Clyde McPhatter's Story
by Melissa
4/10/15: DIAGNOSIS
Twelve-year-old Clyde was just diagnosed with large cell/high-grade lymphoma. About 2 months ago, I noticed he was having some diarrhea, but didn't think much of it at first. When the diarrhea continued for a few more weeks and his appetite seemed to be decreasing (which is VERY unusual), I took him to the vet. It turns out he had lost about 2 lbs (he has always been a very healthy, "robust" kitty, weighing in at around 15-16 lbs.) as well as a low red blood cell count, which concerned the doctor. He guessed it was IBD, but suggested an ultrasound to be sure. The low red blood cell count was a concern because it didn't usually accompany IBD. But because the ultrasound was so expensive and the doctor never mentioned the "c-word" as a possibility, I decided to first try to treat him with steroids (prednisolone), as if he had IBD, and go from there.
Clyde wavered between feeling great and eating like normal to not eating much, and he was alternating between very hard, dry feces and diarrhea. After a month on the steroids with mixed results, I decided it was best to get an ultrasound to find out what was going on. Unfortunately, the doctor found a large mass in his colon, which is what was making it hard for him to pass his stool. He did a needle aspiration biopsy, which came back as positive for large-cell/high-grade lymphoma. He was put on a higher dose of prednisolone (15mg/day) for the tumor, cerenia (8mg/day) for any nausea, and luctulose to help with constipation/keep things moving and get past the tumor.
I'm having a really hard time forgiving myself for the month that passed between the first time the doctor suggested an ultrasound and when I actually did get the ultrasound. I've read large-cell lymphoma moves fast and the survival time depends on how quickly the tumor is diagnosed and treated--with some cats living only a few weeks, if untreated. I can't stop thinking Clyde would have had a better chance had I started all this a month ago!
4/14/15: ONCOLOGIST & CHEMO
We had our first visit to the oncologist today. He suggested an aggressive treatment of chemo, starting with IV/injection administrations today, then weekly treatments for the next 8 weeks. Even with the chemo, he said the median survival time is 6-10 months. It was a hard (and expensive!) decision, but for the time being, I have decided to try the chemo and see how he reacts and progresses. He will also continue with the prednisolone, cerenia, and lactulose.
Another alarming stat was that his red blood cell count had dropped again, from 20% the week before to 13%. This seemed like a lot, but the doctor explained due to possible dehydration the first time, the percentage might have shown a few points higher and the second time was an automated test, which often shows the RBC a few points lower. He suspects the anemia is due to either some kind of gastrointestinal bleeding from the tumor, the tumor itself, the cancer, or a combination of all three. He doesn't feel a blood transfusion is necessary yet, but I have been instructed to keep an eye on Clyde's energy levels and other behavior that might suggest severe, life-threatening anemia that will require one.
4/14/15: REACTION TO CHEMO ROUND 1
For his first round of chemo, Clyde got a subcutaneous injection of L-asparaginase (aka, Elspar) plus an IV injection of Vincristine. To my surprise, he took it like a champ! When he got home, he was acting like his totally normal, HUNGRY self! Almost as soon as he came out of his carrier, he went straight for his food bowl and ate. We've been home for about an hour now, and he's been taking trips back and forth to eat more and more. After a few days with little appetite, which was very sad and stressful for me, I'm glad to have my food-obsessed cat back! Though I'm worried about what lies ahead for him, I'm relieved he didn't come back from chemo a broken man, as I feared.
6/7/15 CONTINUING CHEMO
It's been a while since I've reported on Clyde's progress. I don't want to be overly optimistic or jinx how well he's been doing by actually writing it down, but I also know I first turned to this website for answers and hope on what to expect. Clyde has been doing exceptionally well since starting chemo. Though not completely back to normal, his appetite has increased and he has gained back some of the weight he lost. He's definitely become more picky about his food and I have to change it up constantly and am never sure exactly what he will like. But when I find something he does like, he eats it! Aside from this, he has shown really no side effects to the chemo and seems to be behaving like his old self again. He still loves to go play outside and actually just last weekend brought in a mouse he had caught. The old boy still has it! :) His diarrhea has gone away, and he is having solid bowel movements again, though not as regularly as would be normal. But that's ok. He has been going to chemo treatments every week since my first post in April. I believe next week will be the last weekly chemo and then we go to every other week. The doctor is going to be performing another ultrasound to check on the size of the tumor, and I will report back then. Fingers crossed!
RECAP OF THE LAST 3 MONTHS OF CLYDE’S LIFE
I am sad to report Clyde passed away on September 15, just five short months after being diagnosed with cancer. But I have to say I believe they were some of the best five months of his life. I know probably a lot of people come on here looking for answers, as I did when I first found out he had cancer. So I am here to share the rest of his story in the hopes that it helps those who are scared or sad or unsure of what to do—or a little of all of the above.
CONSIDERING CHEMO
When I first found this site, my questions were, How long will he have to live? Should I move forward with chemo? What kind of effects will the chemo have on his quality of life? When will I know it’s his time to go? First, it is obviously a super personal choice and also a huge financial commitment to decide to try chemo. But in my opinion, it was absolutely worth it. I believe it extended his life and also greatly improved the quality of it. Clyde was never really adversely affected by the chemo and showed no signs of side effects. In fact, he seemed to actually look and feel better after his treatments. Now, clearly, every cat is different, and I’ve read about a lot of cats who didn’t fare as well as he. But my experience overall was a very positive one, and I would do it all over again in a heartbeat—regardless of how many thousands of dollars it cost. And it did cost thousands. There were times I thought about the cost vs. reward and questioned whether it was worth it. I struggled with the idea of paying so much money for what could end up being not much more time with him. And, to be honest, 5 more months really wasn’t that much more time. The doctor said the average survival rate is 6-10 months. But it was enough time to make me feel as if I really did everything I could for him and say my proper goodbye and send him off living like a king. And I am so grateful for that time we had together.
SECOND ULTRASOUND & CONTINUING CHEMO
My last entry left off with the anticipation of Clyde’s second ultrasound. The doctor was hoping for complete remission, since he seemed to be doing so well. However, the tumor, though dramatically smaller in size than his first ultrasound, was unfortunately still there—what the doctor called partial remission. We then stuck to the original treatment plan to start going every other week. But after taking the first week off, Clyde started having balance issues. They weren’t so obvious at first, just a little stumble here and there. Or when he shook his head (which he did every time after I gave him his pills), he would lose his balance a little. So since it seemed as if he was responding positively to the chemo with no side effects, we went back to every week, which seemed to help.
BALANCE ISSUES
When the balance issues first started, I did a lot of research on what could be the cause. He seemed to have a slight head tilt in addition to his occasional stumbling around. I became convinced it was an inner ear infection. The doctors did several exams but could find nothing wrong with him. However, there’s no way to easily tell whether a cat has an inner ear infection, so we decided to start treating him with the antibiotic Clavamox. This was over 4th of July, so unfortunately, I was not home when he started the meds and though I had a couple of people come in to visit him, no one was keeping a close eye on him. His appetite started to decrease and by the time I got back home, he was barely eating anything to nothing at all.
LOSS OF APPETITE
Clyde had always been a very hearty eater, so when he stopped eating entirely, I became very concerned. I started putting out at least 3 different options of wet food multiple times a day and cooking him grilled chicken, which seemed to be just about the only thing he was interested in. For those of you who has a kitty who won't eat and are looking for options, I found Clyde's favorites were grilled chicken, turkey baby food (2nd level or whatever they call it--the one that's just purely pureed turkey with no other ingredients), and occasionally canned chicken (white & dark meat) and tuna. But when he stopped even eating these, I turned into a total crazy person with my floor filled with plates full of food that I hoped would entice him to eat. But he still was barely eating anything, maybe a few bites of chicken here and there, and I started to worry he might develop fatty liver disease (the internet is a very scary place sometimes!). I was at my wit’s end, and thinking that it might his time to go. I mean, one of his favorite activities of life was eating and he wasn’t interested in that anymore. I was going crazy, constantly stressed and on the verge of tears, and spending most of the time begging him to eat something. It didn’t seem like a good life for either one of us anymore.
MIRTAZAPINE & SYRINGE FEEDING
So I took him to the doctor, convinced I would be putting him down very soon. But when the doctor saw him, he said he was surprised to see Clyde looking as good as he did. He seemed pretty unconcerned with the fact that he was barely eating anything. Clavamox is notorious for causing inappetance, and since his balance issues had disappeared, we decided to take him off that and also try putting him on Mirtazapine, an appetite stimulant. The first time he took the Mirtazapine, it was like a miracle! He ran around the room, taking bites of everything I put out for him to eat! I was ecstatic. But that effect only lasted a short while after taking his first dose, and he was prescribed to take it just every three days. I still felt like he wasn’t eating enough. The doctor had also given me Hills a/d prescription food, which is very high in calories and cats supposedly love it. Clyde still wasn’t interested, though. So I started considering syringe feeding. I decided it wouldn’t be a permanent solution. There was no way I was going to spend the rest of his life force feeding him. That would just be miserable for the both of us! But I thought it had been a number of days since he had eaten anything, so maybe if he just got a little something in his stomach, that would kickstart his appetite again… I was so, so nervous to try it. He was a very stubborn and rambunctious cat who didn’t do well with even taking pills. He was even notorious at the vet’s for being very difficult. How was I going to pull this off?! But I watched a few Youtube videos (the internet redeemed itself there!) and set out to do it. Desperate times call for desperate measures and I needed to know no matter what happened that I had tried everything in my power. To my surprise, he tolerated it better than I expected. I wrapped a dish towel around his neck like a bib, stuck the syringe in the side of his mouth (that’s the most important thing I learned: always go from the side, so they have a chance to actually swallow it, rather than from the front where you’re literally forcing it down their throat) and pushed the plunger little by little. Now, granted, the first time wasn’t perfect. He spit out most of it, and I had a moment of despair where I thought it would never work! But I was determined to get something down and tried again. After a few tries, I was getting more down. The syringe only held about 5mL, so it was still very little, but that was just about the amount he would tolerate before getting agitated. I made sure to always stop when it seemed like he had had enough and to not force it too much. It wasn’t much, but it was something. And slowly but surely, it started working, and his appetite came back. Luckily I only had to keep up the syringe feeding for about two days. So this is my advice: there are going to be times when you think you’re both at your wit’s end, but don’t give up if you truly feel there might be other options. Sometimes it may end up just being their time to go. But there were a number of times I thought he was on the brink death and convinced he was done with fighting and then he bounced back like a miracle.
UPS & DOWNS
Clyde was starting to act like his normal self again. Yes, his appetite was down from where it used to be before he got cancer. And yes, I was still booby trapping my apartment with plates of food everywhere, just in case the notion struck him to want to eat one of the fifty million options laid out in front of him. But for the most part, he was living like a king with his pick of whatever he was in the mood for at the moment, and I was satisfied with the amount he was eating, so we were both happy. After a while, I decided to take him off the Mirtazapine. I read about all the terrible possible side effects, and though Clyde didn’t seem to have any adverse effects from it, I didn’t want to keep him on it any longer than necessary. He still took Cerenia for nausea nearly every day plus prednisolone, and I also tried adding Pepsid AC twice a day. The Pepsid actually seemed to really help, and I would recommend at least trying it, if your kitty’s appetite is down. Sometimes with not eating, then eating, and different meds, etc., they might just have a bit of an upset tummy or acid imbalance. Life was pretty back to normal (or as normal as it could be when you have literally 8 plates of food sitting out on your living room floor at any given time). But then the balance issues returned. I thought it could the ear infection coming back, since we hadn’t completed his full course of antibiotics due to his loss of appetite from it. The doctor warned me it might be the lymphoma, but I wanted to try putting him back on the antibiotics. So we tried it, and this time I started right off the bat with making sure I gave him the Cerenia for any nausea the Clavamox might cause and keeping him eating as much as possible. It seemed to work. His appetite was good, and the balance issues disappeared again. Now I was convinced it was an ear infection, even though his oncologist had his doubts. I actually started to become a bit frustrated at his skepticism. But I knew he has a lot more experience than I, so maybe he was just cautious and didn’t want me to get my hopes up… Or maybe he was jaded? I didn’t know. But I was happier thinking it was an infection rather than the lymphoma spreading to his brain, so that’s what I chose to believe. For a while, Clyde was doing really well. I kept him on the antibiotics for a few weeks, and they seemed to be working. But once again, the balance issues started again. Every time it happened, it would break my heart. He would fall sometimes when jumping onto or down from somewhere. I could tell it confused and scared him when it happened. He started being less sure of himself and of moving around. There was a time when it got pretty bad and he became really dependent on me, barely leaving my side. But once again, I thought it was that darn infection. That because we had started and stopped the antibiotics, maybe it had become resistant. So I asked to increase his dose of the Clavamox. The doctor was still skeptical. He warned me again, it’s very likely it could also be that the lymphoma had spread to his brain, but it was just too difficult to tell what the real cause was. But since his dizziness seemed to disappear the other times with antibiotics, I decided to try it anyway. He also suggested we try a new kind of chemo, one that seemed to work well for internal cancer. The only downside was that he could only get it every three weeks. But he had finished his second course of the other chemo, and this seemed like a better/the only other option. So we gave it a go. And again, Clyde bounced back. Then things started really looking up. He was acting better than I had ever seen him since he was first diagnosed! We were both so happy. I look back at those times as some of the best in the last few months of his life, and I am so grateful for it.
THE FINAL DAYS & WHEN I KNEW IT WAS TIME
Things were really great for about three weeks. It was almost time for him to get another dose of the new chemo. Then one day, he seemed to be kind of out of it. Just sort of wandering around and not quite himself/”with it.” The next day, he had his first seizure. At least the first one I witnessed. But I wasn’t home much the day before, so it’s possible it wasn’t the first one. It was actually pretty scary. I noticed that day he seemed kind of restless, walking around, settling down in one spot, then getting up again to sit in another spot. And some spots were not his “usual” favorite spots. At one point, he even got in his litter box and laid down! I thought it was a little weird, but didn’t really think much of it. After doing some research later, I found this is actually a pretty normal precursor to a seizure. Then one time, he got up and started walking somewhere and fell down. He arched his back, stretched out all his limbs and started convulsing. I knew what happened before I even *really* knew what happened. He had had a seizure. Later that night, he had another one. Then another. Then another. They seemed to be happening every hour at this point. It was terrifying. Sometimes I couldn’t tell if that’s what was really happening because they were pretty minor—he would just sort of roll on his back and stretch out his limbs, like he was first waking up or something. But sometimes he would make a weird noise right before, and the more research I did, the more I knew he was having “cluster seizures.” It all happened so fast. Just a week ago, he even brought in another mouse he had caught outside! He was doing so well! I brought him to the vet immediately, and a neurologist examined him. They concluded that between the seizures and the balance issues, the most likely cause was that the cancer had spread to multiple parts of the brain. They prescribed some kind of anti-seizure meds for me to give at home, but it didn’t work. I brought him in one more time, and they gave him a shot of a larger dose of the anti-seizure meds. This did stop the seizures, but I knew it there was no point in continuing down this path. It was clear he wasn’t going to be getting better, and it could only go downhill from here. I made a promise to him and to myself that I wouldn’t force him live past the point where his quality of life suffered too much. I decided the next day I would put him down. I made an appointment for someone to come into my apartment to do it. I had already put him through multiple visits to the vet, which he absolutely hated, and keeping him there nearly all day and night. I couldn’t bring him back there again. The appointment was later in the afternoon, and he wasn’t having seizures anymore, so there were a few times when I questioned whether I was really making the right decision. But I realized it was really my own selfishness and fear of losing him that were behind these thoughts. My decision was solidified when I noticed the few times he got up to try to walk, he was super unsteady on his feet and would only make it a few steps before having to lay down again. I can only say I am so grateful the right decision was so clearly laid out before me. I know it’s not always so clear and a lot of people struggle with knowing when is the right time. But I think, really deep down you will just know. After I had made the appointment, I didn’t know whether I wanted to actually be present when they gave the fatal shot or not. Did I really want to witness the last minutes? To watch the life literally leave his body? I didn’t think I did. But when the time came, I knew I had to be there for him. It wasn’t as bad as I thought it would be. They gave him a shot that in a few minutes would knock him unconscious. The nurse asked if maybe I wanted to give him a few of his favorite treats before he passed out. I said he didn’t really have much of an appetite, but gave him some any way. To my surprise he actually ate a few, which made me happy. He’d gone out the way he probably always dreamed: eating treats until the end. He then conked out pretty quickly after that. We laid him on his favorite blanket and he looked like he was sleeping. When they administered the fatal dose, there was no indication of “the life leaving his body,” as I thought might happen. I read sometimes they give a big sigh, or even worse, empty their bowels. But none of that happened. After a few minutes, the nurse put her stethoscope up to his chest and nodded. Clyde was gone.
THE AFTERMATH
I’m not going to lie, about a week after his death, I couldn’t get out of my head the image of his little lifeless body laying there on his favorite blanket right before they gave him the shot. It wasn’t an easy thing to watch, but I’m glad I did it. I think I would’ve regretted leaving him with strangers in the last moments of his life. Three weeks later, and I still miss him. And I still have stupid little learned behaviors, like my reflex to always stick my foot out when I open the door to keep him from running out. And the apartment still feels just a little empty without him. But, as I said, I’m so grateful for the time we had together and in a way for knowing the end was near so I could give him the best days of his life before he went out. And, boy, was he spoiled! In his last week of life, I was feeding him macadamia nut encrusted tilapia every day and spent more time cooking for him than I did myself! Any time he demanded to be pet, I would oblige, even in the middle of the night, when I was groggy and just wanted to go back to sleep. I used to joke that getting cancer was the best thing that had happened to him. So for all of you who are beside yourself having just found out your cat has cancer and unsure about what to do and the decisions you have to make, whether you decide on chemo or not and struggling with knowing when it’s time to let go, remember above all to enjoy the time left you have together and spoil your little one as much as possible. My only regret is all the times I spent crying and worrying and stressing, which did neither one of us any good. Treasure every minute you have and be grateful that you at least have a warning that the end is near so you can feel satisfied that you gave him/her the best life possible for as long as you could. I hope Clyde’s story has helped a little in letting you know what to expect. Obviously every cat is different and everyone will have their own unique experience, but we all share in the same desire to do the best we can for our best little friend. Good luck on your journey and I wish you the strength when you need it to carry on and the wisdom when you need it to make the best decisions for you and your little one.
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California, USA
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Clyde McPhatter
[ click photos to enlarge ]
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