Bette Struggles Post Treatments with Litter Box Use/How to Clean a Mess

Bette overnight: extra Valium only made her more anxious; she had trouble using the box and went inside the cat house that has a cloth covered pad on it, instead of the urine pads around the box. BUT it got on the floor underneath. I cleaned the floor and the house (we'll see if it survives the washer.) I'll pull the (luckily small) room apart and clean again in case that wasn't all of it. I smelled as I may have gotten it on me while cleaning and had to change; she smelled (she was cleaned.) My smelly clothes went into the basket to be washed today and that basket is upstairs in a closet away from the cats. (More on that below.)

Jimmy, with a history of urinating out of the box, and why he's on Prozac, must be stressed this week due to possibly earlier medication times, his sister smelling after the vet (but luckily he's been kind to her and we separate her for the first four hours home), a disruption of sorts in the daily routine, and possibly because the new formula of his compounded Prozac isn't working. But he's urinated out of the box twice and possibly three times: on a basket of dirty clothes (basket, clothes, wall, floor, under trim, in the cracks of the vinyl tile, etc.-when cats urinate it goes everywhere); against the box and pads on the wall around the box; and on the floor (again it gets everywhere.)

When I clean up urine, first I think of containment: get the trash bag, paper towels, spray cleaner; wipe down box, gather up pads, use paper towels to clean, to soak up urine; put it all in the trash bag; clean area with a spray cleaner but WIPE, don't spray because that just spreads it more; spray/wipe, spray/wipe, etc. Then where I can, I use the kitchen bleach spray-in the cracks, under the trim (spray on the surface, let set a few seconds, wipe the surface and let the bleach sink into the crevices, under trim, etc. where it cannot get on feet/paws but is less likely to bleach out the surface.) Then I wipe it down again with water to get rid of the bleach from the surfaces. (All of this depends on the type of surface you might have.) Everything goes into the trash bag to be put outside immediately or it attracts Jimmy. Any rags go into the washer immediately or he'll smell them and urinate in the vicinity. Even the scent of urine in the laundry/trash bag that lingers will attract him and I tend to spray something like Feliaway to divert his attention-which I need to start using daily again apparently. We go through phases of using it, not using it, using it again.

Bette has also lost 5 oz this week. Given that she was just over 12 lbs and is now under, she has some room to lose weight. But not five oz. a week. She eats well once home from treatment but not so much at night, then gets cut off at 10 pm. I can't use Mirtazapine because it will only drive her crazy and when she has a cut off from eating, that craziness would only keep her up more. We'll worry more about this when she's down to less than 11 lbs and post treatment for sure. 

Things to Consider When Taking Care of a Sick Pet

Bette has begun this week to receive radiation treatment at the vet school for the tumor she has on a nerve along her spine. She seems fine although she had diarrhea last night and I had to get up and clean her and the floor and box. I am exhausted from two long days of driving, etc. She isn't there for the 2 hours they said. She is there for four and a half hours ( so far after two days) so I have had to leave to get something to eat. Time, gas, and food are things I had not accounted for/budgeted for. These are things we need to take into consideration when taking care of a sick pet. 

Things to take into consideration and plan for when taking care of a sick cat-time and money and food for you.

1-I need cleaning wipes for her and for messes in the bedroom so that I don't have to take her down the hall to the bathroom like I did today if she has diarrhea again or gets sick overnight in the bedroom. So I bought some today. For the cats I like to choose baby wipes that are scent free/sensitive skin. Used to be Huggies (also came in a cute Winnie the Pooh package); then I discovered Hello Bello (really good wipes.) By chance I received WaterWipes as a HB substitute when doing shopping pickup order and they work very well, also. So, I bought those today.

2-I'm driving 2 hours and 20 min. round trip. I leave at 7:15 a.m. I'm there-so far after two days-from 8:30-1 p.m. then home with her by 2:15 p.m. That's a very long-after two days exhausting-day and when I get home, I have three hours of time to do chores, then dinner, then an hour of tv, then bedtime at 9:30 pm and hopefully asleep by 10:30.

I'm driving 150 miles approximately round trip, not counting driving in town where she receives treatment if I want to go do something, get something to eat; and not counting the driving in our town once off the highway to get home. That will amount to approximately 3400 miles in one month. I'm spending $28 in gas per day because I'm down to just past a half of a tank by the end of the day and when I fill up, that's the amount I am approximately spending. That will amount to $560 approximately I will spend this month.

I wanted a snack yesterday and spent $4.00. Today I needed breakfast and spent $16. I did not budget for food because they said she would be there for 2-3 hours per day and I thought I wouldn't need anything. BUT she is there 4 1/2 hours so far after two days and if this keeps up I will need to bring food, or spend money for food, etc. I'll have to think about this one because that means it will be $200-$400 for food ($4-$20 per day approx.) to budget.

Bette Davis Radiation

Bette Radiation

Bette Davis is getting ready to start radiation therapy for her Nerve Sheath Tumor at the state's vet school on April 19 for 20 treatments. I read a few websites and collected this information. Various websites repeated the same information but the majority of the below is from the websites links at the bottom.

"Early side effects are usually observed within two weeks after starting radiation therapy and can continue up until one month after the treatment has begun. These effects are usually inflammatory, with areas such as the skin and mucous membranes most commonly affected. Redness, irritation, and ulceration of the treated surface can develop (moist desquamation). Your veterinary oncologist will discuss the side effects that your pet may experience. 

 

For patients who live years following treatment, tumor formation secondary to radiation is possible. In order to be considered a radiation-induced tumor, it must be within (or very close to) the radiation field treated, is not a recurrence of the treated tumor, and is occurring at least 6 months after radiation, but usually longer. Radiation-induced tumors in veterinary medicine are extremely rare.

 

Redness to the skin can occur around the second week of treatment. This is followed by ulceration of the skin surface, known as moist desquamation. This is irritating to your pet, and most animals will try to lick and scratch at the area. It is VERY important to prevent self-trauma with an Elizabethan collar (E-collar) as this increases the risk of delayed healing and infection. The skin reactions will get worse through the end of radiation therapy and may be most severe AFTER radiation therapy is completed. In some animals, skin effects do not begin to develop until radiation therapy is done. The skin will heal in the 2‑4 weeks after the effects are at their worst if there are no complications (infection, steroid usage, and certain systemic diseases). The skin may continue to be thinner or thicker than normal, and the skin pigment may be darker or lighter than normal.

 

Consult with your oncologist before applying ANY topical treatments to radiation sites. If side effects are severe or markedly painful, your radiation oncologist may prescribe a specific topical agent to be administered at home, or may recommend recheck exams and side effect treatment while you’re pet is anesthetized.

 

Late effects to the brain and spinal cord are rarely seen prior to 6 months after the completion of treatment, but can occur years later. Depending on the portion of the spinal cord treated, the patient may have decreased ability to move the hind or front limbs or may even become completely paralyzed. 

 

A portion of the colon, rectum and bladder are often in the treatment field when treating tumors near the pelvis. The lining of these organs is made up of rapidly dividing cells similar to the skin and oral cavity. Irritation of the colon (colitis) may develop near the end of the second week of treatment and may continue for 2-4 weeks after radiation is completed. You may see diarrhea which may contain mucous and/or small amounts of fresh blood. Your pet may defecate small amounts more frequently. Some patients have intermittent colitis long term. Inflammation of the bladder (cystitis) can also occur and follows the same timeline. Clinical signs of cystitis are straining to urinate, blood in the urine, or increased urgency to urinate (asking to go outside many times during the day or accidents inside the house). Your clinician may recommend medication or dietary changes to help alleviate the problem.

Any diarrhea seen immediately following the start of radiation therapy (within 1-3 days) is not related to radiation, but rather to stress from hospitalization. This colitis is treated with oral medication in most cases and may resolve during the course of therapy as the patient becomes accustomed to the radiation routine. If anxiety and stress are persistent, this diarrhea may not completely resolve until therapy is completed.

 

Late side effects are rare but can develop in these areas as well. They occur many months after radiation and are related to scar tissue formation. Scar tissue in the colon may not be a problem if only a section of the colon or rectal wall is involved. If scar tissue forms circumferentially around the colon, this could result in a stricture, resulting in difficulty passing stools. Urinary strictures secondary to scar tissue formation as also possible, which could results in long-term straining to urinate. If the scar tissue completely obstructs the flow of urine, this is an emergency. There are sometimes procedures that can be performed to alleviate a rectal stricture (“ballooning” or stent placement). Stents can be placed in the urethra to reestablish urine flow, however this usually makes the patient incontinent. Fistula formation (holes forming in the walls of the colon, rectum or urethra) secondary to radiation are exceedingly rare, but, when they do occur, are life-threatening.

 

Examples of late radiation side effects include muscle fibrosis, skin fibrosis, bone necrosis (cell death) and subsequent fracture.  Radiation induced secondary cancers have been reported years after a radiation therapy course - this is also a very rare sequelae of radiation.  

Ports-Most complications associated with SVAPs are mild and easily managed, and consist mainly of soreness and swelling around the incisions for a few days.

 

**Many cats recover from paralysis with proper treatment as nerves regenerate slowly. However, a full recovery will depend on the health of the nerve; some nerve injuries will get better in a few months, while others may need surgical reattachment. At home, you can apply heat and gently massage your cat’s affected limb while the nerve is regenerating.  These actions can help your cat relax while reducing pain and discomfort."

Some links:

 

Dutch

Animal Center and Imaging Center

MSCPA Angell

 

 

 

 

Bette To Have Radiation for Nerve Sheath Tumor

UPDATE: Bette will have radiation beginning late April. She had a CT scan today and we get a report next week. She will have 20 days of treatments because those only have a 10% chance of damaging the colon which would end her life vs. 5 days of treatment which has a 30% chance of damaging the colon. I will take her to MSU in the a.m for a few hours and then return with her and then shampoo/rinse/repeat each day.

She will get sick at the end of the treatment for 8 or so weeks. Her condition will worsen for a short while and then she'll recover; or she could be paralyzed. Or it could all go perfectly well. It's one day at a time.

We have been here before with sick cats that have chronic or serious conditions. At first-especially at first-it feels overwhelming, upsetting, unstable, as if life must come to a halt so that you can make adjustments to schedules, project lists, the care of other family/pets, etc. in order to concentrate on the sick cat. Eventually I get organized for their care, I get into a schedule and know where to take care of other people and pets and things. I set aside what I can-maybe I won't paint that many rooms in the next few weeks or schedule workman in the house during that time or during her post recovery time. Those can wait. But the other cats need tending, appointments, updates. I can only pray they do not get sick and that between the two of us we can tend to their appointments. 

How long will we pursue this line of treatment? For as long as she needs, for as long as we can. Yes, so much depends on keeping jobs, saving money, having the ability to tap into savings AND put it on credit cards and use CareCredit and THEN pay it off down the line.  But the tumor won't metastasize into cancer (rare chance) but it can cause worsening of the lameness and inability to pass urine and bowel movements. But plenty of cats are paralyzed and wear diapers and little wheels to get around. It's too soon to think of ending her life just because she's sick. This blog, this Cat Facebook page has never supported the idea that just because a cat is sick it must be put down. We are responsible for them-for FIGHTING FOR them. We must try-try to save our vulnerable cats; try to save our HCM cats with medications and cardiologists and supplements-so why not try to save Bette? (She does not have HCM.)

But I must think of the diameters of determining when it will be time to end her struggle, to call an end to the fight, and how and whom and where to end her life. What is the best case scenario? Which ER-the vet school, our regular ER? Her vet? Her vet visiting her at home? What happens if she crashes because of a complication? Where/who then?

But first, I need to rearrange my schedule for the end of April and into May to take care of her. 

Then I need to prepare for Easter. 

Please pray for Bette's safe and effective treatment outcome. 

Elizabeth Still Has Difficulty Chewing After Dental Surgery

 In March Elizabeth (does not have HCM) had dental surgery to remove what was left of a resorption tooth root that for two years has not disappeared. The vet had also sewed up the pockets of gum around her canines-bucal bone-to keep out material that could lead to infection and deterioration of the bone and teeth. 

BUT she continued to chew with pain as observed by chewing on the side of her mouth, tilting her head, nashing her teeth, etc. So, we went back last week to the dentist who removed what was left of the surprisingly unresorbed sutures and saw she had gum irritation along the surgery site. He gave her a shot of Cerenia-an antibiotic-and said to give her another in two weeks. By the next day, she was chewing normally again.

If your cat is chewing funny, they will need xrays, a dental cleaning, and possibly surgery. All cats should see a cardiologist for an ultrasound of the heart to determine if the cat can undergo anesthesia safely before ANY type of surgery even if they have had one in the last year because anesthesia can cause major life threatening complications. And heart disease can suddenly appear from one year to the next. 

And if you think there is still irritation of the teeth post-op, trust your gut and take the cat back to the dentist for a recheck. You are likely correct about what you are seeing.  As with everything with your pets, if you think something is wrong, likely it is so take the cat to a vet. 

HCM cats CANNOT have surgery because they cannot have anesthesia because it lowers the heart rate and that can lead to stress and CHF and increased complications. If an HCM cat needs surgery that cannot be avoided, careful discussion and a plan around managing the HCM condition and possible complications must be made, with a plan to save the life as needed, and close recovery monitoring post-op at a hospital for a day or so, and further close and careful monitoring at home. 

Bette's Legs Weaken With a Limp Due to Nerve Tumor

 Bette goes to vet school tomorrow for a CT scan and a treatment plan to address her nerve tumor. It has made her legs very weak despite three weeks ago being almost normal. She stumbles going up and down stairs. She has been limping for two weeks on the right leg. She is also showing signs again of struggling to expel fecal matter although she appears to be able to fully urinate. She is still on Prednisolone 1ml BID, Cisipride .05 once a day, Valium, etc. and her pain med Buprenex has increased from .15 to .25 twice a day. We may need to move her over to stronger Gabapentin. We'll know more after tomorrow.