12 weeks

Well it has taken me three weeks to be able to write this blog. Fez lost his battle on October 4th, 2009. We woke up that morning and he had begun vomiting blood. He was still happy and wanted to eat what little tuna he was able to put in his stomach, but he was quiet and no longer wanted to play. He just wanted to be with us. I knew that keeping him around longer would be for me...not him.

I am thankful for the time we had with Fez. The chemotherapy gave us exactly 12 weeks. While these 12 weeks had their ups and downs, for the most part they were a good 12 weeks. We will miss him running loudly down the hall, his requests to play with the laser and his constant quiet companionship while I study.

He has a beautiful resting place up at my parents cottage. We had him cremated by Gateway Pet Memorial. http://www.gatewaypetmemorial.com/ They are amazing people and I would highly recommend them. We buried Fez's urn under a burning bush. Appropriate I thought because every fall, near the time he left us, the leave of the bush will turn a bright vibrant red as a reminder of Fez. A beautiful showy shrub I am sure he would approve of and would even taste if he was given the chance.

The end of "Induction"

Today was Fez's last day of the induction phase of his chemotherapy protocol. The induction phase is an intense chemotherapy protocol that alternates 3 chemotherapy drugs in weekly intervals for 6 weeks. After the induction phase, the response to the chemotherapy will be assessed and the plan for the rest of the chemotherapy determined. Unfortunately, I was not able to bring Fez in today for his chemo, as I was ill. Richard, my loving husband, brought Fez in today. Things went well and Fez is happily sleeping in the study with me as I type. Thank you Richard!!

Fez has gotten used to his routine, and while he doesn't like going on the weekly trips to OVC, he has come to accept it. The oncology group at OVC has been fabulous - thanks Geri, Melanie, Danielle, Paul, Steve, Maude and Amandine!! A week from today, Fez will go in to be re-assessed and we will then know what the plan will be and whether the chemotherapy has been successful. So far, clinically, the chemotherapy has done a great job at eliminating his clinical signs - no more vomiting, diarrhea or inappetance. However, a repeat abdominal ultrasound will be necessary to re-evaluate the stomach mass. So until then, we will enjoy this "in between" knowing and be happy with how he is doing right now.

Irony: When poison makes you feel better

Today has been a good day for Fez. He has been more active and has his appetite back. He received his chemotherapy dose on Monday and for the next few days was under the weather. Today I am happy to report he was asking for food and to play with his laser. It appears that the chemo is at least helping him feel better! While I understand the science, it still seems odd that giving poison makes him feel better.

Day 29: a change of plans

CS Lewis wrote: “To love at all is to be vulnerable. Love anything, and your heart will certainly be wrung and possibly broken. If you want to make sure of keeping it intact, you must give your heart to no one, not even to an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements; lock it up safe in the casket or coffin of your selfishness. But in that casket- safe, dark, motionless, airless--it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable.”

I love this quote.

Unfortunately, it is so true and my heart is really sad right now. Fez went in for his second chemotherapy treatment. He hasn't been feeling himself for the last week and a bit and has only been eating small amounts. Well today we found out why... the mass in his stomach has grown significantly since his previous ultrasound a month ago. It appears that the first chemotherapy treatment did not work. The mass has grown and he is now anemic and weak. The good news is that his stomach had not ruptured - this was a big concern. The debate today was whether or not to give him more chemotherapy. A difficult decision - Fez may feel better if the chemotherapy starts to address the tumor - alternatively, it may make him feel worse. We decided that we really did not have much to loose - so Fez received his next dose of chemotherapy (Vincristine). We are now trying a different protocol - a more intense one. Unfortunately, this means Fez will have to go in to the school weekly for the next 6 weeks. He seemed to deal with the visit ok and has come home and is not hiding! I don't get the impression that the prognosis is good. We will see what the next little bit holds.

One day at a time...

Smorgasbord

Fez has been feeling under the weather this past week and a half. His appetite has steadily declined and he has begun to vomit again. We are a little saddened by this set back. I spoke today with Fez's oncologist (Dr. Woods). Dr. Woods feels that the current chemotherapy protocol may be allowing the cancer to rebound between treatments. We chatted about repeating the abdominal ultrasound and possibly changing his chemotherapy protocol. This is a difficult decision. I did not want Fez going in for chemo weekly or continuously for the rest of his life. I am hoping we can find a reasonable compromise. It looks like we may try the 6 week intense induction and then spread out the treatments... Fez's next chemotherapy treatment is Monday. In the mean time, I need Fez to start eating. So tonight he was given yet another medication (Mirtazapine) an appetite stimulant and anti-nausea medication. It seems to have worked! (Along with the smorgasbord of Tuna and two other tasty types of cat food)

Day 15 - week one blood work

Today Fez again accompanied me to school. He was scheduled to return to have his blood drawn to see how is body dealt with the chemotherapy drugs. Chemotherapy drugs are intended to kill rapidly dividing cells. This is beneficial, in that most cancers fit the rapidly dividing cell concept; however, other cells, such as nascent blood cells (in the bone marrow) also fit the rapidly dividing cell concept. Consequently, the chemotherapy medication can affect his ability to make blood cells, which are essential for survival.

Fez's body has taken the chemotherapy well! It appears that his blood cells are all within acceptable limits!! What does this mean? Well it means that he is still able to fight infections, should he encounter them. It also means that he will likely be able to receive his next dose of chemotherapy on schedule as planned - a good thing! His next treatment is scheduled for Monday August 10th, 2009.

Fez was feeling a little under the weather this weekend - started vomiting again. We have re-started the anti-nausea medications and the vomiting has stopped so far. This vomiting could be related to his chemotherapy medication, as it can cause problems up to a week out or it could be related to the mass in his stomach. Either way - he is much happier now that the vomiting has stopped. I am so thankful for anti-nausea medications!

Here is a picture of Fez. It is from this weekend when he was a little under the weather. He had found a nice comfy spot on the papasan chair to take a nap. Note - He still has his whiskers!!!

Thump thump thump....

This is the sound that Fez makes as he runs around the house. It is a good sound to hear again! Fez has done well so far and seems to be back to himself. He is active and tears around the house. At the same time, he has returned to sitting with me in the study and asking to play with his laser. I wasn't sure what this week would bring. Some animals are a little lethargic, nauseous, inappetant and generally tired after chemotherapy. So far the only negative effect I have noticed is that Fez's appetite has decreased a little. He is still hungry - just eats somewhat less than what he would previously eat.

On Monday, Fez goes back in to OVC to have his blood pulled. We will submit it to determine how his bone marrow responded to the chemotherapy. Like any human on chemotherapy, his white blood cell count will fall and he will be more susceptible to infections. We will need to monitor his blood work as well as any clinical signs that he may not be well. Thankfully he is doing well so far!

p.s. He hasn't lost any whiskers yet!

First day of chemotherapy

Today was Fez's first day of chemotherapy. It is day 8 after his diagnosis. He came to school (Ontario Veterinary College) with me and met the oncology service. The chemotherapy drug Fez is receiving is called Doxorubicin. He can only have a limited number of treatments over his lifetime - so this means likely 4 to 6 treatments total (depending on how he responds). If all goes well, his treatments will be spread out over 3 week intervals. Cats respond fairly well and tend to have fewer side effects than dogs. The most common side effects are lack of appetite, vomiting and diarrhea. So far he is doing well - ate his dinner and has not vomited or had diarrhea. We will see what the next few days bring. Please keep him in your thoughts and prayers. Something I did learn today - he may loose his whiskers.

Feeling better

Fez has had a good weekend. Between the pain medication and the anti-nausea medication, he is almost back to himself. He has returned to his post beside my chair as I sit at my desk and study - something he has not done in a while. In addition, he asked several times today to play with the laser pen. Again something he had given up. Here are a couple of pictures of Fez on the night before his first chemotherapy session. Note the shaved belly from his ultrasound biopsy. Overall he looks great!

Three to six months...

Fez, like many cats, is a vomiting cat. He is mostly an indiscriminate eater and will consume anything that falls on the ground near him. We have always joked that Fez's first serious medical condition will be a foreign body. Over the past 6 months, his vomiting has become more frequent and we have been working him up, suspecting inflammatory bowel disease. His most recent visit to the vet included an abdominal ultrasound, an experience Fez has had before. However, unlike his previous ultrasounds, this one was abnormal. The ultrasound showed a large mass in the wall of his stomach. The mass was aspirated with the help of the ultrasound and the sample was submitted for cytology. This sample led to a diagnosis of large cell lymphoma - a diagnosis we were not expecting.

Most of us know someone or know of someone with cancer, but few of us think about cancer in the context of our pets. Even though I am a veterinarian and I have had, unfortunately, several experiences with pets and cancer, it is difficult when it is one of your own. Treating pets with cancer is a difficult and personal decision. I imagine the experience is similar to treating a child with cancer, they do not understand why they are being exposed to such treatments and why they are sick. I was once told by one of my MD clients that veterinary medicine was much like pediatric medicine: our patients cannot directly tell us what is wrong nor can we communicate directly with them.

I was thankful for a diagnosis for Fez; however, at the same time I am sad. Large cell lymphoma involving the gastrointestinal tract carries a poor prognosis with the average life span, after diagnosis, of about 3- 6 months. This was day one.

Indecision

What to do? Many options were offered for Fez, from intense chemotherapy protocols to exploratory and possibly excisional surgery. The catch... Fez is a cat that "hates" being in the hospital. He hides for about a week after I bring him in to the hospital. To make matters worse, he has very poor veins and often requires multiple attempts to sample his blood. The intense weekly chemotherapy protocol, did not seem the right fit for Fez. I really wanted his remaining time to be with me - not hiding behind the furnace or hospitalized. After several days of deliberation, we chose a middle of the road chemotherapy protocol for Fez - one that may not achieve remission, but hopefully will minimize his clinical signs for his remaining time. The most important part - he will only need to be in hospital for 4-6 treatments, not for the rest of his life.

Stoned

Well not really stoned, just feeling comfortable finally. After Fez was sedated for his ultrasound biopsy, he was much happier and interactive. It then dawned on me - he had been painful. One of the sedatives given was also a mild pain reliever and his demeanor changed because it addressed the pain. Fez now has a prescription of pain medication to keep him happy. He has again returned to being my companion, while I read, and is no longer hiding. The other medication Fez is currently on is an anti-emetic (anti nausea) injection. So far so good, no vomiting since the first dose last night.

It has been a long and emotionally exhausting week. Fez's first day of chemotherapy is on Monday July 20th, 2009. This will be day 8. I am not sure what form this blog will take. It will likely be a journal of our decisions, our highs, our lows. Here is one of my favorite pictures of Fez. He is sitting in the duffel bag that came back from the hospital after my hospital stay a little over a year ago. Enjoy!

p.s. No cats do not go bald when given chemotherapy... they do, however, loose their guard hairs so become softer. Maybe he will rival our other cat Soleil for softness.