feren

Three years ago I made the most difficult decision of my life, and in so doing bid farewell to my best friend. Daddy misses you so much, Ra. I will never forget your amazing personality and how you'd look at me with those eyes full of love. We shared the most amazing journey together. I wish we could have traveled together longer. I will see you at the Bridge.

You read that correctly: $3,097.04. That's what I paid for Ra's medical care in 2014. Well, correction -- that's the total of the receipts that are in front of me. There's a file somewhere in my records cabinet that has other receipts for 2014 medications and surgeries, so the true dollar figure is actually higher, probably by another $300-$500.

All that money spent, all those medications and procedures that he had to endure ... and I couldn't help him to last past New Years. I still don't know if I did the right thing or not. In a very specific sense I have no regrets. It's not as if I think it was "poorly spent" money. I'd spend it all again (and then some) without even thinking about it. But filing these receipts, reading the labs performed and medications prescribed? I just don't know. That I have regrets, that perhaps I kept him here too long through too much pain.

I can feel the grief swelling up inside again. There's a tight feeling in my chest that always accompanies the tears that come when I think about Ra and how much I miss him.

I think it is going to be a long, lonely night.

Got a picture of you I carry in my heart

I said farewell to my best friend today at 2:40pm. He'd been part of my life for 16 years. Ra had seen me both at my best and at my worst. I chose him from a rescue in 1999 because he looked like "a little black panther," but there was nothing little about how he lived or how he loved. He filled a hole in my heart that I didn't know I had. I'm so devastated right now.

Be at peace, Ra. You were part of my life for the last 16 years. You are always part of my shadow, now

Ra went in for a follow-up of blood work today. The results are increasingly worrisome on top of his results from last week:

• BUN is higher (Kidney - bad)
  
• Anemia is worse (Liver - bad)
  
• Bilirubin is higher (Kidney - bad)
  
• ALT is down from 1400 to 950, which is better but is still way out of whack (Liver - sorta good)
  

His creatinine is okay (kidneys) and the level of potassium is normal (finally) but what has me concerned is that this is almost the same thing that hit Diva. She had a "perfect storm" of anemia + kidney failure advancing into the next stage. I'm fearful that this is what is happening with Ra. How do you treat kidney failure? You administer sub-cutaneous fluids. The problem with fluids? You dilute the blood stream and exasperate the anemia.

Our vet is going to re-run the existing blood work and try to get some clarification from the lab as to what type of anemia he has, which can help steer us towards a better treatment plan.

What scares me is that one of the plans involves blood transfusion. Cat. Blood. Transfusion. Because there are just warehouses of feline blood and plasma waiting for situations like this.

All these numbers are joining together and telling a story that's scaring me badly, so badly that I can't even articulate what I'm feeling right now. My productivity for the night is shot, the work I had slated to do for the evening is beyond my level of concentration at this point.

I'm going to wait a bit longer for the air to cool off and then I'm going to go BBQ something and hope that it distracts me. I'll probably end up burning everything because I can't put the right level of focus on it.

But the cat came back, she wouldn't stay away, she was sitting on the porch the very next day.

This entry was originally posted at http://feren.dreamwidth.org/442325.html and is the preferred location to read this journal!

Reposted from this entry by lady_curmudgeon. I have obviously been talking with her every day, but not very much here or on Facebook. I just don't really find myself able to talk about it much in those other settings. I don't know if that's because I'm dealing with it by not dealing with it, or what... but please focus here or Facebook and I'll repost what Mudge shares. Or better yet, you can follow her directly.

---

We finally got the diagnostic report from Ra's procedures last Monday, as you well know. Last we knew, from Dr. B. was Ra would be on the Chlorambucil (the chemo drug) once/daily for six weeks, then every 72 hours thereafter depending on his clinical response. Dr. B said he would call right away to get the drug ordered and to us so we could start treatment.

Go in on Friday for Ra's first B-12 shot. Ask about the Chlorambucil--he's not gotten ahold of any yet, nor has he ordered any, and will make more calls for it later in the day. Sigh. We really wanted Ra to start this treatment regimen ASAP in order to keep the pre-cancerous cells in check and not have them develop into CANCER! WTF?!!?!

At least, in the good news department, Dr. B gave us six weeks worth of pre-filled syringes of B-12 for Ra for us to administer at home rather than bring him in once a week and get him all riled up with a ride to the vet and a vet encounter (which he hates) when we can do it at home and avoid all that stress on him. It's administered sub-cutaneously, so it'll be easy for J to give to him every Friday...Dr. B even gave us a bit of a deal on the B-12 shots. :)

So I call the Dr. B early yesterday afternoon--Chlorambucil still not ordered, largely because Dr. B left the office early yesterday for a wake for the family member of one of his techs. What the everlasting fuck?!?! Decided we couldn't wait any longer, so I asked the tech to ask Dr. B (who was predictably swamped with Saturday morning patients) if we could at least order some of the med from VCA Aurora, if they had it. He said that would be fine, so we called VCA Aurora and, thank Bast, they had the med in stock. Thank Bast, and for many reasons...

VCA Aurora continues to impress. They didn't have anybody from the internal medicine department or the pharmacy in the clinic because it was the weekend, but Dr. Mac from ER heard what was going on and was willing to personally dispense us at least 6 pills to get us through about two weeks worth of treatment so that we could pick it up right away. Six pills for two weeks? Turns out Dr. B either misspoke or misunderstood the Tx instructions--Ra is to get the Chlorambucil every other day for six weeks, not every day! I read the Tx summary copy we got from Dr. B and yep--says EOD, which is every other day to my understanding...Sigh, now I'm worried about Dr. B's ability to treat Ra for Dr. M over at VCA Aurora! UGH!!

We were able to talk to Dr. Mac when we picked up the med to ask her some basic questions--when to dose, with or without food, potential side-effects to watch out for. She was WONDERFUL!! Turns out she's also an internal medicine doc in addition to being an ER doc, so she was able to give us all the information we needed! :) She explained she was only willing to dispense two weeks worth of the med because she wants us to closely monitor Ra for any negative side effects and didn't want us to pay for too much of the med in case he ends up unable to tolerate it and ends up needing to try another med. It's to be taken in the morning with his 5mg of prednisone, preferably with food, but since he's got a tendency to vomit his feeds if he's fed too soon after medication, we're to try giving him the two meds about an hour before we feed him in the AM.

Because he fights us with the potassium supplement in particular, Dr. Mac suggested we not give Ra that particular med on the mornings we give him the Chlorambucil so he'll be more apt to not fight the Chlorambucil pill on those mornings because it's so important for him to get that med in him with minimal fuss. She also suggested we try compounded liquid version of the potassium so Ra's not taking as many pills at once, to give him a break on so many pills. She initially suggested we try compounding it ourselves by crushing the pills and adding the crushed pills to chicken, tuna, or clam juice, but given that Ra's on a hypoallergenic diet that idea might not be the best one and that we should wait and talk again to internal medicine proper on Monday to order the liquid from the VCA pharmacy...

Side effects we can expect from the Chlorambucil are GI upset, immuno-compromise in the form of bone marrow suppression, lack of appetite, decrease in white and red blood cells. Standard stuff for chemo treatment. They'll build over time as his blood saturation of the drug increases. She emphasized the importance of the monthly CBCs to monitor these things.

I asked about Rx foods--he seems to like the W/D alright so far, but what if he starts to reject it? She said we'd have to work with Dr. M from internal medicine to make the decision, but there are a number of other high fiber/low fat Rx diets that could work for him if needs be. That was good to know, just in case.

We think it's taken Dr. B so long to get us any Chlorambucil because it's pretty pricey--the six pills we got from VCA cost $125! Holy Hannah!! I'm thinking it's a combination of the med not being terribly common and that Dr. B is trying to find us the best deal possible for the med as well--he's a cheap bastard and tries to pass the savings onto his clientele. That being said, getting us SOME of the med should've been a priority and that he thought it was a once/daily med vs. every other day is a bit disconcerting and concerning. I'm starting to think Ra's care should be taken over by Dr. Lehal and associates at Brookville Animal Hospital, which is much closer to home an they seem to have it together a bit better than Aurora Cat Clinic. It's something J and I will have to discuss, definitely. I know we both want Ra to get the best and most competent care possible. Not to say that Dr. B is incompetent in any way, it's just that he's made not made any points lately, especially about being incorrect on the dosing regimen on the Chlorambucil. I just don't know...

Ra got his first dose of the Chlorambucil this morning. He wasn't happy about not being fed right after he got his pills like he normally is, but he managed okay. Waited to feed the other two monsters until Ra ate because, when hungry, Ra has a tendency to scavenge off of Lars' bowl. I though the Young Ones were going to explode, they were SOO HUNGRY!! :/ Whatevs, they managed to wait, so it was all good. Now we wait and see how Ra reacts to the Chlorambucil...

For those who don't follow my lady_curmudgeon's journal, she's been sick for the last 4 days or so. I came down with the Martian Death Flu on Monday, spiking an all-time high temperature of 102.8F sometime last night (I think around 1945 hours? I don't recall. Time is without meaning right now). I've been fluctuating between 99.9F and 101.6F since then.

I blame a coworker for getting me sick. Ug, it may or may not have been you.

Of course I called in sick to work today. That doesn't mean I got to sleep in, however. I had to haul ra_kitty up to Schaumburg to see his vet. Without the physical exam the vet's office refused to refill his prescription for Prednisone. Without the Pred, he becomes a very harfy kitty (as he's been for the last five days). So off we went at 0800 this morning. Got there at 0845, waited until 0900, went in for what I thought was an 0910 appointment. Found out it was actually for 0920. Was seated in an exam room and ignored until 0940 -- twenty minutes after the appointment, and I was the first person the vet saw today. That's fantastic customer service. Poking, prodding, yowling was had. Got Ra back at 0950 and was left to sit until 1007 when they finally came by with his pills and the bill. $245.70. Holy crap. His meds cost $12, but to get those I had to pay almost twenty times that amount. Expensive damn cat.

Drove back home, in the door my 1100, had to spend the next 36 minutes resolving an issue for work because I'm the only one with any knowledge of how our VPN system works. Hooray for never getting any off time, even when I'm coughing and hacking and feverish! Once that was done I curled up under the blankets and slept. sometime during my nap Ra joined me on the bed. He's pretty clearly worn out too, from all the yelling & fussing he did. I'm sure the vaccinations and blood draw hasn't done wonders for his energy levels, either.

I just finished a bowl of soup that took me about 20 minutes to eat! I suspect it is because I have zero appetite. Once I finish a quick skim of LJ I'm going to go lay back down in bed and try to catch a few more hours of sleep.

I've up and made a macro of ra_kitty and then posted it to cat_macros. I somehow believe that he will never never forgive me for this. But at least I brought something new to the "Invisible" meme for cat macros!

I had just finished making the bed and was getting ready to settle in under a mound of sheets, blankets and comforters to hibernate for the evening and in so doing also hide from the bitter, nasty cold that has taken control of my particular portion of the Midwest (it's 18F, -9C right now... before windchill). While I was making the bed Ra was indulging in a kitten-like bout of playfullness that had him tearing ass around the room, running in and out of the doorway and generally being a black ball of nuisance and noise. When I finished settling the comforter he ducked under the bed, apparently deciding that 2349 hours is a good time to play a game of "Come and find me, Dad!" Since I like seeing him acting this way after all he's been through I opted to indulge him. I went to the foot of the bed where I'd seen him disappear and, when I settled down onto hands and knees, I played my fingers along the dust-ruffle. I figured that he'd be unable to resist this variation of the "catch the mouse under the bedsheet" game and I was not mistaken. Ra came zooming out from the far side of the bed to surprise his prey. Once he'd had enough of pouncing and biting at the dustruffle he came trotting up to me and, meaning to brush his cheek against mine (or thunk his head into my chin, which is another of his favorite ways to display affection) he got a little too close. That's when both he and I got a harsh reminder that the humidity in the house has been a bit low recently -- the moment his muzzle came into proximity of the end of my nose I saw a blue-white spark jump over and heard the CRACK as an excellent bolt of static electricity bridged the gap. I got shocked on my nose and, naturally, so did Ra.

The expression of absolute dismay and betrayal on his face in the moments immediately following were both extremely cute and decidedly hilarious.

I am a bad cat daddy for laughing, aren't I?

Say what

Known Fact: Yawns are contagious.

Little Known Fact: Yawns are contagious across species. Ra was in my lap and yawned hugely and then I found myself yawning. A few minutes later I yawned... and immediately after I finished, Ra did too.

Hiding out in treetops

... is me at 7:45, groggily trying to boxulate Ra into his carrier in preparation for his vet appointment. No, this trip isn't because he got sick again -- I am rather pleased to say it's for the exact opposite reason. Ra has gone quite some time without being sick (in over six months there has been absolutely no harfing, despite his continued desire to snack on cellophane wrapping) and I felt it was time for him to receive a general checkup along with his vaccinations, so I made an appointment for him to see his doctor at 9 o'clock this morning. The last two years have been rather rough for him and the poor fuzzball's health never stayed stable for more than a few months at a time after each bout, so it followed that he's gone without his boosters for that duration as well. This is something I was never entirely happy about but the doctors at the veterinary clinic agreed it was better to wait until he was in a good stretch before we started stressing his system.

When I put his carrier on the table and coaxed him out for his exam I was reminded that this was the first look Doctor Hailpern has gotten in a while. She was completely taken aback by his size and couldn't stop commenting on it during his general exam. When the time came to weigh him he tipped the scales at a healthy fourteen pounds. I couldn't help but grin when she leaned down, touched her nose to his and said, "I knew you five pounds ago." I grinned even more as she fussed over the scar on his nose (he gave it to himself when he kept nosing open the furnace room's doors after we first moved into the house), scolding him for ruining his "handsome face."

Ra received a clean bill of health and several compliments from the staff who have seen him at his worst. While he was given a rabies vaccination we skipped the feline distemper shot. Doctor Hailpern felt it might upset the balance we've struck between his various health problems and his medications (the doc was heard repeatedly telling Ra, "I love Pred, it makes you want to eat." Prednisolone is his primary medication). Since she told me it was not a particularly big deal for Ra to miss the distemper shot, especially given his status as an indoor-only cat, I also feel this was probably the best choice. One thing at a time, if it'll help him go even longer without a relapse! The doctor also felt this was too good an opportunity to pass up, so she asked to take a blood sample. Since this is the first time in years that he's been into the office while at the peak of health she wanted to check some of his panels and have a "known good" point of reference to put in his file. I didn't see a problem with that, so they took him in back to draw the sample and returned him a few minutes later. I'm amazed by how quickly the time went and before I knew it the time was 9:24 and we were being sent home.

All in all Ra's visit to the vet went very well and I'm pleased with his behavior, minus the hissing, spitting and growling treatment I received at the very end. Since he'd been poked, weighed, prodded, squeezed, probed by a thermometer, jabbed by a vaccination needle, swabbed with excessively fragrant rubbing alcohol and then had another jabbing to get his blood drawn -- all in the span of fifteen minutes! -- I don't begrudge him. After we got home from the vet's office he nestled in with me and started purring, so I guess Daddy is forgiven.

Would we escalate the value to be worth its weight in gold