Bob's Battle with Lymphoma: The Slippery Slope

Five weeks ago, Bob had his 11th round of chemo to treat his small t-cell mesenteric lymphoma. Up to that point he was doing pretty well. He even gained 1 OUNCE, the first gain of the past seven months. I was really thrilled. Here we were, six months into chemo and maybe Bob was going to surprise all of us.

A few days after chemo, Bob began vomiting. He would be hungry, eat, then vomit right afterwards. It was very alarming after him doing so well. I quickly gave him one dose of reglan, to stop the vomiting. It worked, but Bob didn't want to eat any more.

Bob would only lick at his food for a moment, then walk away. I tried 10 or more times a day to feed him a wide assortment of food, in desperation to find the one thing he would eat.

A few days later, I saw Bob in the litter pan. It was clear he had very very severe diarrhea. My heart sank.

I gave Bob some yogurt (plain), some acidophilus pearls, thinking it would help. I found Bob something he would eat. It wasn't what I would prefer he eat, but it was a fairly good quality canned food.

©2011 Robin A.F. Olson. Bob is dwarfed by Nick (left) and Nora (center) who are both 10 pounds heavier.

Since he was eating a bit, I thought he was getting better, but it was my mistake. I wasn't observant enough. Bob was losing weight quickly and just not eating enough to make up for it. The most horrifying thing was that I did not realize his diarrhea was NOT resolved until TEN DAYS had passed. Bob was VERY THIN. I saw he was still sick and got him on Flagyl.

Flagyl works well to treat a number of issues. Barbara Forney, VMD states: “Metronidazole is an antibiotic that is used commonly to treat protozoal infections and anaerobic bacterial infections. It also has anti-inflammatory effects in the bowel. Metronidazole is bactericidal; it kills bacterial microorganisms by disrupting their DNA. It is absorbed rapidly from the GI tract, metabolized by the liver and excreted in the urine and the feces.” It can really help calm down a GI tract and in Bob's case, it worked great.

Bob's appetite picked up, but clearly he was in dire shape. I took hi to the Vet and had him get sub-q fluids to replace all he had lost being sick. That helped him feel more comfortable and he continued to eat well.

The problem with Flagyl is it's very tough on the liver and as you may know, Bob only has 1/2 a liver and his ALT (liver enzymes) are already extremely elevated. This is the slippery slope. Does the benefit outweigh the additional strain on his liver? Bob HAD to eat and he wasn't well enough to do so without it.

©2011 Robin A.F. Olson. Some rest after being medicated, yet again.

Yesterday, Bob had to have his next round of chemo. I was very concerned that we might need to stop since Bob was just barely back on his feet after the last time. We talked at length. This time we would take precautions and treat Bob before he really has a reaction to the chemo. We'd start with a low dose of Flagyl and Cerenia, just for a few days, right after the chemo. Perhaps it would help Bob continue to eat well and put back some of what he lost. If not, it might be telling us that the Mitoxantrone was no longer effective. I wasn't surprised, but I was sad.

We got Bob's blood work back. His ALT is now over 1600. This is very bad, indeed. Bob has lost THREE POUNDS in 5 WEEKS.

I'm going to start syringe feeding him some high calorie food, in addition to the other meals he gets every few hours. I don't know that I can hold ground any more or help Bob get any better.

Dr. Joe, Bob's oncologist said that even despite what is going on, that Bob looked remarkably well and that they go by clinical signs over test results, to some degree. His fur is coming back. He looks more like a cat. Bob's eyes were sparkly and he had good energy even though he's at ten pounds now. The Dr could not feel a mass in Bob's stomach and that was another good sign. Bob has good quality of life, I just don't know how much longer that will be the case.

I just know that I'm sliding along this slippery slope. I'm trying everything I can to find something for Bob to eat that will fatten him up, but the damn cancer takes his nutrition from him. It steals away his life, little by little, until it wins, but in winning it ultimately lose, too.