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Hello everyone.. very long-winded post ahead.. fair warning.. :wink

I have a 14yo (approx.) mostly-indoor cat who had never been sick a day in her life. Back a couple months ago, we noticed "Sissy" was looking a bit leaner. She's always been about 10.5 lbs. We also noticed that she wasn't eating quite as much as normal. She's never been a "big" eater to begin with, but now she'd just take a few small quick bites of her canned food and then scramble away, tho she'd sometimes come back to it later. She's fed from a can 2-3x/day and always has kibble on-hand. We didn't think too much of it, as she was still acting normal and happy.

A few weeks pass, and the weight loss and lack of appetite is starting to be more noticeable. One day she has a bad episode of mucus-diarrhea, and we make a vet appt.

The vet said she looked to be in good shape for her age, but he noted some dental disease, and recommends a cleaning. She's put under anesthesia, and during the procedure a bad upper molar is found and removed.. it's a difficult extraction, and the tooth has to be broken up. He also draws blood for a full work-up.

It takes her a couple days to get her feet back under her. 48 hrs later, she finally starts drinking and eating small amounts of food. The vet said the tooth was quite bad, and puts her on clindamycin.

I try hard to get the clindamycin into her, but pilling her is next to impossible. I end up crushing it into tuna-water solution and shooting it into her. She hates it.

The bloodwork comes back fine, with the exception of elevated neutrophils, which could be secondary to stress.

Several days pass, and she basically goes back to the eating she was doing before. Also not eating as much kibble and treats. We're not seeing improvement, if anything, the slow decline continues. Energy also declining.

I meet with the vet again to explain my concerns (he's nearly 80 yrs old), and he doesn't have much to offer other than blaming her age. He does give me some Baytril, which I get into her for several days.

Then about 10 days ago, she has an episode where she has diarrhea a couple hrs after having a normal BM. She also appears quite "upset" during the episode and vomits a tiny hairball with some fluid.

We make an appt with another vet. This vet does another round of bloodwork, which shows the neutrophils have increased even more, along with her WBC. And her HCT is now on the LOW end, so anemia. The vet takes digital X-rays. Nothing at all remarkable to be seen, other than an empty colon which looked to be gas-filled.

The vet initially wants to prescribe steroids, but given the elevated neutrophils and WBC, she instead starts her on doxycycline solution, which the vet mixed herself.

I give her the doxy for two days.. her reaction to the administration is horrible, worse than the previous attempts even. She drools excessively and foams at the mouth. She also vomits after the last two attempts. A nightmare..

I bring her back to the vet.. this time I see another vet (this office has three). I explain that I need to do something more aggressive to help her, and that trying to deliver these meds is only making matters worse. The cat is now hiding under the bed most of the time, and is otherwise very lethargic. I need to do something to help with whatever this issue/infection is, AND get her eating. She's now under 8lbs, and the muscle wasting is getting bad.

The vet agrees, and gives her an injection of long-acting Depo Medrol and Convenia antibiotic, as well as some fluids, as she was slightly dehydrated.

Less than a day later, Sissy seems somewhat better. Stabilized. She's eating a little better..

A few days pass, and her energy gets steadily worse. Appetite also declining. I notice now that when I pick her up, her little heart is racing.

The next morning she's up at 6am and trying to get in the basement. Then she vomits a small amount of fluid. After this, she goes very quiet and tries to seek a private place. I'm convinced she's dying. She settles under the couch and looks glassy-eyed.

The vet doesn't open til 9am. I get her there (anticipating euthanasia), but she seems to rally somewhat as we wait for the vet.

The vet examines her, and decides to keep her for the day. She says she'll do more fluids again and do a shot of either dexamethasone or prednisolone. She attributes the racing heart to the anemia, and while it's a concern, there's little to be done.

The vet also gives me prednisone pills, 2.5mg, one a day. She's had these for a couple days now, and her appetite has improved somewhat. Also drinking quite a bit. Still, she seems weak and her eyes are mostly sad and distant.

Two different vets, $1000 so far, and I have no idea what's wrong with this cat. Other than what I'VE suggested to the vet, obviously cancer. Or possibly inflammatory bowel.

The vet can find no mass and says her lymph nodes feel normal.

Sissy's brother had roughly similar symptoms in 2010, and he didn't have a mass either. He was ultimately diagnosed with small-cell intestinal lymphoma after spending $4000 at a university animal hospital. He was put on a pred/clorambucil chemo regimen, but didn't have a chance to go into remission. He suffered a horrible abdominal-wall herniation attributed to poor healing after biopsy surgery and had to be euthanized.

I'm not inclined to go down that long road again, and I know this also is likely cancer, but I'm still bothered by a lack of diagnosis.

Anyway, thanks for listening, and I'm open to suggestions..
 

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Discussion Starter #2
Sigh.. my apologies, I did not notice that my earlier post of this had come thru a couple days ago. Please delete this (double) post.
 

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Pokey,

I am so sorry for what you and your cat are going through. What a miserable course of events for both of you. Among all the bloodwork, has a Total T4 been performed to check her thyroid function? If not, that should be done immediately.

Do you have copies of all of her lab results from both vets that you can post here for us to see? That would be very helpful in giving us a better picture of what may be going on with her. If you don't have copies of her labs, I strongly advise you to get them ASAP. You will need them in order to make sense of your online research and in case you decide to seek out additional veterinary opinions and consults.

Did either vet recommend administering subQ fluids at home to keep her hydrated?

Did either vet offer treatment options for the anemia (yes, there ARE treatments for anemia)?

Both dehydration and anemia will rob a cat of her appetite and her strength, and both should be treated. Here is a link with quite a bit of info on feline anemia:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - All About Anaemia

When you get the lab results, the following reference is very helpful in making sense of the various blood values:

Broadway Veterinary Hospital / Laboratory Assessment Descriptions

I hope this provides you with at least some useful information. Please do post her labs when you get them.

Laurie
 

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Hi Laurie, thanks for responding..

I do have lab copies from the first two bloodworks. Another was done late this past week, but I don't have a copy for that one yet. The vet called and told me the results, saying things were not much different than the previous one.

Since the two bloodworks were done at different vets, the formats are different, and it's kinda tough to coordinate them. The first vet sends out the tests, while the 2nd does in-house.

Anyway, I see a T4 value on the first test, done on 2/4. It's 1.5, with the normal range listed as 0.8-4.0. So that looks good. I don't see a T4 value listed with the 2nd set.

I'll share the values from the first test that were "off".

CPK: 888 (56-529)
HGB: 8.9 (L) G/DL (9.3-15.9)
HCT: 27.6 (29-48)
Neutrophils: 10285 (2500-8500)

And now the 2nd work, done on 2/20:

HCT: 24.5% (30.0-45.0)
WBC: 29.25 (5.5-19.5)
NEU: 26.08 (2.50-12.50)

The rest of the values were all normal range, or very close to it.

The vet said the 3rd bloodwork was in line with the 2nd.. tho a bit "better". She said she did see some young RBC formation under the microscope, so she thought that was encouraging..

As for the elevated WBC and neutrophils, it's my understanding that these can show elevation secondary to inflammation, as well as infection.

The vet at the university hospital where I brought Sissy's brother said cancer is notorious for "boring bloodwork". Other than the elevated whites and anemia, that's how you would describe hers.
 

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The first vet sends out the tests, while the 2nd does in-house.
I'm sure you already know that samples tested at a diagnostic lab are usually more accurate and reliable than those performed in-house.

Anyway, I see a T4 value on the first test, done on 2/4. It's 1.5, with the normal range listed as 0.8-4.0. So that looks good.
Agreed. Thyroid looks good.

CPK: 888 (56-529)
Here's some information I found on elevated CPK in cats. From Infectious Disease - Feline Leukemia - VetInfo

"High CPK (creatinine phosphokinase) levels in cats occur for several reasons. There are numerous reports of high CPK levels in the absence of any identifiable disease, too. That may be because of diseases that are hard to find or there may be some problem associated with CPK that we just don't know about. The identified causes of CPK rises in cats are muscle damage, anorexia (not eating), inflammatory bowel disease and pancreatitis (possibly due to intestinal muscle damage, possibly due to not eating associated with these diseases), cardiomyopathy (again due to muscle damage), thromboembolisms (also probably due to muscle damage it causes in rear legs) and a genetic disorder in a research colony of cats with dystrophin deficiency. The CPK value can get into the hundreds of thousands and is commonly in the thousands just from not eating, apparently. This makes it a little hard to figure out how significant a rise in level is. It is still worth looking for any cause of muscle damage, checking for heart murmurs, making sure your cat is eating OK and thinking about pancreatitis. The TLI (trypsin immunoreactivity like) serum levels may be high with pancreatitis and somewhere I think I have read about an increase in pancreatitis in cats with FeLV, so that is another thing you could check out. Monitoring weight over the next month or so would be a good idea, too. As with all testing, lab errors sometimes occur, too. It might not be a bad idea to recheck the CPK level just to see if it remains high."

also ...

Creatine Kinase

As for the elevated WBC and neutrophils, it's my understanding that these can show elevation secondary to inflammation, as well as infection.
That's consistent with my research, though according to the link I provided earlier, elevated neutrophils, in rare circumstances, may indicate cancerous leukemia, as well.

Fortunately, your girl's anemia isn't serious yet. If it drops below 20, though, you should have a serious, immediate conversation with your vet about treatment options.

Any or all of the antibiotics your girl has been on can cause digestive upset and inappetance, and that upset can last for a couple of weeks. I strongly recommend you go to a pet store or health food store and pick up a probiotic to mix into her food to help repopulate her beneficial gut bacteria which have likely been wiped out by all of the antibiotics. I would continue the probiotic for at least a couple of weeks to help get her gut back in good working order.

I am concerned with all of the steroids the vets have pumped into your girl without a definitive diagnosis. If her problems stem from inflammation, the steroids may help, but if they stem from infection, steroids can cause serious problems by suppressing her immune system. In any event, if she does require steroids, prednisolone is recommended over prednisone. According to Plumb's Veterinary Drug Handbook, "Use PO [oral] prednisolone in place of prednisone in cats whenever possible as they do not absorb or convert prednisone to prednisolone as well as dogs. If PO prednisone must be used in cats, consider increasing the dose." Steroid dosages should never be adjusted or stopped except as specifically directed by your vet.

The following links will provide you with a lot of tips, tricks, and techniques for getting more nourishment into your girl:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Persuading Your Cat to Eat
AssistFeed.com: Advice to help a sick cat who will not eat

Laurie
 

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Laurie, thanks again for your help. I knew from my research with Sissy's brother that prednisolone was preferred over prednisone, and I can only think the vet gave me the latter out of sloppiness. When Sissy was kept for the afternoon last week, the vet said she would also give her a B-12 shot, which she neglected to do. I had to remind her when I picked Sissy up.

That's one of the things that's been frustrating with all this. It's tough not having a vet that's willing to invest themselves in the case. They do the routine diagnostics, and if nothing obvious presents itself, they don't have an interest in delving deeper. And I don't necessarily mean more and more tests, I mean something as simple as going over some possibilities with me. I don't think it's too much to ask. I'm not expecting them to keep themselves up at nite thinking about it.

Sissy actually IS eating, but it's an effort. Chewing, especially. The appetite seems to reasonably be there, but the act of eating takes encouragement, or a point in the day when she's feeling a bit better. I've given her a lot of palatable choices, but she seems to be most interested in her standard can food varieties.

Most of her days now are spent under a bed. A good day is when I can lure her out a few times for some food. In the evening I pick her up after a feeding and carry her downstairs for some "normal" interaction, which tends to perk her up somewhat. She still has the energy to groom herself a bit and jump up on the back of the couch to look out the window. If I didn't do this, I think she would spend all her time under the bed.

The wasting has gotten worse in the past week, despite the halfway-decent eating. It's so sad petting her and feeling pointy bones where there used to be girth and muscle. I have to believe she's under 7lbs now.

One thing I forgot to mention.. despite the high white cell counts, she's never had a fever. In fact, her temp has been below the norm whenever they've taken it. So I think that's another indicator that it's inflammation over a systemic infection.

I plan on another vet visit this week and will inquire about the SubQ fluids at home you mentioned. Thanks again..
 

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I knew from my research with Sissy's brother that prednisolone was preferred over prednisone, and I can only think the vet gave me the latter out of sloppiness.
Not necessarily. My vet has a small practice and only stocks meds which he prescribes frequently. Since he doesn't have many feline patients on pred, he stocks and prescribes only prednisone. When I wanted my boy, Noddy, to be put on pred, I had to have my vet write me a script so that I could mail order prednisolone through a vet pharmacy.

It's tough not having a vet that's willing to invest themselves in the case. They do the routine diagnostics, and if nothing obvious presents itself, they don't have an interest in delving deeper. And I don't necessarily mean more and more tests, I mean something as simple as going over some possibilities with me. I don't think it's too much to ask.
Tell me about it. I've left more than a few vets over the decades because of the lack of appropriate vigilance and interest in my animals' competent care and/or their lack of ability or willingness to partner with me. I consider and expect a veterinarian to be a paid medical consultant and partner, NOT a dictator. The indifferent idiots and God-complexed dictators are left eating my dust.

Sissy actually IS eating, but it's an effort. Chewing, especially. The appetite seems to reasonably be there, but the act of eating takes encouragement, or a point in the day when she's feeling a bit better
Dehydration, constipation, anemia, and excess stomach acid can all make a cat mildly nauseous. She may still act hungry and interested in food, but when it actually comes to eating it, the nauseous feeling may stop her in her tracks. Is her coat smooth and shiny, or dull and clumpy? Does she pass normal stool - firm but squishable tootsie rolls rather than small, hard balls? Is she weak? Does she vomit clear, foamy, or yellowish liquid with little or no food?

Most of her days now are spent under a bed.
That's never a good sign, esp. if she's hiding because she feels sick. If she's hiding just to avoid being medicated or syringe fed, that's not as worrisome. It's good, at least, that she still seems to be enjoying some time downstairs doing more "normal" activities.

The wasting has gotten worse in the past week, despite the halfway-decent eating. It's so sad petting her and feeling pointy bones where there used to be girth and muscle. I have to believe she's under 7lbs now.
If you're not doing so already, it sounds like she could benefit from some assisted feeding, along with whatever she's still able and willing to eat on her own. I've been assist (syringe) feeding my Noddy for a month or so now. Like your girl, he's still eating some on his own, but not nearly enough to maintain adequate body weight. I suspect he has intestinal lymphoma (or possibly IBD), but I won't be putting him through a surgical biopsy to find out. He's on prednisolone and metoclopramide, along with a slew of other supplements. He's holding his own and having mostly good days. He doesn't enjoy being syringe fed, though he's begrudgingly compliant. He DOES, however, look forward to receiving subQ fluids twice daily and will follow me around the house yelling at me until he receives them.

One thing I forgot to mention.. despite the high white cell counts, she's never had a fever. In fact, her temp has been below the norm whenever they've taken it. So I think that's another indicator that it's inflammation over a systemic infection.
Sounds like a reasonable assumption to me.

I plan on another vet visit this week and will inquire about the SubQ fluids at home you mentioned.
Fluids can do amazing things for a cat with any degree of dehydration. If your girl isn't eating much, she's likely not maintaining adequate hydration on her own, either. If I were you, I'd push HARD for fluids for your girl ... UNLESS your vet believes there's anything wrong with her heart. A cat with questionable cardiac function can get into trouble with supplemental fluids.

Laurie
 

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A sad update which I'll try to keep brief.. Sissy went to the vet again on Wednesday. There were recent, stronger indications to me that she was nearing the end, and considering her quality of life had clearly become very poor, and at no point during any of the recent "treatments" had she gotten better, I was of the mind that I would have her euthanized.

The vet agreed with my assessment, yet expressed frustration at not being able to diagnose or help her. Unfortunately, this led to a conversation and ultimately a course of trying a couple more things in a last-ditch effort, despite the painstaking decision I had come to that this was all over.

So Sissy came home, and despite drinking and eating a bit early Thursday morning, she spent the whole day very quiet and trying to sleep. Late Thursday evening, she became quite restless for a few minutes and coughed fitfully, but then settled, and peacefully died.

Still, I wish I had released her the day before, and spared her that extra day. Despite it appearing peaceful, I'm sure it was difficult for her. I know we all second-guess ourselves in these situations, but I'm kicking myself for ignoring what I knew was the right decision on Wednesday.

She was my silly and sweet girl, and I'll miss her forever. Thanks you laurief for your kind advice in the recent days.
 

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Don't beat yourself up, Sissy live a good life and knew she was loved.
Making the decision to end a beloved pet's life is irreversible, if you'd not listen to your Vet you would still be 2nd guessing yourself, it's never easy to say good-bye to a beloved pet and your Vet gave you a glimmer of hope.
Try to think of all the love you and Sissy shared and not the sad end.
 

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Making the decision to end a beloved pet's life is irreversible, if you'd not listen to your Vet you would still be 2nd guessing yourself
Of course you're absolutely right, and rest assured her legacy will not be her last difficult few weeks or final day, but the love and companionship she provided over the years..
 

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I might add I know what you're going through, last May I lost my beloved Samantha to the scourge of cancer 5 days after her 16th birthday.
I came in from work to discover her lying on the floor in distress, a trip to the vet and a lot of expensive scans reveled tumors around her spleen and in her intestine.
A probe sample reveled it was a cancer of a type could no be treated by chemo only extensive surgery and at best that would provide another year at best.
I couldn't put my beloved little friend who'd never been sick a day in her life before through that kind of ordeal. I lost my Mother to cancer and she was so much worse after the surgery.
Samantha died in my arms and I miss her dearly everyday, my other cat Chiquita has been a great comfort to me.
I try to comfort myself that 1 bad day doesn't negate 16 happy years of health.
Samantha was not only incredibly beautiful, she was a cheerful and happy soul full of mischief.
 

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I'm sorry for your loss, Pokey. This is little consolation, but at least she passed at home in her familiar surroundings instead of in a doctors office. Take care, chuck
 

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her legacy will not be her last difficult few weeks or final day, but the love and companionship she provided over the years..
I am so, so sorry for your loss of Sissy, and I am relieved that she is no longer battling a failing body. You are a truly admirable caretaker, and I have absolutely no doubt that Sissy felt deeply loved every day that she spent with you and your family. She carried that love with her when she passed. When I lose a beloved 4-legged, I can feel them take a piece of me with them. I am comforted knowing that they are safeguarding those pieces of me just as I safeguarded each of my beloveds while they were in this life with me. Sissy holds a piece of you with her, and she will keep it safe until you are reunited.

Once the acute pain of her loss has tempered, you will see that her legacy encompasses all of the experiences she shared with you, including her last difficult weeks. The critical lessons you learned over the last weeks may, in fact, prove to be the most valuable of all as you apply them to the benefit of your future 4-leggeds and share those lessons with others who may also benefit from their wisdom. Sissy was, as all animals are, a teacher. You and I are loving teachers' aides.

I wish you a peaceful grief.

Laurie
 
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