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I'm not ready to say goodbye
kitty hatred
curvemudgeon
ONCO - Medical Record - Initial Consult
Dec 11, 2013

Technician notes
History: 17y/o MN Domestic Shorthair. Hx of episodic inappetence,
vomiting and constipation dating back to June/July 2013. Owner had been
managing the chronic issues with supportive medications at home due to
Fezzik's extreme stress when going to see a a vet - dyspnea, requiring
oxygen therapy on arrival. Fezzik inappetence and vomiting issues
seemed correlated to constipation episodes for some time. Abdominal
lymphadenopathy and effusion noted on AUS on 12/5/13. Prior abdominal
lymphadenopathy noted on AUS on??? Hx of azotemia.

Prior Blood work: 10/4/13 -- ALB 3.9 (H), Crea 2.4 (H), Amy 1224 (H),
Abs. Lymphs 880 (L)
Biopsy Report: Fluid analysis and cytology - neoplastic effusion r/o
carcinoma v. adenocarcinoma
Date of initial diagnosis: open
3 view thoracic radiograph: not performed at time of ultrasound but
performed in June
Ultrasound: 12/5/13 - abdominal lymphadenopathy and effusion


CM
PHYSICAL EXAM: Fezzik not present for appointment so no PE

Assessment:
Fezzik has a metastatic carcinoma of his intestines and peritoneal
(abdominal) effusion. His recent abdominal ultrasound shows the changes
in his intestines are diffuse as most of his intestines are thicker
than they should be. We do not have a confirmed biopsy of his
intestines, but it is my opinion that the carcinoma effusion on his
abdomen is product of carcinoma in his intestines and lymph nodes. We
discussed this type of cancer and how it can spread to regional lymph
nodes, liver or lungs. We discussed prognosis with no treatment (likely
only a few weeks or as long as we can keep him comfortable (or if we
try chemotherapy (likely less than 6 months, but we are hoping for a
year). We talked about quality of life concerns and how treatment and
traveling would impact his quality of life.

Recommended staging discussed today include: Bloodwork (CBC, Chemistry
panel), Urinalysis, Chest x-rays, Abdominal ultrasound, Fine needle
aspirate

Results of today's diagnostics: none performed today

Treatment options discussed and to be considered:
· Surgery: to remove the tumor. Recommended if possible to remove
primary tumor or reduce tumor burden. However, due to diffuse changes
in most parts of the intestines (based on ultrasound report) surgical
resection not likely possible.
· Radiation therapy: not recommended due to diffuse intestinal disease
· Systemic chemotherapy. We discussed general side effects of
chemotherapy (bone marrow suppression and gastrointestinal signs), the
frequency of treatment and costs. Recommend following surgery to
address metastatic cancer or in the palliative setting (if not surgery
pursue) to target cancer cells and stop or slow down the progression of
his cancer. We compared injectable treatment with carboplatin or oral
options with Palladia (off label use), but Fezzik would need to come to
our clinic for treatment and monitoring.
· Other options such as palliative care to treat systems and make sure
your pet is comfortable. We discussed how to monitor pain and quality
of life issues such as behavior or appetite changes. We also discussed
end-of-life decisions to prevent suffering if we cannot make him feel
better.

Treatment plan:
You have indicated you would like to consider your options and I have
sent you home with cost estimates to review at home. Our main challenge
with treatment is how the trip to the clinic would upset Fezzik and
without checking him we would not be able to give him chemotherapy
safely (side effect risk). Without treatment his cancer will continue
to develop and will soon affect his quality of life to such a degree
that humane euthanasia should be considered to prevent suffering. You
are considering trying him on general supportive medications to help
with possible intestinal pain, inflammation and appetite to try and
keep him comfortable.

Treatments given: none

Medications to continue at home: no changes, but to consider
buprenorphine and steroid for palliative care


My buddy is dying and there's not a thing I can do.

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Condolances, man. Wish I had something helpful to say here.

Oh my goodness. I'm so sorry. Hugs for Fezzik and for you.

I know exactly how you feel, having gone through it with Freya (also around Christmas), and a scare with Shiva.

No, you can't save him, which is horrible. And you can't even tell him what's going on, which might have taken some of the edge off.

But you do have a say in how his story ends. You can make sure he doesn't suffer any more than he has to. You can make sure he knows he's loved, and always has been.

Since time is short, your vet might be able to prescribe stronger painkillers, ones that will do a better job, but that normally aren't prescribed because they have long-term side effects. You can also give him all his favorite foods.

And since you likely still have a few weeks or months, you might have enough time to come to terms with the situation, so that when it comes time to say goodbye you'll be able to accept it.

No, there's nothing good about this. But you had seventeen(?) good years with him. The pain you feel is the price of that love.

And for what it's worth, since you started going through this with Fezzik, I've been more conscious in spending time with Shiva, so that when the time comes, I can look back and know I did right by him.

I absolutely agree with the above.

Also, you write: "My buddy is dying and there's not a thing I can do"

Disagree. There are things you can do, and you're doing them. You're making decisions in his best interest and doing everything you can to make him happy and comfortable.

The sucky thing about having pets is that we almost always outlive them. But that also gives us the chance to make their entire life, including the end, as pleasant as possible.

Your lady is very right. Im so sorry Brian. Fezzik is a great companion and friend. He will be very missed.

I man, this is how much I know I've been out of touch that I didn't know that Freya had died. Down here deep in the academic gravity well, word from old friends sometimes slips by. So very sorry for your loss. Damn, seems just like yesterday you got your Ungrateful Fur Tubes after a trial run with mine.

Dammit. I still owe you a shirt thanks to Seamus. Or is that two? *sigh*

Ah hell. I was where you are exactly two years ago. It sucks. I'm so sorry.

For me it was three years. Yes, and it did suck mightily, I won't lie.

For Seamus the vet and I agreed that quality of life for his remaining days was paramount. Radiation treatment might have given him three to six more months, but he would have been miserable. Which would have made me more miserable. We opted to dope the poor boy up to his gills, which did wonders for his disposition. And mine.

But, one day I just knew. I could tell that he was ready to go. Can't say how I knew, just did. I expect it'll be the same for you.

In which case I recommend House Paws, especially given how ole Fezzik hates the vet. They came to the apartment to put Seamus to sleep, so he went in the comfort of home and not at the Scary Noisy Place Where They Poke You. And There Are Dogs. My friend Paula, that Andrew knows, too, recommended them to me, and I'm so, so very glad she did.

God, I'm tearing up now writing this. Shit. I miss my boy.

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