"Elvis has left the building!" But he didn't exit alone. This loveable, one-year-old cat was joined by Rutabaga (now nicknamed "Rudy"), his new sibling with whom he shares a special bond. Through Penn Vet's Feline Renal Transplant Program, Rudy donated one of his kidneys in order to save Elvis' life.
One lick of a lily
It was one lick of a lily that set in motion Elvis' roller coaster ride.
For Valentine's Day, Bob Armstrong bought a lovely bouquet of flowers for his wife, Paula. Among the beautiful blooms were a handful of lilies. What Bob and Paula didn't know is that lilies are highly toxic to cats. After merely licking one of the lilies, Elvis fell ill.
"Elvis was throwing up; he just wasn't himself," explained Bob. "We knew something was wrong when he didn't want his nightly treat."
The Armstrongs took Elvis to their local veterinarian in Glasgow, Delaware. Initially, he thought Elvis might have an obstruction, but an ultrasound ruled that out. Upon discovering that the Armstrongs had a bouquet containing lilies in the house, he ordered blood work, which showed that Elvis' kidney were malfunctioning. When Elvis' condition worsened, even after receiving fluids, he was sent to Penn Vet on February 27.
"While all of this was happening, I went online to learn more about lily toxicity in cats," said Paula. "I did some research on dialysis and learned that very few veterinary hospitals offer dialysis for cats. When we saw that Penn Vet was listed, we brought Elvis right away."
In fact, Penn Vet is the only veterinary hospital in the Philadelphia area offering hemodialysis, and one of only four established hemodialysis centers along the East Coast.
Upon arrival at Penn Vet's Ryan Hospital in West Philadelphia, the Armstrongs met with Dr. JD Foster, who immediately put Elvis on hemodialysis. "Because he was completely dialysis dependent at that point," said Dr. Foster, "we discussed the option of a kidney transplant."
Despite an improvement after two weeks of dialysis, Elvis started to plateau. "We continually reevaluated Elvis throughout his hospitalization," said Dr. Foster, "but we reached a point where we felt that he wasn't progressing enough with his return to function." It was then that the team decided it was better to switch paths from supporting Elvis with dialysis to moving to renal transplantation.
Throughout his hospitalization, Elvis had 16 dialysis sessions over a period of four weeks. "Dialysis was able to stabilize Elvis and make him a much better candidate for surgery," added Dr. Foster.
The perfect match
Ironically, it was Easter weekend, when lilies abound, when Elvis' dialysis catheter was removed. The transplant surgery took place that Monday – Elvis' first birthday. "Nothing like getting a new kidney for your birthday!" Paula exclaimed.
Having seen more than 145 cases, Penn Vet's Feline Renal Transplant Program is the busiest in the country. Dr. Lillian Aronson, founder and coordinator of the program, selects potential donor cats through a unique collaboration with the SPCA in York, Pa. Cats can accept a kidney from an unrelated cat, as long as they have the same blood type and are cross-match compatible. Following transplantation, patients are responsible for adopting the donor cat and giving them a good home. By rescuing them from potential euthanasia at the shelter, Penn Vet gives these friendly felines a new lease on life, and they, in turn, do the same for the cats in need of a kidney.
Throughout his stay at Ryan Hospital, Elvis was consistently compatible with donor cat, Tortellini. On Monday, Tortellini was anesthetized in preparation for the kidney donation. But, before proceeding with the surgery, Dr. Aronson double-checked his cross matches one last time to ensure that he was still the best match for Elvis.
"We were literally about to roll in with Tortellini when we received the news that he was no longer compatible," said Dr. Aronson.
Cats can develop antibodies as they get their transfusions, leading to changes in compatibility. "This is why we always double-check before going into surgery," Dr. Aronson explained.
Dr. Aronson soon discovered that Elvis was now completely compatible with Rutabaga, a young, black cat the same age as Elvis with a remarkably similar appearance. "They honestly look like twins," Dr. Aronson observed.
Both Elvis and Rutabaga made it through surgery wonderfully. The transplant procedure, which lasted seven hours, involved two surgical teams operating on both cats simultaneously.
"It was a huge team effort," said Dr. Aronson, "involving people in ICU, anesthesia, nursing, critical care, and surgery." It's this incredible collaboration and expertise that truly sets Penn Vet apart. In addition, Ryan Hospital is one of only two veterinary hospitals in the country offering both feline dialysis and transplants.
"It was so impressive from the beginning that Penn Vet even had the dialysis program," added Paula. "We realized very quickly how rare that is. But it was even more extraordinary to have that and the transplant program. Such an integrated program is almost non-existent elsewhere!"
Following the surgery, Bob and Paula wanted to learn more about their new cat, Rutabaga, who they affectionately nicknamed "Rudy." While reading Rudy's records, Paula came across the card from his cage at the SPCA. She nearly fainted.
Not only did Rudy bear a striking resemblance to Elvis, but his original name was...you guessed it…Elvis.
"I literally got goosebumps," Paula said. "It was all so uncanny."
A send-off fit for “the King”
On April 11, after nearly a month and a half at Ryan Hospital, Elvis was ready to go home. Naturally, the Penn Vet team had grown attached to Elvis during his stay, and felt that a belated birthday/farewell party was in order for "the King." The party, complete with balloons, decorations, and a cake, had an Elvis Presley theme, and Elvis even wore a crown for the occasion.
"We practically lived at the ICU," Bob said. "Dr. Foster, Dr. Aronson, the entire ICU team, and everyone we encountered at Penn Vet were not only so knowledgeable, but also so caring and understanding throughout the entire process."
"They impressed us so much with their thoroughness and compassion," Paula added.
Today, the Armstrongs are working hard to raise awareness of lily toxicity in cats, spreading the word at florist shops in the region and through the Faithful Friends Animal Society. Both cats are now recovering well back at home.
"We've found that Rudy is very much like Elvis," Bob said. " He is very laid back and extremely friendly."
"We couldn't have asked for a nicer, better, sweeter cat than Rudy," added Paula.
As of now, Rudy and Elvis have only met through the bars of Rudy's crate, but these doppelgangers will undoubtedly become fast friends in the near future.
In order to continue leading the way in the treatment of conditions affecting the kidneys, Dr. Aronson is working with Dr. Foster and others to develop a Comprehensive Nephrology Clinic at Penn Vet. With a team including two internists, one of whom specializes in genetic and glomerular disease, a transplant surgeon, and a criticalist specializing in interventional radiology, the service will be tailored for patients with both upper and lower urinary tract disease.
"The skills and training of our team are pretty unique and truly unmatched throughout the country," explained Dr. Foster. "Our goal is to eventually see cases as a group so that patients have one-stop shopping for their pet's kidney problems. There isn't a treatment out there that we won't be able to provide."
For information about the University of Pennsylvania School of Medicine visit www.vet.upenn.edu or phone 215-746-8387.