Toby is one of four geriatric cats that share our home. He’s a neutered male, orange and white coloring, just a few weeks short of his 15th birthday.

We know this only because we rescued him at about two weeks of age back in October 2002, after he had apparently been left behind in a large empty field in Kaaawa after his mother moved her other kittens to a new location. Toby had to be bottle fed after being rescued, which made for a special bond with him.

Right now, though, Toby is one very sick cat. Coping with that has been difficult, for him and for us. If you live with animals, you know how challenging these moments of crisis can be.

Toby has a designated “medical corner” while he tries to recover from kidney problems.

Ian Lind

A  strong majority of island households have one or more animals. A 2011 research paper reported that 64 percent of Oahu households include at least one pet, close to the national average of 68 percent.  There were twice as many dog households as cat households, although cats may outnumber dogs.

Other indications of the important role pets play in our lives comes from the pet industry. The American Pet Products Association estimates Americans will spend $29.7 billion this year on pet food, $16.6 billion on veterinary care, and another $14.9 billion on pet supplies, including over the counter medicines. By comparison, baby food sales in the U.S. were estimated at about $7 billion in 2015, while diaper sales were put at about $6 billion in 2014.

Small Appetite, Big Problem

Two weeks ago, Toby didn’t come out for dinner one night. His absence was noted. And he didn’t show up when I filled the cat dishes the next morning.  Was a medical check in order?

On the one hand, you hate to overreact and end up somewhat sheepishly accepting the bill for an unnecessary check-up. On the other hand, failing to detect a problem early often means higher vet bills, and more health risks, in the long run. Since our pets can’t describe their ailments, we’re left to make our own best guesses.

I decided to err on the side of caution, and was lucky enough to get an appointment later that same morning. In just over an hour, Toby and I were in the car heading for our regular veterinary clinic in Hawaii Kai.

Toby in happier times. He came to live in the Lind household 15 years ago when he was just a kitten.

Ian Lind

I thought this might be a recurrence of a urinary tract infection that he had been treated for just a little more than a month earlier. These are somewhat routine in cats. I’m sure that every one of our cats had a urinary infection at least once in their lives, and so I saw the vet visit as reflecting an abundance of caution. I expected Toby to be sent home with antibiotics and instructions to do a recheck when those were gone.

But I was wrong.

Our regular vet was busy in surgeries that morning, and we were assisted by another staff vet. She emerged shortly with preliminary blood and urine test results. A printed page showed the desired range for different measures of organ health alongside Toby’s results. On several key measures relating to kidneys, Toby was very far out of the normal range.

I looked at her for an explanation, which was brief. “His kidneys are failing,” she said.

I was advised to take him immediately to an emergency veterinary clinic near Ala Moana Center for critical care. They had already called ahead, and the emergency doctors were waiting for his arrival.

A Weekend In Critical Care

Toby spent a long weekend in this emergency hospital getting intravenous fluids and antibiotic shots as they tried to kill the bacterial infection which had apparently spread into his kidneys. Daily blood tests monitored his progress.

The news wasn’t good. Despite the intensive treatments, his condition was worsening. With the antibiotics and fluids failing to register, his appetite nonexistent, and his affect increasingly lethargic, it seemed the end of the road. Not much else could be done medically except to continue the same treatment and hope for a miracle. 

But as in so many things, time is money. And time in the high-tech emergency hospital was adding up quickly in dollars and cents (many more of the former, of course). We felt somewhat guilty including the cost in our calculus and, luckily, we didn’t hit the point where we had to abandon promising treatment simply due to the cost. That would have made a difficult emotional situation even harder.

Duke and Romeo were right there to see if any food was going to appear.

When Toby made his first foray out of the bedroom, Duke and Romeo were right there to see if any food was going to appear.

Ian Lind

Following a three-way consultation between our regular vet and the emergency doctors, we decided to shift into hospice mode and continue with palliative care at home. In the face of the inevitable, planning for euthanasia in a comfortable setting seemed the best course of action. We had been preparing to deal with these harsh facts of life and death, as all people with pets must, and all indications were that Toby’s time was nearly up.

This is one of the down sides of living with cats and dogs. Their life spans are only a fraction of our own, so we have to deal with saying goodbye. Over decades of living with cats, we’ve gained considerable experience in dealing with death, but it hasn’t gotten any easier.

New Hope

We arrived around noon on Monday, the Labor Day holiday, to take Toby home. When we checked in at the front desk, we were told the vet on duty wanted to speak with us. We were then shown to one of those small, sterile, but utilitarian exam rooms typical of human and animal doctors’ offices. There were two straight back chairs on one side of the room, plain black plastic upholstery.

We sat. There were small cabinets, upper and lower, with a short counter holding a computer, telephone, and a paper towel dispenser on the wall next to the door. No other furniture. On one wall, a stainless steel exam table that could be folded down for use, Murphy Bed-style.

We waited a few minutes, then the doctor knocked and entered the room. White coat, carrying a clipboard. She stood. We were still sitting. Waiting. She got right to the point.

“I know that you’re planning on taking Toby and arranging for home euthanasia,” she said, looking at us. “But …”

That word hung in the air between us. “But …”

She went on. “But Toby started eating last night. And he ate again this morning.”

Toby hadn’t eaten since his arrival on Thursday. They resorted to force feeding once on Saturday night, and he had eaten a couple of teaspoons of food we brought when we visited on Sunday morning. Other than that, he had pretty much ignored any food that had been offered, but that had dramatically changed Sunday night.

“So,” she  said, again looking at us intensely. “I hope that you will watch him for several days before making any decisions. If he keeps eating, that would be a very good sign.”

She broke a small smile. “I don’t want to give you too much hope, but …”

That word again. We grabbed it and have held tight.

Navigating Uncharted Waters

Toby has been home now for more than a week. He’s eating, sometimes with enthusiasm. Just as important, he’s eating a prescription food created for cats with kidney disease, something our previous cats have refused to do. He’s got lots of chemical assistance, with a new supply of antibiotics, supported by a daily anti-nausea pill, a twice-daily antacid, and an appetite stimulant to be given every two to three days.

64 percent of Oahu households include at least one pet, close to the national average of 68 percent.  There were twice as many dog households as cat households, although cats may outnumber dogs.

Toby has never been good at taking pills — or I should say being given pills. He’s a fighter, and skilled at fending off attempts to drop things down his throat. Sometimes he can be fooled into eating a small pill hidden in a bit of tasty fish or meat, but cats are pretty good at sniffing out such attempts at disguise.  In light of the difficulty of getting pills into him, I decided all but the antibiotics were sort of optional or “use as needed.”

But I was wrong, again. Luckily, I was schooled by our regular vet, who explained that when kidneys go down, there’s a lot going on at the chemical level that the nausea/antacid pills are designed to cope with.

And for nearly a week, we’ve been administering subcutaneous fluid daily. This involves inserting a large needle through the skin on the back of his neck, then letting the electrolyte-rich fluids drain into him from a clear plastic storage bag. Luckily, it sounds much harder than it has turned out to be in practice. Toby will fight the pills, but he has been a cooperative patient when getting fluids.

Prognosis Still In Limbo

Although Toby looks “bright” and appears to feel much better, we don’t know whether he has a chance to survive beyond this short second chance. It depends on whether the sudden infection caused the drop in kidney functioning, or whether he had chronic but undiagnosed kidney disease that was suddenly highlighted by an acute infection. In the former case, it’s possible that eliminating the infection will allow the kidneys to come back, at least to some degree. But if the infection was just the last straw that revealed the underlying kidney damage, the prognosis is less likely to be good.

Another round of tests over the next couple of weeks will probably reveal more. And depending on those results, we’ll have more hard decisions to make.

I can’t help feeling somewhat guilty, knowing that our cats are getting better medical care than many people. It’s true, a sad fact of living in the only advanced industrialized country without universal health care.

But that doesn’t negate the special bond we have with our animals. I was reminded of that fact while watching news coverage of the aftermath of Hurricane Harvey in Texas, as people risked everything under extreme conditions to carry their pets to safety. The Washington Post published an exquisite collection of photographs underscoring this intense reality.

We don’t know where this is going, whether Toby is on his way to recovery or not, but we’re on board for the ride, wherever it ends.

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