Serafina's Battle with Lymphoma

In July of 2018, Jim, Adrienne, and I moved to Ridgewood, New York. We had decided it was time for us to take the next step in our professional careers, and New York was the place we had to go to do just that.

The beginning was hard. Jim and Adrienne were Philadelphians, and I was already a transplant, but New York was new for all of us. It was hard for Vizzy too, our sweet orange boy who made the move with us, now the only pet in his home after growing up with two other cats and a German Shepherd he met when he was still a kitten. Amongst all of us though, Adrienne was especially homesick. In October of that year, after a few rough months of adjustment, she had to go to St. Louis to take an exam– it was one of the reasons we had moved, afterall.

We had talked about fostering cats briefly but never had a serious conversation about it.

While Adrienne was away at her exam, she shared a post about two kittens found in a park that needed a foster with Jim. He decided to bring those fosters home.

Unannounced.

October 25, 2018

I immediately protested. We didn’t have the time for two more cats, we didn’t have the space. I knew we were only fostering, but how could he just bring them home and not say anything?

My mind was changed in roughly 20 minutes, and I am so glad it was.

In our shoebox of an apartment were two little sisters– a tabby, and a tuxedo. I fell in love nearly instantly. They were sweet, and playful, and gentle– I knew from the first night that they were staying, permanently. When she got back, Adrienne, an avid reader and a fan of Phillip Pullman’s novels, decided they would be named for witches. Ruta, the tuxedo– named for Ruta Skadi; and Serafina, the tabby– named for Serafina Pekkala, both Queens of their respective clans.

We fell in love with them, and for over 4 years had no serious problems or health scares; to be honest, we were blissfully inconsiderate of that even being a possibility.

Unlike Jim and Adrienne, I did not grow up with pets– during and after college I lived with some, and I got to know and care for them in a way I hadn’t experienced growing up.

Nothing, however, prepared me for the bond that I would form with Serafina. I will perhaps never understand why, but little Serafina decided that I was her person– she became my shadow, my velcro cat. She slept under my beard as a kitten, and spent nearly every morning on my chest, wailing, as if she had never been fed even once in her life. Eventually she would realize it was still time for sleep, and she would give up, resting her tiny head on my chest, purring away.

October 30, 2018

She loved all of us, but she made it no secret who her favorite was. I learned that I can make her feel safe when no one else can, I can feel her trust when she is upset or afraid. I didn’t ever understand or experience this kind of love before. I didn’t know that a little creature could blink her big green eyes at me and make me feel so warm and cared for. I didn’t know that I had the capacity to love an animal this way, to be willing to do whatever I have to to keep her safe and happy and loved. Every night, even now, when I get in bed she is quick to follow– taking the same place on my chest that she always has, giving me a headbutt goodnight and purring until we fall asleep. Serafina is who taught me how true it is that our pets are our family, in her case, my baby, and that we are bonded to one another.

December 19, 2018

March 7, 2021

On March 1st of this year, our 4 years of peace were interrupted.

We woke up on what should have been a regular morning, a regular day, and noticed that Serafina had a lump on her head.

March 1, 2023

We scheduled a vet visit, and the doctor told us that while this was certainly worth worrying about, it was likely she just bumped her head too hard on something. She was prescribed a steroid and we didn’t think much of it more than an inconvenience.

After about 2 days, the lump on her head was gone. We happily reported to the vet that the problem had resolved, thanking her and her team for their help.

Unfortunately we found this resolution was short lived.

In a matter of days after finishing the steroid, the lump reappeared, so the doctor recommended we do a fine needle aspirate (FNA) to get a closer look at what was going on. We were cautioned not to worry ourselves too much, a lump on the head is simply not how cancer presents in cats, we would find some explanation.

The results came back, and despite its rarity, our worst fears were confirmed. At the end of March, Serafina was diagnosed with lymphoma. It was an especially rare and unique presentation of it, and likely aggressive. We were advised to consult with veterinary oncologists as soon as possible. We secured an appointment at Blue Pearl in Brooklyn for April 11th, and in the meantime Serafina had to be tapered off of the steroid that was keeping the cancer from advancing.

Serafina’s condition devolved significantly in the weeks leading to that appointment. She withdrew– she hid, cowered and coiled in pain and discomfort as the tumor grew, swelling her head and closing her eye. On April 10th we were forced to hospitalize her. Truth be told, when the emergency doctor came back to give us our options, we’d feared he would tell us there weren’t any.

Adrienne and I did not have a long discussion on how we were going to approach this. It was short and direct. We decided that we were going to fight this as hard as we could and for as long as we could, provided Serafina still had a worthwhile quality of life. She was given an estimated 6 month prognosis.

April 8, 2023

That week she started CHOP chemotherapy.

Her first treatment did not seem to go as planned, the doctor was concerned about her lack of progress, and was soon forced to update her prognosis to a matter of weeks. Her steroid dose was amended, and her 2nd chemotherapy treatment was delivered. We were sent to a radiation oncologist to have her assessed for palliative radiation, a treatment used to help keep cancer patients comfortable in the time they have left.

However, to our surprise and delight, that week she turned a corner in a very big way. The swelling of her head and eye completely resolved, and she quickly was returning to her old self. The radiation oncologist we were referred to was shocked– having seen pictures of her in the referral, this was not the cat she expected to meet. Serafina was given a CT scan to assess what exactly we were looking at, but nearly all indications of the cancer had vanished, with just a small nodule showing above her eye, where the lump had previously been. She was not considered a good candidate for radiation therapy, and we collectively chalked it up to a delayed response in the chemo. Serafina looked so drastically different after her 2nd chemo treatment that at her follow up appointment, the nurse that came to the room to bring her to the doctor looked in the window, stopped, and went back to the front desk to make sure she was going to pick up the right cat.

April 23, 2023

We finally had a glimmer of hope. Maybe we could beat this after all. She coasted on chemo treatments for the next 2 months, and we were lucky to have many days of normalcy. However, in June it came to light that she wasn’t responding to all of the treatments in her protocol. Cytoxan and Prednisolone were doing their jobs, but her body was rejecting Vincristine (CHOP’s strongest drug) and Doxorubicin. In short, she’d failed CHOP. We found ourselves left with radiation and emergency chemotherapies as the remaining treatment options.

Serafina was still herself though. We could not bring ourselves to give up on her. We elected to have the mass on her head surgically removed– we did not get everything, but a single round of Cytoxan along with continued Prednisolone allowed her to achieve clinical remission! She was so normal during this brief time, she had so much energy and vitality and was completely herself as if nothing was wrong. Unfortunately we knew this would only last for so long.

June 25, 2023 (post surgery)

July 6, 2023 (clinical remission)

July 11, 2023

July 20, 2023

The next step was to get her scheduled for radiation. Her disease was localized, and now that she was in remission we could kill anything left around it. We were able to get her into Schwarzmann Animal Medical Center, which has some of the best radiation oncologists and technology in the world. Upon consultation she was given a prognosis of 9 months on the low end, up to and over 12 months in the best case, provided she successfully completed radiation therapy. But, there was a catch: to make sure the radiation therapy targeted all of the right areas, we needed to taper her steroid dose off, and let the cancer present itself again. Radiation therapy is not something you can try multiple times, and the doctor needed to make sure the target margins covered every area the cancer was growing; we would only get one shot at this. Reluctantly, we did just that– after the cancer presented again, Serafina underwent another CT scan, confirming that the cancer was localized to her head and that she was in fact a candidate for radiation therapy.

The next weeks were some of the hardest of our lives. Serafina was given 10 radiation treatments between August 9th and 29th. She was an absolute champion during this time, if you couldn’t see her missing hair or shaved little head, you may not have even known what she was going through. She was still a cuddly, loving, and sometimes even demanding little baby. We couldn’t believe her strength. We were ecstatic after she finished. We were able to taper her steroid dose down to nearly nothing, and our biggest concern became making sure we kept her left eye hydrated with drops, daily, to prevent any pain after being within the target site of the radiation.

August 30, 2023

September 9, 2023

Serafina had a two week check in appointment on September 12th, to make sure everything was going smoothly after the completion of therapy. Adrienne and I were incredibly nervous.

But to no avail!

I am paraphrasing but, “She looks great! She feels great! Give us a call in 2 weeks and come see us again in a month.”

She was in remission again and we were so relieved. In April we were told our baby only had weeks to live, and now, 5 months later, we were expecting at least another 9-12+ months!

It felt like we could finally exhale.

On September 20th, just over a week later, Serafina didn’t seem herself. Signs of mild nausea, lack of appetite, a little withdrawn. We thought maybe she was just tired, or had a little delayed radiation sickness. Her head still looked fine, there was no indication that the cancer had started growing again. But two more days passed, and on Friday she was hiding, would drink but not eat, her stomach was starting to look distended, and she wasn’t going to the bathroom.

Adrienne and I got home that night and knew things were not ok. At 3am I took her to the emergency room at AMC.

A doctor came and spoke to me after assessing Serafina, they said she seemed fine overall, but were concerned about her symptoms and wanted to see how her blood panel went. When it came back, it showed her kidney values were through the roof. AMC had extensive records on her from all the treatments she received there, and were even able to compare it to previous values they recorded. I was told that she would once again have to be hospitalized, and they would update me the next day.

When I talked to the doctors next, it was only bad news. Her kidneys were extremely inflamed, and their presentation was consistent with renal lymphoma. Another FNA was performed to confirm, but the writing was on the wall. Renal lymphoma is regarded as one of the most difficult forms of lymphoma to treat, and prognosis is 3-6 months.

We pushed back with the doctors, we felt blindsided. How could this have happened? We confirmed the cancer was localized, we checked and rechecked. We did everything we could to make sure we were making the right decisions. But lymphoma is a special beast. It can lie microscopic and dormant throughout the body. No one missed anything. This cancer just hid itself perfectly. Our year or years have now been cut down to weeks, maybe months.

She was discharged on Sunday the 24th, after 36 hours in the hospital, and still somehow came home herself. We had family visiting and she still managed to be social, to the point of being the center of attention– she acted as if nothing had even happened over the weekend. AMC did an incredible job stabilizing her, and Blue Pearl managed to get her an appointment for the next day, where we were able to get her treated with the chemotherapies that we previously have had success with. In less than a week, she managed to turn herself around again. She is playful, active, and herself, making it that much more difficult to plan for the inevitable, but we understand how limited our time and options have become.

September 26, 2023

We are officially using a rescue chemotherapy option- CCNU. We have exhausted everything we have at our disposal fighting this– physically, emotionally, financially. Adrienne and I are resolved in that we do not want to keep her here just for our own comforts, however, she is responding to treatment well and we can’t stop fighting now after we thought she was getting so much more time, while she still has good days ahead, and still so clearly enjoys being alive (and getting all the love and treats her heart desires).

What we hope for now is help from our friends, our loved ones, or anyone who knows or has known what it is like to go through this. Anything will help, and anything unused will be donated to Flatbush Cats, the organization that originally led us to being Ruta and Serafina’s fosters, who are opening a veterinary clinic in Brooklyn offering affordable care to pet owners and rescuers.

Thank you.

October 2, 2023

These funds will be put towards Serafina's Battle which has included:

2 Overnight Hospitalizations

2 CT Scans

13 Chemotherapy Treatments

10 Radiation Treatments

1 Surgery

6+ Months of Doctor Visits, Medicine, & Travel

End of Life Care