PASSIONATE RATIONS

Somehow food (this blog’s usual subject, however tenuous) just doesn’t seem important right about now.  It’s hard to feel hunger in the face of losing a dear friend.

So, you’ll forgive me if, in the hopes that it might help someone out there who’s surfing the net for information (as I’ve desperately been doing with little luck finding what I really need), I write a bit about my beautiful nine-year-old tabby cat, who was recently diagnosed with likely cancer and who, based on the night we had last night, probably won’t be with us much longer.

Minu came to me as a little nubbin.   When he first asserted himself into my life almost ten years ago, he fit in the palm of my hand (and my hands aren’t very big).   His tiny pink nose was no bigger than a pinprick.   But his spirit was larger than a lion’s.

He came in strutting as if he owned the world, demanding everything life had to offer in the biggest voice a tiny kitten could muster.   And no wonder he felt so bold when I first met him.  He’d already survived a great adventure.

At the time, I lived in Venice (Los Angeles), California with someone who operated a business out of the house.  This was well before I met my spouse.

On the day Minu showed up, one of the company’s employees spotted the little furry creature in our backyard and commented that he’d seen that very kitten that very morning…in Simi Valley!

For those of you unfamiliar with the particular geography of Los Angeles, the Simi Valley is many miles and some impressive hills north and somewhat west of Los Angeles.   Had he hitched a ride in the undercarriage of the employee’s truck?   It appeared so.

Since arriving literally on my doorstep, I’ve striven to give Minu a good life.   I never thought, given what a tuffie he is, it would be such a short one.

He arrived with a little bump of a hernia poking out of his midsection and some parasitic co-travelers.   We treated the worms immediately and took care of the hernia when he was neutered a few weeks later.

I’ve since wondered if that hernia was the genesis of his current condition.  A recent notation from my veterinarian on Minu’s chart points out, though, that a cause arising from his early operations—such as a sponge left inside him upon his hernia operation—would likely have shown up earlier.

Maybe I should have foreseen more troubles.

In 2002, we had been preparing to leave for Cape Cod when I noticed Minu didn’t seem quite right.  As anyone with multiple pets knows, it’s sometimes hard to monitor an individual pet closely unless you isolate them from each other and we hadn’t been doing that.   We’d had no reason to.   Even now, I can’t tell you what exactly it was that tipped me off then, but I knew something was wrong.  Not the mother of a human child, I still know there must be something to that parental-intuition thing.

We rushed him to the nearest emergency hospital.   It was a terrible, stressful 40-minute drive.   This resulted in a several-day hospital stay for him and treatment for a urinary tract infection (UTI) with possible pancreatic involvement.   UTIs can kill cats.  We learned during this episode that he had a shrunken left kidney.   We never made it to Cape Cod that year.

When they discharged him, they gave us instructions for administering subcutaneous fluids and forced feeding.   The doctor noted that, if we couldn’t get him to eat again on his own (which he refused to do while at the hospital), he could develop a certain condition (the name of which escapes me) and die.   I was horrified.   I remember my spouse and I sobbing as we held him, wrapped tightly in a towel, trying to feed him as he continually pulled away.   And I remember the immense joy and relief we felt the day we saw him approach his food bowl on his own and begin eating again, on his way to recovery.   As with the hernia, I’ve also wondered if this 2002 episode has anything to do with what’s happening now.

Since that episode, Minu, until recently, seemed like an exceptionally healthy cat:   bright-eyed and silky-furred.   His old talkative, demanding self.

But the horror of cancer is that it lurks beneath the surface.

It was late in November 2007 when I first noticed something amiss.   Minu seemed to be vomiting a lot.  Cats, of course, are known for their occasional (or not so occasional) episodes of purging.   But this was unusually frequent for him.

If I’ve learned anything over the years of living with animals it’s to pay close attention to your pets’ usual habits:  eating, going to the bathroom, vomiting.   Changes, even minute ones, may signal potential problems.   Our cats and dogs are spirits of instinct, showing no weakness until they can no longer hide it.   In the wild, this is the difference between survival and falling prey.   The irony is that, in a loving home, this survival instinct can betray them into an untimely death.

I isolated Minu from the other three pets to monitor him more closely.   He seemed to be eating and urinating fine, but I noticed that his bowel movements were few and far between and, when they did come, they were thin, tiny, hard nodules—definitely not normal.

I took him into the vet, who conducted diagnostic blood work and a chest and abdominal x-ray.

The blood work was mostly normal, except for a slightly elevated kidney value (potentially related to the condition discovered in 2002).

The x-ray revealed (given the diffusion of the images) what was likely fluid in Minu’s abdomen—not a good sign, particularly combined with his weight loss.   The vet had seen Minu in May and he had lost not quite a pound and half since then, not a good sign in a cat who’d maintained a fairly steady weight previously.   A pound-and-a-half is a lot of weight if you only weigh twelve pounds to begin with.

The vet subsequently took a sampling of Minu’s abdominal fluid.   The cytology (i.e. the analysis of the fluid) came back inconclusive, stating, among other things, that “there is a population of mildly atypical immature epithelioid cells occurring in clusters and sheets.”   The comments state that the atypical cells may represent underlying carcinoma “suspicious in this case.”  

The nature of the abdominal fluid, in conjunction with the lack of raised blood protein levels and lack of fever, ruled out Feline Infectious Peritonitis (FIP: a dire diagnosis).

The vet remained positive, but I could tell things weren’t looking good, something she confirmed when I asked for her initial assessment.   She recommended an ultrasound as the next diagnostic step and we scheduled one.

While we were waiting for Minu’s ultrasound appointment date to roll around, he stopped eating (loss of appetite is known as anorexia in medical parlance).  I had flashbacks to the horror of 2002 as I coaxed him to eat.   Finally, with much relief, I got him to eat what I consider kitty “junk food” (kitty treats and low-end canned foods that smell great to cats and prompts their appetites, but which are considered less nutritionally sound than other foods).   Overnight, he vomited it all up, prompting me to bring him into emergency services, where he received his ultrasound.

I was thinking that maybe he was blocked.   He’d always shown a peculiar penchant for eating plastic bags and ribbons, which can’t be good for one’s digestive system.   I was hoping it was this, because a blockage would be surgically treatable.

The ultrasound confirmed the presence of a lot of abdominal fluid.   The mesentery (basically the lining of the abdomen area) was clumped together into a solid mass.  The doctor was unable to locate Minu’s pancreas where it should be.   His kidneys were both abnormal as of this assessment.   His spleen appeared slightly irregular and “folded upon itself.”

Based on the foregoing, the doctor assessed him to likely have carcinomatosis, which is essentially many carcinomas (cancers arising from epithelial cells—i.e. from the cells that line the inner and outer surfaces of the body, including skin) that have metastasized from their origin point to other organs.   I say “likely” because the origin point for any carcinomatosis/cancer (also called neoplasia) and a 100% diagnosis are not possible to determine without exploratory surgery and biopsies of the affected areas.

The prognosis for carcinomatosis, if he has it (which both my regular vet and the emergency vet suspect is likely—assessments with which my dad—a nurse—agrees, based on the diagnostic reports) is not good.   No particularly successful treatment has been developed for the condition in felines (though I did locate some recent articles indicating that, in humans, there has been some experimentation with surgical removal through scraping of the affected areas in combination with chemotherapy at the time of, and continuing after, surgery).   Resection (i.e. removal of cancerous areas) is very difficult, because the carcinomas are everywhere.  My vet indicates that, in her experience, chemotherapy has not worked well on this condition.  In any case, it would be radical and extremely expensive surgery to try the experimental route…and it might prove too much for Minu to bear.  The loss of his quality of life is the premier consideration.  And though I dearly wish money were no object, the reality is that, for me and for most (I suspect), money also is a very real issue.

So, there we were, left to decide whether we should have him undergo the risks of significant open-abdomen surgery with the hope of discovering that the assessment to date was wrong and that he actually had something more treatable, or whether to simply keep him comfortable as long as we can.  Given the likely outcome, we chose the latter path.   This has been torture.  We have watched his muscle mass waste away to nothing, as his abdomen has become more and more distended.   He has trouble balancing because of it; he’s gone on and off his foods (we try to switch it up to keep him interested); he’s had bathroom issues.

But he still has good days.   He still talks to me, purrs when he sees me, drinks, sleeps next to my head.

He’s counting on me, on us, to make the right decisions.   I’m counting on me.   And I feel adrift.

My vet has earned my undying gratitude, frequently talking to me for thirty minutes or more without charge, helping us evaluate the best options for further non-invasive diagnostics and palliative care.   She suggested a drug known as Mirtazapine, which she heard had “miraculous” results in helping ease discomfort and lessen nausea in felines, which seems bizarre to me since it’s actually an anti-depressant.   It has the added benefit of being administered a quarter pill at a time every three days—cost effective and easier to administer than the three-times-a-day variety of pill.   I was skeptical at first, but it really has seemed to work.   We also have him on quarter tabs of Pepcid AC.   I am monitoring him for dehydration and administering subcutaneous fluids when he seems to need them.

In the midst of this, I think back to the tuff little cat who chose to live with me a decade ago and it breaks my heart.   I don’t think he’s tough enough to win this one.

The one comfort I have is that Minu likely doesn’t know he’s dying.   As always, he has no fear.

I wish I could say the same.