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Please.........don't double-dose Mirataz.................you can get a nasty reaction to that!
Wipe it off if you have.
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Please.........don't double-dose Mirataz.................you can get a nasty reaction to that!
Wipe it off if you have.
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Willy might have cancer / high-grade lymphoma Treatment thread
- Thread starter cmshap
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- #722
I am still dealing with a 2.5-month-old tube of Mirataz that technically expired 1.5 months ago.
I have been giving Willy extra every time I've dosed him recently. And I have done so based on my observations that it has lost efficacy. I don't dose him with it very often, which is why I still have a partial tube left after such a long period.
Not necessarily after exactly 4 weeks, when the manufacturer claims it expires, but it seems to have lost efficacy after 2 months, for sure.
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First, did you read what I sent? Do that, please, the section "Side Effects".
I have posted to others about the "30 day" expiry being utter BS.
That's based on 1. my own "hands-on use and observations......and 2. Minimalist understanding of the chemistry of that chemical: first, it's "inactive"; second, in the sealed tube, it's protected from both light and air, the only 'external' agents that would otherwise affect it.
Have you cleaned off the second ear ?
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First, did you read what I sent? Do that, please, the section "Side Effects".
I have posted to others about the "30 day" expiry being utter BS.
That's based on 1. my own "hands-on use and observations......and 2. Minimalist understanding of the chemistry of that chemical: first, it's "inactive"; second, in the sealed tube, it's protected from both light and air, the only 'external' agents that would otherwise affect it.
Have you cleaned off the second ear ?
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- Thread Starter Thread Starter
- #724
Yes. I appreciate the warnings. My thoughts...
(1) I probably overestimated the dose as "double," as it was probably more like ~1.5x.
(2) Over the last few weeks, I've given him extra whenever I found it necessary to dose him, as a normal dose hasn't worked as well as it did when I first filled the med. This has been brought up by other TCS members, who have found that Mirataz may lose some efficacy over time. Maybe 1-month expiration may be BS, but it's not going to last forever, and the efficacy for individual cats may differ in all of these cases.
(3) I am only using it to get him to ingest other meds without fighting me and becoming afraid of me. He's otherwise eating his normal kibble, and has usually been ingesting his meds without needing any appetite aid. It's these occasional times when he just really refuses to eat that I need to use it.
(4) On that note, it's only like once every 4-6 days that I've found the need to dose him at all, over the last few weeks. But if he starts needing it more regularly, I am not going to bomb him with a huge quantity of the med every single time. I'd get a new tube when this one runs out, and give him a normal dose.
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On many occasions you've stated your wish/intention that this thread document your journey and perhaps help others. In that regard, it's probably best that the information I sent you privately earlier also be posted in the thread.
I had used the word "nasty reaction" earlier in response to the idea of "over" or 'excessive' dosing, i.e. administering a greater amount of a medication than is/was customarily/actually prescribed.......as a potential adverse outcome and in a bid to caution against it.
I had sent you a link to a section of the "Tanya's Guide..." that's an all-you-need-to-know reference about mirtazapine, and I directed your attention to a section on "Mirtazapine Side Effects", about halfway in there.
This is that link: "Tanya's Guide..." - Mirtazapine
It speaks to the medical effects of the drug. This is a snippet from there:
That was - and continues to be - the basis for my expressing concern.
.
On many occasions you've stated your wish/intention that this thread document your journey and perhaps help others. In that regard, it's probably best that the information I sent you privately earlier also be posted in the thread.
I had used the word "nasty reaction" earlier in response to the idea of "over" or 'excessive' dosing, i.e. administering a greater amount of a medication than is/was customarily/actually prescribed.......as a potential adverse outcome and in a bid to caution against it.
I had sent you a link to a section of the "Tanya's Guide..." that's an all-you-need-to-know reference about mirtazapine, and I directed your attention to a section on "Mirtazapine Side Effects", about halfway in there.
This is that link: "Tanya's Guide..." - Mirtazapine
It speaks to the medical effects of the drug. This is a snippet from there:
As a tetracyclic anti-depressant, mirtazapine may cause an increase in blood pressure and heart rate, [and]...orthostatic hypotension so should be used with caution in patients with heart problems. It may increase cholesterol levels...[and] increased urination.
Occasionally you may see reduced white blood cells.
...it may make some cats restless, agitated and vocal...
In some cases, you may see a severe reaction known as serototin syndrome.
That was - and continues to be - the basis for my expressing concern.
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- Thread Starter Thread Starter
- #726
Update: 16 days post-chemo (4th dose)...
I think I am very inclined, at this point, to schedule euthanasia sometime during the coming week.
Willy's tumors are slightly, but noticeably bigger today, and he recoils if I try to gently feel the area at all, which indicates to me that he has pain. And he's shaking his head all the time.
He spent no time at the window today or yesterday, and he always has had his window time every single day of his life here.
He isn't hiding or isolating himself from me, though, and he still has a normal appetite. But it's the pain from the side of his face and around his ear that most worries me. I am getting the impression that he has some degree of chronic pain.
He spent several minutes in my lap on a few occasions today, but otherwise only wants to sleep on the chair. Maybe that's his form of isolation/hiding... like being near me but wanting to sleep by himself.
I think it may be time. I'm going to see how he does tomorrow, and then call both vets on Monday morning to see if there's any sort of pain medicine I can give him. I still have a couple of syringes of Simbadol from his biopsy surgery, which I have already debated giving to him. I am reluctant to without talking to a vet first, although if he looks the same or worse tomorrow, I may just give him one anyway.
I'll have to wait and see what the vets say about the possibility of pain management. Or if nothing else is really going to help much. Things always get worse over a weekend...
Depending on their opinions I may try to get it done ASAP next week, if the consensus is that he has chronic pain. As his tumors are always growing, I imagine it is only getting worse by the day.
I think I am very inclined, at this point, to schedule euthanasia sometime during the coming week.
Willy's tumors are slightly, but noticeably bigger today, and he recoils if I try to gently feel the area at all, which indicates to me that he has pain. And he's shaking his head all the time.
He spent no time at the window today or yesterday, and he always has had his window time every single day of his life here.
He isn't hiding or isolating himself from me, though, and he still has a normal appetite. But it's the pain from the side of his face and around his ear that most worries me. I am getting the impression that he has some degree of chronic pain.
He spent several minutes in my lap on a few occasions today, but otherwise only wants to sleep on the chair. Maybe that's his form of isolation/hiding... like being near me but wanting to sleep by himself.
I think it may be time. I'm going to see how he does tomorrow, and then call both vets on Monday morning to see if there's any sort of pain medicine I can give him. I still have a couple of syringes of Simbadol from his biopsy surgery, which I have already debated giving to him. I am reluctant to without talking to a vet first, although if he looks the same or worse tomorrow, I may just give him one anyway.
I'll have to wait and see what the vets say about the possibility of pain management. Or if nothing else is really going to help much. Things always get worse over a weekend...
Depending on their opinions I may try to get it done ASAP next week, if the consensus is that he has chronic pain. As his tumors are always growing, I imagine it is only getting worse by the day.
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I am so sorry to read this, I am hoping they have some kind of a pain management you could try. Maybe transdermal? I'm not sure if such a thing exists.
Were you able to see the results of Willy's last blood work, and ask the vet if they feel his lymph nodes or other organs are involved? I can only speak for myself and reflect on the situations I've been in, but that would be a factor I would want to explore assuming there is some sort of way to manage any pain or discomfort he's having.
Do you feel Willy needs the appetite stimulant in order to eat his dry food?
I lost a cat last month. He developed a tumor, but it was deep inside the ear canal. It was barely visible, if at all, from the outside but the vet found it when he was under anesthetic. For that reason, and others I suppose, I am emotionally invested in this thread and am very empathetic for the situation you're in.
Were you able to see the results of Willy's last blood work, and ask the vet if they feel his lymph nodes or other organs are involved? I can only speak for myself and reflect on the situations I've been in, but that would be a factor I would want to explore assuming there is some sort of way to manage any pain or discomfort he's having.
Do you feel Willy needs the appetite stimulant in order to eat his dry food?
I lost a cat last month. He developed a tumor, but it was deep inside the ear canal. It was barely visible, if at all, from the outside but the vet found it when he was under anesthetic. For that reason, and others I suppose, I am emotionally invested in this thread and am very empathetic for the situation you're in.
- Thread Starter Thread Starter
- #728
I did. The records don't state anything about that, but way back in the beginning I posted the pathology report from the biopsy surgery, and it said something about the cells that they "possibly arose from lymph nodes, but lack distinctive architecture." That's about all I know regarding lymph node involvement. I quoted the report somewhere in this thread.
I am trusting both my oncologist, and general vet, who share records of everything that happens. I have no reason to believe that they won't give me the best advice.
I'm sure that this opinion may be controversial to some, but I am not in the mood to pour over all the details in Willy's records at this point. I read them once, and the latest entries don't describe any fundamental change in the disease... no noteworthy changes in observations other than mass sizes.
I am tired of living with constant anxiety over his health. It is affecting my ability to work and live healthily. But more importantly, Willy seems tired of dealing with it. All he did today was get up to eat and use the litter box, then go back to sleep on the chair.
I find it highly unlikely I'm going to get any better options from analyzing records and doing research. I have two experts on my side, in cat care and oncology, and I am just going to trust what they say, unless they happen to have opposing opinions. But both vets have spoken highly of each other.
I'm going to ask about pain meds, but I have also decided that I'm never going to force a medicine into him again if he puts up resistance and makes me have to hold his head painfully.
He eventually consumed his prednisolone last night, but today he has not. I just put a small droplet on like 20 pieces of kibble, because he is still eating kibble and has an appetite for it. But so far, he's just sniffed the kibble and left it alone. It must smell weird to him. But I put another dose of Mirataz in his ear (a normal-range dose) hoping that he will eat that kibble tonight.
Not for regular dry food with no medicine on it. He has been eating his regular kibble freely, and even begs for more by sitting by his empty dish and staring at me. I am giving him as much as he wants to eat, without it seeming like harmful overfeeding (he isn't eating so much that I worry about that).
I am mainly giving him Mirataz because he seems more willing to eat food/treats with medicine on them that way.
Thanks, and I'm sorry for your loss.
The tumor in Willy's left ear is much, much bigger than just a few weeks ago. It's the main area he keeps scratching at.
The ear-scratching and head-shaking are why I am so strongly considering euthanasia as early as this week. Even if he is eating, and not hiding in the closet, I still really suspect there is pain involved.
And if I am going to have trouble giving him something like liquid buprenorphine again, and it's going to cause him pain and scare him in the process, I won't want to keep doing it. And the best option in that case, I feel, is euthanasia. Unless there is some other method.
Especially considering that the best odds I've been given are 20%. And even if I could reach that 20% odds, Willy would have to endure more pain in the meantime.
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All the hugs,
cmshap
. I completely understand not going over the reports again and again. It's so horrible that what started as looking promising for Willy's recovery isn't proving to be the case, and that it's turning out to be one of those resistant, fast-moving cancers (my Katie lasted two weeks after diagnosis and I should have helped her go sooner). Much love to you and Willy.
cmshap
. I completely understand not going over the reports again and again. It's so horrible that what started as looking promising for Willy's recovery isn't proving to be the case, and that it's turning out to be one of those resistant, fast-moving cancers (my Katie lasted two weeks after diagnosis and I should have helped her go sooner). Much love to you and Willy.- Thread Starter Thread Starter
- #730
Thank you. The things I need to constantly remind myself of to get through this, which makes me feel like I made the right decisions:All the hugs,
(1) I got at least 4-5 more months of time with him by seeking chemotherapy.
(2) He tolerated chemo extremely well. Like much better than most other cats, according to our oncologist. So he was mostly comfortable while the treatment extended his life.
(3) If I had ceased treatment sooner, he would still have had to go through this end-of-life period, where everything becomes more painful and uncomfortable.
(4) He's definitely feeling the disease now, and declining. If I continue to chase more treatments, which will have a 20% chance of success, I may prolong his life, but it could come with more suffering along the way.
(5) I've done the best I could, and I don't have any regrets. Willy barely made it through his first year of life, before being rescued, but then bounced back and had a great life over the last decade. And he improved my life a lot, too. I'm not a religious person, but the way he just randomly showed up, and how we both helped each other, makes me feel that we were both exactly where we should have been throughout this experience.
(6) I definitely made mistakes along the way, but I don't have regrets because I know I put in a lot of work into learning how to care for cats, as I took Willy on as my first cat. Any mistakes I made have definitely been noted for future cats I may care for.
This all doesn't mean it won't be devastating... but remembering these things is what I will need to do to make it through the decision and its aftermath.
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- Thread Starter Thread Starter
- #731
I've since wasted two more doses of prednisolone trying to mix it into different treats, and he just won't eat any of it. I am thinking it is the chicken flavoring in the compound that he finds undesirable.
I was talking before about the supposed lack of having to refrigerate the med. I never found out any new information about that from the pharmacy where it was compounded. I am always going to wonder if the smell of the med changed over time as it sat out, sealed, but at room temperature.
But, Willy almost always found all smelly foods to need to be buried vs. eaten. I stated my thoughts on that, and my theory that it had to do with his chronic vomiting throughout his life. He hasn't vomited once in over a month, but is now resorting to burying anything with the smell of this chicken-flavored med. And he's not eating the chicken Delectables squeeze treat anymore, even by itself with no meds in it.
I can't begin to describe how frustrating and heartbreaking this is. I don't feel like I have any avenue left to deliver any meds at home.
(1) I can pill him, but cause him pain and stress in the process, making him flee from me.
(2) I can inject liquid meds into his mouth, but with the same problems as pilling.
(3) I can mix meds into his food, but that only works briefly before he begins to refuse it.
(4) Transdermal is about the only method I am able to use reliably. I don't know what is available for that ROA, but I will ask my vets.
So I don't know what to do anymore. I am at the end of my capabilities, and I won't be able to medicate him at home anymore.
All of this will strongly factor into my decisions in the coming week.
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I would tell the vet that you're (rightfully) unwilling to pill/medicate him orally anymore due to the stress and fear it causes him (not to mention the stress on you.) Ask them if there's any pain medicine available that can be applied to the ears, and tell them that's the only thing you're willing to try at this point. If by some chance that could control his pain, as long as he's eating he could potentially have more quality time left.
One of my cats was prescribed an oral medication years ago, because he had stomatitis of the mouth. I gave him one dose and said never again, he fought me so hard and foamed at the mouth, gagged, hacked, and ran from me, spraying the walls with foam and medication. I refused to do that twice a day for life. We did manage to get it under control with other measures, but I feel at that point the "cure" was much worse than the actual disease, so I completely understand where you're coming from on this.
When I went over Tag's records, months had passed. I was happy to have the information, but it did get depressing seeing the gradual down-shift in his over all well being. Like you, we had many good vets on our side and pouring over it did very little except make me depressed further.
I hope there is some way to control any pain or discomfort Willy is experiencing without causing either one of you undue stress.
One of my cats was prescribed an oral medication years ago, because he had stomatitis of the mouth. I gave him one dose and said never again, he fought me so hard and foamed at the mouth, gagged, hacked, and ran from me, spraying the walls with foam and medication. I refused to do that twice a day for life. We did manage to get it under control with other measures, but I feel at that point the "cure" was much worse than the actual disease, so I completely understand where you're coming from on this.
When I went over Tag's records, months had passed. I was happy to have the information, but it did get depressing seeing the gradual down-shift in his over all well being. Like you, we had many good vets on our side and pouring over it did very little except make me depressed further.
I hope there is some way to control any pain or discomfort Willy is experiencing without causing either one of you undue stress.
- Thread Starter Thread Starter
- #733
Thanks to everyone for the support throughout this experience.
I completely forgot that today is my 42nd birthday, probably because I've been so preoccupied with all of this. I only remembered late last night when a family member sent me a message. (I even just had to think about it for a little while to remember what age I will be turning.)
I am glad I get to spend the day with Willy (who is on my lap right now), but it means I'm also going to be receiving some calls from family today, all of whom are probably going to ask "how are you" and the ones who know about Willy's situation are going to ask "and how is Willy?" I honestly don't know if I want to talk about it with anyone today.
The timing of things can be so strange sometimes.
And as I am writing this, Willy started exhibiting body language that I could tell meant he wanted to go to sleep on the chair by himself, so I yielded it to him.
I completely forgot that today is my 42nd birthday, probably because I've been so preoccupied with all of this. I only remembered late last night when a family member sent me a message. (I even just had to think about it for a little while to remember what age I will be turning.)
I am glad I get to spend the day with Willy (who is on my lap right now), but it means I'm also going to be receiving some calls from family today, all of whom are probably going to ask "how are you" and the ones who know about Willy's situation are going to ask "and how is Willy?" I honestly don't know if I want to talk about it with anyone today.
The timing of things can be so strange sometimes.
And as I am writing this, Willy started exhibiting body language that I could tell meant he wanted to go to sleep on the chair by himself, so I yielded it to him.
- Thread Starter Thread Starter
- #734
Update: 17 days post-chemo (4th dose)...
I have firmly decided to stop treatment, and cancelled his next chemo appointment. I'm not 100% he'd make it to then, anyway.
After hearing from my vets tomorrow, I will make a decision about when to seek euthanasia.
He's at least getting some sun, window, and paper-shredding time in today (although just for a short while, and he's losing interest pretty quickly). Yesterday he didn't want to do anything at all.
I have firmly decided to stop treatment, and cancelled his next chemo appointment. I'm not 100% he'd make it to then, anyway.
After hearing from my vets tomorrow, I will make a decision about when to seek euthanasia.
He's at least getting some sun, window, and paper-shredding time in today (although just for a short while, and he's losing interest pretty quickly). Yesterday he didn't want to do anything at all.
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You have done way more than the best that you could.
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I am glad you are still getting some precious lap & conversation time in with Willy. Just to be with him In the moment. Not only are you doing way more than you can, Willy knows it. You’re a good & loving cat owner.
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Making the decision to stop treatment is never an easy one. But if it were me, I'd rather have 3 good weeks vs. 4 weeks of Hell.
I am very sorry. I am hoping the vet has some advice for you. Comfort care has been done in my house many times. And I will do it again when the situation calls for it, and everything else has failed.
All things aside, I hope your birthday was at least OK. I've had people ask (very kindly, I might add) how a sick pet of mine is. In many cases, I'll dig out my happy face and say "oh, they're doing good!" when I know they're not. It's not like I'm hiding anything, or am ashamed of anything, it's just that emotions are exhausting and I just don't feel like getting into it.
I am very sorry. I am hoping the vet has some advice for you. Comfort care has been done in my house many times. And I will do it again when the situation calls for it, and everything else has failed.
All things aside, I hope your birthday was at least OK. I've had people ask (very kindly, I might add) how a sick pet of mine is. In many cases, I'll dig out my happy face and say "oh, they're doing good!" when I know they're not. It's not like I'm hiding anything, or am ashamed of anything, it's just that emotions are exhausting and I just don't feel like getting into it.
- Thread Starter Thread Starter
- #738
Second update: 17 days post-chemo (4th dose)...
Evening...
I found a red, inflamed spot near his ear, that is probably from scratching too much, which he's been doing even more lately.
(By the way, I did try using the sleeve of a t-shirt as a covering over his neck, and he hated that just as much as the collar. I promptly took it off.)
I was always told to watch out for abscesses with actively growing tumors. That I should watch out for any spots on the skin over a tumor that open up into open wounds, and treat that as a medical emergency.
I don't think that's what this is... but he's going to create a wound soon, anyway, by persistently scratching at this area.
He also has been recoiling a bit when I touch his back today. Like with normal petting (he always liked full back strokes). If he is standing up, and I gently run my hand down his back, he crouches or makes his spine concave as if to get his back away from my hand.
I am suspecting that he has chronic pain in other places now, besides the main tumor area. He slightly recoils even when I just reach towards him, now. If he decides to sit on my lap, I just pet his right cheek/right side of his body, as he seems to be okay with that. And he was purring this morning while I was doing that.
I have decided to get a euthanization appointment as soon as possible tomorrow morning. I left my vet a voicemail to call me back about it as soon as she can.
I have read that there is transdermal buprenorphine for cats, mostly used for post-surgical pain. But I have no idea if my vet can prescribe that, if it will be available immediately, how much it would cost, and most importantly, how effective it would be for this situation.
He has fast-growing tumors where I can see a change from day to day. This isn't a chronic pain condition that is going to go away, or even remain static... his condition will only keep worsening no matter what we do. He will keep scratching his ear, most likely, and will eventually cause injuries that will only make things harder.
So, I'm deciding to skip all of that, and just let him finally rest tomorrow. If I can't get an appointment at my vet (although very unlikely she won't fit me in) I am taking him to the pet hospital. I'd just much rather do it at the vet's office, as it is a much calmer, smaller place with only cats around.
Edit: He let me more closely examine the inflamed area, and it looks like there is a scab on it. So I think it's safe to say it was an area where he tore his skin from scratching, and that might have accounted for some of the blood he was shaking off last week.
Evening...
I found a red, inflamed spot near his ear, that is probably from scratching too much, which he's been doing even more lately.
(By the way, I did try using the sleeve of a t-shirt as a covering over his neck, and he hated that just as much as the collar. I promptly took it off.)
I was always told to watch out for abscesses with actively growing tumors. That I should watch out for any spots on the skin over a tumor that open up into open wounds, and treat that as a medical emergency.
I don't think that's what this is... but he's going to create a wound soon, anyway, by persistently scratching at this area.
He also has been recoiling a bit when I touch his back today. Like with normal petting (he always liked full back strokes). If he is standing up, and I gently run my hand down his back, he crouches or makes his spine concave as if to get his back away from my hand.
I am suspecting that he has chronic pain in other places now, besides the main tumor area. He slightly recoils even when I just reach towards him, now. If he decides to sit on my lap, I just pet his right cheek/right side of his body, as he seems to be okay with that. And he was purring this morning while I was doing that.
I have decided to get a euthanization appointment as soon as possible tomorrow morning. I left my vet a voicemail to call me back about it as soon as she can.
I have read that there is transdermal buprenorphine for cats, mostly used for post-surgical pain. But I have no idea if my vet can prescribe that, if it will be available immediately, how much it would cost, and most importantly, how effective it would be for this situation.
He has fast-growing tumors where I can see a change from day to day. This isn't a chronic pain condition that is going to go away, or even remain static... his condition will only keep worsening no matter what we do. He will keep scratching his ear, most likely, and will eventually cause injuries that will only make things harder.
So, I'm deciding to skip all of that, and just let him finally rest tomorrow. If I can't get an appointment at my vet (although very unlikely she won't fit me in) I am taking him to the pet hospital. I'd just much rather do it at the vet's office, as it is a much calmer, smaller place with only cats around.
Edit: He let me more closely examine the inflamed area, and it looks like there is a scab on it. So I think it's safe to say it was an area where he tore his skin from scratching, and that might have accounted for some of the blood he was shaking off last week.
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I am so, so sorry. All the hugs, to both of you.
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- #740
Thanks, all, for your sympathy and support. I might not be back on the forum until after I am back from the vet tomorrow and I've gathered my thoughts. No idea how soon that will happen.
But I want to post some final conclusions as well as whatever my vet says tomorrow about his condition when she examines him.
I also may attach a copy of his full medical records with personal information blacked out, so it can be seen by anyone going through this thread in the future.
But I want to post some final conclusions as well as whatever my vet says tomorrow about his condition when she examines him.
I also may attach a copy of his full medical records with personal information blacked out, so it can be seen by anyone going through this thread in the future.
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