It started in February when I got back from vacation in New York and realized Violet (the cat with the black nose) had lost weight. She’s always been tiny, but at the end of February she was feather-light, swimming in her harness (even when it was as tight as it would go), and like a furry little bag of bones. I went into denial at first–vet visits are traumatic, and maybe it was all in my head or she was going through a thin phase or something. But I had to admit she didn’t eat very often or for very long, and her fur looked dull instead of the usual glossy. Then one night I was watching David Attenborough’s Asia documentary, the episode where there’s this huge human logistic endeavor to release a sun bear back into the wild, and Violet was next to me on the couch. She was curled up like she was ready for a nap, but every time I looked over she wasn’t sleeping, and I was finally able to break out of denial and admit that she was miserable. And if those folks in Asia can figure out the timing of transporting a sun bear via a crate attached to a helicopter in a hot jungle, then I can get online and book a vet visit and force her to go (even if she doesn’t want to).
So the morning of February 24 Violet and I went to the local Vetco to investigate her weight loss. “Well no wonder,” Dr. Tran said, “her teeth are terrible! It probably hurts to chew.” Dr. Tran prescribed Gabapentin for pain and warned that Violet needed dental surgery. (She used the word “extractions.”) In New Orleans in 2023 another vet had mentioned teeth when she saw that Hugo’s teeth had the beginnings of gingivitis. She recommended dental treats, which I dutifully purchased and dispensed. Since then the dental treats had become an exciting part of the day where, morning and evening, the cats and I would either play fetch or hide & seek with the little chicken-flavored fish shapes.

So had the dental treats done nothing? (More on that later.) Fortunately Dr. Tran had a great bedside manner and made space for my “wait, what?!” response, which was a blend of guilty “Should I have been getting their teeth cleaned this whole time,” and confused “How did her teeth get so bad since 2023, I’ve been doing the dental treats, she’s only five years old, and I’ve never had a cat get dental disease before.” Dr. Tran explained that it’s hard to tell with cats, that cats are great at hiding their pain, and that stuff like this can often be genetic so you just get lucky or you don’t. Unfortunately, I’d caught Dr. Tran on her last week at that office, so she needed to transfer Violet’s case to the doctor who was going to be there long enough to get the dental surgery done. She recommended a blood-draw for Violet to rule out any underlying causes, and then I could make a second appointment to meet the other doctor and get the bloodwork lab results.
I got an appointment for the next afternoon and the stellar receptionist Riley was able to add Hugo so he could get his teeth checked too. Were his teeth as bad as Violet’s? Yes, yes they were. They were worse, actually (I found out later). But Hugo’s approach to food has always been more “inhale” than “chew,” so he hadn’t decreased his caloric intake the way Violet had. I explained to Dr. Anne that I was there to transfer Violet’s case so we could get some dental surgery done. “Oh no, no one is getting dental surgery,” Dr. Anne said, indicating the lab results she’d brought. She pointed to page two which showed high symmetric dimethylarginine (SDMA) and blood urea nitrogen (BUN) levels. Both SDMA and BUN get high when the kidneys aren’t filtering properly. Violet had stage 2 kidney disease.

Dr. Anne’s orders were to SLOWLY switch Violet to a renal diet and add the omega-3 supplement Welactin to her diet. Take one month to transition diets, she said, then leave Violet on the new renal diet for one month, then come back to check if Violet’s SDMA and BUN values had gone down. The problem with doing dental surgery on a cat with kidney disease is that anesthesia is bad for kidneys. So before dental surgery, Violet’s kidneys needed to get better, and that’s most likely to happen with a change in diet. Even then, Violet would still have kidney disease and the less time she was under anesthesia the better. So Dr. Anne recommended I get a dental specialist to do the surgery because they’d be able to do it faster. The vet tech printed out Google Maps entries for two dental specialists in Orange County, then walked me over to the prescription food section of Petco and showed me where the renal food was. I didn’t get the chance to ask my mountain of questions like, “How do you feed two cats different diets?”
The answer was on Reddit: microchip feeders. Sure they are expensive, Redditors said, but they are a lifesaver. There’s no other way to guarantee that each cat eats the correct food. Cats have a microchip that’s about the size of a grain of rice implanted between their shoulder blades. The idea behind a microchip feeder is that the lid only retracts if the correct cat approaches the bowl. So the feeder has a bowl with a plastic cover (the cover is open in these photos) and an archway supporting some RFID chip readers. So you program one feeder for each cat, and your problems are solved. Cats are wary of approaching when the plastic cover is moving near their face and making noise, so the feeders have a training mode that closes the lid a little bit more at each step, and over a few days or weeks (depending on the cat) your cat has learned how to use the feeder.

The problem? The feeders work SOME of the time, but not ALL the time. RFID technology is finicky. Is there metal nearby? Or anything electric? The feeder won’t behave as expected. Is there a difference in chip and reader frequency? Is the chip the wrong type? Did the chip migrate to somewhere else inside the cat? The feeder won’t behave as expected. (Does this condo have a space without anything metal or electronic? No, no it does not.) I encountered some unbelievably frustrating things about cat care over the next few months, but for some reason nothing created anxiety the way the unreliable microchip feeders did. At first I thought my feeders were faulty. Violet’s feeder would close randomly while she was eating, and Hugo’s feeder often wouldn’t open at all. I exchanged those feeders only to see the exact same behavior in the new feeders: Violet’s closes, Hugo’s won’t open. So I started working with the company to troubleshoot. After a couple rounds of me sending them these heartbreaking videos of Hugo leaning over his closed feeder looking up for help and them sending button combinations to put the feeder into different modes, they sent a range tester to see if the problem was the feeder sensors. The range tester proved that the feeders worked GREAT, EVERY TIME, and at LONG DISTANCES, the opposite of the way the feeders behaved with the cats. I felt insane. The only way to troubleshoot an issue is to figure out a way to reliably reproduce the problem, and the feeder behavior was consistently unpredictable. Finally I realized the problem was THE OTHER FEEDER. You can’t have them too close to each other (like in these photos). I checked my “other feeder” theory with the company after all our back-and-forth had come to naught, and they said, “Oh. Yeah. By the way, make sure the feeders aren’t next to each other.” So I put the ceramic water dish between the feeders, and now they work most of the time. Hugo’s feeder still doesn’t open sometimes, but it opens often enough that I don’t feel the need to hang around to open it for him anymore. (He’s also gotten good at figuring out how to approach the feeder at different angles until it opens. He starts head-on and if that doesn’t work he backs up, takes a step to the left, then comes in from the side, and that usually does it.) Violet’s feeder will close on her only if the feeder gets too close to the wall behind (you can see there’s a metal grate there). It’s still not as reliable as I’d like, but it’s enough that I feel the cats can be alone for a day.
Even with the feeders sort of working, I mentally raged against the change in circumstances. The cats used to have a bowl of dry food, a bowl of water, and a litterbox. Now they had wet food and feeders with bowls that needed to be washed by hand. (Cats with kidney disease struggle to stay hydrated, so Violet needed wet food as well as dry food–cats like to get their water from their wet food. And you can’t give Violet wet food without giving Hugo wet food, so now there were flecks of meat on the counter, on the sink, on my hands.) One of the kitchen shelves had to be cleared to make room for all the cat meds (the bottles multiplied over the course of the year). The cats used to get a lot of joy from hunting through the house for hidden dental treats, and that game had to end with Violet’s transition to 100% renal diet. (Dental treats have too much phosphorus for a cat with kidney disease, and you can’t give treats to Hugo without giving them to Violet, so the twice-daily treat hunt had to end.) I was sad at the loss of the dental treats and struggling with the new complicated cat routine. I couldn’t go out and do stuff depending on the cat med schedule (at one point meds were given every two hours, more on that later), and I had to make/cancel plans differently than I would have otherwise. I used to stop working at 5 pm and have the evening cat chores done by 5:03 pm. Suddenly the morning and evening cat routine was taking 20 minutes each. In addition to the dishes and the dry food and the wet food and the water and the litterbox and disinfecting my kitchen’s surfaces, I now had to chase Violet down and convince her to take her Gabapentin from a syringe (Gabapentin supposedly tastes bad, very bitter). You can get Gabapentin that’s mixed with flavors like chicken, but the product smells like bottled skunk and is so oily that it will stay on any surface it comes in contact with. (The worst was getting some on her fur, she’d smell like skunk for days. I swear sometimes I can still smell it on her.) And from Violet’s reaction, I’m not sure the flavored Gabapentin tastes better than the unflavored Gabapentin.

Gabapentin is an anticonvulsant used to regulate seizures in humans, but it turns out you can also use it to manage pain and anxiety in cats. (If you want your pet to be calm on the airplane, you’ll probably get a Gabapentin prescription.) So it’s like a sedative. When Violet started Gabapentin, she slept most of the time with occasional wobbly trips to the food dish. (Gabapentin messes with your balance.) I used to sit there and watch to make sure she was still breathing. Over time she got used to the effects and didn’t sleep as much, but the sedative properties were still evident. It was like the personality had been drained from the cat. (Normally, Violet’s constantly talking and insisting on things that she wants. She’s either crawling onto your lap or setting herself down in easy petting range. On Gabapentin, she hung out under the console table, either sleeping or staring. She didn’t really talk or cuddle anymore.) Plus having Violet on Gabapentin long-term was problematic not only because it was bad for her kidneys but also because the rumor is that cats who have been on Gabapentin for a long time can have seizures if they’re not weaned off it correctly. So I felt motivated to get Violet’s teeth treated and get her off Gabapentin as soon as her kidney situation would allow for the dental surgery.
In the pursuit of speed, and because Hugo also needed dental surgery, I figured I’d book a dental consult. After looking over the Google Maps printouts from Vetco and checking the reviews, I went with Pet Dental Solutions in Huntington Beach. I made a lot of cat decisions this year, and it’s not an exaggeration to say that picking Pet Dental Solutions might have been the most fortunate decision I made. Their rigorous pre-op checks provided a much better picture of Violet’s kidney situation. The Pet Dental Solution staff checked both Violet and Hugo and confirmed that dental surgery and extractions were the best treatment. I met with Dr. Maki after the cats had been evaluated and explained my conundrum: Violet needed dental surgery but she had kidney disease and shouldn’t do anesthesia, but in the meantime was on Gabapentin which was harming her kidneys. Dr. Maki’s solution was to get more data. He did primary care at Irvine Pet Hospital, and he suggested we get Violet booked for an ultrasound and some blood and urine labs.

I didn’t realize it at the time, but Dr. Maki had done me a huge favor by getting that ultrasound booked. It turns out most vet hospitals in Southern California don’t have an ultrasound machine. Instead there’s a traveling technician that visits certain days of the week at unspecified hours. So you have to call the vet who calls the technician. The technician decides if/when they feel like visiting that pet hospital, then calls the vet back and the vet calls you and lets you know when you’ll need to be there. There’s no set schedule from week to week, so you get to be surprised and hope that the technician’s in-office hours overlap with a time you can be there. And the chances that either the technician or the vet don’t call back are high, so high in fact that I never successfully booked an ultrasound on my own and always had to call for help from the referring vet’s office. (It’s months later at this point and I’m still waiting on some ultrasound inquiry responses.) At one point I got so frustrated with the system that I took the morning off work and made a list of every vet in Long Beach and the surrounding communities and called all of them asking about an ultrasound. The response was the same: 1) we don’t have an ultrasound machine but we have a technician that visits sometimes, or 2) if your cat isn’t already a patient at this hospital then you can’t get an ultrasound. (Of all the places I called, only one receptionist offered the names of some other places that might be able to do the ultrasound. That one place was Belmont Shore Veterinary Hospital in Long Beach, more on them later.)

Because Dr. Maki worked at Irvine Pet Hospital and because Aldo from Pet Dental Solutions was willing to trade phone calls on the weekend, Violet got her ultrasound on March 18. It was a situation where the technician was visiting the hospital at some unspecified time that day, so they had me do a drop-off appointment where I left Violet with them first-thing in the morning and then picked her up just before they closed at the end of the day. (It was the longest Violet and Hugo had been separated, and I worried that Hugo might be looking for her. But when I got home I found him fast asleep–that’s the photo above–and I’m pretty sure he never realized she was gone.) Dr. Maki was at the Irvine Pet Hospital that day and was able to go over the results with the technician before he called me. “She has kidney stones,” he said. “She needs kidney bypass surgery. Go to UC Davis in San Diego. Let me get you their number.” Again, I didn’t realize it at the time, but this was valuable information that I doubt I would have gotten from most primary care vets. (A vet tech I talked to later had never heard of kidney bypass surgery, much less knew where to get one. And it takes a lot of guts to tell someone that they need to start trekking 90 miles to San Diego for cat care.) The kidney stone diagnosis was hopeful–kidney disease is chronic and just gets worse until the cat dies, but kidney stones might mean that Violet has a chance of getting better if the stones can be removed.
By this point I’d realized that when you try to book a new patient consult with a vet, their next appointment will probably be 2-4 weeks out. (That was my first sign that Pet Dental Solutions was doing things right–their system to get you an earlier appointment if there’s a cancellation. And the system actually works!) So Violet wasn’t visiting UC Davis in San Diego until April 2. In the meantime, I kept the dental surgery process going for Hugo. Hugo had never had labs done, just a visual inspection of his teeth. He needed to be cleared for anesthesia and dental surgery, so he had his pre-op appointment on March 21. Their findings? Hugo has heart disease. Well, Hugo might have heart disease. His ECG showed an abnormality, but there was a chance it was a normal variation. They needed to do another test to check if it was normal or if it was myocardial disease. (I wondered if that was why he was so sedentary. Violet is always sprinting, and Hugo is always sitting. If you pick him up from one spot and set him down in another spot, you’ll find him asleep in that same spot hours later.) The way things were going, I asked for the name of their favorite cardiologist. I hadn’t been sleeping since Violet’s initial diagnosis at the end of February, I’d been eating because I had to, I’d been feeling all the anxiety and guilt, and I did not have any panic left for Hugo’s heart disease diagnosis. Weirdly, my thought was “Of course. Bring it on.” I’d started to realize that humans have no control over anything ever (which is hard to accept for someone who makes spreadsheets for her vacations). So I okayed the follow-up test to confirm Hugo’s heart functionality, and it turns out he’s fine! He doesn’t have heart disease, and he was cleared for dental surgery on April 3. (Yes, yes that is the day after Violet’s first trip to San Diego.)
One of the logistical challenges of all the vet appointments is knowing when to leave the house. I know the time it takes to drive to Pet Dental Solutions mid-morning, but what about earlier at rush hour? What about 5 pm? What if I have an 11:30 am appointment in Sorrento Valley in San Diego (that’s where UC Davis Veterinary Medical Center is). How do I keep the cat in the carrier or in the car for the least amount of time? I need a reliable system for getting to all these vet appointments on time, no matter what the traffic is doing. Eventually I realized the main problem (the 405 freeway through Orange County) already had a solution: FasTrak. As a kid I’d envied folks who had FasTrak for trips down the 91 freeway to Newport Beach. It’s a transponder that allows you to use freeway express lanes, and up until July 1, 2019 it came with a monthly maintenance fee, even if you didn’t use it that month. Now the monthly maintenance fee is gone and the transponder is a little sticker strip instead of a plastic box that you Velcro to your windshield. So I signed up for FasTrak. I finally feel like an adult!

Of course it took me two trips to San Diego with Violet to realize the FasTrak hack. Well, one and a half trips. I signed up for FasTrak in the parking lot in San Diego so I could use it on the drive home. On a trip that long it can save 20 or 30 minutes depending on the traffic situation (especially if you take the 73 toll road). It was mainly the drive back home that was the problem. The drive down to San Diego was magical. You hit the coast just before San Clemente and then drive through that undeveloped section by Camp Pendleton before hitting civilization again back in Oceanside. On our first trip on April 2, the hills were still green and there were low misty clouds floating across the freeway from the ocean into the hills. It’s a stunning corner of the world.
The nephrology department at UC Davis Vet Med Center is excellent, like I wish they had that level of care for humans. As soon as Violet and I got settled in the exam room, the vet tech came in and started taking a patient history. She was actually interested, which was new to me. She was listening closely and asking intelligent follow-up questions, almost like she knew someone would need to know this later. When she left, she said, “The doctor will come in next. He’s a little long-winded.” I had visions of an old white man who wanted to tell me about his dog and who would probably not look at Violet very long (if at all) because he was too busy talking about himself. But in the first few moments of meeting Dr. Le Sueur I realized he’s a talker because he is SO PASSIONATE about your pet’s lab values (he didn’t talk about himself once). This was not a situation where the doctor had 10 minutes with the patient and then had to move on to keep the hospital profitable. Dr. Le Sueur took me line-by-line through Violet’s lab results from both Vetco and Irvine Pet Hospital. He explained what each thing was testing for and what each test result meant and how each results affects the other results. He asked if anyone had explained the ramifications of kidney disease. I thought I understood it, but after talking with him I realized I’d just scratched the surface. It’s not as simple as “this value is high so she has kidney disease, and if this value were lower then she wouldn’t have kidney disease.” It’s more like “this value is high, but if this value is also high then this. And if this value is high but this value is low, then this other thing.” Mainly he was interested in figuring out what type of renal diet Violet should be on. Sure she’s eating food especially formulated for cats with kidney disease, but what stage kidney disease? She’s stage 2, and most renal diets are formulated for stages 3 and 4. She might benefit from this new line of “early support” food formulated for cats with stage 1 or 2 kidney disease. And Dr. Le Sueur had a relatively new test in mind to find out (FGF-23 which checks phosphate levels) to determine the best food to recommend going forward. They could do the test there that day as well as a follow-up ultrasound. (UC Davis Vet Med shares a building with the Veterinary Specialty Hospital of San Diego, so the vet tech could just walk Violet down the hall to Vet Specialty Hospital and get an ultrasound done without having to make an appointment or anything. Again, at the time, I didn’t realize how miraculous that was.)

For Violet’s kidney stones, he explained that she has a large stone nearly blocking her right ureter (the tube between the kidney and the bladder) and that it could become fully blocked at any time (which means a trip to ER). But despite the dire ureter situation, he felt that it was worth it to try to get her to pass the stones (there were some in her kidney as well) in the hope that the surgery could be avoided. He prescribed Prazosin (to relax the ureter and hopefully release the stones) and Meloxicam (to relieve inflammation). Prazosin was originally used in humans to reduce blood pressure by relaxing blood vessels. It seems like a lot of the cat care stuff was originally something for humans. The weight scales at some of the vet offices are human baby scales, and the blood pressure cuffs they use on cats are the ones they use on human babies. (You can take a cat’s blood pressure just like a human’s by putting the cuff on a limb, or you can put the cuff on a cat’s tail which I thought was cool.) Then Dr. Le Sueur says, “Did they tell you she’s anemic?” No, no they did not. So he also prescribed Varenzin, which works by tricking your body into thinking you’re hypoxic (low oxygen), so your body produces more red blood cells to compensate. After talking with Dr. Le Sueur and hearing his treatment plan, I okayed the tests/ultrasound he wanted to do that day and then met with the pharmacist to pick up the Prazosin, Meloxicam, and Varenzin. At UC Davis Vet Med the pharmacist comes out of her office and sits next to you in the waiting room. She holds up each type of medicine and explains a little of its history and how it works and what the possible side effects are and then tells you how to administer it (how often, what dose, what method, and alternative methods if the cat is not tolerating the first method). You have plenty of time to ask questions and you are basically guaranteed to know what you are doing by the end of your pharmacy session. I’ve never experienced such white-glove pharmacy service. Usually they hand you a bottle and you read the label and do your best. After meeting with the pharmacist, I met with Dr. Le Sueur again to go over the results of the lab work they’d done that day. With the two meetings with Dr. Le Sueur, Violet’s labs and ultrasound procedures, and the meeting with the pharmacist, our first visit to UC Davis Vet Med lasted four hours. (The second appointment was six.) It’s insane that the level of care Violet got is out of the question for people.
Violet and I hit the 405 freeway around 5 pm on the way back from San Diego (one of the experiences that motivated me to get FasTrak), so we were late getting home and getting the evening routine going. The next morning at 7:30 am I was in Huntington Beach to drop Hugo off for his dental surgery (barely on time, there’d been an accident just as I was getting onto the freeway, another experience that nudged me toward FasTrak). In addition to the dread around surgery, the heartbreaking thing is that you can’t give the cat food or water the night before. And since Violet’s appointment at UC Davis had required fasting (for accurate labs), the cats had gone hungry and thirsty for two nights in a row. (I tried locking the non-fasting cat in a room with food and water, but being locked in a room freaked them out even more than being hungry/thirsty, so I abandoned that idea.) It is hard to sit there while they ask for food/water and not be able to explain why they can’t have any. I was tempted to hide out or something, but I womaned up and hung out with them, playing to distract them. I realize much worse things can happen around a cat’s surgery, but the fasting thing felt like the worst part to me.

Pet Dental Solutions took good care of Hugo for his surgery. They have you drop the cat off in the morning, then they call you once he’s under anesthesia, then they call you again once his surgery is over and let you know what time to pick him up. The photos above are of post-op Hugo (you can see his wrists are shaved for the IVs), and the bag Pet Dental Solutions made for Hugo’s post-op care. The bag has his pain meds (Gabapentin) and his anti-inflammatory/pain meds (Onsior) and some goodies like a toothbrush and mouth rise. When I picked Hugo up, they had me meet a member of the surgery team in the consult room for a report on the surgery. He had a laptop so we could look at Hugo’s x-rays. Cats have 30 teeth, and Hugo needed 24 extracted. Basically if the tooth moves or wiggles the surgery team will cross-references that with the x-ray to decide whether to pull a tooth or not. Hugo’s x-rays showed a lot of ghostly teeth roots, like the teeth had been dissolved and only the faintest outline remained. So that question from earlier, about why the dental treats weren’t doing anything? It turns out both cats have stomatitis, which is like an autoimmune disease where your body attacks your teeth and dissolves them. Modern medicine doesn’t know a lot about stomatitis in cats or why it happens or what causes it. The surgery team member said it seemed to be happening more often, and that it was affecting a lot of dogs now as well as cats. His (self-admittedly uneducated and unfounded) opinion was that it seemed to coincided with the rise of the grain-free trend in pet food. (And I had indeed been feeding my cats a brand of food that happened to be grain-free. I doubt there’s any research to support the grain-free theory at the moment, but give it a few years and maybe something will become obvious.) The other theory was that stomatitis is genetic and the cats got it from their parents. The surgery team member also believed that brushing the cats’ teeth this whole time wouldn’t have made a difference–the only treatment for stomatitis currently is to pull the cat’s teeth, so we still would have ended up with both cats needing surgery. So it’s good that Hugo got all his teeth pulled at once rather than having to do multiple surgeries over the years, and it’s possible that he’ll need another surgery in the future because he still has six teeth that could start to dissolve. Dissolving teeth is also why you take the cat to a dental specialist–there’s tons of little tooth fragments floating around, and they need to scrutinize the x-rays and make sure they get every sliver. Leaving any tooth bits can cause problems that can lead to more surgery.
I had no idea what to expect from a post-op cat. Would he be in tons of pain? Would he be able to eat without teeth? Would he be traumatized? But that is where Zorbium comes in. Zorbium is a topical opioid that’s applied to the back of the cat’s head at the base of their neck (like flea medicine), and like my sister says, it is the good drugs. (Her cat Marmite got a dose of Zorbium for a foot injury just before this.) It provides post-op pain relief and a sense of euphoria that lasts for four days. So Hugo came back from his surgery as the sweetest most affectionate boy with completely blown out pupils (there’s a video at the end of this post). He was completely toasted, and it was delightful. Hugo is usually affectionate only sometimes, if he feels like it, but post-op Hugo was following me around the house saying, “pet me pet me pet me.” He also had his usual joyful abandon when it came to his food dish, diving in head-first and taking giant mouthfuls of both wet and dry food. So with the Zorbium and the Gabapentin, Hugo seemed to recover without any complications. It was at that point that I started sleeping again. I’m not a huge fan of having the cats on meds, but in that moment Hugo on opioids brought some welcome comic relief.
In the meantime, Dr. Le Sueur’s instructions had been to keep Violet on Prazosin and Meloxicam for seven days and then do another ultrasound to see if she’d passed the kidney stones. He said I could get the ultrasound done closer to where I lived, which is how I ended up taking the morning off work to call every vet in my area only to realize that booking an ultrasound as a non-vet isn’t a thing, especially when you only have a week’s notice. I would run into that repeatedly–a vet or a vet tech (back of house) would tell me to get an appointment or a service from another provider on short notice or to get some information on my own, and that is contrary to the way reception (front of house) works. Like transferring medical records between vets. The vet is under the impression that medical records are sent to other vets at the end of the appointment. And they are surprised when, at the beginning of the appointment, they haven’t automatically received the records from any previous vets. But if you talk to a receptionist, they won’t send records unless they’re specifically asked to by me. I had some vets say I needed to talk to a specialist about something, immediately, and that I could probably get a last-minute appointment since folks hold appointments for this kind of emergency scenario, but in calling around I found out that receptionists take an immediate dislike to you if you imply that you are having an emergency and need to cut the queue for an appointment, especially when the cat has never been a patient there before. No one cuts the queue for an appointment no matter how urgent their “emergency” is. I only got it to work once, and then only because I got lucky on the timing (they did actually have a cancellation for the next morning) and never because they hold appointments open for emergencies. The pet healthcare system is still much better than the human healthcare system, but there is a consistent (and large) gap in communication and perception between how the vets and the staff view the same situation. I suspect it is in large part because receptionists experience the worst of humanity on a daily basis, and people show their better side to the vet.

But regardless of why it works that way, the fact is that I was desperate for an ultrasound anywhere in Southern California on the seventh day (April 9). I thought about calling in another favor to Pet Dental Solutions and Dr. Maki (Irvine Pet Hospital wasn’t returning my calls, so I thought a vet might have better luck getting through), but Dr. Maki had left Irvine Pet Hospital to start his own hospital in Costa Mesa and was still in the middle of getting that set up and going. So I felt I had no choice but to go back to San Diego and just have UC Davis do it. I called their receptionist who reminded me that the ultrasound is technically done next door at Vet Specialty Hospital and I’d have to make the appointment directly with them. So I called Vet Specialty Hospital and explained that Violet was a patient next door and they’d recommended her for an ultrasound. I got the response that I’d heard many times at that point, “Well if she’s not an existing patient, we can’t book an ultrasound.” That moment was the most panic I felt over the cat stuff this year. That was Violet’s last chance for an ultrasound, and she wasn’t going to get one now, and it was only a matter of time before that stone moved and completely blocked her ureter and sent her to ER where a unfavorable outcome was likely. Nearly in tears I called UC Davis back and begged for help. “Hi I just called to book an ultrasound and you sent me next door, but they won’t do it since the cat isn’t an existing patient and I’m not sure what to do at this point and I think I need help.” The receptionist told me to hang on, and then she was gone for a long time. When she came back she explained that she’d had to walk next door and book the ultrasound directly with the nurse. But she got it done. Violet was getting a second trip to San Diego on April 9.
But the April 9 ultrasound showed that the Prazosin hadn’t worked. The stone blocking Violet’s right ureter hadn’t budged. She needed kidney bypass surgery. The surgery itself would take place at Vet Specialty Hospital, and I half-expected them to refuse again since Violet still wasn’t their patient, but they were delighted to book this particular procedure. Violet was all set to be dropped off at 7:30 am on April 15. The surgeon, Dr. Fryer, called to talk through the possible risks and complications, and she did a thorough job, staying on the phone for about 30 minutes. She started by explaining the history of surgical attempts to fix blocked ureters in cats. It was stents initially, but that didn’t work very well, so they tried artificial tubing that acts as a second ureter (that’s where the “bypass” part comes from), and they’ve made several tweaks that have greatly improved the complication rate since then. The official name for the procedure is Subcutaneous Ureteral Bypass (SUB). It works via a tube that goes from the kidney to the bladder to create an artificial ureter. (The tube opening is covered with a grate so that kidney stones can’t get in.) There’s a sort of central hub that the tubing plugs into, so there’s technically three tubes. One tube goes from the hub to the kidney, one from the hub to the bladder, and the third tube goes from the hub to a port that is placed outside the cat’s muscle wall, but under their skin. The port allows easy access for flushing the SUB system, which is a convenient way to address things like blood clots or debris or anything else that might block the tubes. To flush the SUB, the vet applies numbing agent to the cat’s skin and then uses the port to push fluid through the system and clear it out. The use of a central hub to connect all the tubing also makes it much easier to bypass the other ureter if it ever gets blocked. The surgeon just has to go in and connect a fourth tube from the hub to the other kidney. Complications from the procedure had been reduced through using shorter tubes and adding the hub and SUB flush systems, but there was still the risk of leaks in the system, blood clots that could block urine, kinks in the tubing, and bladder irritation (the feeling that you have to pee all the time). The complication rate is about 20%, and the rate improves in cases like Violet’s where the cat is younger and otherwise relatively healthy. Dr. Fryer ended the call by giving me her email address in case I had pre- or post-op questions.

So I bought some surgical recovery pajamas for Violet, packed her food and her meds into her backpack, and dropped her off for surgery. The photo above is blurry, but I love it. I took it in the parking lot just before we went inside for drop off. You’re not supposed to let the cat wander the car while you’re driving, but I’d let her out at the Aliso Creek rest stop so she could see something other than the inside of her cat carrier backpack for the rest of the drive. I took the picture just in case I didn’t get to see her again.
Fortunately the surgery went well. Dr. Fryer did a fantastic job (especially considering the fact that Violet is a small cat). I got to meet Dr. Fryer and thank her, and she said that she sort of had to learn SUB surgeries by jumping in the deep end and swimming, but that she’d done a ton of them at this point. The surgical team had verified that the SUB system had no leaks via ultrasound, and Violet didn’t have any blockages or kinks in the tubing. I picked Violet up mid-afternoon the next day (April 16). Violet had not taken well to hospital life. She refused to eat and by the end she refused to be handled. She’d peed herself and would not permit them to touch her to clean it up. (So that’s great that she’s peeing! And they did a pretty good job cleaning her up despite the challenges.) So they had definitely not gotten her into her surgical pajamas, and she was still in a cone. They also had some specific discharge instructions: keep the cat in a cone (or pajamas) for two weeks, do not let the cat play, don’t let the cat jump, in fact it’s best if you keep her in a room that is separate from other animals and has no furniture in it. No unfurnished spare rooms? Buy a baby play pen and keep the cat there. I’d run into a lot of “just use the spare room” advice throughout this journey. Coupled with the fact that the microchip feeders only work in a space free from metal and electronics, I started to feel like the cat industry thinks everyone lives in a large single-family home.

So I got to weigh Violet’s mental health after being locked in a room or a playpen for two weeks versus the chances that she’d try to play and jump when her body was telling her to rest and recover. It was a chance to practice trusting my gut. (I would run into this later with Hugo and cones. Hugo is so sedentary that he won’t bother the affected area, and I knew that and tried to tell the doctor that. But they just know to prescribe constant long-term cone use. I went with my gut and removed his cone all the times they prescribed it. And I felt guilty each time. But Hugo did indeed not bother the affected area even with the cone off, and his mental health was better because he was able to sleep, eat, and move normally.) It’s tricky because you’ll be both wrong and right. Like letting Violet out in the car is not recommended, and it did decrease her anxiety, but you could argue that I got lucky that there was no car accident. Similarly, I was right and wrong with Violet’s post-op jumping. I was wrong in that she did attempt a jump, almost immediately when we got home, but I was right in that she didn’t try jumping after that. I ended up compromising by closing the bathroom door (Violet likes to jump onto the sink), but letting her roam the living room/kitchen as usual. Was that the best choice? No idea.
Surgery recovery was rough at first. I’m pretty sure she was on Zorbium, but she seemed sore anyway. (And the Gabapentin was still going of course.) She had a gnarly incision that ran the length of her soft tissue, from just under her rib cage to her abdomen. For the first couple days she was so stiff that she couldn’t bend in the middle and couldn’t sleep curled up in a ball. I was supposed to check her incision twice daily for any signs of infection, and she did not appreciate that at all. If you went to unbutton her pajamas she’d growl, which was new behavior. She also seemed like she couldn’t get warm. The morning after I picked her up I was working in the sun and she crawled up onto my chest and lay there until the sun went away. She also had a new desire to go outside on the balcony. Usually she feels indifferent to the great outdoors (that’s more Hugo’s passion), but suddenly she was asking to go outside all the time. I’d lift her onto the chair and she’d sleep in the sun all morning. The good news is that she was eating, drinking, and peeing like she usually does. She did have some bladder irritation (where you feel like you have to pee), but that lessened eventually. A few days after surgery she felt good enough to curl up in a ball, and she liked to spend time grooming her pajamas. During recovery I ended up emailing Dr. Fryer twice, once to understand the symptoms of bladder irritation, and once to check if the incision looked different because it was infected or because it was healing. Vet Specialty Hospital has this nice system where there’s staff members who get the emails and respond instantly to either answer your question (if they know the answer) or let you know they’re getting the doctor to answer your question as soon as the doctor is available. So I was able to worry less knowing I could get an instant email response from professionals. (Vet Specialty Hospital is also an ER, so I felt like they’d know if Violet had some symptom that meant trouble.)
Hugo’s two-week post-op check was April 18, two days after I picked Violet up from surgery. (There was a moment where I realized the only cat carrier I have was in San Diego with Violet and I might not have it back in time to take Hugo to his dental appointment, and I thought I should probably have planned that differently, but it all worked out.) The only call-out at Hugo’s appointment was that his gums were inflamed, and I was thinking, “So you’re saying he’s still breathing, that’s great, no seriously, that’s PERFECT, excellent follow-up appointment thank you.” I also took that opportunity to get Hugo treated for an ear infection that I’d ignored for too long. I wanted to try Belmont Shore Veterinary Hospital, and Hugo’s ear infection seemed like a good opportunity. Belmont Shore Vet Hospital was the only place that’d tried to help me find an ultrasound for Violet even though they couldn’t do it themselves. They are nearby, they have 4.9 stars on Google Maps, and I was not super-thrilled with the way Dr. Anne at Vetco hadn’t allowed questions after Violet’s initial diagnosis. (The good vets don’t just let you ask questions, they hang out in the room like your pet is the only one they have to see that day, and they keep asking for more questions until you’ve run out.)

At Belmont Shore the back-of-house visit with the vet tech and Dr. Pador was fine. They looked at Hugo and prescribed Tresaderm ear drops. I went to the front desk and paid, and they said Hugo would be right out, so I went back to my seat in the lobby. A long time when by. Eventually I got a text message from Belmont Shore Vet Hospital: “Hey we still have your cat.” I instantly realized that they’d kept me waiting there and Hugo waiting in the back because they had no idea I was in their lobby. They’d interacted with me while I paid, and then my face had vanished from their minds almost immediately. Still holding the phone, I leapt from my seat and charged the front desk. From the expression on the receptionists’ faces I could see they realized their mistake, which infuriated me more. I absolutely lost it. (Which for someone as affected by Good Girl Syndrome as me means that I get blunt but remain civil and sort of monotone.) “You didn’t want to call Hugo’s name? You didn’t want to call my name?” I asked, alternating looking at each of them. And internally, You don’t know your own lobby? You didn’t think to look in your lobby? You didn’t even want to try? Out loud I finished with, “Do people just leave their cats?” One thought for a second and said, “Well, no.” Then she laughed, like “What a funny miscommunication, what are the odds?” I knew whatever I said next would be something I’d regret, so I silently accepted Hugo’s cat carrier and left. After I had Hugo stowed away in the Mustang, I sat in the driver’s seat and tried to crush the steering wheel in my hands, trying not to think about how Hugo had been stressed, anxious, and stuck in his cat carrier for that long for no reason. I counted until I was calm enough to drive. Belmont Shore is no Pet Dental Solutions or Vet Med Center, but they are the main game in Long Beach, and I would end up having to see them again.
In the meantime, Violet had her two-week post-op check on April 29. Dr. Fryer declared Violet fit to go back to a life of jumping and playing and running around without pajamas. (They took Violet’s pajamas off at the appointment, and I think it made her very happy.) My main question was, “When can she get dental surgery? How long can you go between bouts of anesthesia when you have kidney disease?” Dr. Fryer explained that you can get another surgery almost immediately. The main concern is anesthesia still being in the system, and it clears quickly. So I finally got to book Violet’s dental surgery for May 22, three months after her initial teeth diagnosis. When I told Dr. Le Sueur that Violet’s dental surgery was booked, he said, “That’s what you’ve been trying to do this whole time!” and I nearly burst into tears. Instead I stammered through a thank you for the high quality of care Violet had received from him, and how nice it was to work with someone who was so passionate about lab results. I realized later that Dr. Le Sueur is passionate about lab results because the cat sometimes gets better. And indeed, because of Dr. Le Sueur’s ability to read Violet’s labs, he’d tweaked her renal diet to the “early support” version, given her the right meds, recommended her for surgery with Dr. Fryer, and continued with some meds post-op. And by the time of her first SUB flush on May 16 (Violet gets regular SUB flushes now to maintain the system) Dr. Le Sueur was able to revise Violet’s diagnosis from stage 2 kidney disease to stage 1 kidney disease. That was contrary to everything I’d read online that said that cats with kidney disease only get worse and never better. Of course Dr. Le Sueur is passionate about bloodwork numbers if this is the kind of thing he can achieve by reading the data and acting accordingly.
By the time Violet had dental surgery, I felt like an expert at the pre-op drop off and the post-op pickup. Mostly I couldn’t believe it was happening, I kept expecting something to go wrong that would require cancellation or postponement. But it went ahead with no problem. Violet only needed 18 teeth pulled (as opposed to Hugo’s 24), so both cats have their canines as well as a random collection of incisors and molars between the two of them. Like Hugo, being down a few teeth didn’t seem to change Violet’s eating habits. For the four days she was feeling the effects of Zorbium, Violet felt affectionate for the microchip feeders and the water bowl. (She’s already affectionate with humans, so I guess her Zorbium behavior needed to be something different.) Because she has kidney disease she didn’t get prescribed the post-op Onsior, but she got some Gabapentin to join the Gabapentin she already had. I’d continued to return to Vetco, the original Gabapentin prescriber, for Violet’s Gabapentin refills. It was tricky to judge how much was left in the bottle so I’d try to get the refill earlier rather than later. I cut it pretty close once, putting the refill run off until the weekend. So when I showed up early Saturday morning to find Vetco dark and locked, I was confused. They were always open Saturday mornings. I wasn’t sure if I had enough Gabapentin to last until Monday (they’re closed on Sundays) but there was nothing I could do. Vetco was indeed open that following Monday, and I was able to get the Gabapentin refill, but the trust was broken. I switched to ordering it online from Chewy (even though Chewy was more expensive and had that horrible skunky chicken-flavor oil added to the medicine.) I was a bit sad to stop visiting Vetco because they were my favorite front-of-house staff. They believed me when I said things, and they were helpful, nice, and good communicators. But in addition to being randomly closed without explanation or warning, and the fact that that whole strip mall is going to be developed into apartments soon, I needed to transition to online ordering anyway because Violet’s “early support” kidney food isn’t sold at that Petco store. I have to admit Chewy is convenient. It’s fast/easy to order or tweak orders, and it’s really nice to not have to drive anywhere for a refill or to have to haul a 40-pound bag of cat liter in and out of the car.

Now that Violet had her dental surgery done, her Gabapentin days were wrapping up quickly. My plan was to follow the Gabapentin schedule set out by Pet Dental Solutions for her post-op care, and then slowly wean her off the drug using whatever Gabapentin I had left. That would make her Gabapentin-free at some point during the second week of June. The only other thing I had to worry about was some blood tests that Dr. Le Sueur had recommended–ionized calcium, and PCV (to check for anemia–Violet had already needed two rounds of Varenzin, so hopefully the anemia was gone now). He said I could get them done closer to home. I called around and found out that Vetco doesn’t offer either of those tests. The place that does? Belmont Shore Veterinary Hospital. Ungh. I thought it through and figured that the issue with Hugo could be prevented. When they say, “We’ll bring your cat out in a moment,” DON’T go sit back down in the lobby, just hover until you see your cat. (I’d seen another woman do that on my last visit.) Uncomfortable? Yes. Effective? Maybe, I guess I’ll find out. So I called them. “You’ll have to do a new patient consult with the blood tests.” Dear lord, fine. Dr. Pador was less-than-pleased that Violet had all this medical history and I just wanted him to do the blood tests based on me claiming that someone in San Diego said so. Eventually we realized he was familiar with UC Davis Vet Med, he’d actually worked there at one point. Did that ease his discomfort that I’d failed to catch him up on Violet’s entire medical history? No, not at all. But he did get the blood tests going. This was the visit where I ran into the vet tech who’d never heard of the SUB procedure, which made me feel less-than-confident. They gave me an estimate of 10-15 minutes for Violet’s blood tests, which turned out to be more like an hour. But at least the receptionist brought me my cat this time. (They remembered me now, they even knew I was “Hugo’s mom” even though Hugo wasn’t at this appointment.) As I left, the vet tech (who’d I’d explained the SUB system to earlier) held the door for me and said, “It’s so cool that you did that.” The good news was that Violet’s ionized calcium levels were normal, the bad news was that she was still anemic and needed to do one more round of Varenzin. So that should be it. Hugo’s teeth and ear were taken care of, Violet had done both of her surgeries, so I just needed to wean Violet off Gabapentin, and do one more round of Varenzin, and that’d be it.
The evening of Memorial Day, May 26, I noticed Hugo sitting on the floor and squinting in one eye. The next morning he didn’t show up for breakfast, which is extremely unusual. I found him under the coffee table, and when he saw me he groaned. It was that kind of groan that I’ve only heard cats give on the day you decide to take them to the vet and have them put down because they’re in so much pain due to previously undiagnosed feline leukemia. It’s the sound of “we should go to ER.” Long Beach Animal Emergency was open, so I bundled Hugo into the cat carrier, set my status at work to reflect the situation, and headed to the ER. We got there around 5:30 am, and the current on-call doctor was in the middle of a surgery that did not sound like it would be quick. I asked if they could at least tell me if Hugo was an emergency situation, and they had the vet tech come out. She was not happy to have been summoned. I told her the story, and she said she’d check Hugo out but that she really couldn’t do much without the doctor. By the time she came back, she’d changed her tone–Hugo was an emergency situation. He had one pupil completely blown out and one narrowed to a slit. She showed me a picture on her phone. My first thought was that Hugo’s ear drops had done neurological damage (it’s rare, but it’s one of the side effects of those particular ear drops). She asked me if I wanted to wait for the shift change at 8:30 am, which was looking like the first chance Hugo would have to be seen. I said absolutely I’d wait based on what she’d found. At 8:30 the new receptionist let me know that the new doctor had to do rounds before she could see Hugo, and she recommended that I go home and wait for a phone call. Around 10:30 am Dr. Ingram called. Hugo had somehow PUNCTURED HIS EYEBALL. They call it a corneal ulcer, and it is supposed to be incredibly painful. Dr. Ingram asked if I’d seen the injury happen, and the only thing I knew was that he’d been sitting calmly on the floor and then was squinting at one point. She guessed the most likely culprit was Violet, even though I hadn’t noticed the cats playing or fighting. Either way, Dr. Ingram sent Hugo home with Onsior (an anti-inflammatory and pain med, the same tablet he’d been on after his dental surgery) and Ofloxacin eye drops (an antibiotic). The photo above is Hugo just back from ER enjoying his Onsior and a snooze against the cool fridge. The other photo is Violet and Hugo in 2023.
It takes a cornea a long time to heal apparently. For the first two days you need to apply Ofloxacin eye drops every 2-4 hours, and then for the next five days apply the drops every six hours. That’ll get the eye about 8% healed. (This is the part where I couldn’t go out and do stuff, and I was loopy with sleep loss at that point.) Dr. Ingram wanted to see Hugo at her regular office (a week after the original injury) for a follow-up check. (Any guesses as to where Dr. Ingram’s regular office is? Belmont Shore Veterinary Hospital. Of course. Of course it is.) Since it was only a week’s notice, Dr. Ingram was able to squeeze Hugo in for a drop-off appointment on June 3 where I left Hugo at reception so Dr. Ingram could see him between other patients when she had time. She recommended I get him to an eye specialist that same week. (This was the one time my last-minute appointment attempt without the help of a vet actually worked–Eye Care for Animals in Pasadena had a cancellation for the next morning.) So on June 4 Hugo and I went up to Pasadena to see the eye specialist.

Dr. Konrade confirmed Dr. Ingram’s diagnosis and explained that there’s a couple reasons why Hugo’s cornea might be slow to heal. It could be some sort of auto-immune situation (which they would test for) or it could be the herpes virus. Usually it’s the herpes virus, in fact it’s so likely that it’s the herpes virus that they just start treating the cat for that while they wait for the results of the auto immune test. (It did indeed turn out to be the herpes virus in Hugo’s case.) Dr. Konrade started Hugo on a small army of drugs: continue the Oflaxacin, add the antiviral Odoxuridine eye drops, add Terramycin ointment (antibiotic), add sodium chloride ointment (draws excess fluid out of the cornea to aid healing), and start Hugo on Famciclovir pills (antiviral). A cat’s eye can handle only one eye drop at a time (or one smear of ointment at a time), so you need to wait at least five minutes between each medicine (and 20 minutes before doing the sodium chloride). So I was doing Hugo’s eye routine for nearly a half-hour three times a day. My phone’s clock app was filled with “Hugo eye routine” alarms. The only thing I could not figure out was the Famciclovir. It’s a large pill, even by human standards. I overnighted myself a pill cutter, and that didn’t work (Hugo could avoid swallowing the pill fragments until they’d turned to mush), so I overnighted myself a pill crusher and sprinkled the pill over his food (that didn’t work, Hugo is sensitive to anything that’s off about his food–he won’t even eat other flavors of food). So I called Eye Care for Animals to ask for help. Maybe there’s a liquid form I can feed him in a syringe? Initially they sent me this video, which blew my mind and which I plan to use if I ever run into this situation in the future. But then they said to just skip the Famciclovir and use the Idoxuridine as the antiviral. They wanted me to keep that routine going and then do a follow-up visit in four weeks.
Here’s Hugo in Pasadena. The vet tech wraps him in a purrito because the vet will need to have her face within claw range when she’s examining his eye. (Hugo goes into freeze mode at the vet, but I can see why they’re cautious.) The day after Hugo’s first eye appointment (June 5) Violet had her dental post-op check and things looked good. (She didn’t even have inflamed gums.) On June 26 Hugo was back in Pasadena for his eye check. Dr. Konrade reduced his meds slightly, and said to come back in four more weeks. This was the visit where Dr. Konrade asked if Hugo rubbed his eye and if he needed a cone. I told her he didn’t rub his eye, she sent a cone home anyway, and I guiltily but deliberately removed it. Driving home from Pasadena around lunchtime was a lot. The quickest way that time of day was through DTLA, but it was still harried and crowded. There are FasTrak lanes on the 110 south, but that doesn’t matter if you can’t get across the freeway fast enough to get to them. It was stressful enough that I decided to call the Eye Care for Animals location in Tustin to see if I could transfer Hugo’s case there. So instead of seeing Dr. Konrade on July 22, Hugo got to visit Tustin and see Dr. Brinkis. (Traffic is challenging in Tustin as well. A vehicle was on fire on the 5 freeway that morning, so only the patients and receptionists got there on time.) I hadn’t expected Hugo’s eye med routine to be going strong this late into the summer, and I’d had a trip planned to the Pacific Northwest since April. (The trip was coming up in August.) I asked Dr. Brinkis if it was possible to keep Hugo’s eye healthy with a routine that the cat sitter could do once a day. Dr. Brinkis suggested switching to a different antiviral drop, Cidofovir, that you can do twice a day (once a day when the cat sitter is there) as well as an L-Lysine supplement that is thought to inhibit the herpes virus. (Hugo refused the L-Lysine supplement the same way he’d refused the Famciclovir pill, “Wait that’s not food.”) Finally, on Monday August 18 (twelve weeks after the original injury), Dr. Brinkis declared Hugo’s corneal ulcer healed. He asked that I continue the Cidofovir drops for two weeks, and then stop.
Here’s a photo of what the cats are doing today while I wrap up this blog post. Violet is at her normal weight, Hugo’s eye looks great, and they are back to wondering if it’s dinnertime yet. On July 25 Violet had another PCV blood test to see if that last round of Varenzin had fixed her anemia, and it had! So Violet is off of all her meds and recovered from both of her surgeries. As of this morning Hugo had his last Cidofovir drop and is also off of all his meds and recovered from both his dental surgery, his ear infection, and his eye injury. The only upcoming vet appointments are for prevention–teeth cleanings at Pet Dental Solutions, vaccines in January, and Violet’s SUB flushes at UC Davis Vet Med.
Since Violet’s initial diagnosis on February 24, the year’s cat-care project has included 16 drugs/supplements, eight vet offices, enough money to re-purchase the Mustang, 1800 miles of driving, and about 80 hours of time off from work. (Some vets seemed apologetic about the money, but none about the time. I wonder if they assume that I don’t work or something. Most of the people waiting in vet lobbies are women, occasionally a woman will have a man with her, and even less occasionally it will be a man by himself.) I’ll admit that I wonder what will happen next with the cats. Violet still has kidney disease, and Hugo’s eye injury was so random. But I’ve seen the way Hugo learned to hack his microchip feeder and how Violet is a pro at taking liquid meds now, and I feel like the three of us will be able to figure the next thing out.
Twenty seconds of post-op Hugo on Zorbium.

What’s happened next:

  • High BP Violet had routine teeth cleaning September 4 then a SUB flush September 5. She had scary-high blood pressure at the SUB flush, so they said to follow up with primary care–maybe it was stress-related from the drive to San Deigo
  • Ear infection Hugo got a second ear infection, so both he and Violet visited Belmont Shore on September 11, Hugo for ear drops, Violet for the follow-up BP check (her high BP turned out to be a false alarm, it was normal at the follow-up 🎉)
  • Cystitis On the morning of September 24, Hugo was having trouble peeing. He’d try and only a few drops came out, so he’d give up only to be back a few minutes later to try again. Urinary blockage is common in male cats, and it can be deadly. The amount of toxins that are building up in your system when you can’t pee can kill you in 24-28 hours. So I updated my status at work and hauled Hugo to the ER. Fortunately there was no wait this time–they had already switched to the morning shift and his condition was potentially severe, so they saw him right away. He wasn’t blocked! It was a good thing, they said, because a blocked cat is EXPENSIVE. Turns out he had cystitis, which is basically bladder irritation. It makes you feel like you have to pee when you don’t. (Violet gets cystitis for a few days when she’s just had a SUB flush.) Even though it was fantastic that he wasn’t blocked, cystitis is not fun. Hugo had a particularly bad case where his bladder was so inflamed that it was bleeding. A lot. Like he looked like he’d just had kittens. The wild thing is that cystitis is idiopathic–they have no idea why it happens. They think it’s likely due to stress. “Has Hugo had more stress this year than normal?” the vet asked when he met with me. Hahahahahahahaha, oh, um yeah, he has. Since there’s no root cause, the vet just sent him home with Zorbium and 10 days of Gabapentin while we waited for the inflammation to go down. Fortunately it did, and relatively quickly as Hugo was back to normal about four days later.
  • Holidays The Year of the Cats gave us a break over the holidays from Halloween to New Year’s.
Hugo and Violet on Christmas morning
  • Cystotomy Violet and I headed to San Diego on January 8 for her first SUB flush of 2026. Her values were excellent, she was in the range of a cat that doesn’t have kidney disease. But when I met with Dr. Le Sueur afterwards, he said “You might want to think about getting her bladder stone taken care of.” Wait. WHAT BLADDER STONE? It was so out of left-field that I thought he was talking about kidney stones at first, like he was saying she had stones on her other side and it might be time to do a SUB on that side too. But no, he didn’t say kidney, he said bladder. “I don’t think I knew there was a bladder stone,” I said. He explained that they’d been watching it since April and that it had grown from 3 mm to 5 mm in that time. I had a million questions like, Why is this the first time I’m hearing about this? Why didn’t we take care of this when we were ALREADY IN HER BLADDER for the SUB surgery? Where did this stone come from? Does she have any other stones? I only asked the last question out loud. Dr. Le Sueur said that although she does have other stones, they are firmly lodged in her kidney walls and don’t seem to be moving, so there’s hope that we’ll never have to deal with them. He then showed me a picture of her bladder and, yep, there’s obviously a large white mass in there. Getting the stone out means another surgery, called a cystotomy. It wouldn’t be as big a deal as the SUB surgery–the surgeon just makes an incision, goes into the bladder, and gets the stone–and since it’s fairly common I could probably even get it done in LA. He said to give him a week to get Violet’s medical records updated and ready to send to the surgeon, and that’d also give him time to ask around and find a surgeon closer to me that he could recommend.

    So Violet and I headed home. Dr. Le Sueur said she’d be acting weird for 24 hours because they’d sedated her at the SUB flush. When we got home she just wanted to sleep. She wasn’t eating or drinking. She had cystitis like normal, where she pees frequently or feels like she has to pee when she doesn’t. But then she wasn’t peeing at all. Normally she pees at least a few drops, but Friday night she started peeing nothing. She still wasn’t eating or drinking. And because I was expecting her to be weird, and because cystitis is normal, and because I’d just seen a scan of the stone clearly NOT blocking her urethra, I ALMOST DIDN’T TAKE HER IN. I was in bed, contacts out, pajamas on on Saturday night, and my gut was screaming that something wasn’t right. She hadn’t been eating or drinking for 48 hours and hadn’t peed for 24 hours. So I got out of bed, got re-dressed, and lifted Violet in her blanket and set her in her carrier. It was immediately apparent she was in bad shape because she didn’t panic or complain about the carrier. Much like when Hugo was in ER for not peeing, Violet’s case was prioritized. (She was second after a dog about to go into heart failure.) They saw her quickly and then sent the on-call vet out to meet with me. VIOLET WAS COMLETELY BLOCKED. Her bladder was not full-to-bursting, but it was really full–hard and painful to the touch. The toxins in her blood/urine were so high that their machine couldn’t measure them. Her phosphorus (which can randomly stop your heart if it gets over 7.5) was at 8. I couldn’t believe it, partly because I’d just seen proof that the stone was nowhere near her urethra, and partly because this doesn’t happen to girl cats. (The ER doctor said this is the first girl cat he’s seen it happen to. Great.) So Violet needed emergency surgery to remove the bladder stone blocking her urethra.

    The problem was that neither that vet nor any of his colleagues felt comfortable doing a cystotomy on a cat that has a SUB. I’d need a specialist. And I’d need to find one immediately. They could unblock her and send her home, but she might just get blocked again. It’d be better to put her on a catheter and fluids and leave her hospitalized until the surgery happened. Well, who’s a good specialist around here? He didn’t know. He thought maybe this place or this place, but it’s really up to me to 1) find someone who was qualified and willing to do it on a cat with a SUB, 2) convince this person to do the surgery ASAP. (Remember my front-of-house/back-of-house rant from earlier? This is a good example. The back-of-house thinks it’s easy for a non-vet to book emergency appointments, and the front-of-house has no problem reminding you that you and your “emergency” can’t jump the queue. It’ll be 2-8 weeks until your appointment just like everyone else.) Neither that man nor the man who came on overnight were able to help me with a surgeon. Fortunately Dr. Kerr came on in the morning. When she called we logicked our way through the situation and by process of elimination decided that it’d be best for Violet to go back to San Diego for surgery. She said there was no question we’d have better luck if she attempted to book the last-minute surgery than if I attempted to book it. “Let me call you right back,” she said. When she called back she’d contacted Veterinary Specialty Hospital in San Diego, booked the surgery, arranged a direct transfer, let them know about Violet’s catheter and what connections they’d need to hook her up when she got there, and she had vocab for me to use and names for me to drop to ensure that the intake process in San Diego went smoothly for non-vet me. I was weepy with relief. When the Long Beach ER called back a few days later to check on Violet, I asked them to thank Dr. Kerr because I’m pretty sure Violet’s surgery wouldn’t have happened in a reasonable amount of time without her.

    Vet Specialty Hospital is also an ER, so there was a question of if Violet could get in immediately or not. The best chance was for me to take her Sunday night when they had three doctors rather than Monday morning when they had one. By the time everything was arranged it was around 10 pm Sunday night. So I headed for Long Beach Animal Emergency to pick Violet up (Dr. Kerr and the folks on staff had Violet and her catheter and her bladder bag and her e-collar all arranged in her carrier for the trip, so I just had to put her in the car). For the first time since I’ve been doing this drive, the traffic was insane. Of course it was. The first accident had traffic across all lanes completely stopped (there was a car upside down), but it started moving almost as soon as I got there. The second accident though … it was in Dana Point, and I got there just as the ambulances were getting onto the freeway. I watched the ambulances disappear around the corner way up in the distance and knew we had a lot of cars to move to get past this accident. Traffic across all lanes was completely stopped again, except for the far right two lanes which were exiting. I sat in the same spot in the fast lane for about 20 minutes trying to figure out what to do. I was a feline ambulance with no lights or sirens or power of any kind. Then the car in front of me just … turned right. They pulled their nose into the next lane and slowly inched their way around until they were driving perpendicular across all the lanes, just slowly pushing from one lane to the next until they got to the exit lane on the far right. So I did the same thing. It was like driving across a parking lot. I got some shocked looks, but it worked. I was able to exit and take a parallel surface street and get back on the freeway a couple onramps later. I could see the lights from the emergency vehicles, but never saw the accident.

    By the time I got to San Diego it was creeping up on 1 am. They were expecting us, which was another huge relief. They knew who I was and why we were there, and they got us into a room immediately. It became clear that they were going to start Violet’s case from scratch. Is her catheter placed correctly? Does she need surgery or are there alternatives? So they got a full history from me and then planned to do their own scans/blood/urine work to check her values. It was like an automatic second opinion, which I appreciated, although I had no doubt Violet would end up in surgery. Much like the situation where they couldn’t do her teeth surgery until her kidney values improved and she was qualified for anesthesia, the Vet Specialty folks had to check Violet’s levels multiple times before they could do the surgery. If they put her under anesthesia immediately it would do even more damage to her kidneys. So they planned to watch her for a few days and do the surgery when it became possible to put her under anesthesia. They asked if I wanted to see her x-rays with her SUB in place. It was fascinating–you can see the kidney and bladder and the SUB tubes and the port, and it’s crazy that someone thought of that and that it actually works. It helped wake me up a bit as it got my brain churning. Finally they asked if I’d like to say goodnight to her, so they brought her in and it was one of those moments where I wasn’t sure if I’d ever see her again, so I tried to memorize the spots of black she has on her ears and nose and chin. She was purring while I gave her neck scratches around her e-collar. The drive home was great. I got a second wind while looking at the SUB x-rays, I was the only car on the freeway at some spots (which felt wild), and I’d successfully delivered Violet to people who would take good care of her. I made it home at 3:37 am.

    Violet’s updates were good for the next few days. She finally had surgery Wednesday evening. Dr. Pike called when she was going into surgery and about two hours later when she got out. (He opened the call with “You guys have really been through it this year, it’s incredible.”) They’d found and removed four stones. The only issue was that her bladder was so inflamed that it bled even if you touched it. And that can form blood clots which can also block her. So she went back on the catheter until her urine stopped showing signs of blood. It looked good Friday morning so they removed the catheter and waited to see if she was peeing okay without it, and she was! So I got to take her home Friday night. She was so happy to be home after being hospitalized with a catheter for a week. On the trip home she wasn’t moving around in her carrier very much until she heard me unlock the door to the condo, and then she got excited. She started trying to break out of her carrier, then once I let her out she ran around and checked on all the things–her food dish, her water dish, her water fountain, Hugo’s food dish, the litter box, the hallway, the pillows, the cupboards–it was like in Monsters, Inc. when Boo finally gets back to her bedroom and is so excited to show everything to Sully. Next Violet dove head-first into the food dish, then drank a lot of water, then peed and pooped (which are four out of four things I’m supposed to watch for as signs that she’s doing well post-op). Most exciting to me is that she’s so good at peeing now. I assumed she’d at least have cystitis after everything that’s happened, but she hasn’t been taking trips to the litter box when she doesn’t really have to pee.

    It’s Sunday now, and Violet still seems to be doing well. So far she has been MUCH more comfortable than for her SUB post-op recovery. In addition to this surgery being less extensive, they also injected her with Nocita which is a 72-hour-long local anesthetic. She’s been able to curl up in a ball to sleep, she’s been her normal demanding self, and although she seems weak she doesn’t seem stiff and sore. She doesn’t mind her incision being checked or being lifted onto/off of things. And she seems cold, but not as cold as she did before. She’s been through it though, both forearms, ankles, and thighs have been shaved and have puncture holes (IVs? blood draws?) in addition to one shaved hip and a mostly shaved tail. Her belly and entire backside have been shaved, and her fur is matted in several places with substances I can only guess at. Her incision is about half the size of her SUB incision, and it looks good so far (you’re supposed to check it twice a day). She’s also been getting Gabapentin every 8 hours to help with pain relief. (The vet tech that handed her off at Friday’s pickup clued me in to the fact that gel caps are less traumatic than liquid Gabapentin, because the liquid tastes so terrible, so I’ve been practicing my cat pilling.) Violet spends her time sleeping in my lap, and she lets me know how much she disapproves whenever I have to stand up. The main concern now is how much this incident damaged her kidneys. It’s possible her values will never be as good as they were at her SUB flush last Thursday. So fingers crossed that she continues to recover well and that they like what they see at the recheck appointment.
Violet attempts to rest comfortably at home
By 1 Comment on Year of the Cats 2.24.25-1.26.26

One Reply to “Year of the Cats 2.24.25-1.26.26”

  1. Nellie!
    I am speechless! I had NO idea what you have endured. I had no idea that cats can survive with many fewer teeth. I learned so much reading what you wrote. But my strongest emotion is profound respect and admiration for you. I was alternately astounded, teary-eyed, white-knuckled, and finally(!) smiling as each episode ultimately resulted in success. You did good. No one could have navigated through all of this better. You are amazing in every way. Hugo and Violet are the most fortunate cats I know.
    So proud right now,
    Mumsey

Comments are closed.