7/13 Ruby Oncology Vet today AMPS 250/+3 244/+9 168/PMPS 136

[Katherine&Ruby]

Yesterday.

Ruby had her oncology visit today. The vet is doing urinalysis and a urine culture and will have results in 3 days. She said that UTIs are very common among kitties with CKD and diabetes while on steroids. Will await the results before starting an antibiotic. She also took some blood for a standard CBC.

Good news: Ruby gained a half pound since she was at AMC at the beginning of June, which means she is responding well to the pred and she said she wants to keep her on it because it’s the best treatment for her SCL. She did want to take the dose back down again to 5 mg because of her rising BG numbers, but does not want to add chlorambucil because Ruby seems to be improving on the steroids alone from the weight gain. I am happy about this as I was really worried about having to contend with side effects from chemo if I am working all the time.

I really trust this doctor and her experience in dealing with SCL in cats. She said that she has seen cats do very well on steroids alone. I am also happy that she wants to take the pred down a notch. We will wait and see what the various tests tell us in a few days.

Hope everyone had a good day.

 

[Wendy&Neko]

Paws crossed for no UTI - Neko never got them in spite of FD and CKD. But I kept spending money on those cultures, just in case. The 1/2 lb weight gain is good. Is she where she should be now?

but does not want to add chlorambucil because Ruby seems to be improving on the steroids alone from the weight gain

I'm sorry the oncologist doesn't want to treat the SCL. Chlorambucil is the drug of choice in the latest vet oncology texts. Cats will see some improvement on pred alone, but it doesn't last as long. I would love to see any papers she has showing the contrary. BTW, the side effects from chemo are not that bad. Predose with ondansetron and give ondansetron for a couple days after, and that's it - as long as doing the every two week regime.

 

[Our Dolly Girl (GA)]

Yesterday.

Ruby had her oncology visit today. The vet is doing urinalysis and a urine culture and will have results in 3 days. She said that UTIs are very common among kitties with CKD and diabetes while on steroids. Will await the results before starting an antibiotic. She also took some blood for a standard CBC.

Good news: Ruby gained a half pound since she was at AMC at the beginning of June, which means she is responding well to the pred and she said she wants to keep her on it because it’s the best treatment for her SCL. She did want to take the dose back down again to 5 mg because of her rising BG numbers, but does not want to add chlorambucil because Ruby seems to be improving on the steroids alone from the weight gain. I am happy about this as I was really worried about having to contend with side effects from chemo if I am working all the time.

I really trust this doctor and her experience in dealing with SCL in cats. She said that she has seen cats do very well on steroids alone. I am also happy that she wants to take the pred down a notch. We will wait and see what the various tests tell us in a few days.

Hope everyone had a good day.

Hi Katherine, such good news. You sound really confident in this doctor and that’s so important. If Ruby continues to gain or at least be stable and not have to have new meds added to the mix, what a blessing. Dolly, Rob and I send our love to sweet Ruby and give her a kiss from us for doing such a good job. I am so happy for you with working at a new job and not having to worry about Ruby taking chemo meds. Great job Katherine. Hugs to all.
Prayers that the culture is clean or easily treatable.I did read Wendy’s message so I know you probably are concerned whether this is the right path for Ruby. I know you will do what’s best for her.

 

[Katherine&Ruby]

The 1/2 lb weight gain is good. Is she where she should be now?

I remarked the other day to DBF that Ruby looks like she's gained weight, and her body condition is better. 5 kilos is a little too thin for her, so somewhere around 5.5 kgs is probably a good weight for her and she should stop there.

I'm sorry the oncologist doesn't want to treat the SCL. Chlorambucil is the drug of choice in the latest vet oncology texts. Cats will see some improvement on pred alone, but it doesn't last as long. I would love to see any papers she has showing the contrary.

I will talk to her again about the chlorambucil when the test results come in because maybe they will reveal something that a physical examination will not. I understand your point, and I wish I could have been there in the room to push her on her rationale a bit more, but I had to step away from an important work meeting in order to take her call and was a bit distracted. It was funny because she asked me why I thought Ruby should be on chlorambucil, as though it was a crazy thought.

 

[Our Dolly Girl (GA)]

I remarked the other day to DBF that Ruby looks like she's gained weight, and her body condition is better. 5 kilos is a little too thin for her, so somewhere around 5.5 kgs is probably a good weight for her and she should stop there.


I will talk to her again about the chlorambucil when the test results come in because maybe they will reveal something that a physical examination will not. I understand your point, and I wish I could have been there in the room to push her on her rationale a bit more, but I had to step away from an important work meeting in order to take her call and was a bit distracted. It was funny because she asked me why I thought Ruby should be on chlorambucil, as though it was a crazy thought.

That’s interesting as in why did she think you were seeing an oncologist? Did you get a response that you were comfortable with? I know you must exhausted so no need to respond, just thinking out loud because I care. Just hugs and I certainly don’t know enough to add my thoughts. We treated our undiagnosed kitty with just steroids (dexamethasone) but she had so many health issues.

 

[carfurby (GA)]

I'm glad Ruby has gained some weight. I hope she continues to do well on the reduced pred dose. I hope she really doesn't have a UTI. Sending prayers.

 

[Diane Tyler's Mom GA]

Hi Katherine, Happy to hear Ruby has put on weight and you are trust this doctor

I'm glad you are going to talk with her about the chlorambucil after all the rest results are in. I hope she will give you are reason for not wanting to treat the SCL ♥
​

 

[Our Dolly Girl (GA)]

That’s interesting as in why did she think you were seeing an oncologist? Did you get a response that you were comfortable with? I know you must exhausted so no need to respond, just thinking out loud because I care. Just hugs and I certainly don’t know enough to add my thoughts. We treated our undiagnosed kitty with just steroids (dexamethasone) but she had so many health issues.

Sorry, I read what you said about talking to her when you get the culture results and all that seemed to have left my brain when I sent my last post. I seem to do that a lot lately I really am sorry.

 

[Katherine&Ruby]

Sorry, I read what you said about talking to her when you get the culture results and all that seemed to have left my brain when I sent my last post. I seem to do that a lot lately I really am sorry.

Oh Adrienne, you are the sweetest, and I know you care so much about us, so please, no apologies!

 

[FrostD]

I'm glad she's gained weight. I don't know anything about the other stuff, but if you're happy I'm happy! Hopefully no UTI.

 

[Katherine&Ruby]

I'm glad she's gained weight. I don't know anything about the other stuff, but if you're happy I'm happy! Hopefully no UTI.

Thanks, Melissa! I do want to trust the experience and intuition of this doctor. As long as Ruby stays eating, pooping, peeing, purring and playing normally, I have no problem with following her lead. As soon as I see any sign of her going downhill, I will push back. Paws crossed for no UTI.

 

[Suzanne & Darcy]

I have mixed feelings about this. On the one hand I am a “fan” of chlorambucil because my cat lived many years on it and did well until the chlorambucil didn’t work anymore. On the other hand I appreciate that perhaps the vet is being conservative and doesn’t want to jump to chlorambucil first thing. On another hand I want to know why the vet doesn’t want to start chlorambucil— I mean — what a question! Why chlorambucil? Uh… because my cat has SCL! And it is the “standard of care.” On ANOTHER hand (this is an Octopus!) I also had a kitty (my beloved Inky) who had SCL (diagnosed via laparotomy and biopsies) with SCL and he was put only on Prednisolone. This was before the days when there was chlorambucil. He did well on pred for about a year and a half but then it got out of control and we had to euthanize (no other treatment at the time as far as I knew!). Broke my heart!! Later when Maverick did so well on Chlorambucil, I always said that if we had had chlorambucil when Inky was around that he would have lived much longer. So… I just want THE BEST for Ruby… whatever that is! I know that you do! Love and hugs and kisses to Ruby Roo and Katherine too!

 

[Katherine&Ruby]

I have mixed feelings about this. On the one hand I am a “fan” of chlorambucil because my cat lived many years on it and did well until the chlorambucil didn’t work anymore. On the other hand I appreciate that perhaps the vet is being conservative and doesn’t want to jump to chlorambucil first thing. On another hand I want to know why the vet doesn’t want to start chlorambucil— I mean — what a question! Why chlorambucil? Uh… because my cat has SCL! And it is the “standard of care.” On ANOTHER hand (this is an Octopus!) I also had a kitty (my beloved Inky) who had SCL (diagnosed via laparotomy and biopsies) with SCL and he was put only on Prednisolone. This was before the days when there was chlorambucil. He did well on pred for about a year and a half but then it got out of control and we had to euthanize (no other treatment at the time as far as I knew!). Broke my heart!! Later when Maverick did so well on Chlorambucil, I always said that if we had had chlorambucil when Inky was around that he would have lived much longer. So… I just want THE BEST for Ruby… whatever that is! I know that you do! Love and hugs and kisses to Ruby Roo and Katherine too!

Thank you, Suzanne. I really appreciate all of the experience and knowledge you, Wendy, and Elise bring to me about this terrible disease. I have all of your words filed away in my mind. The vet told me a long story about an SCL cat that could not be pilled, and didn't wind up taking any chlorambucil and thrived for a while until he died of advanced kidney disease. Her reasoning is that most cats who have SCL don't die of it, so there's no point in throwing the big guns at it from the get go. I understand this and appreciate the conservative approach. I also feel like I've waited and paid for her years of experience and should not discount it. In addition to waiting for the blood test results at the end of this week, we will have another follow up in a month. With careful monitoring on my end and the doctor's, we should be able to come to some agreement about Ruby's care that's in her best interest. So much love back to you, dear Suzanne!

 

[Suzanne & Darcy]

Thank you, Suzanne. I really appreciate all of the experience and knowledge you, Wendy, and Elise bring to me about this terrible disease. I have all of your words filed away in my mind. The vet told me a long story about an SCL cat that could not be pilled, and didn't wind up taking any chlorambucil and thrived for a while until he died of advanced kidney disease. Her reasoning is that most cats who have SCL don't die of it, so there's no point in throwing the big guns at it from the get go. I understand this and appreciate the conservative approach. I also feel like I've waited and paid for her years of experience and should not discount it. In addition to waiting for the blood test results at the end of this week, we will have another follow up in a month. With careful monitoring on my end and the doctor's, we should be able to come to some agreement about Ruby's care that's in her best interest. So much love back to you, dear Suzanne!

Yes! I actually think that if I were in your shoes I would try to forestall the use of Leukeran for a while, provided that Ruby was closely monitored and we would be able to determine when was the appropriate time to begin the chemo.

 

[Wendy&Neko]

Her reasoning is that most cats who have SCL don't die of it, so there's no point in throwing the big guns at it from the get go.

Umm, but if you don't give them chlorambucil, then they will more likely die of SCL. Treating SCL allows them to live long enough to die of something else. Neko had plenty things going on at the same time. And it wasn't SCL that did her in. My first SCL civvie died of pancreatic cancer, after a couple years of SCL treatment - which he barely noticed. Third SCL kitty is so much healthier in remission through treatment. I've seen a couple kitties here with SCL, untreated, or just on pred. They wasted away. SCL is a slow moving disease, so you do have some time as Suzanne said, but believe me, remission is a beautiful thing. You don't get there with pred alone.

I understand wanting to listen to the oncologist, and she does sound like she has plenty of experience. I just am a science based sort of person, and so far the papers I've seen say chlorambucil is the way to go. I am open to seeing anything that says otherwise. By the way, chlorambucil can be compounded into chew treats. It doesn't have to be pills. Mine wolfs down hers in pill pockets.

Chlorambucil is also not a big gun, but rather a medium sized one that is fairly mild. There are bigger guns out there.

 

[Suzanne & Darcy]

Umm, but if you don't give them chlorambucil, then they will more likely die of SCL. Treating SCL allows them to live long enough to die of something else. Neko had plenty things going on at the same time. And it wasn't SCL that did her in. My first SCL civvie died of pancreatic cancer, after a couple years of SCL treatment - which he barely noticed. Third SCL kitty is so much healthier in remission through treatment. I've seen a couple kitties here with SCL, untreated, or just on pred. They wasted away. SCL is a slow moving disease, so you do have some time as Suzanne said, but believe me, remission is a beautiful thing. You don't get there with pred alone.

I understand wanting to listen to the oncologist, and she does sound like she has plenty of experience. I just am a science based sort of person, and so far the papers I've seen say chlorambucil is the way to go. I am open to seeing anything that says otherwise. By the way, chlorambucil can be compounded into chew treats. It doesn't have to be pills. Mine wolfs down hers in pill pockets.

Chlorambucil is also not a big gun, but rather a medium sized one that is fairly mild. There are bigger guns out there.

I would be interested to see what Dr. Jory Olsen would think about this. I guess you could say that my cat Maverick did die of SCL because when the chlorambucil was no longer enough he had a very large tumor in his intestines and we tried the rescue drug Lomustine but it was too late and he couldn’t take it. Poor boy was very sick at the end.