Staying Strong for Gracie: Part 11. The Results.

(Continued from Parts 1, 2 and 3, 4, 5, 6, 7, 8, 9 and 10)

Gracie was flat the next few days. The toll of the sedation and stress from the travel really got to her. We’d been through these lows before after every test and with any luck, Gracie would begin to perk back up. We just had to make certain Gracie’s medication schedule was kept on track and that if she wasn’t eating enough we’d syringe feed her to get the extra calories into her.

Gracie had lost some muscle mass and felt very thin, even though her belly was round from the fluids in her abdomen. I foolishly thought that if we were getting Gracie to eat 5 or so small meals, it would add up to enough calories for a day. I was very wrong. I knew it as I ran my hand along her spine and felt the padding slowly vanish over the course of a week or so. I knew I had to do more so that meant doing math, but first I had to find out how many calories to feed Gracie.

Dr. Carolyn said to aim for 200 a day. Once I sat down and read labels, then had to get on the internet to do research because far too many cat food companies don’t include calorie counts on their labels. I realized that Gracie was grossly underfed even though she WAS eating. She’d only eat about 1.0 oz of food per meal and many of the foods were only 20-25 or so calories per ounce. It meant if she was lucky she was getting a little over 100 calories a day. We HAD to do a better job ASAP.

I returned to my trusty notepad. Sam bought a food processor so we could blend down the foods we knew were better quality and higher in calories. We could also use prescription emergency support foods but I didn’t like some of the ingredients as much. We’d have to experiment because our goal was not just to provide nutrition to Gracie, but to make it as tasty and as positive of an experience as possible. We didn’t want Gracie to feel miserable even though we felt miserable having to take this step.

©2007 Robin AF Olson. My beautiful girl just after the New Year, 2007.

I always keep 35 mL syringes on hand. I like them for syringe feeding because the tip is rather long and they hold a good amount of food. There’s no hard and fast rule about exactly how many cc’s to feed because some cats can’t handle much and others can handle a bit more. It was trial and error all the way and some times the error really upset me because I didn’t want to make things worse for Gracie.

Friday arrived and Gracie acted a bit perkier. We’d just begun to give her a second dose of prednisilone (steroids) and it clearly was helping. Buoyed by her good spirits I could focus on getting some much needed and overdue work done, even though in the back of my mind I knew that today was the day we’d possibly get some concrete news about Gracie’s future.

Late in the day Dr. Carolyn called. The all-too familiar lump in my gut returned as I tried to calmly answer the phone. I reached for another note pad so I could distract myself by taking notes.

Delivering bad news must be something Vets get a lot of practice doing as Dr. Carolyn described what the report said. She was calm and not alarmist so I remained calm, but as she spoke I felt my body begin to slump against my chair.

She paraphrased the medical jargon by saying that we still had NO DIFFERENTIAL DIAGNOSIS. There was NO sign of CANCER, but…

…now Gracie had something called Myelodysplasia.

“Myelodysplasia (myelodysplastic syndrome, MDS) is considered a preleukemic syndrome characterized by ineffective hematopoiesis, resulting in a nonregenerative anemia or other cytopenias. MDS has been described in dogs, cats, and people. The disease can be primary or secondary and is commonly seen in cats with feline leukemia. Primary syndromes probably arise from mutations in stem cells. Secondary syndromes are caused by other neoplasia or drug therapy. Some cats and dogs respond to treatment with recombinant human erythropoietin and prednisone. Supportive care with transfusions may be helpful. Survival is variable because MDS can progress to leukemia; many animals are euthanized or die of sepsis, bleeding, or anemia.”

So basically Gracie’s bone marrow wasn’t working right any more and with low white blood cells and platelets it was dangerous for her to be around other cats because she could easily pick up disease from them. Since she didn't have Feline Leukemia (she'd been tested multiple times for it) I asked what this could be coming from and Dr. Carolyn said either a toxic event or most likely a very bad cancer, probably in the liver. I asked her if there was anything more we should do, treatments or medications. She replied that what we should isolate Gracie (that was NOT going to happen-it was too late now and honestly not fair to put her away in a room by herself at this point. We'd keep our hands washed and she already had her own dishes and litter pan) were doing was good for now and that we should re-test Gracie’s blood work in two weeks. If she was perking up, that was great, it could mean this was immune mediated and that perhaps she’d do okay for a time. We didn’t need to return to see Dr. Carolyn, but if Gracie improved enough we could think about doing the liver biopsy again.

Sam and I began to read as much as we could about MDS, but there wasn’t a lot out there. MDS is rare in cats and there aren’t a plethora of treatments for it. One of them, darbepoetin, could help for a time, but it's very confusing on whether or not anything would help her now. I kept thinking about how Gracie got so sick right after her dental procedure and how that my Vet had just moved his office, he didn’t do the procedure and things were chaotic at his practice. Maybe someone made an error and this, indeed was due to a toxic exposure. A rage began to build inside me that had my mind going to very dark places. At my Vet’s office we joked about not giving my cats Metacam, EVER and now I wondered if that was what was killing my cat, or did she get an overdose of medications with all the other chaos going on with the Vet's moving...because WHERE is the CANCER? We’d done THREE biopsies and NONE had shown cancer.

If this was a toxic event I realized I would have to end my 20+ year friendship with my own Vet—someone who I consider family, whose staff I count as friends. I had to tread very carefully if I was going to go down this path. I needed to calm down and get information about the details of the dental cleaning. I put in a call to speak with Dr. Larry. I was terrified of jeopardizing our relationship, but I needed answers. I knew he would be honest with me even if it was something I didn't want to hear. If they made an error then it would be devastating, but more than anything, I only wanted what I’d wanted these past three months, to find out what was slowly killing my sweet cat and I was desperate for answers.

next up...a consensus on Gracie's illness and the remarkable gift she gave us.