Moonlit Narratives Blog

It is with deep sadness that I post this update regarding our beloved Neo. After a long struggle with many health issues, Neo passed away early morning July 15, 2009. I wish I could have been there with him at the moment he passed; however, I’m very happy to know that he saw his father’s face shortly before he crossed the rainbow bridge. It’s taken me days to work up the courage to write about his death since I’m still very depressed. I also write in support of those caregivers who are undergoing the horrible experience of feline renal failure with their kitty.

On April 18, 2009, we celebrated Neo’s fifth adoption anniversary (the day we decided to be his Birthday since his true Birthday was unknown).

April 20, 2009: Neo vomited food and water throughout the day. I was hoping the problem would resolve itself but decided to call Dr. K, his Primary Vet, the next morning.

April 21, 2009: Dr. K notices some weight loss from Neo’s last appointment (March 9, 2009 for blood pressure follow-up). Places him on I.V. fluids. Orders a few tests to be done. One in which was a GI series (contrast with X-Rays) to determine presence of a possible obstruction. I leave Neo at the clinic for several hours until I’m called back to Dr. K’s office to discuss Neo’s X-Ray results. Dr. K shows me that the contrast has been slow to pass through his digestive tract. We see from the films the problem is primarily in his stomach. He asks for permission to perform surgery on Neo April 23, 2009 to determine whether or not the issues are due to stomach cancer or something else.

April 22, 2009: DH and I visit Neo briefly at the clinic before his big day. Needless to say, I’m a mess.

April 23, 2009: Neo’s operation is scheduled for late morning. By 3:00 pm, Dr. K informs me, Neo made it safely through the surgery and is currently resting. No tumor was found but a biopsy was performed and specimens were sent away for further study to an outside lab. Dr. K diagnosed Neo with gastric atony/gastroparesis.

April 24, 2009: Neo is discharged from the hospital and happily brought home. I sleep in the family room with him partial night. Neo is placed on Reglan 1ml twice-three times daily 30 minutes before meals to aid in his digestion. He is only allowed wet food (no hard chunks). He was not placed on a special diet though I had consulted Dr. K about it. Neo was given a few cans of Hill’s A/D diet upon his hospital discharge and was approved to return to his usual wet food diet, Merrick’s Grammy’s Pot Pie.

May 1, 2009: The lab found no cancer and reports suggest an increased presence of Helicobactor along his digestive tract. Neo is prescribed liquid Zithromax for two weeks daily. Etiology of his gastric atony are unknown.

May 11, 2009: Repeat contrast and X-Rays are taken to follow-up on his progress while on Reglan. Dr. K notes some improvement and decides Reglan should be continued indefinitely. Neo is administered Reglan 1ml three times daily 30 minutes before meals at this point since there is an observable improvement with his appetite on three doses rather than two daily.

May 21, 2009: Blood pressure follow-up with good results. I notice that after May 21, Neo needs a little encouragement to eat, attributing it to his gastric atony. He is fed twice daily at this point and has re-gained a little weight (ounces, not pounds). Feline gastric atony is very debilitating. I researched a lot about this topic online.

June 16, 2009: I notice that Neo’s gums are very pale and suspect anemia (one of the reasons why every caregiver should brush their pet’s teeth). He is taken to Dr. K’s for a re-check on his condition. By this time, Neo has been having episodes of constipation which I wasn’t aware of until Dr. K examines his abdomen. Unfortunately, DH has been scooping the litter and hadn’t noticed a change. Neo is given SQ fluids, a Vitamin B injection, and an enema before returning home. Neo’s BUN and creatinine levels are elevated. He began to have a distinct “vitamins” smell to his fur. I suspect it was due to his renal failure.

June 20 and 22, 2009: SQ fluids administered at Dr. K’s office. Neo’s BUN and creatinine levels are re-tested and are even more elevated than on his previous test results. Neo is put on what I consider palliative care (SQ Lactated Ringer’s 150 ml daily, max).

June 23, 2009: Refusing to give up that easily, I research about homeopathy and try to contact two local vets who practice homeopathy/integrative/holistic medicine. Even if there is no cure for feline renal failure; I still strongly believe in end-of-life comfort care.

June 24, 2009: Dr. A responds to my call. She explains her practice, which includes treatment modalities such as acupuncture. DH and I decide to set up a consult with her. It is scheduled for June 30, 2009. I was hoping for an earlier consult but that was the earliest one available.

June 29, 2009: Last re-check at Dr. K’s clinic. Neo’s BUN is 114 mg/dl and his creatinine is 6.3 mg/dl. I’ve been told the ideal BUN should be < or = 25 mg/dl, while the creatine should be < 2 mg/dl. June 30, 2009: I am impressed with Dr. A’s assessment skills and bedside manner (which is a sad rarity in so many doctors). Neo was given his first acupuncture and aquapuncture treatment today. I wanted him to receive acupuncture since it’s a safe treatment modality, encourages the body’s natural healing processes, increases energy, and hoped that it would help clear his sinuses (we had tried all kinds of conventional medicine, without good results). Neo is also examined by Dr. S (an internist). Both find that Neo’s kidneys are plump versus shrunk as is the case in many renal failure feline patients. They suspect urinary tract infection which has spread to the kidneys. I’m fuming at this point since Dr. K somehow missed this in his assessment. Neo’s blood pressure is also found to be 80 systolic which is very low. His normal average was 160 systolic while on Norvasc. Scans of his kidneys show no growths but a few dark nodules are observed on his liver. Dr. S changes his treatment regimen and suggests SQ LR 150 ml + 150 ml daily to help flush out the infection in his kidneys. I voice some discomfort to Dr. A and Dr. S regarding the SQ fluid amount. Dr. A advises to give SQ LR 100 ml + 100 ml daily and to monitor him closely. I agree to this more conservative approach.

*I was amazed that after a few treatments, acupuncture actually worked well to clear his sinuses. His energy levels were also pretty decent considering how sick he was.

July 8, 2009: Follow-up visit to Dr. A for re-assessment, acupuncture treatments with Vitamin B aquapuncture, BP and BUN & creatinine re-check.
BP: 130 systolic
BUN: 150 mg/dl
creatinine: 10.5 mg/dl
I receive a call from Dr. A, to increase SQ fluids to 150 ml + 100 ml daily max. with close monitoring; SQ fluids 100 ml +100 ml daily min. with close monitoring.

Over the next few days, I scrutinize over Neo’s condition. There are overall good and bad, gains and losses. Not knowing what the future would bring, I made a point to let him spend as much time outdoors (on the porch) as possible, supervised of course.

Since June 30, 2009 Neo’s daily regimen was as follows:

Norvasc 5 mg 1/4 tablet every other day
Baby Aspirin 81 mg 1/2 tablet every Mondays & Thursdays
Reglan 1 ml via syringe 3x daily 30 minutes before meals
Cyproheptadine 1/4 tablet once daily
Clavamox 6.25 mg tablets twice daily
Ranitidine 1 capsule twice daily; Neo had been on Pepcid 10 mg 1/4 tablet hour of sleep previously but the Vets at KBVH thought Ranitidine was better at helping the food move through the digestive tract better to relieve constipation
Unflavored Metamucil 1/4 tsp. every morning. Metamucil was mixed into Neo’s baby food. I wish he could have tried Miralax 1/4 tsp. instead since the Dr. A later suggested it when I complained that his stools were like rubber on Metamucil. I wish she could have thought of it earlier.
Aluminum Hydroxide 1 ml twice daily with meals (while on baby food) to prevent phosphorus build-up in his system.
SQ Lactated Ringer’s 100 ml + 100 ml daily
Food: Gerber’s Baby Food Chicken & Hill’s K/D Chicken canned wet food. I was impressed that Neo had gained some of his weight back and that he had fairly good appetite considering how sick he was. He was spoon fed every meal for about a month.
Water: He barely drank since he was getting his liquid requirements SQ. After he was diagnosed with renal failure, I only saw a few times that he hovered over his water bowl after having lapped some water a few moments ago. He also did not have frequent urination as would be expected for a typical patient with renal failure. I thought he urinated proportionate to his fluid intake.
Aquapuncture & acupuncture treatments once weekly

July 14, 2009: This was a scheduled appointment with Dr. A. Neo had grown weak since the day before and was having some problems getting into his litter box. Even though we had given SQ fluids, staying on the conservative side, his body could no longer tolerate the fluids. He had some mild edema on his right sided extremities the morning of this appointment. Dr. A administered Lasix to help rid the fluid build-up. She informed me his blood pressure was great, his BUN and creatinine were lower than previous labs; however, he was extremely anemic and could not receive a blood transfusion (contraindicated in fluid overload cases). I refused euthanasia for him since he was rallying so hard to stay with us. Who am I to decide when is the right time? Neo was always so full of life and cheer; there was no way I was ever going to give up on him. It was for him to decide when he needed to leave us.

Neo remained partial day to receive treatments at KBVH. DH and I brought him home 9 pm that night. I was told by the hospital staff that he exhibited good appetite while he was there. DH and I watched the 2009 All Star Game on television. I was happy that we brought Neo into the family room so we could be together. I remember lying next to Neo on the couch, falling asleep with his paw in my hand. When I awoke, I could see my reflection in his eyes. I wept a little, not knowing how long he would be with us. His response to the hospital treatments seemed promising but I guess it was his time to re-join his brother, Calvin.

Neo passed away the next morning. I cleansed his face and body and took him outside onto the patio. He was cradled in his blankets. I wanted to spend as much time with him as possible before bringing him to the local crematory. It was one of the saddest days of my life. His fur was so soft; softer than it had ever been in the years he lived with us (maybe from the baby food?). I couldn’t believe how beautiful the day was- mildly warm, sunny skies with wisps of cirrus clouds, and gentle breezes. I wish we could have enjoyed it together. I prayed for him; something I hadn’t done for years.

Neo had a heart of gold and a pure soul. There are few humans and creatures alike that could be described as such. Many people complimented on his outer beauty/handsomeness but few were blessed to know his inner beauty. He was a friend to all, be they human, dog, or fellow cat; familiar or guest. He was my first baby boy and my entire world. My emotions hung on his every happiness. Neo will be forever remembered and loved. Every moment with him was truly golden.