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.