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.
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
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