Friday, February 24, 2012

Tiptoeing Through The Trauma (and other detritis)

Today is exactly one month since Scruffy's cancer was diagnosed, and he was in the hospital.  And since the oncologist told us, without treatment, his life expectancy was around four weeks....  But, here we are!

Scruffy's once luxurious  whiskers are now brittle and wispy.  Some of them have already fallen out, apparently.  Side effect of chemo....
Pre-chemo whiskers, white and soft and numerous....

We had what was most likely our last visit with Dr. B, the ophthalmologist, today.  He gave me a big hug as we were leaving.  Nobody said, "Scruffy probably won't be here for the next visit in four months",  but it was in the air.  He'd been called in to look at the ulcer in Scruffy's eye while he was hospitalized, so he knew what was going on medically.  I cried.  As usual.  He's a very nice man; he took care of Black Kitty, too,  almost 15 years ago when he got glaucoma.  It's nice to know one good vet specialist, in case someone else, God forbid, gets some horrible eye disease.  Today's visit showed that, while the corneal ulcer from a couple weeks ago has healed, there is still some scar tissue and inflammation - which requires four days of the ointment we had back when Dr. B saw Puffer in the end of January.  And, his eyes were severely dry - because of dehydration?  I don't know - and now we've got something called Genteal Gel Severe (well, actually, I bought the Genteal Gel Drops Moderate/Severe, because, although they were both $10, I just thought that, given all the stuff I have to do to him nowadays, another drop would be easier for both of us.  I guess we won't know if it's working or not, come to think of it, since we probably won't be back. ) Ocular pressure in both eyes was 11, which is excellent.  And that little stripe that has turned up at the bottom of his right eye, beside the second melanosis, is indeed another melanosis, but it's not raised and not a matter for concern, even if we weren't in the clutches of the other diseases.

The little line in his right eye is a new melanosis.  The blur beside it is an older one that has changed very little in almost a year.
My little cat, who never meowed once in the almost 9 years I've had him, has taken to making this awful, croaking meow at the oddest moments.  It's a little unnerving.  I don't know how to interpret it - is he having discomfort?  Is there something wrong that I could fix if I could figure out what it was?  It seems strange that all of a sudden there are all these noises coming out of his little mouth.

The return of diabetes has turned out to be pretty much of a non-starter.  He hasn't had a shot since last week, and to be honest - and I can't believe this is even true - I keep forgetting to test him.  As long as he's under the renal threshold, and since the urine test strips aren't registering anything, including glucose, there are way too many other things to worry about.  At this stage, I'd be more concerned that he'd end up hypo than anything else.  His bg today at the hospital was 153, which isn't horrible, or shootable.....  And he even gained an ounce and a half since last week.  Pretty good for a cancer kitty, huh?

Good news today - his phosphorus level was down from 10.1 last week to 7, and the iCA was 1.27, down from 1.60.  Major improvement, although it has required enormous, mind-boggling  effort from me - feeding has become a big, drawn-out ordeal twice a day.  (The in-between feedings, just for Scruffy - are okay; nobody else has food that he thinks he has to eat instead of his own.)  It is somewhat rewarding to know that the phosphorus binder and the lower phosphorus food seems to be working.  Bad news was - and it's really pretty bad - creatinine was 6.2, up from 6.0 last week, and BUN was >140, which is as high as they are able to measure, I guess.  Last week, it had been 138.  I don't have a good picture of what exactly, if any, the relationship is between phosphorus/calcium  and BUN/Creatinine.

I talked to the oncologist today about stopping the chemo.  It's pretty obvious we're in a race here to see if the kidney failure gets him first, or if the cancer comes back and does him in.  Either way, the doctor seems to think that if we're lucky and things go well, we might have a year, and that, in his opinion, the kidneys are going to be the winner of the race.  I didn't really understand why, if the tumors were gone, we needed to even be talking about a two year period of chemotherapy, but apparently, remission of the tumors doesn't mean that there aren't still a bazillion lymphoma cells floating around inside him, just waiting for someplace to land and launch new tumors.  And while the expense has quickly reached the overwhelming stage, just reducing the weekly quantity of blood tests would significantly reduce the cost.  Today's appointment was $300, but $200 of it was bloodwork......  Trouble is, I have such a need to know if it's working.  You know, like I have to try twice as hard if it's not, so I NEED to know every week what's doing inside him.  Well, maybe not.  I don't know.  I have to think about it, I guess.

When he came home from the hospital, I made a chart of medications, etc. that he needs every day.  Because, given the vagaries of my memory these days, there was otherwise no way he was gonna get anything that was right.  And now there's all this new stuff to remember.

 I made a new one tonight, that will hopefully keep things straight.  One of the new additions is Cytoxan, a chemo drug that I had to order from someplace in Arizona.  It's apparently a capsule, and is to be given to him every other day for a month. I have to wear latex gloves in order to handle it.  Geez.  I don't want to even think about giving it to him.  He's very hard to pill, to begin with, and he's already got a whole mess of other pills to swallow that AREN'T poisonous.   I haven't been able to bring myself to open the box, although it arrived yesterday in the mail.

Tomorrow, we have an appointment with a cardiologist, to see what the deal is with the heart murmur, and to check his blood pressure and to find out what amount of fluids is safe to give him on a daily basis.  And after we come home, I'm not taking him ANYWHERE until his next chemo appointment, a week from now.

Sometimes I get so mad at myself for feeling so whiny and overwhelmed.  Poor Scruffy is the one who's doing all the suffering and dying........

One last picture, thinking about his Quality of Life:

This is blurry because he's actually IN MOTION - jumping down from the third level of the cat tree, where he had gone to see if he could eat whatever someone else had left (that didn't have phosphorus binders in it!).  Now, true, he doesn't look too hot, and he has that unpleasant urine-y odor to his skin/fur, and he's lost some weight - but LOOK AT HIM!  So determined to eat that he's hopping around four feet off the ground!  This is what I can't seem to explain to some of my family members, who think that I'm keeping him alive out of some selfish need of my own, or that he's such a huge burden.  Neither is true, at least not right now, I don't think.  And I am taking such pleasure in sharing this time with him, however long it lasts.  He's such a responsive little guy, and so focused in getting whatever he wants, it makes me laugh.

So, I guess we'll keep muddling along for as long as we're allowed to have that privilege.

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