Protentional dangers of chemo drugs to pregnant wife/other cat

[menorton]

Hi All!

My 11 year old cat (Jaco, black american shorthair) was recently diagnosed with Small Cell Lymphoma after a mass obstruction was found in his GI Tract. The surgery, thus far, was successful in removing the mass. However, the long term care plan is Prednisolone (daily) and Chlorambucil (every other week). Chlorambucil is the chemical, it goes by the brand name of Leukeran. The problem is that Chlorambucil, like all oral chemotherapy, is very toxic. My wife, who rescued Jaco 9 years ago (I married in), is pregnant and in her 2nd trimester. While she is healthy and normal, she cannot interact with this drug at all. This also means with Jacos urine, feces for 48 hours after I give it him. His saliva is also a concern during this time, not for us, but for our other cat. We also have a second cat who likes to eat Jacos food and lick his bowl -- both interactions with his saliva.

My question to you all is: What are your experiences with chemo drugs with at risk family members and other cats?

The 48 hour time period every other week is cause for significant concern as far as getting other people/cats sick. And not just during pregnancy either, what about during breast feeding? What about Jaco licking the newborn baby?

We obviously will bring this up with our oncologist soon, but I would like to know what your all experiences with this are. I have never dealt with a sick cat, or chemo, or having a family, so this is all very new to us. My wife is beyond worried for the fetus, and hates that she may just have to choose him over our cat.

Thanks all.

[fjm]

What a difficult position to be in - I really feel for you both. I would start by getting more information, including on how long you need to treat saliva, urine, faeces etc as potentially harmful. You will obviously need to be responsible for giving the cat his medication, and cleaning litter boxes, etc. The safest procedure, if you have the space, might be to dedicate a room or outdoor run to his use for the few days after the treatment, until you know the risk has materially reduced. If it is only fortnightly, and you make his space warm, comfortable and interesting, he should be fine confined for a couple of days at a time. Then it is a matter of getting into the routine of gloves, double bagging, etc, etc, but that all quickly becomes a habit.

[menorton]

From what I have read, his saliva/feces/urine should be avoided by everyone (me, her, other cats) for 48 hours after I have given him his pill. This means cleaning his litterbox 2x a day for these days. Afterwards, throw away all of the litter and put new litter in. But what about the other cat using the litter during the these 2 days? Will this be harmful to him?

As for dedicating a space, we currently live in a smallish appt. The only space we have for him is where he currently is, the guest bathroom. We must think of quality of life at all times, we can't force him to live in a bathroom 2 days out of 14 days for the rest of his life. All while potentially remaining a radiation danger (maybe?) to the rest of the family. This is a horrible position to be in.

If we remove the leukeran and only give him the steriod prednisolone, you are looking at only a few months to live.

[Mollycat]

I don't know about chemo but I can tell you a cat that's been treated with radioactive iodine is usually sent home with strict isolation protocols including safe handling and bagging of waste and limited physical contact and time spent in proximity. I'm surprised if they gave you these drugs without going through all this in great detail and discussing the hazards with you properly. I wouldn't wait to bring it up with the oncologist soon, surely a phone call to the guy who prescribed the drugs should give you the clearest guidelines?

[menorton]

Oh! Sorry to be unclear. At this exact moment, Jaco is recovering from the surgery to remove the mass. It happened yesterday (Feb 3rd). The two drugs (pred and leukeran) have only been discussed. They have not yet been ordered, so my house is currently chemo free. We are probably a week or 3 out from them, assuming the liver and lymph biopsies come back a good result (not certain).

[booktigger]

My friend's cat had chemo following surgery, she had to take her cat to the vet for the chemo pill to be administered, as bloods have to be taken before each tablet, and it was for 6 months I think

[menorton]

Interesting. What I read (internet) was that you can give the pill yourself. Having the vet do it obviously is safer, but its more expensive since now you are mandatory going to the vet 12x (2x month x6 months). And unfortunately, it doesn't solve the problem of isolation post chemo.

Cancer sucks.

[menorton]

We had only a day to make a decision, and while we both did a ton of research, isolating the cat due to chemo drugs never came up. Nor was it brought up to us by the Dr. At the time, the decision points were:

1a: Finding a low-cost surgery center. Shoutout to Anicira Vet Center in Manassas Va. The surgeons aren't board certified and they offer no wellness checks, but damn were they able to offer me a great price with amazing service and quality. Hope Center wanted $7200 for surgery + 3days in-patient. Pender Vet, our normal vet, wanted $3700-$5000. Anicira did it for $1500+biopsies. They even gave me a courtesy call today to see how he was doing. Wife and I can't speak more highly of them.
1b: Making sure we could get Chlorambucil cheaply. Leukeran is $25 a pill, but the schedule is thankfully every other week. $24 x 26 times per year is ~$630. Even better, I found a compounding pharmacy (BestRx) in NY that can compound me Chlorambucil 2mg (same chemical/dosage as Leukeran) for $4 per pill! Thats a yearly cost of $97, free shipping. A very big IF, but I still need to talk to my oncologist to see IF the compounded is just as good as the name brand.

While I researched we had to stay away from salivia, feces, urine, we didn't figure out then how expansive this would be. Sometimes you just need a few days, which we distinctly did not have.

We will be talking with the oncologist about everything in this thread and more when we get the multiple biopsies back. Should be 5-7 days from today.

[booktigger]

It must be different in the US, but in the UK, part of the reason for the chemo to be given by the vet is to have bloods done first, to ensure that the cat is healthy enough to be given it (her cat went monthly). Yes, it is an added cost, think my friend paid £4k for the treatment - her cat also had surgery first, the biopsy was inconclusive, which is why her vet recommended chemo to be on the safe side, although she doesn't have pred as well. If your cat is on pred long term, that also requires blood tests to ensure it isn't causing any health issues.

[menorton]

Yes, you are correct. Due to both Luekeran and Prednisolone, CBC (complete blood count aka bloodtests) is needed at first every few weeks, then can be stretched out to every few months

[middleboop]

Hi there.

We've just found out our girl Nyla has lymph node cancer and my wife is also in her second trimester. We're currently working out the risks involved in the chemo medicine and I just wondered what you ended up doing with Jaco and if you or anyone on this thread had any advice or experience with this? Such an awful thing to go through

[menorton]

Hi!

So our son is a year old, and both he, our cat (Jaco), and my wife are very healthy. The cat is so healthy that he continues to jump on countertops to get food when we aren't looking, and loves to try and explore the HVAC ducts so I had to put up webbing to deter him.

Sorry to hear about your Nyla, this is really terrible to go through. Assuming all the surgery is done (if any was needed, hopefully not, was very $$), you are probably now on a pill regimen? Jaco has small cell lymphoma, so its apparently very treatable (perpetually) in cats.

Our treatment process:

• PREDNISOLONE compounded chews every other day, at 2.5mg

• CHLORAMBUCIL every two weeks, at 5mg

We are def paying for convenience when it comes to the Pred for Jaco. The compounded chews are $89 every 4 months (60 chew supply, every other day). Yearly cost of $267. But man, they make it easy. No mess, no piller, just take a chew square out, put it on a disposable tray, and he sees it as a treat. Actively looks forward to it, and loves the chicken taste. We tried the non-compounded, the pred pills themselves were cheaper then a dime a dozen, but we had to use a piller or mix with it, and it was a huge pain. Jaco does not like the taste of the pred pills one bit.

As for the chemo (chlorambucil), the cost is doable. 5 pills (1 pill every 2 weeks, 10 week supply) is $45. Yearly cost of $234. If you want them to be compounded, it will cost more. But here is the trick, mix the pill in with a some creamy stuff in the links. You don't need alot, like a dime size, as the pills are very small. USING CHEAP MEDICAL GLOVES ($5 for 100 pack amazon), mix the cream with the pill on a disposable tray. Again, this is like a treat to my cat.

That being said, giving jaco the chemo, cleaning up after him, then being wary of his licks, spit, puke, and vomit for 24 hours is a process. We are used to it, but it was at first alot of work. This is our schedule:

Chemo Day (Sunday):
-Scoop the poop. We have 2 cats, 2 litter boxes that they both use since we don't know how to teach them to share. We turn these around so that the entrance is facing the wall. We don't want jaco in using these for his post chemo 24 hours.
-Use temporary kitty litter box for the first 24 hours. Personally, to help keep cat litter from being spread, we get a big disposable litter box (cardboard), put the liner in it, then put the disposable cat litter in that. It's somewhat of a process, but it is very clean and easy to get rid of. If you did everything right (every cat is different), then after a day, you only have to get rid of the litter and the liner. The cardboard box you keep, since it should be clean. Amazon sells a 10 pack for $50, which seems alot more then when I bought it. You could just as easily take a cardbox box and cut an entrance into it.
-Put on the medical gloves, and take the pred out of the fridge. Take the treat cream out of the fridge too. Don't listen to the 'dispose of after x days' on the cream, we keep it in the fridge and even roll/add a binder clip to the open end. It lasts for several months. Put a dime size amount of the cream in a tray, mix the chemo pill in it, and give it to the cat
-Once you have Nyla has eaten the chemo and all the cream, trash the tray and then throw the trash out too. We use a small trash bag (plastic bag) that goes straight into the trash. Then wash your hands thoroughly
-We do this Sunday night, right after we put the kid down at 730pm. That way, the next interaction with him and the cat is 12 hours later (7am). That window is only an 1-2 hours then the kid is off to daycare. By the time he comes back, Jaco is basically chemo free. Your kid isn't born yet, so no daycare, but thats something to keep in mind for the future

If you only have one cat, you may not need the temp kitty litter. But you def need to still scoop it the day of and daily for 2-3 days after chemo.

Jaco got diagnose in Feb 2021, which was about 1st trimester for my wife. Kid was born end of July 2021, and its now July 2022. Year and half later, Jaco's bloodwork is great, fur and spirit are great.

One thing to note is that pred does cause an increase in hunger, thirst, and aggression. So more water, somewhat more food but not a ton. As for aggression, we bought a cat pheromone plugin to call him down. Yearly cost is maybe $100? He started getting way too aggressive towards us about treats, we bought that, a day or so later he calmed down. This was months ago and hes been fine ever since. Still always hungry though, so we dont keep food out for long unattended.

Hope this helps!

[menorton]

Oh and the vet bills are kinda high though. Every 2 months we take him in for bloodwork, CBC, etc.. They range for $140-$250 each. So early cost like $800? I mean all these yearly costs do add up, im glad we can afford it.

[menorton]

links:
cat cream
https://www.amazon.com/gp/product/B07VC ... =UTF8&th=1

phermone diffuser. Multi cat is more expensive than a single cat house hold
https://www.amazon.com/gp/product/B071G ... UTF8&psc=1
https://www.amazon.com/ThunderEase-Mult ... KMR8&psc=1

Cardboard litter box (if applicable)
https://www.amazon.com/gp/product/B07PN ... UTF8&psc=1

Liner for cardboard litter box (if app)
https://www.amazon.com/gp/product/B01DU ... UTF8&psc=1

Temp litter box itself
-We buy then $5 each or so from Harris teeter