I originally published this on October 15, 2010. Peaches was 20 years old and had been diagnosed with renal failure in March that year. I’d been chronicling our path together through the seasons, for my own sake and for the sake of others who were also caring for a cat in renal failure, hoping to provide real-life guidance so others would know they were not alone in their level of caregiving. Peaches would come to the end of her path on October 20, just five days after this, but she was the boss of the whole process and I never once felt any fear or regret from her, I just followed her along; she was very clear in her instructions. Very much like this time of the year, I am remembering her and thinking of those of you who are also caring for cats and other pets in end-stage renal failure.
Peaches taught me well: Don’t look forward in fear, but be with the moment. As the end inevitably draws closer, love, don’t fear.
I have always found it ironic that, as one of my kitty’s lives apparently draws to a close, we grow ever closer, communicate more clearly, share deeper expressions even as we are certain we’ll soon part. While I think of all my other cats through the day, I am constantly aware of Peaches and her condition, and I think she is of me. At this point, as Peaches and I walk a little farther along the path together, we grow close in a way that wasn’t possible earlier because we know what is ahead. The trick of it is to use that knowledge for good and not ill, for our mutual wellness and not to give into sadness and the fear of loss but to celebrate each other for as long as we can.
Peaches may last quite a while longer, but this last waltz, the quick changes in health, the need for greater care, constantly looking for the sign from Peaches, while they are the sweetest time we’ll ever spend together are indeed the most difficult. And again, I thank those who’ve gone before and taught me what to look for and what to do, and not to fear but to love.
This past weekend I thought I might be saying farewell to Peaches very soon. She wasn’t eating, was occasionally vomiting and was one moment constipated and another with uncontrollable runny diarrhea, her sub-q fluids pooled up in her right front leg and paw for nearly 18 hours and I could hear gurgling in her abdomen that made me think I heard the toilet running.
But instead of reading the “I am preparing for my transition” which I expected, her expression read, “I feel like crap. Can’t you do something about it?”
Peaches may be 20, weighing in at 4.8 lbs. at her last exam, a little wobbly, pretty deaf with bad eyesight and sometimes confused, but she is one feisty, resilient kitty. Determining her state of mind at this point is a little different from others I’ve known, having only known her for the past five years. Most of the cats I’ve had previous to this I’ve taken in as adults, but I’ve still had more years of a relationship and can draw on that to help me read where they are now.
Peaches chose to have a new life
Peaches has a very direct personality, though, and once she decided—yes, she decided—to become a member of this household (“This will do,” she said to herself) I got the feeling she had also decided to make a change in her self. The woman who had given her to me told me that Peaches had always been shy and fearful, was rarely seen by guests and her sister seemed to dominate her. The Peaches who emerged from the spare kitty room, however, was social with all the other kitties, friendly with guests, and devoted to me, curiously exploring her surroundings and enjoying every moment of every day. Once the Fantastic Four came along with their energy and lust for life, she ignored their childish taunts and found a use for them in keeping her warm and comfortable as they cuddled around her. This was not a tiny, fearful senior kitty.
So I don’t think Peaches feels she’s ready for any transition but wants to enjoy this incarnation a little longer. My job is to help her stay as healthy and comfortable as possible until she’s ready to move on. I trust her to let me know.
Caring for the geriatric chronic kidney failure kitty
To say I’ve been preoccupied with Peaches lately is to make a great understatement. A cat who is dealing with chronic kidney failure can’t really maintain her own internal balance and to a smaller or greater extent needs assistance from her person. In order to keep kidney function as stable as possible, that balance includes not only hydration but also diet, activity level and, well, I’ll say “output” because “elimination” sounds a little too grim. One element too far away from center can throw the whole body off, and if it persists for too long balance sometimes can’t be restored.
I work with my veterinarian in all my observations and decisions regarding Peaches, and the poor woman will often get several calls in a day or several days in a row as I’m working with a condition, but she always patiently returns my call and helps me to the next step when I need guidance beyond what she’s already taught me. She usually uses observation and physical exam for diagnosis and avoids testing where the condition is obvious. Where Peaches is concerned, we don’t test for kidney values since I can’t imagine taking blood from little Peaches as often as we’d need to, and her skin is so thin now that I have difficulty properly inserting the needle to administer fluids let alone my veterinarian extracting blood from her tiny veins. These levels can fluctuate even through the course of a day and observation of her physical and social activity is usually an adequate indicator of her current condition because I adjust her treatment as I see a change.
Assessing with both physical and social cues
Every day begins and ends with an assessment of Peaches’ condition and in between are constant checks of how she’s doing, what she’s doing, if she’s hungry, if she’s not, if she’s produced anything or not, whether she is active or not, all determined by the actual activity and social cues—if she looks comfortable, if she’s curled normally or sleeping in her normal spot, if she went back upstairs for her morning nap in the bathroom, if she joins me at my desk and so on. Cats are masters at hiding things and simply dealing with sometimes horrible discomfort, so the social cues are just as important as the obvious physical ones and are sometimes an early clue to a later change in her condition.
As I had written earlier, she was greatly weakened by our infestation of fleas from the squirrel nest I unintentionally brought down from the attic, resulting in greater anemia. We resolved the fleas, but rebuilding her strength with diet and fluids took a while. Peaches has always been troubled by constipation and any vitamin supplement, especially the high-potency liquid vitamins, exacerbates this so the process of rebuilding her strength and a putting a little more meat on her bones was an especially slow process.
The most Peaches ever weighed while with me was six pounds so reducing by 1.4 lbs. was significant. When I carry her I tell her she just feels like a handful of dryer lint especially considering her dilute calico fur, but her fragility is almost frightening, her bones feel rubbery and birdlike and there’s not enough of her to fill both of my hands.
A few weeks ago she began an odd seizure-like activity in which it seemed her right hind leg had just given way unexpectedly and she stumbled sideways and fell several times. A physical exam didn’t find anything, and the stress of putting little Peaches though diagnostic tests would likely not have found anything, or found any condition we could do anything about. I continued to observe her, but it simply stopped after about a week. It was likely neurological and related to her weakened condition and I’ll still be looking for it as her condition continues.
Not the end, just a really upset stomach
This past weekend, the nausea associated with kidney failure had finally gotten the best of her, though it took me a while to determine this. The reflux was likely burning her throat and causing a stomach upset that made eating out of the question, resulting in all the gurgling noises I heard, and her continued lack of eating made the condition worse as her stomach became completely empty and the constipation turned to a frequent diarrhea, dangerously dehydrating her. She was rapidly losing any nutritional and functional balance and, uncontrolled, this could easily weaken her enough that balance couldn’t be restored, and I could easily lose her to this downward spiral. While it might have been a virus of some sort, in treating the symptoms she responded readily pretty much ruling out a virus.
I always have on hand a mixture of allopathic and naturopathic, pre-packaged and homemade treatments, some curative, some palliative. The first thing to tackle was the reflux, so out came the Pepcid, one-quarter pill dissolved in water and put in her mouth with a syringe to neutralize the existing stomach acid (I always picture putting out a fire). A little later this was followed by a strong lukewarm tea made from slippery elm bark to coat the mucous membranes of her mouth, throat, esophagus and stomach which were probably raw from the reflux. In the meantime 50ml of sub-q fluids; though 100ml is usually the minimum therapeutic dose, this is all she can absorb at one time at this point, and I could give her another dose a little later once she’d absorbed these. I want her to be well right away, but I have to relax and space these treatments so I don’t upset her either with my handling or my own fears.
Though stewed pumpkin helps elimination problems of both constipation and diarrhea, Peaches can’t eat enough pumpkin to make a difference, so I was hoping that treating the major symptom would help to resolve the others. Still, a little of this and a little of that. I keep CatSure on hand though it’s heavily milk-based because Peaches will usually lap up a little bit. The extra fluid doesn’t hurt, nor do the extra carbs to give her energy and perhaps a little weight as she metabolizes it, but the recommended amount is way too much. I also have Nutri-Cal which she enjoys and which has the side effect of also helping to settle her stomach and coat those raw mucous membranes, though I sometimes need to take it up in a syringe to get a bit in her mouth.
Neither of those is a substitute for real food, though, so next is a fresh jar of baby food, chicken or turkey with broth. Her interest in this shows me her progress, and once she’s eating her baby food with some enthusiasm I offer little chips of raw salmon or venison which I’ve thawed in my fingers. If she gets to this point I know we’re on the way to recovery. I have to be careful with the amount of raw meat, though, because it’s difficult for her to digest, but as long as she can digest it, it’s like a direct injection of real and fresh nutrients and Peaches loves it.
I also have canned cat food on hand in addition to this. Since she seems to love salmon they are usually salmon-based varieties, and while I try to keep with premium brands of grain-free organic cat food, I admit I’ll feed her whatever it is she wants to eat if that’s what she wants at the moment—eating something is better than not eating at all if that’s the choice to be made, and my goal is to get her back on the best diet she can possibly eat and digest.
Imagine the reaction of the rest of my household as I pull out all the appetizers and entrees for Peaches! Oh they’d love some CatSure, they certainly wouldn’t let any go to waste like Peaches does! And the NutriCal, just a taste—please! Baby food, oh the smell is heavenly! I do usually hand out raw salmon and venison; I actually try to feed it to them as often as possible though it’s difficult for eight cats.
I’m extremely careful with the canned food though, especially the non-premium varieties. I’ve had several male cats through the years who suffered from persistent urinary tract issues, and aside from a raw diet, Wellness was the only food that kept them consistently clear. Jelly Bean is very sensitive and a very clever food thief and had apparently been stealing more of Peaches’ food than I knew, especially the non-Wellness varieties, because he paid for it in some extreme urinary distress, also this weekend! That’s another story, but all of it together kept me pretty busy checking litterboxes and conditions.
It takes time, lots of it
And all of this means time spent observing often to the exclusion of other things, late nights and early mornings, leaving my desk repeatedly during the day, following Peaches around while I’m on the phone with someone, postponing appointments and scheduling around how she feels. Some days not much gets done, but Peaches is taken care of.
Peaches, though, is quite well right now. I’m working upstairs this afternoon and she just came trotting up the stairs, output some positive stuff in the bathroom and came to check on whether or not I intended to feed her any time soon or if she was expected to starve.
Right now Peaches is sitting on my keyboard shelf demanding food. I’m so glad we have a little more time.
You can read more about Peaches’ condition in these articles:
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