Artemis, it’s decision time…

Thanks to today’s X-rays and ultrasound, we have some answers. Sadly for Artemis, the answers are not good. Not good at all.

Artermis’ left kidney is quite small, only 2.8cm long. A normal cat kidney might be 3.5 to 4.5cm. Perhaps she was born with it small, perhaps it’s been damaged later. Kidneys do shrink with some chronic problems. But either way, it’s clearly dodgy.

The right kidney is bigger, but there’s a kidney stone. It’s only 1.5mm in diameter, but we’re talking about a cat not a human. That stone is currently blocking the urethra, and perhaps a back-up of urine is inflating that kidney. It’s possible the stone has only just moved there, which could explain the reversal of Artemis’ blood results over the past few days.

“I would have thought she wouldn’t have recovered as well as she did initially with that stone there,” Dr Emily Payne at Pet Vets told me this afternoon.

Now if this were simply a kidney stone, we’d just operate and remove it. “If it was just that one kidney, the prognosis wouldn’t be too bad,” Dr Payne said. But with the other kidney clearly not right? “The outlook isn’t that great.”

Since so many people now have a stake in Artemis’ future, I’ll present the options and ask for your advice.

There are less-invasive surgical techniques, which I’ll perhaps-inaccurately call “keyhole surgery”, that could remove that kidney stone. The operation would have to be done by the University of Sydney’s surgeons. The cost would be in the order of $3000. If in their pre-surgery investigations they decide that full surgery would be required instead, that’d be more like $4000 to $5000.

If we did some pre-surgery investigations — and the Uni has better imaging equipment and more experienced operators — that would probably cost under $1000, and would count towards any subsequent surgery costs.

There is no guarantee that surgery would succeed, of course. It may well be that both kidneys have been damaged beyond repair. That wouldn’t be known until the surgery had been done, the stone removed, and this process of determining kidney health done all over again.

Even with successful surgery, Artemis might well require a kidney transplant — and apart from the massive cost would they even recommend it in these circumstances? — or permanent dialysis-like fluid support, or more. And don’t forget that we haven’t even considered those lesions in her mouth — although my gut feeling is that with all this talk of kidney problems it’s less likely to be the dreaded mouth cancer.

Costs so far have been $109.10 for Pet Vets’ initial work, $558.85 for the emergency hospital visit, and around more $1300 at Pet Vets so far. That’s a total of just under $2000.

Donations so far total around $3500. In other words, they cover the costs so far, plus any pre-surgery investigations. They would not cover any surgery itself, nor any subsequent costs.

I’ve told Pet Vets that I’d discuss Artemis’ condition with you all overnight, and that I’d be in touch tomorrow with our decision on how to proceed. So how should we proceed?

Before you answer that, do remember that not all stories have a happy ending. Remember the sunk cost fallacy. And have you seen the news? There are bigger stories unfolding this week. I should also flag that some donations were from friends who insisted I should also take care of myself, given my need to move house.

So… what say you all?

I will be here to moderate comments and answer questions through the evening and until I decide I’ve run out of energy.

[Photo: Artemis at Pet Vets, 9 January 2011.]

66 Replies to “Artemis, it’s decision time…”

  1. This is one of those questions to which there is no right or wrong answer. Choose the approach that fits how you feel in your heart, tempered by what your brain says. All answers are equally correct at this stage.

  2. So the question is: operate or not. You can do a pre-op investigation for $1000, but that is only to determine which operating method to follow. Unless it can tell them that there is something else going on which does not require surgery.

    Artemis had kidney problems, so both kidneys were on the blink. One is dodgy, so the normal one was also affected. If this was caused by the stone, the operation can restore it back to its normal function.

    If it was not the stone, surgery will not help (unless the kidney was being affected and had a stone at the same time by coincidence, not likely).

    As the vet says: “The outlook isn’t that great.”

    I am afraid you have to prepare yourself for a hard choice.
    All the best and you have my support, whatever your decision might be.

  3. Over the past week I’ve been overwhelmed by the outpouring of generosity. Tonight I am being overwhelmed by the outpouring of emotion and support. Thank you.

    I won’t have much to say tonight. Obviously conflicting advice is coming in, making it very difficult to weigh. However I do appreciate it all. Us humans face these situations each in our own way, so I’m happy that there are differences of option.

    I will, however, answer any clinical or similar questions as they come in — although I must admit that my posts over the last week have included pretty much every fact that the vets have told me. You have as much of the story as I do.

  4. Oh dear. I’m hardly qualified to give advice, since I am in no way a “cat person” and I would balk at even spending what you already have spent on a “dumb animal”. But even when I take that into account, it sounds to me like your best path is to have her humanely put down. Just… don’t go in for homeopathy, OK? I don’t think the placebo effect works on cats.

  5. Like Dean, I agree with what Nick and Susan have said, and think you also need to look after yourself. I worry that because animals can’t understand why treatment is happening it must be very distressing for them.

  6. We face something similar with an 18 1/2 yo mini-dachshund – it’s $500+ for each trip to the vet. That’s for routine “keep healthy” stuff. We’ve made the decision that as much as we love and have lived so long (and in Canada, Japan and Australia) with our little dog that big money should be spent on humans. If we had to face spending thousands and were willing to spend it, we would give to Fred Hollows or something for people. That’s why we haven’t had her cataracts done. Our dog isn’t a human (she just seems like one!). Walter @Adamson

  7. Obviously a very hard decision. I don’t think I can offer any advice or comment beyond which has already been said, it’s a personal decision – and sadly money plays an important part in our lives.

    My one original comment is, if you decide to not go ahead with the surgery on artemis, look at putting some of the remaining funds towards pet insurance for apollo.

  8. I would ask your vet would they would do if this was their cat. They have to present you with all options, but if you ask, they will tell you which ones are realistic and which ones are just shots in the dark.
    Also, it might not hurt to get a second opinion. I know your vet is very likely to be wonderful, but it doesn’t hurt to hear another professional’s opinion. Perhaps ask someone who treated Artemis at the Sydney Uni Hospital for their take on this situation.
    Best of luck in making this very heartbreaking decision.

  9. My friend, I’m not going to blow sunshine up your ass – it’s the quality of life that she will have post treatment that is important, for her sake. Forget the money, forget the time, just concentrate on what’s best for her.

    I was on the verge of having to make this decision with one of my dogs (14 years old), but the vet wouldn’t give up on her and, guided by that person’s caring and knowledge, we prepared for the worst, only to receive a phone call to “come pick this damn dog up – she’s barking so much I can’t think”.

    The point is, no matter how much I love her, I would have been prepared to make that decision for her sake. It would have killed me to do it, but her happiness and quality of life came first.

    I can’t tell you what to do, and I’m not going to try. Be guided by the Vet, and your love for Artemis. She’ll let you know what’s right for her.


    P.S. When you are ready to move house, please tweet – I’m sure we can organize transport and bodies.

  10. Hiya….this is an awful choice to have to make.

    If I relate this back to my OWN health…I had two very different cancer scenarios and treatment plans given to me by two different specialists a couple of years ago.

    I know PetVets and the Sydney Uni folk are awesome, but it might not hurt to get another opinion. are awesome also. If their opinion concurs and the prognosis is poor, then I think you can maybe take the option of bringing Artemis home until you see an obvious decline (hopefully can be managed with some meds) before you say the final goodbye. This might cost another $200-300 but to my mind would be money well spent so you can be very sure of whichever decision you make…you won’t ever need to ask ‘what if…’

    Whatever you decide, you and Artemis are in my thoughts. I live in dread of being in the same position.

  11. I read the two issues as being quality of life and money. If money was no object and you had a lazy $10k sitting in the bank then you would be looking at Artemis and merely making medical judgements. What are the medical advisors saying? Yes, we can try this or that, but Artemis is sick.

    I think I’m with Susan and Nick. And like Susan and Nick, I think I’ll be giving extra smoochies to my kittehs tonight if they’ll let me. Hugs. xxx

  12. Dear Stilgherrian

    Here’s my advice, which I hope you won’t regard as hard-hearted. Please look after yourself first. Don’t put yourself out on a limb providing expensive care for a pet that may not work. Cats, whilst magical companions, are replaceable. You aren’t. I say this as one who is devoted to my cat, as I have been devoted to several preceding cats.

    That being said, whatever your decision, you have my support and respect for doing the best you can for your dear pet.

  13. The way I see it, the most important thing is to ensure she doesn’t suffer and as such agree with Nick Hodge’s view. I honestly believe that if I found myself in your situation I would still be of the same opinion, however that said it would absolutely destroy me to have to act on it.

    Remember there is no right or wrong answer.

  14. Stil,

    This is the hardest and I really feel for you.

    When I lost my Spolly, it was in similar circumstances: he was sick, very sick, but perked up when under care at the Uni clinic to the point where he didn’t even know he was ill. In his case, it was just the drip getting him hydrated and managing the pain: masking things, that is.

    In making our decision we had to consider how unwell he was outside the clinic, the prognosis for his future, and his quality of life including future medical and surgical interventions. We took the hard decision and let him go after saying our farewells. There’s still a blue-cat-shaped hole in my heart, but it was the right thing to do for the Spollinator.

    Artemis is relying on you as her human to do what’s right for her. Trust your heart; it knows what’s right.

    Auntie xoxo

  15. A tough choice, as everyone has said. If you feel she’s a dying mammal, then perhaps you need to let her go…

    Of course this advice is only given on what I’ve read – if things change, then my advice would change too. I also realise this opinion is only one…

  16. We lost one of our cats to leukemia (even after treatment that gave her some extra weeks with us), so I can empathise.

    I say do the pre-surgery investigations. It, and the second opinion, will give you a better idea of the possible prognosis.

    If the kidney stone is causing swelling (filling?) of one of the kidneys, means that that kidney is working (IANAV, but seems logical).

  17. Dear man, such a terrible decision to have to make but one many of us have had to do at one point.

    Being an ex vet nurse and fulltime cat person, I have been in your shoes so completely understand. I could tell you my tales but they are irrelevant to you now. As mentioned by someone else, I would ask my vet to be honest and tell me what they would do in my circumstances.

    Your case is made more difficult by the need to move home in hurried circumstances. The ability to nurse Artemis at home may therefore be something you can’t predict being able to do.

    I would say though, not to base your decision on the fact that so many people have donated to Artemis’ cause and perhaps thinking you would be letting them down by making this or that choice. Go with your heart and what you think Artemis can bear or what she needs.

    I can tell you, that letting her go, if that is the case, and with the right vet, which seems is what you have, is a quiet and gentle procedure and nothing to be afraid of.

    All my thoughts are with you this evening.


  18. My mother in law’s cat (tonkinese) has just been through a similar issue to artemis. A year or so ago ago she was diagnosed with kidney failure and the vet put her on a small dose of Valium to keep her comfortable and to help increase her appetite. She improved considerably and quickly, though recently she has become unwell again and X-rays showed that both kidneys have shrunk a lot. I’m not 100% clear on all the facts but I don’t think that the decision of euthanasia is being discussed between the vet and mother in law yet. The difference is her cat didn’t develop kidney stones, but perhaps with Artemis, if the surgery to remove the stone is successful, a course of Valium could help to sustain her quality of life for a while longer.

    Good luck through all of this.

  19. 37 years ago, my parents had their pet puppy (<1 year old) put down because they weren't sure they could afford the treatment. To this day, my mother regrets that decision, and she is definitely not the sentimental type. I don't know why she regrets it (she won't talk about it these days), but the wet eyes when she used to speak about marks the depth of that pain.

    My advice, which has only as much worth as you wish to ascribe to it, is to not make this a financial decision. Instead, think of likely quality of life if surgery was successful, and indeed the likelihood of the surgery succeeding at all.

    If it was me, I'd be seriously thinking of euthanising Artemis. I'm sure it is as hard to read as it was to type. I am clearly not a vote, but it does not look good. I would think "what if…?" to my dying day, but at least I would know that I made e decision that I felt was right for my dear cat.

    If I recall correctly, you grew up on a farm and you know all animals must die eventually. Make the last moments gentle and infused with love.

    Those are my thoughts. Use them however you may. Whatever decision you make will be a considered one, so of course I will respect it and support it.

    Best of luck to you, Artemis and Apollo.

  20. It’s tough. How is she going? Whatever decision you make will be the right one. See if you can speak personally to your vet and ask if she were in the same position what would she/he do? My cat is as special to me as Artemis is to you. I agree completely with Wendy’s analysis. Life is a son of a bitch, I hope things get better for you. xx

  21. Stil, as they say, when it rains it pours.. there are many events happening both to us and those around us. Unfortunately, recently you have had some heavy decisions and burdens.

    I can empathise however, I too have had the pain of having to lose a friend.. Tessa was a tabby tortoise shell cat i had all my childhood. She was a great friend and comfort to me and saw me though some very tough times. She was an outdoors cat, we got her from a shelter and she was just too “wild” to be able to want to say inside, a real “roamer”. She loved our shady block in Hyde Park in Adelaide and she proudly patrolled her territory. Sadly this meant she always came home and ultimately led to one of the hardest choices…

    We tried fruitless times to find our Tessa a new home. Taking her blocks even suburbs away to live with family friends, people she knew and had met before.. however, as the old ABC kids tune went “The cat came back”. She wouldn’t let go of us nor her patch.

    The person who would be the new homeowner had 2 lively dobermans and like oil and water this just wasn’t going to mix for her.

    I loved Tessa greatly and the night before the move to QLD we organised to go to her vet and hold her one last time while she was put to rest. It was a very calm, sombre occasion, however it was the right thing for her all things considered.

    Weighting up all options is tough, its never a nice process.. I remember my time with Tessa fondly and the life we shared together.

    Its not easy, it never is… people share your pain… you will know what is right, unfortunately I can only share my own experience to weight in rather than give an answer.

    thinking of you,


  22. This is awful. Nothing is going to make it easier.

    Stil, I think in this case you must try to put Artemis first. I think that means saying goodbye to her. She won’t understand tests, surgery, etc etc etc and ultimately these may not help at all. It’s so hard, I know. But I think this is what you need to do.

    Thinking of you.


  23. Such a difficult decision. But as others have said, you have to look at Artemis’ quality of life after each option.

    I had a beautiful cat for 22 years, almost all my adult life, and several times over her last few years we thought she wasn’t going to make it any further. Our vet would up or change her medication (arthritis, pain and seizures) and she would improve and soldier on.

    However, I regret for her last year or so, the vet and I maybe kept her going when her quality of life wasn’t really there, and we should have made the decision earlier to give her a peaceful end. Hindsight is easy but letting her go was not. 5 years later I still miss her dearly.

    But each circumstance is different. Also you need to look after yourself as well. If Artemis’ quality of life will not be there after the operation then perhaps it is best not to proceed. I think from what your vets are saying, that may be the case.

    My thoughts are with you,
    Damian (@quog on twitter)

  24. I can’t really offer any insights, except to agree that you have to make the right decision for you and Artemis and let the money take care of itself. 

    I won’t relate all of my war stories, but three years ago our Neo had a tear in his urethra which took 3 weeks in hospital and $3,500 before it miraculously healed (even the vet was surprised). The vet never told us the cost up front, just kept telling us to hang in there and even offered to do last ditch surgery for free.

    Every day he comes for a cuddle when I get home from work. I know that the $3,500 was an investment and every cuddle is a dividend – more so as I have read your posts. He will pay me back well and truly by the time he (hopefully) goes from old age.

    Make sure you will know in the future that you did the best for Artemis. At least get some further investigations to confirm what should come next. Let your decision be the best for her rather than for you (and that could mean either way depending on results of the investigations). 

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