32 Flavours...and then Some!

Dr. Lehal did not give us good news when I spoke to him this morning after my last post. Everything that could be done medically for Ra was already being done. There were no "hail Marys" to dig out of the playbook--the playbook was all already in play. There was brief talk of trying to limp Ra through another weekend, but Dr. Lehal was pretty sure we were looking at the end, and very soon...

Wanting to avoid the trauma for all parties involved of going to an emergency vet in the middle of the night over this weekend, J decided that it would be best to send Ra over The Bridge today while Brookville Animal Hospital was still open. While saying our goodbyes at home would've been best, it was not really an option, so we got an appointment for 1340, scheduled near the close of business so we all could take our time saying goodbye with minimal fuss and bother.

We'd been taking Ra to his myriad vet visits in Jazz's old carrier, but J wanted Ra to go out in the carrier he originally came home in so we dug out Ra's old soft-side carrier and its fleece liner. We had Weather today, so the roads were a little greasy from the wintry mix so it took slightly longer for us to get to the animal hospital than normal, and long enough where Ra soiled his carrier with a soft poop that he managed to get all over his right leg. We spent the first ten minutes of our time in the exam room gently cleaning Ra and the fleece liner in the carrier. It was a somewhat welcome distraction from all the barking dogs that were still being looked at. Ra was so out of it the barking dogs didn't even make him flinch. J tried to hold Ra on his lap, but Ra wanted little to nothing to do with either of us. He wanted the cool tile of the floor. Eventually J sat on the floor with Ra, giving much pettins and lovins. I largely left the boys to say their final goodbyes...

Around 1415, Dr. Lehal was done with all his other appointments and could devote his full attention to us. J asked him questions--was there absolutely anything else we could do to keep Ra more comfortable and in better control of his bodily functions. No, everything was being done at its maximum dose already. Would re-adding the correct dose of Atopica make a difference--we'd been giving half the normal dose because we'd run low and the hospital was having trouble getting the liquid name brand Rx of the med for us--no, it would not likely make a difference, and if it did, not for long.

J made the final decision to let Ra go over The Bridge around 1430. Ra's veins were so bad from dehydration and his ongoing renal failure it was decided a port would be installed for his comfort for the impending injections. He officially Went Over The Bridge around 1440. We lingered for about another half hour more after that with Ra, continuing to love and pet him til we were sure his spirit was gone on its way.

Ra and J were best buds for over 14 years, almost 15. He was about 18 months old when Ra picked out J at Strays Halfway House back in '00. J is bereft, devastated and heartbroken and misses his friend dearly. I was a part of Ra's daily life since August of '07 and I, too, am heartbroken and miss my buddy. He was a joy and a frustration, feisty and loving. He was our Buddy Cat. We will miss him so very much...

Rest well, Ra Buddy. You are loved and will be dearly missed...

I haven't updated on Ra in awhile because things have largely been the same--a mixed bag of good days and temporary set backs that have kinda slid into each other and turned into a bit of a blur.

He'll be good for a few days to a week, then he'll start randomly vomiting despite being on two anti-nausea meds. We've learned how to care for him when this happens--hydrate him a bit more with the sub-q fluids, feed a bit less so there's less to vomit up, and perhaps give him a dribble of the pain med we've got for him every now and again to ease any possible discomfort.

His blood work, which is now due again actually, remains largely the same, which is good in some ways and bad in others. His Red Blood Cells remain quite low at around 20% despite giving him the $expensive Aranesp med that's supposed to help increase same. The two iron supplement shots he got didn't do shit, either. :(

We've managed to somehow maintain his weight at around 8 pounds, which is Way Too Skinny for a cat his frame size, but at least we're maintaining that much. He's managing to do pretty well most days at his now 3/4 can of A/D syringe feedings and actually putting on an ounce or two! We're pleased with every ounce we can get.

There have been some changes to his medication regimen. He's off the Aranesp for his RBC; since it really wasn't doing any more to increase same, Dr. M at the VCA decided it was time to take him off it. We're a little bit concerned this might not be the wisest of moves--what if it's actually helping to maintain the RBC percentage he's currently at and being off it causes the number to plummet again? All that can be done is to take him off it temporarily and see what happens.

Additionally, we're tapering him off the "chemo" drug Chlorambucil--he's getting it every fourth day for the next six weeks, then every fifth day for six weeks after that and it'll be reevaluated after that. So far that's a mixed bag--when he gets it now he tends to be "off" and a bit more likely to be barfy on the day he gets it and the day after. This makes both J and I sad and there's not a whole helluva lot we can do about that, either, save for what I mentioned earlier.

While it's good that he's being taken off of or tapered down off of certain meds, I can't help but feel as though Dr. M. (his specialist from the VCA who Ra's regular vet is in constant contact with) is sorta winding down on Ra's active care in favor of a more palliative/hospice care. We've yet to confirm that's what's actually going on; I want to ask about that, but it's J's cat and he needs to ask the tough questions like that and he's so far not had the time or heart to ask. I can't say as though I blame him for avoiding that topic--I know I avoided talk like that with my two girls as much as possible when they were still alive...

Regardless, on more days than not, Ra is still pretty bright eyed and a relatively active part of our household. We give him our best lovins, pettins, and whatever else we can give him every day. He's slowing down, obviously, but not giving up on life just yet, so we keep going with more assertive treatment of what's ailing him. We take it as it comes, a day at a time when we can, smaller increments when we can't go as long as a day. Still, it's very difficult to watch him struggle on the bad days. Poor ol' fella...

The vomiting stopped after the AM pill barf on Tuesday morning, thanks to the shots of Cerenia and Metoclopramide. The only problem with the Metoclopramide is it gives Ra the most nasty pure liquid diarrhea. :/ We were originally at 3x daily for that drug, but Dr. Lehal cut it down to 2x daily, and finally down to 1x daily. So far, so good with the low dose. I made an executive decision to take him completely off the Metoclopramide this morning--if he barfs, then he goes back on it, simple as that. We simply cannot have him liquid pooping every damned time he does a # 2. It's got to be hard on his system, and I know he *hates* me following him around to wipe the remnants off his (likely) sore ass once he's done if I catch him in the box dropping a watery deuce.

Because of the "liquipoo" situation, Dr. Lehal suggested we start Ra on a kitty probiotic, which we were able to pick up at PetSmart. It's a once weekly thing, though we gave him his weekly dose and a small amount more yesterday in hopes of calming his stomach. Don't know if we should've done that, but it was a mutually made executive decision, so we'll see what happens. The worst that could happen would be that his bowel movements would go the opposite direction and he'd get a bit constipated, but hey--we've got the Lactulose for that if that comes to (not) pass.

So, yeah. I think we're on the right track. Please keep your fingers crossed and keep on sending that oh-so-necessary healing energy! :)

I spent Thursday night in Kenosha with my cousin, so when J told me Ra's blood draw results I wasn't home or near a computer I could use to give an update...

...Things largely remain the same: kidney values, same; liver values, ever so slightly improved; RBC: 22% from 21%, so not much improvement. Gained about four ounces, too...Meds all to remain the same, and I don't have to bring him in for another routine blood draw to check his values until the morning of the 21st, which is kind of nice I must say...

While I'm bummed that there's been little change in the serum blood values department, nothing has gotten worse, so there's that going for us, which is nice.

In the food department, some interesting developments. He's eating more kibble on his own again, especially early in the day. As far as syringe feedings go, that's *very* interesting! He's now waiting in the guest bath when hungry for us to pass by the door, and when we do he meows loudly to let us know he's hungry and expecting to be fed! Weird, eh? Even weirder, he's showed some interest in what we're putting down him with the syringe, be it either the hypoallergenic shit he's been prescribed and we're supposed to feed him, or A/D we aren't really supposed to be feeding him but feed him every third day or so in attempts to put some much needed weight back on him. If J pushes a small amount out of the syringe, a good share of the time, regardless of food type, Ra will eat the small amount of food at the end of the syringe on his own. We thought this might mean he's getting more interested in eating the wet foods on his own, but when we put the bowl of it in front of him he'll sniff at it, but won't eat any of it. Only from the syringe, which, again, is weird, but hey! He's interested.

In addition to that, he's stopped fighting the syringe and eagerly takes the food when it's syringed into his mouth/down his throat. This has made syringe feeding less of a daunting task and I daresay if it could be considered enjoyable in any way, a little more easy to bear. He still needs to sit on J's lap to be fed, but not braced against J's chest with his face held steady to syringe the food in--a welcome development for every living being involved. Ra's also learned "You're free to go" after he's done being fed means he can leave the room, though we still keep the door to the guest bath closed when we're in there feeding him so he doesn't wander off in the middle of the proceedings.

That's what's going on in Ra Land right now. Not good, but not bad, either. We'll take it...

In the Pam's A Klutz move this morning...

Ra and I were in the kitchen together, which was most fortuitous because it was time for his Atopica, usually his first med of the day. It's a liquid and dispensed with its own special syringe. He HATES the stuff and has been running away from me and fighting me when I finally catch him to give him the dose as of late.

Today was no exception. We were both in the kitchen and he saw me with the syringe and booked it, so I ran after him. Caught him by the stove and had him by one hand, syringe in the other and I tripped over my own feet, hit the floor HARD on my right knee, and (for good measure) slid same knee into the bottom of the stove. OUCH!! :(

It doesn't appear that I've caused any grievous damage to my knee, but the middle of my knee cap bruised instantly and the skin on my knee remains red even about an hour after this happened. No noticeable deformity and it doesn't hurt terribly, although it aches pretty darn good. :/ Hopefully my usual achy body cocktail of two extra strength tylenol, 600mg of ibuprofen, and a Flexeril will squash any pain I might end up feeling. I'll be keeping an appropriate eye on things as the day progresses, and assess again tomorrow before I decide whether I'll test that knee for yoga tomorrow afternoon.

As for Ra? Poor fucker still got all of his Atopica--I didn't spill a drop of the stuff as I fell, and though he fought the good fight I managed to get it all down his gullet. ;)

It is with a heavy heart, indeed, that I report the latest news on Ra. The severe anemia is being caused by both kidney and liver failure. With his current med and food regimen, Dr. Medinger at VCA internal medicine gives Ra three to four more months at best. We're adding Aranesp for the anemia and Ursodiol for the liver. Fortunately we were able to get the Aranesp through Costco Pharmacy; I understand it's somewhat hard to come by. It'll be here tomorrow afternoon. Our poor, sweet old man...Our hearts are breaking...

...and none of us, particularly J (who does the actual syringe feeding) and Ra, are enjoying it. Ra simply will NOT eat much kibble on his own, as much and as often as I try. I don't think it's because he doesn't like it, but because it must set heavily in his tummy or something. I just don't know what to do. He seems to want to eat Lars' and Dorene's kibbles, but since their food isn't hypoallergenic...yeah...Even then, he loses interest in it fairly quickly after starting to eat it.

Ra's random feverishness seems to be getting under control--when I pick him up for his meds/feedings, his bare belly still feels a bit warmer than normal, but not nearly as hot as it was last week. I did buy an 8-second timed thermometer especially for kitty use so that we could monitor Ra's temperature, but since neither of us know exactly how to take a cat's temp rectally properly without perforating anything, we've not yet tried taking his temp here at home. I think when we're at the vet tomorrow I'll have Dr. Lehal show me how to do it.

Over the course of last week, Ra went from loose stools to straining to go and not actually achieving download; constipated once again, so putting him back on lactulose was in order. Dr. Lehal told me to start small--only 1cc--and that was plenty enough. Sent Ra right back into loose stool land. :( We simply must figure out a good way to regulate that particular bodily function. Poor fella. :( He seems a bit embarrassed when he inevitably ends up with poo on his feet after a particularly bad one while he's trying to bury his business. Either J or I end up chasing after him to clean him up if we notice him post-download, something Ra REALLY doesn't like. Hey, gotta keep the house from getting all gunked up with cat shit, ya know?

So it goes. We've got a pretty solid routine as far as giving the myriad of meds and timing of the two syringe feedings in between all of that. It's a still a lot of stress and work, but Ra is seeming to be doing ever so slightly better, so we keep going. I even caught him hanging out on the cat fort in the den on Saturday! Took him some effort to get up onto the shelf he was hanging out on, so that's a good sign that he's getting a bit stronger and feeling a bit better.

With Ra being largely nourished with syringe feedings, it was decided that Dr. L should see him yesterday morning for a re-check. So I took him in. Exam done. Ra was running a temp of 103!! That's pretty hot for a cat, not a good sign since he's been on that antibiotic for about a week now. Did a thorough physical exam and noted that Ra complained most incredibly when Dr. L palpated a certain part of his tummy. Dr. L also thought he felt something abnormal in that spot, so x-rays were done.

It took him FOREVER to come back with the x-ray results, largely because he was scrutinizing them so hard. He came back into the exam room and re-palpated Ra's tummy, which caused a minor uproar. Showed me the x-rays and explained his concerns--the area where Ra complained about palpation showed an area of either food pocket or a possible mass and his colon was FULL of gas--just totally bloated with it. So Ra was diagnosed with colitis and Dr. L wanted us to follow up ASAP with VCA Aurora and Dr. M. about the possible problem area in Ra's tummy--located at the juncture between his colon and his small intestine. He recommended another ultrasound of the belly at the very least, and whatever tests Dr. M thought were necessary.

Got a 1300 appointment with VCA. J went with me. A partner vet of Dr. M's gave him his first exam. We talked about a lot of stuff--how Ra's not been getting around very well as of the last week or so--weak on his feet, uncoordinated, scared to jump, etc., Dr. L's observations about Ra's tummy and his x-rays. Partner vet palpated Ra again and felt nothing unusual and asked if Ra had perhaps had a bowel movement from the time he was seen by Dr. L and before we took him into VCA--we didn't know, so we were of no help. He tested Ra's leg's range of motion and made him walk back and forth in the room. Took him a good 40 minutes! He was THOROUGH!! Then he went to talk to Dr. M to see about next steps.

About 20 minutes later Dr. M personally examined Ra, again very thorough, again many questions about Ra and his behavior and his visit with Dr. L earlier that morning. Dr. M ordered a follow-up belly ultrasound, a neurological consult, and some blood work. We got the estimate for the treatment plan and were told it would take about two hours for what was planned. We went off to eat and came back just about around the time he was done...

Ultrasound: was negative for anything abnormal in the belly and showed basically the same as the one taken back in early June. Neurology: normal. The coordination/movement problems are largely caused by bodily weakness likely from the potassium deficiency the blood work uncovered and from lack of eating enough, and same would rectify when both of those issue were taken care of.

Blood work: Came back with the aforementioned potassium deficiency, stage II renal failure, mild anemia and VERY elevated ALT liver enzyme. Ra's ALT liver enzyme was shown to be elevated last week--went from 158 back in early June to 300 last week. Yesterday they were skyrocketed up to 1390! Holy Shit!! The first thing we asked about regarding the blood work was what about fatty liver disease?!?! Dr. M reassured us that Ra's liver showed no signs of fatty liver disease on the ultrasound, that it looked normal, and that ALT was not necessarily an indicator of fatty liver disease.

That being said--Dr. M felt it was necessary to aspirate some of Ra's liver tissue in order to find out just what might be upsetting his liver. So J approved that procedure and we waited in the very noisy and busy waiting area while that was being done. We should get the results for that test as early as Thursday night or Friday morning.

Dr. M took Ra off the antibiotic (good, as it wasn't seeming to be of much benefit anyway). He increased the prednisone for his PM dose to 5mg from 2.5mg. Put him back on potassium supplements; half a 468mg pill every twelve hours. Rest of med regimen remains the same. Encouraged us to really try to get Ra to eat the proper hypoallergenic diet, but if he wouldn't, obviously any food he'll eat is the way to go. So we picked up ten cans of hypoallergenic Royal Canin to syringe feed vs. the really rich and not hypoallergenic A/D crisis food. See Dr. L in 5-7 business days for the lab results and further treatment.

So, yeah. Ra and J and I had ourselves a day yesterday! Poor Ra--his belly fur had just sorta started growing back from the last time they shaved it for an ultrasound and they had to shave it again yesterday! :/ Tried the new canned food this morning and that went over like a brick--what a mess--he seems to prefer the A/D over the hypoallergenic; at least he doesn't try to spit out the A/D whereas he was trying to spit out the hypoallergenic this morning. Hopefully he'll get used to the new food, as it's definitely better for his guts...Sigh, let's hope!!

I've been trying to get him to eat his kibbles on his own, but no love. So, we continue with the A/D syringe feedings. We've been doing 32ml twice a day, and are probably going to increase that to 32ml three times a day.

Got up at the ass-crack of dawn today to get his metoclopramide (one of his anti-nausea meds) into him so we could wait a half hour before we fed him before J had to get ready to leave for work. He's getting feistier with each feed, which is probably a good sign that he's feeling a bit better, but it's hard to know if that's the case or if he's Had Enough of the syringe feeding. Still, he generally took it like a champ. I'm ever so glad J is so good at doing it, and that I can help where ever I can--it's really a two person job to make things go as smoothly as possible.

I think the liver supplement did a number on him, poor fella. That's when the liquid/pudding poops started, when the lethargy got worse, when the appetite went into the crapper. Far too coincidental for it not to be that.

Our big concern right now is that his liver function will continue to falter and/or worsen. Fatty liver disease is an all-too-real possibility right now. I lost my Smudge kitty to that damned disease back in '06 when she was only six years old, I'll be damned if I'll lose another kitty to it without a fucking good fight. :(

Calls are in to both Dr. L. and to VCA Aurora internal medicine to give them both updates on Ra's condition. I fear a trip out to Aurora is probably in order given Ra's anorexia as of late, but perhaps they'll defer to Dr. L to do the work to spare Ra the trauma of the long car ride. He *Hates* that car ride, and I hate to do it to him if I don't have to.

Sigh. Our poor, poor kitteh...

...back in April of 2012, back when he was the healthiest cat in the household. My, how things have changed. :(