and he's eating & drinking & grooming & peeing & purring! The price of which is that I'm now oodles in debt to my parents (and oodles of grateful). What's wrong this time? Well, it was super scary for a while, and while he's home and happy now, there's a grim road ahead for my beloved and I. Follow for the story.
I took him in to his regular clinic on Thursday because he was Not Doing Well. Actually, I'd taken him in on April 11th originally, for what was obviously a bladder infection, then April 20th (bless my cat, I'm convinced he thought he was doing me a favor by getting me out of the Big Family Easter Gathering), and April 24th because his presenting symptoms weren't getting any better and he WASN'T EATING and was scarily lethargic. Wouldn't groom. Just sat in his sink and peed where he lay. Occasionally stared mournfully at his food buffet (three separate dishes with various combinations of canned salmon, canned kidney diet, and dry kidney diet) but wouldn't touch it. Just slurped down the canned salmon water, which I cottoned onto quickly enough to keep pouring bottled water over the flakes of salmon so he'd at least have something in his stomach.
I was shitting-my-pants scared. This alleged bladder infection, for which we were now on our third antibiotic, was either not going anywhere or it wasn't the problem.
So Thursday we high-tailed it to the vet clinic for the fourth time in three weeks. Unfortunately, it wasn't my preferred/usual vet, but it was one who I know practices good medicine. But after examining the beast and doing a CBC, she was pretty full of gloom'n'doom regarding Levitas Cat, saying flatly that we were looking at end-stage kidney disease.
I was horrified. Cat and I have been managing his kidney disease since its diagnosis in October. I truck his ass down to the clinic for subcu fluids twice every week, he gloomily eats his kidney diet, and regular bloodwork shows that his values are stable. What did I do wrong, I asked myself. I thought when I accepted the diagnosis in October that careful management would still net us some good mileage together, Cat and I. I felt ROBBED. Also, it's finals week. And I'm alone. As usual. My life is a fortress of solitude and isolation — except for Cat.
I called my best friend, an internal medicine specialist. He agreed - something else was wrong. But the problem is that Cat was in too bad of shape for any invasive diagnostics. For one, he was severely anemic. His PCV was 12, although his normal range is lower than normal normal, which is 30. They gave him IV fluids and were able to get him an abdominal ultrasound. I'm lucky that the clinic's weekly radiologist was there and could administer and interpret it. (Actually, I knew he'd be there. That's why I took him in on Thursday instead of waiting for his regular vet on Friday. It's depressing how well I know the staffing of a large veterinary practice.)
Ultrasound showed pyelonephritis, pancreatitis, thickened bowels, and swollen lymph nodes. Suggestive of lymphoma.
I cobbled together a plan. Put him in an emergency care facility for 48 hours and see how he did. If he improved, it meant we could look at diagnosing the problem that was causing the debilitating symptoms. I called my parents, crying, begging for a loan (by way of credit card #). Mom offered to drive in. I refused. I didn't want to see anyone. Also, I had a final on Friday.
So I took Levitas Cat to a referral emergency clinic nearby that I knew had a sharp reputation. When I did all the intake paperwork, I checked the "No" box for CPR. That's one of the most difficult things I've done in my life, but I knew that my kitty was in bad shape and I had to be realistic. As soon as he arrived they put him on an IV drip of enhanced hydration, anti-emetics, antibiotics, and something else which I forgot.
Long story short - because Erudita needs a cigarette but won't smoke until she publishes this post - Levitas Cat had a blood transfusion to raise his PCV (that's basically his red blood cell count, stands for packed cell volume) from clinical emergency level to functional level. It worked. He started eating, grooming, and being alert. More than 24 hours after the transfusion, his PCV is holding steady at 22. I called up there frequently and visited him twice for an hour each. The staff were wonderful. I'm a needy client so I got copies of all his case notes. It has notes like "Per owner's request, make a 'nest' of blankets when changing bedding" and "Plays in water bowl - do not fill to brim."
But the bad news.
He had a chest x-ray and it showed some super wonky abnormalities. My consulting veterinarians called them "sketchy" and "worrisome." Even I could see the sprawling grey masses on the radiographs of his lungs.
Cutting the diagnostic narrative short, it's either lymphoma or a fungal infection (evidence for the latter being a possibly-recently-developed "Roman nose" which signifies a particular fungal strain, the name of which I cannot recollect at present). Either one is bad, treatment wise. And either one is expensive, diagnostic-wise.
What do I do?
I took him home tonight because I want to see how he does with home care. I know that we've spent the past 48 hours (and $2k) treating the symptoms, not the problem. If he keeps eating and drinking and peeing and purring and grooming it means there's still hope and that it may be worthwhile to spend borrowed money to borrow more time with him. One thing is certain - I won't let him suffer. But neither will I snuff out a life when there's still a valid fight to be fought.
I've left out lots of details and relevant information in my quest to finish this post so I can untangle/awaken my legs, go take a piss, refill my wine glass, and have a smoke. And pat my cat on the head on my way out. That's because I have spent this time sitting on the tile floor of the bathroom, back against the cabinets, as Cat snores contentedly in the sink above my head. My laptop battery's about to die. Let's raise a glass to Levitas Cat averting that fate this weekend.