Bella Colella

What Really Matters

September 26, 2021

Nothing makes you realize what doesn’t matter, when it becomes so clear to you what does. I started chronicling my Bella’s kidney journey in late July. I thought it was important for everyone to be aware of how quickly things can change and how important it is to trust your gut. And still, even if it may be too late, you have to try. When I first started writing this, I didn’t know how it would turn out, but I didn’t want to forget any of the details.

On Friday, July 23, Bella started acting unwell. She was licking her mouth oddly and then shortly after, threw up white foam. Turns out that mouth licking is a sign of nausea. She had little appetite. We watched her the rest of the day and on Saturday, and by Sunday, we hadn’t seen her go #2, and she wasn’t herself. Bella was hiding from us which is completely unlike her.

On Sunday, we took her to the vet, who opened special for us to see her. They x-rayed her and said that she was full of poo. I’m not a specialist, but I saw the x-ray and it looked like a fair assessment. Truth be told, Bella was a wild girl that day and booked it off the table and down the hall after one side of her x-ray had been done. Matt (my husband) caught her as she was making her escape. They gave her a shot for nausea, and we left with some laxative medicine. Matt and I had a bit of a laugh about the cause.

We were instructed to give her the laxative morning and night for up to 7 days. Monday through Wednesday, Bella seemed like her old self, back to her usual antics. We thought everything was fine.

Come Thursday, we could tell she wasn’t feel well again, and again threw up white foam and wasn’t eating. We called the vet in the afternoon, and they told us we could bring her the next day, Friday, July 30.

On Friday morning, she seemed a bit better and Matt and I debated taking her to the appointment. But we knew she still wasn’t quite right, and we decided we’d rather do it then than wait a few days and realize nothing had improved.

At 1pm we had our appointment and they did another x-ray. I could see immediately that the vet was alarmed by the look on her face. We learned that her kidney was extremely enlarged. They weren’t able to do an ultrasound until a bit later that day at 6pm, and they wouldn’t let us stay with her.

Crazy enough, my sister and brother-in-law had flown in that day to see us for the week. We picked them up at the train station, and then Matt brought me right back to the vet for Bella’s ultrasound.

Bella is very nervous around people she doesn’t know. When it was time for her scan, the vets called me into the room because Bella was hiding under the table. They’d already shaved some of her fur on her belly. They held her on the table with me looking at her while they did her ultrasound. One of her kidneys, the one that was enlarged, was surrounded by liquid of some kind. The team quickly realized it was serious. She needed a CT scan, and they offered it nearby. But the concern was bigger than that – they feared she needed surgery on her kidney and there were only a couple in the country that could handle what she needed.

One of the best in the country was 3 hours away, and they could see us that night. We immediately got in the car and drove, with almost nothing with us but Bella. Usually we keep her in her carrier because it’s safer, but this time, we decided to let her be free. She loved it and even stood on my lap and looked out the window for the first time in a moving car.

We arrived to the hospital around 11 and they quickly started doing tests. Her creatinine levels were high – 5.6. Creatinine is a measure of kidney function, and these levels equate to stage 4 kidney failure. Bella’s kidney was leaking something into the capsule surrounding it, but at that point, we didn’t know what. They needed to stabilize her with fluids overnight before they could do any further tests.

The next morning after a night of fluids, Bella’s creatinine levels had improved slightly and were down to 4. Now stage 3. They did the CT scan and realized it was worse than we all realized.

The sac around her kidney was filled with urine, and if ruptured, it would go into her stomach and she would likely die. We were told she only had hours.

We only had 3 choices – all of them seemed awful in the moment. Do nothing. Euthanize her. Remove the enlarged kidney through surgery. The last option was the only feasible one, and the only one I really considered. But we felt hopeless, as the veterinarian and surgeon didn’t seem to feel she had a great chance. While cats can live with one kidney like humans, from the CT scan, her other kidney didn’t look too good either. They weren’t sure it could sustain her. This was likely a case of acute on chronic kidney disease (ACKD) in the right kidney and chronic kidney disease (CKD) in the other. I kept asking if they could just drain the fluid out, and the answer was always the same – the kidney was damaged and if they drained the fluid, the capsule would just fill back up again.

We had the vet hospital call our local vet and explain the situation. I implored her for any other choices. There were none. She said if it were cat, she would do the surgery. I asked the vet hospital for the very best case scenario – they said if she goes home after 72 hours.

And so, at 6pm on Saturday, Bella went into surgery to have her kidney removed. Before her surgery, we had brought Bella her favorite bouncy ball toy and she immediately recognized it. Even the vet was impressed. We knew that the Bella we knew and loved was there and would fight. But we left devastated wondering if we would ever see her again, and if so, for how long.

Around 8:30pm that same night, we got a call from the surgeon that the surgery went well and perhaps the other kidney wasn’t as bad as expected. She was now recovering.

The next morning, Sunday, we spoke with them at 7am, and she had just woken up the hour before. We were allowed to visit her at 1pm.

When we went to visit her, she was certainly out of it and very groggy. We brought her favorite kind of cat food – tuna – and she gobbled it up. We were thrilled. She even tried to stand up. Her creatinine levels had decreased to 3. Still stage 3, but on the cusp of stage 2. She had drainage in her belly to take out anything from inside that shouldn’t be there from her surgery. She also had continuous IV fluids.

Sunday night we heard from the veterinarian that her levels were still stable, and she’d eaten again that afternoon.

Monday morning, we again heard from the vet and her levels were stable still, and she’d again eaten…this time her kidney food. We were allowed to see her at 1pm on Monday.

When we saw Bella on Monday, she looked brighter. We gave her a pouch of her new kidney food and she ate the entire thing…and was looking for more. They had removed her drainage, and she had peed by herself. Her creatinine levels had dropped to 2.7/2.8. Now in stage 2…barely, but there nonetheless. They said if she continued like that, she could go home the next day.

That night, we heard again from the vet for the nightly update. Still stable, still eating, and if this remained, Bella could go home on Tuesday.

Tuesday morning, she was still stable – her levels were down to 2.5 and she was off fluids. By Tuesday around lunch, we learned that the 2.5 levels were from the day before and she was down to 2 from that day’s testing. Bella was off fluids and her BUN / urea numbers were 81. (BUN is another measure of kidney performance, and these were higher than normal, but within range for a cat with CKD).

Even though we could have brought her home at this point, it was advised we let her stay for 1 more night to check her levels in the morning without fluids. At this point, Bella was “best case scenario.” I shouldn’t have expected anything less. As of Wednesday morning, her numbers were still 2 for creatinine and 80 for BUN. When we arrived at the vet hospital, Bella was all packed up ready to go, bouncy ball included.

She needed to go to the local vet about a week later (August 12) to get her stitches out and blood drawn to check her levels again. While they said she had healed really well once the stitches came out, taking her blood was an awful experience – really upsetting for her and for me. Then when we got the results back, I was told her creatinine was 3.3. That firmly put her back in stage 3 for chronic kidney disease. Her BUN had decreased dramatically though, down to 28 (from 80!) which put her easily in normal range. From research and messaging with the vet hospital who did her surgery, it sounded like machines could be different from place to place. Perhaps the low number read too low and the high number read too high. The important thing is not to go higher when testing on the same machines.

For nearly 3 weeks after coming home from her surgery, Bella was doing so well. Eating, drinking, pottying, playing, cuddling, sleeping on my pillow. She seemed nearly like her normal Bella-self. She even carried around her favorite bouncy and caught a fly mid-air.

Then, the morning of August 21, we changed her food to a different renal wet food (Purina NF). This was stupid. We finished the pack of 12 of her original food and wanted to see if she liked the new one. She did, and she ate her breakfast.

I was gone for a portion of the day in the afternoon, and that night she ate a bit. In the early morning of August 22, we woke up to her throwing up – white foam, and then also some lightly colored liquid later. I was hoping it was because I shouldn’t have changed her food so quickly like that. We found we actually had 1 left of the previous brand, and Matt went out to buy more. She ate a bit in the morning the next day, Sunday, but throughout the day she was on and off hiding. It wasn’t clear if she peed. But at this point, I’m still thinking it’s not an issue. That we just shouldn’t have switched her food, maybe she was feeling a bit nauseous but otherwise fine given her behavior the last 3 weeks.

Monday (Aug 23) comes around and she eats almost nothing for breakfast. Isn’t drinking. Isn’t pottying. Won’t even eat her favorite treat. Luckily we had an appointment already scheduled for that day to check her levels, and when we got there, we immediately explained her symptoms. I was thinking worst case, her creatinine levels would be a bit higher and she might need to stay for a couple of days to get fluids.

They did an ultrasound, and saw that her remaining kidney had something wrong…this vet tech called it a cyst, but she didn’t seem to actually know. Kept saying it was really serious but not giving us any next steps. We then asked for the blood work and her creatinine had jumped to 13.6, BUN was 121 and potassium was 8.4. This was only 10 days from her last appointment when she had 3.3 creatinine and 28 BUN. I was starting to face the possibility of losing her.

Since this wasn’t our normal vet as we had been at the beach over the summer, and we realized we weren’t getting answers, I called our usual vet at home. She had a specialist ultrasound tech on staff that day, and so we drove 2+ hours to get that done. There was clearly something blocking her renal pelvis, which is the part that connects the kidney to the (very tiny) ureter. What it was, no one was sure. Maybe blood, could be an infection. Bella’s CKD had become ACKD in her remaining kidney. She was completely blocked with only 1 kidney. Our vet seemed pretty hopeless and flat out said that we couldn’t do nothing. We should either euthanize her, or take her to another specialist vet hospital where they could try to stabilize her with fluids (but not too much because her kidney was already full of urine and we didn’t want to risk it rupturing like the other one). Then they could test the fluid to see if it was an infection, and then drain the urine from her kidney through a tube outside her body, and then give her more fluids and the right antibiotic to treat the infection if that’s what it was.

Off we went on Monday about 45 mins away and arrived around 9pm. They tested her levels again with EMO gas which is a much more accurate test – this was not for creatinine but for electrolytes to determine what fluids to give her. Potassium was 7.2 on this test…only hours after the last test…it had gone down it seemed. However, in reality, it turns out the machines can be quite different. Always remember that when looking at numbers. Still, that level is quite serious as it could lead to heart failure, and so they started her fluids keeping that in mind.

The next day we called for an update in the morning at 10 as we were told that we could. Nothing, no results yet from ultrasound but would call us when they knew more. 2pm, still nothing when we called. At this point, I also have my vet calling since she referred us. Around 5pm, we get a call from the surgeon that Bella’s creatinine is 17 and she needed to go into immediate surgery. This was August 24. We were told she’d need a feeding tube after the surgery as she may not be eating on her own. Honestly, I didn’t have hope that she was going to make it through.

A couple of hours later, we got a follow-up call that technically the surgery went well. She made it and was recovering, and my hope was recovering too. Bella was a fighter. The bravest girl I know. From talking to our vet, the mass was something soft, perhaps blood and inflammation but was being tested. I was also told something like a stent was put in to hopefully prevent from happening in the future.

On August 25 at noon, we went to see Bella. So different from our last experience at the vet hospital in intensive therapy. Because she had the feeding tube, I guess she wasn’t hooked up to fluids separately. They were giving her water through the same tube. It sounded like she had eaten a bit on her own which was good news. They brought her out onto a table and she walked around a little, but soon rested. She looked tired and sad. She hadn’t peed yet and her levels were still around 17. She ate a little of the renal canned food we gave her. I kissed her head a million times, and looking back, it was still not enough. I told Bella she was my best friend because she was and she is. I had brought her favorite bouncy ball toy and the vet carried it back in with her. That was the last time I saw her.

Early morning on August 26, we got the call around 7am. We lost her. As soon as we were on the phone with the vet but before we heard the news, Sammy started crying loudly. That will stay with me forever. Her levels were too high, her remaining kidney was damaged and urine leaked into her stomach. She went into a coma. I’m told she wasn’t in pain as she had methadone analgesic therapy. I hope in my heart that is true.

We had seen Bella just 12 hours before, leaving the vet clinic for the last time at 1pm on August 25th. We now know that she passed almost exactly 12 hours later at 1am on Thursday. That Wednesday night, I had called the vet a bit after 8pm and there were no changes at that time, and she passed less than 5 hours later.

The ringer on the phone was off that night. We had it on for so many nights in case the vets called. But it was off. But now we know that based on the time of the first call at 3:23am, they called us after she passed, so there was nothing we could have done. There is no scenario where we could have been there in Bella’s final moments. I made the choice to not see her after because I couldn’t bear to. I didn’t want to remember her that way and I know she wouldn’t have wanted that either.

The day that she passed, they did a swab of her left renal pelvis and it was negative for bacteria or “difficult germs”.

They tested the the blockage, and found that it was made up of calcium oxalate dihydrate (weddelite), calcium oxalate monohydrate (whewellite) and carbonate-apatite (calcium phosphate).

Here are the challenges…

1) Calcium stones must be surgically removed (unless too small to be noticed and/or not creating problems). Calcium stones have a somewhat unknown origin, whereas struvite stones are typically related to infection. Meaning that antibiotics or change in diet wouldn’t have been able to dissolve these stones. When I look at Bella’s blood work from the night of August 23rd, her calcium levels were 1.12 mmol/L. Normal ionized calcium levels are 1.12-1.32 mmol/L, so she was within normal range, if even on the low end of the range vs the high end. While not all cases of calcium kidney stones show high calcium levels (hypercalcemia), high calcium wasn’t reflected in Bella’s blood work at the worst of times.

2) Stones in the kidney seem to be far less common (was even told by my vet “really rare) than stones further down in the urinary tract. They are also much more difficult to detect because there are typically little if any signs. Kidney stones often aren’t found unless they are causing issues (like a blockage).

What I find crazy is that with everything that happened in late July, the vets did ultrasounds and a CT scan, and there was no reported evidence of a blockage in her left kidney at that time, only her right. These exams showed both kidneys, and in fact both kidneys are often mentioned in the reports. So in a span of 3 weeks, Bella went from no visual evidence of a blockage in her left kidney, to one so severe that her remaining kidney also failed her.

One of the things I had been wondering about since her first x-ray on August 25th is – what side of her body did they do, knowing they only did one? Turns out it was her right side – which was the correct side for the issue at the time. That Sunday, her kidney didn’t raise a red flag on her x-ray, and by Friday is was so enlarged that the only option was to remove it. I still can’t fathom how things can change that quickly.

Now I’m left questioning, and will likely never know, did undiagnosed chronic kidney disease cause her kidney stones or did kidney stones cause acute kidney problems which then turned into CKD. Either way, while CKD can be treated though never cured, there doesn’t seem to be a clear way to prevent these kinds of calcium kidney stones and the only way to remove these stones is through surgery. I’ve felt all along that had it just been CKD, we could’ve had more time together. It was the acute kidney failure that took her from me.

Bella knew I didn’t want her to suffer, but I think she also knew how difficult it would be for me to make that decision for her. She left this world on her own terms, as mysteriously and unexpectedly as she came in, with a rare illness, but still not as rare as her.

I’m completely heartbroken. Devastated to have lost her, but even more so, so unexpectedly and so young. Bella was only 10 years old, turning 11 this November. She lived a happy and seemingly healthy life. Sammy, Matt and I were her world, and she was ours.

I share all this because if it can help even one other pet, one other person, it will give me some small bit of solace.

What have I learned and what do I beg for all of you with cats?

Even if kidney stones are rare in cats, chronic kidney disease is common.

Look out for signs of it and other illnesses. Don’t feel you’re being a hypochondriac. If your cat MAY be drinking more or MAY be peeing more, or peeing outside the box, don’t assume there’s a reason behind it. If your cat gets stressed going to the vet and you’re trying to save them from that, call your vet and take them anyways.

Do blood and urine testing regularly – ask your vet if you don’t know when to start. Also check with your vet if they offer SDMA testing. This is a specific type of blood test that shows kidney function earlier than most BUN and creatinine levels. Whether it’s 7 years old or 10, cats should get tested just like humans so you can see early if something is wrong and also develop a baseline for their normal levels. Don’t wait until something is wrong.

Do your own research. Doctors and veterinarians are specialists, but it’s up to us to ask the right questions.

And lastly, most importantly, cherish every moment together. In the blink of an eye, your world and theirs can be turned upside down.

I wish I had more time with her. I’m envious of the people who do with their own pets. But the one thing someone said to me that really stuck with me is that I wouldn’t have wanted another cat for longer. Another cat wouldn’t have been Bella. “Those 10 years you did have with her are no doubt more dear to you than 18 or 21 years with some other cat.” And it’s true. Bella is irreplaceable, now and always, and I wouldn’t trade our time together for anything. I just wish she didn’t have to leave so soon.

“The pain of grief is just as much part of life as the joy of love. It is perhaps the price we pay for love, the cost of commitment.”

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