Chlorambucil Advice

[ifwewerebirds]

Baby Lilly is set to start her Chemo- Chlorambucil on Friday night. I'm literally TERRIFIED.

Here's the quick story- after crazy diarrhea and a brief placement of a feeding tube, we treated for suspected IBD starting the 2nd week of Oct. We did not do the biopsy because she went through hell coming off the anesthesia from the feeding tube. They did do a sonogram in Oct and again last week and found more thickening, but no GI masses. Only the teeniest of masses in front of her heart, too small to do that needle biopsy procedure- in Nov, same size.

Her blood work is actually pretty good. WBC very good, just a little low for muscle and Potassium. All other pretty good. However, despite Budesionide, Metro and some others her diarrhea has persisted. She gained back two lbs with feeding tube and is currently at 6.9 lbs. She's always been around 7.

My fear is that she absolutely HATES liquid medication and it seems nausea has been persistent throughout her treatment so far. She started throwing up foam and sometimes meds last week. We started Prilosec and it seems to help, though not completely resolve.

While her numbers look really good and if this is SCL, it seems to be caught very early I am terrified that she will have a negative reaction to the drug. I'm fearful of it making her feel terrible. Right now you can tell she doesn't feel great, but she is generally alert, into food and treats and wants to play with her feather toy but it seems like if she moves too fast she gets burpy. She is still very loving. She's definitely not ready to quit. Btw, she will be 15 in April.

What is your experience with Chemo? What do you think I should expect? I know most cats tolerate the treatment well, but she is very sensitive to meds like Metro and Cerinia- crazy foaming.

Thank you.

 

[Kieka]

It's been 10+ years since I went through Chemo with one of my cats. I couldn't tell you the specific medication he had. We took him to a pet chemotherapy specific practice. He had two hour appointments weekly throughout his treatment where he was hooked up to an IV at the center plus medications at home. He didn't have any problem with anesthesia for the initial surgery to remove the first lump we found nor did he have trouble after the chemo. He also seemed to tolerate the treatment fairly well outside of hating the driving and constant appointment. The medications for pain and nausea worked and he didn't lose a noticeable amount of weight.

In my case it did buy him some time but in hindsight I don't know if it was worth it. After several months of treatment his lump came back in the same spot and spread rapidly. We had caught the initial spot quickly (about a gumball size) and he was in chemo within a week with no other symptoms. The vets were highly optimistic between how quickly it was caught and how well he handled treatment. But he only lived about 9 months from the initial discovery even with treatment. It just came back with a vengeance and was inoperable the second time because it had latched on to his artery. He lived probably an extra 6 months with treatment but the entire time was filled with vet visits that decreased his quality of life during that time.

If I had to do it all over, I would do the same because I didn't know the outcome. If I knew the outcome before? I wouldn't have done it. With my current cats there is only one I would do chemo with because he has the personality to get through the frequent vet visits and still have good quality of life. My other two I would just give them medication to treat their pain and cherish the time they have left. Every cat will respond differently but I do think temperament and the prognosis have to be key factors. If it was anything less then a 50% chance of positive outcome, even for my baby boy who would handle the vet well, I wouldn't put them through it.

In your case, you know your cat best and only you can make the call. I wish I could give you more direction but I can give you support. You are your cats advocate, if you were in her spot what would you want?

 

[SandyLion]

Still early to truly know but how is Lilly handling the chemotherapy? My buddy Sandy is scheduled to start Chlorambucil this week and I am worried about the side effects as well. Hope Lilly is doing well!

 

[ifwewerebirds]

Well, it's sort of hard to say. We've been trying to get the Mirtazapine right. She's been throwing up more than she used to, so trying to figure out the culprit on that.

 

[SandyLion]

I am terribly sorry to hear that. Hopefully, you can figure out what might be causing it to remedy the problem. On the Mirt have you noticed an increase in appetite? Also, how long after you started the meds did the vomiting increase?

If you need support through this time, I would be happy to chat, as I am going through a lot of the same scary things with my buddy. When is your first check up post starting the meds?

 

[ifwewerebirds]

Thanks so much Sandy. I really appreciate that. I feel overwhelmed daily, not just by her condition but by all the other issues that can arise as well. It's hard to stay on top of everything.

I'm actually getting a second opinion on Monday at a different office. Our current IM vet told us that if her diarrhea didn't clear up after 5 total doses to increase her chemo to 5x per week M-F. Get out of here. That's nuts.

On a positive note, I found a perfectly formed cat poo in the box- normal size and everything without diarrhea this morning. It's the first time in 10 weeks. Now, I'm concerned about her getting inflammation in her esophagus, worried about fatty liver, worried about if her litter is too dusty. I actually switched it to Smart Cat and she tried to eat it, for Christ's sake. I'm worried about her having to take so many meds and the fact she's been on Metro for 2 months straight. I'm worried about her nutrition; our current vets keeps telling us that doesn't matter (ridiculous). I'm worried about her taking Mirtazapine.... at this point, I don't really sleep. It's definitely a struggle.

 

[ifwewerebirds]

Oops, I forgot to answer a couple of your questions. Yes, she definitely eats on Mirtz. She wants to eat dog kibble and Saturday she ninja-ed her way into another room and ate boiled chicken which made her throw up NINE times.

Right after she came home from ER, we realized she can no longer eat hard food or treats at all. She throws up white, foamy vomit. It's really intense. It's like acid reflux or something. You can hear it frothing inside her. When she finally gets it out, I'm terrified she's going to aspirate it. Then on Thanksgiving, the same thing happened when she ate pate, so we blend all of her food now.

One thing I'd recommend is to keep a log of everything. I bought a scale on Amazon and weigh her every day. I log that, how much she ate and if she had diarrhea or vomit. Then, I have a daily log where I just write down everything that happens; when we give meds, food; how her behavior was, etc. Tonight, I'm going to go and color code with a highlighter, like one color for vomit, one color for diarrhea, etc. I'm trying to see trends. Hopefully, this will help when I go for the second opinion.