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. Being of a rural background I have a pragmatic view of such matters, if you can afford it without strain then spending money on animals can be judged by how much trauma it will cause them and the quality of life after. I’m more a dog person than for cats but have been involved with putting a number of animals down and although it is always deeply distressing, it is usually for the best. Providing you are not doing it for a silly reason and are concerned with the animals well being, then although a hard decision to make it is often the best.

    It does sound very much like you have accepted what the decision should be, it is one that only you can make. I’m sure you will be supported either way.

    All the best.


  2. Our dog had surgery at Sydney uni vet and they were very professional and good. While they gave you some very high figures we found that with our dog, the estimate being between 3500 to 7000 that it came in at 3500. They gave us the high figures just in case, so I think that while they are quoting a large range of figures most times it is the lower one. Lulu pulled through a lot of it despite them saying she wouldn’t. On the other hand she was never the same again and her quality of life was reduced, she just didn’t have any energy anymore and she died two years after surgery.

    The vet told me that her quality of life would go down but I obstinately believed that she would be fine, after all they said she was supposed to have died already and Lulu was an incredibly strong dog. If I had known how she would be after surgery I’m not sure I would have continued. She always seemed so happy around me but I think I was in denial about her quality of life, you really need to consider this aspect considering her body will struggle after surgery and the potential dialysis etc.

    Thinking of you,


  3. Thank you again for all your thoughts. I’m hitting the sack now, so any new comments may not appear until I approve them in the morning. There is much to think about, and I will try to approach it freshly in the morning. Again, thank you.

  4. Hi, I wont tell you any stories about my cat, this is about you.

    Sydney Uni is the top top facility, and you pay top dollar for a top dollar result. That’s the way it is. Ive taken a few hundred cats to vets around Sydney, this is a top vet that we only used twice because of the cost.

    The costs are high, but you dont have time to shop around or go to Gladeville or one of the other specialist vets with all the machines. If PetVets say this is the right thing you re doing the right thing.

    If you have the money, and it’s been given to you to rescue Artemis, spend it on the investigation if it leads to and saves money in the full term of things and ask for more.

    Logic and “he’s just a cat” arent a thought in this. But if they say (as you said) that this isnt going anywhere and he will suffer then take that decision with the heavy heart it brings.

    My 2 cents, hope it’s OK to say.


  5. Stil,

    In no matter what you decide at least have Artemis home with you when you do decide. Cuddles and kitteh pats. If you need to say goodbye it can be in the privacy of your home. Also discuss the options with Artemis. She will understand.


  6. So much thoughtful advice. I am not able to comment on the medical side at all. Personally I would feel easier if I’d done the investigation, even though it might be delaying a decision and cost a little more. In a less than ideal end result, I would like to know I’d taken everything into consideration. Was once faced with a decision a little like this one with Artemis, albeit less critical. I made the call quickly and wish I had taken a little more time.

    It really is, as most of your supporters have said, your call right now.

    As Dassa commented so nicely, you will be supported whatever your decision: no-one in this forum seems to be going anywhere until you are back on firm ground.

  7. Stil, you’ll know in your heart when it’s time for Artemis to take that long green nap.
    It will all work itself out.


  8. Hi there,

    Firstly, only you can make this decision and you have to be able to live with your decision.

    Based on the information you have shared, I would do the extra tests and scans and also consider getting a 2nd opinion from a recommended Vet. These steps and these additional inputs may help you make not only a better decision – but a decision you can live with.

    Given Artemis is not that old, the worst outcome – in my view – would be asking “what if”. It seems some pretty basic “what if’s” can be addressed with a few more scans and perhaps another opinion.

    If the scans and second opinion are not encouraging then you have to make another decision about the surgery. But it seems to me – based on the information you have provided – that you do not have enough information yet.

    Good luck. This is very difficult and I dread the day we are faced with similar decisions about our beloved dog.


  9. I agree with SLL. Only you can make this decision. Me, I’d have the presurgery exploration and decide on that, but I’d be realistic. A kidney transplant would be going too far UNLESS I really couldn’t let go. I have 3 cats: one of them would certainly get a transplant if he needed it because *I* couldn’t let him go, as long as he would be happy afterwards. Continued dialysis would not be an option for me because I couldn’t explain to my cats why I keep hurting them.

    I hope this helps you focus, Stilgherrian.

  10. Stil,

    I agree with Suzie, SLL and Sandra. Take all reasonable steps to get the most complete set of information before making the decision. Regret is a terrible thing I would hate to be in the “I wonder if…” situation.

    Ultimately it is Artemis’ long-term health, wellbeing and quality of life that matters.

    And on the topic of funds, you’ve at least got my pledge for some more of my pocket money if it is decided Artemis needs surgery.

    Good luck deciding.

  11. First, let me thank you all again for your comments and support. I cannot respond to every point individually, but let me at least summarise my thoughts this morning.

    To recap the situation as I understand it, Artemis has at the very least one clearly dodgy kidney and a kidney stone blocking the other. Surgery could remove the kidney stone, but the questions would still remain. How much liver function is left? And for how long? The entire spectrum of possibility may remain, from enough to live happily with ongoing health care, to zero. Or maybe not.

    This morning I found this information sheet on Chronic Renal Failure in Cats [111kB PDF], produced by the University of Sydney’s veterinary people. It does answer some of the questions people have had about longer-term issues. It confirms that a cat can have already lost 70% of its total liver function before there are external symptoms.

    It also says that a kidney transplant costs $8000. Since the PDF file is dated mid-2010 I’ll take this as a current ball-park figure. And we can plug that back into the spectrum of costs that were outlined in the original post.

    In other words, moving through to kidney stone surgery would require further donations of double what has been donated so far, i.e. the total costs would triple. If a kidney transplant were to be required beyond that, a further amount of double that again, i.e. the total costs would be 7x. Roughly speaking.

    Finally on costs, some people have pointed out that the University is relatively expensive and will also quote high. That’s true. However my understanding is that they have the surgeons with the needed skills. And we do need to plan against the possibility of the higher-end costs.

    There has been quite a bit of support for the idea of at least doing further imaging and diagnostics, since they’d be required before surgery anyway and would probably be covered by the money raised so far. I am not averse to this idea. But the question is whether that would actually give us any more information about Artemis’ chances, rather than just choose a path for surgery.

    I am about to leave for a midday appointment at Pet Vets, to see how Artemis is faring and to discuss the options. I have clear questions in mind.

    1. In that spectrum of possibilities of remaining kidney function, from 100% minus known damage down to zero, do we know where we sit? What is the likelihood of each possible outcome? How confidently do we know this?
    2. Would further imaging and diagnostics increase our confidence in this knowledge, or not?
    3. What is the likelihood of success versus failure of the surgery, given Artermis’ current condition?

    I will make a decision at this consultation. Either we will proceed to those additional diagnostics, which then means another decision point after that. Or we will not, and the story ends. I understand that the decision is mind.

    My next post will be late this afternoon, whatever I decide.

    If we are at the end, I will need some time to myself before writing. If we are continuing for now, I will make all of those arrangements first and get Artemis to the hospital so I can give you proper details. Either way, it will take some time, so please don’t read anything into my absence from the internet this afternoon.

    Again, thank you for all your comments overnight — and even the further donations which came in. I do hope you all realise how incredibly helpful you’re being.

  12. Having recently had to put down our lovely cat on Boxing Day for these same reasons (severe renal failure, toxicity levels,literally, off the scale) I completely empathise.

    Facing a $4k vet bill for fluids, scanning, and little chance of long-term success and comfort, and a further $4-$12k for surgery and transplants, themselves with a less than 50/50 chance of comfortable survival beyond a year, we had to have a very sad coffee to think it through.

    Our moggie was 13 years old, and I couldn’t ask her to suffer through hospital, pain, surgery and recuperation for several months, and have only a low chance of surviving without pain for next xmas.

    I’m collecting her ashes, have several pictures selected and there will be a special place in the house for her memory to stay with us.

    Cold, I know, but having seen another family pet suffer through long illness, I couldn’t let this one suffer too. The house, and our lives, are not the same since her passing, but al east I put an end to her suffering.

  13. Sorry, but this is real advice from being in a similar situation.

    Do not mourn now. While she is still alive, you still have a wonderful friend who can love and be loved. Keep celebrating that now, even as you face some tough decisions.

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