Bette Davis Died After Struggling Post Radiation Treatments

May 19:

Bette’s life is now done. We chose to put her to sleep. I don’t know what happened but she’s so quickly declined. She wasn’t lucid. She was in and out of it. She wasn’t really aware of her surroundings. Because she would physically panic If off oxygen, they arranged for us to go back to the room and see her in the oxygen cage and talk to her and say goodbye. Then they brought her out so that we could hold her and pet her and she started to struggle a little bit but she was so out of it also because of the pain meds, but in a different way that when they gave her the first medication that usually puts them to sleep, and usually stings, and a cat who is conscious enough reacts, she did not react. And then she was quickly gone with the next medication. We are now dropping her off for a necropsy, so that we get an idea as to what happened.

UPDATE: See a later post about her necropsy which showed she had cancer in the brain.

Bette Has Had Many Issues Since Beginning Radiation

Bette began the process of radiation treatment without any issues. The first few days she was home, used the litter box, ate well, then slept but was also up later in the day, moving about, being taken from room to room. But quickly small issues emerged-litter box use and ability to eliminate, lameness, exhaustion, fast breathing, inappetence, drooling, open mouth, weak front legs, weak side of face. No one knows the cause. We are going to the dentist on Monday 5/15/23 because he's an expert and will be able to evaluate and offer suggestions as to cause and treatment. We are to hear from her neurologist about setting up an MRI recheck on Monday and hopefully we can get her in sooner than the June appointment we already had set. The following are notes from the notebook I have kept about her treatment. I tried to clean them up so that they make sense, replaced person and place names. The grammar or sentence structure is not always correct. 

4/19  Began radiation treatments Wednesday-Friday. Never sick, tired, ate well at home. Restless at night. Used litter box without issue. Good 4/19-21. Looked and acted normally. But quickly lost use of left leg, no weight on it.

4/22 Signs of difficulty eliminating. Increased Miralax and Cisipride and Forta Flora. Smaller bowel movements. Began difficulty getting into the box as leg got weaker. Began urinating periodically on pads and not in box. Still looked normal. Eating ok.

4/24 High amount of blood in urine. Not using box, urinating over box onto pad or on pad. Dark red. vet school checked urine and no bacteria. Red blood cells they thought from stress. Increased Buprenex, Methigel, water by mouth. Ate ok but not as much.

4/25 Vet school prescribed Gabapentin at bedtime-50mg/1ml; we gave .75ml. That settled her down at night to sleep. 

4/26-4/28 Better, using box, restful, slept well at night. Could move up and down basement stairs on her own. 

4/29 Urine out of box, restless at night. Gave more Buprenex, water by mouth, Methigel. 

Weight was 11.11. 

4/30-5/1 normal, weaker legs, unable to move as much, box use getting difficult. Eats well enough. 

In May-begins squinting eyes, slight drooling and wetness around mouth. This increases daily.

5/1-Monday-normal day, fine post treatment. Good evening. Ate well.

5/2 Evening-can’t get into litter box, puts legs in but butt is out and urinates onto pads. Can still slide her body and drag left leg and use front legs to move around. Is drooling.

5/3 Came home from vet school dirty and wet around mouth, chest, legs because the drooling has increased greatly. The gunk on her is food she tried to eat after treatment. 

5/4 Thursday vet school radiologist sees ulcer in right eye. Gave antibiotic gel cream for eye bacitracin neomycin polymyxin. She is now very lame, harder to move around but she can move herself. Continued drooling out of mouth all day into next. Could still eat. Began urinating laying on pad and it got all over her. Got urine sample from pad into vet. Eye gel glues eyes closed, makes a mess on face. 

5/5 Friday BD urine on pad laying down, on herself 5:30 a.m. Her vet said Thursday's urine sample has high amount of bacteria although not sterile sample. Dr gave Zenequin. Seems tired and not able to get into box easily. Drooling is worse, very wet. Eats only some. Eyes closing more, gel on face. Afternoon and evening-used the box by getting into it and only got a little wet with urine. 

5/6 Saturday -Was fine in the a.m. and ate but by the afternoon was clearly run down. Wouldn’t eat all day. Gave water PO often and she rejected it. Difficult getting food into her with syringe. Eyes squinting, second eyelids out on both eyes, drooling, open mouth, weak, tired. She hadn’t had a BM or urinated since Friday 5:30 a.m. Was afraid she was crashing or had blockage or fistula. Seemed cool, less pink. But BR was normal at home. Took her to vet school ER. Tested-despite clinical signs nothing tested positive. BR/HR/temp/BP normal. ER doesn’t know why she’s drooling. Or why feeling/looking miserable. She hates having her mouth touched. Bladder at ER was small but she wasn’t dehydrated in skin test nor in blood work so did not give fluids. Urine tested positive for bacteria so continue Zenequin. Left leg has good blood pressure but less muscle mass. Gave Onedansetron for nausea, suspect drooling nausea related. She ate very well for them-although a drooling mess. They cleaned her face and she looked perfect.

5/7 Sunday-finally urinated on a pad 2:30 pm as she lay and had to be cleaned. She perked up afterwards and ate and drank for five minutes. Then slept. Then by 6 pm. seemed run down again. Never urinated all day or night. Looks miserable. Ate little. Gave water PO. Drooling increasing, even more wet on body. Eyes squinting closed more. 

5/8 Monday Dr. Radiologist said tumor may not be shrinking, litter box issues related. Discussed Saturday ER. Needs followup MRI. Left leg has no feeling-blood and good pressure (ER) but wasting muscle tone. Mouth is held open slightly, drooling is excessive, tongue is out. Eyes squint more. Vet school radiologist doesn’t know why. Sort of dismissed it as mouth soreness. *They’ve never had a mouth injury during intubation. Bette looks miserable. *On Monday Dr. Radiologist said ER urine sample was not bacteria but would not say why the ER said bacteria other than ER doctor misread it. Said to end Zenequin. Said to end Buprenex, give Gaba 1ml BID and not just at bedtime. Decided to do 1ml Gaba post treatment, ½ ml dinner, ½ ml bedtime. Evening heard jaw click noise, open mouth more, tongue out, not comfortable. NO urine or BM since Sunday.

Finally urinated 3:30 a.m. Tues. on pad.

5/9 Tuesday-Drooling is worse. She’s wet, hard to hold down meds, jaw makes noise, heavy breathing, open mouth. BR was 80 in the morning when we arrived at vet school. It did not fluctuate while we waited for treatment. Dr. Radiologist said it was normal BR when in treatment. She later said she did not react when mouth and face touched-but then said that was done under anesthesia (so not a good indicator.) She was drooling post treatment and was dirty from struggling to eat and keep it down. Mouth was opened, tongue out. BR was excessive. They still released her. And it got worse in the car going home. Decided to go to local AEC. They put her on oxygen and that calmed her immediately. Blood work shows some iffy-most to do with breathing fast; and some white blood cell counts are low. Lungs clear, eyes irritated. Gave Optimax eye drops. Don’t know why mouth is opened, drooling, fast breathing. May be signs of pain or injury or anxiety. Took xrays of body and nothing is wrong internally-no fistulas, no blockages. 

5/10 Wednesday Gave Valium in a.m. before treatment instead of post treatment to help with anxiety if drooling is related. Radiologist concerned that radiation causing breathing issues but denies mouth soreness still. Finally urinated 2:30 pm on pad at home. We then saw Dr. Vet to review issues. She checked mouth, teeth and said it’s pain reflex but cause is unknown. Might be TMJ or nerve damage. Related to intubation likely. Said to give Buprenex post treatment to help with jaw pain and to use it as break through pain control as needed. Checked eyes-irritated, no ulcer. Said to use Topamycin for eyes post treatment, lube pre treatment. Bette BM 10 p.m.; urine by midnight pads and on her. Her mouth is opened, slack, drooling excessive, tongue out still. Gave buprenex at home. Can’t keep down Gaba with drooling and bitterness of med. AEC bloodwork-showed low WBC count, off RBC counts; and off CO2 counts due to fast breathing. And low potassium. Give Renal K. Kidneys normal. Decided to stop Onedansetron except as needed since drooling isn’t nausea related but likely pain. Giving more water by mouth. Eyes squinting closed. 

5/11 Thursday radiology treatment; said they will compound Gaba into pills (ordered from NJ pharmacy) because drooling is excessive and with bitter Gaba she can’t keep it down. She came home DIRTY from spitting up her food at vet school post treatment. Giving Renal k potassium and buprenex post treatment. She cannot CHEW today, can’t eat her dry food or treats. Drooling is worse ever. Decide to give only Buprenex because she can keep that down; Gaba at bedtime. Must be gentle with mouth, hold it partially closed to help her swallow. Careful not to choke on meds or aspirate liquids. Giving water by mouth.  Slept rest of day. No urine/BM. Eyes-especially right-keeps closing. Mouth still open/drooling.

5/12 Friday BM 3:45 a.m.; front legs seem weak-especially RIGHT front leg. And vet school called and said they suspect drooling now is from TMJ or trigeminal nerve damage. Could be inflammation or a tumor or damage. They say this has never happened before. 

Urine in crate by 1 pm. Once home. Giving tuna juice, water by mouth, buprenex. Decide to syringe feed AD. Renal K, etc. Right eye is not opening up as much, right side of mouth NOT sore but left is. We suspect her right side of face nerve damage. Eye does not respond to touch. Pupils look the same. Hard to lift herself and move with weak front legs. 

5/13 Saturday less drooling, less opened mouth, tongue only out a little. Must be careful when syringe feeding-hold mouth closed, go slowly, and with meds. She is eating some on her own. Clean her, protect catheter paw. Right side of face not responding as left to touch or pain. Suspect weak front right leg, doesn’t seem to resist as front left. Hard for her to move around. Right eye not blinking when touched. 

Urine and bm in box 9:45 a.m. A little wet. Eating on own in late day/evening and syringe feeding. 

5/14 Sunday Weight down to 10.13 from 11.11 a month ago, and 11.3 a week ago. Not eating on her own. Careful with syringe feeding. Mouth not as opened. Does open it and breathes fast but can mostly close it, especially when sleeping, or tongue is out a little bit. Urine/bm 9 a.m. in box and only a little wet.  Slept well over night. 

Bette Radiation Treatment Update Last Two Weeks

May 2-3

Bette is doing well. She is having trouble urinating in the litter box but we have pads around the box so she has gone on those. But it seems she still has no blood in the urine or a UTI but we will continue 9ml water PO (by mouth), Buprenex .25 or so, and Methigel 2x a day. She has not yet gained use of her lame rear left leg but is able to quickly get around and up and down furniture. She is eating well, maintaining weight after losing 9oz in late March-April. We continue to put her in different rooms so that she is not shut up in just one (she usually spends the day post treatment in the enclosed dining room although the French doors allow her to see us; and her siblings hang out with her after she has rested.)

May 1

My husband drove Bette to the vet school for treatment today and will drive her up on Friday as well.

I gave him notes on the drive-time it takes, when it's boring (long, flat section), the dead animals he should try to ignore (there are so many!), where the police hide in their HUGE blue SUVs, the scenery (long, flat, boring), exactly when he'll be tired, exactly where and when there will be traffic. I even told him which gas station to stop at, the blond cows at the yellow house, and the geese and goslings in the marsh along a road. I told him which left turn to take to get to the vet school, to stay in the left lane and not the right when going down that street, and how to hand her off to the attendants. All of which he rolled his eyes and scoffed at until I told him rather forcibly to PAY ATTENTION! And then when he got home he said that I was right about almost all of it, but did I mention this one spot? Yes, I had but he must have still been scoffing.

April 27

A good day for Bette. She is over the obvious blood in urine but we continue to treat it as if still there. She didn’t sleep well Tuesday night so we increased the Gabapentin from .50ml to .75ml (the script calls for 1ml) and she slept well and used the litter box without crying or being disturbed. And she was able to get around (too much med and it makes cats wobbly.) She did well at today’s treatment.

The drive is now becoming automatic. And the wait from 8:30 to 11 or so (today we left at 12) is flying by. I read the news, my book or magazine, and suddenly she’s done.

But I still need a break. My husband will take her Monday and Friday next week.

April 26

So far this morning, Bette is doing much better. Her urine does not appear to be showing any signs of blood. And she used her litter box. We will continue to do the water by mouth every 2 to 3 hours, the extra Buprenex, and the Methigel. And, if it happens again, then I will contact her regular vet who will give her Zenequin . But I think right now everything is going in the right direction and that her bladder is going to hopefully calm down.

April 25

Bette possibly has bloody urine. I saved the pad to take today to treatment. She went at bedtime 10:30 pm in the box but over it onto the pad. It was light red orange. She had an accident in the crate on the way home and it was very dark orange and her urine has been stinking since Friday. So I didn’t know if yesterday it was the radiation treatment but last night it was rather dark looking. But since she only went one time, I didn’t think it was necessary to take her to the ER. She received her bedtime pain med which may have helped. We’ll know more later.

So-The vet school checked and thought she had no bacteria in the urine and suggested not giving antibiotics. They didn’t give sub q fluids to wash out the bladder and any irritants or bacteria that might be there but did give the regular amount of fluid she receives each day with her treatment. They did not offer me guidelines to address the issue. I’ve never had a vet dismiss this problem. They thought it was just stress since she does have a history of idiopathic cystitis. So I called her vet office once home and left a message with them asking her to call me Wednesday when she’s in. And that wonderful woman called me on her day off!! She said if this continues, she’ll prescribe Zenequin antibiotic because there could be bacteria and the pad wasn’t showing it. If it clears up, then Zenequin worked. Meanwhile, give more Buprenex (pain relief/inflammation reducing), water by mouth (we do 9ml a few times), and Methigel to improve the ph level of the urine. The radiologist did finally prescribe Gabapentin for night time.

I would have taken her to the ER last night had she continued to urinate and was in pain when urinating. We have had to do that years ago with Baby, Bette, Elizabeth; and Myrna-with HCM-was frequently in the ER after 8 pm.

April 24

Bette-good Sunday day. Slept well overnight. Good Monday so far. My husband and I changed my schedule since getting up at 4 am was exhausting for me. It’s amazing how one more hour and a half of sleep can feel great! Up at 5:30; shower and dressed; downstairs to make my breakfast and tea-now to go-and her meds; give her meds, crate her, finish gathering whatever; go to car. By 7:25-five minutes late but still ok-in the car.

He will medicate and feed other four cats, clean boxes, do waters. When I’m home I’ll empty dishwasher/put in dishes, sweep; feed and medicate Bette (as soon as we are home). Then do my list of things to do.

He has hours of vacation he can use that allows him to take off an hour or so in the morning to care for the cats. He will be up earlier to take care of the cats for the days when he has an 8 am call.

Granted, I’m not a wash and go person. If I were, I suppose I could roll out of bed, shower and dress, etc at 6:30. But that’s never been me. Not that I put on makeup for over an hour but it’s not five minutes either.

April 23

Bette had a good Saturday of moving around or being moved and resting. Last night she slept very well. Not sure why compared to a restless Friday night. She used the litter box. We didn’t give her extra Valium. She slept on the bed and then the floor. So-I slept well for the first time in days, including a restless Friday night. The weekend break has been good for both of us. After she urinated in the cat house Friday night, and the urine got on the floor, and after cleaning the floor three times, I covered the floor with pads, even under blankets. You can see her sleeping under the rocker and see how small is the room.

Bette Davis Radiation

Bette Radiation

 

Bette Davis is getting ready to start radiation therapy for her Nerve Sheath Tumor at the state's vet school on April 19 for 20 treatments. I read a few websites and collected this information. Various websites repeated the same information but the majority of the below is from the websites links at the bottom.

"Early side effects are usually observed within two weeks after starting radiation therapy and can continue up until one month after the treatment has begun. These effects are usually inflammatory, with areas such as the skin and mucous membranes most commonly affected. Redness, irritation, and ulceration of the treated surface can develop (moist desquamation). Your veterinary oncologist will discuss the side effects that your pet may experience. 

 

For patients who live years following treatment, tumor formation secondary to radiation is possible. In order to be considered a radiation-induced tumor, it must be within (or very close to) the radiation field treated, is not a recurrence of the treated tumor, and is occurring at least 6 months after radiation, but usually longer. Radiation-induced tumors in veterinary medicine are extremely rare.

 

Redness to the skin can occur around the second week of treatment. This is followed by ulceration of the skin surface, known as moist desquamation. This is irritating to your pet, and most animals will try to lick and scratch at the area. It is VERY important to prevent self-trauma with an Elizabethan collar (E-collar) as this increases the risk of delayed healing and infection. The skin reactions will get worse through the end of radiation therapy and may be most severe AFTER radiation therapy is completed. In some animals, skin effects do not begin to develop until radiation therapy is done. The skin will heal in the 2‑4 weeks after the effects are at their worst if there are no complications (infection, steroid usage, and certain systemic diseases). The skin may continue to be thinner or thicker than normal, and the skin pigment may be darker or lighter than normal.

 

Consult with your oncologist before applying ANY topical treatments to radiation sites. If side effects are severe or markedly painful, your radiation oncologist may prescribe a specific topical agent to be administered at home, or may recommend recheck exams and side effect treatment while you’re pet is anesthetized.

 

Late effects to the brain and spinal cord are rarely seen prior to 6 months after the completion of treatment, but can occur years later. Depending on the portion of the spinal cord treated, the patient may have decreased ability to move the hind or front limbs or may even become completely paralyzed. 

 

A portion of the colon, rectum and bladder are often in the treatment field when treating tumors near the pelvis. The lining of these organs is made up of rapidly dividing cells similar to the skin and oral cavity. Irritation of the colon (colitis) may develop near the end of the second week of treatment and may continue for 2-4 weeks after radiation is completed. You may see diarrhea which may contain mucous and/or small amounts of fresh blood. Your pet may defecate small amounts more frequently. Some patients have intermittent colitis long term. Inflammation of the bladder (cystitis) can also occur and follows the same timeline. Clinical signs of cystitis are straining to urinate, blood in the urine, or increased urgency to urinate (asking to go outside many times during the day or accidents inside the house). Your clinician may recommend medication or dietary changes to help alleviate the problem.

Any diarrhea seen immediately following the start of radiation therapy (within 1-3 days) is not related to radiation, but rather to stress from hospitalization. This colitis is treated with oral medication in most cases and may resolve during the course of therapy as the patient becomes accustomed to the radiation routine. If anxiety and stress are persistent, this diarrhea may not completely resolve until therapy is completed.

 

Late side effects are rare but can develop in these areas as well. They occur many months after radiation and are related to scar tissue formation. Scar tissue in the colon may not be a problem if only a section of the colon or rectal wall is involved. If scar tissue forms circumferentially around the colon, this could result in a stricture, resulting in difficulty passing stools. Urinary strictures secondary to scar tissue formation as also possible, which could results in long-term straining to urinate. If the scar tissue completely obstructs the flow of urine, this is an emergency. There are sometimes procedures that can be performed to alleviate a rectal stricture (“ballooning” or stent placement). Stents can be placed in the urethra to reestablish urine flow, however this usually makes the patient incontinent. Fistula formation (holes forming in the walls of the colon, rectum or urethra) secondary to radiation are exceedingly rare, but, when they do occur, are life-threatening.

 

Examples of late radiation side effects include muscle fibrosis, skin fibrosis, bone necrosis (cell death) and subsequent fracture.  Radiation induced secondary cancers have been reported years after a radiation therapy course - this is also a very rare sequelae of radiation.  

Ports-Most complications associated with SVAPs are mild and easily managed, and consist mainly of soreness and swelling around the incisions for a few days.

 

**Many cats recover from paralysis with proper treatment as nerves regenerate slowly.2 However, a full recovery will depend on the health of the nerve; some nerve injuries will get better in a few months, while others may need surgical reattachment.2 At home, you can apply heat and gently massage your cat’s affected limb while the nerve is regenerating.2 These actions can help your cat relax while reducing pain and discomfort."

Some links:

 

Dutch

Animal Center and Imaging Center

MSCPA Angell

 

 

 

Bette To Have Radiation for Nerve Sheath Tumor

UPDATE: Bette will have radiation beginning late April. She had a CT scan today and we get a report next week. She will have 20 days of treatments because those only have a 10% chance of damaging the colon which would end her life vs. 5 days of treatment which has a 30% chance of damaging the colon. I will take her to MSU in the a.m for a few hours and then return with her and then shampoo/rinse/repeat each day.

She will get sick at the end of the treatment for 8 or so weeks. Her condition will worsen for a short while and then she'll recover; or she could be paralyzed. Or it could all go perfectly well. It's one day at a time.

We have been here before with sick cats that have chronic or serious conditions. At first-especially at first-it feels overwhelming, upsetting, unstable, as if life must come to a halt so that you can make adjustments to schedules, project lists, the care of other family/pets, etc. in order to concentrate on the sick cat. Eventually I get organized for their care, I get into a schedule and know where to take care of other people and pets and things. I set aside what I can-maybe I won't paint that many rooms in the next few weeks or schedule workman in the house during that time or during her post recovery time. Those can wait. But the other cats need tending, appointments, updates. I can only pray they do not get sick and that between the two of us we can tend to their appointments. 

How long will we pursue this line of treatment? For as long as she needs, for as long as we can. Yes, so much depends on keeping jobs, saving money, having the ability to tap into savings AND put it on credit cards and use CareCredit and THEN pay it off down the line.  But the tumor won't metastasize into cancer (rare chance) but it can cause worsening of the lameness and inability to pass urine and bowel movements. But plenty of cats are paralyzed and wear diapers and little wheels to get around. It's too soon to think of ending her life just because she's sick. This blog, this Cat Facebook pa
ge has never supported the idea that just because a cat is sick it must be put down. We are responsible for them-for FIGHTING FOR them. We must try-try to save our vulnerable cats; try to save our HCM cats with medications and cardiologists and supplements-so why not try to save Bette? (She does not have HCM.)

But I must think of the diameters of determining when it will be time to end her struggle, to call an end to the fight, and how and whom and where to end her life. What is the best case scenario? Which ER-the vet school, our regular ER? Her vet? Her vet visiting her at home? What happens if she crashes because of a complication? Where/who then?

But first, I need to rearrange my schedule for the end of April and into May to take care of her. 

Then I need to prepare for Easter. 

Please pray for Bette's safe and effective treatment outcome. 

Bette Davis