... And One Step Back

Actually, it seems like several steps back. Bullwinkle really hasn't been very interested in food the last couple of days. Yesterday he got very wobbly and weak -- I am sooooo hoping that's a side effect of the chemo -- and he's pretty subdued today. I'm not overly worried -- yet -- because we have an appointment with Dr. Kelly, the cancer vet tomorrow. She's going to do more bloodwork to see how things are going and if we should continue with the chemo. Probably needless to say, my heart will be broken if she thinks we shouldn't.

The photo above is another very early shot of Bullwinkle. He has always liked to sit on people's shoulders -- their left shoulder, to be precise, never their right shoulder. He's always been very uniquely himself, even at a very young age.

A little of the backstory: Bullwinkle's original, diagnosing vet sent him home to die -- she said nothing could be done for sub-lingual squamous cell carcinoma. I went out on the web to research it, and everything I found seemed to confirm what the original vet had said. So I settled in (very unhappily) to hospice care.

When Dr. Blackshear came to see him -- three weeks after the original diagnosis, and more than two after the biopsy results confirmed it -- she said, "Oh, I have a patient who had exactly the same thing -- and she did very well on chemotherapy." I was very skeptical but she kept pushing me -- and well, now Bullwinkle's on chemo. I have no idea whether Bullwinkle's will turn out to be a success story or not -- but I want other people to know that there are options for treating their pets. So that's one of my two goals for this blog -- to help people know what might be available. I feel we lost precious time in getting treatment for him -- and I'm hoping to help other folks keep from losing that time. (This is the place that's treating Bullwinkle, by the way.) The other goal of the blog, of course, is to keep Bullwinkle's many friends, admirers, and supporters updated on his progress.

Last night, Bullwinkle's Auntie Joyce -- our neighbor who has gone wayyyyyy above and beyond -- came over and videoed the feeding tube process. The four posts below show how it's working for us.

Using the Feeding Tube, Part One

I was a little overwhelmed at first -- nervous about feeding Bullwinkle through his feeding tube. Now I've fed him probably 25-30 times (I'm aiming for 5 times a day, more often on the weekends) and I have a bit of a system down. I want to stress that, beyond what the cancer clinic told me, and my own experiences, I really don't have a clue. I'm definitely not an expert, and for all I know, maybe this is all wrong. (We go back to the clinic tomorrow; perhaps I'll learn more then.)

In other words: if you're just getting started feeding your pet through a feeding tube, I think you should follow the directions of your vet, and not necessarily adopt my technique(s). With the help of Bullwinkle's Auntie Joyce, however, we made some videos which, hopefully, might make it easier for you to get started. The main thing I think I've learned is: have everything ready before you start. Here's step one:

I know it's hard to see the little stopper for the feeding tube (I didn't communicate my intentions very well to the camerawoman ahead of time), but you'll be able to see it in a later video. To recap what I did in this one: first I took the stopper out of the feeding tube. Then I put the tip of the syringe with Bullwinkle's pain meds right inside the feeding tube and pushed the fluid in.

Next: I pulled the syringe out of the feeding tube (it wasn't screwed in or held in by suction or anything else, so it was just a matter of moving it) and then screwed the syringe with the food onto the feeding tube. I want to reiterate that none of these syringes have needles and also, that this doesn't seem to be a painful process in any way for Bullwinkle -- uh, except for the need to more or less stay in one place for 20-30 minutes.:)

Using the Feeding Tube, Part Two

After I got a little food into Bullwinkle, I unscrewed the food syringe, and screwed on the syringe with his antibiotic. Then, when I'd gotten all the antibiotic into the feeding tube, I unscrewed that syringe, and screwed the food syringe back on, and resumed feeding him. I made sure I held the tube up when I was changing syringes because I learned very early on that if I didn't, gravity would let the food and water flow out of the tube.

Also this process of giving him the pain meds, a bit of food, the antibiotic, and more food is not one the clinic told me to adopt -- it's just what I started doing because it seemed to work best for both Bullwinkle & me.

I started, in the video, to say that the feeding process is a little boring. Up until this morning, the only place Bullwinkle would allow me to feed him was on top of the washer. Yesterday I went out and bought a new blanket for him -- a soft fleece thing from the thrift store -- and to my great surprise and pleasure, he was sleeping on it this morning. I'd put it on the sofa, which meant that I was able to sit next to him when I started feeding him -- and he very quickly crawled into my lap for the rest of the feeding. The only thing missing was a cup of tea for myself.

Anyway, especially at the beginning, it was hard to keep both Bullwinkle and me still for 20 or 30 minutes. Also I think he may still have been agitated from the anesthesia he was given when they put his feeding tube in. So I read children's books out loud to him. I got the idea from when my friend Deb had lung cancer and had one lobe of her lung, and five ribs, removed. She was very, very sick and hallucinating like crazy from all the drugs they were giving her. I kept going to visit her but it was kind of the same thing -- she didn't have much to say and I didn't want to blather on incessantly and in a cheerful way -- so I read the Harry Potter stories to her. She says now that she really liked hearing me read them to her (although she can't remember any of them). In any case, if nothing else, reading stories aloud to Bullwinkle kept me from feeding him too fast.

Using the Feeding Tube, Part Three

The clinic stressed that it was really important to flush the feeding tube with water after each feeding, and also with more water twice a day. I'm terrified that the feeding tube will clog up -- I believe that, at this point, it's literally Bullwinkle's lifeline -- so I've been extra-diligent about flushing with water.

Using the Feeding Tube, Part Four

The last video is just a recap of the entire feeding process -- and shows the stopper for Bullwinkle's feeding tube.

Food

Thank goodness for the feeding tube. Bullwinkle is still super skinny -- I can feel every vertebra in his back -- but at least he's getting some food and a substantial amount of water into his little body. Just being able to get pain meds and antibiotics into him (without a significant power struggle) is worth the price of admission alone -- my ever-present anxiety level is significantly lower than it has been.

He is much, much better. I don't know how much of that is simply the food and water, and how much (if any) is the reduction of the tumor. His pain level is still significant, I think -- he starts whining about 10 hours after the last dose, but for an 8-hour period or so, he's a pretty happy camper. In terms of quality of life, his is greatly improved over the last few weeks. It may even be better than at any time since his biopsy on January 21. I told Dr. Kelly that I didn't care how long he lived, I just wanted him to have a decent quality of life while he was alive. Of course, now that he seems to be getting better, I have great hopes -- and want him to live longer too. :-)

That's the good news. The not-so-good news is that it's still very difficult for him to eat -- at this point it's still a case of the mind is willing but the body is weak. He's very interested in food, but it's difficult for him to get any substantial amount past his mouth on his own. (But it's not for lack of trying.) And ... to my great dismay, I noticed when he did a big yawn tonight that some parts of his tongue were white. I think that's not such a great thing.

Here he is trying to eat. I know it looks really tough & painful -- I think it is. But it's soooo much better than where he was a week ago. He wasn't even trying then.

Two Steps Forward ...

... and one step back. When I got home tonight, Bullwinkle was in a pretty bad mood, whining and looking rather disgruntled. Naturally I did what any good kitty mother/housekeeper would do -- I gave him pain meds through his feeding tube immediately. :-)

His neck is very itchy and his mouth is bothering him -- he keeps reaching up with both paws to try to get something out of his mouth. But when I rattled the magic bottle -- the plastic container with kitty tartar control treats -- he barreled across the room and up onto the second level of the cat tree, which is the only acceptable place to eat kitty treats (everyone knows that!). I put a few out ... and he actually ate some! Keep in mind that these are hard treats -- amazing.

The photo is one of the earliest I have of Bullwinkle (and uh, yeah... I was a bit younger then too). It was taken with the very first digital camera I had -- a Sony Mavica that recorded the pictures to a floppy.

Bullwinkle's Swollen Face

The cancer clinic finally returned my call and said a swollen face is a fairly common side effect of chemotherapy applied directly to an oral tumor. I returned home from work this evening and was relieved to see that Bullwinkle's face was much less puffy.

Dr. Kelly said I could give him food to eat in addition to feeding him through the tube. She said a smorgasbord would be a good idea and said that cats really like junk food -- she mentioned Fancy Feast as an example. I found a can of it and opened it up -- wow, did Bullwinkle ever get interested! I mashed it up with water and he eagerly went over to the dish, but gave up almost immediately -- it was too difficult for him to eat. So I scooped a bunch of the solid food into the dish and that was a different story. I don't know how much (if any) food he actually got into his little body -- but he definitely managed to spread it over a good square foot of the floor in his excitement (tile, thank goodness, easily cleaned). I really don't think he's been that motivated by food since before he was diagnosed.

Uncle John came over to see him earlier in the evening and shot video. You can see Bullwinkle and his feeding tube in this video -- and yours truly making a fool of herself as well.

Bullwinkle's First Chemotherapy Session

Bullwinkle started chemotherapy on Monday. Dr. Kathy Blackshear sent us to the pet cancer clinic and I honestly didn't believe they'd be able to help him -- he hadn't eaten for two weeks and was really skinny (5.7 pounds!). But they did some bloodwork and amazingly, his liver & kidney functions were just fine; and they took some x-rays and learned that the tumor (which is beneath his tongue and attached to it) hadn't grown into the bone. So all that made him a good candidate for at least trying the chemo. And besides, he just seems to be a survivor. He's been telling me all along that he has no intention of dying, ever, and certainly not any time soon. I'm starting to believe him.

I asked for a quote of how much it would all cost before they did anything. The amount is obscenely large -- too large to talk about. Let's just say that: a) I could've bought a fairly decent used car for it; and b) I'm pretty sure I can't afford a used car of any quality. Nonetheless, after I talked to Dr. Jeannette Kelly and felt like I understood what the chances of success were (50/50 that his quality of life would be improved), and looked at my checkbook, and decided I really don't have to go to Arizona next month after all, it was very clear to me that I wanted to try it.

So Bullwinkle came home with me on Monday, completely loopy from all the anesthesia. He immediately busted out of the soft-sided pet carrier, before we ever got out of the clinic, and was hell-bent on running through the parking lot. (Not that he could have -- he couldn't stay upright for more than about 4 or 5 seconds -- but he didn't seem to realize that.) I ended up holding/restraining him in my lap all the way home -- thank goodness my neighbor Joyce was driving. I really don't think I could've done both.

He has a feeding tube now. I fed him (his first food for two weeks!) Monday night and he immediately fell asleep and stayed asleep through three more feedings, into Tuesday. He hadn't been comfortable enough to sleep very much or for very long prior to that. I can also get antibiotics and pain meds into the feeding tube -- that's all very encouraging, and is definitely improving his quality of life already.

Dr. Kelly said it was possible that we'd know if the chemo had a good chance of success within 24 hours. When I asked how I'd know, she said his mouth wouldn't smell so bad, and he'd at least try to eat. Both of those things have already happened, which seems almost miraculous! On the other hand, the right side of his face (which is the side opposite the tumor) is puffed up pretty badly -- he looks like he's half Persian (right side) and half alley cat (left side). I still haven't gotten an answer from the clinic about whether I should be worried about that -- which I hope means it's fairly normal.