Where Do We Go From Here? Up, Of Course!

So, two episodes of heart failure (5/2/08 & 5/19/08) resulting from fluid retention first caused by Prednisone and then Methylprednisone. Visit to Dr. Richter (internal medicine vet) and Dr. Orvahlo (cardiologist) on 5/23. The verdict: 3 month break from all steroids, continue with Leukeran, B12 shots, diuretic and start on half dosage of Enalapril for newly discovered mitral valve regurgitation. Check kidney function in 3 weeks. Follow up in 3 months. If cardiac function improved, then Budesonide can be tried as a replacement for Prednisone.

I brought Sally home, along with a tiny sliver of hope.

Thank god that Sally's been taking pills as long as she has!! Trying to poke 1/4 and 1/2 tablets down a 7 lb cat's tiny little throat is nearly impossible without the aid of Greenies Pill Pockets (which she won't touch) or a pill shooter (which has been my best friend since 1996).

We went back to ABC in 3 weeks for her follow up. This would be her very first CBC since starting Leukeran and Enalapril and I was a nervous wreck. If her white blood cell or red blood cell counts dropped, she would have to stop the Leukeran and all hope for her survival would be gone. If her kidney function was elevated, she would have to stop the Enalapril which was helping her battered little heart work better.

Finally! The first good news in 2 months!! Sally gained 6 ozs! Doesn't sound like much but it is when you're as small as she is. Yaay! All the hand feeding turkey 3-4 times a day was working! Dr. Hansche gave her the last of the four weekly B12 shots and drew blood for her CBC. Dr. Martin called the next day with the results. More good news!! Her white blood cell count dropped from the high of 26,000 to 16,500 (only slightly above normal). Red blood cell count normal. However, her BUN and creatinine levels were both elevated so Dr. Hansche would follow up with Dr. Richter to see if she should stay on Enalapril or not.

Mid week, Dr. H called to say Dr. R said to stay with the half dose for another 3 weeks and then re-check. 3 weeks go by with Sally continuing to vomit bile virtually every morning between 2-5 am. I had heard through the Yahoo Lymphoma group that cats can be given small doses of Pepcid to help with nausea and vomiting. I asked Dr. Hansche at her next follow up and he green lighted her for 1/4 tablet as needed. Another 3 ozs gained!! Dr. Martin called the next day. WBC down to 15,000 and RBC still perfectly normal. BUN and creatinine were still elevated but at the same levels as they had been 3 weeks prior. Dr. H followed up with Dr. R who said to try increasing Enalapril to 3/4 dose and follow up in 3 weeks to see how her kidneys were doing.

At this point, Sally had been on Leukeran for almost 8 weeks exactly. I had heard over and over that cats with small cell lymphoma took longer to show improvement on Leukeran, usually 8-10 weeks. As if by magic, right at 9 weeks, Sally turned a major corner. The daily vomiting stopped. Her energy level was better, she was interested in all her favorite things again, she began grooming herself again. She was now up to 7 lbs 13 ozs from her low of 7 lb 1 oz much to everyone's delight. I was starting to catch glimpses of my old girl again and nothing made me happier!

3 weeks and another CBC. Dr. Hansche was pleased at how much better Sally was looking. Another Sunday and another call from Dr. Martin with test results. WBC now 13,500, RBC normal, kidney function still elevated but still stable. Dr. Richter said to go for the full dose and check in 3 more weeks.

It was time for her 3 month re-check with Dr. Richter. With some anxiety, I scheduled her appointment for August 30th, the day before Emily's birthday. We were his first appointment that morning. I filled him in on her improvements and accomplishments. He wanted to do a follow up ultrasound to see how her intestines looked. He gathered her up and headed upstairs. I went out to the waiting room and held my breath.

About 20 minutes later, Dr. Richter came out with a look of complete surprise on his face. He uttered the words I couldn't have imagined hearing just four short months before: "No evidence of active cancer." Translation = REMISSION!! The layering and inflammation that had been so obvious in April were gone. All of her lymph nodes were normal. Pancreas normal looking. Kidneys looked about as expected for a cat with elevated values. But overall, he was amazed at how well she'd done on just Leukeran alone. He said that every trial he had ever seen had used a combination of a steroid and Leukeran and that the steroid proved to be the key component in achieving remission. He was frankly dumbfounded by her remission, but was pleased as could be with the outcome. He said she could now go to having her CBC done every 8 weeks and that she needed a follow up with Dr. Orvahlo to make sure her heart looked good. Obviously, no steroid was needed. She was to stay on Leukeran indefinitely.

I pratically ran out to the car. Who would I call first with the good news? Dorian? My mother? I sat in the car with her on the seat next to me and laughed and cried at the same time. I couldn't believe it! All of my hard work, tears and stress and Sally's determination and strength had paid off. My prayers had been answered! She looked at me as if I'd lost my mind. No one gives dirty looks better than a cat! Hers clearly said, "Stop that foolish noise and take me home!!"

So we headed home with something that had been absent for the last 6 months: hope for the future.