Tuesday 5th February 2015, we started on our journey from Manchester to The Small Animal Teaching Hospital (SATH) in Liverpool, full of hope that our much loved Phoebe cat would be cured from cancer.
What a day to be snowing! Already stressed by the whole situation, and feeling bad that Phoebe couldn’t have breakfast as she will be having anaesthetic later, we looked hopelessly on as the traffic crawled through the thickening snow. Phoebe meowed angrily at the back from her carrier as I checked my watch constantly. Our appointment was at 9am – we had set off at 7.45am and didn’t hit the motorway till 9am!
Afraid that we would lose our appointment I phoned the hospital, who were brilliant. They assured us they would still see us. Relief didn’t even come close!
I was in awe when I saw the hospital, firstly because I’d recognised it from the Animal Hospital TV series. Entering through sliding automatic doors, there was a large waiting room with separate seating areas and a friendly sympathetic reception. Water available for pets, vending machine for humans – it was a veterinary heaven, and a wonderful establishment, if only we didn’t have to be there in the first place!
After checking in at the desk and filling out forms, we were taken to one of several consultation rooms by a lovely lady called Ana Rita who asked about Phoebe’s health from being a kitten to present and then examined her. Both Bart and Phoebe are incredibly well socialised cats and although they are not crazy about being at the vets, they tolerate all the necessary groping with no grumbling whatsoever. Which makes them very popular clients!
Phoebe was to stay overnight where she would have various tests, including ultrasound to investigate the cancer in her stomach and radiographs and samples to be taken by needle to check if the cancer had spread. As it turned out Phoebe ended up staying 2 nights due to waiting for tests to be performed. We missed her and so did Bart, who wandered around the house calling for her.
When we picked her up we were like eager children. Phoebe has a B cell lymphoma affecting the stomach wall. The good news was that the cancer hadn’t appeared to have spread although there was a possibility that some microscopic spread of the disease may not have presented itself yet. More results were pending but we were to return in a week to see the full story and discuss treatment. Phoebe hadn’t eaten particularly well while she was at the hospital and she mewed all the way home. She went mad for her poached fish that I had prepared for a treat and Bart was suitably happy again. So for the time being, we were grateful for every bit of good news we had and enjoyed having Phoebe home.
Over the next week we watched Phoebe like a hawk. Although we continued with the same medicines we started with, we could still expect her to be sick at least once a day. And the blood coloured vomit made a return 2 days before we were due in Liverpool again. Her weight had gone down to 3.45kg – not dangerously underweight but she had lost half a kilo since the vomiting started. We were relieved to be back at Liverpool for her next appointment which was on Valentine’s Day. James was our oncologist, who explained that the blood in Phoebe’s vomit was the tumour ulcerating and it was expected to reduce, or stop with treatment. The suggested treatment would be chemotherapy, as surgical removal would be more invasive and would also remove some healthy tissue of the stomach wall so reducing the size of the stomach. Chemotherapy will be in the form of an injection (vincristine and cyclophosphamide) and Phoebe would need to have this once a week for a month initially.
The treatment of cancer in animals is different to treatment of cancer in humans. It isn’t considered ethical to cause animals suffering with larges of amount of chemo, so they are given smaller doses which hopefully will be effective in treating the cancer, or at the very least slow down the development. Cats in particular seem to cope with chemotherapy quite well but we can still expect to see side effects like hair loss and nausea. The sense of taste can also change, so we will need to watch which foods Phoebe prefers. As well as this, we have been advised to manage her waste with gloves and to double bag it before disposing of it.
Over the next few weeks, we made the trip to Liverpool every Thursday with Phoebe. She is fed the night before but not on the morning of her treatment as she has to have a blood test prior to the chemo, and it can affect the results. The blood test checks the white blood cells – if they are too low, then Phoebe would not be able to have chemo on that day. While she stays to have her treatment, Steve and I have 2 or 3 hours to kill before picking her up, and this is how we got to know the Wirral so well!
It did us good to get out to explore the local area while Phoebe was in good hands as there are great areas for walks to clear your head and to take your mind somewhere else. The Wirral has a lot of sandstone and you see formations of it at Thurstaston Common. The largest one is ‘Thor’s Stone,’ which, having time on our hands, we climbed on a number of occasions!
The hospital is also not far from West Kirby beach, where you can walk out to Hilibre Island on a good day. I haven’t made the full journey to the island yet as we had to turn back due to the tide, but we’ve had a stroll on the path round the boating lake. Its nicknamed ‘the Jesus walk’ as it looks like you are walking on water when the tide is high enough. Again, you have to check the tide before venturing out!
Nearer to the hospital in the village of Neston, there is a fabulous little coffee shop called Elephant Coffee which I fully recommend. Independently owned, they do serious quality coffees, with home made food and served by friendly efficient staff. They provided us with some much needed light relief during our stressy days! Their location can be found here http://elephant-coffee.co.uk/contact-us
If anyone has the misfortune of serious illness with a pet and end up being referred to the Small Animal Teaching Hospital, I hope all turns out well, but it really is a good place to be referred to. The staff and students there are very professional and empathic, very much appreciated when you are nervous and emotionally charged. And there is a waiting room full of other anxious owners, just like Steve and I! As well as the appointments, the odd emergency comes in too, which can be distressing to see, but great that the staff are so efficient and dealing with cases like these.
Phoebe coped well with her first chemo treatments and soon became a favourite with both staff and students as she didn’t need sedating for her injections! Every little helps with the cost! When we get her home, sometimes the bandage will have slipped off, revealing a shaved area on a foreleg where the injection site was. Her vomiting stopped almost immediately but we still had to give some medicines; 1 x Prednisolone tablet 5mg twice daily, a quarter of a Famotidine 20mg tablet once a day (instead of that messy Zantac syrup!) and to continue with Antepsin. Phoebe hated the medicines but I became an expert after experimenting with different methods. I have long given up trying to force a tablet down her throat and with the help of a pill splitter and mortar and pestle, I ground tablets up and made pastes with them. Depending what tablets they were, sometimes I added a single drop of water to make the powder bind before adding a tiny amount of Webbox Lik-E-Lix, which is like a yoghurt for cats. Using a blunt knife, I make this into a paste thick enough to stay on my finger and then I can smear this into Phoebe’s mouth. Rather than open her mouth which makes her resist, I lift the upper lip at one side of her mouth and pop the paste in under her cheek. Sometimes, she may froth and lose some of it, but I am confident that she gets most of her meds this way as in the past she had a habit of holding tablets in her mouth to spit out later! Sometimes I miss, and some of the paste ends up on her face, but again, its not lost as she cleans it off. The most difficult part of medicating Phoebe was that she learnt to hide when she heard the sound of the mortar and pestle!
At week 3 of chemo, Phoebe’s blood test showed that her white blood cell count was low and she couldn’t have treatment, which was disappointing, but it just meant her body needed a bit longer to recover before the next bout. She had treatment as normal the following week, and also a scan to see how the lymphoma was doing. Scans bump up the monthly veterinary bill considerably, costing aroung £200 each time. Add to that VAT and chemo plus various other addititions it can add up to around £400. A ‘cheap’ vet bill for me would be for chemotherapy only which was around £130. A good reason to make sure your pet has adequate insurance!
By April, Phoebe’s medication had been reduced to one Prednisolone tablet every other day and a quarter of a Famotidine tablet daily. The fact that she had not been sick while under treatment had made us quietly optimistic and sure enough, the sheet we were given at the end of the next scan read “there was no evidence of the gastric mass, and the subtle changes they saw in her intestines have also improved. There was no enlargement of any of the abdominal lymph nodes. She is in complete remission and we are very happy with her progress.”
However, we still needed to continue with treatment for a while. Cancer has a nasty habit of coming back. Instead of every week, Phoebe’s appointments became fortnightly. We had a bit of a hiccup at the end of April when Phoebe was sick twice and went off her food. After phoning Liverpool, they advised us it was a reaction to the chemotherapy that can suddenly happen (some patients get it all the time, so I guess we’ve been lucky). They got in touch with my local vet, Beech House, to arrange for Phoebe to have an anti-sickness injection and pick up some anti-sickness tablets (Cerenia).
Shaun at Beech House, was pleased to see Phoebe doing well and Liverpool had been updating him with all her visits at the hospital. The anti-sickness treatment worked a treat and Phoebe was fine again. Funnily enough, she never had a reaction like that again. Over the next few months we continued to go for chemotherapy sessions which became every 3 weeks, with an occasional scan to check she was still in remission. James our original oncologist left the hospital to further his career, which unnerved us slightly. Strange isn’t it, that we get used to a certain vet? Phoebe was still in good hands and we got used to seeing different faces after that. James made a brief return to do some cover work and was happy to see Phoebe’s improvement, adding that it hadn’t been all good news for some of his other clients. It was a sobering thought.
It hasn’t been all plain sailing though. Chemo takes its toll over time and it was important that Phoebe ate well. We pandered to her tastes, fed her separately from Bart and increased her wet food to keep her weight up. Luckily she’s not a terribly fussy eater, and she maintained a steady weight of 3.85kg since treatment started. Sometines her white blood cells show up as low, and she would have a reduced chemo dose. As a one off she was also given an antibiotic injection to help her immunity.
From the outside, Phoebe didn’t look like a cat receiving serious treatment, although she had shaved patches on her forelegs from various injections. Sometimes she would have treatment through a back leg due to the veins in the forelegs having being used so many times, but she was a model patient! By summer, her fur along her back had thinned and she had lost her whiskers and all but one of her long eyebrow hairs Her shaved belly from the scans, was permanently in a state of regrowth. But Phoebe didn’t care about her uneven fur, and behaved as normal throughout, demanding attention and occasionally winding up Bart! Sometimes, after a chemo session, she may be quieter than normal for a couple of days, or a bit off her food, but the treatment for her cancer was all in all a positive experience for us. So far, so good anyway – I know only too well not all pets have the same happy outcome and I am thankful to all for Phoebe’s recovery to date.
I will conclude our cancer story soon – its been painful sometimes reliving it through diaries and paperwork so apologies for the delay! Hope our experience will help others – please feel free to comment or get in touch 🙂