Last chapter on earth

May 26th 2014 2

It has been two months since my Angel girl crossed the bridge and now it is time to tell the story of her final weeks on earth. Betty came into my life when I desperately needed an angel. She looked after my soul for 15 years. On Jan 29th 2011 she was diagnosed with diabetes. Just a few months after my heart had been so trashed by the rascal. Her illness gave me focus and priority. I injected her with insulin every 12 hours for two years.

Her acromegaly diagnoses on August 13th 2012 devastated me. But I never gave up, despite the poor prognosis. I found a drug trial at the RVC and in Jan 2013 Betty became the star pupil on the trial, entering complete diabetic remission. We continued to visit the RVC monthly for her tests and injections and she continued remission. She did develop a common side effect of her drug and that was diarrhoea. We kept it to a Mr Whippy consistency with an exclusion diet.

In November 2013 her stools improved after adding a fibre to her diet. She did well on a normal diet. However, she had lost 0.5kg and concerns were raised. In December a scan showed intestinal swelling and Ruth talked about a biopsy to test for IBD and lymphoma, but I have always been averse to putting Betty through surgery. Ruth suggested resuming the exclusion diet until the next visit. By January further weight loss had occurred and we discussed biopsies and an alternative option of treating her for these diseases anyway, as the treatment is the same for both.

However, before I made a decision, Ruth called me and suggested another option. This was to reduce the amount of trial drug Betty was given and put her on a a diabetic diet to try and keep her in remission. And that is what we did on Feb 21st 2014. At this appointment I mentioned that I thought Betty was showing some slight instability in her hind legs.

Tues 4th Mar

I was working from home on this day and Betty was in my office with me as usual. She tried to jump onto my lap and fell awkwardly, hitting her back on the desk leg. This was the day I became concerned. Over the next few days I noticed increased weakness in her hind legs and they seemed to slide as she tried to walk. By Friday it was really noticeable.

Sat 8th Mar

I took Betty to my local vet. They did blood tests and found elevated liver enzymes and anaemia. So an appointment was made at the RVC for the following Tues. I was told to call if Betty worsened. I rearranged the house to stop her using the stairs or falling from any height. I made my bed on the floor in the living room so I could be with her.

Adaptation

Makeshift bed on the floor

Mon 10th Mar

Ruth called to see how Betty was. Her condition seemed to be worsening and I was so concerned that Ruth arranged for Betty to come in that night as an emergency. On the way, Betty did a poo in her basket and got covered in it. I rushed her into the toilets at the RVC and cleaned her up before we saw the vet. We wrapped her in a towel but she had a seizure in my arms. The nurse rushed her away from me in panic and that was the first time I thought I may lose her.

I sat in the waiting room for what seemed like hours until I was finally called in to see the vet, Kerry. She said Betty was stable but that she was very poorly and they were 'concerned but not panicked'. I had to leave her there overnight in intensive care.

Tues 11th Mar

I returned to the RVC for a 10.30 appointment, with my mum for support. I saw Sophie this time. Sophie told me that Betty had deteriorated during the night and could no longer stand or see. They believed she had a problem with her brain. I was then given some of the most difficult choices of my life. 

  1. PTS, or CT scan requiring low risk sedation and giving limited info, or MRI scan requiring anaesthetic but giving best info? – MRI (no brainer)

  2. If an untreatable condition was found during the MRI, wake her up or not? - Not

  3. If she failed to wake up after the MRI, revive her or not? 

The third question confused me in my already sobbing state. Then Sophie explained how CPR is done the same way it is done to humans and could cause serious trauma, such as broken ribs. Through big tears and throbbing chest, I whispered 'No, don't hurt her'.

I visited her before the scan. She lay in her intensive care cage with big blind pupils, hissing at movement because she was so scared. I managed to slide my hand in and stoke her for 30 mins before I had to leave.

The rest of day was agonising. We waited in reception for 5 hours to find out if Betty had survived. Sophie finally came out and beckoned me in. My little fighter girl had done it. She needed help with her breathing but she had pulled through. Nothing of any note had been found wrong with her brain. So they gave her thiamine for a possible B1 deficiency and steroids in case her pituitary had multifunctioned or part died. I had changed her diet in the previous two weeks, after much research into food for diabetics. There was a possibility that something in the food had caused a B1 deficiency and I was racked with guilt.

I was not allowed to see her as she was in an incubator, but I returned the next day.

Wed 12th Mar

On drive to the RVC I talked to myself all the way, praying and believing she would be up and seeing again. When I was lead into intensive care my heart skipped a beat, she mewed when she saw me and she stood up. I spent an hour stroking her in the cage. She was not out of the woods and still not peeing for herself but she was improving.

Thurs 13th Mar

Sophie said the turn around in the space of 12 hours was remarkable. But they didn't know which drug had caused the improvement. On Thursday Betty was moved to cat ward and I was able to have her on my lap in a room at my visit. She was also able to use the litter tray by now.

Fri 14th Mar

I sent Sophie fact sheets regarding the food that Betty had been eating. Sophie wrote me this email back:

Hi Amanda, 

No problem- I will arrange for her to come home with some wet Hills m/d for now. Looking at the ingredients the Macs should be fine. Her intestinal swelling or bloat is something we do see with some of the cats on pasireotide as somatostatin analogs can decrease intestinal motility. The only way that we would be able to determine between IBD or lymphoma would be to take biopsies of her gut either with GA + endoscopy or surgical biopsies. You can think about this and let me know.... 

Tomorrows discharge is all arranged for 11.30am and she is comfortable and eating well without pain relief, so we will not give this as it may make her more lethargic and in some cats they can become quite flat so would make monitoring her difficult. The appointment for Tuesday is also arranged for 9.30am. 

I hope she continues to do well and I look forward to seeing her next week. Please do not hesitate to contact us if you are concerned about her this weekend.

That day Betty was purring and up at the bars of her cage for the vets. Her mediation was given orally and she had an ultra sound scan of her abdomen. I was hoping to take her home, but Sophie said she wanted to keep her one more night as they had seen abnormalities in her liver and pancreas.

She was taken off the steroid to determine if it was the thiamine that had caused the improvement. Sophie said that Betty would start to deteriorate by Sunday evening if the steroid was the drug that had worked. The problem with the steroid was that it could potentially make her diabetic again. So we didn't want to give it if it was not necessary.

Sat 15th Mar

I picked Betty up and took her home. She seemed lots better though she was still wobbly. I cancelled a night out with friends and enjoyed the day with my three cats. My house was still turned upside down to prevent Betty from climbing the stairs or falling from any height. I slept on the sofa and made steps up to it for her. She lay by my belly while I stroked her and every time I drifted off to sleep she crawled further up towards my face, until I opened my eyes and we were nose to nose.

Sofa bed

Sun 16th Mar

Betty seemed fine so I kept a daytime appointment with family. I spent an hour in the garden with the cats in the sun and when I left the house Betty had been in and out of the cat flap and was snuggled on the rocking chair. I returned in the early evening and she still seemed fine then. But by 11pm I saw signs of relapse and once again I rushed her back to the RVC as an emergency.

After another torturous wait, I saw Kerry again and begged her to give Betty the steroid immediately. She said that a blood test was needed first and that Betty would be given her life saving steroid in a couple of hours. I got home at 3am.

Mon 17th Mar

I was meant to see Jack Whitehall at the O2 but my friend Anu was understanding and found someone else to go with.

I visited Betty for 90 mins and I saw Sophie again. Betty had been made to wait for her steroid until that morning and had deteriorated again though not as bad as the first time. She was not able to stand but did improve during the day. The test for Addisons was inconclusive. This meant the Betty was being treated for symptoms rather than disease. We still had no idea what was wrong. A neurologist thought that Betty may have age related neuro degenerative disease and that her other issues were unrelated. This made no sense to me.

Tues 18th Mar

Betty still had limited sight and her head was bobbing but Sophie told me that she didn't think Betty was ready to stop fighting. She said Betty would come off the drug trial until her present condition had been stabilised. I sat with my girl for two hours.

Wed 19th Mar

Betty was given her steroid orally from this day. I worked 8-4 (early for me!) and then commuted home and drove to the RVC. By now I was physically and emotionally drained and just wanted my girl home.

Visiting hours

Thurs 20th Mar

Another 8-4 day and crazy travel.

The second Addisons test proved that Betty did not have this disease. The conclusion was therefore age related neuro degenerative disease (like dementia). Sophie said that it meant her neurological symptoms would continue to worsen over time.

During the whole time Betty was in hospital I was always assured that she showed no signs of pain. But Sophie told me I must always consider quality of life. And I must look for signs that Betty had had enough. She said that they would continue to monitor her and her other issues (anaemia and liver enzymes) but she made it sound like we would just be keeping her going until her quality of life was too poor. It was horrible news.

Fri 21st Mar

I met with Sophie hoping to take Betty home but Sophie said that although she was brighter and stronger, Betty's anaemia had continued to worsen and they wanted her stable before she could come home. All tests results were back by now and nothing conclusive had been found. Her steroid had been doubled and there was still scope to double it again. She was also on some antibiotics as they suspected IBD related triad disease. I stayed with her 2-3 hours as usual and she sat on my lap. Every visit it broke my heart to watch her being taken back to the ward.

Sat 22nd and Sun 23rd

I didn't go to see my hero, Neil Hannon at the RFH on Saturday and I missed CTE volunteering on Sunday. I emailed one of my oldest friends asking for a loan to help with the rising costs. I needed to ensure that my decisions were affected by nothing but the best choice for Betty. I would have done anything.

I visited for 2-3 hours each day as usual and held back my tears each time she was taken away in her hospital basket. I was desperate to get her home by now.

Mon 24th Mar

I sat in the waiting room and Sophie came out with a bag of drugs in her hand. This meant my girl was coming home. I screamed with joy in reception. Her anaemia had stabilised but not yet improved. Sophie told me there was nothing more they could test for or treat and all that was left was to double the steroid if need be. She reminded me again about quality of life. And we came home.

Cuddles

Betty ate her food ok and she sat on my lap all evening. But at about 11.30 she got up, stumbled, and was violently sick. It was projectile and mostly water, loads of it. She collapsed into it and struggled to try and get up. I jumped off the sofa and lifted her away from it and held her until she calmed down.

She seemed depressed for the rest of the evening. I called Sophie and she told me that once was ok, but if it happened more than twice then that would be a problem.

I slept on the sofa again but Betty stayed in her basket all night.

Tues 25th Mar

Betty seemed better. She was eating and drinking though she still had not been to the toilet. I worked from home but still had to keep the stairs blocked to keep her safe. I ordered a huge pen so that I could section off the house when I went back to work in London, to keep her from harm and I ordered a stair gate so I could keep her upstairs with me at night.

I kept coming down to check on her and she was moving about and seemed ok. At one point I found her on the window cill. She was still far too wobbly to risk that, so I took her down and moved the cat tree she had used to get up there.

At 4pm my heart sunk. I was checking on her and she did the same projectile vomit, collapsing again. This time she would not eat or drink and I was so fearful that she had not absorbed her much needed drugs. She lay on the floor looking sad. I emailed Sophie explaining what had happened and she replied: 

So, unfortunately there are only a couple of options. One is adding in another antibiotic to continue treatment for cholangitis and the second giving injectable or oral anti-sickness medication (your vet can do this so you don’t have to come all the way here).  If they are happy giving you the vitamin B12 they may give you some daily anti-sickness medication to administer-I can call them tomorrow morning for you….. What are your thoughts?
… 

I have just emailed you back, I am sorry. Unfortunately we are running out of options. Let me know what you think to my previous email. I will totally be guided by you as to how much you want to try. 

Sophie x 

I called Sophie to say I did not want to wait until the following day. She called my vet and gave him the recent history of Betty's treatment and arranged for me to see him that evening to get an anti-vomiting drug for her.

Alan's first question to me was 'how far are you prepared to take this?'. He explained that I was a cat owner with more fight and dedication than any he had met before but it concerned him that I may never give up. He was wrong. I told him, 'she is not going back to hospital'. Her temperature was lower than normal and he said that it indicated her body was not functioning properly. She was dehydrated and he said he could keep her in, back on a drip and test her blood again. I asked what would happen if I took her home and he told me she may pass away peacefully but she may suffer organ failure and seizures. Knowing I would not leave her, he offered to do the blood test immediately and go from there.

The anaemia result was improved but he said it may have been distorted by dehydration. He also said he was not at a point where he needed to hit me on the head and force me to give up. So he gave her the steroid she may have missed and an anti-vomiting drug. But he said that the anti-vomiting drug could only be given once and would only last 24 hours. He told me above all to keep her warm.

That night I stayed awake all night on the floor. I pulled her to me and she spooned me for about an hour before she walked away and crawled under the table. She didn't sleep either. She tried to eat but her belly grumbled loudly after one mouthful and she gave up. I heated up a bean pillow every hour and covered her with a blanket. She kept dragging herself further under the table. I prayed and prayed 'Betty, go by yourself peacefully or get better, don't make me choose'.

By 5am I had decided I had to take her back to Alan to say goodbye. I thought I had seen the look in her eye that Sophie had described when you know they have had enough. Sophie and Alan's words were echoing around my head, 'how far are you prepared to take this?', 'there may be no Betty at the end of it', 'she will continue to deteriorate', 'age related neuro degenerative disease', and images of her in the hospital and the awful vomiting that may return.

I called Alan at 7am in tears and said it's time. She lay in her basket calmly but she mewed at me at the door of the surgery and stood up. A flutter of hope hit me. I told Alan I thought she maybe had improved. Her temperature had not worsened but Alan said she was a very depressed cat. She was so dehydrated that the only choices left were PTS or back on a drip there or at the RVC. I felt enormous pressure to stop fighting and I felt Betty had lost her fight now. Above all I could not put her back into hospital. It didn't feel right. It didn't feel fair to put her through more of that to delay my heartbreak. But I was also stressed, sleep deprived and alone.

And so she passed away peacefully on my lap. Alan could not even use a vein in her legs because she was so flat.

29th Apr - The post mortem result that broke my heart.

I allowed the RVC to collect Betty's body and carry out a post mortem. I wanted my little pioneer to bestow one last gift to help other acrocats in future.

There were no signs of neuro degenerative disease and her pituitary gland looked normal. She had severe chronic inflammatory disease and her intestine was dramatically abnormal. There were fluids in her intestine and abnormalities in her liver. She also had a tiny mass in her lung. Lymphoma was felt unlikely but could not be ruled out as steroids reduce the chance of a diagnosis. The neurological symptoms could have been caused by a reaction to metabolic derangements or lymphoma.

IBD is a very treatable disease. But Betty's condition gave little time for accurate diagnosis or treatment. I asked if I had made the wrong choice and if she could have been saved. Ruth said she may have recovered with intensive nursing but that I probably made the fairest choice.

It was the wrong result for me. I wanted 100% conclusive evidence that Betty's quality of life would have only worsened and that I had prevented suffering and given her a peaceful crossing. The tears fall as I write this, but truthfully you can only ever know the outcome of the decisions you make and not of the ones you didn't. Betty knew I loved her and she loved me back. I lost my purpose the day she died but I really believe she was ready to let me go and watch over me from a new place. She left when she felt my heart was healed enough to focus on myself again.

Every night I light a candle for her and every day I tell her I love her. My heart and my head are filled with memories and I cherish the special bond that we built whilst she was sick.

Cremation

Betty was cremated on Fri 4th April. I was undecided and considering scattering her ashes, so she came to me in a scatter box. Once I had her I could not let her go. I want her scattered with me. So I began a long search for a more permanent urn. The only one I found that was worthy was an original hand made box on Etsy. It was made from wood in the national park where the artist lived. The only problem was that it was in the USA and they only shipped there. But Nan and Steve responded to my appeal in one email and agreed to give international shipping a try. Nan went to great lengths to make a small profit and a huge difference to a stranger. I am eternally grateful and consider them friends.

The box was the perfect dimension to fit the scatter box without needing to move Betty. I put her last collar and some favourite toys of hers inside too. It is truly beautiful to stroke and hug each night.

Betty's toys

Resting place

I am also hanging some canvas's of Betty, so that I see her beautiful face every time I go to sleep and every time I wake up. She will always surround me and is an intrinsic part of who I became.

Thank you to all who looked after us during the last difficult weeks:

  • Ruth
  • Sophie
  • Alan
  • All at the RVC
  • Emma
  • Anu
  • Mum
  • Jenny
  • Ingrid
  • Lu-Ann
  • All on the FB acromegaly group
  • Nan and Steve
  • Jellyhead 

It has taken me two months to be able to write this, but my blog has always been dedicated to Betty and her last chapter on earth had to be told.

Betty collage

xXx

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