Scruffy's diary

July 8, 2000: Scruffy has been diagnosed with hemangiosarcoma, an aggressive and incurable cancer that originates in the lining of blood vessels. This is a cancer that is not too uncommon in dogs, but is very rare - almost unheard of, if you believe some sources - in cats. Scruffy's condition first manifested as a subcutaneous tumor on her face, which has since been removed. HSA is a cancer that typically metastasizes fairly quickly (dogs will often die within weeks of diagnosis) though cutaneous and subcutaneous tumors may be somewhat less aggressive. Unfortunately, the pathologist's report indicates that there are probably still cancer cells in the tumor location, and we expect the tumor to recur as the first manifestation of serious progression of Scruffy's disease. Furthermore, due to its origin in blood vessels, the cancer cells disseminate quickly and easily through the system, making it nearly certain that, at the time of detection, the disease had already spread systemically.

As of today, about two months after diagnosis, we are pursuing chemotherapy, which is, again, not expected to cure her, but which we hope may extend her life by a few months, during which she can continue to be a happy cat and make those around her happy as well.

It not being an easy thing to deal with, I'm recording our progress here, in the hope that other pet owners may find something of value in our (ongoing) experience. Up to this point, I have been 'back-filling' the history, back to the point we first realized that there was something wrong with the girl. From now on I hope to record significant events and milestones as they occur.

I am including information about the cost of the odyssey because this is a very real concern when making a decision about how to treat a sick pet, and for how long. We would all like to make decisions about our pets on the basis of what's best for them and us but, sometimes, we can't ignore the expense, and must make hard and practical choices. The dollar accounts are not intended to impress anyone with my own largesse or commitment to lavishing care on my moggy. They are simply factual reality, which must be taken into consideration and dealt with. An alternate account of Genesis states that, "On the sixth day, God created veterinary science to keep the cat healthy and the man broke." This is not far from the truth!

Disclaimer: I am not a vet, nor an oncologist, nor an expert in any way on the subject matter at hand, except, perhaps, the role of a human caring for a terminally sick pet. Much of what I will record about the illness and treatments is the, perhaps misunderstood, result of online research (usually done when I should be working) and conversations reconstructed from memory or the half-assed notes that I sometimes take. If you are dealing with a similar situation, you should confirm everything you read here with your own vet, oncologist and research.

Needless to say, I do not endorse, in any way, any web sites or pages, commercial or otherwise, that I link to!


If any readers have corrections or clarifications, I would love to hear from you! At some point I will try to put together a page of links to useful online resources I have found on the subject of hemangiosarcoma, pet cancers in general, and caring and/or grieving for sick pets.


June 5, 2001

Scruffy had her third diagnostic re-staging since the end of chemotherapy. "Hemangiosarcoma - no evidence of spread or recurrence 0 chest x-rays and abdominal ultrasound all normal."

Cost:

Brief Examination

$30.00

Blood Collection

$7.00

Total Body Function Panel

$66.00

Radiograph - Initial

$60.00

Radiograph - Additional View

$80.00

Recheck Abdominal Ultrasound

$139.00

Total

$382.00

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May 10, 2001

It has been quite a while since I've posted an update. To be perfectly honest, the last 'real time' update was December 8. I've just now filled in a few more dates since then from my notes, but this is the first time I've actually sat down with the page in about six months! Part of this has been due to technical problems that have made actually posting updates to the site from home impossible. Hopefully that is now resolved. On the other hand, during this time, not a whole hell of a lot has happened. Scruffy is fine. You can read about how her March diagnostics turned out (excellent) and if she has shown any signs of sickening, they have been too subtle to notice. Beginning some weeks ago, I have been feeding her a special 'prescription' high calorie food, and the result has been that she feels like she's taken on some weight. She seems to like the food a lot and, unfortunately, so do all the other cats. Of course, not only is it way too fattening for everybody else, it's way too expensive to feed to all four! In recent weeks her appetite may have fallen off a bit, but these things are very hard to gauge. Is she not eating everything in the bowl this time because she doesn't have the appetite, or because she's still stuffed from last night's pig out? Or has she decided that she simply doesn't like this particular flavor of food any more? My cats have never previously been choosy eaters, but I have determined that the quickest way to make a cat finicky is to give them a choice!

With the warm weather, all the cats have been showing a lot of eagerness to get outside.  I'm reluctant to allow Scruffy out, partly because she is not wearing current tags, and partly because I worry that she could be sicker than she's letting on, and may decide to go off somewhere to die. When she gets to that point I want very much for her to be here. However, I have indulged her a few times and she has had a rollicking time out in the yard. Minstrel, on the other hand, is banned from going out by his dermatologist, who doesn't want him exposed to fleas and mites. Speaking of which, it is time (past time, actually) to put all of them back on flea treatments. I'll pick that up on Saturday, when I have to go over to the vet's anyway to get more of the fat food.

Other big news is that I've taken in yet another cat. This one, Volya, is another feral... an older half brother, in fact, to Boo, who I took in last October. This fellow, being at least a year older than Boo, and at least one and a half years longer 'out there,' is much more skittish and hidey than Boo was, and has consequently caused a great deal less disruption in the kitty status quo. This has been a considerable relief so far, although most of my concern has been for Mouse, who reacted very badly to Boo... actually became physically ill, and then continued to 'act out' her anger at the change in the household until well into February! Scruffy, with most strange cats, will initially be very hostile, and then will settle into an attitude of tolerance and acceptance, though she seldom will become friends with other cats. She reserves her affections for people.

It is time to schedule Scruffy's next appointment with the oncologist, which should occur around the first week in June.

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March 21, 2001

It's taken a while for me to get back to the oncologist. Much of the discussion revolved around Scruffy's 'remarkable' good health. I brought up the question of a misdiagnosis, i.e. is it possible that Scruffy did not have hemangiosarcoma to begin with? Her reply was that a false negative is far more likely than of a false positive when diagnosing these forms of cancer. Remissions are possible but in the final analysis there is just too little known about how this disease effects cats to know for certain how long the good health will last, or how long it would have lasted had we not pursued treatment. We talked about the weight issue, and I expressed my idea that possibly some of Scruffy's weight loss between October and December was simply due to her dislike of the special food that Minstrel must eat, and which was the only dry food left out during the day at that time. I've been pursuing different feeding strategies since then, to better keep Minstrel out of the food he should not be eating, while at the same time giving the others the choice of the types of food they like to eat, and that this might account for the weight increase since that time. I also asked if we could try a special high calorie food, and the doc gave me the names of some products that they recommend, which I should be able to get from the regular vet.

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March 7, 2001

In a message left at my office, the oncologist says that the results of Scruffy's bloodwork was all excellent. What is remarkable about her condition, says the doctor, is how unremarkable it is! The only thing that makes her worry a little is the weight loss, but since Scruffy has actually gained a little weight between the last two visits, that does not concern her too much. She would like to see Scruffy in another three months, which will be early June and just about a year since chemo-therapy began. If she still looks OK then, we won't need to do it again for a longer period, unless she begins to worsen.

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March 5, 2001

Scruffy had her second diagnostic re-staging since the end of chemotherapy. "She looks good. Her weight is up a bit to 6# 11oz. The chest x-rays and abdominal ultrasound are normal - no evidence of metastasis."

Cost:

Brief Examination

$30.00

Blood Collection

$7.00

Total Body Function Panel

$66.00

Radiograph - Initial

$60.00

Radiograph - Additional View

$80.00

Recheck Abdominal Ultrasound

$139.00

Ward Charge

$27.50

Total

$409.50

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December 8, 2000

The oncologist 're-staged' the diagnostics on Scruffy today. I dropped her off in the morning and then drove back to pick her up later. The tests all came up clean, though we are still waiting for some blood tests, which should be back by Monday. I asked to doctor to note Scruffy's weight. It is down to six pounds five ounces, 3 pounds lighter than when she started six months ago. The doctor comments: "I will call with blood results on Monday and to discuss the weight issue. There is no evidence of cancer spread. The swelling on the bridge of the nose could be scar tissue or local recurrence of the cancer - the only way to know for sure is to biopsy and I am not sure that is warranted at this time. Her weight today was 6#5 oz. When we started seeing her in June she weighed 9#5 oz."

Cost:

Recheck Abdominal Ultrasound

$139.00

Radiograph - Initial

$60.00

Radiograph - Additional View x 2

$80.00

Blood Collection

$7.00

Superchem w/ CBC

$64.00

Ward Charge

$27.50

Total

$377.50

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December 3, 2000

Scruffy will spend this Friday, 12/8, at the oncology clinic undergoing diagnostics ('re-staging') to determine if there has been any progression of the cancer since chemotherapy ended two months ago. She is still enjoying leftover turkey from Thanksgiving, and appears to be getting along well with Boo, the kitten. Occasionally she smacks him one, just to remind him to show the proper deference and respect, demonstrating that she still has plenty of vim and vigor.

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November 22, 2000

Scruffy has become quite a bony girl. She was never fleshy, for sure, but you can now feel her individual vertebrae and every bump on her skull. I don't know if she's lost weight over the last month or so, but she certainly hasn't put much on. Curious, a few days ago I put her on the bathroom scale and came up with a weight of seven pounds neat, which would be a small loss since her last visit to the oncology clinic… if the scales are close to each other in calibration, which is doubtful. Scruffy is eating… like a horse! Which is encouraging. She has become used to, and quite insistent on, receiving canned food… possibly to the point where she has given up the dry food entirely, unless she's really hungry. Between the three non-diet-restricted cats in this house, we are now going through an average of three cans a day… and this is not the 29-cents-a-can stuff, this is the fancy stuff at 50 cents for a can only a third the size! I guess I could try the cheaper, more mass-market stuff, but Scruffy really likes this particular brand, so we'll indulge her in the time she has left.

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November 17, 2000

I'm not really sure what point there is in having the diagnostic 're-staging' done on Scruffy, which will be due during the first week in December. The purpose of these tests is to determine if the cancer has resumed progressing, and how far it has progressed. However, as I understand it, there are no further practical treatment options if it is progressing, so will the only benefit we derive for the expense be the knowledge that Scruffy may be checking out sooner rather than later? I put the question to the oncologist. She affirms that the purpose of the testing is to catch any progression/metastasis early on, before the animal actually begins showing signs of sickness, when there are more options for successful treatment. But are there any options for treatment at this point? Scruffy's had her allotment after all. Well, sometimes it is possible to begin chemotherapy with a different drug, although she sounds reluctant to pursue any of them with a cat, perhaps because there is so little real, practical knowledge on the matter. On the other hand, it is sometimes possible to administer more than the standard dose of chemotherapy. This makes sense to me, considering the ease and aplomb with which Scruffy underwent her five months of therapy. If the re-staging reveals progression, and it is possible to resume the chemotherapy, will we do it? Well, that's a question I'll have to address somewhere along the line. For the time being, it seems that the most compelling reason for the re-staging is to simply know where she is. Might we be into the end game, or is that still in the future? We will have the re-staging… at least this time around.

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October 6, 2000

Final chemotherapy and 're-staging' of the diagnostic tests. Boy was she annoyed by the time I arrived to pick her up in the evening! The oncologist comments: "Scruffy looks good. Her chest x-rays and abdominal ultrasound do not endecate (sic) any evidence of spread of cancer. We gave her last dose of chemo today. Please make an appointment for recheck in about 2 months - at that time we will do an exam, chest x-rays, and blood work if she is still losing weight. The weight loss may be due to appetite suppression from the chemo - if so she should pick up after we stop."

I asked for a rundown on Scruffy's weight changes over the course of the treatment:

06/05/2000
9# 5 oz.
07/07/2000
8# 2 oz
08/07/2000
8# 5 oz
09/05/2000
7# 8 oz
10/06/2000
7# 2 oz

As you can see, she lost over a pound between treatments #1 and #2, made some of it back by #3, and has since lost an additional pound. We'll see if she makes any of it up over the next few weeks and months.

Meanwhile, Minstrel's ongoing bald-spot drama requires that he go on a special, hypoallergenic food. Since all the beasts share the same bowls, and a few day's worth of experimenting has satisfied me of the impossibility of keeping him out of any bowl of food, short of locking him and it in separate rooms, it seems that they all need to go over to it. Which is a drag, as it costs $4 a pound! Scruffy and Mouse, meanwhile, can still enjoy some canned food each day, as they tend to eat that bowl to the bottom (unlike the dry food), so I can keep an eye on it and them and keep Minstrel away from it. We've been working with the new food for about a week now and they all seem to tolerate it well.

And Horrors of Horrors! Another cat has moved in! Yes, I went insane and caught one of the feral kittens living in the garage (after his sister was hit and killed by a car last week) and brought him into the house! So far he's been segregated in a closed room till he mellows out a little, so nobody's actually met him yet, nose to nose, claw to claw or nose to butt. On the other hand, I'm also cat-sitting for a friend! That one arrived two evenings ago, spent a day sequestered and has been loose in the house for the last day or so. Nobody likes him, of course. But Scruffy at least, being supremely self-assured of her position in life and in this house, seems to be taking it in stride.

Cost:

Blood Collection

$6.60

Complete Blood Count

$36.00

Radiograph, initial

$60.00

Radiograph, additional view

$80.00

Recheck Abdominal Ultrasound

$139.00

IV Catheter Placement

$30.00

Sedation

$25.00

Injection fee

$8.80

Adriamycin, 5 mg

$13.00

Ward Charge

$27.50

Total

$425.90


With chemotherapy completed, here's the summary of the expenses so far:

03/09/2000

Office visit

$43.40

03/20/2000

x-rays

$95.50

04/28/2000

x-rays

$50.00

05/06/2000

surgery & biopsy

$232.50

05/18/2000

oncologist; consultation and tests

$579.10

06/05/2000

Chemotherapy

$134.40

06/17/2000

CBC

$32.00

07/07/2000

Chemotherapy

$185.70

08/07/2000

Chemotherapy

$186.80

09/05/2000

Chemotherapy

$158.20

10/06/2000

Chemotherapy, tests

$425.90

 

Total

$2,123.50

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September 5, 2000

Today was Scruffy's second-to-last chemotherapy. Nothing much to note. Scruffy was her usual thrilled self during both the rides there and home. The doctor's only note is that her visit next month will be "last chemotherapy and re-staging (abdominal ultrasound, chest x-rays.") At home, I've been a little concerned with Scruffy's weight, so I've added some canned food to the diet (normally I only give them dried food) to encourage her to eat. The only challenge is to make sure that Scruffy gets some before Minstrel barges in and inhales it all down!

Minstrel, meanwhile, is having his own problems (a little dermatological issue), which dictates that all the moggies will be using a topical flea treatment. I started Minstrel and Mouse on this around the middle of last week, but felt I'd better clear it first with the oncologist in Scruffy's case. She said that would be fine, so Scruffy began on the treatment a few days later. The doc also approved her for getting her annual shots, which I've never gotten around to having done. At this point I don't know if I plan to.

Cost:

Chemotherapy - Extended

$55.00

IV Catheter Placement

$30.00

Injection X 2

$17.60

Adriamycin, 5 mg

$13.00

Blood Collection

$6.60

Complete Blood Count

$36.00

Total

$158.20

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August 16, 2000

Scruffy, August 12, 2000. The shaved patches on her front legs are where she receives the chemotherapy IV. Scruffy in the Window
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August 7, 2000

Scruffy's chemotherapy went well. The oncologist does not think there are indications of renewed or new tumor growth on her face. She has actually gained a little weight since last time, though she is down about a pound since we first began. This was the third of five treatments. The next one will be at the beginning of September. A repeat of many of the tests they performed at the beginning, to determine whether and how much the cancer has spread, will accompany the final treatment, in October.

Propofol, as seen on the cost matrix, is an IV anesthetic.

Cost:

Chemotherapy - Extended

$55.00

IV Catheter Placement

$30.00

Injection X 2

$17.60

Adriamycin, 5 mg

$13.00

Blood Collection

$6.60

Complete Blood Count

$36.00

Propofol 0-80 LB

$28.60

Total

$186.80

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August 5, 2000

I've observed a bump on Scruffy's nose, which, I'm afraid, may be another subcutaneous tumor. It's not in the same location as the original tumor... but that spot may be swelling again as well. When you look at an animal every day it is, ironically, hard to notice subtle changes. I am anxious to hear what the oncologist says on Monday. Unfortunately, accompanying her to the therapy is not a simple business. It normally takes an hour, and it takes longer with Scruffy because she needs to be sedated. I'll have to drop her off before 7:30am, then come back to meet with the oncologist at 11:30am. Then we can both go home.

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July 28, 2000

When I started this, I thought it'd be a little more dramatic. Thankfully, however, Scruffy stubbornly remains healthy and happy! Her next chemotherapy is August 7. This will be the third of her five treatments. I'm thinking of taking the day off from work so I can have an opportunity to meet with the oncologist and have a thorough mid-point briefing. A friend comments that it looks to her like Scruffy has lost some weight, but I can't tell. She's never been a 'substantial' cat to begin with (unlike certain other moggies I live with).

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July 15, 2000

It's been a quiet week in Lake Wobegon and there's not much to report. Scruffy is fine and (apparently) happy. One question I will have to put to the oncologist is whether it's a good idea for Scruffy to have her shots, which are coming due this month. Since we don't expect her to live the year, it might seem to be a superfluous expense, but Scruffy is an outdoor type of girl and I like to indulge her, especially now that she is sick. At the same time, there are wild animals in the neighborhood (raccoons and opossums, even the occasional fox), along with a colony of feral cats. And, of course, there is Animal Control. I have never actually seen Animal Control in the neighborhood, but if they came by, and if they netted up a cat without current tags, they probably wouldn't care if she has cancer or not. On the other hand, the shots and vaccinations simply may not be good for Scruffy, in her current condition.

Here's a summary of the expenses so far:

03/09/2000

Office visit

$43.40

03/20/2000

x-rays

$95.50

04/28/2000

x-rays

$50.00

05/06/2000

surgery & biopsy

$232.50

05/18/2000

oncologist; consultation and tests

$579.10

06/05/2000

Chemotherapy

$134.40

06/17/2000

CBC

$32.00

07/07/2000

Chemotherapy

$185.70

 

Total

$1,352.60

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July 9, 2000

Is Scruffy slowing down? It's so hard to tell sometimes. She seemed a little slower to me, a little less active on Friday evening, after we came home from the chemotherapy. But perhaps she was just tired. I look at her sometimes and wonder also if her fur might be losing some tone. But then I look at her the next day and she looks fine, goes outside, runs around happily, grazes like a cow, and all seems fine. You would hardly think she was a 14-year old, let alone one with an incurable disease.

There is one thing, however: Scruffy is a cat who would prefer not to use the litter box for 'number twos', if she can find a place more to her liking. For almost as long as I've had her, her favorite spot has been the bathtub! I realized today that it's been some months now since I've found her calling cards in there. The bathtub is guarded by a set of those heavy, sliding glass doors, but she has demonstrated in the past that she can open these... don't ask me how. Is she no longer able to muster up the strength or energy? If this is the limit of her infirmity so far, then she still has quite a long way to go.

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July 7, 2000

I dropped Scruffy off for her second chemotherapy this morning and picked her up, as usual, in the evening. She complained most of the way home... big surprise. The oncologist's comments (by note): "She looks good - I do not perceive the area on her face to be progressing or regrowing at this time." That is good news!

We do not need a CBC at the two-week mark this time. They will be done with her treatments from now on. Scruffy's next treatment will be in four weeks.

Cost:

Chemotherapy - Extended

$55.00

IV Catheter Placement

$30.00

Injection X 2

$17.60

Adriamycin, 5 mg

$13.00

Blood Collection

$6.60

Complete Blood Count

$36.00

Ward Charge

$27.50

Total

$185.70

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July 4, 2000

Scruffy's CBC looked very good, according to the regular vet. She is scheduled for her next treatment to be this Friday, 7/7. Again, it will be drop-off thing.

Scruffy is happy, purry and fine. You may recall that the oncologist, when we first met her, opined that the tumor would recur within a month, from that day. Well, that month has passed. I have looked closely to see if the swelling has worsened, but it's hard to tell (remember, the swelling was there for weeks before I even noticed it!) In actuality, the swelling has never entirely gone down. I will especially want the onco's assessment of whether the mass is there or not. The day we determine it be there will probably be the day we know that we're into the final month or two.

I don't think I mentioned it earlier, but one of the 'anecdotal' reports on HSA in cats that the onco was able to find, reported an 18-month survival, with chemotherapy. More typical, however, are the six to nine months stated in the literature.

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June 17, 2000

Scruffy had her first CBC today. Her regular vet, rather than the oncology clinic performed this procedure. Since they... ahem... 'know' her, they asked that I bring her in and leave her, so they could sedate her before trying to draw the blood. However, when I returned for her three and a half hours later, they reported, with some surprise, that she had been a perfect angel, had held still, been nice, no injuries to anyone, no need for sedation. Wouldn't you know!

The vet said her blood looks good -- thick, red and healthy. Apparently, animals undergoing chemo will sometimes have blood that looks thin and "Kool-Aidy". The results will come back on Monday or Tuesday, and then we'll know how her system's holding up under the chemo. She continues to look and act fine, her usual crabby self.

Cost:

Lab: CBC - Comprehensive

$32.00

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June 7, 2000

Scruffy continues to do well. She is eating and behaving normally and has informed me in no uncertain terms over the last two days that she is ready to go outside and play!

I spoke with the oncologist today about the treatment 2 days ago. She affirms that it went well. Scruffy did not appear to be stressed with spending the day in the clinic or being in the cage. The only problem was that she squirmed so much that they had to sedate her to insert the IV. I told the oncologist that this behavior is not likely to go away as the therapy continues: If anything, expect it to get worse. Fortunately, Scruffy's regular vet claims that Scruffy responds to sedation better than any cat she's ever encountered: She goes out quickly on very little, and then revives quickly. I'd rather that we didn't have to do it, but in itself it is not a showstopper.

The next milestone will be a CBC (Complete Blood Count), to be performed by the regular vet on June 17. What they will want to look for, I understand, will be an overly severe suppression of white blood cells, along with suppression of certain liver functions. If either is excessive, we will have to re-evaluate whether to continue therapy. This mid-treatment blood check is the only one that will be required, if all turns out acceptably. Subsequent CBCs will be performed at the oncology clinic when Scruffy receives her chemotherapy, at monthly intervals.

The next chemotherapy will be on or around July 5.

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June 5, 2000

Scruffy had her first chemotherapy today. To review, the drug is doxorubicin (brand name Adriamycin,) administered via an IV catheter in a procedure that takes about 20 minutes. The entire treatment, including blood draws etc. takes about an hour. Considering the minimum hour travel time between home and the clinic, I had little option but to drop her off in the morning and pick her up after work. Though I tried to be stealthy in getting out and preparing the carrier, Scruffy has gotten to the point where she somehow always knows when my intent is to take her on a trip. Getting her out of the box spring in which she was hiding, combined with traffic, made us about 20 minutes late. True to her usual style, she complained the entire trip, except when I had my hand in the carrier giving her rubs. I signed all the forms and left, getting to work only 20 minutes late.

A call to the clinic at about 3:00 PM, to check on her status, revealed that she was, at that moment, undergoing treatment.

I arrived back at the clinic to collect her at about 7:30 PM. I was feeling very apprehensive about how she would be. My greatest anxiety is that the chemo will affect her in such a way as to essentially change who she is. I was prepared to find her asleep, though, and perhaps listless or lethargic. Actually, the first thing she did when they brought her out to me was to complain loudly at me through the door of the box! When I opened the door to adjust her blanket, she instantly tried to bolt! Apparently, she had plenty of energy and was feeling in fine fettle.

 On arriving at home, she appeared perfectly fine: Walking and running around, eating, purring, pissing off Mouse. She even got into her favorite hiding place, which involves a four and a half foot jump, hanging on by her front toes from a sill while she muscles a cabinet door open with her nose, followed by a hard scrabble up the wall and over the sill. If today's experience has slowed her down, it is only from Warp 9 to Warp 8. This might work out after all!
Scruffy, the evening after her first chemotherapy. Note the scar on her nose from where the tumor was removed about a month ago.

The discharge instructions state that she had no problems while at the clinic, although she struggled so much while they were placing the IV that they had to sedate her. That sounds like Scruffy.

Cost:

Chemotherapy

$55.00

IV Catheter Placement

$30.00

Injection

$8.80

Adriamycin, 5 mg

$13.00

Ward Charge

$27.50

Total

$134.40

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June 1, 2000

After much thought, and several conversations over the last few days with the oncologist and her staff, I have decided to begin chemotherapy for Scruffy. Her first treatment will be on Monday, June 5, and she will have to spend the day there, as I will not be able to take time off from work. I would rather have her go tomorrow, as I'm anxious to see how it all will go.

It's been a very difficult decision, and I have flipped on it a number of times before reaching this point. There are emotionally compelling reasons to take either course, and as one of my confidants told me, there is no wrong choice. The corollary of that is, of course, that neither might there be a right choice, a choice I feel I can live with. The bottom line, for me, became that, if doing chemotherapy does not seriously degrade her life, then I can not stand by and not at least try. All things being equal, I would rather have her around as long as possible. But not at her expense. She must remain a happy cat. If chemo exacts a severe toll on her, then I don't want to put her through it. But I don't know what that toll will be. I am assured from several quarters that the toll is not great. We need to see if that is true.

There were several points I wanted to clarify with the onco before committing to this course, however:

We will see what Monday brings.

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May 29, 2000

"Adriamycin is the brand name for doxorubicin. The -mycin is what makes it sound like an antibiotic. In fact, it is classified as a cytotoxic antibiotic and is derived from a species of Streptomyces. Its effect against tumors is due to the cytotoxic (cell killing) activity.

Side-effects are certainly possible and tend to be dose dependent. Cardiac and kidney effects are cited as being the most common. On the other hand, you need to recognize that the disease you are treating is fatal. This means you compare benefits and risks, then opt for the lesser of the evils.

You are faced with tough decisions. My thoughts are with you and let us know if you have other questions. We may or may not be able to answer. <g"

A posting on the Compuserve PetsVets forum
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May 19, 2000

The report from the oncologist is that all the tests show negative. Scruffy is in very good shape, considering. There are no coherent tumors anywhere... yet, and the blood looks good. Again, this does not mean that Scruffy does not or no longer has the cancer, just that it has not yet progressed to a certain point. The doctor feels that she is an excellent candidate for chemotherapy.

She is also contacting other vets to find out more about hemangiosarcoma in cats. Most information appears to be of the anecdotal nature, rather than hard studies.

My immediate concern is the, albeit seemingly unlikely, possibility that Scruffy could begin hemorrhaging, as I heard described yesterday. I'm planning to go away for a few days, leaving the beasts on their own. Is there any chance that such a thing could occur at this stage of her disease, thus making me reluctant to leave her for too long a period? The answer is that there is no need to be concerned about that eventuality at this point.

Since both people at the clinic who are qualified to administer the treatments are to be out next week, we will not be able to start chemotherapy until the week after... if that is what I want to do. I am going in circles. The oncologist does not feel that a delay of a week or two will cause us to 'lose ground'... a delay of month, perhaps, but not a week. This is all good, as I really need to think about this and try to determine what's best for the both of us. I'm on vacation next week, so that should give me some time to worry on it.

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May 18, 2000

Scruffy and I saw the oncologist today. It was a long drive, through unpleasant weather, and we were half an hour late. Scruffy was taken to 'the back', and some moments later I was called into an examination room, where I found her waiting in her box. A few minutes after that the oncologist joined us. While we talked, Scruffy wandered the room curiously, or got rubs from me.

The oncologist reiterated much of what I have already learned. She feels that, with chemotherapy, Scruffy might survive six to nine months. Without, the initial tumor will recur within a month, with metastasis and complete systemic progression occurring subsequently in as little as a month. In other words, she may not survive more than three months. Much of what she says speaks to the aggressive nature of the illness: due to the fact that the cancer cells extended to the very margins of the biopsy sample, local recurrence at that location is certain. Due to the origin of HSA in blood vessels, spread is quite rapid and thorough. By the time it has progressed to the point at which diagnosis has become possible, cancerous cells will have spread throughout the body, though other tumors might not yet have formed. HSA tumors themselves tend to be quite bloody (not surprising, since they originate in vascular tissues) and prone to rupture and hemorrhage. A not uncommon 'final outcome' is that a tumor on an internal organ will rupture, and the animal will begin to hemorrhage internally. When this happens, the animal will collapse and go into shock. Death will follow.

Fortunately, Scruffy does not appear to be anywhere near that point. As I mentioned, if untreated, the original tumor can be expected to recur within the month. As it grows, it will probably begin to impinge on the sinuses, causing her breathing difficulties. It also might begin to invade the eye socket, causing discomfort and running. It may be prone to rupture and bleeding as well. As mentioned elsewhere, metastasis typically begins with lymph nodes, frequently involving the spleen. Spleen removal is a treatment often pursued with dogs.

Speaking of dogs, this oncologist has never seen a case of hemangiosarcoma in a cat. All her experience with the disease has involved dogs.

The recommended treatment is chemotherapy, using doxorubicin (Adriamycin). This is administered as an IV drip, once a month, for 5 treatments. Treatment is accompanied by blood tests, to determine the patient's status and progress. The entire process takes about an hour, and costs around $200 per treatment. Side effects are reportedly slight, in most cases, but may include bone marrow suppression, GI upset, allergic reactions, cardiomyopathy (weak heart muscle, but only if more than 6 doses are administered... not an issue in our case) and tissue damage if the drug leaks outside the vein. In most cases, I am told, side effects are simply a general 'offness' - perhaps lethargy or moping - for a few days after treatment, and loss or tone in the fur.

Before beginning chemotherapy, she (the onco) will need to run a series of tests, to better establish Scruffy's current condition. These include various x-rays and ultrasounds, as well as a comprehensive blood analysis. The cost of these tests is close to $500. They can determine if metastasis has occurred, and how far it has progressed. Unfortunately, due to the malignant nature of the condition, a negative outcome does not rule out that microscopic metastasis has not occurred. In fact, it is almost certain that it has.

I told them to perform the tests. I do not know if we are going to do the chemo, but if we do they will have to be done. And I want a better idea of what her state is. I had made arrangements to take half the day off, so that I could drive Scruffy down and then back, before going to work. Instead, I left her there. Since they are also an emergency clinic, they are open 24/7, so I could pick her up in the evening.

Which I did. The weather today was abominable, with severe thunderstorms, winds and hail. Traffic lights were out all along the route home. Trees were down. At one point I even saw a roof lying by the side of the road! The trip home was a two-hour ordeal. All the time, I'm feeling guilty because I have this cat here, who does not have long to live, making her waste her time sitting in a box in a car, for hours on end, instead of letting her hang at home, doing the catty things that make her happy. And thinking that, if we do the chemotherapy, there are going to be several more trips like this (though, hopefully, not as excruciating.) Is that something I need to take into consideration, in deciding what to do next?

But I put the carrier on the front seat next to me and made most of the trip with my fingers through the gate, so I could rub Scruffy's nose. She seemed to appreciate that and eventually stopped complaining. Just how much do they really object to the things we think they object to? How much of it is just our feeling of what we would object to? I would dislike, extremely, being shoved into and kept in a box all day. But cats, and Scruffy in particular, enjoy being inside things... boxes, drawers, paper bags, and closets. I would dislike being made drowsy and lethargic by a drug, forced perhaps to sleep my life away. But my cats seem to sleep about 20 hours a day anyway, so who's to say they'd even notice, or mind, if they were being put to sleep?

It's tough to sort out. The onco will contact me with results of the tests tomorrow. We're going away for the weekend, and I hope that her condition has not become so severe as to throw those plans in question.

Cost:

Medical Consultation

$80.00

Radiograph - Initial

$60.00

Radiograph - Additional View X 2

$160.00

Two Cavity Ultrasound

$267.50

Blood Collection

$6.60

Feline Comprehensive Panel

$85.00

Total

$579.10

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May 15, 2000

The vet removed the sutures from Scruffy's face today, an indignity she endured with only moderate struggle. The scar is healing nicely and has scabbed over. You would not know that Scruffy is sick. I spoke with the daughter of Scruffy's original owner last night, to fill her in. Scruffy's main problem with her illness seems to be that I keep grabbing her and shoving her into that damned box and taking her to that damned nasty lady in the smelly place, and then leaving her there!

There was no charge for removing the sutures.

If chemotherapy does not have a good chance of success, I do not want to subject Scruffy to it. If it will make her miserable, even if it will successfully extend her life, I do not want to subject her to it. If it needs to be administered on too frequent a basis, either with pills that I will have to give her, or with frequent trips to one vet or the other, either of which will make her miserable, I do not want to subject her to it. I am not happy that she is sick and will die from this illness, but I think I am OK with letting nature take it's course. The experience of one friend, who lost a cat to cancer recently, was that chemotherapy gave her an additional nine months with her cat, during which time he did not suffer any side-effects to the treatment. He even gained so much weight that she had to put him on a diet. On the other hand, another friend, with two cancerous cats, has been so disappointed with the results of one's chemotherapy that he has decided not to pursue it with the other. Different cancers are treated with different drugs, and respond differently to treatment. The mast cell cancer that afflicted, and eventually killed, my one friend's cat does not seem to be very aggressive, and reportedly responds very well to treatment. The reason it became so serious in this particular cat was that it was misdiagnosed for over a year. Had it been caught earlier, it might have been completely cured. This cancer does not sound anything like that cancer at all.

We see the oncologist in three days.

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May 12, 2000

According to the vet this morning, hemangiosarcoma is quite aggressive. According to the pathologist's report, the tumor will certainly recur, possibly in as little as a month. Metastasis can proceed with what sounds like blinding rapidity to me: Three or four weeks. For these reasons, if I am to have Scruffy examined by an oncologist, it needs to be relatively soon: Within a week or so, if possible.

Again, the vet repeats that the available chemotherapy does not appear to have more than a 55% success rate, and may have a significant impact on the quality of Scruffy's life.

The veterinary oncologist they refer people to is located at the University of Wisconsin, in Madison. Ouch! On the other hand, I have the name and number of one located in another Chicago suburb, about an hour away. This is still not exactly convenient, but a good sight easier to deal with than a drive to Madison! This is the oncologist that treated my friend April's cat for mast cell cancer. My vet does not know the oncologist, but does know of the facility she works at, and says they have an excellent reputation.

Highlights from the pathology report: "Subcuticular/fascial hemangiosarcoma, well differentiated... high potential for local recurrence and progression... moderate potential for regional and systemic metastasis... metastasis, when it occurs, is typically to regional lymph nodes and less commonly to other body systems... this is a malignant neoplasm..

I will at least hear what the oncologist has to say. It sounds like there may be little we can do. I do not want to subject Scruffy to chemotherapy that will make her miserable. I have made an appointment for next Thursday. I will have to take half a day of vacation.

The most important thing, I decide at one point, is that Scruffy needs to be happy in the time she has remaining. The only consideration when dealing with her is that she must be happy. I later re-evaluate this and conclude that, were Scruffy able to understand such a thought, she would probably interpret it as a license to get a way with murder! We must be reasonable about this. :)

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May 11, 2000

The wait has been a little longer than I expected, but today the news came: Scruffy has hemangiosarcoma, which is a malignant cancer. I will be taking Minstrel in tomorrow for a follow-up on some treatment he is receiving, so I will talk to her in person then, and also receive a copy of the pathologist report to pass on to an oncologist, if I decide to consult one. There is chemotherapy available for this condition, but the vet says that it has only a 55% chance of success, and feels that it may have a significant quality of life impact.

This is about the worst news. I closed my office door for a few minutes, just to feel miserable, and to rue the day when I will have to decide to have Scruffy put to sleep. When I had time, I did a little on-line research on the topic of HSA. There is little out there on cats: Apparently it is not common at all in cats, though it may be more prevalent in dogs. A web search on hemangiosarcoma returns hits that mostly concern dogs. And there was one tribute on PetLoss.com to another cat with the disease. I have placed Scruffy's name there, on their 'special needs' list: Pets with serious and/or life-threatening conditions.

For her part, Scruffy is doing fine. I gave up on the antibiotics after a few days, after one pill turned into paste in my hand after being in, and bouncing out of, her mouth eight or nine times. I hope that whatever treatment (if any) we choose to pursue does not require daily pill giving like this. I'm not sure it can be done. That by itself could impact her quality-of-life to the point where its not worth pursuing.

Her scar appears to be healing nicely, and I have not observed her scratching at it at all. She gets a big hug and lots of rubbing for being a special cat.

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May 6, 2000

It seemed a little quiet around the house last night, without Scruffy there to fill the room with purrs... or to get in Mouse's face and cause hissy fits.

Scruffy was her usual, complaining self when they brought the box out with her today. She is now graced with several stitches running along the right side of her nose. It looks just as swollen, but I'm sure that's just due to the insult of the surgery etc. and that it will diminish. The vet showed me the mass they removed, floating in a little plastic jar full of formaldehyde. Not much to look at for sure. An ugly little piece of meat. Looks a little small, compared to the size of the swelling on Scruffy's face. The vet reiterated much of what she told me on the phone yesterday. There is about a 50/50 chance whether a muscle tumor is benign or malignant. If it is benign, then I guess we're done: The thing is out. If not, then...

Scruffy will require antibiotics twice a day for five days. Knowing how tough she can be to handle though, the vet reassures me that this is a prophylactic measure, and if it becomes impossible, not to worry that she get each dose. I am to watch out for her scratching at the sutures. If that turns out to be a problem, I should put one of those megaphones over her head. She'll love that!

She will have to come back in 10 days to have the sutures removed. That will be about Monday, May 15. We may have the pathology report Tuesday, but Wednesday is more likely.

I spoke with Racquel, my ex-wife, who first brought Scruffy home over eight years ago, to fill her in on what is happening. I have decided not to call the daughter of Scruffy's original owner until I hear the biopsy results.

The waiting will not be easy. The thought that Scruffy might have cancer is very depressing. My good friend April recently (less than three weeks ago) lost one of her cats to cancer. I am hoping that it will turn out to be benign.

Cost:

Feline anesthesia

$30.00

Surgery: Tumor removal - subdermal

$125.00

Lab: Biopsy 1 tissue

$76.00

Rx: Amoxicillin 1mg X 10

$1.50

Total

$232.50

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May 5, 2000

Over the last week I've done a little research on-line, and have communicated with a few vets, who agree that the exploratory surgery is a reasonable course, given that abscessed tooth roots have been considered and ruled out.

I also placed some phone calls to determine exactly how old she is. I've been thinking that she's 12, but realized that I wasn't at all sure about that. Before she goes in for invasive treatments and such, it seemed a good idea to determine just how old she is.

Turns out, according to the daughter of Scruffy's original owner, that Scruffy is 14! Thinking back now, that makes sense. I now remember being told, at the time that she arrived eight years ago, that she was five or six. Since then I had just remembered that she was older than Minstrel, who is now 11, and had placed her at 12, or maybe 13.

I delivered Scruffy to the vet for her surgery this morning. Spoke with the vet late in the afternoon. She reports that the surgery was more extensive than they anticipated and they want to keep Scruffy there overnight for observation. They removed from her face what the vet describes as a muscle tumor. This is a very unusual location for one. Fortunately, they do usually come out fairly easily. Muscle tumors prove to be malignant about 50% of the time. The mass will be sent to a veterinary pathologist for biopsy on Monday. I will need to medicate Scruffy with antibiotics for about 5 days.

I'll summarize the expenses tomorrow, after I retrieve Scruffy and have a chance to talk to the vet in person.

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April 28, 2000

Rhinoscopy is a messy and bloody affair that I have been reluctant to inflict on Scruffy. Now some weeks later, we are repeating the x-rays to see if there has been any change. The swelling looks larger, to me, but these things are sometimes very hard to read.

Scruffy did not have to spend as much time at the vet's as last time, as I have the day off. I dropped her off just before noon, and recovered her about 4 hours later. The radiograph results were just as vexingly inconclusive as last time. This time, both vets at the clinic examined her while she was under sedation. Scruffy's regular vet agrees that swelling appears larger, and believes she was actually able to sort of grab on to it and move it around a bit, indicating that it is located in the soft tissue outside the bone and not in the sinuses. Her partner, who is actually the senior practitioner there, has not seen anything quite like it "in 30 years of practice." The vet no longer suggests rhinoscopy as the next step. If the swelling is located outside the bone, then an examination inside the sinuses will not reveal much. They now recommend surgery, to see just what is in there and, if possible, to actually remove the mass. This will be another all-day affair. As I've already scheduled to have next Friday off as well, we'll do it then.

Since Scruffy did not have to wait as long following her examination before I was able to retrieve her, she was still a little loopy from the sedative when we got home. The vet has said that Scruffy responds better to the anesthesia than just about any cat she's ever seen. She goes under quickly with relatively small amounts, and then recovers very quickly.

I am beginning to worry about her.

Cost:

Radiograph, additional

$20.00

Feline anesthesia

$30.00

Total

$50.00

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March 20, 2000

As there has been no change in the swelling on Scruffy's face, today I took her in for x-rays of her head. This is a procedure that requires sedation, so she had to spend the day there while I went on to work. The results are inconclusive. On the one hand, there is no sign of anything that could be interpreted as a hard-tissue tumor, but on the other hand neither is there anything that can tell us what the condition is. What it is not is an infected or abscessed tooth. While she was under, a visual inspection of the inside of her mouth showed nothing. The vet prescribed an anti-inflammatory, to see if we can get the swelling down that way. If there is no change, we may repeat the x-rays in a few weeks, or have a rhinoscopy exam of the nasal passages.

Cost:

Radiograph

$65.00

Feline anesthesia

$30.00

Rx: Prednisone 5mg X 10

.50

Total

$95.50

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March 9, 2000

My attention was drawn, by a friend, to the swelling on the right side of Scruffy's nose about a week ago. Scruffy has recently completed three weeks of treatment for a urinary tract infection, during which she saw the vet 4 times... and spent 3 days at the clinic. Nobody there had seen this; I haven't seen this. But it's impressively large, quite obvious once you realize it's there. It looks to me like it could be an abscess, except that I don't see any injury or other source of infection.

The vet does not think it looks like a boil or abscess. There is a tooth root that goes up into that area, and an infection in that tooth could account for it... except that the tooth looks clean and healthy. It is a soft swelling, so a hard tumor seems unlikely.

The vet administered an antibiotic injection (in case it is an infection, source unknown) and gave her a prescription for antibiotics, to be administered over the next week or so. If there is no change, the vet would like to x-ray Scruffy's head. That will require sedation, which means that she'll have to spend a day there.

Cost:

Office visit and examination

$30.00

Rx: Antirobe 25mg x 12

$5.40

Injection: Antibiotic

$8.00

Total

$43.40

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