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.

No change

We haven't seen much in the way of improvement since starting the steroid therapy, the hope was that his left eye would loosen up enough that we could have a protective lens put in.  For now we'll continue with the artificial tears and ophthalmic ointment.  No apparent infiltration of the disease on the right side of his face yet.  Sometimes Pika seems normal but he is sleeping a lot more than he used to and I'm concerned that he may be losing weight.  This afternoon I'll see is I can get a current weight on him, he was around 13.5 pounds last time I weighed him at home.  All I have at home is a bathroom scale to do this, so I'll just weigh myself while holding him and again after I've put him down and figure out the difference.  It'll have to do until our next visit to the vet's office  Our vet has asked us to bring him in for a check-up in mid July, the other cat who was on this high a dose of steroid developed kidney issues after several weeks but that one was undergoing chemotherapy as well so she thinks he will be OK in that regard.  We can lower the dose if necessary.  She will also check his left eye to see if our treatment regiment is working well enough or if we will have to look at other options, such as having the eye removed.  He still isn't exhibiting signs of pain, I hope to keep him off the pain meds for as long as possible but as soon as it's necessary we'll start him on buprenorphine injections twice a day.

A treatment begins

On Saturday I spoke to our vet at Family Pet so we could start a treatment, I don't like doing nothing.  Getting to the clinic to pick up a prescription would have been very difficult due to the Old Town Art Fair and the Wells Street art fair going on, it would have been impossible to find a parking spot within a mile of the house if I were to have driven to the clinic for the drugs.  Luckily the vet was able to call the prescription in to a nearby Walgreen's for us to pick up.  The drug we are using is MIllipred (prednisolone 5 mg twice a day), a corticosteroid that should help reduce the inflammation caused by the disease and at least make him more comfortable.  He seems to be tolerating the medication well, we hope to see some results within a few days.  I have heard of pulse steroid therapy being used successfully in the treatment of human myofibroblactic sarcomas , but have not found any reference to that therapy being used in veterinary medicine and don't know if it is applicable to this situation.  On Friday I put out some feelers to a few people in research at the University of Chicago, hopefully someone down there will have some knowledge of this disease and may be able to suggest a therapy to treat the disease itself rather than to just manage the symptoms.  In the meantime I'll continue to scour through publications to try and find a treatment with promise.

A little progress?

The opthamologist returned my call on Wednesday, we discussed the options we have.  The chemotherapy they tried on the only other case of this condition they have seen seemed to work for the first two treatments, but the animal declined rapidly after the third.  I don't want to subject Pika to that much discomfort for something that has no history of success.  The doctor suggested that we should pursue the treatment with our own vet since Pika is used to them and it will be less stressful for him.  She faxed their treatment protocol to Family pet.  On Thursday I called to make sure they had received the information and left a message for our vet that I could be reached at any time except between 4pm and 6pm when I would be in a meeting.  Naturally, the call came between 4pm and 6pm and I couldn't answer.  By the time the meeting finally broke up the doctor had left for the day.  She'll be back in the office on Saturday so I can talk to her and try to get started on a treatment regiment.  It will be difficult to get to the clinic this weekend due to the art festival going on in our neighborhood but I'll do what I have to if it means some relief for Pika.  Pika is still acting normally and is affectionate as ever.  Last night I noticed him scratching the left side of his face a few times o it is definatly bothering him.  Hopefully the steroids will help with that.  The opthamologist also mentioned that the other cat had received Buprenex as an analgesic, it is on opiate (buprenorphine) and doesn't have the dependency issues with other opiate analgesics like morphine.  We use this routinely at work, the one thing I'm concerned about it is that buprenorphine causes appetite suppression, so I'd prefer to hold off on that until Pika seems to be in pain.  Hopefully there will be some movement on the treatment front tomorrow.

Waiting

I'm still waiting for the ophthalmologist to get back to me with a treatment plan.  With the exception of the eye that we are treating with ophthalmic ointment and artificial tears, Pika seems to be in good shape and acting normally.  I was looking through some photos from early in the year, I unfortunately don't have many of the cats, and found two that show the time window where symptoms began.  The first, to the left, was taken on January 13th.  There is no noticeable squinting of the left eye.  The second, to the right below clearly shows him with the squint.

On Monday our regular vet called, she had received the report from the opthamologist and just wanted to know if we needed anyone to talk to about the diagnosis.  Unexpected, but the vets at Family Pet Animal Hospital have always been great.  We talked about the treatments that may be proposed, steroids and chemotherapy are the two most likely.  Betty and I talked about it and we would probably prefer the steroid therapy, it can be done at home where he is comfortable.  The chemotherapy would require Pika to go in for multiple days to get IV treatment, which he would hate, and would most likely make him sick and miserable.  It would also be much more expensive and we don't exactly have piles of extra cash laying around to pay for this.  Besides, I can't find anything in my searches to indicate that chemotherapy would have a better outcome than any other treatment option.

 Information about this condition in cats is sparse, the vet gave us a copy of this article before we left the clinic on Friday.  Another page shows a slideshow presentation in the condition here.  WARNING, this page contains some graphic images.  

Since I work at a hospital, I have been able to peruse Medline and Pubmed for articles.  There isn't much about the feline disease but I've found a lot of papers about human myofibroblastic sarcomas.  I don't know if the condition in humans is similar enough to what Pika has to be applicable, but one treatment that seem to show promise is pulse steroid therapy followed by a large dose of steroid or radiation therapy which in some cases has resulted in remission.  A second promising therapy in humans is the use of an ALK inhibitor.  I'll have to bring these up when I talk to the opthamologist (hopefully) later today.

Meet Pika

Today I'm going to do something that I never envisioned myself doing before...I'm starting a blog.  Not just any blog, but a blog about a cat.  Now I'm not what you would call a fanatic pet owner.  Sure I've loved all the pets I've had over the years...cats, dogs, birds, fish (well, "love" may be too strong a word for the fish) even turtles and snakes briefly.  I've never felt the need to write about an animal, until now.  So why start blogging about a pet now?  The reason will be revealed later in this post as well as the true purpose for this blog.  First, let me introduce you to Pika.

One day in February 2001 we were driving along Touhy Ave. in Niles Illinois, we being my girlfriend Betty, her daughter Jenny and me.  I was in culinary school at the time and wanted to grow some herbs in our kitchen window to use in my cooking.  Up in Niles there's a nursery called Meinke Garden Center that's been there forever, I asked if they would mind if we stopped there so I could pick up some herb seeds.

As I was perusing the seed selection, I heard the cashier ask Jenny "Would you like to see some kittens?".  Well of course, who wouldn't want to see some kittens?  We had recently adopted a cat from a shelter, a solid black girl we named Boo after a cat I had while growing up, so we naturally followed the employee to another greenhouse.  There we saw a litter of kittens that couldn't have been more than a week or so old, so young that their eyes hadn't opened yet.  One of them stood out from all the others, it was a grey and white one with a pink nose who was louder that all the rest and always fought it's way to the top of the pile.  He was so small that he easily fit in the palm of my hand with room to spare.  "You know, we're adopting them out if you're interested." the employee said, and that was it.  We left with my packets of seeds and a promise to come back to pick up our new cat when he was weaned.  Several weeks later we received a call from Meinke's telling us to come pick up our kitten, he was destroying their plants!  And so, we brought him home.

Boo really didn't know what to think of Pika when we brought him home.  He was still a tiny thing, with a stumpy little tail and eyes that were way too big for his little noggin.  At first we only put them together for short periods under supervision.  Boo would hiss at him, after all this was HER house, but he would keep on going up to her until she just accepted him as her brother.  As Pika grew bigger, his tail seemed to stay a little stubby. Betty used to grab his tail and joke that she'd stretch it out to normal length, eventually is did grow to a size proportionate to the rest of his body.

The subsequent years have held a lot of good times, and some very bad ones.  The 9/11 attacks, being laid off from my job a month afterwards, family deaths and other crises.  No matter what happened, I knew that when I got home the little Pika would be there waiting to make me feel better.  At one point when he was a few years old he was on a table when I leaned down to pet him.  Without warning he jumped up on my back and lay down on my shoulders, with his head resting on my left shoulder and his rear on my right.  This became a favorite thing for him to do when I came home from work, always in the same position with his head over my left shoulder.  Sometimes he would jump up there with no warning, like when I was looking for something in the refrigerator or the pantry.  Sure I had a lot of scratched on my back and shoulders from where he grabbed on to me, but it was worth it.  He would ride around on my shoulders as I went about my business around the house.

Pika would often chase his tail at different times.  After a bit we began to realize that shortly after the tail chasing sessions it would rain.  My best guess is that the changing air pressure and/or humidity caused some type of irritation at the tip of his tail which caused him to chase it around, but we liked to think that he was actively causing the rain by chasing his tail.  I know, stupid cat owners!

The years have gone by uneventfully, with both cats being happy and mostly healthy.  Our animals received regular veterinary care and we always took them for additional check ups whenever something seemed wrong.  Now comes the reason why I decided to write this blog.  Pika is sick...very sick.

Back in January we noticed that Pika was squinting his left eye.  We assumed that he just had something in there of that he and Boo had sparred a little with each other and she had gotten a good swipe in.  When the eye hadn't resolved itself after a few weeks we took him to the vet (which is someplace he does NOT like to go!).  She found that he had an ear infection, cleaned it out and gave us some medication to use at home to get him back to normal.  After a few weeks the ear infection was gone, but the squint remained so we took him back.  This time we were prescribed some antibiotic/steroid eye drops to try for a week.  When this still did not resolve our vet suggested we take him to an animal ophthalmologist (yes they DO exist).  We made the appointment and took him to the clinic in mid March.  The doctor examined Pika and told us that it looked like he had Horner's syndrome due to the ear infection.  This is an inflamation of the cranial nerve feeding the eye.  All of the classic signs were there, a somewhat rigid eyelid and a smaller than normal pupil size.  This was good news!  Horner's syndrome generally resolves itself after about six months.  We went about our business for the next few months, things were very busy at work so I wasn't able to pay that much attention to the cats.  We traveled out of town for Jenny's college graduation, then I had a major accreditation inspection at work I had to get ready for.  The inspection went extremely well, everyone was happy, then the bottom fell out.

On June 1st I woke up as usual and started getting ready for work.  Pika was laying at the foot of the bed, so I went over to give him a few pets.  When I saw his eye I knew something was very wrong, it was cloudy and covered with a thick mucous.  Pika had lost the ability to close his left eye, which had become irritated and started producing extra mucous to try and compensate.  Once the eye clinic was open we called and were able to get an appointment for later that afternoon.  Another doctor saw Pika, and the diagnosis was very different.  Pika is suffering from Feline Restrictive Orbital Myofibroblastic Sarcoma, a.k.a. Feline orbital pseudotumor.  I'm still in the process of finding out all I can about this disease, and that is the true purpose of this blog.  The disease isn't cancer, it causes the formation of scar tissue which results in the other tissues to become firm and lose their elasticity.  It is also progressive, moving along the facial planes to the other eye and the mouth.  At the time of the second exam, the left side of Pika's mouth was also showing signs of the disease.  currently there are no treatments that seem to be effective and the mean survival time after symptoms manifest, even with intensive treatment, is about 9 months and we first saw the squinting five months ago.  One of the doctors at the clinic has treated this rare condition before, we are waiting to hear from him to see what our next move will be.  For now we're treating the affected eye with ophthalmic antibiotic ointment, artificial tears gel and flushing with saline as needed.

So that is the reason for this blog, not only to allow me to write about an animals who has grown to mean a great deal to me personally, but to document our struggle with this disease.  As I do my research on this disease I plan to post links to those sources here.  Anything we try to treat this condition will be described here.  No matter what the outcome, I hope this information will be of some use to someone who may have to deal with it in the future.  I don't know how much time we have left with Pika, maybe weeks, maybe months, maybe more.  For the time that we do have, I intend to make sure he is comfortable, happy and as pain free as possible.  If or when the day comes that his condition robs him of a comfortable existance we will have to make the painful decision to release him.  This will be a very difficult day for me, but the last thing I ever want is for Pika, aka Peanut, aka The Nutty Buddy to live in pain.