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Cat Forum / Cat Anecdotes / December 2007Oscar's visit to the specialist
DH, Oscar and I went to an internal medicine specialist today. Oscar has not been acting like a sick kitty in the slightest -- she's alert, and I've heard her thundering around the house, chasing who-knows-what from here to there. The main difference is that she's avoiding us (probably because we are Those Who Medicate) and that she seems to dislike most of the foods she used to adore. All of that doesn't change the fact that she has cancer, though, so ... Apparently, online reading materials aren't all that accurate, since they tend to conflate a lot of different cancers into general terms. According to this specialist, small cell lymphoma has different factors than other types of lymphoma, and that it's in the GI tract even further changes the situation. Apparently "small cell" is a positive thing -- it means that the cells are only slightly mutated, meaning they are not behaving as aggressively as blast cells, which are a much worse situation. And apparently, cancer feeds on carbs, so I wish Oscar liked wet food better. The specialist thought dry kitten food was a great idea (higher in protein than dry cat food), but I just checked and Evo has min. 50% protein compared to the kitten chow's 40%. So I put down some Evo and we'll see if Oscar will accept that. We talked a lot about chemo and the pros and cons -- it sounds like the particular chemo pill, Leukaran, is pretty benign compared to most chemo treatments. The main question is, can we pill Oscar and can we do it without traumatizing her? It would be once every other day, possibly (depending on how she does) reduced to once every three or four days. Also blood tests for the first few months to monitor her white blood cell count. We'd also need to give her Prednisone (actually a variant that's more feline-friendly), either daily in a suspension or as a shot once every three weeks. Apparently there's a pharmacy in town that will compound in pet-appropriate flavors, too. So .... DH and I are still discussing all of this. We have prescriptions for both the meds if we decide to go that route. Both of us agree that if we try chemo and Oscar refuses to be pilled, is traumatized by the pilling, or has unpleasant side effects from it, we will not continue to force it on her. But we came into that visit being so sure we wouldn't do chemo. Now, not sure. Honestly, I don't want advice; I think I understand the situation pretty well, and I can talk to the vet further if I need to. I just wanted to let you guys know what's going on. Right now, Oscar at least appears to be healthy and comfortable, and that seems to mean that I am coping much better than when she was frail and I thought she wouldn't make it. I mean ... when I thought she had a few days or weeks at most, it was all pretty traumatic. Now, it sounds like she has a chance of one or two relatively pleasant years ... it's hard to feel that with the same immediacy. (Or it could be six months. Or fewer. As the vet said, this is where a crystal ball would be helpful.) I do think these visits where Oscar might be picked up, but otherwise isn't manhandled, are maybe good for her comfort level with vets. We did pull her out of her carrier to look at her stitches, and the vet showed us how we can try to pop a pill into her ... but other than that, it was pretty mild. The vet even took Oscar's temp via her armpit! Wonder why they don't do that more often.  Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca (((((((((Monique, DH and Oscar))))))))) SignatureJoy Life's a trip! ...But it doesn't come with a map. -- Ziggy > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. I am so sorry what you are going through with your beloved Oscar. We are sending you our very best purrs. if you wanted advice I wouldn't give it because you said the most important thing, you are going to do what is best for her and that gets you wings in my book, Lee > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 66 lines] > > pictures: http://www.bounceswoosh.org/rpca > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. Well, it's a good news, not so good news kind of thing. We're continuing to purr for Oscar and for you and DH. I'm sure you'll do the best you can for Oscar. Sam, closely supervised by Mistletoe I am keeping you all in my thoughts. There is also another food by Nature's Variety that is a "low carb" dry food, Instinct. It might be more palatable. You could try the Evo and NV canned foods, she might like one. It's true, carbs are like food for cancer. I hope you find a treatment regime that works. > I am keeping you all in my thoughts. There is also another food by > Nature's Variety that is a "low carb" dry food, Instinct. It might > be more palatable. You could try the Evo and NV canned foods, she > might like one. It's true, carbs are like food for cancer. I hope > you find a treatment regime that works. Thank you for the ideas. There's a food we got a sample of -- made with Venison and salmon! -- that Oscar likes. I think it's a local product, rocky mountain somethingorother. It's dry (sigh) but guaranteed min 42% protein, better than the Purina kitten food (40%), not as good as the Evo (50%). Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. Sending heartfelt purrs that Oscar will continue to enjoy her life. MLB > But we came into that visit being so sure we wouldn't do chemo. Now, > not sure. Honestly, I don't want advice; I think I understand the > situation pretty well, and I can talk to the vet further if I need to. > I just wanted to let you guys know what's going on. Yes, please keep us updated. This sounds a lot more hopeful than your last update. Purrs for the hard decisions in front of you. SignatureMarina, Miranda and Caliban. In loving memory of Frank and Nikki. >DH, Oscar and I went to an internal medicine specialist today. <snip> Purrs for her health, and for you to be comfortable with whatever decision you end up making. So much of the decision has to be based on the personality of the patient. Of my three, LB is easy to medicate, and a couple minutes afterwards all is forgiven. Spotty isn't difficult, but she harbors a grudge for quite awhile and hides out after each dose the one time I had to treat her. Sammy is a real trial and fights the meds. She doesn't hide out after being dosed, she sits across the room glaring at me plotting her revenge. > So much of the decision has to be based on the personality of the > patient. Of my three, LB is easy to medicate, and a couple minutes [quoted text clipped - 3 lines] > doesn't hide out after being dosed, she sits across the room glaring > at me plotting her revenge. Oscar fights, hides, runs, generally makes us and herself miserable -- but recently she seems to have decided that after the meds are over, she has at least a few hours of safety. At least, the last few times, after we've medicated her she hasn't bothered to go into hiding. Once I noticed this, I've been encouraging it by offering treats after the meds. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >DH, Oscar and I went to an internal medicine specialist today. >But we came into that visit being so sure we wouldn't do chemo. Now, >not sure. Honestly, I don't want advice; I think I understand the >situation pretty well, and I can talk to the vet further if I need to. >I just wanted to let you guys know what's going on. (SNIPPAGE) It's VERY good to hear that Oscar is doing so much better, and may have a much better chance at a longer, much better quality life. I certainly hope that is the case, whether you decide to proceed with the chemo or not. Purrs on the way for the best possible outcome for Oscar. ~~~~~~~~~~~~ "Life without cats would be only marginally worth living." -TC, and the unmercifully, relentlessly, sweet calico kitty, Kenzie. How you behave towards cats here below determines your status in Heaven. - Robert Heinlein Life is very difficult. Once you understand that, life becomes easier. -Buddha > And apparently, cancer feeds on carbs, so I wish Oscar liked wet food > better. Try some of Fancy Feast fish diets, most of them are very, very low in carbs. I use them to wean diabetic cats off insulin. The specialist thought dry kitten food was a great idea (higher > in protein than dry cat food), but I just checked and Evo has min. 50% > protein compared to the kitten chow's 40%. So I put down some Evo and > we'll see if Oscar will accept that. You can also try Hill's Prescription Diet m/d and Purina DM. Both are low carb diabetic diets. > We talked a lot about chemo and the pros and cons -- it sounds like > the particular chemo pill, Leukaran, is pretty benign compared to most [quoted text clipped - 7 lines] > there's a pharmacy in town that will compound in pet-appropriate > flavors, too. Speak to your vet about omega-3 supplements (derived from menhaden or salmon fish oil only- not from plant material). EPA and DHA alter the fluidity and permeability of cancer cell membranes making them more susceptible to chemotherapeutic drugs and the cat's own immune system. They also help limit tumor growth and help prevent cachexia and metastasis. Print this out for your vet: http://maxshouse.com/Oncology/Nutritional_Care_of_Cancer_Patients.pdf Best of luck, Phil > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 4 lines] > possibly (depending on how she does) reduced to once every three or > four days. My Jeeves had an instance of megacolon and was prescribed a pill to take twice a day for the rest of his life. This is a cat who has to be heavily sedated for a routine visit to TED and even then the adrenaline kicks in and he can burn right through the sedatives. The sweetest boy at home but I didn't want him to start hating us for twice a day cramming a pill down his throat. There is a product called "Pill Pockets", a small soft treat with a pocket in it to put the pill. I insert the pill, squish the treat around it so it becomes a little round treat and Jeeves BEGS for it! SignatureElise (supervised by Gossamer & Jeeves) pics: http://photos.yahoo.com/dragonandthistle@snet.net > My Jeeves had an instance of megacolon and was prescribed a pill to > take twice a day for the rest of his life. This is a cat who has to [quoted text clipped - 6 lines] > pocket in it to put the pill. I insert the pill, squish the treat > around it so it becomes a little round treat and Jeeves BEGS for it! I tried it -- she won't even eat it plain! Unfortunately she has always been a very picky eater, and her illness is making her much more so. She won't even eat chicken breast or tuna, foods she used to beg for! (Never though I'd miss her begging ...) Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. {{{{{{{{{{{{ Monique }}}}}}}}}}}} Still purring for Oscar. SignatureAdrian (Owned by Snoopy & Bagheera) Cats leave pawprints on your heart http://community.webshots.com/user/clowderuk > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 40 lines] > traumatized by the pilling, or has unpleasant side effects from it, we > will not continue to force it on her. I can't tell you what to do in your situation, Monique, and I won't criticize you no matter what you decide because I know you love Oscar and put her best interests first much more than any of us here. But please consider this... pilling even a difficult cat* takes, at most, about 5 minutes (not counting the 25 you spend chasing them down, but you can get around that**). The other 1,435 minutes in every day can be used to offset those 5. I know it's human nature to focus on the negative and ignore the positive, but try to weigh those 5 minutes against the other 1,435 when you're making your decision. Also consider that, unlike humans who regret the past and dread the future, cats live in the moment and will forget and forgive very easily. *Sammy is 18 pounds of pure muscle and will not hesitate to bite or scratch if we do something to her she doesn't like, so I had to find a way to pill her that 1) was quick and easy; and 2) I had a reasonable chance of living through. What I found works very well: First, fill a large syringe with water and place it within reach of where you'll give her the pill. Take a piece of real butter (unsalted) that is roughly twice as big as the pill; shove the pill inside and mush up the butter so that the entire pill is covered. This does two things, it both disguises the taste of the pill with a taste she'll like, and it makes the pill very slippery so it will glide down her throat easily. Sit down on your heels with you knees apart and wedge Oscar between your legs with her butt in your crotch (sorry for the crudity, but I'm more worried about making the instructions clear). Bend over her so she can't jump upwards and away. Put your left hand under her chin, cupping her mouth and tilt her head up towards your face. Put the thumb and index finger of your left hand into the corners of her mouth forcing her mouth open and pushing the skin there over her back teeth slightly (she will hesitate to bite down on her own flesh). Stick the pill on the tip of your index finger (the butter should help it stick without falling off) and push it as far as you can to the back of her throat then *immediately* close her mouth and hold it closed with her head still tilted and immediately blow into her nose. Repeat blowing into her nose until you feel her swallow. As soon as she swallows the pill take the syringe and put the tip into the corner of her mouth and squirt water slowly until the syringe is empty. It's important to follow a pill with water because some medications will stick in a cat's throat and can cause an abrasion or a stricture that will cause further problems in getting her to eat. Immediately after that give her a treat and praise her lavishly in a high-pitched voice for being such a good girl. Once pilling her becomes quick and easy she'll be less traumatized and will start looking forward to the treat rather than dreading the pill. **You'll have to find the one thing that she absolutely can't resist - with Sammy it's Fancy Feast Gourmet Gold dry food which I use as treats rather than for their meals, but every cat is different and you'll have to try and find what it is for Oscar. Call her to you with a "special" phrase that you only use for calling her to treats. Do this 3 or 4 times a day, but use one of those times to pill her and vary the times so she doesn't detect a pattern. > But we came into that visit being so sure we wouldn't do chemo. Now, > not sure. Honestly, I don't want advice; I think I understand the > situation pretty well, and I can talk to the vet further if I need to. > I just wanted to let you guys know what's going on. I'm sorry, I can't help but try to solve a problem when I see one - *especially* when it's a friend who is hurting over something. It goes without saying that you don't have to take the advice - as I said above nobody loves Oscar more than you do, and only you can judge what her quality of life is like. > Right now, Oscar at least appears to be healthy and comfortable, and > that seems to mean that I am coping much better than when she was [quoted text clipped - 11 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. Purrs that it's years and not just months that you have her with you. Hugs, CatNipped >> So .... DH and I are still discussing all of this. We have >> prescriptions for both the meds if we decide to go that route. Both [quoted text clipped - 31 lines] > her a treat and praise her lavishly in a high-pitched voice for being > such a good girl. I never did the butter thing but Persia's pills were very small. Blowing on the nose while holding her mouth shut automatically induces the swallow reflex. After a couple of times she just sort of sighed, "Okay, here we go again" and it wasn't a huge struggle to medicate her. (I tucked her under my left arm, though, rather than hold her between my legs. And the vet never said I needed a syringe with water, although this sounds like a good idea.) Jill > I never did the butter thing but Persia's pills were very small. Blowing on > the nose while holding her mouth shut automatically induces the swallow [quoted text clipped - 3 lines] > never said I needed a syringe with water, although this sounds like a good > idea.) I wish Mojo was that easy, he's as strong as an Ox and really doesn't like to be pilled. Ideally it's two man job, one to hold him down and one to pry open his jaws, and even when you think you've succeeded, there's about a 50% chance you'll find the pill spat out somewhere around the house a day or so later. Just as well he heels well, because treating him is next to impossible, even the vet agrees ;-) -- Nik Simpson >> I never did the butter thing but Persia's pills were very small. >> Blowing on the nose while holding her mouth shut automatically [quoted text clipped - 13 lines] > > -- Nik Simpson Mojo sounds like Oscar in this regard. I've only given her liquid meds so far, and it's torture for both of us, and she gets more difficult with every dose. And she avoids us for days. I'm hoping pills will be easier, but I'm not holding my breath. If it's too traumatic for her, I'm not going to force the issue. It's not like she'll ever be cured; the best we can hope for is a chance at a remission. It's not worth making both of us miserable. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >> I never did the butter thing but Persia's pills were very small. Blowing on >> the nose while holding her mouth shut automatically induces the swallow [quoted text clipped - 10 lines] > around the house a day or so later. Just as well he heels well, because > treating him is next to impossible, even the vet agrees ;-) One of my friends has a diabetic dog who has to be given insulin shots. His solution was to always give the dog a small treat at the same time he gave her the shot. Now, when it is time for the shot, the dog will seek him out. Obviously, from the dog's point of view, the treat outweighs the discomfort of the shot. SignatureJohn F. Eldredge -- john@jfeldredge.com PGP key available from http://pgp.mit.edu "Reserve your right to think, for even to think wrongly is better than not to think at all." -- Hypatia of Alexandria > One of my friends has a diabetic dog who has to be given insulin > shots. His solution was to always give the dog a small treat at the > same time he gave her the shot. Now, when it is time for the shot, > the dog will seek him out. Obviously, from the dog's point of view, > the treat outweighs the discomfort of the shot. Oscar doesn't mind shots much; she minds being held immobile, though, which is a prereq. But in order of difficulty I'd say it's shots -> pill -> liquid meds. SubQ was a big fight; I think she could feel that cold (relative to her body temp) liquid rushing in and of course that felt unpleasant. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >> One of my friends has a diabetic dog who has to be given insulin >> shots. His solution was to always give the dog a small treat at the [quoted text clipped - 8 lines] > SubQ was a big fight; I think she could feel that cold (relative to > her body temp) liquid rushing in and of course that felt unpleasant. I've heard you can warm the bag of subq fluids first by putting it in a warm water bath so that the temperature difference isn't so uncomfortable. I did give subq fluids to 2 cats over a long period of time and we did the treat idea like your friend did with his dog. Christine > DH, Oscar and I went to an internal medicine specialist today. I'd say the results were pretty positive, so we're purring for a good outcome with Oscar having a good couple of high-quality years with you. I'm sure you'll find a way to medicate without causing undue stress. Purrs Gordon & the FF > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 5 lines] > > All of that doesn't change the fact that she has cancer, though, so... Purrs for Oscar, and for your and DH's nerves. I know you'll make the best decision. And really, pilling isn't all that difficult once you get the hang of it. After a while Persia (who also doesn't like being picked up) just sort of looked at me like "Here we go again" and didn't put up such a fight. Jill > Purrs for Oscar, and for your and DH's nerves. I know you'll make > the best decision. [quoted text clipped - 3 lines] > just sort of looked at me like "Here we go again" and didn't put up > such a fight. I didn't answer this earlier because I was really angry at the "not all that difficult" comment, and I know you were saying that to be helpful and reassuring. So I didn't want to blow up at you. Oscar has been so difficult in many ways, and historically she *has* held grudges for medical treatment. Anyway, we just gave her her first chemo pill today, and it went surprisingly smoothly. We used the technique the vet recommended -- the pill went right down the hatch. Oscar swallowed a few times, then looked at us, waiting for the other shoe to drop. "What, you tackled me and that's it? Where's the torture?" I followed up with some treats. If she has any side effects from the stuff, we'll probably know in a few days. Hopefully it continues to go this smoothly. The liquid prednisone is much worse. It's prednisone, which is bitter enough that when I've taken it it activated my gag reflex, flavored by the manufacturer with cherry, then put in a bacon-flavored suspension by the pharmacy because they say it's the only flavor strong enough to mask the cherry. Oscar *hates* it (and I can't blame her). The first time we gave it to her, she foamed at the mouth and drooled uncontrollably. The second time, she vomited clear liquid. Every time we give it to her, she licks her lips and generally acts like she's queasy. Also, probably because it's so awful, she doesn't clean it off of herself very well. I also have concerns about getting it onto my skin, which I seem to do every time we try to dose her. So I've asked the vet to give us a prescription for injected steroids. That will be DepoMedrol. She thinks it's more likely to cause diabetes than the ingested form; I'm thinking, how likely is it really that she'll get diabetes before the cancer gets her? The injection would only be once every three weeks, too, so a lot less torture for Oscar ... unless of course it *does* trigger diabetes. But she's been at risk for that all along, getting steroid shots for her EGC. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Anyway, we just gave her her first chemo pill today, and it went > surprisingly smoothly. We used the technique the vet recommended -- the > pill went right down the hatch. Oscar swallowed a few times, then > looked at us, waiting for the other shoe to drop. "What, you tackled me > and that's it? Where's the torture?" I'd be interested to know what this technique is. Occasionally I have to pill my cats, and none of them are particularly receptive. > The liquid prednisone is much worse. It's prednisone, which is bitter > enough that when I've taken it it activated my gag reflex, flavored by [quoted text clipped - 5 lines] > time we give it to her, she licks her lips and generally acts like > she's queasy. Oh, poor Oscar! :( That foaming at the mouth thing sounds scary, or at least, an indication that her body really wants to reject the stuff, at least if ingested orally. That sounds like a miserable experience for everyone. The shots do sound like a much better idea. Purrs and good luck, Joyce > > Anyway, we just gave her her first chemo pill today, and it went > > surprisingly smoothly. We used the technique the vet recommended [quoted text clipped - 4 lines] > I'd be interested to know what this technique is. Occasionally I > have to pill my cats, and none of them are particularly receptive. Hrmm. There isn't really a "trick" to it -- and it may not work quite as well the next time; who knows. But here goes. There are two things -- one is to tilt her head straight up, the other is to put pressure on either side of her jaw to open her mouth slightly. These are very small pills. Then you drop it and because her head is tilted straight up, the pill goes right to the back of her throat. The idea is to keep it from dropping on her tongue, because she can use her tongue to wiggle the pill back out. What we did is, I held her and positioned her face while DH dropped in the pill. With one person I imagine it would be much more difficult. Now, this is all assuming it really worked and that I won't find the pill on the carpet somewhere someday ... > > The liquid prednisone is much worse. It's prednisone, which is > > bitter enough that when I've taken it it activated my gag reflex, [quoted text clipped - 10 lines] > stuff, at least if ingested orally. That sounds like a miserable > experience for everyone. The shots do sound like a much better idea. My understanding is that the foaming at the mouth is a response to the bitterness of the pill. It's really foul stuff, prednisone. I guess this stuff is technically prednisolone. > Purrs and good luck, Joyce Thank you. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Anyway, we just gave her her first chemo pill today, and it went > surprisingly smoothly. We used the technique the vet recommended -- the [quoted text clipped - 3 lines] > If she has any side effects from the stuff, we'll probably know in a > few days. Hopefully it continues to go this smoothly. <snippage> Glad to hear the chemo pill went down so well. It sounds much more sensible to give her the steroid shots than the supension. Many purrs on the way for all the medicating. I went through a lot of similar things with Frank and Nikki in their later years. It's tough. Hang in there! SignatureMarina, Miranda and Caliban. In loving memory of Frank and Nikki. > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 61 lines] > that, it was pretty mild. The vet even took Oscar's temp via her > armpit! Wonder why they don't do that more often. {{{{Monique}}}} No advice, since you didn't want any, and I'm not sure I have any, anyway. It's a tough choice and a hard situation. I am glad you have time with Oscar while she's still seeming healthy and comfortable; that is wonderful for both of you. Hug her lots and lots. Purrs to you both (and DH, too). Ginger-lyn SignatureHome Pages: http://www.moonsummer.com http://www.angelfire.com/folk/glsummer (homepage & cats) http://freepages.genealogy.rootsweb.com/~summer/index.htm (genealogy) http://www.movieanimals.bravehost.com/ (The Violence Against Animals in Movies Website) Many purrs for Oscar. --Fil > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 27 lines] > chemo treatments. The main question is, can we pill Oscar and can we > do it without traumatizing her? <snip> Lots and lots of purrs, Polonca and Soncek > DH, Oscar and I went to an internal medicine specialist today. > [quoted text clipped - 65 lines] > > pictures:http://www.bounceswoosh.org/rpca I am so sorry to read this. I am late in posting but my computer had an untimely death. Purrs going out for you Monique and Oscar. Please keep us posted on Oscar's progress. Belated Happy Birthday and Happy Thanksgiving! Winnie |
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