OMG - something positive!!

"Diagnosis:  Functional (flow) murmur:  We did not identify a hemodynamic source of Scruffy's heart murmur and this murmur is not associated with any structural defect.  Sometimes murmurs can be heard with other disease states or secondary to stress (fight or flight response.)  No therapy is indicated for this murmur.

Diet:  Please ensure that ScruffyPumpkinPattyPaws is eating and drinking.

Treatment:  No cardiac medications are indicated at this time.

Restrictions:  None."

Whoppee.  And I liked this doctor, too.  She was very accessible, and nice to Scruffy, and willing to take time to answer my questions.  (I was somewhat less fond of her when I paid the bill and it was $507.  That's over $1000 in two days.  If you could see me now, you'd know that I'm shaking my head in utter amazement.)

The ultrasound showed a totally normal heart.  The doctor said that sometimes as cats get older, the position of their hearts in their chests can change, which can cause slight murmurs.  His blood pressure was also normal - 140mmHg.  No restrictions on fluid administration, either, which is good news for the CRF.

She suggested that we return in 4-6 months for a recheck echocardiogram to monitor for any progressive changes as a result of his anemia.    We'll see.....

They brought Scruffy out in his carrier and put him in an exam room, and then came to get me from the waiting room.  They left me with him to wait for the cardiologist to come to talk to me.  I looked in the carrier, and Scruffy was sitting in his kitty pi with his back to me.  And nothing I could do or say would convince him to turn around.  He's quite the expressive little fellow, isn't he? He never turned around at all until we were in the car and on our way home.  :-)

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.

Bits of Scruffy to hold in my heart....

1) Yesterday, it was an amazing February day in Pittsburgh.  Although it was chilly, it was a beautiful day, and oh, the sunshine!  It just poured in the windows on the front of the house.  (Which would have been even more striking if I would ever get around to calling the window cleaner to come!)  There were a half dozen places on the cat trees where there was a huge droplet of sunshine, just begging for a cat to come and nap there.  The sky was the most brilliant blue...  All in all, it was stunning.

Around 3:00, I decided I had to drag myself out to get cat food and kitty litter.  But, when I sat down in my chair to put my shoes on, Scruffy came waddling over at his top speed, hopped up on the couch, walked across the end table, and plopped himself down on my leg.  And then he looked up at me like, "Well, put your hand over here so I can sleep!"    Which I did, because having him nap in my cupped hand is one of my favorite things in all the world.  And he immediately slipped off to sleep.  I was preparing to follow him - well, can't very well buy cat food and kitty litter if you can't get out of your chair, right? - and take just a TINY rest, when Milkshake must have noticed that there was napping going on.  He jumped up, too, and settled in between Scruffy's side and my right arm.  And then he put his tail, his head, and his left front paw around Scruffy - just encircled him with white furry body parts.  And the three of us slept until something woke me up two hours later.  We were still warm and snuggly and peaceful, and it made me so glad that I'd stayed home.

2)  For years, Scruffy has found it necessary to supervise my showering.  As soon as I turn the water on in the shower, there he is, sitting in the middle of the bathroom.  Except for the couple of months before he got cancer, when I was - and yes, I'm ashamed - so mad at him for peeing on the rugs repeatedly that I could hardly look  at him.  And he obviously got the message, because he pretty much avoided me.  This makes me so sad, but I guess there's nothing to do about it now....  He didn't come to sleep with his head in my hand any more, he  didn't show up when I got a shower, and I frequently had to hunt all over the place to find him to give him his pills.  When Claudia, the animal communicator said he offered to make a deal with me - if he could stop taking prozac, he'd stop peeing - I was dubious, but agreed.  And suddenly, we were back to normal.  No more hiding, no more avoiding me, and even, for a while, no more peeing on the carpet.  It lasted about four months, and then he started again.  I told him, as patiently as I could, that I couldn't live with that behavior.  But he didn't stop it, so last November or December, I started giving him the prozac again - half the previous dose, and I explained that it wasn't to punish him, I just needed him to stop.  (Yeah, I know, it sounds psycho, but....  you do what you need to do, I guess.) And it's been okay, oddly.  He never started hiding again, or avoiding me; he pretty much did stop peeing on the rug.

Anyway, so the other day, I was going to get a shower, and he didn't show up.  He was sleeping on the heated mat on the window ledge in the kitchen.  I went out and woke him up and said, "Hey, Puffy. Tubby Uppers?"  Yeah, baby talk, I know.  And he just sort of looked at me blankly, and then put his head back down.  So, I went back to the bathroom.  Got a really long shower - till all the hot water was used up! - dried my hair, got dressed, and when I opened the bathroom door, THERE, sitting in front of it, was my little Puffer.  He'd gotten himself up and dragged his poor sick little body all the way to the other end of the house so he could sit in the bathroom with me, and I'd closed the door so he couldn't get in.  I felt so bad.

3)Scruffy was the most laid back cat I've ever had.  Nothing bothered him.  The day I brought him home, back in 2003, he wandered all over the house, paying no attention to the three other strange cats - including Poor Psycho Picklefritz.  He poked around the basket the cat toys were in, he sniffed their food dishes, he stopped to look out the front windows.  And then,  suddenly, a half hour after he arrived, he started to shriek in pain.  I had NO idea what was wrong. Touching him was impossible - it was clearly agonizing.  My sister and I managed to get him into a carrier and into the car.  We drove to the closest vet that was open - where it turned out, he had a urinary tract blockage.  Apparently due to stress, oddly, for a cat who gave no appearance of being stressed.  This was the first of three blockages that had to be surgically undone.  Were they all because of stress?  Got me. He was still my calm cat that nothing bothered.  I had to poke him with the sweeper to get him to move out of the way.  He didn't mind the hair dryer, he loved when strangers showed up.... Just pretty much oblivious.  As long as no one touched his tail.

Three or four years ago, after a dental, he had a major personality change.  I don't know what could have happened to him - it was the same vet I'd been taking him to for years, and he'd had several other dentals.  No explanation, but all of a sudden, my laid-back kitty turned into a raving monster at the vet.  Hissing, spitting, howling, scratching, biting - I never would have believed it was the same Scruffy.  When he developed the melanosis/melanoma in his eye and we started having fairly frequent appointments with the ophthalmologist, I accidentally came up with a solution to what was becoming a real problem - I stuck a kitty pi in the carrier.  It was possible to just slide him in and out of the carrier, and as long as no one did anything to him that required taking him out of the pi - he was fine and dandy.  It worked at the regular vet, too.  He'd go back into the carrier and spit and carry on, but as long as he had his pi, he was good to go.

4)  Scruffy looooved riding in the car.  (This started before he got diabetes and I learned all the good stuff about feline safety and health from FDMB.)  He loved to sit on the lap of whoever wasn't driving and look out the window.  So, I hunted around and found a "Doggy Seat Belt", size small.  It was perfect for him.  Just a sort of harness, covered with fake lambs' wool.  You slipped it on the dog/cat, adjusted the straps, and hitched it to the car seat belt.  I was real proud of myself for coming up with such a perfect solution to how to take him in the car by myself.   Until......  I looked over, and realized that he had somehow figured out how to slither out of the Doggy Seat Belt, and he was standing on the seat, looking out the window.  Talk about panic - I pulled over so fast,  I hit the curb.  That was the last trip with the Doggy Seat Belt.  My other "good idea" for taking him in the car was to buy a baby sling sort-of-thing.  I thought I could just put it on, stick him in it, and he'd just sit there while I drove.  Another fantasy, unfortunately.  He didn't want any part of the "just sitting there." He lasted about five minutes, and then he wanted OUT.

Oddly, one last thing about the car - his glucose level would drop.  I mean, DROP.  The first time I noticed that he had a kind of wild-eyed look in his eye, we were on the way to the chiropractor in another county.  I pulled over and tested him - yes, I took his meter where he went - and he was at 27.  He'd spent years in the 300's and 400's, put him in the car, and he's 27.....  At one point, he was in really high numbers for a long time, and I actually stuck him in the car and drove around to see if it would help lower his bg.   It didn't.

5)  It's kind of funny to think about how cats never get to go outside.  Well, probably not funny to the cats, but.... I feel very strongly that I do not want cats that have access to the outside - although we've never ever had a problem with fleas on the ferals I've brought in, I know they're lurking out there!  Along with garter snakes, and cars going up and down the hill too fast.  All good reasons why my cats are indoor cats.  But, in a moment of lunacy, I thought that it would be wonderful if they all had little walking jackets - with matching leashes!, and we'd go for little walks in the yard.  I ordered these cute little nylon "jackets" - just a rectangle of brightly colored nylon with a Velcro buckle for adjusting the size.  I started with Milkshake, who of course had to do that silly "oh, my god, what did they put on my back, it weighs a ton, I can hardly walk, I'm smashed into the ground, how could anyone do such a thing to a sweet cat like me...."  You know the routine.  But, eventually, he caught on.  And he actually DID walk and sniff the grass, and I took a lovely picture of him standing on the sidewalk, surrounded by the last of the pretty purple rhodendron blossoms.

Encouraged by all that success, I thought Scruffy could be my next victim.  I got him all strapped in - and he didn't need to flop onto his side in terror or anything!  And we went outside.  Walked around the house, pretty successfully, but as we came around to the driveway side, he took off around the car.  And wedged himself on the far side of the front tire of my car.  I'm shrieking and clicking on his retractible color-coordinated leash, when all of a sudden, it flew back toward me, and there was no cat at the end of it.  NO CAT.  I was in a panic.  He'd been a stray, and had never really shown the least desire to go outside ever again.  And  I'd forced him to!  Dumb.  I went around and around the house, calling him frantically.  (And trying to avoid the snakes that I knew were just lying there in wait for me.)  No sign of him.  After fifteen minutes of frantic, exhausting searching, I thought, maybe if I go inside he'll come to the door. So, I did.  No Scruffy.  I went to every door, opened it, and called him.  No sign of him, but then, all of a sudden, I heard a cat howl.  I ran outside, and there he was - sitting at the end of the house, yelling at the top of his lungs, and waiting for me to come and get him.  Which I did.  And then, I put away all the little walking jackets and the matching leashes, and no one here EVER goes outside, except to go to the vet.

6)  The day, the second week in January, 2012, when I took Scruffy to the vet for bloodwork so he could have a dental, I was totally unconcerned about the results.  Except for the occasional higher than usual cholesterol result, which was probably related to the diabetes, he'd never had anything in his bloodwork to worry about. We joked about how Scruffy "never not eats."  And then oddly, the next morning, he didn't want to eat.  No nuzzling all the other dishes, no gulping down his own.  Very peculiar.  And then the vet called with the results, and that very first high calcium level.  And ALT and AST were a smidge higher than normal.  The beginning of the end.  With no warning, no sign that inside him things were going horribly wrong.

Back to the prozac, and eating.  Prior to our "bargain", I was giving him his prozac every morning, in a pill pocket.  He's very hard to pill - it's like there's not enough space in the back of his throat or something.  When Milkshake opens his mouth for pills, there's all kinds of room back there, but Scruffy..... not so much.    So, every morning we had this big ordeal with the pilling.  It would take multiple attempts usually.  He could spit a pill out and it would land three feet away.  Or twine its sticky gooey self into his long, scraggly fur.......  So, anyway, eventually, I'd manage to cram the little pill ball into him, and he'd jump down to eat.  And he would sit and eat and eat and eat - I have never seen a cat eat the way he would.  Totally focused on how much he could get into his stomach.  And then, he'd throw up all the extra food - and the PILL - in a disgusting mess on the floor.  And in ten minutes, he'd be back in the kitchen, chomping away at the food that was left, while I  forlornly poked through the pile of barf to see if the pill was really in there or not.  And whether you believe it or not, it was INTENTIONAL.  He knew exactly what he was doing, and he did it every morning!

Oh, there's so much more.  Eight plus years, with this dear cat with the enormous personality.  Not nearly long enough. He's still sitting at the top of the steps waiting for me when I come home.  He wakes me up 12 times a night now, headbutting me so I'll scratch his ears.  I've been exhausted ever since he came home from the hospital.  He has been totally fixated on me, and on food, since he got here all those years ago.  He doesn't bother any of the other cats.  He has spent 8 years trailing around behind me, waiting for me to sit down so he can climb up onto my lap.  He has always been a barfer - ate and ate and ate till he threw up, and now, on chemo, he hasn't thrown up once.  That ragged fur that somehow always looked so smooth in pictures.  The giant fluffy tail that no one is allowed to touch, and the teeny-weeny, two-inch-high legs.  I always thought that his stomach was dragging on the ground until the first time I shaved him for the summer; he had a regular cute little cat body under all that fur!  The awful, horrible thing that was growing in his eye, and that could have shortened his life three years ago;  I guess that was lucky, wasn't it?   I talk to him 20 hours a day, because  he's always right there behind me.

How am I gonna get used to his not being here?

Quality of Life

I seem to be drifting, or maybe rolling along kicking and screaming, I don't know - toward trying to find acceptance of the potential loss of Scruffy.  It's clearly inevitable - despite the apparent remission and disappearance of the lymphoma tumors, his kidneys are overtly on borrowed time.  Special food, fluids,  phosphorus binder, (and a new addition, a probiotic intended specifically for CRF cats given to me by Choy-Foong) - and yet, the kidney bloodwork just gets worse and worse and worse.  I don't want him to suffer; I don't want to keep him alive just because I  need to have him here. And yet, despite the hopelessness of the situation, and the stress of trying to maintain him as best I can, I am convinced that he's not ready to leave yet.

This is the Quality of Life Scale, developed by a vet named Alicia Villalobos:

Quality of Life Scale1         The HHHHHMM Scale
Pet caregivers can use this Quality of Life Scale to determine the success of pawspice care. Score patients using a scale of 1 to 10.
Score	Criterion
H: 0 - 10	HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary?
H: 0 - 10	HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
H: 0 - 10	HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
H: 0 - 10	HYGIENE - The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.
H: 0 - 10	HAPPINESS - Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?
M: 0 - 10	MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk?  Is the pet having seizures or stumbling?  (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
M: 0 - 10	MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
*TOTAL=	*A total >35 points is acceptable for a good pawspice

                                                        
1.Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 
09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal 
Bond, by Blackwell Publishing, Table 10.1, released 2006.

I can't bring myself to sit down and do this, to assign points to Scruffy's life,  right now.  Just looking over the categories, I think strongly that I'm right, he's not in the lower ranges at this precise moment in time. There is, I have to admit, some comfort in thinking that somewhere along the way, this chart could be helpful in pushing me to make a reasoned determination that we can't go on.  But not now.  For now, we'll keep doing what we can do.  I am seriously considering giving up the chemotherapy.  It's incredibly expensive, it's starting to seem to have side effects that are unpleasant for Scruffy, it may be contributing to the kidney failure (although the oncologist has said that the drugs they're using are not kidney-toxic...), and I have to keep reminding myself why I am putting him through this.  Which is a good question, of course.  Why?  Not just "because I can."  Sincerely, I want to allow Scruffy to be here as long as he wants to, and as long as it's possible for him to be comfortable.

When this whole nightmare began - can it be only a few weeks ago? - and The Puffer ended up in the hospital, I was desperate to find an animal communicator to talk to him - to tell him that I would come and get him, because I didn't even get to say good-bye to him - and to find out if he thought he wanted to go on.  Two communicators talked with him.  He was saying then that he was just tired, "drained".  While he was still in the hospital, he seemed to be more hopeless, more ready to give up.  Once he came home, and he resumed what was pretty much his old life, with the addition of a whole bunch of medication and vet appointments and the occasional insulin shot again, he just was himself.  Wandering around with that ploofy, untouchable tail in the air, sleeping in my hand, eating enthusiastically.  I keep saying,  "If you didn't know he was dying, you'd never know he was dying."   And that's still true, although his appearance is getting pretty sad, with all the shaving and the weight loss, particularly in his little face.  He doesn't jump as well, but then, he's old, and he's got horrible diseases - what do I expect??  The essence of my ScruffyPumpkinPattyPaws is still there, still as oblivious to pretty much everything but me and food.  So, I feel like, as long as there isn't pain involved, as long as he can still enjoy his food, and the contact and affection I can offer him in huge quantities, we're still in the game. I don't know for how long, and I wish I could arrange the end to be the way I want it to be, without the vet and his cold stainless steel table, but.....  What's the Alcoholics Anonymous motto?  About changing what can be changed and accepting what cannot?  I guess that's where we are. Reaching somewhat desperately for acceptance of something that should never have even happened.  It stinks.  (Obviously, I have a ways to go to find that stupid acceptance....)

My sweet boy, on the day that we learned that the tumors were gone.  Very short-lived euphoria......

The Ups and Downs of Having a Cat with Cancer......

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!)

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.

Chemotherapy

Scruffy is getting the Madison-Wisconsin Protocol (25 weeks total)

Week 1:  CBC, Vincristine IV, Asparaginase (Elspar) SQ, Prednisone PO

Week 2:  CBC, Cyclophosphamide (Cytoxan IV, Furosemide (Lasix) IV, Prednisone PO

Week 3:  CBC, Vincristine IV, Prednisone PO

Comes Week 4, at which point there's a problem to be solved:  Scruffy's kidneys are not doing well.  The Week 4 drug - Doxorubicin (Adria) IV, Diphenhydramine IM, and Prednisone PO is very hard on kidneys.  I didn't retain all of the discussion with the oncologist, but it appears that, if we don't use the Doxorubicin, then we're no longer doing the Madison-Wisconsin Protocol.  And he named another Protocol - I want to say "CHOP", although I'm not sure that's right.

Week 4 also includes "CBC, ECG, *ECHO" as well.  Dr. E said that he thought it might be a good choice to do another ultrasound next week, to see if there has been any change in the tumors that would indicate that the treatment is having a positive effect.  I don't know what *ECHO is.  I have another paper they gave me that is a description of a variety of chemotherapy options; maybe it's listed in there.

Week 5:  CBC - blood work only.

Week 6:  CBC, Vincristine IV

and so on, alternating the 3 drugs.  Six months of treatment, when the life expectancy they gave us for "successful treatment" was four to twelve months........

The only good thing about all this so far is that there appear to have been NO side effects or reactions to the chemo at all.  Scruffy was in the hospital for the first dose of vincristine, but I did see him the next day, and aside from the trauma of hospitalization and catheterization and chemo and not eating.......  Well, he didn't look good, but he was responsive, and he actually ate a little bit for the first time in more than two days.  The second treatment, also no side effects.  I do think that he's mildly nauseated generally, and have been giving him Zofran (ondansetron) every 12 hours since he came home on Jan. 23.  He's eating fairly enthusiastically - I have only given him cyproheptadine twice in the last week and a half; it seems to make him hyper, and he was eating adequately without it.  Peeing and pooping appear to be normal, also.

Sadly, the steroids (dexamethasone IV, then prednisone pills)  immediately raised his glucose level.  When he came home, I got ketodiastix and started checking his urine.  (He's not nearly as regular as he was in the old days!)  Always above the renal threshold, which for him seemed to be around 180.  So, on Monday, Jan. 30, I started him on Levemir again.  (Day 1392 of his being OTJ, which breaks my heart.  Everything breaks my heart these days....)  Tiniest little dose - under the zero line - seems to have a significant effect.  And whatever I remember from four years ago - which isn't much, apparently - I don't know that it will apply now.  Because now, in addition to the cancer, he's got daily fluids added to the mix.  Today, for example,  (recorded in his spreadsheet, linked on the righthand column) he started out at 258.  I'm pretty sure there was virtually no insulin in the shot I gave him the night before, hence 258.  I gave him another "under the zero line" shot this morning, and he apparently dropped most of the day - he didn't appear to have started back up until +12, and was only at 119.  I don't think I can risk shooting that low without any idea how he's going to do.  Maybe this method won't work so well with Lev, which needs patient, stable dosing, but given the other circumstances we have to deal with, I don't see that it can be helped.  Every hour that he spends under 180 is a plus for his kidneys.

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....