Thursday, June 26, 2008

Day 13 Home 3

Today is the first time I gave her fluid under the skin myself, under supervision of course. The feeling of the needle going into her flesh is something I do not enjoy but I know that I need to get the procedure right so that I can administer this at home daily from perhaps the next week onwards. She does not seem to feel the pain of the needle going in and that is a big relief to me.

No weight loss today though her appetite is now much better. Hopefully she will be 500g heavier tomorrow as I am increasing her food intake by 10% every day.

Today is our 10th ROM anniversary and I had clean forgotten about it due to Xin Xin's illness until last night. I thought the Wife would have forgotten it too since we have been so focused on getting her back on her feet these 13 days until I receive a SMS from her this morning wishing us a happy anniversary. But what touched me was the sentence she added below.

"Just glad our family of seven is still intact this year." I completely agree.

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Wednesday, June 25, 2008

Day 12 Home 2

She looks slightly better today. Still slightly dehydrated. We will need to syring her more water after each feeding since she is not drinking enough on her own.

Her appetite is slightly better. I managed to syringe her some k/d wet food in one seating without much fuss. As her weight is still only 3.5kg, a loss of 10% before she was ill, getting food into her system is important. We will have to feed her more to assist in her weight gain.

We finally let her meet the rest of the gang today after the vet visit this evening. Kim Kim and Bon Bon hissed at her. It must be because she smells quite different. As she has not been grooming this past week, she smells more like the vet office than the familiar Xin Xin they used to know. There was no reaction from Yuan Yuan though she was a little cautious around her. We'll continue with this nightly until she is strong enough to be around them without supervision. For the time being, she'll have the luxury of sleeping on our bed at night and during the day.

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Tuesday, June 24, 2008

Day 11 Home 1

I think she was really glad to come home. Her posture is now more relaxed as she is sleeping in all sorts of funnt positions again. She has also gone back to her old habits of wanting to be on my lap whenever I am working on the computer table and sniffing the Colgate in our breath every morning. She is less tensed and hopefully, this will aid in her recovery.

She is still not eating. The vet has explained that because of her high BUN level, it is causing her brain to sense food as urea or ammonia thus diminishing her appetite. We are still syringe feeding her 4 times a day, hoping that small and more meals will let her body absorb more nutrients. The good news was that she is still attempting to drink water on her own though there is still some hesitation.

We brought her back to the vet for fluid injection in the evening. This will probably go on for another week or so until she is stronger and we have an alternative solution.

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Monday, June 23, 2008

Day 10 - Xin Xin's home

She's finally home. :)

She is now sleeping on our bed, her favorite place for lounging and resting at home. We are letting her rest before we let the gang meet her tomorrow morning. I think they know she is back as they, especially BB and YY, are crowding in front of the bedroom door sniffing away.

She is very weak as she has not been eating or drinking on her own. So it was a small sigh of relief when I see her walk to the water bowl and proceeded to have a few sips of the water despite hesitating for a while. She's not interested in food yet as we had just syring fed her at 8pm.

And despite being away for so long, she still know the litter box is the place for peeing. Her last pee before she came home was at the vet when we were visiting her. There was not much as she has been off the drip for a few days. It was clear urine, meaning that it will still be time before her kidneys can fully function.

They did a blood test on her tonight. It showed improvement which even astonished the vet.
  1. BUN (10 - 30 normal): Off the chart (Sat 14 Jun 08); 180 (Wed 18 Jun 08); 70 (Mon 23 Jun 08). There is quite a lot of improvement but it is overall still high. According to a website, we need to bring it down to 60 - 80 for a kidney patient.
  2. Creatinine (0.3 - 2.0 normal): 19 (Sat 14 Jun 08); 10.9 (Wed 18 Jun 08); 3.3 (Mon 23 Jun 08). There is vast improvement and hopefully she can bring it lower.
  3. Phosporous (3.4 - 8.5 normal): 8.7 (Wed 18 Jun 08); 6.1 (Mon 23 Jun 08). It has dropped to the normal range.
  4. Calcium (8.0 - 11.8 normal): 12.0 (Wed 18 Jun 08); 11.9 (Mon 23 Jun 08). Slight improvement here.

She now weighs 3.65kg, down from 4.0kg when she was admitted last Sat on 14 Jun. Her whole stomach has sunk in as she is not taking in enough food. We will try to handfeed her again before we retire for the night but I hope she will eat on her own soon. I had rushed to buy some rice and minced chicken just now so that we can cook some chicken porridge for her tomorrow as suggested by Katie (thank you). Hopefully the refined carbo + the limited protein will give her some strength and put on some much needed weight.

The vet had told us that although her kidneys have seemed to improve and the amount of water in her chest cavity have been reduced, her heart is still giving her a lot of problems. The prognosis for cats with such an ailment is not good, usually only 3 to 12 months with a minority of cats lasting 2 years.

Food intake, weight gain and dehydration are major issues. To combat dehydration, we'll be sending her to the vet every evening to get some fluid under her skin at least for the next week. After that, we'll have to see what happens as going to the vet on a long term basis is not a solution.

I never would have guessed our atheletic Xin Xin would actually be a heart patient one day and when she is still so young. It's heart breaking to see her so weak but it comforts us that at least she is now at home and resting, definitely less stressed than at the vet. Hopefully, she will continue to grow stronger and beat all odds to stay alive for another few years.

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Sunday, June 22, 2008

Ouch! My tail!

As our attention was all focused on Xin Xin this past week, we did not really pay a lot of attention to the rest of the gang.

On Thur night, I had noted that Chang Chang was sitting funny. His butt would hang in the air when he should have placed it down on the floor. I thought it was some crazy stunt from him again as his behavior has changed a little ever since Xin Xin was hospitalised.

It was only last night we understand why he was sitting funny. We were serving wet food and as usual, he ran into the kitchen begging for it. However, his long tail was not fully straight up like previously. Instead, it was hanging a little listlessly downwards. And when we touched the base of his tail, he growled in pain and refused to let us touch it.

The vet told us it could be a broken tail (unlikely as he can still move the end of his tail) or a very bad bruise/sprain caused eith er by trauma (eg a door slammed into his tail which is impossible since all doors were closed and locked), kids pulling it too hard (no kids at home) or through a fight where he was bitten hard on the tail.

We thought the last option could be a reason as ever since we introduced Feliway latel last month, Kim Kim had actually regained some of her aggression when she was younger. When Chang Chang had turned adult, he had been gradually nipping away her power base. But in these 2 weeks, Kim Kim has actually turned more aggressive in asserting her position in the household by hissing at Chang Chang very so often when their paths crossed. She had taken over some of his favourite sleeping spots too.

Although clinical studies have shown that Feliway will either have no effect or a positive impact on making cats less stressful, it seems the opposite has happened on Kim Kim. Perhaps it is not Feliway at all as the vet had mentioned but something else which we have not put our finger on.

Either way, it seems that Kim Kim could have bitten on chang Chang's tail very hard during a fight. The vet could take an X-ray now but even if it reveals a fracture, there would be nothing he could do except let it mend on its own. And therefore he had advised us to monitor for another few weeks. If it is a bad bruise, it would probably take a couple of weeks to heal on its own.

I don't understand why all the bad things are happening at the same time.

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Day 9

She looked ok this morning. She had been given a sub-cut and force fed a little. I think she defecated last night as there was a lingering smell of poo on her coat.

Her breathing was not as bad as yesterday. It is still a little laboured and ragged but she seems more at ease now. Perhaps some water has started clearing from her lungs.

We had to force feed her almost 15ml of a/d wet food as the clinic will close at 2pm and then there will be no more people to feed her. Hopefully she will eat on her own tonight.

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Saturday, June 21, 2008

Day 8

She was taken off the drip last night after we left and given an injection to help purge water from her lungs. A sub-cut was also given this morning to help her fight dehydration.

The vets took another X-ray of her lungs and heart this morning. There was water surrounding her lungs, causing them not to be able to expand fully. Her heart had also grown abnormally larger so as to pump more blood through her body.

The prognosis was not good. It could be her heart defect which caused the kidneys to fail and also ultimately the water in her lungs. And because the kidneys begin to fail, her heart had to work harder. It is just a big circular reference with no real solution in sight.

As she is no longer on the drip, she can probably be discharged early next week but she will have to take medication for her heart and kidneys. But dehydration will be an issue. We may have to give her a sub-cut at home.

We are not sure how many more days she will have with us. We know it is a dead end for her. There seems to be no more hope. She is not eating and drinking on her own and this compounds the problem. I hope she can at least get past her 7th birthday which is in 6 months time but I think it is probably just a dream. I am not even sure if she can clear 30 Jun.

But if she is to leave us, I would rather at home in familiar surroundings with the gang and us around her. I think she will feel better this way.

She is not in pain now but as her organs start failing one by one, I know we may have to send her on her way to reduce her suffering. We would never want our little girl to suffer needlessly.

I asked the Wife if she had a good life with us. She said she doesn't know. She could have been adopted by another household and her life may have been very different. She may then not have contracted this illness. Or she may have, if her heart defect is genetic.

I choose to think she had a good life with us. She had been a very energetic and mischievious kitten, often driving the Wife up the wall with her abundance of energy. By the time I manage to reach home after work, she would be worn out and would curl into a little fur ball in my arms.

And as she grew, she became very attached to us and us to her. Because we have 5 cats in the household, she learnt to find snippets of time to have our undivided attention. In the morning when the gang is busy eating their breakfast, she would just have a few kibbles before dashing into the bedroom waiting for the Wife to come out from the bathroom. The Wife will then spend the next half hour or so talking and stroking her while she does her make up and changes into her working clothes.

And when it is my turn to get out of the bathroom, she will already be on the bed, meowing softly away as she waits for her usual pat on her head and a few head butts. It is also the time of the day when I will tell her what a good girl she has been while I change. When we say "Xin Xin, let's go", she knows that is time for her to leave the room and she will obediently walk out without any fuss or objection.

I think she sleeps the day away waiting for our return at night as she will always be the first to greet us. She will push her little head past the door opening waiting for me to pat her before rushing to the main gate to check. I always think she is checking if we had brought home another cat which will mean another competitor to fight for our affection.

I know we will miss her very much.

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Friday, June 20, 2008

Day 7 - She meowed at us for the first time

She finally meowed at us for the first time since she was hospitalised last Sat. Although there was no sound, her mouth opened to form that very familiar round shape whenever she meows for our attention. We take it as a good sign.

The vet assistants fed her this morning so there was no need for us to feed her. Peed last night and again this morning when we visited. Clear diluted urine but it is starting to have that faint ammonia smell again. Fairly hydrated.

Her nose is slightly pinkier than last evening. More alert. 3rd eyelids have retreated a little more. The paw with the drip was a little swollen due to the drip and she has little mobility in that leg but we are massaging it as often as we can to encourage more blood flow.

She slept in the crook of our arms again. And even turned to lay on her flanks so that my arm can act as a pillow. We smiled at that as that is what she always does at home. Somehow she likes to place her little head on our arm or a rolled up towel.

And thank you Katie for the information. She is currently on k/d wet formula which is formulated for kidney patient kitties. The vet informed that she needs to be on this formula for the rest of her life as it has a lower protein content. We'll check with the vet on her diet once she recovers enough to go home.

Update for evening visit:
She peed once in the afternoon and another time when we were there. The clinic fed her some food but that was not enough so we syringe fed her around 10ml of k/d wet food again.

Her breathing was ragged again but not as bad as Tue. Vet confirmed she has water in her lungs again. She had 2 injections on Tue to purge out the water and it worked well as her breathing was ok on Wed. Another injection was given on Thur but water somehow got lodged in her lungs again. She will get another injection tonight. The only problem with these injections is that her kidneys will be working to process these medicine meaning that they will not have enough time to heal. But if water continues to be lodged in her lungs, she may not be able to breath effectively and if the water continues to rise, she will drown.

Her abnormal heartbeat may also complicate matters. Her heart pumps 3 times every beat rather than 2 times for a normal cat. From the time she was young, 2 different vets have told us about her heartbeat during her annual physical checkups, the 2nd time just this Apr. Her heart pumps strongly and as she was young then and has no known illnesses, perhaps the vet did not elaborate and we did not enquire further as well. Xin Xin has always been an active kitten and cat. Before she turned 3, she could play an hour continuously, running and jumping without much rest in between. Between 3 and just a week ago, she still runs and jumps every day even though she can no longer last an hour. She was the most atheletic in the gang and we had thought nothing about her heart especially since it was mentioned that she had a strong beat. However with the kidney failure, this issue is causing additional concern.

It is a dilema now. She needs to be hydrated for her kidneys to heal and her drip is already slow at 1 drop every 3 seconds. But this seems to be causing her lungs some problems. If the drip stops, she will get dehydrated and her kidneys will fail further.

We can only leave the medical decision and work to the vets. And hope that she can recover despite all the odds stacked against her.

The only bright side is that she is still alert though a little tired. She was still seeking our arms for comfort this evening. Xin, you got to continue fighting. We really want you home with us again, no matter how long it takes.

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Thursday, June 19, 2008

Day 6 - She seems alert, same as yesterday

She appears alert this morning. She peed during the night again and the vet assistants had to clean her up before we could see her. Not much or no food intake on her own during the night. She is hydrated. Her skin falls back quite smoothly after pinching.

We syringe feed her again today. She is now more cooperative and we manage to get around 1.5 to 2 table spoon of k/d wet formula into her.

She slept in the crook of our arms again. The end of her tail was twirling around softly as we sang and spoke to her. After 2 hours of intermitent feeding and resting, she went back to her kennel to rest more.
We'll see you again this evening, our little girl.
Update on evening visit:

She peed in the afternoon and again when we visited. It was a lot and diluted. Looks like the kidneys are still not functioning properly as normal pee is low in quantity and very concentrated.

She did not eat in the afternoon so we syring fed her again. I think we got her to eat at least 10ml of slightly watery k/d wet formula.

She should be feeling better as for the first time these few days, she laid down on her side and placed her head on my forearm before going into a very deep sleep within seconds. Her whiskers started twitching during her REM stage. I believe she was dreaming about running around at home again.

On the home front, we had expected Yuan Yuan to miss Xin Xin's absene the most as she was the one closest to her. However, Yuan Yuan's behavior did not change. It was as if she had never known her adopted mum at all. And surprisingly, Chang Chang's daily routine had changed. He ate less, started snoozing on our bed which Xin Xin had always been very fond of, and had been calling out for no particular reason. We are not sure if he misses Xin Xin even though they had been bitter enemies for our affection since CC was a day old.

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Wednesday, June 18, 2008

Day 5 - There are bad days and there are slightly not as bad days

She looked slightly better this morning when we visited her. Her ragged breathing has more or less diminshed as she had peed most of the water out of her lungs. She peed once yesterday afternoon and 2 more times when we visited her in the evening. And another time between 8pm last night and 8am this morning.

We were told she ate some of the k/d wet food on her own last night, which was a good sign.

She looked fresher this morning. Her once very pink nose had lost its colour since last Sat but looked slightly better now. A little dehydrated as they reduced the drip yesterday trying to flush the water out of her lungs.

The blood test done this morning showed slightly better results.

  1. BUN (10 - 30 normal): Off the chart (Sat 14 Jun 08); 180 (Wed 18 Jun 08). There was slight improvement but it was overall still very high. According to a website, we need to bring it down to 60 - 80 for a kidney patient.
  2. Creatinine (1.0 - 2.0 normal if I remember correctly): 19 (Sat 14 Jun 08); 10.9 (Wed 18 Jun 08). There was improvement but we still need it to be lower.
  3. Phosporous and calcium: Around 0.2 above the highest number of the normal range. It is not too much of a concern at this time.
The vet mentioned that there has been improvement but there is still a high chance that she might not make it. He will put her on the drip for another few days before doing another blood test. He is looking to treating her kidney failure first before putting her on some special diet to remove the stone. We know deep in our hearts that if Xin Xin ever recovers from this, her lifespan would have been effectively shortened. She would be a CRF cat from now on. But all that is secondary at the moment. We just want her to recover as much as possible and go home with us and spend whatever the number of years she has with us. We miss having her at home. We know she misses being home as well.

She is getting used to the routine of us visiting in the morning and evenings. And in between, we hope that she will rest as much as she can. And together with whatever treatment she is receiving, we really hope her kidneys will continue to heal as much as possible.

And thank you all for the best wishes. We will pass them on to our little girl tonight.

Update on evening visit:
She looked the same as when we left her at around 12 noon. She still has the mild runny nose, probably from a mild cold.

She looked alert. We were told she ate a little in the afternoon on her own but did not pee.

She slept for almost 45 min with her tiny head stuck to the crook of our arm. That was a good sign for us as she often does that at home. When she desires some comfort and sayang, she will seek us out and sleep on our arms with her head tucked into our palms.

And just as we were about to leave at 8.30pm, she stood up and peed. It was a lot of pee, and quite diluted. We will have to check with the vet if this is the desired result.

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Tuesday, June 17, 2008

Day 4 - We want her to get better

We really want her to but I think we may really have to accept the reality that Xin Xin may not pull through at all.

When we visited her this morning, her breathing was ragged. X-ray showed that there is water in her lungs. It also showed a kidney stone approximately 0.5cm in her kidneys. Surgery does not seem to be an option. There seems to be nothing the vets can do except to hope that the stone will break down and perhaps be flushed out. We really wish that will happen but deep down, we know we are hoping for a miracle.

The drip is painful. Everytime she moves her foreleg, she will meow in pain. It really breaks our hearts. There is just nothing we can do for her at all. We sang to her, we told her that Yuan Yuan is waiting for her back home, we told her to be strong, we told her Chang Chang is waiting to fight her back home, we told her that we want her to still be the first to greet us whenever we reach home.

Our home is suddenly very quiet without her presence. I am not sure if the 4 of them noticed her absence. We do. Very much.

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Monday, June 16, 2008

Day 3 - It doesn't look good

She does not look as well this evening compared to this morning or yesterday. We had to force feed her.

She will be on the drip again tonight after a gap of almost 12 hours. Hopefully this will help her recover.

But we looked at her and what we saw made us cry. Again.

We know she is a fighter. She has to fight this battle alone. Only she can win this battle.

I told her we want her back home with us again. Healthy and forever. I am not sure if she understood me. I hope she does.

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Tuesday, June 03, 2008

Meows of Wisdom 1

When kittens are born they cannot see.
After about six days they open their eyes,
look around with interest,
then close them for most of their lives.