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!