Wolfie's home. report not good :(

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Cheryl and Winnie, May 29, 2010.

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  1. Cheryl and Winnie

    Cheryl and Winnie Well-Known Member

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    Dec 28, 2009
    I got home with him around 9pmish.

    He is very weak and wobbly. had to shut the door to the basement to make sure he doesn't try and do the stairs.

    His LFTs ( liver function tests) jumped up and this time his bilirubin was up too. they said he is a little jaundice. I was expecting a very yellow cat. but I can't tell.

    u/s showed ---
    liver mass --- either his previous cystadenoma has enlarged greatly ( even though benign they can grow)
    or he has developed a malignant adenoma. I was told that the location of it made the IM spec uncomfortable to take an aspirate.

    the mass my vet felt was enlarged lymph node. there are many. and thickening of his small intestines . His stomach was hard to tell if thickened or was folded over on self.
    no aspirate done . grrrrrrrrrrrrrr

    his kidneys, although the function is still steady, have become smaller than before. ( although it could be subjective from one ultrasounder to another.

    his pancreas looked ok for a change.

    choices given.

    1. open him up for biopsies of all masses and small intestine and possibly remove 1/2 of his liver ( which would be only treatment for an adenoma)
    with a HCT of 17, his kidneys and yes I must factor in his almost 19 years ( june 19 bd)
    they didn't think he would make it through the surgery.
    I had decided in december w/ the cysts that I would not have surgery done ( usually not necessary for that condition but sometimes is ) because it is no small thing to take out half of a liver in any cat, let alone a very sr. guy with other issues.

    2. say good bye

    3 bring him home and treat him with palliative care. they said for the weekend. I don't think they expect him to be around long :cry: :cry: :cry:

    I chose door number 3. I called the vet here ( ours is out of town) but talked to the tech a long time and one of the other docs will be on call all weekend so that made me feel much better. the way they described him on the phone I didn't know what to expect, and didn't want to have to worry about running back into buff if he declined further. I did ask to increase pred. or switch to dex.
    and it was pretty much left to me so I went w/ the dex since it did so much for winnie.

    they screwed up his meds ( I'll spare the details but they were 12 hours late) that means he had his pred at 4p and they were telling me to wait and give the dex at 4 the next afternoon. no way.
    i gave it tonight. If we had increased the pred instead, it would of been dosed tonight.
    hopefully I can talk to someone tomorrow about a loading the dose for a few days. ( the vet that was treating him was in surgery and we didn't hear from him -- was getting pretty late -- so hopefully this am or I will call )
    they put him on .5 tabs and winnie was originally on .75 and then eventually went to the .5
    He has dropped wt so maybe he is less than winnie was. although she was down a lot then. who knows what they did to decide that.

    He started to meow as soon as we got in the door at home. He knew where he was and he wanted out of the carrier. walked around a bit and then went for a snuggle bed. I have stuck with him and when I went out to the kitchen to eat, he came with. we are glued together .

    I did discuss things a long time with the vet. The IM is a very conservative guy ( I know him from winnie's dx) but technically very good -- but that also gets in his way as he can't get out of the box.
    He has to say we can't say for sure if this is lymphoma b/c no biopsy.( I didn't speak to him , but to the vet that treated wolf when we got to hosp. we were there under ER. ) well he is already on pred. so for this to show up fast and furious, I would say from my experience and from wolf's sudden tanking and other symptoms that it is the big C. this vet agreed with me . nice guy -- has 7 cats of his own.
    He did say he and dr. b talked a long time about it. and b/c the im is by the book he won't recommend leukeran w/o biopsies. I told this vet that was nonsensical. if it were ibd you will still use leuk.
    thing is, I could still maybe get it from my vet. but with the liver thing and the anemia and kidneys ..... not sure it is good idea.
    it really knocked winnie out when she first started. and it can cause low blood counts.

    my mind is going all over. I want to fix him somehow. but how can I put him through risky surgery ?
    If it were just his liver or just the GI L. ok. I might do more. But w/ both going on and his other stuff. and being so weak and yes I hate to put the age thing in but it is something I must consider.
    IT seems too much. My head and heart are all over the place .

    I think about going to the onco in rochester. she will aspirate. but to what ends? what will that change?

    thoughts, ideas welcome.

    thank you for your continued support. I know this is very long...... i actually went back and took a lot out.
    so much going on.

    please keep those prayers and good wishes coming for Wolfie.


    Hoping the dex gives him a nice perk.
     
  2. Jayne & Sweety

    Jayne & Sweety Member

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    Jan 16, 2010
    Cheryl, I don't have any advice but wanted to tell you, my thoughts are with you both - sending healing vibes.
     
  3. tuckers mom

    tuckers mom Well-Known Member

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    Dec 28, 2009
    I'm sorry, I have no advice but wanted to let you know that I've been thinking about you and will continue to send strength and healing vibes.

    (((hugs)))
     
  4. chriscleo

    chriscleo Well-Known Member

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    Dec 28, 2009
    i'd PM jess and jojo for further advice, cheryl.

    do you have pain meds for him and something against nausea?

    i know other vets give some kind of chemo even without definitive lymphoma dx because it's just not always definitive. (cleo's IM vet and i discussed doing just that before we ended up removing her spleen and finding the enlarged node in the mesentery.) definitely steroids, tho. would dex be part of a protocol if you are talking lymphoma versus liver adenocarcinoma?

    they took no aspirates at all? (thinking of possibility of getting them typed for more definitive cancer dx.) not sure whether just one area was difficult to aspirate or all. guessing specialist would have done it if he/she felt safe doing it, unless they needed an ok first or ran out of time before the weekend.

    is he already on denamarin for liver support?

    sounds like you actually have a good handle on what you want to do (no surgery but see if you can add/increase meds). gonna PM you...
     
  5. Ronnie & Luna

    Ronnie & Luna Well-Known Member

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    Dec 28, 2009
    (((Cheryl))) sending healing vines for Wolfie

    Hopefully Jess, Jojo or Dr Lisa will see this thread, but definitely, see if you can PM them.

    (((hugs)))
     
  6. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    ((((Cheryl))))) I have no experience or advice, but lots of hugs. Lucy and Jazzy are singing their Meezer songs nice and loud, those Meezer songs can work miracles. Come on, Wolfie!
     
  7. Pat and Skipper (GA)

    Pat and Skipper (GA) Member

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    (((Cheryl and Wolfie)))
     
  8. Patticass & Tyler (GA)

    Patticass & Tyler (GA) Member

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    Oh Cheryl, I was so hoping for better news. I don't know what kind of advice to offer other than trust your gut. I'm holding you both in my heart and prayers.
     
  9. Linda and Bear Man

    Linda and Bear Man Well-Known Member

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    Dec 28, 2009
    (((Cheryl))) I am sending many prayers and healing thoughts your way. I think that if it were my cat, I would have done the same thing you have done. I agree that surgery is not a good idea. All the supportive meds like Dex, anti-nausea, appy stims, pain meds, possibly fluids would probably be helpful. If you want to try Leukeran (and you know the risks - I would be worried about nausea making him feel worse), I think the vet should allow you to try it. Chemo IS palliative care in the treatment of cats with cancer. If Wolfie is stable next week, maybe the onco could discuss it with you, but I would not be doing any biopsies. Too much risk from anesthesia for one thing. I hope that you are able to enjoy some quality time with him this weekend. My heart goes out to you and Wolfie.
     
  10. Jess & Earl

    Jess & Earl Member

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    Dec 28, 2009
    Cheryl, I'm so sorry to hear this bad news.

    Is he on any gastro-protectants like famotidine? Remember that steroids can cause ulcers, and you have a cat who is very anemic. Please use caution in increasing the dose or dosing more often.

    You mean the enlarged lymph nodes? That could be from metastasis of any kind of cancer. We know his liver has a big, rapidly growing mass so that is our first suspect.

    I agree, unfortunately, that is seems like there is cancer somewhere. The liver seems like a candidate given the aggressive growth and increase in liver enzymes.

    Leukeran is far from benign. I wouldn't touch it if I were you. You have a very anemic cat who is unlikely to tolerate another drug (besides the steroid) that can cause bone marrow suppression. Besides, I am more worried about the liver mass than the lymph nodes (which may just be reactively inflamed). As far as the thickened intestines go, that is not an uncommon finding and I'm not going to pin my hat on it being GI lymphoma. The big picture is a cat with signs of liver failure, a big liver mass, anemia, abdominal lymphadenopathy, and PS they also saw some intestinal thickening.

    I can understand why they didn't aspirate the lymph node, assuming there was one that was aspirat-able. He's anemic, appears to be in liver failure, they don't know his clotting status and the most pertinent information would come from the liver, not a lymph node. (These aspirates often come back as "reactive inflammation", even if it is cancer, it's very frustrating.)

    He can't have the surgery unless he stabilizes. THe liver also has a role in maintaining the ability to clot, so he would need clotting tests first, and if even if he can clot normally he would need to have a blood transfusion for sure as he cannot tolerate *any* blood loss.

    My treatment decisions for Earl were made with this thought in mind: Will he come home afterward and enjoy life? I was willing to do XYZ procedure, despite his being a basket-case, health wise, if the chances were strong that he would come back home and have quality time. That's why I did the brain surgery, though most people here probably thought I was nuts. THere was a good chance he'd come home and have quality time, which he did (13 months). I euthanized him when I took him in, he was very weak, low BP, PCV of 14. Based on his previous diagnoses and testing, I knew that it was very unlikely that I could take him home and have him live life as he wanted.

    I think you know your options here, Cheryl :( There isn't much that can be done in terms of diagnostics, and even if you had a diagnosis he is not in a good place to start chemo for anything (because his PCV, liver function, and he is already inappetant). This may be one of those situations where you have to let him guide you, let him tell you where he wants to be and how comfortable he is.

    I"m very sorry. I wish I had some insight, some loophole to point out, but I don't see one here. Hugs to you both.
     
  11. Lisa and Merlyn (GA)

    Lisa and Merlyn (GA) Well-Known Member

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    Dec 28, 2009
    ((((((((((((((((((((((((CHERYL)))))))))))))))))))))))))))))

    Many tears here. I am sorry the news is not good. Continuing to send cyber hugs and support.
     
  12. WCF and Meowzi

    WCF and Meowzi Well-Known Member

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    Dec 28, 2009
    (((wolfie))) (((cheryl)))
    talk to him, hold him, love him
    many tears ...
     
  13. HollyandSpader(GA)

    HollyandSpader(GA) Well-Known Member

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    Sending all sorts of good thoughts your way.

    Wolfie is lucky to have you.
     
  14. JL and Chip

    JL and Chip Well-Known Member

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    Dec 28, 2009
    Hi Cheryl. Deep sigh. I'm so sorry.

    For what it's worth, I think you did the right thing choosing door #3. I'm flashing back to last year as I went through a lot of the emotions and decision processes with my Charlie as you're facing now. Charlie was nearing 18 and had IBD, CP, CRF, diabetes, etc....and then an ultrasound showed a dreaded liver mass. The docs were quite certain it was an aggressive form of carcinoma but without a liver biopsy...well, you know. No official diagnosis. We talked about the possibility of exploratory surgery and aspirates and all of what you're describing. I was desperate -- chemo? pred? surely something could be done?

    My heart wanted to fix him more than anything in the world. He was my once-in-a-lifetime cat and we were joined at the hip....and it was hard to remain logical in my decisions. In the end, his clotting factors were off due to the compromised liver and there really were no options. He wouldn't have made it through surgery and I knew that as desperate as I was to save him, this time was different. As Jess said, if doing a procedure gives them an opportunity for longer life with some quality, then hey, I'm in. I had done just that with Charlie numerous times before and he had lived years longer. But inoperable liver cancer? No, that was different. We were at the end of the road.

    I brought him home and gave him my undivided love and attention. The hardest part was wrapping my head around the fact that there was nothing more to be done. I wanted a miracle but settled for just having Charlie sleep near my head and camp out on my lap and follow me around the house...for however many days he had left. When it was time, it was blatantly apparent. One day something just "broke" and, although I came periously close to running him back to the E.R., I knew better. Knowing something is coming doesn't always equate to being ready for it when the time arrives and I had to talk myself through the process. A tech came to the house and put him down here at home, surrounded by the rest of the crew, on my lap as usual.

    You're wrangling with a lot right now but I'm sure you'll make the right choices. Charlie wanted more than anything to be with me, and there was no way I wanted him to die alone in a hospital cage. That helped me through the urge to push for more diagnostics and more drugs and more procedures. There was no hope for "fixing" what was wrong with him, and in the end, if I couldn't fix it, I knew I shouldn't pursue more stuff.

    I'm so sorry. They own a piece of our heart and take it with them when they go. Appreciate each and every moment you have with Wolfie (I know you are), and know that we're silently here by your side as you step through the hours and days to come.
     
  15. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    (((((cheryl and wolfie)))))
    no advice... just sending lots of hugs.
     
  16. dian and wheezer

    dian and wheezer Well-Known Member

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    oh cheryl ! I am so, so sorry. The pain. But you know you have given all your cats everything and done whatever needed to be done whenever. You have always been there for each of them. there always comes a time. no matter what or when and even knowing does not make it any easier. I know that from Mr. chubbs. He was the first animal that I had to make the decision. It is not an easy thing to do but we cat people always put or aniamls before ourselves no matter how much it hurts.
    May God grant you the strength and wisdom to come through this
    ((((Cheryl)))) ((((wolfie))))
     
  17. Steph & Cuddles (GA)

    Steph & Cuddles (GA) Well-Known Member

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    Dec 28, 2009
    (((Cheryl))) I'm so sorry. Wish it were better news. :sad: I think you made the right decision about option 3. That's basically what I did for Cuddles without realizing it. We started her on pred though, and that gave me an extra week with her. She had a mass in her abdomen, but even a needle aspirate didn't show anything conclusive. I guess it's such a small sample, it's hard to tell anything from it anyway. So keep that in mind too. I know in my head & heart that the big 'C' took her from me.. but it still leaves that nagging doubt in the back of my mind because we couldn't prove it.

    Isn't dex the one you give every 2-3 days? Or can you dose it every day? I remember Bandit being on pred for her asthma I think it was, and we were going on vacation for the weekend. They gave me dex I believe, so she could go the weekend without someone having to pill her every day. Then again, I think it was a shot.. so not sure if the pills are a daily thing.

    I know your heart is breaking, and you want him to feel better. But please keep his quality of life in mind. That's all we really care about in the end. Are they still enjoying being with us? Even if they are (like I think Cuddles was.. she didn't want to let go), sometimes their bodies are giving out, and it's the most loving thing we can do for them, is help their bodies along. Cuddles couldn't walk, or even sit upright.. lost control of her bodily functions, but her eyes were still bright, and she was aware of everything going on around her. It still broke my heart, but I knew it was what I needed to do for her. On the drive to the ER vet, she was lying on my passenger seat, and intently watching the shadows from the street lights go by in the car. Still very alert, and herself.. but her body was letting her down. I'm not saying that's now with Wolfie, but just watch. I'm pretty sure you'll know when enough is enough.

    (((((Cheryl))))) it's so hard watching our furbabies get old & sick. :sad:
     
  18. Sherry & Squirt (GA)

    Sherry & Squirt (GA) Member

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    I'm so sorry to read this. My heart goes out to you and Wolfie. My thoughts and prayers are with you...
    Sherry & Squirt
     
  19. Michelle and Doodle

    Michelle and Doodle Member

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    Dec 28, 2009
    Oh (((Cheryl))) I am so so sorry.
    I don't even know what to say - I have no experience and no advice to offer.
    All I can do is send you much much love...
    I'm holding you and (((Wolfie))) close to my heart.
    *tears*
     
  20. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Sending prayers for comfort for your Wolfie. Prayers for strength for you. My heart goes out to you.
    j.
     
  21. OptOut

    OptOut Well-Known Member

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    Dec 28, 2009
    Cheryl,

    I'm so sorry for both of you; I'm tearing up just thinking about how hard this weekend will be. As CF said, just love him lots, and lots and pray for miracles.
     
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