Decisions, decisions

Fig seems to be responding well to his second steroid injection, which I gave him last Saturday. His appetite is normal, and he has put some weight back on. He is active and alert, and doesn't seem to be in any pain. I can look at him and momentarily forget his diagnosis.

So, the time is at hand to decide about his second chemo treatment. The vet wants me to bring him in for another blood panel to see how the first treatment, nearly a month ago, has impacted his white blood cell count before giving him another dose. He warns that going ahead without the test could be risky, should his count be too low. I see the sense in that, but remember the experience of his first panel - he got so stressed out that he became nonresponsive and was drooling; the vet thought he might have had a seizure. Is that risk more acceptable than the risks inherent in not testing him? To compound the equation, there is the cost of the test - not insignificant. I am fortunate to have a friend who is willing to share the cost with me, but it is still a consideration. It shouldn't be (guilt is telling me that a responsible pet owner will have the resources needed to provide whatever treatment her pet needs), but it is (reason is asking me if I can afford expensive lab tests for a cat with an incurable disease when I have postponed some routine, but expensive tests for myself this year out of financial considerations).

The other question casting a shadow over this decision is the impact it will have on Fig. Will the chemo weaken him, will it make him feel sick? After the first treatment we had to contend with bouts of constipation and diarrhea, alongside his unpredictable incontinence. It wasn't fun forcing pumpkin down his throat; he and I both ended up with as much pumpkin on our outsides as went into his insides, and I know he didn't understand that I was doing it for his own good. Thank goodness the pumpkin worked, though, in conjunction with a stool softener. Better a more gentle approach than a harsher one, I think, given his health.

So, given his seemingly improved health, should I try the more aggressive chemo or stay with the moderate one? Will the more aggressive chemo give him more time? What will the quality of that time be? What matters to Fig? What is the impact of all this on us?

The fact that euthanasia is an option with pets, unlike people, both simplifies and complicates the basis for making health care decisions. When our beloved companions seem to be suffering and treatment is either not efficacious or affordable, or when the burden of caring for a sick animal overwhelms us emotionally, physically, or financially, we can "put them out of their misery." And perhaps, even feel noble for having made such a difficult decision. I'm not kidding myself about the difficulty of that decision, either - it is no small thing to decide to end a life, even if it is the life of an animal. Hopefully that decision is a long way off.

For now, I will probably opt for the blood test, and based on the results and the vet's recommendation, decide to continue with the moderate chemo or try the more aggressive chemo. But this time I will insist that the vet allow me to remain with Fig while they draw his blood, rather than allow them to take him to a back room where he is cut off from me. I know my presence calms him, so I owe him that much.