Good Night, Baby

Bullwinkle's last morning in the sun

I said my last good night to Bullwinkle yesterday. There were so many ups and downs throughout his illness that I sometimes felt as though I were watching a ping pong game -- he's winning! he's losing! he's holding his own!

And he did indeed seem to be holding his own earlier this week. But his last descent was sudden and steep: from trying to eat shrimp Wednesday night to a bleeding mouth that was starting to smell bad again on Thursday evening, to what appeared to be unbearable pain last night, even after pain meds.

I will write more -- but not right now. Thank you all so much for your support for both of us -- it has meant more than I could ever express.

Brave Troopers

Bullwinkle and Auntie Martha:

Is that her left shoulder?

(We were all younger then.)

Bullwinkle seemed very anxious this weekend every time I left the house, and he spent as much time with me as he possibly could while I was home. Today was another 13-14 hour day for me, and even though Aunties Martha and Lina came over to feed him dinner, Bullwinkle seemed very disgruntled by the time I got home: he was crying piteously and wouldn't come over to see me. I picked him up and he climbed onto my shoulder (the left one of course) where he has stayed ever since. I am actually flushing his feeding tube as I write because he will not be dislodged.

He really doesn't feel very good -- yet, it still doesn't seem to me as if he's ready to give it up. He's been a very brave, stoic, and heroic trooper; if I'm ever in his situation, I hope I behave even half as well as he has.

Auntie Martha (photo above) is quite the brave trooper herself: she gave away one of her kidneys to a perfect stranger, in an historic 3-way "paired donation" a couple of years ago -- and KRQE aired a show about her experience this morning. You can see it here. Bullwinkle & I are very proud that she's our friend.

Back to Bullwinkle: I'm worn out worrying about him and grieving for him. When I woke up this morning, he was curled up in a tiny, tight little ball and was very still. For a moment I thought he had died in his sleep -- and then I saw him breathing and realized he was still alive. The relief I felt for that short moment made me understand that what bothers me more than anything is the prospect of actually putting him down. I so wish he would die peacefully in his sleep....

The Comeback Cat

Snoozing in the sun this morning.

Bullwinkle's amazing. He feels much, much better tonight than he has for weeks. It was quite difficult to feed him through the feeding tube tonight -- he kept wanting to run around. He rode around on my shoulder most of the evening, sniffing (in a very engaged way, I might add) at every bit of food I tried to eat. So I opened a can of Fancy Feast for him (salmon) and he practically buried his head in it. (He did try to eat some but wailed while he was trying -- I think it must really hurt to try to use his tongue.)

My coworker John, who hates cats (and who therefore can't be trusted, so he's probably wrong), claims that Bullwinkle has no intention of ever dying, because he finally has me right where he wants me -- wrapped right around his little claw. :-)

I took a short video of Bullwinkle while he was purring and kneading on my shoulder; you can see it here.

I really want to thank you all for your sympathy, support, and encouragement. They've meant so much to me, and I really do think they've meant a lot to Bullwinkle too (in some way that's impossible to understand or gauge).

Reprieve!

Dr. Blackshear came and spent quite a bit of time with Bullwinkle & me this afternoon. The short form of the story is that, while she said it wouldn't be premature to put him down today, she also said that if it were her cat, she wouldn't do it yet. Plus she said she has known -- it's been real clear -- when it was time to put down her own pets. Since it was certainly clear to me when it was time to put Jezebel down, I'm going to try to trust myself and wait for that time with Bullwinkle too. Not to mention that Dr. Blackshear doesn't seem to think he's suffering terribly at this point (and he does seem quieter and more peaceful than he has since before the last chemo treatment).

So that's the story in a nutshell; I cried all day long and am exhausted. But I do feel privileged and relieved to be able to spend more time with my baby kitty-boy.

Bullwinkle snoozing on my shoulder this morning.

Frustration

Bullwinkle is feeling somewhat better tonight. I have an appointment with Dr. Blackshear tomorrow afternoon and we will talk about whether we should do hospice care with him or put him down -- it feels to me as if it could go either way. I do think that finally, tonight, he's starting to realize some benefit from the most recent chemo treatment. He's alert and has acted more like his old self than he has for a couple of weeks. But regardless of what my decision is for him tomorrow, we are not going back to chemo.

When I got Bullwinkle home from the cancer clinic on Monday, I could see he had some tape wound pretty tightly around his right forefoot. I figured that's where they'd drawn blood from, so I left it on that night -- but it was bugging him so much yesterday that I decided to take it off. After I'd gotten most of it off, I realized it was holding what looked like a catheter in place. I called the cancer place last night and basically said I would have appreciated being told that they were leaving a catheter in his arm, and could they please call me and let me know how to deal with it since I'd already taken most of the tape holding it in place off. I asked them to call me at home if they returned my call at night, but if they called during the day to please call me at work. I gave them both numbers. Naturally they called me this morning at home -- while I was at work (that was frustrating).

So... after being gone for the better part of 14 hours, wondering why I hadn't heard from them, I returned home at 9:30 p.m. to hear their message, which was something like: "We understand that a catheter was inadvertently left in Bullwinkle and we really apologize; all you have to do is pull it out and put pressure on it for 45 minutes and everything will be just fine." Wow. I'd call that another frustration (although that may be an understatement). I hate how cynical I feel right now -- but they were quite deliberate Monday about making sure they got paid before I took Bullwinkle home. Too bad they couldn't have been as meticulous about removing the catheter.

As if that weren't enough, I checked Bullwinkle's feeding tube tonight (I could tell it was bothering him) and the stitches holding it in are really tight and are pulling his skin up -- and his skin is very warm around there. Chalk up yet another frustration -- to say the least.

My poor little kitty-boy has had such a rough time -- and I'm really starting to feel that part of that tough time has been inflicted on him by the very people I've paid (and paid well) to take care of him.

The whole thing just sucks.:(

Roller Coaster

Bullwinkle is in pretty bad shape this morning. He cried last night and today in a very plaintive way, a way I hadn't heard before. And when I was feeding him thru his feeding tube, on a blanket on the washer (the approved feeding place), he cried a bunch of times as if he was in pain and then peed all over the blanket. That's a big deal because he's always been a very meticulous cat and even last week, when I was feeding him and he had to pee, he just jumped down and went to the litterbox (with me crawling along on hands & knees behind him). He also has a swollen chin from the chemo yesterday -- it looks like a little white goatee. He seems quite miserable all around.

Bullwinkle when he was young.

He'd go out looking for trouble if none was handy.

To make matters worse, I saw Bullwinkle's diagnosing vet briefly yesterday. She asked how he was doing and I said I didn't think I'd gotten him to the cancer place in time for a remission to be a possibility. She bristled and said something along the lines of time not being the reason remission won't be a possibility. I really didn't have it in me to argue -- but I also didn't have it in me to lie -- so I just said, "I wish I'd gotten him there earlier." Her response: "I sense a subtext here." I decided to be a little clearer and said, "I wish you'd referred him." (I don't remember feeling angry at that point, just really sad.) She really bristled then and said now wasn't the time or place to talk about it, and she walked away.

This vet is the only person Bullwinkle has ever growled or hissed at. I wish I'd listened to him earlier -- I'm now thinking he was onto something. And in my small world, she's the vet who said nothing could be done, while two other vets (Drs. Blackshear and Kelly) are saying they've had cats go into remission from this kind of cancer -- sublingual squamous cell carcinoma. Part of the reason I decided to go ahead with the chemo was that I hoped that perhaps this would be an experience the diagnosing vet could learn from -- sadly, it was ultra-clear yesterday that that won't happen.

March

March: the month of Sandia hairstreaks, the vernal equinox -- and the second month I was sure Bullwinkle wouldn't live to see. For some reason, when he was diagnosed in January -- and in pretty bad shape -- it really bugged me that he wouldn't see the second month of 2010. So I'm surprised (and pleased) that he's made it into the third one.

We just returned from the cancer clinic. There's good news and bad news. The good news is that he definitely responded well to last week's chemo treatment -- the tumor got smaller. More good news is that the tumor hasn't grown into his jawbone at all, as they often do. The bad news is that the tumor has grown into his tongue -- and some of his tongue is necrotic (dead) and will fall off. On the plus side is the knowledge that kitties' tongues can get stronger with use, even if they have only partial tongues; on the minus side, though, is that most of his tongue is affected. He may never eat on his own again (however motivated he is). Dr. Kelly now guesses he has a 10% chance of remission -- down from 50% last week.

Bullwinkle definitely felt much better over the past week, so she's suggested chemo as palliative care for now. And my overriding goal is for him to be relatively happy and pain-free while he's alive -- so I consented to a second chemo treatment today. (I've now spent 1 1/2 months of my take-home pay just at the cancer clinic.)

But... Dr. Kelly said that when she saw him last week, Bullwinkle "was a dying kitty." She said he was so hypothermic then that his temperature didn't even register on the thermometer.

... 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 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.

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.