I have just published a full accounting of the Artemis Medical Fund. Thank you so much for your generosity. In summary, your donations covered all costs, and the remainder was almost the same as the total from people who told me to keep the remaining funds myself. There was a small difference, a little over $50, so I’ve made a $100 donation to the Cat Protection Society of NSW through their online donation page at Everyday Hero.
In early January 2011 Artemis, one of the two cats with whom I have been sharing my life these past seven years, fell gravely ill. Originally we thought it was food poisoning. But then she collapsed and nearly died. Over the subsequent week there was false hope as she seemed to recover. But eventually we found that she was suffering serious kidney failure. Her life ended on 13 January 2011.
This series of posts covers the last week of Artemis’ life. It chronicles an amazing story of human generosity as friends and strangers alike donated money to cover her veterinary bills. The story did not end well, but these posts and the many comments upon them represent the creation of a bond that will not fade. Thank you, everyone.
Artemis breathed her last breath at 12.37pm AEDT today. It was a peaceful moment. I held her while she moved from this world into the next. I cried. I am crying now.
Artemis led a gloriously adventurous life, if perhaps short at a little over seven years. She hunted everything from moths and grasshoppers to rats and noisy miner birds, eating most of them. She even brought us the striped marsh frog from the garden pond — three times before she learned, the hard way, that it’s poisonous. She never did catch a currawong, and I’m glad of that.
Artemis used up one of her nine lives when her tail was crushed and eventually amputated.
Today I chose to take her ninth.
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.
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.
Well that’s not good. With intravenous fluids reduced to 1.5x maintenance levels for two days, Artemis’ blood test results headed in the wrong direction. We now need to discover if there’s some reason for the kidneys not working other than, well, failed kidneys.
Creatin levels climbed back to 690. Urea was back up to 22.7, although that’s not the worst it’s been. Red blood cell count is still low, in the mid-20s instead of the 30+ it should be in a cat — although that’s possibly just a symptom of the high fluid levels. Electrolytes are still a bit whacky.
So Artemis goes back on the 2x maintenance levels of intravenous fluids — the poor man’s dialysis — until we figure out what’s going on.
And yet, Artemis has reportedly been “even more feisty” than she was on Sunday. She’s been eating overnight, she’s interacting with staff, and she’s showing all the signs of simply being frustrated with having to be in a cage.
After consultations with a specialist at the University of Sydney, a plan has been agreed upon. Ultrasound, X-rays and attempts to culture potential infectious agents to see if there’s some treatable cause of the kidneys not working. That’ll begin tomorrow and we’ll have news of the ultrasound and X-rays around 24 hours from now.
If none of those procedures reveal anything treatable, then we’re looking at untreatable kidney failure. It may not be that. But it’s a distinct possibility, despite Artemis’ apparent external health.
As for exploring the options, there is a veterinary surgeon in Melbourne who does kidney transplants. Enquiries have been made, and we’ll see what the requirements are, but… you know… We’ll see.
Artemis’ latest blood results have just been phoned through. Creatin has continued to drop, from 416 to 376, slowly moving towards the normal maximum of 212. Urea is down from 36 to 19.5, again moving steadily towards the target 12.9. Phosphorus and calcium have stabilised. Her red blood cell count is low, but that’s possibly just because she’s on such a high rate of fluids.
The decision has been made to reduce the flow of intravenous fluids down to 1.5x maintenance levels, rather than the 2x she’s been on, and see what happens over the next 48 hours. For the background to that, see the post from earlier today.
“We’re looking at the possibility we could get [her] through it,” says Dr Meredith Gibbs.
I’ve just spent half an hour with Artemis, and here’s a picture. While she’s showing marked improvement, she’s still on fluids at twice the normal maintenance level to flush out any toxins — think of it as poor man’s dialysis — and it’ll still be some days yet before we really know what’s going on.
First the good news. Artemis has been eating. While she was obviously annoyed at still being connected to the drip, she was exhibiting her normal behaviours. I’m friendly, but don’t touch me. Yes, I want attention, but don’t pick me up. How can I escape from this table? How can I get my leg out of this uncomfortable bandage? This is a great sign.
However she needs to stay in this stable state without being on intravenous fluids.
As I mentioned earlier, the blood tests done on Friday afternoon showed that the enzymes associated with kidney problems had been declining, although they were still way above normal levels. Urea levels, for example, had dropped from 113 during the crisis night to 36, but they should be below 12.9. Creatin levels were at 416 on Friday, when they should be below 212. On crisis night they were so high that the measurement technique didn’t even work, even with the blood sample being diluted.
Curiously, certain blood tests showed indications of acute kidney problems, but others were associated with chronic problems.
In brief, as I discussed with Dr Meredith Gibbs today, Artemis was so profoundly ill — so near death! — that everything was very different from normal. We shouldn’t read too much into any of this, but simply take everything one step at a time.
And the next step is further blood tests this afternoon, 48 hours after the last batch. If all these enzyme levels are returning to normal, then the intravenous fluids will be reduced slowly to see what happens — to see whether Artemis’ kidneys can now sustain their function or not. If the blood tests are not showing sufficient movement towards normal today, well, she stays on the high-level fluids for another 48 hours. And then we try again.
So what’s the longer-term view?
Just a quick note to say that I’ll have a full report on Artemis’ health once I’ve visited her at Pet Vets at midday Sydney time. That’s in about an hour, and I’ll post something perhaps an hour or two after that.
There was brief news from Dr Emily Payne on Friday night to say that various kidney-related enzyme levels were still high but reducing relatively quickly, which indicates both that the suspicions regarding liver disease could well be correct and that the issues may not be severe in the long term. The plan then was to keep her on fluids for another 48 hours and update the plan, which of course brings us to now. Please stand by.
About 7.30pm this evening Dr Emily Payne from Pet Vets left a voicemail with an update about Artemis: “She’s drinking a bit of water for us, and she has eaten a very small amount of food as well, so that’s good. And she’s purring when she gets a pat.”
“I’m so glad she’s doing well, I really didn’t know if she’d make the night,” said our vet Glen Kolenc a short time ago. And yet Artemis did make it through the night, thanks to interns Dr Helsa Teh and Dr Dharshinee Rajkumar and their team at the Sydney After-hours Veterinary Emergency Service.
“On presentation Artemis was collapsed and her gum colour was slightly muddy,” says the discharge statement. “She was given oxygen by mask and started on shock rates of intravenous fluids. Her blood pressure improved afterwards.” Artemis then spent the night in hospital on the drip, with methodone for pain relief.
While there is a lesion in her mouth which, as I explained yesterday, “could be a tumour”, the report also says that “her small kidneys and very dilute urine despite being dehydrated is suggestive of kidney disease”.
This morning, thanks to James Neave providing transport and Kate Carruthers covering the bills for now, Artemis was transferred back to our regular vets at Pet Vets, Petersham. She’s back on the drip and at the start of a few more days in hospital while tests are run and diagnoses reached.
At lunchtime Dr Emily Payne called from Pet Vets to say the first of the blood results were back. They show very marked kidney disease going on, “all kidney-related enzymes high”, “this all relates to kidneys”. And if it is kidney disease, well, it’s generally manageable long-term. It could even explain the mouth lesions: ulceration. We’ll find out more over the next few days.
However for the time being it’s mostly a matter of getting Artemis her strength back and then figuring out what’s going on. There will be uncertainty for a while, but she’s alive and now in no immediate danger.
My especial thanks to the many, many people who’ve given support, both personal and financial.
Donations have now well exceeded $2000, and this will probably cover the emergency treatment, hospitalisation and diagnoses currently scheduled. Whether further treatment is needed remains to be seen.
Of course if the mouth lesions do turn out to be cancer then we’re in for a bumpy ride. But it may not be that, and Dr Payne emphasised that at this stage we simply don’t know.
Thank you, everyone.
Right now I’m mentally exhausted, and I didn’t get much sleep last night. I will respond properly to comments in the next instalment. But for now, I’m taking a nap.
[Photo: Artemis, 30 May 2004.]