One heart-wrenching day after another

While there can really only be one more horrible day - yet to come and not even to be thought about - than the day that Scruffy was diagnosed with cancer (and a heart murmur and kidney failure, like one awful disease was not nearly enough...) - this morning was definitely in the running for Day I Never Wanted To Come.

It was clear that - only 3 months from the fourth anniversary of being officially OTJ (off the juice, in feline diabetes speak) - the introduction of dexamethasone by IV in the hospital and prednisone pills at home were going to wreak havoc with Scruffy's glucose levels.  His last official lab test glucose level - on January 17th - was a lovely 51. (Which was actually a smidge lower than I would have expected.  Maybe cancer does eat sugar?)   From the introduction of steroids, on January 23, 2012, Scruffy's been around 200-250 each time I tested him.  I bought urine test strips, and sure enough, there was glucose spilling into his urine.

It's been so long since I had to worry about any of this stuff, and my mind has definitely deteriorated in the last 4 years.  But, I clearly can't risk DKA or further kidney damage from lack of treatment of diabetes.  

I wanted to use Levemir again - a human insulin that produced the OTJ status the first time.  It was gentle, long-lasting, didn't sting when injected, and gave him good control.   My expectations and goals are totally different this time, though.  I simply want him to be under the renal threshold.  I'm not interested in doing a whole bunch of testing or fine-tuning dosages.  I don't know how long I will have him here, and I don't want to make him any more miserable with treatments than he already is.  He was such a good diabetic cat the first time around - more than 7,000 ear pokes and who knows how many shots, and he never protested.  Except for the time I bought ReliON syringes....  he could apparently tell the difference between them and the BD's that I usually used.   The most efficient way to purchase Levemir for use with a cat is in the form of a "pen,"  a measured cartridge that humans can use by dialing the size of the dosage they wish to give and allowing the pen needle that is attached to inject the insulin.  Since this doesn't permit the tiny doses that cats generally require, we still need to use a syringe to withdraw the insulin from the pen and inject it into the cat.  Levemir comes from the pharmacy in a box with five pens.  Given the usual small dosages needed for treating a cat, five pens would last a very long time, and it's sadly unlikely that Scruffy would even be here long enough to use up that many pens.

So, I "networked" - asked a few very good friends if they might have any extra Lev pens, and was kindly offered four different pens by Pamela, Vicky, Melissa, and Dian.  Two of them would require shipping, which makes it more difficult in the winter, but Melissa and Dian are within driving distance.  Yesterday, Melissa and I met - and had a nice lunch at Cracker Barrel and a good visit - and she gave me a partial pen of Lev, a box of syringes, and a box of Kleenex to mop the tears that seem to appear unexpectedly and often.  Tomorrow, I'll met Dian - more lunch and more understanding friendship! - and she has another partial pen.  Of all the many pleasures Scruffy has given me over the eight years he's belonged to me, meeting and loving the special people from the Feline Diabetes Message Board is right up there on the top of the list.  Crazy cat ladies - well, maybe.  But smart, caring, thoughtful, wonderful humans - for sure.  I have been so fortunate.

This morning, I tested Scruffy again.  I'm really kind of quivery about this whole thing - I can't see well enough to fill the syringe, my math skills are so minimal I can't even figure out the dosage by the lines on the syringe - oh, and I really DON'T want to have to do this.  But.....  He was at 200.  So, I fed him - and of course, today was the first day he wasn't determined to eat out of every plate on the floor.  he did finally eat a little Gourmet Chicken FF and drink some lactose free milk, so I figured he was good to go.  I oh-so-carefully drew just a tiny little bit of insulin into the syringe - as close as I could get to the first line on the barrel, which is some totally unknown amount, but presumably way less than a half unit.  I made the tent, and poked poor Scruffy.  He probably got next to no insulin, I don't know.  At least, it was a first step, I guess.

At +3, he's 180.  Not a lot of movement, lol. I'm not gonna keep poking his ear.  If he pees, I'll check and see what the strip says.  That's the best I can do for him, except to tell him again how sad and sorry I am that all this has happened to him.  It's really not fair.  I gotta go find Melissa's kleenex.

Glucose level - 243 :(

Scruffy's home.

Jan.23, 2012

I wasn't sure that I'd even get to write that.  This is Monday night.  This morning, Dr. E called from the Specialty Hospital and said that he thought that the Puffer could come home today.  His ionized calcium level this morning was 1.34 , down from 1.38 yesterday.  But - his creatinine was 3.3, up from 3.1 yesterday.  He weighed only 10 pounds, 2 ounces today, no surprise since he had eaten virtually nothing from Thursday afternoon until Saturday afternoon, when he began to voluntarily eat small amounts of Fancy Feast Gourmet Chicken.  (Which was his "go to" food when he began to eat again after being diagnosed with diabetes back in 2004.)  Speaking of which, his glucose level has climbed steadily since he was hospitalized and since he was being given dexamethasone by IV for the last three days.  It was 184 on Jan. 21,  210 on Jan. 22, and 251 today, Jan. 23.  The doctor thought that stress from the hospitalization could be impacting the glucose level.   Truthfully, I'm hesitant to even test him now that he's home, but I suppose I'm going to have to.

The official report, made on information gathered between Jan. 20 - Jan 23, 2012, after ultrasound and other assorted tests, includes the following information:

"Diagnosis:  Large cell lymphoma of liver and spleen; kidney failure, history of diabetes mellitis, history of urethral obstruction.

Radiographs:  Possible cardiomegaly, decreased detail within the cranial abdomen suggestive of mild effusion or inflammation.  Hepatomegaly was noted as well.

Ultrasound abdominal:  On the spleen, there were multiple large, hypoechoic, heterogenous masses up to -80mm to the right of the midline.  On the liver, there was a single 27x20mm mass similar in appearance to the liver mass.  The peritoneal cavity had mild/trace effusion.  Single small mass between stomach and liver of questionable origin.

Ultrasound-guided aspirate:  consistent with large cell lymphoma

Ascultation of the heart reveals grade II-III/VI systolic murmur.

Urinalysis:  SG: 1.014, remaining values WNL   (Because his kidney values - creatinine, etc - showed virtually no improvement even though the calcium level is approaching normal, they have added "kidney failure" to the diagnosis.)

We came home with:

Azopt drops for glaucoma (already prescribed since June, 2010.)
Prozac (already prescribed since August, 2010, discontinued for 4 months in 2011, restarted in December, 2011.)

Prednisone - 5mg - 1 tablet every 24 hours until evaluation at appointment on January 26, 2011.  May be tapered off at that time.

Cyproheptadine - 4mg - 1/2 tablet every 12 hours to stimulate appetite.

Famotidine  (Pepcid) 10mg  - 1/4 tablet every 24 hours until recheck.    For nausea.

Renakare:  1 2meQ capsule every 12 hours with food.  Potassium supplement.  (However, this is actually a huge white pill, not a capsule, and even broken into small pieces, was a real problem to get into Scruffy.  He's very difficult to pill, and we've now got a ton of pills to give him.) This will hopefully be discontinued at the Thursday appointment if his potassium level has normalized.

Buprenorphine - to be given if he appears to be uncomfortable, although they don't expect that he should be "overtly painful."

Next Thursday's appointment is to include bloodwork  to recheck CBC, and Chem 8 test, and IV cytoxan/lasix chemotherapy.  It makes me shudder to think of it.  I am not convinced/committed to completing the entire schedule of chemotherapy, which includes treatment virtually every week for six months.  I think at either four weeks or six weeks, they plan to do another ultrasound to see if there has been reduction in the tumors. If there does not appear to have been any progress toward remission at that time, the option seems to be to stop and do nothing further, or to change to another protocol.  Given that the predicted survival of my sweet cat was "four to 12 months", I'm not sure I want to waste six months of that time making him sicker, and I am sure that I would not want to start another kind of treatment.  They are insistent that cats don't suffer the distress that humans do with chemotherapy; I'm not sure how they know that, and we all know how expert cats are at hiding their pain.

There is much more depressing information that I don't have the energy or desire to add right now, although I will post it maybe tomorrow, since it's potentially of interest to others who may be contemplating chemotherapy for their cat.

Here's a little more upbeat stuff:

It took FOREVER to get Scruffy sprung from the hospital. Although we had made what we thought was an "arrangement" to pick him up at 2:30 (and my husband had a doctor's appointment of his own at 3:30), it was almost 4:30 before I finally had poor Scruffy in my arms.  And then, we were taken to one of the exam rooms to get the medication and instructions and information sheets about the chemotherapy program - which is the Madison, Wisconsin protocol, by the way.  Then we waited a little longer for Dr. E to come and actually hand over the discharge papers, the buprenex, and Scruffy's kitty pi, which must have been left in his cage.

We finally got out of there about a quarter to five.  And by the time we'd gone a mile or two, it started to pour.  Tons of rain.  As we entered the area of Wexford, the most amazing thing happened:  an enormous, brilliantly colored, complete rainbow appeared in front of us, with a second rainbow forming to its left.  Stunning, defined stripes of color, and funniest of all, it looked like the end of it would be right in our back yard!  Well, of course, it wasn't, but it sure was close.  We decided that that was Scruffy's good luck rainbow, and hopefully, it means that he will survive whatever chemotherapy he ends up having, and that we will be allowed to have him for what will hopefully be a lot longer.

When we got home, I carried him upstairs and put him down in the living room.  There has been a sort of manic quality to his movements since being in the hospital - kind of jerky, unplanned-seeming movements, and his back legs aren't totally functional, which may be one of the side effects of the chemo.  Anyway, he looked around for a minute, and then headed immediately to the kitchen, where he climbed into one of the litter boxes and sat, looking kind of dazed, for the longest time.  When he got out of the box, I went to sit in my chair and he galloped over to assume his usual position on my right leg, with his little head cupped in my palm.  He had  trouble jumping up onto the table, and when I went to "help", I discovered that his whole bare-shaven little stomach was wet.  With chemo-infused urine, lol.  And we were instructed not to touch any of his "productions" for five days....  (He had what they thought might be a urinary tract blockage while in the hospital, although there was very little sediment when they catheterized him.  The catheter was removed just minutes before we got him, so I assume that it had caused some irritation and maybe lack of control.)   Anyway, he sat there, and purred mildly for about a half hour.  Then, he jumped down and headed for the kitchen again, to see what the other cats had left in their dishes.  He snuffled around, while I opened a can of Gourmet Chicken and gave him a little plate of lactose free milk.  He gobbled down half the can of FF, and I put the other half down for him and he ate that, too.  My poor cat that hadn't eaten a total of an entire can of food in two weeks!  He continued to make periodic food searches until around 9:30 or 10:00, when he got up and peed again, then climbed up on his window ledge and curled up in his kitty pi on the heated mat.

None of the other cats showed much interest in him.  He has a really odd smell to him, and I was a little concerned that maybe the others would reject him or not recognize him because of it, but it didn't seem to be a problem.  My little Milkshake was the only one to make any effort to "greet" Scruffy.  He jumped up beside The Puffer, and tried to lick his head, but all he got for his kindness was a whack with Scruffy's paw.

The one odd thing seemed to be that he didn't put his head down.  He just sat, eyes open and his head in the air, for nearly an hour.  I wondered if he was sleeping with his eyes open.  He didn't react to sound or noises, except for one unpleasant exchange between Minnie and Burble, when he turned his head toward the noise.  He got up twice to drink some water, and did a long, involved circling thing before laying down again, this time with his head down.  He's been generally napping now (although right this minute, his eyes are open halfway.)  It seems a little odd.

One other matter of interest, I suppose, is the cost so far.  (No one has mentioned the cost of the chemotherapy itself.)  I did say that I didn't think we could afford another regular charge of $900 for the several scheduled ultrasounds, and Dr. E said that it would likely be more in the range of $300 or $400; the original one include the aspiration and a ton of lab work.  Somewhat comforting.

The two page bill, which included the information that the charge for the "Hospital Level 2" is $90 for weekdays and $108 for weekends - summarized the charge for all of things that had been done to/for Scruffy on Friday, Saturday, Sunday, and Monday as $2,264.00.  A fairly shocking amount.  (It was my intent to tell the person doing the money collecting NOT to say all that financial stuff out loud, but unfortunately, just as she started reciting all of the gruesome and expensive details, my husband wandered over to the desk and, of course, was regaled with all of the numbers.  It was even more shocking to him, I guess.....

At any rate - with the exception of the fact that I don't know how I'm gonna get the potassium pills into Scruffy twice a day, and that I'm not convinced that Pepcid/famotidine is going to control nausea sufficiently now that he's eating again - my sweet kitty is home again.     I have cried practically non-stop for four days, and now, to be able to hold him and pet him and just have him here is wonderful.  He's such an odd little guy, with probably the most interesting personality of any cat I've ever had.  I'm going to concentrate on treasuring however many more days we have.

Scruffy's Rainbow

First meal at home

Milkshake's greeting

Scruffy has lymphoma.

It hurts my heart to write that.  In his liver and spleen.  And the hypercalcemia is causing kidney failure.

I thought this post would be a report of the results of the second bloodwork, and the arrival of the results of the fPLI test.  (He got a 14; normal is 1.0 to 3.5.) And to mention that I weighed him again this morning and he was down to 10 pounds, 5 ounces.  And that there is a sort of odd, squishy quality to his abdomen when I pick him up.

To summarize the second bloodwork, AST and ALT were elevated more, although not horrifically.  Amylase was high/higher.  Glucose was 51.  I wish I could laugh about that.  Total calcium was significantly higher, and his creatinine and whatever the other kidney thing is were both abnormal this time, although they had been fine just a week ago.  The vet sent a referral for an ultrasound.  When I called them, they said two weeks.  It was becoming apparent that we didn't HAVE two weeks.  I flung everything I could think of into the conversation with the receptionist, including Dr. B, the ophthalmologist.  And somehow, she discovered an appointment she hadn't seen before for this Friday, only two days away.

In the meantime, although Scruffy would turn up in the kitchen every time I put food down for the cats, he couldn't seem to bring himself to eat.  I started putting a whole handful of kitten chow on his plate, and carrying it around to wherever he ended up sitting down.  He also would still wander out to the living room where Milkshake eats, but instead of inching up closer and closer to sneak a bite of Milk's food, Scruffy would just meatloaf down a couple inches from Milk and watch him eat.  I picked up a couple of cans of AD because even the ham baby food wasn't enticing him, and I was getting worried about taurine and all the other neutrients he wasn't getting enough of.  The one thing he wanted and ate eagerly - and which was probably a terrible thing to give a cat with calcium in his blood that was killing him - was lactose-free milk.  I never give any of the cats milk, although Black Kitty started every morning of his life inside with a nice dish of regular old milk and we never thought a thing about it.

I have the dates all confused in my head.  I need to get a calendar, I guess.  The Sunday after the second bloodwork was done - and there was an error that delayed the testing and the return of the results, so it was right after we got the report - Dr. G. said he thought that we should start doing fluids.  It has been one of my fondest desires NEVER to have to do fluids with one of my cats.  I have been needle phobic forever; it took me months to be even moderately comfortable with insulin needles, and they were 31 gauge.  But - it had to be done.  We took Scruffy down to the office and got a quick demonstration of how to do it.  I thought Rege was intending to help, but the next day, he announced that he was NOT going to.  I managed to do it myself, and my sweet cat never fussed at all.  Not a move, not a peep out of him.  I expected, though, that it would make him feel so much better.  It didn't seem to.  And he wasn't peeing any more than usual, which also surprised me.    I discovered that Costco sells/will order Lactated Ringers - a case for $26.19 or there abouts.  Dian gave me a website that sells the needles - Terumo's, too! - Dr. G. gave me disgusting Monojects that stuck to Scruffy's skin like glue; they were horrible to use.  And I bought sets of tubing.  All set to go.  Scruffy and I got through five days of "giving fluids" without much trauma, and without his making the least protest.  I took pictures, for no particular reason.  I guess I wanted to prove that I was able to do it, no matter how I hated it, and what a good cat I had for tolerating it when he felt so lousy.  As you can tell from his fur, he felt crummy, and he was still purring when I rubbed his ears at the end.

Another installment of this nightmare tomorrow.......I'm too weepy and exhausted to do any more tonight.  And I miss my Puffer terribly already and it's only been 13 hours.  

10 pounds, 11 ounces. :(

Scruffy's not doing very well.

Tuesday, January 10, 2012

He's been licking his lips for two weeks or so, and doing some throwing up.  Nothing very major, nothing particularly unusual.  His teeth are again in need of a dental, so I made an appointment for him to have bloodwork.  He's never, in all his years, had any bloodwork results that were abnormal except for glucose and cholesterol.

But, this one came back with:

ALT   154 (high)   ref. range  10-100
AST   106 (high)   ref. range  10-100

Calcium   12.8  (high)  ref. range  8.2 - 10.8

Amylase - 1407  (high)  ref range 100 - 1200

Plus:

Neutrophils  (high)  9225   ref range  2500 - 8500  75%

When Dr. G. called with the bloodwork results, I was shocked that there was something wrong, and even more by what it appears to possibly be.  Hypercalcemia.  Excess calcium.  Most often an indicator of lymphoma, or also of parathyroid adenoma, or kidney disease/failure, or hyperthyroidism.  Only, his kidney values were just fine, as was his Total T4.

Also, he's lost somewhere in the range of at least a  half pound.  His little face is tiny, suddenly.  And then I realized that his fur is horrible - getting dandruffy and sticking up all spiky in every direction.  When he lays down, meatloaf-style, the fur on the tops of his back legs sticks out like clumpy batwings.  He's never had nice fur, but this reminds me of all those months of uncontrolled glucose levels in the 300's and 400's......

Spiky hair from his ears to his feet.  :(

Poor Scruffy's been very sniffly for several weeks.  He did finish a course of zeniquen for herpes in early December, successfully.  I had thought maybe the lip-licking might have had something to do with his ears, actually; he has a history of ear infections, and if I rub in front of his ears, he shakes and scratches at them in a fairly frantic manner.  He's been sleeping significantly more than usual for the last week. One night, he didn't even show up to sleep with me for the first time in months, although he's always tucked away with his little head in my hand in the morning.   For the last two days, he's been throwing up foam once or twice a day, usually when his stomach is empty.  And he's drinking  water very frequently, although he doesn't seem to be spending any more time in the litter box than usual.  (Unless, of course, he's wandering downstairs to pee on the rug when I'm not around. )  I was consoling myself by thinking that at least he was still eating in Scruffy fashion.  Scruffy never not eats.  Until this morning, when he ate only a few bites, sniffed and wandered slowly away.  (And the final blow - the melanosis in his right eye - I can't see it totally clearly and I haven't been able to get a picture of it - seems to have a second area of discoloration suddenly.)

It was the vet's suggestion that we wait two weeks or so and then retest the calcium level, and add in testing on a bunch of the other possibilities.  And an ultrasound -  which would be interesting, I guess, solely because everyone who has ever examined his abdomen has thought that there was Something Wrong In There.  (That was the reason that the Emergency Hospital thought that he had FIP, way back when I first brought him home in 2003.)  He did have xrays with the last dental, about a year ago, that included his lungs and the area around them, and his hips and spine; there didn't appear to be anything abnormal then.

Anyway, with today's rare and frightening lack of interest in food, I called the vet and asked about cerenia, which he had mentioned the last time I talked to him a couple days ago.  We have never resolved our definition of "vomiting" and "regurgitating" - I think Scruffy's throwing up his whole life has been "regurgitating" - the food never hits his stomach; he just gobbles it down, and within seconds, it comes right back up, untouched by teeth or digestive process.  The vet says that cats don't "regurgitate", and that it's vomiting.  Not that all of that is of any particular import, it's just an issue that has come up repeatedly.  Anyway, I thought I would try pepcid, but after thinking about it, I realized that, with all of the other stuff that seems to be going on, maybe it would be better to just start out with the Big Gun instead.  Turns out cerenia, which I know people on FDMB have had very good experiences with, is an injectible.  Dr. G. says it stings.  And that it can be given with an insulin syringe, sub q.  Thank God, I guess.  It took me forever to get used to giving Scruffy insulin, and the only other time I ever had to inject anything, they gave me four HUGE syringes full of Reglan to inject into my little 3 pound kitten, Burble.  With one of those enormous thick syringes and needles that are NOT insulin equipment.  I could only bring myself to do that once, and it was horrible.  I just don't know if I can do injectible cerenia, and I have mixed feelings about doing something that will cause him more pain and discomfort.  So, anyway, there's a pill form, which may or may not last 24 hours, like the injectible does.  I picked up 4 pills - I don't know why that number, since it's Tuesday and the fifth day is Sunday, when the vet's not open.  I guess to see if it works or not.  I came right home and gave him the first pill, with his prozac, because he's really difficult to pill, unfortunately.  Another reason to consider the injectible, I guess.  Waited three or four hours for the pill to start circulating, and then got out the food.  He did come out to the kitchen and wait in his usual place for his dish, but he didn't really eat any of it.  He likes to wait until I fix the dishes for Tootie and Milk - adding a little dry kitten food for them, and I always put three or four pieces on his plate at the same time; he did eat that dry, and a couple of snuffling bites of the canned.  And then he went back to sleep for three or four hours.

Dr. G. said today that 12.8 isn't exactly the level of calcium that is considered an alarm sign for hypercalcemia/lymphoma.  That's closer to 15, apparently.  And he says that electrolytes can vary - we might have just caught him at a time when it was unusually high.  But it's high enough to need to be checked, because high calcium can cause kidney disease, among other awful things.  An elderly cat who had totally uncontrolled glucose levels for more than two years and still manages to have well-functioning kidneys doesn't need anything to damage them.  I spent a long time reading stuff I didn't really understand about hypercalcemia today; everything that I thought might be an explanation for his level seemed to be negated by all the other stuff that's suddenly going wrong with him all at once.  The weight loss is worrying and sudden.  What if he's working up to hepatic lipidosis and that's why his liver values are screwy?  See, why didn't I ask the vet that?  Should I call him and ask him tomorrow?  Wouldn't he have mentioned it if he thought it was a problem?

I have literally spent every minute that this poor cat has lived with me keeping him alive.  He had a urinary blockage a half hour after I brought him home - the first of three that required surgery in the first two months I had him.  And then the "FIP scare", and the "sinus infection" that turned out to be herpes, and the diabetes and DKA, and the iris melanoma and subsequent laser surgery, and then the glaucoma, and now - after worrying for 3 years about the possibility of melanoma metastasis - now lymphoma, maybe?  Not fair.  I am so weepy I can hardly look at him.  The poor thing, none of this should have happened to him.

More ophthalmology stuff

Another visit - apparently there was an eye-related emergency, because we had to wait almost an hour for Scruffy's appointment.  Dr. B. seemed rushed and stressed during the time we were there - although I notice that we were charged for the SST test, they didn't do it.  Only $17, I guess.

Anyway, eye pressures were very good again - 13 in the right and 14 in the left.  Under 20 is desirable.  I got refills of the Flurbiprofen, and of the ulcer solution, and a prescription to send to Canada to order Azopt.    A couple months ago, a woman that I knew from the EpiKitty Yahoo board posted on Facebook that she had some glaucoma drops that her father had purchased for his dog.  (The dog had died.)  Turned out, the drops were Azopt!  The bottles were only 5ml, as opposed to the 10ml that I've been buying at Costco, but I was paying $117 for one bottle - these were  $28 for two or three!  I just finished the second of these bonus bottles, and despite an article I read from Consumer Reports about the hazards of ordering from Canadian pharmacies, I had no problems with the anti-convulsants I was ordering for Milkshake, and I don't expect any problem in getting glaucoma medication from there.

General report - 1) no regrowth of the iris mass, ocular pressures controlled,   and 2) no change in the focal iris pigmentation

So, good news and no more appointments hopefully until January, 2012.


 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


8/11/11  Animal Communication

(I forgot to post this months ago, and now, since it's somewhat lighthearted and I am definitely NOT, I'm just trying to figure out a way to tack it onto an older post, instead of having it show up on top with all of the cancer stuff.....)


By August of 2011,  Scruffy's "inappropriate elimination" was pushing me right over the edge.  I was cleaning the carpets downstairs every week, and crawling around with my black light at night; sniffing when I came in from the garage, and paddling around in my stocking feet to see if there were wet spots.  He was spending most of his time hiding.  A couple of times a week, he'd poop right beside the litter box downstairs.  I was so annoyed with him I could hardly bear to look at him.  He hadn't come to sleep with his little head in my hand for months.  He had also started what appeared to be an intentional technique for avoiding the prozac pill every morning - he would just go from dish to dish, vacuuming up the cat food, until he threw up.  Once the pill was disposed of, he'd eat some more.  I was feeling persecuted and angry and guilty about all the eye drops he hated and the pill-giving.   I mean, after all, who rescued him from a short and miserable life outside?  Who spent almost 4 years testing him and giving him insulin shots, and who got the tumor in his eye removed???  He OWED it to me to use the damned litter box.  Only, unfortunately, he didn't seem to feel the same way.

Someone from the Feline Diabetes Message Board mentioned that she had been in contact with a new "animal communicator."  It was a person who had been around the board for years and had been/is fostering a ton of diabetic cats.  I had positive feelings for both the communicator and the communicated-with.   And I was so desperate for help that I decided to try it.

My only other experience with animal communication was a couple of years ago, when Hope and Linda and Dale gave me an hour with a communicator in Ohio.  (It doesn't matter where the communicator is; location isn't significant.)  And it was very interesting.  The communicator said that both Milk and Scruffy had spinal issues; I took them to the holistic vet here, who does chiropracty, and sure enough, without even knowing what the communicator said, he diagnosed the exact same problem location she had for both cats. And she had suggested some herbals for Milk's uncontrollable seizures. (I actually bought them from her, but couldn't bring myself to give them to him.)  There were some other things she said that weren't particularly applicable, but......

So, I made the appointment on-line.  Very well set-up website, very easy to pick a time.  Kind of expensive - $30 for 15 minutes, one cat and $60 for 30 minutes, two cats.  But, well worth it if works, right?

I wanted to be very organized about what I needed to know from her. My concerns were,  well, of course, the Scruffy-peeing stuff, and Milkshake's weight loss.  When the time came for our appointment, she asked only for the name of the cat and the color of its coat.  (I think I was so desperate for help that I may have told her that Scruffy was making me crazy, but I'm not sure.)  At any rate, she went away and came back in a couple of minutes and said, "Scruffy thinks you're mad at him."    I said, "Well, DUH.  I'm enraged!"  She talked to him some more, and he told her that he didn't like the Prozac.  He didn't like the way it made him feel.  (And I had increased his dosage as his peeing got worse, which made me feel even more guilty.)  He said he'd use the litter box if he didn't have to take the Prozac.  I was VERY unsure about making such a deal.  (And thinking that I had to be NUTS!)  But, I agreed, as long as he actually was going to cooperate.  He had to understand though, that because he was having a herpes attack, I still needed to give him zeniquin.  She said he didn't have a problem with that.  And she had to tell him that there was no choice about the eye drops, either.   We talked about Milkshake, who she felt had something going on internally, but couldn't identify what the problem was, and then hung up.

That was at 2:00 PM on a Sunday afternoon.  At 7:00 PM, Scruffy wandered into the kitchen and for the first time in months, PEED in the box.  Right in front of me!  I was stunned.  That night, he turned up the minute I was ready to go to sleep, and snuggled into his old place.  He started following me around again, waiting for me to sit down so he could sit on my lap.  It was all amazing.  And for a good two weeks, he seemed to have gone back to his old diabetic pattern - he peed twice a day, at the same time, right in the middle of his meal.  I was ecstatic.  At the end of that time, I again talked to Claudia.  I wanted her to ask him how he thought he was doing with our little agreement.  I didn't get that she understood my question, or that he answered it, but anyway, I felt comforted.

And then, I discovered a puddle in the laundry room.  On the vinyl floor, and when I tried to get the smell out, it got worse and worse.  (That was when all the downstairs peeing started - I moved a nice big litter box to the laundry room, thinking that he'd be happy to have a box down there.  He wasn't, apparently; he peed all over the floor a dozen times and never hit the box once.)  Eye-wateringly stinking.  I tried talking to him.   It seemed more hit and miss; sometimes he'd use the box, sometimes he didn't.  I noticed, to my extreme dismay, that both Burble and Duncan were beginning to watch when Scruffy was in the litter box and to chase him afterwards.  Not exactly what we needed.

And then - this was about 3 weeks ago - he peed on the floor right in front of me, twice.  I was in a frenzy.  I rushed to the computer after the second episode and looked up Claudia's website.  And tried desperately to get an appointment to become available.  Which never happened - I finally noticed that she was on vacation.  So, I had time to calm down, and I "discussed" with Scruffy my annoyance and disappointment with his behavior.

The outcome of all this - well, in the end of November, 2011, or the beginning of December, I started him back on Prozac.  Half the dose he had been on before.  And it seems to have been successful.  Haven't found more than a couple puddles on the rug since then.  I hated doing it to him, but I just didn't feel like there was any choice.  One more thing that I will be eternally sorry happened to my poor cat....

6/14/11 - catching up on ophthalmology

We're still having the every-four-months-appointments.  And eyewise, things have been good.   The eye-dryness measure (I don't know what its actual name is - they put a small tab of treated paper in each eye and hold it closed for a few seconds; I posted a picture of it before) which is reported as "STTs" on the appointment record,  was 12 in the right eye, and 13 in the left eye.  The eye pressure,  which is how the glaucoma is monitored -  was very good - 11 in the right eye, 13 in the left.  (The melanoma and surgery were in the left eye.)  Although I haven't taken any pictures of his eyes to Dr. B. lately, he feels that there has been no change in the melanosis that remains in the right eye.   It always looks a little more spread out to me; I do need to photograph it, I think.  At any rate, if it's growing, it's doing it very slowly.

At the end of this appointment, the technician mentioned that I was to continue putting the Azopt in BOTH eyes.  I didn't know that.  I could swear that I never heard Dr. B. even say that he needed the drops in both eyes.  So, obviously, I hadn't been doing it.   And Scruffy's personality changes had not improved - adding even one more drop of that thick white stuff was just likely to make him even less cooperative.   The essence of it is, I am keeping two drops a day in the back of my mind, but the reality is, when there appears to be no problem with the pressure in the right eye, I just don't know if it's going to get done until it becomes medically unavoidable.

Aside from that, the appointment summary was:

OU (both eyes):  lens sclerosis
OD (right eye):  focal iris pigmentation site (ventral quadrant) 6:00 position
OS (left eye):  previous laser surgery (for iris mass) - no evidence of regrowth.

We had the usual discussion of Scruffy's presumptive age again - almost three years ago, Dr. B. said that he felt, judging from the condition of  his eyes, that he was between 10 and 13 years old.  So, that would make him somewhere between 13 and 16 now, I guess. And he continues to have adequate vision in the eye that had the tumor, which is good.  All in all, except for the spitting and hissing and biting that went on, a pretty good trip.  (Except for the guy in the waiting room with the enormous black dog with the ear-piercing barking.  One of the technicians said that he has three more of that same dog - can't remember the brand - at home.  I hope he wears a hearing aid that he can turn off.....)

Well, this is distressing.

I just noticed that, of all the blogs for diabetic cats listed on the sidebar here, only Carolyn and Spot's "Sugar Babies" cats and Karen's Pearl  are still with us.  It makes me really grateful that - given Scruffy's unknown age, the melanoma in his eye, the unfortunately inexpert 3+ years of diabetes treatment by me, and now glaucoma - my fluffy boy is still up and kicking. 

Way behind on things here - my intention, last May (2010!)  was to list Scruffy's quite good blood work, and comment on his still diet-controlled diabetes status, his on-going need for a dental, and the continued non-cancerous situation of his left eye.  However.....  being a major procrastinator, I never quite got around to it.


And then, along toward June, for some reason, his eye started looking odd to me.  It's very difficult to explain, and given the fact that his iris is quite distorted as a result of the laser surgery, it has never actually looked "normal"  for the last two and a half years.  Anyway, I made an appointment with Dr. B, and sure enough - and there was absolutely NO way to "see" this - Scruffy now has glaucoma in his left eye.  (There are no visible symptoms of glaucoma.  I'm attributing my thinking there was something wrong to, well, I don't know to WHAT; maybe just the connection we have?  Anyway, I was right!)  The pressure was not terribly high - in the 20's - I need to go and look up the actual report, as I wasn't really intending to write here today.  Anyway, it was not totally unexpected, of course, given the tumor and the surgery.  Just distressing.  We were given a human glaucoma eye drop called Dorzolamide.  Tiny little 10ml bottle for around $55.  Two drops per day in the "affected eye."  And thus started a horrible period for poor Scruffy which I will forever regret.

From the first drop, Scruffy reacted terribly to the drops.  He snarled, he hissed, he hid, and worst of all, he went back to peeing all over the house with a vengeance.  He no longer slept with his little head cupped in my hand, which he had done for years.  I never saw him from one day to the next, except for the times when I tracked him down/grabbed him while he was eating in order to give him his prozac and the miserable eye drops.  I asked several times if there was an alternative glaucoma drop that we could try.  And there was, but it cost almost twice as much, and there didn't seem to be much point in trying it because the ingredients were essentially similar.  Dr. B never really said if the reaction Scruffy had to the drops was normal or not.  I never actually asked, I suppose.


We finally managed, in November, 2010, to get the dental done. It went well, and I requested xrays of Scruffy's lungs to try to make sure the melanoma hadn't metastasized.  (It's fairly common for the cancer cells in the eye to be spread through the tear glands and other pathways to other parts of the body.  Several melanosis cats that I am familiar with ultimately died of lung cancer.)  Dr. G said that the lungs were clear.  He also xrayed Scruffy's abdomen and hips, which he said were normal.  The Puffer doesn't jump very well any more - I was concerned about the possibility of arthritis. Must just be that he's getting old.)

The glaucoma was very well controlled by the Dorzolamide.  The cat, not so much.  In the meantime, we accumulated two more kittens (which Scruffy generally ignored; he's not very "cat-oriented".)  And my mother had a major heart attack, was hospitalized for a month, spent five weeks in a nursing home, returned to her apartment where she needed support and help, had another heart attack, two more hospitalizations.......the essence of it was - there were entire weeks when I was gone 15 hours a day and none of the cats got much attention, although I never missed the medications for Scruffy and Milkshake.  It all added up to Scruffy's turning into a rather sullen, isolated, unhappy cat; the laid-back, sociable kitty just disappeared.  My sweet cat, who had tolerated more than 7000 ear pokes and who-knows-how-many insulin shots over nearly four years without a single objection, became unhinged from the eye drops.  

Finally, at the end of January, 2011, I was running out of Dorzolamide again.  I decided that, regardless of the increased cost, I needed to try the other medication.  In addition to the behavioral reactions, Scruffy was plagued with a black crusty discharge from his left eye; when I wiped it off daily, it left a reddish color on the kleenex, like blood.  Dr. G had said  previously, that it wasn't blood, it was iron and was related to the medication.  He prescribed yet ANOTHER eye drop - I was supposed to be giving Scruffy the glaucoma drops twice a day, Flurbiprofen drops (to treat something or another about the surgical site) every other day, and now, a drop to treat the irritation and infection that was apparently caused by the glaucoma drop.  You think he was miserable before?  We had reached the point where, while I could get both glaucoma drops into his eye every day, there was no possibility of giving him either of the other drops on a regular basis.  So,  I requested a sample of the alternate glaucoma drop, and it was amazing!  It's a thick, gluey white stuff, unpleasant looking, but Scruffy doesn't object to it at all.  No more hissing, no disappearing all day, he's back to snuggling on the arm of my chair and sleeping wherever I am.  Most of the time, when I put the new drop - which is a medication called Azopt, and cost $117 at Costco for a 10ml bottle - he doesn't even bother to blink or close his eye.  The other drops had to have been causing him serious distress, and I am so full of regret for making him so miserable for the last nine months.

Two weeks after starting the Azopt, we had our regular appointment with Dr. B.  Scruffy's eye pressure was 12 in both eyes!  He was doing so well that the opthalmologist felt that it would be possible to decrease the glaucoma drops to once a day.  (Oh, it makes me nervous, but I do have faith in him!)  We've been having an appointment every three months to monitor the glaucoma (and a small melanosis in the right eye,  as well as the former surgical site) and I guess that will continue.   But so far, so good.  I've pretty much got my Scruffy back, with the exception of the occasional litter-box offense.  Although I will probably never be able to totally relax about sniffing and checking all Scruffy's favorite places to "express" himself......

It's been a long time, sadly......

Since Halloween, which is kind of amazing.  It's not that there hasn't been anything going on with The Puffer.  He's had another good report on the condition of his eyes  - both the one that had the laser surgery and the other eye, which has a new melanosis that we're watching.  He had bloodwork that was good - I think his cholesterol level was the only thing that was out of range.  Despite the much-discussed dental that still  needs to be done, he continues to have reasonable blood glucose levels - I just tested him a few minutes ago and got a 68!   (Which is significantly lower than usual, I have to admit.)


This has been a bad winter for the state of Scruffy's fur.  It was so awful that a few days ago, I bought a wonderful cordless clipper, and started shaving him.  It's amazing to see him without his fur, because he looks so chunky with it.  Without it, he's really quite svelte.  (I'm cutting back on the pictures because my computer died a few weeks ago and I don't want to fill up this laptop with stuff until I get a new desktop.  I am going to take a picture of his new "do"  to post here, even though it's not quite "done.")  It also appears that the lumpy lipoma on his  right side has either diminished in size (do they DO that?) or gone away.


Back in January, when we went to Dr. B, the ophthalmologist, I mentioned that our regular vet had suggested trying famciclovir for Scruffy's herpes, which has been awful for months.  The sneezing, the snorting, the nose-running - the poor cat.  Dr. B. - who uses famciclovir because he has patients with herpes eye problems, agreed that it was well worth a try.  He wrote a prescription for twelve 125mg pills, to be given 1/4 pill twice a day for no more than 2 weeks.  Verrrrry expensive stuff, that famciclovir - almost $6 a pill.   Fortunately, it was a round pill, which made cutting it into quarters somewhat easier, but ....  I've been giving Scruffy (along with his prozac for  "inappropriate urination" ) a nightly 1/4 chlortrimeton to try to help with the nasal/sinus problems.  During the duration of the time he got famciclovir,  I stopped the chlortrimeton to see if I could determine whether there was any significant effect of either of the drugs.  As it turned out, I couldn't give him the morning famciclovir pill - every morning for four days, after I gave it to him, he'd eat and eat and eat in a really driven fashion until he threw up. So, I just gave it to him in the evenings with his 2AM snack, and it stayed down.  There really wasn't any huge improvement, sadly.  After the two weeks was up,  I went back to the 1/4 chlortrimeton nighly.  A month or so later, I again refilled the famciclovir prescription, and tried it again.  There seems to be an initial positive response, but  it doesn't last, and it never did seem to be completely effective.  I think - although Dr. G, our regular vet, didn't seem to agree - that by now, it's possible/likely that he's got  sinus inflammation/infection going on.  I found an unexpired packet of a week's worth of clavamox, and gave it to him, and in my opinion, it was effective.   I think I'm going to  ask Dr. G for a prescription for something antibiotic, and schedule the dental in the very near future.


So the essence of Scruffy's life is, we're still plodding along.  He needs the prozac still, I guess - I found a puddle in my craft room three times that I'm pretty sure were Scruffy Productions.  I never see him in the litter box anymore, but I also never see him spraying or digging at the carpet or furniture, so I'm assuming things have been better with the addition of another cement-mixing litter box in the laundry room downstairs.   (The EIGHTH!)  He's about ten years old now, in the estimation of the ophthalmologist, so he and Busy are Senior Citizens of our household.  (Well, aside from my husband and I, oddly.)


The Countdown Clock to keep track of how many days (and hours and minutes!) Scruffy's been off insulin has given up the ghost.  I can't figure out  what could have happened to it; it just disappeared, even though the html code is still there.  I tried repeatedly to replace/fix it, without success.   I really miss having it up there, because we're coming up very rapidly on the TWO YEAR ANNIVERSARY of his OTJ!  April 8, 2008 - still an amazing thing that makes me shake my head every time I think of it.  I wrote to the Pyzam people (whose website contains all sorts of interesting things like countdown clocks) to see if they have a solution or a suggestion.  I have one on Milkshake's blog, put up at the exact same time as Scruffy's, and that one's still perfectly functional.


I need to go and hunt up the blood work report, and the ophthalmology report, and a new picture of The Puffer with his crew cut.

Halloween

Of course, I have to annoy the boy cats (not the girls, because they're way too vicious, and the kittens are too uncooperative) - with Halloween costumes. It's been a couple of years since we dressed up for the occasion, and no one is any happier now than they were the last time. I don't care if they're annoyed; they're so darn cute.

On to the important things:

1) Started prozac on Tuesday, October 20, 2009. After a highly unsuccessful two and a half months on paxil. And Wonder of Wonders - it seems to be working! I have to admit to still having the occasional twinge when Scruffy heads off for unknown parts in the middle of his breakfast. But, I've seen him actually USING the litter box (or ONE of the 8 litter boxes I've got all over the stupid house!) every single day but two since we started. Okay, so now that I do the math, that's only 11 days, but it seems SO much longer. Sadly, I don't notice any particular improvement in the Fearsome Tootle's behavior, but maybe it will just take a little longer for the prozac to affect her.

2) Postcard to set up Scruffy's next ophthalmologist's appointment arrived in today's mail. If you look closely at his right eye in the Pumpkin Picture, you can see the distinct brown circle at its lower inside edge - that's the next iris melanosis. Which has darkened, become more distinctly circular, and gotten bigger since the last time I was able to get a picture of his eyes. (Missed having a picture to take to an appointment with Dr. B for the first time in three years!) He's to be scheduled for a January or February appointment. I guess we'll aim for January. I hate the thought of all this potentially starting again.

3) Still no dental. And he's had some pretty horrifying numbers occasionally - the worst was a 188, out of the blue and presumably some hours after he'd eaten. (Although I think that he may have gotten trapped downstairs by/with Tootie, which would be a good reason for increased glucose levels. We had a brief, very brief period of about a week when the herpes seemed to have taken a vacation. I should have hiked him down to the vet's immediately and had the dental done. But, I didn't, partly because of inertia and other stuff that had to be done, and partly because I am thinking that he's going to need complete blood work, as well as xrays of his hips and lungs. The thought of dragging him down there twice was just more than I could bear. But, given the potential of needing a dental's likelihood of screwing up his OTJ status, I know it HAS to be done. Soon....

Anyway, it was a very quiet, damp, chilly Halloween here in The Land of Kitty Delight.

No. (and TMI alert, too)

To answer the question from the previous post. Paxil does not seem to be doing much of anything to address the peeing/spraying problem. In the last two weeks, I've watched Scruffy like a hawk every morning. I follow him all over the house. I sit on the steps while he's downstairs, watching the little stinker pretend that he doesn't have the intention of peeing down there someplace the minute he sees me go back up the steps. I have actually seen him poop in a litter box twice in that time span, and pee three times. Unfortunately, in the same three weeks, I've watched him back up to the china closet (3 times) and the bookcase (2 times) and spray. Right in FRONT of me. The first couple of times, I just watched helplessly. I have no basic information about spraying - what exactly the process is, or anything. I assume that it's an expression of severe displeasure on the cat's part, obviously, but other than that.... I have always heard/believed that once a cat starts to pee, they can't stop. (I do apologize to anyone who might be reading this, but I have to get it off my chest. I only WISH I could get it off the rug!) The last two times I came around the corner of the kitchen to discover Scruffy making a puddle in front of the china closet, I yelled, "HEY, what are you DOING?" and he scrambled off in mid-stream. So, if this is spraying, rather than peeing, he does appear to have a modicum of control over it. Not that that fact - correct or not- has any relevance to the problem at hand. Or at foot. I think at least a dozen times a week that I am SO glad that I didn't get that new carpeting.

In addition, Scruffy seems to be hot all the time now, too. Well, yes, he's got that really long, fluffy fur, but he seems to sleep restlessly lately, and he gets up frequently and moves to what appear to be cooler places - from my lap to the table top, from the kitty pi on the window ledge to the wooden shelf beside the ledge; he gives me the definite impression that he's uncomfortably warm now. Anyway, I'm not satisfied with paxil, (which is doing NOTHING for Tootie as well - it doesn't even make HER sleepy!) - and as soon as this last so-called refill of 10 pills (shared between Puffy and Tootle) is gone, I'm asking the vet for Prozac. Plus, he prescribed this tiny amount of itsy-bitsy pills - only 10! - and they charged $1.70 PER PILL. I am willing to sign all sorts of pledges or whatever that no one will use this medication but the two cats - if only he will please give me a prescription for a decent number of pills so that they are a reasonable price.

Scruffy's eye looks pretty good. I am still trying to get a decent picture - the last ophthalmologist appointment was the first time I didn't have a picture to leave with him, and at the time ( a month or so ago) I really thought that the eye that had had the laser surgery looked greatly improved. The small, faint melanosis in the right eye looks slightly darker to me, which could be my imagination. I really want to get a picture to compare it to. His next appointment is, well, at some unspecified date, because I thought I hung the appointment card on the fridge, but apparently not. I think it was six months this time, which might put it in January or so of 2010.

I just read a paper from Cornell regarding feline iris melanosis/oma that I came across by accident. (Checking the Site Meter listings, it was on the same Google page as Scruffy's blog.) 18 pages of information that made me feel kind of uncertain about whether or not I should have just had his eye removed, instead of doing the laser surgery. (And that also made me think that that first ophthalmologist, Dr. K - who I did not care for in the first place! - should have never allowed the growth of the melanosis to have gotten as far as it did. The statistics quoted in the Cornell paper - for a study of 34 cats with iris melanoma - were pretty bleak in terms of the number of cats who had metastasizes of the cancer. But the data was only gathered from the eyes that were removed, since there doesn't seem to be a way to really detect malignant/benign iris growths in cats, for some reason. So, hopefully, the laser treatment will be effective and protect the Puffer. Particularly if we may be faced with the necessity of making the decision a second time....

The photo below, while blurry, of course - I am the Queen of Blurry Photography! - shows at least an idea of the improvement in the left eye that has occurred in the last couple months. The brown goblet-shaped remnant of the surgery has become smaller. The pupil is still pulled out of shape, and will undoubtedly not show much improvement, since the adhesion will probably alway be there.

Is the Paxil successful?

Got me. I haven't seen this cat - whose litter box habits I monitored twice a day for FOUR YEARS - use the litter box one single time in almost two weeks. I have NO idea where he's going now. He apparently must be, or he would have exploded by now. (Although, he does look significantly more "rounded" than he did...) I have added two more cement-mixing trays, one in the living room and one in the dining room, in what seem to be two of his favorite target spots.

I am pretty sure that he was, at some point, peeing on my beloved heart-shaped braided rug in the laundry room. So, I threw it out. He does stroll in a leisurely fashion down the steps in the middle of every meal, which I would assume is a very bad sign, but I have no proof.

He started the Paxil on Saturday, August 1. The culture and sensitivity urine test was negative, which meant that there was no bladder infection to contribute to the problem. (I had been told that Prozac would be more effective, but my vet was insistent that we try Paxil first, and since I had already filled the prescription for Tootle, I agreed.) The dosage is 2.5mg. The pill is 10mg, so that's 1/4 of a pill. A teeny-tiny, minute little dose. And, for the last week, that tiny little pill has turned poor Scruffy into a zombie. He sleeps virtually non-stop. Well, yes, I know he's a cat, and that's what they do, but this is EXCESSIVE. Nothing like his usual pattern. As additional evidence, there's a huge difference between what Scruffy seems to be doing with Paxil and what Toot's doing with it. She's minimally calmer and less aggressive, unless there is food involved, and she's awake; she's patrolling the food dishes, she's guarding the bathtub, she's watching the kittens through the screen - in essence, she's still got a life. Poor Scruffy - I'm not so sure.

So, here's my dilemma: 1) I don't know if it's working. 2) It's turning him into a fur-covered log. While it is absolutely necessary for the peeing and spraying to stop, I feel a need for Scruffy to have some of his normal life going on - looking out the screen door, trailing around behind me in case I might sit down and he could sit on my lap, playing with the occasional toy, knowing when it's time to eat without having to be poked....

What to do, what to do? Well, for today, and possibly for much longer, until I gather some evidence that the litter box avoidance problem has returned/never left, I didn't give him any Paxil. And he still slept deeply virtually the entire day, but I figure that's because he's got some quantity of the drug left in his body.

I don't want to ruin the quality of his life because I haven't found homes for the kittens. He deserves much better than that. He's been a patient, loving, placid cat through all of the disturbance of feline diabetes, and herpes, and laser surgery for what was probably a melanoma in his eye - I owe him something for all that, don't I?

(That said, the annoyance - nay, possibly "rage" is a better word! - I felt the day he backed up to my bookcase in the dining room and sprayed right in front of me makes me more than a little concerned if there's some long-term fallout from stopping the drug so early.)

"Inappropriate Elimination...."

or, a less emotionally-charged way of saying, Scruffy's peeing all over the house. I've added two more large cement-mixer litter boxes, and variety of cardboard boxes - love those priority mail packages! - as hopeful obstacles to his use of any of the six or seven target sites I know for sure he's used. (I hate to even contemplate how many other places he may have "visited." )

I am inclined to think that this is a behavioral thing, rather than an infection of some sort, mostly because 1) he's NEVER had a UTI, despite three blockages that required surgery years ago, and 2) I know he hates the kittens in the bedroom. And, if a good and loving and safe home for all five of the little sweeties would turn up tomorrow, I would let them go in a heartbeat, although it would kill me. But, for now, they're here and he's here and we can't have this "inappropriate elimination" thing going on. Period.

I made an appointment for him to have a cystocentesis tomorrow afternoon. I asked the technician if she knew if the vet DID them, and it became apparent that she didn't know what I was talking about. Scruffy is NOT fond of Dr. G. Scruffy is the proud possessor of The Massive Fluffy Tail That Must NEVER Be Touched. I don't know how this procedure is done, but I'm sort of hoping that it involves the use of anesthetic gas of some sort, for the sake of the well-being of all of those involved.....

One last sad thing - I think I will have to stop and buy another carrier this afternoon on my way to my mother's house. The only one I have that's big enough for Scruffy's tubby little body is the carrier that my sweet MommyKitty died in last week. I don't think I can use it, ever again. Even with Scruffy's own kitty pi inside. It's too painful a reminder of her loss, and I can't deal with it now. Or ever, probably.

This is my sweet MommyKitty, who will stay in my heart always. She should have lived a long and happy life, being cherished and loved.




I would sincerely appreciate three or four days without any sort of crisis, if anyone Up There is listening.

Good news eye appointment!

This was the fourth post-laser surgery appointment with the ophthalmologist. (And the only one that I didn't have a picture of the eye to give him! Despite my best efforts - I am the queen of blurry photography.) Scruffy's left eye has changed fairly significantly over the past few weeks - the shape and color of the small, martini-glass shaped "attachment" between the pupil and the edge of his eye are both improved; the size and shape of the attachment are smaller, and it's a lighter shade of brown than it has been. His pupil is still pulled out of shape by the adhesion that formed after the surgery, but his eye still looks better.

Other good news - normal eye pressure is between 10-20/under 25; Scruffy's measured 10 in the right eye and 12 in the left, so glaucoma is not a current concern. The retina and other eye structures were all normal, and his vision is apparently unimpaired. I had noticed some squinting - including an alarming experience where he hopped up on the table beside my chair and his left eye was completely closed! But, there didn't appear to be any particular problem going on. Because of the adhesion's effect on his pupil's ability to change shape, he's more sensitive to light in that eye, but daylight/low lamplight doesn't seem to cause discomfort. Although at the last visit, both of his eyes were somewhat dry, they were both acceptable this time. He is still to get the Flurbiprofen drops every two or three days.

Further good news is that the size of the newly developed melanosis in the right eye appears to have remained the same. Dr. B. did not feel that there were any changes to its appearance.

We were late for the appointment. Scruffy feels that he needs to supervise any showers I take, and while I was getting ready for the trip to the vet, I made the in credibly stupid mistake of including in my general conversation with him (well, he's there - I'm not gonna ignore him!) a comment about "going for a ride in the car." He didn't react immediately, but the minute I opened the bathroom door, he was gone like a flash. And no amount of bribery - even a piece of the dreaded dry kitten food wasn't effective! - could entice him to show his furry little face. I finally found him - after I'd already had to call and explain that we were not going to be on time - hiding behind the massive big screen tv downstairs. I can't move it, and there was no way to get behind it from either side. So, I tossed a magazine over the top of the tv - I don't know where exactly it landed, but I definitely heard Scruffy shuffle to the opposite end of the television. Two more magazines, and he showed up in grabbing-range at the side of the couch. He was more than normally "spitty" during the appointment. He hissed and spit at the technician and her newbie, at Dr. B., and at me, after I'd returned him and his favorite kitty pi to the carrier. And even after the door was closed, I could still hear the hissing. It must be hard to be small enough to be smooshed and carried around against your will. Anyway, he was happy to be home, and within minutes, was cheerfully sitting on the window ledge beside my computer, slurping at his paws and watching the birds.

The next appointment is not until November, barring changes in either eye. This was really good news.

Poor Scruffy....

Just finished making an appointment for the long-put-off dental. I did make a stab at cleaning his teeth last week. It didn't go nearly as poorly as I expected (and yes, I did watch the Cornell video that says you should take a month to get them used to the idea of teeth-brushing).

The sinus stuff is still present, but so much improved that I think it'll be okay to finally get the dental done. His glucose levels have been back to normal, it seems - there have been some pretty awful numbers in the 100's over the last month or so. I am still giving him both the chlortrimeton and zeniquin once a day. He is breathing more easily and less noisily, and the obnoxious sneezing-in-your-face hasn't occurred for a good week or so. Small steps, major gratitude to the Powers that Be.

Cinnaminnie is in heat again. For the 322,456,798,543rd time. Scruffy has suddenly decided that it is his civic duty to try to assist her in her quest for a boyfriend; he didn't seem to notice her previous attempts to entice him by her wiles. He apparently doesn't realize that he's no longer equipped for the job. (And he's the only one of the four male cats who's ever presumably actually had experience - the others were neutered as kittens.) As I said in another context, poor Scruffy....

MAY I help you?

I have a "site meter" here. It's an interesting way of keeping track of how many people look at Scruffy's and Milk's blogs - I was amazed to see the number of places all over the world where people had seen the names of my cats! Every country you can think of. (Google is an amazing thing!) Many were just here by accident, and a bunch seem to be attracted by that horrible "cheezburger" picture that I don't know what to do about. But, unless someone leaves a comment, I really don't have any way to communicate with anyone specificly.

That said, a person that Site Meter says is from Buffalo, New York - but who seems to be reading Scruffy's blog in what I think might be Dutch (?) - has been here a LOT. Frequently, several times a day. Everytime I see on the record that there was another visit, I wish desperately that he or she would leave a comment about what they're looking for - if there's any way at all to help, I would be very happy to do so. I would guess that this might be a person with a cat that has iris melanosis, judging from the pictures here that he or she is looking at. Anyway, it's a disease with a limited amount of time to have treated, and if there's any information I might have, or some other way to help, please leave me a comment. It doesn't need to be posted publicly. I'd love to hear what you're looking for and to try to be of assistance.

Another visit to the ophthalmologist

Well, rats. I can't find the papers from Scruffy's appointment on April 8. I don't remember the numbers, but his eye pressure was good in both eyes, and unlike the last appointment, his eye didn't appear to be irritated or to be too dry. The eye test with these strips is done prior to each examination, and measures the amount of moisture in his eyes. It doesn't seem to bother him at all....







This is the most current picture of Scruffy's left eye, which Dr. B. says is doing satisfactorily. The vision is still good in it, there is no indication of glaucoma, and it continues to be his belief that the brown goblet-shaped "attachment" at the lower edge of his eye is not the tumor that was previously there. There is no thickening of that brown tissue. As is easily visible, the shape of his pupil has changed, however. Dr. B. feels that that is the result of an adhesion that has developed that is pulling the pupil out of shape, and limiting the ability of his eye to react as effectively to light. I have noticed that he squints now in bright light.

I am still to give him a drop of flurbiprofen every other day, to combat the tendency toward inflammation. The drops seems to bother him more now than they did previously - he flinches and fusses after every drop; Dr. B. said that we can change him to another kind of eyedrop if it becomes too much of a problem. I think it's tolerable for now, but when this bottle is empty (which should be fairly soon), we'll change to the other drop.

There was NO change in the size or shape of the melanosis in the right eye. Thank God.

One final issue was the ever-present sinus problem. (Which has been different from his customary herpes episodes ever since it began last summer.) It occurred to me to worry that maybe some of the melanoma cells from his eye might have drained into his sinuses and could be the source of the sniffing/sneezing/dripping stuff. Dr. B. said that it was possible, although unlikely, and that at some point, if it continues to be intractible, Scruffy could/should have another chest xray, and possibly xrays of his sinuses or an examination of them. He wrote a prescription for Baytril, which The Puffer has only actually gotten one dose of into his system. He throws up within minutes of getting the pill, no matter what time of day I give them to him. I give him 1/4 of a cholortrimeton tablet a couple of times a week, which does help to dry up some of the dripping. It was "sinus" infection that gave him diabetes, way back in the fall of 2004; the vet we were going to then gave him a shot of depomedrol for it, and three days later, he was grabbing food off our plates and started losing weight. He hasn't exactly led a charmed life, has he?

One Year! No Insulin!

Celebrate, celebrate,
Dance to the muuuusic!




It's an older picture, but one of my favorites. (His eyes are still normal....) It really doesn't seem like it's been a year. I remember how nervous I was, and how at the last minute - just the very end of the two-week OTJ period to make it official - he had some higher than usual numbers. But, we persevered. And here we are.

Congratulations, my sweet Puffer. You did good!

Brother, am I sorry I did THAT.......

Today was our 3-month visit with the ophthalmologist. The morning went well, I got hold of Puffer and crammed him in the carrier with no problem, and then, I got lost on the way. Ended up - with only 5 minutes left before the scheduled appointment - making a huge loop and right back to where I'd started out, almost. Every road seemed to be full of potholes and sharp S-curves and right angles. We finally get to the Speciality Hospital, and there is a couple waiting to pick up two yipping white Scottish terriers. And waiting and waiting, yipping all the while because only one dog was brought out to go home; the other one apparently had an unfortunate accident and had to have a last minute bath, according to the technician I was eavesdropping upon. But the waiting room is cavernous, full of hard stone surfaces and nothing at all to absorb sounds, and the dog barking made my ears hurt. Scruffy kept scrooching further and further back into the carrier, trying to escape. It was not felicitous. Then the appointment, where, aside from the paper tapes in the eyes, they really don't do anything unpleasant to him. But he seems to feel obliged to hiss and spit anyway. ScruffyPumpkinPattyFractiousPaws. Eventually we checked out, went home by way of the route I should have taken this morning, and once he was home, he seemed more relaxed. He nibbled at the breakfast that was left.

Purely out of curiousity, because Scruffy was not a cat who ever seemed to exhibit much in the way of vet stress, I thought I'd test his glucose level. Bearing in mind the messy, unpleasant sinus stuff and the difficult two+ hours he'd just been through. And got a 170. One Hundred Seventy. Suffice it to say, my heart fell. My heart plummeted. My heart fell off a cliff into the ocean. Tomorrow's his first anniversary as a diet-controlled, non-insulin dependent cat. And he's got a 170. Is it stress? Is it the cancer in his eye? Is it those awful teeth? Is it illness? Is it falling out of remission? Is it too close to having eaten a little? I have no idea. All I know is, it was very upsetting. SO, now he's been napping on the window ledge in the big fuzzy black pi for the last couple hours, and he's eaten three more times, a little here and there - and he was just 117. Better, I guess. BUT - good enough? Dear God, I HOPE so.

ETA: 83 at 2:30 AM! And we're officially at The Puffer's One Year Anniversary. I still can't quite believe it.

Scruffy's snuffly....

This has been going on since last August - and possibly even earlier. I just remember August because the ophthalmologist wanted whatever's going on in The Puffer's sinuses cleared up before the laser surgery. He gave me a prescription for - rats, can't remember what antibiotic it was (Zithromax - the ophthalmologist looked it up at the next appointment), but it cost like $5 a pill because they prescribed the brand name - and increased the amount of lysine. That seemed to work for a couple of weeks, and then everything started over again. Scruffy's been on clavamox twice since the beginning of December, 08, and he's still really miserable. I know at least a portion of it is herpes, since he's having these really extended periods of reverse sneezing. But he's also got a drippy nose. No watery right eye, though. Which may have something to do with the laser surgery; who knows?

Dr. G (regular vet) suggested giving Scruffy 1/4 chlortrimeton pill, which does seem to dry him up somewhat. I don't know if there's a warning about using it for the long term, though. We have an ophthalmologist appointment next week, so I can at least ask Dr. B what he thinks. What worries me is the possibility that there's something more going on in his sinuses. I wonder if an xray would show anything? He's still getting double lysine twice a day; it hasn't seemed to help.

I realized the other day that it's my fault that Scruffy has all those orange "Fractious" warnings on his folders at various vets' offices now - I don't think I ever thought to tell any of the vets that he has NEVER allowed anyone to touch his big thick tail, and now he's clearly having pain/discomfort in his hips. They're probably trying to drag him out of his carrier and he's reacting uncooperatively because it hurts him. I feel really bad. He used to be the most mellow cat ever born. Nothing bothered him. I did ask Dr. G. to xray his hips, but he didn't want to anesthetize Scruffy just for the xray. (Or maybe he just doesn't want to risk being ripped to shreds?) If his head clears enough to have a dental, I guess we can combine all the various xrays with it and do everything at once.

Unintended result.......

There has been a sudden surge of people looking here at that horrible picture of the cat with the incredible eye disease from "icanhazcheezburgers.com". It just seemed kind of odd. I was never able to find out if the complaint I made at the cheezburger site about the picture got any follow up, and if it was removed.

The other day, in an idle moment, I googled "cat eye" or words to that effect, and sure enough, there was that stomach-turning picture. ONLY - Scruffy's blog address was underneath it! Like I was the person who posted that obscenity. Now I don't know WHAT to do about it. It's presumably up there on Google for eternity, so it wouldn't do any good to remove it from the blog, would it? This is obviously a PRIME example why you shouldn't post naked pictures in your blog, or pictures of crimes being committed, or whatever.

The recent ophthalmologist visit

I forgot to record the results of the appointment with Dr. B on 1/13/09.

It started with unloading The Puffer from his carrier - for some reason, his kitty pi wouldn't slide out, and he wasn't about to leave the carrier without it, so it took two of us to tilt the carrier almost straight up and down and convince him to come out. One of the things I like about this ophthalmology practice is that they always put a nice soft towel on the stainless steel table. Then the technician gathered up her equipment, and with a kind of odd tone, asked me if I'd hold Scruffy's head so she could put the strips in his eyes. I said yes, but was a little surprised, because normally, the tech does everything. Anyway, I held his little chin, she stuck the strips in his eyes (and WHY didn't I have my camera turned on for THAT spectacle?), and Scruffy never moved a muscle. When she had read the strips, she said, in a surprised tone, "Well, he wasn't nasty." I said, "No, did you expect him to be?" And she showed me his folder, which had a big orange sticker on the front of it which said "FRACTIOUS"...... He's been treated in this clinic for more than two years, and has NEVER been "fractious" in the office. But then, I remembered Dr. B. saying that my poor kitty was extremely uncooperative when they were trying to get him ready for the surgery. And then I realized that he's generally gotten pretty crabby lately. I wonder what's causing that? Old age? Arthritis? The misery in his sinuses? Transference from his negative experiences at the regular vet's office?

On to the examination. Despite my concern about the larger amount of dark brown tissue in Scruffy's left eye, Dr. G felt that it is not related to the melanosis/oma. He thinks that the large dark area is possibly an indication of: 1) some burned tissue left from the laser treatment; 2) dark brown pigment underneath the iris, which has been thinned by the laser to the point where the pigment is visible; and 3) there may still be more post-surgical healing. There was no "re-elevation of the brown iris laser site since the last exam." (Elevation is considered to be an indication of malignancy, apparently.) There appeared to be no change in the vision in that eye, although there was increased dryness and inflammation. (Which I felt bad about - I had noticed a few days before the appointment that Scruffy was squinting, which is a sign of discomfort and inflammation - who knew? I had plenty of the Flurbiprofen eye drops left - I just didn't know that they should be used.) Pressure in the eyes was good - 13 in the right eye, and 14 in the left. The treatment was to begin giving him the Flurbiprofen eye drops and the atropine ointment again.

The bad news is that the melanosis in the right eye is "slightly wider (but not elevated." In about 9 months, the growth in the right eye has gone from being a pinpoint to being a noticeably larger brownish area that sort of resembles Saturn. Dr. B's intent is to watch it closely. It took only a year and a half for the first melanosis to go from virtually invisible to having tentacles and requiring surgery.

The next appointment is April 8, 2009.

A few more pictures:

Scruffy weighs 12 pounds, 11 ounces.

Which would be just fine, if his little legs were two or three inches longer... Knowing how rotund he is now, I have a hard time picturing what he must have been like when he weighed 14 pounds, the week before he got the Depomedrol shot that gave him diabetes.....

And he's had the most miserable sinus stuff going on for weeks now. Clavamox (pills, this time, instead of the messy liquid) hasn't touched it. Wherever he sleeps, there's a little puddle when he moves his head, because his nose runs and he sneezes and sprays all over the place. He looks just miserable.

Picture 3 months post laser surgery

January 13, 2009. About three months from the surgery to deal with Scruffy's iris melanosis/noma. (Dr. B., the ophthalmologist, is still convinced that it was the latter.) Here is this visit's eye picture - well, I spent two days taking pictures trying to get a really good one, but this was the best of a bad bunch:




It shows, in the lower outside section of Scruffy's left eye, the brown tissue that had me worried that it might be the return of the tumor. It has changed shape since the surgery, and size. But Dr. B. is convinced that what is showing is not a remaining tumor, but that the iris is significantly thinned now, and there is colored tissue under it that is now visible, and brown. He saw no elevation of the brown tissue, and no sign that there was anything unusual about it. He also said again that some of the discoloration might be detritis from the laser's burning of the tissue during the surgery. He did not feel that three months was necessarily the limit for any sort of further changes that might happen with the left eye. He felt that the eye was healing satisfactorily at this point. The pupil is somewhat distorted in shape now, and if you look at the eye from the right angle, you can see that there is a slight irregularity of the surface of the eye, I suppose caused by the removal of tissue that the laser demolished.

I picked this picture specifically, however, because it had a good view (relatively speaking) of the iris melanosis in Scruffy's RIGHT EYE. Which is growing, at least as rapidly as the left one did. I compare the left eye pictures from May 5, 2006 to September, 2008 - just over two years, and the incredible growth and branching out - those awful tentacles - that occurred in it in such a short time. And I stew about what the progression of this melanosis in the other eye means - if it continues at the speed it seems to be demonstrating, I suppose the likelihood is more laser surgery on the other eye, at the least.

We will be continuing the every-six-months appointments, to monitor the left eye's situation, and to hopefully prevent the right eye from getting into the same shape because it was allowed to grow so much before the surgery was done. The plus of the situation is that we are now Dr. B.'s patient, which I am much happier about.

This is sickening.

Just came across an I Can Haz Cheezburger lolcat that has me really upset:



It says that it was submitted on September 27, 2008 - and I wonder if that poor cat is still alive. (Judging from the wasted appearance of his jaws, possibly not.) I looked all over the place for some indication of a way to contact the owner, but didn't find it. I did submit a complaint to the cheezburger website.

I can't believe that ANYONE would allow a cat's eye to be in this condition, much less that they'd submit it as a joke.

Merry Scruffymas!

Another Christmas with The Puffer - I do wish I knew how old he is. He showed up in Baden at Thanksgiving, 2003, so I know he's at least 5 years old. Dr. B thinks that he's about 8 - no more than 10; I don't know, maybe it's the arthritis or something, but he sure seems older than that to me....

Happy Holidays from the Fluffy One!!

Lookin' Good (the slideshow)

Lookin' Good!

(The slideshow above is of today's appointment. I can't figure out how to get it and the narrative together in the same post.)

Today was Scruffy's follow-up appointment with Dr. B. Three weeks after the laser surgery. He seems to be pretty much back to himself, although he's been off alone more than usual - for some reason, he's taken to huddling on the love seat downstairs, despite the cold.

So, Dr. B. was very happy with Scruffy's eye. There is a noticeable area - perhaps 1/4 of the size of the melanosis - of dark brown tissue at about 5:00 on his iris. This, the doctor felt, is most likely burned tissue left from the laser itself; he thinks that it may eventually be sloughed off. There is also - apparently invisible to the naked, non-professional eye - a small area of tan-ish tissue, which is the actual remains of the tumor, I believe he said. He was very happy with the "regression" of the melanosis, and said that it is somewhat likely/possible that it might regress even more over the next few weeks. It was a very good sign that the regression started during the procedure. He is convinced - though there's no way to prove it- that the growth was malignant, but doesn't feel that there is anything that needs to be done about it, unless the area would regrow rapidly or significantly; laser surgery could be done again, presumably. He felt that check-ups using xrays or MRI or whatever to search for more melanomas would be more risky to Puffer than helpful. A concern with iris melanosis is the possible development of glaucoma, and he again checked the pressure in Scruffy's eye(s) - 15 in the right eye, 16 in the left eye (where the melanosis was). Both are good numbers and indicative of no pressure problems. Dr. B did say that, had there been an indication of glaucoma at the previous appointment, he would not have done the surgery, but would have recommended enucleation. (And because of my awful experience with my beloved Black Kitty, I would have agreed, sadly - I would never want another cat to go through what Black did because I didn't understand the treatment options.) Dr. B. feels that Scruffy's procedure was very successful, and that the eye appears to be healing, although there is some inflammation still. "Mild uveitis"? (The directions they gave me only included medicating the eye for two weeks, and, instead of calling and asking if I should continue, I just quit using them. I feel really bad about that.) He has re-prescribed the flurbiprofen drops for 4 more weeks and as needed after that, and the atropine ointment every other day for 10 days. Contrary to their warnings, Scruffy had absolutely NO reaction to the atropine ointment, but he certainly hates the flurbiprofen. (Sounds like a cartoon name, doesn't it?) His pupil is a little distorted, which will probably not change, but isn't likely to cause him much trouble. And he is likely to be sensitive to light, which the atropine is supposed to help with - it will encourage the pupil to change sizes so that adhesions don't develop. He also said to watch for something like brown "glitter" floating around in the eye - it's a sign of something bad, but I don't remember what.

Other general information - the procedure took about 40 minutes. I thought that was a long time; the doctor thought it was pretty quick, considering how many times he had to apply the laser. (Five, I think he said.) And they did check his blood pressure during the surgery- 115, 90, and 80. Dr. B. said anything under 150 they regarded as being acceptable. They checked his glucose level, too, but I don't remember what it was - I think it's in the previous post, anyway. There was some discussion about the fact that he wasn't their most cooperative patient - I don't know what happened to my laid-back kitty who loved everybody and was so pleasant.

We slid him in and out of the carrier in his kitty pi - boy, that makes it so easy. He just sits in it while everybody does whatever to him. And then, after he slid back into the carrier, he hissed and spit three times at the technician standing beside the table. Just to let her know that her efforts were NOT appreciated, I guess.

I had taken my camera along because I wanted a picture of the doctor using this fascinating machine to look into Scruffy's eye. I hadn't said anything to Dr. B about taking a picture, because I was just going to take it without a flash, which wouldn't bother anyone. Only, the stupid camera - I pushed the button with the lightning bolt picture on it, which I believe is the Controller of the Flash, and when I took a picture - after they'd turned off the room lights so they could look at Scruffy's eyes - the stupid flash flashed. Dr. B and Scruffy and the two technicians all jumped. I felt so dumb. Haven't looked at the pictures yet - but I will put his picture here. I don't think I got a very good shot of the interesting eye machine, unfortunately, and it'll be quite a while, probably, before I take a picture of Scruffy's poor eye.

The next appointment, barring complications, is January 13 at 2:00. Now I won't have to worry about the appointment card falling off the fridge and disappearing forever.....