Willy might have cancer / high-grade lymphoma Treatment thread

[tarasgirl06]

Actually, no. Air is MUCH, MUCH drier in here when temps outside are coldest. Because there is a building-wide thermostat somewhere that decides when to kick the heat on or off based on the outside temperature. So when it's coldest outside, it kicks in much more frequently.

As individual tenants, we can choose whether to turn our individual units' radiator valves on or off. So we are basically all-in, or all-out in accepting heat that the whole building provides (and it's free, not included in rent, which is the only reason why any of this is still bearable).

When it's very cold outside, building heat kicks in all the time, and you have to truly babysit your radiator valves in order to keep your apartment warm but moderate. Like constantly get up from the couch, turn the valve off for an hour, then get up again and turn it on, etc.

My point was that this is a mild winter in Wisconsin thus far. Heat has been running in my building, and air has definitely gotten drier, but it's nowhere near what it gets like when outside temps are approaching 0 F.

We've had multiple winters like that, and I am afraid to touch light switches. Guaranteed shocks everywhere. Even when petting Willy! I have shocked him numerous times and he thinks it's coming from me, and gets a little annoyed for a while.

But I've already made a long story longer. My main point is I am positive the environment -- dry air -- is a contributing factor to Willy's thirst. But then he is also on a steroid -- methylprednisolone -- and is older than he ever was during previous winters.

Since he is definitely not diabetic, I am not continuing to worry about this. Just explaining why I was so worried before getting a diagnosis today.

Right!
I have cousins in Janesville. They have an old house and I've never asked about their heat, but being a transplant from TX, I'm pretty sure he keeps the house warm enough.

 

[iPappy]

What a tremendous update!! I'm so glad Willy is doing so well with his treatments and I hope he's forgiven you by now
As far as the increased thirst goes, my vet has told me that when their bodies are working hard, little "weird" things like that sometimes happen and no one knows why. But as long as his labs are good, he's tolerating everything, and looks and acts like his old self, I'd do what you're doing and keep note of it but not let it bother you so much (easier said than done). Thanks for the updates cmshap !

 

[cmshap]

To everyone who has been following this thread, and to any newcomers:

There is now some introductory text added to the beginning of my first post, which briefly clarifies Willy's condition (due to the semi-confusing title of this thread), as well as provides a set of links to the important milestones during the course of his treatment.

Hopefully that will make this thread easier to navigate for anyone wishing to gain as much information from it as they can.

Thanks, mani , for implementing this.

 

[iPappy]

To everyone who has been following this thread, and to any newcomers:

There is now some introductory text added to the beginning of my first post, which briefly clarifies Willy's condition (due to the semi-confusing title of this thread), as well as provides a set of links to the important milestones during the course of his treatment.

Hopefully that will make this thread easier to navigate for anyone wishing to gain as much information from it as they can.

Thanks, mani , for implementing this.

That is great, it's so wonderfully organized! If someone is looking for specific info they can just scroll to what they are looking for. Great idea to do this!

 

[cmshap]

Update: 11 days post-chemo (3rd dose)...

Happy New Year, everyone.

I'm sorry for the lack of updates. I personally had a health issue for which I spent a night in the ER several days ago (self checked-in for caution's sake... not like an ambulance emergency), and my general level of energy has been very low. So I've been sleeping a lot.

Thankfully, it has been holiday season, so I could get away with that. Also, Willy has been very low-maintenance. Meaning he's been eating just fine without having to regularly dose him with Mirataz. He's been energetic, for his age... meaning I play with him when he seems alert, and then he tires out at about the same time that I do, and we both take naps. It's kind of funny because we have like the exact same energy levels right now.

I'm getting better, it's not serious but just a health issue I have to watch out for and take care of moving forward. I don't have any problem describing it but I don't want to get too far into those details with a general post. But Willy and I are doing fine.

I recorded some prime video of Willy chasing down, tackling, and destroying a paper ball that I will post later.

As far as his chemo treatment, he seems to be responding quite well. But I'm a little concerned as I've spotted a small tumor inside of his left ear (he had one in his right ear previously, which shrank a lot, but now he has one in his left ear, which is on the same side as his "main" tumor -- the biggest one that's below his left ear). I don't know how long he's had that tumor as I never really looked inside of his left ear with a flashlight like I've been doing lately.

He's still shaking his head every now and then throughout the day, which our oncologist said is probably from a feeling of pressure caused by the tumor on the side of his face. But I wonder if it's really from the little tumor in his ear, because he always shakes his head when I pet his head and press his ear down as I glide my hand over the top of his head. It does not seem painful at all, but it must be uncomfortable.

His next chemo appointment isn't for a few weeks, but I want to call the oncologist this week and bring up the ear tumor
I don't remember her discussing it, although I know she thoroughly examines his entire body on every visit. I just want to know that the ear tumor is on the record as being observed, and not something that just sprouted up recently.

Other than that, he seems happy, has the normal energy level for a senior cat, and although he shakes his head which seems like he experiences some discomfort every now and then, he still seems to be living a happy life. He is talking to me constantly, like always, and following me around. And he never hesitates to chase a paper ball.

 

[Kwik]

Happy New Year to you and Willy - wishing you both good health,peace & Joy in 2024

 

[tarasgirl06]

Echoing Kwik 's wishes and adding ours.
*PRAYERS* for your quick recuperation and wellbeing. *PRAYERS* also for sweet Willy, always, of course. It sounds like he's been doing quite well.

 

[FeralHearts]

How are things going? Been thinking about you both.

 

[cmshap]

Update: 23 days post-chemo (3rd dose)...

Unfortunately, not a happy update this time. And I need any advice I can get.

Willy had been doing well, and nothing was really changing, until over the past week, and especially over the past few days.

What's still the same (good signs):

1. Appetite and eating habits are mostly okay. I've had to dose him with Mirataz occasionally, but it's not an everyday required thing.
   
   
2. Drinking habits are the same. He still drinks a ton of water, but that hasn't changed, and was determined not to be a symptom of anything on the last visit.
   
   
3. Energy is still the same. He is not lethargic at all. He engages in play.
   
   
4. He's not hiding, like a cat in chronic pain would.
   
   
5. Litter box usage and output is normal, and the same.

What's new, different, and concerning:

1. Tumors are growing rapidly. As of 5-6 days ago I started noticing obvious growth from one day to the next.
   
   Every morning, I can feel and see slight but noticeable growth on the tumor under his left ear. It first feels like a multitude of small, bulbous growths have formed on the surface, and then the size of the whole thing grows larger, mostly in the outward direction.
   
   It's not nearly the size of what it was before he started chemo, but the extreme pace is really worrying me. You can easily see a bulge again, now, and you can see it getting bigger over a matter of days.
   
   
2. It's creeped into the inside of his left ear canal. He always had a small growth inside his right ear canal before, and now he has one inside his left ear that looks bigger than the other one.
   
   (Although, I can't be sure if he did also have one in that ear before, that I wasn't aware of, but the oncologist was. She did map out at least one other small tumor on his body that I wasn't aware of, so I can't be 100% sure it wasn't there before... but it's definitely been growing, in either case.)
   
   This is a problem because he is frequently scratching at both ears now, which can only lead to possible injuries and infections. Plus discomfort. He is also shaking his head a lot. (I will have to make sure he doesn't have another ear infection.)
   
   
3. He seems restless at times. Like he kind of paces around, looking bored (gently pawing at random things, so like in a playful way) but he's doing this multiple times a day. I try to play with him whenever I see him like this, and he engages in play briefly. But then he will just get up randomly from a nap or rest, and start pacing around.
   
   I interpret this as discomfort. Like it isn't letting him sleep as well as he used to. He always shakes his head a bunch of times immediately after waking up.
   
   He also is spending much less time on my lap these days. He will settle there and then climb off shortly thereafter. Which could be part of the restlessness, but also another reason (see below).

What I'm doing now...

1. His next chemo appointment is on Thursday 1/18 in the afternoon, which is 5 days from the time I am writing this post. That's not a long time, but the pace of the tumor growth worries me enough that I called the oncology department and left a message to try to move it up earlier in the week. That might not be possible, but we'll see. In 5 days I feel like it's going to be huge.
   
   
2. Between his first and second chemo appointments, there was a 4-week span. A similar thing happened then, where the tumors shrunk over the first 3 weeks, then started to grow a small amount during the 4th week. One theory I have is that the methylprednisolone shot is wearing off around the end of week 3.
   
   I called oncology yesterday and said I still had prednisolone pills, from before chemo started. I asked if I could try giving him those pills during this last week, and they said that it could help, but it could also carry risks of GI issues like stomach ulcers, can increase risk of diabetes, etc. (by stacking another steroid on top of the shot). I decided to try it, since his blood sugar was perfect when last tested, and he hasn't shown any signs of GI distress lately (hardly any vomiting).
   
   I can't pill him anymore, because of the location of the tumor (it seems to cause him pain or discomfort when I grip his head in the way I learned how to do it with him, so he fights me and gets frightened.
   
   AND, he refuses to eat all wet food, stews, broths, pastes, etc. While also always outsmarting Pill Pockets throughout his entire life. So I had to find a way to get a crushed pill into him using dry food.
   
   I decided to crush a pill, chop it up into finer powder, put a drop of water on it to turn it into a paste, then roll individual Temptations treats over the paste to coat them until the paste was gone. To my surprise, that worked, and he ate them just as eagerly.
   
   So I'm going to be dosing him with 5mg prednisolone daily until he is seen by the oncologist. I am taking the risks, while prioritizing the most serious problems. Of course, I have no idea if it will make a difference. I've been doing this for the past 2 days.

I still have hope, but the fact that we are at this stage now, where tumors are growing rapidly after 3 monthly chemo doses, makes me just pragmatically think that the treatment protocol I chose may not be strong enough for Willy's cancer.

I'm not trying to be pessimistic here, but if we can't do 3-week intervals due to white-cell count issues, and a 4-week interval is too long to beat down the cancer, then the protocol may just not be strong enough. I am just preparing for that being a possible conclusion.

But I couldn't possibly afford the more comprehensive protocol, so this is the best I can do.

Maybe the oncologist will decide it's worth the risk of switching him to 3 weeks after examining him. We'll see. But I'm more concerned about just the next week right now.

What is the most troubling is that our relationship has changed a little recently, because of this. I've been doing too many "medical" things with him, like palpating his tumors every day, trying to pill him and causing him pain when doing so, holding him down to look inside of his ears or apply Mirataz, etc. I think this is another reason why he has become less of a lap cat. Sometimes he walks up to me like he's about to jump into my lap, looks at me and pauses, then goes to lie down elsewhere. Like he's hesitant and not knowing if I'm going to do something uncomfortable to him.

So, I'm trying to be hands-off except for petting, and applying Mirataz. I don't want him to feel like he needs to avoid me during however much time he may have left.

Here are some pictures from just a couple of days ago. It doesn't look like much, but the bulge is noticeably bigger today. I'll try to get some current ones.

 

[iPappy]

" So I'm going to be dosing him with 5mg prednisolone daily until he is seen by the oncologist. I am taking the risks, while prioritizing the most serious problems."

IMO...this is the way. Prioritize the serious problem, it's possible that a few days of the daily prednisolone won't cause any issues or side effects. IIRC, it's more or less the long term usage that can cause issues after so much time has passed.
I am sorry things aren't going well, especially since you were sick a few weeks ago. Did the oncologist make any comments about it taking several rounds of chemo to keep the tumors from hopefully growing at all?
If he walks up like he wants in your lap, then pauses, have you tried giving him a slow-blink? That seems to let a lot of cats know "it's OK, no threats or problems here." If that doesn't work, extending your index finger out to him near his nose and letting him sniff I've read is a friendly cat "hello".
for you both. I'm hoping you get good news on Thursday, or, sooner if they manage to get you worked in.

 

[cmshap]

" So I'm going to be dosing him with 5mg prednisolone daily until he is seen by the oncologist. I am taking the risks, while prioritizing the most serious problems."

IMO...this is the way. Prioritize the serious problem, it's possible that a few days of the daily prednisolone won't cause any issues or side effects.

It's actually somewhere between 5 and 10 mg. Because I know there's medication loss when I do this process, every step of the way (crushing, chopping, making a paste, coating dry treats). Some powder gets lost or stuck to the plate, falls off the treats, etc.

So I'm starting with two 5mg tablets when I do this, and I use most (like 80%) of the end result, knowing some of it is not actually being ingested, and that it's overall an inefficient method.

 

[iPappy]

It's actually somewhere between 5 and 10 mg. Because I know there's medication loss when I do this process, every step of the way (crushing, chopping, making a paste, coating dry treats). Some powder gets lost or stuck to the plate, falls off the treats, etc.

So I'm starting with two 5mg tablets when I do this, and I use most (like 80%) of the end result, knowing some of it is not actually being ingested, and that it's overall an inefficient method.

We do the best we can. Not to go off topic, but I am not 100% sure Goofy got all he needed through his feeding tube as it would bubble out if he moved his head to the left. I'd say your 80% is a good comparison. I eyeballed it and did the absolute best I could. I'm glad you're seeing oncology this week so they can help you through this.

 

[tarasgirl06]

cmshap and iPappy Suggestion if you are able: get a mano y metate. It's a grinding apparatus in two parts. It might help in crushing medicines.
And yes, very good that you are trying to move up the date, cmshap .
My read is that Willy is not soliciting play. He is wanting relaxation. Slow blinks, loving talk and just being close, but not necessarily physical petting or play, may be just what he wants right now.

 

[cmshap]

Suggestion if you are able: get a mano y metate. It's a grinding apparatus in two parts. It might help in crushing medicines.

I don't mean to go too far into the weeds here, but I am quite adept at the old razor-blade method of chopping and powdering pills. One of the unfortunate skills I learned from my non-sober days that actually comes in handy today.

The weirdness comes from trying to coat DRY food in powdered medicine. I had to experiment with some other old, expired human pills I had lying around first before wasting Willy's medication while finding the right method.

I specifically use Temptations because the powder adheres to the texture of the surface well (edit: because it's kind of like a semi-soft solid texture, so I press the powder into it), and he loves them so I know he will eat them.

My read is that Willy is not soliciting play. He is wanting relaxation. Slow blinks, loving talk and just being close, but not necessarily physical petting or play, may be just what he wants right now.

That's exactly what I am doing. He still spends all his time near me, but I hate to have him think that if he feels like climbing in my lap, he may be reluctant due to wondering if I'm going to poke and prod him. So I'm really trying to avoid that.

One thing that puzzles me is that when he's in one of his restless moods, he also comes close to me and meows at me repeatedly. I don't know what he wants. It doesn't seem like pain or distress, and it's not related to food or litter box or anything else. If I get up and initiate play myself, he will usually engage, but I don't quite know what to make of the staring and meowing while 2-3 feet away.

 

[tarasgirl06]

I don't mean to go too far into the weeds here, but I am quite adept at the old razor-blade method of chopping and powdering pills. One of the unfortunate skills I learned from my non-sober days that actually comes in handy today.

The weirdness comes from trying to coat DRY food in powdered medicine. I had to experiment with some other old, expired human pills I had lying around first before wasting Willy's medication while finding the right method.

I specifically use Temptations because the powder adheres to the texture of the surface well (edit: because it's kind of like a semi-soft solid texture, so I press the powder into it), and he loves them so I know he will eat them.



That's exactly what I am doing. He still spends all his time near me, but I hate to have him think that if he feels like climbing in my lap, he may be reluctant due to wondering if I'm going to poke and prod him. So I'm really trying to avoid that.

One thing that puzzles me is that when he's in one of his restless moods, he also comes close to me and meows at me repeatedly. I don't know what he wants. It doesn't seem like pain or distress, and it's not related to food or litter box or anything else. If I get up and initiate play myself, he will usually engage, but I don't quite know what to make of the staring and meowing while 2-3 feet away.

He's definitely communicating with you. I'm glad you aren't sensing that he's in pain or distress. Cats are very good at covering these things, because they are both predator and prey in the natural world.
If he eats the treats right away, you could get a fine spray bottle, spray the treat and then coat it. That should work if he eats them right away.You could try coating the treat in a fine oil, and then applying the powder, as an alternative.
*And yeah. Gotcha.*

 

[cmshap]

Update: 24 days post-chemo (3rd dose)...

My senses may be deceiving me, but I can almost swear that there was a little bit of tumor shrinkage between yesterday, when I wrote the last update, and today. At least, one spot that felt like it was protruding yesterday feels flatter, almost a little concave, today. And his fur sticks out a little less on that side.

We are on day 3 since I started administering the ~5-7 mg prednisolone myself.

I think it may turn out that he needs stronger, or probably more appropriately, longer-lasting, steroids in addition to his lomustine chemo treatments.

I will let the oncologist know about all of this tomorrow. She is always worried about cats becoming diabetic, because then the treatment will have to be adjusted which I am positive won't be enough for Willy. But like I said in previous updates, his blood sugar was "great" at the last visit 3.5 weeks ago. So I am just hoping that it will stay the same.

I am always the pragmatist, so I am trying not to turn little things like this into exaggerated hope. But a good sign is always a good sign.

Edit: He's also scratching the tumor a lot today. Not the inside of his ear like he was doing before, which I mentioned being a concern -- but the surface of the outer tumor. He always itches the most when shrinkage is happening.

 

[tarasgirl06]

Update: 23 days post-chemo (3rd dose)...

My senses may be deceiving me, but I can almost swear that there was a little bit of tumor shrinkage between yesterday, when I wrote the last update, and today. At least, one spot that felt like it was protruding yesterday feels flatter, almost a little concave, today. And his fur sticks out a little less on that side.

We are on day 3 since I started administering the ~5-7 mg prednisolone myself.

I think it may turn out that he needs stronger, or probably more appropriately, longer-lasting, steroids in addition to his lomustine chemo treatments.

I will let the oncologist know about all of this tomorrow. She is always worried about cats becoming diabetic, because then the treatment will have to be adjusted which I am positive won't be enough for Willy. But like I said in previous updates, his blood sugar was "great" at the last visit 3.5 weeks ago. So I am just hoping that it will stay the same.

I am always the pragmatist, so I am trying not to turn little things like this into exaggerated hope. But a good sign is always a good sign.

*PRAYERS* ongoing for sweet Willy, for you and for his care team.

 

[fionasmom]

If the tumor shrinks/enlarges, there is probably some sensation that goes with that, even a non-painful nerve sensation like tingling. I agree that you need to discuss the steroids with the oncologist. I had two SCL cats on pred for a long time and neither became diabetic. Not saying that it does not happen, but sometimes you have to make a choice regarding treatment.

 

[cmshap]

Second update on Day 24 post-chemo (3rd dose)...

Okay, there is definitive tumor shrinkage. Like even during the course of the day since I wrote the last post.

I dosed him again tonight about 4 hours ago with oral pred. He just jumped on my lap, and I felt the tumor, and it's smaller than it was this morning. Just by a tiny amount, but I can feel certain specific bumps that have gone down.

Again, to summarize... he gets a methylprednisolone shot once a month at his chemo treatments, which is supposed to last 4 weeks. But it seems to wear off after 3 weeks, and then the tumors start growing fast again.

I started him on 5-7mg oral prednisolone 3 days ago, and the tumor growth was not only stopped, but starting to reverse.

Any expert advice on this scenario, from anybody reading this? I will be speaking with Willy's oncologist tomorrow to discuss. But I want to make sure the right medication plan is figured out for the last half of his long-term chemo treatment plan.

And to add to the above, he's been more affectionate and less anxious all afternoon/evening.

I'm not jumping to conclusions, but just from my general observations, he was fine for 2.5 to 3 weeks after the last chemo appointment, then his tumors started growing and he started getting more restless and keeping away from me, like I described.

Then I start him on additional doses of the same drug he was injected with 3.5 weeks ago, and things start moving back in the right direction.

It's hardly the scientific method, but I can't help but think proper management of steroids during the remainder of his chemotherapy is going to be key to possibly reaching remission. If we haven't missed the window yet.

(He's had 3 treatments. He is scheduled for 2 more, but the oncologist said she sometimes does a 6th treatment in cases where it's appropriate. I will do 3 more if necessary.)

...and, in addition, he's been sleeping much better through the night tonight than he has in about a week.

I've been up all night half working, and half not sleeping, and Willy has been out cold. For the past week he was waking up frequently and pacing around.

 

[tarasgirl06]

Second update on Day 23 post-chemo (3rd dose)...

Okay, there is definitive tumor shrinkage. Like even during the course of the day since I wrote the last post.

I dosed him again tonight about 4 hours ago with oral pred. He just jumped on my lap, and I felt the tumor, and it's smaller than it was this morning. Just by a tiny amount, but I can feel certain specific bumps that have gone down.

Again, to summarize... he gets a methylprednisolone shot once a month at his chemo treatments, which is supposed to last 4 weeks. But it seems to wear off after 3 weeks, and then the tumors start growing fast again.

I started him on 5-7mg oral prednisolone 3 days ago, and the tumor growth was not only stopped, but starting to reverse.

Any expert advice on this scenario, from anybody reading this? I will be speaking with Willy's oncologist tomorrow to discuss. But I want to make sure the right medication plan is figured out for the last half of his long-term chemo treatment plan.

And to add to the above, he's been more affectionate and less anxious all afternoon/evening.

I'm not jumping to conclusions, but just from my general observations, he was fine for 2.5 to 3 weeks after the last chemo appointment, then his tumors started growing and he started getting more restless and keeping away from me, like I described.

Then I start him on additional doses of the same drug he was injected with 3.5 weeks ago, and things start moving back in the right direction.

It's hardly the scientific method, but I can't help but think proper management of steroids during the remainder of his chemotherapy is going to be key to possibly reaching remission. If we haven't missed the window yet.

(He's had 3 treatments. He is scheduled for 2 more, but the oncologist said she sometimes does a 6th treatment in cases where it's appropriate. I will do 3 more if necessary.)

...and, in addition, he's been sleeping much better through the night tonight than he has in about a week.

I've been up all night half working, and half not sleeping, and Willy has been out cold. For the past week he was waking up frequently and pacing around.

Well, then, my conclusion, and bear in mind I have not been through this, would be your conclusion -- asking the oncologist about more frequent meds, top priority. Plus the "extra" treatment, very probably, as it seems you and the oncologist are leaning toward that and it seems to be the way to proceed. But again, I have not been through this so don't take my opinion/feeling as gospel!