One year later.

It has been a year since Pika was claimed by feline restrictive myofibroblastic sarcoma.  I have been doing periodic literature searches on PubMed and other sites I have access to through work, but the condition is very rare and any new articles I've found are focused on the histopathology of the condition rather than treatments.  There was one recent article about pancreatic cancer that peaked my interest, the study looked at the anti-cancer properties of bitter melon.  Bitter melon is commonly used in the cuisine of many Asian cultures, beside being used as a culinary ingredient it is used in traditional medicine as a treatment for diabetes.  It is thought that some compound or combination of compounds found in biter melon helps regulate glucose metabolism at a cellular level, which is why it is thought to be effective for diabetes.  This same mechanism has been found to be effective against cancer cells, whose uncontrolled growth consumes a lot of glucose.  By reducing the level of glucose metabolism in cancer cells the bitter melon causes the cancerous cells to starve and eventually die, normal cells do not need to metabolize as much glucose to operate and are not affected.  A synopsis of the study can be found here.  It would be interesting to see if bitter melon could be used to stop a myofibroblastic sarcoma from spreading and even killing the defective cells.  That along with serapeptase to digest the excess scar tissue laid down by the myofibroblastic sarcoma might have some value in prolonging the life of or improving the quality of life for an animal patient.  Biter melon can be found at many asian markets and an extract is available in capsule form at places like The Vitamin Shoppe. 

Goodbye little buddy.

At 4pm this afternoon we took Pika one last time to the vet's office.  After taking him in back to install a catheter in his front leg the vet brought him back in to the room and asked us to let her know when to start the procedure.  First, propofol was injected.  This is the same anesthetic that Michael Jackson overdosed on.  Pika grew limp as the drug took effect, I could tell that he was no longer in any pain.  Once we were ready to proceed a euthanasia solution was injected in to the port, and while we petted him and told him how much we loved him I watched as the light drained from his eye.  It was over in a mater of a few seconds.  Pika's pain is over, it was all we could still do for him.  I have nothing but respect for how Family Pet Animal Hospital has helped us in dealing with his disease over the past few months.  In time, our pain and loss will subside and all we'll have left are the happy memories.  All the trouble he would get in to, all the times he would sneak up and jump up on my shoulders without warning, all the times I would come home from work beaten down by the world and he would do something to instantly lift my spirits.

This is how I'll always remember my little buddy.  Rest in peace Pika, you've earned it.  And goodbye little buddy.  I'll continue to search out papers about the horrible disease that claimed your life far to soon and will post information on this blog when it is found, but for now we'll be dealing with the loss of a fuzzy family member who brought much joy to our lives.

The end is near.

Pika's behavior has changed in the last few days. He is sleeping much more than usual and when we look for him he tends to be in closets or other secluded spots.  To me, this says that he's in pain.  He also doesn't appear interested in food anymore, and for him that is huge.  I scooped him up last night so I could get a weight and wasn't happy with the result, he has dropped from 13.5 lbs down to 11.5 lbs.  I'm afraid the end is near.  After work this afternoon I'm going to swing by the vet's office and pick up some buprenorphine, an opiate analgesic.  We hope to give him a happy, pain-free long weekend but I'm going to make an appointment to take him in on Tuesday to release him from his pain.  It will be a very sad day, I wish I could have done more.

No news is??

Things are still pretty much the same, the eye continues to look horrible but Pika is not showing any indications that he is in pain.  We did notice a small blister under his eye on Friday that seemed to be bothering him, so the serrapeptase treatment was suspended for a few days to allow the lesion to heal.  I'll reassess this afternoon and decide then whether to start the enzyme treatment again.

Last week I read an interesting paper describing the use of a NOX inhibitor as a therapy for liver fibrosis.  From what I could understand, NOX (NADPH oxidase) is part of an inter-cellular signaling pathway that results in the recruitment of macrophages to areas of inflammation to lay down scar tissue.  If it works as a treatment for out of control scar tissue formation in the liver, would it do the same thing for a myofibroblastic sarcoma?  So far I've only looked at treatments to reverse the damage after it's already been done, I would love to find a way to stop the damage before it happens.  The problem is, I don't really know that much about the particular NOX inhibitor that was used and since it is still experimental I highly doubt I could obtain any for my own purposes.  There are some NOX inhibitors that are available that I've been looking at, but they are expensive and I haven't been able to find papers that would be helpful in determining the correct dosage for a cat.  For now this will have to join the ALK inhibitor I was looking at as something that may hold promise, but which I will not likely be able to try.

An article about the NOX inhibor treatment can be found here:

http://www.news-medical.net/news/20120808/Study-reports-new-potential-NOX-inhibitor-therapy-for-liver-fibrosis.aspx

No noticeable improvement

We've been doing the serrapeptase for three weeks now.  The eye still looks horrible, all around the ulceration the orb is bright red.  I'm not sure if that's a good thing or bad, it may be the body trying to heal itself.  He still usually acts like he is feeling fine...playful, good appetite, affectionate, but I don't see any indication that the enzyme is digesting any of the scar tissue that's keeping the eye open plus I see what looks like further deformation around his snout.  I do believe that the serrapeptase is making it though the stomach and in to his system, we are seeing small amounts of blood leaking from the eye which I believe is due to the anti-clotting properties of the enzyme.  Since yesterday Pika hasn't been very interested in the wet food we give twice a day, he still likes his treats (Pit'r'pats and greenies) but we'll have to get his weight more frequently to make sure he isn't declining.  It may be time to look at other options in addition or instead of the serrapeptase, but as soon as we feel we can't keep him comfortable and pain free we will have to let him go.

Another vet visit

We took Pika back to the vet on the evening of July 16th, she said that the eye was still deteriorating badly and there wasn't anything else she could do for him.  The exam report would be sent to the opthamologist and we should call her the next day to see what else could be done.  She didn't even charge us for the vet visit, though we did purchase another tube of the ophthalmic ointment.  The next day I called the eye clinic but our vet wasn't in, so I left a message for another of the doctors asking that the exam report be reviewed and offer ideas on our next step.  The doctor who called back said that the report was very complete so there wasn't a need for us to bring him in, Dr. Park would be back on the 24th and they would discuss the case.  At the time, we had just started giving him serrapeptase in hopes of softening the tissue that had become stiff with scar tissue and I wanted to give the treatment more time in hopes of seeing improvement.

So here we are.  Over the last week I've been playing with the serrapeptase dosage and I believe there has been an improvement.  He seems to have much better energy, but I don't know if that can be attributed to the enzyme.  Betty brought home one of his favorite treats which we rarely have on hand because it is bad for his teeth...angel food cake from Dominick's.  We first discovered his taste for this confection after we had bought a cake as part of a dessert.  Someone didn't put the plastic cover back on securely, and the next morning I came down to find the cover on the floor and much of the top of the cake eaten off.  We didn't really know what happened, so the cover was just put on properly.  Later that day we found Pike trying to pop off the cover, he ended up pushing the entire container off the counter.  Since then we have occasionally picked up a cake and offered the cats small amounts from time to time, but now we keep the cakes in a cabinet so Pika can't help himself.  The increase in energy we have seen over the past few days may be due to the serrapeptase or due to the extra sugar and protein he is getting from the angel food cake.  One thing I do attribute to the serrapeptase is the small amount of what I believe to be blood on the fur around his affected eye, the enzyme inhibits fibrin clotting which would explain the leakage.  I an encouraged by this since if it is the case it would mean that the serrapeptase is making it though his stomach and in to the bloodstream.  Now if it will just start working on the stiffened eyelids so they can close we may have an effective treatment here.  That is my hope, but if the eye deteriorates further we will have to make a decision on whether to opt for surgical removal of the eye or euthanasia.  I wasn't able to give him a dose of serrapeptase this morning as he was able to move aside the obstacles I set in place to prevent him from going under the bed, I think he likes to go there since it is completely dark under the bed and he still has some sight in his bad eye.  Since he can't close the eye he may be seeking out total darkness so he can sleep.  The problem is that there is no way we can get him out of there without completely disassembling the bed, which takes at least 30 minutes and can be a problem if we need to take him in to see a vet.  When I get home from work he'll hopefully be out and I'll be able to give him a large dose of serrapeptase.

A decline

On July 3rd we noticed that Pika's eye was looking pretty bad.  The vet clinic had closed early due to the July 4th holiday and would not reopen until the 5th when we already had an appointment, so we decided to wait until then instead of taking him to the emergency clinic.  We increased the frequency of ophthalmic ointment and artificial tears to try and keep him as comfortable as possible until the appointment.

The vet placed a dye in Pika's eye to make it easier to visualize the extent of the problem, he had a 10mm x 4 mm corneal ulceration.  To treat the ulceration, the eye was anesthetized with drops and the ulceration was debrided using betadine soaked swabs.  Then small holes were poked in the ulceration with a hypodermic needle to encourage neovascularization which will hopefully encourage healing of the ulceration.  I believe this prcedure is called Anterior Stromal Puncture.  The final piece of the treatment was to withdraw a blood sample, spin it down to remove cells and puts drops of the resulting serum in the eye 6 times per day for 5 days.  This was the difficult part since we both work during the day and it would be difficult for one of us to be at home during the day, but we (mostly Betty) managed to do it, Betty had to go back the next week to get more blood drawn to replenish our supply of serum.  I had to go out of town for a week during this time which put a pretty big strain of Betty but she did a great job with Pika's treatments.

While we were at the vet clinic I brought up a few things I had found during my research that might be useful as treatments for this disease.  The first is Vitamin D therapy, which we have not tried yet since it is a fat soluble vitamin which can have some serious toxicity if too much is given.  The second item, which I was more excited about, is a proteolytic enzyme called serrapeptase.  This enzyme, first isolated from the digestive tracts of silk worms, digests the fibrin that is a major constituent of scar tissue.  It's used to help reduce internal scar tissue from surgery or sports injury and is not regulated as a drug.  The vet seemed to think this may be of value in treating Pika, so I ordered some serrapeptase from Amazon but then found that I could also get some from The Vitamin Shoppe located within walking distance of home.  I picked some up from The Vitamin Shoppe the night before I had to go to Kentucky for a week, rather than start Pika on the enzyme and then skip town I opted to wait until I got back.  While in Kentucky I started taking the serrapaptase myself at various dosages to see if there would be any side effects that might be a problem for the cat.  I didn't notice any problems so I started Pika on a high dose of serrapeptase within an hour of returning to Chicago on Saturday the 14th.  The capsules contain 40,000 activity units (AU) and the human dosages go from 1 capsule at the low end to 3 capsules (120,000 AU) at the high end twice a day.  I calculated the high dose for Pika based on his body weight divided by mine (6/100) multiplied by high dose of 120,000 AU.  That resulted in a dose of 7200 AU, but using the average human weight of 70kg the dose comes out to 10285 AU so I decided on a dose 8000 AU to simplify things.  This means I can get 5 doses out of one capsule.  I do this by dumping the contents of 1 capsule in a shot glass and adding 5 ml water.  I use a syringe to suspend the powder in the water and draw 1 ml for a dose.  My biggest concern now is how much of the enzyme makes it through the stomach intact and enters the bloodstream since it is no longer contained in a capsule.  I may look for a low-dose capsule of serrapeptase that we can give to him intact if I can't find any information on the use of the enzyme without an enteric coated capsule.