If only...

Megat resting on Sunday...

I was thinking that if only I can still get that Gerbers Chicken baby formula, I would be able to give Megat his hepavite with this since I am sure the chicken would disguise the taste. Megat likes this too as I had given the amigos this when they had fever from vaccinations and sterilisations. I have not seen this for some time. Maybe it has been taken off the market. I had tried the Heinz one (I think) of beef and potato but he doesn't like it..and neither do I.

Hepavite woes

Megat ate all his supplements with good grace until it comes to the hepavite. This must really taste very bad - worse than his prednisolone. I had tried to put the hepavite in the duphalac as duphalac is very sweet and might disguise the taste. Poor Megat actually gagged so badly on it and he had to spend some time trying to get rid of the taste. Even his eyes watered from it!I have been trying to give him the hepavite once a day to see if he can get used to the taste instead of twice a day. Maybe tomorrow I would give him only half his capsule and try to build up his tolerance for this. Alternatively I can just give him the milk thistle and forget all about the hepavite that is supposed to help his liver cope with the vincristine.

I am quite surprised that he did not protest too much with the suppository tonight too.

Congrats Megat!!

Megat resting after dinner...

We decided to cross our fingers for good luck. Grandma wished twice as hard :)

Tanaka in the meantime practised Yoga for peace and harmony :) He sits like this quite a lot.

Our appointment today was actually for 3.45 but we came early. Thank goodness for this as Dr L called for us at about 3.10 pm. WAHH!! We were so impressed. He got down to business immediately and asked me if I had good news for him. I told him Megat is doing well, he is active and eating with good appetite.

So we got him on the table and Dr L proceeded to refer to his notes then he said in firm tones that I must continue with this particular protocol of low doses of vincristine with a 2-week break after a series of 8 doses, coupled with the sang hwang, colloidal silver and Lukeran tablets. In this way he said, we do not have to subject Megat to continuous blood tests. After all he is a 13 year-old kitty. He said that 80% of his patients using the same protocol lived 2 or 3 years longer. I told him that I was very pleased with Megat's state of affairs and would follow this particular protocol.


He then checked Megat's vitals. Gums - hmmm rather pale. He prodded his abdomen. I was very anxious. he checked and prodded and said that he could not feel any hard lumps anymore except for...poo!!WAHHH....I was so pleased and kissed Megat and told him he was a very good boy! Dr L then proceeded to check the rest of his body and announced that he felt no other lumps :)) The both of us could not help grinning although Dr L cautioned me again that THIS in no way means that Megat is cured as there is no cure for lymphoma but it looks promising that he would be able to make it past the 4 months. I said in the previous entry that my best hope was that his lymphoma would not grow in size but this was the bestest news I think. However, Dr L is giving him hepavite capsules (which he hates, even with mashed papaya) for his liver as he is being given a chemo drug.

It could not be helped that Megat has to be given an enema- Microlax. Dr L lined his carrier and gave him the enema. Megat did not beat an eyelash. "this is a good cat. he is so well-behaved." I didn't show Dr L the scratches I got. Why mess his image I thought.

Megat lost no time in poo-ing. I was glad the cab driver did not protest as Megat whined and complained about being in a carrier with poo! He hit his face against the sides of the carrier and it was agood thing I had bought him his very own semi-soft carrier. Once home, I brought him to the loo and Cousin R and I bathed and shampooed him. Cousin R was very impressed with Megat as he enjoyed the warm bath and would even offer us his butt to clean :) Once cleaned, I put him in his night cage and he was finally quiet and rested...not without poo-ing 2 more times though.

However, he was very naughty and did not want to eat his supplements. He spewed all of them out, even the one which was always his favourite. He was having none of it. I was not angry as I thought he had behaved very well during the vet visit, the ride home, the bath and he deserved some aggro time :)

So we do not have to see Dr L until the 8th of September. Way to go Megat!

End of 1st series of chemo protocol

Megat stalking the house...

This Tuesday Megat will see Dr L and it will be for his 8th chemo shot of vincristine. Dr L said that after every 8 shots, the cats will get a 3-week break. Of course I would have to bring him back if he does not feel well. I think he will have to get one ultra-sound after every series to see the progress of the lymphoma. We hope for some good news - I hope the lymphoma has not gotten any larger - that is all that I dare hope for.

Visit with Dr Sh

Hmm...more strange docs

We got to the hospital way ahead of our appt and Dr Sh saw us. Megat got weighed and he has lost some weight - he is 3.68 from 3.74 but the vet didn't think that this was a concern. She took his temperature 38.1 as he was hot and felt his abdomen. The assistant found it a little difficult to take his renal temp as Megat has wisened (??) up to this and had clamped his muscles tightly. Then Dr Sh looked into his mouth and his eyes and pronounced him fit for his 7th chemo shot. She kissed his head twice and told him to be a good boy. It went very well I am very glad to say.


I asked Dr Sh to give Megat his Tuesday suppository as I thought it would lessen my stress this evening when he gets his supplements and obviously it would lessen Megat's stress as well. She first tried to take out some of his poo as she did not want him to poo his suppository. "Woah..phenomenal muscle control!" she said and tried her best to coax him to do as directed. Then with more lubricant she managed to give him his suppository. Thank goodness. She said that after 2 weeks (of letting me have my way), he has become wiser and know what to do to get his way. Aiyah!! THAT is Megat for you.


It didn't take long for the whole thing and we were out in 10 minutes at most. Thank goodness I do not have to coax him to into his suppository today. Yippee!

PS
Megat was very sleepy when he came home and so I put him in his cage until dinner. He sat and napped and after dinner, he pooed in his bins. Of course his blanket was stained by poo and sang hwang. he made many protests until I cleaned him up, shampooed him, wiped him with mango scented wipes and changed his litter. Then he rested comfortably until its time for supplements. He got his treats and is now walking about doing his parameter inspection of the living room :)

Results of vet visit - no vincristine today

wbc too low at 2.12 from 3.26 last week

Dr P was quite confident that we could do the chemo today - vincristine but his haematology test indicated other wise. She was pleased with his condition for last week and told me that the Endoxan was a little milder than the vincrsitine and so he should be more energetic. She was also pleased with his prep results. He has put on a little weight and is now 3.54 from 3.5 kg.

I am very pleased that his liver seemed better with his ALT at 90 (normal 20-100). His last test had his ALT at 105. The milk thistle may have done a lot of good here. His BUN is 22 from 27 (normal 10-30) and his CRE is 1.2 from 1.5 (normal 0.3-2.1). Even his TP has gone down to 8.7 from 9.0 (normal 5.4- 8.2). I think this would be the result of syringing him with about 60 ml of water daily. These last 2 days I had only syringed him with about 10 ml of water since he suddenly decided to drink by himself on Saturday. But I am very kiasu and syringed him anyway as I don't think he drinks enough water. His GLU h/w has gone up to 165 from128 (normal 70-150). She didn't think this was a concern though. I read that this could be due to stress. He really does not need diabetes in his life now!

He is down to 1/4 tab of his steroid prednisolone too. I can only hope that next week his wbc is good enough for his chemo.

2nd chemo session cyclophosphamide

Megat's blue bandage at the site of his IV catheter is reminicent of wounded POWs...
"I know what you are up to san. Don't think I don't!"
Megat at his hanging basket right after dinner.

Megat sitting with me after his supplements. Furgive and furrget...

Megat's haematology test gave his wbc count as 3.26 from last week's 1.88 so he was able to undergo his 2nd IV of cyclophosphamide or Endoxan. His platelets were down to 68 from last week's 90. His rbc was the highest in 3 weeks at 6.70. His weight was also down to 3.5 from 3.63 kg. The doc was not worried though about his other vitals saying that Megat was otherwise ok. I asked the doc about his stools and she checked. She said that she did not feel a lot of them so I guess he was able to go do the necessary. I had been worrying about his constipation as I had not been able ascertain if he had indeed gone and done the job last week.

I was able to be with him throught the whole IV process and I was glad that he was a very good patient. He had three rounds of blood taking as the pressure in his lower leg was too low. Also the pressure in one of his neck veins was no good as the doc put it. So she got blood from his jugular. THAT was fast and furious. Throughout all this Megat seemed unperturbed.

She gave him the Endoxan and told me that the side effects would be vomitting, a little anorexia and diarrhea. She also said that as the drug would go through his bladder, he mght get a little blood in his urine but I was not to be alarmed. I was to make sure that he drinks water regularly as if not his uterine system would get a little irrtated and that would be where the blood would come in. Then she flushed out his sytem with 2 vials of saline solution and gave him an anti-emetic, Metomide. Throughout the process, he was quiet and of course he earned alot of praises from everyone.

At the end of the whole thing, Dr Ly came in and spoke to Dr P about his patient that was also undergoing chemotheraphy and that his patient was doing very well indeed. Dr P told me that she hoped Megat would have the same results :)

Of course he still has to take prednisolone but only 1/2 a tab per day.

We decided that apart from his usual supplements tonight, Megat would have to take about 20 ml of water in a syringe. Of cos I think after his fussing, we got only about 15 ml of water. But that was quite a success as he also would have the water from the mashed papaya and the water in which I had diluted the mushroom tablet. He also had his usual portion of ling zhi.

I am glad to report that even now he has forgiven me all that fuss and is now sitting by my side , asking for a good round of brushing...

Chemo Review 1

Megat's hematology test did not allow his second chemo session as his wbc was 1.88 from 3.97. As this was below the required level of 2.5, Dr P said his cyclophosphamide IV would be postponed till next week when she hoped it would be higher. So he has to only take one tab of prednisolone at 5mg per day. Of course with this , his LYM has decreased to 1.23 from 2.18 (normal 1.5 to 7). The doc recommended that I give him some lin zhi mushrooms to increase his immune system. I had actually got him tablets of 16 mushrooms from 1herb.com that seemed to help other people and their pets to deal with their immune system and cancer and so will give him that instead as well as the milk thistle for his liver.

So essentially his supplement, as of today, consists of 1.5 ml of duphalac and 1 dessertspoon of mashed papaya (he still has constipation) + 2 tablets of mushroom formula and 6 drops of milk thistle. I read that it would be better to give him an aggressive dose of mushroom in the first few weeks of his cancer but as he still has to get used to it, I am only giving him 2. If 2 is the rec dose for an adult, it should be okay for a cat with lymphoma. I will put the pic up once my cpu is ok.

He was also a little dehydrated as he was not drinking much last week and so, if he still refuses to drink this week, I was to syringe him with 10ml of water every hour. Dr P thought that 1x sub q would be enough if I can give him the water in syringes. Of course, as though he understood the doc, Megat immediately drank water from his Dora cup when he came back from his consultation and even today, he continued to drink throughout the day although I would have liked it if he had drunk more. He had drunk more before the chemo.

On the brighter side, his platelets has increased to 90 from 33 although his PCV has stayed at a constant rate of 26 %. His ALT, on the other had, had decreased to 105 from 122.

Dr P also reported that his physical state is good although he is thin. But she recommended that he stays on his renal diet and I was not to subsititute it with another one, even if the diet has no grain in it. I would put water in his dry food but I know he would eat none of it wet. I had tried this the first time he had to go on the diet. :(

Anyway, he is looking brighter and has much more energy but maybe this could be due to the fact that he did not have his chemo this week.

1st Chemo for Megat

Oh dear. I know that light in your eye san...

Dr P informed me of the chemo protocols and what was in his future if I elected for him to have chemo. He would have a cycle of 8 weeks of chemo before we would have to do an ultra sound to see if the chemo was having any positive effect on him. Megat would also have to have a blood test every week before the doc progress with anything else to see if it was possible for him to continue.

The side effects would be - vomitting, no appetite, listlessness and if he should lose any hair, it would be his whiskers only. But the doc said it was unlikely that he would lose any as it would be only in extreme cases. She said that cats go through chemo relatively well but she needed me to be sure that that was the way I wanted to go. Whatever I decide, she said that his hematology tests must allow me to make the decision as if it was not good, then no chemo would take place.

As usual Megat was very good at the blood letting and then we had to wait for the results.

Megat's hematology test was not so good.

WBC = 3.97 (5.5 to 19.5 normal); PLT is 33 (300-800 normal); but his RBC is ok at 6.26 (5 to 10 normal) However even if his WBC is 3.97, it was still more than 2.5, which makes it ok for his first round of chemo with Vincristine.

And so I had to make a decision for Megat. Dr P showed me his personal chemo protocol and what will be done when.

We are doing Vincristine which is an IV; prednisone (a steroid at home which he takes every day at 1.5 tablets a day); cyclophosphamide ( a tablet at home) and adramycine - an IV. We have to be at the hospital every tue and the doc would take his blood test to see if he could proceed for the whole first series.

02/06 - Vincristine (45 minute IV) + prednisolone (steroid pills)
09/06 - cyclophosphamide (IV) + prednisolone
16/06 - Vincristine (IV) + prednisone
23/06 - adriamycine (IV if possible - depends on his platelets) + prednisolone
30/06 - rest
07/07 - Vincristine
14/07 - cyclophosphamide
21/07 - Vincristine
28/07 - adriamcycine
End of 1st cycle - Ultra sound to check mass and organs

And so I had to decide and I opted for the chemo. I know that a wiser choice would be to have a second opinion but I was afraid that the longer I waited, the worse it would be for him. He had a 45 minute IV with Vincristine and after a 20 minute wait time, we went home.