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silent meowlook

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I have seen cats given their first chemo treatment and start eating and feeling better. I have seen them go into remission for years. Those cats seemed to feel well and have a good quality of life. But this involved weekly visits for the first month then bi weekly then monthly, and always a CBC fine first to make sure the WBC was normal before treatment. I worked at the specialty hospital from 2005 till 2014. Things may have changed, but I haven’t heard of it.

I have also seen cats have a bad reaction to chemotherapy after treatment and die a horrible death. That was rare though. Most did well at least at first.

I have also seen cats go into remission and do well, only to have the cancer crop up somewhere else. Or, a different kind of cancer crop up.

There was a cat I knew that belonged to a lady that had 7 related cats. She didn’t have any money and asked if I could look at a small lump that was under the cats eye. I did, and it was tiny. I asked the IM vet I worked for for advice. He told me to do a cytology, get a sample with a needle and put it on a slide. I did, stained it and he read it. He said he didn’t see anything that looked suspicious and that it was probably nothing to worry about.

I got the lady and the cat an exam with a general practice veterinarian through a group that helped low income people pay for veterinary care. The vet she saw sent her home with a prescription of Prednisolone to shrink it and planned to remove it. I talked to the IM vet and he agreed with me that it was an idiotic plan. So, I told the lady not to give the pred. This cat was overweight, like all her cats and one was already diabetic that I was also helping her with.

Within 2 weeks the small growth that was the size of pencil tip grew to the size of an unshelled almond. I took her to my work and was told I needed to see the ophthalmologist due to its location. They took a wedge biopsy and it came back in a few days as adenocarcinoma. By then it was walnut sized. I brought her back and the eye vet explained they would have to remove the eye and a portion of her face and they still couldn’t be sure the margined would be clean. The cat went home for the owner to decide what she wanted to do.

I didn’t hear from her for two weeks. Then she called me and said the cat had lumps all over and wasn’t eating. She wanted me to see what could be done.

The cat was dropped off and all of her lymph nodes were swollen and hard. The tumor was misshaping her face. The IM vet explained to me it was probably lymphoma as well as the adenocarcinoma. The lady came down and signed for euthanasia and left.

I euthanized her cat.

It was horrible and a memory I wish I didn’t have. I don’t know what would have happened if I hadn’t stuck a needle in it, or if she had followed the general practice veterinarian’s advice. I will always wonder that and feel responsible.

The reason for the story about little Darby, is that cancer sucks. It is unpredictable and unfair. I hate cancer.

So, I think the oncologist feels he knows what is going on with your cat. But, sometimes specialists can be wrong. Sometimes nothing you do is enough and sometimes you can get several years of a decent quality of life. ( or so we humans think, who really knows how the cat feels).

This is an extremely personal issue with so many unknowns. Nobody but you can decide what is right for your cat, but you. I will say though, the only guarantee is that in 15 years you will still be wondering if you did the right thing, o matter what you decide to do. It sucks! No other way I can put it. I am so sorry all this is on your shoulders. I wish there was something I could do to help.
 
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FeralHearts

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Hi. Just glanced at your post, not the replies. Having worked with IM specialists and having done allot of Chemo patients, I think I can help you understand what’s going on better. Let me just get home first.
Thank you.


Briefly; The presentation was consistent with lymphoma due to multiple swollen lymph nodes. Although, usually dogs present that way, not cats. At least what I have seen.
She only has the one swollen lymph in the leg that they can see but all the bumps on her neck and head they think is also cancer.
but yes, the gist was probably lymphoma. They humm and haa'd a bit (a lot) puzzled and then systematically went over options.
I asked them shouldn't we test to see and they said they expect they'll find it everywhere and don't test unless you are going forward. Which honestly I can't decide without knowing. If it's really bad everywhere - then probably not but if it's only a little everywhere then I probably would. It's had to say without facts.

But yup ecenically that's what happened. It confused the lifeout of me because how can you even think of a treatment without knowing. My only guess would be through experience?

Where I would have to take her 2 -3 times a week is a distance. She would have a hard time with it - as would i with work - which I would need to pay for it.

There is a medicine in the US that I can do at home. I'm getting the name and will let you know.

He wanted to know if you would pursue chemo because if not, there is no point in testing. ( his mind).
That seemed to be it. Which was a mind melt for me.

If this is lymphoma, it does usually respond well to chemotherapy. But, that is a big commitment, not just in time but also money.
This is what I'm understanding IF it is Lymphoma (probably is but..). Odds are not in her favour. Especially with her off again on again eating. That much worse.

EDIT - just saw your second post - will reply in a bit.

Thank you :-)
 
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FeralHearts

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And today I'm back on the roller coaster of Syringe feeding. On the plus - I woke up this morning and she had come upstairs on her own again to look out the window. That put a smile on my face because all of this has been heartbreaking but the fact she was staying in a rec room and not jumping to her window laying basking in the sun was hard to see. So the fact that she traveled upstairs, on her own, to the living room window - even for a bit - was nice. I want her to have as much joy as she can have.

What happened during the visit that seemed to have caused an increase in Mia's interest to eat?
Since we were back to syringe feeding again I wonder if she was just really thirsty and that's why she took inthe wet food. I will be asking about the Ondansetron today when I speak with her vet.

S silent meowlook FeebysOwner FeebysOwner fionasmom fionasmom Furballsmom Furballsmom Kieka Kieka

Thank you all so much for sticking on this journey with me so I wasn't all alone.

You all have helped more than you realize.

S silent meowlook

Thank you for sharing all that. Believe me, that helps a great deal. Information and other experiences tend to help me to rationalize and think a little clearer though the pain. Staying level headed through it - not easy. You want to grasp onto any hope at all... and then you have to try to think of what's best for them and not you. It's a hard balance. I have to say a near impossible one.

Your post made me cry - but that's a good thing. I cried for you, for Darby and all other other animals that have to go through this. It's such a complex illness and it sucks. Someone needs to make a device so they can talk to us! Would be so much easier for them and us.

These things are exactly what we need to talk about so that others can learn from all the experiences, medication, procedures. In the end it helps us to make better choices... but you are right.. .no matter what choice I make I will second guess it 15 years from now. It's a hard truth but I think a normal thing to do as well. We need others to help keep us balanced through it so we don't go completely insane.

Darby's story was no doubt a really hard one for you to share and I value and appreciate what that must have been like for you to relive that writing it out. So you know, it wasn't in vain.

I'm one of those that prefers the hard truth or things rather than a pretty lie. That lie catches up and makes it so much worse later. It's one of the reasons I like my vet so much. She is honest.

The first time I met her was when their original vet was on mat leave and she smacked me over the head with a brick and actually was pretty matter of fact (rather blunt) lol but politely as she could - said my current vet was wrong about something ... and she was right... the vet had been wrong. At first I was offended and thought "how on earth am I going to work with her?" and then I realized she was EXACTLY who I needed. Honest, incredibly smart, kind and ... fearless. She was all for what was best for her patients. When their originally vet came back from mat leave she decided to move away to another province. They had another vet to replace her but I asked for them to keep the current one. I will be asking her to review today a few things and hit me with a brick if she need to. I won't mind.

As for helping - you have. I know it's impossible to see through messages on a form you you will need to take my word for it. You absolutely have.
 
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FeralHearts

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I asked her lovely vet about Ondansetron - she has agreed to try that.

The vet has let me know she can't take the Mirataz with it. So I can start the Ondansetron tomorrow and we'll see if that does the trick.

This is a trial and error now on why she's not eating. Let's hope it's this works. The Mirataz def made her more vocal and she wants to eat. .. but she's scratching at her ear and her ears are hot and still not eating on her own most days.


:vibes::purr: (I don't post this one very often any more because there are a lot of memories attached, unless it's for a special cat or person 😻💕 )

Thank you so much. XOXOXO It means a lot. XOXOXOXOX

-----

If all this wasn't enough... Charlie has to go back to the vet as he's crying at the litter again and straining and someone's pee smells a bit like ... of all things... HONEY. and that's not good either. So I have that mystery to sort out now.

I think someone might put me in a rubber room soon.
 

silent meowlook

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That is a good plan, talking to the vet you trust. Specialists are weird. Some have huge egos and some only think on a box. All are smart but smart comes with quirks. I’ve worked with ones that were brilliant jerks and ones who were needy crying babies. But, all do have the extra education needed to treat what they treat.

Has anyone done a recent abdominal ultrasound or a chest X-ray? If no chest X-ray has been done, I think you should do one, because if this has spread to the chest it is pointless ( in my own opinion).

Sorry if I missed something, but if I understand this, there still isn’t an official diagnosis? I know they say you shouldn’t look for zebras in a herd of mustangs, but maybe there is a zebra. Without a diagnosis this specialist is honestly speculating based on experience. Maybe they need to do more diagnostics?

The other thing would be a second opinion specialist but I doubt you have time for that. Because, it sounds like things are moving quickly.

I wish I had answers for you. I do know that if it is lymphoma you do need to move quickly.

These specialists see so many cases that they can forget there is an animal with feelings and a person whose world revolves around that animal attached.

I do I’d a working interview at a holistic integrated hospital and was impressed. But it seemed like their cancer patients were only there after chemo. I could be wrong.

I don’t envy you with all the decisions you are being forced to make. It isn’t fair. With human medicine you aren’t expected to make decisions that require not only a medical degree but a specialty degree.
 

silent meowlook

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Yeah, the person that said life doesn’t give you more than you can handle should be slapped upside the head. In all fairness if you decide to go the rubber room route, you will get hungry and bored after a while and probably need to use the bathroom at some point. 🙀
 

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The vet has let me know she can't take the Mirataz with it. So I can start the Ondansetron tomorrow and we'll see if that does the trick.
I don't want to add to your woes, but my cat has been taking both Mirataz and Ondansetron. I have never been told that it can't be done. There are numerous cat owners on the CKD io forum who use both as well, and I am sure there are on this site too. I am confused.

I will add that Feeby doesn't get a full dose of Mirataz daily, actually she doesn't even get a half dose daily - about every 2-3 days. But she gets Ondansetron daily, and on the days she gets Mirataz. I have found that daily use, especially a full dose of Mirataz, can be a bit 'overkill'. I have seen others say the same. Dosing with Mirataz is somewhat of an experiment, tbh, and my vet had no issues with me doing so.

Mirataz is supposed to have an anti-emetic effect in addition to being an appetite stimulant. Ondansetron is more or less just an anti-emetic.

I will do some more searches, but I think your vet is being overly cautious - and it would be helpful if you knew her thought process about this. There is no reason that you can't ask a vet to explain their approach to things. I do it all the time and will never stop. It is my right to understand what their thinking is on anything they do.

I am sorry for all of the things you are going through.
 

silent meowlook

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I think there may be some confusion. Some medications can’t be taken with Mirtazipine like some of the anti depressants such as Prozac ( fluoxetine) but cerenia snd ondansetron are fine.
 
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FeralHearts

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That is a good plan, talking to the vet you trust. Specialists are weird. Some have huge egos and some only think on a box. All are smart but smart comes with quirks. I’ve worked with ones that were brilliant jerks and ones who were needy crying babies. But, all do have the extra education needed to treat what they treat.

Has anyone done a recent abdominal ultrasound or a chest X-ray? If no chest X-ray has been done, I think you should do one, because if this has spread to the chest it is pointless ( in my own opinion).
I did speak with her Vet and we went over testing which she is more than willing to do... like you all said.. she said it won't change the outcome and even if we find something up with her intestines or a thickening making it hard for her to eat - she's not a candidate for surgery. We would also have to knock her out - which also has risks.

I think a x-ray at the very least is worth it. I think it might show enough to know somethings.


Sorry if I missed something, but if I understand this, there still isn’t an official diagnosis? I know they say you shouldn’t look for zebras in a herd of mustangs, but maybe there is a zebra. Without a diagnosis this specialist is honestly speculating based on experience. Maybe they need to do more diagnostics?

The other thing would be a second opinion specialist but I doubt you have time for that. Because, it sounds like things are moving quickly.

I wish I had answers for you. I do know that if it is lymphoma you do need to move quickly.
The specialist, without more tests, has said it looks like typical case lymphoma even though everyone agrees that it's unusual for it to present the way that it has in the leg like this. So yes, she is speculating based on experience and that FNA etc.

There are those lumps on her head, chin and neck as well. Without testing they think those are cancer too.

If it is lymphoma - the way I've watch this progress so quickly.... treating her might be very unkind. Which is why I'm so all over the place - that what if it's not.


These specialists see so many cases that they can forget there is an animal with feelings and a person whose world revolves around that animal attached.

I do I’d a working interview at a holistic integrated hospital and was impressed. But it seemed like their cancer patients were only there after chemo. I could be wrong.
Most of the holistic ones that seems to be the case, it's either with Chemo or after.

I don’t envy you with all the decisions you are being forced to make. It isn’t fair. With human medicine you aren’t expected to make decisions that require not only a medical degree but a specialty degree.
Thanks. That's exactly it - I'm feeling like I have to make choices and decisions with little to know information and a million questions and do it really quickly and then hope to helk I've made the right ones.


Yeah, the person that said life doesn’t give you more than you can handle should be slapped upside the head. In all fairness if you decide to go the rubber room route, you will get hungry and bored after a while and probably need to use the bathroom at some point. 🙀
I agree they should be slapped... realllllllyyyyy hard.

LOL true about the rubber room!!!


I don't want to add to your woes,
You can never add to my woes ... only help.


I don't want to add to your woes, but my cat has been taking both Mirataz and Ondansetron. I have never been told that it can't be done. There are numerous cat owners on the CKD io forum who use both as well, and I am sure there are on this site too. I am confused.

I will add that Feeby doesn't get a full dose of Mirataz daily, actually she doesn't even get a half dose daily - about every 2-3 days. But she gets Ondansetron daily, and on the days she gets Mirataz. I have found that daily use, especially a full dose of Mirataz, can be a bit 'overkill'. I have seen others say the same. Dosing with Mirataz is somewhat of an experiment, tbh, and my vet had no issues with me doing so.

Mirataz is supposed to have an anti-emetic effect in addition to being an appetite stimulant. Ondansetron is more or less just an anti-emetic.

I will do some more searches, but I think your vet is being overly cautious - and it would be helpful if you knew her thought process about this. There is no reason that you can't ask a vet to explain their approach to things. I do it all the time and will never stop. It is my right to understand what their thinking is on anything they do.

I am sorry for all of the things you are going through.
I can ask her but she made sure I was told about three times not to use them together. She was pretty adamant about it. Maybe it's because she's now got Prednisolone too?

From what I understand we won't be using the Ondansetron daily at this point. She mentioned Cerina to but it was either that or Ondansetron not both.

Thank you so much. I feel so lost and I don't know if anything I am doing is right at all. It's a sea of trial and error.

I think there may be some confusion. Some medications can’t be taken with Mirtazipine like some of the anti depressants such as Prozac ( fluoxetine) but cerenia snd ondansetron are fine.
My Vet said and she made everyone who spoke to me today be very clear I was not to use both Mirtazipine and Ondansetron. Like I would kill her if I did type seriousness. In fact I can't give the Ondansetron tonight because I gave her the Mirtazipine this morning.
 

silent meowlook

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There is a risk of sick serotonin syndrome in people using Mirtazipine and odansetron together. So, yeah, don’t use together.🙀
 
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FeralHearts

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There is a risk of sick serotonin syndrome in people using Mirtazipine and odansetron together. So, yeah, don’t use together.🙀
Yikes.

See smart Vet.

Should I have gone with her Vets originally suggestion of Cernia?

I think this is going to be trial and error to see what is going to work for Mia.
 

fionasmom

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I think that you said that you were not using AHCC right now. I would not put it back into the mix as it will react with the ondansetron as we discussed. Ondansetron is considered better for nausea versus vomiting.
 
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FeralHearts

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Yes I stopped the ACHH I decided the vet was smarter than me :-) and to listen to her and wait for oncology first. (Better late than never I guess.)

...and yes I remember that. I won't mix stuff up and risk making it worse. I committed that one to memory! but thank you deeply and sincerely for the reminder just in case as that would be a bad bad bad thing to forget!

She's not throwing up so I think it's either nausea or appetite - however so far the appetite is hit and miss with the Mirtazipine and it's making her ears hot and she's scratching them. So I think it's not sitting well with her. Probably a reaction to it.
 

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You have to go with your vet over all of us, but I will tell you I also know people who give their cats Pred and Mirataz and Ondansetron and never heard of any one of those cats dying, or even becoming ill, from the combo. There is something to be said that Pred can cause an increase in appetite, but it doesn't necessarily do that for all cats. There is no human issues with interactions between Pred and these other two meds.

But as noted above there can be a RARE reaction - again primarily based on humans when using both Mirataz and Ondansetron called serotonin syndrome. So, yes, the simplest way out of this is to do what your vet said and don't give them both to your cats despite the rare possibility of the serotonin reaction.

The other thing I think mentioned before is Elura as an appetite stimulant - maybe that is an option that could replace Mirataz - and may be able to be used with either Cerenia or Ondansetron.
 

fionasmom

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Elura is an entirely different appetite stimulant that works along different lines in the body. I have used it for a cat and a dog (Entyce) and had no reactions. Cyptroheptadine is an older drug used for appetite stimulation and I don't know if it would serve your purpose here or not.
 
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FeralHearts

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You have to go with your vet over all of us, but I will tell you I also know people who give their cats Pred and Mirataz and Ondansetron and never heard of any one of those cats dying, or even becoming ill, from the combo. There is something to be said that Pred can cause an increase in appetite, but it doesn't necessarily do that for all cats. There is no human issues with interactions between Pred and these other two meds.

But as noted above there can be a RARE reaction - again primarily based on humans when using both Mirataz and Ondansetron called serotonin syndrome. So, yes, the simplest way out of this is to do what your vet said and don't give them both to your cats despite the rare possibility of the serotonin reaction.

The other thing I think mentioned before is Elura as an appetite stimulant - maybe that is an option that could replace Mirataz - and may be able to be used with either Cerenia or Ondansetron.
Yes always the vet - but this is wonderful thank you very much as it gives me other options to present and ideas. It's like anything else - people get used to doing one thing that works for "most" things they encounter - and then there is the "odd ball". So more options and ideas to present is a good thing. Especially when it comes to getting her to eat and without that... well you know how that will go.. and quickly.

With Mia this is going to be trial and error. She doesn't complain so it makes it harder and I have to be a lot more diligent and super observant and even then - I'm never sure.

This chic boo boo fights sedations - I'm talking heavy sedation that shocks people and I know this is part of the former feral in her- her survival instincts are outstanding... and in this case it's this very instinct that is playing against her in some ways.

I'm hoping the per will help her to feel a bit better and get the appetite going - so far - not that I have seen. Tonight is her second night on it. Last night was her first. It should have already kicked in I think - so this is not looking promising and I know I can't stop Pred suddenly. So there's that. I'm not sure how long I should give it - I think a week I should know? Same with the Ondansetron - if after a week nothing - back to the drawing board?


Elura is an entirely different appetite stimulant that works along different lines in the body. I have used it for a cat and a dog (Entyce) and had no reactions. Cyptroheptadine is an older drug used for appetite stimulation and I don't know if it would serve your purpose here or not.
Thank you as well - other options to present if these other options fail. Hopefully something will work.

Can you tell me how it works differently?
 

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Elura is actually intended for cats with CDK who are losing weight because of that condition. It mimics ghrelin, which is a hormone released by the stomach. This hormone signals to the body that it is time to eat. Mirtazapine, conversely, is an antidepressant and cyproheptadine is an antihistamine, both of which have a side effect of increasing appetite.

My personal experience is that Elura did not work at all in a young cat, although it did not hurt him, and that in all cases it has a much slower effect. I was underwhelmed by both Elura and Entyce, but that is just my experience. However, I would not discourage anyone from trying it.

Pre Covid, I had to euthanize a very wild outdoor feral. We arrive at the ER in the middle of the night and are brought in. They try to sedate the cat, who is seemingly immune to sedation and becomes even more ratcheted up. I am shown out of the room because of liability (they were entirely trustworthy). I know exactly what you mean about a cat/feral who fights sedation.
 
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Thank you for that information and for sharing that story. I am so sorry you had to experience that too.

Many people just look at me like I can't be right. They often don't believe that feral can, and do, in a lot of cases respond differently than those that were raised inside. Sometimes you have to look at them with a slightly different lens.

The language of the cats seem to be not the same too. It's bizarre to watch.

A little Mia update:

After having the conversation with her Vet yesterday she dug into some research and all the info we had. )The notes from oncology were barely anything and didn't even make mention of the US drug she referenced so I will have to call again.)

Since Mia is not presenting normal the homework began and she is sending some of the research home with Charlie tonight. (Who is not doing great and I'm a bit on the worried side but will wait for the tests to come back before i go insane.)

The research she found that matches Mia - it is a rare form of skin cancer that starts in the leg exactly where hers is. Tarsal Lymphoma which is precisely what Mia's is looking like. All the cats also " No association with positive retroviral status was found". She is also clean. It's not 100% but that is what it appears to be and makes a helk of a lot more sense.

As you all have pointed out - the outcome is the same but having something more solid helps to process this and digest and accept what's going to happen.
 
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Update: Her belly hurts. That I can tell for sure. Which is probably making her nauseous as well. It really is looking like I'm going to lose her sooner than later because of this. I can try a few more things - I pick of the Ondansetron tomorrow as the pharmacy is closed. The other thing I wonder about is that she was on so many antibiotics the past few months and that UTI that started all this.

I think we need to check that and if that not it - then it's the cancer.

I would hate to let her go and find out it was part of that BAD UTI and two lots of anti-biotics, (one March 30 + and then another heavy dose the end of June antibiotics) that caused her tummy upset and we've lost time. If it's not that - then I think it might be time to let her pass. I feel bad at the idea of having her go through a check but at the same time...

I hate this.

The more I research and read the vets research the more I'm thinking this sounds exactly right.

This is part of the research: Cutaneous lymphoma of the tarsus in cats: 23 cases (2000-2012) - PubMed

Charlie will be having an ultrasound. Asthma is acting up and now he has pancreatitis. My heart can't take much more.
 
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