Xin Xin is fighting back

Go away, CRF! Go away, cardiomyopathy! I will win you one.

Day 37 Home 27 - It gets more difficult injecting her

I am not sure if it is the formation of scar tissue arising from daily injection or she has grown bigger thus stretching her skin more, but it has been getting more difficult to inject her with sub-cut fluid everyday. I have a harder time finding a new spot to inject her.

Last Fri, we made 5 unsuccessful attempts to inject her. She was squirming her way all over the bed, refusing to be co-operative at all. The needles went in but came out again 5 times and we did not manage to get a single drop of liquid into her. And because she became so stressed out from the whole procedure, we just abandoned the idea of injecting her that day. But luckily for us, she was co-operative on Sat and today, allowing us to get 300ml of liquid into her.

I will be flying again tomorrow. Hopefully the Wife will not have an issue on Tue evening.

Day 33 Home 23 - She can jump much higher now

I got home at 8+pm tonight as there was a company event that I needed to attend.

I opened the bedroom door expecting her to be meowing incessantly for food and a few pats on her head. There was none. I searched the whole bedroom but could not find her until I heard her meows - from outside the window.

A couple of years ago when we had just moved back home after a major renovation, we had not meshed up our bedroom window as they were never allowed in there unless we were home. And when we were home, we would always close that window to prevent them from jumping. However there was one time we forgot and Xin Xin jumped through. Luckily, there was a wide ledge around 1.5m whereby she could land and move about safely. If not for the ledge, she would have fallen 10 floors. She was stuck there for an hour or so before we noticed her missing. To cut a story short, I had to jump out onto the ledge as well and scoop her back to safety.

From then on, that window was meshed up with my specially designed acrylic panel. These same panels are used in their room and the living room where they are allowed full access 24 hours a day. It allows for maximum light into the house while still allowing the breeze to blow through. For over 3 years, these panels had functioned as planned beautifully. None of them even ever attempted to squeeze through the holes even though they were within easy reach. The holes were just too narrow to slip through. Perhaps only a 6 month old kitten could do it and the gang was generally much bigger in size than a kitten.

She was out on the ledge again. And she was panicky. I had to jump out onto the ledge and scooped her back to safety, moving more than 20m without any safety equipment, just hanging on to the gently sloped ledge with my bare feet. The image of her losing her footing and falling 10 floors kept flashing in my mind as I climb the window and stepped onto the ledge.

I inspected the window and panel mesh again after that. The panel was still in place. The glass window was in the same position as it was for many many weeks, sealing off any other holes. The window sill was 1.1m above the ground. And there was no intermediary object she could use to propel herself forward except for a wobbly clothes hanging apparatus, which had remained intact and in the same position ever since we moved back home.

I still cannot fathom how she could jump 1.1m (she could easily do that before she was ill but not anymore now) and actually squeeze through a hole less than 6cm wide. Her bone structure is definitely bigger than the size of the hole. Has she become that much stronger than she can jump 1.1m effortlessly?

Until I can seal up the loophole this weekend, that window will be shut. The room will be a little stuffy especially during the day but she will have to bear with it for a few more days.

Daily sub cuts

The Wife is traveling today. She will be back this Fri.

I was traveling the past 2 weeks for 3 days each time. I will need to fly again next week. And probably for the next few weeks.

My job requires me to fly at least once a month for a minimum of 5 day at a stretch. It was not an issue for us before Xin Xin's sickness but now it is posing a very big challenge, logistically and emotionally.

In the first 3 weeks when Xin Xin was back home, her condition is mostly good but sometimes bad. And the bad portion always seem to occur when I am not around. She will either be having breathing difficulties, diarrhoea or some other issues. The Wife will then get a little panicky and all I could do was ask her to get her to the vet asap.

The last 2 weeks were also the time when we start giving her sub-cuts at home. It was not such a problem when both of us were around as the Wife would hold her while I do the injection. However, when I was not around, she needed another pair of hands to help. There was nofirm pair of hands available and so she had to rush back from work and send Xin Xin to the vet for the sub-cut before the practice closes at 8pm.

We thought her mother could perhaps help to hold Xin Xin while the Wife did the injection but her mother freaked out at the sight of the needle. So no go again and she had to rush to the vet again.

Then we started training her sister to do the holding last week in anticipation that she will be traveling this week. I am pleased to announce that it was a smooth operation tonight. Her sister managed to hold Xin Xin down and pacify her while I injected her with 200ml of Ringer's solution. I hope it will be smooth sailing tomorrow as well.

And next week, the Wife will have to do the injection while I am overseas. Hopefully, she will not flinch since it has been some time since she last did a sub-cut.

Day 32 Home 22 - She's alert

It's been slightly over a month since she was diagnosed with acute renal failure, then chronic renal failure and finally hypertrophic cardiomyopathy.

For the last 4 weeks, it has been a big roller coaster ride with bad days, especially in the first week or so and better days, like now.

We have finally gotten down to a routine after 4 weeks.

The Wife will do the early morning feed while I will do the lunch feed since I can reach home easier. Evening feed is dependent on who gets home early enough from work. We will then share the night feed depending on who is not as tired. Feeding her each time is a half hour job as she refuses to eat her wet k/d food and has to be syring fed. She will only eat her Fancy Feast Ocean Feast formula willingly but we know that is not the food she should be taking. We are currently trying to get her to eat the Waltham Renal rf 23 dry food (thank you San). She took to it enthusiastically last Sat but has since lost interest in it. We will need to try harder.

Feeding medication 3 times a day is getting easier now as we become more adept at pilling her. But then she shows that she has a trick or two up her sleeve too. She can actually spit out the pill after 5 minutes so we have to closely monitor her after pilling.

The worst routine of the day must be the daily sub-cut injection, especially if one of us is traveling. It is probably the only thing we do not want to do but know that it is a life saver and has to be done. It is a very emotionally draining affair and I always heave a big sigh of relief whenever I can finally pull out the needle.

Alert but not as energetic as 2 months ago, she is now weighing in at around 3.6kg. We are still hoping that she will gain weight since she is eating the recommended amount of food but it has been an uphill affair. The only good thing is that she is not losing any weight. Wet food does not seem to have the weight gain impact like dry food. We have also seen that in Chang Chang when he was solely on wet food during his medication period.

The gang has slowly got used to the idea that she is Xin Xin, once part of the gang. There are less hisses now though Yuan Yuan is still not acknowledging her adopted Mummy. I think Xin Xin feels it and is a little sad about it.

Her meows are sounding stronger every day and she can now jump up the bed without the need of the stool. Her heart is pumping fast and we can see visually that it has expanded as her chest bulges out a little.

I know she is resting now on the bed and waiting to see me return home in an hour's time.

Day 23 Home 13 - Blood Test

She was at the vet today for a follow-up blood test. Results were encouraging. All major factors are within the normal range. Her medications are taking effect.

1. BUN (10 - 30 normal): Off the chart (Sat 14 Jun 08); 180 (Wed 18 Jun 08); 70 (Mon 23 Jun 08); 25 (Sun 6 Jul 08). There has been quite an improvement in this area. 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); 2.2 (Sun 6 Jul 08).
3. Phosporous (3.4 - 8.5 normal): 8.7 (Wed 18 Jun 08); 6.1 (Mon 23 Jun 08); 5.9 (Sun 6 Jul 08).
4. Calcium (8.0 - 11.8 normal): 12.0 (Wed 18 Jun 08); 11.9 (Mon 23 Jun 08); 11.5 (Sun 6 Jul 08).

As long as we keep her hydrated everyday and she takes her kidney medicine, she should be do ok. But we can expect good days and bad days for the rest of her remaining life.

She has a heart murmur and will have it forever. Her heart beat is still fast at 200 to 240. In medical terms, she has hypertrophic cardiomyopathy (HCM), something similar to what those supposedly healthy young men who drooped dead while they were jogging.

Research indicates hypertrophic cardiomyopathy may have a genetic component and can affect cats at any age. However, hypertrophic cardiomyopathy is most common in young cats more than one year old and in middle-aged cats. It bears repeating, though, this disease can strike any cat at any age. That is a sickening thought, isn't it?

Symptoms can be extremely variable:

• lack of appetite
• gagging
• difficulty breathing
• increased respiratory rate
• reluctance to move around
• pain or paralysis to the hind legs when blood clots gets stuck in the distal aorta back in the back limb where the aorta splits. In human terms, it is something like DVT (deep vein thrombosis)

Once pain or paralysis sets in, there is going to be no cure. We will then have to let her go peacefully so that she will not suffer anymore. Our vet's cat suffered a blood clot a month ago as well and he could only reduce its pain by letting it go. I think that may be the most humane solution. We would not want to have her suffer any unnecessary pain.

Prognosis for HCM is not good. Patients typically last 3 to 6 months, though there are cases whereby some lasted 2 years with diligent medication and a stress free environment.

We'll just have to take each day as it comes.

Day 21 Home 11

Over the past week or so, she has gained a lot more strength but she is still weak, skinny and not yet out of the danger zone. What was heartening was that she has still maintained the weight when she was discharged. She is eating almost 1 can of k/d daily but the loss of muscle mass around her limbs especially meant that it is going to be difficult to put on weight.

She ate a few mouthful of food herself yesterday. This is the first time she had fed herself. But she lost interest after a few mouths so we had to syringe feed her again.

Yesterday was also the day we first injected her with a subcut at home, unsupervised by the vet. I am not sure what it was but it sure was harder at home than at the vet. She flinched and meowed when the needle went into her skin. It could either be less loose skin since she is slightly more hydrated nowadays, our nerves or the fact she is more relaxed at home than at the vet. It was probably a combination of all factors.

We don't look forward to the subcut at all. Neither does she. We will be injecting her again once I complete this entry.

She is relaxing in the wardrobe now. I hope she will be cooperative tonight.