In Memoriam

This weekend (yesterday actually) was the one year anniversary of the day our first cat, Marquis, passed away after his battle with chronic renal failure.  He had been diagnosed over a year earlier and his death hit us pretty hard since we had been dedicated to his treatment for a year and he had seemed to be doing well until his health just crashed at the very end.  It was one of the motivations to start this site in the first place.

Last image of our Snowshoe cat Marquis

I had been meaning to write more about our battle with feline chronic renal failure, but it was a subject that I've been avoiding for awhile.  Certain breeds of cats such as Siamese and Snowhoes, of which Marquis was, tend to suffer more from chronic renal failure or CRF.  CRF, as opposed to acute renal failure, is a gradual weakening and deterioration of the kidneys.  Acute renal failure might be due to the cat eating something toxic, but can usually be treated with full recovery.  However, chronic renal failure is more insidious.  Kidneys are strong organs, but unfortunately this has the side effect of not being able to detect the progress of CRF until more than 70% of the kidney function has been irreparably lost.

The kidney has several important functions:

1)  Filters out waste material from the blood (these tend to be nitrogen-containing molecules from the breakdown of proteins from food)
2)  Regulates electrolyte concentration (sodium and potassium ions, which have an effect on ion channels)
3)  Produces EPO (erythropoietin), a hormone involved in producing red blood cells

Once the kidneys become compromised, the body slowly gets weakened, which accelerates the deterioration of the kidney function.  The blood starts to accumulate waste since the kidneys are not as effective at filtering them out.  This can be tracked through blood tests for creatinine and BUN (blood urea nitrogen) levels, which are markers for this waste.  Elevated levels are a key marker of renal failure and are one of the first indicators of CRF.

So how can we treat this?  The standard method is to approach the problem from two directions.  The first is to switch to a low protein "renal" diet.  This is food that has low amounts of protein (which contain phosphorus and nitrogen) so that when the body metabolizes it, there are less nitrogen-containing waste products poisoning the blood.  There are several veterinary diets that you can use, but you can also look up the phosphorus levels of common cat food.

Dry Cat Food Phosphorus Analysis
Wet Cat Food Phosphorus Analysis

The other approach is to dilute the waste products in the blood stream.  This is done by giving the cat water---most CRF cats tend to be more thirsty than normal due to this.  As a result, the cat urinates more frequently which also helps to remove the poisons.  Wet cat food is highly recommended over dry food to the water content.  But to take it one step farther, one standard of care is to give the cat subcutaneous saline injections directly---the saline is then absorbed into the bloodstream.  This is not a pleasant act, but Marquis was actually very good about it---in the morning we would sit him on the couch, pinch up the skin of this neck, and then slowly inject the saline.  He would sit there and wouldn't complain and we would give him a treat afterwards.  He became used to it after a while.

Subcutaneous saline injection therapy for CRF cats

There are other more involved treatments that you can do, such as potassium supplements (to make sure that the cat's electrolytes are balanced), iron supplements (to battle anemia due to low red blood cell count), and EPO injections (highly expensive).  We ended following the diet and saline injection approaches.  We found a low phosphorus wet food and we gave him daily injections of ~50 mL of saline.  This worked well for Marquis---he lasted for over year and basically showed no symptoms of his illness until his kidneys finally started to fail.  At that point, he became too sick to eat regularly and he quickly lost his weight and strength.  At the end, he had lost more than half of his weight and wasn't able to walk or stand.  It was heartbreaking.

CRF is a devastating disease and it is a terminal disease.  However, there are steps that you can take to treat it and give your cat good quality of life.  Some good sites that helped us with it:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure
Feline CRF Information Center
Sub-Q Survey of CRF Cats

And the best community for owners of CRF cats is at The Feline CRF Support Group at Yahoo Groups.  This is an amazingly supportive community of people who have been through CRF.  They gave us very kind messages of support and understanding and helped us get through the situation.  Thank you!

Dust to Dust

We received the remains of our lemon kitty Marquis this week.  It felt a little unreal to drive down to the animal hospital we had been so often, only this time without the uncertainty of what was going to happen.  We had his remains individually cremated---we had discussed burying him, but since we live in a condo with no outdoor area, we had no good spot.  And if we eventually end up moving away, we could always keep him with us.  Plus, he was never an outdoor cat to begin with.  They placed his ashes in a nice wooden box that we can keep with us forever.

 Marquis sitting in his favorite spot one last time

I miss his charm and good lucks.  Everyone who's met him has mentioned what a beautiful and sweet cat he was.  I miss his big blue eyes and his big paws with six toes on each foot.

I miss how he would follow us everywhere.  He never liked being alone and always wanted to be near people.

I miss how he used to come up and wake us up every morning to play.  I miss how he used to come down the stairs and greet us when he heard us come home from work.  I miss how he would then climb halfway up the stairs, stop, and look back and wait for us to follow him up.  If we didn't, he would come back down and nudge us forward.

I miss how he would twist, turn, and twitch in pleasure as you pet him.  I miss how he used to roll over for a belly scratch and then grab our hands with both paws to lick them all over.

I miss how he used to go crazy playing with rubber bands.

I miss how he loved car rides.  He loved to sit up and stare out the window as we drove.

I miss how he enjoyed water and even let us wash him in the shower.  I miss how he would chase his tail in the bathtub.

I miss how we could clip his claws with no fuss.  He would just sit there politely until it was done.

I miss how he would sit in the sink and wait for us to turn on the tapwater to drink from.

I miss how he would lie on us and knead us with his front paws all night.  If I would call him, he would come sit on me.  Then if my wife called him, he would jump over and sit on her.  We could keep doing this over and over again until he would get dizzy.

I miss how no matter what time of the day, you would always find him sleeping in a sunny spot.  I miss his yawns after a long nap.  I miss how he stretched first his front legs and then his back legs when he got up.

I miss his quiet, polite meow voice.  He was never whining or demanding.  He wouldn't complain if he was hungry---he would just sit patiently in front of us food bowl.

I miss how he quietly sat and begged us for food when we were eating dinner. Although he could, he never jumped on the table while we were eating.  He just waited until we were done (except the one time he swiped away my wife's chicken wing with neither of us noticing).

I miss how sweet he was.  He didn't have an aggressive bone in his body and he never hissed or striked out at anyone, even strangers.

I miss our kitty.

Cleaning

We spent the weekend thoroughly cleaning our house.  Part of the reason is that a sick cat is not really a clean cat and, as a result, does not make for a clean house.  Part of the reason is that the new cat Bumper has always been scared of our old lemon kitty Marquis, so we thought by removing his scent she would be more comfortable.  Part of it was to give us something to do, a project, anything to take our minds off of what had happened.

At least those were the reasons we told ourselves.  I wonder if deep down this was a coping mechanism and that the real reason was that we were trying to remove all traces of him.  We put away all of his things---his toys, his bed, his brush.  We cleaned and put away his litter box.  There is nothing left to remind us of him except for a few pictures on the wall.  If he never existed, then we wouldn't be hurting, right?  If we could clean our minds of him, it might scrub away the pain and help us move on.

The house does feel emptier now and more dark.  But clean and perhaps antiseptic.

Love is Watching Someone Die

August 20, 2010 was when our world changed.  We came home early from work to take our lemon kitty Marquis to the animal hospital to finally end his suffering.  He was too weak to stand and we couldn't ignore what was happening.  There was nothing left that we could do.  The car ride was a quiet one, neither of us saying too much while the cat was sleeping on the floor.  He used to love car rides and would sit and stare out the window, but this time he just lay there.

At the animal hospital, they brought us into a room and we stayed with him for a while, gently holding and petting him.  As weak as he was, he still rubbed his head against our hands and even started weakly purring.  He couldn't eat or stand, but the last thing he would do is reach for us.  The doctor came to take him away briefly to put in a catheter---as the doctor picked him up, Marquis' eyes became wide and he stared at us when we didn't follow.  It broke our hearts.  Why weren't we following him?  Why were we abandoning him?  After several minutes, the doctor returned with our cat's leg bandaged and with a syringe attached.  He asked us how long we needed, but after caressing the cat, we told him we were ready.

It was over so fast.  My wife was kneeling down and looking into his eyes as the doctor pushed the syringe in.  I was gently cradling his head in my hands.  In seconds, his head dropped and then lay still.  He didn't cry out or move---he just rested his head and stopped breathing.  The doctor checked him with a stethoscope and told him that he was gone.

My wife was crying the whole time.  I tried to stay strong, but when the doctor's voice started cracking as well, that's when I couldn't help myself.  I couldn't see through my tears and I started choking.  The doctor left us and we stayed with the body.  Our kitty lay still.  His eyes had never closed the entire time.  His tail was large and bushy.  Was he scared at the end?  Was he in pain?  Should we have stayed and comforted him longer?  Should we have done more?  Those are questions that will never be answered and doubts that we will always have.  My wife picked up his body and held him.  His body was like a rag doll and it was heartbreaking to feel how fast it had turned cold.

When we were ready, the doctor came to take the body away for individual cremation.  After about a week, his ashes will be returned to us.  It took us a while before we were ready to go back home.  The drive was a quiet one.

Marquis, our snowshoe kitty:  2000 - August 20, 2010.  Rest in peace.

Feeling Yourself Disintegrate

Our lemon kitty Marquis was diagnosed with chronic renal failure over a year ago and we've been able to treat him with daily subcutaneous fluid therapy to keep him hydrated.  He was doing very well for over a year until about 4 weeks ago, when we came back from a wedding to find that he had crashed.  We took him as soon as we could to the animal hospital and it was revealed that this kidney functions had deteriorated significantly.  They placed him on IV fluids for several days, but unfortunately that had no effect on his condition.  Rather than keep him alone in a cage, we brought him home, but sadly he has gotten worse over the last several weeks.

He has lost a lot of weight and is only 4 lbs after being over 10 lbs a month ago.  His ribcage shows through his fur and the rest of his body is sunken in.  He's not really not eating anything and we've tried dozens of different foods, including his old favorites.  We even tried giving him some rotisserie chicken, which he used to follow us around the world for.  His nose is brown, peeling, and crusty.  His fur is not growing back from where the doctor shaved him to put the IV in and the underlying skin is patchy and brown.  He's finding new places to hide and he doesn't have the energy to jump up to his old favorite places.  And he smells bad, particularly from his mouth, but even from the rest of his body as toxins have been accumulating without being cleared by the kidneys.

We've been trying to fight this with almost an entire pharmacy's worth of medicines.  We've increased his sub-q fluid intake to 120 mL a day.  We've also been giving him Prednisone daily, Cobalamin injections weekly, and lately Reglan and Pepcid to try and control any nausea and get him to eat.  At a checkup last week, his numbers haven't changed but his phosphorus levels are now high, so we've been treating him with aluminum hydroxide binder.  Nothing has really worked at all and his condition has just gotten worse.  We've tried assisted feeding (syringing some liquid food into his mouth) and it was a disaster---he was fighting and clawing and the syringe clogged and spurted food everywhere. 

The whole ordeal has been traumatizing to us and him---every morning and night, we have to fight him to medicate him and now he runs away from us to hide when he used to run to us.  He can barely move now and walks with a limp and spends most of his time lying down.  This is the first time that anyone or anything close to me has been dying.

How much is too much?  How do you know when is the end?  His quality of life has decreased so much that we're not sure if there's anything we can do to bring him back or if it would even be worth it.  It's been a really intense emotional roller coaster ride---one morning, he'll eat a bit of food and we'll get our hopes up but then the next day he's no longer eating and acting worse.  But this last week has been all downhill.  It's really hard to know when to end his suffering---sometimes his eyes are kind of unfocused, but most of the time I can see in his eyes that he's still there.  How long do you wait?

Tonight, we reached the point where he was too weak to make it to his litter box and he ended up lying in a pool of urine.  We placed him in his bed and he collapsed and lay on his side.  We just gently held him, but he still had enough energy to rub his face against our hands.  He barely had enough energy to stand, but he used his last reserve of energy to keep rubbing his face on us and weakly purr.  We stayed with him for a while until it looked like he was relaxed, but when we stood up, he lifted up his head and stared at us with wide eyes.  He didn't want us to leave him and kept looking at us until we came back and held him.  His eyes closed in peace.  We stayed with him until he fell asleep.

This is likely the end.  We just want him to be released from his suffering.  He's been fighting to stay for our sake, but I think he knows that we've made peace with it.  He doesn't have to fight any longer.

My wife likes to say that I'm usually very rational and don't show my emotions very often, sometimes resulting in people thinking that I'm cold or flat.  I've wondered this about myself as well.  From early on, I've learned to try and keep an even keel, sometimes to the extent that I wonder if I really am just not as emotional as other people.  Now I know that's not true.

Hello Kitty

A friend of mine from work watched over our kitty for several days last January when we were away.  He shot this short video with his iPhone that shows our cat at his healthiest.  Our cat had never met my friend before, but didn't hesitate to perform his favorite activities---twisting and turning, flopping over on his back waiting for a belly rub, and grabbing your hand with his paws to lick it.  I've never seen a cat that craved human contact so much before...he was our sweet, one of a kind little guy...  (Hosted on here on Flickr in case the embedded video doesn't work).

More on Our Lemon Kitty

As I mentioned earlier, I never really thought of myself as a cat person.  Most of the people at work tend to be dog people too.  I guess I can agree with them with respect to most cats---the stereotypical cat kind of keeps to themselves, but Snowshoes are different.  When we were looking for cats, we definitely met some cats who displayed stereotypical cat behavior.  They acted pretty standoff-ish, didn't like to be held or touched for very long, or even hissed at us when they got mad.  Our lemon kitty Marquis, however, has never made an aggressive move towards us.  He's always been very sweet and loving.  We joked that he was raised by dogs but had the advantage of knowing how to use a litter box. 

He would do things that are pretty unusual for cats.  We didn't let him sleep with us since my wife has some slight cat allergies, but he would come up and wait patiently by the bedroom door each morning to welcome us.  He used to come down to the door and greet us when we came home from work every day.  His favorite activity was running up to us and then flopping over for a belly rub and then twist and turn.  He was a licker---he would grab our hands to rub his face and lick it all over.  He could do this for hours if you let him.  He was a pretty lazy cat and didn't even show any interest in laser pointers or other cat toys.  He would just sit on or next to us the rest of the night, occasionally grabbing our hands for a belly rub.

He was sweet tempered enough that he would sit quietly when we trimmed his claws (he had six toes on each foot).  We could even wash him in the shower and he wouldn't complain.  If he got sad or upset, he wouldn't strike out---instead, he would go and sit in the corner until we came to pet him.  Once he got diagnosed with chronic renal failure over a year ago, we were able to subcutaneously inject him with 50 mL of saline daily to keep him hydrated and he didn't complain.  I don't know if we would be able to do that with most cats.

He's so sick and weak now that he barely has energy to move.  He can only walk with a slight limp to the litter box.  But whenever he sees us for the first time in the morning or when we come home from work, he still has enough energy to grab our hands and rub his face over them.  Now he can only last for a couple of minutes, but you can tell that's what he's been saving his energy for.  It's what he lives for---even in the end, all he wants is to be with us.

As weak as he is now, he still has enough energy to grab our hands for a good rub.

Our Lemon Kitty

I never thought of myself as a cat person.  I've always thought of myself as a dog person, but having a dog just doesn't fit well into a modern professional lifestyle Being stuck at work, we just don't have enough time to take the dog out each day.  In contrast, cats can be more independent and can look after themselves more easily.  Plus, my wife preferred cats, so we decided to look into it.

However, we started doing some research into different cat breeds and Snowshoe cats immediately jumped out at us.  Snowshoes tend to be more sociable and affectionate and "dog-like" than typical cats, so we thought this might combine the best of both worlds.

We visited several local animal shelters and had a chance to visit with different cats.  We quickly saw that each cat had a distinct and unique personality---some were louder and more playful, others were more shy and timid.  And others, like a cat name d Andrea, only tolerated petting for several minutes before turning her back on us and hiding in the corner.  We didn't find any cats that really stood out to us.

The old saying that "you don't choose your pet, your pet chooses you" became true for us.  We browsed Petfinder for a while until we saw a listing for a Snowshoe named Marquis up in LA.  Taking a chance, we drove nearly an hour to visit with him.  He was sitting in his cage, but as soon as he saw us, he perked up.  He immediately started rubbing his head against our fingers and then even grabbed our hands to lick them.  We immediately fell in love and just had to adopt him.

However...the big problem was that Marquis had an eye infection.  In fact, his eye was squeezed shut and oozing .  The shelter had him checked out by a vet who said that it wasn't anything serious.  We just had to treat him with some eye medicine.  This probably should have been sign, but we just couldn't help it---we had to adopt him.

And so that's how we ended up with our "lemon" kitty.  He's always had problems.  He eventually got over his eye infection (although it sometimes crops back up again), but after a few months we had to take him to the vet who diagnoses benign cysts in his ears.  He had bad teeth and we eventually had to take him in to get some teeth extracted after they started getting infected.  That's when we found out from the blood tests that he had early chronic renal failure, which we've been treating for over a year now.

And despite all of this, he's been the most sweet, loving companion we could ask for.  I don't know if anyone else would have picked a cat with an eye infection or could see through all of his health shortcomings, but he chose us and has loved us ever since.  Maybe we could have gotten a younger, healthier cat, but we'll stay with him no matter what.