Death of a kitty
The post below is not 'new news' -- it's something I've been meaning to post since early July. It may be 'new to you' or it may be something you already know about via Facebook or elsewhere.
Our cat, Marie, passed away on July 6, 2022 after a lengthy battle with cancer.
If you have actually been following me here or on Facebook, you'll recall multiple posts about poor miss Marie over the last few years. (See here, and here)
Marie started having health issues in mid-2020. She developed a huge bloody tumor on her left side and numerous smaller tumors here and there. We had the biggest tumor surgically removed -- twice. Each time it grew back within a few months. It never metastasized internally and she never seemed to really notice it much; she had as much or as little vim and vigor as she'd ever had. However, when you have a tumor that looks like this (see picture) weeping blood, you realize that you've got to act.
In late 2021 and early 2022 it became obvious that something more needed to be done, and that's when she began a program of CCNU oral chemotherapy, given every six weeks or so.
The tumor started to shrink within a week or two of the first dose. Six weeks after the first dose she had her second dose, and the tumor really began to shrink at that point. She also lost a lot of appetite (one presumes due to nausea from the chemo) and we were given mirtazapine in salve form to smear inside her ears to stimulate her appetite. Each time she looked a little droopy, the mirtazapine would have her back to normal pretty quickly.
After five months, the tumor looked like this:
Carole and I were delighted. The oncologist at Peak Veterinary Referral Center in Williston was delighted. There was next to nothing in the veterinary literature about treating feline progressive dendritic histiocytosis, and on at least one celebratory checkup I suggested that perhaps she could get a good paper into some journal or another on the subject.
We agreed to administer one final chemotherapy treatment in mid-June, "just to make sure get all the cancerous cells".
That's where we made our big mistake. If we hadn't done that, she might be alive today.
After two weeks or so, her appetite began to wane again. Unlike the previous occasions, mirtazapine did next to nothing to perk her back up. We told ourselves that it had helped a bit and that she had shown more appetite, but frankly, I suspect we were just seeing what we wanted to see.
After two days of lher ooking like a limp dishrag we hustled her off to Peak again, where we got the news that she had a hematocrit that was lower than anyone (the oncologist or the technicians/nurses) could ever recall seeing in a living cat. It was on the order of eight percent. Her red cells were all but gone. Her white cells were all but gone as well. It was as though she'd just stopped making new blood cells.
I consented/begged for heroic measures because a) I'm an idiot and b) I felt responsible, having cheerfully encouraged that final round of chemotherapy a couple of weeks earlier, that final round that seemed to have blown up on us all catastrophically.
The oncologist warned that going all-out would be ... expensive.
I said "I'm opening the checkbook, doc, please save her."
Carole, for her part, was much less sanguine (see what I did there?) about Marie's prospects and the value of spending ... well, spending as much as we wound up spending. But she knew how soft-hearted I am about cats and other animals and did not want me mad at her later, saying "if you'd agreed to take out a second mortgage to pay for treatment, she'd be alive now!"
They gave Marie meds to stimulate blood cell production and transfused blood into her and she perked up considerably.
For, oh, about 12-14 hours.
Then it all began again. She dwindled. There was another transfusion and more meds. A bit more perking up, but not as much as before.
I visited her on the afternoon of July 5 (Carole had to work) and petted her and told her I loved her and once again, saw hope where there really wasn't any.
But late that night -- around 1:30 am on the 6th -- we got a call from Peak, from the oncologist herself. Marie was fading quickly and was, in the words of the oncologist, trying to die. She said they couldn't keep on endlessly transfusing her because other cats might need the blood as well (and cat blood banks are not as well stocked as human ones; there was only so much to go around) and because it really didn't seem to be making a difference. I could tell that she didn't want to be giving us such bad news, but that particular oncologist is a very nice, caring woman and clearly wished she could be saying just about anything else.
I knew what she was looking to hear from me and I said it. "I understand. It's time to let her go." Carole was sitting next to me, half asleep (it was 1:30 in the morning) but squeezed my hand. She knew how upset I was and was going to be. The oncologist said they would provide euthanasia so she would not suffer any longer.
Cue the tears.
The next morning I ordered her a headstone from the same company that we've gotten headstones for our other four deceased cats, dug a suitably deep hole in the sad patch out by our shed where the others are, and went by the vet to pay and to pick up her body.
We have a strange ritual we do for all our cats when they die. We bury them in their preferred pet bed, with their personal food bowl, with any other items that were especially significant to them, and wrap it all up in a shroud of some kind. In Marie's case we buried her with a blue bath towel -- not an especially large one -- but one that had done good service over the years protecting Carole's lap from Marie's claws whenever Marie jumped up to get petted. Whenever Marie had seen Carole put that blue towel on her lap, she'd known it was time for petting and would rocket right on up there.
We never would have been able to look at that old blue towel again without thinking of Marie, and we knew that if there was a kitty afterlife, she would probably want it with her.
---
We are now down to three cats.
One is Jacqueline, the long-haired black cat that I adopted at the same time as Marie, from the same shelter. They had been at the shelter together for months -- black cats are not adopted as quickly as other cats -- and had actually been together before that at the house that wound up surrendering them to the shelter. As far as I knew, Jacqueline had never known life without Marie around and I didn't know if she would behave differently or strangely when Marie was no longer there at mealtimes, no longer sharing sunny spots. As far as we can tell, though, she's taken it in stride. If she's noticed the loss, it hasn't changed her behavior.
Our other two cats, Maggie the tortoiseshell kitty and Max the orange tabby, were not as close to Marie as Jacquie had been, although we had certainly seen plenty of times when Max would use Marie as a hassock or pillow, often when they were sharing sunny spots. They don't seem to be super broken up about Marie's passing.
But nonetheless, I am. The oncologist said that there were two possible reasons for Marie's cell count plummeting -- one was an immune reaction caused by the chemo, where Marie's system attacked itself, or, that we had basically nuked Marie's blood-cell-producing marrow.
I (not a veterinarian) think the second theory is most likely correct. We were probably damaging her marrow with each chemo dose, but it wasn't until the last one that we finished wiping it out. We will never know if she'd have had many more years of life if we had stopped after the second to last dose, since the tumor was all but invisible at that point; perhaps she could slowly have built back her blood cell production capacity.
I still regret so many things, not least of which is my happy "You could get a great journal article out of this, doc!" comment. You know that old saying, "the operation was a success but the patient died?"
Well. We clobbered that tumor, but at the cost of her life. And all my "we're opening the checkbook, doc, don't spare anything that could help, no matter what!" did was prolong her suffering.
I'll never stop wishing it could have been otherwise.
Our cat, Marie, passed away on July 6, 2022 after a lengthy battle with cancer.
If you have actually been following me here or on Facebook, you'll recall multiple posts about poor miss Marie over the last few years. (See here, and here)
Marie started having health issues in mid-2020. She developed a huge bloody tumor on her left side and numerous smaller tumors here and there. We had the biggest tumor surgically removed -- twice. Each time it grew back within a few months. It never metastasized internally and she never seemed to really notice it much; she had as much or as little vim and vigor as she'd ever had. However, when you have a tumor that looks like this (see picture) weeping blood, you realize that you've got to act.
In late 2021 and early 2022 it became obvious that something more needed to be done, and that's when she began a program of CCNU oral chemotherapy, given every six weeks or so.
The tumor started to shrink within a week or two of the first dose. Six weeks after the first dose she had her second dose, and the tumor really began to shrink at that point. She also lost a lot of appetite (one presumes due to nausea from the chemo) and we were given mirtazapine in salve form to smear inside her ears to stimulate her appetite. Each time she looked a little droopy, the mirtazapine would have her back to normal pretty quickly.
After five months, the tumor looked like this:
Carole and I were delighted. The oncologist at Peak Veterinary Referral Center in Williston was delighted. There was next to nothing in the veterinary literature about treating feline progressive dendritic histiocytosis, and on at least one celebratory checkup I suggested that perhaps she could get a good paper into some journal or another on the subject.
We agreed to administer one final chemotherapy treatment in mid-June, "just to make sure get all the cancerous cells".
That's where we made our big mistake. If we hadn't done that, she might be alive today.
After two weeks or so, her appetite began to wane again. Unlike the previous occasions, mirtazapine did next to nothing to perk her back up. We told ourselves that it had helped a bit and that she had shown more appetite, but frankly, I suspect we were just seeing what we wanted to see.
After two days of lher ooking like a limp dishrag we hustled her off to Peak again, where we got the news that she had a hematocrit that was lower than anyone (the oncologist or the technicians/nurses) could ever recall seeing in a living cat. It was on the order of eight percent. Her red cells were all but gone. Her white cells were all but gone as well. It was as though she'd just stopped making new blood cells.
I consented/begged for heroic measures because a) I'm an idiot and b) I felt responsible, having cheerfully encouraged that final round of chemotherapy a couple of weeks earlier, that final round that seemed to have blown up on us all catastrophically.
The oncologist warned that going all-out would be ... expensive.
I said "I'm opening the checkbook, doc, please save her."
Carole, for her part, was much less sanguine (see what I did there?) about Marie's prospects and the value of spending ... well, spending as much as we wound up spending. But she knew how soft-hearted I am about cats and other animals and did not want me mad at her later, saying "if you'd agreed to take out a second mortgage to pay for treatment, she'd be alive now!"
They gave Marie meds to stimulate blood cell production and transfused blood into her and she perked up considerably.
For, oh, about 12-14 hours.
Then it all began again. She dwindled. There was another transfusion and more meds. A bit more perking up, but not as much as before.
I visited her on the afternoon of July 5 (Carole had to work) and petted her and told her I loved her and once again, saw hope where there really wasn't any.
But late that night -- around 1:30 am on the 6th -- we got a call from Peak, from the oncologist herself. Marie was fading quickly and was, in the words of the oncologist, trying to die. She said they couldn't keep on endlessly transfusing her because other cats might need the blood as well (and cat blood banks are not as well stocked as human ones; there was only so much to go around) and because it really didn't seem to be making a difference. I could tell that she didn't want to be giving us such bad news, but that particular oncologist is a very nice, caring woman and clearly wished she could be saying just about anything else.
I knew what she was looking to hear from me and I said it. "I understand. It's time to let her go." Carole was sitting next to me, half asleep (it was 1:30 in the morning) but squeezed my hand. She knew how upset I was and was going to be. The oncologist said they would provide euthanasia so she would not suffer any longer.
Cue the tears.
The next morning I ordered her a headstone from the same company that we've gotten headstones for our other four deceased cats, dug a suitably deep hole in the sad patch out by our shed where the others are, and went by the vet to pay and to pick up her body.
We have a strange ritual we do for all our cats when they die. We bury them in their preferred pet bed, with their personal food bowl, with any other items that were especially significant to them, and wrap it all up in a shroud of some kind. In Marie's case we buried her with a blue bath towel -- not an especially large one -- but one that had done good service over the years protecting Carole's lap from Marie's claws whenever Marie jumped up to get petted. Whenever Marie had seen Carole put that blue towel on her lap, she'd known it was time for petting and would rocket right on up there.
We never would have been able to look at that old blue towel again without thinking of Marie, and we knew that if there was a kitty afterlife, she would probably want it with her.
---
We are now down to three cats.
One is Jacqueline, the long-haired black cat that I adopted at the same time as Marie, from the same shelter. They had been at the shelter together for months -- black cats are not adopted as quickly as other cats -- and had actually been together before that at the house that wound up surrendering them to the shelter. As far as I knew, Jacqueline had never known life without Marie around and I didn't know if she would behave differently or strangely when Marie was no longer there at mealtimes, no longer sharing sunny spots. As far as we can tell, though, she's taken it in stride. If she's noticed the loss, it hasn't changed her behavior.
Our other two cats, Maggie the tortoiseshell kitty and Max the orange tabby, were not as close to Marie as Jacquie had been, although we had certainly seen plenty of times when Max would use Marie as a hassock or pillow, often when they were sharing sunny spots. They don't seem to be super broken up about Marie's passing.
But nonetheless, I am. The oncologist said that there were two possible reasons for Marie's cell count plummeting -- one was an immune reaction caused by the chemo, where Marie's system attacked itself, or, that we had basically nuked Marie's blood-cell-producing marrow.
I (not a veterinarian) think the second theory is most likely correct. We were probably damaging her marrow with each chemo dose, but it wasn't until the last one that we finished wiping it out. We will never know if she'd have had many more years of life if we had stopped after the second to last dose, since the tumor was all but invisible at that point; perhaps she could slowly have built back her blood cell production capacity.
I still regret so many things, not least of which is my happy "You could get a great journal article out of this, doc!" comment. You know that old saying, "the operation was a success but the patient died?"
Well. We clobbered that tumor, but at the cost of her life. And all my "we're opening the checkbook, doc, don't spare anything that could help, no matter what!" did was prolong her suffering.
I'll never stop wishing it could have been otherwise.