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!