Not all miracles have a happy ending. I've had a really shitty couple of weeks, the culmination being the realization of this lesson. There were some good things that happened, though. After my unpleasant encounter at VIMP after Kia's post-op check, I was able to get in touch with HSFC about that bill and they not only said they would cover it, but they also could help me with the cost of her food. Then, my neighbor checked under my car hood and found out the odd smell coming from it was due to a piece of material from the battery cover laying on top of the engine. I promptly removed it and have not smelled that odor since, although the issue of my possibly bad compressor still lingers. That issue proved most problematic the following Thursday. Kia was completely out of cat food so I had to run to PetSmart to buy her a single can just to get her through to my next paycheck, when I could buy her enough for the next 2 weeks. However, the drive from my office to PetSmart (a distance of maybe 2 miles) took over an hour because of severe flooding that resulted in major road closures. My gas needle was hovering just above empty and I was crawling along, sometimes not moving at all, and praying I wouldn't run out of gas because I have $15 in checking until my direct deposit kicks in at midnight, and I still had to buy a can of cat food so my kitty could eat the next day. Not only that, but it was pouring down rain outside and my windows were fogging up but I couldn't unfog them because, every time I turned the defroster on, my engine would start racing again, threatening to plow my car into the car in front of me on the severely congested roadway. I had to either roll down my windows and get soaked or risk rear ending someone.
So anyway, that was Thursday. I didn't get home from PetSmart until almost 7:30 so my babies' dinner was quite late and Kia was *not* happy. I called VIMP the next day to see if Kia's test results had come back yet. She said they hadn't but not to worry because it takes 2 weeks to do the test, plus a day or 2 to come back from the lab. She said if I hadn't heard anything by Tuesday to call them again. My mom thought it was a bad sign that they hadn't come in yet, but I was feeling pretty optimistic that it was just a long test and perhaps the flooding affected the lab courier's route or something. I managed to have a pretty good weekend in spite of it. Monday rolled around and I was excited for 2 things: Monday Night Football with Tom Brady and Miss Universe. I had just put dinner in the microwave and was about to sit down to enjoy my evening when my roommate texted me. She had just landed at Dulles airport and her ride home from the airport bailed on her, so she needed me to come pick her up. I'm not very experienced in driving to and from airports so I was nervous about navigating the complicated infrastructure, but I went because I know I would expect the same thing from my roommate. I made it there OK, despite the sun glaring in my eyes and making it nearly impossible to see the road signs. I pulled up by the curb and called her to say I was there and she said she was getting her luggage at baggage claim and would be up shortly. No sooner had I hung up when some "security official" with a bright orange vest said to me: "Ma'am you cannot park here. You have to circle around." I told him my roommate was on her way up the escalator at that very moment so it would be stupid for me to pull away, but he remained adamant that I had to pull away and circle around until she got there. I yelled at him, "No! If I circle around, I will get lost! I'm telling you, I will get lost!" But he would not hear it. So, I had to drive off (just 2 seconds before she walked out the door) aaaaaaaaand guess what happened?? I. Got. Lost. I was so frazzled by the exchange, I missed my ramp and ended up in the pay to park lot. Instead of grabbing a ticket, I tried pressing the help button numerous times until someone finally picked up. I told them I didn't mean to end up here and I didn't want to waste $4 because of it. They told me the first 7 minutes are free so I just needed to take the ticket and drive right out the exit. Well, that proved easier said than done. There weren't any signs clearly defining the exit so I drove around and around, growing more frustrated by the second (what a waste of time and gas!). When I finally found the exit, I was worried my free minutes had lapsed. Fortunately, they hadn't, but then I had to figure out how NOT to take that same ramp back on the freeway and how NOT to make the same wrong turn into the pay to park lot again before I made it back to the curb to pick up my roommate, who just had to wait several minutes for me, unnecessarily.
As you can see, these last several weeks have been one big frustration after another. The next day was Tuesday and I still hadn't heard from the vet yet. I called them at 6:45 that evening (knowing they close at 7) to see if they had come in yet. The receptionist said no, but she would call the lab to see where they were and call me right back. I waited and waited but she never did. On top of all of that, I had spent the afternoon feeling rather iffy. I could tell by my swollen glands and body aches that I was coming down with yet another infection (six weeks to the hour of my last one). My symptoms started right after lunch that day and worsened as the day went on. I knew by that night that I would probably have to call off work again the next day, which I did. I felt like hell Wednesday so I stayed home and concentrated on drinking fluids and taking the extra antibiotics from my last illness. I did manage to make a stop at the HSFC, though, to drop off the 3-lb bag of food that Kia couldn't eat. I took her with me so I could meet Janice in person and allow her to meet the kitty they've been putting so much money into lately. She asked me how she'd been doing and I said really good. She was eating like a pig and putting on weight, slowly but surely. I was very happy with how her recovery was going. I told her I was still waiting for the phenotype test results and would let her know as soon as I got them. She reassured me that they would continue to help with the cost, no matter what the results were.
Three hours later, I was on the phone to my mom when the vet rang through. The news was devastating. The test showed that she did indeed have intestinal lymphoma and we would need to start chemotherapy treatments as soon as possible. I asked what her prognosis was and they said it could be six months to a year, or a year and a half, or even several years. They simply didn't know. It would all depend on how well she handles treatment. I have to give her half a tablet 3 times a week, in addition to the presnisolone, plus monitor her white blood cell count regularly. He also said he wants me to keep her on the expensive special diet for roughly 4 months, so it won't be until the end of the year when I can start switching her back to her old stuff. It's going to be a long, arduous road that will ultimately lead to the same grim destination. It's every pet parent's worst nightmare.
I still refuse to believe she actually has this disease. It just doesn't make sense that she would show absolutely no symptoms of something this serious. I feel like maybe the results got mixed up at the lab, or maybe it's all one big scam just to get me to shell out more money to the Virginia veterinary industry. If I had the money, I'd get a second opinion. It's just so unfair. I've done nothing but love my kitty dearly since the day she appeared at my feet at the car dealership. I've jumped through all kinds of hoops just to keep her alive for the past 6 weeks. After her stricture miraculously opened, I really thought everything would work out. I thought the hard part was over. Turns out, it was just beginning.
Sunday, September 18, 2011
Saturday, September 3, 2011
A Major Bump in Kia's Road
Kia is now 2 weeks post-op and seems to be doing well. Me, however? I'm stressed out to the max. I've been awake since 5 am and even vomited once from my stomach being all up in knots. Money is a major stressor for me and talking about it will instantly put me in a bad mood for at least the rest of the day. Yesterday was no exception. Kia went in to VIMP for her 2-week check up. I got off work at 1 so I was able to come home and feed everybody lunch before heading out to Manassas in the mid-afternoon, holiday weekend rush hour traffic. It took me over an hour to get there, making me slightly late for her appointment. A couple weird things happened on the way there, too: I stopped by the rental office after work to give them my rent check and thought I smelled something funny coming from my car. It almost smelled like either cleaning fluid or fresh leather. I thought maybe it was something in the parking lot. But, I smelled it again on my way out to Manassas, too, and then again on the way back. I have no idea what it is, but any unusual smell that comes from your car is unnerving, especially when you know you have no money to have it checked out and would be screwed if your car died on the road because of it. The other thing that happened was Kia started panting pretty hard on the way there. I NEVER run the air conditioner in my car because it's just too expensive to waste gas on something like that, but I felt sorry for her, so I rolled up the windows and turned it on. She stopped panting, but my engine started revving up and down and my car would lurch forward every time it did. I had to hold down the brake pedal extra hard to keep it from driving me into the car in front of me. Finally, I turned it back off because I couldn't take it anymore. Not sure what's causing it, but it's yet another thing I should probably have looked at, if it can wait until I have the money for it (if I ever do).
At Kia's appointment, they examined her and found she appears to be doing as well as can be expected and had gained back a little under half a pound. I was hoping she'd gain more, but they said sometimes IBD can block the absorption of nutrients, although the steroids should help with that. They said I can always feed her more food, but those cans are $2.39 each and I just don't have the money for that. They gave me instructions to begin tapering her off the prednisolone (thank God!). Instead of 10 mgs a day, I'll be giving her 7.5 then eventually 5 and then possibly 5 every other day until she's completely off of it. I only have to give her the Famotidine for 2 more weeks, too, then I can stop it. So, that will be one less pill to crush up. She still needs to eat her special food for at least 2-4 more weeks before I can attempt her old (less expensive) food again. It can even take up to 4 months for a cat's digestive system to "forget" the old food that was causing the inflammatory response. Since the results of the type test weren't back yet, all of this could possibly change, depending on what they are. They said they're expecting them sometime next week. Overall, things appear to be going as well as they could be for a cat with her diagnosis. They said they wanted to see her again in 2 more weeks for another check up and to repeat some blood work, to make sure the steroids weren't making her develop any unpleasant side effects (e.g. diabetes or kidney disease).
I went to the front desk to check out and was told the total charge for today would be $113.20. I told them I'd been going through HSFC for all my care but they said that this visit had not been authorized by them. I was like, "What do you mean? All my other vet visits had been authorized." She told me that, since they do not work directly with HSFC, they don't call them to authorize the visits ahead of time like Caring Hands had done. They had only been given authorization for the 2 visits I'd had so far. It was almost 6:00 so the HSFC wasn't open for me to call them right then to straighten this out. They said I could call them on Tuesday and see if they'd retroactively cover it, but I would have to pay something on it today. Well, they were saying I owed them $113.20 and I only had $50 in my checking account until next Friday. If I wrote them a check, it would just bounce right back. She told me I could apply for Care Credit, but I said I already have and was rejected. I have no credit cards, savings account, or anything extra stored under my mattress. Whatever I have in checking is literally all I have. They kept saying, "Well, sorry but we don't DO payment plans." Seriously, how can these places not do payment plans when their services cost so much?!
I stood there for a while, fighting back tears and trying to make them understand that, I'm sorry but I just cannot pay for it today. If I had known the visit wouldn't be covered, I wouldn't have scheduled it. I still owe the emergency room $70 for my ER visit back in July and will probably get sent to collections if I don't pay on it soon. Plus I still owe $25 to my ENT (and am supposed to pay another co-pay at my next voice therapy appointment), plus I have to go see my regular doctor before they'll refill my blood pressure medicine, plus my car is several months past due for an oil change, plus all those weird things that happened with it on the way down, plus I haven't had a haircut since February simply because I haven't had the money, plus all my other bills that are normally due, and of course I have to find a new bank before my current one starts charging a monthly fee for checking accounts. It just never stops! Someone always has to have another cut of my money even though I cannot possibly spare another dime. I have nothing left over for anything fun like trips to Europe, outdoor adventures, or massages and manis/pedis. The amount I'm forced to live on every month is less than what most people in D.C. pay in rent. So, either they make a helluva lot more than I do, or they just have fewer bills to pay, or both.
Well, she offered me the option of signing a statement authorizing them to charge the amount to my debit card at a later date. But, I told her I hate authorizing any sort of automatic withdrawals because I just never know if the money is going to be there. She said I would have to pay it within a month, but that would make it no later than Oct. 3, and the first part of every month is bad for me because I always spend the vast majority of my paycheck on rent. The earliest I could conceivably pay it would be Oct. 7 because that's when I'll get an extra pay period where no major bills are due. I was planning on getting my car work done, getting a haircut, renewing Kirby's yearly HomeAgain membership, and paying my yearly car tax during that period. But, it looks like now I'll be paying vet bills instead. If I have to pay for another visit plus blood work in 2 more weeks, then I just can't do it. I'll simply have to take my chances on her recovering on her own with no veterinary supervision. If the test results come back showing lymphoma, then I guess she'll only have a couple more months to live and I'll have to live with the fact that my cat died unnecessarily simply because I'm too poor to pay for her care.
In the end, I signed the statement authorizing them to charge my debit card on Oct. 7 but I doubt I'll even be able to afford it then. I plan to email Janice on Tuesday to see what the future of Kia's care looks like, but I'm not feeling very optimistic at all. That whole exchange pretty much ruined my entire weekend. I called my mom on my way home just to vent my frustrations. I feel like nobody understands just how dire my financial situation is right now and even if they did, they wouldn't care. I'm sure I'm not the only person with this problem, but it certainly feels like it (especially when I read all those Facebook posts about people going shopping, taking exotic vacations, and buying all sorts or luxury items). And then there's the whole separate issue of that douchenozzle from M&T bank accusing me of causing damage to his car (which I did NOT!!) and forcing me to report it to my insurance company, thinking they would actually go to bat for me and put a-holes like him in his place, but instead they just cut him a nice, fat check and went on with their next case (after raising my monthly rates, of course). Basically, they just sponsored a night out at the nearest rooftop bar for him and his friends. It pisses me off so much that there are people like him in this world who just act like bullies and expect people to give them their way. Then there are people like me who are honest and work hard for every cent they earn but can't even afford to keep their pets alive. What the hell is wrong with the world? When does good actually triumph over evil? Will people ever understand (or care) that their actions DO affect others? Will there ever come a day when I can afford more than just the bare essentials? I'm starting to seriously doubt it. I used to be optimistic that things would turn around for me one day, but that day never happened so I've had to take some pretty drastic measures just to survive. I'm tired of keeping my hopes up only to be disappointed. I'm so broke, I can't even afford optimism anymore.
At Kia's appointment, they examined her and found she appears to be doing as well as can be expected and had gained back a little under half a pound. I was hoping she'd gain more, but they said sometimes IBD can block the absorption of nutrients, although the steroids should help with that. They said I can always feed her more food, but those cans are $2.39 each and I just don't have the money for that. They gave me instructions to begin tapering her off the prednisolone (thank God!). Instead of 10 mgs a day, I'll be giving her 7.5 then eventually 5 and then possibly 5 every other day until she's completely off of it. I only have to give her the Famotidine for 2 more weeks, too, then I can stop it. So, that will be one less pill to crush up. She still needs to eat her special food for at least 2-4 more weeks before I can attempt her old (less expensive) food again. It can even take up to 4 months for a cat's digestive system to "forget" the old food that was causing the inflammatory response. Since the results of the type test weren't back yet, all of this could possibly change, depending on what they are. They said they're expecting them sometime next week. Overall, things appear to be going as well as they could be for a cat with her diagnosis. They said they wanted to see her again in 2 more weeks for another check up and to repeat some blood work, to make sure the steroids weren't making her develop any unpleasant side effects (e.g. diabetes or kidney disease).
I went to the front desk to check out and was told the total charge for today would be $113.20. I told them I'd been going through HSFC for all my care but they said that this visit had not been authorized by them. I was like, "What do you mean? All my other vet visits had been authorized." She told me that, since they do not work directly with HSFC, they don't call them to authorize the visits ahead of time like Caring Hands had done. They had only been given authorization for the 2 visits I'd had so far. It was almost 6:00 so the HSFC wasn't open for me to call them right then to straighten this out. They said I could call them on Tuesday and see if they'd retroactively cover it, but I would have to pay something on it today. Well, they were saying I owed them $113.20 and I only had $50 in my checking account until next Friday. If I wrote them a check, it would just bounce right back. She told me I could apply for Care Credit, but I said I already have and was rejected. I have no credit cards, savings account, or anything extra stored under my mattress. Whatever I have in checking is literally all I have. They kept saying, "Well, sorry but we don't DO payment plans." Seriously, how can these places not do payment plans when their services cost so much?!
I stood there for a while, fighting back tears and trying to make them understand that, I'm sorry but I just cannot pay for it today. If I had known the visit wouldn't be covered, I wouldn't have scheduled it. I still owe the emergency room $70 for my ER visit back in July and will probably get sent to collections if I don't pay on it soon. Plus I still owe $25 to my ENT (and am supposed to pay another co-pay at my next voice therapy appointment), plus I have to go see my regular doctor before they'll refill my blood pressure medicine, plus my car is several months past due for an oil change, plus all those weird things that happened with it on the way down, plus I haven't had a haircut since February simply because I haven't had the money, plus all my other bills that are normally due, and of course I have to find a new bank before my current one starts charging a monthly fee for checking accounts. It just never stops! Someone always has to have another cut of my money even though I cannot possibly spare another dime. I have nothing left over for anything fun like trips to Europe, outdoor adventures, or massages and manis/pedis. The amount I'm forced to live on every month is less than what most people in D.C. pay in rent. So, either they make a helluva lot more than I do, or they just have fewer bills to pay, or both.
Well, she offered me the option of signing a statement authorizing them to charge the amount to my debit card at a later date. But, I told her I hate authorizing any sort of automatic withdrawals because I just never know if the money is going to be there. She said I would have to pay it within a month, but that would make it no later than Oct. 3, and the first part of every month is bad for me because I always spend the vast majority of my paycheck on rent. The earliest I could conceivably pay it would be Oct. 7 because that's when I'll get an extra pay period where no major bills are due. I was planning on getting my car work done, getting a haircut, renewing Kirby's yearly HomeAgain membership, and paying my yearly car tax during that period. But, it looks like now I'll be paying vet bills instead. If I have to pay for another visit plus blood work in 2 more weeks, then I just can't do it. I'll simply have to take my chances on her recovering on her own with no veterinary supervision. If the test results come back showing lymphoma, then I guess she'll only have a couple more months to live and I'll have to live with the fact that my cat died unnecessarily simply because I'm too poor to pay for her care.
In the end, I signed the statement authorizing them to charge my debit card on Oct. 7 but I doubt I'll even be able to afford it then. I plan to email Janice on Tuesday to see what the future of Kia's care looks like, but I'm not feeling very optimistic at all. That whole exchange pretty much ruined my entire weekend. I called my mom on my way home just to vent my frustrations. I feel like nobody understands just how dire my financial situation is right now and even if they did, they wouldn't care. I'm sure I'm not the only person with this problem, but it certainly feels like it (especially when I read all those Facebook posts about people going shopping, taking exotic vacations, and buying all sorts or luxury items). And then there's the whole separate issue of that douchenozzle from M&T bank accusing me of causing damage to his car (which I did NOT!!) and forcing me to report it to my insurance company, thinking they would actually go to bat for me and put a-holes like him in his place, but instead they just cut him a nice, fat check and went on with their next case (after raising my monthly rates, of course). Basically, they just sponsored a night out at the nearest rooftop bar for him and his friends. It pisses me off so much that there are people like him in this world who just act like bullies and expect people to give them their way. Then there are people like me who are honest and work hard for every cent they earn but can't even afford to keep their pets alive. What the hell is wrong with the world? When does good actually triumph over evil? Will people ever understand (or care) that their actions DO affect others? Will there ever come a day when I can afford more than just the bare essentials? I'm starting to seriously doubt it. I used to be optimistic that things would turn around for me one day, but that day never happened so I've had to take some pretty drastic measures just to survive. I'm tired of keeping my hopes up only to be disappointed. I'm so broke, I can't even afford optimism anymore.
Thursday, August 25, 2011
Update on Kia: New Fork in the Road
Kia will be one week post-procedure tomorrow. She's been doing extremely well since I brought her home last Friday night. She's eating constantly (and driving me crazy by waking me up at all hours of the night, asking for more food). The prednisolone seems to be doing its job. She's keeping everything down with the exception of Sunday afternoon and yesterday afternoon, when she stole food from my plate while I wasn't looking. That all came right back up. But, she immediately resumed eating her special kitty food and that stayed down just fine. It's a lot of extra work grinding up her pills into powder and mixing her food up into a pate-like consistency. Her food is very expensive, too. I went from spending 50 cents a can to $2.39 a can and will likely have to keep doing that for the rest of her life. But, of course she's worth every bit of it. I'm thankful every single day that she's still here with me, and I waste no opportunities to tell her so.
The vet from VIMP called me yesterday with her biopsy results, saying they were "interesting." Apparently, everything in her stomach was unremarkable but her intestines showed some inflammation of her lymphocytes. From the looks of things, she appears to have Inflammatory Bowel Disease, which could be what caused her to vomit violently enough to form a stricture in her esophagus. So, there's at least one more piece to this mystery puzzle. However...IBD and intestinal lymphoma look the same under a microscope. The only way to tell them apart is by a phenotype test where they stain the sample with a special dye and check to see if there's many of the same cell (lymphoma) or a bunch of different cells (IBD). Well, that test costs $500. HSFC has already invested several thousand dollars into her care, so what are the chances of them paying for yet another diagnostic test?
Well, VIMP called them to ask them that very question and called me back later with the answer. They said yes, they would cover it... HOWEVER... since they've spent so much money on her in such a short period of time, this would likely be the end of them covering her expenses. Another option VIMP presented me with was foregoing the test and just treating her for lymphoma anyway. This involves a powerful chemotherapy drug which, while inexpensive in and of itself, would require constant monitoring of her red cell count and frequent visits to the vet to keep an eye on her condition during the course of treatment. So, either way, it would add up to a lot of money for the entity paying for it. A third option would be to not do anything and just gamble on the fact that it's probably just IBD and not lymphoma. I'm not much of a gambler, especially when the health and well-being of my animals is involved. If it were my money and price were no object, I would choose to have the type test done. But, I need to be sensitive to the fact that this is not my money and, if done, would leave me with very few options if the results were bad. Therein lies my dilemma. The downside to all of this is that she almost definitely will need further treatments in the future, whether to re-dilate her esophagus or to monitor her blood work or even just to make sure she's still doing OK on her new diet and not losing any more weight. I'm not banking on getting much more funding from HSFC, so I'm not sure what's going to happen if and when this further treatment is required. It's highly unlikely I'll be able to afford it myself.
So for the last day or so, I've been weighing the pros and cons of each option. Do I go for the definitive answer that spells the end of my financial assistance, do I play it safe by going for the less expensive treatment and put her through a round of chemotherapy that she may not even need, or do I do nothing and risk it coming back to haunt me later if it turns out she does have lymphoma? I traded calls and visits with vets all afternoon and evening, trying to figure out what to do. I even emailed Janice this morning to ask her advice as someone who's footing the bill for all of this. I was leaning towards doing nothing because my gut instinct is telling me it's not cancer, but I know I will second guess myself every single day. Well, Janice called me this afternoon and told me she had already authorized the type test. She also said she didn't mean for it to come out sounding like they wouldn't do anything to help me in the future, but that they would just need to give it very careful consideration from here on out. She asked me Kia's age and about her general health, probably as a guidance point for their higher-ups. I told her she had just turned 11 a few months ago and had been the epitome of health up to this point. She never went to the vet except for her yearly dental and had never been on any medications, except for maybe 2 times (once when she had a roundworm infestation as a kitten and the other when my parents' cat scratched her on the eyeball back in 2007).
So, it looks like we're getting the definitive answer after all, although I can't even think about what would happen if the results come back positive for lymphoma. I can only take it one day at a time right now. It's been a crazy freakin' week already, between Kia's surgery on Friday, the earthquake on Tuesday (and subsequent aftershocks!) and now the impending hurricane, which forced us to cancel our 60-person camping trip at the beach this weekend. The silver lining to all that is that I no longer have to leave Kia home all weekend, plus I get my $40 deposit back, which I can put towards her food or my yet-outstanding medical bills. It's still horribly disappointing, since I was definitely looking for a chance to get away for a couple days and this trip was sure to be an awesome time. But, we're still having a hurricane-themed party/BBQ on Saturday and, for God's sake, I still have Kia here with me! That alone is enough to let me see the silver lining in all of this!
The vet from VIMP called me yesterday with her biopsy results, saying they were "interesting." Apparently, everything in her stomach was unremarkable but her intestines showed some inflammation of her lymphocytes. From the looks of things, she appears to have Inflammatory Bowel Disease, which could be what caused her to vomit violently enough to form a stricture in her esophagus. So, there's at least one more piece to this mystery puzzle. However...IBD and intestinal lymphoma look the same under a microscope. The only way to tell them apart is by a phenotype test where they stain the sample with a special dye and check to see if there's many of the same cell (lymphoma) or a bunch of different cells (IBD). Well, that test costs $500. HSFC has already invested several thousand dollars into her care, so what are the chances of them paying for yet another diagnostic test?
Well, VIMP called them to ask them that very question and called me back later with the answer. They said yes, they would cover it... HOWEVER... since they've spent so much money on her in such a short period of time, this would likely be the end of them covering her expenses. Another option VIMP presented me with was foregoing the test and just treating her for lymphoma anyway. This involves a powerful chemotherapy drug which, while inexpensive in and of itself, would require constant monitoring of her red cell count and frequent visits to the vet to keep an eye on her condition during the course of treatment. So, either way, it would add up to a lot of money for the entity paying for it. A third option would be to not do anything and just gamble on the fact that it's probably just IBD and not lymphoma. I'm not much of a gambler, especially when the health and well-being of my animals is involved. If it were my money and price were no object, I would choose to have the type test done. But, I need to be sensitive to the fact that this is not my money and, if done, would leave me with very few options if the results were bad. Therein lies my dilemma. The downside to all of this is that she almost definitely will need further treatments in the future, whether to re-dilate her esophagus or to monitor her blood work or even just to make sure she's still doing OK on her new diet and not losing any more weight. I'm not banking on getting much more funding from HSFC, so I'm not sure what's going to happen if and when this further treatment is required. It's highly unlikely I'll be able to afford it myself.
So for the last day or so, I've been weighing the pros and cons of each option. Do I go for the definitive answer that spells the end of my financial assistance, do I play it safe by going for the less expensive treatment and put her through a round of chemotherapy that she may not even need, or do I do nothing and risk it coming back to haunt me later if it turns out she does have lymphoma? I traded calls and visits with vets all afternoon and evening, trying to figure out what to do. I even emailed Janice this morning to ask her advice as someone who's footing the bill for all of this. I was leaning towards doing nothing because my gut instinct is telling me it's not cancer, but I know I will second guess myself every single day. Well, Janice called me this afternoon and told me she had already authorized the type test. She also said she didn't mean for it to come out sounding like they wouldn't do anything to help me in the future, but that they would just need to give it very careful consideration from here on out. She asked me Kia's age and about her general health, probably as a guidance point for their higher-ups. I told her she had just turned 11 a few months ago and had been the epitome of health up to this point. She never went to the vet except for her yearly dental and had never been on any medications, except for maybe 2 times (once when she had a roundworm infestation as a kitten and the other when my parents' cat scratched her on the eyeball back in 2007).
So, it looks like we're getting the definitive answer after all, although I can't even think about what would happen if the results come back positive for lymphoma. I can only take it one day at a time right now. It's been a crazy freakin' week already, between Kia's surgery on Friday, the earthquake on Tuesday (and subsequent aftershocks!) and now the impending hurricane, which forced us to cancel our 60-person camping trip at the beach this weekend. The silver lining to all that is that I no longer have to leave Kia home all weekend, plus I get my $40 deposit back, which I can put towards her food or my yet-outstanding medical bills. It's still horribly disappointing, since I was definitely looking for a chance to get away for a couple days and this trip was sure to be an awesome time. But, we're still having a hurricane-themed party/BBQ on Saturday and, for God's sake, I still have Kia here with me! That alone is enough to let me see the silver lining in all of this!
Saturday, August 20, 2011
La Kia Mia: A Kitty's Road to Recovery From the One-Way Street of Death
I have so much to be thankful for right now. I know I haven't written in a while. I tend to be very good at keeping myself busy, going out, and having a life. It's something I didn't do much of in Ohio, so I like to take advantage of having that opportunity nowadays. The last 3 weeks, however, has been one of the most intense, trying periods of my life. Saturday, July 30, 2011 was just like any other day. I fed my girls their dinner, then went out to a pub crawl in Petworth (hmm..."Pet"worth. Foreshadowing, perhaps?), had a raucously good time, came home in the wee hours of the morning and crashed in my bed with my girls at my side. By the time I woke up on Sunday morning, everything had changed.
I took Kirby out for her morning potty walk. Kia always meets us at the front door when we come back in, usually whining for her breakfast, which she knows is the next thing on my To-Do list. But, that morning, she didn't. It was unusual, but not overly alarming. When I went to put Kia's bowl in her usual eating spot, I saw a long, thick tube of regurgitated food and hair laying in its place. It was quite a bit bigger than her normal regurgitations and looked like she'd coughed up a pretty nasty hairball. Again, unusual but not overly alarming. When she didn't come out to eat her breakfast, I figured she was probably just sick. When she didn't meet us at the door for her dinner, either, it became pretty apparent that that's what was going on. She was also acting very lethargic and uninterested in food in general. I told myself I'd give her a couple days to get over it on her own, and if she wasn't better by Tuesday, I'd call the vet.
Let me take a minute to explain something about veterinary care here in Virginia: It's ridiculously expensive. No, I mean *ridiculously* expensive! Back in Ohio, Kia got spayed for less than $70. Annual vaccinations are around $25, and I get her yearly dental prophylaxis for around $100. I looked into pet insurance once and realized I'd be paying more for the insurance premium than the actual cost of vet care. (And the problem with pet insurance is that it's not really insurance so much as it is a reimbursement program, so you have to be able to front the money in the first place.) Well, that's not the case in Virginia. An office visit alone is $50, dentals are easily $300-500 and surgery is...fuhgeddaboutit. It's like you have to belong to an exclusive top-tier income bracket just to have a healthy pet. I can't afford any of that on my meager salary, so I just take them back to Ohio for all their veterinary care that isn't an immediate need. Another problem is that I'm currently in voice therapy with a Speech Language Pathologist and had recently been to the ER for a tendon injury, so all of my money lately has been going towards doctor's bills and co-pays and gas money to drive myself to and from all these appointments. Needless to say, I'm stretched thinner than ever now. Since I had just spent the vast majority of my recent paycheck on rent and barely had enough left over for gas and groceries (and I had to do some careful planning and pre-gaming in order to go to the pub crawl on Saturday without spending any money), you can understand my hesitation to pay for a vet appointment if she was just going to get over it on her own in a couple days.
So anyway, I gave her a deadline of Tuesday before calling the vet. Well, Tuesday rolled around and she still wasn't any better. Her appetite had returned, but she would get a few mouthfuls of food down before it all came back up again. She couldn’t even keep water down. Plus, she was making this weird gurgly, burpy sound when she ate, kind of like someone swishing water around in their mouth while gargling. I decided at that point that something was seriously wrong with her and I needed to call the vet. On top of that, I had developed a bad respiratory infection and had to have my mom (who’s a nurse) call some antibiotics into my pharmacy, which ended up being $18 that I wasn’t planning on spending. I felt like hell so I called in sick to work, then called Banfield and told them about Kia. They offered me an appointment that afternoon, but I explained to them that I had $47 in checking and the cost of their office visit alone was $48.95, plus any medications given would be extra. They offered me a coupon for a free office visit, so I took it. They did an exam on her and noted she was slightly dehydrated and said there could possibly be a number of things wrong with her. It could be the early stages of renal failure (which I had just lost Aria to not quite a year and a half ago), thyroid, liver, diabetes, gastrointestinal disease, or any number of other things. They also said that something they don’t see a lot of but is still a possibility is intestinal lymphoma. Basically, nothing good. They recommended a complete urinalysis and chemistry panel in order to rule out things like kidneys, liver, thyroid, and diabetes. Well, the cost of that was around $400, which was not even within the realm of possibilities. There were also X-rays they could do to rule out any sort of intestinal blockage at about $200 per image. I told them there was just no way I could do that unless they offered some kind of payment plan, which would be stretching my income even thinner than it already was. Since they don’t offer payment plans, they gave her some subcutaneous fluids and a shot of Pepcid, in case it was due to excess acid in her stomach, and sent me home with some after care instructions. They only charged me for the Pepcid and fluids, which came to $25, but I had also spent $18 on my antibiotics, so I was now down to $4 in checking and I didn’t get paid for another 10 days. (To make matters worse, I found out that day that my bank was doing away with free checking accounts and was going to start charging a monthly fee of $7 for checking and $5 for debit card usage. I called them just to rant and point out that if they deducted that amount from me today, it would overdraw my account.)
That afternoon, I called around to several vet places to see if any of them offered payment plans for things like blood work or X-rays. None of them did. I called my vet in Ohio and found out they could do the same blood work for $130. It was better than $400 here, but still more than I had at the moment, and of course there’s the issue of buying gas to make the 8-hour drive up there. Meanwhile, she’s still vomiting up everything and we’re losing precious time. The more calls I made, the more it became apparent that my cat would most likely die because I can’t afford to get her the care she needs. Wednesday morning, I spent a large amount of time crying in the bathroom at work out of frustration. I tried applying for Care Credit, but of course was rejected due to my less-than-stellar credit rating. When Banfield called to follow up on her that afternoon, I begged and pleaded with them again to help me out. They said to call the Humane Society of Fairfax County because they have a program where they cover the cost of vet care for people who can’t afford it. I called HSFC and left a tearful message on the office manager’s voicemail. She got back to me that afternoon and emailed me a release form to sign, stating I do not hold them responsible for anything that could go wrong during the course of treatment, etc. I was hesitant to sign it at first because, technically, I’m not supposed to have Kia. My apartment has a 2-pet limit (which is already maxed out between my dog and my roommate’s dog), so if they found out about Kia, I would either have to give her back to my parents (where she’d get terrorized and beaten up regularly by the same cat that bullied her every day until we moved) or I’d have to pay another $25/month in pet fees, which is even more money I don’t have. In the end, I signed it and prayed they wouldn’t dig any deeper. By the end of the day, the office manager called and told me they had agreed to cover the cost of her appointment and blood work and all I had to do was call the vet they were sending me to and set it up. I called the vet right away and made the appointment for that night at 6:30. The vet was in Centreville, which could take a while to get to during evening rush hour. I left work at 5, went straight home to let Kirby out and feed her and put Kia in her carrier to make the 12-mile drive, which took almost an hour in traffic. That place (Caring Hands Animal Hospital) was very nice. Kia’s an excellent patient to begin with but they were very kind and gentle with her. They got her blood drawn, took her in the back for some X-rays, gave her some more subQ fluids, and even tried feeding her a minute amount to see if she’d eat. She did, but it wasn’t enough to convince me something wasn’t seriously wrong with her. I even showed them the video on my phone of her eating and then making that weird sound before barfing everything back up. No one seemed quite sure what to make of it. Her blood work came back completely normal, so that was a bit of good news. They got the X-rays developed and said everything looked normal except there seemed to be a large amount of undigested food in her stomach for a cat who was barely eating, and there was also a fair amount of gas in there. They wondered if there was something wrong with her digestive system that made her unable to move food through it very quickly. They decided to have her fast for the rest of the night, then bring her back in the morning for some follow up X-rays to see if anything had moved through. I didn’t get home until 9 that night and had to wake up at 6 so I could drop her off in Centreville at 7:30 and make it back to work in time during the morning rush hour. When I went to pick her up that night, her X-rays showed that the food had moved through her stomach and everything seemed to be OK. The vet brought up the possibility of it being Inflammatory Bowel Disease, which can develop in older cats and causes vomiting. She also brought up the possibility that it could be intestinal lymphoma, which presents with the same symptoms as IBD and can be very hard to distinguish from it. She sent me home with a bland diet of Hill’s i/d to see if that calmed down her stomach. I gave it to her that night and she seemed very interested in eating it and even kept a few mouthfuls down. I was very grateful. I sent the HSFC a thank you card, telling them how much I appreciated their helping me get the vet care she needed. It really seemed like the worst was behind us.
After a couple days of bland food, Kia resumed vomiting everything back up again. She had continued making that noise when eating and could only seem to eat a few mouthfuls at a time, but was at least making an effort. Now, no amount of effort she made could help her keep anything down long enough to digest it. It was agonizing to watch. I called Caring Hands and told them things weren’t getting any better. I wasn’t sure if the HSFC would cover any more follow up visits. I emailed Janice (the HSFC office manager) and told her the situation and asked what my options were. They agreed to send her back for another appointment at Caring Hands. Dr. Nagy examined her again and said it could possibly be a food allergy. She gave me a hypoallergenic food to try. She also said they could possibly do an ultrasound on her to check for any blockages the X-rays may have missed, or to see if the thickness of her intestinal lining had changed due to IBD. The cost of an ultrasound was between $600-$800. I didn’t think there was much chance of getting the HSFC to cover that, but Caring Hands said they could talk to them and see if they would. Meanwhile, we tried the hypoallergenic food and the same thing happened: a couple mouthfuls into her meal, it came right back up. That noise she was making was very disturbing. It sounded like there was something caught in her throat that made her physically unable to swallow anything. I wondered if she had a hairball stuck (like a residual piece of that barf pile I cleaned up the day the whole problem started) or had eaten a toy or some other small object. My untrained and unprofessional opinion was that something was physically precluding her from being able to swallow food.
I called Caring Hands again the next morning and said she still wasn’t able to hold anything down. By this time, it had been almost 11 days since her last full meal. She was already down a half pound since her appointment at Banfield, which doesn’t sound like much, but on a 6-lb cat, that’s a huge difference in one week. They spoke to HSFC, who spoke to me, who spoke to an internal medicine specialist, etc. Amazingly, they agreed to cover the cost of an ultrasound for her at the Veterinary Internal Medicine Practice in Manassas. I scheduled it for the following Tuesday, August 16 at 2 pm. It was a 3-hour appointment, so I had to miss a whole afternoon of work and gradually make that time up in 1-hour increments over the rest of the week. Tuesday rolled around and I put her in her little carrier and made the 20-mile drive out to Manassas. She had to be fasting for 12 hours before her ultrasound, so I hadn’t been able to feed her anything for breakfast. It was torture hearing her cry, knowing she was starving but not being able to give her even a morsel (not that she could hold it down anyway). At the vet, they did another exam on her and asked me to elaborate on what’s been going on. It was now 2 and half weeks since she’d been able to eat normally. She obviously wants to eat but vomits within 30 seconds of swallowing anything. They weighed her and she was down another half pound. She had lost nearly 20% of her body weight in 17 days. From the looks of things, she was slowly but surely wasting away. It was agonizing to watch.
They took her to the back for the ultrasound and told me I could either hang out in the waiting room or leave and come back in an hour. I chose to go grab lunch at Subway, since it was almost 3 and I hadn’t eaten anything yet. (I actually hadn’t been able to eat much since this whole problem started. My mental state was: if Kia can’t eat, I don’t deserve to eat until I can fix her.) When I got back, they took a minute to type up the report, then went over it with me. Overall, things looked relatively normal. They noted again a lot of gas in her stomach and said her mesenteric lymph nodes were slightly enlarged. The most surprising thing to me was a tiny nodule in her liver, measuring just over half a centimeter in diameter. They explained those happen and it’s most likely benign and unrelated to her vomiting. Basically, there was no obvious cause of her condition, so they suspected it was due to diffuse GI disease and recommended an endoscopy with biopsies of her stomach and intestinal lining. Well, the cost of that would be $1300-$1500. I felt like I was lucky enough to get this far on HSFC’s dime, so I had serious doubts they would cover such an expensive test, especially since everything else had come back normal. VIMP said if cost was an issue, we could try just treating her with steroids and see if it helps. If it does, then the problem is most likely inflammatory (like IBD or lymphoma, although biopsy would really be necessary to know which). They agreed to fax their findings over to Caring Hands, who would talk to HSFC to see what they would cover, and in the meantime give her more subQ fluids and a steroid injection. They told me to keep her on the bland/hypoallergenic diet and that I could feed her a small snack when I got home but to give her a minute first to rest and recuperate.
I got her home around 5:30. Immediately, she shot out of her carrier and ran over to her empty food bowl then gave me a look like “You’re still not feeding me? WTF!?” I took Kirby for a short walk to give Kia a minute to rest, and when I came back in I fed her a piece of leftover turkey from my sub, since the vet said that would be OK to give her. She scarfed it down, even biting my finger in the process. Of course, it came back up. She was so starved, though, that she tried re-eating it. It came back up. She continued vomiting even after everything was out. Then, she started burping up all this white foam, choking and gasping for air and writhing around on the floor. Her lungs were making gurgling sounds. I had no idea what to do. I tried patting her back, rubbing her throat, even holding her upside down to drain the vomit out of her lungs. Finally, I called VIMP. They asked if I could drive her back to Manassas in time but I knew I couldn’t. Her eyes were huge and dilated like a person dying of asphyxiation. My cell phone dropped the call, so I just stuck her in her carrier began driving over to Banfield. The whole time, she continued burping/gargling, and gasping with wide eyes. She kept rolling around in her carrier, trying to find a position she could breathe in. At one point, I thought I heard an ambulance siren approaching in the distance, but it was actually her lungs whistling like a tea kettle. I just started crying out to Jesus to please help her and save her. I honestly thought she was going to die right next to me in the car. I got to Banfield and rushed her up to the counter, yelling “Help! She can’t breathe! She’s choking!” They took her back and started working on her while I paced the waiting area and prayed over and over. I have no idea how many minutes later, but a vet came outside and told me she was stable. Her lungs were wheezy sounding, so she probably had aspirated some vomit, but she was OK now. They gave her fluids, another Pepcid injection, and an anti-vomiting injection and told me not to feed her anything else tonight to give her a chance to stop vomiting. Again, they didn’t charge me for the office visit, so the bill for the injections came to just under $50, which was the money I had set aside for my outstanding medical bills that month. So much for paying anything on those for a while.
I took her home and was too traumatized to even eat anything for dinner. I knew I wouldn’t be able to sleep at all that night and there was no way I could make it in to work the next day. This whole situation was making me physically ill. I was quickly getting to the point where, if she was fixable, she needed to start getting better, but if not, she needed to hurry up so I could start the grieving process rather than continuing to watch her suffer. There was also the issue of the upcoming camping trip in 10 days. I didn’t want to leave my roommate with a dying cat. And, if she was going to die, I wondered if I should go on the trip at all. I’d already paid for my spot 4 months ago, but maybe I needed to stay home and spend Kia's last few days with her.
I stayed home from work again the next day to give myself a chance to recover mentally, and I started making some phone calls. First I called Caring Hands to tell them what had happened. They asked if I could bring Kia in for a follow up that day. They also mentioned, if HSFC doesn’t cover the cost of the endoscopy, I could take her down to Virginia Tech, where it would be much cheaper. I called VT and found out they could do the whole procedure for $500-$800, and they also offer in-house financing for people unable to pay the full cost up front. I called my vet in Ohio and asked how much they would charge. I found out they could do the endoscopy for $150, but are unable to do any biopsies in their office. For that, they would have to send me to OSU. I called OSU. The cost of an endoscopy w/ biopsy was the same there as it is here, and they don’t offer financing. So, my best option seemed to be to take her to VT. I’d have to take even more time off work and would be making payments for about 10 years, but I was willing to do anything to save my kitty’s life.
When I got to Caring Hands for her appointment, I told the vet all of this. She said that, while it might help for my vet in Ohio to do the scope, it would only be for exploratory purposes in the event there’s an obstruction the X-rays and ultrasound didn’t pick up (which was highly unlikely). Since she believed we were dealing with diffuse GI disease, Kia really needed to have the biopsies done. The fact that she was vomiting right through the anti-vomiting drugs they’d given her at Banfield was a bad, bad sign. She said she would talk with HSFC to let them know the situation and hope for the best, fingers crossed. She gave her more subQ fluids, another steroid injection, and told me to keep trying to feed her the bland and hypoallergenic food.
At dinner, I tried feeding her just 2 pieces of the dry food, just to see if she held that much down. She did. So I waited 5 minutes and fed her 2 more pieces. Those seemed to stay down as well. I waited a few more minutes and gave her a tiny handful of about 10. Everything came back up. Clearly she could only eat food in the tiniest increments. What was I supposed to do if we couldn’t get her fixed? Quit my job so I could feed her 1 or 2 pieces of dry food every 5 minutes over the course of a day? This cat was quickly running out of options.
The next day, I heard from the vet at Caring Hands. She had just talked to HSFC and they were considering covering the cost of the endoscopy. Since it’s such an expensive test, they had to consult their higher-ups first, but they’d let me know as soon as possible. By that afternoon, I heard from her again, saying they had agreed to pay for it. I called VIMP just as they were hanging up from talking with Janice, and they set it up for the next morning. I had to drop her off in Manassas between 7 and 8 am and she was the first patient of the day so she would be put under right around 9. This was Kia’s last chance for survival. If they couldn’t figure out the problem, she was basically doomed to die of starvation.
That night, she lay next to me in bed with her head in my hand (as she tends to do when she falls asleep while I’m rubbing her). I listened to her purr and thought about how we met 11 years ago. She came up to me while I was car shopping at a used car lot and screamed at me until I picked her up. She was 4 months old and covered in mats, burrs, dirt, fleas and had a bad case of roundworms in her tummy, and she wouldn’t let me leave without her. I’d never had a cat so blatantly pick me out of a crowd and demand that I adopt them. In fact, I didn't adopt her; she adopted me. She chose me to be her mommy and we belong together. I still grieve over Aria every day. I can’t lose Kia, too. It’s too soon say good-bye. Not now, not like this.
Of course, she had to be fasting for her surgery, so I couldn’t feed her breakfast once again. I fed Kirby her food and Kia had her face in the bowl, trying to get to it, which she has never done before. That poor cat was just desperate for any sort of nourishment. She was even up on the counter while I was putting food in Kirby’s bowl. I had to keep moving it away from her and I felt awful about it. At VIMP, I held her, kissed her, and wished her good luck. I said good-bye to her as they took her into the back, wondering if perhaps it would be the last time I ever saw her alive. I had no idea what they would find in there once she was under anesthesia, but I was not getting a good feeling at all. I prayed hard but didn’t feel like God was going to heal her this time. I felt like this was it. I called my mom on my way in to work after leaving VIMP and tried to work out a “what if” plan. For instance, if they look in her stomach and find she’s riddled with cancer and there’s nothing they can do, should I have them put her down right there while she’s unconscious, or should I let her at least have a fighting chance for a miraculous healing? What if she dies while I’m away at the camping trip? Maybe I should have my parents take her so I don’t have to leave my roommate with a doomed animal. I kept telling my mom how I did not have a good feeling at all, and she said she didn’t either, which was a really bad sign. Usually, my mom is the first to sense when things will be OK.
I arrived at work early and sat in my car for a while, crying and praying for everything to go well and for them to at least find an answer, even if they couldn’t fix it. As I prayed, I began to feel more of a sense of peace. Except it wasn’t so much peace, but more like acceptance. I was beginning to accept the fact that things were going to happen the way they were meant to. I had no idea what to expect, though. For a second, I felt like God was telling me the news wouldn’t be good, but wouldn’t be fatal either. But, I pushed it out of my head because I didn’t want to get my hopes up.
I kept my cell phone in my pocket at work and tried hard to keep my mind busy, even though I felt like I could throw up any moment. Just before 10, my phone rang. My heart jumped, thinking that if they’re calling already, something had to have gone wrong, like she just died on the table. But, it was just the vet saying they were running a little behind and would be getting started soon. They had also repeated her ultrasound and blood work and everything still appeared normal. When I hung up, my hands were shaking. About an hour later, the phone rang again. It was the vet saying he’d found the problem already: she had a stricture, or narrowing, of her esophagus caused by a buildup of scar tissue. A normal cat’s esophagus is about 2 cm in diameter, and hers had narrowed to about 2-3 mm, which is why she couldn’t get any food through it and was vomiting everything back up. He couldn’t even get the scope down past it. He said those things can be tricky to treat because the natural tendency of the esophagus is to scar up again even after dilation therapy. He said he’d go back in with a Foley catheter and try to dilate it a little but it would likely require several subsequent dilations over a period of time before it would be fully open again, if it ever did get fully open again. When I hung up, I couldn’t tell if I was relieved or what. I wasn’t sure what it meant going forward or what her long term prognosis was, but at least we knew it wasn’t cancer or some other disease that couldn’t be treated. I think I was mostly just glad to finally have an answer.
Less than an hour after I hung up with the vet, he called back again. He said he’d gone back in with the Foley cath and managed to get it in past the stricture, which was very difficult. They inflated the balloon slightly a few times and began the dilation process. After a few conservative attempts, they inflated the balloon a little more, at which point the scar tissue completely broke down and the stricture opened up entirely, revealing a normal-looking esophagus underneath. They were able to pass the scope all the way through into her stomach and obtained several biopsies, despite everything looking normal. It was truly a miracle! Only then did I really begin to feel like things would be OK. Of course, she’s not out of the woods yet, as there’s always a chance the stricture could come back. And there’s the added question of: how did it get there? It could be congenital, it could be caustic, it could be from a violent vomiting incident (which may be due to diffuse gastrointestinal disease), or maybe just a fluke. I told him about the large tube of vomit I’d cleaned up the day this whole thing started and he found that very interesting. Maybe she’d thrown up so violently, she damaged her esophagus and caused scar tissue to form around it. And maybe she’s throwing up that violently because she has GI disease, or maybe it was a nasty hairball, or maybe something else. We won’t know until the biopsies come back next week, and in the meantime we have to keep her on a bland, liquid food diet, give her steroids to prevent the scar tissue from reforming, and keep giving her pepcid and sucralfate to protect the lining of her stomach and intestines. If the results come back negative for any disease, I can switch her back to regular food after 3 weeks or so. We discussed all that when I picked up her after work. She was groggy and irritated with the staff, but looked good otherwise. They told me I could feed her a small meal of blenderized z/d that night, but not to overfeed her in case she was still nauseated from the anesthesia. I could begin crushing up all her pills and mixing them with water tomorrow, since she can’t have anything hard or solid. The vet showed me before and after pictures of her stricture and said that, even though he doesn’t see those too often, he had never seen one just completely break away like that. It was amazing! My cat is a walking, purring miracle!
I got her home around 7:30 and, once again, she tore from her carrier straight over to her (still empty) food bowl. I waited a minute or two before mixing up her meal. While I was mixing it, she jumped back up on the counter again and had her face all up in it. I crossed my fingers and held my breath as I watched her eat, praying it would stay down. She swallowed hard a few times, but it never came back up! I even got her sucralfate down without it coming back up. This morning, I fed her a much larger meal and it also stayed down. When I fed her her watery meds, those stayed down, too, and as far as I know are still down. It’s been 3 weeks, but her tummy is finally full again! I know it’s still very early and there’s still biopsy results pending, but her recovery seems to be going well so far. Just the fact that she’s able to eat again is a huge relief. Honestly, the surgery could not have gone any better. I thought for sure it would be the beginning of the end. Just a couple days ago, I was picking out a shoe box to bury her in. Now, it looks like she just might be OK! I’m so thankful for all the doctors, vet techs, friends, and family who prayed for us, and people from the HSFC who gave her the chance to get treated in the first place! Without any of them, she certainly would have starved to death. I’m so thankful for my kitty being given a second chance at life and I’ll never forget all the people who allowed it to happen! I have so much to be thankful for!
I took Kirby out for her morning potty walk. Kia always meets us at the front door when we come back in, usually whining for her breakfast, which she knows is the next thing on my To-Do list. But, that morning, she didn't. It was unusual, but not overly alarming. When I went to put Kia's bowl in her usual eating spot, I saw a long, thick tube of regurgitated food and hair laying in its place. It was quite a bit bigger than her normal regurgitations and looked like she'd coughed up a pretty nasty hairball. Again, unusual but not overly alarming. When she didn't come out to eat her breakfast, I figured she was probably just sick. When she didn't meet us at the door for her dinner, either, it became pretty apparent that that's what was going on. She was also acting very lethargic and uninterested in food in general. I told myself I'd give her a couple days to get over it on her own, and if she wasn't better by Tuesday, I'd call the vet.
Let me take a minute to explain something about veterinary care here in Virginia: It's ridiculously expensive. No, I mean *ridiculously* expensive! Back in Ohio, Kia got spayed for less than $70. Annual vaccinations are around $25, and I get her yearly dental prophylaxis for around $100. I looked into pet insurance once and realized I'd be paying more for the insurance premium than the actual cost of vet care. (And the problem with pet insurance is that it's not really insurance so much as it is a reimbursement program, so you have to be able to front the money in the first place.) Well, that's not the case in Virginia. An office visit alone is $50, dentals are easily $300-500 and surgery is...fuhgeddaboutit. It's like you have to belong to an exclusive top-tier income bracket just to have a healthy pet. I can't afford any of that on my meager salary, so I just take them back to Ohio for all their veterinary care that isn't an immediate need. Another problem is that I'm currently in voice therapy with a Speech Language Pathologist and had recently been to the ER for a tendon injury, so all of my money lately has been going towards doctor's bills and co-pays and gas money to drive myself to and from all these appointments. Needless to say, I'm stretched thinner than ever now. Since I had just spent the vast majority of my recent paycheck on rent and barely had enough left over for gas and groceries (and I had to do some careful planning and pre-gaming in order to go to the pub crawl on Saturday without spending any money), you can understand my hesitation to pay for a vet appointment if she was just going to get over it on her own in a couple days.
So anyway, I gave her a deadline of Tuesday before calling the vet. Well, Tuesday rolled around and she still wasn't any better. Her appetite had returned, but she would get a few mouthfuls of food down before it all came back up again. She couldn’t even keep water down. Plus, she was making this weird gurgly, burpy sound when she ate, kind of like someone swishing water around in their mouth while gargling. I decided at that point that something was seriously wrong with her and I needed to call the vet. On top of that, I had developed a bad respiratory infection and had to have my mom (who’s a nurse) call some antibiotics into my pharmacy, which ended up being $18 that I wasn’t planning on spending. I felt like hell so I called in sick to work, then called Banfield and told them about Kia. They offered me an appointment that afternoon, but I explained to them that I had $47 in checking and the cost of their office visit alone was $48.95, plus any medications given would be extra. They offered me a coupon for a free office visit, so I took it. They did an exam on her and noted she was slightly dehydrated and said there could possibly be a number of things wrong with her. It could be the early stages of renal failure (which I had just lost Aria to not quite a year and a half ago), thyroid, liver, diabetes, gastrointestinal disease, or any number of other things. They also said that something they don’t see a lot of but is still a possibility is intestinal lymphoma. Basically, nothing good. They recommended a complete urinalysis and chemistry panel in order to rule out things like kidneys, liver, thyroid, and diabetes. Well, the cost of that was around $400, which was not even within the realm of possibilities. There were also X-rays they could do to rule out any sort of intestinal blockage at about $200 per image. I told them there was just no way I could do that unless they offered some kind of payment plan, which would be stretching my income even thinner than it already was. Since they don’t offer payment plans, they gave her some subcutaneous fluids and a shot of Pepcid, in case it was due to excess acid in her stomach, and sent me home with some after care instructions. They only charged me for the Pepcid and fluids, which came to $25, but I had also spent $18 on my antibiotics, so I was now down to $4 in checking and I didn’t get paid for another 10 days. (To make matters worse, I found out that day that my bank was doing away with free checking accounts and was going to start charging a monthly fee of $7 for checking and $5 for debit card usage. I called them just to rant and point out that if they deducted that amount from me today, it would overdraw my account.)
That afternoon, I called around to several vet places to see if any of them offered payment plans for things like blood work or X-rays. None of them did. I called my vet in Ohio and found out they could do the same blood work for $130. It was better than $400 here, but still more than I had at the moment, and of course there’s the issue of buying gas to make the 8-hour drive up there. Meanwhile, she’s still vomiting up everything and we’re losing precious time. The more calls I made, the more it became apparent that my cat would most likely die because I can’t afford to get her the care she needs. Wednesday morning, I spent a large amount of time crying in the bathroom at work out of frustration. I tried applying for Care Credit, but of course was rejected due to my less-than-stellar credit rating. When Banfield called to follow up on her that afternoon, I begged and pleaded with them again to help me out. They said to call the Humane Society of Fairfax County because they have a program where they cover the cost of vet care for people who can’t afford it. I called HSFC and left a tearful message on the office manager’s voicemail. She got back to me that afternoon and emailed me a release form to sign, stating I do not hold them responsible for anything that could go wrong during the course of treatment, etc. I was hesitant to sign it at first because, technically, I’m not supposed to have Kia. My apartment has a 2-pet limit (which is already maxed out between my dog and my roommate’s dog), so if they found out about Kia, I would either have to give her back to my parents (where she’d get terrorized and beaten up regularly by the same cat that bullied her every day until we moved) or I’d have to pay another $25/month in pet fees, which is even more money I don’t have. In the end, I signed it and prayed they wouldn’t dig any deeper. By the end of the day, the office manager called and told me they had agreed to cover the cost of her appointment and blood work and all I had to do was call the vet they were sending me to and set it up. I called the vet right away and made the appointment for that night at 6:30. The vet was in Centreville, which could take a while to get to during evening rush hour. I left work at 5, went straight home to let Kirby out and feed her and put Kia in her carrier to make the 12-mile drive, which took almost an hour in traffic. That place (Caring Hands Animal Hospital) was very nice. Kia’s an excellent patient to begin with but they were very kind and gentle with her. They got her blood drawn, took her in the back for some X-rays, gave her some more subQ fluids, and even tried feeding her a minute amount to see if she’d eat. She did, but it wasn’t enough to convince me something wasn’t seriously wrong with her. I even showed them the video on my phone of her eating and then making that weird sound before barfing everything back up. No one seemed quite sure what to make of it. Her blood work came back completely normal, so that was a bit of good news. They got the X-rays developed and said everything looked normal except there seemed to be a large amount of undigested food in her stomach for a cat who was barely eating, and there was also a fair amount of gas in there. They wondered if there was something wrong with her digestive system that made her unable to move food through it very quickly. They decided to have her fast for the rest of the night, then bring her back in the morning for some follow up X-rays to see if anything had moved through. I didn’t get home until 9 that night and had to wake up at 6 so I could drop her off in Centreville at 7:30 and make it back to work in time during the morning rush hour. When I went to pick her up that night, her X-rays showed that the food had moved through her stomach and everything seemed to be OK. The vet brought up the possibility of it being Inflammatory Bowel Disease, which can develop in older cats and causes vomiting. She also brought up the possibility that it could be intestinal lymphoma, which presents with the same symptoms as IBD and can be very hard to distinguish from it. She sent me home with a bland diet of Hill’s i/d to see if that calmed down her stomach. I gave it to her that night and she seemed very interested in eating it and even kept a few mouthfuls down. I was very grateful. I sent the HSFC a thank you card, telling them how much I appreciated their helping me get the vet care she needed. It really seemed like the worst was behind us.
After a couple days of bland food, Kia resumed vomiting everything back up again. She had continued making that noise when eating and could only seem to eat a few mouthfuls at a time, but was at least making an effort. Now, no amount of effort she made could help her keep anything down long enough to digest it. It was agonizing to watch. I called Caring Hands and told them things weren’t getting any better. I wasn’t sure if the HSFC would cover any more follow up visits. I emailed Janice (the HSFC office manager) and told her the situation and asked what my options were. They agreed to send her back for another appointment at Caring Hands. Dr. Nagy examined her again and said it could possibly be a food allergy. She gave me a hypoallergenic food to try. She also said they could possibly do an ultrasound on her to check for any blockages the X-rays may have missed, or to see if the thickness of her intestinal lining had changed due to IBD. The cost of an ultrasound was between $600-$800. I didn’t think there was much chance of getting the HSFC to cover that, but Caring Hands said they could talk to them and see if they would. Meanwhile, we tried the hypoallergenic food and the same thing happened: a couple mouthfuls into her meal, it came right back up. That noise she was making was very disturbing. It sounded like there was something caught in her throat that made her physically unable to swallow anything. I wondered if she had a hairball stuck (like a residual piece of that barf pile I cleaned up the day the whole problem started) or had eaten a toy or some other small object. My untrained and unprofessional opinion was that something was physically precluding her from being able to swallow food.
I called Caring Hands again the next morning and said she still wasn’t able to hold anything down. By this time, it had been almost 11 days since her last full meal. She was already down a half pound since her appointment at Banfield, which doesn’t sound like much, but on a 6-lb cat, that’s a huge difference in one week. They spoke to HSFC, who spoke to me, who spoke to an internal medicine specialist, etc. Amazingly, they agreed to cover the cost of an ultrasound for her at the Veterinary Internal Medicine Practice in Manassas. I scheduled it for the following Tuesday, August 16 at 2 pm. It was a 3-hour appointment, so I had to miss a whole afternoon of work and gradually make that time up in 1-hour increments over the rest of the week. Tuesday rolled around and I put her in her little carrier and made the 20-mile drive out to Manassas. She had to be fasting for 12 hours before her ultrasound, so I hadn’t been able to feed her anything for breakfast. It was torture hearing her cry, knowing she was starving but not being able to give her even a morsel (not that she could hold it down anyway). At the vet, they did another exam on her and asked me to elaborate on what’s been going on. It was now 2 and half weeks since she’d been able to eat normally. She obviously wants to eat but vomits within 30 seconds of swallowing anything. They weighed her and she was down another half pound. She had lost nearly 20% of her body weight in 17 days. From the looks of things, she was slowly but surely wasting away. It was agonizing to watch.
They took her to the back for the ultrasound and told me I could either hang out in the waiting room or leave and come back in an hour. I chose to go grab lunch at Subway, since it was almost 3 and I hadn’t eaten anything yet. (I actually hadn’t been able to eat much since this whole problem started. My mental state was: if Kia can’t eat, I don’t deserve to eat until I can fix her.) When I got back, they took a minute to type up the report, then went over it with me. Overall, things looked relatively normal. They noted again a lot of gas in her stomach and said her mesenteric lymph nodes were slightly enlarged. The most surprising thing to me was a tiny nodule in her liver, measuring just over half a centimeter in diameter. They explained those happen and it’s most likely benign and unrelated to her vomiting. Basically, there was no obvious cause of her condition, so they suspected it was due to diffuse GI disease and recommended an endoscopy with biopsies of her stomach and intestinal lining. Well, the cost of that would be $1300-$1500. I felt like I was lucky enough to get this far on HSFC’s dime, so I had serious doubts they would cover such an expensive test, especially since everything else had come back normal. VIMP said if cost was an issue, we could try just treating her with steroids and see if it helps. If it does, then the problem is most likely inflammatory (like IBD or lymphoma, although biopsy would really be necessary to know which). They agreed to fax their findings over to Caring Hands, who would talk to HSFC to see what they would cover, and in the meantime give her more subQ fluids and a steroid injection. They told me to keep her on the bland/hypoallergenic diet and that I could feed her a small snack when I got home but to give her a minute first to rest and recuperate.
I got her home around 5:30. Immediately, she shot out of her carrier and ran over to her empty food bowl then gave me a look like “You’re still not feeding me? WTF!?” I took Kirby for a short walk to give Kia a minute to rest, and when I came back in I fed her a piece of leftover turkey from my sub, since the vet said that would be OK to give her. She scarfed it down, even biting my finger in the process. Of course, it came back up. She was so starved, though, that she tried re-eating it. It came back up. She continued vomiting even after everything was out. Then, she started burping up all this white foam, choking and gasping for air and writhing around on the floor. Her lungs were making gurgling sounds. I had no idea what to do. I tried patting her back, rubbing her throat, even holding her upside down to drain the vomit out of her lungs. Finally, I called VIMP. They asked if I could drive her back to Manassas in time but I knew I couldn’t. Her eyes were huge and dilated like a person dying of asphyxiation. My cell phone dropped the call, so I just stuck her in her carrier began driving over to Banfield. The whole time, she continued burping/gargling, and gasping with wide eyes. She kept rolling around in her carrier, trying to find a position she could breathe in. At one point, I thought I heard an ambulance siren approaching in the distance, but it was actually her lungs whistling like a tea kettle. I just started crying out to Jesus to please help her and save her. I honestly thought she was going to die right next to me in the car. I got to Banfield and rushed her up to the counter, yelling “Help! She can’t breathe! She’s choking!” They took her back and started working on her while I paced the waiting area and prayed over and over. I have no idea how many minutes later, but a vet came outside and told me she was stable. Her lungs were wheezy sounding, so she probably had aspirated some vomit, but she was OK now. They gave her fluids, another Pepcid injection, and an anti-vomiting injection and told me not to feed her anything else tonight to give her a chance to stop vomiting. Again, they didn’t charge me for the office visit, so the bill for the injections came to just under $50, which was the money I had set aside for my outstanding medical bills that month. So much for paying anything on those for a while.
I took her home and was too traumatized to even eat anything for dinner. I knew I wouldn’t be able to sleep at all that night and there was no way I could make it in to work the next day. This whole situation was making me physically ill. I was quickly getting to the point where, if she was fixable, she needed to start getting better, but if not, she needed to hurry up so I could start the grieving process rather than continuing to watch her suffer. There was also the issue of the upcoming camping trip in 10 days. I didn’t want to leave my roommate with a dying cat. And, if she was going to die, I wondered if I should go on the trip at all. I’d already paid for my spot 4 months ago, but maybe I needed to stay home and spend Kia's last few days with her.
I stayed home from work again the next day to give myself a chance to recover mentally, and I started making some phone calls. First I called Caring Hands to tell them what had happened. They asked if I could bring Kia in for a follow up that day. They also mentioned, if HSFC doesn’t cover the cost of the endoscopy, I could take her down to Virginia Tech, where it would be much cheaper. I called VT and found out they could do the whole procedure for $500-$800, and they also offer in-house financing for people unable to pay the full cost up front. I called my vet in Ohio and asked how much they would charge. I found out they could do the endoscopy for $150, but are unable to do any biopsies in their office. For that, they would have to send me to OSU. I called OSU. The cost of an endoscopy w/ biopsy was the same there as it is here, and they don’t offer financing. So, my best option seemed to be to take her to VT. I’d have to take even more time off work and would be making payments for about 10 years, but I was willing to do anything to save my kitty’s life.
When I got to Caring Hands for her appointment, I told the vet all of this. She said that, while it might help for my vet in Ohio to do the scope, it would only be for exploratory purposes in the event there’s an obstruction the X-rays and ultrasound didn’t pick up (which was highly unlikely). Since she believed we were dealing with diffuse GI disease, Kia really needed to have the biopsies done. The fact that she was vomiting right through the anti-vomiting drugs they’d given her at Banfield was a bad, bad sign. She said she would talk with HSFC to let them know the situation and hope for the best, fingers crossed. She gave her more subQ fluids, another steroid injection, and told me to keep trying to feed her the bland and hypoallergenic food.
At dinner, I tried feeding her just 2 pieces of the dry food, just to see if she held that much down. She did. So I waited 5 minutes and fed her 2 more pieces. Those seemed to stay down as well. I waited a few more minutes and gave her a tiny handful of about 10. Everything came back up. Clearly she could only eat food in the tiniest increments. What was I supposed to do if we couldn’t get her fixed? Quit my job so I could feed her 1 or 2 pieces of dry food every 5 minutes over the course of a day? This cat was quickly running out of options.
The next day, I heard from the vet at Caring Hands. She had just talked to HSFC and they were considering covering the cost of the endoscopy. Since it’s such an expensive test, they had to consult their higher-ups first, but they’d let me know as soon as possible. By that afternoon, I heard from her again, saying they had agreed to pay for it. I called VIMP just as they were hanging up from talking with Janice, and they set it up for the next morning. I had to drop her off in Manassas between 7 and 8 am and she was the first patient of the day so she would be put under right around 9. This was Kia’s last chance for survival. If they couldn’t figure out the problem, she was basically doomed to die of starvation.
That night, she lay next to me in bed with her head in my hand (as she tends to do when she falls asleep while I’m rubbing her). I listened to her purr and thought about how we met 11 years ago. She came up to me while I was car shopping at a used car lot and screamed at me until I picked her up. She was 4 months old and covered in mats, burrs, dirt, fleas and had a bad case of roundworms in her tummy, and she wouldn’t let me leave without her. I’d never had a cat so blatantly pick me out of a crowd and demand that I adopt them. In fact, I didn't adopt her; she adopted me. She chose me to be her mommy and we belong together. I still grieve over Aria every day. I can’t lose Kia, too. It’s too soon say good-bye. Not now, not like this.
Of course, she had to be fasting for her surgery, so I couldn’t feed her breakfast once again. I fed Kirby her food and Kia had her face in the bowl, trying to get to it, which she has never done before. That poor cat was just desperate for any sort of nourishment. She was even up on the counter while I was putting food in Kirby’s bowl. I had to keep moving it away from her and I felt awful about it. At VIMP, I held her, kissed her, and wished her good luck. I said good-bye to her as they took her into the back, wondering if perhaps it would be the last time I ever saw her alive. I had no idea what they would find in there once she was under anesthesia, but I was not getting a good feeling at all. I prayed hard but didn’t feel like God was going to heal her this time. I felt like this was it. I called my mom on my way in to work after leaving VIMP and tried to work out a “what if” plan. For instance, if they look in her stomach and find she’s riddled with cancer and there’s nothing they can do, should I have them put her down right there while she’s unconscious, or should I let her at least have a fighting chance for a miraculous healing? What if she dies while I’m away at the camping trip? Maybe I should have my parents take her so I don’t have to leave my roommate with a doomed animal. I kept telling my mom how I did not have a good feeling at all, and she said she didn’t either, which was a really bad sign. Usually, my mom is the first to sense when things will be OK.
I arrived at work early and sat in my car for a while, crying and praying for everything to go well and for them to at least find an answer, even if they couldn’t fix it. As I prayed, I began to feel more of a sense of peace. Except it wasn’t so much peace, but more like acceptance. I was beginning to accept the fact that things were going to happen the way they were meant to. I had no idea what to expect, though. For a second, I felt like God was telling me the news wouldn’t be good, but wouldn’t be fatal either. But, I pushed it out of my head because I didn’t want to get my hopes up.
I kept my cell phone in my pocket at work and tried hard to keep my mind busy, even though I felt like I could throw up any moment. Just before 10, my phone rang. My heart jumped, thinking that if they’re calling already, something had to have gone wrong, like she just died on the table. But, it was just the vet saying they were running a little behind and would be getting started soon. They had also repeated her ultrasound and blood work and everything still appeared normal. When I hung up, my hands were shaking. About an hour later, the phone rang again. It was the vet saying he’d found the problem already: she had a stricture, or narrowing, of her esophagus caused by a buildup of scar tissue. A normal cat’s esophagus is about 2 cm in diameter, and hers had narrowed to about 2-3 mm, which is why she couldn’t get any food through it and was vomiting everything back up. He couldn’t even get the scope down past it. He said those things can be tricky to treat because the natural tendency of the esophagus is to scar up again even after dilation therapy. He said he’d go back in with a Foley catheter and try to dilate it a little but it would likely require several subsequent dilations over a period of time before it would be fully open again, if it ever did get fully open again. When I hung up, I couldn’t tell if I was relieved or what. I wasn’t sure what it meant going forward or what her long term prognosis was, but at least we knew it wasn’t cancer or some other disease that couldn’t be treated. I think I was mostly just glad to finally have an answer.
Less than an hour after I hung up with the vet, he called back again. He said he’d gone back in with the Foley cath and managed to get it in past the stricture, which was very difficult. They inflated the balloon slightly a few times and began the dilation process. After a few conservative attempts, they inflated the balloon a little more, at which point the scar tissue completely broke down and the stricture opened up entirely, revealing a normal-looking esophagus underneath. They were able to pass the scope all the way through into her stomach and obtained several biopsies, despite everything looking normal. It was truly a miracle! Only then did I really begin to feel like things would be OK. Of course, she’s not out of the woods yet, as there’s always a chance the stricture could come back. And there’s the added question of: how did it get there? It could be congenital, it could be caustic, it could be from a violent vomiting incident (which may be due to diffuse gastrointestinal disease), or maybe just a fluke. I told him about the large tube of vomit I’d cleaned up the day this whole thing started and he found that very interesting. Maybe she’d thrown up so violently, she damaged her esophagus and caused scar tissue to form around it. And maybe she’s throwing up that violently because she has GI disease, or maybe it was a nasty hairball, or maybe something else. We won’t know until the biopsies come back next week, and in the meantime we have to keep her on a bland, liquid food diet, give her steroids to prevent the scar tissue from reforming, and keep giving her pepcid and sucralfate to protect the lining of her stomach and intestines. If the results come back negative for any disease, I can switch her back to regular food after 3 weeks or so. We discussed all that when I picked up her after work. She was groggy and irritated with the staff, but looked good otherwise. They told me I could feed her a small meal of blenderized z/d that night, but not to overfeed her in case she was still nauseated from the anesthesia. I could begin crushing up all her pills and mixing them with water tomorrow, since she can’t have anything hard or solid. The vet showed me before and after pictures of her stricture and said that, even though he doesn’t see those too often, he had never seen one just completely break away like that. It was amazing! My cat is a walking, purring miracle!
I got her home around 7:30 and, once again, she tore from her carrier straight over to her (still empty) food bowl. I waited a minute or two before mixing up her meal. While I was mixing it, she jumped back up on the counter again and had her face all up in it. I crossed my fingers and held my breath as I watched her eat, praying it would stay down. She swallowed hard a few times, but it never came back up! I even got her sucralfate down without it coming back up. This morning, I fed her a much larger meal and it also stayed down. When I fed her her watery meds, those stayed down, too, and as far as I know are still down. It’s been 3 weeks, but her tummy is finally full again! I know it’s still very early and there’s still biopsy results pending, but her recovery seems to be going well so far. Just the fact that she’s able to eat again is a huge relief. Honestly, the surgery could not have gone any better. I thought for sure it would be the beginning of the end. Just a couple days ago, I was picking out a shoe box to bury her in. Now, it looks like she just might be OK! I’m so thankful for all the doctors, vet techs, friends, and family who prayed for us, and people from the HSFC who gave her the chance to get treated in the first place! Without any of them, she certainly would have starved to death. I’m so thankful for my kitty being given a second chance at life and I’ll never forget all the people who allowed it to happen! I have so much to be thankful for!
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