Since about Wednesday the 12th Ra has been throwing up. Those of you familiar with Ra's medical background already know that this isn't a particularly new trick that he's learned, it's a manifestation of a life-long medical condition (non-neoplastic feline inflammatory bowel disease) he has been living with since November 2001. Because of the IBD he takes 2.5mg of Prednisone (a steroid) every day and will have to do so for the rest of his life. The Pred usually does a good job of keeping the IBD knocked down and in a state of remission, but it's not a guaranteed fix by any stretch of the imagination. What this means for me is that every six or seven weeks it will flare up and he'll vomit a few times. It's a fact of life I've just come to accept and live with. The usual routine for dealing with these bouts is to double his dosage to 5mg of Prednisone per day and just wait it out with lots of paper towels and carpet cleaner. Usually in a day or two he'll be back on his feet and feeling fine.
In this case, the usual routine didn't work. I tried waiting it out, thinking that maybe he just needed a few extra days of increased dosage before he'd level out. I was wrong in that line of thinking, and it was about to be made very clear to me.
Things took a turn for the worse at the beginning of this week. Ra couldn't keep anything down, no matter how little of his food he ate. Even the water he drank would come back up a short time later. I started to grow worried. Tuesday and Wednesday saw dramatic changes in his personality -- he had become lethargic and quiet. He didn't run up the hallway to greet me when I got home, he spent most of his time curled up in a very small ball someplace warm. When he got motivated to move around the house he walked very slowly, as if it was taking a great deal of his concentration to manage his four legs. He stopped pestering me in the mornings for food. Wednesday night and Thursday night he didn't eat at all -- the food sat in his bowl, completely untouched. When I held him he was limp and very subdued. It seemed like he wanted to do nothing more than stay curled up with me and sleep. While he's no longer a kitten and doesn't spend 23 out of 24 hours terrorizing my home, this is very much not his usual self.
Thursday evening I made an appointment at the vet's office in Schaumburg, secretly hoping that I'd come home to find him feeling better so I could cancel the visit. He wasn't showing any signs of improvement. Friday morning, when I got out of bed, Ra just stayed in the room and didn't follow me into the kitchen. I tucked him in under some of my blankets, went to work for the first half of the day and came home early so I could run him up to see the doctor. I'm glad I did, as the first words out of the vet's mouth upon examining him was "this is an animal that needs to be hospitalized." Ra was severely dehydrated and showing signs of significant jaundice. He didn't protest at the doctor's poking and prodding except for a disgruntled growl when the thermometer went north and a lot of howling when the doctor probed his abdomen. The vet commented that this was a very alert state for a cat in this condition... but for Ra it's about as opposite from the normal as you can get. The doctor and I talked for a few minutes, discussing Ra's symptoms. The vet said that Ra needed to be kept for a minimum of two days for what he termed "aggressive treatment" along with a lot of testing. It was decided that Ra's bloodwork would be done inside the hospital as opposed to being sent out as there was a need for fast results. After that, the vet picked up my cat and disappeared into the back part of the hospital while I was sent on my way with an empty cat carrier and a promise that I would hear from him within a few hours. The entire appointment lasted less than 14 minutes.
I drove home in a pretty bad state. The things we talked about in the consultation room weren't all that great. The vet told me about the "triad" of conditions that usually are involved with IBD. First is the IBD -- which we already knew is something that Ra is living with. The second point is hepatitis of some point, which we briefly skimmed over. I didn't get a lot of details on that as it didn't seem to be the vet's primary concern. The third point was of much greater concern -- pancreatitis. If this was in fact an attack the steroids I was giving Ra to try and help his vomiting weren't helping things, they were actually aggravating the situation. Doctor Todd also expressed concern that this could be the onset of symtoms from fatty liver disease, a condition I've had past experience with (fatty liver is what claimed the life of my blue-fronted amazon parrot several years ago). While I was in the vet's office we discussed the probable need for Ra to undergo exploratory surgery to examine his liver and aspirate some cells for testing. In his weakened state that was something that could not occur immediately, he needs to be stabilized and rehydrated first before the risk of general anesthetic can be taken.
I came home and sat on the couch with my laptop and a DVD playing. I worried a lot, but a number of my friends were there and gave me a lot of support. I think I owe a lot of thanks to amichele2, duncandahusky, fiskblack, enveri, neowolf2, roho, takaza and urocyon for their companionship, compassion and concern last night. It meant a lot.
At 5:24 Friday evening I got a phone call from the animal hospital with information about Ra's bloodwork -- something that struck me as a surprise since I wasn't expecting the lab to come back until later that evening. Doctor Todd filled me in on some of the results they'd gotten. Two enzyme tests they had conducted came back with absolutely horrendous figures. The ALT elevation should be anywhere from 12-130, with 130 being considered "high." Ra's ALT levels were at 850. The GTP test should score at 0 or 1... Ra came in at 19. Both these tests pointed to significant cellular damage to his liver. The doctor reiterated his concern that it was an attack of pancreatitis, though he reminded me that the triad is not to be overlooked. The plan as he felt it should go would remain largely unchanged. Ra was to be treated aggressively with IV fluids to restore and maintain hydration. Along with the fluids would be a prophalactic antibiotic treatment to stem off any chances of a secondary infection due to the startling increase in bacteria that was in his system. The vet also added medications to the regimen to reduce the pain and nausea that Ra was suffering. At that point there was little I could do but ask where we were to go from there. Doctor Todd assured me that they would reassess Ra tomorrow and see how he was responding to the treatment. They were also going to try force-feeding him in the morning to see if they could get some nutrition into his system. With his liver essentially shut down (hence his jaundice) they can't feed him intravenously. The downside of force-feeding is that it adds extra stress to the animal and can cause them to purge, which completely eliminates any benefit of the action. Before I got off the phone the doctor reminded me that exploratory surgery on Ra was still quite likely unless he showed significant signs of improvement. He also warned me that If they had problems they were going to place a peg-tube in Ra's stomach in order to have a way to feed him and maintain his nutrition.
I'll be calling the vet's office in a few minutes to talk with the doctor and see what the overnight treatment has accomplished. I'm really worried for the poor thing right now, as he's undergone a lot of medical hardship already. I don't want to see him have to go through more, but if the vet feels this is the way to go then I'll put every dollar I have towards treatment. As several people observed last night, Ra's a "tough little bastard" and I love him very much. I want to make sure he gets better as soon as possible.
Here's to hoping.
Higher and higher