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Cat: Half-n-Half

Type of Lymphoma:

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Half-n-Half's Case Study  

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Other Diseases/Conditions:
Mild heart murmur, Hip dyslpasia

Story: Half-n-Half came to me when my brother and his family were moving and I offered to cat-sit 5 of their 6 cats in August of 2006. Almost upon arrival, Half began to suffer projectile vomiting of undigested dry food at least once a day; and I noticed she was underweight. I took her to her regular vet in the beginning of August who did blood work, but couldn’t find anything wrong, except a slightly elevated white blood cell count. Observing Half’s behavior, I noticed she would gorge on food, then vomit. She had a ravenous appetite. She and her brother were very skittish and came from a household that had dogs and a new toddler. Thinking the gorging was causing the vomiting, and might be a behavioral, I tried various diets to little avail. Half did begin to put on some weight and was keeping wet food down. But the vomiting did not stop. In late October I finally took her to my own vet, who also did blood work, but found nothing unusual either, and felt Half’s diagnosis was probably pancreatitus. I proceeded under the assumption of this diagnosis, working on getting her on a diet that would help her. She began injectable metoclopramide and famotidine for the vomiting, which did wonders. She also started to receive B12 injections once a week. The vomiting still did not stop, though it had lessened. It was somewhere here that, for me, panic must have set in. Ironically enough, on petting Half one day, I felt too small lumps at her sides. So on the 14th of December, Half went in for x-rays which showed nothing significant; it was just her kidneys. With Half’s being so thin, they were more palpable than normal.

Feeling both foolish and relieved, I got a call from the vet who had now witnessed Half’s projectile vomiting, and expressed alarm. At first she suggested exploratory surgery, but with Half having a heart murmur, and my not wanting to jump into surgery, we finally decided on an ultrasound. Half went to an internal specialist for her ultrasound; a delayed decision I will never ever forgive myself for. On December 19th, I stood in the examination room, staring at the ultrasound which showed GI Lymphoma in three spots of Half-n-Half’s intestinal walls. I was not shocked – deep down, I had known something was terribly wrong. The specialist mentioned three different chemo protocols, but did not seem positive about pursuing them. He also said getting a needle aspirate really wouldn’t tell them anything. He also said I could not start the most aggressive chemo without a biopsy. I then reviewed all options with my regular vet, whom I trust implicitly, and she contradicted each thing the specialist had said. I had to decide what I was going to do. I pretty quickly knew that “nothing” was not an option. It was very simple for me – Half is sick, I have to make her better. So I struggled horribly with which chemo protocol to pursue. I didn’t want to put her through any more grief than she had to go through. My vet recommended the needle aspirate hoping any more info might help with my decision. We proceeded with the aspirate, which showed a Medium Grade Lymphoma with some aggressive characteristics. It included both large and small cell lymphoma. This didn’t help me in the least. Finally one night over the holidays, Half was crying out intermittently, and I knew I had run out of time. Since it was the holidays, and I couldn’t actually start chemo, my regular vet called in pain meds and Prednilisone to give to Half until I could start her treatment. I also had Half’s metoclopramide & famotidine made into oral suspensions as I knew Half was sick of getting stuck three times a day. I knew I had to start something, but I didn’t know what. My vet asked if I would travel to Virginia (about an hour and half away) to consult with an oncologist.

On January 5th, I took Half to Southpaws in Fairfax, VA where her oncologist said that starting anything less than the aggressive chemo would be a waste of Half’s time. The protocol selected was a 49 week protocol. I was overwhelmedputting Half through all this for a year? Eventually I realized it all added up to about 15 weeks of vet visits for the treatment. But it meant two visits those weeks to get her blood count. I determined to find a vet nearer to me for the blood work so Half wouldn’t have to be on the road so long, which she hated.

On that same day at the oncologist’s, Half got her first treatment of Vincristine. She threw up about 4 times as a side effect of the drug, but the worst came the next evening. Around 6:00 pm Half was shivering and would not walk on her own. I rushed her to the emergency room, where we discovered she was severely dehydrated. She was rehydrated and came home. She was basically her normal self. On Monday I learned that this can happen with the first round of chemo because the cancer is hit so hard, it can also kill a bunch of electrolytes. I wish I had been warned because I thought I was losing her. She and I had made a pact that she would hang on to give the chemo a chance. And when I sat with her at the emergency room, I kept reminding her of her promise. After Half’s recovery from the dehydration, she suffered no more side-effects of chemo. She had her second round of chemo on January 15th, when she received Cyclophosphamide. At this point the plan was to receive her chemo at my regular vet each Monday. This time, after the terrifying dehydration scare, I had the vet administer intravenous fluids to keep her hydrated. The following week, on the 22nd, Half had her third round of chemo, Mytoxantrone. After each of these chemo treatments, Half did what was, for Half, great. She had more energy, had her usual healthy appetite, and looked pretty good. She just still did a lot of crouching, as if she weren’t 100% comfortable. Every few days after treatment, I slept on the dining room floor with her to monitor her.

The following week, the week of the January 29th, Half was scheduled for a week off of chemo, which turned out to be a nightmare. She was doing quite well, until Wednesday morning, January 31, when my husband called me on the way to work to say Half had thrown up. This was 9 days after her last treatment, so I was hoping against hope that this was just a side effect of her last drug, the Mytoxantrone. Over the next 24 hours, Half threw up 4 times. She didn’t want to eat and I knew she was heading for severe dehydration. I drove her down to the emergency room of her oncologist to be examined. They insisted that this was too long after treatment for the vomiting to be a chemo side-effect. They felt it was the cancer and wanted to readjust her protocol. They couldn’t seem to explain what they would base that on, so I insisted on an ultrasound. I headed home to Baltimore, and just as I reached my door, the oncologist called to say that Half had intussusceptions - one part of her intestine slipping into the proceeding part, hence causing a blockage, and eventual death. I had two options – euthanize or surgery. Surgery was risky for Half in that as a chemo patient, she had a compromised immune system, and many times part of the intestine dies and has to be removed. Splicing intestine is very risky, in that it doesn’t always hold back together and the leakage poisons the system. So I opted for surgery. If Half-n-Half had any chance of beating this horrible disease, I had to give her every opportunity. They wanted to do surgery right away as the usual survival time for an intussusceptions is 24 hours, and it had already been about 30. I asked if I could see her before surgery and they said I could try. I immediately turned around and headed back to Fairfax. I got to see Half before surgery. She was feisty and alert.. I got a hotel near the hospital and waited while Half was operated on. I had seen her at 4:20 and at 7:30 I got the call that the surgery was over, Half was doing well, and there had been no need to cut the intestine. They simply slipped it back in place, and stitched the loops together to help prevent it’s happening again. This meant that the chance of infection for Half was almost nil. For the first time that night Half-n-Half laid beside me in a completely relaxed position. I had such high hopes for her recovery. I was sure there was nothing Half could not conquer.

Half was due for her 4th chemo treatment, Cytosine, on Monday, Februray the 5th. To allow her a little more time to recover, the oncologist rescheduled it for the 7th. I decided to have her treatment done at the oncologist in light of Half’s recent surgery. Half had also developed an eye infection. I dropped Half off and when I was just getting to work in DC, her oncologist called to say that Half-n-Half’s lymphoma was not responding to treatment. I was devastated. Her oncologist said that the cancer had proven itself resistant to 98% of chemotherapy drugs. There was no point in proceeding with the 4th treatment. Half’s intestines were still thick, plus there was a swollen lymph node in her belly now. Her oncologist suggested CCNU, which is a capsule that was to be given once a month. We agreed to give her the first dose that day, and hold off on Elspar in case the CCNU didn’t have any effect either. They gave her intravenous fluids, an injection of B12, ointment for her eye infection, and I went and picked her up and took her home. That evening was one of the best evenings Half had ever had. She was jumping up on the cat tree, the coffee table and acting like a slightly slower version of a perfectly normal kitty. Over the next few days Half didn’t do quite as well, but she was back to how she had been. She still crouched, but I’d find her more often curled up sleeping like a normal kitty.

On the evening of February 10th, Half’s right paw started to swell slightly, and it clearly hurt her. By Sunday morning, it was bigger and warm, and I suspected an infection. That afternoon, I administered Sub-Q fluids. I called the emergency hospital in Fairfax who told me to put hot packs on the paw and see if it went down. Knowing that time was never on my side with Half, I instead put Half in the car and drove her down to emergency in Fairfax. The emergency doctor didn’t seem too concerned but I explained I knew a whole lot more about Half than he did, and when they took her temperature, they found it was slightly high. They put her on Cefa-drops and sent us home. The next morning, Half’s left paw had started to swell as well, and she was coughing, which she had never done before. I packed her up and drove her back down to Fairfax. At this point, I was struggling with the decision to give her Elspar as well and if the cancer was spreading, I wanted to do it now. Half stayed in the hospital all day, to get various tests, while I waited in a nearby hotel. In the late afternoon, I received news. The good news was that Half’s cancer seemed like it was going into remission. The bad news was a radiograph showed a swelling in Half’s esophagus. Did I want them to try passing a tube to rule out a blockage. Yes. Hours later they called to verify that it wasn’t a blockage, but that Half was suffering from a hiatal hernia due to all the bloating of her stomach and intestines. Her stomach was being pushed up into her esophagus causing the coughing and a lot of acid reflux which was damaging her esophagus. There was nothing they could do. Surprisingly, however, when they repeated the radiograph to insert the tube, the esophageal swelling was unaccountably gone. The doctor was hopeful. Half’s leg was looking better, but had to have her entire right leg shaved to monitor the swelling. I took Half home with 7 days of pain medication, and a quadruple dosage of metoclopramide to keep her bowels functioning. We added Zantac to minimize the acid reflux. Half was at the lowest she had ever been. I was giving her pain medicine three times a day and she simply looked like she was done. She didn’t want to walk very far or eat or go to the bathroom.

It was at this point, I permanently moved to the floor of our second bedroom, and Half pretty much made the two bedrooms in the back of our house her space. I thought I was watching Half’s last days. On the 14th, I called my regular vet to discuss at home euthanization. Half was scheduled for a recheck of her leg the next day, February 15th, and I debated not taking her in. It was for a drop off and I was afraid of her dying at the vet. Finally, I decided to take her in but managed to get an appointment so I could wait for her. When we got to the vet, Half was a different cat. She was alert, jumped out of her carrier, and even sat in the window for a bit. The oncologist said that Half was in a narcotic induced stupor and her adrenaline was overriding it. We took her off pain meds, and her Cefa-drops. The swollen lymph node in her belly had gone from the size of a marble to the size of a thumbnail since the 7th. Her intestinal walls were thinner. Her eyes were clearing up. It was thought that her limping, which altered between her two front legs by now, may be the lymphoma dying off, releasing fluid into those limbs. But the oncologist had to warn me, even given all the good signs, if Half’s intestines and her esophagus were just too damaged to function then it is just too late. I couldn’t even be happy about the remission. Everything shifted for me in that moment. All I cared about now was keeping Half comfortable. The weeks of protocol that had stretched out before me only two months ago instantly dwindled to days and soon, it would be hours. The oncologist said to give Half time. It took Half a while to get the pain med out of her system. Her last dose had been the morning of the 15th before her vet visit.

On the evening of the 16th I came home to find Half sleeping on the bed – hitherto unheard of. So I just let her sleep. By now I felt Half was life-tired and I just wanted her to rest and have some peace and comfort. And this is when the days turned into hours. She was due for follow-up blood work the next morning, but I cancelled the appointment. Whatever else lay in store, I knew in my heart that Half needed to rest. And she was lying curled up, content, like a perfectly normal kitty. By this time, she needed more encouragement to eat. She would lie on the bed while I spoon fed her. She would still walk, but I constantly monitored her.

On Tuesday, the 20th, fearing dehydration, I took her to the nearby vet she’d never made it to for blood work and got fluids. Meanwhile, earlier in the week, I had kept a phone consultation I had made with a holistic vet in NC. He had sent me remedies that I had not yet started because I had since found out that Half’s cancer was starting remission and knew I would do the next CCNU if she did improve and wasn’t sure if I should do both. Finally, on Feb. 19th, I started the holistic remedies, thinking that if they help her feel better, that’s all I can hope for right now. On the evening of February 20th, I thought it was the end for Half. When I came home she was very lethargic as normal, but didn’t even want to stand up. I knew she wasn’t dehydrated because she had just had fluids. She lay stretched out, which meant her intestines or tummy was bothering her. Eventually, late into the evening, she stretched out next to me, her tail straight out and still, her breathing labored, her mouth slightly open. I stroked her bare belly and felt two soft lumps. It was either air, gas or the cancer. I just lay with her, sitting lying about a foot away because she hates to be crowded and sang to her. “You Are My Sunshine.” Ditto, who had appointed himself Half’s feline caretaker, came in and laid beside her, his long legs stretched out toward her. We stayed like that until Half fell asleep. I was sure by morning, she’d be gone. But when I woke, I found her up and alert. She wouldn’t actually eat, but was interested in the food. I thought maybe the air or gas had passed and she was still feeling crummy. By now I had decided that I would have to come home at lunch to encourage Half to eat and give her one of her three daily doses of metoclopramide. Half jumped off the bed and almost walked all the way out to the kitchen – only about 4 feet, we have a very small house. She ate only a few bites. And she was back to crouching. To my amazement however, she went over to the cat tree and gave it a few scratches. Then she crouched back down. I left her there to rest. While Half’s intestines seemed to be functioning ok, her esophagus was not. She had been gagging intermittently since the previous week, the coughing was occasional, and her breathing was raspy.

When I returned home that evening, the 21st, Half’s throat was a mess. She wanted to eat, but gagged. I could even hear her throat constrict when she swallowed. She had a few choking fits. Eventually she gagged so hard she brought up some phlegm. If my heart could break anymore, it did. Half wanted to eat, but if her throat wouldn’t let her, then what? I lay down with her on the floor as usual, she slept in the doorway, curled up. I got her to eat a bit while lying down and then suddenly around 10 pm, she just got up to eat on her own. She ate from that bowl, and then went around and sampled the other dishes that I had tried to tempt her with earlier. She ate A LOT. She walked around and purred and even investigated some nooks and crannies she’d never cared about before. She even played with her stuffed snake for a few minutes. She was a completely different kitty than she had been the night before. She stayed that way until we both fell asleep, around 1:30 am. The next morning she was not as frisky, and had only a little appetite. At lunch, her appetite was better, and she had a rather healthy bowel movement, indicating her bowels were still functioning ok. Over the next few days, Half seemed to be feeling a little better. Her appetite was improving, and she started to venture out again into the other parts of the house. Every day, Half and I celebrated her tiny little victories.

Outcome: On the morning of February 24, 2006, Half-n-Half’s belly was bloated and she seemed very uncomfortable. At 2:30, she had projectile vomiting, followed by some horrible wrenching. Immediately, her belly deflated and she seemed to feel a lot better and went to lie in the sun. I knew she had another blockage. She had to have an ultrasound. I arrived at the Emergency Clinic in Fairfax at 4:00 pm. I waited in the waiting room for about an hour with Half, at which time, I felt a lump under her chin. I feared it was an enlarged lymph node. The ultrasound of her abdomen was indicative of a blockage, but this time, her intestines were so distended, the doctor could not see the source. Surgery was the only option. I returned to Baltimore and waited for the hospital to call. At around 7:00 pm the doctor called to prepare me for the three outcomes: 1) another intussusception, 2) a mass that could be removed, or 3) nothing. They wanted to know if they opened her up, and found that it was #3 did I want to wake Half-n-Half up post surgery. Finding nothing meant that Half’s bowels simply could not function properly and they themselves were the blockage. Every time she ate, she would just throw up again. While her upper bowels were working hard, her lower bowels would not allow anything through. I had time to think as they would call once they were in surgery. I knew in my heart if that was the diagnosis, that I had to let Half go. And somewhere even deeper down, I knew that’s what is was. The call came at 9:45 pm. They had found nothing; and there was nothing they could do for her. Half-n-Half had not suffered so far, and I would not allow her to live like that, so at 10:00 pm on February 24th, I made the decision to let Half go. I thought of going to see her, but she would not know that I was there. The last time I saw Half, she was curled up, like a normal kitty, dozing off behind me on a chair, while I sang to her. After I was off the phone, I went to Half’s bedroom, held a picture of her and sang “You Are My Sunshine.” At 10:05, Half-n-Half was gone.

I later obtained the surgery report and read: “The intestinal wall did not appear to be thickened or irregular. There were a small number of mildly enlarged abdominal lymph nodes.” Half-n-Half was winning her battle with GI lymphoma. Her little body just couldn’t take any more. I will always miss her and will be always amazed at what a brave little girl she was, so often much braver than I.

- By Jean Half-n-Half's Mom -

Watch Half's video, in Explorer, you will need to double click the start button
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