My Cat Charlie - Pancreatitis? Lost alot of weight and Little appetite

  • Thread Starter Thread Starter
  • #121

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
So the unfortunate news about Charlie with his Ultrasound today with FNA was while we will await the results by Thursday...the oncologist mentioned they were able to see the mass in his colon/large intestine area specifically. They were able to successfully take a sample with needle. While the full report is being written and will know more details tomorrow - oncologist says nothing else was really found with the ultrasound - nothing at least of significant concern or to address he said. However, the more unfortunate part was that due to the location of the mass, he said it nearly rules out the mass being either Benign or something related to IBD - instead very very likely its one of the three forms of cancer he mentioned to me during his check up earlier. So...I guess there goes all positive thinking and hopes I had of it being not just treatable, but also something he can overcome. Only thing I'm relieved somewhat now is that it seems we are going to find out what he has once and for all, but avoided all together the surgical biopsy. But quite the sad news that oncologist now too thinks its cancer as well...
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
We'll know soon enough about the mass. But what about the teeth? Are you going to make an appointment for that? He may respond well to the chemo but only if you can keep him eating. And instead of relying exclusively on medications, we should at least see if anything needs to be done with his teeth.

As for chemo, most cats tolerate it very well with few if any side effects. It isn't nearly as destructive to quality of life in cats as it is in people. When you hear back from the onc., he can give you a treatment plan and what to expect. Make sure you understand when you should bring him back in for a checkup and any signs/symptoms that you should bring him back without delay.

Reading back through my journal with Krista, I didn't have nearly the support you already have. I regret not working with an internal medicine specialist for her IBD or an oncologist when it turned into lymphoma. I regret not having better advice on steroids. But I am also suspecting that her lymphoma started presenting much earlier than I previously thought. It may have been presenting as early as this time last year. That means that even with only a partial remission (she finally had full remission in her last month), we still got 10 or 12 more months together. That time was so precious despite how stressful her poop and poop puke issues were. I have so many pictures and videos and memories from those 10 months that will remain long after I forgot what it was like to interrupt my cat mid-squat on the carpet and chase her to a litter box. But we also potentially had a different cancer. Krista didn't have a mass.
 
  • Thread Starter Thread Starter
  • #123

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Gosh that is sad to hear about your Krista. Yeah after all the advice given here and on that other site you mentioned - I was already leaning on doing that surgical biopsy...but something told me to try again with the pet hospital - albeit further from my home, see if the oncologist can check my cat out. I explained that my vet didn't want to give the referral until he did the surgery...but look now! I may be able to already get the answer without having done that surgical biopsy. Plus, the hospital was soo accommodating in sense that they didnt really require to have that referral - and instead they themselves requested all of Charlie's medical records for oncologist to review and still set up the appointment. It really makes me relieved and to your point, wish also you went that route with specialist. I didn't want to give up on my 15 yr boy as we did with his brother at age of 11. Plus having Charlie on insurance really helped out as well.

Interesting you mentioned your cat about pooping on carpet. our cat been like that nearly ALL his life (hence why we thought his appetite was THE only issue). My cat in nearly all of his years - he would be hunched over and drop stool around the apartment. He would literally any place he can find, even at times the boxes he slept in, or even worse, on my mothers bed! It was soo frustrating because he woudl typically cry loudly to sort of warn us he needs his litter, so if we were awake or around, we certainly carried him to his litter and he would do it there. Other times he'd just do it outside - usually over night as we slept. But he been doing this for SOOO many years that our primary vet thought it was just behavorial and thought that Charlie trained US to take him to litter - despite him doing his urine on his own in his litter box. It was only his stool that he would do alot of outside. Makes me wonder as well that pooping outside of litter all this time was the sign of this mass forming...but gosh its been nearly his whole life, its hard to tell, let alone have him survive this long with that issue. And suddenly NOW especially in the past week or so, he has been using his litter to even pass stool all on his own! Got us sad because like, here we are possibly near the end of his life and just now he decides to be obedient and disciplined to use his litter box, its quite strange.
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
It could be the passing stool was so uncomfortable in his case that he associated the experience with the box itself. Cats have been known to do that.

In Krista's case, her first poop always, always, always made it to a box. It was only if she had to return to the box two or more times in a pooping session, the more times she had to return to the box, the less she wanted to. If she had to poop a third time, that was going on the carpet. The second one was 50/50 whether it made it to a box. But the first one always made a box. She tried. I know pooping was a miserable experience for her when she had the clostridium infection last summer and when her lymphoma started (which I believed was still clostridium hence why I now think her lymphoma started earlier than I thought before.) Often if she had to poop two or more times in a session, she was going to throw up afterwards from the effort or the experience. Sadly, I wouldn't learn until her last couple of months that the fish flakes I was wrapping her pred pill in (to get her to take the pill herself) were inflammatory and the reason we were not achieving full remission. When I had to switch her from the fish flakes wrapped pill halves to transdermal gel in her ear, her poop nonsense finally ended. I feel horrible that I was delaying her remission trying to make her nightly pred routine easier on her. Had we given transdermal gel a more honest try the first time we got it, we probably could have achieved an earlier remission. I am grateful that her final month was spent in remission though. But that's neither here nor there now. None of this speculation changes the outcome or gives me a minute's more time with her. It is what it is. I tried my best and only wish I had consulted specialists for her gut and butt like I did for her teeth.

Krista had tooth resorption. On top of the IBD and pancreatitis and a bout with liver inflammation, her body was eating her teeth. Every few months, her eating would slow to a crawl and I'd take her back to the vet and beg them to pull more teeth. This went on for a year and a half until finally she had such a mismatched mouth of few teeth that her vets no longer wanted to do any more work in her mouth. They refused to do a dental exam I requested and said, "take her to a dentist!" We lucked out and got into a dentist in two weeks when the typical wait time is two to six months! A wildfire was burning near his service area and likely clearing his schedule with the evacuations of neighboring towns. We got a same day procedure in the afternoon after the consultation in the morning. By evening when I brought her back to the hotel room, she was eating like a champ again. Her eating never suffered again until her final weekend with the bladder infection that proved too much for her tiny weakened body.

It is possible that this mass in Charlie's gut has been slow growing for a long time and that he's been bothered by it for a long time. It is also equally possible that all this slow eating and tooth grinding is partly or mostly due to his teeth. He is 15, after all. Tooth issues are common in senior and geriatric cats. I would take all that money and trouble you saved with not having to do a surgical biopsy and reinvest that into a dental exam with new mouth x-rays. Then you can go full steam ahead with the treatment plan for his mass knowing that you're not overlooking another potential problem. Even if it is cancer, that doesn't mean the teeth aren't also a possible source of pain and disease for him too.
 
Last edited:
  • Thread Starter Thread Starter
  • #125

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
So I did get back the Ultrasound report, posting it on here. Not the greatest of findings/report, bit surprised/concerned how it found slightly more issues compare to the utlrasound performed weeks ago. Just now awaiting result of that biopsy hopefully tomorrow. The mass did appear to be slightly smaller as oncologist first described just from physical exam - but that could be just the effect of the prednisolone of reducing the size. Oncologist didn't say its result of prednisolone...but my primary vet kinda did when he wanted to approach with 10mg of prednisolone daily in hopes to "shrink" mass. But to go along with the other findings, now I fear many other things could be contributing to his diminished/picky appetite. Today he didn't do too well eating wise and went back to hiding under neath the table short while ago while hunched over.
 

Attachments

  • Thread Starter Thread Starter
  • #126

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
I got the report of the Biopsy...as the oncologist warned about both Prednisolone affecting the result of the biopsy + the chance of it still not being definitive (preferring surgery), the results came bac inconclusive...

He further explained the possibility that it can be a type of still like carcinoma, mast cell tumor (which I think its benign?) or still be lymphoma. But Oncologist says either way, for the surgery biopsy the whole mass has to be removed. The only caveat is that if the mass is on a blood vessel, then there's that chance it can't be removed because it would be too dangerous to remove even by surgeon. Obviously costs to get it removed at the hospital is through the roof...not even my insurance reimbursement will be enough to cover it. However, he did mentioned if my primary vet is comfortable doing such surgery , he can do it as well and it may be cheaper to do it there. So I sent over the reports to him to see what he can do for me. Hoping he can help, though I know a surgeon would be ideal...its just costs. And upsets me somewhat the FNA did not come back conclusive...it was a long shot I guess.

From what I read on the report, however, if I interpret it right, while it still can be a form of cancer, and maybe because Charlie's weight has been somewhat stable, it could be that its a benign form of tumor which i guess either way has to be removed. Plus is in descending colon so its near the end and not possibly affecting his other organs. But Im no expert in this, and because it was inconclusive Oncologist said he was sorry that the FNA didn't provide much light or guidance on what he has.

If anyone has some knowledge on this would greatly appreciate it. It's been a tough month , and I am still considering the surgery as Oncologist did say there's that chance when he removes it, in addition to a medication that he would get cured. So that's the only slight hope of Charlie coming through...but seems like a long road ahead.
 

Attachments

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
Can you ask whether tapering him off pred fully and waiting a couple weeks beyond that would provide a better FNA?

Sorry it was inconclusive.
 
  • Thread Starter Thread Starter
  • #128

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Can you ask whether tapering him off pred fully and waiting a couple weeks beyond that would provide a better FNA?

Sorry it was inconclusive.
It was a lot of info from the oncologist to take in...that i completely forgot to ask that until after I hung up the phone. That's what I thought too but I will ask him again tomorrow. But even so, I think the oncologist said that he was confident that the mass will be something that has to be surgically removed , thus suggesting instead of going with the bigger needle biopsy, to go with surgery instead to have it removed. Plus since for the biopsy they would have to sample the whole mass to either way it gets removed. Chances are that even with a new FNA, and it is lymphoma, sure thats chemotherapy but still a long time to wait from now for him to be off. oncologist did say it can take from 2-4 weeks free from prednisolone to be cleared out of his system. So a month, like he also said, may be too much and he can deteriorate quickly in that time frame. So its a risky chance to take, which I understood so that is why I had went with the FNA this week rather then later. Eitherway I took a chance, spent $2k so far on this ultrasound FNA...so now just left with either possibley a better FNA in about few weeks time (if charlie has that...) or straight to surgery.

My primary vet just replied to me email but he did not say No that he CANT do the surgery. He said its too much and too important to discuss via email so I have to call him in tomorrow. Hoping he can give me at least the help with the surgery - or maybe even he can suggest to be off the Prednisolone and perhaps a better FNA can be taken.
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
Another option, because his weight does seem to be stable, is to try another course of pred and see if that further shrinks the mass. Before you try this, I would ask if one of the radiologists can confirm that between the two ultrasounds, the mass did indeed shrink as it sounds like it did.

But if you wait on the biopsy, his condition could deteriorate further making the biopsy not recommended.

It's hard to say what I would do if it were my cat. I would ask the vet and the onc to list a few options for you and understand their risks and typical outcomes.

1. Do nothing. Obviously you're not going to do this. But it's helpful to have a best guess at what the progression might look like if you did do nothing.
2. Pawspice. Make him comfortable with medications. Ask if the onc believes there might be any pain involved or if it's probably just nausea and poop nonsense. At a minimum, you'll likely need Cerenia or ondansetron (Zofran) for nausea and either mirtazapine or cyproheptadine for appetite stimulation.
3. Another course of pred and compare the ultrasounds. There's the opportunity cost of waiting but if this works, you might not need the surgical removal of the mass.
4. Surgical biopsy and removal, if possible.
5. ??? what else ???
 
  • Thread Starter Thread Starter
  • #130

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Yes, I will definitely ask.

But my goodness, i just was researching about the potential chemotherapy and such medications...is it true its THAT expensive for one of those medicines? I didnt even consider it being nearly $400 for just a medication. Im used to paying like 25-40$ per medication at our primary vet.
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
Yes, I will definitely ask.

But my goodness, i just was researching about the potential chemotherapy and such medications...is it true its THAT expensive for one of those medicines? I didnt even consider it being nearly $400 for just a medication. Im used to paying like 25-40$ per medication at our primary vet.
I don’t know. Krista’s chemo drug, Leukeran, was $50 to have it compounded into a concentrated anchovy flavored oil. The pills would have been cheaper. But Krista was notoriously difficult to pill. This is why I thought I was so clever when I got her to take her pred pill each night by wrapping the pill halves in fish flakes. If only we had given the transdermal an honest chance the first time we got it....
 
  • Thread Starter Thread Starter
  • #132

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
So couple of updates.

Charlie been off prednisolone now as of last Monday. Have given him 1mg of Mirtazapine 2 days ago and somehwat helped better for him to eat. Not ravenously - thought he would go back to his old food but he came close to give it a few bites then stopped. Guess he will never go back to it...

This morning had an appointment with Surgeon specialist which I had to make in order to get an actual Estimate for the surgical biopsy. So - he explained thoroughly how surgery would go and all, the risks/complications, and whast to come after. Cost wise - comes out to be $6700 for the surgery/possible removal of mass while primary vet is just $2700 to do simply the surgical biopsy. Whom do I trust more? Hard to say considering our primary vet since he's done surgery in past and all turned out fine. However, hospital estimates lists a TON of more injections to cope with tissue reforming, pain control, anti nausea, iv fluids, etc. and seems to be a proecude that requires him to stay just one night and next day he comes home - while primary vet would keep him for 2 nights/3 days. Slight scary part at primary vet is that no one watches pet over night...while at hospital that is 24/7 there is someone there to watch him.

The SCL forum group suggested-they say to forget the removal and just go with the biopsy only as they feel its most likely Small Cell Lymphoma rather than large cell or other rarer form of cancer so no removal of mass would be needed and most likely be just chemotherapy.

So all in all it is a such a stressful situation to know what to decide now - either surgical possible removal at hospital or just surgical biopsy (cheaper route) at vet. My only fear there is that if i do through vet - not only he remains there for 3 days, but he cant eat 3 days but yet the surgeon specialist says he can eat the next day after his surgery at hospital (such contrasting opinions on when he can eat). Plus surgeon lists a whole bunch of injections compared to our vet - but offers no collar/cone to prevent Charlie from licking his stitches but primary vet does. Would Charlie be ok on just IV fluids for 3 days with no food? its a $4,000 difference in cost...but just hard to choose now what to do as oncologist says to have it done to remove mass/biopsy but SCL group says to not remove it and instead just biopsy it.

Lastly, upon surgeon check up this morning, remarkably (unless incorrect but doubt it as they use KG metric and measure it to the hundreths position), he was weighing 3.74kg thus meaning 8.2lbs! He was 3.45kg last week meaning 7.6lbs. Rather interesting as well.
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
I would always prefer a specialist over a general vet. And I would always prefer a specialist over random strangers on the Internet. If you have insurance, and I believe you mentioned you do, this should be an easy decision. Go with the specialists.

I'm no lymphoma expert. But it was my impression that SCL doesn't form a mass as much as it thickens the walls. That's why it's more difficult than LCL to diagnose with an ultrasound alone.

Considering the risks and possibility for complications, I would stick with the full service hospital that can handle any situation including anything overnight. Having major surgery and then left unsupervised overnight would make me very nervous. If it were my cat, that alone would make me want to go with the hospital. Finally, you wouldn't want to do this twice. If the surgeon can biopsy and remove any mass in one procedure, I would want to opt for that.
 
  • Thread Starter Thread Starter
  • #134

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Update on Charlie

I had just brought him in yesterday morning to our primary vet for his intestinal biopsy. I had chosen to go with primary vet - granted knowing a hospital might have been more safer including the overnight care/stay, but cost was just too much that would still cost me out of pockets nearly $4k after my insurance partial coverage. At same time I wasn't going to give up so I decided to go with primary vet. Plus after a final call with oncologist/surgeon the day prior, they still made it seem that there was that probablity the mass wouldn't have been removable to due to location/critical. Even my primary vet mentioned that last week as well. So in the case that it couldn't be removed, Hospital would have just taken the sample and yet still be as expensive in their estimate, probably just few hundred dollars cheaper for the lesser amount of stitches needed.

So after my primary vet called me back to update on Charlie, he underwent anasthesia and everything went fine. They took sample of the mass and also of lymph nodes to make sure if its cancer, that it hasn't spread to other areas. I also had requested to take dental xrays which proved that he apparently had two broken teeth so it had to get extracted. Well it wasn't mandatory , he asked if I wanted to proceed while he was still under anasthesia, so I said ok. It probably was the reason why he didnt want dry food and especially the teeth grinding. However, I do recall him having mouth issues and at least a broken tooth at least 2 years ago. But he has eaten just fine back then so we figured it wasn't really bothering him too much. Unless now in addition to this possible cancer, his teeth were giving him problem as well.

But one thing my vet told me is that the mass is NOT removable. And hospital would have said the same thing. I felt somewhat relieved that i went with primary vet because I easily now saved several thousand dollars by going to hospital. Now I can use that saved up money for potential chemotherapy/medications in near future. One thing certain - no 2nd surgery would be needed since that mass can't be removed. However given that its not removable - probably does confirm that its NOT some benign tumor and instead cancer which...well at this point nothing to be done. If its SCL that can hopefully have him on remission and last few more years would be great but who knows what the outcome will be. I still feel bit sad he was all alone over night...but he has been there before for his bladder obstruction many years ago and had to stay at least one night if I recall for that other surgery. Im sure he is doing ok, just awaiting on vet's call today to see how Charlie is doing.
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
Cats are stoic about pain. Charlie’s probably been eating through pain for a long time because what choice did he have? Even if that mass is the worst scenario, just by extracting those broken teeth, you have already improved his quality of life. 👍
 

Rowen

TCS Member
Young Cat
Joined
Aug 22, 2020
Messages
79
Reaction score
130
Location
Rogers Park Chicago
I'm so glad you have the full picture now, and re having his teeth delt with. I constantly wonder how much Gems tooth decay had to do with the original throwing up and start of everything- she was not showing any other signs of pain either. Did the tooth decay, stress of tooth extraction, vet visits- compromise her immune system and push everything else to the front- because its when it all started.
 
  • Thread Starter Thread Starter
  • #137

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Update on Charlie:

Well, I think it turned out to be the worse case scenario as it is not lymphoma or benign tumor but instead Colorectal Adenocarcinoma. Based off what Ive read so far, seems the outcome is not too good. The only good news my primary vet said was that it hasn't spread to his lymph nodes. Whether its a matter of time he said he doesn't know... But now I await for oncologist to review the report today and call me back on how to proceed.

Another concerning thing is that I read up on these carcinomas in colon, is that they mestasize quite rapidly...but he has been like this for a month if not longer but he def isn't doing worse. He is eating just fine in fact even better then before! Not lethargic or hiding or even acting sick...just now having stool issues again as that mass Im sure is affecting how he passes stool unfortunately. But apparently a solution to this Adenocarcinoma is to surgically remove it along with chemo therapy and maybe prednisolone. However, my primary vet said that it could not be removed - and that there's no way even surgeon would try to remove it - My guess as the surgeon explained to me after consultation - is that if its on a critical area like on blood vessel or something else critical, then it may not be removable. So I took that gamble thinking its nto removable and went cheaper route by doing biopsy solely at my vet. Now I hope the oncologist will not provide surgical removal as ONLY option because...then Ill be stuck on whom to believe. If my primary vet with many years of experience says it can't be removed, then I would believe that. Not because Id ont want him back on surgery, He can, but I certainly don't want to risk if its too critical to even consider removing it. So I hope it would just be chemotherapy and/or prednisolone.

Attached is the report of the biopsy.
 

Attachments

Rowen

TCS Member
Young Cat
Joined
Aug 22, 2020
Messages
79
Reaction score
130
Location
Rogers Park Chicago
Im so sorry to hear his- I'd never even heard of- so I looked up. As you say you need real information from one of your doctors to do whats needed. If you cant remove because of risk, chemo is available, and whether hes up for any of it is whats important. He sounds good right now and quality of life is an important factor.
 
  • Thread Starter Thread Starter
  • #139

miguel99nyc

TCS Member
Thread starter
Adult Cat
Joined
Sep 19, 2016
Messages
296
Reaction score
125
Another update: Hoping I can get helpful insights on this by anyone...

So after speaking with Oncologist, he gave me only two options - either surgically removing the mass which is still no guarantee of curing him, or running risk of performing surgery to find out either it can't be removed OR if it is removed, some cancer cells may remain in the intestinal area and/or spread to other organs thus still creating the symptoms Charlie been having all this time.

My doubts with this surgery was that my primary vet deemed the mass not removable...so if I even attempted to do such surgery AGAIN with surgeon, and if turned out to be not removable again, then I wasted the money,let alone do more physical harm to Charlie. Surgeon said he would have to speak directly to my primary vet to see what he saw and compare notes as to why my primary vet deemed it not removable. And so if they both agree it isn't removable, then it isn't suggested to proceed with surgery and instead with just chemotherapy. That's now my next problem.

Oncologist says with chemotherapy alone, although not impossible, he said it was a very very very long shot of it curing Charlie. For one, he said most cancers respond to certain type of medications but the adenocarcinoma that Charlie are usually resistant to chemotherapy...so that is why he suggested surgery only. Now the issue with the medication is that while it would be 3x a week for a month, he would then need to be rechecked bloodwork to see if medicine is affecting any organs and such. Afterwards, i dont know what would be next - i didnt ask because I was just in shock what I heard as my two options - either way seeming not a good outcome after or a low chance of anything good coming out of it.

So now the medication Oncologist was talking about was Palladia. They dont carry it in the hospital (oddly...?) and that he would have to order it either through Chewy or PetMeds sight?? It's crazy, I never heard that a hospital wouldn't carry such medications, let alone only offer to have it order online. Also upon reading, it doesn't seem to really target Charlie's colorectal adenocarcinoma AND it seems to be primarily for dogs?? I cant really seem to find much info online about this drug for cats. So I'm now very nervous. :(

I will speak with primary vet tomorrow morning to see what else he can suggest...but it seems like I dont have too many options as far as medications...

Anyone else have experience with colorectal adenocarcinoma, would be greatly appreciated. Thank You
 

daftcat75

TCS Member
Top Cat
Joined
Sep 7, 2018
Messages
7,065
Reaction score
12,297
A lot of medicines approved for use in dogs are allowed with cats for off-label use.

Perishable medicines, like some chemo drugs, that aren't used often aren't likely to be kept at the hospital. They would be ordered from their pharmacy of choice on demand. It surprises me that they couldn't just order the medicine from their pharmacy and supply it to you that way. Maybe they figure it would be more convenient and possibly cheaper to go through an online pharmacy.

Remember chemo doesn't affect cats the same way as people. If you're worried about the effect of the chemo on Charlie, chances are you won't see any side effects.

You may not get a cure or remission. But maybe you get more good months with him because you were able to arrest its growth. Were you able to get a radiologist to compare the two ultrasounds to see if pred did indeed reduce the size of the mass like you thought? In many cases, the chemo drug is safer than the steroids for long-term use. So perhaps you do another course of steroids tapering it off completely or to a maintenance schedule, preferably something every other day. Then with the steroids, you also do the chemo three times a week. Perhaps you cycle off the steroids completely and do another ultrasound. Maybe bounce that option off the vet and onc the next time you talk and see what they think.

Is he eating better/less grinding since the tooth extractions?
 
Top