Cali has cancer :(

JustPlainHeidi said:

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

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That's wonderful!   Collective prayers work!  Continued prayers for Cali!!!!!!!

It is amazing what an emotional rollercoaster this experience can be.  So far, we've been getting increasingly positive news about Cali, but every time the vet calls my stomach drops and I want to throw up. Every morning when I wake, my first thoughts are of sick Cali...wondering how she is doing, wondering how much time we'll have together, wondering how this will all end.  I feel like there is an electric current running through my body at all times, waiting to respond when something bad happens, and keeping me from relaxing even when there is good news.  

We visited Cali Friday afternoon (1/18/13) after her good report from the vet.  Seeing her in the ICU cage was pretty heartbreaking.  At first she didn't really respond to us, she just sat there facing forward and breathing heavy.  Then it was like she woke from a fog and she started rolling around in her cage wanting pets.  We stayed with her for 10-15 minutes rubbing her face and her newly shaven belly.  She purred once or twice, but not for very long.  They tried to give her warm tuna while we were there as well but she didn't seem interested in eating it.  They assumed that was because she had just eaten her entire daily nutritional needs a few hours before we got there.  

Friday evening I was both elated that she was showing progress, concerned that it was not enough progress, and worried about her future prognosis (I'm a worrier by nature so this is giving me plenty of fuel).  I really wanted to celebrate her small miracle but I didn't want to let myself get too happy or relieved because we have so far to go.  

Saturday morning (1/19/13) we got a call from the vet around 8:30 although we had told them we'd be in to see Cali a bit later anyways.  Of course this made me worry that something bad had happened that couldn't wait until our visit.  Instead it was the vet from Friday morning calling (the one that had suggested euthanasia rather than treatment due to her condition) with another encouraging update.  Cali was even more alert than when she examined her on Friday and when she pet Cali, Cali arched her back as a normal cat would do and purred.  She was encouraged to see such a turn around and wanted to discuss our plans for the weekend and beyond.  We set up an appointment with her for 10:30 so both my husband and I could talk with her at the same time.

I grabbed an old t shirt that I had slept in and I rubbed it all over the other cats and dogs before leaving the house so Cali could have something that smelled like home.  We waited in an exam room for a lab tech to unhook her from the IV and when they brought her in, she was sitting up in the lab tech's arms, looking around all bright eyed.  The vet was running late so we had 30 minutes alone with Cali which she used to demand a lot of petting and attention from us.  She rolled back and forth purring and kneading the air the entire time.  The spark was back in her eyes and she seemed very relaxed and happy.  


We had about a 1 hr talk with the vet about Cali's improvement, prognosis and treatment options going forward.  She said she had already tapered Cali's fluids back and was thinking about capping the IV at lunch time to see how she would do on her own.  It seemed she was feeling optimistic about her ability to eat/drink on her own and stay healthy enough for us to continue some form of treatment.    We talked about some other cancer cases she had treated successfully with oral chemo and/or steroids which offered some encouragement.  They are definitely willing to work with us to keep Cali as healthy as we can for as long as we can.  Tuesday's upcoming biopsy results will hopefully help give us some idea of what cancer we're trying to treat which should help us pick a path.  It is all still very scary and overwhelming though.

A few minutes ago (1/20/13) we got another call from the vet's office and apparently Cali's appetite has really taken off and she is eating very well.  Her attitude has apparently also improved to the point that the tech couldn't hear her heartbeat over all the purring.  I'm hoping we'll get to bring my girl home tomorrow because this house just isn't the same without her.

Sandy...I am SO sorry you're going through your own medical nightmare right now.  I find it nearly impossible to know what is the right decision and everything seems so uncertain.  I know we all realize pets are only with us for a finite amount of time but it really doesn't seem fair to have to deal with these types of painful situations just because we chose to love a cat.  I hope you get some clear (positive) answers soon and that Cleo feels better every day.

Thank you to everyone for your positive thoughts, prayers, good vibes.  This is such a tough situation and I wouldn't wish it on anyone, but I am so glad you are all here to support our family.  Thank you thank you thank you.

~Heidi

I SO happy to hear that Cali is doing so well.  I'm more than familiar with the emotional roller coaster while deailing with my Cindy, so I can empathize with the every present anxiety.  Continued good wishes for even more improvement and happy days ahead

I'm so happy to hear the good news. It sounds like she was very happy to see her mom & dad!    I hope she gets to go home soon.

Continued prayers for Cali!!

Such happy news!!!!! Oh I hope she comes home SOON!!!!

...and more because the "one day at a time" thing IS so hard! :heart2:

Yesterday was an awesome day, Cali came home and I could tell she was feeling pretty stellar.  I didn't expect her to want to eat but I set out some food and she immediately attacked the tuna.  The vet also warned us to bring her back if we hadn't noticed a bowel movement within 3 days, and she had one within 15 minutes of being home.  She wandered around surveying her territory, purred while I pet her, and cuddled with me on the bed before we tucked her away in her own room for the night.

This morning I could tell she had eaten again overnight.  All in all about 1/4 can of tuna between 6 pm and 6 am.  Still obviously not enough, but a start.  She couldn't wait to get out of the room to explore a bit before being locked up again and she seemed pretty energetic.

I just got home from work a little while ago and found that she really hadn't eaten during the day.  I found a bit of the dark yucky colored vomit and a cat that is less perky than I left her.  

We're going to contact the vet to see about continuing anti acids (bought some pepcid ac last night) but I'd also like to keep her on an anti nausea med and some appetite stimulants.  All they gave her yesterday before sending her home was famotidine so I'm guessing it has been a few days since her last anti nausea med/appetite stimulant. Is there anything else I should be asking for?

~Heidi

...and as she vomited blood, and you suspect bleeding ulcers, you should ask about sucralfate. It will help heal the ulcers. Once healed, the pepcid would help prevent them.

For the appetite stimulant, if they used mirtazipine, it should work for three days, and your instructions will likely to be to give it to her every three days. For the anti-nausea med, I really hope they give you cerenia. It has worked so well for us. That's a daily pill (1/4 of the 16mg pill will most likely be the instructions).

For the famotidine (which is pepcid a/c), if you give it on an empty stomach that's going to stay empty for an hour (so at least an hour after and before eating), it will provide 24 hour antacid coverage. :nod:

she perks up again with the meds!

Laurie...

As always, I appreciate your words of wisdom.  I asked for the meds you suggested yesterday and the vet sent us home with 1 medication, an anti-nausea med that begins with the letter 'm' and is in liquid form to be given 2x/day.  She wasn't actually in the office so her receptionist was acting as the go between and told us we would need to discuss the other meds with the vet.  My husband did get to talk to the vet in the evening and she said we could try the sucralfate although she suspects a bleeding mass, rather than bleeding ulcers so she wasn't optimistic that the sucralfate would be able to heal everything.  I'm also not sure why they seem so reluctant to prescribe an appetite stimulant but I'm not going to give up on that.  I will ask for the cerenia and mirtazipine by name and see if that gets us any further.  I know they gave Cali some diazepam while she was in ICU which they said would increase her appetite but that it could only be given once.  It obviously helped, so I would like to use something like mirtazipine to keep that going.

We did get Cali eating a bit again but she still isn't breaking any records.  We fed her warm tuna at 9pm, midnight, and 4am and she ate about half each time.  All total we got about 1/2 can of tuna into her since last night so we dosed her with the anti nausea meds again this morning before leaving for work, and I'm having my parents come over a couple of times today to feed her and monitor her.  To even maintain her weight, she needs to start eating more than that, and I'd really like to see her eat something other than just tuna (the high calorie food we bought would go such a long ways towards getting her weight back up, if we could only get her to eat even a tiny bit). 

We also heard a preliminary report about the biopsy findings (vet was out of the office so she had someone read them to her).  They couldn't diagnose 100% based on the slides but they did see lymphocytes on 7 of the 8 slides so I think we're all leaning towards large cell lymphoma.  I'd like to start treating it as such, but I don't want to make Cali initially sicker if she's already teetering so closely to the edge.  I did get some info from a yahoo feline cancer group about using Elspar (L-asparaginase) initially to decrease the size of the mass before proceeding with a CHOP (or COP) protocol, but that is all greek to me right now.  I'm going to try to do my research before we talk to the vet so I have some questions to ask. 

~Heidi (and Cali)
 

Elspar is typically part of the chemotherapy cocktail protocol, especially if it's a mass in the stomach. :nod:

I'm not familiar with an anti-nausea med that begins with "m." :dk:

I wonder why they think the tumor is bleeding? According to our oncologist, large cell lymphoma tumors usually mass at a site of chronic inflammation, which in stomach masses is typically an ulcer. :dk: I would think that either way sulcralfate would help - either way, if something's bleeding, she's losing blood, and that's not a good thing.

The typical chemo, as we discussed before, does cost quite a bit. But there may be other options we didn't discuss or pursue. :cross: Lazlo was in very, very bad shape when we started. Our thinking was that since he already feels so sick, the only hope was to start treatment and hope it works.

I do hope your vet is open to giving her supporting therapy that should help her feel better, and increase her appetite!

FYI, for Lazlo, we had to try all kinds of things to get him to eat while his appetite was still a bit off. We used freeze dried liver (both beef and chicken), powdered on top of his food, Fortiflora (just fluffed over the top for the strong animal fat smell most kitties love, not used as a probiotic); warming up his food, bonito flakes, freeze dried salmon.... chicken baby food often worked.

Something else to consider is syringe feeding. I expected Lazlo to fight it, but he didn't. He waved his head around at first, but once I got a little bit of the canned a/d (prescription food meant to be used in a syringe) into him, he stopped fighting. I think he "got" that it was food, and appreciated that he didn't have to really have it in his mouth.... (I squirt it into the back of his cheek so he can just swallow it). It was kind of like he wanted the nourishment, but didn't want to have to eat (because he was nauseous).

Continued vibes for you and Cali!

Thinking about you and Cali and sending vibes     If you haven't already discovered it there are two very active groups on Yahoo for feline lymphoma and assisted feeding that are really worth joining at this point - just a wealth of information and people going through what you are right now.   

Thought I should check in since Cali has been home for a week. 

She got a depo shot on 1/21 before coming home from ICU and she showed improvement throughout the week.  We continued the anti nausea meds in the morning and the evening and she kept eating on her own (although not as much as she really needs).  Every day she seemed a bit perkier and actually started grooming herself again.  Saturday 1/26 we also picked up sulcrafate to help with her bleeding ulcers.  We're supposed to administer it 3x/day but we're lucky if we can get it in her 2x since it has to be taken on an empty stomach, spaced out from other meds etc.

I came in contact with a fellow Austinite who recommended her vet (her cat is currently undergoing CHOP there), so we set up an appointment for Cali yesterday.  At first it appeared that the vet was ready to start chemo today but then she talked to some oncologists and changed her mind a bit.  Since our initial needle aspiration didn't return with a definitive lymphoma diagnosis, she is very wary of starting the CHOP protocol.  She was informed that doing chemo if she doesn't have cancer could actually kill her, so now my husband and I are left to decide what to do. 

Since we've done steroid treatments for that last few weeks, the vet wasn't optimistic that we would be able to get an accurate diagnosis.  She mentioned that we could try using a scope to grab a sample, but that it might result in inconclusive findings and could possible damage the stomach.  She wouldn't suggest opening Cali up for an actual biopsy so that really isn't an option.  We're going to ask to try another needle aspiration to make us more confident that we're treating the correct thing but if that doesn't give us an accurate diagnosis, we'll still need to decide how to proceed without having all the facts.

We can try chemo and risk ending her life more quickly if it isn't cancer or we can stick with the steroids since they are low risk and they seem to be helping, but she will also have a shorter lifespan.

I'm incredibly conflicted and don't know what to do.  Just thinking about this decision makes me sick to my stomach

~Heidi

I've kept little Cali in my prayers. I will also pray for a correct diagnosis to be found.   

We were very fortunate to get a diagnosis from the needle biopsy, because he'd been given 2 shots of depo over the previous month. Have you asked the vet about the timing of another needle biopsy in relation to the depo shot?

I'm glad her appetite has been better!

FYI, the vet told us it was OK to use the sucralfate with food - and Lazlo's ulcers did heal. Just a thought... :rub:

Continued for Cali, and I hope you're able to get a definitive diagnosis!

Oh  my gosh, I know exactly what you're gonig through not being able to get an accurate diagnosis.  My Cindy's first ultrasound and needle biopsy came back negative, but after a month on Prednisolone the mass doubled, and she was losing weight.  The second untrasound and multiple needle aspirates came back likely lymphoma but maybe endocrine (?). A DNA PARR test also came back inconclusive. Our vet told us that no oncologist would start chemo without an accurate diagnosis.  One vet told us they could use a larger needle but that might drag the cancer cells to other parts of her body.  Fortunately she was otherwise healthy (if you can be healthy and still have cancer) so she was a good candidate for surgery, which she had Friday.  Still no guarantee we will get a diagnosis from it because of being on the Pred. 

You and Cali are in my thoughts and prayers that you can get a good diagnosis and begin a treatment soon 

It is with a heavy heart that I post this update but you have all been so wonderful that I owe you the ending to this story 

Our new vet got us a referral to A&M on Friday 2/1/13 for another ultrasound guided aspiration.  Cali had been eating well all week after a steroid injection on Monday 1/28/13 but she had also started vomiting daily after eating.  Luckily we weren't seeing coffee grounds in her vomit so we were hopeful that the bleeding ulcers had subsided.  She had a great week, spent lots of time outdoors enjoying the sunshine and the rest of her time in my lap or cuddling with me in bed.  Her appetite was the best it had been in weeks, and she enjoyed a variety of flaked seafood.  Thursday night 1/31/13 we let her spend the night in her favorite kitty hammock in the kitchen and we packed her up for the trip to A&M Friday morning.

After a quick history and physical exam, we were told to return 3 hours later as it would take some time for them to perform the aspiration.  We went out to the movies and grabbed appetizers for lunch in an effort to distract ourselves but I felt sick to my stomach almost the entire time.  A&M called while we were sitting in their parking lot to tell us they had performed the ultrasound and that we only had 2 options.  They would meet us in the lobby in 5 minutes to discuss.

My intuition told me it was bad and I started shaking but I tried to remain strong as they took us to an exam room to show us their findings and discuss the situation.  They let us know that what they found during the ultrasound made them abort the needle aspiration and switch to a chest x ray instead.  This is what they showed us first.  They explained that a cat's stomach lining should be millimeters in width, and Cali's was centimeters in places.  There was absolutely no normal stomach lining visible.  Worse than that, it appeared that her stomach lining had perforated.  They showed us the organized pockets of gas in the intestines where they belong, and the splotches of gas around her stomach and in her chest cavity where they didn't belong. They explained that gas and stomach contents were escaping into her abdominal cavity which was no doubt quite painful. With no healthy stomach available, option 1 was to remove her stomach entirely, which came with a very poor prognosis.  Option 2 was to end her suffering.

After all she had been through this past month, I couldn't imagine causing her any more pain just to keep her with me for a little bit longer.  She was such a good girl and a gentle patient until the end, but she had been through more pain, discomfort, and fear than any sweet kitty deserved.

They showed us to a small room with a couch, and brought her to us bundled in a quilt.  She was perky and bright eyed and very much her usual self.  She demanded my husband rub her head hard, and she purred sweetly while I rocked her in my arms.  We could tell she wanted to get out of the blanket and explore and at one point she jutted her poor shaved little paw out of the blanket to grab at a piece of paper my husband was holding.  It was the most painful and most beautiful time and I can't think of it without crying.  I could have stayed in that room holding her until the end of time, but ultimately I had to decide when I'd had long enough to say my goodbyes.  My heart was completely broken as I handed her over and it is a moment I hope I can stop replaying in my head some day.

We agreed to let A&M perform an autopsy both for their learning purposes and for our understanding of what took our poor Cali away too soon so hopefully we will finally get some answers.  We're also having her cremated so I can sprinkle her in the garden that she loved so dearly.

I so greatly appreciate all of you offering helpful info, advice, support, love, prayers to me over the past month.  You were a great comfort and I can't thank you enough.

~Heidi
 

Oh hun.... I'm at a loss for words. Cali was obviously so very loved and knew it, and you did what was right for her. :heart2: I'm just so sorry that was the situation. I think it's really wonderful of you to let them autopsy her, as gruesome as that sounds, she'll help other kitties, and that's such a wonderful, truly wonderful thing, especially with all she's been though. :rub: :heart2: ...and she'll still come home to enjoy her garden. :heart2:

Holding you especially close to my heart right now!! I'm so sorry. :heart2: :grphug2:

Oh Heidi I'm so sorry you lost Cali.
I agree that it was a wonderful thing to let them do an autopsy. Very hard to be so unselfish in the midst of shock and grief, but that may help future cats down the road.

I'm going to close this thread and suggest that you post a memorial thread to Cali in the Crossing the Bridge forum, when you're up to it.

I'm so sorry Heidi to you and angel Cali.