Cali has cancer :(

I started a thread the other day asking for advice on my 10 year old DSH who had decreased appetite and increased weight loss:  http://www.thecatsite.com/t/253560/...haking-head-possible-lymphoma-any-experiences

We took her to a specialist today and before they even did an ultrasound, they were able to feel a mass in her abdomen.  Not sure how our vet missed it, but it is what it is.  They continued on with an ultrasound and found a very large mass in her stomach.  Apparently her stomach lining is severely inflamed (wall is an inch across?) and there is hardly any empty room.  They also mentioned that that surrounding lymph nodes were enlarged and affected.  

They gave us a couple of options but they all really sucked.  We could biopsy, determine the type of cancer, and if possible treat with chemo giving Cali 4-8 months (if it even turns out to be treatable).  Or we could wait and see if the steroids she got yesterday bring the stomach inflammation down enough to allow her to eat a bit.  If the steroids help, we could continue a less potent version every week giving her a few weeks to possibly a couple of months.  

She was very cuddly when we got home but then she got up and hid under the bed which is not like her (and not a good sign I know).  She hasn't eaten anything today nor had much to drink (but she got pumped with IV fluids yesterday so she should still be hydrated).  We got her out from under the bed and thought we would give her some pain meds.  After the meds I opened a can of food and when she smelled it, it was obvious that she got nauseous and began throwing up.  What came out of her was very dark and almost looked like old blood.  We tried getting a hold of our vet to determine if it was "time" or if there was more we could do etc. but we haven't heard back.

At this point we're really not sure if we should ask for anti nausea meds or something and wait a couple of days to see if the steroids help, or if we should just let her go know before she suffers any more.

~H

Oh l'm so very, very sorry  

Hugs and vibes for Cali 

Our Lazlo was diagnosed with a "massive mass" in his stomach. Like your Cali, they wondered how there was any room in his stomach for food when he ate (which he hadn't been doing much of at that point).

The masses in stomachs are very hard to detect until they're large - the stomach is up under the rib cage.

On the x-ray, it was so big it made all his other organs squished.

We had it biopsied to determine the type of cancer, and we opted to try the chemotherapy, because he seemed to handle the trips really well.

He completed the six months of chemo in January. We stopped having ultrasounds done after the second month. We didn't want the expense, and at that point, we'd determined we were going the full course.

Three weeks after his last chemo treatment (January of 2012), the ultrasound revealed he'd gone into complete remission.

He was throwing up, his appetite was off, and we were worried he'd come out of remission a few months ago. We decided to have another ultrasound done. He remains (knock wood) in remission.

This is our journey: http://www.thecatsite.com/t/234030/mega-massive-vibes-for-lazlo-urgent

Even if you opt for palliative care, I see no reason to put her down just because she's got a mass in her tummy. You can give her an anti-nausea medication (cerenia), you can give her an appetite stimulant (mirtazipine). You can put her on pred to help with the inflammation. You can spoil her rotten, and let her tell you when she's had enough. :heart2:

Lazlo was very, very sick and unhappy. Without treatment, the vet thought he had about four weeks to live. We started the chemo, and he just felt better and better.

We did have a set back - Lazlo had bleeding ulcers (which could be seen on the ultrasound done to measure the tumor prior to treatment). We started him on treatment for that immediately. But for some reason, no one suggested we KEEP him on the meds, and they came back. But the meds worked again (pepcid a/c and sucralfate), and then we just kept him on the pepcid a/c to prevent them from coming back.

And the length of time of remission is typically 9 - 18 months, according to Lazlo's oncologist. There is a 50% chance kitty will go into complete remission, and a 15% chance she won't tolerate chemotherapy.

Cost is discussed in this thread: http://www.thecatsite.com/t/253436/anybody-know-how-much-chemo-costs-for-a-cat


I'm so sorry. :heart2:

I'm so sorry too for Cali and you - I lost my dear cat Buddy to lymphoma over a year ago after trying chemo.   You should be aware that if you start chemo you want to do it sooner than later, treatment with prednisolone by itself for a week or two will actually lessen the effect of the chemo.  BUT the pred alone can give great relief for a little while.  In my dear Buddy's case things didn't work out and he reacted badly to the chemo.    He handled stress and vet visits amazingly well, so I felt it was worth trying but for a cat that that would traumatize I would not have.  Your love for Cali will help you find the best path 

Poor Cali!

Sorry to hear the news Heidi..  

Thank you so much for the responses and words of sympathy.  I am still in a lot of shock and having a hard time processing everything.

Laurie,

Your post touched me a lot and I keep coming back to Lazlo's story.  His situation sounds so very much like Cali's and I want the success that you've had!  I don't want to give up on her just yet but it is hard to justify all of the cost and effort involved when her prognosis is poor (if lymphoma 4-8 months WITH chemo).

The doc we met with yesterday was an internist and he quoted $350 per treatment, with 16 treatments necessary.  Since she still needs an official diagnosis and other sundries, he estimated $7-8K for maybe half a year extra with her.  A big part of me balks at that number, but the other part of me imagines how precious those extra months would be.  We've asked our vet to help us find a more affordable chemo option.  Apparently they have done chemo in house before so hopefully they would be a bit more affordable since they are local and generalized, or there is a slight chance we could get hooked up with Texas A&M's teaching hospital and do chemo there.

Before we can even get that far, we need to get Cali a bit healthier.  The comment on bleeding ulcers really hit home.  Yesterday afternoon when I offered her canned food and she immediately got nauseous and vomited blood, I thought that was the end for her but it actually seemed to make her feel better.  She came out of hiding and cuddled with us the rest of the evening and this morning she was looking perkier (although still not wanting food).  From what I read online she has a number of symptoms associated with bleeding ulcers, so I dropped her at the vet this a.m and asked them to please try treating her for bleeding ulcers along with giving her some anti nausea meds and some appetite stimulants.  I'm really hoping this can help get her eating on her own again so we can just focus on a cancer treatment plan instead of crisis management to keep her alive.

I kept going over and over the options yesterday and the only one that gives me any shot of having Cali in my life a year from now is chemo.  At the same time, I'm in a position where I'm facing expensive fertility treatments for myself that I really can't afford, and $8k more in vet bills would add to my already substantial pile of debt.  I don't want this to come down to a money decision but reality is what it is.

Today our doc is going to try to do a needle biopsy.  They originally suggested getting her medicated and hydrated today and opening her up tomorrow to grab a sample but that just seems to invasive given her current state.  We'd like to see if a needle biopsy can give us a diagnosis without requiring her to heal from an invasive procedure.  If the vet can get a sample today, we won't get a diagnosis back until Monday or Tuesday so I hope we can get Cali's strength up over the weekend.

Can you think of anything else we should be doing for her right now?  If she's not going to start eating on her own, I'd be willing to do an e-tube but there may be no point if there are no long term treatments that will help.  Yesterday's vet only recommended a feeding tube if we're doing chemo, but not if we're doing steroids.  He said we should only do steroids if she begins eating on her own.  Of course he never suggested that she may not be eating much due to bleeding ulcers, so that may change things a bit.

Gah, the more I type the more conflicted I become.  I just want me kitty healthy again.  I want to do whatever it takes to get her there but I may not be able to afford what she really needs.  If I can't afford it, and I don't give her that opportunity I am going to feel incredibly guilty.  I just don't know which way to go.

I guess I'll have to take it one step at a time.

~Heidi

I'm so sorry to hear about your Cali!  I know how difficult it is to know which is the best choice to make. I am facing a situation where my Cindy has just been diagnosed with cancer as well but we still aren't sure which kind.   I will say a prayer that you will be able to decide what the best option is for Cali and for you, and that you will have peace whatever you decide.

I'm very sorry to hear about Cali's diagnosis and am sending lots of

Oh hun... It is a big expense, and for results that aren't guaranteed. But that quote is rather astronomical. It also assume Cali's got large cell lymphoma (which is most likely). I'm so glad you're getting the needle biopsy done.

Honestly, we feel so very, very, very lucky and blessed that Lazlo responded so well. :rub: It was a long shot, everyone sounded so grave and ... almost hopeless, really. The oncologist was just "factual," but did say that cats with tumors that large had gone into remission. And then after the first two ultrasounds (after the first cycles of four), he always seemed unhappy with how much (or little) Lazlo's tumor was shrinking. We ended up calling him "Dr. Gloom" and just stopped getting the ultrasounds done. We also put him on a raw food diet just before he ended chemo, as it's considered the "cancer starving" diet. How much of a role that's played in his remission, I have no idea.

But no matter what you decide, to make her more comfortable, I'm guessing your vet will give her a shot of cerenia (anti-nausea med). I don't know what they can do there for ulcers (I mean "in house" at the vet vs. at home). The treatment we used for Lazlo was

Yunnan Biayao ( http://en.wikipedia.org/wiki/Yunnan_Baiyao ; you can buy it here: . The instructions for Lazlo (an adult cat that weighed 9 pounds at the time) were 1 pill every day for 3 days, then 1 pill every other day for 4 days, then 1 pill every three days until they were gone). This helps stop the bleeding and helps his bone marrow produce red blood cells.

Pepcid a/c (Famotidine) 10mg. Given once daily, at night, at least one hour after a meal and one hour before any food. This helps with acid suppression enabling the ulcers to heal.

Sulcralfate 1g pills: give 1/2 tablet (they're big) once daily. I think they can be crushed and added to wet food - I just pilled Lazlo with them. These coat the stomach, like a giant bandaid, and help the ulcers heal.

This course of treatment worked inside of two weeks. We found it's best to keep him on the pepcid a/c and sucralfate to prevent them from coming back.

If they give her mirtazipine as an appetite stimulant, and she acts too nutty, let the vet know you want to try cyproheptadine instead. :nod:

But $350 per treatment? I would definitely call around, and check in at Texas A&M. :nod: That is almost double a lot of Lazlo's treatments. No one would ever fault you for providing palliative care rather than pursuing a more aggressive treatment, because no matter WHAT the charge, it's a big financial commitment. :heart2: FYI, what you can do is what we did. We met with the oncologist and decided to at least try the treatment. If you see her feeling better and better, then it makes it worth the financial struggle to pay for the treatments (even though that doesn't mean she's going into remission, I don't want you to have unreasonable expectations). But if she doesn't take well to it, she doesn't start feeling better... then she made the decision for you, and even though none of us think you should feel guilty to opt for palliative care, YOU won't feel guilty, because you tried. :heart3:

In the end, sweetie, we're never prepared for the news that one of our cats has a terminal disease. And the fact of life is that it ends. And the contract we make with our pets going into our relationship with them is that we will most likely outlive them. So no matter WHAT you decide, know that you've given her as much love as you've got to give, and she's had a wonderful life. There is nothing wrong with just making her as comfortable as possible, because in the end, even with treatment, the cancer (if large cell lymphoma) will take her - it's just a question of when. :heart2: :grphug2: :heart3:

Given you have access to Texas A&M, I expect you'd be able to find a holistic DVM you can get to. If you want to skip chemo, but use alternate treatments that may help, you can look into neoplasene and supporting antioxidant therapy. I did a quick search and found this: http://www.holvet.net/neoplasene.html I know it's available orally (but difficult to administer) - I see this talks about injectible, and they were going to come out with a patch... with the large mass, the odds are probably against this type of treatment working, but you never know! Miracles sometimes do happen.

:heart2: :heart3: :heart2:

Just know we're here for hugs, support, and to answer any questions we can. :grphug2: :grphug2: :grphug2:

You and Cali are in my prayers.  God bless.

Quick update:  Cali got IV fluids, anti nausea meds, appetite stimulants and antacids yesterday.  She ate a couple of tablespoons of tuna fish last night (which is an improvement from nothing the day before) but is apparently still not interested in eating today.  The vet that looked at her today said she seems perkier and appears to be feeling a bit better, but she hasn't made a miraculous recovery.  She received her steroid shot 3 days ago today so they said she should be showing improvement today if the steroids would be able to help.  They also said that working with A&M for chemo probably won't be much cheaper, but that we'd have access to a larger staff to help.

They don't suggest we bring her home today because they think she still needs the IV and other supportive care that we couldn't provide here at home.  She is now under 8lbs so she is continuing to lose weight but they don't recommend an E tube right now because there is little room in her tummy for food anyways.  The local vet that had success with another cancer patient didn't seem optimistic about Cali as the other patient was younger, weighed more, and his cancer had been caught earlier.  She suggested with think about euthanasia sooner rather than later.

I don't want to make her sit in a cold metal cage all by herself if there's no hope for any improvement, but I feel like we haven't really given the ulcers a chance to heal yet so I don't want to give up either.

We have discussed possibly bringing her home tonight and loving on her all we can and then sending her to the rainbow bridge tomorrow but even typing that out makes me feel like I'm in a bad dream.  I don't want her to suffer or hurt.  I don't want her to be scared and alone.  But I don't want her to be gone yet either.

My heart is breaking.

~Heidi

 Oh Heidi, my heart is breaking for you. It is a tough possition to be in. I will pray for Cali & for you, with help & guidance for the right desission. Sending you healing, loving vibes & prayers!! 

                                                          

Oh sweetie! :heart2:

Add my prayers for you and Cali. :heart2:

So sorry about Cali.  I wish you all the best in this difficult time.  My Ruby died last July with lymphoma. 
 

Thank you for your words of comfort.  It helps knowing there are people out there that can relate to my situation.

A good update this time:  I asked for a small miracle: for Cali to start feeling better, to show some improvement, to start eating on her own again and my prayers have been answered.  My hubby just talked to the ICU nurse who informed him that Cali ate 1/2 can of food on her own since 10 am (tuna and Recovery).  I can't even remember the last time I saw her eat that much since this whole ordeal began.  She was much more alert and bright eyed and apparently even walking/jumping around.  Yesterday she weighed 7lbs15oz and today she is up to 8lbs3oz.  I know that isn't a huge improvement, and this still might not end well, but it's a step in the right direction and I'm so grateful for it at this point.

I really think the bleeding ulcers were causing the most noticeable problems so Laurie, thanks for mentioning that.  I'm not sure my vet would have offered to treat Cali for that if I hadn't known to ask and we might not only have missed out on time with her, but potentially also a chance to treat her longer term.

We've agreed to let Cali stay at the vet's this weekend to get her strength up while we wait for the biopsy results.  I'd like our vet to start the process of getting us hooked up with A&M so we'll be all ready to go when/if Cali is ready.  I also need to see if our vet charges any less than the places in Austin (which I doubt, but fingers crossed just in case).  

The best part: I get to go visit her in just a few minutes and I couldn't be happier  I have no idea where this journey will take us, but I'm so glad it's not ending tomorrow.

~H

I'm so happy to hear that!

Oh hun, I'm so glad she's feeling perkier! That's GREAT!

Keep it up Cali!!!! :rub:

My heartfelt prayers go out to you and Cali! Give her all the love you have and your heart will tell you what is best. I am now going through a situation with my
Cleo who has just been diagnosed with Low Grade Lymphoma. Gave her prednilosone for two weeks and she filled up with fluid on her lungs from the drug. Was rushed to the emergency hospital at 2 in the morning and had to go into an oxygen tent and was given lasix to get rid of fluid from pred.medicine.Have to start Lukerin but she is feeling so great that I really do not know if I want to start this kind of drug. I am completely torn.

To all those walking a tough road tonight.