I always kind of thought in the back of my mind that I wanted to die in my sleep or something. Not really see it coming. But just today, as I was thinking about Flower, and the way that she faced it made me reassess. I guess we all have to face death one way or another; all of us, human or cat or otherwise, will face death. And it seems to me that if Flower had to face it, then why should I be so fortunate as to die in my sleep and never see it coming. She knew that day that it was her day to die. I know this. She taught me that the only thing any of us can do is to just stare back at death as it approaches. In that last moment I just hope for the strength to keep my gaze steady. And I hope that I'm awake.

Bedtime

I think the first time that I became aware that something was wrong was when I realized that Flower did not come to get me to tell me that it was time to go to bed. Thinking back I try to fill in the blanks. I suppose she stopped eating and became lethargic because the lymphoma was already attacking her intestine, making her nauseated. When we would try to administer meds to her the first week, she wouldn't take them. She hated all of that stuff. That was really hard. Administering sub-q fluids was a little easier; she didn't fight as much. But she still didn't like it, and I felt like it was a last resort type of effort. The doctor's at VCA felt like she was having complications with FIV and that was causing her sickness. We should have started then looking for problems associated with FIV, but they wouldn't give me any treatment options for her.

Flower would always come to get me at night to tell me that it was time for bed. In fact that helped me get to bed at the right time so that I could get a good night's sleep. She would come over to my desk, where I was usually studying, and put her paws up on my leg and meow. She was pretty persistent about it if I didn't get up right away. Then she would kind of follow me around while I got ready for bed; she would go with me into the kitchen or sit outside the bathroom while I brushed my teeth. Often I would put her on my bed, but if I didn't stay in my room with her, she would get up and follow me again. Sometimes at night I still expect to find her waiting for me.

Playtime

I used to always come home and wake up in the morning to find the rugs on the floor all out of place and twisted around. Because we have hardwood (Pergo) floors, the rugs would shift and slide around and sometimes get bunched and folded up when Flower would run around. She had always been a lively and playful cat. She would run around and chase things that weren't really there, and I was sorry that I didn't get more toys for her earlier. She never really seemed that interested in a lot of toys though. Certain things she liked; Ashley got her a laser pointer for Christmas which she would chase around and pounce on for quite awhile before tiring of the pointless game that she could not catch. Flower also liked to catch crickets which somehow got into the house often. She would typically play with them for a short time and them eat them; maybe she liked the crunch. One day she found a spot on the wall that she played at for what seemed like forever. She pawed at the wall and then ran away, and she did this repeatedly. I don't know what got into her that day in particular, but she was certainly in a playful mood. She always found something to pretend to chase after. It was typical that the rug in the hall would be folded over in the morning because she would run up and down the halls, and when she tried to stop on the rug, she would slide right into Ev's door. At night too, when I got home from class or work, the rugs in the front room and the hall would be in that state. So, I was always happy to know that she was an active, healthy kitty who enjoyed playtime.

Doing Homework

Flower always liked to be where the people were. She often sat in the front window on her little house, which Ashley gave her for Christmas, where she could see everything in the front room. Before that, she would lie on a towel that I placed on the floor by my desk, or more frequently, she would go into Varr's room because it was carpeted. Sometimes she would sit in the doorway to the hall where she could look at me at my desk but also down to Varr's room. She also liked to sit on the front couch. You could tell her favorite spot if you saw it because on the white couch it's the spot that's covered in black cat hair. Typically though, she would prefer to sit in the front window or by my desk for awhile, but I think she really liked her spot on the couch. Once in awhile I would move my stuff over to the couch and sit there. Whenever I did this she would come and enjoy the company on the couch. I would sit in the middle or on one side and she would sit on her side. Flower was very comfortable here and content to simply lie next to me and let me do whatever school work I had. She never pestered me, and in fact, I often wished that she would come and spend more time with me and sit on my lap or something like that. Occasionally I picked her up at my desk and placed her on my lap. She tended to move from there up to my desk and sit or lie kind of off to the side, in front of my laptop. Because my desktop is glass, it's usually cold, and so, Flower never stayed there long. But I was glad that she liked being there for a bit. I always had wanted to get a table or something that I could put next to my desk with a blanket or cat bed for her to sit on so that I could enjoy her company and give her a comfortable place next to me. I am, however, glad that she enjoyed going to Varr's room as well. I know that Varr had a special way of petting her that she liked a lot. She tended to not stay in one place for long when I pet her, but she really liked Varr's pets. I was happy, too, that my roommate enjoyed having her around and enjoyed giving her love and attention. Even Ev let her in to his room a few times, where she would sit in the window and look outside; that's what he told me. Before she ever became sick, I would miss her a little bit when she wasn't around where I could see her. I had to remind myself sometimes that it was better that she enjoyed everone's company and got love from all of us.

I closed the door to my room for basicly three years before Flower. Since she came here, I always had my door open for her, even at night. I think it will be uncomfortable for me to close my door tonight.

Belly Rubs

Flower loved belly rubs. But sometimes she could only handle them for so long. When she had had enough or she was in a feisty mood (often in the morning, when I would pet her before getting out of bed), she would grab my hand with her front paws, bite it with her teeth, and scratch at my hand with both of her hind paws. I was a often surprised that she never broke the skin while doing this. I never figured out for sure if she thought she was playing or not. She liked these pets, though, and I liked to give them to her. Sometimes she would lie in the sun, and sometimes she would be on the white couch in the front room or on her house in the front window or on the blue rug in the sun by the door. It didn't matter where she was, really. But I guess I always knew when she had enough. Other times she seemed to lie there forever. The more vigorous the rub, the better. I could tell when she really wanted one because she would roll over on her back when I walked in the room. I don't think I knew a cat who enjoyed belly rubs as much as Flower.

A Little Bit of Closure

Dr. Ikeda thinks that Flower may have had lymphosarcoma, or lymphoma. Her liver and kindey where spotted, and he looked at samples of these tissues under microscope. He emphasized that he is not a pathologist, but he suspected that Flower had developed this cancer. It can act quickly, as it is blood borne.

Dr. Ikeda also said that her intestine was essentially swollen in a few areas and was not as soft as it should be. This is was also the case for the pylorus from the stomach to the small intestine. It is likely that it was difficult for her to pass food from her stomach to her intestine because of the problem with this valve.

Flower was also completely spayed, having had all of her reproductive organs removed. We cannot know, then, whether she may have ever had kittens or not. One of the few things we do know about her previous life is that she must have been overweight because she was placed on a weight-reducing diet at the shelter before we got her.

My cat Flower

waiting for a belly rub in one of her favorite spots in the sun

Flower died today. I sat and held her until she passed. I showed her the window where she liked to sit in my room, and I spoke to her to make sure she knew it was me who was there with her. I was at times sad and at times relieved; Flower fought so hard this past month. I can't imagine the endurance that it took. I knew that it was her time, but her time came too soon. I let her know how much I loved her and that it was okay for her to go. I wanted her to know that I understood that she was suffering; I had only wanted to help her be better throughout her ordeal, but in retrospect, she was hardly herself for the past month. The Flower that I will remember is the Flower who was affectionate, and who loved snacks and treats, and who loved the sun in the morning and would wake my up by biting my chin. That is who Flower was.

Valentine's Day

Today was a real downer for Flower. The day started off fine. She vomited some last night, which I cleaned up this morning. Then, when I got home from work, I found where she had tracked some stool across my bed. I have several extra layers of blankets and sheets on my bed in anticipation of this, so it wasn't really a problem; I just take off the top 2 layers, replace them with clean, and put them in the wash. Today I decided that I should just go ahead and was all of my linens though. I moved Flower to the front window, where I also fed her her normal 6PM dinner. Ashley came over a little later on and we went to Petsmart to get a couple things for Flower (including some shampoo, since she was in dire need of a bath), then to Blockbuster to rent a movie, and finally to pick up a pizza at Round Table. I don't think we were home for 5 minutes with the pizza when Flower threw up. This was particularly bad, however, because she was lying in a blanket on a low table in the front window. I guess she must have tried to get up quickly and got caught because, when I heard her and turned around, she was on the floor, on her back, pinned between the bases of two tables, with the blanket covering most of her, and vomit all over her face and paws. I came as soon as I turned around; when I heard her I knew immediately that something was wrong, but I wasn't prepared to see her lying helpless and supine on the floor. I felt so badly for her, for how helpless she is right now. This is not the Flower I have come to know. I decided to go ahead and give her a bath right then so that I could clean the vomit off of her as well as clean her behind. This went better than the first time; I don't know if she was tired or if it was because I had Ashley's help. I used the bathtub this time also, instead of the sink. While I cleaned her backside, she moaned and cried; it must have hurt her badly, all of the feces that had built up in just about 48 hours. I continued to bath her and then rinse her off. I held her in a towel for several minutes to try to help dry her off. Since then she has been sleeping with very little effort to do anything else. She even remained unmoving through her midnight meal.

I figured that the vomiting of the past few days would pass as it had seemed to diminish in quantity with each subsequent episode, but tonight was significantly demoralizing. I just have to keep going though, I feel like she has been making progress and I can't stop here if that's the case. I need to maintain some degree of objectivity in assessing her progress in order to make the best choice for her.

Tired

Flower has not been cleaning herself, and I had to wipe her butt once before, but today I noticed that she was getting really dirty. In fact I think I could smell it on her. At first I started to clean her up with a wash-clothe, but I quickly realized that I was going to need to give her a bath in order to get her clean. I ran some water in the bathtub, and when I took her in and began to lower her into the tub, the claws came out. I decided to try this in the kitchen sink instead, which was only slightly less painful. I was encouraged, however, by Flower's new found zeal and strength to avoid that water. Eventually I managed to keep her in the sink long enough to get her wet. It was pretty difficult to get her washed up, and I'll probably have to repeat the process in a couple of days since I didn't have any soap that I felt was appropriate. I'll have to get some help with this next time.

The other issue today was that Flower has avoided using her litter box on several occasions now. This started when she either couldn't get out of my room at night or couldn't get in to the bathroom. The last couple of times, however, I have found stool on the floor of the bathroom next to the litter box and I have found pee in my closet (on my dirty laundry). Most of the afternoon I spent doing laundry and cleaning carpet. I now have a litter box in my room in addition to the one that's in the bathroom. My closet (which does not have a door) is also blocked by a large piece of cardboard. The laundry is still getting done; there's at least one more load to do. I even washed her new kitty bed, which had poop on it. Flower is now OFF of the clindamycin, which should help to avoid the loose stools which had become ever-present. Hopefully with her food staying in her system longer, she will begin to see improvement as she is able to extract more nutrients from it over the longer time. Until Monday, at least, we are waiting and hoping for some signs of progress from her.

I realized this evening that I have already begun to shift my thinking to a new "normal" for Flower. I used to come home expecting her to be at the door, waiting for me, feeling better and like herself again. Now I come home and know that I need to check for stool and pee around the house. I don't want to think of Flower in these terms; I miss her following me into the kitchen, begging for food, and I miss her coming to get petted while I'm at my desk doing homework and coming to get me when it's time for bed. And I miss that she doesn't wake my up in the morning or at night when she needs to get out of my room to use the litter box. I know that Flower is a good cat and likes to follow the rules; she'll make sure that I let her. I'm tired of seeing her suffering, sleeping all day, not able to clean herself.

Observations: Relapse

Flower threw up again today. She hasn't thrown up in nearly a week since we started her on ondansetron. The odd thing is that I checked her food afterward, and I found pieces of plastic, as if from a zip-loc bag, in her food. I imagine these pieces were maybe larger to begin with but since I put them through the food processor they could easily have been cut into smaller pieces. I don't know how they got in the food, but I wonder if they have something to do with her vomiting today. I hate to think that I've been feeding her food with this stuff in it. After she vomited, Flower was visible chewing on something with a loud, sharp crunching sound. I don't know if this might have been from her litter. I was thinking that maybe she was chewing her litter to make herself vomit because she's not feeling well with the food that we're forcing in her via the feeding tube.

Status Report: Relapse

Flower threw up again today. She hasn't thrown up in nearly a week since we started her on ondansetron. The odd thing is that I checked her food afterward, and I found pieces of plastic, as if from a zip-loc bag, in her food. I imagine these pieces were probably larger to begin with but since I put them through the food processor they could easily have been cut into smaller pieces.

An Accident

I didn't leave my door open enough for Flower tonight, so unfortunately I awoke at 1:30AM to the sound of a tiny waterfall. I don't know if she tried to wake me and couldn't, or if she simply saw that she couldn't get out and found a place. She didn't urinate on the bed or in the middle of the floor, but instead, she found an old bag of mine in my closet to pee on. Actually, when I first woke up, I couldn't find the pee and thought that it must have been my imagination, although I did find a stool on the rug. But even this she did reluctantly, because after I got up and opened the door, she went to the litter box and finished her poop. Note to self: be sure to keep the door open enough for her to get out or bring the litter box into my room.

Status Report

Today Dr. Ikeda informed me that Flower does have active FIV. I'm not exactly sure what that means for her prognosis, though. He and Dr. Duesberg both indicate that a cat with FIV is treated for illness in the same manner as any other cat; it's just that her immune system is already compromised and not as efficient as another cat's. Dr. Ikeda also said that he still feels like this is more a GI problem than a direct result of the FIV infection. It's tough for me to know what to think because I see Flower and she is so weak, and I can't tell if she's in pain or really tired from fighting these infections or both. All I know is that I don't want to make her suffer for no reason.

Flower has been unable to clean herself effectively for the past week because of the bandage on her neck. I've been worried because she has some stool stuck in her fur around the anus; I have no doubt that this has gotten worse in the past couple of days since I started her on the clindamycin, at which time I began to notice significantly runnier stools. I did notice that she was licking herself this evening, however, which gives me hope for her. Other than going to the bathroom, Flower simply sleeps or stays in bed all day lately. I picked her up and took her to the front window this morning and then tried to put her by my desk with me this afternoon, but both times she stayed for only a few minutes and then went back to bed when she couldn't get comfortable. She is handling her meals very well, and the meds too. Tonight I will begin to add in one additional feeding for a total of 5. The goal is to have her keeping down at least 30-35cc in each meal, but tonight I will start with 20-25cc.

I found myself thinking today about when we brought her home from ACCIM last week and she was still feeling the effects of the anesthetic. But she was so affectionate and loving and she was actually looking at her food and eating. The fact that she didn't stay that way was really hard for me the past couple of days. I'm confident in her ability to get better and recover from this but I'm impatient and I don't know how long I can wait to see improvement. Little improvements are good though and so I have to focus on those. Flower is a strong cat and she can recover from this with my help.

Oversleeping and Observations

I overslept this evening, missing Flower's mealtime. I laid down at 10:30PM to take a nap before her midnight meal, but I slept through my alarm and woke up at 3AM. This makes about 9 hours between meals, which is much longer than I wanted. It did, however, make me think about changing her overall feeding schedule to try to get nearly the entire volume of one can of food in. If I feed her 35cc at each meal and give them at 6AM, Noon, 6PM, 10PM, and 2AM then I can feed her 175cc daily; most recently I mixed one can with a minimal amount of Pedialyte to make a total volume of 200cc. If one can is 220 Cal (not 100% certain about this), and I assume 0 Cal for Pedialyte, then 175cc gets Flower to about 192 Cal per day: not quite 220 but close. If I increase each serving to 40 cc then I can get the full can of food in. I need to double-check with the doctors about this volume.

On another note, she's seems to be getting stuffy in her nose. There have been several times now when she will breathe her mouth, make an odd type of purring sound, something that could almost become a growl. I think from the doctors that this is a sign that she is developing an upper respiratory infection, somthing to keep in mind. I don't want her to get any sicker right now if I can help it, but I think the meds are taking their toll on her as well.

The meal for tonight/this morning was @3:30AM. It's now about 4:00 and she's purring or breathing heavily, I'm not sure which. I gave her ondansetron and cyproheptadine with her meal just now and about 30cc of food. When I fill the syringe to 35+cc of food, eject the food into a container to heat it, and then refill the syringe, I always come up shorter than I expect. She seems content right now; I was worried about taking so long between doses of ondansetron that she might vomit again, but she seems fine so far.

Status Report: New Meds

I talked to Dr. Deusberg this afternoon after she got Flower's test results back. The biopsy came back with moderate inflammatory bowel syndrome; the cytology on the pancreas came back as what could be considered sub-acute pancreatitis; and the toxoplasmosis test came back with a low positive for IgM. So we have no clear winner here for what's making Flower sick but rather several mild conditions that can all each result in lethargy and nausea. Add to that the side-effects of the various medications and we've got one sad little kitty. The doctor said that I can reduce the cypro to one dose per day to see if that helps, and the doctor's assistant said that once Flower has had a few days on the various new treatments, I may begin to reduce her ondansetron to see if that helps as well. I'm full of mixed feelings as I look at Flower; the fact is I still have a sick cat. I can't keep her like this forever if all I have is hope. She needs to show some life and some vitality for this to serve it's purpose. If these meds don't get her feeling better then I'm going to have to reconsider our course moving forward. I also need to be sure to keep pushing with the food in order to get to one whole can of food daily. Right now I'm only getting about half of a can. Flower has stayed strong and now it's time for us to get her some results.

Flower sleeping with her face in the blanket.

Status Report

@7:15 AM Flower got 26cc of her food/pedialyte/ranitidine/prednisolone mixture (1 can food and pedialyte combined to make a total volume of 250cc) and 5/6cc flush of water/cypro. She slept through the night without getting out of bed. This morning behavior is unchanged: still lethargic and unresponsive to petting with only a small flick of the tail. At some point during the last 2 weeks she began to bury her face under her blanket; I think because she can't bend her neck normally.

Looking Up

Flower's doing much better over the past couple days. I think she's mad at me though. She's been pretty friendly with Ashley and with Varr, but she ignores me most of the time lately. If she can keep her food down tonight, that will be 2 days (8 feedings) without vomiting. (I'm keeping my fingers crossed right now, because I just fed her the last meal of the day less than 15 minutes ago.) Dr. Duesberg prescribed ondansetron for vomiting/nausea and cyproheptadine (again) for appetite. The anti-vomiting medication must be working but I'm not so sure that the cypro is doing its job. Cyproheptadine can cause sedation (or excitation), which seems to be the case for Flower; and ondansetron can cause headaches and dizziness. So we have a host of side effects that reinforce her lethargic behavior. At her worst times she won't even acknowledge me. She's that way right now; I pet her and she stares straight ahead without even responding to my touch. I hate this. I'm separating her ondansetron and cyproheptadine doses beginning tonight so that I can evaluate the effects of each on her mood and energy level. I gave her ondansetron tonight so I'll give cyproheptadine in the morning and continue alternating; she's getting a meal every 6 hours. I'm also anxious to hear back on the test results for the biopsies and the pancreas (aspiration). The medications right now are just alleviating some of her symptoms in order to help get food down, but we're going to have to start treating the cause soon. On the bright side though, over the last two days she's been able to keep down almost one whole can of food. She continues to urinate regularly and had the first stool tonight that she's had in a week. These are all good signs but I still want to see her back to her old self! Hopefully she and I won't have to wait too much longer.

Observations: Back from the Internist's

Today was pretty rough. At the internist's this afternoon the ultrasound revealed a bright pancreas. So because Flower had her pancreatic enzymes checked at the previous vet, I was immediately distraught and saw this as going down the same path of checking and rechecking the same things, on some kind of wild goose chase. The internist was confident, however, that the pancreas was inflamed and suggested taking a sample via aspiration. The other thing that she suggested, with no other apparent symptoms in Flower from ultrasound, was to endoscopically examine her esophagus, stomach and duodenum. I began to see that I might be sending Flower down a path of increasingly invasive procedures with few results. Plus there was the cost to consider. I thought about this hard, and I thought about the consequences of the procedure. My fear was for Flower to go under anesthesia again, having a tube placed in her throat, waking up groggy and sore and worse for all of it. The benefits seemed uncertain. If ulcers were found, medicate; if inflammation was found, medicate; if lymphoma was found, medicate. So at this point I knew that this was the last of it. If this didn't reveal some definitive and effective treatments then I would be done torturing Flower with continued and probably unnecessary procedures. I decided to take this one last chance; it was and is my desire to avoid future vet visits. She has had so much stress and still is not eating on her own and barely holding down food.

I had to go to work so Ashley would have to go back to pick Flower up. Unfortunately I also had a lab to make up for chemistry after work, so I was anticipating not getting done until at least 9. More unfortunately I was delayed several times and did not end up leaving the lab until nearly 11 PM. I was worried and frustrated with repeated test ands no answers and, more importantly, a declining Flower. I was, however, relieved and surprised to find a lively, affectionate, and outgoing Flower when I came home. Ashley gave me the run down from the doctor, but I could hardly believe it when I saw Flower walk up to a plate of food. She had remained attentive to food but had shown little interest, especially in the previous 3 or 4 days. For a while her face just hovered over the bowl, but at least that's progress. To my amazement, she actually started eating on her own from the dry food. this afternoon and evening was probably one of the hardest days that I have had, but tonight, when Flower was up and walking around and enjoying people, I felt like I had, in fact, made the right choice.

At the Internal Medicine Vet

We're at the vet's office again, waiting. Yesterday Flower took four meals without vomiting. This was the best we've done so far. This morning, however, I was not so fortunate with her. She threw up her entire meal after about 30 minutes. This is one of the longest delays Flower has had between feeding and vomiting, with the longest being one hour. I had hoped after yesterday that these feedings would get easier, but I we're not out of the woods yet. So here we are, at the internist, waiting on an ultrasound, still trying to figure out what we can do for Flower.

Watching

Flower threw up most of her food in her last meal last night at midnight. This morning, however, she has so far kept her meal down. She was up for a little while, looking out the window. These are my favorite times. I see that she's still interested if only for a short tim each day. I'm just not sure if these short periods are enough for her right now. I hope I'm not making her suffer. She also began to lick and bite at the bandage on her left paw this morning. This was a pleasant surprise to see her again interested in her own comfort level. Especially after last night. Each time she throws up, it knocks her down a little more. Last night she was so tired that she slept threw the night without even getting up to turn around. I kept the window open for fresh air and covered her with a towel to keep her warm. We're on the way to the doctor's again this morning to see what our options are since she's not able to keep the necessary amount of food down. I'm still hopeful, but I'm ready for some answers. I can't put Flower through this forever.

Observations: Gag Reflex

I had a bad idea earlier. I was eating my bagel and Flower looked curious. I decided to let her smell it. If I had stopped to think about this I would have realized that this was a bad idea given her history of the gag reflex. But I didn't think about it. The good news is she didn't throw up. She did gag two or three times, however, before she settled down. And even then, she continued to stick out her tongue in a licking motion for a couple minutes afterward. Then she went to the litter box but didn't urinate or pass stool as far as I could tell. She's sleeping soundly now; this happened about an hour ago.

Status Report: Portion Control

Flower has the feeding tube in and is slowly getting used to it. She also still has the IV catheter in her left paw, and I think she'll feel a little better (and more nimble) when that comes off. At first she had the cone/hood on so that she wouldn't chew at the bandage on her paw, but now she is either so tired to care or has gotten used to it so we leave the hood off. She still sleeps more than usual.

We began feeding on Friday evening and this went okay. She vomited a little bit before the feeding, which seemed to be mostly saliva. It was a little thick and "drooly" but also mostly clear; there seemed to be little food or bile in the vomit. Varr helped me with the first feeding and we got through it fine. Flower didn't like it much, but she was still getting used to it at that point. No more vomit that night and a little urine in the litter box.

Saturday morning we missed. I was at work in the morning and if I had realized how much food she needed for the day I would have done her first feeding in the morning. But I waited until the afternoon. We tried the first feeding and I didn't set everything up just right so I ended up with a little too much food including the meds mixed in. The metronidazole is an antibiotic that is mixed separately from the prednisolone (steroid) and the lexotinic (iron supplement), so I had two portions of food. The first step is a 10 cc flush, followed by food (mixed with prednisolone and lexotinic). Then I plugged the feeding tube and refilled the syringe with the second portion of food (mixed with metronidazole). After feeding this to her, I gave Flower her dose of amoxicillin and then flushed with 10 cc more water. After all of this, she was pretty disgruntled and she threw everything up within 5-10 minutes. I should have thought more about the total volume before hand which probably was very near to 60 mL. I need to be more aware of the total volume of everything going in when mixing and preparing the different portions.

The second feeding on Saturday happened about 2 hours after the first one. I paid attention to the total volume and used a little less food as well. I mixed the meds into the appropriate portions and delivered a total volume of 40-45 mL. She kept this food down fine and continued to sleep through the afternoon.

In order to try to get her full compliment of food in for the day, but in a shorter period of time, I decided to try smaller feedings spread out into more intervals. This also has the effect, however, of delivering a larger total volume of water to her during a given time period. I chose 3 hour intervals; Flower would be fed at 7:30, 10:30, and 1:30. The first two of these should be food only and the last one should include her second daily dose of meds. After the 7:30 feeding she threw up a little: maybe 5-10 mL within 10 minutes. I was nervous about the rest of the feeding after this but I decided I needed to try anyway. At 10:30 the feeding went very well and after 20 minutes I was content that she wouldn't throw up. I decided to try to sleep and relax before the 1:30 feeding. At 11:30 Flower woke me up when she vomited again. This was more than the first, but I didn't get a good look at the amount. It seemed to be about 1.5-2 times the volume of the first. After this, I decided not to follow-up with the scheduled 1:30 feeding but to wait until morning. After Flower threw up, she went to the litter box and urinated. Then she went to Varr's room and I let her sleep in there for awhile. At 3:30 I woke up and went to retrieve her from Varr's room and bring her back into my room. We slept the rest of the night more-or-less soundly. I woke up briefly because she was making some odd sounds which I could not distinguish as snoring or burping, but I eventually got back to sleep.

Sunday morning: Ashley came over to help me this morning. Last night I developed a method to help keep all of the food warm and prep the medications as well. I also came up with a schedule to divide the portions up and to avoid having to deliver multiple portions of food mixed with different medications at the same feeding. I have a pan of water on the stove with a thermometer in the water. The heat is on the lowest setting which keeps the water between 100ºF and 120ºF. I mix Flower's food with water in a ziploc bag, which I can then keep warm until feeding time in the hot water. I cut a hole in the bag and dump the food directly into the syringe. This way I can monitor the volume a little more closesly. Then I deliver the medication into the syringe, with the food and shake well. For the water flush, I simply use warm tap water from a bowl. This morning's feeding consisted of 1/6 of can of Hill's A/D, prednisolone, and clavamox (amoxicillin). The total volume of food and prednisolone was 16 mL with 1 mL of amoxicillin administered separately. I used a 10 mL flush before and after the food for a total volume of about 37 mL.

I am going to try to continue with several small portions today every three hours. I may reduce the flush slightly in order to keep the total volume down.

Observations: Post Feeding Tube Session 1

Varr helped me administer fluids to Flower via the feeding tube. I was really nervous on this, but I got the food mixed and made sure it was warm. Because I have to mix the meds with two separate portions of food, I had some food ready in the syringe and another portion of food in a bowl. I started with 10 mL of water and then followed with the first portion of food, which was about 15 mL. Flower was pretty calm through most of this; she started to get a little unsettled toward the end of the first portion of food. After this portion was done I had to cap the tube and refill my syringe with the second portion. I administered this, but she was definitely getting more agitated at this point. After the second portion of food, I flushed the tube with just 5 mL of water. Finally, I administerd the amoxicillin via the tube and flushed with the last 10 mL of water. Varr sat with her and pet her while I cleaned up the supplies and she is still resting soundly. Her eyes are finally closed now, they seem to be often stuck in a half open state with an empty gaze straight ahead that is uninterested in the world. Sometimes, like this morning when she was up, I see that she is still full of life. And other times, like now, I wonder how much pain she really is in. Maybe I should just let her go. I hope more than anything right now that this feeding tube works and that she begins to regain some strength and lust for life (and food). I can't tell if she's so somber this evening because of the procedure today, but she just seems sick of everything and so dejected. I want to turn this around for her, but I can't let it take forever; this needs to happen soon, for her sake.

Something for Flower

I would like to give Flower something to help keep her occupied and give her something to focus her attention on. I thought that I might get some fish. She spends so much time looking outside, as so many cats do, and considering that right now we really can't try to play with her much, I think that fish might be a good idea. They could give her something to watch, to give her a focus that might entertain her and stimulate her postively. They are low maintenance, and they're colorful; everybody likes looking at fish, not just Flower. The ones that I liked, however, are little more expensive than I thought. Or rather the fish tank/filter/etc. is more expensive than I thought. Not quite sure what to do here but all I know is I can't just let Flower sit and waste away; I've got to do something to keep her motivated and active.

Status Report: Feeding Tube

Last night Ashley and I tried the Valium/Diazepam without success. Flower hated the medicine and she yelled and jerked away from it. At this point I really feel that I am belying her trust because she can't understand why I'm doing the things I'm doing to her. Especially after today. I spoke with Dr. Ikeda on this morning and given the lack of feeding even with additional medication, he and I decided that the feeding tube would be the best option to give Flower the greatest chance at getting healthy or at least maintaining. The feeding tube allows us to provide her with water, nutrition, and medication without injections or force feeding or forcing pills. Right now I just hope this works.

Ashley and I went to the vet's office to pick up Flower this afternoon and to learn how to administer food via the feeding tube. Although it doesn't seem difficult, it was not something that Flower especially enjoyed. They gave her one feeding before we got there and then demonstrated how with a small amount of food so that we could learn. The food must be mixed with water to make it soupy. About a quarter of a can should fill a volume of 35 mL (and maybe a little extra) when mixed with water. This food is drawn into a syringe to be fed to her via the tube. Another syringe is used for water. We have two medications and a supplement that need to be mixed in with the food. The food should be mixed with warm water so that it does not shock her system when it hits the esophagus and stomach, which can cause vomiting. Ever since we gave her this food earlier, she has been making rather odd sounds: some gurgling in the stomach and intestines, some burping, and some odd breathing sounds (which the doctor said is likely from the tube in her trachea used during the surgery). The most disheartening, however, was when she vomited a small amount this evening. This came right before Ashley and I were to administer her nightly feeding/medication. Afterward she didn't want to stay in my room. She sat in front of Varr's door for nearly 10 minutes and then even went to Ev's door to try to get in. Finally, unsuccessful, she came back to my room and sat in the doorway. I had to pick her up and place her on the bed and she is now sleeping and snoring oddly. I hate to wake her but I have to do the feeding for this evening. I'm waiting, hoping that Varr might come home soon because I'll need some help to make it as easy as possible on Flower.

At the vet's office today, we found out that Flower is becoming anemic. Her red cell volume on a PCV was about 29% yesterday and then 27% today. At the time of the surgery the doctor was pretty worried; having done a PCV with the blood taken while under anesthesia, Flower's red cell volume was at only 14%. But he double checked it after surgery, and returned with the 27% value I just mentioned. Her gums are pale, which is not good. He gave us a supplement (see above) that we will give her with food that contains iron and some other components to help with red cell development.

Status Report: A Second Opinion

Ashley and I met with Dr. Ikeda this morning in order to get a second opinion. I brought Flower and all of the paper work from the previous visits and we sat and talked with the doctor and with the nurse for about an hour and a half about Flower. He was pretty puzzled by her condition also and didn't yet have any clear answers. His assessment was more optimistic, however, than what I've been hearing lately. Her symptom's all point to some kind of gastro-intestinal disorder and he suggested that this be the first place we look. Having already had x-rays done about a week ago, we need to next get an ultrasound done; we just need to decide whether to go to the specialist or have it done at the vet's office. He also suggested a feeding tube for her, which at first I was very reluctant toward. Ashley has mentioned this to me before, but I didn't think it was something to consider in Flower's case. The fact remains, however, that all we know right now is that she won't eat on her own, and that she seems to feel better (although not 100%) after returning from the vet when she has recieved IV fluids and she has eaten. After talking with Mom and with Ashley about it I decided that the feeding tube gives us the best chance to help Flower until we can find out what's going on. The doctor called me back later in the afternoon, however, and told me that Flower had started eating some dry food on her own after only having been on the IV for a short time. He felt that we should wait and see how she'll do on her own with a new prescription of diazepam*. So we'll administer it this evening and again tomorrow evening in the hopes that she'll eat on her own. With so many ups and downs in the last week I'm ready for some answers but it appears that I will have to wait awhile longer to find anything out for sure. Tonight Flower is sleeping again, curled up in a little ball; I've taken off her cone and she has her paw with IV catheter installed draped over her head, not quite sure what to do with it. I'm anxious for Flower to give me the sign that she feels better but for now it seems that she still wants mainly to sleep; I'm always worried when she's sleeping. I want her to wake up and pester me in the kitchen and beg for treats. But she's not quite ready for that. In the meantime I am focused on giving Flower the best chance and on giving her as much of my time as I can afford.

Status Report

Today I started with a positive outlook but had some hard ups and downs during the day. I gave Flower her sub-q fluids and Valium this morning before school and then Ashley came over later and gave Flower her dose of amoxicillin. When I came home this evening Flower still hadn't eaten anything and so I began to worry. Ashley and I played with her for 15 or 20 minutes even though she was barely interested. Finally, I decided to try re-dosing her with cyproheptadine. This did not go well. I tried hard to get her to take the tablet but after 2 or 3 attempts she began to foam at the mouth and finally threw up. Watching her throw up is painful. I don't think that I've seen a cat wretch quite so violently as Flower does. She threw up twice: the first was mostly green and brown and included the little food that she had eaten and then again within a couple minutes, this time mostly yellowish in color. She continued flicking her tongue, and I was worried about letting her go a full 24 hours with virtually no food, so I decided that we should go to urgent care again to try to get some answers and hopefully a little help. Dr. Crook was very nice and she suggested that in order to find what was wrong we would start back at the beginning with testing. Since I already have an appointment to see Dr. Ikeda in the morning, I decided to wait on more testing. I did have them give her some anti-vomiting medication and something to help decrease acidity in her stomach as well as show me how to properly give her the tablets. Jeff was really helpful here and explained how he does it. I can use two fingers behind Flower's head and the thumb and index finger on the upper jaw to hold her mouth open and head back and then use the other hand to pull the lower jaw down and deliver the dosage. Hopefully I can do this more deftly than I have been. He went ahead and gave Flower the dosage of Valium and now we're at home in bed. As I was getting ready for bed, Flower came to find me a couple times and seemed to not want to go to bed without me, which I appreciate. I just hope I can do some good for her. Over the last six months I have worked to build her trust and I don't want to let her down. I want to be able to keep her safe and healthy. She is sleeping now, but I hope that she will wake me up tonight with loud chomping; I left about a third of a can of the A/D food for her and some water.

Also, as a side note, the past 2 days I have recorded about 25 mL of water gone from her bowl by the front window each day. I hope that this is because she is drinking it and not because it is evaporating. I make sure that the water stays out of the sun, but I still wonder.

Observations

Cleaned Flower's littler box this morning. I used bleach this time, which I did not do last time. I was sure to rinse thoroughly using the hose in the back yard. I think I just cleaned her litter box right before school started which would have been about a week before her symptoms began. Flower slept through the night in my room. I tried to play with her this morning, but she was only barely interested. Varr helped me with sub-q fluids and Valium, which is getting easier. She still really hates taking the Valium and flicks her tongue to try to keep it out of her mouth. I set out about a third of a can of Hill's A/D but she hasn't touched it yet. She's sleeping in the sun and spent a little time grooming herself this morning. 

Status Report

This morning I was awoken at 5 AM to the sound of Flower eating out of the food dish that I left at the foot of the bed. The relief that I felt then was tremendous. I didn't get up then; I just went back to sleep and checked in the morning. This was a good change from the day before. I haven't checked her litter today or changed her water yet this evening; I'm anticipating that she hasn't used the water dishes I've been keeping out. The good news is that she was more active today than she has been by Ashley's account. She has been pretty sedentary during the times that I've been home but Ashley said that she was playful this afternoon. I gave her the Valium and amoxicillin this morning (7 AM) and I need to give her the evening dose of amoxicillin for tonight still. She hasn't eaten since I've been home, but I did find some salmon at the pet store that she ate earlier in the afternoon (~4 PM). I also picked up some catnip and some Kitty Kaviar, which she was somewhat responsive to this afternoon, and I tried to play with her again this evening (8:15 PM) but with little success. Only a couple pats and bites. The goal right now is to stimulate her and give her about 30 minutes of playtime everyday or at least the opportunity for at least 30 minutes of playtime. Ashley and I are dividing playtime into 3 sessions of 10 minutes in the morning, afternoon, and evening. With no clinical findings (the urine culture and stool came back today: both negative) we have to assume that she may have simply had a virus or other infection or that she may be depressed or bored. So the meds should help make sure that she's not sick and we will spend the time to make sure that she has something to do during the day. Tomorrow I will also administer sub-q fluids.

This morning when I checked her litter box, there seemed to be about the same amount of both stool and urine as yesterday.

Status Report

Today was a stressful one: for me and for Flower. This morning, Varr helped me administer sub-q fluids to Flower, which, again, she hated. We did manage to get about 50 mL (cc) of fluid in her though. I also tried to get her to take a Valium. She really hates this. I thought I got her to take it but then found it on the couch about an hour later. I had to get her to take another one by myself which was incredibly difficult. I went to class afterward (about 9:30 AM) and left some food out, and when I came home (at about 3:30 PM) she had eaten all of the Hill's A/D and several treats that I left out for her but she seemed very tired and didn't get up from my bed. On my way to class, I stopped by the vet's office and dropped off a stool sample. The urine culture was still in progress but both should be done by tomorrow (Tuesday 1/27). While I was home in between classes I played with Flower until she got tired of it, for a total of about 10 minutes.

Without any clear sign of what is actually wrong with her, I think it might be something as simple as depression. So much of her behavior just seems inexplicable at this point. She eats very little and drinks hardly anything on her own. She sleeps a lot and doesn't follow me around much anymore. She didn't wake me up this morning and she hasn't come to get me at bed time in at least a weak either. It's worth noting that yesterday morning, Sunday, she did wake me up by pawing at my face. I gave her no meds on Sunday other than the amoxicillin.

Tomorrow I intend to pick up some more different types of food. She seems to consistently eat the "gravy" from wet food and does enjoy treats periodically. I'm not sure, but I'm considering that she may have some food allergy. Or simply some other aversion to foods; she has had a gag reflex to some foods for as long as she has been here, but the list of foods to which she gags may be increasing. Today, also, she barely drank any tuna water even though I left it out all morning. I refilled all of her food and water bowls and made sure that were wide and shallow. She has not had any of the water I have been leaving out. Also, I have been trying to use Pedialyte with her instead of tap water.

And just to remind myself: don't forget that she threw up back on Thursday, which you might have forgotten to tell the doctor. The vomit was yellow and frothy.

Sub-q fluids, Valium, food, and 10 minutes of playtime

Status Report

Flower woke me up this morning: a good sign as this is something she has always tended to do with me. I woke up and offered her a very small amount of no-salt-added tuna in plenty of its own water, which she did not eat or drink but only tasted. She did eat some cat treats: the kind from Grandma Mary and some that Ashley just got yesterday. I offered her some of the A/D food several times through the day, warming it up and not warming it up, which she did not eat. She ate some more treats again later from Ashley. We went to the store to get a couple toys for her to try to get her active a little bit and also picked up another kind of food that Ashley recommended. Flower only ate the "gravy" from the food and did not eat any of the solid portion. Also, this evening, after checking her water in the kitchen, I found that she has not had any of it to drink in the past 24 hours. I changed the bowl to a ceramic one, refilled the water with bottled water, and placed a couple small pieces of her dry food in the water in order to facilitate her depth perception. I also replaced her dry food (which I saturated with water), and provided some Pedialyte for her to drink in the living room (also with a couple pieces of dry food added). She began this morning more active than before and last night I scooped a lot of urine out of her litter box, but as the day has progressed, she has become more sedentary. Tomorrow I will administer sub-q fluids in the morning and try giving her a dose of Valium to stimulate her appetite, as well as continue her course of amoxicillin. I go back and forth between being worried and hopeful, but ultimately, Flower simply seems depressed. I don't know how else to characterize her behavior.

Another thought: I offered her food this morning and then, even though she hadn't eaten, I went ahead with her amoxicillin dose. It's possible that this might have upset her stomache in such a way that she didn't feel well for most of the morning or afternoon.

Final comment: I have left a veritable smörgåsbord out for Flower and just now she got up off of the couch to take a look around. She passed by some tuna-water and the Pedialyte I decided to try but she did go for some of the food that Ashley got this afternoon. It appears that she mostly licked off the remaining gravy and I cannot tell whether she actually ate much of the food or not.

Flower's fur is soft and dander-free - I can tell she's been grooming herself. This is different from how she was before. She was flaky and her fur was a little clumpy. Thinking back now, I'm sure she hadn't been grooming herself normally in the past few days. It's nice to have Flower back.

Status Report

I worked most of the day and missed Flower. Toward the end of the day I was pretty anxious, not knowing for sure what was going on with her. I read another blog post last night recommending tuna-water for cats that won't drink. Apparently this is a common problem. Ashely was understandably concerned about giving Flower so much sodium, so I decided to get low-sodium tuna. At the store, on the way home, I picked up tuna-in-water, Pedialyte, and some Gerber veal and lamb. I got ordinary canned tuna at Ralph's but I also went to Trader Joe's to get tuna with no salt added. When I got home Flower was sitting in the window, a normal spot. I came in and opened the no-salt-tuna and poured the watery "juice" from the can. As soon as Flower saw me pick up the can, her eyes opened wide, and when she heard the can opener, she came immediately. I poured the tuna-water into a bowl and placed it in front of her on the floor, with hope but also apprehension. She smelled it momentarily and then lapped the approximately half of the tuna-water down. When she was done drinking, I fed her some tuna from the can, but she ate only a small portion. She laid in my bed for awhile afterward, and then, when she heard me in the kitchen, came to investigate. I gave her some more of Hill's A/D food, and again, she ate only a small portion. But at least she is eating consistently.

Status Report

Ashley helped me administer sub-q fluids this morning. Flower did not like it. I only managed to get a very little amount of fluid in her. She did not like the way that I stuck her and she continued to growl and moan as the fluid went in. I may not have stuck her correctly or in the right place. She drank some chicken broth (that I made from chicken gizzards) last night: about 5 tbsps. And then she drank some more of that this morning. She also ate some of her dry food to which I added water last night. She was slightly more energetic this morning but that might have been simply because she did not like the needle.

Observations

Flower has been sedentary most of this evening. She visited the litter box once immediately after arriving home and probably once more later. I have not checked to see if she urinated or passed stool. Oddly, she sat on the blue couch most of the evening; she even went back there herself when no one was there. She stayed there through the evening until I brought her to bed about 15 minutes ago. She stayed here shortly and then got up and went into the hall: a farily normal habit. She has just gotten up again, suddenly. Although it is not unusual for her to leave my room to go to the bathroom or to sit in the hall for some time, her behavior does not seem to quite fit normal. She scratched at the rug vigorously, another common habit and she gave it a good show of vigor. However, when I picked her up from the couch to bring her to bed earlier, she was extremely docile.

Status Report

I just picked Flower up from the vet. She was anxious and ready to leave I think. Once home she walked around and checked her usually spaces, including her litter box. She smelled her food but ate nothing yet. She was just sitting with me, and she seems tired: like normal at the end of the day. I filled her bowl with 25o mL of water and will wait to see how long it takes her to drink it. The tech showed me how to administer sub-q fluids using a towel in order to prevent Flower from scratching or fighting. The technique is simple; the skin on the back of the neck is pulled away and the needle simply goes in through the folded skin. I should administer 50 cc every other day with otherwise normal fluid intake. I may administer as much as 150 cc if she is not drinking but I should call the vet to check Flower's other symptoms first. I also now have Valium for Flower; I am supposed to give her one-half of a tablet once daily in order to stimulate appetite. I also have amoxyicillin to give her: 1 mL twice daily. This will probably last for the duration of the next week and then some. I hope this works.

Flower, Lateral View

Progress Continues...

I spoke with Dr. Smith from VCA Animal Hospital on the phone after work this morning. She and the doctor from last night still have little conclusive evidence for what is actually wrong with Flower right now. All we seem to know is that she won't drink much on her own. Last night, apparently, she urinated copiously with the IV although I'm not sure whether she ate or not. We also had the veterinarian at the urgent care take x-rays which came up with no significan findings. When I spoke to Dr. Smith this morning Flower still didn't seem to be eating much and so she wanted to try using Valium in order to increase Flower's appetite. I don't know yet if that has happened. The doctor last night began a course of antibiotics that will be continued today at VCA. I may go in today to learn how to administer sub-q fluids to Flower in the event that she not begin eating and drinking again on her own. I asked Dr. Smith several questions today, and from our conversation I learned many things. The A/D food is high in both protein and fat and has antioxidants and is designed to be highly palatable for animals. I may give some low-sodium chicken broth, milk, soy-milk, or lactose-free milk to her to try to keep her drinking if she still does not want to drink water. Milk can be hard on cats intestinally, although there is little difference between the effects of dairy on humans and cats. But it may help Flower get the fluids that she needs. The best way for me to monitor her fluid level is simply from urine output. I asked also if there were some way to assist in grooming other than brushing and the doctor said that that was about it. She had no other recommendations to assist Flower in grooming herself.

Ashley made a good point today; why did we not start her on antibiotics in the first place? I don't recall now whether the vet recommended this in the initial consultation or not. I was definitely confused after receiveing the bill and then trying to go over each item individually, and I just hope that I did not make an error in judgment and decide to postpone antibiotic treatment should it prove effective at this point. Ashley is concerned that the veterinarian may not have presented this initially and that we have gone on a wild-goose chase with so many tests, x-rays, etc.

Hope

I picked Flower up from urgent care about 45 minutes ago and she's doing fantastic. She's lively and energetic and active, although she hasn't groomed herself. She was started on antibiotics last night and will continue them at the vet today. She and I are waiting right now; it's my desire to spend some time with her this morning before leaving her, again, in someone else's care.

Waiting

Flower is now at the Urgent Care Clinic overnight. This is the first night in the past 6 months or so that she has been living with me that she has not slept in my bed. I keep looking down; there's a sweater at the foot of my bed where she might often sleep that I see from the corner of my eye. I think that it's her but then I look and it's not. She's not here right now. After spending so much time in the shelter, I don't think that she has forgotten what that place was. And although I think they were kind and loving to her, I think she must have been lonely. I hope she has not been lonely with me here. There are many days where I am at work or at school or both and I am gone for many hours. Sometimes Varr is here and sometimes not. I just wish I could let her know somehow that they can take care of her and I cannot. I wish she could understand me when I say that I'm coming back for her. But she doesn't know.