The Lucy Situation
Sep. 7th, 2023 10:50 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
shannon_aI am fearful of writing anything about Lucy's current situation, lest it change immediately hereafter, but here's what's going on:
Last Friday we saw Dr. Christine and due to another failure of the sutures holding Lucy's feeding tube in place, she suggested that we remove the tube. Kimberly and Dr. Christine and I talked it over a bit and ultimately decided the timing was bad, since it offered the possibility of us spending a week of trying to get Lucy to eat, and then making a hard decision that would exactly coincide with my departure. So instead Dr. Christine gave up her lunch on Friday and stitched the tube back in for Lucy. The plan was to continue palliative care over the next three weeks and then pull the tube upon my return.
But then we had a long three-day weekend that were led by Lucy entirely refusing to eat for 28 or so hours following that mini-surgery and the sedative. We were initially certain that we were just done, but even after Lucy started eating a day and a half after her sutures were resown, we really weren't certain of the viability of keeping this going for three weeks. Among other things, we were afraid that she was just going to pop the sutures again because she was scratching insistently and we'd been told the skin around Lucy's stoma was getting increasingly weak.
To give us some more info, we graphed out all of the data we had on Lucy's eating, which was a daily record (with just a few days missing here and there) that dated back to the end of May. The main thing that it showed was that Lucy hadn't eaten great since her crash that started around July 20th. There had been some improvement starting in late August, but it had peaked at her eating maybe two-thirds of what we offered her, as compared to weeks of perfect eating before the July crash.
We were able to see some potential correlation here and there. For example, we have no idea why she crashed when we took her to Oahu way back in June, but it looked to us like the recovery from that was due to an increase in anti-nausea drugs. Further, I'd been long certain that her improvement in early July had been due to an increase in steroids, but the crash afterward had always been mysterious. Now it seemed more likely that it was a first sign of the infection we started treating weeks later.
Maybe. It's all maybe. That's what has made what Kimberly calls "the rollercoaster" so frustrating.
Anyway, the most important part of all of this was that it got Kimberly and me really talking, and we were able to come to the conclusion that she was more comfortable taking Lucy in to the vet to be put to sleep on her own, if that was necessary while I was gone, than she was continuing palliative care that she now felt was useless.
So we bugged our vet on Tuesday, after Labor Day was over, and Dr. Christine gave up her lunch (again), this time to remove Lucy's tube entirely. At the same time, Lucy came off of the continuing antibiotics we were giving her to try and stave off infection during this palliative period and we also put her prednisolone back up. All told, we felt like that gave her the best chance of eating, as we'd had her on the chemotherapy long enough that we expected to see results (if there were any to be seen), we'd be restoring the pred which was the next (last) thing on the TODO list, and also we'd be taking away the antibiotics and for that matter the tube that might be deterring eating. But we didn't expect much, especially after seeing how poor her "improved" eating had been in recent weeks, compared to earlier periods in the crisis.
And after she got home from the vet, Lucy begged for food, and when we gave it to her she ate it all, with some encouragement. (That mainly means letting her walk off after half a plate, waiting for her to return, then offering her the plate again under different circumstances. That day, I think I did it in her cat carrier, one of her "safe" places that she feels more comfortable finishing food.)
This pattern has generally continued. Poor eating in the morning (which is the norm), and then mostly full meals at lunch and dinner, though mostly with encouragement, returning her to eat one time. It's not sustainable, but for the moment it's food while we try to restore the eating habit.
Lucy got 225 kCal of food on Tuesday, though she was tube fed in the morning before the tube was removed. She got 200 kCal yesterday, all on her own. Our estimate is that she needs 150-180 kCal at her current weight, but that 120-150 kCal would leave her at a bit more normative weight.
So we are EXTREMELY cautiously maybe-optimistic that the chemotherapy we've given her has actually done some good and Lucy might be back on her feed. But we are well aware not only that she's crashed two or three times previously amidst this, but also that this could just be the novelty of having the annoying tube out of her neck. So, this is a very fragile maybe-optimism, and I'm not sure we think there's a great chance yet that things will turn out well. But we haven't even seen a response to the increased prednisilone yet, which took about 3 days last time, and thus puts us to tomorrow night.
Mind you, we do have a downside to all of this: medication application. I'd been giving Lucy pred pills for, I dunno, maybe a year before all of this. Pill pockets didn't work. Compounded treats didn't work. So it was pilling, mostly with a shooter. Some nights it was over in a flash. And other nights there were 5-10 minutes of growling, flailing, and spitting out pills (mostly on Lucy's part, not mine).
And now I've got three pills to give in the morning, which is one more than I could fit in my classic pill shooter (and a new one I picked up on Tuesday that's bigger doesn't seem to work as well for us), and two in the evening. So that's been unpleasant. But if the eating continues, we can combine the pred pills to just one in the morning and hopefully wean her off the anti-nausea. That would put us back to the one long-term pill which is fine.
But we also have chemotherapy liquid twice a week, and that's less fine. We haven't tried to administer it orally yet, but that's on our list for later today, so fingers crossed. It's a carcinogen and can cause allergic reactions, so we have to be very careful of it, and Lucy has a habit of spitting up oral meds.
So that's where things are. Lucy has no tube. Lucy is eating. Lucy will get her collar off tomorrow when her stoma is closed up. But, we don't know if we have a long-term solution or not. I don't know if my kitty will still be around by the time I'm back from Germany. But it feels much better than leaving Kimberly with a cat who was either being tube fed or just not eating.
We've done our best. If Lucy actually keeps eating, every day we have from here on is a blessing, and if not, these last days still were.
Last Friday we saw Dr. Christine and due to another failure of the sutures holding Lucy's feeding tube in place, she suggested that we remove the tube. Kimberly and Dr. Christine and I talked it over a bit and ultimately decided the timing was bad, since it offered the possibility of us spending a week of trying to get Lucy to eat, and then making a hard decision that would exactly coincide with my departure. So instead Dr. Christine gave up her lunch on Friday and stitched the tube back in for Lucy. The plan was to continue palliative care over the next three weeks and then pull the tube upon my return.
But then we had a long three-day weekend that were led by Lucy entirely refusing to eat for 28 or so hours following that mini-surgery and the sedative. We were initially certain that we were just done, but even after Lucy started eating a day and a half after her sutures were resown, we really weren't certain of the viability of keeping this going for three weeks. Among other things, we were afraid that she was just going to pop the sutures again because she was scratching insistently and we'd been told the skin around Lucy's stoma was getting increasingly weak.
To give us some more info, we graphed out all of the data we had on Lucy's eating, which was a daily record (with just a few days missing here and there) that dated back to the end of May. The main thing that it showed was that Lucy hadn't eaten great since her crash that started around July 20th. There had been some improvement starting in late August, but it had peaked at her eating maybe two-thirds of what we offered her, as compared to weeks of perfect eating before the July crash.
We were able to see some potential correlation here and there. For example, we have no idea why she crashed when we took her to Oahu way back in June, but it looked to us like the recovery from that was due to an increase in anti-nausea drugs. Further, I'd been long certain that her improvement in early July had been due to an increase in steroids, but the crash afterward had always been mysterious. Now it seemed more likely that it was a first sign of the infection we started treating weeks later.
Maybe. It's all maybe. That's what has made what Kimberly calls "the rollercoaster" so frustrating.
Anyway, the most important part of all of this was that it got Kimberly and me really talking, and we were able to come to the conclusion that she was more comfortable taking Lucy in to the vet to be put to sleep on her own, if that was necessary while I was gone, than she was continuing palliative care that she now felt was useless.
So we bugged our vet on Tuesday, after Labor Day was over, and Dr. Christine gave up her lunch (again), this time to remove Lucy's tube entirely. At the same time, Lucy came off of the continuing antibiotics we were giving her to try and stave off infection during this palliative period and we also put her prednisolone back up. All told, we felt like that gave her the best chance of eating, as we'd had her on the chemotherapy long enough that we expected to see results (if there were any to be seen), we'd be restoring the pred which was the next (last) thing on the TODO list, and also we'd be taking away the antibiotics and for that matter the tube that might be deterring eating. But we didn't expect much, especially after seeing how poor her "improved" eating had been in recent weeks, compared to earlier periods in the crisis.
And after she got home from the vet, Lucy begged for food, and when we gave it to her she ate it all, with some encouragement. (That mainly means letting her walk off after half a plate, waiting for her to return, then offering her the plate again under different circumstances. That day, I think I did it in her cat carrier, one of her "safe" places that she feels more comfortable finishing food.)
This pattern has generally continued. Poor eating in the morning (which is the norm), and then mostly full meals at lunch and dinner, though mostly with encouragement, returning her to eat one time. It's not sustainable, but for the moment it's food while we try to restore the eating habit.
Lucy got 225 kCal of food on Tuesday, though she was tube fed in the morning before the tube was removed. She got 200 kCal yesterday, all on her own. Our estimate is that she needs 150-180 kCal at her current weight, but that 120-150 kCal would leave her at a bit more normative weight.
So we are EXTREMELY cautiously maybe-optimistic that the chemotherapy we've given her has actually done some good and Lucy might be back on her feed. But we are well aware not only that she's crashed two or three times previously amidst this, but also that this could just be the novelty of having the annoying tube out of her neck. So, this is a very fragile maybe-optimism, and I'm not sure we think there's a great chance yet that things will turn out well. But we haven't even seen a response to the increased prednisilone yet, which took about 3 days last time, and thus puts us to tomorrow night.
Mind you, we do have a downside to all of this: medication application. I'd been giving Lucy pred pills for, I dunno, maybe a year before all of this. Pill pockets didn't work. Compounded treats didn't work. So it was pilling, mostly with a shooter. Some nights it was over in a flash. And other nights there were 5-10 minutes of growling, flailing, and spitting out pills (mostly on Lucy's part, not mine).
And now I've got three pills to give in the morning, which is one more than I could fit in my classic pill shooter (and a new one I picked up on Tuesday that's bigger doesn't seem to work as well for us), and two in the evening. So that's been unpleasant. But if the eating continues, we can combine the pred pills to just one in the morning and hopefully wean her off the anti-nausea. That would put us back to the one long-term pill which is fine.
But we also have chemotherapy liquid twice a week, and that's less fine. We haven't tried to administer it orally yet, but that's on our list for later today, so fingers crossed. It's a carcinogen and can cause allergic reactions, so we have to be very careful of it, and Lucy has a habit of spitting up oral meds.
So that's where things are. Lucy has no tube. Lucy is eating. Lucy will get her collar off tomorrow when her stoma is closed up. But, we don't know if we have a long-term solution or not. I don't know if my kitty will still be around by the time I'm back from Germany. But it feels much better than leaving Kimberly with a cat who was either being tube fed or just not eating.
We've done our best. If Lucy actually keeps eating, every day we have from here on is a blessing, and if not, these last days still were.