Five Weeks Later

A few days ago, I realized that I hadn't meditated since losing Lily. Been a little busy with this surgery recovery thing.

I closed my eyes and thought about meditating about Lily and she rushed into me. This warm, overwhelming, "where have you been Mama?" rush of unconditional love. If I hadn't been lying down, I would have been knocked down by it. It felt just like it would at bedtime, when Lily would come up onto the bed, rise up on her back feet to hug my neck and head butt my face, multiplied by about one thousand. I couldn't stay there long; it was so powerful.

Lily always was like that with me. Throwing herself at me with love. Debbie experienced some of this when Lily stayed at her house for 5 weeks in the spring. Lily would give Deb body slams during the night, wanting her belly rubbed.

Wow, next time I visit her, I'll go in more prepared.

Peace always, my Lily Belle

I helped Lily pass this evening, gently into the night, here at home. Her cancer was progressing rapidly.

Never again will I feel that soft paw on my leg, asking for food or attention.

Never again will I hear her scratch on her bedroom door, letting me know for the umpteenth time during the day that she wants to be let out.

Never again will I feel her body slam mine at night, as she asks for a belly rub.

Never again will I feel her cold, wet nose on my nose as she rubs my face.

Never again will I feel that rabbit-like fur, warm, and soft, and silky.

Never will I forget her joy with living, and her immense love for me, her one and only person.

My GA Ruby has been watching over Lily since we found out she had cancer, and has greeted her soul into the vastness.

Lily, this was my gift to you. I will keep you forever in my heart, and I will be forever with your soul.

Venita, October 25, 2008

Post on FDMB

I Reached the Mobile Vet

Lily will be euthanized tonight between 8:30 and 9 pm. She's not ready, but it is the best decision I can make given the circumstances.

I love you Lily Belle.

Struggling with a Decision

Today is the day that I was to take Lily for boarding for a week, so that she could be properly medicated while I am away from home for a breast reconstruction surgery.

She has been progressing downward rapidly, and I am concerned about her living her last few days away from me and terrified and not understanding why I have abandoned her. And if the vet has to euthanize her while she is there, I would be devastated that I was not with her to hold her while she passed.

I think I have a vet scheduled for a home euthanasia this evening, but I'm not sure because her answering machine was acting wacky. No message, no beep, just a long silence until that grating BEEP BEEP BEEP sound of a failed connection. I spoke to the vet in person, and this was going to be a "special" visit due to our circumstances, but I was to leave a message with name, phone number, and address.

If Lily is going in for boarding, she has to be there by 1pm. After that, I have made the PTS decision, but then what if the vet doesn't show up or I can't contact her.

Lily was doing better yesterday, even playing with the cat dancer, but this morning is having trouble breathing. There are blood splatters all over from when she sneezes.

Her leaving is inevitable, and under ordinary circumstances, I would wait until she gave me a sign. But these are clearly not ordinary circumstances.

I spoke to Deb last night, and she said she would prefer to remember Lily going out cat dancing.

Me too. I just hope I can get a message through to that vet this morning to confirm that we are on. I am so anxious about what would happen if come Sunday morning Lily is still here and I have no way to board her or euthanize her.

I'm waiting until a decent hour to call the mobile vet to make sure she is coming.

I'm Losing Her

The tumor in her mouth has returned, and it is growing fast. It has covered another tooth. It's not ulcerated, but it is getting red, probably from abrasion with food. I don't see any other tumors or holes in her mouth.

About 3 days ago, she started bleeding from her nose. This was from all the sneezing she was doing. And her eye is getting weepy from the blocked tear duct. I took the first picture 10/21/08.

The second picture is the next day, 10/22/08. It is clear to me that the tumor is getting bigger, and the eye is still weeping.

Now she is not sneezing as much, but is making a raspy noise when she purrs. It also seems that her breaths are deeper; I can see distinct rising and falling in her chest.

She is failing so much faster than I expected. I thought we would have a couple of months. Now I am truly wondering how I can possibly put her to board with the vet for five days starting on Saturday. (I have to leave town for a surgery.) She is semi-feral, and going out of the house terrifies her. Having strangers in the house terrifies her. Do I really want her final days to include being (or totally be) at a place that terrifies her. God, this reminds me of when I got her from the shelter and she clung to me, telling me that she truly did not want to be in that strange place

And just last night, we played with her cat dancer.

Symptoms Starting

Lily has been sneezing alot. Yesterday, her face was sweeling and her nose had a tiny touch of blood. I gave her 2.5mg of prednisone. I have a call into the vet about whether it is right to start medicating her. I am also looking for a local supply outlet for ES Clear. It's a supplement that supposed to slow the growth of cancer in cats.

Fun Things about Lily

Lily can do back flips. I hold her with both hands on her back, and raise her butt a bit, and she plips over onto her feet. She can do high board and low board.

Lily hugs. That's how I first fell in love with her. She crawled out of my arms, up around my neck, and hugged me--a paw on each side and her face buried into my neck. Lily hugs people at the vet's office. They don't realize that she's not loving on them--she's terrified.

Lily's hidden her aminal someplace again, so yesterday I went out to buy the one other toy she will play with. A cat dancer. This isn't a picture of Lily, although it looks like her. It's a stock photo of a cat with a cat dancer.


Lily will haul ass back and forth in the upstairs hallway. She only does it when no one is around. If we are sitting downstairs and hear the kathump-kathump-kathump, we both just smile and shake our heads.

Leaps Baby Gates

Thinking ahead to when Lily will be less safe mobilizing because of pain meds, I approached Craig's List for a baby gate and a dog crate. I picked up the baby gate yesterday.

Turns out Lily can leap over the thing. A clean jump, "no net." When it comes to the time we really need it, she won't be able to leap. However, being accustomed to doing it, she might try and hurt herself. So, even though it's a convenient way to put her into her dry food room, and for her to let herself out, I'm probably going to take it down until....

I got a new picture of Lily two days ago. Still can't see much going on with the right side of her face. But she is having external tears, and I clean the crusties off her face once a day.

Lily at Rest

She still doesn't know she's sick.

Medical Therapy

We will have to manage the progression of Lily's cancer with antibiotics, anti-inflammatories, and pain medications.

The antibiotics are easy. Lily tolerates Clindamycin very well.

For an anti-inflammatory, we will use prednisone. We have some in Jim's medicine box. She should get it SID or BID, one-half to a full tab of 5mg. The prednison also will act as an appetite stimulant. Dr. Duda says Lily can have anything she wants to eat.

Pain meds are still a mystery to me. Tramadol is an option (.25 tab), but Lily didn't do well on it after her oral surgery--it's very bitter and she drooled alot. The vet suggested it could be compounded, but Lily doesn't do treats, and I can't see that a liquid would be less bitter than the pill. Maybe I should try pilling her with empty capsules, to see whether that might be a delivery option.

Buprenex is another option, because it comes in a liquid form that can be given subQ or orally. Just a drop on the tongue. However, Jess tells me it's not a long-lasting pain med. Used mostly for breakthrough pain. Works for 4-6 hours.

Jess also suggested fentanyl patches as a long-lasting pain med. However, I believe that Dr. Duda said that fentanyl might curb Lily's appetite, which would not be a good thing.

Lily Visits the Oncologist

We took Lily to the oncologist at the University of Pennsylvania on Tuesday, October 7. The oncologist is Lili Duda.

Lily's appointment was at 11:30; we were there until about 4:30. A very long day for all 3 of us.

Here's the written report from the visit:

Lily presented to [our] Radiation Oncology service for further work-up and consultation after a diagnosis of right maxillary osteosarcoma was made by your local veterinarian.

Overall, Lily looks very good for a 15 year old cat. She has a small heart murmur, as you know. There is a 1.0cm x 0.5cm oval, ulcerated area where her upper right canine tooth used to be. There is some associated swelling and slightly decreased airflow from he right nostril. Lily is also a little thinner than normal. All other physical exam findings were unremarkable.

Preliminary review of the chest radiographs (X-rays) did not show any evidence of metastasis (spread of cancer) to the lungs. Lily does have a mildly enlarged heart and hyperinflated lungs. Although the thyroid panel performed in April was normal, we recommend repeating a thyroid level (T4) because hyperthyroidism can be the cause of both of these findings.

A Complete Blood Count (CBC) was performed prior to sedation for oral radiographs. The CBC was within normal limits. A mini chemistry panel showed normal liver and kidney values with a mild elevation of the BUN.

Interpretation of the oral radiographs is pending review with the oral surgeons and I will call you with the results.

As we discussed, osteosarcoma of the jaw bone is a locally invasive cancer (into surrounding tissues) but metastasis is relatively uncommon. Complete surgical removal of the tumor (partial maxillectomy) can be curative. It is necessary to determine how big the tumor is and how much of the bone (maxilla) is involved. We will be able to better determine whether Lily is a surgical candidate based on the dentistry service interpretation of the oral radiographs taken today. If surgery is potentially an option, a CAT scan will be needed to confirm the tumor is amenable to surgery and to help the surgeon determine the surgical margins.

Radiation therapy is another option that is available should you choose not to elect surgical resection or if the tumor is too big to make Lily a good surgical candidate. Radiation therapy is a palliative procedure that involves one treatmetn per week for up to four weeks. The procedure is not curative and is meant to shrink down the tumor and help minimize symptoms such as pain and bleeding for anywhere from a few to many months. Also, there is a variety of medications that can be used to treat infection, inflammation, and pain.

We will contact you when the interpretation of the oral radiographs are back from dentistry at which time we can proceed with a treatment plan. In the meantime, please feel free to contact us with any questions or concerns.

Please remember there are no "right" or "wrong" decisions for Lily. Rather, there are several options, each with their own advantages and disadvantages. We will support you in any decision be it using only medication for supportive care or something more aggressive.

Thank you for bringing Lily in today. She is a wonderful patient to work with and we truly enjoyed having her with us!

We felt pretty hopeful after that visit. I was willing to spring for the ~$4K for the CT scan and surgery.

But our hopes were dashed the next afternoon when we got a call from Dr. Duda. The oral surgeons felt Lily was not a good surgical candidate. They felt the tumor would show larger on the CT scan, and that with such a large tumor, there was a high risk of leaving part of the tumor behind. The truth, it came out, is that the surgeons there don't have much experience with this type of surgery on a cat. Dr. Duda said if it were her own pet, she would be hard pressed to have the surgery done. Lily would come home on a feeding tube, requiring alot of aftercare, and a large risk is that the incision could split open.

Such sadness. My Lily is dying.

Lily as a Seal

This is one of Lily's odd behaviors. She likes to lie with her front legs stretched behind her. Puts me in mind of a seal.

Lily's Aminal

Lily has this toy animal, I call an aminal, that is her dear toy. This is the only toy Lily has ever adopted. It used to be beautifully fuzzy, but it found its way into a hot dryer and is now lumpy. Lily loves it despite its worn appearance. She will accept no substitutes.

Lily's aminal often goes MIA. I searched it out last night and found it deep under the TV cabinet. Immediately, she started flipping it into the air. Her aminal was home!! She often fetches it to me, howling as she comes. I hope for that today.

A Day at a Time

I saw my therapist yesterday. I had stopped seeing Ann, but the Graham Center's Cancer Survivorship Group thought I still needed help, so I'm back on a limited basis.

Yesterday we talked about my upcoming loss of Lily. I told Ann I wasn't sure whether I wanted Lily to go before my surgery or after. I didn't know which would be better to wish for.

Ann said to stay in the present, and enjoy Lily every day. And not to pray for specifics; only to pray for the best. Ann is so smart.

I meditated at acupuncture again today. I took my sleep mask to keep the tears out of my ears. I opened the portal and was staring at a large group of pet souls--souls who had had bone cancer. I wasn't sure what to say. They were all so sad for me. Ruby came and Lily came and they just sat in front of me and let me sob my sadness into their fur.

I wasn't actually sobbing, but there were some tears on that sleep mask. After the portal closed, I placed my fingertips on my upper jaw, and wished Lily's cancer away.

After I came home for the day, I laid on the bed and Lily snuggled under the covers. She usually doesn't like to be under the covers, but the house was cold. She purred and I petted.

Axial Skeletal Osteosarcom

News from the vet on Thursday. Osteosarcoma. A type of primary bone cancer. Rare in cats; extremely rare to have it present in the bones of the face. Lily's is in her maxilla (upper jaw). Thus it is called axial skeletal osteosarcoma.

From Googling, I've found only a little about the condition in cats. It is aggressive. It metastasizes to the lungs. [Edited: The oncologist later told me that osteosarcoma in the flat bones, as Lily has, does not normally metastasize. It is, however, locally invasive.] My vet couldn't give me much guidance about its progress. Looks like that with treatment (surgery/radiation/chemo), the median survival rate in cats is 5.5 months (from a very small study).

I am taking Lily to the oncology department at the Vet School at the University of PA on Tuesday. I will ask for X-ray to see how far it has invaded the bone and whether it has already gotten to her lungs.

I am not looking for heroic measures, but I am looking for quality palliative care. I also want to know how much quality life she has left.

This so sucks. Lily was feeling better today. The anesthesia and pain meds really put her down.

Tramadol Makes one Drool

Lily's on Tramadol, for pain. Please be advised, if one gets tramadol stuck in one's mouth, rather than put down one's throat, one drools. Alot. Who would have thought a 7 lb cat could drool like a Newfoundland?

That was yesterday, Wednesday. Lily was miserable almost all day from the trauma of the Tramadol. Last night, when she only got antibiotics and not Tramadol, she took off like a shot, but soon came back for snuggles and slept most all night with me in her bed on my bed. Ennis slept with us too; probably because he had been shut out the last 3 nights and wanted to make sure he was still allowed in now that the door was open.

I washed my comforter last night. Lily had bled on it during that time I thought the tumor was an abscess. The vet said her lower canine tooth was puncturing the tumor. Now the evidence of that part of her disease is gone and will soon be forgotten.

Deb was so kind to invite Lily and me to her home for the weekend. I think she wants to say her goodbyes to Lily. We aren't going because Lily doesn't travel well and we don't want to give Lily any extra stress.

Tears in my Ears

I had acupuncture yesterday afternoon, something I do to try to bring sensation back to and relieve pain in my feet and legs. Chemo-induced neuropathy.

Acupuncture involves about 30-40 minutes of laying on my back with needles stuck in me in various places. Usually, I take a head set and listen to a book on tape. I didn't do that yesterday. I decided I wanted to meditate on Lily's situation, and see whether I could find any better answers than I have found so far.

When I meditate, I usually visit with cats. Usually the souls of past cats of mine, but sometimes friends' past cats, and sometime living cats.

So I started into meditation, and opened the portal to where I usually visit cats. My heart and mind were full of my sorrow over Lily's situation. Ruby came to me.

Ruby is one of my former cats. She was a rescued street cat who loved being inside with people and didn't suffer my other cats gladly. Ruby passed in the fall of 1993, and it was Lily who took Ruby's opening in the household. Ruby never met Lily, although Ruby met and well tolerated the kitten littermates Maxwell and Ennis for a few months from June 1993 to her death.

Ruby was a difficult cat. Lily is a difficult cat. I took it as a good sign that Ruby came to me. Ruby had an oral tumor when she was young, but it was removed very early and although it was pathologized as a cancer (I don't know the kind), she never had a recurrence or metastatic disease. And no treatment other than the excision of the tumor.

Ruby agreed to what I asked for. That she watch and guide Lily. That she explain to Lily what is happening to her. That she help Lily let me know when she has discomfort or pain. Lily came to us for a bit, and understood that Ruby would be her spirit guide.

I wanted to ask Ruby to take Lily's cancer away, but I feel that is not one of her powers. Ruby knew that I wanted to ask her to remove the disease, and did not offer to help in that way, although I got the feeling she was going to look into it.

We finished our conversation and I focused on my upper right canine tooth, as if I were inside Lily's mouth, trying to draw the cancer from the bone there. Trying to take it away.

During this meditation, I had a few tears roll down the sides of my face and into my ears. I couldn't wipe the tears because I had needles in my fingers and in my ears. I tried to keep my eyes shut, because it was when I opened and closed my eyes that a tear would break loose and begin its slow, deliberate track down my face and across the ridges of my ears.

Next time I'll take a sleep mask to catch the tears.

At the Beginning of the End

Lily is a 15 year old domestic short hair brown tabby cat. Yesterday, Monday, September 29, I took her to the vet for what I hoped was a tooth abscess. I had found the swelling around her right top canine tooth a week earlier. I had put her on Clindamycin, an antibiotic, in the intervening week. The vet, Dr. Alan, only does surgeries on Mondays.

On initial examination, Dr. Alan said it was an oral tumor, not an abscess.

Sure there was/is hope the tumor was benign, but (as I since googled) benign mouth tumors in cats are rare, and not particularly friendly.

Lily has been treated for chronic renal failure (kindey disease) for about 2 years. She's been treated for hypertrophic cardiomyopathy (heart disease) for a little over a year. She's been in a slow decline because of the CRF, losing weight and now down to 6 lbs, 8 oz. I had warned Jim that because of her HCM, she might experience an emergent event that would take her life.

I wasn't ready for cancer.

Dr. Alan removed the soft tissue of the tumor and the broken canine tooth it was surrounding (broken tooth was rotted; it had been fine at her check up in May). The tumor has invaded the bone (upper jaw). The vet did not attempt to surgically excise the tumor from the bone.

The pathology will be back later this week. The best hope the vet could give me is that it might grade as a slow growing cancer.

Given Lily's age and other medical conditions, the vet already has advised me twice against "heroic" measures (bone surgery, chemo, radiation). I agree. Based on what both the vet and I expect the pathology to show, we will keep a watch on her comfort and quality of life as the cancer progresses.

She came home from the vet around 7pm. You have never seen a cat so happy to get home. Despite being groggy and stumbly from the anesthesia and pain meds, Lily had to inspect every inch of her domain. I carried her about so she could check it all out. I even took her to check out the lump on the couch (Jim).

Lily was very restless during the night. Also famished. She ate 2 cans of fancy feast and some dry food. She was up and down the bed all night, refusing to use the assistive stool I had placed at the end of the bed. But she is a determined soul.

She used the litter box both as a toilet and as a bed for awhile.

This morning, she refuses to be behind a closed door. She wants normal back. Because she seldom goes downstairs during the daytime, I figure she is relatively safe allowed to prowl the upstairs. She is still stumbly, and will be getting a pain pill (Tramadol) soon. She also will be on Clindamycin for a week. I am dreading looking in her mouth when I medicate her.

I started this blog to journal her passage. From what I read, oral cancers in cats can be very aggressive. We may not have more than a month or two of good health. At this point, I expect the cancer to continue to take over the bones in her jaw and sinus (will have to watch for sneezing), into her lymph system, and then her lungs. She will not be in pain, and I will watch carefully for discomfort.

She will pass at home, as Maxwell did, with the help of a visiting vet.