign of him. And when we came home, I said to Rege, "We really should let the other cats see Puffy so that they understand that he's dead and he isn't coming back."  I did that when Chugga died, and I do think it helped.  But, the thought of getting poor Scruffy out of the bag and all that that entailed and implied was overwhelming.  So, we didn't do it.  I told all the others that Scruffy wasn't coming home again, but you know.......fat chance they understood.  And Milkshake was still among the missing.  We'd been home about three hours before he turned up, and he had - I am not imagining this - this puzzled, concerned look on his little face.  He stood on the arm of my chair and stared into my eyes.   He walked all over the place, he checked out the bathroom, he looked in the heated bed in the kitchen where he and Scruffy had been spending a lot of their time.  I KNOW Milk  disappeared this afternoon because he could sense that something awful was going to happen, and I know right now that he still doesn't know what to think about where Scruffy is and why he's not here to nap on. And I share the sadness I am sure he feels.

I always had this little fantasy that cats we love who die are afterwards floating around behind our left shoulder (you know, the one where the heart is) after they're gone.  So, my beloved Scruffy, if you're back there yet, I just hope that you know how much I loved you, and how hard I tried to take good care of you, and how amazing it was that you were such a sweet gift to me.  I love you dearly.

ScruffyPumpkinPattyPaws on his last day

Sunday, March 4, 2012

An odyssey into feline kidney failure

(Note:  I haven't finished this post yet.  I wanted to include the reports from each weekly chemo visit.  And to try to fix up whatever went wrong that put those stupid white highlights on all this stuff.  But, I can't do it right now.  I'm having a very hard time even coming here - the other day, someone asked for information that I knew was in this blog, and it was really a struggle to even look it up.  I don't seem to be healing from Sruffy's leaving, and until something magically fixes that........  Anyway.)

I can't get straight in my head ( or heart) how less than two months ago, I thought everything was fine and dandy with Scruffy.  I was at the vet with another cat, and on the spur of the moment, decided to make an appointment for him to have bloodwork and a dental. And while that unthinking impulse led to the detection of lymphoma and CRD/F  - finding diseases (other than the diabetes and glaucoma)was the furthest thing from my mind.  I even said to the vet, after he'd taken the blood to analyze it on his machine, "I'm not really much worried.  He's never had anything worrisome show up on bloodwork."  Little did I know.  (I also said, "Scruffy never not eats," which turned out to be the day  before he decided he didn't want to eat. )

Here's the official evidence of what has happened in such a short time, as well assorted comments and whining,  raging against the Universe, I guess.

1/6/2012  Bloodwork done at vet's office, on his machine.  (I did once ask how often that machine is calibrated, which was apparently an offensive thing to say.....)

Abnormal results:

AST  (SGOT)    106  (HIGH)  ref. 10-100
ALT  (SGPT)     154  (HIGH)  ref 10-100
Calcium   12.8  (HIGH)  ref   8.2 - 10.8
Amylase 1407 (HIGH)  ref 100 - 1200
Neutrophils   9225  (HIGH)  75%  ref  2500 - 8500

Normal results:

Urea Nitrogen  35  ref 14 - 36
Creatinine   2.3    ref  0.6 - 2.4
BUN/CR ratio   15     ref  4 - 33
Phosphorus  5.5    ref 2.4 - 8.2
Potassium  4.1   ref 3.4 - 5.6
Total T4   1.3   ref  0.8 - 4.0

WBC   12.3     ref 3.5 - 16.0
RBC    6.95     ref 5.92 - 9.93
Hemoglobin   11.7   ref 9.3 - 15.9
Hematocrit    33.7     % ref 28 - 48

and glucose - not that it matters - 90.

Here began the nightmare.  Although I didn't understand any of it at the time, my vet expressed concern about the HIGH Total Calcium level.  And said that maybe it was just a one-off result, that electrolytes aren't necessarily always exact, etc.  And I should wait two weeks and have the bloodwork repeated.  Of course, by the time I got home and started reading a little bit about elevated calcium, I was in such a panic that there was no way I could have waited two weeks.  So.......

1/13/2012   Bloodwork done at vet's office and sent to Antech.  Reported 1/14/2012

Abnormal results:

AST (SGOT)  115  ref 10 - 100
ALT (SGPT)  151   ref 10 - 100
Urea Nitrogen   41 (HIGH)  ref 14 - 36
Creatinine   2.8  (HIGH)  ref  0.6 - 2.4
Glucose  51 (LOW)  lol
Calcium  14.5   (HIGH)   ref  8.2 - 10.8
Amylase   1226  (HIGH)  ref  100 - 1200
fPLI  14

Normal results:

Phosphorus  5.5     ref 2.4 - 8.2
Potassium  3.8    ref 3.4 - 5.6
T4   1.2   ref - 0.8 - 4.0

WBC   9.5     ref 3.5 - 16.0
RBC    6.23   ref  5.92 - 9.93
HGB  10.7     ref 9.3 - 15.9
HCT   31.8      %   19 - 48
Absolute Neutrophils  6650  ref  2500 - 8500

So, further panic ensued.  I was instructed to do fluids at home.  My vet recommended getting an appointment for an ultrasound as soon as possible.  Less than two weeks, was his suggestion. When I called, I was originally told that there was nothing available for two weeks, but then, an appointment was available in three days.  I took it.

1/20/2012   Scruffy weighed 10 pounds, 2 oz, by the way.  Down more than a half pound from what he had been in December, 2011.

"Xrays indicated:  possible cardiomegaly; decreased detail within the cranial abdomen suggestive of mild effusion or inflammation.  Hepatomegaly was noted as well.

Ultrasound abdominal:  On the spleen there were multiple large, hypoechoic, heterogenous masses up to ~80mm to the right of the midline.  On the liver there was a single 27x20mm mass similar in appearance to the liver mass.  The peritoneal cavity had mild/trace effusion.  Single small mass between stomach and liver of questionable origin.

Ultrasound-guided aspirate:  consistent with large cell lymphoma

Istat Chem 8:

Glucose  184
BUN 67
Creatinine 3.9
Potassium  4.4
Chloride  131
iCA (ionized calcium)  1.84

Urinalysis  SG:  1.014, remaining values WNL

T-bili:  0.2  ref 0.0 - 0.5

Scruffy was hospitalized immediately after the ultrasound was completed, and was given a first treatment of vincristine for the lymphoma.  Official diagnosis:  large cell lymphoma of liver and spleen; kidney failure, history of diabetes mellitis, history of urethral obstruction.  I didn't even get to say good-bye to him; they had told me to go home and they would call me to come back and pick him up; didn't happen......

I might also add, even though the fPLI was VERY elevated - 14! - the IM specialist who did the ultrasound said that they had had multiple experiences where the fPLI was not considered accurate after ultrasound testing was done, and that they didn't regard it as a very useful test at this time.  There isn't any further information about pancreatitis on any of the papers, though.  I never did have the feeling that Scruffy had pancreatitis when all this began.  And maybe once the lymphoma was confirmed, there really wasn't any pancreatitis....

1/21/2012  Bloodwork done during hospitalization:

Istat Chem 8:

Glucose    184
BUN   76
Creatinine    3.5
iCA    1.48
Cl    131

He was started on IV fluids, with dexamethasone added, hence the 184 glucose level.  He also had what they felt was a urinary blockage overnight; when the oncologist called around 10 AM, they still hadn't done anything to FIX it.  They  did catheterize him eventually and remove a very large amount of urine, and the catheter remained in place until he was released from the hospital on 1/23/12.  He had not eaten anything since the evening of 1/19/12, because he was to be fasted prior to the ultrasound, and he had refused all food in the hospital.  I came to visit him in the afternoon of 1/21, and brought his favorite food, some lactose-free milk (yeah, I know - phosphorus and calcium and vitamin D - but I didn't about any of that then), his kitty pi, some paper plates to feed him on; he actually ate about a half can of Gourmet Chicken FF while I was there.  I also brought his glaucoma drops and prozac pills.

1/22/2012   (in hospital )

Istat Chem 8  

Glucose  210

BUN 67
Creatinine   3.1
iCa  1.38
HCT 23
HGB 7.8  
remaining values WNL

1/23/12   Istat Chem 8  (in hospital)

Glucose  251
BUN 63
Creatinine  3.3
iCA 1.34 
remaining values WNL 

He was released from the hospital on 1/23, late in the afternoon, with an appointment to return for a second chemotherapy treatment on 1/26/12.  He looked horrible and smelled even worse. We were so glad to have him home.  He settled right in, ate like a horse, and seemed like maybe this was going to be okay.

1/26/12   second chemotherapy treatment.  He was given cytoxan for the first time, with lasix to keep it from remaining in the bladder any longer than necessary.

CBC was "pending" - their lab's machine was broken or something.
Chem 8:

Glucose  213  HIGH  ref 60-130
BUN  90  HIGH  15-34
Creatinine  3.8  HIGH  1 - 2.2
iCA 1.50 HIGH  1.2 - 1.32
Potassium    4.6  HIGH  2.9 - 4.2

PCV (Hematocrit)  36 (on separate machine)   24 - 30
Hemoglobin   9.9  8 - 13

He was started on prednisone when he was released from the hospital.  Although the glucose was elevated today, it wasn't nearly as awful as I had expected.  He weighed 10 pounds, 3 ounces.   While his weight hasn't changed much, it seems to be rearranging itself - his abdomen feels kind of squishy, and his head is so bony.  He loves to have his ears rubbed, the area in front of the actual ear, and now there's no flesh there, to speak of; just boney projections that make it hard to do. His little face has become even littler...  :(

This was also the first time there was a mention of a heart murmur:  "Auscultation of the heart reveals grade II/III/VI systolic murmur."  There has never been any indication of heart murmur before this.  It was suggested that, since we're giving fluids at home and he's getting fluids with the chemo, having a cardiologist check things might be a good idea.

The oncologist's comment after this treatment:  "Today we gave a second chemotherapy treatment since Scruffy has been showing some clinical improvement at home.  His bloodwork shows persisten elevation in kidney values and also the calcium as we discussed.  This likely indicates lymphoma is not in remission yet, but this is not unusual as it typically takes several weeks for cats to respond fully.  We are going to continue going forward with treatment one week ata time as long as he is having good quality of life at home."

And, I had noticed that he had something (which turned out to be an ulcer) on his left eye.  They arranged that Dr. B, the ophthalmologist, come down and look at it while Scruffy was waiting for treatment.  Which was nice of them.  Eye stuff really hurts.  A follow-up ophthalmology appointment was scheduled. 

 He didn't have much of a reaction to the IV cytoxan.  He was a little lethargic the second day, but ate normally and was normally active.  (Well, that's relative with a sick cat, but he was up and around, he was alert, he used the litter box, etc.)  I keep saying, if you didn't know he was dying, you'd never know he was dying.  So much of the time, he has been absolutely himself, despite all the horrors that were going on inside his little body.

Feb. 26, 2012

This is about all I can stand of this right now.  I realize it's kind of obscure, and no one but me would be interested - but I keep seeing places where I would give anything if I'd understood more about what was going on, or if I had realized that there were actually things that I could have been doing that might have helped.  By the time Choy-Foong came along and offered information and support and Aluminum Hydroxide and azodyl, maybe too much time had already gone by,  and too much damage had already occurred.  (Yes, now I'm fixated on azodyl doing some miraculous healing and making The Puffer feel a zillion times better.  I have to have my illusions, or I don't know if I can go on with this.)   I have been sproinging from despair and hopelessness to thinking maybe things aren't as awful as they seem to knowing that yes, they are that awful.  The essence of it all is, once the kidneys are so significantly damaged, they're not going to recover.  Period.  I read lots of letters from people whose CRF cats had been hanging around for 5 years, or 9 years, or whatever, but most those cats seemed to have a very slow onset that their owners were able to treat effectively from the beginning.  Also I didn't see anyone mention simultaneous lymphoma, come to think of it.  And now, I'm sproinging from is he going to die horribly here at home in a matter of hours, do I need to find someone to euthanize him (significant annoyance with my regular vet), to amazement at the fact that he has already eaten a significant amount of food THREE times this morning, he woke me up at 7AM to rub his ears and then we napped with Busy and Milk and Burble for an hour.........  All so normal and non-deathlike, I guess.

I have an appointment to have him euthanized - I can't say "put to sleep" - they're not asleep, they're DEAD - tomorrow afternoon.  I told the vet when he called yesterday - another long story, but I think I'm going to be looking for a new vet - that Scruffy has never really fallen off the Quality of Life Scale.  There are times when he seems weaker, times when he doesn't eat as enthusiastically, times when he looks so pitiful it makes me cry, yes.  But, there are even more times when he's just Scruffy - the same scraggly little brown cat he always was.  And yes, I want desperately to spare him pain and whatever awfulness comes with dying of kidney failure, but right now, I don't SEE any pain, I just see him living like he always has, only eating stuff he's not crazy about.  This is a horrible responsibility.  I don't want to do "it" too soon, or too late.  Crap.  All I do is cry at the drop of a hat any more.