The Wrah-Wrah is Forever.

Ronnie James will have been gone for five days tonight, and it’s still so hard to walk through the house seeing all the places and things he loved… seeing where he should be or would be, were he still here with us in his furry gray suit, and thinking of what he would be doing. This house without him in it just isn’t right. Callaghan, Nounours and I hope you know how much we appreciate your caring, compassion and concern for the loss of our little lovebug.

Here are the words I wanted to say on Friday, but couldn’t. I just wanted to share with you the events of the week leading up to Ronnie James’ death. I also wanted to write a little tribute to the Wrah-Wrah.

 

Ronnie James the night we brought him home (Monday). Wide-eyed and content.

Ronnie James the night we brought him home (Monday). Wide-eyed and content.

 

We brought Ronnie James home from the hospital on Monday night last week, and the next day, he had an exceptionally good day. With his chest freshly tapped, he was his usual happy and active little self. I took the day off from work to be with him. He ate and drank well, also as usual, and he kept himself close to my side all day… and I do mean even closer than usual. Everywhere I went, he went. Every time I settled on the couch or on the bed, he climbed up on me to snuggle, or he curled up next to me. Callaghan was mostly not here, as he spent much of last week working on-site, but later, when I told him about the day, he was encouraged. We ended the day with the tiniest bit of hope.

On Wednesday, I stayed home with the Wrah-Wrah again – I’d asked for those two days off in advance, as soon as we knew that we were bringing him home on Monday evening – and again, he was happy.

But he also told us that he did not wish to keep his appointment for Thursday’s x-ray/fluid re-check. As heartbreaking as this was to us, it made sense, and it wasn’t unexpected.

I thought I’d seen hints of maybe a miracle the day before. He’s eating so enthusiastically! I thought. Maybe if he eats a lot, he’ll get strong enough for his body to be able to absorb the fluid accumulating in his pleural cavity! Maybe he can be one of those lucky cats who survives chylothorax!

Maybe, maybe, maybe.

Deep down, I knew I was kidding myself. They don’t call it “end stage” when it’s not. There’s no turning back from the complication of pleural fibrosis. That was the problem… the pleural fibrosis. And that was what I was afraid of all along.

I called Dr. M., anyway, to talk about the Thursday follow-up appointment. He explained that if Ronnie James had accumulated enough fluid to be tapped, the radiologist would have to insert the needle into each pocket in order to aspirate enough of it to relieve the pressure around the lungs. This would create even more pockets for fluid to fill in the pleural cavity. At the rate Ronnie James had been accumulating fluid in the hospital up until the moment he was released, the likelihood of finding a tappable volume of fluid on Thursday was 99.9%.

Did we want to put him through that again for those kinds of odds? Certainly not… and Ronnie James didn’t want to go back there again, either.

We didn’t want a single minute of Ronnie James’ short time left to involve anything but pleasantness and contentment for him, and getting stuffed into his carrier and carted back to the hospital wouldn’t qualify as pleasant. We didn’t want to “buy him time” for selfish reasons. The reality at that point was that nothing we could do would change the outcome, so we canceled his appointment in order to spare him the ordeal.

I spoke with Dr. M. a second time, and also with his primary care doctor at our main clinic, who referred me to someone she knew who made house calls. Then, with my heart crumpled into something unrecognizable in my own chest, I made the phone call. The house-calling vet had room in her schedule for us for the next evening… Thursday night.

Thursday morning, I woke up planning to go to work, but as soon as I got out of bed, I knew that I had to be with Ronnie James on his last day in this world. His favorite thing had always been me being home with him. That was when he was the happiest, and I didn’t want to deny him that at the end, if I could help it. I asked my supervisor if I could take one more day. I’m incredibly grateful to have been able to spend Ronnie James’ last three days at home with him. That time with him was invaluable.

So on Thursday, May 14, Ronnie James got 100,000 more kisses. I got to press my face against his, feel his whiskers on my cheeks, and breathe in the adorable, sweet smell of his kitty breath (a scent that only a cat mom can love, I know). I got to feel his purring on my heart as he stretched out and slept on my chest.

One of the most frustrating things about chylothorax is that it doesn’t lead to a typical, end-of-life decline… a decline that you can see. A decline that makes you feel better about the euthanasia. Ronnie James continued to eat, drink, and use his litter box normally until the very end. Not only that, but he was excited about his meal times and his treats throughout the day. He loved drinking from his water fountain. He loved hanging out in his toy corner. Psychologically, all of this made the decision to euthanize even more difficult. We never observed a diminishing quality of life, so we felt like we were killing him unnecessarily. We had to keep reminding ourselves that the fluid filling up his little chest would soon suffocate him.

With chylothorax, cats and dogs are just fine, until they’re not… and when you can see that they’re not, they’re suffering. You see them struggling to breathe. We didn’t want to take that chance. We didn’t want to end up at the E.R. with him in the middle of the night again. That was not how we wanted his death to happen; that was not what we wanted his last experience to be. When we brought him home from the hospital on Monday night, we promised him that we wouldn’t let him suffer, and honoring that promise became our mission in life for those few days we had left with him.

All day Thursday, the most painful thing was to see Ronnie James being so totally normal. He acted like a normal cat on a normal day. He scarfed up his food and drank water from his water fountain. He came running for his treats. He sat at the window and watched his birdies, chattering at them. He roamed around the house, checking everything out with his usual curiosity, and the only odd thing there was that he did this looking kind of detached, as if he was exploring a house that he’d never seen before. It was like he was patrolling, or doing a military re-con exercise. He investigated the whole place thoroughly and purposefully. It was like he was making sure that everything was okay.

As on the previous two days, he spent lots of time snuggling with me. He spent lots of time snuggling with his beloved Nounours. When Callaghan was home, he spent quality time with him, as well.

The vet arrived that night, and Callaghan, Nounours and I were as ready as we were going to be. Ronnie James was ready, too. He was still behaving normally, but his breathing had started to grow faster in the last few hours, so we knew that our timing was good. Chylothorax parents at the end of the struggle know the nuances to watch for very well. We know how to count our baby’s breaths every four hours to gauge when some kind of action should be taken. We were confident in our decision regarding what action to take this time. At 9:59pm, from the comfort of his own home, Ronnie James entered into a better dimension, leaving his embattled body behind in this world. He died in my arms, with his head in his Daddy’s hands, as he loved that so much, and with his brother Nounours nearby.

My heart was destroyed.

I’m going to reiterate, because I can’t say it enough… it was agonizing to put a perfectly normal-looking and behaving cat to sleep. It wasn’t at all like when I had to put my Frankie kitty to sleep because of kidney failure. Frankie did all of the typical things. He stopped eating. At the end, he pretty much stopped moving. It was visibly clear that he was near death. Looking at the Wrah-Wrah being so normal, we just had to keep reminding ourselves of the Armageddon happening inside his chest. We had to remember that in a very short period of time, he would have started to suffer. Liberating Ronnie James from his earthly body was the only humane thing we could do.

The venomous caterpillar that set off this disastrous chain of events won. We did everything we could to save Ronnie James; the damage was just too extensive. But if we hadn’t rescued him from that woman in Montélimar, he would have continued living in misery before dying horribly on his own, slowly suffocating to death from the inside. That is how Dr. M. described a natural death from chylothorax.

I categorized all of my posts about the Wrah-Wrah’s experience and put the category as a link in my blog’s sidebar to make it easier for people to find. There’s a paucity of information about this disease online, and I hope that my documentation here can be helpful to cat and dog parents who find themselves confronted with this terrible diagnosis for their fur-babies.

The Wrah-Wrah was extraordinarily brave and so strong and so full of life until the very end. His love of cuddles and kisses never abated. He never lost his taste for his favorite treats. His beautiful gray fur stayed velvety soft. He continued vocalizing his conversations with us, and he continued saying “I love you” with long, slow blinks of his wide eyes. No one gave kitty eye-blink kisses the way he did, by the way. He would find our gaze, hold our eye contact, and initiate the gesture, keeping his eyes closed for a few seconds before slowly opening them again, making sure that we didn’t miss it.

Ronnie James was my little soul mate from Day One. As I said to a friend the other day, he was my angel kitty who came and saved me when I was grieving the loss of Detta, my kitty who went missing in the French Alpes. I love Nounours dearly, but the Wrah-Wrah and I immediately formed a bond of a depth and strength I’ve never experienced with any other being. It was only in mid-October 2012 that we brought the two little guys home. When I start to dissolve in anguish over having had such a short time with Ronnie James, I remind myself that I should be grateful for every day that I had with him. And I am. I’m so very grateful for every day that I had with the Wrah-Wrah in the two years and seven months he was with us.

Sometime last fall, when we thought we were just dealing with asthma, I started to feel panicky about Ronnie James. I had an ominous feeling. We would be administering his inhaler asthma medications, and I would suddenly tear up and ask Callaghan, desperately, Can the Wrah-Wrah be Forever? I wanted to hear someone say, Yes, the Wrah-Wrah is Forever.

And you know what? He is. The Wrah-Wrah is Forever.

Like his namesake, Ronnie James was a little rock star. Throughout it all, no one could believe how brave he was, how alive he was. Everyone who knew him adored him. He was just such a smart, sweet, and most personable and loving little kitty. Ronnie James will always be my Rainbow in the Dark.

Here is a sampling of some of the pics I took of the Wrah-Wrah in his last three days. I especially wanted to capture his snuggly moments.

On Tuesday the 12th:

 

Curled up on my robe on the couch.

Curled up on my robe on the couch.

 

Curled up against me....

Curled up against me….

 

Laying on my belly, hugging me.

Laying on my belly, hugging me.

 

I couldn't resist taking a picture of it reflected in my laptop screen.

I couldn’t resist taking a picture of it reflected in my laptop screen.

 

Stretched out on my legs, looking at pictures of himself.

Stretched out on my legs, looking at pictures of himself.

 

On my legs, on the bed. I ruffled his fur to demonstrate his new mohawk.

On my legs, on the bed. I ruffled his fur to demonstrate his new mohawk.

 

On Wednesday the 13th:

 

Sleeping, hugging my legs.

Sleeping, hugging my legs.

 

He jumped up to sit on his favorite bar-stool even the day before he died.

He jumped up to sit on his favorite bar-stool even the day before he died.

 

On Thursday the 14th:

 

He kept eating up until the very end, too.

He kept eating up until the very end, too.

 

Ronnie James fully enjoyed loving on his Daddy, too, when he was there.

Ronnie James fully enjoyed loving on his Daddy, too, when he was there.

 

On Friday, I have a story of Nounours’ to tell, as we’ve been witness to a true phenomenon in his grieving process for his brother.

Thank you again for reading, and for being here with us.

Operation: Spoil Wrah-Wrah Wrotten

Ronnie James stayed in the hospital for three more days after I last updated here. We brought him home yesterday, after work.

It was a long weekend of worry and wait. We continued to visit the little guy twice a day, and we called the hospital every four hours to ask about the status of his pleural effusion. The volume of the fluid in his chest did decrease significantly from where it’d been earlier in the week, but hovering around the 8-10 ml range (down from 20-30!), it was still too much to warrant removing his chest tube.

So yesterday afternoon, Ronnie James underwent anesthesia again, and Dr. M. and the radiologist performed a lymphangiography. This procedure allowed Dr. M. to see whether we’d have a shot at the one last surgical option available for chylothorax: cisterna chyli ablation. The study results showed that the surgery would be irrelevant, since the problem was not leakage from the thoracic duct. The thoracic duct ligation surgery had been effective. The fluids were coming from somewhere else, likely from the pleura, as a result of pleural fibrosis. We are out of options.

The good thing about being out of options, though, is that the Wrah-Wrah is now home with us. He’s home, and we’re enjoying him, loving him and spoiling him with attention while we’re waiting for the next thing to happen.

Ronnie James is just the toughest little guy! His spirits are high. He’s happy and active, eating and drinking. But his little body is showing signs of wearing down. For one thing, despite eating well, he’s losing weight. We’ve stopped feeding him the prescribed low-fat diet. We’ve halted attempts to force him to take the loathed rutin. There’s no longer any point to these chylothorax medical management strategies. We’ve more or less entered a hospice phase here at home, and in this phase, we’re going to give him anything and everything he wants.

Dr. M. sent Ronnie James home with us last night so we could spend a good few days with him while he’s happy and alert. Freshly tapped, it will take maybe 48-72 hours for the increasing volume of fluid in his chest to slow him down again. I’m staying home with him today and tomorrow, because it’s out of the question that I’m not here to spend his last few days with him.

On Thursday, we’ll take him back to Dr. M. for an x-ray to see where we are with the fluids. We’ll probably have to make The Decision at that time… for real, this time.

Of course, I’ve got a slew of pics from the weekend.

From Friday:

 

Ronnie James got all the cuddles!

Ronnie James got all the cuddles!

 

Sleepy Wrah-Wrah.

Sleepy Wrah-Wrah.

 

"I can't even with this long underwear!" ~Ronnie James

“I can’t even with this long underwear!” ~Ronnie James

 

Ronnie James, our little dragon.

Ronnie James, our little dragon.

 

The Wrah-Wrah can chill with the best of them.

The Wrah-Wrah can chill with the best of them.

 

The Dude Abides.

The Dude Abides.

 

Here’s me on Saturday wearing my paw earrings just for the Wrah-Wrah:

 

Going to see my baby! Paw earrings required.

Going to see my baby! Paw earrings required.

 

On Sunday, many pictures were taken:

 

Mother's Day at the hospital!

Mother’s Day at the hospital!

 

"Happy Mother's Day, Mommy!" ~Ronnie James

“Happy Mother’s Day, Mommy!” ~Ronnie James

 

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

Ronnie James moved into a larger kennel on Saturday. More room for rolling around!

 

I got to hold him!

I got to hold him!

 

Daddy scritches are the best.

Daddy scritches are the best.

 

And on Sunday night, we got to spend an hour with him in a private room.

 

Wrah-Wrah cuddles in progress!

Wrah-Wrah cuddles in progress!

 

"I can spend forever in Daddy's arms." ~Ronnie James

“I can spend forever in Daddy’s arms.” ~Ronnie James

 

Snuggling with my baby on Mother's Day. Gratitude.

Snuggling with my baby on Mother’s Day. Gratitude.

 

A miracle could still happen, right? A miracle, an inexplicable turn-around, whatever you want to call it… it could still happen. But Ronnie James will tell us. He’ll tell us what he wants to do, and when he wants to do it. Our job is to listen. At the moment, I’m only hearing his happy “I see birdies!!” sounds as he watches the front yard through the living room window, and I’ve never heard anything more precious.

Ronnie James’ complicated case.

Ronnie James did not come home yesterday, as planned. He’s still in the hospital.

 

Ronnie James recovering in the oxygen chamber the evening of his surgery. (Thoracic duct ligation and pericardectomy)

Ronnie James recovering in the oxygen chamber the evening of his surgery.
(Thoracic duct ligation and pericardectomy)

 

His surgery went well, and he did well, like last time. Dr. M. said that once again, he came through it “like a champion”! The chylothorax seems to be resolved – there’s no more chyle leaking where it doesn’t belong. The Wrah-Wrah is happy and alert, loving all the cuddles and pets he’s getting. He’s eating with good appetite. His disposition and attitude are fantastic!

So what’s the problem?

His chest cavity just keeps filling up with fluid.

As I said, it’s not chyle. Rather, we’re looking at some sort of nondescript, inflammatory-ish fluid, and at this point, no one can say with certainty what it’s all about. A little bit of such fluid could be normal following a surgery. It could be caused by the chest tube, itself, even. But the amount of fluid we’re talking about here is well out of range. Ronnie James’ case is a complicated one, and it’s tough. We’re still battling the ripple effect of his contact with that venomous Pine Processionary caterpillar.

This current iteration of pleural effusion could be a fluke, as in, maybe a “pocket” of fluid resulting from the surgery just released all at once over the night (that was Wednesday night). Or, it could be something scarier, such as his pleura lingering in a self-perpetuating cycle of emitting fluid. Whatever the case, we can’t bring him home until the pleural effusion stops, since his chest tube needs to stay in place in order to drain the excessive fluids.

On his part, Ronnie James is totally oblivious to the danger he’s in, as he’s been busy in pursuit of Dr. M.’s heart (which he successfully captured, might I add). During morning rounds yesterday, Dr. M. found himself engaged in a Wrah-Wrah love fest. The Wrah-Wrah had been rolling around, asking for belly rubs, until he ended up on his back in Dr. M.’s arms, purring furiously as he got his belly rubs with two hands.

“Isn’t he cute?!” I asked Dr. M. when he told me about this.

“Oh, he’s adorable!” he answered the same second the question was out of my mouth. Exact words. Then, later, he said, “He HAS stolen my heart!”

Dr. M. has been Wrah-Wrahed. It happens.

Several other doctors and some of the technicians and staff have also fallen in love with the little guy. This is what the Wrah-Wrah does best, just being himself… his affectionate, smart, happy, interactive, funny, sweet, sweet self. Everyone who spends any time with him at all loves him!

Because Ronnie James’ two-part modus operandi in life is:

  1. Find all the hearts.
  2. Stealz them.

 

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

Ronnie James the day after surgery, off oxygen and resting in a kennel in the ICU.

 

As I write this, we don’t know what today will bring. I’m going to work, as usual. But will Ronnie James come home tonight? We can’t say. We don’t know. We hope so. We miss him, and so does his Nounours.

 

Poor Nounours! He misses his brother.

Poor Nounours! He misses his brother.

 

I’ll keep you posted. Thank you for reading, and for keeping Ronnie James in your thoughts and prayers.

Happy Friday, All! =)

The Wrah-Wrah Wrollercoaster (or, the WrahWrahCoaster).

Ronnie James goes in for another surgery today. We’re dropping him off in about two hours, at 7:30am.

This development resulted from yesterday’s trip to the vet, when it was found that fluid has filled his pleural cavity again. His chylothorax persists with an aggression that’s frightening. A chylothorax-specific surgery might be able to stop the process; it’s actually a combination of procedures: Thoracic duct ligation plus pericardectomy. This is our next step, and it’s our last.

We were told that the success rate for this surgery is 80% for cats, which is encouraging… but we’re not sure if the Wrah-Wrah will have a chance to try for those odds. We won’t know until Dr. M. opens him up today and examines him. If the developing pleural fibrosis (a complication of chylothorax) is still mild enough to be survivable, Dr. M. will move forward with the surgery. If the pleural fibrosis turns out to be beyond-hope bad, on the other hand, he’ll drain Ronnie James’ chest for the last time and close him up. We’ll have the “end of life” discussion. It will be time to address the details of The End.

 

Callaghan with Ronnie James at yesterday's appointment.

Callaghan with Ronnie James at yesterday’s appointment.

 

Thing is, Ronnie James has been doing so well outside of his bizarre, catastrophic emergencies. You literally only know half of it, because I haven’t yet written about the other half. I will, at some point soon. It’s just… the other day, I joked to Callaghan that “Wrah-Wrah is going to outlive us both long after he sends us into cardiac arrest with his near-death episodes.”

We’ve been on the WrahWrahCoaster going 500 miles per hour for months, and sometimes, it’s like we’re barely strapped in. The relentless and extreme ups and downs have been exhausting.

 

With the Wrah-Wrah at home, after our appointment.

With the Wrah-Wrah at home, after our appointment.

 

So today, we’re trying for this final possible solution.

We’re glad that Ronnie James had such a good weekend this last weekend. He looked better and seemed to feel better than we’d seen him since, well, maybe ever. All weekend, we enjoyed an unusually alert and active Wrah-Wrah, who was everything a healthy Wrah-Wrah should be – he was hungry and thirsty, playful and talkative, and just as flirty and affectionate as ever. He stayed close to us, wherever we were. He’s our bright little lovebug, and we’re going to give him every chance at survival we’re able to give him… and we’re so grateful that we’re able to give him these chances.

Here are some pics from the weekend:

 

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

The Wrah-Wrah looking so alert! You can see the wheels turning in his head, too.

 

The Wrah-Wrah's poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

The Wrah-Wrah’s poodle-like cut is growing out. When the fur on his back is ruffled, it looks like a mohawk from this angle.

 

Now that his fur is growing out from his last surgery, he’s cultivating kind of a faux-hawk on his left side. Depending on where they shave him this time, we might bring him home with a full-blown ‘hawk!

The Wrah-Wrah goes to the E.R. (and proves once again that he has more lives than the average cat.)

Well, that was a night.

Ronnie James is back in the hospital. After a few days of observing him, calling the hospital, making appointments and then canceling them as he’d seem not-fine one minute and then much better the next, not knowing what his new “normal” is supposed to look like after his surgery (like all cats, Ronnie James is incredibly skilled at hiding the extent of his discomfort), we knew last night that he needed to go to the E.R.

A technician triaged Ronnie James the minute we got there, then immediately took him to the ICU and put him on oxygen. It was scary – scary enough for the doctor to come in and warn us that the Wrah-Wrah might not survive the thoracentesis that had to be done – but the little guy made it through. He was looking much better when we kissed him goodnight before coming home. He was alert and active in his oxygen chamber, being his usual flirty, affectionate self. He’s unbelievable! We were cautioned that he’s not “out of the woods” yet, but he’s looking just as spry as ever!

We shouldn’t have been surprised by this development, as Dr. M. had clearly warned us that Ronnie James would likely require one or two more thoracentesis (chest tap/draining) procedures following his surgery. We were prepared for this likelihood. We just weren’t prepared for the situation to arise in such a dramatic and scary way. I mean, we truly almost lost him last night.

The E.R. doctor, who was wonderful, showed us Ronnie James’ x-rays and said, “Look at this… I don’t know how he was still alive!”

The Wrah-Wrah is a miracle kitty, that’s how.

His x-rays showed nothing but white. On a normal chest x-ray, dark areas of a healthy size and shape would be visible. Those would be the lungs with air in them.

In this one view of Ronnie James’ chest, there’s no dark area to be seen at all:

 

Thursday, 4/23/2015 - Wrah-Wrah's chest cavity is completely filled with fluid. No lung is visible.

Thursday, 4/23/2015 – Wrah-Wrah’s chest cavity is completely filled with fluid. No lung is visible.

 

And in this view, the side view, you can see a small, grayish area with rounded edges “just kind of floating there.” That’s the Wrah-Wrah’s lung. It was surrounded by so much fluid that it was barely functioning. It’s like a ghost lung.

 

Thursday, 4/23/2015 - That faint, ghostly dark roundish area in the center, just below his spine? That's his "lung." That's all he has left, and with all the fluid crowding it, it was barely working.

Thursday, 4/23/2015 – That faint, darker gray area in the center, just below his spine? That’s his lung.

 

The doctor talked to us carefully and made sure that we understood the precariousness of the situation before he performed the thoracentesis. The procedure was extremely high-risk because Ronnie James’ condition was life-threatening. But everything went well. 300 ml of chyle was aspirated, and that wasn’t even all of it!

 

Thursday, 4/23/2015 - This is the fluid that was taken from Ronnie James' chest cavity. It's 300 ml (a cup and a quarter), and it's not even all that was in there. The doctor didn't want to try to drain all of it, because it would have been too risky. The fluid is chyle (chyle can either be cloudy or pink).

Thursday, 4/23/2015 – This is the fluid that was taken from Ronnie James’ chest cavity. It’s 300 ml (a cup and a quarter), and that was just some of it. The fluid is chyle (chyle can either be cloudy or pink).

 

There’s still “quite a bit” of chyle left in the Wrah-Wrah’s pleural cavity. The doctor said that it was too dangerous to try to get it all, but enough was removed to allow for more normal breathing. They might try to remove a little more sometime this morning.

Now, we wait to hear from Dr. M. when he comes in, examines Ronnie James, and reviews the whole situation. We don’t know what’s going to happen next. It’s at least comforting to know that what has happened so far had been anticipated… and the E.R. doctor said that he’s hopeful. Also, most importantly, the Wrah-Wrah isn’t suffering continuously.

 

Thursday, 4/23/2015 - Ronnie James felt better after his thorocentesis. He was wide-eyed, active and heart-meltingly lovey-dovey when we went to visit him in his oxygen chamber before we left.

Thursday, 4/23/2015 – Ronnie James felt better after his thoracentesis. He was wide-eyed, active and heart-meltingly lovey when we went to visit him in his oxygen chamber before we left.

 

Look at those wide, bright eyes!

We’re keeping our thoughts positive.

Ronnie James has a new nickname: Cat Squared (he has 81 lives, apparently)

I wanted to thank you all again for thinking of us and taking part in our journey to better health for Ronnie James with your kind well-wishes and interest in his story. I didn’t mean to tease in my last post. I just didn’t have much time for writing last week! Also, I wanted to talk to our doctor again before I sat down to scribble this out.

This is the short story:  Ronnie James was sick and gradually dying when we rescued him in the fall of 2012, but we didn’t know anything was wrong until he started coughing about 11 months ago. We now know that he’s been evading death for years, somehow surviving a thing that would have killed most mammals. We are in awe of him.

 

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

Ronnie James, Sunday night, 4/12/2015. Angel kitty with his halo of lights!

 

The detailed story goes like this:

In the operating room on Friday, April 3, Dr. M, our surgeon, opened up Ronnie James and found his left cranial lung lobe in a state of semi-decay; he said it almost looked like it was “rotting” in his chest. The mysterious mass seen on the CT scan turned out to be a mushroom-shaped (“pedunculated”) object that oozed a “weird, thick mucus-like material” when the stem broke off.

Dr. M tried to describe what he saw in the center of the mass, but he couldn’t quite find the words. I got the impression that he’d never seen anything like it before.

He told me, “It looks like it might be something of an infectious nature,” but he seemed to be baffled. He suggested that the mass might be a remnant of an old infection that Ronnie James’ body had tried to wall off. As he spoke, I envisioned an oyster protecting itself from grains of sand by coating the foreign material with its own bodily secretions.

But the bulbous, sickly pearl inside Ronnie James almost killed him. At first, its point of origin wasn’t obvious; it appeared to be attached to the bottom of the left cranial lung lobe. Actually, it seems to have grown off of one of the bronchi, clogging it and causing the lobe to collapse and consolidate. It’s possible that the mass ultimately caused blockage of Ronnie James’ thoracic duct, either directly or indirectly, as it was on the same (left) side. We’re hoping that this was the case, because if it was, then it answers the question of “What caused his chylothorax?”

Chylothorax, the filling up of the chest cavity with chyle, was the chronic issue we were aiming to fix, the problem we had to solve in order to save Ronnie James’ life. If the mass was causing it, well, problem solved! The mass is gone now.

Our surgeon said, “Until the labs come back, we can’t rule out cancer. I’ll tell you what, though… this doesn’t look like any cancer I’ve ever seen. I don’t know what this is.”

All along, Ronnie James’ labs have consistently tested negative for cancer. Dr. M had to say that he couldn’t rule out cancer until the labs came back, but the fact was, no one really thought that it was cancer.

Whatever it was, it was weird.

The weirdest thing was that standing before our kitty’s exposed insides, Dr. M and his team were still more or less flummoxed. Nothing was adding up or making sense, but he went ahead with the planned lung lobectomy, which was absolutely what had to be done, and removed “the entire mass and left cranial lung lobe as well as a small amount of an adherent adjacent lung lobe.” Samples of everything were sent to the lab for analyses and cultures.

While Dr. M was working in Ronnie James’ chest cavity, he also did an ultrasound on the second, smaller mass the CT scan had detected in Ronnie James’ neck.

 

Ronnie James' left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

Ronnie James’ left cranial lung lobe, part of an adjacent lobe, and the mass were removed. The mass seemed to stem from one of his bronchi.

 

When the lab results came back a few days later, they showed that the inside of the lung mass was comprised of fat necrosis (dead fat). Necrotizing tissues and edema were also found throughout the lung lobe. There was “scattered mineralization.” We were indeed looking at decaying organic matter and an old infection, an infection with a history… and it was chronic.

Considering all of this, it’s miraculous that we didn’t lose Ronnie James to something like sepsis or cardiac arrest. Other than his intermittent episodes of coughing and his more recent bouts of prolonged lethargy, he had seemed just fine. He’d initially been diagnosed with asthma, which he may or may not actually have.

But what could have caused Ronnie James’ ancient infection? He’d tested negative for Valley Fever. He’s been an indoor cat since we’ve had him, anyway. We couldn’t stop thinking about it… we were faced with a medical mystery that had to be solved so we could take the best next steps toward complete recovery. It was maddening. What could have wreaked all this havoc in Ronnie James’ pleural cavity?

Then we thought back to the first time we ever took Ronnie James to the vet, when we were still living in France, and we remembered the cause of that problem. It was the Chenille Processionnaire, and it explains everything.

 

Chenille Processionnaire, or Pine Processionary.

Chenille Processionnaire, or Pine Processionary.

 

In October 2012, soon after we adopted 8-year-old Ronnie James from an impoverished woman in Montélimar in southeastern France, we noticed that he was having trouble eating. We took him to the veterinary clinic closest to us, which was down in Bourg de Péage. (In France, our home-base was in the Alpes, about 100 miles from the recent plane crash. I’m sorry to be able to use the location of that awful event as a point of reference, but there it is.) We thought that dental problems might be causing him pain, but when the vet opened his mouth, he simply remarked that Ronnie James had experienced some sort of contact with a Chenille Processionnaire (“Pine Processionary” in English), a venomous caterpillar common in southern France. The tip of Ronnie James’ tongue had been “burnt off,” and it was this disability that impeded his eating. Our vet immediately recognized the characteristic chenille processionnaire damage to Ronnie James’ tongue; there was no question about it.

I’d never heard of anything like it. The Pine Processionary doesn’t exist in the United States. According to Wikipedia, it’s only found in southern Europe and in parts of Asia and Africa.

From what we can understand, animals such as dogs and cats are harmed by this caterpillar either because of poisoning from its venom, or because of an allergic reaction to it, or both, in any case being potentially – even often – fatal. Incidentally, I found some disturbing images of dog and cat tongues either burned, like Ronnie James’ tongue, or amputated at the tip (due to contact with this caterpillar).

 

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They're common where we lived in the Alpes and all over the French Riviera.

Les Chenilles Processionnaires (Pine Processionary caterpillars) are often seen traveling end-to-end. They’re common where we lived in the Alpes and all over the French Riviera.

 

The caterpillar’s venom is released when its tiny hairs break off, or when the caterpillar ejects the hairs in self-defense. The toxins are in the hairs. Dogs and cats suffer when they have direct interaction with the caterpillar, or when they come into contact with pine needles or other organic matter on which the caterpillar’s hairs had fallen. Ronnie James could have licked the caterpillar, or he could have stepped on the hairs while walking around outside, or, more likely, knowing him, he might have played with the caterpillar with his paws, batting it around. Whether he walked on the hairs or played with the caterpillar, the toxic hairs would have stuck to his paws (they stick to whatever they touch), and Ronnie James’ tongue would have been burned when he went to lick his paws, as cats do.

At the same time, a venomous hair or two could have traveled down into Ronnie James’ lungs.

It happens. It happens to dogs and cats who roam outside in areas infested with the Pine Processionary.

Dr. M, who had (along with the rest of his surgical team) noticed the unusual damage to Ronnie James’ tongue when they were prepping him for surgery, agrees that more than likely, this is what happened to him. Though we didn’t witness the caterpillar encounter, we can all look at the evidence before us and do the math. In this case, 2 + 2 = Pine Processionary caterpillar damage in the Wrah-Wrah’s lungs. It would also account for the smaller mass found in his neck, lodged in his throat area, as the way that was presenting also matched the type of damage that could be done by the Pine Processionary.

Everything we can see points to this caterpillar.

Two things are for sure: Ronnie James survived an inordinately long time after his encounter with the caterpillar, and he was certainly dying by the time the surgeon removed the dead lung and surrounding infected areas. And we’re not finished yet. One of his lab cultures came back positive; the infection is alive.

 

thatasianlookingchick.com-pineprocessionarycaterpillar

 

One for the “WTF, Nature?” archives, if you ask me.

We’re so proud of Ronnie James. He’s been such a good sport throughout this ordeal, and he did extremely well in surgery. Everyone was surprised when he didn’t need oxygen therapy to transition out of anesthesia, as dogs and cats typically do after surgery. He started breathing on his own again as soon as they unhooked him! We credit this bit of badassery to the fact that the Wrah-Wrah had long since learned to get along without that nasty old lung.

So that’s what happened. Years ago, Ronnie James inhaled or ingested toxins from a caterpillar. And to think that I’d blamed myself for bringing him here, back when we thought he’d developed asthma from being in the dusty desert! The whole time, he’d been suffering the effects of an environmental hazard that doesn’t even exist in North America. I can’t believe we brought this demon caterpillar venom back from France with us, embedded in the Wrah-Wrah’s lungs. That was more baggage from France than we’d bargained for.

Now that we know the root of the problem, we have a better idea of what to do for Ronnie James. We’re going after the remaining infection with an aggressive, extended course of antibiotics. We’re also continuing him on his asthma treatments, as he’d shown slight improvement on them (the steroid inhaler was helping to hold the infection at bay, and the bronchial dilator inhaler was helping to open up his airways).

Tomorrow, the Wrah-Wrah goes back to Dr. M to have his stitches removed, and he’ll be checked for need of further thoracentesis (chest tapping/draining). We were cautioned that it wouldn’t be unusual for him to need to have his chest drained one or two more times following the surgery. Our hope is that after a month or so, he’ll no longer have to deal with chylothorax and all the treatments it necessitates.

We’ve had a couple of scary episodes with coughing and vomiting in the last few days, but he checked out fine at the hospital; the episodes aren’t surprising given that his insides are adjusting to the changes, and he’s still recovering. Overall, the Wrah-Wrah continues to do much better. He’s happy and more active now than we’ve ever seen him. He is exponentially better, in fact. He’s next-level Wrah-Wrah!

A happy kitty is a kitty without dead lung tissue rotting in his chest with a weird, bulbous, rotting-fat-filled mass. We still have a long road ahead of us; Ronnie James’ long-term prognosis depends on how he responds to treatment from this point on. Anything can happen, but we’re optimistic!

 

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Sleepy Ronnie James. He just woke up from his evening nap. (4/13/15)

Frankenkitty Comes Home!

Or, shall we say, the FrankenWrahWrah.

Ronnie James, one week post-op. (4/10/2015)

Ronnie James, one week post-op. (4/10/2015)

The results of Ronnie James’ surgery are unbelievable, better than anyone thought possible.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op. Still coming out of anesthesia, heavily medicated.

Friday, 4/3/2015, Day Zero: Our first sight of Ronnie James after his surgery, about five hours post-op… still coming out of anesthesia, heavily medicated.

Hello, Wrah-Wrah!

Hello, Wrah-Wrah!

He’s half hairless. He’s got a five-inch-long incision with about 20 stitches, plus a few stitches closing up the hole where his chest tube had been. He’s minus his left cranial lung lobe, part of an adjacent lung lobe, and a mysterious mass, and he’s breathing much easier now!

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn't wandering around the house crying).

Poor Nounours missed his brother so much, he literally waited at the door for him to come home (when he wasn’t wandering around the house crying).

We were all kind of confused going in, but the truest story of the Wrah-Wrah could be seen when our surgeon opened him up and looked inside. The phone call I received at work after the surgery was bizarre because what the surgeon found was bizarre. It fact, it was so bizarre, I have to save the story for the next post.

Meanwhile, here are some pics of our little warrior!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Saturday, 4/4/2015, Day One: The day after his surgery, we went from the gym directly to the hospital to visit Ronnie James. We were allowed to hold him. He was so out of it and scared!

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

Sunday, 4/5/2015, Day Two: When we brought him home on Sunday night, Wrah-Wrah went straight to my office to rest, relaxed on his pain meds.

His fur had been shaved so precisely for the surgery, it looks like he's wearing half a coat! That spot in the center is where his chest tube had been.

His fur had been shaved so precisely for the surgery, it looks like he’s wearing half a coat! That spot in the center is where his chest tube (for drainage) had been.

That is quite an incision there, little guy.

That is quite an incision there, little guy.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties' toy area in the living-room has been one of Ronnie James' favorite hang-out spots since he's been home.

Monday, 4/6/2015, Day Three: Pain-killers in full effect! The kitties’ toy area in the living-room has been one of Ronnie James’ favorite hang-out spots since he’s been home.

So many toys! Too many decisions.

So many toys! Too many decisions.

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James' after-care. Between his different meds and his compress treatments, there's something to be done six times each day. He's doing so well!

Tuesday, 4/7/2015, Day Four: We had a rhythm going with Ronnie James’ after-care. Between his different meds and compress treatments, there’s something to be done six times each day.

He's spent a lot of time snuggling up to me in my office at home.

He’s spent a lot of time snuggling up to me in my office at home.

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

Thursday, 4/9/2015, Day Six: Breathing so much easier now!

We’re so grateful to everyone involved in the Wrah-Wrah’s medical journey (which isn’t quite over, but we’re certainly off to a great start!) and well-being, from the doctors and staff at our two clinics to all of you who’ve been keeping him in your thoughts and prayers. Next week I’ll fill you in on What the Heck the Surgeon Found. 

Happy Friday, All!

Ronnie James update Number 2 – Out, damned mass!

Sorry… I couldn’t resist the Shakespeare reference.

I’m postponing my March Favorites post until Tuesday, since this morning we had to take Ronnie James (Wrah-Wrah!) to the hospital super early. A lot more has happened since my last post about the Wrah-Wrah… that post, you know, in which we were so relieved and optimistic. In fact, since that very day I updated you guys, something else happened (as you know if we’re Facebook friends), and it’s continued to be an up-and-down kind of situation. The new developments have been relentless, and now, this morning, Ronnie James is going into surgery. The surgeon is going to perform a lung lobectomy to remove one Ronnie James’ lung lobes – the one with the mass, which may or may not be cancer, and which may or may not be causing his chylothorax, either because it’s cancer, or because structurally, it’s creating a blockage of his thoracic duct. In any case, the mass has to go. We consulted with several doctors at two different places, and everyone agrees that we can’t not take a serious measure at this point. He had to have another 150 ml of fluid removed from his pleural cavity the other day. We have to at least try to stop the flow of lymphatic fluid into his chest.

Because other than this, Ronnie James is very healthy, happy and active. He has a great appetite. He’s not at death’s door, so to speak. He’s not saying, Mommy and Daddy, I’m ready to go. He’s just saying, Mommy and Daddy, please stop the coughing. And so we’re going to try. Here are some pre-op pics, starting from late last night:

Ronnie James the night before his big surgery adventure! (4/3/2015)

Ronnie James the night before his big surgery adventure! (4/3/2015)

We've arrived at the hospital. Ronnie James is snug in his carrier, reassured under Daddy's touch. (4/3/2015)

We’ve arrived at the hospital. Ronnie James is snug in his carrier, reassured under Daddy’s touch. (4/3/2015)

Off to get tucked into his cozy hospital bed! Jordan loves the Wrah-Wrah, too. (4/3/2015)

Off to get tucked into his cozy hospital bed! Jordan loves the Wrah-Wrah, too. (4/3/2015)

Ronnie James will likely remain in the hospital under 24/7 care through Sunday. With the exception of the gym on Saturday morning, we’ve canceled our weekend plans so we can spend lots of time visiting him.

Thank you for your kind thoughts, prayers and well-wishes! I’ll post an update next week.

Happy Friday! =)

Update on Ronnie James (for anyone who’s interested), or, Saving the Wrah-Wrah.

As you probably know if you’ve been reading here for a while, we’ve been treating Ronnie James, aka the Wrah-Wrah, aka le petit Wrah-Wrah, aka our furbaby, aka our son, for asthma for the last seven months. Well, a lot’s happened in that time, and some of you have been so kindly asking after him, so here’s the latest.

After his initial diagnosis of asthma, Ronnie James’ progress fell into the familiar, frustrating “one step forward, two steps back” pattern. With each step back, we’d return with him to the vet, and each time, his chest x-ray would come out looking different than the previous one. In November, his x-ray showed a collapsed and consolidated lung, conditions that are typically seen as complications of feline asthma. That was disheartening enough, but after a fairly unchanged January x-ray, he suffered further decline and another crisis, and back we went for more imaging. This was in the first week of March, and we found ourselves confronted with an x-ray that was abjectly frightening. It sent us down a rabbit hole of worry and fret. We’re just now emerging from the other side.

Ronnie James’ chest x-ray that day – it was March 4, I believe – was ghostly white, practically opaque. His chest cavity was so filled with fluid that we couldn’t see his heart, and his abdominal area looked the same. His liver was obscured. His stomach was obscured. It was alarming hearing the doctor navigate around Ronnie James’ insides as we stared at the screen. We were basically looking at a cat-body-shaped silhouette filled in with murky whiteness. We were looking at a big question mark.

“Right here is where we should see his heart,” the doctor said, pointing at a section. “Here is where his liver should be. And his stomach would be here – ” She paused as we bent closer to try to see. “This right here,” she said, tapping a small black shape, “is his lung. The black shows that there’s air in there.”

But none of his other vital organs could be seen.

Long story short, more tests were conducted, and two days later, we were relieved to find that things were okay in his abdominal cavity. But the pleural effusion issue – his chest cavity filled with fluid – had to be resolved. All signs pointed to a disease called chylothorax. We were referred to a specialist. Ronnie James needed next-level testing, and he needed to have a chest tap to drain the fatty lymphatic fluid that had no business being there. Our doctor was hesitant to perform a complete aspiration because the fluid had accumulated directly over Ronnie James’ heart.

However, the very next day, of course, was the day we were scheduled to board a plane to France for a week! One extremely long week, from the perspective of a critically ill kitty and his parents.

While we were in France, the doctor emailed with two options for veterinary specialists, animal hospital facilities with state-of-the-art equipment to tackle specific and complicated medical situations for animals, and we couldn’t do anything about it until we got back. We needed enough time and internet access to thoroughly review the two specialists online, and we had to be able to call them with questions before choosing one. I felt like it was a stupidly clichéd race against time, and it was. We’d done our online research into Ronnie James’ condition. We knew that it was critical to drain the fluids from his chest as soon as possible. The timing of the whole thing couldn’t be worse.

So all that week in France, I ran around during the day, cried at night, anxiously exchanged messages with Ronnie James’ beloved Auntie Margaret, who generously, expertly and compassionately kitty-sat and medicated Ronnie James for us, and got little to no sleep throughout. Don’t get me wrong! I still had an awesome, wonderful time and tremendous fun with everyone, but throughout it all, a part of my mind ceaselessly counted down the minutes to getting home and taking the Wrah-Wrah to the specialty hospital.

Back in Arizona, we researched the two facilities, made our phone calls and scheduled Ronnie James for an appointment with the internal medicine specialist at the hospital we chose. We took their earliest available slot, which was for Monday the following week (yesterday). I was beside myself. We’d already waited a week, and now we had to wait another whole week! But THANKFULLY on Wednesday night last week, the clinic called to tell us there’d been a cancellation for the next day, so we were able to get him in on Thursday.

Ronnie James at the specialty hospital, pre-thoracentesis and extensive testing.

Ronnie James at the specialty hospital, pre-thoracentesis and extensive testing.

We were grateful and beyond relieved that with their imaging equipment and many years of experience, the specialists were able to perform a complete thoracentesis on Ronnie James, safely aspirating 120 ml (the equivalent of three large syringes!) of milky-white fluid, chyle, from his chest cavity. Chylothorax was confirmed.

Post-thoracentesis, resting.

Post-thoracentesis, resting.

120 ml of chyle (~1/2 cup!) was removed from the Wrah-Wrah's little chest cavity!

120 ml of chyle (~1/2 cup!) was removed from the Wrah-Wrah’s little chest cavity!

Alleviating the Wrah-Wrah of his pleural effusion was one thing. The remaining critical task was to determine the underlying cause of the chylothorax, if there was one. (50% of chylothorax cases are idiopathic, meaning that there’s no known cause.) We had to get to the root of the problem so we could take some action to prevent his chest from filling up with fluid again! Thursday evening, the internist showed us Ronnie James’ CT scan. Contrast revealed a suspicious 2cm x 1cm mass in his left lung lobe. It was also confirmed that his right lung lobe had collapsed. A biopsy from the mass and more fluid samples were sent out to an external lab for analyses and cultures.

The results wouldn’t be back until Monday, so we settled in to wait again. It was a long wait. As some of you can (unfortunately) attest, the longest wait of all is the one between the words “we found a mass” and the receipt of the lab results.

Meanwhile, we spent the weekend marveling at the Wrah-Wrah’s restored vitality since his chest tap. He was back to his old self! He was alert, active, awake more than asleep; he was talking (wrah-wrah wrah wrah WRAH! Wrahhhhhh!), playing, flirting with us and running around, throwing himself on the floor and rolling over for belly rubs, purring furiously (as if to make up for all the purrs lost during his illness), engaging in his favorite games and raising hell with Nounours again. We hadn’t seen him like that in months! Without the fatty lymphatic fluid crowding everything in his pleural cavity, Ronnie James’ lungs could expand normally again. He was getting more oxygen, and it showed. The difference was dramatic.

Ronnie James returning to his former self over the weekend.

Ronnie James returning to his former self over the weekend.

Late Sunday afternoon, we received a wondrous surprise phone call from a doctor who was working with our internist. She reported that Ronnie James’ labs had come back free of cancer and infection!

This brings us to today. At some point today, the internist will call to report the details of the lab findings – one of the cultures is still pending – and to go over a game plan for the next steps. Part Two of the restoration of the Wrah-Wrah’s pulmonary health will begin soon, and with luck, it’ll be uneventful maintenance from there on out!

We’re hopeful that we can find a way to resolve this for him so he can live out his lifespan with a high quality of life. He’s only 10… he has at least 10 more years to go!

Thank you all for your kindness and support. We feel the love, and so does Ronnie James. We feel blessed, too, to have a wonderful, caring team of doctors between the University Animal Hospital and the VCA Specialty Animal Hospital. They saved Ronnie James’ life, and we can’t say enough how grateful we are to have this precious little guy with us, being his old self!

There aren't enough kisses in the world for the Wrah-Wrah....

There aren’t enough kisses in the world for the Wrah-Wrah….

Thank you all for reading! Please pass this post along to any kitty or doggie parents you may know who might be going through the same or similar medical crises with their furbabies. It would be wonderful if Ronnie James could provide with a little information and hope.