Mikan

[fub]

Today, we had to let Mikan go.

Four weeks ago on a Friday, we noticed one of her eyes was a bit darker than the other. We thought nothing of it, until we noticed that she was in a bit of distress. It turned out her right eye was filled with blood! Of course, this was very concerning and we called the vet emergency number — it turned out that our regular vet was on duty, so we took her in. They couldn’t see/find anything: perhaps she had gotten a hit on her head? But it should clear up in a few days.

So we took her home and kept her indoors. And sure enough: day by day her eye seemed a bit lighter as the blood was slowly cleared away. And then Wednesday, in the morning, she was on top of klik’s desk and fussing a bit, so I picked her up and put her down on the floor. Immediately she went into that ‘careful investigation mode’ that cats have if they are in a new environment. And then we saw that now both of her eyes had filled with blood!

It was very upsetting to see her so lost in an environment that should have been so familiar to her. Of course we called the vet and we could take her in that afternoon.

We got the same vet as the one that saw her on the previous Friday, so that was good. She checked Mikan’s eyes again, but could not really make out what the extent of the damage was and look for possible causes. This will require a visit to a vet with specialised equipment and skills. And since it’s vacation time, there is not much availability for that. We secured a spot on Tuesday afternoon in Arnhem, the next city over. They also offered to call the “kitty eye doctor hotline” but that might mean we’d have to pack her in the car and drive to The Hague or Amsterdam with her. Since she hates travel, we decided against that — it would only stress her out more. So we decided to wait it out.

During the rest of the week, she’d been relaxing, she was eating, she was walking around and getting pets when she wanted. She was adjusting very well, which was very encouraging for us. We certainly calmed down a lot. We took her to the appointment with the kitty eye doctor. She looked in Mikan’s eye and they also measured her blood pressure. Turns out that her blood pressure is way too high. This could have many different causes, such as her heart murmur or thyroid hormones or something else. The effect of the high blood pressure had been that the pressure on the eyes built up, and then fluids can build up behind the retina, which can then become detached. This had been the case with the right eye (the one that went earlier) and it seemed unlikely that she could see through it, though the pupil still reacted (slowly) to light. The retina on the left eye had become detached for a large part as well, but that was still attached on two spots. So we got medication to lower her blood pressure. The aim was that the fluids would drain and the retina would return to its normal position. With some luck, some vision would be restored in that eye.

We also had eye drops to treat the infection in the eyes, so the blood could be re-absorbed faster/easier. After a week, we’d take her to our regular vet to check her blood pressure and to draw blood for various blood tests. And then the week after that, we’d have a repeat appointment with the eye doctor to assess any progress.

The medication worked. Even though she hated being held down for the eye drops (three times a day!) and the pill, her eyes cleared up and it was apparent that she could see better. She managed to climb on the couch and get back down safely on her own, things like that. On Monday was the checkup at our own vet. They took her blood pressure, and the news there was good. It was over 200 a week earlier, but it was back to somewhere between 160 and 170 — on the high end of normal blood pressure. Given the fact that she was stressed because of the vet visit, it was probably lower at home. They also drew blood (which wasn’t easy because of the way her veins run, apparently) for all kinds of blood tests.

But her situation worsened, she was not doing well. Later that evening we got a call from the vet with the results from her blood work, and those were cause for concern. Mikan had severe anemia, and a slightly elevated white blood cell count. The white blood cell count could be explained by the blood in her eyes: the reaction of the body to that is similar to that of an infection. But the low red blood cell count is cause for concern: there are no obvious causes that result in anemia and high blood pressure. We had additional tests done, to see if it’s leukemia (the variant caused by a retrovirus) or FIV (the Feline variant of HIV).

Meanwhile, we had to grab her and administer medicine to her four times a day (three eye drops and a pill) and she had gotten fearful of us. That was really heartbreaking, and we decided to stop the eye drops. Her vision had cleared up sufficiently, and without long term prospects it’s pointless to continue the torture.

Mikan was getting more withdrawn. She had always been very good at conserving energy, but she seemed really tired. She spent the whole day lying under a bench in the spare room. We put food and water out there, and she did eat (and also probably drink). But when she wanted to come back downstairs she lied down halfway up the stairs and rested. After an hour I picked her up and put her on the floor, and then she walked around for a bit, but quickly retired to lie on a cushion.

Yesterday, the vet called, and confirmed that Mikan’s tests for leukemia and FIV were negative — that’s good news. So he wanted to see Mikan again and take some blood for further tests. He didn’t know what could have caused the anemia and we wanted to find out. And perhaps her body had gotten the memo that it needed to produce more red blood cells?

So we took her in. The vet was supportive of our decision to stop the eye drops: they had done their job, the eyes were clear now, and she can see enough. Before taking blood, he weighed her and listened to her heart and breathing. He was not happy with what he saw. Mikan has lost 2 ounces of weight since Monday. We’ve seen her eating, but she weighed 3.2kg on Monday and now just over 3kg — that’s a huge weight loss in four days. And her heart and breathing was not smooth either, it cost her effort to breathe.

The high blood pressure, the anemia and the heart-lung situation are (most likely) not caused by the same thing. Instead of a single cause, it seems like Mikan’s body was facing a systemic failure. We decided to not subject her to more examinations and medical interventions. I had to cry, then Ingeborg had to cry when she saw me cry, and then the vet had to cry when he saw us cry. But this was the best decision for Mikan, as hard as it was on us.

She got an injection with prednisone, to prevent any auto-immune responses, and we took her home. She seemed a bit perked up, but it’s clear she was very tired. Our hope was that she might just coast along for a while: maybe the predinsone would help her and once it is done we could get another shot?

But this morning I came down and she was clearly so, so tired. Her breathing took her a lot of effort. Clearly she was not perking up. And with Chibi, our previous cat, we had waited too long — something we are desperate to not repeat. We decided it was time to let her go.

We called the emergency number, the vet hospital was on duty, we went there, the vet agreed with our assessment of the situation, and we said goodbye to Mikan. The last thing she must have felt was us caressing her.

She was with us for 11.5 years. She leaves behind a huge hole in our lives.

Mikan executing her “signature move”, something we called a “cuteness attack”

Crossposted from my blog. Comment here or at the original post.

Comments

[twelvthdoctor]

I'm so sorry for your loss. I've been mentally preparing myself for this for 2 years now since my cat Lexie was diagnosed with kidney disease. She's been slowly declining ever since, but I think it's been starting to pick up the last couple of months. It's not easy.

[fub]

Thank you. And I'm sorry your cat is declining. It is not easy to make that decision: you don't want to do it too soon, but you surely don't want to wait too long and prolong suffering.

[twelvthdoctor]

Thank you as well. Yes, that's precisely the dilemma I'm at, constantly, is not wanting to make her suffer or to do it too soon.

I found a helpful website a while back that said to look at a bunch of different factor and reassess over time, such as do they still like to receive affection, partake in and enjoy some of the activities they usually do (even the more inactive ones like sunbathing), still attempt to eat food, hide more (compared to usual, not counting if they already do a lot by personality, or if they're picking different spots that seem odd), urinate out of the box more, etc., taking into account how they usually are. If they're still doing many things like their usual selves, rate them at a 7-10 for each category. If they're starting to decline, but still are seemingly doing okay and overall comfortable, rate them at a 4-6. If they're starting to really seem to be taking less interest in things, or are outright avoiding or otherwise seem miserable or in pain, rate at a 1-3. After taking into account all of these individual things, average out the score, and if they're overall in a 7-10, they're probably still early-stage. If they're on average 4-6, time to start monitoring but not really time to panic yet. If they're on average a 1-3, time to start considering euthanasia or to at the very least consult with the vet to assess further and maybe do some tests.

I'm sure without using the exact system I just described, that's what you did for your cat. Weighed everything. Some of what you were describing with the drops was a similar decision I had to make even earlier on in this process with pilling Lexie, giving her an appetite stimulant. She was fighting it so hard every day, even wrapped in a towel, and as much as I want her to not feel nauseous so she can eat more and not lose weight so rapidly, putting her through this every day to the point that she's yowling, hissing, and foaming the pill back out the mouth because she hates it that much, just didn't seem like it was adding to her quality of life, either.

I don't mean to bombard you with all of this about my cat while you're grieving your own, but I only say all of this to say that I think you went through a lot of the same thought processes I'm also going through, so I understand it completely, and think that as heartbreaking as it is, you did all of the right things and timed it just right. This is all new to me because I only had one cat growing up, and my parents had to put her down when I'd already grown and moved out, so it's a very fresh and raw pain facing this looming future.

Peace and comfort to you as you navigate your way through this. Your cat was very well-loved.