I didn’t like the title of my last post. I shall return to my default subject for cat medical updates.
I have engaged in a lot of cat-gallows-humor that past few days, but I’ll keep that to myself, including calling this a “dying cat blog”.
As we move closer to the inevitable, Aremid did greet me from his perch when I got home last night. And I wrote in a draft post, “rather than take these as positive signs of any recovery, I’ll just take them as positive moments as we reach the end of the journey. Aremid will be around at least through the regular part of the weekend. My vet is going to be out of town. But Monday could be the day.”
Well, we added Cerenia to his medication cocktail last night. This is to suppliment Zafran to help with nausea.
And, for the past twelve hours, Aremid has been showing flashes of his former self, if I consider his former self to be how he was getting about a few weeks ago. A few weeks ago, I was not considering putting him down.
He has not been having trouble eating anything I’ve put in front of him. More importantly, I haven’t had to put food in front of him; he’s sought out food on his own. His meek meows have generally been subjugated by his classic loudy whiny meows that have irritated me for 16 years. He hasn’t hidden in his dark places at all.
So I think I’m pushing back the Doomsday Clock for at least a day, but likely longer, since the first day of work-week is, selfishly, a very bad day to do this.
I’ve begun to write a bunch of different blog posts in the last 20 minutes or so. Five stages of grief. How I’m trying to feed him baby food. How my vet is humoring me by me I can come in to pick up another medication that might curb Aremid’s nausea since the Zafran doesn’t seem to be doing it. How I see all the signs now.
I don’t know how to deal with this.
I finally get it that he’s miserable. I didn’t get that being old and decrepit and only half-lucid much of the time did not make for that bad a quality of life when you still had your person loving on you. I still don’t know if I get that. But if I imagine being nauseous all the time, and there’s no relief, I begin to realize that, at this point, each new day is not really a gift.
We’ll see. If I were completely in acceptance mode, I would be planning the end. I’ve heard people say that they spent one last night with their pet, that they had planned it like that. I don’t want to plan that. I would rather that my vet pick a random time to knock on the door and say, “Ok, I’m here to do it right now.”
Ok, enough morbid thoughts for now.
This morning’s post was supposed to be accompanied by this photo. While Aremid seems upset here, and he was, because he was at the vet, at least he was up and about and observing. Right now, he is in a pathetic curl-up up against me on the couch. He’s in more of a jagged oval than a circle. And he’s listless. I can see his side filling with air and then releasing it. Is this labored breathing or how it has always looked? I should know from watching him for 16 years. But I don’t. Or, more likely, I just don’t want to know.
I have been in denial. I think my vet was trying to gently let me know this morning that I should be planning to put Aremid down soon. The ultrasound was inconclusive, just like it was last year. Last year, Aremid rebounded a bit, particularly after he started prednisalone. But that weapon has already been used. Now, we’ve just added anti-nausea and appetite-stimulant meds. I don’t think they’ve made much difference over the past 10 hours. When I put Aremid in front of food, he seems to be devouring it. But he doesn’t stay on top of the food long enough to devour very much, and I don’t seem him returning on his own.
The signs are there if I want to see them. He is doing “lipsmacks” which is when he seems to be licking the top and bottom of his mouth, particularly after just having eaten. This means he is feeling nauseated. His eyes often seem like they’re focused on absolutely nothing. He hasn’t been hiding out-of-sight all that much, but typically when he’s next to me, he still has that aloof hiding vibe about him.
Just last week, he seemed to be ok, but that’s how these final days and weeks and months and years go. Every glimpse of his old behavior gives the false hope that he is rebounding. Today is the first day that I truly beginning to get it, that Aremid probably isn’t going to be rebounding.
This month marks 16 years with Aremid. This cat defines me. There is no Toastie without Aremid.
But there will be someday. He can’t outlive me, because I don’t know who’d take him in.
And he may be on his ninth life right now. He’s been getting by with his hypothyroidism and irritable bowel for the last couple of years, with daily methimazole and prednisalone. But he’s been losing weight again and not being himself. He’s been hiding. He’s been listless, at times, and lethargic the rest of the time. He eats when there’s food in front of him, but I don’t see him making the effort to go and eat. He usually responds to me, but I am used to him always responding to me. His vocalizations, which have generally been whiny and annoying for 16 years, are now meek.
So it was not good news when the results came back from the vet that all of his bloodwork came out fine. This means we don’t know what’s wrong. We’ll probably put him on an antibiotic just in case there’s an undetected infection.
I should break out my real camera, which has been out of sight since Mexico six months ago, but I suppose I don’t really want great pictures of Aremid looking so bad.
He actually doesn’t look quite so bad in the picture from the vet’s office back on Friday. But he seem to have gotten worse over the last three days.
All this being said, I am not at all ready for the “he’s lived a good life” sentiments.
That being said, he’s right next to me on the couch now, and, the way he looks right now, I’m worried.
Zellouisa was about to come off insulin about 5 years ago after having been on it for about a year. Moving to a low-carb Fancy Feast diet did the trick last time. Unfortunately, Aremid’s health has taken precedence over the past year, meaning I’ve been putting out dry food (loaded with carbs) easily accessible to Aremid so he could gain some weight, as well as any Fancy Feast he’d eat (gravy varieties add a bunch of carbs). Z was losing a lot of weight, too, I noticed, and she, like Aremid, was drinking a lot of water.
She wound up saying at the vet’s overnight after having some vomiting following her initial visit. In all, she was at the vet’s for three straight days. Lots of tests, lots of $ spent. Her insulin was high, and she had a UTI. (That rhymes!)
So she’s back on insulin. Surprisingly, she likes getting the shots. Zellouisa will actually come to me when I open the fridge. I do pet her a lot afterwards. All in all, she’s been a heck of a lot more affectionate since that overnight stay at the vet’s.
This post is a week late. I took Aremid back to the vet last Friday, worried that the new meds were not helping. I was, then, pleasantly surprised when my vet told me that Aremid’s weight had gone up a whopping 9 ounces in 13 days. She could also tell that some muscle had returned. So, as of a week ago, we thought that the prednisone was helping a lot, and he probably has been suffering from irritable bowel disease (in addition to hypothyroidism).
Aremid pics from a few days ago, and some of the other cat who lives here…
A few more
So this is what this blog has become…just a series of human and pet health updates…
Aremid at the vet / 2011.03.26
“Severe muscle wasting on his head, scapula, and neck”
Down to 6 pounds, 15 ounces
Slightly elevated T-4, so his methimazole dosage for his hyperthyroidism has gone up.
And, since his condition can be completely attributed to hyperthyroidism, he has now started on prednisone, which will treat inflammatory disease, if that’s afflicting him.
We will see if Aremid finally starts putting on some weight for a change. If he doesn’t improve in a couple of weeks, we will add Leukeran, which is used to treat lymphoma.
Thank goodness for Greenies Pill Pockets.
Aremid and I are in a holding pattern. My wonderful vet, and I’m not being facetious, my awesome vet Dr. Simpson of Morrisville Cat Hospital (who I hope will not be alarmed to find her name on this ridiculous blog) suggested that we get one more reading of Aremid’s thyroid levels, since his was borderline high last time, but not high enough to cause a deviation from our treatment plan. It’s a small chance that his hypothyroidism has relapsed, but a chance worth taking when there is an expensive procedure coming up that can possibly be avoided. So, I’ll take him in Saturday for that. And we’ll go from there.
I can’t find the battery charger for my new camera. I’m sure it’ll turn up, but, in the mean time, I will post classic photos of my sweet, skinny cow cat, who, years ago, could leap atop a door…
My vet said there was “good news and bad news.” The good news is that the aspirate analysis did not show any lymphoma. The bad news is that this doesn’t mean there isn’t lymphoma. Aremid isn’t getting any better, and the ultrasound had clearly shown significant organ damage.
One guess on what could be afflicting Aremid is inflammatory bowel disease. This could be treated with prednisone.
The only way to know for sure what’s going on is to get a biopsy of his intestinal tract. This can be done via surgery or endoscopy. Either one is pricey. Surgery is dangerous for an old, frail cat, so I think I have ruled out that option. Unfortunately, for a reason I didn’t quite catch, a biopsy would not be helpful if Aremid were to have already started prednisone. I guess it would change the cells in such a way as to make lymphoma difficult to detect?
So, the options are to either start him on prednisone, which is not a costly therapy, and hope that whatever ails him is helped. (I think prednisone might be a treatment for lymphoma, too).
Hmm…this link is pretty informative, but has some upsetting information:
Cats with intestinal lymphoma treated with prednisone alone have a life expectancy of 45 to 60 days
It is very difficult to distinguish inflammatory bowel disease from lymphoma without a full-thickness biopsy (a full-thickness piece of intestine) obtained via exploratory surgery. A less invasive method of obtaining a sample is via endoscopy, usually adequate for diagnosis but full thickness biopsy samples cannot be obtained this way.
Damn…the studies on lymphoma treatments are not very promising, referring to positive responses to treatments in terms of weeks, not years.
If I were recovering from a kidney transplant right now, I’d be away from home for a month, and I’m not sure how I would be able to deal with this, logistically or emotionally. (So there’s a silver lining from this past week’s transplant debacle.)
A small fortune was spent today to get Aremid an abdominal ultrasound. A couple of aspirations were performed, and it’s unlikely that any good news will come of the test results, which I won’t find out about for another week or two. His spleen is enlarged, and his liver and kidneys look abnormal. The vets think he almost certainly has some variety of lymphoma. And, from there, the prognosis ranges from very bad to “reasonable” (being able to keep him comfortable for awhile). I’m not sure what that really means. I gather from the internet that you try chemotherapy, and you can tell within a couple of weeks if it’s going to work or not. I realize that everyone with a 15-year-old cat has to deal with the inevitable. I am not ready to concede that he’s has a long, happy life, and that I should be grateful for the time I had with him.