This year’s been a time of ups and downs for Tucker. Fighting leukemia since at least 2005, probably since 2003, has lately been depleting his reserves; twice now this year we’ve seen the sharp and radical decline of a cat who’s gradually getting tired of fighting.
Leukemia – straight up leukemia, not “feline AIDS” – happens when the cat’s bone marrow is no longer producing red blood cells at a high enough quantity to meet his body’s needs. The pancreas will step up a bit to try offsetting the shortfall, but the pancreas’ ability to produce RBCs is supplementary at best. The pancreas swells up significantly as it’s overworked. The treatment is daily corticosteroids to stimulate the marrow, and strong antibiotics (because the steroids impair the immune system). That manages the problem, but doesn’t cure it. It only slows down the deterioration process. In our case, it slowed it down significantly: Tuck was given a three-month prognosis in May 2005. He’s now over four years into a three month death sentence.
Like I said, this year’s been hard for him. The first sharp decline came in March (we wrote about that here); he lost weight, slowed way down, rarely ate or drank, slept all day. The blood tests weren’t good and the vet said he probably had weeks left. So we kept him comfortable, found new tricks to keep him eating and drinking, and he started turning around. A few weeks later, he was back to his active self and gaining weight again.
The latest decline started at the beginning of July, the same thing again. Weight loss, sleeping all day, not eating. A steeper decline than the March one, steep enough for us to start having serious discussions over end of life issues. We decided to keep him eating and drinking, not forcing it on him but strongly encouraging it, and to see what happened. If he continued to worsen, we’d make the call. Otherwise, he’s been fighting his way back to life for four years – he might do it again. We didn’t want to count him out until we knew it was time.
And sure enough, the last few days he’s been gradually rebounding. Knock on wood, it seems we’ve bought another reprieve. With some luck it’ll be another few months or longer before we’re here again.
Part of the problem of tending a sick animal over a long period of time is that after he’s been acting normal for a while, you start forgetting that he’s sick. You’re still doing the twice-a-day meds and rearranging your lives to accommodate the illness, but it’s part of the everyday routine – the disease is managed again and you start lowering your guard. Then he takes a turn for the worse, and not only does it take a little while for you to properly recognize it, you also have to remember or relearn all the little tricks you used last time to turn him around.
This time I told Kristi that we needed to write a “Tuck Critical Care” sheet and put it on the fridge for the next time. She agreed and started sketching out what worked this time, and we recalled what worked back in March. I plan to type it up.
Many people, when that initial diagnosis comes down, decide right then and there to end it. I can’t blame them – the vet typically will offer up the worst case scenario (i.e., he’ll be dead in two weeks) rather than the long term possibilities, given regular attention and care. I can’t blame the vet for doing that, either. We and Tuck have been fighting his cancer for over half his life, a war that I’ve always known that we never had a chance of winning, a war that I never in my wildest dreams expected to last over four years.
I also don’t blame anyone for not wanting to fight that battle. It can be a long, hard, expensive, heartbreaking slog. I had my own reasons and I don’t regret fighting it – but I can tell you that it’s not for everyone or every situation. Responsibility comes in all shapes and sizes.
I just wanted to drop in here today and post what we’re doing, what we’ve been doing. If you have a sick cat, maybe it’ll help; I suppose it would also help with a cat reaching the far end of old age. If you have anything to add, feel free to comment. It’s all after the jump.
Tuck Critical Care:
1. KEEP HIM HYDRATED. One of the side effects of the prednisone is dehydration. Dehydration contributes to his congestion, and if he can’t breathe, he can’t smell. If he can’t smell, he won’t eat. Aside from his meds, keeping water in his system is top priority. (Especially in an arid climate such as ours here in Northern California, where summer humidity typically sits in single digits.)
Tuck’s a water cat – he loves running water. But when he’s down, running the tap may not be enough. A bowl of CLEAN and FRESH water with ice cubes sometimes works. But if it doesn’t, crack open a can of cheap human-edible tuna and let him drink out the water. Then whenever you need him to drink, take the bowl out of the fridge, park him next to it, and put in a handful of lukewarm water. Mix it around. He’ll drink. Do this several times a day when he’s not drinking on his own.
2. MAKE SURE HE EATS. Being a predator by nature, a cat needs to eat every day or else liver problems start happening. It’s vitally important that he gets nutrition as regularly as he can. Tuck’s a tuna nut, so when we can’t get him to eat anything else, he’ll usually eat tuna. Have a bowl of kibble (we feed him Innova dry) nearby at all times, particularly near wherever he’s chosen to sleep out the day. Several times a day, sit him up at the bowl and encourage him to eat. Don’t force feed him. When he’s down, he forgets. Remind him regularly to eat.
When he’s not eating well, we give him gel-based vitamin supplements. You can buy it by the tube at Petsmart – we call it “gooping him”. Tuck hates it and it’s not particularly fun to administer, but it keeps him going and forestalls possible liver damage.
3. KEEP HIM SOCIAL. When Tuck isn’t feeling well, he won’t want to be around people – he’ll go find a soft, quiet corner of the house and sleep there around the clock. He needs stimulation. Bring him out into the living room when everyone’s around, force him to socialize, pet him, talk to him, play with him, etc. You’ll be amazed at how important this step is.
4. KEEP HIM ON HIS MEDS. No matter what. Twice a day pred and 2cc of Pet Tinic, once a day Baytril. Without them, he goes downhill sharp and very fast.
5. WATCH THE BOX. Is he using the litter box? Watch what he’s leaving and how often. That’ll usually tell you if he’s getting enough to eat and drink. (Also, if you have a sick cat, he or she may stop using it and instead go somewhere else. This is one of the earliest signs of a health problem – don’t ignore it, and don’t punish the cat for it. Get him to the vet. It took us forever to get Tuck back to using his box, and even then he wouldn’t use cat litter. We have his box lined with folded out newspaper.)
6. LOOK FOR SIGNS OF TURNAROUND. Any indications that Tuck’s tending to the daily business of life are good. Cleaning himself. Using the litter box on his own, without reminder. Eating and drinking on his own, without reminder. Socializing on his own. Playfulness (or irritation). Improved coordination (when he’s down low, his jumping balance and eye-to-paw coordination is off). The reasserting of his normal personality quirks.
The turnarounds are slow in coming: at least days, sometimes weeks. You just have to take it day by day and keep a close watch for signs that he still has some fight in him. Hopefully he’ll turn around and come back to a managed state. These steps will at least give him (and you) the best chance at a few more months – or years – of life together.
Note: None of this is about prolonging an animal’s suffering. When Tuck’s condition is managed, he’s playful and lively and not suffering – it’s only when he turns downward that he has real problems. Neither of us condone forcing an animal to stay alive against its will, or in conditions of pain or a significantly impaired quality of life. But as long as he’s fighting, we’ll help him do it.