and kidney failure and a heart murmur..... At this point, it appears that it's mostly the downs. Maybe it was because all this happened so quickly and so unexpectedly - the first week of January, when I took Scruffy for bloodwork so he could have a dental and his calcium level was elevated, cancer and kidney failure were certainly not anything that I would have ever expected to be dealing with just two weeks later.
Last week, (Feb. 9) I left Scruffy at the Hospital for his ultrasound and bloodwork. Although the schedule included another chemotherapy treatment, I had pretty much decided that - unless there was shockingly good news from the ultrasound , indicating that the chemo was working - I was going to tell the doctor that we had had enough, and would just allow Scruffy to live out his life. Since the ultrasound scheduling is uncertain because they only have one machine and emergencies have priority, I had to drop him off at 8:30 AM. When, by 2PM, I hadn't heard anything, I called and asked if anyone had seen my Scruffy. The oncologist got on the phone and told me that the ultrasound had found that the tumors in his liver and spleen were gone. "No evidence." I was so shocked and surprised that I had to ask him to hold on a minute while I cried. Nothing in Scruffy's appearance or behavior would have led me to believe that he was suddenly tumor-free. In fact, I had cancelled an appointment with his ophthalmologist on Monday because he was so lethargic and miserable. Additionally, the bloodwork showed that the ionized calcium level was back in the normal range - 1.31! Hematocrit and hemoglobin were both low, but the oncologist felt that it would be safe to give another treatment. I agreed, although I didn't understand at that time why it would be necessary if the tumors were gone. Obviously, my knowledge of lymphoma is minimal. As we were ready to leave the hospital, I asked if they had done a phosphorus blood test. Choy-Foong had sent me Meowzi's can of aluminum hydroxide, and I wanted to know what his most current phosphorus level was. To compare the huge improvement I foolishly expected to see, as it turned out. The level was 10.1. Horrifying. (Normal is 2.6 to 6.0.) His other kidney values were not good, either. BUN was 114 (norms - 15-34), and creatinine was 4.6 (normal - 1-2.2) The assumption was, with low protein/low phosphorus food, and the addition of the aluminum hydroxide, those values would improve significantly.
Anyway, I brought him home after the treatment. This time, like two of the previous three chemotherapy treatments, he didn't seem to have any particular reaction. He wasn't lethargic, he ate voraciously (on his own - I have given him very little cyproheptadine (appetite stimulant) since he started treatment, maybe five or six 1/4 pills.) His fur was less spiky. He was up wandering around more. He was just himself. He still smelled unpleasantly like urine- my theory is that, since he has such long fur, when they shaved his stomach for the first ultrasound, he could no longer gauge exactly where he was on the kitty litter when he peed - every time he hopped out of the box, he was soaked from his neck to his tail. It has been very cold, inside the house and out, and I really was hesitant to give him a bath, but the odor was becoming hard to tolerate, and it seemed like we could use a sort of "celebration." I have some wonderful vet shampoo that smells like coconut, and without a whole lot of commotion or carrying on - although with a lot of growling! - I scrubbed up my little Scruffy, from his shoulders down to the untouchable tail. He even let me dry him with the hair dryer - noises like the hair dryer and the sweeper have never bothered him. Except for his tail, which was unfortunately still wet and tangled four or five hours later.... Anyway, he looked wonderful. And he doesn't hold a grudge. (See how much softer and less spiky his fur looks!)
This week, since the "no tumor" news, has been a stress-filled blur, pretty much. I had already made a list of low phosphorus canned cat foods that he might eat, and had bought three or four different kinds of "kidney diet" vet foods. Armed with these foods, and the aluminum hydroxide, I started what I hoped would be a dietary routine that we could maintain and that would keep the kidney failure at bay. Not so much..... The first problem that came up was the fact that - despite how pleased I was that Scruffy's appetite was so healthy - his pattern has always been to eat his own food, and then to cruise all the other cats' dishes and polish off whatever he finds there, too. With the aluminum hydroxide, my plan was to add a measured amount - based on his weight and the dosage on the can - to his food. It's supposedly tasteless and odorless. And after the first couple tries, Scruffy didn't appear to care that it had been added. (Unlike the Miralax, which he needs because he had been constipated a week before and I don't ever want him to have to go through that again, and aluminum hydroxide is likely to be constipating.) The goal is to make sure that no food is ever permitted to be in his stomach without an accompanying dose of aluminum hydroxide to bind to the phosphorus and carry it out of his body, instead of allowing it to get to his kidneys. Hence, a "phosphorus binder." So, I had to find someplace to put the dishes for the other cats where they could eat, but Scruffy couldn't get to their food. And, conversely, to prevent the other cats (especially Milkshake, who had had low phosphorus on his last bloodwork!) from eating Scruffy's stuff. Everyone else appeared to be convinced that Scruffy's food - special diet and additions aside - was WONDERFUL and TASTY and WELL WORTH GETTING YELLED AT. Scruffy has not been jumping very well since beginning chemotherapy, so I thought that maybe if I put the other dishes on the cat tree, he wouldn't be able to get to them. Which worked exactly one day. The second morning, I carried all the dishes to the living room, which required half a dozen trips - and before I finished delivering all of them, Scruffy was up on the second level, chowing down on Fancy Feast..... Feeding is now still a work in progress - the best success so far involves feeding Scruffy up on the counter after he gets his pills while everyone else waits. If he fills himself up first, he's less intent on eating from the other dishes. Less intent, however, not "disinterested." :-(
The second problem is that Scruffy's a nibbler. He eats for a couple minutes, then wanders away and comes back in an hour and nibbles again. Since he has been off insulin - 2008 - I've always free fed. They can eat whatever they want, whenever they want. Which does NOT work now that Scruffy can't eat anything that doesn't have the phosphorus binder in it. I don't think I can solve this one. I can't make him eat when he's not interested. Well, yeah, I could force feed him, I guess, but when he's eating well on his own - just not conveniently for me - I think it's a quality of life issue that I don't have the right to interfere with. The best I can do appears to be to stay with him while he's eating, chasing away anyone who wants to share his food, and to pick it up and put it away somewhere when he's done. And then, to watch and see when he strolls back out to the kitchen (or climbs the cat trees!) and get out his previous dish again and see if he'll eat from it. It's taking quite a chunk out of my day.
Third problem: I have to write to someone on the Feline Phosphorus Management Yahoo Board and find out about this aluminum hydroxide management stuff. I can't get in my head why dosing for it should be based on the cat's weight. The formula is supposed to be to give a specific amount mixed in with food - 100mg x the weight - 10 pounds, for Scruffy, divided into two. Well, if he only ate twice a day, maybe that would work. But it seems to me - and I'm sure wiser, more experienced people developed the formula and there are dozens of reason why I'm wrong, believe me - that it should be based on the amount of FOOD instead. If he's eating six times a day, then there are presumably four times when he doesn't have any concurrent aluminum hydroxide in his stomach when the food's there, right? I don't know. I do know, I'm making myself crazy trying to get all this stuff right.
Last night, I took Scruffy to our regular vet, to make sure he wasn't constipated, and to see if he thought that B-12 should be added because of the newly developed anemia. (I'm sort of floundering around here - there are all these medical problems, but the oncologist isn't supposed to be handling all the specialty needs, I guess, like cardiology and internal medicine. The diabetes, I can handle. Everything else, not so much.) To my surprise, he didn't think it was particularly necessary, or that there was any reason to add B-12 for anemia at all - I don't know enough to know if that's true or usual, just that many of the people on the Yahoo CRD board seem to be giving B-12, and I thought, since it's water-soluble, that it would be safe and useful. He was willing to order some injectible B-12 for me. Since we were there, I asked for bloodwork to be done to check what I just assumed would be the "improvement" in his phosphorus levels, and the hematocrit level. To my distress, there was NO improvement. None. His phosphorus level, after all this fiddling around with special foods and phosphorus binder and whatever - was still 10.1, and even worse, the total calcium was 14.6, which is an indicator that the Ionized Calcium is no longer in the safe normal range. BUN was 100 - slightly better, but not good - and creatinine was even worse - 5.0. Hematocrit was 19, had been 20. I'm so depressed.
I also asked for a referral to a cardiologist for evaluation of the new heart murmur - referred to as a "II-III/VI" murmur. I want to be sure that giving fluids is safe for him, and to have an amount that's correct. Also to know about his blood pressure - many of these CRD/F cats seem to be on blood pressure medication to benefit their kidneys. We just were given an appointment for Feb. 24 at 1:00. We have TWO appointments for Feb. 23 at the same place, one for the ophthalmologist, and one for another chemotherapy treatment.
Are we approaching the point of "diminishing returns"? When exactly is enough enough? Can I justify the stress and distress for both Scruffy and me, as well as the incredible expense, when it is starting to look horrifying apparent that there isn't going to be a good outcome for my sweet boy? I felt justified in not having "put him to sleep" - how I hate that phrase, they're not sleeping, they're DEAD - a couple weeks ago as a variety of people seemed to feel I should have done. But where is the cut-off point? When is it hopeless? I'm not ever going to be "ready" to be without him. But I don't want to keep him alive if he's in pain or if he's clearly ready to go. At this point, he's exactly who he has always been. A little scragglier, a little wobblier, but not near the time when some horrible decision has to be made. He's not. He's really not.
Last week, (Feb. 9) I left Scruffy at the Hospital for his ultrasound and bloodwork. Although the schedule included another chemotherapy treatment, I had pretty much decided that - unless there was shockingly good news from the ultrasound , indicating that the chemo was working - I was going to tell the doctor that we had had enough, and would just allow Scruffy to live out his life. Since the ultrasound scheduling is uncertain because they only have one machine and emergencies have priority, I had to drop him off at 8:30 AM. When, by 2PM, I hadn't heard anything, I called and asked if anyone had seen my Scruffy. The oncologist got on the phone and told me that the ultrasound had found that the tumors in his liver and spleen were gone. "No evidence." I was so shocked and surprised that I had to ask him to hold on a minute while I cried. Nothing in Scruffy's appearance or behavior would have led me to believe that he was suddenly tumor-free. In fact, I had cancelled an appointment with his ophthalmologist on Monday because he was so lethargic and miserable. Additionally, the bloodwork showed that the ionized calcium level was back in the normal range - 1.31! Hematocrit and hemoglobin were both low, but the oncologist felt that it would be safe to give another treatment. I agreed, although I didn't understand at that time why it would be necessary if the tumors were gone. Obviously, my knowledge of lymphoma is minimal. As we were ready to leave the hospital, I asked if they had done a phosphorus blood test. Choy-Foong had sent me Meowzi's can of aluminum hydroxide, and I wanted to know what his most current phosphorus level was. To compare the huge improvement I foolishly expected to see, as it turned out. The level was 10.1. Horrifying. (Normal is 2.6 to 6.0.) His other kidney values were not good, either. BUN was 114 (norms - 15-34), and creatinine was 4.6 (normal - 1-2.2) The assumption was, with low protein/low phosphorus food, and the addition of the aluminum hydroxide, those values would improve significantly.
Anyway, I brought him home after the treatment. This time, like two of the previous three chemotherapy treatments, he didn't seem to have any particular reaction. He wasn't lethargic, he ate voraciously (on his own - I have given him very little cyproheptadine (appetite stimulant) since he started treatment, maybe five or six 1/4 pills.) His fur was less spiky. He was up wandering around more. He was just himself. He still smelled unpleasantly like urine- my theory is that, since he has such long fur, when they shaved his stomach for the first ultrasound, he could no longer gauge exactly where he was on the kitty litter when he peed - every time he hopped out of the box, he was soaked from his neck to his tail. It has been very cold, inside the house and out, and I really was hesitant to give him a bath, but the odor was becoming hard to tolerate, and it seemed like we could use a sort of "celebration." I have some wonderful vet shampoo that smells like coconut, and without a whole lot of commotion or carrying on - although with a lot of growling! - I scrubbed up my little Scruffy, from his shoulders down to the untouchable tail. He even let me dry him with the hair dryer - noises like the hair dryer and the sweeper have never bothered him. Except for his tail, which was unfortunately still wet and tangled four or five hours later.... Anyway, he looked wonderful. And he doesn't hold a grudge. (See how much softer and less spiky his fur looks!)
 |
| Scruffy thinks that I can't get a shower without his supervision - he's sitting here waiting for me to show up... |
This week, since the "no tumor" news, has been a stress-filled blur, pretty much. I had already made a list of low phosphorus canned cat foods that he might eat, and had bought three or four different kinds of "kidney diet" vet foods. Armed with these foods, and the aluminum hydroxide, I started what I hoped would be a dietary routine that we could maintain and that would keep the kidney failure at bay. Not so much..... The first problem that came up was the fact that - despite how pleased I was that Scruffy's appetite was so healthy - his pattern has always been to eat his own food, and then to cruise all the other cats' dishes and polish off whatever he finds there, too. With the aluminum hydroxide, my plan was to add a measured amount - based on his weight and the dosage on the can - to his food. It's supposedly tasteless and odorless. And after the first couple tries, Scruffy didn't appear to care that it had been added. (Unlike the Miralax, which he needs because he had been constipated a week before and I don't ever want him to have to go through that again, and aluminum hydroxide is likely to be constipating.) The goal is to make sure that no food is ever permitted to be in his stomach without an accompanying dose of aluminum hydroxide to bind to the phosphorus and carry it out of his body, instead of allowing it to get to his kidneys. Hence, a "phosphorus binder." So, I had to find someplace to put the dishes for the other cats where they could eat, but Scruffy couldn't get to their food. And, conversely, to prevent the other cats (especially Milkshake, who had had low phosphorus on his last bloodwork!) from eating Scruffy's stuff. Everyone else appeared to be convinced that Scruffy's food - special diet and additions aside - was WONDERFUL and TASTY and WELL WORTH GETTING YELLED AT. Scruffy has not been jumping very well since beginning chemotherapy, so I thought that maybe if I put the other dishes on the cat tree, he wouldn't be able to get to them. Which worked exactly one day. The second morning, I carried all the dishes to the living room, which required half a dozen trips - and before I finished delivering all of them, Scruffy was up on the second level, chowing down on Fancy Feast..... Feeding is now still a work in progress - the best success so far involves feeding Scruffy up on the counter after he gets his pills while everyone else waits. If he fills himself up first, he's less intent on eating from the other dishes. Less intent, however, not "disinterested." :-(
The second problem is that Scruffy's a nibbler. He eats for a couple minutes, then wanders away and comes back in an hour and nibbles again. Since he has been off insulin - 2008 - I've always free fed. They can eat whatever they want, whenever they want. Which does NOT work now that Scruffy can't eat anything that doesn't have the phosphorus binder in it. I don't think I can solve this one. I can't make him eat when he's not interested. Well, yeah, I could force feed him, I guess, but when he's eating well on his own - just not conveniently for me - I think it's a quality of life issue that I don't have the right to interfere with. The best I can do appears to be to stay with him while he's eating, chasing away anyone who wants to share his food, and to pick it up and put it away somewhere when he's done. And then, to watch and see when he strolls back out to the kitchen (or climbs the cat trees!) and get out his previous dish again and see if he'll eat from it. It's taking quite a chunk out of my day.
Third problem: I have to write to someone on the Feline Phosphorus Management Yahoo Board and find out about this aluminum hydroxide management stuff. I can't get in my head why dosing for it should be based on the cat's weight. The formula is supposed to be to give a specific amount mixed in with food - 100mg x the weight - 10 pounds, for Scruffy, divided into two. Well, if he only ate twice a day, maybe that would work. But it seems to me - and I'm sure wiser, more experienced people developed the formula and there are dozens of reason why I'm wrong, believe me - that it should be based on the amount of FOOD instead. If he's eating six times a day, then there are presumably four times when he doesn't have any concurrent aluminum hydroxide in his stomach when the food's there, right? I don't know. I do know, I'm making myself crazy trying to get all this stuff right.
Last night, I took Scruffy to our regular vet, to make sure he wasn't constipated, and to see if he thought that B-12 should be added because of the newly developed anemia. (I'm sort of floundering around here - there are all these medical problems, but the oncologist isn't supposed to be handling all the specialty needs, I guess, like cardiology and internal medicine. The diabetes, I can handle. Everything else, not so much.) To my surprise, he didn't think it was particularly necessary, or that there was any reason to add B-12 for anemia at all - I don't know enough to know if that's true or usual, just that many of the people on the Yahoo CRD board seem to be giving B-12, and I thought, since it's water-soluble, that it would be safe and useful. He was willing to order some injectible B-12 for me. Since we were there, I asked for bloodwork to be done to check what I just assumed would be the "improvement" in his phosphorus levels, and the hematocrit level. To my distress, there was NO improvement. None. His phosphorus level, after all this fiddling around with special foods and phosphorus binder and whatever - was still 10.1, and even worse, the total calcium was 14.6, which is an indicator that the Ionized Calcium is no longer in the safe normal range. BUN was 100 - slightly better, but not good - and creatinine was even worse - 5.0. Hematocrit was 19, had been 20. I'm so depressed.
I also asked for a referral to a cardiologist for evaluation of the new heart murmur - referred to as a "II-III/VI" murmur. I want to be sure that giving fluids is safe for him, and to have an amount that's correct. Also to know about his blood pressure - many of these CRD/F cats seem to be on blood pressure medication to benefit their kidneys. We just were given an appointment for Feb. 24 at 1:00. We have TWO appointments for Feb. 23 at the same place, one for the ophthalmologist, and one for another chemotherapy treatment.
Are we approaching the point of "diminishing returns"? When exactly is enough enough? Can I justify the stress and distress for both Scruffy and me, as well as the incredible expense, when it is starting to look horrifying apparent that there isn't going to be a good outcome for my sweet boy? I felt justified in not having "put him to sleep" - how I hate that phrase, they're not sleeping, they're DEAD - a couple weeks ago as a variety of people seemed to feel I should have done. But where is the cut-off point? When is it hopeless? I'm not ever going to be "ready" to be without him. But I don't want to keep him alive if he's in pain or if he's clearly ready to go. At this point, he's exactly who he has always been. A little scragglier, a little wobblier, but not near the time when some horrible decision has to be made. He's not. He's really not.
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