Good Bye

I'm sorry this has taken me so long to update but Rumble passed on Sunday, October 23rd, 2011. 

Now all I can do is miss him and second guess every decision I ever made.  Was the surgery and 6 extra months we got worth it?  He hated the dr. visits and the chemo made him so sick and I swear I wouldn't have put him through it if I didn't honestly believe that he would make it.  He was so young; I feel cheated.  He was my heartbeat on four legs.  I get mad and sad every day.  I have a hole in my heart and it hurts. 

I thought the two of us were special enough that he would make it.  Someone has to make up those 5% odds, right?  Why not us?  God has all these miracles in His pocket, why didn't He use one on us? 

I don't know if anyone, anywhere has even read this, but I hope it helped a little. 

If love could have healed, Rumble would have lived forever!

Update

Well, Rumble has been on his "drug holiday" for over 6 weeks now and I am very disappointed to say that he hasn't gained any weight.  In fact, he has lost some weight.  Because of this we are going to hold off on starting another round of chemo until we get some meat on his bones. 

We are going to try two different things for about 6 to 8 weeks and then see how he is doing.  One, we are going to be giving him B12 shots once a week for atleast 4 weeks.  B12 is a great energy booster.  It works through the red blood cells by enabling them to carry oxygen more efficiently.  B12 shots are also highly recommended as mood boosters.  All I know is Rumble feels great for a few days afterwards.  Trouble is, I hate taking him into the vet every week for a shot.  He is easily distracted with the kitty treats I bring so it's not the shot that I'm concerned about, but the stressful trip up there in his traveling box.  So, my vet gave me a syringe to practice with and I now do the injections once a week at home.  Rumble has plenty of extra skin hanging loose so right after I put his breakfast in his bowl, I pull out some extra skin, push the needle into the skin until I feel a pop, and inject the liquid.  He barely notices since he's busy eating. 

Second step is changing his food from the low calorie Hills Prescription I/D to a higher calorie Hills Prescription A/D described as, "For the nutritional support of pets recovering from serious illness, accident and surgery.  Cats and dogs can undergo significant metabolic changes when recovering from a serious illness, injury or surgery. During these stressful conditions the body is challenged to maintain strong natural defenses and spare lean body mass, which makes it is even more important to feed the right food. Cats and dogs need extra energy and nutrients, in an appetizing form, to encourage the recovery process."

When talking to our vet contact at OSU about his weight loss, she said "the cancer is hungry and he needs more calories to maintain his body plus the cancer."  Not what I wanted to hear.  I still don't understand if they were able to cut all of the cancer out and if it hadn't spread to any other parts of his body, then why do they still refer to him as "having cancer"?  Can't people recover from cancer?  I hear about it all the time, animals too.  Why aren't they considering Rumble as having survived his cancer? 

I broke down the other day; haven't done that in awhile.  It was my own fault.  I read an article on msnbc called "The Perfect Day."  It was about a guy learning his dog was having heart failure and he decided his dog needed the perfect day before he passed.  He took the day off work, they slept late, he gave him a hambuger patty and bacon for breakfast, sat on the floor and hugged his dog for awhile and broke down and cried, they chased red balls in his backyard until he grew tired, they went for a swim in a local lake, came home and napped together on the bed, went for a slow hike on their favorite trail and spent time sitting on a rock and listening to nature, went home for sirloin steak cut into small pieces, and they went to bed.  That really does sound like the perfect day.  His dog passed a few weeks later.  What would the perfect day for Rumble include?  Would I be able to recognize the end of his journey and provide him with "the perfect day".  I'm crying all over again.  This whole thing still sucks.  I expected him to be fat and happy by now.  Instead, he's still way to thin, but I guess still seems happy.  Our vet says as long as he's eating and he's still happy, then things are ok.  Still sucks though. 

Chemo Increase

After our scare last time with the free floating liquid in Rumble's abdomen, my vet decided to up his chemo by 10%.  That sounded ok to me.  He wants to find the balance between the most medicine possible with the least amount of side effects.  Well, I think there were side effects. 

As you know anyone on chemo vomits; so does Rumble.  We like giving him the Mirtazepine pill for nausea because it also has an appetite stimulant.  Well, this last week Rumble vomited so often that we had to combine both the pill and the liquid anti-nausea medicine (Metaclopramide).  It still didn't work all the time.  He puked probably twice as much as he normally does and I think the vomit changed.  It is usually pretty clear because I think it's mostly made of drool and few bits of food.  This time it was dark brown and smelled horrible.  I was not happy.

So, after vomiting both weeks during his drug holiday, I asked for the chemo to be taken back down by 10%.  They agreed.  This is week one of round five of his chemo treatments.  We are only doing five rounds this time, so I'm really looking forward to this all being over for awhile. 

They have changed how they are administering the chemo.  It was originally 2 chemos, 4 hours apart, but that meant putting him under anesthesia twice and Rumble was really beginning to fight the second anesthesia.  So, now they are giving one, waiting 20 minutes, and giving the second.  You all know there is no set guideline to follow with this disease.  I asked if this would hinder Rumble and my vet explained the first chemo breaks down the cancer cell walls and defenses.  The second chemo kills the cells.  So, is 20 minutes enough time for the first chemo to act before putting in the second chemo, he really doesn't know.  But, that's what he has decided is best for Rumble at this time. 

Rumble did not gain any weight, which I was really disappointed to hear, but he also did not lose any weight.  With the change in his vomit over the past two weeks, I was ok with that.  We have his second week of round five chemo this Friday.  I'm really looking forward to it all being over.  We will have a 6 to 8 week break before we bring him back in for an ultrasound and decide on our next plan of attack. 

Thanks for keeping Rumble in your thoughts and prayers.

Weight Gain

We found out Rumble gained 0.25 pounds this week.  That's great; a fourth of a pound in a week is awesome.  He now weighs 0.1 MORE than he did when he went in for surgery back in April.  We are on an upward slope and climbing steadily. 

Chemo was good.  "Unremarkable" is always the term you want to hear.  That means his blood was within normal parameters and chemo went just fine.  I always enjoy it when my checkout papers say "unremarkable" at the top. 

Two weeks off and we start round 5.  Then our vet thinks Rumble will get a month to 6 weeks off, we will bring him in for his ultrasound sometime, and decide after all that, what to do.  Maybe chemo once a month?  Who knows?  Let's all just cross our fingers that he has another great two weeks off during his drug holiday and gains at least another 0.6 pounds like he did last time. 

Good News

Well, my vet called around 4pm Saturday and said after having everyone in the pathology department take a look at Rumble's slides....they decided they were NOT cancer cells.  Prayers answered! 

He said they were not the normal cells that they were looking for so they had a hard time identifying them.  What they were looking for, I don't know, but he said they were the cells that line the inside of your abdomen, kind of like your skin on the inside.  He didn't expect them to be loose and free floating in this liquid so that's why it took so long to identify them. 

Soooo, YAY!  Not cancer cells like he thought but he said the liquid is still a concern because no one should have extra liquid just floating around in their abdomen.  We have another ultrasound scheduled in 6 weeks. 

We have week 2 of round 4 of chemo on Friday so I guess it will be back to business as usual.  Thanks for your thoughts and prayers. 

Good news - Bad news

Good news - Rumble had a great two weeks and gained weight.  0.6 pounds YIPEE!  That's great for a cat at his current weight.  We must have found the correct balance between the enzymes on his food and the enzymes we mix into a slurry and shoot down his throat after each meal. 

Bad news - They did an ultrasound of Rumble's abdomen to see how things were looking and our vet saw some free floating liquid that's not supposed to be there.  He thinks it's coming from the pancreas and the cells do not look normal.  There in the waiting room, in front of other people, he told me he thinks it is most likely cancer cells because they didn't look normal to him.  They drained the liquid (about 5ccs) and are testing it for carcinoma cells and they will give me a call tonight or tomorrow. 

Apparently, when the pancreas is diseased with cancer, it just crumbles and pieces dissolve and break off and just float around.  So our vet thinks he has some cancer cells just floating around in his abdomen looking for an organ or wall to attach to.  That's why pancreatic cancer is so bad and usually involves other organs.  This sounds horrible and our vet said it is not good news. 

He will increase Rumble's chemo by 10% since his body/blood seems to be tolerating it so well.  We just started round 4 of 5.  I was hoping to be done soon.  He said we might also add another oral drug to be administered at home, but didn't explain any further. 

He considers Rumble a success story, but I'm just not feeling it today.  I went in with such high hopes because I knew he had a great two weeks and had put on weight.  I watched a family of four today in the waiting room learn that their dog has some sort of pancreatic lymphoma and I broke down watching them break down.  It hurts so much and I'm so tired of bad news. 

Please send Rumble prayers and energy that these cells are anything in the world besides cancerous or that they respond well to the uppage of chemo.  Thanks for thinking of us!

A Good Week

FINALLY, Rumble has had a good week.  We seem to have had two bad weeks in a row and I was really worried about having to put in that feeding tube, but Rumble has just been great this week so I'm hoping we don't have to. 

I almost don't want to post because I don't want to jinx him. 

We've changed two things recently so I'm not sure which one to attribute it to.  One, Rumble is on a new canned cat food from Hill's Prescription Diet called i/d Feline Gastrointestinal Health.  This is a description from their website:  "Dietary indiscretion, food allergies, or lack of digestive enzymes can affect your cat's digestive health. Efficient digestion is essential for your cat to be able to build and repair tissues and obtain energy, and for these reasons it is important to feed a food that is formulated to help support digestive health.

At Hill's, nutritionists and veterinarians have developed clinical nutrition especially formulated to help manage cats with digestive health problems. Due to its easily digestible ingredients, Prescription Diet® i/d® may also be helpful for cat recovering from gastrointestinal upset and routine surgery."

Rumble loves it.  He is eating it just as well as he ate the Whiskas Wet Food Packets.  I'm really excited.  I will shop around to find the lowest price, but our vet carries it all the time for around $30 a case and each case holds 24 cans, I'm guessing.  Rumble started eating about a can a day but the last few days, he's eaten 2 cans a day and I'm loving it!  EAT, BABY, EAT!

Second, we have started giving Rumble half of his digestive enzymes through a syringe, mixed with tuna juice that I like to call his "slurry".  The other half is sprinkled on his food and mixed in; hopefully the smaller amount allows the food to smell and taste a little better.  As I've said before, it's not the easiest giving a cat a liquid medicine, but some combination of the new food and the slurry mix have worked because Rumble has had the best, solid poop he has had in months.  And, he's only going once, maybe twice a day so the food is staying in his system longer and getting more properly absorbed.  YAY!  Before this, he was going 4 times a day or more and it was pure liquid. 

In my opinion, he has put on weight this week and my husband even commented last night that his coat looks richer and more like it used to.  His mouth ulcers haven't bled since my last post.  This was a drug holiday week for him so I think that probably helped.  He has chemo again on Friday of next week, but that's still another 7 days for him to recover and put on more weight.

Mouth Ulcers

For the last few weeks, I've been watching two small, white ulcers in Rumble's mouth.  I first noticed them because he was extra drool-y.  Out vet said to just watch them and make sure they don't get any bigger.  He also said that Rumble has probably always had this mouth ulcer virus, only now, because of the immune suppressing chemotherapy, his body is not able to fight them from popping up. 

So we've started giving Rumble half of his enzymes on his food and we are mixing the other half with some tuna juice and are putting it in a syringe, making him swallow it, in the hopes that his food tastes a little better and that he will eat more.   We did that the other day and I noticed drops of blood on the floor.  He was drooling half blood half tune juice out the side of his mouth.  Not alot, but enough to freak me out.  He has a new mouth ulcer at the corner of his mouth where his lips meet and it's super red and slightly bleeding.  I called the OSU vet and he said as long as it doesn't get in the way of his eating and he doesn't paw at it then there is not much we can do about it. 

I hate this "watch it" attitude.  Something new crops up and they just want me to watch and say to call if it gets any worse.  But in this case, it has gotten worse, I called, and they again said to just watch it.  When will Rumble finally starting feeling better?  When will he start gaining weight?  How can I help him and treat these mouth ulcers? 

He is on a drug holiday this week, so I'm hoping his body takes it easy this week and does some of the things that I want him too:  gain weight, clear up these mouth ulcers, solid poop.  Thanks for keeping him in your thoughts and prayers.

Money

I hope everyone here understands that Rumble has no expiration date stamped on the bottom of his foot. 

When we adopted him into our family, we promised to make sure he had the best possible life and that includes medical care.  I think the majority of people think we are crazy for the amount of money we have spent on Rumble but you can't put a price tag on life and as long as it's still a good, loving life, we will keep on keeping on. 

My husband and I pride ourselves in having no debt expect our house and student loans.  But that has all changed with Rumble.  We were able to pay for alot of his expenses with cash from our savings, but since then we have opened a Care Credit account and have put money on our credit card. 

Care Credit is a 12 month, interest free credit card as long as you completely pay it off in 12 months.  If not, they hit you with interest at 26.99%.  That is huge.  We plan to do everything possible to pay it off in 12 months and if not, at 11 months, we will transfer everything left onto our credit card that runs at 12.99% interest. 

I will be completely honest with you about money.  This hurts my brain a little and I don't want to add up the final number.  Every original appointment with our vet cost $75 plus whatever additional we had done.  Blood work, Ultrasound, and X-rays cost anywhere from $200 - $300 each time and I think we had 3 sets done.  His surgery, anesthesia, pain meds, stay in the ICU, all his meds, post-op, everything he accrued while in the hospital, cost around $3,500.  The first week of his chemo includes two medicines (one rare) and runs us about $440.  The second week of his chemo only has one medicine (the rare one) and runs us about $240.  He has 5 rounds of chemo.  I've been told the feeding tube will cost around $250.  His Viokase is expensive and costs around $80 for 4 ounces but that seems to last us about a month to 6 weeks.  The two anti nausea medicines are cheap, in my opinion, around $8 each.  We go through a ton of food, litter, trash bags, and cleaning solution every week.  I'd say around $20 a week. 

For the first time ever, we are living pay check to pay check.  We are slowly building our savings account back up and are trying to pay off the Care Credit as fast as possible.  We do not have insurance on Rumble, but I sure wish we had.  Now, everything would be considered pre-existing so I'm not sure that it would be much help to add it.  We do have Home Again insurance but that's only if he sustains an injury after having escaped our home.  Hind Sight is 20-20, right?

Please don't be scared by the amount of money it takes.  It has been worth every penny to us and we have never looked back. 

Feeding Tube

I found out yesterday during Rumble's chemo appointment that if he doesn't gain weight soon, as in the next few days, then we are going to have to put in a feeding tube.  He has a great appetite, something is just not balancing with his enzymes so he's not gaining weight but even still losing weight. 

I feel like I'm failing, like I'm not doing enough or like I'm doing something wrong.  I broke down yesterday while in the waiting room of the vets.  No particular reason, after I had already been sitting there for a few hours.  I just broke down.  I thought I was crying quietly enough for no one to notice and I hid my face behind the book I was reading but within a few seconds, one of the receptionists was in the chair beside with a box of tissues asking if everything was ok.  Poor lady, how does she sit there and watch people cry every day?  She was probably also thinking, "Poor lady" about me.  It just got to be too much.  Chemo, which he hates, and then to find out he's going to need a feeding tube if we can't get his weight under control.  I just lost it.  I felt a little better afterwards.  I think I need to break down every now and again, just wish it hadn't happened in the waiting room, but they have seen it all before.  

So, we are now mixing the Viokase in with some tuna juice and giving it to Rumble by syringe after his meals.  You all know it's not easy giving a cat liquid medicine and these are big doses because it's alot of powder, we are lucky if half the liquid goes in at all.  Our vet also gave us some easy to digest cat food.  Rumble doesn't normally like food that comes in the form of pâté  but he really ate it well last night.  So, I mix half a serving of Viokase on the food and give the other half mixed with tuna juice either during or after his meal.  We need to decide by Friday if this is going to work otherwise, our vet wants to do the feeding tube on Friday.  "Better sooner than later", he said. 

My only good thing to report is that Rumble had not pooped in his box last night or this morning.  That makes me think all the food from yesterday is still in his system and is being absorbed correctly and we should see something small and solid in his box tonight.  I sure hope so!

Vomit

Believe me, there will be lots of Vomit for awhile.  Rumble was throwing up twice a day until we leveled a few things out.  They originally gave us a liquid medicine that I filled at our local Walgreens called Metoclopramide.   Through some trial and error we found that if you give this liquid medicine about 20 minutes before you feed them, then everything seems to stay down pretty well.  Too early seems to make him sick on the medicine itself and too late just does nothing. 

So my husband wraps Rumble in a towel and I try to squeeze the entire syringe into the side of Rumble's mouth.  They give you instructions and tell you to make sure and get it into the side pocket of his cheek to make sure that he doesn't inhale any of the liquid but to be completely honest, we are just glad to get the liquid into his mouth at all.  I try to hold his head still and work the syringe tip into the back corner of his mouth and separate his lips and I just squirt.  I usually get about half of it in there, wait a few seconds, give him some verbal praise and a kiss and then try for the second half.  Not the easiest or cleanest process.  Did you know cats can spit?

Another medicine that we like better is Mirtazepine.  We only got this medicine because I asked for it.  It is an appetite stimulant and anti nausea.  They are very tiny pills that you are supposed to cut into even tinnier fourths and give to your cat.  I tried dividing a few with a knife and a razor blade but it didn't work very well.  Instead we went to Petsmart and bought two things: a pill cutter and a pill popper.

The pill cutter has a V-shaped slot that you drop the pill into and a razor blade that cuts through the center of the V, cutting the pill in half.  Because I need to cut mine into fourths, I drop the pill in long ways first and then drop each piece in horizontally and cut them that way.  It's easier. The pill popper works by pulling out the center of the syringe type part, dropping the pill into the empty center, putting the syringe part back in, sticking the whole thing as far into your cat's mouth as possible and pushing the syringe part, dropping the pill into the cat's throat.  I always have a regular syringe filled with water or tuna juice and give it to him immediately following the pill hoping to aide in the swallowing process. 

I find that with the pill Mirtazepine, Rumble's vomiting is reduced from twice a day to once a week, maybe.  It's great, we love the pill.  Plus, he seems to be hungrier which is always what we are aiming for.  The pill maybe more of a pain to administer, but I don't care because it works.  The pill should only be given every 2 to 4 days and we usually aim for 3.  I find that Rumble starts to drool alot if he's feeling nauseous so if I ever see that, I immediately give him a pill, whether it's been 2 days or 4. 

Good luck with your medicine.  It's been trial and error for us, but these are the best medicines and how we try to make it work.

Post Chemo

Rumble is "toxic" for 48 hours after chemo.  That's what chemotherapy drugs are, poison they are using to try to kill off certain rapidly dividing cells and that poison has to leave his body eventually.  So, for 48 hours, he is not allowed to leave his comfortable guest bedroom living quarters that we have made for him. 

Litter Box:  They give you specific instructions on how to change his litter box.  Wear a double layer of latex gloves, a surgical mask so you don't breathe anything in, and wash your hands immediately afterwards.  That sounds like alot of trouble to me.  Instead we take a kitchen trash sack and rip it down one of its long seams and lay it awkwardly open inside his litter box and put litter inside the trash sack.  That way all we do is gather the edges of the trash sack and immediately throw it away in the outside trashcan so we actually never come in contact with the litter at all.  Way easier!

During this 48 hours, we always leave Rumble's window partially open.  He likes to sit on the window seal and yell at the birds anyways (through a screen of course). 

We were a little freaked out about the whole "toxic" situation at first but as I've sat in that waiting room for hours I've listened to a bunch of cancer conversations and most owners aren't freaked out at all.  I feel comfortable reading a book in there with him for a few hours but they advised me against sleeping in there with him during the 48 hours.  Post-op, I felt the need to be with Rumble as much as possible so I had slept a few nights in there with him.  I think it was more for my comfort than his because I've always enjoyed when he sleeps against me, right behind my knees.

So, just be smart about cleaning the litter box.  You can use our trash sack trick if you like.  We also don't let any other house hold pets play with Rumble until the 48 hours is over. 

Viokase - Digestive Enzymes

Lets talk Digestive Enzymes. 

When Rumble first came home from his surgery, he was eating like a crazy person and I was super glad.  He was pooping alot but that was to be expected.  When we went back for his first post-op appointment, he had lost weight.  WHAT?  I was ticked.  How could he have eaten so much and lost weight?  Something had to be wrong.  That's when I was reminded about the digestive enzymes. 

Another reason I was upset is because the vet didn't have any for me to take home with me.  They don't have enough patients on the enzymes to keep it in stock.  So, here I was, my cat had just survived surgery, you knew half of his pancreas was gone, but you didn't order me any digestive enzymes on the off chance that he might need them.  I was furious.  The vet closed at 5pm and it was already 5:30 but I made her and everyone else sit there while I called my vet back home and ordered some enzymes through him.  It took awhile because he had to call around and hunt some down but everyone could see how furious I was so they sat there and waited.  That was probably best for their safety :)

So it' an easy to use powder that you just sprinkle on their food and it helps with their absorption, right?   WRONG!

It's also called Pancrea Powder or the name brand I eventually bought was called Viokase and it is exactly what everyone is thinking it is...animal pancreas ground up into a fine powder (don't inhale near it EVER).  As I would imagine, the powder tastes horrible and Rumble is refusing to eat.  We buy him two types of dry food:  Nutro and Blue Buffalo.  So we decided to switch to wet food and see if that would mask the taste.  We spent big bucks on those big expensive wet foods and he still wouldn't eat it.  So we went for the cheap stuff, Whiskas Pouch Wet Food. AND he loves it!

We think the smell is strong enough to mask the odor of the enzymes.  The instructions say to sprinkle the powder on the food and wait 20 minutes.  This gives the enzymes time to start breaking the food down even before it is consumed.  It's a pretty cool chemical reaction to watch, but Rumble doesn't like it because the smell of the food is gone by then.  Our vet says as long as the powder is going down with the food, she's happy.   So, now we sprinkle the powder onto the food, directly in his dish, mix it up well, and immediately let him eat. 

The next day, Rumble has a solid poop for the first time in a month.  The rule of thumb with prescriptions is, order before you run out.  Don't forget this!  If you run out and have to wait for your next order to come in, then remember that everything he eats will be of no nutritional value to him what so ever and he will virtually be starving.

I feed Rumble anytime he appears hungry and he eats pretty willingly.  As he's gained some weight, he doesn't immediately eat and he doesn't finish it all but it is all gone by the time dinner rolls around.  He eats it all eventually.  He needs to nearly double his weight for him to be back to what he was a year ago.  I want him to be fat and happy!

Chemotherapy

Chemotherapy for cats is not the same as it is for humans.  The vet keeps saying, "We are going for maintenance, not for a cure."  I don't really understand that because I thought we were fighting for a cure.  Why wouldn't we fight for a cure?  I asked that exact question, "Why not?" and was told in order to go for a cure, we would have to push enough chemo into Rumble so that he would experience the same reactions that humans did and we didn't have the right to put his body through that without being able to explain it to him.  Ok, that makes sense, I guess, but I still want a cure. 

Chemotherapy attacks rapidly dividing cells so they are trying to prevent any leftover cancer cells from spreading any further.  Ok, but does that mean he will have to be on chemo forever?  I don't know.  Right now I just know he's on 5 rounds of chemo and each round is three weeks long.  If he loses any hair, I've been told it will only be his whiskers because they are made of a different type of cell than the hairs on his body are. 

Before each round of chemo a blood CBC is run.  I'm not exactly sure what that stands for but I know they are testing his blood to make sure his body will be able to handle the chemo.  If his platelet counts and other things are not within normal ranges, then they won't proceed.  Rumble has had normal ranges. 

Rumble is always sedated prior to chemo.  Poor guy, I know I wouldn't sit still either if I were him, so it's easier to just put him to sleep during the process. 

Week 1 of chemo includes a combination of two drugs Carboplatin and Gemcitabine.  The latter of which is a rare chemo for rare cancers so they don't keep it in stock and have to special order it.  Because of this, his chemo treatments have been rescheduled because the pharmacy/oncology/whoever, failed to order the Gemcitabine.  Week 2 of chemo is only one drug so the whole process takes about half the time. 

Because Rumble is receiving two chemos in one session, they are being given 4 hours apart.  Because no one in the city can give Rumble the chemo he needs, I drive an hour up to OSU, usually our appointment is at 9am, and then I sit in the waiting room and read a book for the next 6 hours, hopefully I am out the door by 5pm when they close but I have left as late at 7pm.  It takes so long because they have to examine him, wait for his blood work to come back, sedate him, give chemo 1, wait 4 hours, sedate him again, and give chemo 2 and then let him recover a little while they talk to me about everything. 

Makes for a very long day.  I don't know why, but at the end of chemo treatment days, I'm exhausted.  I drove for an hour, sat in a waiting room for 6 to 8 hours, and then drove an hour home.  I didn't do anything strenuous but I go home, feed Rumble and make sure he is comfortable and immediately go to bed for the day.  Being a care taker is exhausting. 

Pick UP day!

Yay, the time to pick him up from the hospital and bring him home had finally come.  Two doctors had been treating Rumble, one from Internal Medicine and his Surgeon.  They brought me into a room and the Internal Medicine doctor spoke to me about pain meds and what things to watch and look out for during post op care. 

Then the Surgeon came in carrying Rumble and nothing else in the world existed.  All I wanted to do was reach through the crate and hold him and he was reaching those tiny black paws through the crate towards me.  Meanwhile, the surgeon was talking to me and I wasn't hearing a word she was saying and after a few seconds, I told her so.  At that point, the mean Internal Medicine doctor took Rumble away so I could focus on the surgeon.  I cried.

It wasn't fair to bring him into the room and then take him back out.  They probably knew the reaction I would have so they should have waited to bring him in until everything was said and done.  Thus a good reason to go to these appointments with two people if you can so two sets of ears can be listening.   I listened to the surgeon with my eyes but that was all I could manage.  She said everything I needed to know was on the papers I would be taking home so why she was wasting my time, I don't know.  She drew a nice picture of his intestinal tract, showed me the parts she cut out, and told me things to watch out for when at home.  Blah Blah Blah, bring my Rumble back please. 

Then the time came.  They brought him back and I got to hold him for the first time in a week.  He was so handsome, so happy to see me, although he smelled different.  Rumble has always smelled like cinnamon to me, but I didn't care, he was in my arms and was coming home. 

Rumble had been shaved in many areas for the surgery: two inch lengths on all four legs, around the front of his neck, his entire belly of course, and about 2 inches at the base of his tail.  They assured me they didn't shave him in any area unless it was necessary but it still seemed like alot.  The neck and tail were shaved so they could measure the amount of oxygen in his blood.  His belly was covered with a taped bandage they said to leave on until next week and they would remove it during his post op visit.  He looked and smelled different, but I didn't care because he was coming home. 

I brought him home and let the two dogs and other cat smell and say "Hi" to Rumble through his crate and then I took him to his new suite.  We had simplified the guest bedroom into his new palace.  It has a trundle bed that we pulled out to make a nice step up to the top bed where we thought he'd sleep the most.  We kept the room dark, cool, with lots of places to sleep, plenty of food, and water.  I slept in there with him the first few nights.  I think it was more for my comfort than his but he seemed to appreciate my company. 

After a few days, we started letting him roam around the house for a few minutes with the dogs outside and Zeva in another bedroom.  I watched him like a hawk and didn't let him jump up on anything.  He ate, slept, and pooped/peed just fine.  I watched for bleeding at the sight of surgery and in his poop but saw nothing.  He was a champ, my champ, and he was home.

Post Op - in hospital

Rumble stayed in the hospital for nearly a week and I was ok with that.  I was nervous to bring him home so soon.  Post Op he had some trouble waking up from the anesthesia and that really worried me. They called me when he was out of surgery and I was excited.  They called me at 8pm and he still hadn't woken up and that worried me.  My student called me at 3am on Wednesday and he was more awake but not fully.  The Dr. called at 8am Wednesday and said he was almost to the "drunk" phase of anesthesia and told me to not worry because sometimes an animal just reacts to anesthesia differently and it takes them a long time to wake up.  Around 8pm, a full 24 hours post surgery, my student said Rumble was fully awake and I breathed a sigh of relief. 

Tone of voice is very important to me.  It always has been, even as a kid.  My student at the time was male and had the worst tone of voice ever, especially over the phone.  I told him I felt like a needy girlfriend because he wasn't calling me often enough, thus the 3am phone call.  But, when he actually called, my heart nearly fell out of my chest because this sad, slow, monotone voice said, "I've called to talk to you about Rumble."  Turns out he was just updating me on his status but at the time I thought he had passed and the 3am ME nearly broke down.  I hate roller costers.  My heart was pounding because it was 3am and I was receiving a phone call and it was my student from OSU on the phone sounding as if Rumble had died.  I wanted to strangle him but instead I thanked him for the call and asked when he would be calling me again. 

His vet explained to me that Rumble was just getting over the effects of the ketamine that was a part of the anesthesia.  That is the only part of the anesthesia cocktail that can't be reversed with another drug; it has to be naturally secreted out and that takes awhile.  She called him awake, just really really relaxed, and that doesn't sound too bad in my opinion.  After the last two weeks I've had, I feel like I could have benefited from some ketamine ;)  (j/k)

All this time, Rumble had been in the ICU because it is monitored 24 hours a day by students and the on call physician.  The operating room is always cold so Rumble's temperature had dropped and they were having trouble raising it back up to the 101 degrees they were looking for.  So he stayed in the ICU pretty much until the day he came home, and I preferred it that way. 

Because of the high bilirubin count, Rumble had started to turn yellow with jaundice.  But, after they gave him a new bile duct, his bilirubin count continued to go down and the white skin of ears ears immediately turned less yellow.  Immediately after surgery, Rumble's bilirubin count went down from 3.4 to 3.1 and by the next day it was down to 1.1.  Amazing how quickly that part of him came into balance.  We still had a little way to go to get to 0.3 but we were on the fast track. 

His surgery was on Tuesday morning and we brought him home Monday, April 11th.  Don't worry too much if your little guy doesn't immediately wake up from anesthesia.  And please be nice to your vet students, even when you want to strangle them.

Surgery

Well, the day finally arrived.  Rumble was scheduled for surgery at 10am on Tuesday, April 5th. 

Of course, me being the shy, non-talkative type, no one in my office knew what was going on.  Just kidding, EVERYONE knew what was going on and they were all waiting on pins and needles with me to get the call.  At the time, we were working together in a large room and my cell phone was ever present.  My surgeon said if they called quickly after they began it's because the cancer was too wide spread and they were going to close him back up.  If they called later, it's because they thought the surgery could be a success and had proceeded. 

Noon rolls around, no call.  I'm opptomistic.  Finally, 1pm rolls around and my cell phone rings and I jump on it like a fat kid on a trampoline.  The positive prayers and thoughts had worked:  Rumble came through surgery ok. 

They took about a third of his stomach but the cancer didn't seem to be in his duadenum or his small intestines so they were able to directly connect the remaining stomach to his duadenum.  They took about half his pancreas but she said they left enough that he wouldn't need insulin shots but he will need a digestive enzyme added to his meals but that's just a simple powder added everyday.  No biggie. 

They took biopsies of his liver and lymphnodes because they were big and angry but the tests came back as just that, big and angry, a reaction to his backed up bile and other stuff not draining properly, the cancer had not spread to the liver or lymphnodes as far as they could tell.  So that's great news.

They did have to remove his gallbladder from where it normally sits and connect it directly to his duadnum because the duct was angry and wasn't working anymore.  They said as long as everything is there, it doesn't matter how the plumbing is connected. 

Just a reminder that this is the worst type of cancer, small cellular cancer, not big tumor cancer, so it could have spread to other areas that they can't see even though they tested them.  Buuuuuut, I'm extremely happy and so was the surgeon.  Assuming he has no post op problems, which include pancreatitis or leaks, he can come home next week. 

My co-workers said they were going to blame me if we didn't win the lottery this weekend because I used up all of the luck I had.  I told them I was going to go out and buy a separate lottery ticket and win because I was the luckiest person alive. 

Thanks again everyone.  I know one of the reasons he's doing so well is because I had so many people praying on his behalf.  He means the world to me and thanks for everything.    

Worried Sick

I have a new appreciation for the phrase, "worried sick".  I have never in my life been as sick as I was Sunday night, April 3rd.  I've heard stress can take a physical formation, but I didn't truly believe it.  I was so sick that I could hardly function when I took Rumble back up to OSU for his surgery. 

His surgery is scheduled for Tuesday, April 5th at 10am.  I really liked his surgeon.  She explained that not only does Rumble have cancer but he has really rare cancer.  No one on the staff has ever seen/treated a cat for this type of cancer and there are currently only 20 cases in the whole US being reported.  Great!  Just what I wanted to hear, right?  I cried on the surgeon, hugged and kissed Rumble good bye, and let my student take him back.  I hope he understands. 

So my surgeon walked me to the front desk and I just lost it.  Completely lost it on the poor waiting room receptionist.  I would not enjoy riding that roller coaster.  How those women handle themselves when people are just crying and dripping snot all over their clean counters, I just don't know?  She was trying to get information from me and I was just sobbing so hard that I couldn't get words out.  My surgeon brought my check out papers, handed them to the lady, helped me get my wallet out, gave me a hug and said she would do her best.  I guess that's all I could ask for. 

I went to my car, nearly dehydrated myself through tear loss, prayed for Rumble and his new surgeon, and drove home.

What's a Bilirubin?

Holy Crap, it was a long day.  We left at 8am and didn't get back home until 8:30pm.  I was exhausted and I did nothing but sit in a car and drive or sit in a waiting room and wait.  Weird?

Upon entering OSU, I felt welcomed.  Very open waiting room and I barely sat down before my "student" came to greet me.  OSU is a teaching hospital so each case is assigned a student.  They are on three week rotations so don't be surprised if you have a different student at your next visit. 

I was initially hopeful.  Our Dr. was optomistic and said they can do surgery on a pancreas (you don't need the whole thing to survive) and the different vital ducts can be rerouted.  His plumbing would be changed if needed, all things I wanted to hear. 

So, I left Rumble there to get x-rays of his chest, an ultrasound, a needle asperate (?) taken of the mass and analyzed and a urine collection taken directly through a needle into his bladder.  The whole bladder thing was checking for a rare, but prevalent in oklahoma more than people think, fungus that can be flushed out of a system with medicine.  I have never prayed for a fungus before but that's what I hoped was wrong.  How amazing would it be if the mass was just a swollen part of his organs due to a fungus that could be treated with medicine?  Probably too good to be true. 

His chest x-rays were clear.  Our Dr. said if they found cancer in his lungs then they would not proceed at all.  But, thankfully, his lungs were clear.  Our Dr. said they look for the 3-L's:  Liver, Lymphnodes, and Lungs.  If the 3-L's are clear then they have a fighting chance and will continue with surgery. 

Turns out it's not the fungus we were all crossing our fingers for and it's not exactly a mass of any sort.  A mass would be easy to remove.  You can see a tumor and remove a tumor fairly easy.  Instead, Rumble is diseased with rare, clumpy cancer.  They have to remove the diseased part of his stomach and reroute ducts and even then she's not hopeful because you can't see this weird cancer, meaning it could be in other parts and they wouldn't even know it. 

Currently, his bile and stuff is backing up into his stomach and not draining, because the stomach walls are inflammed and it can't drain, so his liver is working over time and having trouble. His bilirubins are already sky high.  A normal bilirubin count is between 0.1 and 0.4 and Rumble's was 3.4 (always the over achiever).   We are to watch for more jaundice over the weekend. 

They will remove and do what they can but our new vet said this is not a fix and she doesn't think he will return to normal.  She will call tomorrow when she schedules the appointment with the surgical team for monday and tell me what time to bring him back.  So, I'll be going back to OSU monday morning. 

To Fight or Not to Fight?

Treating his symptoms and letting him go was NOT an option for us.  Rumble was barely 10 and so healthy and such a fighter that I felt like I owed him the chance to become one of the 5 out of a 100 and win his battle. 

So, do we let our local vet open him and explore?  If the carcinoma turned out to be anywhere but between the pancreas and the stomach, then our vet would try to remove it.  If it did turn out to be in that bad spot, then he would take a sample and close Rumble up and send him on to a specialist. 

As it turns out, when you have tough decisions to make like this, no one can help you decide what to do, no matter how many times you ask them.  I wanted someone to just shoulder the responsability for a little while and tell me what to do.  I got pretty much the same answer from everyone, spend some quiet time alone with Rumble and together we would make the right decision.  Sucks, but I guess that's the right answer.  Get quiet...go inside...ask...and listen. 

Rumble told Naomi, "I would just as soon go to OSU because I know my mom won't be happy unless everything possible is done.  Follow my instincts and heart."  Words of wisdom.  I wish I had listened to my instincts and heart back in January. 

We decided to skip our local vet and head straight to the specialist.  We brought Rumble to the Small Animal Hospital up at Oklahoma State University located in Stillwater, OK.  I didn't want Rumble to be opened twice and I didn't want to pay for two operations so we decided to go ahead and take Rumble to OSU, even though we were avid OU fans!  Our first appointment was Friday, April 1st.

Other Healing

I firmly believe in the power of prayer so at this point, I enlisted the help of my friends, family, animal communication specialists, and healing groups.  I truly believe that no cat has ever had so many prayers or healing energy sent on their behalf as my cat Rumble did. 

First, I said my own prayers, as I had done from day one.  My husband and I prayed for Rumble every time we came together in prayer:  before meals, after soccer games, before bedtime, at church.  Anytime I had a quiet moment throughout my day, I said a prayer for Rumble.  I was thankful for him being in my life, thankful for his health thus far, and I asked God to place his healing hands on Rumble to help him through this ordeal.  I also asked for knowledge for all the doctors involved that they would have the skills to proceed successfully and the compassion to care for Rumble as much as I loved him.  I've seen miracles; I know God uses them.  I just hoped He saw me worthy enough to answer, "Yes". 

Second, I contacted my Animal Communicator, and friend, Naomi McDonald.  You can find information about Naomi at http://www.brendamcdonald.com/  and her blog at http://www.shamanswisdom.blogspot.com/  Naomi immediately responded, talked to Rumble, talked to me, and met with me the following Saturday to discuss what she read. 

Third, I got on my email and I let everyone I know that I needed help.  I emailed everyone in my animal communication classes from Naomi and one of them pointed me towards an online Distant Healing Network at http://www.the-dhn.com/  The DHN is an organization of many hundreds of complementary therapists. They are spread all across the world and volunteer to give their time freely, accepting requests for help to ease the suffering of all who ask.  Within an hour of submitting my request, I got a response.  Rumble had been assigned to a team with members across the globe so I know he would be covered in prayer, and healing energy, at all times throughout the day. 

Fourth, I needed some personal healing.  A HUGE part of my life (apart from Rumble) was coming to an end and I needed a new focus.  As I look back on it, this organization that I was involved in ended precisely when Rumble got sick, otherwise I would have broken down.  If I had to keep up my obligations with this group AND focus on Rumble, I simply wouldn't have made it.  Both my friends and family all said they would pray for Rumble and me and I didn't understand exactly why they thought I needed it until later. 

I'm thankful for all the prayers and healing energy that I received both from my friends and family.

He sees "something"

So I take Rumble to another vet here in the city who is going to perform the Ultrasound.  I drop him off because the vet is busy and has squeezed us into his schedule for the day.  They inform me that Rumble will come back with a shaved belly and that unless Rumble cooperates, he will have to be given anesthesia to help him calm down. 

I come back hours later and the vet sits me down in the waiting room, not a private room, which irritated me.  Yes, the waiting room was empty, but I would rather have not cried infront of the receptionist, news like this should have been delivered in a small private room, just me, the vet, and Rumble. 

Turns out that Rumble has a mass between his pancreas, duadenum, and stomach.  The vet can't exactly tell where it is but he knows that all three organs are affected.  There, in the middle of the waiting room, I learn that my heartbeat on four legs has an incurable cancer with a 95% rate of death within weeks after diagnosis. 

Through my sobs, I ask the vet what our next step is.  He said I had three options: 

1. Treat his symptoms and let him go.
2. Have our vet go in for exploratory surgery and assess the damage.  If it’s pancreas or duodenal, close him up and take him home and treat the symptoms, if it’s anywhere else our vet would try to take it out if he can. 
3. Go to surgical specialists and let them open him up and try to take it out even if it is in the pancreas or duodenal. 

No decision needed to be made right there so I took Rumble home.  I wasn't exactly able to hold much back in the waiting room when he told me, but I REALLY let it all out in the parking lot in the car.  I said a prayer, composed myself well enough to drive, and took Rumble home. 

I wanted to include the Ultrasound and X-ray pictures because I think stuff like this is really neat.  I can't tell you what exactly is in each picture, or where the mass is, but here they are anyways. 

What it's NOT

Rumble continued to lose weight and after Spring Break I decided to take him back in.  From January to March, Rumble went from 11.6 pounds to 8.8 pounds.  That is a HUGE weight loss for a cat.  His fur was no longer black and rich.  When he moved you could see his skin underneath in some areas.  His bones were starting to stick out and it feels really weird to pet him and feel everything. 

His temp was 104 degrees, which is high for a cat.  According to our vet, his chest was clear and his abdominal palp showed no pain and no masses.  His blood/serum work did return a high globin count which our vet said, "he is in a fight against something; either a virus or leukemia."  Our vet wanted to rule out some infections so he took Rumble's blood and tested it for several things:  FeLV (feline leukemia virus) was negative, FIV (feline immunodeficiency virus) was negative, and FIP (feline infectious peritonitis, which had to be shipped off to be tested) was also negative.  We also know that it is not worms, liver/kidney failure, or hyperthyroidism.  Our vet also noted that his back was sensitive so he gave him a steroid shot.  So we ruled out a few things that it was NOT but we still don't know what it is. 

Our next step was to take a look at his abdomen using an ultrasound.  Our vet said he could do the ultrasound but if he found anything, he would send us to someone for a further look so we decided to skip the cost of our vet doing the ultrasound and just go straight to the next guy to begin with.

I should have pushed harder for more tests back in January; I should have listened to myself more closely.

My Heartbeat

On Tuesday, November 13th, 2001, my boyfriend became my fiancé and Rumble became my heartbeat on four legs.  He opened the truck door for me and as I was about to crawl in, I saw a tan basket sitting in my seat.  I went to toss the basket into the backseat when I noticed a black cat with huge yellow eyes staring at me.  As I turned around to ask where he came from, my boyfriend was down on one knee and asked me to marry him.  My engagement ring was around the collar of the cat sitting in the basket.  I said, "Yes" and I got an engagement ring and a cat all on the same day. 

We took the cat back to my fiancé’s apartment and he promptly ran under the bed.  We didn't see him for the rest of the night or the next 3 days when I came over to visit either.  BUT, we could hear him purring from every room in the apartment.  Thus his name, Rumble. 

My husband likes to tell the story of how exactly he picked Rumble, or rather how Rumble picked him.  My best friend/childhood pet was a solid black cat with yellow eyes named Norman.  So, my husband knew what he was looking for.  He didn't want a kitten because they get adopted too easily so he went into the 2 years and younger room.  As he was playing with a black cat that had one white foot, he felt a paw tapping him on the shoulder.  My husband turned around and there was Rumble, sitting at the top of a cat tree, letting him know that he needed to turn around to find him. 

Thus the story of how Rumble chose my husband, how I got my ring, and how Rumble became my heartbeat on four legs.

He's too skinny

I remember telling my husband during Christmas 2010, that our cat, Rumble, was losing weight and looking skinny.  He agreed, but since his yearly appointment was always at the first of January, we decided to wait and see what our vet said. 

Mama Knows Best!  I should have listening to myself more closely but our vet convinced me that Rumble's weight lose was a natural reaction to the new things in his life:  we bought our first house 3 years ago, added a second dog 2 years ago, and added a kitten one year ago.  Sure, being the owner of a house, two dogs, and a fellow kitten could make a cat lose weight, but I thought there was more to it than that. 

He also began acting differently.  Rumble was always affectionate, but he usually hung around us, not directly on us.  Come to find out, he was exhibiting another symptom called Heat Seeking.  Rumble went from sitting on top of the couch behind us to directly sitting on our laps every chance he got.  I loved every minute of it; I only wish I had known it was a symptom. 

I wish I had listened to myself more closely and had started getting Rumble's blood tested during this first appointment in January.  Don't ever doubt yourself.  Please trust your instincts and push for tests to be done.  Don't let your vet convince your head when your heart knows that something is wrong.