I know this road. I've walked it more times than I care to recall. It's the moment at which I realize the time I have with one of my cats is coming to an end. The road is full of hopeful moments that will ultimately lead to despair and to the final choice we must make for our cat, one day.
I hate this road more than I can say. It eats at my heart and taxes my reserves. I try to prepare myself, but there is no preparing for death. It comes, as it does for all of us. We either accept it and find peace or fight and have the same end, no matter what.
On Saturday I got Bob's blood test results. His liver function, one test indicated by his ALT, was stratospherically high. A normal value would be 10-100. Bob was at 1240.
Other liver values were also very high, save for his Bilirubin, no it's not a sandwich, it's a blood test. That test result was normal. This is a good thing.
From Cat World, Australia, I found this description of Bilirubin:
Bilirubin: This is a major breakdown product of red blood cells. When red blood cells wear out they are trapped in the spleen and destroyed, releasing bilirubin into the blood. This type of bilirubin is called unconjugated. This bilirubin is transported in the blood to the liver, where it is taken up & conjugated (joined with glycuronic acid). This conjugated form may either be stored in the liver cells or excreted into the bile. Bilirubin levels are increased in cats with liver disease, gallbladder disease or have excessive destruction of red blood cells (known as hemolysis).
What do these numbers mean? See THIS web site for some helpful guidelines.
Then the kicker came today. Bob had an ultrasound done of his heart and abdomen. I thought I was going to be able to sit in during the ultrasound, but Dr. K said it would be quicker if he was on his own. Super Deb assured me she'd be with him and answer any questions. I kept thinking about this and that thing I wanted to make sure he knew, but in the end, nothing I was worried about mattered.
I took Super Deb's dog, Jayne for a walk, instead of twiddling my thumbs in the waiting room. It was freezing cold outside with a bitter wind. I tried to shake off the fear of what I would find out in a few more minutes. I tried to not cry thinking about it. I know as any good cat-parent knows-something is wrong, I just didn't know what it was. I didn't really WANT to know.
When I returned to Dr. Larry's office, grabbed a magazine about celebrities and their fabulous lives and pretended to look at it. I saw Super Deb. She wouldn't make eye contact with me. Then Dr. Larry arrived to start his day. He didn't even look towards the waiting room. Maybe it was not a big deal that he didn't look, but it seemed like no one wanted to even give me a hint as to what was going on.
Sam arrived with Petunia and Nora. He sat next to me, but we didn't speak. It's been a common thread here for a very long time. We only speak when necessary. Something is going on with Sam. I can guess, but he won't talk to me about it. Instead he hides in his office in the basement and plays his guitar. He mumbles this and that. He helps out around the house, in silence. Each day I grow a little more resentful, more angry. I am shut out and alone. I didn't do anything wrong. I can't wait forever for his life to be in a place where he feels like being a partner to me again. I'm still suffering from the car accident, in tremendous pain, but he does nothing. No comforting. No nothing. With all the stress I have about Bob, he only taps my shoulder or brushes my hand. When I need him most, he is the furthest away. I have to ask myself how many more years can this go on? What happened to having joy? Companionship? Even a dear friendship? For so long I have tried to encourage him to trust me, to talk to me, to give him guidance and support, but I am tired of trying.
So, Sam is there, but not there. I am there, but wishing I was somewhere else.
Petunia is getting a dental. One of her molars has a HOLE in it! Was THIS what was causing her to go on a pee-storm throughout the house? Fight with the other cats? Did she also have a urinary tract infection or impacted anal glads? While under anesthesia we'd be finding out. Maybe after all these years, I'd finally have a true end to the inappropriate urination going on in my home.
Nora was there to check her foot. We thought she had ringworm, but turns out she did not. She has some sort of fungal infection on one foot. It hasn't spread. We've treated it and it's getting better. But what about BOB??! Will someone please TELL ME what is GOING ON?
Dr. Larry took a deep breath. That was all he had to do. I knew it was bad news and he was preparing himself to speak.
Bob's heart is normal, which is very good, but...
Fun with ultrasound results.
As you can see, above, the many LONG words that I can't make heads or tails of spell out that Bob has a 5 cm mass present in the right lobe of his liver. It is not possible to tell if it's a cancer or if it's a benign tumor that could be treated or removed surgically.
With FIV+ and being a senior cat, Bob may not be a good candidate for surgery. He may have cancer and if they do the surgery they will open him up, then say they have to put him down. That it would not be fair to wake him up when he will only live a little while longer, anyway. It's a big crap shoot.
©2010 Robin A.F. Olson. Bob ponders his future (on his new blanket from Jennifer)
Thanks to one of my readers who works with FIV+ and Feline Leukemia positive cats, she told me something shocking:
...for any kitty that has been tested since the beginning of this year with the new IDEXX 3-way test (FIV/FeLV/HW), you cannot trust ANY positive result on the FIV or FeLV component: incredibly high rate of false positives, confirmed by retests with the western blot for FIV or the IFA for FeLV. the true positive rate on retest is the normal, VERY LOW, percentage. (and, of course, the FeLV component only tests for EXPOSURE, and most cats are able to process the virus out of their systems, which is why retesting is imperative. usually, the retest should be done 90-120 days after last exposure, but with the nationwide problems on the new test, we-who-get-the-panicked-calls-to-place-these-cats are advising that cats be retested immediately. (IDEXX does know about the problem, and will admit it to vets; however, tho they've asked for the names and contact info for those who have stats--national rescues, and special-needs sanctuaries--they've never followed up when they were provided with same.
©2010 Robin A.F. Olson. Blitzen and Nicky try to cheer Bob up.
Even though Bob was tested years ago, this is the time to make SURE he is FIV+ because that will effect his ability to get a surgeon to take on his case. Because he was not neutered at an appropriate age, he got FIV. This is my Mother's fault and I will never forgive her for not caring for her cat. His life would have been so much better if he'd been neutered sooner and not left outdoors to get into fights with other territorial males.
©2010 Robin A.F. Olson. Blitzen decides to lick Bob's head while Nicky is...Nicky.
I started to cry when I got the news...big, shaky tears. I tried not to cry, but he knew I couldn't hold back. Dr. Larry rubbed my arm and told me about a woman whose dog had the same thing Bob does. That he opened the dog up and saw the mass and called the owner and said he should put the dog down. The mass was too big. The dog would die anyway. She was going through a bad divorce. The dog was all she had. She demanded he cut the mass off-so he took half the liver. The dog lived...another two and a half YEARS. But Bob's not that dog and Bob could have cancer and Bob has FIV+ and he's a senior...blah blah blah...
©2010 Robin A.F. Olson. Blitzen being cute, as usual.
I just wanted to fall over, curl up in a ball and weep. But that won't help Bob get better or live a bit longer, at least.
So I asked a few questions, then left the exam room. The first thing I saw was Moonpie's face! His new owner, as promised, brought Moonie and Patty to meet Dr. Larry now that they are adopted. I couldn't have been happier to see their friendly faces. I took Moonie out of his cat carrier and held him. He sat comfortably in my arms. Both cats meowed furiously at me. I hope they weren't asking me to take them home. I wanted to, but they will be happy in their new home one day. Right now they're doing well, but are still scared. Their new owner says that each day the calm down a bit more and become a bit more cuddly. With three young boys to play with, it's a big change for them. I told her to give it a month and that I'm always there for her whenever she had a question. She told me to come visit them any time. It would be too tempting to sneak them back home with me, but it was really GOOD to see them again.
©2010 Robin A.F. Olson. My boy, Bob.
We loaded Bob into the car, alongside Nora and drove separately home. I got Bob fed and gave him his liver medicine. He ate well, then went to his heated bed for a nap. It was just like any other day, completely unremarkable, save for the part that I know there may not be many more such unremarkable days ahead.