Misty Grey

Mom went with me and Misty to Tampa for the appointment with Blue Pearl. The doctor there examined Misty, reviewed all her records, and talked to me about the options.  The numbers for chemo/radiation were not encouraging – they would be expensive and arduous and buy Misty months maybe, if we were lucky.  Amputation really is her only hope for any kind of a cure.  I told her that my impression was that my vets were worried about Misty’s age, and that they thought that the sarcoma was already all through her body.  She said that her impression from talking with my vets was that their worry was more about Misty’s heart arrhythmia.  She told me some encouraging stories about older cats who did well after amputations.  She said she would look at the Xrays (which for some reason didn’t come through with the other information), and that if her look at it confirms what my vets found – nothing growing in her chest, lungs or heart, that the next step would be to do an ultrasound and see if everything looks good there.  Problems with the spleen can cause the type of arrhythmia that Misty has so she suggested it would be a good idea to make sure the spleen is OK and no cancer is there or anywhere else in her abdomen.  She said she would talk to my vets and explain to them about the statistics and how sarcoma acts differently in cats than in humans, and the slim chances that chemo and/or radiation would be of much help. And that she’d put it all in writing and give me a copy too.

My little pickle, all tuckered out from the efforts of chasing the Red Dot, wrestling with her ribbon, and rolling in catnip.

The cutest part isn’t visible in this photo – she still has catnip stuck to her chin.

EDIT: Here is the text of the oncologist’s report:

Today we discussed that we suspect that Misty has a soft tissue sarcoma on the right forelimb starting just above the carpus and extending to the elbow. Cytology is not 100% but we suspect on the basis of the growth over a 4 month period, palpation, x-rays and cytology that this is a soft tissue sarcoma. Definitive diagnosis would require a biopsy. We discussed that the most definitive treatment for a soft tissue sarcoma on the limb would be amputation, additional options would include definitive radiation to gross disease (control rates of approximately one year), possible chemotherapy to slow tumor growth (which works in approximately 40% of cases and lasts a few months) and metronomic chemotherapy (low dose chemotherapy long term – studies on response are ongoing). We discussed that the concerns for removing the limb are based on concern for what is causing the arrythmia. As the echocardiogram is normal, an abdominal ultrasound would be recommended to rule out abdominal disease that could cause this (ie splenic disease). We would recommend another ECG prior to surgery and discussion with a cardiologist as highest probable causes of the arrhythmia and to determine the safest things we can do anesthetically to ensure that Misty does well at her time of surgery if this is what you decide to move forward with. Please call if you have any questions regarding Misty.

Rest in peace my sweet little darling Alley. I will miss you so much.

I got her an antibiotic pill instead of the liquid, it worked.  I gave her as much Nutrical as I could, and bought all kinds of cat food for her to eat, she seemed to like Newman’s Own liver the best – maybe because of her anemia. She sweetly licked about a total of a can a day off the fork or spoon I would hold for her while she sat curled in her little closet bed.  She came out to use the litterbox but the rest of her time she spent in the closet. Her test came back – she didn’t have FIP.  They said that they could do more tests to try and find out whether it might be cancer or heart disease – and then we would know how long she might live.  Not how to save her… simply information on how long before she will die.  Since she was barely eating and never coming out of the closet I wasn’t sure it would be a good idea to drag her out to the vet and put her through being shaved and poked and prodded – possibly forced to go under anesthesia – would she even live through something like that? I told them I thought I would hold off and we will see if the Lasix and Nutrical could get her back to some stronger place then we would think about more tests.  However she didn’t even make it another few days after that phone call.  On Saturday she stopped eating, and on Sunday she wouldn’t drink either.  I brought her in on Monday morning after we sat outside in the sunshine and I told her all the things I loved about her and petted her and cried. I already miss her so much. My mom came with me to bring her to the vet.  She waited outside while I took Alley into the examining room.  I petted and hugged her and told her all my favorite memories while she fell asleep and then they came in and gave her the injection.  I will get her ashes back in a few days.

I was too upset to call yesterday.  But today I dragged myself out of the dumps and made an appointment.  Next week Misty and I will go see the oncologist, Blue Pearl in Tampa.

So this morning was supposed to be Misty’s surgery, and when I arrived my regular vet’s partner Dr. P came out from back to talk to me – the woman who treated Alley.  I don’t remember exactly what she said to me or asked, but I replied with something along the lines of “Well no, I am not happy about amputating my cat’s leg, but this is the best shot for Misty.” She said “No, it’s not.”  I stared at her.  This was what they’ve been pushing me to do all along, why am I all of a sudden being told it’s not?  I said “What do you mean?”

To sum up what she said, her husband had sarcoma too and he died from it. She thinks she knows all about sarcoma and that it behaves the same way in cats as it does in humans.  He had it all through his body by the time he was at the point Misty is now, and there is no way an amputation will save her, I will just be making her go through this surgery for no reason and she will suffer through the recovery and die anyway. I ought to just let her enjoy the time she has left. Misty is too old, and her heart arrhythmia makes it dangerous.  Her… father?  grandfather? had health problems and he was old like Misty and they wanted to take his legs and he asked her “Don’t let them take my legs” and she didn’t. All this stuff, these stories just shoveled onto me in a pile.

My vet came out during all of this and confirmed she was on board with canceling the amputation too.  They had talked for a long time last night and it was just breaking their hearts to go forward with this surgery.

W?

T?

F?

They scheduled this surgery and then waited until the morning-of to tell me this?

The took me in the examining room and talked to me some more (other patients were starting to arrive and I was kind of being turned into a spectacle, both vets hovering over me talking at me while I held my kitty and cried).  I asked them what I am supposed to do now?  Just wait until Misty’s leg breaks and put her down?  That doesn’t sound like a very nice way to go.  Or shall we hope the cancer didn’t go into the bone and that isn’t really what is showing on the xrays, and then maybe instead the thing will grow and grow until it outgrows its blood supply and become necrotic, a painful open wound that will never heal and eventually get infected? How is that better than giving her the chance that the amputation will give her?

They gave me the information for an oncologist and tell me to go talk to them, to do my research and make sure I know all my options and that I am really sure that this is what I want to do.

I left crying, frustrated, angry, with a pamphlet and a phone number, and my Misty, who just seems happy to be going home without being poked and prodded too much.

I think you saw my other little cutie in another photo earlier with Misty. Last night while I was at the vet with Misty I made an appointment for them to see Alley today.  She has not been looking well, bloated or something, and yesterday she seemed to not eat anything.

Alley saw Misty’s vet’s partner, Dr. P.  She seemed nice enough.  They did some blood tests on Alley – she was found to be pre-thyroid in spring 2013 so we figured it might be that getting worse. The blood tests revealed that her thyroid hasn’t gotten any worse but she is anemic, and her immune system is going absolutely nuts. An Xray shows that her abdomen and chest are very full of fluid, she must barely be able to breathe, the poor little girl.   All of this was not good news, Dr. P said that I should not expect Alley to get better, and that I will more than likely lose her soon.  They do a test to tell if Alley has FIP, since her symptoms are consistent with that.  We will get the results in a few days.  In the mean time they gave me some Lasix to help bring the fluid down and give her some literal breathing room.  Some Nutrical, a high-nutrition paste to help with her anemia and give her energy since she wasn’t eating.  And antibiotics, just on the unlikely chance that her infection is being caused by something bacterial.

She was a little sweetie the entire vet visit, headbutting my hands and knees and face and purring and cuddling up against me. When we got home she retreated to the corner of my walk-in closet.  I took her into the bathroom to give her the antibiotics and Nutrical and Lasix. Before she went back into the closet I put some blankets in there so she would at least have something soft to lie on.

The antibiotics were not a fun thing.  She had some kind of freaky reaction to them – her mouth just started foaming like crazy, all over the place.  The poor little honey, she was just so terrified and confused when this started happening.  It lasted maybe like ten minutes, me following her around with a towel trying to wipe her face and her flipping her head around trying to fling off the streamers of foam. I will call the vet tomorrow and see if I can get a pill instead, we can’t do this twice a day for ten days.

I know this is a blog about Misty, but I am including a photo of my little Alley-Phooey here.

Per the ECG, Misty’s heart is fine.  Whatever is causing the arrhythmia, if something is, it isn’t heart disease.  I knew it would be fine – though my vet seemed annoyed when I said that.  Misty is healthy.  Very healthy, glowingly healthy.  I didn’t need a test to know she didn’t have heart disease, I’ve seen what heart disease does to a cat and Misty simply couldn’t be living the life that she lives if she were struggling with that kind of a health problem.  She’s had that heart murmur her whole life too, every vet has noticed it, and every vet has pronounced her healthy in spite of it. This is not a cat who is on death’s doorstep.

See?  She is glowing right now!

So I took some time to think, research, save up money, consult friends, and generally just to get my courage up.  And Christmas and New Year’s went by, and my birthday.  Misty’s lump has grown but she still seems to think nothing of it.  My heart is breaking but I know I can’t wait forever so I called the vet today and made the appointment for her ECG.

One of the things I came across was the Tripawds community, where I read some stories of other cats who had similar problems to Misty’s and how things went for them.  It made me feel better to find that other people had made the decision to amputate with the fine needle aspirate rather than a biopsy, and that Misty is not the only cat diagnosed with sarcoma and that others survived it.

And, this: http://refurbthecat.tumblr.com/

This time they got a good sample.  The cytologist report said that it is consistent with connective tissue sarcoma.  It could also be a reactive fibrosis, the report said.  I talked to my old vet and my new one, they said there is not a lot of chance it is a fibrosis, he way it is growing.  I feel like the new vet is pushing me really hard for an amputation, which is heartbreaking for me to consider.  Misty seems to be perfectly fine, she has no pain and the thing doesn’t seem to be bothering her at all.  I asked if there is a possibility for an excision of the tumor and they said not with a connective tissue sarcoma, it mixes itself right in with the tissue, it’s not a nice neat little package they can just cut out.

So the next step is for me to decide what I want to do, I have some research to do and some thinking.  My new vet says if it were her cat she would do the amputation right now.  My old vet says that sounds like the smartest route too.  The idea seems so extreme though, to put Misty through that when she seems perfectly happy.  Well, mostly, it definitely gets in her way sometimes.  And it is getting bigger.

Misty’s “sister” Alley is in the foreground.  The two are enjoying a rare quite moment within less than 3 feet of each other.  I think Misty must not have noticed Alley was there, or she would have gotten up and moved away.  Alley can be kind of a jerk, she smacks Misty every now and then for no apparent reason.  Misty is very non-confrontational, she just want to be left alone, so she avoids Alley and leaves whenever Alley comes near, even if she isn’t being a pugnacious cute little bully.

So the vet’s office called today.  Misty’s EKG revealed an arrhythmia. VPCs – ventricular premature contractions?  She will need more tests before she can have any kind of surgery.  To make sure her heart can handle going under anesthesia, and also to rule out any nasty underlying causes.  There would be no point in doing an amputation if something else horrible is about to kill here.  🙁

An electrocardiogram will be the next step before she can have any surgery.

But in the mean time we still know nothing about the growth on her leg.  In frustration I asked the doctor what she thought I should do and she didn’t really have a good answer.  Finally after going around and around with her I asked, “Could we maybe try another fine needle aspirate?  The first one I am pretty sure missed the mass, but now that she has had antibiotics and the swelling around it is gone, we know exactly where it is – and it’s bigger and easier to find.” I probably didn’t say it as clearly and concisely as that, but that was the gist of it.  She brightened at that and we did the aspirate.  Hopefully this will tell us something, and it is a lot less painful for Misty than a biopsy.

Goodness, this is all getting so expensive!  What terrible timing – the move has been costly already. By the way, we moved because my fiance got hired for a handsome salary by a large company down here – he works in IT. He moved down ahead of me, back in July.  I stayed behind to pack and clean and sell the house.  Since I didn’t have a job down here, I had to stay until the house was sold in order for us to be able to afford the mortgage at home AND the rent in FL.  And in order to get the mortgage from our house in NY off our backs we ended up selling it at a loss.  The closing is tomorrow, we did all the paperwork last week and then sent it to our lawyer by FedEx. Oh well, at least the mortgage will no longer be eating up every cent we have.  Now if I can find a nice job down here.  Currently I am working remotely for my “former-ish” employer in NY, on a temporary basis.  But due to weird administrators’ politics I was not able to retain a full-time position, I am working 3/4 full time, with a proportional decrease in pay.  This is part of the reason I had to stay in NY – until the house had a buyer we couldn’t drop my pay down to 3/4.  Anyway, now that the house has sold, this should be enough to get by on while I find something new. And it is nice that I am able to work part-time and from home during this time when Misty needs so many appointments.  I will get to take care of her once she does have surgery, if she does.

After talking to “All The Vets” I have decided to schedule Misty for a surgery.  I’d like for it to be only a biopsy but what I have asked is for them to go ahead with an excision if they find something exciseable (is that a word?), or the amputation if what they see when they go in is conclusive enough.

It just doesn’t seem logical to jump straight to an amputation.  I’d really like to know what we are dealing with and get some statistics before I make a final decision.  The vets are not sure it is a good idea to put Misty through the possibility of two surgeries, but I really don’t see how I can make the decision to amputate her leg when we aren’t sure.  It would be different if we were at least having the possibility of providing her with some relief from ongoing pain or something, but she seems just fine.  She still tucks that one leg sideways, and the growth seems like it might be bigger, but she’s happy and healthy and clearly not in pain.

So anyway today is her pre-surgery exam.  They are doing a bunch of tests to make sure she is healthy enough to go under anesthesia.  We will get the results tomorrow and if they are good then she will have the biopsy on Wednesday.

My poor girl, she hates going to the vet so much, and I so hate leaving her there alone.  She huddled against me and curled in my lap the whole time we were waiting and talking, until they took her away for the tests.  I get her back later on today, they will call me when she is ready.