Edit 2009-01-27: We learned Kenzo's pathology results today. It turns out Kenzo he had a tiny tumor that obstructed his bile. This resulted in the damage to the pancreas and liver that eventually led to his death. We are told that the tumor was very small and hard to identify even during the autopsy. It wasn't until they put the tissue into formalin that they were able to see it. Identifying it in the first place would have probably required a CT or an MRI, and removing it would have required a very involved procedure that would have been very high risk even in an otherwise still healthy cat. There is apparently no way he could have been saved on St. Kitts, and his chances would still have been poor even with state of the art skills and equipment.
When our cat Kenzo fell ill, and we were browsing the web for information and other people's experiences, we mostly found reports by people whose cats survived. It may however also be useful to hear failed accounts, so as to know what to look out for.
Kenzo was a big, gentle, adorable, 5-year old male cat who weighed 7.5 kg (16.5 lbs) before his illness. He was happy, playful and loving, and had a marvelous character. He had been overweight, but not obese; his stature was simply majestic for a cat. Genetically, he came from a prohibited liaison between a Turkish breed female and a Persian breed male.
In early December 2009, we left for a 10-day holiday and left Kenzo and Chanel (his female cat companion) in the care of a roommate. When we came back, we noticed that Kenzo had lost considerable weight. He went from 7.5 kg to 6.5, which the roommate had failed to notice. She merely observed the total food eaten by both cats, which remained normal, but did not notice Kenzo's loss of weight.
Mistake #1: Failure to spot the problem when it starts.
At this time, Kenzo showed no other signs of problems. He was cheerful and playful, and showed passion for chicken breast when we fed it to him. We therefore assumed that he might have simply not liked the food he was being given, or stopped eating due to stress of our absence. We thought this despite the fact that we had left for longer several times before, and the cats never had any problems.
Mistake #2: Failure to call a veterinarian as soon as noticing the problem.
Since Kenzo only lost weight but was still happy and playful, we thought perhaps a parasite might be involved. It was also time for the cats' monthly shot of Revolution, a parasite preventative, so we administered that just in case. A veterinarian later told us that this probably overburdened his liver.
Mistake #3: Failing to consult a veterinarian before administering medicine after noticing a problem.
Since Kenzo seemed relatively fine, and his toenails had grown long during our absence, I clipped them. He resisted, and my persistence added to his stress.
Mistake #4: Adding stress to a cat that already has a problem.
The next day, day 2, Kenzo didn't eat at all. On day 3, I noticed yellow color around his mouth. I raised this with my wife, but she thought it was from the food he was recently given. I was suspicious, since I had never before seen such discoloration after he ate, but did not pursue the matter further.
Mistake #5: Failure to recognize the onset of jaundice.
On day 4, I noticed that the yellow color around his mouth persisted. This time I suspected jaundice, and I checked the inside of his ears. They too were yellow. I conferred with my wife. We immediately called the emergency veterinarian and promptly brought Kenzo to them. He stayed with the veterinarian overnight.
On day 5, we came back to the vet to talk about results and see Kenzo. He was none too happy about the clinic environment and had not eaten much at all. They had done bloodwork and an ultrasound, but not a biopsy. His liver enzymes were all out of whack, his bilirubin was 9 where the normal is up to 0.9, but the rest of the bloodwork was fine, so they suspected that he has hepatic lipidosis. This is a dangerous liver condition in a cat that hasn't been eating. It is caused by the general inability of cats to process their stored fat. The treatment is to force the cat to eat enough for the liver to recover.
In the vast majority of cases, hepatic lipidosis is a consequence of another condition, but the underlying condition wasn't diagnosed. We all assumed Kenzo stopped eating due to stress of our absence, and/or due to the new person taking care of the cats.
This wasn't, in fact, the case. We didn't learn until the autopsy that Kenzo had pancreatitis.
Mistake #6: Failure to diagnose the underlying cause of hepatic lipidosis.
When we returned home, Kenzo showed some interest in food and ate a significant amount, but not enough given what the vet said he was supposed to. Jana took it upon herself to force-feed him over the next two weeks, which she did heroically. We did this in hope of avoiding him having to get a feeding tube, which would involve surgery to place it into his stomach through a hole in his throat.
The force feeding should have worked to help his liver. But what he really had was pancreatitis, and he needed an IV of fluids and electrolytes to keep him hydrated, as well as not that much feeding, to give rest to his pancreas. With oral feeding, he just wasn't getting (and keeping) enough fluids.
Mistake #7: Failure to hydrate the cat.
Mistake #8: Prolonged treatment based on an incorrect/incomplete diagnosis.
Kenzo didn't seem to be doing much better, so we called the vets, but were reassured that the treatment we were giving him was fine. We continued force feeding, even though we were worried because his energy level rose right up when he wasn't eating, and bottomed out when he was fed.
Mistake #9: Failure to reconsider diagnosis when treatment is not working.
Kenzo seemed to be getting worse, and the force feeding was very wearisome, so we finally insisted on bringing him in to get more tests and a feeding tube.
When we brought him in the second time, tests showed that his bilirubin was 19 - twice what it was the first time. He had lost more weight, and was down to 5.9 kg. They performed bloodwork and ultrasound again, but it was right before New Year's, so the people needed for a more detailed checkup were all off-island - celebrating in the US with their families, not having their cat die on them.
Tests showed that his gall bladder was enlarged and his bile flow was obstructed. He underwent surgery to receive a feeding tube. We were told to continue administering food, and now also antibiotics which they hoped would reduce internal swelling and remove the obstruction. What he would have really needed is more thorough tests and/or surgery, but the necessary people weren't on island.
We took him home December 31 and were told to bring him back on January 5.
He seemed to be improving slightly on antibiotics, and the feeding was much simpler with the feeding tube. (If your cat needs force feeding, definitely get a feeding tube.)
However, on the evening of January 3, he just seemed to fall of a cliff. He lost all energy - couldn't even climb out of the litter box after peeing - and looked like he was about to die. We brought him in first thing next morning.
We hoped they could still operate and do something, but it was apparent to the vet immediately that he was dying, that he wouldn't survive anaesthesia, and that euthanasia was the only remaining option. Reluctantly, this is what we did.
Autopsy showed that his bowel had ruptured, which was probably what caused the drastic decline the previous evening. The rupture itself was fatal and irreparable. The main problem, however, appeared to be severe pancreatitis, which had destroyed his liver in turn.
Autopsy also showed scarring of the intestines, which would point to Inflammatory Bowel Disease, but he didn't recently show any such symptoms. We suspect the scarring may have been from when he was younger, and was unrelated to the recent situation.
After the autopsy, the veterinarians reassured us that there was nothing we could have done. That given the state he was in, he would have died no matter what we did, even at the point when we first brought him.
We're not so sure that is the case. If none of the above mistakes had happened - and perhaps if this wasn't a godforsaken island which all the skilled people leave over New Year - then, maybe, Kenzo might have lived.
As it is, we are left with a tuft of his hair... his favorite toy... and the next 10 years without our beloved, special, irreplaceable companion.