15 year old cat not responding to chemo- when to stop diagnostics

trianglekitty

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I'm going to try to keep this short, but Jonas has a long, complex medical history. Seriously, he's filled three files at the vet's office (and that's just his primary vet.)

Jonas came to me as a half-dead blind feral kitten. No one expected him to make it through the day (the actual plan was to euthanize him, but he woke up long enough to bite me and I figured he had some fight and deserved a chance.) He just kind of kept not dying, but throughout his life has had a number of health problems. He seems to have almost no immune system, which makes him very vulnerable to infections. Despite this, he's generally been a very happy, robust cat, with maybe one crisis a year that required a trip to the University or various specialty vets.

Over a year ago Jonas started having trouble with very bad diarrhea and low appetite. We try very, very hard not to sedate Jonas, as he had a cardiac arrest under anesthesia as a kitten. His primary vet won't touch him on the surgical table because of this. He also dropped a lot of weight very quickly and was very frail. The internal med. doctor did an ultrasound and found intestinal thickening that was suggestive of small cell lymphoma. With Jonas' condition being what it was, she agreed to presumptive treat without a biopsy. Jonas was started on Chlorambucil.

For quite some time Jonas did very well. He gained back much of the weight he had lost and was eating with enthusiasm. However, he would have occasional times where his appetite would drop off for a few days. He also still needed daily Cerenia or he would start vomiting. On a recheck ultrasound there was still some thickening, though it had markedly lessened. The vet opted to keep him on Chlorambucil.

About two months ago Jonas had a neurological event. Over the course of an hour he completely lost the ability to walk. After 14 hours at three different vets, it was determined he either had a brain tumor or had suffered a stroke. As he recovered slowly over the course of the next few weeks it was clear it was a stroke. His blood pressure was found to be high and he started on medication for it. On recheck it was normal. The stroke left him with some neurological issues in his rear legs, but he was still able to get around quite well.

It felt like over the last 3 months or so that Jonas' periods of low appetite were getting closer together. There were also some odd events. A month after his stroke I took him to the emergency hospital in the middle of the night because I thought he was head pressing and was worried about his pressure. It was normal, but it looked to me like he was head pressing and grimacing at times. He's had on and off congestion that no one is sure of the reasons for. Sometimes his rear legs seem worse, which is strange for a stroke recovery- normally recovery is consistent.

About a week ago Jonas had three days where he didn't want food AT ALL. He would actively run away from it. We started an appetite stimulate and scheduled an ultrasound, which took place today. For the past two days he's been eating much better, which is probably the medication kicking in. However, he seemed weaker and even got caught on the lip of his litter box.

The ultrasound showed what I feared, which is that the thickening has worsened. He had also lost over a pound in just one month. The doctor is no longer sure that it's small cell. She's not even sure if the chemo EVER worked, though I disagree since he did get better for a sustained period of time. The doctor is concerned that there is something else going on, and that it may not even be intestinal. Maybe there is something going on in his brain, or maybe there are multiple things happening.

At this stage, we have two choices.

Schedule an MRI and a biopsy. There is a risk he won't wake up. There's a chance they won't find anything, or that what they do find won't be treatable. Small cell is basically the best case scenario in terms of response to treatment, so if it isn't that it's likely to be something not good.

Or increase his steroid and just see if it does anything at all. Maybe it won't, or maybe it will give him a little more comfortable time, but this is basically accepting that we're going to lose him soon.

I am very, very torn. Every other cat I've lost, I've known what was wrong and how treatable it was. This would be the first time I'm stopping without knowing exactly what is happening and if it is or is not treatable. Part of me wants to move forward with the MRI and everything just so I'll know for sure and will have the comfort of knowing I did everything I could.

But part of me also feels that Jonas is a 15 year old cat who everyone expected to die as a kitten, and he's already endured so much in his life. If we do find it's a brain tumor or a more aggressive form of cancer, I'm not sure I'd opt to treat. And to be frank, the MRI is very expensive. I've done MRIs on Jonas in the past for various reasons, but he was younger and what we were looking for was more likely to be treated. I'm not actually sure where I would find the money right now. And I absolutely HATE that it is coming down at least in part to money, because I've never let that factor in before. With Jonas it has always been he gets what he needs and every other consideration comes second.

On the other, other hand...I know how blessed I am that Jonas has been with me this long. He's beaten the odds so many times. Even so, I'm not ready to say goodbye yet. I lost my mother two years ago after being her caretaker for most of my adult life, and honestly the thought of losing Jonas hurts worse.

Any advice or thoughts would be appreciated. This just sucks, really.
 

solomonar

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Could you go for a second opinion?
MRI is very sophisticate, it requires high skill to interpret correctly, and mistakes are always possible. Could you ask (diplomatically) for an alternative investigation?
Sometimes doctors jump to rapidly into imagistics, while old classical methods of investigation may work at least in an indicative way.
 

FeebysOwner

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Hi. Poor, but lucky to have you, Jonas. Is it even a remote possibility to perform a fine needle aspiration instead of an actual biopsy. I've heard, under many circumstances, FNA can be done without anesthesia - but is generally conducted with an ultrasound, rather than an MRI.Is there any chance that the Chlorambucil has lost its effectiveness, and another drug could be tried in its place?

I don't know if there is any correlation with the thickening, but have heard about a number of IBD cases - particularly involving weight loss - that Vitamin B12 shots have helped with malabsorption. Has Jonas' B12 levels been checked?

Hopefully other members will come along soon and offer their input. Please keep us posted.
 

mrsgreenjeens

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Yes it does suck :alright:. But I have to ask you this. What would Jonas want? YOU above anyone else, might know the answer to that question. You know him best. We don't know him at all. Is he still happy? Do you think he still finds joy in all the little things life holds, or he tired and ready to go? I know it's hard, oh so very hard, but we have to think of them, not us at times like this and not let them suffer if that's their future.

If you cannot afford an MRI, no one will fault you for not getting one, especially if you wouldn't opt to treat. I would talk to your Vet and ask for the best case scenario if you DID the MRI versus the worst . As you said, it doesn't sound good. But could there be a good outcome? And, of course, you could always try the Vitamin B12 and steroids that are a common IBD treatment,just in case. If nothing else, steroids should help make him feel better for awhile, even if it's cancer (I think).
 

Joan M

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I am so, so sorry you are going through this. It's just awful. We want to hold onto them forever.

I tend to try to keep both my cats and dogs going for longer than I should. I realize it after the fact and beat myself up for putting them through so much. But we are trying to make them better, and sometimes it works and gives them more time.

Finances come into the picture, whether you want them to or not. That's not wrong, it's just a lousy part of the whole picture. But it sounds like you are willing to spend more, if you know it will help. That's the issue - will it help? Will it make him better or make him suffer longer. It's a difficult situation, and you are the only one who can make that choice.

What I have done when I have not been sure is ask the vet - if this was your cat, what would you do? I ask them for an honest answer either way. They don't care about prices, so they will do what they think is best for their cat. Maybe it would help you know which way to go if you trust your vet and can do that.

And I understand about losing a parent and then a pet. I lost my mom, then my dad, then my dog, then my cat, over 7 years, like dominoes - each one within a year or two of the last. It was rough, and I understand crying more over your cat - it's compounded grief, and it's very strange. I couldn't get more parents, but I could get more animals, and I did. They don't take the place of the ones lost, but they sure help you love again. But you will still cry, and that's okay.

No matter which choice you make, it will not be the wrong one. You will know when it's time. Hang in there. You are a wonderful cat parent.
 
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trianglekitty

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Just a follow up. I had a long conversation with Jonas' primary vet. She's treated him since he was a kitten and I actually used to work with her as a veterinary technician.

Her opinion is that anything found on an MRI is not likely to have a good prognosis at this point. Which oddly does make me feel a little better. She also pointed out that Jonas does NOT do well at the vet without me. If it is a different form of cancer that requires in hospital chemo, I wouldn't be able to be with him due to covid. He becomes very aggressive and stressed. She said that if he were hers, she would not do more diagnostics at this stage.

I also had a long talk with the oncology department at the specialty center. They gently told me they would give me an appointment if I wanted, but they were unlikely to have any other options or suggestions other then the things we're already doing.

So I think at this point we're just in palliative care, and maybe for not much longer. He had an *awful* night a few nights ago- he had very bad diarrhea and then fell in it and had it all over his face. I was up at 3am bathing him. That is not something I want to put him through. But...we did increase his pred (actually doubled it) and he is already eating much better and having normal stool. So I'm going to give him a few more days to see if he gets stronger.

I know in my heart that we're very near the end.
 

mrsgreenjeens

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:alright: With the Pred, he may have more time than you think. But every day now is a blessing. Whether he has days, or weeks, he knows he is loved, and YOU know you have done the best by him. My hearts goes out to you. We're here for you :hugs:
 

2CatsAndADaphne

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So sorry to read your story about Jonas. My goodness, how fortunate he is to have had you for 15 years caring for his every need!! I read your update above and feel for you. I had a 14 year old cat get diagnosed with cancer which was eradicated with an amputation and he lived a few additional years as a tripod cat, but the final weekend with him was so traumatic. Everything happened so quickly, his decline was very rapid. Maybe this is what is happening to Jonas right now. I know my cat was hanging on and hanging on and hanging on until he just couldn't anymore. It is never an easy decision. It is clear you are torn. I have no advice, just wanted to let you know I read your story and am hoping for the most peaceful end possible when Jonas's time comes, for both you and him.
 

Joan M

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This is the hardest part of having a cat. 💔 You have been so wonderful with him, and he knows it.
 

fionasmom

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I just want to say that as I started reading that Jonas came to you as a kitten I did not realize that it would develop to the point where he is 15 years old.....you have done a remarkable job with a cat who would have had no chance had it not been for you. I just can't say how remarkable what you have done for him has been.

The pred may buy you some time and quality of life with him; it has for me with various cats over the years who were not good candidates for anything else.

This is where I am in situations like this.....I told my cat vet several years ago that I will do no testing that is only academic and which will not result in any further treatment for any number of reasons....cat would not survive the treatment, cost, etc. I used to and it made me feel as if I was doing something I suppose but in the end it was futile activity and sometimes stressful for the animal to have to undergo the testing.

Money is absolutely a valid consideration especially when results could be so uncertain and there is no shame in not going into debt for what might be a failing cause. It is not the same thing as saving an animal who could certainly have been saved if someone would have paid the bill.

Lots of people, if they would admit it, miss their animals more than human family members for so many different reasons.
 
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trianglekitty

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Just to give you some sense of what a *warrior* this cat has been...

As I said, Jonas was brought to my vet hospital after a young woman found him sitting in the middle of the street at night, in the pouring rain. He was grotesquely underweight, almost comatose, and both eyes were so infected they were swollen to the point he couldn't close them.

The woman who found him couldn't afford treatment for a random stray and the prognosis was obviously very grim. The plan was to euthanize him immediately. It was a very busy night and the vet got called away before she could give him the injection. He woke up enough to bite me, and on a whim I tried offering him some food. When he scarfed it down I decided to ask if we could give him a chance, with the understanding I would assume all responsibility for payment and would be responsible for finding him a home if he lived.

For *weeks* I expected to find him dead every morning. He was still hanging on, but he also wasn't getting better. We eventually decided that the infection in his eyes was so severe that it was draining his strength. In a last ditch attempt to save him I decided to have his eyes removed. The surgery was performed by the youngest vet at our practice. It was her first eye removal.

I knew there was a very, very good chance he wouldn't make it through surgery. Indeed, I got a call letting me know he had gone into cardiac arrest. I told them to tell the young vet that it was okay and not her fault and not to attempt heroic measures.

She didn't listen, and worked on him for three minutes until she got him back. I got a huge shock when I went into work that afternoon and found him sitting up on the surgical table instead of bagged in the freezer!

The cardiac arrest happened just after his right eye was removed. Obviously the left eye got a stay of execution. The right eye was the more infected of the two, and removing it actually worked as intended. He turned the corner almost immediately after the surgery and started gaining weight.

He eventually came home as a 'foster'. I even found a lovely woman several states away who already had a special needs cat and was willing to drive up to meet me halfway. The problem was that the fate of Jonas' left eye was still unknown. I wanted to wait a few months to see if it would need to be removed as well. It did heal over, but it kept getting ulcers and adhesions. Also...well, I was very much attached by this point. His adopter finally called me out and told me Jonas was already clearly where he belonged.

As a kitten, Jonas was frankly a complete and utter punk brat. He was *bad*. Very aggressive, to the point he was difficult to handle. And he was *relentless*. I found myself sitting on the floor on night at 2am sobbing because he would *not stop biting.* Keep in mind I'm a vet tech who has worked with many, many cats, including many ferals. I had never had a cat that defeated me so badly. But he was also incredibly loving and whip smart and such a fighter that you couldn't not admire him. I eventually had to take him to the University of Penn for a behavioral consult. The behaviorist was amazed that this little blind kitten was so incredibly confident. He walked out of the carrier and owned that room. She basically told us he was so smart that he was bored and we needed to run his furry rump and stop being overprotective. I started taking him to work with me and leash trained him and did other enrichment. He was forever a very nippy cat (still is) and he's pretty awful for anyone else, but we came to understand each other. He would sleep cuddled against me, which his forehead pressed against my cheek and his paw draped over my chest.

The left eye continued to have issues, but we found he did have a very small amount of sight in it. Just light and shadow, basically. Then Jonas developed an ear infection. This is when we started to realize that Jonas' immune system was basically nonexistent. I woke up one morning and he had a mild head tilt. Two hours later he was so vestibular he couldn't walk. He spent three days at Penn in the ICU. The swelling in his ear was so severe it permanently paralyzed the left side of his face. The inability to blink caused the interior of his already damaged eye to collapse.

At this point the plan was to remove that eye. Badly damaged eyes in cats can grow a rare cancer that is almost always fatal. That second surgery was done at the University.

For a month after the surgery Jonas was *severely* depressed. He barely moved. I was convinced he was missing that tiny bit of sight he had. It was devastating to see him so still and I started to seriously consider euthanasia. We did numerous rechecks and blood tests during this time and found nothing. A month to the day after the surgery I woke up to find that left socket horribly swollen. He had had a hidden infection brewing the entire time. He had to go back in to have it reopened and cleaned out, and a day later was back to his usual punk self again.

However, that socket would continue to cause problems. The surgeon left behind tear duct tissue. The fluid would become trapped under the sealed skin of the socket and cause swelling and pain. Jonas had to go back into surgery twice more to clean up the mess the surgeon left behind. I want to point out that the *first* eye, the one my baby vet did...that healed beautifully and never had a single complication.

There were other random things. Jonas developed a massive amount of swelling following a rabies vaccine. He had to see oncology and have a wide margin biopsy done to check for vaccine related sarcoma. Thankfully it was only inflammatory tissue, but we could not vaccinate him after that. He would randomly get strange yeast infections on his paws and the *tops* of his ears that the dermatologist had never seen in a cat before. He had a very, very strange event where he started to collapse in his rear legs. I did an MRI and it found some arthritis and herniated discs, but nothing that would account for the severity of his symptoms. I started taking him to physical therapy and did laser therapy, which did seem to help. Then he started to actually walk backwards. No one could figure it out. I really thought I would have to euthanize him since we couldn't seem to find the source of his pain. Then I noticed he was slightly gaping his jaw. On a whim we did a dental, they pulled one bad tooth...and the walking backwards instantly stopped. To this day no one has any explanation for it.

I know this is such a huge, ridiculous list of maladies for one little cat. Every time I had to take him to a new vet and run down his history I would see their eyes go wide. It paints a picture of an animal in constant pain and disability. But Jonas at every point was weirdly robust. Always active and purring and eating and causing a ruckus.

(The issues with his immune system also always made every single new vet recheck him for FeLV/FIV. I swear this one cat has been tested dozens of times.)

Then last year he really started to go downhill and lose weight. Again, I thought that was going to be it. Again he surprised everyone and gained back everything he lost. Then a few months ago he had the stroke. I woke up at night because I felt him climb out of his bed beside me and fall into me. When I set him on the floor I could tell he was weak in the rear. I took him to the emergency room, but they thought he just aggravated his arthritis and prescribed pain meds and rest. By the time I got him home he was flat on his side and unable to rise. By that time his regular vet was open. They sent us to VSEC in Philly. VSEC didn't have a neurologist at the time, so they sent us to Penn. It was 14 hours in various hospital waiting rooms. Penn told us they couldn't diagnosis him for certain without an MRI. Even if we had opted to do it, they would not perform it because Jonas was an unvaccinated cat with severe neurological symptoms, which made him a rabies suspect. The doctor at Penn was very certain that it was a brain tumor and not a stroke based on the severity and sudden onset. For some reason I strongly felt it was a stroke. I'm glad I listened to my instincts, because otherwise I probably would have euthanized him that night.

The first few weeks were rough. Jonas was already walking a little by the time we came home from Penn, but he was circling and falling. I had to hold him up in the litter box. I had to hold him up to eat and kind of scoop the food into his mouth while he took savage, uncontrolled bites. It's a good thing it turned out not to be rabies because he got me good a number of times. There were multiple days when I was sure I was going to need to take him in at any time to euthanize.

But after the first week or so it was a steady upward trend toward recovery. He still has some neurological issues in his hind legs (he drags his rear paws slightly and his gait is abnormal.) But he was able to get around quite well, use his cat stairs up to the bed, and even go down the house stairs (with me going down backwards in front of him for safety.)

So. That's Jonas' story. I'm not a person who makes quick decisons. I'm much more pragmatic then emotional. But I'm so, so glad I made a split second decision that night so many years ago and took responsibility for him. I remember rolling my eyes at myself and then thinking it didn't matter anyway because he was obviously going to die overnight.

Sorry, I know this was super long and I doubt anyone will read it but he's been such a fighter. And you can see the constant theme of thinking I would need to euthanize him only for him to recover from his latest misadventure and thrive.

Oh, did I mention in all of this that he has asthma and needs an inhaler daily? This cat!
 

FeebysOwner

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Thank you for that story. Jonas is a fighter, warrior, and resilient - and some of the reason for that is because of you. You hang in there with him, because of him, and for him!!
 

Joan M

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I read it! You are BOTH amazing!! It is so hard to give up any cat, but when you work so hard with one, it is even more so. I hope you have sweet, sweet hours, days, or weeks with Jonas, whatever time is left for him. You are both warriors.💕
 

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That is a beautiful story of both of you and what you have done for each other. :hearthrob:
 

Furballsmom

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Hi!
I'm personally not either way about whether to go ahead or to stop, since it's not my little man and every cat and situation is so very very different, but if there's something in the links below I wanted to provide them in case you weren't already familiar.

(apologies for any dead links);
Financial Assistance – Day By Day Caregiver Support Inc.

Financial Aid for Pets

No Money For Vet Care? How To Find Help And Save Your Cat's Life

About Waggle | Vet Financial Assistance | Financial Aid For Pets
 

Purr-fect

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I read it too.

Thank you for sharing.

Jonas isn't just a fighter. He is a champion and you have been his coach in the corner all these years. Im impressed by both of you.
 
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trianglekitty

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At this point, I'm fairly sure there is something progressive happening in his brain. I had to take the bed apart and put the mattress on the floor today because he fell over the side repeatedly last night. That's something he's never done. He's also been eating in a way that gets his food caked over his nose, which again is new. He's still able to get around fairly well and even came down the stairs this morning (which my hands around him to make sure he didn't fall), but his mobility is worsening. Or rather I think it's his ability to reliably tell where his body is in space.
 

fionasmom

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I am sorry to read that but do agree with you. I had a cat once who developed neurological issues, probably in his brain, and the description matches...not knowing where his body is in space.
 
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