Update 7/23/08

Hey everybody,

Today (July 22) is the third anniversary of my baby Hesha's CRF
diagnosis. She'll be turning 18 in a few weeks as well!

Hesha is doing well, with stable kidney values (creatinine in the high
2's and low 3's, BUN in the 30s and 40s). Her arthritis continues to
slow her down, however, so I'm always looking for ways to treat it --
she's a difficult one, with lots of food allergies and intolerances.
She still manages to get up and down the stairs two or three times a
day to go out on the patio to soak up the sun and rub her face in her
catnip plant and take a few nibbles of her cat grass. Her favorite
thing to do is stand in the middle of the bedroom while loudly
demanding to be snuggled, and then wait to see how long it takes me to
dash in from elsewhere in the house to accommodate her. :)

Since her diagnosis, Hesha has eaten the k/d dry food, along with a
small amount of t/d to keep her teeth clean (which has apparently done
a great job, BTW, since she hasn't needed a tooth cleaning since her
diagnosis, knock on wood!). She also gets daily Pepcid A/C, Salmon
oil, vitamin B12 and B complex, and a couple drops of Fer-in-sol for
iron. Oh, and also 1/64th teaspoon baking soda for her metabolic
acidosis.

Hesha has gotten sub-Q fluids for only short periods of time during
those three years -- after her initial Metacam-induced crash, after a
kidney infection a year ago, and after her recent metabolic acidosis
crisis in April. I've pretty much weaned her from the fluids again,
since she's drinking lots of water and seems to keep herself
adequately hydrated, although I have been giving her 125 ml or so once
every week to 10 days just to make sure she doesn't "get behind" in
her hydration. Not sure it's completely necessary, but if I notice
she hasn't eaten as much as usual for a couple of days I give her the
fluids just to be safe.


9/13/2008

My beautiful 18-year-old Hesha just died a little over two hours ago.

After giving me an update this morning that Hesha was still stable,
the hospital suddenly called to say that Hesha had just had an
"event", probably a clot, and they had her on a breathing tube. By
the time I got there, she'd had another event of some kind, after
briefly regaining consciousness and breathing on her own for a few
minutes while I was racing to the hospital.

When I arrived, she was not breathing on her own and her eyes were
dilated and staring. I agreed that they should go ahead and put her
to sleep. I held my face directly in front of hers as they removed
all the tubes and started the injection, and strangely she blinked her
eyes once and kind of looked around briefly as if she was aware of her
surrounding for a moment. I thought she might be regaining
consciousness, but then she was gone. If she had become aware during
that last moment then the last thing she saw was my face. I know she
always knew I loved her like crazy.

Hesha was diagnosed with CRF over three years ago, and really was
never very sick during that entire time, except for a couple of brief
crashes. She never lost weight (even gaining a couple of pounds over
those years on the high-calorie renal food) and remained her usual
beautiful self even at the very end. Even the morning of her
hospitalization on Wednesday, she went outside on the patio for some
sunshine and readily lapped up some of her wet food I use to give her
supplements. We had a vet appointment that afternoon because of some
intermittent diarrhea over the last few months and because her
appetite had been slightly down over the last week or so. The vet and
I thought she had a GI problem like IBD, GI lymphoma, or possibly
hyperT, so they did a blood test and we went home. But barely two
hours later the call came that her renal values were through the roof
and I brought her in to be admitted. Both the vet and I were shocked
because she wasn't acting particularly sick.

Ultrasounds showed she probably had at least a partial blockage of her
right kidney, and her numbers didn't really come down over the next 36
hours of fluid therapy. I had decided to give her one more day on IV
fluids and mannitol to see if she would improve, then I was going to
bring her home this evening and do sub-Q fluids and keep her
comfortable and hope she improved in the comfort of her home.

But I think the hospital, which she hated with a passion, was just too
much stress for her. I was afraid of that, but I wanted to make sure
I'd at least tried to give her a chance to recover. She'd had a
couple of crashes before which she bounced back from, although nothing
with numbers this bad (BUN over 200, creatinine over 11 as of
yesterday). The vets said this morning that she was still resting
comfortably and they took her to do one more ultrasound to see if
there was any change in her kidney, and she fought them like crazy as
usual (she HATES to be handled by vets and is always fractious at the
hospital). Just after they put her back in her cage she began to gasp
for air and show extreme signs of neurological problems. X-rays
showed fluid on her lungs. The vet thinks she had a stroke and her
kidneys and system just shut down.

I was all prepared to bring her home today and was researching assist
feeding in case she wouldn't eat. I'd never had to do that before and
was dreading it, actually, as I believe Hesha would have hated it.
But I was prepared to do whatever it took to give her a fighting
chance to recover from this latest episode.

I think I'm just numb right now. I've had a few days to prepare for
this, as the vet had been fairly pessimistic with her numbers being so
bad. And for the past three years I knew this was a possibility at
any moment, and I made sure that I spent as much time with her as
possible and enjoyed every additional day I had with her. I've read
all the stories and knew that a CRF cat can be sailing along doing
great for a very long time and then suddenly take a turn for the
worse. And I knew as of a year ago that Hesha had fairly extensive
calcification in her right kidney and could develop an obstruction at
any time. But she's bounced back before when there was pessimism from
the vets, and I had spent over two hours visiting her at the hospital
last night where she was amazingly calm and content, purring and
giving me little kisses. I guess part of me was suspicious that this
could mean she wasn't doing so great, as ordinarily she is miserable
at the hospital and doesn't try to hide it, but I really wasn't
planning for something like this.

Hesha's quality of life was great the first couple years after her CRF
diagnosis, and her kidneys stayed quite stable most of the whole three
years, until the end, with creatinine in the 2's and 3's and BUN in
the 30s and 40s (her last blood test before this hospitalization was
in June and her creat was 3.2 and BUN 45). Unfortunately her
arthritis worsened quite a bit starting about a year ago, so she had
become much more limited in her movement and couldn't really jump up
more than about a foot. But she still got herself up and down the
stairs a couple times a day to go out on the patio for some sun, and
would go to her special "play" spot several times a day where she
would call me to come give her snuggles.

Of course I feel terribly guilty about giving Hesha Metacam for her
arthritis three years ago, which put her in acute renal failure with
resulting CRF. I can't help but wonder how she would have done and
how long she would have lived had I not done that. But one thing I
can say was that her renal failure was a real wakeup call for me that
she was not going to be around forever and helped me to really
concentrate on enjoying the time I had left with her. So in a way
it's been a positive thing for both Hesha and me.

I also feel very bad that she had to spend her last days in a place
she hated so much. I was hoping to avoid that, but it wasn't to be.
I kept telling myself I wouldn't put her through that again, but if I
had refused the hospitalization when her numbers were so high and she
had then gone downhill and suffered I would have always regretted not
at least trying to get her professional treatment to see if it would
help. But I can't help but think that if I'd just kept her home she'd
still be with me now.

I guess I can be thankful that she did so well right up until the end
and she didn't "waste away" as happens with some CRF kitties. And I'm
glad that I didn't have to make the decision to put her to sleep when
she was still fully conscious -- something I've dreaded and played
over in my mind many times these last three years, and which I'm still
not sure I could have gone through with.

I've never really been good at accepting death, and I just feel like
this all ended in such a failure. I realize there's ultimately no
other possible outcome, but that doesn't change how I feel. Maybe
some day I'll think differently about it. I was always secretly
hoping Hesha would live far longer than any kitty in history. :) But
even that would not have allowed us to escape the inevitable.

I want to thank all the people here on this list who helped Hesha and
me over these last three years. I know that the things I learned from
all of you helped Hesha live so well with her disease all this time.
So many of you are so very caring and so selfless in giving of your
time and energy to help other people and kitties, that I'm full of
admiration for you. It was always good for me to know there are many
others who care as deeply about their kitties as I do. Among my
friends and family, probably only my mother (lifelong cat lover) truly
understands how I feel about Hesha and why I put so much time and
effort into her care.

I wish all of you and your kitties the very best of luck going into
the future, and in particular my thoughts are with those whose kitties
are struggling right now. We're all trying to do the very best we can
for our kitties, and I think we can take comfort in knowing we've
given them -- and are giving them -- the best lives we possibly can.
If we could choose, none of our kitties would ever get sick, be
scared, or feel pain. But of course we know their precious lives
would not be possible otherwise, so we deal with it as it comes and
help our kitties and each other as best we can. In the end I guess
that's all our sweet kitties could ask for.