Should I try metronomic chemotherapy for my cat?
October 31, 2014 9:09 AM   Subscribe

You are not my vet. However, I have seen a regular vet and a veterinary oncologist and now have some difficult choices to make and I would be very grateful for first hand accounts from people who have tried metronomic chemotherapy with their pet (especially cats) or other people's pets (if you're a vet or if you're close to someone who has gone through this sort of thing before). I am seeking advice and real-life experiences to supplement any advice regular vets or oncologists may give me.

Sorry--this is rather long but I am at my wit's end. I fee so alone and so full of guilt and worry.

I have a wonderful cat whose "official" name is Dorje, but we call him George. George is a domestic shorthair orange tabbyish fellow. Neutered when he was young. He has been with me for 14 years. He was perhaps a year old when he showed up on my doorstep so it's probable that he is closer to 15 or even 16. I have never had children. I am almost 40. For me, this cat and and my other cat are like my children. I love them intensely. George also happens to be the nicest, gentlest, sweetest animal I've ever known. Not a mean bone is his body, really. He never scratches or bites. He just loves.

Back in May of this year I was petting him and noticed a very small, bone-hard bump on his head, almost on his forehead. It concerned me, but he'd had a couple of benign bumps and moles over the years, so I wasn't immediately concerned. However, the area started to spread out a bit. It became soft and squishy and more diffuse so I took him to the vet 2-3 weeks after I first noticed it. It had been a while since I had taken him to a vet for a check up so I went to the vet that was closest to where I live. There is an animal hospital close to my house that takes walk-ins and has weekend hours so my boyfriend and I took him in in early June. The vet who saw him that day suggested that they run his blood work and aspirate some cells from the area and send them off for cytology. The results: lab work was all normal but the thing on his head was "probable soft tissue sarcoma" with "possible bony involvement." I was given a referral to a veterinary oncologist. The fluid they drew from his little lump magically made the squishy lump virtually disappear for a couple weeks but then it started to puff up again.

I took George to see the oncologist (in July) who explained that the placement of the tumor on his head would make it impossible to remove by surgery alone ($3k-4k). She said that surgery plus a month of radiation (another $4k-5k) would be advised and would likely extend his life another few years. At the time she had also presented metronomic chemotherapy as an option, but discouraged me from going that route, because, although cheaper, would not be likely to cure the disease and could damage his kidneys. I make about $35k/yr. My credit sucks so Care Credit was not an option. There were other incidental tests and things that would be necessary. I just didn't have $10k. I have been trying to save. Begging for help from others. Hoping I could beat the disease before it got too bad to treat. In retrospect, I should have tried metronomic chemotherapy much sooner. It may have prolonged his life and made him feel better but until about a week ago he was feeling FINE. At least as far as I could tell. I know cats are very stoic, but George was (and still is) eating and drinking. He was cuddly and happy and playful. The tumor continued to grow, which concerned me. I've cried myself to sleep over it many nights. But I really thought I would somehow be able to come of with the money for the "best" treatment.

In the last week, things have taken a very rapid turn for the worse. Toward the end of last week I noticed that his balance was way off. He was falling off the bed, stumbling a bit. His back legs seemed week. Also, he stopped looking at me. He stopped grooming me and my other cat (usually one of his favorite activities) and would just stare into space. He has become withdrawn, which is not like him at all.

I suspected that this horrible cancer was growing into his ears, throwing off his balance, and possibly his eyes. His vision seemed affected.

I took him to the regular vet on Wednesday and saw a very nice doctor. Much more seemingly compassionate than the first vet I saw at that clinic. She tested his urine for infection. She ran his blood work again. He has lost 3 lbs since August and was dehydrated (she gave him sub-q fluids). She suspected kidney problems, but the blood work came back fine. I was sent home with a few doses of buprenorphine and an appetite stimulant. She also said he seems to have gone blind. This happened in a matter of days. Last week he could follow my finger with his eyes. Now, he can evidently sense light but can't really focus. I am unsure if this is the sole source of his depression and disorientation, or if the tumor is causing him pain, or if cancer in his brain is causing other neurological problems...all probably impossible to know for sure without an MRI or host of other expensive testing.

Curiously, he seemed to have much more energy after getting the fluids and pain meds at the vet. He has been pacing the apartment a lot, which is distressing to watch, but to some extent I think he's trying to make sure he knows where everything is. After the last vet visit he was charging around, much more steady on his feet...

I'm going back to see her tomorrow to have some x-rays done to see if his skull looks normal or if there's some very obvious damage. Maybe the soft tissue sarcoma is getting into his brain? Maybe it's not a soft tissue sarcoma at all. Maybe it's been in his bones all along. I never had a biopsy done. The oncologist didn't think it was necessary.

Soooo, after all of that, what I'm wondering is this: Does it make any sense to try the metronomic chemotherapy at this point? Has anyone ever known it to make an animal FEEL better and/or reverse damage already done? I plan to ask the doctors but I trust vets like I trust car mechanics, you know? I hate to say that. I know there are so many wonderful vets out there and I don't begrudge them wanting to make money at a profession they studied and trained extensively for, but I want to do what's best for George, not what's best for the vet's bottom line. I don't want to make him suffer needlessly but I also don't want to give up on him because, honestly, I would trade my life for his if I could. The guilt I feel about this is enormous and I love him so much, so dearly, that euthanizing him is going to break my brain. I will do what needs to be done, but I'm already in pieces. I love him with my soul. He deserves to feel good or he deserves to be let go if feeling good again just isn't in the cards. I just don't want to give up if there's anything I can do.

Advice from anyone who has been through similar stuff or knows someone who has is very much appreciated. Please be gentle, though. I am very fragile right now. Metronomic Chemotherapy, for the uninitiated, is not the same as chemotherapy that people get. It is not a large, sickening dose. It is small dose, that is given in the form of a pill at home every day. Knee-jerk reactions are not helpful. If you don't know what metronomic chemotherapy is, please look it up before telling me I'm crazy to even consider it. I am interested in it as a palliative measure. I want to extend George's life but quality of life is just as important to me. He is depressed right now. Part of this may be that he's adjusting to blindness. If you've had a cat that went blind and temporarily went off his/her food and water at first, I'd like to know. I know he can adjust to being blind, but he shouldn't have to endure pain and confusion. He puts his head against the wall or other surfaces, which makes me think he hurts. I don't want him to hurt. Is there any way the metronomic chemo could make him stop hurting and/or shrink this awful tumor? Has anyone ever experienced a positive change from it like that before?

My heart is breaking. Please help me with what to expect if you've been there.

If you have questions that I don't answer right away (I will try to) or you'd rather share your story privately you can email me at a.mellifera@gmail.com
posted by apis mellifera to Pets & Animals (16 answers total)
 
Aw, your poor little kitty. It's so sad when our feline friends are ill. I'm sorry that I can't give you specifics related to that form of chemotherapy. But I just want to say that when my very beloved senior cat developed cancer, we made the decision not to treat it. About 25% of that was related to the cost, but the other 75% was just the idea that repeated vet visits, administering meds, etc, would be causing the cat so much stress for so little up-side. Regardless of whether a cure could be the result of treatment, my cat's advanced age made it very likely that his life was close to ending anyway.

So we decided to make his last months very, very happy. Lots of pets and cuddling, all of his favorite foods, never a complaint from me when he chose to sleep right in the middle of my pillow. Stuff like that. And about 18 months later it was clear that he was starting to no longer enjoy his life. And we made the decision to euthanize.

Good luck to you and George.
posted by BlahLaLa at 9:38 AM on October 31, 2014 [10 favorites]


"Does it make any sense to try the metronomic chemotherapy at this point?"

About seven years ago, my wife and I went through a similar situation with one of our cats. He developed cancer near his spinal column, and he would go through periodic bouts of paralysis of his hind legs. Diagnosing the issue was difficult (he was a young cat, so cancer wasn't really suspected at first). After we finally got the right diagnosis, we took him to a veterinary oncologist. I honestly don't remember the type of treatment he received, but it cost us something like $5,000, and it didn't work. Also, I don't think his quality of life was very good, and I felt bad about taking him to the vet's office all the time.

Anyway, my wife and I regretted pursuing the aggressive treatment, and we both agreed that we wouldn't do it again in the future, if we were faced with a similar situation.

Best of luck to you and George. I know only all too well how difficult this all must be, both for you and George.
posted by alex1965 at 10:17 AM on October 31, 2014 [4 favorites]


My cat had cancer for 2.5 years and I only regret the last treatment we did for him.

I hate to be harsh but at this point, I would keep him comfortable with pain meds and so on, and start planning to let him go. I know. I know. I know so much. But I sat next to my boy and I told him it was okay to let it go, and then he started on the way out. They will hold on for you.

I know it's the worst. I'm so sorry. But from what you've said, having been through what I've been through, I would get together a plan to let him go at home, where he will feel safe and loved.

Please feel free to memail me.
posted by Medieval Maven at 10:42 AM on October 31, 2014 [6 favorites]


A few years ago, my cat Jack developed metastatic pancreatic cancer. He didn't show any symptoms until a few weeks before his diagnosis, and he was very, very sick. We loved that cat so much and took him to the hospital and the oncologist and spent somewhere on the order of $10k before all was said and done, and it maybe bought him an extra month. We did very small doses of regular chemo (not what you are describing with the pills, but similar in that it was designed to be palliative rather than curative). It still made him sick. I was happy for the extra time I had with him, but felt really guilty for making him sick. I regret trying the aggressive treatment.

We gave him all the extra love and cuddles and stinky treats we could. We got subq fluids to give him at home - it's really easy and made him feel SO much better and more alert - and my husband dropper-fed him meat baby food (pureed ham) when he wouldn't eat. If I had to do it all over again I would have just kept him comfortable and just treated his pain. Believe me, I really, really, really understand how much this sucks, but letting him go without further suffering was the best thing we did for our little dude.
posted by bedhead at 10:49 AM on October 31, 2014 [2 favorites]


I'm so sorry this is happening to you. My beloved cat, who was also like my child, died a few weeks ago and I understand how devastating it is. The symptoms you describe make it sound like your cat is very near the end. If it were me, I would opt for euthanizing to make his last moments as peaceful as possible.

I am so sorry. You will get through this. You will get through this.
posted by Librarypt at 11:05 AM on October 31, 2014 [1 favorite]


I've had two critters who got cancer in their old age. The first one, we didn't have him put down when we knew it was hopeless - he died at home after a while. I think it was very hard for him, but we just couldn't or didn't deal with it. I was young and hadn't had a pet before. I don't really want to tell you the details I remember.

The second time, years later, was a beloved kitty who was the sweetest (they all are, aren't they?), and we saw the X-rays, thought for one day, and decided for her. We were there when they did it. It was so quick and easy for her, but so hard for me - I remember how I felt, sitting in the car afterward.

I have maybe 20 years of perspective on these two events and I can tell you so very strongly that I regret the first one and not the second one.

If George is acting weird and you think he's hurting and confused and scared, please, believe and learn from my experience. Go do it today. Hold him while they do it. It'll be very hard for you, but easy for him, and you will never ever regret it. I'm so sorry.
posted by fritley at 11:08 AM on October 31, 2014 [3 favorites]


I will also chime in a second time to add that if you do decide that George is suffering too much and you opt for euthanasia, see if there is a vet in your area who will do it at home. We found one who did and it was SO much better for all of us.
posted by bedhead at 11:34 AM on October 31, 2014 [3 favorites]


I'm so so sorry you and George are going through this.

I'm a vet, but this is not veterinary advice. It would impossible to ever know how George would respond to metronomic chemo, and I've never seen a case exactly like George's before.

However, head-pressing is a fairly serious sign to be seeing in a cat. It almost certainly means there is disease in his brain - which is most likely invasion of the sarcoma through the skull. Unfortunately there aren't a lot of other things other than brain tumours that cause head-pressing in a cat :(

I think the greatest gift we can give our animals is knowing when it's time to help them pass away peacefully - before they go through too much suffering and pain.

I always say this because it's true...I have never had anyone say they put to sleep their pet too soon - but I have had many people say they regret how long they waited.

I'm not saying that putting George to sleep is the only option, but it sounds like it could be the kindest thing for him. Another option would be to call or see the oncologist again - they would be better placed to give you an updated prognosis and options now that the clinical situation has changed.

However, given what you said, and taking my experiences as a vet into account, if you were my client I would either recommend euthanasia or purely palliative care. I wouldn't recommend chemo, and I don't know if I'd recommend x-rays either.

Again, I'm so so so sorry.
posted by peanut butter milkshake at 11:36 AM on October 31, 2014 [10 favorites]


I'm so sorry. I still have sad memories of a similar week-long decline, and in hindsight, almost every hour we waited before calling the vet to our home and saying goodbye took a little away, felt like an hour too long.
posted by holgate at 12:05 PM on October 31, 2014 [1 favorite]


"Thunderbolt of Enlightenment (dorje)", that is a cool name for a cat.

My cat Zafu (named because she liked to sleep on a zafu cushion when she was a kitten), died in March. She was ailing with kidney disease, and we were treating her with fluids, but eventually she just didn't seem to want to go on, and so we stopped treatment and had a mobile vet come to send her off shortly after. My only regret was not having her on painkillers the week before she died, the vet didn't offer and I didn't know that was an option. Like you, I loved her with all my soul and I am crying as I write this.

I believe that when cats get to an advanced age, and 15/16 is advanced, they are at the end of life . They are not people, they can't go, oh, hey, yes, I will endure this painful period of treatment that has x percentage of success (and meaning for a cat, maaaaybeee 1 or 2 more years more life with variable quality of life). Like everyone else, I would be looking for comfort care and finding the right time to call a mobile vet.

And I am presuming because of your cat's name that you are a buddhist, as am I. What got me through my cat's death was treating her like the sentient being that she is, as are we all. I gave her a buddhist funeral the following day, and prayed for a beneficial rebirth and had my sangha do the same. I honored her death, and her life, as best as I could.
posted by nanook at 1:11 PM on October 31, 2014 [2 favorites]


Thank you all for your kind and thoughtful words. I have sobbed like a baby reading. I knew, in my heart, that the end was coming, and dragging him to radiation every day would have sucked hard for him anyway. He hates the vet (going to and being at).

It would be easier if other systems were failing. If his kidneys were going, too, or his heart or thyroid. "You know, he's getting old, everything is starting to go..." But, No. Just the evil fucking cancer.

I've euthanized animals before. It's never easy. it's always soul destroying and I am particularly in love with this kitty. We just cuddled on the couch together for an hour or so, him purring happily and then he got up and drank a lot of water then ate some food. I know the end is close, but I'm glad we can still enjoy these times together. I've always valued them but never more than now.

I'm taking one day at a time. I will take him to the vet tomorrow. I will continue with the pain meds and sub q fluids if he continues to seem more alert and interactive like he does today, but I get it. Head pressing is not good. He doesn't do it all the time, but I feel horrible seeing him do it at all.

I am arranging for a very nice veterinary hospice lady to come to my home when I'm ready. One of the regrets I've had from euthanizing animals before was taking them to a scary, foreign place and stressing them out so they were freaking out at the moment of death. Uh-uh. Not doing that again.


I had just hoped, of course, I'd hoped someone would say, "oh yeah, that exact thing happened to me and my cat and that chemo shrunk that tumor down to nothing." or "it turns out it wasn't even cancer!"

Definitely grasping at straws. But if you knew this guy you couldn't blame me.

I am worried about how I will deal with it. I've been a wreck the past few days and he's still here. I have been trying to prepare myself for when he's not. When I can, I try to give myself little breaks from the pain. Little mental vacations like a tv show or a movie.


It means a lot to me that you've recognized my pain and reached out to me at a time like this. So many people just don't understand.

Again, thank you.

And, on preview, Nanook--yes, Dorje. Mala and Dorje have been a pair for 14 years. Mala is getting up there, too, but is still vital and healthy.

I had a cat I named Tenzin, but only for a very brief time. He was a 10-year old, battle-worn street-tom but he was very sweet and unearthly in a way. Unfortunately he had kidney failure so I only had 6 months with him. I did go somewhat overboard on trying to extend his life, partially because his life had been so hard and this was supposed to be his comfy retirement--it wasn't fair.

But I did read to him from the Tibetan Book of The Dead. I was thinking about doing that with Dorje. I told him today that if there's a "place" that he's going after he leaves here, I hope to one day be with him in that place. I really do.
posted by apis mellifera at 1:30 PM on October 31, 2014


I have nothing to offer you but hugs and fellowship, apis mellifera. I'm two months past my cat dying and some days its easy and others I'm still gutpunched in random ways.

Warm thoughts to you and George.
posted by kimberussell at 1:54 PM on October 31, 2014 [3 favorites]


I lost my beautiful best-cat-ever cat back in April and it still hurts. He went into rapid kidney decline over a few days and was gone well before I was ready to let go. I made the decision to put him down when it was clear that he was in pain and there was very little hope that any aggressive treatment would even work should I pursue that route.

Hugs. I know how gut-wrenchingly awful it can be. I'm finally to the point of considering adding another cat to our two-cat family, but I still miss my big guy every day.

I'm sorry you - both of you - are going through this.
posted by guster4lovers at 5:27 PM on October 31, 2014 [1 favorite]


You're both fortunate to have each other. You know what his life contains, and you'll know when it contains less than it should, and your love will be your guide here, and it will carry over no matter what.
posted by holgate at 8:55 PM on October 31, 2014 [2 favorites]


Sorry it took so long for me to "resolve" this question. 3 days after I posted it, after spending every moment with him, having my ex-boyfriend (for whom I have deep, complicated feelings--but that's another story) drive 4 hours just to spend a few hours visiting with him, taking him to the vet one last time to spend $200 on x-rays and fluids and pain meds, I woke up on Monday November 3rd and looked at him lying on my bedroom floor and knew I had to make the call.

The pain meds only seemed to give him enough strength to pace around and to try to squeeze his head into any tight space, to to relieve/hide from the pain wherever, however he could. When he wasn't on the pain meds he would sleep anywhere, was limp and exhausted. He had started peeing on the floor (he had already tested negative for a UTI--I think he was just too confused and/or weak and blind to be bothered to find the littler box). He had been refusing food and water for a couple days. I could not let him continue on in that way.

One of my biggest regrets was in not getting a 2nd opinion--or more importantly--not at least trying metronomic chemotherapy for him when he first got the diagnosis. Maybe it wouldn't have bothered him much. Some cats tolerate it very well. And seeing as how he was as old as he was, my worries about what it might have done to his kidneys were silly. If I had ignored the oncologist's "best recommendation" ($10k is the only way to go!) and at least tried the chemo ("second best"), he might still be here, purring happily beside me. I don't know. Now I will never know.

When the hospice vet came to my apartment, she and her assistant were very kind and gentle and I will never again take a cat or dog to a vet office or animal hospital to be euthanized unless it's an emergency and there is truly no other alternative. George is the 3rd animal I've had to "put down" in my life and it has been excruciating every time. However, this time, my beloved friend was not struggling or freaked out. He was peaceful. That alone is worth more than I can say. They say you don't remember the details of their deaths, but I do. I remember them all as clearly as if they had happened yesterday.

I held him for hours, talking to him and crying, kissing him and petting him, and when they came, they gave him a sedative and then the death shot. He was gone in seconds.

I have read that in Islam, souls of "infidels" will be violently torn from their bodies. I mention this not because I think George suffered such a death at all but because I felt as though my soul was torn from my body that day. I just wanted to go with him. I still just want to be with him. I used to be a drug addict. I did have a notion to call my former dealer, but that passed quickly. I didn't want anything to moderate the pain of his loss. I doubt anything short of IV sedation could. I just want to be with him.

Few people understand. I haven't told many, because if one person tells me "it was just a cat" I won't be responsible for my actions. They took my baby from me. My boy. He's gone. Now there's a hole in my heart that nothing can fill and it doesn't take much to turn me into a blubbering mess.

My other kitty knows he's missing. They were lifelong companions for 14 years. She howls for him. She looks for him in the places where he would hide when he wasn't feeling well and makes low, guttural noises. She's looking for him still, calling out to him, and it's been a few weeks now, which is so painful to witness. I have been spending as much time with her as I can. I brush her more. They used to groom each other regularly. They used to just sit next to one another on the end of the bed. Pals. My heart is as broken for her as it is for me.

Why am I writing this? Part of it's therapeutic--but it's also in case anyone else comes across this thread, someone in a similar situation--I wanted to suggest that you may want to *try* metronomic chemotherapy for a soft tissue sarcoma if you can't afford the 10 gs they want for surgery and radiation. Or if you don't want to put your elderly cat or dog through that much trauma and stress. Metronomic chemo is given at home, like regular medicine. I would do literally anything for another month, another week, another hour with George if he had felt well enough to enjoy it. The important thing is starting it sooner rather than later. You will know quickly whether or not your animal friend can handle it or not. I will always blame myself for not trying. For not giving it a chance to work.

I also want to strongly reiterate that euthanasia at home is the best thing you can do when euthanasia is your only option. Your animal will not be afraid or stressed. He will be as comfortable and feel as safe as he can because he's with you. The last things he will feel in this life are your love and the safety and warmth of your embrace. He deserves that.

I believe this to be true for people as well. Both of my grandfathers died in hospice care: one at home surrounded by loved ones and one in a hospital, alone. I think I know which I would prefer for myself...

Anyway, thank you, again, to everyone who responded to my question. You are good, kind people. I held him until he grew cold. I kissed him and petted him until I put him in the ground. My mom lives in the country so I was able to bury him on her property. Her husband dug the hole for his grave in a sunny spot. In the spring we will plant something there. I'm thinking something pretty, with orange flowers. Orange like his fur.

Hold your fur babies. Give them lots of love and cuddles. Sneak an extra treat to them just because. "Goodbye" always comes too soon.
posted by apis mellifera at 9:32 AM on November 23, 2014


I am so sorry, apis mellifera, on the loss of your boy. It's going to take a long time to heal, I won't lie. "Proud" is a patronizing word when you don't know the person, so I'll say I'm very happy you didn't call your former dealer. Holler and cry and moan and write and grieve, even if people tell you you're overdoing it.

Thank you for following up and the only good thing that will come is that I bet 100% someone will be comforted by what you wrote.
posted by kimberussell at 7:01 AM on December 5, 2014


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