Switching from vetsulin to prozinc: Part 14

Time for the next part in the saga... http://www.felinediabetes.com/FDMB/...to-prozinc-part-13.176803/page-2#post-1955332

 

Vet called back about Smokys ultrasound results, still waiting for blood work results. It's not good news at all. The thickening of his intestinal walls is much worse than six months ago. The radiologist said high probability of intestinal lymphoma and one of his kidneys is enlarged.
I told the vet no invasive procedures on him.
She said the only treatment option I can try is to switch to prednisone and try chlorambucil. Mind you, this is w/o results from blood work which cld come back that he has malabsortion issues and needs enzymes to correct it. I don't know what I shld do. Does anyone have a cat who took chlorambucil and how does it affect them? Does it make them feel really sick? I am debating on whether to have him put to sleep at this point.

 

So sorry for the bad news, Lisa I didn't read this entire thread but it was the most talk of Chlorambucil: http://www.felinediabetes.com/FDMB/threads/bix-update.31888/#post-331190
Gator & H is the member that used it and predisone. Don't think they've been around for quite a few years, can't even tag them just in case. Joanna & Bix also had a kitty with GI lymphoma looks like.

Article: http://veterinarycalendar.dvm360.com/managing-feline-gastrointestinal-lymphoma-proceedings

 

I called Smokys old vet to make an appointment to talk with them about possible euthanasia for him. I'll have to wait until I hear back from them tomorrow. He is more comfortable with the staff there and their bedside manner is far better. I don't know if it will come to that but I need to be prepared for it.

In one way I'm thinking it would be harder for him to go through the effects of the chlorambucil and pred. But there's always that nagging doubt about putting him through anymore. I'm worried he is in pain and about the possible side effects from the chlorambucil. The vet said it might extend his life a year or two but I have to look at quality of life for him too.

 

Oh my, this is such a lot for you to think about, Lisa. It's never easy to make a decision like this. Is it worth posting on the main forum asking about experiences with chlorambucil? Would having this information be helpful in your decision-making? We're here to support you in whatever you decide.

 

Thank you Kris.I thought about posting on the main health page. I'm just sad to see him looking so sick and he is almost 12. I didn't think that was old for a cat. He has not really improved all that much since last September so I'm not sure what to do.

 

No need to decide anything right away. Give it a little time to percolate in your mind. Maybe check out Yong's article link above and ask about chlorambucil. Try to make an assessment of Smoky's quality of life - eating, peeing, pooping, interacting with you, pleasurable activities, etc. Is it up and down? more down than up? trending down? Talk to your old vet. The good ones know how to discuss this compassionately. It's a process ...

 

Oh Lisa, I'm so sorry! I think Kris has given better counsel than I ever could. I just echo what she said that whatever you decide, we support you. After you have all the information from the vets and consider Smoky, I know you'll make the right decision, whatever it ends up being. Sending you and Smoky love and hugs.

 

I think Smoky looks forward to eating most of the time. He hides the rest of the time. My roommate says he watches out the bedroom window for me to come home from work. The window faces the street so he can see my car pull into my parking space. He doesn't want to sit with me anymore, just eats and goes straight to his carrier.

 

Oh Lisa, I'm sorry to hear that news. I think Kris is right...you don't need to make any decisions today. Take some time, do a bit of research, and then you can decide what is best for you both. NO MATTER WHAT YOU CHOOSE, we are here for you! We support you totally.

I know it's hard, but remember also that whatever decision you make is the right one, as it was made out out of love.

 

Smoky was 156 for PMPS so I'm guessing 0.5 units for tonight? I started him on the prednisolone tonight so will see how that affects his BG. He also started on an antibiotic tonight. I have B12 injections to give once a week.

 

Sounds right. Sending you and Smoky hugs and hopes that the new meds bring him some relief.

 

Smoky at 198 BG for amps. Started him on 5 mg of prednisolone last night. I'm thinking 0.6 units for am dose wld be OK?

 

Should be fine, Lisa.

 

Smoky was laying in his cat bed in bedroom this morning. He wasn't hiding in the closet or in his carrier.

 

Smoky was 185 for PMPS, it's been 12.5 hours since his last shot. I'm giving him the 0.6 unit dose again. He gets the prednisolone right after his pm shot. I'm waiting a few minutes for him to finish eating.

 

So far no jump up in BG with the prednisolone. Any difference in his demeanor today?

 

He is out more today and was laying on my lap for a little bit while I was laying on the bed.

 

I'm so glad to hear he came out and you had some snuggle time!

 

Smoky came out for a second time to lay on my lap on the bed again. I can tell he doesn't feel well though. I'm debating on whether I shld give him the bupe or not.

 

Is there a downside to giving it? (I haven't ever used it)

 

It can make them lethargic and diminish their appetite sometimes.

 

May 7: Smoky BG at 179 for AMPS. His numbers seem to be going down a little each day although the prednisolone seems to raise his BG a little more than the budesonide did. I'm thinking I shld hold the 0.6 unit dose yet. Or shld I try a little higher dose?

 

He seems fine with 0.6 u, Lisa. If you're off tomorrow and his numbers are similar maybe try 0.8 u then? You could get a mid cycle test to see where that takes him.

 

I'm off work today and tomorrow. I gave him the 0.6U dose for am. I'm not sure how much the prednisolone drops his BG during the day. I'll get in a few extra tests today to see how he is doing on the new med.

 

I'm going to try to grab a few hours of sleep before Smokys +4 test and lunchtime.

 

Smoky at 101 BG for +4 test. He has been pretty hungry today. He ate 7.5 oz for breakfast, and 3 oz of food for lunch. I have to give him a B12 shot today after dinner. He has been out quite a bit today but still has that peaked look. I gave him the bupe last night and it seemed to help him. My vet called in a prescription for 3 pre-filled syringes of the bupe with 2 refills. I'm not sure if I shld just give it to him at night, he seems to feel worse then. I thought about twice a day but the pharmacy is closed on Sunday. I'll be going over the treatment plan with his original vet on Monday that his current vet suggested for Smoky. I dread the idea of talking with him about the "other" possible option.

 

It's so good to hear he's rallying a little - having a good appetite and spending more time out with you. Know that we are all there with you in spirit tomorrow.

 

Keep in mind, Lisa, that talking to your vet about the "other" option is only talking. It doesn't mean you have to act on it. You can take whatever time you need to think it over. Meanwhile you'll be giving some different meds to Smoky that might just help him.

 

Smokys old vet called me back today to go over the results of his ultrasound. How many vets will do that on a Sunday? It's not looking good for my boy. There are multiple growths showing up on the ultrasound. It's not just in the intestinal wall and both his kidneys are enlarged.
His old vet said renal cancer may be there as well. There is just no way to tell w/o a biopsy being done but I'm not going to do that to him. I have to question why his current vet would suggest all these new meds having read this same report.

I don't know if it's right or not to try and give him the chlorambucil and have him go through possible side effects from that.
I did tell my old vet that I would need a week or two to make a final decision.

 

I'm so sorry to hear that things don't look good. In human medicine, some doctors will push for treatment even if the chances of survival/recovery are almost non-existent. Other doctors will present likely outcomes and push for hospice if the odds are not favorable. I wonder if something similar happened with the new vet: maybe no matter what the reports said, she might push for treatment?

Are you still meeting with the old vet tomorrow? Or were you able to get your questions answered during the phone call today? I love that he took the time to call you today and talk through what he was seeing in the reports. He sounds like a good vet.

 

Did your old vet have anything to say about whether chlorambucil might help? It was very nice of him to call you.

 

He pretty much answered my questions over the phone. He did mention that all I could do was make him as comfortable as possible in the meantime. I'm mad that the new vet didn't even bother to call me to go over the results from the ultrasound. She just automatically gave me all these meds for him to try that cost me a lot of money.

 

I guess you have to decide whether you want to give these a try or not. I know you're worried about making him feel worse. Very difficult situation ...

 

He doesn't really think that it will help him for long but said I could try it. He said I shld question his new vet about why she decided on the course of treatment that she did

 

Such a difficult situation, Lisa . I would question the new Vet on how / why she decided the course of treatment. But I do like to question almost everything .

 

This sure illustrates how important good communication with a vet is.

 

I'm sorry to hear that Lisa. Take some time and really think it through...and I would question the new vet too. Then you can make a decision. Remember that you have our support no matter what you do.

 

I talked to both my old vet and current vet. My original vet for him since he was a kitten is an old country doctor. He doesn't believe that chemotherapy will help much and says it will just make Smoky feel worse than he already does.
My current vet claims to have treated a lot of cats with cancer at her practice whose life expectancy ranged from 6 months to two years. I thought I cld try the chlorambucil until the end of the month and see how he does on it.
I was trying to accept and process the reality of having to let him go. I didn't want to do the same thing I did in Oct when I didn't treat him out of fear of giving him a cancer drug for IBD. I gave him 2 mg of chlorambucil an hour and 15 min ago. Soon after I gave him the dose he became very tired and peaked looking. The instructions are 2 mg every 3 to 4 days which I think is twice a week.

 

It may be that he'll come to tolerate it better over time as is the case with many human meds. I understand your thinking in wanting to try this first. We're here for you ...

 

I agree with your thought...I'd want to try it too. You can always go back and change your mind if needbe, but I think you'll feel better having given it a try. And maybe he will feel better after he gets used to it. That does happen.

 

Definitely understand wanting to give it a try. Hoping for good results for Smoky . We're here for your Lisa

 

Smoky was 172 for PMPS tonight, 14 hours after his morning shot. Shld I give him 0.5 units or same as am, 0.75? I'm giving him his shot about an hour late

 

I'd stick with 0.5U since his PM cycle is going to be shorter and the number is a little higher from a longer day cycle

 

Thanks I was thinking along the same lines as you.

 

Smoky was 207 for am BG, this was only 10 hours after his pm shot. I was thinking he might be OK with 0.8 units this morning. He did get into my roommate's cats dry food last night. I can't monitor today so shld I give a lower dose?

 

I think that dose should be OK.

 

I gave him 0.75 units this morning.
My roommate is home today to watch him for me.

 

My mom is throwing a guilt trip at me now about Smoky. She keeps telling me I am just in " denial" about the cancer. I just found out on Sunday the results of the ultrasound and the treatment options for him. She keeps telling me he is suffering every day and is in constant pain. I guess she wants me to not even try to treat the lymphoma at all and just put him to sleep right away.
She is not even taking into consideration that the meds may actually end up helping him to feel better. She says all the meds will do is make him sicker or not help at all. I'm not stupid and I know I will have to let him go at some point, it's cancer after all. Sorry, I'm ranting again, it's just so frustrating.

 

My mom is throwing a guilt trip at me now about Smoky. I just found out on Sunday the results of the ultrasound and the treatment options for him. She keeps telling me he is suffering every day and is in constant pain. I guess she wants me to not even try to treat the lymphoma at all and just put him to sleep right away.
She is not even taking into consideration that the meds may actually end up helping him to feel better. She says all the meds will do is make him sicker or not help at all. I'm not stupid and I know I will have to let him go at some point, it's cancer after all. Sorry, I'm ranting again, it's just so frustrating.

 

I'm sorry you're hearing this. It adds to your stress level. Do you have any sense that the pred and chlorambucil are having a positive effect? I know it's likely too early to tell.

 

I just started him on the chlorambucil last night and the pred about a week ago. I think it's too early to tell yet

 

Smoky BG at 167 for PMPS. I'm thinking 0.5U for tonight's dose?

 

Should be OK, Lisa . How are you holding up?

 

I'm doing OK so far. My friends and family are trying to rush me into making a decision. He is my cat and I have to at least try to help him with meds first.

 

That's so hard. Don't let them rush you, Lisa. This is YOUR cat and YOUR decision...and you have to do what you think is right. For what it's worth, I'd do the same thing you're doing. Remember you have our support.

 

Smoky was 298 BG for am reading.
Is that a bounce from the 209 last night?
His insulin is three months old so maybe that is the reason? His BG has jumped up a bit since starting the prednisolone. Any ideas on what to give for am dose?

 

It's more likely to be the pred I think. You could give 0.8 u again because you're away at work. Maybe try 1 u when you can test mid cycle if the trend continues?

 

I gave him the 0.8 unit dose for am.
I'm sad that the only thing Smoky looks forward to anymore is mealtime.
He only had one dose of the chlorambucil so far. I just want my old Smoky back again.

 

Hang on to that for now, Lisa.

 

Smoky dropped down to 144 BG, 12 hours after am shot. His BG was 298 this morning I'm thinking of giving him 0.5U for pm dose. Does that sound alright?
I wanted to add on that he didn't eat much for dinner. He did eat pretty well two hours prior.

 

Sounds good to me

 

Thanks Yong. I know the pred will raise his BG some later on but don't want to give him too much.

 

How are you holding up?

 

What a lovely number!!!

 

I'm OK so far but I can tell Smoky is declining in health a bit.

 

I think you're doing a great job of responding to the shifts in his BG with small adjustments and keeping them as consistent as you can, while still doing what he needs to keep him safe. I wouldn't worry too much about him having a small dinner, but if you think it was too small, you could try to get him to eat a bit before the onset around +2.

I'm so sorry he's declining a bit. Sending love to you and Smoky both.

 

You're doing great Lisa, and just make sure Smoky is comfortable. I'm sure he is very happy to be with you through all of this

 

How are you doing, Lisa?

 

I'm worried that the meds don't seem to be helping him much. His PMPS was 175 so is 0.8 unit dose OK or stick with the 0.5 one? Put in wrong BG for pm, was 157 not 175.

 

It's hard to know for sure without any recent mid-cycle tests, but my best guess is that the 0.8 would be okay, especially since you're giving him the pred. at night right now, right?

 

Yes, giving him pred at night. I decided to go with 0.6 units since his appetite is down today. It's Smokys 12th birthday today. I gave him a little bit of FF gravy lovers turkey feast. I know it's not good for his BG but the poor guy was so happy to get a few bites of it.

 

Lol....I think a little gravy lovers was a perfect birthday gift!!! HAPPY BIRTHDAY, Smoky!!!

 

Happy birthday Smoky! What;s a birthday for if you can't cheat on your diet a little bit??

 

Happy Birthday to your boy! He deserves a gravy treat!

 

I fell asleep flat on my back on the bed with Smoky sleeping stretched out on my legs. We just woke up not long ago from our cat nap.

 

Thinking of you and Smoky. Sending positive thoughts. Happy 12th Birthday, Smoky. I would have given him the gravy food for his birthday too!

 

Oh I didn't get on computer last night but Happy Belated Birthday, Smoky! Hope he enjoyed his cheat treat
I'm guessing there are quite a few fur baby birthdays this month