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.