Review Fluids in abdomen

I had a very tiring time but am better now.

I brought Megat to the vet yesterday as his abdomen was even more distended and he had difficulty walking, going to the toilet and getting up on the bed. He had some difficulty breathing on Thursday night as well.

When we saw Dr Ly he immediately said that he would have to remove some of the fluids . So he had a brief consultation with the imagists and then Megat was whisked to another part of the hospital for the procedure. Dr Ly then informed me that once they have extracted as much fluid as they can, they would do another ultra sound for him to see all the organs and the pancreas as well. We didn't manage to see the pancreas last week because of the fluid.

After some time Megat came back yelling and very alert. It was good sign that he was complaining about what they had done to him and he was eager to see what else went on in a hospital. I was very glad for that.

They had extracted 450ml of fluids from his abdomen. The ultra sound was clear and there was nothing worrying in any of his organs. There was only the thickening of his intestines which Dr Ly told us about some months ago.

Dr Ly said that since there was nothing else, he suspected that Megat's lymphoma was active again as there was no cure for that. So the final decision was to continue to help him to lead a comfortable life with no chemotherapy (which was decision I made some time ago) and so the protocol remains much the same. If the fluids accumulate again, the only way is to remove it. This time they had used just the needle and not the suction as it would be easier for Megat and less traumatic. However there is still some fluid remaining as they wanted to be safe.Btw his PCV remains good at 27.

This morning I had given Megat a bath as he has been unable to take care of himself well and he was unable to go into the litter bin because of his distended abdomen. He was quiet during bath time protesting only when I had shampooed his feet. Here he is drying himself.

He even had a drink if water. I must say that this is only the third time that I had seen him drink water in many months. I think it's because I made the decision to lessen the SubQ fluids. He has not had any SubQ fluids in 2 days as I think the fluids may have contributed to the accumulation of fluids in his abdomen.

From today however I would have to give him the SubQ but only 150 ml instead of 250 ml daily. Dr Ly recommended this as he said the SubQ may have contributed to the edema. (Thanks D for drawing my attention to this possibility)

This is Megat taking a break on my bed that he climbed onto by himself. He also has a new collar. Megat seems happier as he has always been very particular about cleanliness and would demand that I clean his litter in his night cage immediately if he had pooed in it.

Here Megat is sitting on grandma's bed. He had not been here for 3 weeks which was the duration of the edema. Now he is resting well with grandma.

I am much more positive now about his condition than before. Even though Dr Ly said there was nothing to be done about the fluids I am glad we still have the option of extracting it when (not if) it happens again.

He will still be with the albumin regime that needs to be taken neat, not in his food nor with his food. Dr Ly also recommended Th17 capsules, a protocol that provides for cancer care. We will look into it as it has had good results for cancer patients.

- may all be well and be blessed -

Update on Osteopathy Therapy for Megat

Dr L treated Megat yesterday. As usual Megat was quiet as Dr L performed acupressure. Megat left kidney was marginally better than 2 weeks ago but still it was encouraging. 

He advised that I give Megat some home-made beef or chicken broth if I have to force- feed him in the mornings instead of the pumpkin-potato-beef mixture of commercial baby food. Less dry food was the recommendation as well as his kidneys need to improve. Dr L felt that a compromised kidney might contribute to his problems in his intestines. 

We are making the beef broth for him today. I was supposed to make a broth out of beef and bones and feed it to him in the morning, with no vegetables. I also found a few cans of no-grain Call Of The Wild, and had sieved that to feed him this morning. He liked it quite a bit as he did not spit it out at me. I had added a little gravy from Whiskers beef and chicken. 

He eats by himself in the evening and he also has about 15 to 20 gm of kibble for a snack. For this I say thanks everyday :)

Later today he is going for ultra sound and of course his vincristine injection. 

Keep the Faith Megat!!

Relapse

Megat had a relapse and his lymphoma is back - his intestines this time. Dr Ly did tell me repeatedly that there is no cure for lymphoma and it might come back so I was in a sense prepared for this. I am not as scared this time round and will do the same as before.

The regimen will now be just the 0.1 of vincristine with the usual protocol of:

The chemo protocol that has helped him through his first bout of lymphoma is below. This is what we will follow this time round. 

Sang hwang suppository 1x a day

2.5 sang hwang extract (1 ml in the morning and 1.5 ml in the evening)

2 ml colloidal silver (1x1 twice a day)

10 drops of milk thistle/silymarin (if liver functions deteriorates)

1.5 ml duphalac for constipation. 

He takes all this in a mixture of strained pumpkin and papaya. 

250 ml Hartmann's Solution daily for SubQ

He would get 8 weeks of vincristine with a 3 - week rest and 1 comprehensive blood test after the 8 weeks.

He is now asleep but he has a slight fever from the vincristine. 

Vet Review 5 April 2012

Megat sitting pretty with me...

his test results on 5 April 2012

Dr L was plaesed with him as well. "The coat is good and he's put on weight!" He was 3.9 at the last review but now he is 4.35! I am glad with that as he has been vomiting a few times. Dr L said he could be allergic to one of the canned food that we give him in the morning or at night. But he gets very little of that even so.

The worrying lump on the underside of his right hind leg has not changed in size or shape so Dr L said there was nothing to worry about now and I should just continue with the same regimen that we have. And so we shall.

I am a little concerned that his TP is 8.5 but Dr L said I should just give him the usual 1x sub-q. The last time he vomitted for a whole day. His TP was 7.9 and Dr T said I should give him 2x a week sub-q. I have to think about this a for a few days...hmmm...

Good Intentions...

are sometimes just that san!

Our plan to give Megat less meds backfired on us. Last week he got only 3 days of meds and fought us very hard on those days. He is not usually so contrary and would take his meds quite easily (with some fight as usual) but last week, it was all fight and very little meds!

So we decided to give him his lingzhi as usual so he would just expect to get it every day (5 days a week with weekends off) as usual. I think he forgot he has meds to take and considered each alternate day, the first day he was ever given meds!

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.

Constipation

Really san..you should just have called the hospital..tsk...

I was really concerned and anxious for Megat as he had tried to go to the toilet twice today and was not successful at the 'poo' business. I followed him the 2nd time he tried and saw him trying vainly to poo. I had given him some pumpkin for dinner and he ate some of it. Actually this week he was not very eager at eating dinner at all. So I went to the web to read up on ts and saw Online vet. of course, always curious, I asked my question and after 5 minutes got an answer. Of course I didn't have to honour my promise to pay the vet through paypal but I thought I should as she had ansered the question (at least I hoped it was so and the question was not naswered by some robots!)

PS: Eversince I gave him pumpkin, he has been very regular and it was today that I noticed he was not going regularly! I immediately thought of that this might be one of the side effects of the treatment. :(

I thought I should post the answer since I had bought it.


My question


My cat has not been able to poo the whole of today. he tried twice but was unsucessful. he is 13 years old and has just had Vincristine IV on tuesday 020609 and 1.5 tablets of pendnisone 5mg. Can I give him anything to help him with this constipation? I gave him some pumpkin but it didnt help him.


The answer

Hi,
Oftentimes milk will be a natural laxative in cats. I would try giving him several tablespoons of milk to see if that will help soften his stool. I don't generally find that increasing the fiber in a cat's diet helps with constipation, so I wouldn't give any more of the pumpkin. Sometimes giving a hairball medication, like laxatone or petromalt, can help stool "slide" easier.

The more liquid you can get in your cat, the better. If he likes canned food, I would feed him that and actually mix a little more water in it to make it soupier. If he likes tuna, I recommend making "tuna cubes"--1 can tuna in a blender full of water. Mix well, then freeze as ice cubes. Give several cubes each day. Diluted low-sodium chicken broth is also good.

If the constipation doesn't resolve on its own in a day or two, I would take your cat to your regular vet. He may need an enema to get rid of really hard stool. Then your vet can prescribe something like lactulose as a stool softener for long-term use, if needed.

Good luck!
Dr. Scarlett

Dr. Scarlett (Online) -- Cat Veterinarian -- 100% Positive Feedback on 146 Cat Veterinary Accepts
I am a practicing small animal veterinarian with 14 years experience.


Anyway megat had a few licks of milk (before I went online of course) and now he is already in his night cage. I had always made his wet food dinner more soupy right after he had to have the sub qs. Maybe I would try the tuna ice cubes. :)

Prednisone blues

I dun have to take it just because you think I should san...

Trying to get Megat to take his dose of prednisone is an uphill task. He took it in his food for the first 3 days and then he refused to take it all of yesterday (1.5 tabs). He refused to eat the food that I had put powdered prednisone in twice. Then this morning he decided to not eat nor be enticed by even the tuna juice with the prednisone.

I was getting perfectly desperate and anxious when sister S (who is here on a break) taught me how to give him the pill directly. "Scuff his neck and open his mouth with your forefinger. Then place the pill at the base of his tongue, near his throat. Close his mouth gently (so he could still breathe) and caress his throat so he would swallow. Wait and see him lick his lips. Then you would know that he has swallowed his pill. " She then showed me how to do it and Megat took his pill very gracefully. I then tried it for myself for his 1/2 tablet and it was quite successful.

So I am now very encouraged and am quite confident to do it all by myself tomorrow morning. I don't think it would hurt him very much that he had lost his 2 tablets. !! I hope not *cross fingers*

However with Megat, I know that he would refuse to open his mouth some time next week and so I would have to come up with something else sooner rather than later.

Letter to My Cat after his 1st chemo

Dear Megat

You were as usual very brave at the vet's. They told me you were a very good patient but we know that already although it did not hurt to be told that again :) I hope you did not think that I was very rude not to consult anyone about the chemo but you know it would have been as difficult for them too to make such decisions.

I hope the 45 minutes was not too bad. I sometimes do not know how it must be as you were calm but later, in the taxi, you were aquiet and looked calmly about as though nothing of consequence had happened but we both knew that something had.

The doc told me that I should give you only a little canned food to eat as you may vomit the whole thing up again but you did not. I had grounded the prednisone well and I hope you did not taste it too much. I am sorry I could not give you any more of your favourite canned food cos , well you know, we did not want you to throw it all up again. I was very glad you took the milk thistle in your stride :)

I was quite anxious when you had a temperature and I saw you were trying to find some where cool to rest. I called the hospital at 10 pm and asked them if you should even be having a temperature and they said it with chemo patients, this could happen although it does not happen to every patient. I am sorry it had to happen to you. I had put the cool water cushion in the freezer and then at one side of your cage so you could have somewhere cool to rest if you needed it. I am glad you still felt that salmon treats should be eaten no matter what. No, it doesn't matter if you do not eat the dry food that I had placed in your cage in case you got hungry. I know you look forward to this every night. The doc said it would be better after 2 days at most.

Be Well Megat...goodnight

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.