Pampers' Poster Boy:


At left Max is just 'hanging out' as the sun has gone down and there is no activity out his favorite window. He is on a bench we built for him, to keep him mentally fit with the stimulation of outdoors.........you know, squirrels, birds, especially crows, can get even a paralyzed boy on all fours.

Hamlet makes a great cushion, (below), and this way, Max is the one getting the Vitamin D......smart boy!
This type of scene has always been common with these two, (see other interaction here), and for some reason the quality and quantity seems to be increasing, as though Hamlet is protecting his weaker friend.

In the past, I have read, and been told, that cats have waists. If that were true, I am sure it would be easier to keep diapers on cats!

There are more photos of Hamlet and Max on the main cat page, including where the cat was who belonged in this diaper.

Paralympics:

Here we have Max at 7AM, waiting for breakfast and bored. You would think that being reduced to two working limbs would slow him down. He has been playing with the ball above his head. (see left - above his left ear), long enough for me to stop what I am doing to find the camera.

He has slowed down a little, as he can't quite keep up to the balls he hits any more.

Note in th photo to the right that Max has a white bandage on his knee. He is still so very active that he keeps wearing down the skin, causing abrasions.

Paralysis has not slowed our boy's spirit, or energy levels.

These two photos were taken at a point in time where it was suggested we consider having Max put to sleep.......you be the judge.

Available Liturature of Note

My favorite book, of all that I have found on this subject is Cancer Chemotherapy: A Veterinary Handbook , by Kevin A. Hahn. Unfortunately, I thought our vet would be interested in his books, as I have been commenting on the good information he has provided to feline lymphoma groups over the years, so I gave the ones I had to her, and now have to order more..........they are that good. Veterinary Oncology is his other book. I have found other books I ordered to be more basic, and not technical enough for me to actually grasp how I can improve Max's condition. Just my personal opinion, of course.

Chemotherapy Protocols:

The hardest information we had to find in a short space of time is an outline for Dr Rogers Fred III protocol, that contains Elspar, and has definitely saved his life at one point in time as the Elspar was necessary to reduce the size of a tumor cutting off Max's esophagus, so that he couldn't swallow, at all. We thank Dr Fred for his information, and for the followup support he gave to our veterinarian, as needed. So far, his support has given Max more than an extra year of life, interacting with the world he loves.

Dr Rogers Fred III Rescue Protocol:

This list doesn't give dosages, however, a knowledgable veterinarian should be able to work out what your cat needs:

Induction:
(5mg prednisolone daily)
Week 1: Elspar(L-aspiranginase) and Oncovin(vincristine) (both IV)
Week 2: Oncovin(vincristine) and Cytoxan(cyclophosphamide) (both IV)
Week 3: Oncovin(vincristine) and Cytoxan(cyclophosphamide) (both IV)
Week 4: Adriamycin(doxorubicin) (IV)
Week 5: No chemo. Do x-ray and chem profile

Repeat Entire Cycle One Time

Maintenance:
(5mg prednisolone every other day)
Treatment 1: Elspar(L-aspiranginase) and Oncovin(vincristine) (bothIV)
Treatment 2: Oncovin(vincristine) and Cytoxan(cyclophosphamide) (bothIV)
Treatment 3: Oncovin(vincristine) and Cytoxan(cyclophosphamide) (bothIV)
Treatment 4: Oncovin(vincristine) and Cytoxan(cyclophosphamide) (bothIV)
Treatment 5: Rheumatrex(methotrexate) (Oral or IV)
Do x-rays and chem profile on last week of each cycle

Repeat entire cycle two time at 2 week intervals (20 weeks total)
Repeat entire cycle five times at 3 week intervals (75 weeks total)

Red Bank Veterinary Hospital
197 Hance AvenueTinton Falls, NJ 07724
Ph: (732) 747-3636
Fx: (732) 747-6562
www.rbvh.net

Recently, we have added Cytosine Arabinoside which is showing some effect. We add it as a separate protocol, with recommendations from Dr Fred regarding spacing of time between treatments.

The effects include the fact that Max is now rushing to litter boxes to eliminate feces/urine, (not sure which, yet), even though he cannot climb into the litter box at this point in time. Poor little fellow looks inside the box, and hangs his head as he is aware he can't climb into it. Sometimes this is all very hard, both to maintain, and to watch, but his adoring looks and purrs when when I give him his massages make up for it, as do his attempts to be 'normal' with the other boys, who are not treating him like a vulnerable victim, as his upper body is extremely strong.


Max's Original Chemotherapy Protocol:

Provided in May 2002

Induction:
Vincristine 0.5 mg/m² IV once weekly
Cyclophosphamide 50mg/m² PO q. 48 hours
Cytosine arabinoside 100mg/m² SC day 1 and day 2
Prednisone 40 mg/m² q 24 hrs for 1 week, then 20 mg/m² q 48 hrs for 6 weeks
The above phase is continued for six weeks.

Maintenance:
Methotrexate 2.5mg/m² PO 3x per week
Chlorambucil 20mg/m² PO q 2 weeks
Prednisone 20mg/m² PO q 48 hours
Vincristine 0.5mg/m² IV every 4 weeks

There was no discussed protocol for long term maintenance as Max was showing no signs of residual cancer. We dropped the prednisone quite early in the maintenance phase as we have concerns about its long term use. We did the maintenance protocol about twice, without prednisone, before deciding to stop chemo altogether. Our choice wasn't wrong in this particular situation as Max did not come out of remission for three and a half years, at which time there were new issues and a new protocol was chosen, both by us, and by our veterinarian, that was more appropriate for the battle back into remission again.

After an ultrasound showed no signs of lymphoma, along with blood tests showing him clear, we decided against maintenance the first time we used the second protocol, (Dr Fred's), however, we feel this was a bad decision as he came out of remission within about three or four months.

The fact that Cytosine arabinoside MAY have had a benefit for Max in the early days of his cancer is worthy of note, as his cancer stayed away for so long, and since returning, (without the Cytosine arabinoside), it has hit his spine twice; once with a lump attached to the spine, and second with presence in the spinal fluids, causing him to have lower paralysis, including effecting his ellimination processes. The Cytosine arabinoside is again having some effect as we eventually added it as a separate protocol, with recommendations from Dr Fred regarding spacing of time between treatments. This, of course, is personal observation, not scientific proof that the drug caused the improvement.

Prednisone Concerns:

The second round of Dr. Fred's protocol was about half way through the first maintenance round when Max developed limb weakness, and regressed quite quickly into some paralysis. We attempted to use specialists at Canada West in the hopes that they could come up with better ideas and answers. I was hoping that the choice would be made to use Cytosine arabinoside as I had read a lot about its success. This was started, but then, just as some slight improvement was starting to show, Canada West switched to Lomustine without consulting us. They had a legal right to do this as we had signed waivers, based upon the fact that they had chosen the preferred drug in the beginning.

Canada West also insisted we needed to double Max's dose of prednisone, and, against my better judgement, I accepted their choice and administered it for a short period, until I saw just how much muscle wasting was happening as a result.

The following sites clarify why I do not like using prednisone, which is good for short term prevention of inflamation, but has its side effects:

For patients on oral corticosteroids, another serious potential side effect is suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to adrenal insufficiency, said Serge A. Jabbour, M.D., of the Thomas Jefferson University here.

and at the same site:

The portion of the inhaled drug that does not make it into the lung but is instead swallowed, and the ensuing systemic effect interferes with the growth process.

Evidence that prednisone-induced myopathy is reversed by physical training.

Human growth hormone prevents the protein catabolic side effects of prednisone in humans.

The ratio of observed to predicted (by nomogram) urinary creatinine excretion was lower in patients than controls, resulting in a corresponding underprediction of creatinine clearance by nomograms in the patients taking prednisone

Effect of Short-Term Prednisone Use on Blood Flow, Muscle Protein Metabolism, and Function

SIDE EFFECTS: Fluid and Electrolyte Disturbances, Musculoskeletal, Gastrointestinal, Sermatologic, Metabolic.

Physiotherapy:

When I consulted a physiotherapist about what could be done to help Max recover use of limbs that had wasted so badly in a short period of time, she suggested using the full range of movement for each leg.

• I started by stretching the leg to its full extent, gently pushing it back close to his torso, and then stretching it up to his head, and back again. The first day I started with five on each leg, then next day I did ten, and so I have increased it to the point where we are now doing three batches of 50 per leg, to make 150 per day. There were days that he was showing less appreciation than normal where I would cut back a bit, or not increase the number of stretchs.


• The second stage of this is rubbing toes, and limbs to increase circulation as flow of blood is important for maintenance of the limb. I do this by rubbing them gently between my hands.


• The third thing I do is massage the spine, gently, as another method of getting blood to flow to areas affecting, or affected by the paralyis.


• The forth area that I personally have spent less time on is Max's tail. I should probably work harder on his tail as I can see his old 'annoyance' flick once in a while when I am massaging legs. This may, or may not, be related to improvement.

Aside from chemo drugs, we have been consistantly giving Max a #4 size capsule of Moducare, twice a day, Vitamin E, (200IU D-Alpha Tocopheryl), twice a week, and recently added ascorbic acid in #3 gelatine capsules. As Max's kidneys were enlarged from the start, in 2002, we are also including a ground tablet of Renal Essentials in a #3 capsule. Our personal observations are that this may be providing some support as his kidneys have reduced in size in the latest ultrasounds done this year, which was why we mistakenly stopped chemo with such confidence. At the present time we have also added Maglucate as a gentle feline form of Phillips Milk of Magnesia, mainly because it contains magnesium gluconate. So far we are not observing improvement with the Maglucate as he has lost peristalsis, but the stools are softer.

Poor little guy is starting to feel like a medicine cabinet before meals.

Here is Max, (right), my darling monkey who doesn't think twice about grabbing at legs when you try to descend the stairs while he is sunning himself on a step. In this photo, he was helping with the Christmas lights after being declared in remission from his first bout with renal lymphosarcoma. He loves to be a helper.


Max was diagnosed with renal lymphosarcoma in May of 2002, and had a serious battle with his cancer. The photo above left shows him being very tolerant with the bandage wrapped around his middle as he had a Transdermal Fentanyl Patch attached to a shaved spot. For the whole period of his chemo, Max was a fighter, and although he wasn't strong enough to have more than the most minimum amount of drugs administered to defeat the cancer, he perservered and kept us going through the dark hours with his impish spirit. He defeated the cancer and has been a jewel in our home ever since. We all love him, humans and cats alike.



A note here for owners of felines contracting cancer, that the cost of chemo is spread over the space of several months, and the benefit is spread over years. Well worth the attempt if your vet indicates there is a chance of recovery.


Since the original post for this, in October of 2005, Max was again diagnosed with renal cancer that had spread very quickly to a lump that was squeezing his throat so that he couldn't swallow. We syringe fed and got him onto the Dr. Rogers Fred III protocol that provided for a newish drug, Elspar, that shrank his tumour within a couple of days, so that he was soon eating on his own. In February 2006, he was once again declared in remission and as he is so happy these days, we have stopped the protocol to give him better quality of life, as we know the cancer will one day return. Lymphoma stays in the lymph fluids until it finds another target.


At left, Max is eating lemon grass that we order regularly from Richters. Of all the types of grass we have supplied over the years, this is comparable in popularity with cat nip, which is why it has to be hung above the cat tree so that it can't be totally destroyed in one meal.

November 2006:
Recently, we noticed Max having increasing difficulty with his hind quarters, and his usual extremely talkative tail was drooping and silent. This slowly developed into paralysis in the hind end, with the worst event happening after an increase in his prednisone to twice the dose previously maintained without visible side effects, at 5mg per day. Max is now unable to use his hind quarters at all, and needs help with elimination of feces, as well as needing a diaper. He is still extremely active and alert, and has improved slightly as he is given four day batches of chemo directed at the blood brain barrier. We found useful information at Cats With Paralysis that helped keep us going.

December 6, 2006:

On December 3rd, Max either had a nightmare in his bed, or heard the coyote that was checking the yard, (footprints in the snow). As DH puts it, he "shot" out of his bed and flew to the floor below, hitting his hind quarters on a stool on the way down. He has howled a bit, once in a while, when I am caring for him, and it appears that he either damaged himself when he 'flew' off the bed, or his cancer could be progressing. Whatever the reason, Max has not chosen to voluntarily climb on or off furniture since that point in time, and we are concerned. If we are very, it may turn out to be bruising or strained muscles, and he may heal. He still enjoys his physio to the point of purring when I do it.

Note: On the day that I had to choose to release Max from his pain, he was desperately straining to get away from it, in spite of limited ability to move, in what seemed a similar manner to the incident above, so we think that the serious pain he was experiencing started to appear at that point, and that it wasn't a nightmare at all. He seemed to go through periods of pain, and then recover, only to have it return. As Max was not a vocal boy, judging his pain was about the most difficult part of this experience. We know that there were times we probably medicated him when he didn't need it, however, at the end, he was short changed by our lack of understanding.

December 8, 2006

Max's vet came back from holiday yesterday, and we are lucky she did. She has better equipment, and more experience dealing with the lack of peristalsis connected to paralysis, and I wasn't sure if an assessment was going to suggest Max be put out of his misery. I had forgotten to provide his favorite food in with the diapers and warm blankets, and when DH and I stopped by to check on him after about six hours, we could hear his bellowing for food from the vet's office door as we entered. He went in looking like Kayla had, which frightened me, and now he was back to holding himself very erect, and was ready to eat like there was no tomorrow..........and there is.

This morning he was back to getting himself off furniture, although I haven't seen him climb onto anything yet.

We are aware that the Cytarabine Arabinoside, aka Cytosar-U has not reduced the paralysis after treatment. This is what we expected as sources of information such as the one above clarify that this drug "interferes with the growth of cancer cells, which are eventually destroyed". The maintenance chemo he is on did not prevent the paralysis, so we believe he may be living on borrowed time, however, the standard life expectancy, with chemo, for his condition, is one year, and he is well into his fifth.

December 14, 2006

Max cannot pull himself around much any more. A foot or two at a time exhausts him, and he usually stops there and waits for someone to notice his distress. On the night of December 12, I went to move him from his 'dinner table' where he was sharing with the other boys, and after a couple of quiet wimpers to let me know he was uncomfortable, he swung around and bit my hand deeply, to the degree that I had to have a tetanus shot and antibiotics as the bite was looking red by next morning. Max has always been a gentle soul, no matter what, so he must have been in severe pain.

Luckily I had Metacam in the boys' medicine chest, with instructions for dosing Max, and the product was only a year old, so I gave him a loading dose for pain immediately. Shortly thereafter he was quite content to be 'serviced' with food and water throughout the night as he was feeling better. This is not all due to the paralysis. We are assuming that the cancer has returned to his body in other parts that may be swelling and causing him discomfort, so we are keeping him on Metacam for the time being. This seems to make him very comfortable and ready to check out birds, squirrels, and toys for brief encounters.

An added major concern for us is ensuring he is not dehydrated as he can't reach water on his own, and would spill any container that he could use withouth help.

When we were bringing Max home from the vet yesterday, he was pulling himself up to the car window with the two working legs he has left, and was very interested in everything that was happening around him, as he always has been in the car. He was also attempting to move around to fend for himself when we were out for a few hours, later. It is also very important to him that he be with the other boys, even if he can only observe the interactions and not take part. He is showing clear signs of wanting to be on this earth, with his family.

December 16. 2006

The metacam wasn't working yesterday, and all other options could not keep ahead of what was causing the pain to increase in Max's little body so quickly, and to such a degree of pain that he showed he was in agony. He had been frantically trying to get away from the pain and howling at me to fix it, but finally I didn't have any answers left for him, other than to give him the final escape. At 5:50PM, December 15, 2006, we released Max from his pain, and now there is a very big hole in our lives.

The last few weeks of Max's life, I was noticing that he could not hold his spine straight when I lifted his back legs. Early in the paralysis, he would happily run around on front feet while I held his hind feet above the floor. His favorite trick had been trying to take me under furniture, and through the tunnel used by all the boys. If he flipped over to his right side, near the end, he would cry out and writhe around until he got back over to his left side. Any time I tried to lift his hind legs to help him move faster and more easily to his destination, he could not move his front legs well, and his body was quite twisted. He was better managing on his own. At the end, we did not want to put Max through any more tests to give us answers, so we can only assume that the tumor grew to be a major problem in his spine, and possibly the change in posture as he pulled himself around caused stress on his spine as well.

It is extremely hard for any pet owner to switch from primary caregiver to being the person that chooses the release from pain for an animal in distress. While I have trained in courses that include writings by Elizabeth Kubler Ross, this doesn't exempt me from travelling through the stages of grief, as does every human being, each in their own time.