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31-Oct-2010: Last weekend Nermal went into his second crisis related to his end-stage kidney disease. The vet kept him over night and rehydrated him, getting him stable enough to go home. At the time he came home he was not eating, and we had hoped it was simply because he was uncomfortable at the vet. The next week proved to be very difficult as he ate and drank very little. His subcutaneous fluids were increased in frequency to every day. Tuesday he finally ate quite a bit of his own volition, and he spent time drinking out of the toilet, which is something he was never able to do before as the lids were always kept closed, but it was the only way he would drink. The events of that day lead to a great deal of hope, but the following day he was back to his ill behavior. Thursday he was started on a hand-feeding routine.

Finally on Saturday it was obvious he was slipping beyond the point of recovery. He began protesting his feeding and continued to prefer being in the bathroom either in the sink or in the tub. As an ornery punk it was clear the he was trying to fight against his decline, but this fight would be fruitless with the inevitible near.

His last ride to the vet was relaxed, quiet, and uneventful. He was alert, calm, and seemingly comfortable throughout, and left us quietly. He took a deep breath and released what seemed to be a huge sigh, as his pain was gone and he could finally sleep.

02-Jul-2010: I am very, very saddened to report that Nermal, at the young age of six seven years-old, is in the end stage of kidney disease. For some time now we have known that he stays close to clinical dehydration and his kidney blood values have been high. As a result, his kidneys have been a constant source of concern, even if just in the back of our minds as he has presented well otherwise.

Recently, however, he had become lethargic and less of himself, including some muscle wasting in his hind quarters. Last weekend he was in obvious distress and made a visit to the vet. His BUN, creatinine, and phosphorus levels were extremely high with some readings off the scale, as well his red blood cell count was less than half normal level. Since then he has been on medication to reduce phosphorus levels and had a change in diet to a low-protein kidney-sensitive food.

He is doing better since, showing signs of returning to himself, but this belies the fact that his kidneys are 75% - 90% defunct. He has lost much of his ability to concentrate his urine, instead passing almost all of his fluid intake. He will begin a hormone injection to stimulate his bone marrow to produce red blood cells, and subcutaneous hydration twice a week as, eventually, regular water intake will not be enough to keep him hydrated.

Obviously this is not moving towards a cure; this is end-of-life maintenance. These activities will continue until he either passes on his own or becomes so distressed that the more comfortable option is euthanasia.

22-May-2004: Nermal's first birthday passed quietly back sometime in March. The nearest we can figure is around March 18th or so. Well, it did not pass TOO quietly. He had a special birthday treat, which he shared with his big step-brother, Hermes.

It is interesting to have him at this age now, which is approximately the same age as when I adopted Hermes. He does a lot of the same things, like (most recently) crying at me while I am in the shower... he is really very curious, and cautious, about that wet stuff coming from the shower head. He is very needy and seemingly attention starved, and loving. Even so, he is still very MUCH a kitten; more kitten than any cat I have even been around in my life. He is still our ADD kitty (very distractable -- the girlfriend says Nermal reminds her of me in that regard.) And he is still very playful. Other than the way he sits with his leg cocked out to the side, lays with his hind-end hovering just off the ground, or his slightly awkward gait, you would never know he ever had a problem with his knee. He is a highly active, good natured, and spiritful cat. We are both very happy that we were able to bring him in. Hermes is moderately satisfied, though he is still a bit of a jerk to Nermal -- Alas, that is what big brothers are all about, right?

09-Mar-2004: I am not doing so well with updates ;) Anyway, it turns out that last week Nermal did not have to have surgery! The protrusions in his knee are apparently bone spurs that have developed around the injuries. However, under sedation the vet was able to move the leg in its normal ranges of motion, and even able to bend the knee more fully than Nermal does on his own. The knee does not feel arthritic, so no concerns exist about the use of his knee at this time. YAY! None of the four pins have moved a milimeter since the original surgeries, and everything looks perfect.

He was pretty damn grumpy when we went to pick him up. In fact, I have never heard him growl so loudly. He has a shaved patch on his arm where the vet had preped him for intravenous medications if necessary. We have noticed that he is bending his leg more and more, and though he still cannot bend his knee fully, he does now bend his upper leg at his hip completely.

03-Mar-2004: Wow! How many months since the last update? Well, good news is on the horizon. A little over a week ago Nermal had to make a visit to the vet for a persistant snotty discharge in his left eye. (By the way, he is now 11.4 pounds!) The vet also took a look at his knee, and after feeling it a little bit decided that it might be time to pull the pins left from the last surgery. It seems that the bone has healed very well and it pushing the pins out, causing them to protrude out into the knee area. While this does not seem to be causing Nermal any pain or discomfort, removing the pins can only help the pressure in the area. While we are not getting our hopes up, it is possible that removing the pins and cleaning up the surrounding scar tissue in the knee may actually restore almost full mobility in his knee.

What is really amazing about this is that as we approach Nermal's first birthday (approximated as March 18,) we have to think back to last year when I found him on the highway. The prognosis for his leg was grim, but we put the time, effort, and money into it anyway. Now, and against the odds of his age, small size, and soft bones, he has an almost fully flexible, functional leg with which he can run, jump, climb, and play with his big brother Hermes.

I know I have said it here before, and I might actually get around to doing it, but I have a lot of Nermal pictures that I need to put online. He is such a big kitty now; much much larger than the day I found him, a furball hardly bigger than my fist.

His surgery is scheduled for tomorrow, and we will pick him up as soon as the vet calls us to let us know he is ready. Both of us have taken Friday off so that we can have a long weekend to attend to his recovery, which the vet says should only be a day or so, if that long.

21-Aug-2003: It has been almost a month, and Nermal is progressing quite well. He has been allowed to be left out of his room 24/7. He plays well with Hermes, and the two of them have an obvious sibling rivalry.

About a week-and-a-half ago we had the vet do an X-ray of his hind quarters to make sure the leg was doing well, and to check on what appeared to be a problem with his back. Everything checked out fine, his leg has healed much better than ever expected, and he even got neutered while he was there. heheheh

He has gotten pretty big, and I was able to dig up some photos of him back when he was smaller, which I will post up today. I am hoping to be able to show how much he has grown since then with some newer photos I will be taking soon.

Our final bill for taking care of Nermal is just over $1100 total. This is only what has been charged to the Care Credit, and does not include (nor do we plan to include) any other costs, since those costs are just part of owning a pet.

24-Jul-2003: Two weeks ago we took Nermal to the vet for a follow-up. At the time we were told that everything seemed to be healing fine, and he was using and placing the leg as much as could be epected.

Yesterday he had another follow-up during which the doctor gushed about the success of the surgery and how well he is doing now. He told me that the leg has healed far better than and far beyond his greatest expectations. He weighs in at 4.5 pounds, three times his weight when I found him. He is now allowed to climb and run around pretty much unrestricted, though we still lock him up at night to prevent any problems with the other cat. I am taking a week vacation and when I return I think we will let him roam around 100% freely.

That having been said, this will probably be the last news update about Nermal's surgery and recovery. Other news will revolved around the site and other Nermal events. I also have a number of disks to go through to find site-worthy pictures. I will be taking some new ones to show how much he has grown and how well he is recovering.

04-Jul-2003: Spoke with the vet doctor yesterday and he said that things are going so well with Nermal's leg that he recommends discontinuing physical therapy. Instead we are to let him have supervised play time with Hermes, go swimming, and have an area where he is allowed to pretty much play and roam freely. We will be taking him back next Thursday for a follow-up, but things look very optimistic. He still limps on his leg when he runs or plays, but he uses and places it, and that is fantastic.

01-Jul-2003: We brought Nermal home yesterday. We have to keep him relatively inactive, and prevent him from climbing up on and jumping off of objects... yeah, he is a kitten right, so that should be easy...

In any case, he has been home, and we have taken him swimming to exercise his leg. There is a much more upbeat prognosis all around. Because we are both working during the day, Nermal will need to be boarded daily. This works out fairly well for his physical therapy as, to accomodoate my newly acquired uneasiness about performing his PT, the vet will be giving him PT several times during the day, and then we will swim him at night.

Last night he laid in my lap for a good hour stretched out and purring, and it really hit me how big he is getting. I really just want this to all be over so we do not continue to miss out on each other.

27-Jun-2003: Spoke with the doctor today. He says that the surgery went better than expected. He was able to suture AND pin the patella and the crest. Everything was a tight, firm fit. He also said that he was able to clear out a good deal of the scar tissue in the knee, so he actually will gain a greater range of motion because of this incident!

We went by to see him tonight, and his leg is VERY swollen, shaved again, and he has to wear one of those lamp-shade collars :( He also has an elastic bandage on his ankle to help keep it bent, which also helps keep the knee bent as well. The bandage is due to come off Sunday, and his new physical therapy will start Monday. We will bring him home Monday (hopefully.)

25-Jun-2003: The doctor was tied up with a couple of emergencies, so I was not able to speak with him. But a vet tech told me tonight that Nermal came through the procedure well, and they would like to keep him for a couple of days for observation. We are hoping that tomorrow we can visit with him, though I am not optimistic about this considering my assumption of the necessity of limiting his movement for the time being.

24-Jun-2003: Site created.