Cos (cos) wrote,

Jessie cat's week

One of those posts that's more for me than for anyone else; I wanted to get this all written down while it's still clear in my memory. Also, a place to point people to if they want to know how Jessie cat's last week went.

Last weekend she ate less than usual, though still at the lower end of what's normal for her. In hindsight, we also realize she didn't chase things or want to play much, but since that also sometimes happens, we didn't notice at the time. Still, her eating less reminded us we were going to take her to the vet soon anyway - her previous visit in the fall had measured somewhat low red blood cells, and they weren't sure whether it was a concern, so they said to check again in a while. So Monday morning we called and made an appointment for Thursday.

Monday, she seemed listless. She didn't eat or drink until Alice offered her some wet food in the evening, which she ate a little bit of (she usually doesn't like wet food, but as a novelty she sometimes goes for it), and a bit of water. We called the vet and tried to move up her appointment to the next morning, but the soonest they had available was Wednesday. Monday night we decided to take her to the 24 hour emergency clinic rather than wait for the appointment. By then, she seemed clearly unwell, breathing faster than normal and just sitting on a cloth in the closet and not going anywhere.

Soon after they took her in at the clinic they came out and told us she had a fever of over 104 (99-101 is normal), was mildly dehydrated (she hadn't had a drink since the previous evening, so no surprise), and she might have some discomfort at a spot that corresponded to the pancreas. They were going to keep her overnight and probably through the next day. They had put her on an IV to rehydrate her, and given her pain medicine and anti-nausea medicine, and started her on antibiotics. If she had an infection, as seemed likely, then she might not want to eat or drink due to nausea and they hoped the medicines would get her appetite back, and in the meantime that antibiotics could help her with the infection. They would also take some blood tests.

I hoped that this was just an infection, but her immune system is weak since she's had FIV all her life, so she wasn't able to handle it on her own. With their help, maybe she could beat the infection and be back to normal.

Tuesday morning, we learned that although she seemed happier and less distressed, her fever was still high, and her blood tests showed very low white and red blood cell counts. We might have to transfer her to a hospital with an internal medicine specialist, but first they'd get a radiologist in to do an ultrasound and see what's going on with her organs.

Alice visited her while I was at work, and brought over some of her usual food and treats. She was affectionate and purring and much more alert than she'd been on Monday, and the staff said she'd been affectionate with them too. She still wasn't eating or drinking, although she was still getting the IV to make up for that, and since she seemed more comfortable now they hoped she'd eat something later in the day.

Later that afternoon, from the ultrsound results we learned that something was going on with several of her organs, and they weren't sure what. It might be cancer. Based on her relative lack of reaction to what they saw, they concluded that this had been a slow gradual deterioration rather than something sudden. They needed to take tissue samples to diagnose it accurately, but that wasn't safe with her really low red blood cell count; they were hoping if she beat the infection her blood might recover, and they took another blood test.

We visited on Tuesday evening, along with Alice's sister, who's known Jessie cat for years and loves her. This was the first time I saw her since we left Monday night. She was so much better! She tried walking, though it was kinda awkward since one of her front paws was all wrapped up with IV plugs sticking out of it. She purred and seemed happy. She was still breathing heavily/quickly, which they told us was due to anemia - she was compensating for having too few red blood cells. But overall it was encouraging.

They told us her temperature hod gone down to 101.8 in the late afternoon, but was back to 103 now. They wanted to keep her another evening to see if they could get her fever down and to see what the new blood test results were, and whether they could take samples to find out more about what was happening with her organs, and that based on how things went we'd probably want to transfer her to a hospital with internal medicine specialists on Wednesday. We went home both hopeful and scared.

Wednesday morning, we learned on the phone that her white blood cell count had recovered a lot, to just below the low end of normal range, and her temperature went back down to 101.4 overnight. But her red blood cells were still very dangerously low, and she still wasn't eating. They thought she wasn't making any red blood cells, and suspected some sort of bone marrow disease, but weren't sure what. They suggested we consider taking her home while she was still comfortable and plan for euthanasia fairly soon.

However, since they still hadn't been able to get samples to accurately diagnose her, we could try getting her a blood transfusion and then do more tests. We decided we wanted to do that, to find out for sure what she had and what treatment options we had. So, it was time to transfer her to the hospital. They found a place not too far away in Kirkland, WA, called and arranged everything, sent over the records, and said Jessie was expected. We came over and picked her up and drove her over.

On the ride Jessie was almost like normal for a ride in the car, meowing somewhat at first, then calming down. She popped her head out of the carrier and even seemed to want to come out, though I kept her in, and she purred. More scared, still with some hope. It now seemed more likely than not that this wasn't going to be treatable, but we still had a decent chance of finding otherwise. And if not, hopefully she could at least beat the infection and we'd have her home for a while.

At the hospital they outlined the plan, which sounded a lot like what the clinic had described, though with more steps. After a blood transfusion, they'd do some tests, including the tissue samples plus another ultrasound. Also, they were keeping her in an oxygen chamber, because she was so anemic, and this allowed her to breathe normally and get enough oxygen. Once they figured out exactly what the underlying issue was, they'd know if it could be treated and we'd know what to try next.

Our first report from the hospital told us she didn't seem to be in pain. However, they'd done another ultrasound and her organs were in trouble. Enlarged liver, mottled spleen, distended vain, and so on. Weak pulse, and dangerously low blood cell count confirmed. The next step was to give her a blood transfusion, to make it safe to do more tests, but we shouldn't expect results until Friday.

I went to work, it was just after lunchtime.

I'd only been at work for about an hour when Alice asked me to call her right away. The hospital had called. Jessie had reacted really badly to the red blood cell transfusion, and went into shock. They hadn't even been able to try to give her plasma, which was what they'd planned next. They revived her and she was still alive, but they didn't how if she'd hold up. Alice came to pick me up at work and we drove right to the hospital, fearing that she might have to die in the hospital, distressed and in unfamiliar surroundings.

When we got there they asked us again whether we wanted them to take her out of the oxygen chamber, not knowing if she could stand it. But we knew the only way we could take her home was if she could stand it, so we needed to try. They brought her to the room we were waiting in... and she was okay. Breathing fast, but much less so than she had been on Monday night at home or Tuesday night at the clinic. Alert, and happy to see us. And her temperature was back down to 101.8, which they said was the high end of normal, and not feverish.

She still hadn't eaten or drunk anything. Away from the IV and oxygen chamber, and not having eaten for days, she would not last long, but she seemed okay enough for one last night. Since she couldn't take a blood transfusion, she couldn't be diagnosed or treated. Whatever was ailing her, her FIV was going to prevent us from doing much more about it. The vets believed that whatever was happening to her had started weeks ago, but there was nothing that could've been done to stop it.

So we had the hospital discharge her, and take off the IV; they gave us pain medicine to give her every 8 hours (after giving her one last dose via the IV), which they said would make her drowsy. They made it clear that since she hadn't been eating or drinking for two days, we should not hold on to her for more than a day, because in a day or two she'd start to get miserable again. We didn't want to have to take her back to the clinic, we wanted her to die comfortably at home. The hospital gave us the names of a few at-home vets, and we found one who could come over on Thursday afternoon (it was now Wednesday afternoon).

We told people who know and love Jessie cat what was happening, and invited those who were nearby to come visit and see her one last time. A few friends, Alice's sister, and a really nice woman in our building who has helped watch and feed Jessie a few times this year when we were travelling, came over at different times and hung out with Jessie for a bit and said goodbye to her.

Wednesday evening felt like a miracle. On getting home in the afternoon, she perked up. She drank a bit of water we offered her. She hopped off the bed, went under it for a short while, then came out, walked around the room a bit, and hopped back onto the bed. She enjoyed the visits, and drank a bit more water. She spent the night on our pillows, purring. Thursday morning early, when we woke up to give her the next dose of pain meds, she seemed even better, and when we offered her treats she ate them eagerly and wanted more! We rationed out treats so she wouldn't eat too fast, and after an hour or so we gave her a small plate of her regular food, which she also ate eagerly. She also took a very long drink of water - I got a video (since it's really cute when she drinks!) so I know that she was drinking for more than 90 seconds.

Thursday she seemed almost like normal, except low energy and not wanting to play. She ate several times, and drank more, and took a walk around the apartment, and went to the litterbox. She purred most of the time. I even went to work for the afternoon. We called the at-home vet and postponed to Saturday. Jessie spent the night on our pillows again.

When she first had a few drinks on Wednesday we'd called the cat hospital and the emergency clinic to see if we could talk to any of the doctors who'd seen her, to get some advice, but all those doctors were either seeing patients or out. It was actually her usual clinic who called us the next day; they'd been given the records from the other two places, and the doctor there wanted to check in with us. We made an appointment to get her looked at on Friday morning.

At the cat clinic, they said she didn't have an elevated temperature, and seemed to be doing well. They told us what to look for, gave us more pain meds (the hospital had only given us enough for a few days), and an antibiotic to keep her infection at bay. I wanted another blood test to see if she had a better red blood cell count, but they said that was premature; she had some, from the aborted transfusion, but the question was whether those cells would take, and whether she would make any more of her own, even if too slowly for long term recovery. We should also check for bruising on her abdomen (her belly had been shaved for the ultrasounds), which would be a sign of internal bleeding indicating organ failure; she didn't have any such marks currently, which was a good sign.

We made another appointment for a week and a half; if she was still doing okay then, they would do a new blood test.

Nothing about Jessie's underlying condition was resolved, and it was still untreatable, but if she'd beaten the infection and she was eating and drinking, we had more time. How much time? We didn't know at this point if she had days or weeks to go, but based on what the vets said, there was even an outside possibility of a month or two, if whatever what attacking her organs was progressing slowly enough and if she'd make a low level of red blood cells. We called the at-home vet again and cancelled for Saturday, though we told her we might need her soon, we just didn't know when.

The rest of Friday was much like Thursday, except I stayed home from work all day to hang out with the cat. We stopped giving her the pain meds in the afternoon, because she didn't seem to need it, and would appreciate the extra alertness. We walked to Fremont (15 min from home, it's where work is) to have lunch and get groceries and buy Jessie a present: A small pot of wheatgrass, which we sometimes call cat grass. Alice had been growing a new pot of it for Jessie but it wasn't sprouted yet, so we got some that was fully grown. Jessie loved it, and chewed on it and batted it with her head like usual. Much of the rest of the day, I read books in bed with the cat purring beside me.

Saturday, we even spent some time doing other things, and letting Jessie nap peacefully on the bed. But in the early evening we noticed she hadn't been walking or getting off the bed, and she hadn't eaten or had any water since midday. We tried to offer her some of both, several times, and she wasn't interested. Her usual cat clinic was closed by now, and it was time for her antibiotic, but it could make her nauseous if she took it without food and we didn't know what we should do.

We called the emergency clinic and the cat hospital and left messages asking for a vet to call back. Decided not to give her antibiotics, and gave her a full dose of her pain meds. Maybe that would help her want to eat again?

Someone from the emergency clinic called back, late that night. They agreed with our decision not to give her the antibiotics, and to give her the pain meds, and they said we could also come over to pick up an appetite stimulant. They'd given her one on Tuesday, and one dose is for 72 hours, though it doesn't always work. They also warned us that if she deteriorated again, one thing that could happen is that she'd be so short of breath that she'd start to panic and feel very scared and distressed. I realized maybe that had started to happen on Monday night when we first took her in. We texted the at-home vet to say we may need her on Saturday.

I did go to the clinic to pick up the appetite medicine, and when I got home, Jessie got off the bed and walked a little bit. After using the litterbox, she went into the closet where she'd gone on Monday, and curled up on the same cloth. We put her food and water next to her, but we now realized this could be it. She wasn't nearly as bad as she'd been on Monday, and her breathing was still like it had been the past couple of days (faster than normal, but much slower than earlier in the week), and maaybe she'd eat something in the morning?

We got up very early again on Saturday, to give her the next scheduled dose of pain meds. She hadn't eaten or drunk anything, not since midday the previous day. The at-home vet we'd been talking to, who seemed really nice, was sadly all booked up for the day, and would not be available the next two days due to Christmas. Alice tried again to reach the other at-home vets whose numbers we'd been given on Wednesday, but got voicemail or closed offices. We were worried we might have to take Jessie back to the clinic for the end, and we really wanted her to have a nice peaceful death at home.

I called around, the clinic and the hospital, and got numbers of a few more. At first I only got one number, but they made a comment that made me realize they were only telling me about the ones in Seattle itself, so I asked what about at home vets in nearby cities/towns. They said that would probably cost more, but gave me a couple more numbers. We called them all, and one called back - should could come later that morning, in a few hours.

By this point, Jessie actually seemed a bit better - likely due to the pain meds she got just before we went to bed and again when we got up. She got up and left the closet, walked all the way across the apartment, visited her usual litterbox (rather than the temporary extra we'd put in the bedroom), and walked back to the bed to hop on. But this minor rebound was certainly going to be short-lived. What most likely happened was that she'd gotten a boost of a few days from the partial blood transfusion, but her body wasn't accepting the new cells and they were dying off and she wasn't making any more.

Alice got on the bed next to Jessie, and Jessie immediadetly walked over and climbed on top of her, and curled to rest. She stayed there, alternately napping and waking up and purring a while, for the next two and a half hours, until the vet called. When the phone call came and I got up from the bed, Jessie also got up and took one last walk around, while I went outside to let the vet in.

She got her sleep shot at 10:09, and was fast asleep in a couple of minutes, with her head resting on my hand. She didn't even seem to notice getting the shot, it was such a thin needle and the vet injected it in so very very slowly. Soon she started snoring softly and cutely, like she used to in the past when sleeping, but which I hadn't heard her do much recently.

While she was sleeping, we watched her breathe, and the vet shaved her paw and took a clay impression for us. She asked which paw and Alice picked one of the back paws, which the vet said was a first; I guess people usually pick a front paw. But it turned out to make for a much better impression in the clay than front paws usually make.

She got her second shot at about 10:30, I think, and it took effect quickly.

Jessie had a very trying Monday, Tuesday, and half of Wednesday. But from Wednesday afternoon until the end, she had a good three days, mostly comfortable and happy. I'm glad the sequence went as it did, with an acute warning first, and then a good few days after we knew the end was near. We got to get used to the idea while we still had her with us, and we got to spend a lot of time with her after we already knew it could be the last time we'd get to do so. Her death was easier on both her and us that way.

Crossposted from Dreamwidth - link to original post (comment count unavailable comments on DW)

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