Boot's Story:
Part II: Cancer

Last edited on January 6, 2006

12.12.04: It began with the limp. I noticed it on a Sunday and immediately thought it must be an abcess, the lump was so huge when I ran my hand over his rear leg.

We took blood and X-rays that Sunday and attempted an aspiration. It wasn’t pus, the vet on call said. I knew then.

12.13.04: Boots came back the next day to be looked at by our regular vet. The pathology report was in. The lump had to come out. It was malignant.

The irony of it all was that his bloodwork was perfect in every respect. For 4 years Boots and I had fought his chronic renal failure and his normal bloodwork indicated we were succeeding at slowing the progression. And now this. Dr. R. remains optimistic and refers us to a veterinary oncologist. My heart was in my shoes. I couldn’t feel anything but despair, sadness, and acceptance over the inevitable. I fight bouts of nausea. I had no idea this would hit me so hard. I cannot wrap my brain around the word: Cancer.

12.24.04: I am unable to get into any kind of Christmas spirit. The usual joy I take in buying the few Christmas presents I need is gone. Everything is a chore. I feel no anticipation this season, only dread and hollowness. But today I feel I must put up the tree. If this is to be my last Christmas with Boots, I want it to be special. After much soul searching I have come to the conclusion there will be no desperate measures to prolong Boots’ life. I am unwilling to make Boots pay a price for my own fear of letting him go. His needs come first and my grief must be postponed until after it is all over.

I find as I go through the motions that my spirits lift a bit. I guess sometimes if the spirit doesn’t find you, going through the motions helps you find the spirit. The tree is up, and it’s beautiful. Feeling better, I set up my villages. Tonight is peaceful and I am accepting of whatever the fate that is to come.

12.30.04: Today is the day we see the veterinary oncologist. Although I have come to some acceptance over this, I feel physically ill. I am bracing myself for the words I don’t want to hear, and the question I don’t want to ask – how long?

It is an odd twist of fate that the clinic we are referred to is only 3 miles from our home. I did not understand the irony of this at first. The clinic is hard to see, set back from the street between an apartment building and a car wash. It is unobstrusive, small and cottage-like but with a very Big Name – Western Tumor Group. We park, and enter the lobby. My first surprise was how big the lobby was. This clinic is shared between human doctors and two veterinarians. In the morning it is used for human cancer patients, and in the afternoons for the four footed kind. Soothing green carpet, green leather sofas (with discreet reminders to keep pets off the leather), and a large aquarium along one wall. My first thought is one of calm. So unlike the hectic, packed waiting room of our regular vet.

I register and wait to be called. Mr. Tally is in the car with Boots. As is our custom at our regular vets, we keep Boots in the car until they’re ready so he isn’t freaked out by the strange smells, the crowd and the sounds. I sink down into the comfortable sofa and watch. The waiting room is almost empty – only 4 groups of people waiting that I can see, and one dog.

Everyone is happy. The staff is upbeat and solicitous. The people I observe around me are calm and patient. Two owners are talking to each other like friends. Finally a technician comes out with a dog on a leash who comes bounding out to greet his owner. The technician is a warm friendly man with a pony tail who stoops down to pat his patient, give him a hug and say goodbye. On his way back he collects the beautiful retriever sitting patiently and wagging his tail. The man asks the owners if there is anything he should know about – anything we need to tell the doctor. He runs his hands over the dog, searching and soothing while talking with the owners.

This is not what I expected. No one here seems anxious or teary, except me. Within ten minutes we are called and I run out to get Mr. Tally & Boots. The examination room is small, but soothing. Carpet on the floor and mats on the examination table. Not at all like a regular vet clinic.

We have brought leg & chest X-rays with us, Boots’ last bloodwork and his surgical notes. The doctor is reviewing everything the nurse tells us, and will be in in a moment. Mr. Tally & I make inane conversation. We are both stressed and tense. My eyes blur occasionally as I wait for the sentence to come in.

The door bursts open and a giant fills the doorway. He is cheerful and soothing and welcoming. I wish I could remember everything he said. Only later did Mr. Tally and I piece together the conversation, filling in the blanks as our brains struggled to take everything in.

It is a localized tumor, Dr. A said, and low-grade. It has probably been growing for some time although we wouldn’t have seen it through Boot’s long hair. It had invaded his knee joint and surrounding tendons. We caught it early enough before it could damage the bones, which look strong and healthy. The surgeon had removed 99% of it, but even one cell left behind would mean it will re-grow. We can slow this down for a good period of time, but we cannot cure it. The treatment is radiation 3 days a week for 5 weeks. There will be no side effects except fatigue and the prognosis is hopeful.

Dr. A was interested in Boots’ history. This is a rare cancer he told us, one of a half dozen he had seen in his entire practise. It is a malignancy called a Plasma cell tumor and it is involving the same cells affected by Boots’ stomatitis and his eosiniphilic granulomas. Both are allergic, inflammatory responses involving plasma cells. He was even more interested when we told him Boots’ was on Thyroxin, and asked if that had been double checked as hypthyroidism was extremely uncommon in cats. He mentioned a connection there, but I don’t remember what it was. I must research it on the net.

He was also surprised over Boots’ bloodwork. I mentioned his creatinine had been as high as 5.2 but now it’s down to 2.1. Dr. A. asked us about fluids and we told him 150 cc’s 5 times a week. He mentioned early studies about increasing tubular efficiencies with the remaining kidney tissue by being aggressive with fluid therapies. He was also surprised to hear we didn’t have Boots on a protein restricted diet. He specifically asked if Boots had ever been on k/d. I said we had tried it, but he wouldn’t eat it. I decided I didn’t want to restrict protein in a carnivore and Dr. A said my instincts were right.

Dr. A spent a long time talking with us, answering each question that popped out of our heads and staying with our reeling chain of thoughts.

Mr. Tally and I looked at each other and decided to give Boots this chance. We looked at the estimate and Mr. Tally’s eyes met mine, and he said without hesitating – we’ll manage. I fought back tears of relief, looked up at Dr. A and croaked out a thankyou. The words kind of stuck in my throat. Dr. A took my hand in both of his.

We booked our 15 treatments, and next Monday we’ll begin.

Week 1 (Jan 3-7): Mr. Tally took Boots in on Monday and Wednesday because I was at work. The hardest part of the treatments is not allowing him to eat for 8 hours. They have to anesthetize him for 10 minutes while they do the radiation. On Monday he came home with little green markings on his leg to triangulate the radiation. He showed no ill-effects except an enormous appetite and a little wobbliness from the anesthetic, which passed within the hour.

I took Friday off so I could see for myself what the process was like.

I have to agree the worst part is keeping the food away from Boots. Picking up the food also drives the other 8 nuts. And we have to be careful because Scamp and Buster are diabetics and have to eat. What a circus. The food gets picked up and Boots has the run of the house. Then Buster gets crazy and we know he has to eat, so we put Boots in the den and put the food back down. When everyone has eaten the food goes back up and Boots gets let out. Only now he’s really beginning to feel the hunger and he’s begging. I try to lie down and he’s on my face, nipping my nose. We finally barricade ourselves in the den and count down the hours. Finally it’s 2:30 and we’re on our way….

Again, I was struck by the calmness of everyone in the waiting room. Two ladies drive in 2 ½ hours from Lancaster twice a week with Max, who has lymphoma. There are people here who drive hours to get to this clinic. It continues to amaze me that we live 15 minutes away from a place that pet owners drive from all over several counties to have their pets treated. Almost like Boots continues to be blessed by whatever angel sits on his shoulder. Max is a well behaved black lab that obviously has no fear of being here. A gentleman is typing away on his laptop in the far corner next to the aquarium. A young woman comes in with two energetic shepards – again, no fear, no quivering, no crying. They bolt through the doors like they own the place. We bring Boots in with us as I am satisfied that this place is not near as stressful as our regular vets is.

The young male technician I saw before comes in, being patiently led by a straining dog anxious to see dad – Laptop man – and they leave. As the tech passes to pick up Max, he stops by to see Boots and tells us his fellow technician R. is in love with our cat. One of the women puts Max’ toy clown in his mouth and Max happily trots out of the waiting room. That picture gives us all a smile.

R. comes out to get Boots and Mr. Tally introduces us. She tells us what a great soul Boots has, and how everyone in the back adores him. I am very comfortable with the staff here. I know Boots is in good hands. While we wait, someone comes out to get Shelby, one of the pair of Sheppards. Shelby trots obediently into the back and immediately the other dog begins to cry. We all kind of laugh because it’s clear this dog has separation anxiety but it is so dang cute. The owner just laughs and says he does this every time. He’s forcing his way up onto her lap, and this giant dog is just sitting there in her lap, completely burying her, crying with his ears pricked up, never losing his focus on that back door. Another couple comes in with “Gargoyle”. Mr. Tally has told me about this couple – they’re Goths. Dressed all in black - She’s got black lipstick and nails. But they’re a cute young couple and they immediately sit down with Shepard Lady and start a conversation. Lady Goth has brought some books with her which she is lending to Shepard Lady, telling her no hurry in returning them. They start discussing raw food diets. Some time later Shelby the Shepard comes bursting through the door, and the dogs are reunited and there is much happy tail wagging in the lobby. We all smile. The Goth couple has treats in their pockets and there is quite a lot of happy tail wagging by Gargoyle and the Shepard pair as they share treats off the floor. Finally Shepard Lady untangles all the leashes and says her goodbyes. We all wave and tell her to drive carefully in the rain.

This is not at all what I expected radiation treatment for cancer to be. There is no weeping here. No anxiety, no tension. It is obvious that people begin to develop relationships as they see each other at the same time on the same days. Boots has had no apparent effects. He’s eating well, his activity level is good and his strength seems to be returning from the major invasive surgery to remove the tumor.

I am glad we made this decision. Whatever time this gives us, it is a gift.

Week 2: (Jan 8 – 14): We celebrated Wednesday by noting the 5th treatment puts us 1/3 of the way through the process. Boots is doing great. His appetite is good, but I’ve been cheating by giving him 1/6 Periactin tablet on his off-treatment days. Both to keep him eating and to fill him up in preparation for his 8 hour fast the following day. He has maintained his weight at 10 lbs. R. weighs him for us each time he goes in.

On Monday Mr. Tally came home and mentioned he had overhead J. (the tech with the pony tail) talking to Shepard Lady and telling her she couldn’t give Shelby any anti-oxidants during the treatments. We wondered about this, so on Wednesday I sent the Pet Tinic and Nutrimalt (after fluids treat) I give Boots to the clinic with Mr. Tally to have them check it out. Sure enough, they said no Vitamin A or E during and for 3 weeks after the radiation treatments. Well, shoot, why didn’t somebody tell us? It isn’t mentioned in the patient sheets. Rachel said there’s no scientific proof that they destroy the free radicals the radiation triggers, but they would rather we didn’t supplement during the therapy. I’m glad we asked. No more Nutrimalt treats for Boots after fluids, but I’m sure we’ll manage OK.

Last Friday Max's Mom was telling the tech how much of a water drinker Max The Dog was, and how difficult it was (they drive 2 hours in and 2 hours back 3 times a week to this clinic) for Max to go without water. They give him bottles of water in the car on the way home.

The Wednesday session, Mr. Tally is telling me, J. the Tech brings Max back out from treatment and he is straaaaaining, pullllllllling on the leash and he finally pulls it out of the tech's hand and bolts past everyone sitting in the waiting room, makes a hard right and bolts straight into one of the two bathrooms with the doors open when not occupied. Mr. Tally says the first thing they all heard was gurgle, gulp, gulp, gulp, gurgle, slurp, gurgle, slurp, slurp. Max's mom is hot on his trail and she reaches the bathroom just as the entire waiting room hears this big BARF!!!! Well the whole waiting room broke up, Max' mom was mortified and the tech was reassuring her they'd seen worse. Anyway, Mr. Tally reported that it was quite the humorous moment and all involved had a good laugh.

Tomorrow marks the end of our second week. I’ve opted not to give him any Periactin today to see how his appetite is, and he’s eating well without it, so I’ll let it go for now unless I see his weight beginning to drop. About 4 am this morning Duffy and Gizmo had a wowzer hissy fit and everyone filed in to watch, including Boots. His interest level remains active and alert, and he is doing great. Gizmo, on the other hand, peed all over the computer table at about 5 am as a so-there communique to Duffy.

Monday is Martin Luther King day and a vacation day for me, so I’ll be taking Boots in and giving Mr. Tally a day off.

Maybe we can really do this.

Weeks 3&4: Boots continues to do well. There are no side effects whatsoever, and we are noticing improvement in his mobility and his energy level. I had expected him to be more lethargic the further into the treatment we got, but instead Boots has begun to get up onto places he hasn't been for a while. Several years ago he gave up jumping due to arthritis in his lower back, but we have placed several Tupperware footstools around the house to use as stepping stones to his favorite places - the rag box on the shelf in the pantry, our bed, the sofa in the living room, a step-up to his favorite scoop on the cat trees. I hadn't realized that he had just stopped getting up in these places until I began to see him in them once more. I believe the tumor wrapped around his knee joint was not painful, but as it grew it restricted his range of joint motion and prevented him from attempting to access some of these places. It brings joy to my heart to see him wrapped up in a tight ball, encircled within a scoop in the cat tree. He is doing better. The improvement is noticeable.

Week 5: Our Final Week We have scheduled a final appointment with the veterinary oncologist on Monday. Although I can see noticeable improvement in Boots, my heart holds it's breath for a final prognosis. I remember back 5 weeks ago sitting in this very room, holding back tears and trying to compose myself for what I thought was a hopeless, despairing situation. Five long weeks ago, it seems like another lifetime, with some other person I no longer recognize clutching the X-rays and lab work and being afraid to hope for the possiblity of a miracle. Five long weeks ago, and today here we sit, full circle.

Dr. A enters the room, once again filling the doorway with his presence. That first week my brain was so locked up with the possiblity of losing Boots I recongnize now that I failed to take in so many details. I needed him to repeat much of what he covered that first time around. But today, today we got the final results of his therapy, and what a leap my heart took. This tumor is low grade, and localized. It has a 90% remission rate after the first year of treatment. Boots has responded to the treatment amazingly well. Dr. A says the tumor has shrunk beyond anything he could have expected. The radiation from the final treatment will continue to work for 3-4 weeks and we will need to schedule follow-ups once a month for the first 3 months to check on the continuing progress after the treatments have ended.

I am sure it is a much different Tally that sits before him today. Smiling, calm, composed and grateful. We have brought a small gift for Dr. A and his incredible staff who have not only supported and cared for Boots, but who have supported us through this process. There are no words I can share with this man who has given us so much hope. I think back to the dark tunnel I entered 6 weeks ago when the Cancer word was first mentioned, and how far I have come on this journey with my husband and with Boots. We have also brought a small gift for R, who has been Boots' radiation technician and primary caregiver through these 15 treatments.

My husband has proven to be my strongest support - an unfailing, cheerful, optimistic partner who has been both my strength and Boots' caregiver throughout this entire process. Due to work committments I was unable to be there every other day for 5 weeks, but Mr. Tally - this man who 17 years ago had never met a cat - was there for him every single day, re-arranging his business appointments and meetings around Boots' radiation schedule. How many women can find a man this loving, this committed, this strong a fighter for life? I am indeed blessed by those who fill my life.

Day 15: Boots Graduates: Today was Boots' 15th and final day of treatment. I walk out of a business meeting to call Mr. Tally to check up on their last day. I wish I could have been there. The staff loves Boots, and today he was presented with a Certificate honoring him as an official "Rad Grad".

I arrive home to find Boots curled up in an impossibly small space, oblivious to all of the radiation, strange smells & places, being transported to and fro 3 times a week and suffering few side effects from being withheld food for 8 waking hours 3 days a week. Curled up in that small confined space I see a happy cat, free from pain, nausea, lethargy, or weakness. I see my Boots, aged but still active and interested in life.

Tonight I thank God. I will light as many candles as I can to thank Him for the blessing of an understanding and compassionate husband, for giving Boots the fighting instinct he has had all these years, for our experienced and caring vet, and for the blessed gift of Dr. A who reassured us we could do this. Tomorrow I will take down the Christmas tree. I am very superstitious, much to my husband's amusement. I have kept the tree lit every night since we began this journey. It's job is done. Tomorrow I will pack it away for another year and pray that Boots will be able to share it with us next year.

I do not know what the future holds for Boots and I. Would I do this again? In a heartbeat. One day we will surely part, but not today.

Today is a good day...

April 20, 2005 - No further swelling in the joint area has been noted. His shaved leg makes the joint easy to see. We are considering keeping it shaved in order to keep an eye on it. It doesn't seem to bother him, and he's just grateful that that cast is off for good. Boots' activity level is high - higher than it was before the tumor was removed. Watching him pounce on his furry mice, stand on his hind legs and try to open the door of his old favorite hidey hole in the closet, noting his hefty appetite and his mobility all over the house - I believe the tumor must have been stealing his strength for several months. And although I know he was in no pain until the limping which triggered the first vet visit, I do believe it's encapsulation around the knee joint hampered his range of motion.

Boots' arthritis and his 16 years of age will never rewind the clock back to his youth. But with all the Tupperware stools we have about the house to assist him in getting to his favorite places, his activity around the house has noticeably increased.

We're on borrowed time with Boots, but what 16 year old cat isn't? This is a remarkable soul who is not yet ready to leave this life for the next. And thanks to a remarkable vet and a very special oncologist he isn't moving on to the next plane today, and all our tomorrows are a gift.

Thank you from the bottom of my heart to our regular vet, to Boots' oncologist and the staff who made this treatment so painless for all of us.

And a special thank you to the Guardian Angel who sits on Boots' shoulder and blesses this house.

Our journey continues....

August 13, 2005 - Boots is doing better than ever. My husband says we've turned the clock back 2 years. He's alert and active. I have even caught him making small jumps from the floor to the sofa when he thinks I'm not looking.

January 6, 2006 - We celebrated Christmas this year with special thankfulness. Putting up the tree I remembered our last Christmas, and once again I thanked God and all the guardian angels who gave us another Christmas with Boots. He continues to do well, and the last exam he had in September showed no reoccurance of the tumor. He sleeps with us at night, still bites my nose at 3 am to be fed, curls up in his snuggy, gets up on the cat trees with help from the little stepstools and continues to have a good life. We are indeed, very blessed.

Boots today, curled up in his snuggy and happy!