After 5 days of being hospitalized, Sabine is resting comfortably at home.
The previous week, since around Valentine’s Day, Sabine was acting a little odd…nothing too alarming, but she was urinating outside her litter box way too frequently (she did on occasion when we left on a trip, so we thought this was the same thing). It didn’t strike me as completely abnormal as she was still eating regularly, begging for scraps, and didn’t have any change in behavior. By Wednesday, I had a gut feeling something was not quite right. Usually, when I wake up in the mornings, Sabine will either greet me by my door, or she will meow at me when I come downstairs, and then follow me to the kitchen. She looked at me, but didn’t meow or follow. She’s such a vocal cat, that this struck me as odd. I tested her by giving her treats, and she begged for them, going through her arsenal of tricks and pawing at my leg. Because of this, I didn’t think anything was serious, but was still paranoid, and scheduled an appointment at the vet the following day.
I took Sabine to the vet early the next morning. The vet examined and weighed her, and didn’t find anything out of the ordinary with the initial exam. This would be equivalent to a routine exam that a cat gets at a yearly check-up. Because of the ‘odd’ behavior, the Dr. recommended a blood test and x-ray.
Several hours later, I returned to go over the blood results. The Dr. pulled out a highlighter and started highlighting several values that seemed high…not just marginally high, but exceedingly high. Most notably, her BUN and Creatinine were about 5x the upper limit normal value. Sabine was beyond Stage 5 critical levels. These values indicated her kidneys were not functioning properly as a result of either Acute Renal Failure (ARF) or Chronic Renal Failure (CRF). CRF usually occurs in much older cats (Sabine is not yet 5 years old), so the assumption was she had ARF, which is caused by ingestion of toxins (antifreeze, lilies, aspirin, ibuprofen, etc). It’s not treatable, but a cat can fully recover. CRF, however, is a slowly progressing disease of the kidneys, which is not curable, but can be maintained. Many cats with CRF are able to live quite long lives.
We started Sabine on aggressive treatment, hoping that if she had ARF, that diuresis treatment would lower her levels, and that we would be able to either maintain her levels as a chronic level or that the kidneys would flush all the toxins over time, and her kidneys would return to normal.
After her first full day in the hospital, her numbers dropped two points, but her values were still so high. We kept hoping that they would drop further. Many cats don’t respond to treatment immediately, and sometimes get better before they get worse. The next day, we received a call from our doctor — she said that Sabine wasn’t eating, and that at this point, the treatment didn’t seem to be working, and that we should probably start to consider “options.” My stomach dropped. Then I puked.
Before we did anything drastic, I asked they repeat the blood test to make sure that she truly wasn’t improving. Surprisingly enough, her blood results indicated a significant drop…I was elated…maybe the treatment WAS working. For the first time in days, I felt hopeful. One moment, I was the lowest of low, the next, I had renewed hope. I was determined not to give up on Sabine, and I started discussing options and next steps with Sly and Jenn. We agreed to a new plan: keep Sabine hospitalized/stable until we could schedule an appointment with a specialist in internal medicine. We discussed going to UPenn for dialysis treatment, if it was determined she was a suitable candidate, and that the renal failure was acute (and thereby, dialysis would be short term). Our limit in terms of treatment, was a kidney transplant. Based on the information we found online, it didn’t seem like a realistic option in terms of level of invasiveness, quality of life after the transplant, success rate, and life expectancy post-operation. Since the organs come from a healthy lab-raised cat, as part of the transplant agreement, you are required to adopt the donor cat. Not a dealbreaker if we were to go that route, but definitely an interesting ‘side effect.’
I picked Sabine up from the hospital this morning, and drove her to the special vet hospital. Sabine was just so good the entire trip — she sat on the car seat and enjoyed the entire ride — just like the first time I drove her home from the Pet fair — calm and sweet as ever.
The Dr of internal medicine thoroughly examined Sabine, pored over her records, and took an ultrasound. She explained that the ultrasound was the only way for us to see a full picture of her kidneys, and determine if there were any other causes for the spike in BUN levels. A little over an hour later, I met with the Dr to discuss results. It turns out that one of Sabine’s kidneys was quite a bit smaller than the other, and it was possible that it never even functioned at all. That was a possible root cause. The other possibilities included Sabine’s kidney somehow being damaged at an early age (like when she was spayed), or that she was born with a genetic kidney disease. She said that either way, she thought it was more in line with chronic renal failure, since a cat with such high levels with ARF would be a lot sicker. But since Sabine had probably been dealing with reduced kidney function over time, she had just learned to adapt, thereby tolerating higher levels. It was only at the point when her kidneys “crashed” that we were able to actually notice visible signs of a problem. This amazes me — Sabine’s kidneys are probably at a 90% or more loss in functionality at this point, which means she’s probably been functioning at 75-80 at a normal level for some time now.
Our options for further treatment basically was just one thing — a kidney transplant. We discussed it further, and she said that it’s not something she ever pushes her clients towards — she’s seen a few success stories, but she said she’s seen many others that were not successful, and the aftermath was pretty heartwrenching. I asked again about dialysis, and she confirmed that even if we pursued dialysis, it would be an ongoing treatment because it was her opinion that her kidneys were not able to recover to normal functionality at this point. She told me we’d do everything we could to make Sabine comfortable, and just monitor her health on a daily basis. With misty eyes, she apologized that she had to give me bad news, and that she could tell Sabine was such a sweet kitty. I had to fight back my tears.
It was a relief to finally know on some level what happened to Sabine, as well as know that I tried everything in my power to make sure that she had every chance possible to survive. And I’m at peace with our decisions that we have made concerning her past and future treatments.
Sabine was sent home with several medications to reduce nausea, increase appetite, as well as “Sub-q” fluids. After I was given a demonstration on how to inject Sabine with the fluids, Sabine was discharged, and taken home. Once again, she rode the entire way in the passenger seat, just like a little baby.
Sly and I set up her favorite chair next to our huge picture window that looks outside into the woods where other cats and squirrels and birds play. We put down towels and puppy training pads everywhere, along with water and food. Pandora was not pleased…the moment she saw Sabine in ‘her’ spot, she went ballistic — threw a temper tantrum, and ran downstairs to our basement, screaming, swatting things, and being her typical pet cemetery self.
Sabine has slept the majority of the day — she’s lethargic and stumbles quite a bit, but you can tell she recognizes home, and is happy to be here. She still responds to our voices, and makes an effort to follow me around the house (although very slowly), and be with me and Sly. I have noticed that she is seeking out dark, isolated places at times, and has not really wanted to sleep on my lap as she usually does. She’s so light and weak right now, that when she jumps down from the couch or chair, she practically flips over from the effort.
I’ve been watching her nonstop — if she gets up, and looks like she wants to drink water, I’ll pick her up gently and set her back down. In this weakened state, I know Sabine doesn’t have much longer. I’ve been spending my time with her just keeping her company, telling her how much I lover her, how much she means to me, will always mean to me, and talking to her about good memories we’ve shared. I told her that if she needs to go, that I’ll be okay, that I’ll be beside her no matter what. It is one of the most heart breaking things I’ve ever had to watch, and that it’s happening to my little baby girl absolutely kills me.
I’m taking comfort in these final days in knowing that I at least have the time to say good-bye, and as painful as it is, I will always treasure these final moments with my Sabine. I wouldn’t trade them for anything in the world. There’s no place I’d rather be right now.