The kitten who refused to die

Elvis the kitten has already burned through 9 lives -- and he's only a year old.

His ordeal has a (mostly) happy ending, but what an ordeal it's been: A near fatal encounter with a deadly flower; renal failure; four weeks of kidney dialysis and, finally, a $15,000 kidney transplant at the University of Pennsylvania. He's still not out of the woods.

The saga begins on Valentine's Day when Elvis' owner, Bob Armstrong, brought home a beautiful bouquet of blooms for his wife.

A few days later, Paula Armstrong noticed their jet-black kitten acting strangely.

"He wouldn't eat his treats at night," said Paula, a retired development officer for the University of Delaware.  "Usually, Elvis and our other cats would up jump up on the bed and lay down. And then they got their treats. But one night he refused. And that had never happened before."

Elvis became lethargic. He started throwing up. He stopped eating all food.

Alarmed, Bob and Paula took Elvis to their local vet in Glasgow, Delaware.  Blood samples revealed the kitten's kidneys were failing. The vet asked Paula if she had any houseplants.

"I said 'no,' but I mentioned our cut flowers," Paula said. "And I started listing everything included in the bouquets. As soon as I said 'lilies' the vet was suspicious."

Lilies are kryptonite to cats. Though dogs also can be poisoned by the flowers, just a taste of a lily can kill a kitten.

"It's one of those things that owners don't realize," said Lillian Aronson, the founder of the renal transplant program at Penn's School of Veterinary Medicine.  "And it doesn't take very much."

Poinsettias, which have a far worse reputation as a feline poison, are not nearly as toxic, she said. Every part of the lily is deadly poisonous to cats and ingesting very little can prove fatal in three days.

Elvis was a relatively new addition to the Armstrong household. Paula had spotted Elvis and his two brothers in August as they traipsed across in her backyard following a stray.

"He had short black hair, very sleek and shiny and seemed to already have a wonderful personality," Paula said. "So we called him 'Elvis'."

Paula has had cats all her life, but she there was something "exceptional" about the tiny black kitten.  He was the alpha cat among the three brothers. He was always on the top tier of the cat tower. And he loved to ride the vacuum cleaner.

It was Elvis' warm and friendly disposition that won Paula over.

The vet told Paula that Elvis would die without dialysis.

"I had never heard of cat dialysis before," she said. But when she got home, she feverishly looked online for a vet who could provide dialysis for Elvis.  She found Dr. JD Foster at The School of Veterinary Medicine at Penn.

When Elvis arrived at Penn he was in complete kidney failure.

Foster, a Penn veterinarian, immediately placed Elvis on dialysis. The toxins that had built up in kitten's blood needed to be filtered out.

The hard road would take time.  Every three days -- for a month and a half-- Elvis was hooked up to a dialysis machine.  And still there were no guarantees he would ever return to his playful self.

Paula and Bob drove two hours nearly every day to be with their kitten.

One night, as Bob was cleaning the living room floor, he discovered a single leaf from a lily. It had been punctured by two tiny teeth.  Though her cats were all indoor animals, she had all the lilies in her yard torn up from the roots.

Meanwhile, at Penn, Elvis had reached a plateau.

"We were seeing some slow improvements," said Penn's Aronson. "But he was completely dialysis dependent and could not urinate at all."

The dialysis bought Elvis four weeks, but if he was going to live, he needed a transplant.

Penn Vet has performed about 150 kidney transplants since the renal program's inception in 1998, Aronson said. Patients come from as far away as California and Kuwait.  Elvis would be their first ever patient laid low by a lily.

If he was going to have a transplant, Elvis needed a donor.

The hospital strikes an agreement with the owners of the sick cats. Donors aren't just a resource for spare parts. If your animal gets a transplant, you have to take the donor animal home with you, too.

"Owners love that aspect of the program," Aronson said. "They feel they are saving the life of the animal that saved their cat's life."

Every few weeks, someone from Penn drives to an animal shelter in central Pennsylvania and returns with several young adult cats.

On arrival, they're treated like royalty.

Each is rechristened. A Penn Vet nurse chooses a category. One week it was vegetables, so the new cats got names like Broccoli Rabe and Rutabaga. The next it was pastas: Ravioli, Tortellini, Linguini.

The cats are socialized, checked for infection and cardiac disease, and evaluated to see if they're good transplant candidates.

Tortellini appeared to be the best candidate.

On April 1, Elvis and Tortellini were shaved and prepped for surgery. A last minute blood test threw a wrench in the works. Because Elvis had had numerous transfusions, they were no longer compatible.

Rutabaga, a sleek, black, splittin' image of Elvis, was summoned as a last minute replacement.

Using operating microscopes, Aronson and two other doctors simultaneously performed the surgery on both cats.

"It's very stressful, and there's no room for error," Aronson said. "But it's not just me. It's a whole team that works together."

Six hours later, Elvis had a new kidney.

It wasn't until the next day that Paula and Bob learned of the last minute donor.

Paula asked Aronson if she could see Rutabaga's vaccination history. A small card fell out of the cat's file.

On the slip of paper was his Rutabaga's original name: Elvis.

"It was beyond weird," Aronson said. "You couldn't make it up. We were all floored!"

A few days later, Elvis and the cat formerly known as Elvis – now called Rudy – went home to New Castle County.

» READ MORE: Elvis, the comeback

Elvis was his perky self, running around the house with his new best friend.

"He was back to being a happy cat," Paula said.

In early May, however, Elvis began to weaken.

Another hour-long trip to Penn revealed the new kidney wasn't working.

"There was no longer blood flowing to the transplanted organ," Paula said. "It was lost."

Elvis, however, wasn't done. Unlike his namesake, it was not time for this Elvis to leave the building.

Penn doctors rushed Elvis into the emergency surgery. On the operating table, Elvis went into cardiac arrest. The doctors wouldn't let him go.

"He was literally dead for 5 minutes," Paula said. "They used the paddles. They shocked his heart. And they brought him back."

The next morning, he was grooming and eating.

"One of the doctors there said it was just miraculous," Paula said.

Elvis had one more surprise to spring, despite his travails on the emergency room.

His old kidney had improved enough to sustain him. Having the donated kidney, if only for five weeks, had bought Elvis some crucial time.

His renal cells had regenerated.

Elvis has returned home again. He's on immunosuppressant drugs. He eats a special diet.

"He's great now. He's running," Paula said. "I have to keep him on restricted activity, which is difficult. When I let him out of his crate now, I have to stalk him."

He receives daily injections, Paula said, but the kitten's a good sport and doesn't fuss during the procedure. Paula said that if necessary, Elvis would return to Penn for another transplant.

"We have friends who think we're crazy to do this for a cat," Paula said. "It was a very expensive proposition. I wouldn't have done this for every cat I've ever had. But this cat was worth it to us.

"I just told everyone we're spending our kids' inheritance," she laughed. "Our daughter said she would have done exactly the same thing."

The story isn't over, she said. But Elvis is back to being a vivaciously playful cat.

"This cat should have been dead a month ago," Paula said. "People say cats have nine lives, but nine is so far in the rear-view mirror!"

Contact Sam Wood at 215 854 2796, @samwoodiii or samwood@phillynews.com