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.