Monday, January 2, 2017
I brought Pumpkin in to see the vet on Saturday, concerned because he seemed even thinner and his appetite had become increasingly erratic; then too, there’s the frequent vomiting. Turned out he’s lost about another pound from his already scrawny weight a couple of months ago; he’s down under seven pounds now, skin and bones, and he ought to be closer to ten. They managed to draw blood for testing despite his near-collapsed veins, and then Dr. Montesano and I sat down to discuss where to go from here. It’s more than just thyroid that’s the problem; given the improvement in his coat, it’s not likely even primarily thyroid right now (depending on the blood results). Most probably it’s some kind of gastritis or inflammatory bowel disease, perhaps even gastric lymphoma, which would have to be confirmed by biopsy. We’re not going to do a biopsy, of course, let alone chemotherapy if it is lymphoma; we agree given his age and condition it’s palliative care only, and we’re looking at months, not years, and quality of life at this point. So what to do? The vets and I had previously discussed steroid treatment but been reluctant given his heart murmur; steroids could push him into congestive heart failure. But that treatment could shrink an inflamed and thickened gastric lining, help him to absorb nutrients better, in fact it’s part of the suite of treatments for lymphoma anyway, so what the hell? I could give him a daily pill or he could have a shot good for a month (though if anything went wrong there’d be no way to take it back); I said go for the shot. He also got a dose of mirtazapine (Remeron). In humans it’s an antidepressant; in cats it stimulates appetite while helping to suppress nausea, a half-pill every three days. A short while after I took him home I offered him food – and he devoured it, as much as I thought safe to give him. He wasn’t too keen on supper but ate more small meals in the evening. On the vet’s advice that at this point it’s calories calories calories we need to worry about, not balanced nutrition, I’d stocked up on baby food, those teensy Fancy Feast cans, and some deli sliced chicken breast on the way home, and he liked what I offered of that. Sunday he ate eagerly, again frequent small meals. He was more vocal than usual, a bit more charged up, but those are known side effects of mirtazapine, and overall he was doing way better, behaving normally, snuggling up to me. Success! For however long, success. Dr. Montesano called earlier this morning for mutual updates, while slugabed me was still transitioning from awake to get out of bed. Mine: as outlined above. Hers: His thyroid and other blood levels looked good. Keep on as planned, his next dose of mirtazapine due tomorrow. Then I went downstairs to feed breakfast. And a lethargic Pumpkin wanted none of it. Nothing I offered tempted him. At all. Not even deli chicken. Nope nope nope. God DAMN. I called the vet’s office, was able to speak briefly with the vet before she went into surgery. Could be the mirtazapine has worn off already; could be.... Well, the plan is to watch him, see if he’ll feel like eating later. If he doesn’t by this afternoon, give him his next dose a day early, and let her know what’s going on by tomorrow. And if he still won’t eat? Quality of life, not length, will determine what comes next.