Apuaa's Story
by Jennifer
Apuaa came to us in 2003, severely malnourished and with a broken hind leg. She made a swift and full recovery and became the sweetest of our four cats. Ever a shy kitty, she made our basement family room her home, hiding from the other cats and sometimes even me and my husband. In July 2012, we noticed her presence in the upstairs rooms had become more common. She became needy, seeking attention often, which was very unlike her. I'd cleaned vomit more frequently around that time and later noticed her shocking weight loss (she has always been a big, fluffy cat, so her weight loss went undetected until I made the rare move of picking her up). We took her to the vet the next day (7/30) and learned she'd lost 5 pounds since her visit 2 years prior. The vet gave her IV fluids and an antibiotic and advised us to watch her closely.
The very next day, I noticed a lump behind her ear. We returned to the vet two days later; he aspirated the lump and diagnosed it as Lymphoma. He prescribed Leukeran and Prednisolone. Within a week, her appetite had returned and she began acting like her old self again. She had gained 3lbs, as well. We continued her treatment in the following weeks, until Prednisolone became unavailable. Apparently, the medication was on backorder with the manufacturer and no pharmacy in the area had it in stock in pill form. We tried a substitute (Medrol) beginning on 8/23. She took the first one in a treat, as she'd done with the Prednisolone, but refused to take it in the days that followed. After a week of trying and failing to get her to take the medication, I requested the syrup form of Prednisolone (8/31). While she took the syrup, her appetite seemed to diminish once again. After a week or so, we took her back to the vet wherein he discovered a lump in her abdomen. He administered a steroid shot and advised us to keep her on the Leukeran. She began eating regularly again and we hoped she was on the road to remission, despite the minor setback with the steroid and the mass on her abdomen.
In early-mid September, we noticed she wasn't eating much and she began hiding again; we returned to the vet with her on 9/20 and learned the mass in her belly had not diminished; she'd also lost 2lbs. The vet performed a biopsy of the abdominal mass and another lump behind her jaw. We expect to hear the results on Monday (9/24).
She is sicker now than ever before, I believe, and refuses to eat solid food. I've been feeding her canned chicken/tuna juice or cat milk, as she appears to have an aversion to canned food altogether. She seems to *want* to eat--when I open a can of food for the other cats, she often runs into the kitchen, but when the food is set before her, she turns away. I've tried giving her scrambled eggs, as well, but she only nibbles at it for a moment, then shuns it like most other food. She has vomited a couple of times this weekend, and has not been nearly as affectionate or social as before (of course; I'm sure she's feeling terrible). We are supposed to give her the Leukeran today, but with her vomiting, I'm afraid she won't be able to keep it down.
The vet discussed the possibility of surgery with us at our last visit. If the mass from her belly can be safely removed and her Lymphoma otherwise treated, I believe we will go ahead with the surgery. But her currently weakened state has me thinking that we are grasping at straws...I wonder if her quality of life will ever improve. I knew that the Lymphoma would eventually return, but I'd read so many stories of cats who'd lived in remission for a couple of years; I hoped she might have some life left in her and that I could give her some more time. This is the terrible decision that most pet owners have to face--deciding what's best for the animal instead of what's best for us. She is the first of our animals to get sick, and I truly dread having to endure this with the others, but know it's inevitable.
We will find out the biopsy results tomorrow (hopefully). She finally ate tonight around 8:30 p.m. and seemed to eat a little more than she has the last few days. Shortly after eating, she retreated into an open space under a shelf in the kitchen, which was passing strange, but we've become accustomed to somewhat strange behavior from her lately. Gave her Leukeran and an appetite stimulant tonight at 11:00 p.m. She began projectile vomiting about 30 minutes later, and I carefully inspected the small bit of vomit for the pills. Luckily, the medicine had dissolved, but I don't know how much might have dissolved before she got sick. As I type this, she is rubbing on my leg, purring and meowing. This is truly heartbreaking.
UPDATE (9/25): I took Apuaa back to the vet yesterday. The vet observed that she was in worse shape than he'd thought after talking with me on the phone that morning. The lumps behind her jaws were larger than before, and her vomiting and diarrhea were bad signs, as well. He said we could try chemotherapy (vincristine) and steroid (medrol) injections, but that she has a slight chance of recovering, given her weakened state and the fact that she may have already gone into remission once before. She was also given IV fluids and vitamins, as well as an anti-nausea medication. He mentioned that some patients have opted for feeding tube insertion at this point, but I told him I wouldn't put her through that. He agreed it would be hard on her and possibly counterproductive with the risk of infection. He said the chemo injection would be risky, since the drug could fatally poison her if he were to miss the vein at the injection site. Luckily, he did not miss, and we returned home. She ate a small bit of baby food and sat with my husband in the recliner last night as we watched tv. By bedtime, she had retreated to her hiding spot in the closet and hasn't resurfaced since. We've checked on her and know that she is still with us, but she has not come out to eat.
The vet advised me that she would begin showing signs of improvement this week if the chemo is going to be effective at all. He said we should know by Friday--if her appetite has not returned, then we will know that the time has come to say goodbye. I'm hoping my vet can come to my house to administer our mercy; if not him, I intend to find a vet willing to do so. Though I will feel terrible regret for putting her through (potentially) a week of suffering, I hope she may understand my last act of kindness and know I did all I could to help her.
OUTCOME: Apuaa came to us on a Saturday in September, and we said goodbye to her 9 years and 2 weeks later; she was our gift from the Universe, and we had to give her back. She was just a month or two shy of being 10 years old. We were hopeful that final week--the week that began with the Vincristine and Medrol injections--but by the 4th day, we decided to humanely end Apuaa's suffering (9/27). The vet called me on Thursday and we discussed the complicated logistics behind having him come to our house and I agreed to bring her to the clinic that day at 5:30 p.m. I took off work and spent the day with our sweet and terribly sick cat. She hadn't eaten since Sunday, and her behavior was painful to watch. She slept a lot and had no interest in food. We tried everything to get her to eat, but she was clearly sickened by the smell/sight of food. It was hard, in those final hours, to think of purposely ending her life. After all, she was still getting around and seemed alert and aware. I had to keep reminding myself that her survival instinct was sustaining her and that she would never feel good again. Her passing was quick and peaceful; she meowed only once on the way to the clinic, which was a stark contrast to the protests she'd always exhibited in the past. I hope she knew that we were trying to help her.
I hope that my story, while quite sad compared to some of the other stories I've read here, helps in some way. Her illness presented itself in June, though she may have been showing subtle signs a month or so before that; by July, she was on chemotherapy and steroids, and by early August was improving. I'm still convinced the steroid interruption in mid-August was her undoing. There's no way to know for sure, but she had been doing so well until then. At any rate, I take comfort in knowing that she got to enjoy one more month of life. She had our undivided attention in that time, got plenty of uninterrupted naps in the sun, and ate the best food we could find.
Those few months were an emotional rollercoaster, as you probably are beginning to understand if you're on this site, reading Apuaa's story. If I've learned anything from this, it's that any unusual behavior from your cat is cause for concern. Check your cats' bellies, jaws, ears for lumps if they're acting strangely (or even if they're acting normal); watch for frequent vomiting. Cats are quite skilled at concealing illness, but there are subtle signs if you know what to look for. Also, don't skip steroid doses. Even if your cat's lumps have diminished and its appetite is good, the steroids are still very necessary in sustaining the remission. A 2nd remission is rare, if not impossible. If you want to talk or have questions, please don't hesitate to email me--jepumphrey at gmail dot com.
Good luck. 
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Apuaa
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