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.

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.