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).

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 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.