Sally's Regime

Here is our daily routine.

The white board is used to keep track of Sally's chemo days. She takes her Leukeran every other day so I need some help keeping track of it. I also use it to note when she needs appointments for CBCs, ultrasounds, B-12 shots, etc.

The pill bottle on the left is the Leukeran (brand name for Chlorambucil). I have to wear gloves when handling it, especially when it's cut in half. It's a 2 mg pill and she takes 1 mg every other day. It has to be refrigerated to keep it in an inactive state. It's a carcinogen so it's vital to handle it correctly. The pill gun in the plastic bag marked "Chemo Only" is used only for Leukeran.

The three pill bottles in the center from left to right are Lasix (brand name for Furosemide), Diltiazem and Enalapril. These are her heart meds. She takes 1/2 tablet of Furosemide every 12 hours, 1/4 tablet of Diltiazem every 12 hours and a whole Enalapril once a day.

Diltiazem is our old friend. She has been taking it since she was 2. It is a calcium channel blocker that relaxes her heart muscle. Her Hypertrophic Cardiomyopathy causes the heart muscle to thicken and stiffen up, interfering with normal heart function. In Sally's case, it effects her left ventricle.

Enalapril is her newest med. Her cardiologist, Dr. Orvahlo, prescribed it for her after an unltrasound last May revealed mitral valve regurgitation. The mitral valve is where the blood re-enters the heart from the lungs. Sally's leaks. Enalapril is an ACE Inhibitor and, among other things, lowers her blood pressure to take the stress off her mitral valve. It has the unfortunate side effect of putting strain on her kidneys so that's why she has her kidney values checked every time she has a CBC.

Furosemide is a diuretic. It keeps fluid from building up in her chest. It was prescribed for her after her first episode of congestive heart failure last May. It works like a dehydrator so she drinks A LOT of water. It also causes her kidneys to work harder.

The small vial in the center is B-12. The syringes next to the bottle are very small. Her dosage is 1/4 cc. She was found to be deficient as a result of the thickening and layering in her intestines caused by her lymphoma. B-12 deficiency is serious all on its own and can make cats VERY ill. She now gets an injection every time she gets her CBC because I can not bring myself to do the injecting. Sally has no body fat and the shot needs to be given in a muscle. She's very tricky to inject. Dr. Hansche and some of the techs have had trouble with her too so I'm glad to know it's not just me!

The Cosequin for her arthritis is in the box. It's powder in a capsule so I sprinkle one over her canned food in the morning.

Next to the box is a pill cutter, her pill gun and her daily pill minder.

I give her a small amount of canned food every time she gets pills for several reasons. She can't hide them in the corner of her mouth to spit out later if she eats. Also, since she's getting several meds at a time, I figured it would be easier on her stomach if there was a little food in there too. She thinks she's getting a treat for being a good girl. She is actually very easy to pill, at least for me. We've just had lots of experience!

Dr. Hansche okayed giving a 1/4 of a Pepcid to help with nausea in the early days of her chemo. Before I could start giving it to her, the vomiting went away but we have it in case she ever needs it.

Sally can't have raw food or vaccinations because she's on chemo. Even though her red and white blood cell counts are normal now, her immune system is compromised because of the Leukeran. A little repsiratory infection could potentially turn into pneumonia so we have to be careful that she doesn't get sick.

Sally only gets filtered water. She drinks a lot because of her kidney disease and Oceanside's water is very very hard.



Here is her dry food. I buy a 6 lb bag of Royal Canin Prescription Limited Ingredient Diet Duck and Green Pea and mix it with a 4 lb bag of Prescription Diet K/D. They are both low in protein to help relieve some of the strain on her kidneys.

All of these things help us manage her lymphoma, HCM, CRF, mitral valve regurgitation and arthritis. Some days I don't know how I keep it straight but it's all vital to keep my little girl alive and healthy.

RC - $35 per bag
K/D - $18 per bag
Leukeran - $53 for an 8 week supply
Furosemide - $9 for a 60 day supply
Enalapril - $4 for a 30 day supply
Diltiazem - $4 for a 90 day supply
B-12 & syringes - no charge (thanks to Dr. Hansche)
Cosequin - $20 for 80 capsules
Pill gun - $8 each
Pill cutter - $10 each
CBC - $120 every 3 months
Cardiac Ultrasound - $495 + $75 office visit once/year
Abdominal Ultrasound - $395 + $75 office visit once/year

Healthy & happy cat in remission - priceless!

Finding Our Groove

Just because Sally is in remission, it doesn't mean that the fun ends. Not by any means!

After her ultrasound, Dr. Richter recommended CBCs every 8 weeks. Her kidney values were still a concern and just because she had been tolerating the Leukeran well didn't mean that things couldn't change. Fortunately they could be done by Dr. Hansche because Dr. Richter was comfortable with flow of information between the two offices.

I had been researching cat food online, looking for the optimum brand that would meet all her needs. IBD dictates a high protein/little or no grain diet. The common belief among owners of lymphoma cats is that carbs feed cancer so little or no carbs is best. Heart issues need low sodium. Ideally she should be eating canned food but Sally always has been a grazer. You simply can't leave canned food out all day - especially the fish flavor they like - without your house smelling to high heaven! So after weeks of looking, I settled on EVO dry. I figured I'd run it by Dr. Hansche to make sure it was okay. No way Jose. Dr. H said that cats with kidney disease need as low protein as possible.

Okay, back to square one. The K/D dry she was already eating is the lowest with 21%. The Eukanuba I was mixing it with was 34% so that had to go. Do you know how hard it is to find a food that means all of her requirements? Next to impossible! But I did find one that seemed to meet every point. Royal Canin Limited Ingredient Lamb & Green Pea. A novelty protein, no grains and only 30% protein. I convinced Dr. Hansche to write her a prescription for it.

Opinion is divided on how protein effects cat's kidneys. Several members of the IBD and CRF groups I belonged to on Yahoo told me I was making a mistake. But hey, Sally LOVED the taste and it couldn't hurt her so I decided to go with my gut instinct.

CBC done September 30th. Weight stable at 8 lbs 4 ozs. Dr. Hansche is VERY pleased with how Sally is looking. He called with the results the following Wednesday. RBC and WBC normal. Kidney values DOWN for the first time in three months!!!! Her creatinine had gone from 3.4 in August to 2.8. Normal is 0-2.4 so she was getting closer! Ah, I love being right!!

We discussed her wobbly legs again as she seemed to be getting more unsteady on her feet. Dr. Hansche felt that it was arthritis which at her age wouldn't be unusual. Unfortunately, the normal treatment for it is Prednisone so that only left us with doing nothing or giving her pain meds. I didn't feel like her legs were keeping her from moving around, she was just very stiff when she first got up. We decided to just keep an eye on it and see how things progressed.

For the next two months, things seemed to be pretty stable. Her next CBC would be just after Thanksgiving. But before then, a very important day. Sally's 14th birthday! I made chicken and dumplings for dinner that night because she just loves to eat the chicken out of it. She gave me a wonderful present that morning and did something she hadn't done in a very long time. She jumped to the top of her barrel and wanted to look out the window. She was pretty wobbly and for a minute I thought she would fall, but she found a good spot and got stabilized and wound up sitting there for quite a while. I almost wanted to cry. I couldn't remember the last time I had seen this sight.


I picked out a thank you card to send Dr. Hansche and told him how grateful I was for the care he had given Sally and Emily over the last few months. I thanked him for giving me the chance to have Sally for another birthday. I don't think a day in her life has had as much meaning for me as November 3, 2008.

Thanksgiving came and with it a foil wrapped package from grandma. Mmmm, turkey!! Sally ate a huge pile of it as soon as we came home!

Next CBC November 25th. Things still good but now almost positive that the wobbly legs are arthritis. The weekend before this appointment I had picked Sally up right after she got up on Saturday morning and she growled at me. She has NEVER growled at me. Ever. It scared me at first but then I realized that I had picked her up on her right side and it seemed like her right leg was weaker than the left. Unfortunately, we just have to watch her and if she seems to be painful, pain meds are about the only option. CBC results - Creatinine now down to 2.7. Way to go!!

The weather started getting very cold (at least for the southern California coast), barely climbing out of the mid 5o's during the day. Sally started spending more and more time on our bed, getting down only to eat and use her litter box. Legs very unsteady and also noticing that her wrists are unstable and look like they won't lock up and support her. I talked about it on Catster and had several fellow seniors recommend Cosequin, a glucosamine supplement made especially for cats. I'm not a big believer in supplements and herbal remedies. I think they can be helpful in certain situations but not enough is known about them and their interactions. I had gotten a lot of recommendations and suggestions of all different kinds of things to give her for her heart, kidneys and cancer but didn't trust any of them. The suggestions for Cosequin came from sources that I trusted very much, like Sally's guardian angel kitty's older sister and a 20 year old Siamese that helped run the "Olde Furts" group that she belonged to on Catster. I asked Dr. Hansche about it and he said that it couldn't hurt her but warned that it took a good 8-10 weeks to see results. I found some online and started giving it to her shortly before Christmas. There were 80 capsules in the box. I'd see how she was doing at the end of the box and if I didn't see any improvement I wouldn't order it again. In the meantime, we started leaving the electric blanket on for her, much to her delight!

A new year. A grateful mama and a happy kitty. What more could one ask for?

February 7th and another CBC. A little disappointed that for the first time in 6 months, Sally's weight is below 8 lbs. She's at 7 lbs 15 ozs, but with her diminished activity during the winter because of her arthritis, Dr. Hansche wasn't overly concerned. The good news is that the Cosequin seems to be helping. While still wobbly, Sally is now moving easier and less stiffly. She's even been caught galloping around at night when she thought no one was watching. A full panel wasn't done this time so we don't know her kidney values but her RBC and WBC are still perfectly normal.

We seem to have found our groove. Now we just have to maintain this delicate balance!