Pam’s cat Emily – Page 2 – Second Chance AIHA Dogs

Keymaster

Hi Pam, and thank you everyone for your replies.

Pam and I only recently “met” via a very good feline anemia list, but as you can see this is a complex case and there are no clear answers at the moment.

I’m so glad you found your way here Pam, although sorry you have had to. I understand how hard it can be giving pills – As Sheena knows, I once ended up in the ER from the gentlest of cats! Mable is currently on prednisolone for an allergy and fortunately she has been very easy to pill, now that I have found the right treat to hide it in. I’m using Webbox cat delights, which may not be available in US but I’m sure there is something similar. It’s like a small pepperoni for cats (cat treat sticks) and I break a piece off and tuck the pill in there, no problem. I usually give her a couple of pill-free pieces too, so that she doesn’t get suspicious.

When Molly was sick, I tried every food under the sun to get her to eat. Ultimately all she would take was her normal, boring cat food. I’m guessing you’ve tried hiding it in various treats or cooked beef? My aunt used to put her cat’s medication in a small amount of the food before giving her the full feed, to make sure she took it, or squeeze it into a piece of chicken. There are lots of videos on Youtube which might be worth a look. This one seems the most straightforward and least stressful to me. https://www.youtube.com/watch?v=OtZ-8YT-etM
I do understand how hard it is. I remember being very close to tears forcing pills into Molly when she was so ill. I coated them in butter and gave water from a syringe immediately after, but it was horrible.

Some antibiotics can be administered via injection if your vet is happy for you to do this. It looks like Baytril is available in injection form but there are some issues with cats relating to additional side effects, so this would definitely need the go ahead from the vet. I’m just reading up and apparently there are some pharmacies (Pet Script?) which can make up oral Baytril (tablets or suspension) into cat-friendly treats. It might be worth looking into if Emily has a real aversion to taking medication. Baytril is apparently also available transdermally, although again there seem to be controversies about how well this is absorbed.

The article you posted has some great information I agree. I also note it states that hepatosplenomegaly can be a normal finding in cases of IMHA due to extramedullary hematopoeisis. I have been working out Emily’s absolute reticulocyte count (http://www.eclinpath.com/hematology/tests/absolute-reticulocyte-count/) and agree that it appears she is non-regenerative at the moment. What I absolutely do not understand is how she has maintained her PCV since May without a regenerative response and without a transfusion, unless – and I’m hoping someone can help me out here – this is the result of extramedullary hematopoeisis.

One of the real sticking points I think is whether Emily should be on immunosuppressants. Of course, if this is IMHA, then yes. If not, and if it is FHM, then apparently this could make things worse (although pred alone doesn’t seem to have done so far). I think that the PCR test is the way to go – apparently Idexx do an FHM specific PCR which is quite sensitive (http://www.idexx.com.au/pdf/en_au/smallanimal/reference-laboratories/diagnostic-updates/realpcr-fhm-test.pdf) and I can see your vets have mentioned this in their summaries.

Everything I am reading on FHM says it is typically regenerative, but not always so if there is a concurrent disease affecting the bone marrow. I know that your vets have tested for FeLV/FIV – do you know if this has been repeated in the infectious disease panel? As to IMHA always being regenerative, I think we are living proof that this is not so. The “standard” IMHA is strongly regenerative, but the immune system can decide to attack the baby red cells in the bone marrow instead. Patrice’s Chance, Sheena’s Worzel and my Molly are all examples of non-regenerative IMHA, as well as many others who have used the forum. This is quite a useful little diagram I found to see if we can get any ideas: https://ca.idexx.com/pdf/en_ca/smallanimal/reference-laboratories/feline-anemia-diagnostic-algorithm.pdf

Pam, well done for hanging in there and asking all the right questions. I know this must be a huge worry and I really hope we can help you get the answers for lovely Emily.

Mary and Mable x

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Keymaster

Hiya Pam

Goodness, this is hard getting medications into your poor Emily – more difficult than with doggies for sure. My very old friend Theresa (by whom I met Mary) wraps her “difficult ones” in a towel to give meds – it avoids ER visits! I can appreciate that it is not ideal to say the least, but maybe worth a try????? Mary – your ideas are really worth a go – good luck Pam – very frustrating for you. Emily sounds like a real sweetie pie & we always feel bad showing this stuff down their necks – they don’t understand we ARE trying to get them better! Is there any way you could restrict her to a certain area, so that she can’t sneak off & hide? Or even a large cage?

From what you have said, my suspicions still go with an infection – it will take someone far more more clever than me by far to be certain. At the end of the day though, why not go with treating an infection? What’s to lose? Nothing actually. That was what we did – basically, doxycycline will kill of just about anything & that was what we opted for with Worzel. A course of antibiotics may prove/disprove our theory & would do no real harm. But he needed that immuno-suppressant as bone marrow failure was obvious. Would you be able to dissolve & syringe an antibiotic, rather than use a pill? If not, an injection surely is available. It does worry me that pred alone may not be the right thing to do BUT because she is nowhere near emergency levels, you do have time to play with, so no need to panic.

I am sorry the vets have this strange illusion that IMHA is regenerative – we have had many, many cases classed as non-regenerative – hence the explanation on the first page of the website. The level of regeneration for Emily is no where near high enough BUT she is producing some baby red cells – not enough admittedly but a bit better than the big fat ZERO Worzel was producing – maybe this could be why she is holding her level? Or the pred is preventing over-destruction of the cells? Or as Mary rightly says, she has reverted to producing cells in organs other than the bone marrow, which is keeping her going. The body is amazing & will always try to heal itself somehow – by reverting to embryonic stage for blood cell production in certain circumstances, as with Patrice’s Chance.

I am so sorry we can’t give you a more precise answer – that really is internal medicine specialist territory, plus infectious disease expert investigation. Could there be a second factor that sent Emily over the edge, such as a recent vaccination? Or a flea/tick/heartworm treatment? Worth asking you if there is anything else you can think of – even eating something she shouldn’t have?

Trying to get to the root of the problem is not easy – Pam, I really feel for you & Emily. At least she sounds pretty feisty in herself – that’s always good news – even if she is picky with food, at least she will eat some things!

Love Sheena & the boys xxxxx

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Pam

Guest

Today is early Saturday, (Aug 1st) and I still have not gotten any infectious disease results for Emily. She has still been on only 5 mg of Prednisolone. Pilling was going OK except for yesterday.

At the start of the week she was eating well and seeming very happy and it was going well. However, I am worried now. Yesterday she ate in the morning with me giving her food under the bed as I often do to make sure she eats. The last time she ate was about 3:00pm after I had managed to get one of the canned foods she liked the week before. She was staying under the bed so I didn’t get a chance to give her the prednisolone until 7:00pm which was late. Most days I was giving it to her about 11:00am to Noon. Most days she was coming out more and I would then find a chance to give her the pill earlier.

When I gave the Pred at 7:00pm she fought very hard not to take it and spit it out, but I managed to get it down her. However she was not acting OK about it afterwards. Usually after I give her treats and food and she purrs and calms down. However, she refused food. Then several times she vomited a small amount of foamy liquid that looked tinged with the color of her food. She eventually went into seclusion upstairs in a corner. This morning she is staying on the main floor but hiding when ever I come close and I don’t believe she’s eating. I’ve been pondering all night if I should try to see if they would see her at my old regular vet on a squeeze in basis, since they close early on Saturday at noon. Or should I take her back to the specialty hospital that is an hour from my house? I have not been too happy with the specialty hospital so far. They charged me a lot and have left us hanging. The specialty internist doesn’t think IMHA can be non-regenerative and her idea was to do exploratory surgery. There is a emergency vet a bit closer to my house but then I’d need to explain the entire case so not sure which way to go. Yes, as Mary said, Emily had maintained HCT that ticked back up to 27 on July 17th, but I wonder what has happened since then? We dont’ know. On July 17th she put on Baytril for 5 days because of fever, but that ended July 21st and they haven’t rechecked her even when I went back for another blood draw on July 24th. I am wondering if the reactions yesterday were brought about because I gave her the Pred so much later than usual? Or could it be there was stomach acid building up? Or maybe her anemia is worse?

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