the veterinary oncologist called back to discuss chuck's results with joe and me at six o' clock last night. the slides weren't entirely conclusive: it's possible, ironically, that the oral steroid our vet prescribed on thursday (and which we gave him at home for the first and only time that night) changed the look of his cells prior to the collection on friday afternoon. she told us we could try to strengthen the diagnosis - which one wants to do because cancers' responses to various treatment options can vary so widely by cell type - by sending what they've already collected out to colorado for a PARR test, an assay which identifies lymphoma in dogs and cats via DNA. a negative PARR test, she explained, isn't very useful, as false negatives are possible; a positive, on the other hand, could be treated as a certainty. with that certainty, the big remaining question is whether we're dealing with small cell lymphoma (which tends to progress more slowly and for which she would likely prescribe oral chemo) or large cell lymphoma (which moves faster and would in turn potentially mean intravenous chemo to be administered at the hospital; i was thinking about that scenario as i weighed the facility we chose against the one our vet recommended, as the latter is across town and not easily accessible by train). she strongly suspects it's small cell, given that chuck's weight loss was significant (he's just under 10 pounds now and was at about 13 last february) but not sudden (it's been happening over the fall/winter; we thought for most of that time that he was simply eating less because he has old-man teeth) and he seems to be in high spirits (he chirrups and follows me around the apartment at shoulder level just as he always has). i asked if we could be more diagnostically aggressive - of course, i want to give him the best possible treatment at the earliest possible date, not to move through clue-style eliminations of rooms, weapons, and suspects - but the other immediate option would be a comparatively invasive biopsy. chuck would need to recover for a week or two before beginning chemo based on the results, and we would traumatizing him with a potentially-unnecessary major procedure.
so we are starting him on leukeran, also known as chlorambucil, chemotherapy which we'll administer via two-milligram pills every other day (we're going to talk about adding the steroid, prednisone, back in after we get the results of the PARR test). after about a month, we'll bring him back in for more ultrasounds; if his cancer seems to be responding well, we'll keep that up for a year and re-image again. veterinary chemo prioritizes the minimization of side effects, since companion animals don't know (as human patients do) that they're suffering in order to feel better. the bad news is that with that in mind, dosages are much lower and recurrence is therefore more frequent; the good news is that chuck might have some gastrointestinal distress, but it's also possible that the leukeran and prednisone could stimulate his appetite. if we're lucky, he could feel better than he does now.
if we're lucky. i folded up on the phone at my desk as the oncologist began using the words "year" and "years" when she spoke of what could happen next. as i said a few days ago, the panicked googling i was doing last week made me feel like chuck was dying in our arms. our vet, in turn, was so unenthusiastic about the idea of aggressive treatment that i was convinced chemo would be joyless time purchased at our poor little cat's expense, and the caretaker narratives i found online were feel-good rainbow bridge stuff that contributed nothing to my understanding about what i should do for my family. friends and friends' friends have been incredibly generous with their experience and support, i'm building the lexicon i need to find real talk and hard data about what we'll face, and i'm finally starting to feel like i am doing the best i can.
i made some shockingly good bagels this weekend - like, i-think-i-might-formally-be-a-real-new-yorker bagels - and i'm one movie away from the end of ye olde death-by-academy-award-nominee marathon. i have been meaning to tell you about antarctica (the researchers down there really love tom jones, among other things). my blog is not eat pray chuck, and i won't be journaling his bowel movements. i will, however, continue with my customary, random tales of my excellent black cat, and i'll share everything i learn about how to take care of him. if you find us in the course of panicked googling, i hope we help you do the best you can.
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