My husband and I just had to say good-bye to our one-year old kitten, Ramone. Yep. He was just barely one. My heart so goes to all of you who have been through this. Not that it is any easier when they’ve been by your side for 5, 15 or 25 years. It’s never easy. Never. In fact, I call it the black hole of sucking. It is an indescribable pain, a hurt like no other. But at one, we were literally blind-sided by the words “kidney failure.” Of course, at one, everyone – rightfully – expects to have many happy years with our kitties or puppies ahead of us, and any pet taken from us so young feels particularly devastating.
The truly tragic irony of this situation is that we had to let Ramone go on the one-year anniversary of the day we brought him home. That exact day. One year before. Kidney failure. In a one-year old cat.
My husband and I were at the vet. Gary is a very outgoing, very … exuberant person. Gary’s not good at sitting down and waiting. So I’m in the exam room. The cat we brought in and the vet are in the back. I hear Gary bellowing as he walks past the door, headed for the crowded reception area “OMG THAT IS THE CUTEST KITTEN I’VE EVER SEEN! WE HAVE TO ADOPT THAT CAT!!!!” That little voice in my head immediately screams “NOOOOOOOOO! NOT KITTENS!!!!” (We have twelve older cats at home!) I pop out of the exam room to run interference. (Don’t worry, we know everyone that works in the clinic, and they already know we’re crazy. It’s a source of amusement for them).
“Gary, we can’t just adopt someone’s cat!” “I DON’T CARE WHOSE KITTEN THAT IS, WE HAVE TO ADOPT THAT CAT!”
Linda (one of the receptionists) says “Actually, I think Gary’s talking about one of the kittens just brought in from the hoarding rescue.” The little voice: “Oh GREAT. There’s no getting out of this one!”
The cogs in my head have flown into high gear. What was I going to do? Gary just got out of the hospital two weeks ago. He almost died. He “should” have died. He had a less than 10% chance of surviving the multiple organ failure (caused by a damaged heart valve from numerous tick bite infections) combined with his “I’ll just walk it off” attitude to illness (Little voice in my head: “MEN!”). Tick bites … from trapping feral cats all over Northern New Jersey dating back almost 20 years. I wanted Gary to get a service dog to motivate him through what will be a long recovery. But he wanted this kitten. Gary is smitten. Gary is determined. This is GOING to happen. I turn to Gary, “You cannot adopt just one kitten.” I turn to Linda, “Are there any other kittens?”
And thus it was we came to adopt the cats we named Maxzee and Ramone.
OK. So now it’s a done deal. Our new-to-us seven-week old boys were so riddled with infections and parasites, they needed to be isolated at the vet at least their first few days (especially as we have immune compromised cats at home). Having accepted the situation – Gary needed these kittens – it was exciting – KITTENS!!!!! We’d fostered years before (we suck at it; we get far too emotionally invested. Trap-Neuter-Return was our thing). But we’d never kept baby kittens. We got them healthy, we adopted them out. But these boys we were going to get healthy – for us! And HOW thrilling for me? I get to apply all I’ve learned about diet and supplements for health over the past decade since beginning our raw feeding journey. I was so hopeful we could avoid the chronic illnesses we’ve had to manage in our older clowder.
I prepared food for them (with EZComplete, of course!) and took it to the vet. In isolation, we couldn’t visit with them. Gary is not a particularly patient person. By day three, we’d already prepared our home for the kittens. We had an introduction cage set up in our bedroom. We stopped by the clinic to drop off more food and to ask if we could just SEE them. We understood we’d have to stay outside the glassed-in isolation area. And WOW were we shocked at what we saw: one kitten per cage. The little orange kitten – officially Ramone – was on his back feet, his front legs looked like windmills on the bars of the cage, and he was screaming! The little black & white kitten – Maxzee – was balled up in a corner of his cage, staring the wall.
Gary FLIPPED out. I WANT TO SEE A VET. RIGHT NOW. (Our vet wasn’t on duty). The tech that took us back says “Gary, they’re all in with patients.” THE BLACK & WHITE CAT IS DYING. LOOK AT HIM! HE’S LOSING HIS WILL TO LIVE LIKE THIS. THEY HAVE TO BE TOGETHER! WHAT ARE YOU PEOPLE DOING???!!!! (Gary is a deeply caring person, but not the most tactful. If he thinks it, he says it). Clearly out of the “danger” zone by now, we decided they weren’t doing anything there we couldn’t do at home. We waited while they crated the kittens – together – and gathered their things. Ramone and Maxz were COMING HOME!!!!!!!!!!!!!!!!!!!!
Together, our baby boys thrived. Home, in our care, Maxz and Ramone healed rapidly. Consuming what seemed an incredible amount of food, they quickly grew into handsome, healthy young cats. And yes, Gary did need those kittens. Their impact on his health and well-being was immeasurable. My heart sang. Nothing like kitty nurses to purr him to sleep despite his discomfort. And nothing like kittens to impart the innocent joys of just being alive. And, perhaps most important of all, Gary did more laughing that first month with the kittens than in the previous two or three years. Gary was healing, too.
Eleven months after bringing the boys home, Ramone seemed a bit off. Skipping a meal here or there isn’t unusual for kittens, but his behavior was subdued. That isn’t normal. Concerned, off to the vet we went. Alarm bells went off in my head when I saw it was the vet calling first thing the next morning. We were NOT prepared for the news: “Laurie, Ramone is in kidney failure. He needs to be admitted to the hospital for IV fluids. You need to bring him as soon as possible.” My head was buzzing. The room started spinning. I heard nothing after that. Ramone was in kidney failure. Kidney. Failure. He was just one! At this age, the most likely cause is ingestion of something that damages the kidneys. But we’re well aware of toxins to cats, have no plants, and all of our cats are indoor-only. I dropped off Ramone for the four days of IV fluids. I called Carolina with the devastating news. I took her advice and got down on the floor and searched the house. I could find nothing to explain it.
Even stranger? His kidney-related blood values on day four of IV fluids were the same as when tested after 36 hours. If this were an acute problem, his kidney values should have continued to improve. An abdominal ultrasound showed no congenital problem with his kidneys, and the vets began to suspect a genetic problem at the “microcellular level.” The little voice in my head: “NOOOOOOO NO NO NO NO NOOOOOOOOOOOO!” We brought our Ramone-y Pony home (nick-named during a growth spurt when his legs REALLY shot up!). Instructions were to give him daily sub-q fluids, and I use a form of vitamin B3, niacinamide, to lower phosphorus. Recheck was in one week. I needed to assist feed him the first day home despite cerenia and an appetite stimulant. But that was it. He needed the nausea and appetite support for only a few days, and he seemed back to 100%. THANK GOD. Blood work on recheck confirmed our observation. I was to continue giving him daily sub-q fluids. The next recheck was scheduled one month out. Life went back to normal, adjusted for the new routine of fluids and niacinamide. We were comforted that this might have been an acute episode after all.
The evening before his one-month recheck, Ramone vomited violently. He hunched up, like a very nauseous cat, or a cat in pain. He had zero interest in the last meal of the day. I thought maybe he had a blockage. Rather than wait for his appointment, we took him in first thing. …and I can barely get the words out, because once again, we were completely unprepared: Ramone was in kidney failure. Again. My panic level went through the roof. They wanted to do another ultrasound. OF COURSE. The moment I heard the very somber tone of the vet's voice when he called with the results my heart sank. “Laurie…” was all it took. That was followed with “It’s not good.” I had to choke back the sobs. The ultrasound showed complete lack of structure in his kidneys. This was genetic. The vet wasn’t sure how much time we’d have with him, it could be just a few days. His kidneys were not capable of supporting life. The little voice wasn't little, it was screaming. "NOOOOOOO NO NO NO NO NO NO NO NO NO NO NO NO NO NOOOOOOOOOOOO!!!!!!!!!!!!!!!!!!!!!!!!"
Is it time for heroics?
We faced the problem of every pet parent at a time like this: what do we do? How do we handle this? We are willing to go to the ends of the earth for our cats, money (almost) no object. We will do ANYTHING for our cats.
We seriously struggled to decide how much to do for Ramone. He's so young, should we consider getting him a kidney transplant? Or … What if sub-q fluids and cerenia and ondansetron made him feel better? Could we buy more time? What if I kept pilling him with niacinamide – could bringing down his phosphorus again enable him to spend more time with us? What if the vet was right about the kidney failure, but wrong about the timing, and Ramone potentially had months, not days? What if I assist fed him to get him through a few days – would that get him over a hump, giving time for sub-q fluids and meds to kick in? What if…. WHAT IF? WHAT IF? WHAT IF???????????
And this is when we need to turn to friends who understand our desire, but who can provide a more rational outlook. A dear online friend to Carolina and I, Amy, put a beautiful voice to end-of-life decision-making at times like this. She coined it “Love and Cheese Danish.” And Carolina – and others on Facebook, also familiar with Amy’s gift to those of us going through this incredibly painful process – reminded me of the very basic principle of Love and Cheese Danish. The message is simple: make decisions based on what is best for your pet, not for you. It is 100% about their quality of life. That is ALL that matters. Make their last days, weeks, or months an absolute heaven on earth. Worry only about their happiness and comfort and spoil them rotten. Feed them those human foods they love (so long as they aren’t actually toxic, of course!) Shower them with love and happiness and make being here FUN.
Of course our time with our pets is always too short. Of course we want to do everything we can to make them feel better so we have more time with them. In fact, as I talked through how far to go with Ramone with Carolina, it became clear I had to fight EVERY instinct I had to “DO” something. It is so much easier to act than to not try; to not fight for more time together. Doing NOTHING to prolong life is damn near impossible.
Carolina helped keep me on point. The ultrasound was definitive: Ramone’s kidneys cannot support life. Any time would be temporary. A kidney transplant is an extreme process – and it certainly isn’t best for the donor cat that must also be adopted. Ramone would be put through hell, especially as he was not a kitty with a calm personality who loved to travel. As a cat, Ramone may anticipate a meal, but he does not hope he’ll feel better tomorrow. He knows today, right now. One of the (oh so many) beautiful things about cats and dogs is that they live in the here and now. This knowledge must inform our decisions at times like this. One of the last, most difficult things we can do for our fur babies once diagnosed with a terminal illness is give them peace and joy while they are still here with us. Decision-making when our pet has a chronic disease that can be managed should not be the basis of decision-making when they have been diagnosed with a terminal illness. To prevent our cats or dogs from suffering, we need to acknowledge the difference. Carolina gently helped me refocus on Ramone, not Ramone’s length of life with us. Not what we want. Not more time. No matter how much I didn’t want to hear it – no matter how much I didn’t want to do it – no matter how hard I had to fight with my desire to act – my heart knew Carolina was right. And what was best for Ramone was NOT SUFFERING. It was time for Love and Cheese Danish. Ramone had saved Maxzee. Ramone had helped save Gary. It was time to just love our little boy. It was time to stop trying to save him. It was time to make what time he had left with us glorious.
Ramone received fluids and shots of cerenia, famotidine and B12 before being sent home with us. He strutted on those long legs, tail up, head-butting us and his kitty friends. He arrived home just prior to mealtime. He was excited for the meal, standing on his hind legs as he always did, pawing the edge of the counter, meeping, waiting for me to “accidentally” drop a piece of meat, a special treat no one else got. I already knew his “cheese danish:” playing with the feather wand toy. Ramoney Pony LOVED to “play feather,” so of course that’s what we did after dinner. He didn’t play with his usual verve – so I slowed it down for him. He growled contentedly each time he caught it (so freaking cute he never lost that!), and I laughed and cried at the same time. He tired quickly – but he was so happy!!!!!
At bedtime, I asked him if he’d sleep with me as he had been this past month. I carried him to bed. He curled up into my chest and neck for what turned out to be one last time.
When I woke up the next morning, he was under the bed, hunched up. He’d never done that before, the hiding. He had no interest in eating, only drinking water. He was totally uninterested in feather. It was already time.
Ramone left this life peacefully, at home, on the day of his one-year anniversary of coming home to us with Maxzee. He’d been our angel. He’d performed his miracles. It was time to let him move on. We gave Ramone the hardest gift to give, the last gift any of us can give our beloved. We didn’t let him suffer for us. And I thank Carolina and all of my friends for helping me – us – make the right choices for Ramone.
Sometimes, all the “cheese danish” in the world can’t get them past whatever it is that is taking them from us. But this approach will always guide us to what is best for our babies. As Amy writes, with this approach our pets “knew nothing but love without the stress before saying good-bye.” It may hurt us the most, and it IS unquestionably he most difficult path – but knowing we’ve done what is best for THEM helps us adjust to our tremendous loss.
Love & Cheese Danish
Written by Amy Lindemann Cichowski and published here with her permission.
“Many years ago, our dog Ellie Mae started to bleed from her mouth. The vet found a tumor on the roof of her mouth and the biopsy showed that she had a highly malignant form of cancer. He removed what he could, but gave her a 30-day prognosis, due to the fast growing nature of this type of cancer.
Ellie Mae was our heart dog and we wanted her as comfortable as possible for the last days of her life. We bought her canned food (which she absolutely loved), DH slept on the floor with her (and would often wake up to find her up on the sofa and he on the floor), and everything we did with her was things that she wanted to do. One morning we had some cheese danishes that we bought from a bakery and decided to break one up, put it on a plate and feed it to her while she lounged on the sofa. Ellie Mae was a smart girl, and quickly realized that with all this special treatment, she didn’t want to leave us for a while. She got cheese danish a lot from us, and lived another 18 months before she died from a massive stroke at age 14 (old for her size). The ‘Love and Cheese Danish’ treatment was born.
I’ve used this for every one of my babies when they have been given a terminal prognosis. When Bob Marley and Eightball were diagnosed with cancer in 2010, Bob lived another 7 months with a lung cancer diagnosis (they gave him 2 months), and Eightball lived for a year.
I know we all spoil our babies, but there are some things that I do differently during their treatment. I found that Eightball loved to be fed on the kitchen counter, and while he loved to sit on my lap, was often crowded out by the other cats. He immediately got top lap priority and was grateful for it. The vet prescribed medications which didn’t settle well with him – first of all he hated to be medicated and secondly they appeared to upset his stomach. He freaked out with every trip to the vet so I stopped forcing it on him. Sometimes the treatment causes so much stress that it adds to their fragile condition more so than helps them. I would never suggest to anyone to stop what the vet prescribed, but realize that I talked to the vet before I made any changes.
He thought it was fun to drink out of our water glasses, and even more fun when he thought he was getting away with it (we used to scold him for it), so I’d leave glasses of water around the house so that he could “get away with it” and drink from them. If he was settled in my lap and I needed to do something, well, that something had to wait (if it could). He thrived.
Finding their “cheese danish” isn’t always easy, particularly if they are spoiled in the first place. But I always work to find what makes them happiest, and it’s almost as if they start to enjoy life so much that they put in the extra energy to live longer. No restrictions on what they want to do (unless it truly harms them) and give them things they least expect. Give them what they want, and love, love, love on them the entire time.”
Obviously, if kitty is on medications that will do harm if just stopped, discuss any change in treatment with your vet. But when nothing seems to help, consider ‘Love and Cheese Danish.’ And maybe you’ll find the end isn’t as near as you feared. If it is? Kitty knew nothing but love without the stress before saying good-bye.
Fly free, Ramone. Thank you for joining us as a stop on your way....
~ Laurie (& Gary, my hubby)
Postscript 2020. Gary, Laurie's husband, lost his fight in November 2019.
Gary had many kitty angels waiting to greet him, including baby Ramone.