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.

Bette Recovers Ability to Walk/Use Litterbox with Steroids-Must Monitor

Bette again has responded quickly to prednisolone given twice a day (as opposed to once daily) and can now fully walk and go to the bathroom without issue.

But much like HCM, this is a disease that will grow and get worse over time. And much like HCM, we must monitor her daily for signs of the disease and complications, and monitor her ability to walk and use the litter box.

We are not allowed to increase the prednisolone in the future because more than 2ml a day will lead to immune suppression which might occur regardless. Immune suppression can lead to an increase in viruses taking hold (but she's indoors and on lysine for Herpes so that might reduce the probability.) But long term use can also suppress her response to vaccinations which can be a concern although she is an indoor cat. (But the distemper virus is air borne and can be brought indoors on us as well.)

Other long term effects of prednisolone for cats is not the same for dogs (dogs have more possible issues) but it can lead to edema-fluid retention similar to humans, or over eating (and she needs to lose one pound as it is. She's 12.3 and really should be about 11 lbs especially given her mobility issues.)

Here's one of many links you can find online about prednisolone. 

AND as a reminder-STEROIDS CANNOT BE GIVEN TO HCM/heart disease cats (and dogs.) It causes fluid retention, is contraindicated with diuretics. Bette does not have HCM.

Medications she is currently on:
*Valium 1/2 tab of 2mg tab BID (twice a day)-since 2010 for litter box issues.
*Prednisolone-1ml BID-steroid

*Buprenex pain medication - .15 BID-for a few days for her right leg pain to get her past this recent issue. We will do at least once a day going forward to see if she's in a lot of pain and if less of it affects her ability to be comfortable for now. I can increase it as needed. This is a less severe pain medication. The neurologist suggested gabapentin which we have used on other cats for other issues and it is too difficult to control. It makes them loopy even at very low doses.
*Cisapride-once a day for now-a medication to help her expel fecal matter. Works internally not at the rectum but might help here body prep the matter to push it out. We can do it BID but for now just once in the a.m. to get her past her recent issue. She has had normal bowel movements since Saturday. Is that the prednisolone or the cisapride?

*Cerenia four times a week to control pancreatitis.
*Chlorpheniramine-anti histamine for her eye/skin inflammation she began to have in 2021. Four times a week.
*Gels: lysine, Methigel (urine), Laxatone (to help her gastro mobility) four times a week

Bette Davis Develops Nerve Sheath Tumor Rear Along Spine

Bette Davis was seen in January for rear leg lameness, immobility of the tail, and difficulty going to the bathroom. I posted about it at that time. She was treated with antibiotics and prednisolone. By the end of January, she had finished the course and had fully recovered her mobility and ability to go to the bathroom. But two weeks later in February, she developed bathroom issues so was put on prednisolone 1ml once a day. That worked fine until March when March 6 she suddenly showed signs of rear leg lameness again. We had an appointment for Wednesday March 8 by which time she had gotten weaker, had again developed bathroom issues-inability to urinate or defecate fully. This time we opted for an MRI because she could have spinal cord or vertebrae injuries or lymphoma-although her gastro scan did not show signs in her organs of lymphoma (although it can appear elsewhere.) Both respond to prednisolone to reduce inflammation. 

Today, March 9, was the MRI. Unfortunately, she has cancer but one we did not think about-Nerve Sheath Tumor. It is growing along the nerve on the left side of the spine but growing into the right side of her rear limb which is why she is weak in the rear legs but has significant discomfort in the right rear leg. It has also made her numb in the rear end and rectum area, making it difficult to urinate and defecate. 

The solution short term is to increase the prednisolone to 1ml BID for the rest of her life. She cannot increase the amount of the prednisolone even as she might grow weaker and have more difficulties going to the bathroom because then immune suppression issues will develop, leading to other various health issues that are even more serious. 

Radiation is a possibility but expensive: the vet estimated $7-10k. We have been referred to Oncology at the state vet school and might hear from them next week. At the consultation, we will learn more. How will we pay for it? From savings, investment account from which we can borrow without penalty, CareCredit, credit cards. But how often will she need treatment? And we have four others, three of whom are her siblings and the same age with their own issues (Katharine has HCM now.)

There is no surgery possible as far as we know for her tumor.

Diapers and rear leg lameness might also be in the future. There are plenty of cats on social media that do both and seem to live happy lives. BUT with her nerve cancer, pain will be an issue and pain meds will be needed in the future. BUT it is likely not life threatening the vet said and she could live a normal rest of her life existence. But then again, he gave her a year before her life was impacted and that is when people tend to put cats to sleep. 

We prefer not to do that especially after we lost Baby by putting her to sleep without fighting for her life (in 2021 she had been in the ER for a week dying of acute pancreatitis and I failed to bring her home to either try to get her to recover or let her die at home.) I don't want to run the risk of letting Bette go too soon just because taking care of her isn't easy, just because she can't easily move around if she can manage. I must decide how I want things to end for her so that I'm prepared. I was so prepared for Myrna's death in 2015 after six years and nine months of facing the fact. But I was so caught off guard with Cooper (who lived five months after being diagnosed with heart disease) and Baby that I still feel a lot of shame and heartbreak.

Here is one link to one explanation. You can Google for others if interested. 

"...Nerve sheath tumors (NSTs)...are benign or malignant mesenchymal tumors and they originate from periaxonal Schwann cells (schwannoma) and fibroblasts (neurofibroma/neurofibrosarcoma). Due to its mesenchymal origin the terminology for NSTs is diverse and a wide range of names has been used in the literature, e.g., neurinoma, schwannoma, neurofibroma, neuro(fibro)sarcoma, neurilemmoma, neurogenic sarcoma, and neurofibromatosis. Currently the most widely used name is nerve sheath tumor...NSTs may occur in every large or small nerve in the body...grow outside the dura mater (extradural) they may extend along the pathways of the nerve roots into the intervertebral foramen. Once inside the spinal canal they may develop an intradural-extramedullary component or even an intradural-intramedullary component (Figure 1). Clinical signs include severe, unexplained, and intractable pain, thoracic or pelvic limb lameness, monoparesis, ataxia and proprioceptive deficits. Early diagnosis and an aggressive surgical protocol maximize the possibility for complete tumor resection sparing the limb. NSTs have a high rate of recurrence, and the overall prognosis is considered poor..."