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The Ache of Not Knowing What to Do

Since my cat, Bob was diagnosed with having a 5cm mass on his right liver lobe, I've been feeling very confused about what to do next. I keep asking myself, “what is best for Bob?” What would HE want? What is humane to DO to him? Is it worth carving him open to give him more time? If so, how much time? A month? A year?

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©2006 Robin A.F. Olson. 2006. Just after Bob came to live with me.

Bob means the world to me. He's the Ambassador-the head “greeter” when I walk in the door. He's the boss. He slaps around the underlings. He's an old orange Tom with crystal green eyes. His purr has a musical, squeaky, quirky quality to it and he's quick to get that motor running. He loves everyone he meets and everyone loves him.

I don't know how old Bob is. My Mother, the intrepid photographer who documented every second of our lives, had photos of him that went back to 1999. I know he was an adult when he first showed up as a stray, at my Mother's back door. She always left out food for any hungry cat.

Bob, we guess, is around 14 or 15.

Bob has FIV+. I just re-verified it using a Western Blot test. There is no way I'd mess with wondering if Bob's previous snap test was a false positive when his health is in such jeopardy.

That said. Bob eats ravenously, though he is losing weight. We've checked his thyroid and that is working fine. Bob still grooms himself and continues to have good litter box manners. He even plays with little Blitzen from time to time.

According to the ultrasound, most of Bob's internal organs are operating normally and within limits. I see some very big words that I tried to look up...they basically say “cancer”...maybe. It reads: “There is a nodular cluster in the area of the mesenteric lymph nodes which represents mesenteric lymphadenopathy.” So, does Bob have cancer that has metastasized or is it just an infection brewing or is it from the liver problems?

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©2009 Robin A.F. Olson. 2006. Bob, last year.

Thing is, I'm a GRAPHIC DESIGNER. I'm a WRITER! I'm NOT a Vet! I'm a loving mom to lots of cats. I just want to know what to do and no one seems to be able to tell me. They say I have to decide. My options suck.

I met with Dr. Ann Hermans, a homeopathic Vet. Dr. H has been helping me try to cure Gracie's mysterious rash. She's had it over for 2 years. Nothing has really helped, but Dr. H has given me some treatments for her that have soothed her anxiety a GREAT deal and, in turn, helped to calm her skin down and she no longer “barbers” her fur, nor does she vomit those clumps of fur every few days. This is meaningful. Does it translate into they type of care that could support or even help Bob be stronger-a better candidate for surgery? Some people say it's tomfoolery, but I trust Dr. H. She has a degree from Cornell. She knows her nutrition in ways I wish ALL Vets did. I brought Bob up to see her a few days ago and I left feeling hopeful. That with some adjustments to Bob's treatments and nutrition, I would fortify him so he would be more ready for what may come next. Would we cure his liver mass this way. No. But there is a respect for how the body heals itself without beating it up by pushing drugs into it that cause bad side effects.

I wanted to leave it at that. Take a few weeks. See how Bob does. See if we can put some weight back on him. But last night, I started to worry. I found out that this mass could rupture and Bob would die in a few hours. It could also start to cause fluid to fill up his abdomen. It's also HUGE and we need to remember it's NOT going to get any smaller.

Perhaps the time to act is NOW while Bob is still BOB. Before he starts to slip into a weakened state where I have no options to help him other than give him a peaceful farewell.

BUT...with the liver, you have to do a “wedge” biopsy. This is SURGERY. You can't get a good liver sample using a guided ultrasound needle biopsy. The cat has to be carved open and they get a chunk out. DO they take the entire mass out at that time? Maybe. I don't know. Do they look inside and see what ELSE is going on? Look for more signs of cancer? Yes. Will they potentially see that Bob cannot be saved or helped..that it is too far gone and too severe..that it would be CRUEL to wake him up out of sedation and better to let him die on the table?

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©2010 Robin A.F. Olson. Last week. Bob enjoying catnip pillow.

I can put my foot down about some things. I can tell them that under no circumstances are they to let that cat die on the table, but it's serious, expensive surgery and the recovery has to be considered, as well...and the fact that Christmas is coming and that means Vets and their staff may be tougher to come by during the recovery process. Is it better to wait until after the Holidays or get to it NOW while Bob is at the best place in his health, he can be?

I know so many of you have faced a situation like this. There is no clear cut answer. There is no knowing if what is done will help your cat in any way. There is no way to know if it will significantly shorten the life of your cat, too.

There is just no knowing...and that is a heartache no one should have to bear.

When the Going Gets Tough

I know this road. I've walked it more times than I care to recall. It's the moment at which I realize the time I have with one of my cats is coming to an end. The road is full of hopeful moments that will ultimately lead to despair and to the final choice we must make for our cat, one day.

I hate this road more than I can say. It eats at my heart and taxes my reserves. I try to prepare myself, but there is no preparing for death. It comes, as it does for all of us. We either accept it and find peace or fight and have the same end, no matter what.

On Saturday I got Bob's blood test results. His liver function, one test indicated by his ALT, was stratospherically high. A normal value would be 10-100. Bob was at 1240.

Other liver values were also very high, save for his Bilirubin, no it's not a sandwich, it's a blood test. That test result was normal. This is a good thing.

From Cat World, Australia, I found this description of Bilirubin:

Bilirubin: This is a major breakdown product of red blood cells. When red blood cells wear out they are trapped in the spleen and destroyed, releasing bilirubin into the blood. This type of bilirubin is called unconjugated. This bilirubin is transported in the blood to the liver, where it is taken up & conjugated (joined with glycuronic acid). This conjugated form may either be stored in the liver cells or excreted into the bile. Bilirubin levels are increased in cats with liver disease, gallbladder disease or have excessive destruction of red blood cells (known as hemolysis).

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What do these numbers mean? See THIS web site for some helpful guidelines.

Then the kicker came today. Bob had an ultrasound done of his heart and abdomen. I thought I was going to be able to sit in during the ultrasound, but Dr. K said it would be quicker if he was on his own. Super Deb assured me she'd be with him and answer any questions. I kept thinking about this and that thing I wanted to make sure he knew, but in the end, nothing I was worried about mattered.

I took Super Deb's dog, Jayne for a walk, instead of twiddling my thumbs in the waiting room. It was freezing cold outside with a bitter wind. I tried to shake off the fear of what I would find out in a few more minutes. I tried to not cry thinking about it. I know as any good cat-parent knows-something is wrong, I just didn't know what it was. I didn't really WANT to know.

When I returned to Dr. Larry's office, grabbed a magazine about celebrities and their fabulous lives and pretended to look at it. I saw Super Deb. She wouldn't make eye contact with me. Then Dr. Larry arrived to start his day. He didn't even look towards the waiting room. Maybe it was not a big deal that he didn't look, but it seemed like no one wanted to even give me a hint as to what was going on.

Sam arrived with Petunia and Nora. He sat next to me, but we didn't speak. It's been a common thread here for a very long time. We only speak when necessary. Something is going on with Sam. I can guess, but he won't talk to me about it. Instead he hides in his office in the basement and plays his guitar. He mumbles this and that. He helps out around the house, in silence. Each day I grow a little more resentful, more angry. I am shut out and alone. I didn't do anything wrong. I can't wait forever for his life to be in a place where he feels like being a partner to me again. I'm still suffering from the car accident, in tremendous pain, but he does nothing. No comforting. No nothing. With all the stress I have about Bob, he only taps my shoulder or brushes my hand. When I need him most, he is the furthest away. I have to ask myself how many more years can this go on? What happened to having joy? Companionship? Even a dear friendship? For so long I have tried to encourage him to trust me, to talk to me, to give him guidance and support, but I am tired of trying.

So, Sam is there, but not there. I am there, but wishing I was somewhere else.

Petunia is getting a dental. One of her molars has a HOLE in it! Was THIS what was causing her to go on a pee-storm throughout the house? Fight with the other cats? Did she also have a urinary tract infection or impacted anal glads? While under anesthesia we'd be finding out. Maybe after all these years, I'd finally have a true end to the inappropriate urination going on in my home.

Nora was there to check her foot. We thought she had ringworm, but turns out she did not. She has some sort of fungal infection on one foot. It hasn't spread. We've treated it and it's getting better. But what about BOB??! Will someone please TELL ME what is GOING ON?

Dr. Larry took a deep breath. That was all he had to do. I knew it was bad news and he was preparing himself to speak.

Bob's heart is normal, which is very good, but...

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Fun with ultrasound results.

As you can see, above, the many LONG words that I can't make heads or tails of spell out that Bob has a 5 cm mass present in the right lobe of his liver. It is not possible to tell if it's a cancer or if it's a benign tumor that could be treated or removed surgically.

With FIV+ and being a senior cat, Bob may not be a good candidate for surgery. He may have cancer and if they do the surgery they will open him up, then say they have to put him down. That it would not be fair to wake him up when he will only live a little while longer, anyway. It's a big crap shoot.

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©2010 Robin A.F. Olson. Bob ponders his future (on his new blanket from Jennifer)

Thanks to one of my readers who works with FIV+ and Feline Leukemia positive cats, she told me something shocking:

...for any kitty that has been tested since the beginning of this year with the new IDEXX 3-way test (FIV/FeLV/HW), you cannot trust ANY positive result on the FIV or FeLV component: incredibly high rate of false positives, confirmed by retests with the western blot for FIV or the IFA for FeLV. the true positive rate on retest is the normal, VERY LOW, percentage. (and, of course, the FeLV component only tests for EXPOSURE, and most cats are able to process the virus out of their systems, which is why retesting is imperative. usually, the retest should be done 90-120 days after last exposure, but with the nationwide problems on the new test, we-who-get-the-panicked-calls-to-place-these-cats are advising that cats be retested immediately. (IDEXX does know about the problem, and will admit it to vets; however, tho they've asked for the names and contact info for those who have stats--national rescues, and special-needs sanctuaries--they've never followed up when they were provided with same.

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©2010 Robin A.F. Olson. Blitzen and Nicky try to cheer Bob up.

Even though Bob was tested years ago, this is the time to make SURE he is FIV+ because that will effect his ability to get a surgeon to take on his case. Because he was not neutered at an appropriate age, he got FIV. This is my Mother's fault and I will never forgive her for not caring for her cat. His life would have been so much better if he'd been neutered sooner and not left outdoors to get into fights with other territorial males.

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©2010 Robin A.F. Olson. Blitzen decides to lick Bob's head while Nicky is...Nicky.

I started to cry when I got the news...big, shaky tears. I tried not to cry, but he knew I couldn't hold back. Dr. Larry rubbed my arm and told me about a woman whose dog had the same thing Bob does. That he opened the dog up and saw the mass and called the owner and said he should put the dog down. The mass was too big. The dog would die anyway. She was going through a bad divorce. The dog was all she had. She demanded he cut the mass off-so he took half the liver. The dog lived...another two and a half YEARS. But Bob's not that dog and Bob could have cancer and Bob has FIV+ and he's a senior...blah blah blah...

©2010 Robin A.F. Olson. Blitzen being cute, as usual.

I just wanted to fall over, curl up in a ball and weep. But that won't help Bob get better or live a bit longer, at least.

So I asked a few questions, then left the exam room. The first thing I saw was Moonpie's face! His new owner, as promised, brought Moonie and Patty to meet Dr. Larry now that they are adopted. I couldn't have been happier to see their friendly faces. I took Moonie out of his cat carrier and held him. He sat comfortably in my arms. Both cats meowed furiously at me. I hope they weren't asking me to take them home. I wanted to, but they will be happy in their new home one day. Right now they're doing well, but are still scared. Their new owner says that each day the calm down a bit more and become a bit more cuddly. With three young boys to play with, it's a big change for them. I told her to give it a month and that I'm always there for her whenever she had a question. She told me to come visit them any time. It would be too tempting to sneak them back home with me, but it was really GOOD to see them again.

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©2010 Robin A.F. Olson. My boy, Bob.

We loaded Bob into the car, alongside Nora and drove separately home. I got Bob fed and gave him his liver medicine. He ate well, then went to his heated bed for a nap. It was just like any other day, completely unremarkable, save for the part that I know there may not be many more such unremarkable days ahead.

Not Bob.

The other day I noticed that Bob looked dramatically thinner. It seemed to happen overnight. I know that Bob's a senior and seniors always seem to lose that padding in either side of their back, near their hips. I tried not to freak out. Bob is eating well and has some “spunk.” Even goes after Blitzen to play once in awhile. Since we're at the tail end (pardon the pun) of a rash of upper respiratory here, I thought I'd have Bob checked out. He's vomited a few times, but not often enough to concern me and his eyes seem a bit sunken.

This morning I took Bob and Petunia to visit Dr. Larry. I thought it would go fairly smoothly for Bob. He's been in pretty good shape for a senior with FIV+. Then Super-Deb weighed him. He's lost over ONE POUND since September.

Then Dr. Larry started to feel Bob's abdomen. He had an odd look on his face. My heart sank.

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©2010 Robin A.F. Olson. Bob, his usual calm self waiting for his X-ray results.

It wasn't that he felt a specific mass, but something didn't feel quite right so he had Super Deb take him to get X-rayed. Dr. Larry stepped out of the exam room. My heart started to pound in my chest. I had a flashback to 8 years ago when Dr. Larry was gone for a good 20 minutes, supposedly looking at x-rays of my cat, Squeegee. I think it took that long because he didn't want to tell me her cancer had spread to her lungs and that she only had a few months left to live.

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©2010 Robin A.F. Olson. Bob's X-ray. The area in the center, left is the area of concern.

I love Bob so much. That he was my Mother's cat, makes him even more precious to me. He's the last reminder I have of her, though I have to add, she NEVER took Bob to the Vet. We used to fight about it. That's why Bob has FIV+ now. He was left outdoors during the day and he wasn't neutered until he was well into adulthood. I managed to bully my Mother into getting it done, but by then it was too late for Bob. I realize how ironic it is to have a cat that reminds me of fighting with my mother, but I'm more devoted to making sure Bob has the BEST Vet care because of how poorly he was treated in the past.

The x-rays showed something wasn't quite right. Dr. Larry talked about cancer or a benign liver tumor that is completely operable or something else...I started to cry. I didn't want to but I couldn't help it. I know Bob won't live forever. None of us will. But I want Bob to live forever. Is that too much to ask?

They pulled blood and I'll have results tomorrow. Bob's always had high liver values, called ALT, so it wouldn't be a surprise that there is something going on with his Liver. Super Deb just called me to let me know that they pulled some strings and a very well respected radiologist is going to be giving Bob an ultrasound on Tuesday-far sooner than I had hoped.

So now I wait and try not to freak out when I don't have all the information, but I can't help it. It's Bob.

Not Bob.


Not on My Watch: All the Kings Horses...

It's tough to write through tears, but I will do my best. The big Maine Coon kitty, who was dumped at Henry County has been euthanized.

What started off as a morning filled with promise, ended with despair. Big Boy was rescued. I thought I was going to be the one to do it, but Barb, from WCR beat me to it. I was glad she could do the job. I don't have the resources she does and I didn't know where he would go IF he was ever stable enough to be transported. Barb had plans for him, but sadly, they never came to pass.

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©2010 Henry Co. Care & Control. We lost a great cat today. Rest in Peace, Big Boy.

Our Bobby picked up Big Boy from the shelter. They had him all ready to go. The staff was so happy to see him leave. Bobby told me he was as friendly as they come. A big, sweet kitty, very thin, but he didn't seem to be ailing, just thin. It gave me hope that perhaps he just needed some good food and love and the rest would improve over time.

I thought of Chester, at 21, surviving without food or water or shelter for days and having the strength to come back. I hoped the same would be true for this beautiful cat.

Bobby told me the Vet Tech thought the cat was very old. When I heard the news, my heart sank. I feared the worst and indeed my fears were not unfounded. The kitty had a snap test done, which indicated he was FIV+. That alone would not warrant a death sentence, but the cat was also, over 17 years old, had very bad teeth, an eye problem, liver failure, kidney disease and was emaciated. He was facing his last days before he was brought to the Shelter and now they realized, it would be more humane to peacefully end his life.

I have been very lucky and I know that won't always be the case. I've never had to make the choice to euthanize a foster cat. I hope I never do, but that's not realistic. Barb had to make a very tough choice, but she did what was best for the cat.

This afternoon, the big Maine Coon was held in the arms of a very loving and compassionate Vet Tech as he was administered the shots that would end his life. If nothing else, this cat knew love in his last moments. It has to be worth something-even if his life could not truly be saved.

Bobby wrote me with the news of the sweet boy's passing. He said we should honor him by rescuing MORE cats and I have to say, that sounds good to me. As soon as I can, I'm going to rescue a maine coon (or more than one) in his honor.

For now, we cry our tears and feel heartbroken that we only got to know this cat on his final day. There are so many more cats in need, who are at death's door, who we must find a way to help.

Let's all take a pledge today, to do at least ONE THING to save a cat's life TODAY. Donate $1 (or more if you can) to a cat rescue group, like Barb's, donate used linens or buy food for your local shelter, adopt or foster a cat. Do this one thing in honor of this wonderful cat, who can watch us from the Rainbow Bridge and purr with joy that his death was not without meaning.

What Time Is It? It's 2:30 (tooth-hurty).

I learned at an early age that I would never be a sports heroine when instead of gracefully grabbing a fly ball in my mitt, I caught it with my FACE. The ball hit me on my upper lip, chipping my top two and bottom front two teeth. I was 9. I was wearing the new, matching bright orange polyester short set my Mother had just got me from K-Mart. I was terrified I'd get blood on my clothes and get yelled at, so while I was screaming and squirting blood, I held my head forward to drip onto the ground, as I walked the three (hundred, it seemed) blocks back to my family's house.

I was lucky that just about at that time, my Dentist had learned about a new procedure where you could use some sort of concrete (or whatever) and bond it onto the chipped teeth. He did the repair, while I was trying not to pass out from having all the nerves exposed in my teeth.

The repair lasted all these MANY years, but it was discolored and the bonded material was chipping away over time. It didn't look great and my front teeth, well, they aren't so aesthetically pleasing, anyway, Dentist, Dr. David, who is awesome, who I share the same birthday with, same day and YEAR, has been after me to get veneers.

What a complete waste of money. Pure vanity! Just re-bond the teeth and be done. But the re-bonding won't ever match and will discolor. The material will fail and I will still have teeth that flare out at the bottom, like an outdated skirt from Goodwill.

We're about to lose our Health Insurance and I had some money left to use in the dental plan. I figured I was going to get about 25% off if I did the veneers, so in case I ever become famous, I figured, why not?

Let's just say, that although Dr. David is a fine Dentist and I really like him a lot, I can't understand how celebrities get a full set of these things. Holy crap! It's not that painful during, well not painful at all, but afterwards, yikes, not fun, but the WORST is when the temporaries come off and you get to hear your temporaries being CRACKED, following by pieces of the material falling down your shirt. I know I'm going to have nightmares about this.

After the chipping, cracking, buzz sawing, I was left with a fat lip, numb inside my nose and gums and with a much nicer smile. I will post before and after photos, maybe.

Bob Dole, my cat, also went to the dentist, well, he saw Dr. Larry. Since Bob has FIV+, he's prone to having gum/teeth problems. Bob's down to about 6 teeth and we're doing all we can to KEEP what he has left. Dr. Larry told me that Bob had a nasty looking molar and that it needed work now to prevent it from having to come out later. We ran the usual blood panel and everything looked normal, except for Bob's ALT. Bob has never had a normal ALT, but word was it was not as high as it had been in the past. I give kudos to his raw diet and no-more-kibble nutrition for making a difference.

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That said, all the good blood work in the world wasn't going to assure me that the sedation wouldn't kill Bob or mess him up badly. I hate having Bob sedated and I'm sure I'm a pain in the ass about asking to have someone call me the second he's awake and the procedure is done. Bob's old. I don't know how old, but maybe 14 or so?

The other thing Bob needed was a haircut. I do brush him, but not often enough. He gets nasty mats and with the warm weather upon us, I thought that for once I'd get him a “lion cut” which would remove all the mats and give him a fresh look for the summer. I hoped he wouldn't be embarrassed.

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Bob took it like a champ. Bob is unflappable unless he's hungry-then there's a LOT of flapping. Sam and I picked him up at 6:30pm. We got to see him in his cage. The cage card had “FIV+” highlighted in marker, under his name. It made me sad. Bob had to be separated from the other animals. I never think about him being contagious to anyone. In fact, I am going to have his combo test re-run. I dunno...are there false positives?

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Bob looked a bit sad. He didn't have any teeth extracted, which was great, so I knew he would be too uncomfortable. I called to him and opened the cage door. He looked so odd! It was if there was Bob's head, attached to another body all together. I could still see the mackerel stripes where his fur was trimmed away. He feels very nice and smooth and has very cute fur “boots” on this legs. Super Deb, knew I'd be posting photos of her work, so she made sure to do an extra nice job. I never thought writing a Blog would bring a perk like that! Yes, Super-Deb, you will still be called “Super.” You did a good job. I think Bob appreciates, too, that you “expressed” his anal glands (if you want to read more about why cats need their anal glands cleaned out, see my post here). I'm sorry I didn't notice he was having a problem back there! I was also surprised that Bob has STUD tail! What's up with that? I guess once a stud, always a stud.

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Bob's home now and crabby. He wants to eat. I'm not supposed to feed him, so I fed him a little bit. He wants more and is hissing at all the other cats and checking out their empty plates for a scrap to eat. I want to eat, but my gums are killing me and the nerves in my front teeth are throbbing. I'm crabby, too. Sam had a crown replaced yesterday and a filling done a few days ago, but somehow he remains crabby-free. It's been “2:30” for too long. Here's hoping for a time change coming soon.(crossing paws).


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