Saving Tyrion Lannister - Day 2 Post-Transplant and a Brother

After all of the stress of not knowing whether or not Tyrion was going to stop bleeding and basically make it to this day, in true Tyrion fashion, our little lion pulled it off.

When I received the morning call from his transplant surgeon, Dr. Aronson, this morning, he was less than 24 hours out of his 3rd life saving procedure.  She said when she called up to the hospital last night he was already up and eating as well as grooming himself.  That he looked like a different cat as far as demeanor and affect.

This morning when she laid eyes on him, she said she was amazed; that his progress was remarkable, which means a lot coming from her.

Shortly after 10am, she called back with his labs.  His creatnine was 1.  ONE.  Normal.  He basically has normal kidney function again. During our research of the transplantation process, we learned that sometimes it can take a transplanted kidney up to 2-3 days to start fully functioning.  This would have been devastating for Tyrion.  During the transplant, his dialysis catheter was removed and there was no longer a way to remove waste from his blood. Just this fact alone seems like an amazing feat for that little kitty!

We received some photos and a video of him this evening and he is eating with vigor (spoiled and being hand fed, but regardless, he was eating).  He looked bright!

Tyrion may be ready for his homecoming on Wednesday if he continues to progress.  We are very nervous about bringing him home.  My friend Lisa likened it to handling a newborn on their first day home and I have a feeling she is spot on.  I'm sure we will be over-aware of every little thing he does and analyzing it to death.  It's been four weeks since this journey began...thank goodness Ryan convinced me something was wrong, but to think that we thought that *maybe* he had an eye infection and was dehydrated.  Our armchair diagnosis was a little off.

This is our beloved Dr. Cleroux (left).  I wish I knew how many hours we've spent talking on the phone with her over the last month.  She and her student Wanxin had spent a lot of time with Tyrion both before and after the surgery.  In fact, Dr. Cleroux said the ICU was going to start making them mind the visiting hours.  He is well loved, that is for sure. 

And last, but certainly not least...

the reason Tyrion is feeling great today.

Meet Phish.  Or shall I say Jaime Lannister.

While Jaime is not a typical kitty cat name, we felt it was the only choice.  

If you are a Game of Thrones fan (we obviously are!), you know that's where we got the name Tyrion.  Tyrion Lannister has been our favorite character since we began watching 3 years go.  Just like the show/book, Tyrion is a little person, just as he is a little cat.  

The reason we chose Jaime Lannister is because he is Tyrion's brother.  Not only is he his brother, but he saved him from an almost certain death, just as Phish/now Jaime, saved our little Tyrion.  Ironically enough, on the show, Jaime loses a body part (his hand) in battle.  Similarly, our Jaime lost his kidney.  They have a very unique connection in the story, and now real life.  

So that's our story for today!  We hope that the days continue to pass drama/complication free.  The sooner we can get these two home, the better!  

Thank you to all of our family, friends and even complete strangers for continued support and prayers!  Tyrion isn't going to let us down!

Saving Tyrion Lannister - Transplant Day

After a long night of tossing and turning, thinking, worrying and praying desperately, I received the call I had been waiting for from Dr. Aronson, the transplant surgeon, saying it was go time.  A final type and cross match had been completed and Tyrion would receive his life saving kidney from a donor named "Fish".

Fish would go first.  At 8:30CST, Fish was being prepped for the transfer and his procedure would take around 2 hours.  Tyrion would be next. 

Tyrion's internal medicine doctor, Dr. Cleroux, called soon after and said that Tyrion was being readied for his part as well.  She reported that his hematocrit (the red part of the blood cell) was 34 - nearly normal!  As a reference point, when we first took him to Hillside in Dallas, it was 10, since then it has swung anywhere from 12-21.  She said he was feisty during his morning assessment and that he was in a good place; as ready as he was ever going to be for this.  We all agreed, it was now or never.  

Today was one of the longest days ever.  Instead of waiting anxiously for our daily call from the hospital, we didn't want the phone to ring until at least 4 or 5pm.  Anything earlier would mean complications, of which there were many potential ones.  I received an email from Dr. Cleroux around 4pm saying that everything was going well so far.  At 6pm, the call finally came from Dr. Aronson,  The transplant had been a success.

During the surgery, his left kidney was removed.  Sometimes both kidneys are left in place, which eventually just shrivel up and "die", but when a biopsy on the left side was obtained, the kidney started to "ooze" and bleed, so it was removed for that reason and for space.  

The only major complication during surgery was when Dr. Aronson attached the vessel of the kidney to the aorta, there was some leakage of blood from the suture/attachment site.  She added another stitch, it still leaked a bit, then added a mesh like patch, which seemed to resolve the issue.  This potentially creates one of the more worrisome scenarios for complication.  Tyrion was no stranger to clotting issues, as he had one exactly two weeks ago, where he was leaking blood from around his dialysis catheter site and his blood volume was dropping quickly.  This was corrected with a combination of therapy and never occurred again until today, mostly due to irregularities in his clotting abilities.  If this area begins to leak again, it would likely be fatal. 

So once again, we want time to pass with no phone calls until tomorrow morning.  A phone call means a problem.  

This day seemed like it would never come and I am still in a little bit of disbelief that it all went off without too many hitches.  Tyrion is far from out of the woods, but with each passing day, his odds improve.  He will spend the next few days in the ICU and will be very closely monitored.

Bringing him and "Fish" (who's new name shall remain top-secret for now) home together will only get closer and closer to happening in the coming days.  I'm sure those days will be filled with ups and downs and we will continue to wait each day for no phone calls. I can't wait to meet Tyrion's new brother, they already have a special bond.  Fish did beautifully during his part & will spend the night in the hospital, mostly just for observation as he had the easy part out of everyone today.  

To say this team of surgeons and medicine doctors at U Penn are incredibly skilled would be a gross understatement.  What they did today was nothing short of amazing.  Not because it was our cat, but because the odds were certainly not stacked in Tyrion's favor.  He is the smallest kitty (and maybe the youngest) to receive a kidney transplant.  His case was far from straight-forward or textbook leading up to today.  If it could go wrong, at some point it did.  We are still in the dark about what the cause of his kidney failure was, but a biopsy should be able to tell us in a week or two.  As Dr. Cleroux told us, Tyrion certainly made them think out of the box every step of the way.  I can't imagine how proud they must be that they all did this.  Tyrion not only ended up having our support systems behind him, but pretty much the entire hospital staff as well, as they had all taken such good care of him, sat with him during his 6-8 hours dialysis treatments or had slept in their arms.  I think it's safe to say they all love him, just as we do.

What I wouldn't give to be able to give that little kitty a snuggle and a kiss right now.

**Update:

At 4am this morning we got a call from the transplant surgeon stating that her concerns about internal bleeding were beginning to present.  Tyrion's blood pressure had dropped and he was not looking well.  A radiologist was called in and verified that he had some blood pooling in his abdomen, although it was impossible to know what was causing it.  Our only choice to save Tyrion was to send him back to the OR to see if this could be fixed.  While we were putting his tiny body through yet another major operation, with no guarantees, we felt that the entire process, including the receipt of this fresh new kidney, would have been in vain had we not proceeded.

Around 9am, Dr. Aronson called and said that they did it; they had saved him once again.  The bleeding was not coming from where we had all feared (where the organ met the aorta or vena cava), but from a microscopic surgical suture - not even visible to the human eye without a microscope.  Since Tyrion's clotting factors were not back to normal yet, for some reason he was bleeding from that teeny, tiny, pin point area.  I think it is amazing that she could even find where the bleed was coming from, let alone remedy it.

So another pothole in the road, detoured.  Tyrion...you are giving your mom and dad daily heart attacks. Please stop.

We will be updated again this afternoon, baring any further complications.  I am holding a constant prayer vigil in my head, day and night.  

Tyrion - Pre-Transplant Day

  

Saving Tyrion Lannister - It's A Go

Barring any further complications today, with the last cross match tomorrow morning or with the donor cat, Tyrion is a go for his transplant tomorrow.

This news came with a hour long conversation with Dr. Aronson, (the best and most experienced feline kidney transplanter in the U.S. and quite possibly the world) about what *could* potentially go wrong.

Besides the things I mentioned in my last post, other complications could involve technical difficulties, the immaturity of Tyrion's vessels and their ability to withstand stitching or surgical clamps, clots anywhere in his body or a brittle aorta.

All of these things are 100% unknown until the procedure is underway.  Scary stuff.

I am so nervous for this kitty and tomorrow holds for him.  I already know it is going to be a long day, but the later the phone call comes, the better.  We will know around 9/10 am CST if everything is truly a go, the first two hours will mainly be dedicated to taking care of the donor, and then Tyrion will get his chance.

It's literally another do or die day for him.

We gave him his best chance at survival and the surgical team will be doing their best to make it happen.

Here's to hoping for the best.

Saving Tyrion Lannister - Take Nothing for Granted

The ups and downs have begun again.

While Tyrion's overall status has been pretty good, concerns are beginning to roll in.  With his possible kidney transplant dangling in front of us, at this point, nothing is still for certain.

His primary veterinarian brought up some things that she and the transplant surgeon had been discussing.  My head spins when I think about them.  First and foremost, he is a small cat, in fact, the smallest cat/kitten to ever be a kidney recipient.  Can you imagine how tiny a 5 lb kitten's vessels are?   Interesting bear fact: a typical cat's urethra (the vessel for urine removal) is only the size of a needle on a flu vaccine.   We won't actually know if everything will "fit" until the procedure is underway.  What we do know is that their transplant surgeon is incredibly skilled.

Cats that require dialysis prior to transplantation also are at risk for mineralization of the aorta (the main artery within the body) - a process I'm not even sure I completely understand. If this has happened, it won't be discovered until the procedure and would exclude him from receiving the new kidney.

Over the weekend he also developed some new symptoms, mainly swelling in the leg opposite of where his dialysis catheter is.  At first there was great concern that he had developed a clot, but a closer look (via ultrasound) revealed nothing.  He still has some swelling, but it has also gone into two other paws/legs, leading to the belief that it may just be that he is holding onto a little extra fluid.  Even the smallest change in his body weight (like 0.2kg) is a HUGE shift for a 5 lb cat. (A clot would also equal disaster for potential transplant).

He seems to feel his best after his dialysis treatments.  He wolfs down his fodo and is alert and awake.

They let him roam around in some of the rooms there so that he can stretch his legs.  We've been told everyone there knows and loves him, that he sleeps in their arms.  That is something that makes me feel better about him being there - he is well loved.

Something else that has to change or correct itself is his white blood cell count.  White blood cells are what the body uses to fight infection.  For some reason, ever since the failed attempt at placing the dialysis catheter into his corkscrewed jugular veins, his white cell count has been high.  As far as we know, there is no other source of infection, because if there were, he wouldn't have been started on the immunosuppressant, a pre-requisite for the transplant.

Speaking of the immunosuppressant...he was getting too much over the weekend and was feeling kind of punky because of it and vomited.  The dose was cut back and he is responding much better to it now.

So, as you can see, things continue to be up and down.  The transplant surgeon will be contacting us tomorrow to go over EVERYTHING we need to know; risks, itinerary, requirements, etc.  It is overwhelming to think about, especially when I only want to think about bringing him home.

I think I've gotten a little ahead of myself regarding Tyrion's homecoming.  I've started clearing an upstairs room so that we can take turns sleeping and working from upstairs, so that someone is with him all of the time.  For the first few weeks, he will have to be isolated away from the other animals and will also be unable to jump (to prevent any abdominal trauma), so we are working on removing furniture and placing a bed on the floor.  That way, he won't be contained to a cage or a small area.  He'll have room to roam and one of his people close.  Then today, I was quickly returned to the reality of it all.  He hasn't even gotten to Wednesday yet.  We don't even know if Wednesday is going to happen. Everything has to be *perfect* to make this a go, and even if it is a go, there are so many unknowns that basically scare the hell out of me.  I think we may have all taken it for granted that this was just going to happen and turn out perfect.  Tyrion has overcome so many other obstacles, initially, this one seemed minor, when it is really the means to the end.  It will be another situation where it either works or he will not be woken up...that is IF we get to that point.  Like Ryan said, despite the outcome, at least will will know that we did everything we could to give this sweet kitty the best chance at life.

It will be another week where we sit on pins and needles.  Getting to the surgery, getting through the surgery and recovering properly from the surgery.  All situations that could go really smoothly or awry.  I am trying to stay positive and saying lots of prayer...hoping that things work out the way they already have in my head.

Little kitty looks a little rough...

Please continue to keep our little Tyrion in your prayers.  It's going to be a rough week, where we will taking nothing for granted.

Saving Tyrion Lannister - We have a MATCH!

I know that the updates have been a little less frequent this week, but I almost look at that as a GOOD thing.  In our world these days, no news is good news.  When the daily phone calls are shorter, it means Tyrion's day was better.

So, on with the latest turn of events!

We got some great news on Wednesday.

While we were somewhat worried that Tyrion wouldn't match an available kidney donor due to the number of blood transfusions he’d had until this point, he not only matched one donor, but TWO!

To say this was a huge relief would be an understatement.  He is no where close to being home free, but he surpassed another big hurdle.

His primary veterinarian, Dr. Cleroux, emailed me Thursday morning and said that the last time they did dialysis, the waste in his blood was 99% removed.  They did the same today. He is feeling pretty dang good after those treatments.   Well enough that he is starting to “pose” for pictures again!

He did have a very, very short seizure today during dialysis.  Apparently this isn't unusual, but isn't typically the norm this far into dialysis treatment - it usually happens in early, initial treatments and is most likely due to the quick removal of waste from his blood (the goal of dialysis).  He responded well to the treatment they gave him for the seizure and don't seem overly concerned about it in general. 

He naps a lot during his long treatments.  The little "cup" on his tiny face is oxygen; common during dialysis.

Dr. Cleroux suggested we stretch the treatments out to every three days instead of every two, just so we don’t have to give him more blood than is needed; mostly in order to keep him as a “match” for his donor, meaning only potentially two more dialysis sessions until transplant.  

She also mentioned that his hematocrit (the red cells in the blood) was 26!  That is over double what it was when we started this whole ordeal. He is no longer loosing blood anywhere, which is a win, and his bone marrow is obviously triggering the creation of new red cells.  He gets a weekly injection of an agent similar to what humans get to stimulate red cell production as well.  It takes a few weeks to start working, so I have a feeling it is finally starting to work! 

Look how pink that little nose is!!  It was almost white the night we took him to the ER.

He was moved out of the ICU on Monday.

Here he is in his new “room” with his baby.

If everything goes as planned (and we still have to talk with the transplant team), Tyrion will likely receive his new kidney  Wednesday or Friday of next week.  The donor that has been chosen at this point is a large, (three times Tyrion’s size!) jet black cat.  In fact, Ryan is pretty sure he saw him when he took Tyrion to U Penn initially.

As always, we are so thankful for all of the prayers that have been said for our little Tyrion.  Looking back, I was initially very unsettled about putting Tyrion through all of this, especially with all of the risks involved.  No one wants to see their pet suffer.  It is so difficult because you can’t really explain to them why you are doing this or why they have to go through it, but now I am so happy we made the choice to give him the best chance.  I am thankful there was a “fix” of sorts for what was wrong with him.  Thankful that it wasn’t something terminal, such as cancer or leukemia, which is quite common in cats.

I also wanted to add this article I found while perusing around on the U Penn Vet website.  It is not only heartwarming, but it really addresses the real reason people take drastic measures to save their pets.  Dr. Aronson is the amazing surgeon who will be transplanting the kidney for Tyrion and Lynn (the cat rescuer) is the nurse who we will be working closely with during and after the process as Tyrion will be on immunosuppresants, which will need to be monitored, for the rest of his life. In fact, they began immunosupressing him today (just another step in the transplant process). 

http://articles.philly.com/2014-11-16/news/56395362_1_dogs-and-cats-princess-transplant

The article also speaks to the donor process, something I have been asked about by several people.  The donors are taken from a nearby animal shelter.  While these cats may not necessarily be able to  “consent”  to the process , they are loved and cared for at Penn Vet, and most likely saved from being euthanized.  Almost like a new lease on life for them as well.  The donor has a pretty easy recovery in comparison as well.  They are typically feeling very good the day after the procedure.  As I had mentioned in an earlier post, Tyrion’s donor will return home with us. In fact, he already has a name, which we will reveal later. 

Please continue to keep Tyrion in your thoughts and your prayers.  I feel like God is listening (doesn't he always?)!  I lift both Tyrion and the phenomenal doctors caring for him, up daily.   I feel in my heart that Tyrion will be coming home soon (maybe even within the next two weeks) and pray for a smooth recovery and transition for him and his new sidekick.  Life will be drastically different for us, but I am incredibly thankful for this huge responsibility.

If you'd like to help us in Tyrion's journey, feel free to visit our fundraising page: http://www.gofundme.com/u5dp6x5d9s

Saving Tyrion Lannister - Weekend Update

Tyrion had a fantastic weekend!  His vet called me Saturday while I was running my ultra marathon and told me he was having a "phenomenal" day! That certainly put a spring in my step and a smile on my face! He was eating like a little piggy and just looking better overall.

His primary vet, Dr. Cleroux, called us just a bit ago and said today he was in the best "spirit" he had seen him in.  He looked brighter and was being feisty enough during his dialysis treatment that he had to have some sedation!  This is the Tyrion we know...the one that takes three humans to hold him down to get a temperature in his backside.  This is a *great* sign!

The only semi-concerning thing today, was that his potassium level was 9.0!  Normal potassium levels are from 3.5-5.  One that high in a human would almost surely cause heart arrhythmia, cardiac arrest or even death.  Tyrion was showing zero signs of trouble.  They also had a harder time finding a blood cross match for him today, which worries us a little, as this is the first time this has happened.  Hopefully, this is not a precursor/sign for finding him a kidney match.  This process is going to start happening tomorrow or Wednesday.  They have three donor cats there that have the same blood type as Tyrion (type A), but they have to cross match on other levels as well.

So now we hope and pray that this is the next test this tough little kitty can overcome.

The wonderful vets at the hospital sent us some adorable pictures and videos over the weekend.

This kitty....we miss him so much! What I wouldn't do to see him feeling well right now.

Saving Tyrion Lannister - Friday

The ride continues.

Tyrion had a *really* good day today.  As in, probably the best he's had since he's gotten to U Penn.  He ate half of two meals (by far the most he's eaten in a day and that was just up until around 4pm), was up walking around in his cage, using his litter box and even got a little bath (which he politely protested. His primary veterinarian is off for two days over the weekend and the is on again for FOUR STRAIGHT WEEKS, but still took the time to send us a couple of pictures and an absolutely adorable video of this after his bath, out walking around outside of his little home and hiding.  I'm still smiling.

Tyrion received dialysis today and hopefully will not need it until Monday.  He is completely out of the oxygen cage (yay!) and his hematocrit (the red cells) are holding, but still not anywhere close to normal (most likely due to his poor kidney function).  The bleeding in his cathetersite remains non-existent for today, but he is still loosing some blood in his urine.  We also learned today that he has been bumped up on the transplant priority list to #2.  Meaning, our sunny day scenario of him receiving a transplant the week of the actual Memorial Day holiday would be his week, granted he matches and the final infectious disease tests come back negative (so far, so good).  On the flip side, his potassium seemed to rise quite quickly, especially for being off of dialysis only 36 hours.  He can have dialysis again if he needs it, but we want to try and minimize the occurrences to three times a week to keep the number of blood transfusions low as well.  Each time he receives dialysis, he gets another transfusion, making his chances of matching another cat for a kidney possibly more difficult.

We *really* need him to stay well over the weekend.  I'd love to see him have two or three great days in a row.  If he stays well over the weekend through Monday, he will finally be transferred out out of the ICU.  It's also Louis' birthday Sunday.  He really needs a good day that day!  We are counting on him.

So that's it for now...I'm off to get a few short hours of sleep.  I've got a 30 miler to rock out in the morning!

Saving Tyrion Lannister - The Roller Coaster Ride

Tyrion’s care remains a roller coaster of events.  One good thing continues to be followed by 2-3 worrisome things and those things are usually very worrisome.

Yesterday was one of those days.  Tyrion’s vet, Dr. Cleroux, called around noon, which was unusual to begin with.  She said she had a number of concerns (mind you, these concerns are never minor).  Tyrion had been bleeding around the dressing that surrounded his dialysis catheter, he was losing blood in his urine and stool and had a hematocrit (the red cells that carry oxygen in our blood) that was dropping as fast as it could be replaced.  Through yesterday, Tyrion had received a total of 9 transfusions, which is a lot even for their hospital.  Something about this that is of growing concern is because of all of those transfusions, will he be able to match to a donor cat?

For some reason, he just would not clot at the location where his catheter was; he was saturating several dressings over a short period of time.  While the site wasn't “gushing”, it was still leaking consistently.  To make matters worse, he needed dialysis, which posed a problem of its own, as the blood has to be thinned with an agent called Heparin, to allow for good flow and prevention of clots during the dialysis process. With blood oozing from his catheter site, thinning it even more was not something that was going to bode well for him at this point.  On top of all of this, he just wasn’t feeling well. 

Once again, he was at a point where we were forced to make last chance efforts.  If those efforts did not correct his issues, we decided that the only fair choice to him would be to let him pass.  Needless to say, yesterday was another really hard day.  If you remember, the day before was a good day.  One step forward, four steps back.

Dr. Cleroux presented us with a choice of using a medication that did not have any evidence based research showing any results in cats, but had good results in humans called DDAVP.  We hoped this would help his kidneys stop producing blood in his urine as well as help him with clotting as well as increase his blood pressure.  His low blood pressure was likely a cause of low blood volume (from the leaking), yet another reason he couldn't have dialysis.  So we did it.

Thank God Dr. Cleroux called with decent news this morning.  Some combination of the DDAVP, a plasma transfusion he received, a pressure dressing to his leg or the dialysis he was able to receive later in the day worked.  His catheter site has stopped oozing blood for now, he no longer has blood in his urine or stool and his hematocrit is holding steady (but still about half of what it is supposed to be).  He was able to have his dialysis late yesterday and finished around 7am EST this morning.  The great news today was that his renal values were actually NORMAL!  Not super high, semi high, but normal.  Dr. Cleroux said she could see that he was feeling better as he ate a little bit this morning and was licking/bathing himself; two things he hasn’t done in a long time. 

We’re still waiting for the rest of the infectious disease tests to come back to clear him for transplant, hopefully we will have some good news on Friday as well. 

Once again, the power of prayer amazes me.  I feel like this little kitten has so many friends, family members and even complete strangers pulling for him, that he just cannot let anyone down.  He is a true Tyrion Lannister, fighting the fight, overcoming when we worry that might not.  He continues to surpass my expectations.

Tyrion certainly isn’t out of the words by any means.  We still have challenges.  One that is concerning is completely out of our hands.  With as many blood transfusions as he has needed, Dr. Cleroux was concerned about their blood bank running out of blood that he is compatible with.   I pray that the time never comes when he really needs it and it is not available.  I pray that they are able to replenish their supply; not only for Tyrion, but for the other pets they treat as well.  I pray that we are closer to getting the transplant he needs.  That *maybe* the week after next it is his turn.  But most of all, I pray that he comes home.

 

Addendum:  So I wrote this post around noon.  Things have shifted yet again.  Tyrion received a plasma transfusion this evening and had another mild reaction to it.  This becomes more concerning as he continues to need transfusions.  While the reactions have been mild, a fever with some slightly labored breathing, they still pose just another potential problem in his care.  He ate again this evening and the sores in his mouth and GI tract are likely healed, but those are not even on the top 3 list of worries right now.

So another night of worry unfolds; we sit with heavy hearts.  Hopefully there will be some better news in the morning.  Getting a new kidney for him isn't as easy as it sounds.  Sometimes I feel like that day will never get there, but I have to hold out hope.  I battle with a lot of feelings such as 'is this fair to this little kitty'?  Well....no.  It's not fair that this poor little thing has these majorly big issues, but what is fair is that he is getting his best chance at life.  I also wonder how much his little body can take. Tomorrow will likely be another wild ride as it will involve another transfusion, another chance of a reaction and other obstacles.

Continue your prayers for our little kitty, they have already proved powerful.  We need him home.

Saving Tyrion Lannister - Tuesday

While we didn't hear from Tyrion's resident veterinarian by phone today, she did send us a picture and a note this morning...

"Tyrion is looking a bit better this morning.  He licked a little bit of his food overnight.

He will have to have another blood transfusion today (I will spare my readers the details of why).

Tyrion is sitting up and looking around a little, which he has not done in a few days.  He definitely has more energy! One baby step at a time!  Also, the ulcers on his tongue look much better today!"

As I mentioned earlier, Dr. Cleroux also sent a picture, he certainly had a little liveliness in his eyes, but I don't feel comfortable sharing it right now.  It kind of gives me the sads looking at it.  I just have to keep in mind that he is getting a little better every day now.  There will certainly be more set backs, I'm sure, but I still feel like the worst is behind little T.

We are *really* happy he was looking a little more alive today.  It's what Dr. Cleroux was looking for from him today.  I anticipate he will do dialysis again tomorrow and follow a more traditional three day a week schedule (Monday, Wednesday, Friday) from now until he can receive a transplant.

Keep praying for our little lion.  The power of your prayers have proved amazing so far!

Until tomorrow...

Saving Tyrion Lannister - Monday

Just a quick update on how little kitty is doing today.

Ryan returned to Dallas today and we left Tyrion in the hands of the team at U Penn.

Today Tyrion had 8 hours of dialysis and tolerated it very well.  Another really good day for him. They were able to get his renal values down by 50% again today, which bodes well for him.  We are praying that he starts looking better tomorrow.  So far, he hasn't really perked up at all.

He has developed some sores in his mouth and GI tract (stomach and likely intestinal tract) that were being treated, but probably still made him feel pretty rough.  These were almost certainly caused by his high renal values.

Tyrion remains in the ICU, but we are hoping that after he gets his red blood cell levels up he can be weaned off the oxygen and be placed on a medical floor.

We also learned that all of the test that Tyrion needs to have done to clear him for transplant have been completed.  Now, we wait for results.  We've already learned he's passed one, some of thehttp://jojocouture-southernfriedsoul.blogspot.com/2015/05/saving-tyrion-lannister-monday.html?m=1m can take up to a week.  Sunny day scenario: T goes for a transplant the week of Memorial Day, BUT as we have already found out, a lot can happen between now and then.

Tomorrow will be a rest day for little kitty.  I think he deserves it!

The main resident, Dr. Cleroux (spelled correctly here) on Tyrion's case was kind enough to send us a picture of him while he did dialysis today.  Like I've mentioned before, these vets are just amazing.  One example: since Tyrion's catheter is in such an unusual spot, Dr. Cleroux and Dr. Foster (one of the department heads) have taken it upon themselves to be the ONLY two people that can handle the site or the dressing around it.  Last night in the middle of the night, after being at the hospital all day, Tyrion's dressing became soiled.  Dr. Cleroux got up, came into the hospital and changed the dressing herself in order to prevent any infection in the site.  I've said it once and I'll say it again, I cannot even comprehend the dedication that these veterinarians have to seeing their patients through to health.

I'll leave you with the picture we were sent today.  If you look closely, past all of the machines and tubes and blankets, you'll see Tyrion all tucked in, warm and cozy.  What I wouldn't give to cuddle that little kitty right now.

Want to help Tyrion Lannister on his journey to a transplant?

http://www.gofundme.com/u5dp6x5d9s

Saving Tyrion Lannister - It was a good day

To say today was a great day would be an understatement.

First off, it's Mother's Day.  I got to spend the day with my super cool almost 9 year old!  We really needed each other this weekend...it was a rough one.

But it was a good day.

A good day that could have spelled sheer disaster.

Today was the day our precious kitty, Tyrion, underwent what could have been the final step in our journey to save him.

Dr. Clarow, the main vet who has been working with us on Tyrion's case (this kitty actual has a whole team behind him) called early (8:30am CST) to let us know the surgery was about to take place.  We had agreed upon parameters in which certain events would or would not take place.  If the catheter could not be place, Tyrion would not be woken up.  If there was no flow in the catheter, the same.  Minutes seemed like hours.  I felt sick to my stomach and was crying at the drop of a hat.

While we were waiting, Ryan called to tell me his flight from Philadelphia had been cancelled due to the weather in DFW (it was a L O N G night).  Nothing says Mother's Day like sleeping through tornado sirens at 7am! It was almost a blessing that his flight was cancelled because I can't imagine having to land in Dallas only to turn my phone on to see if the kitty you'd hung your hopes on had lived or died.

We decided the longer it was that we heard from them, the better.  For the shorter time would've meant they were unsuccessful.

Finally around 2:30, 6 hours after this had begun, the phone call came.

I held my breath, said a little prayer, and tried to hold back the tears.

When we were deciding to take this step with Tyrion, we were told that this top notch, world class facility, had only attempted this type of procedure in a cat one time.  It was not successful.  They were able to place the catheter, but adequate blood flow was not achieved. Those aren't good statistics.

Just a little side note on the U Penn veterinary facility....

These doctors work tirelessly to heal the broken animals they take care of.  They are there day & night, weekends, weekdays, from sun up until sun down.  Quite honestly, I'm not really sure when they sleep.  They spend hours on the phone with us & want ever step to be a success just as much as we do. You can tell they are invested in the patients they take care of, just as their owners are.

I answered the phone.

Tyrion DID IT.  They were able to place the catheter in the first femoral artery they tried, with no crazy corkscrewing or detours to the area in his heart where it needed to be.  Not only had the renal team nailed the procedure, but Tyrion had already been on the dialysis we longed for for nearly 20 minutes and was doing well.

My oldest friend Lisa told me yesterday...good things happen on Sundays.  (Remind me to *always* listen to her.)

Dr. Clarow sounded just as ecstatic as I was.  This time instead of tears of sadness, there were finally some tears of joy.  She said Tyrion's entire team celebrated this large victory.  Good things happen on Sundays.

Dr. Clarow called again this evening and told me that Tyrion did a full 6 hours of dialysis.  I know that sounds long, but they had to go very slowly due to his size.  They pulled off 40% of the toxins in his blood in just one treatment (they can't totally clear the blood as it would send his little body into a tailspin).  She was pleased.  We were pleased.  This is the good day we all prayed for.  All I kept thinking all day was 'good things happen on Sundays.

Tyrion will have dialysis again tomorrow.  Likely for 8 hours if he can tolerate it.  His feeling tube was removed from his nose and placed in his belly which will be much more comfortable for him.  He will likely feel pretty badly tomorrow, but come Tuesday or Wednesday, he should start feeling really good.

So for the next few weeks, he just needs to maintain, pass a few more tests to be cleared for dialysis and be matched with a donor cat.  Sounds easy, right?  Knowing Tyrion, there will be many more potholes along this path, but he is our lion.  I told y'all he was a special kitty.

Continue your prayers.  We really need and appreciate them.

Happy Mother's Day to all of my skin and fur mom friends!

It was a great day.

Saving Tyrion Lannister - Saturday, May 9th

Today was another long day.  An emotional day.

Tyrion was scheduled for his dialysis catheter placement this afternoon.  We knew he was fourth in the lineup, and didn't anticipate that surgery would start until late this afternoon.  Afternoon turned into early evening and we had heard nothing.  The main veterinarian on his case finally called me around 7pm and said that surgery #3 was underway, but turned into an emergency situation and she didn't think Tyrion's procedure would start until late this evening and would likely go into the early morning hours, depending on any complications along the way.

Earlier in the day, Ryan went to the U Penn hospital to see Tyrion, which was likely, but not a certain, to be the last time he would see him.  While we continue to hold out hope, praying for a miracle and documenting one for the books, we know this procedure comes with great risk.  One of two things would be the outcome of this.

Our favorite scenario:

The catheter passes, good blood flow is achieved and he starts dialysis hours after recovery.

Our most unfavorite scenario:

The catheter does not pass, or he has wonky venous pathways, like they saw in his jugular veins.  Or the catheter does not allow for good blood flow, something essential for dialysis treatment.  At either point, we have agreed with the veterinarian, that the procedure will be aborted and Tyrion will not wake up.

This scenario is devastating to me.

I am sobbing just thinking about it.

Today when Ryan saw Tyrion, Louis and I got to talk to him over the speakerphone. We told him how much we loved and adored him over and over and over, to stay strong, that we knew he could do this; that he had to.  I apologized for all of the times I got upset that he knocked over giant glasses of water on my office chair, my computer and kitchen floor.  Those things seem like such minor incedents right now.  We miss him so much.

Even though it's only been a week since he's been hospitalized, I fully expect to see him bounding around the corner when I get ice out of the dispenser in the fridge or run the faucet (this cat has a thing for water).  The house misses him.

Loves water so much: fell in the tub.

So for today, no set backs, just pauses.  Since the procedure was delayed, I came to a conclusion with the vet, that we would hold off until tomorrow.  He is not in grave danger, he is just feeling punky.  I felt more comfortable having a surgical team that was rested, versus a team that had been on their feet in an OR all day.

So we wait.  Again.

Hopefully things will go as planned and he will be in surgery by mid-morning.  It may be a little later, but things will no doubt happen tomorrow.

We continue to pray for a miracle.

If you'd like to help support us in kitty's care:

gofund.me/u5dp6x5d9s

Saving Tyrion Lannister - Friday

First and foremost, Ryan and I are overwhelmed by the incredible amount of support that we have gotten from our friends, family and even a handful of strangers.  We will never forget this or the kindness people have shown us.

It's hard to believe that it has been a week since this nightmare started, especially when the days are long, spent waiting for anticipated phone calls from the amazing vets at U Penn.  It seems as though one bad day precedes just another.  When we get a kernel of hope, it is crushed with more bad news.

Today, a veterinary cardiologist would evaluate Tyrion as part of the transplant requirements and just to check on what we were dealing with.  This was not an invasive procedure, so it was almost another day of rest. Early this morning we had learned that Tyrion had maintained his red blood cell count over night, actually increasing a little bit independent of another transfusion; a good sign that his bone marrow was still functioning somewhat.  How things change so quickly....we waited all day for a call from the lead vet on Tyrion's case.  It was a long day.  She finally contacted us around 8pm to tell us some abnormalities were seen on Tyrion's echocardiogram, but that this wouldn't necessarily rule him out for a transplant, but it didn't help matters either.  We learned that Tyrion is kind of like the cat version of Benjamin Buttons.  He is a little old man in a little kitty body.  The things that were presenting on the echocardiogram were things that were typically seen in a much older cat, as were his issues with his kidneys.  His case involves more twist and turns everyday.  The transplant nurse warned us this would not be an easy road, but I'm not sure anyone could ever be prepared for this pothole filled path.

At this point in time, medical management (medications and interventions) are failing Tyrion.  Our choices were laid out very clear in front of us.  Go for  a possible dialysis catheter in his femoral (thigh area) artery or give up.  As long as I've had pets, I have never wanted to be presented with this choice.  I'm always reminded of my black lab, Kirby's passing.  While sudden and unexpected (even though he was 12), it was fast.  We didn't even have a choice in the matter.  He was gone before I could get dressed to take him to the vet.  I've always been thankful I didn't have that choice.  It's hard to know when to say when and while there will always be those people who have vastly different opinions than what we have regarding what we will or will not put our pet through, it is ultimately not their choice at all.  We took Tyrion to U Penn with the intention of doing everything we could to get him back home happy and healthy and we reaffirmed that commitment to him tonight. Through many tears, we decided that we are going forward with the placement of the femoral artery catheter.  It is all we have left.  Our last hope that Tyrion will pull through.  All along, I've felt that the dialysis process would be the most difficult hurdle to overcome for him due to his size and frailty.  We feel if he can just get through this, he can overcome anything.  Tyrion - our little lion.  We are hoping for a Game of Thrones (for those who don't watch, Tyrion is a main character on the show and his namesake) ending to this, with Tyrion persevering.  If there is a day that we could all use some extra prayers, it's tomorrow and Sunday.  There are many risk not only to placing the catheter, but to performing dialysis thereafter.  If we can get him through the first treatment, I have no doubt he will prevail.  Some people may feel silly praying for a cat, but like I said earlier, this kitty is not just our pet, he is a family member just as all of our pets are.

Tomorrow evening will be make or break for this precious kitty.  We had a choice to allow him to die without intervention or at least try.  We have decided this is his very best chance at life and we will not look back with regrets or what ifs.  Maybe we are prolonging the inevitable...but, maybe we aren't.  At this point, we think Tyrion's legacy will long live on at U Penn.  We think he is teaching them more about treating small kitties with very strange disease processes.  At every turn he has run into an unexpected road block.  We hope this is not the case tomorrow.

Some people have asked (or incorrectly assumed) about where the kidney donation comes from.  The kidney donor would come from a pool of cats that they have at U Penn that have already been cleared to be donors.  Tyrion would have to be typed and cross matched, just like any other human getting a transplant.  Whichever hero cat matches him then becomes ours, which we welcome with open arms.  If a donor can save little T's life, we will give that cat it's best cat life.  Cats, like people, can also live with just one functioning kidney.  I'd give that kitty my OWN kidney if I could.  The donor cats are never euthanized.  Ryan told me these donor cats kind of live the high life at the hospital (which happens to be named "Ryan Hospital").  They have a huge cat playground and have the run of the place, in areas where they are allowed of course.

So for tonight, I try to think about all of the fun/good times we had with this little kitty.  I don't want to imagine how he looks right now.  I know he feels bad and I can't explain to him the rhyme or reason behind his feeling crappy.  Some may say this is inhumane treatment of an animal, putting him through all of this, but quite honestly, this kitty is getting better medical care than some people.  Because we stay committed to him.  Every person makes their own choices and limits for their animal.  I'm choosing not to share some of the outcomes that may occur tomorrow, because there is only one good scenario. As Ryan said tonight, tomorrow evening he will either be getting better or he will be at peace.

So until tomorrow, I'll share some of the good times (which there are so many) we've had with this kitty in the short time we have had him in our lives.

Not even 24 hours in his forever home.  This is one of his favorite tricks; jumping up on us (and scratching the bejesus out of us in the process) and sitting on our shoulders like a parrot.  Eventually, Ryan had taught him to do this on command. 

Tyrion LOVES the warmth of the computer and when he was teeny tiny, he used to fall asleep on the keyboard!

I'm not sure if this is a trick?  It sure is funny though!

Best pals.

Little T *loved* his Christmas stocking.

Another "trick".  Seriously, this kitty is constant entertainment, but at the same time has made some huge messes! Open glasses are never safe! Chocolate milk was his very, very favorite thing to swipe.

Curious kitty in his first snow.  He was so cold, but inquisitive (and pretty stunning in the snow).

Tyrion is a one photogenic cat!  He put up with my incessant picture taking without complaint.

Always finding him in silly places. He was originally named "Joker" (his brother was Batman) because of his "mask" marking.  He definitely lives up to his original name.

I told you he likes his picture taken.

The boys. Biggest and smallest. Even though Roscoe outweighed little kitty by 100lbs, he had zero fear of him.

If you'd like to contribute to our fund helping with Tyrian's medical cost, please visit:

http://www.gofundme.com/u5dp6x5d9s

And once again, thank you all for your thoughts and prayers.

Saving Tyrion Lannister

Last November, we decided as a family that we wanted to welcome another kitty into our brood.  After careful selection, we found an adorable kitten that was for adoption through the SPCA and it was pretty much love at first sight.

While our other kitty Khleo, wasn't exactly pleased with these new developments, eventually she grew to love her little brother.  Our little family, fur and skin was complete.

Tyrion, who lived up to his character's name (we love 'Game of Thrones'), was always a small kitty.  He didn't grow that much in the five months we've had him.  We thought this was a little odd, but just chalked it up to him possibly being a small cat like his sister Khleo.  Over time we noticed he was becoming more sleepy.

Instead of going up to Ryan's office to hang out with him at night (vampire hours), he was cuddling up with me when I went to bed (which I didn't mind at all).  We again, discounted this and thought that he was just growing.

These two have the most unique bond, but he still likes my breath better. :)

But this past Friday, things started falling apart.  Ryan noticed that little kitty (Tyrion) was staring into space, we were finding him in areas he'd never gone in our house before and he wasn't getting overly excited about food or coming when called.  He was a very veracious eater, but last Friday, he didn't come when called...his call was shaking a bag of treats.  This kitty has always come when called.  We think of him more like a dog than a cat.  He is always in the dog food, our food and his food and now he wasn't.

The evening before Tyrion started showing more signs he was not feeling well.

We decided that maybe it wouldn't be a bad idea to take him into a 24 hour vet.  We drive down to Hillside Veterinary Clinic in Dallas and I was fully expecting to learn that maybe he had an eye infection (he had some dark matter in his eyes) and was possibly a little dehydrated. We nearly took the vet's advice of conservative treatment of sending him home on fluids that would be administered through a subcutaneous injection and some medication to help stimulate his appetite.  For some reason, in a twist of fate, we thought maybe we should go ahead and at least get some lab work, a complete blood count and a kidney profile at the least.  What we learned next can only be described as shocking.  Tyrion was in kidney failure.  At 8.5 months old.  He was also severely anemic.  Little kitty's gums were white as was his nose. His hematocrit level (one measure of red blood cells) was 10.  Normal levels are around 35.  We new he would need a blood transfusion, but that posed another problem.  There were no available packed red cells (the type of blood he needed) at this particular vet and none to be found/available at surrounding vets.  We were desperate.  In an incredible act of kindness, one of the veterinary techs at Hillside, Jesse, volunteered her cat to be a donor for Tyrion.  Her kitty provided him with two lifesaving transfusions, but we were still getting nowhere.  His levels continued to peak and then drop.  The vets at the practice were confused, as were we.

Saturday

We received a call Saturday morning from the vets stating his condition was not improving.  They would continue to monitor his kidney function and level of anemia.  None of these numbers improved during the day, in fact, they got worse.  By the time we got down there to see him Saturday evening, he was being prepped for another transfusion, his third.  This time another vet tech whose name we never learned, volunteered her cat, Mittens, who looked like an older, fluffier version on Tyrion, to be another donor.  When he saw us, he perked up a little bit, but he was still very lethargic.  He was sleeping in his litter box, but did eat a little bit for us.  The first food he'd had in awhile.  We left feeling defeated.  This poor little kitty wasn't getting better, in fact he was getting a little worse.  He was unable to receive any fluids at that time as they didn't want to dilute the fresh blood he'd just had.  He was being tested for anything and everything, looking for a reason for his kidney failure, which is odd in such a young cat.  His symptoms have never fit into a neat little box of symptoms.  We always knew he was kind of a weird cat, in an endearing sort of way.

Sunday

Sunday brought some difficult decisions, a great deal of tears as well as worry.  We felt there was nothing more Hillside could do for him. We had a sonogram done, which didn't show anything terribly significant, which left us even more confused.  We made the decision to transfer him to a critical care facility in Lewisville, the Center for Veterinary Specialty and Emergency Care.  We were told this facility housed the best of the best veterinary nephrology (kidney) expert in the area.  We rushed him to Lewisville where he was re-evaluated.  Even though we had no idea what was going on inside this little guy, we were told his only hope for survival was renal dialysis, something that is also performed on humans with kidney failure.

This was a very trying decision to make.  On one hand, I didn't want my poor little kitty having to live with tubes sticking out of this neck and having to be fed by a feeding tube, but on the other hand, both Ryan and I wanted this kitty to have the BEST chance at life.  We discussed how very special this kitty is to us.  Tyrion isn't just our pet, he's part of our family.  We had to think about what we would do for any other of our family members.  Because the Lewisville facility was only equipped to do dialysis on larger cats, with larger dialysis catheters using a higher quantity of blood, we were advised to possibly pursue treatment at the University of Pennsylvania in Philadelphia as the treating physician, Lisa Thompson (who is the BEST in this area), was familiar with their program and knew one of the heads of the department.  It was an option, but we just weren't sure yet.  We wanted to see how he did through the night.  When we left Tyrion, he was quite playful.  He didn't even look sick.  He was rubbing his cheeks on our hands like his normal self.  He's always loved smelling my breath (I told you he's a *special* cat) and he was doing just that.  It was hard leaving him.

Monday

Monday morning brought no new answers, few changes in his condition other than that little Tyrion's potassium level was climbing because of his kidney's inability to perfuse correctly; a condition that could ultimately send him into cardiac arrest.  We quickly decided that U Penn would be his best shot.  So we purchased a plane ticket for Ryan and he was off to Philly just 4 hours later.

Saying our goodbyes.

Ryan arrived at U Penn that evening and Tyrion was taken into their care.

Tuesday

We wanted to dialysis to start right away on Tyrion just for the sake of getting him to feel better, but several things had to happen before that could begin.  Because his kidneys were not working well, he began accumulating fluids in his lungs.  The veterinary team had to aspirate the fluid (through a small needle) and collected nearly 1/4 of a cup.  Keep in mind Tyrion is a 5lb kitty!  He still had fluid on the right side of his lung, but started to fuss during the procedure and the team did not want to push him.  Another day was about to pass without getting this little guy on the dialysis treatment he needed. Ryan was able to stay in Philly and was able to see him once that day.

Tyrion on Tuesday

His kidney values were holding and not getting worse.  We were able to speak with one of the department heads, Dr. Foster, about Tyrion's care and began to feel comfortable with their plan despite the fact that he still was not on dialysis.  A decision was made that he would be prepped the next morning for the placement of his dialysis catheter.

Wednesday

Tyrion's procedure was delayed because of other emergencies.  They did not start the catheter placement until around noon.  During this time he received yet another blood transfusion...another mystery to us.  Where were these red blood cells going?  We knew he had likely developed a small ulcer in his upper GI tract (I'll spare you the details), but that was not a good explanation.  His belly was not full of blood.  The catheter placement started around noon and around 6pm we received a call that it had been unsuccessful, despite the best efforts of the some of the best veterinarians and vascular surgeon.  This was a crushing blow to the hope that we had that he would get dialysis soon.  His jugulars, instead of heading down a straight path to his heart, both took corkscrew turns (again...,.a "special" kitty).  We were once again back at square one.  During the procedure, they WERE able to tap over an additional 1/2 cup of fluid from the right side of his lung, something that would enable him to breathe much easier.  The renal veterinary team, with the best of the best feline vets, would come together on Thursday to discuss the case and the next steps.

Thursday

Thursday was a rest day of sorts for Tyrion.  No poking or prodding.  The team was able to place a endotracheal tube that would allow him to receive liquid nutrition, something he desperately needed as he hadn't had any sizable intake since the week prior.  Thursday afternoon, the vets convened to discuss Tyrion's case, they will update us Friday morning.  He didn't get any worse on Thursday and his potassium level was actually coming down a bit, but he also wasn't getting better in any sense. Ryan saw him Thursday evening and it was hard for me to even look at the picture of this little boy.  My heart hurts for him.

Thursday - the day after an unsuccessful surgery

While all of this treatment has been going on, Ryan and I have been talking with the renal transplant team (yes, a kidney transplant for a cat) at U Penn.  This was our hope for him when we left Texas,  U Penn has one of the most successful transplant programs in the US.  This is Tyrion's only chance at an extended, normal life at this point. Many cats go on to live several years after an uncomplicated renal transplant.  While most pet owners would/could never consider this possibility, we did.  Yes, it's kind of crazy.  Yes, it's a huge financial burden.  But at this point, we are willing to do anything to save this kitten.  We made commitment to him when we adopted him from the shelter that we would care for him in sickness and in health and provide him with the best kitty life.  Did I ever think I'd have to consider getting a cat a kidney transplant?  Never.  But, for this one?  He's special.

Unique, I am.
Baffling everyone, I do.

In the meantime, we talk with veterinarians for a few hours every day, discussing what we can do to get this kitty stable enough to go on to transplant.  Ryan is still with Tyrion.  I am at home with Louis and the rest of the pets.  They miss him.  I miss him.  We want our kitten back.  We don't just want A kitten, we want Tyrion to come back.  We keep telling ourselves he can hold on.  He is a lion.  If you've ever met Tyrion in person, you know what a sweet, sweet kitty he is.  He loves and cuddles with everyone and anyone.  Our other cat Khleo, continues to search the house for him, won't go outside anymore because she doesn't have her pal.  The house just isn't right without him.

I will continue to update my blog as we get more information on Tyrion as it is difficult explaining to all of the people (we love that you all care!) what is going on with him every day.

We have set up a Go Fund Me site for Tyrion's care.  We are prepared to take on what we need to to see him through this, but any help is appreciated.  All of Tyrion's care has added up quickly, an ICU for a cat does not come without a high price, we have learned. We even told each other today, we don't care if we get wedding gifts.  We'd rather have our kitty come home. I remain hopeful that I will travel to Philadelphia in the coming weeks to get Tyrion and bring him home; healthy, and with a new lease on life. 

We should have more news, which I will share later today or tomorrow.  If nothing else, please pray for this little boy.  He sure needs a big miracle right about now. 

The link to our Go Fund Me site, if you'd like to help save our little boy is:

gofundme.com/u5dp6x5d9s