Our war to save Pink from renal lymphoma (cancer) and his progress toward recovery.
Listen while you read to “Resistance”, an unpublished Panache piece that has Celtic war march-like sensibilities representing our determination to fight for Pink’s life.
March 1st, 2012
The beginning of this story left off with Pink’s doctor referring us to an advanced specialist hospital following his diagnosis of acute renal failure and finding a huge mass in one of Pink’s kidneys.
The next day was beautifully sunny and warm, and seemed to be a promising omen. It was a bit complicated though, because I had made the appointment with the specialist right at the end of the previous day by which time Chi was already booked for a shoot. I originally thought that I could just somehow attach Pink’s carrier to my scooter and ride with him from our home in Chinatown to West Hollywood (closer than Westwood, but still a bit of a hike!), however upon a more rational analysis decided that even if Pink were healthy he would still find the noise and vibration of what would most likely be at least a 40 to 45-minute scooter ride a little traumatic, and in his present critically ill condition, that would be absolutely contraindicated. Duh!
It was a bit of a logistical gymkhana, but I got Pink to his appointment at the specialist hospital and Chi to his shoot and picked up the x-rays from Pink’s regular doctor to bring along. The specialist doctor was very nice, and discussed an array of options to treat Pink, starting with getting him on an IV flush to help him detox from the kidney failure and take an ultrasound to determine the composition of the golf ball in his kidney, and if that is inconclusive, follow up with a “fine needle aspiration”, which is just what it sounds like: suck up a little of the mass in the kidney through a thin needle and analyze it, which is not unduly costly to the humans or distressing to the cat. Pink actively participated in the conversation with the doctor and agreed to the proposed plan. Seriously! He vehemently protested when we started talking about surgery, which we were not going to do because it had such a high mortality rate and was extremely expensive and may not even be appropriate depending on the outcome of the tests.
They also needed to run a couple more tests on Pink, and the whole bill to hospitalize him that weekend and perform the recommended diagnostic procedures would cost about $1,200. Although timing was critical, I absolutely had to talk to Chi before letting go of that amount of cash, and said I’d almost certainly be back with Pink the next morning after I had a chance to discuss this with my husband. I paid for the consultation and the urinalysis we took a sample for during the appointment and headed back home. It just so happened that Chi called from set to ask how the appointment had gone just as I started inching down Sunset Blvd. in rush hour traffic after leaving the hospital. I explained what had happened at the appointment, and he said to take Pink back to the hospital to get him on the IV flush immediately and pay for it with the rent money, and then he’d transfer some money from Japan to cover the cost. I next called the hospital to make sure they were still open and brought Pink back.
The next day was Friday, and the doctor who was supervising Pink’s treatment called to let me know the outcome of the ultrasound and fine needle aspiration. It turned out to be renal lymphoma (cancer), and she suggested that we come to the hospital to visit Pink and discuss options for treatment. The recommendation was to put him on the University of Wisconsin-Madison chemotherapy protocol, and after four weeks (one round) it is almost always known how the cat is responding to the treatment and whether to continue. This was going to run up another $1,500 bill, but generally people don’t get hung up on worrying about money when their baby’s life is on the line. We decided to commence the chemo that day and keep him on the IV flush for another day.
Pink came home from the hospital on Saturday evening, March 3rd, and after a pretty good night, had a not-good day on Sunday that started out all wrong with our epic fail with giving him his meds. He had to take three pills: an appetite stimulant, an anti-nausea pill and one Prednisolone, which is a day-to-day maintenance drug for the cancer (a corticosteriod with anti-inflammatory properties), plus a liquid antacid and some phosphorus binder powder to put in his food, assuming we could actually get him to eat. He also had to have subcutaneous fluids administered by a needle under his skin each day too.
Cats are notoriously difficult to give pills to, and first I tried pushing the pills down his throat, which totally stressed him out and made him vomit (and made me cry!), and then Chi suggested that I try crushing another round of pills and mixing them with water to give with the oral syringe that came with the antacid, and that just made him gag and foam at the mouth and drool all over the place. He wouldn’t even touch his breakfast, and just sat by the water bowl looking absolutely miserable for a long time. It was absolutely traumatic for all of us.
The subQ fluids we gave him that evening was just as bad. Chi held him and I had to stab him three times to get the huge needle deep enough under his skin (on his back just below his shoulder blades) so it would stay in instead of slipping out and dribbling the fluid all over him. Again, it was absolutely traumatic. I felt as if I had just qualified for a grand prize as the worst cat nurse in history. What made it all the more hellish and heartbreaking was how the other three cats shunned him and were nasty to him when he was already feeling bad enough already. That is typical though, when an animal comes back home with the “hospital smell”, and in Pink’s case, he must have really smelled terrible to the other cats since he had been too sick to groom himself for over a week and the oils were building up on his fur.
It was a horrible, worrisome three days of medicine torture and hardly getting him to eat anything at all, and on Tuesday I called his doctor and she said that if the pills were making him really miserable and he didn’t seem to be having nausea (except because of the pills), then we could discontinue two of them: the appetite stimulant and the anti-nausea ones. We had ordered the Prednisolone in compounded form (smushed up and suspended in a liquid solution that tastes like a chicken treat, so hopefully that would be less stressful to administer, and it had arrived by that evening. Thankfully he started eating treats again by Wednesday, although he still wouldn’t touch his regular food. He looked dramatically better by Thursday, although the liquid Prednisolone was still a bit of a nightmare to administer, and I kept missing his mouth and squirting it all over his head since he squirmed and struggled so much. It is very sticky and difficult to get off.
While my focus and energy was so intently fixed on fighting for Pink’s life, I felt as if the intricate tapestry of all of our lives was being torn apart and the pieces put back together in a different pattern by some unseen force without our active agreement or participation. As each day crawled by as if the frame speed had been slowed way down, my ability to remember other things and willingness to deal with them fell into the gaps between frames, and I became aware that everywhere there are people, there is among them a transient demographic group whose world revolves around the question: “Will my critically ill (or injured) loved one survive for another day?” followed by the next compound question: “Will s/he eventually recover sufficiently to have a worthwhile quality of life; and will our lives ever go back to ‘normal’?”
During our sojourn within this unfortunate demographic, other things that normally occupied a huge tract of my personal timeline and consumed most of my energy, like the marketing and administrative drudge work for the Panache Orchestra, house and garden projects, web/media projects, day-to-day household maintenance, day job, all the various and sundry things I have to manage and deal with every day, became very unimportant to me, eclipsed by the shadow of Pink’s illness and hoped-for recovery. Pretty much all I wanted to do was spend as much time as I could cuddling my baby and trying to get him to eat and take his meds.
He began eating more and more treats in increasing variety, and then had his follow-up appointment and next chemo treatment on Friday, March 9. When the doctor did the physical exam, she commented that his kidneys had returned to a normal size (after being enlarged almost 2x from the tumor), indicating that the first chemo injection had destroyed the tumor. She did a simple blood test to check his red and white blood cell count and kidney values, and the blood count was ok, and his kidney values were dramatically reduced from the previous week when he was hospitalized. They were still a bit high, but the levels they were at when he was hospitalized meant that he was as good as dead, and very possibly would not have survived through the night if Chi hadn’t called me when he did and had me hospitalize him and get him on the IV flush that evening instead of waiting till the next morning! Also, that evening when we did the kitty dinner ritual, fully expecting him to refuse to eat as he had been all week, we looked on in delighted astonishment as he started eating his regular food! He didn’t eat much, but compared to nothing, that was a major milestone!
More milestones followed over the coming days and weeks: he ate more and more, was less and less feisty with the medicine (he still hated it, but didn’t act out as much, and in fact, actually started coming out to the kitchen at medicine time, brave boy!), began grooming himself again, and coming to the door to greet me when I came home, just as he used to before he got sick. We were thrilled beyond description when the other cats one by one accepted him back into the family. Gureyo started the ball rolling, Jaco quickly caught on and followed suit, and eventually Laxmi got with the program after being really mean to Pink for at least another week or so.
Pink still hasn’t recovered his strength to the point where he could actively play and run around the way he used to, but one evening at dinner time, Jaco began gently playing the boxing game with him, reminding him of that daily pre-meal ritual. Chi told me that one afternoon Pink boxed a round with Gureyo before lunch. His appetite kept improving until by early April he was eating as much and as quickly as he used to before he got sick, and we had to again lock him in a bedroom so the other cats could finish their food without him stealing it.
An interesting phenomenon occurred during the six weeks between when he first became critically ill in late February and early April: As his appetite waned until it disappeared altogether, the other Panache Cats seemed to all boycott food out of solidarity with Pink, and as his appetite increased, so did theirs. Either that, or they realized how well that worked out for Pink, i.e., that by refusing to eat his regular food (the Panache Cats are each given a specifically weighed-out portion of Wellness brand grain-free canned food morning and evening), he got taken into the office and given special treats. It got to the point where all the cats were eating as if they had just come off a month-long hunger strike, which I guess is what was actually happening.
On April 7th, when Pink was due to begin his second round of chemotherapy after one week off to give his system a rest, we decided (out of financial necessity) to switch protocols to a different drug (Lomustine. or Ceenu) that is administered as a capsule once every three weeks. Pink’s progress continued upward until mid-April, and then his energy level began to taper off, getting more and more subdued, even though he continued to eat and drink more or less normally. At his next chemo appointment on April 27th the pill could not be administered since his white blood cell count was too low. That was the first time that had happened. However his kidney values were the best yet, practically completely restored to normal functioning,so the subQ fluids were backed down to every other day instead of every day. His liver was checked and found to be ok too.
I had a feeling that there was more to this story than I was aware of, and began doing my own cancer research.