Ambrose was diagnosed with Chronic Renal Failure (CRF) on April 10, 1997. He was only 8 years old. At that moment my life changed profoundly in ways I could not have imagined then. What follows is the story of our 3 year battle with CRF and the journey we undertook together. One that I am now traveling without him. Ambrose came to me a few
days before Thanksgiving in 1989 when he was less than a year old. The
timing was wonderful because I have been thankful ever since for his presence
in my life. I had 8 other cats then but fell instantly in love with
my shy newcomer. He was slender, charcoal gray and white with huge startling
beautiful green eyes, a little smudge of black on his nose, and an incredibly
tiny little tuft of white at the very tip of his all gray tail. God's
paintbrush, I told my friends. Proof that God existed and had a sense of
mischief, for what other reason could there be for it to be there?
His diagnosis occurred 8 years later during a checkup occasioned by a bout of constipation. I cannot stress enough that every all kitty owners give their cats checkups and blood panels at least annually. Ambrose had never had a blood panel before and except for one bad upper respiratory episode, he had always been healthy. But cats hide illness well as I was about to discover. Not only did he have a heart murmur, but his blood urea nitrogen (BUN) and his creatinine (CRT), important measures of kidney function, were significantly beyond normal levels. Ambrose was in kidney failure. I was devastated, confused, shocked, and totally in the dark. I had no idea what to do. I asked how long we had and my vet said, "Maybe 6 months." I remember those days so well although they seem like a lifetime ago. I could not believe that I would lose him. Although I had 8 other cats, Ambrose was my favorite, my love. I raged, I cried, I prayed. I woke up every morning feeling sick and helpless, wishing desperately that this would all go away. But it didn’t and finally I went to work to find out what I could do. I know that what I was looking for was not just information to help me deal with this terrible thing, but a way to find the miracle that would save him. I never stopped looking and praying for that miracle throughout the following three years. There was so much to learn. Cardiac ultrasound and a blood pressure check were done to determine the severity of the heart murmur and whether subcutaneous fluids (subqs) for the CRF would be safe. Fluid therapy and a diseased heart are mutually exclusive and would have doomed him at the start. Thankfully the murmur was mild and I began subqs and gave them daily from then on. Subqs are crucial for maintaining hydration and electrolyte balance and to assist in remaining kidney function. I also started him on a low protein/low salt/low phosphorus diet to reduce the amount of waste passing through the kidneys. My job involved computer
work so I began to steal every available minute to search the internet
for information on feline CRF. I was a computer novice then so time
was lost in learning how to negotiate the web. But I soon found the site
for the wonderful Feline Chronic Renal Failure Information Center (http://www.best.com/~lynxpt/)
and their email support list. Here I found everything I needed to
know, a place for information that has proven even more up to date than
many veterinary clinics and where everyone (about 30 people in 1997, over
900 now) was facing the same ordeal and urgency as I. Immediately
I bought a computer for home and settled down to discover what I could
do to keep Ambrose with me as long as possible, to prolong his life as
well as to ensure his daily health and happiness.
The causes of CRF are varied. Dr. Margaret Muns, DVM, in Ypsilanti, MI, says, "There is no primary ‘all or none’ cause of feline CRF. It is a multi-facet type disease. Several different factors may combine, or work separately to induce chronic renal failure." These causes may be primarily: genetics, aging wear and tear, toxins, an acute renal crisis, pyelonephritis, or periodontal disease. It may also occur secondary to inflammation of the kidneys due to immune system reaction to diseases such as FIP, FeLV, heartworm, and lymphosarcoma. Dr. Nancy Scanlan, DVM, of Sherman Oaks, CA, is one of the increasing number of veterinarians who suggest that "it is not unreasonable to suspect that excessive vaccination may contribute to kidney failure." As the number of vaccines increase, the number of kinds and cases of auto-immune diseases increase. According to Dr. Scanlan, kidney problems may be caused by a mild form of auto-immune disease. Once bloodtests and urinalysis confirm the diagnosis, the kitty can be maintained for a variable period of time which cannot be predicted. A motto of our list group is "treat the cat and not the numbers." Every cat is different and reacts differently to the disease. Dr. Muns says, "Some cats with bad numbers do well, while others with not so bad numbers don’t do well." The key to treatment is threefold: diet, hydration, and medication. While there is some controversy currently as to whether a low protein diet should be emphasized and if so, at what stage, until further findings, it is recommended. Most of the waste results from protein so the idea is to use a diet low in maximally useful protein. There are a number of different veterinary diets for CRF available. A word of warning: most are not as tasty as commercial foods so the kitty owner may be challenged to find novel ways to coax their kitty to eat. Syringe and spoon feeding have been resorted to with varying degrees of success and mess. Ambrose ate from a spoon for 3 years, maintaining his weight throughout. Some CRF kitty owners make up their own diets from recipes, which are either homemade or obtained from good books on the market on natural cat care. But a word of warning. As Dr. Muns says, "It is always MUCH better for a cat to eat, than to worry about WHAT it eats…. the diet does no good if it sits in the bowl uneaten. It can even do harm if the cat goes on a ‘hunger strike.’" Hydration therapy, or subqs, is critical. As the kidneys deteriorate, the cat may either stop drinking, not drink enough, or experience nausea/vomiting. In any of these instances, dehydration is the result. Blood flow through the kidneys is reduced which leads to more rapid kidney deterioration. Subq fluids will not heal or repair the kidneys but will assist in maintaining remaining kidney function. A kitty will often perk up noticeably once fluid therapy is begun. Subqs are usually given by the owner although at first the thought of sticking Fluffy every day with a needle can be rather intimidating. Fluffy however does not usually mind it as much as her owner. Ambrose, with his usual trust, accepted it from the beginning and it became a special time for us. Medications and supplements are also important. Vitamins B and C are often given to compensate for what is lost through excessive urination. Extra potassium may be needed for the same reason. There are medications for lack of appetite, for stomach acidity which is common and causes a cat to lose appetite, for constipation, nausea, imbalance of calcium, too much phosphorus, anemia, high blood pressure, and less common side effects. Some medications may be bought over the counter or from mail order or pet supply stores Others are prescribed by the veterinarian. It is crucial that cat-owner and veterinarian form a working partnership. Too often this does not happen. The problem is with the owner who may be unwilling to go the course and the veterinarian who is not familiar with maintaining a CRF cat or assumes that the owner does not want the expense of treatment. Which is all too often true. CRF requires a commitment from caregiver and veterinarian. For the owner it can be long and costly as well as physically and emotionally exhausting, for much of personal life is given over to care of the ill cat. A good relationship between owner and veterinarian is vital My fight against CRF began that April a little over three years ago. Daily subqs were fortified with vitamins B and C. Ambrose was always good about his subqs. He would snuggle down into my lap and as the fluids ran would lick a snack of baby food off my finger. I loved this time, for the quiet closeness between us. Afterwards I would hold him close and tell him what a good boy he was and how much I loved him. Which, of course, he knew. With his food, he was not at first as cooperative and I tried feeding him by spoon. It worked and for almost three years, he ate his breakfast and dinner from a little silver spoon acquired years ago at one of those many European street-corner souvenir stands. Before each meal, he would have a dry food hors d’oeuvre and then we would settle down on the living room floor. In the evening during his dinner, we sometimes watched the news. During breakfast it was usually the Weather Channel so he would know whether it would be a day for sunning in the "catiary". He gained a pound right away and maintained that weight for three years. It was another of our times together, just the two of us. Ambrose received a daily supplement of potassium for over a year following diagnosis. I also gave him daily a tiny amount of lactulose, used to treat and prevent constipation, and a small piece of Pepcid AC for stomach acidity. But this was all he ever needed in addition to the fluid therapy and the special diet. In my continuing search for a miracle, I also made an appointment with a holistic veterinarian recommended by friends. She told me on examining Ambrose that "we will cure him." Which I knew could not be true, but hope was always strong. I liked her but had nagging misgivings about the treatment she recommended: rice and eggs frequently, daily Coenzyme Q10 and hawthorne (which I could accept), a very large daily amount of vitamin C (which I couldn’t for fear of crystallization in the urine), and lastly, colloidal minerals and mercurius sol, a homeopathic remedy. She also told me that I would have to forego treatment by conventional methods as only in that way could the regimen she prescribed be effective. We did try it for a short period of time, but Ambrose reacted badly to the mercurius sol and there was too much controversy over colloidal minerals for me to feel comfortable using them. I also was very reluctant to completely give up all conventional treatment. So we abandoned that course. During the course of his illness, Ambrose was stable and happy. His routine varied little as did the numbers on his regular every other month blood tests. His care involved a restructuring of my days in particular and my life in general. I monitored him so closely, reading every tiny bit of change in routine as either an ominous omen or cause for joy. Caring for him was riding on an emotional rollercoaster. If he seemed to be having an off day as I went to work then I was off. If at noon, he attacked a piece of yarn, then my afternoon was euphoric. His requirements took precedence over almost everything else. I found that balancing other life commitments with his was not at all easy to do and most of us on the same path have undergone major life changes because of it. In the CRF email list, I found constant support, whether our days were good or not so good. We were all committed to the same thing, heart, soul, and checkbook. My education progressed daily and the bond between us deepened. We played our funny little games every day and I treasured them as I was all too aware that next week, next month, next year, it could be over. In my miracle search, I returned to the holistic and began giving Ambrose a daily liquid supplement of milk thistle, dandelion, alfalfa, marshmallow, hawthorn, gingko, garlic, and oatstraw. He received this for almost two years and in his last year I added Coenzyme Q10. and Vitamin E. I will never know if these supplements "worked" but he continued to do well. Basking in the sun in our "catiary." playing with his favorite red pompom balls late at night, ferociously attacking his scratching post, collapsing in his wonderful little "kittyflops" against me - all these wonderfully silly little games that we adored. As he was doing so well, I was often asked if I had considered a kidney transplant. I had, but understood that his heart murmur ruled him out. In addition, as Dr. Marty Goldstein, DMV, has said, "they don’t always succeed & are prohibitively expensive, and the drugs needed to prevent tissue rejection, if the operation is successful, take a severe toll on the pet’s overall health & immune system." As the third year anniversary of his diagnosis approached, change occurred without warning. In the early months of this year he was scheduled for his regular checkup, blood panel, and annual cardiac ultrasound. All were suddenly bad. His blood panel report showed he was anemic. My vet, Dr. Karen Schoen, DVM, assured me that she was not surprised that this usually happened much earlier. "You’ve already beaten the odds," she told me, but this didn’t help my state of mind - he was no longer stable and I feared what this might mean. To treat the anemia, Ambrose was given a daily iron supplement, which he liked. On same panel, however, his calcium count was over the high normal range. Dr. Schoen decided to retest but the results were even worse. This was also serious and special testing to determine whether he would be eligible for a relatively new treatment for high calcium that Dr. Schoen would supervise. The results were good and plans were being made to begin, but it was never to take place. Ambrose’s cardiac ultrasound revealed extremely high blood pressure and enlargement and thickening of one side of his heart. He now had heart disease as well. All over again I was devastated and in anguish. I knew that this could happen, just as I had known that kidney disease is irreversible. But I think I never believed that it would. I remember those last weeks so well, but try not to think of them. Medication for the high blood pressure was started and he seemed to be doing well. But soon I noticed that he was less active and seemed to tire very easily. On a re-check we discovered that his blood pressure was now very low and the dosage was reduced. But it was already out of our hands. A few days later as we snuggled in the early morning I put my head to his chest to listen to his heart as I often did. But this time I could hear faint wheezing, a tightness in his breathing. I rushed him to the clinic but he was in heart failure. On Dr. Schoen’s recommendation, I drove him immediately to a specialty clinic where he was put on oxygen and intensive care for three days. At first the veterinarian there was optimistic, but when I visited on the second day, he shook his head. In his words, Ambrose "decompensated and went down like a rock." Ambrose was so ill it broke my heart. . In order to save him, to save his heart, he had to be dehydrated at risk to his kidneys. After three years of disease, the pressure proved intolerable. . I had promised him years ago that I would never let him suffer. Now I had to honor that promise. On noon of April 21, he left me. As I buried my face in his warm fur, I didn’t think I could survive. I had always known that I would be without him someday, but it was a thought only. Down deep I never stopped looking for the miracle. To the last minute, I thought something would save him. He was my friend, my companion, my love, my soulmate. Even now as I write this, the tears are falling and I still cannot believe that he is gone. I closed his beautiful
green eyes and clipped some of his fur, including the little paintbrush
tip of his tail. And went home alone.
I learned much from our three year battle with CRF, more than I can write here. When I began this journey with Ambrose, I knew nothing of holistic medicine and what little I knew came late. Not so long ago, Dr. Scanlan suggested nutrients to be given to support kidney function before renal disease strikes. Her recommendations, which apply to healthy and ill cats as well, include the antioxidant vitamins C and E, B-Complex, Coenzyme Q10, Omega-3 fatty acids, desiccated glandular kidney tissue, and calcium carbonate. Allopathic and holistic medicine are both vital to the health of our CRF and other kitties. I applaud the veterinarians from each area who are working with each other. I hope in the future there will be more. I have written this to tell of Ambrose and me. Of the three years we traveled together down a road that had only one end. Of the disease of CRF, what it is and how it can be fought. To show that it can be managed and slowed for months, even years. Although he was terminally ill, for Ambrose those were years of health, yes health, and happiness. And for both of us, of delight in small things, of the daily joy of being together. I never stopped searching for that miracle – to the very end when I looked into his eyes and knew that there was no more. We stole three years from that disease. Three years of beauty and joy and love that will never die but will live in my heart for the rest of my days. That was our miracle. |
