Pam’s cat Emily

[admin]

Hi Pam

I can see you are at your wits end – dealing with Emily’s fear & her hiding under the bed must be so hard & I have no experience with cats like this – I’m so sorry, Pam – I wish I could suggest something miraculous. Poor little girl must be really freaked out with all this. I presume you can’t even get her out from under the bed very easily? I do think the transdermal pred is a good idea in the circumstances and – yes- it could be her GI tract is irritated with the drugs – pred tablets should be given with food to minimise the damaging effects, but even so, it can cause ulceration.

I agree with Vally – go to the vet you trust & tell them exactly how you feel – you need help here. I prefer a vet with gut instinct who looks at symptoms & assesses the best course of action, as well as lab results – action is the operative word! I am also not enamoured with your specialists as they don’t seem to have any plan apart from “exploratory surgery” or much idea about IMHA – well, being honest, we know they are in fact sadly lacking on knowledge, putting it politely.

In my opinion, surgery is not an option at this point, could be harmful, as well as pointless, as Emily’s neutrophils are low & her bloods are not in normal range – I would consider taking a leap of faith & start higher dose pred & chlorambucil as if it were definitely IMHA (or lymphoma – so what’s to lose?) if I were in your position, but I’m not a vet of course. Remember many of the drugs we use for IMHA are in fact chemotherapy & anti-rejection drugs – they have many uses. Then if she shows any signs of infection – and you need to watch her like a hawk as this is when it might rear it’s head – immediately get her started on high dose antibiotics (doxycycline preferred) for a few WEEKS.

You must be frustrated beyond belief – stuck in limbo for weeks with no-one helping you & Emily. I think someone has to make a decision here, otherwise this will drag on & on.

Love Sheena xxxxx

[admin]

Hi Pam

Poor Emily and poor you. This is a horrible situation for you both. Did Emily eat or have any water immediately after the pred? I’m wondering if it may have become stuck in her oesophagus if not, which is quite common in cats, and whether this could have caused the foamy vomiting. When Molly was very sick and having 3x5mg pred tablets, I gave a ml or so of water from a syringe after each pill, to help it go down.

This site is about cats with CRF but there is some excellent information about various cat issues which I find very useful. Here is a page about pilling and alternatives:
http://www.felinecrf.org/medicating_your_cat.htm

I agree with Vally and Sheena about seeing a vet you trust, but I know this is not easy at the moment. I am very much hoping the infectious disease results will be in soon and give you some idea about what to do next. Exploratory surgery doesn’t sit well with me for the time being. It feels like the most invasive of all the options and is a lot for Emily to go through.

The site above also mentions transdermal preparations and I think you might be right that this could be a good option. I know there are issues with absorption, but you and Emily can’t keep going through this battle every day. Apparently there are also flavoured gel caps for cats, but I appreciate your concern that Emily’s stomach may be irritated, and I think that’s very possible. Molly also did not have stomach protection and if I could go back in time, that’s something I would change. She never had the voracious appetite so often associated with prednisolone, and I wonder if this is why. Are you able to ask if she can have something? I know on the anemia list people were talking about sucralfate, which is apparently excellent.

Hoping that you and Emily have had a better night.

Mary and Mable x

[lynn]

Pam,
I am sorry to hear of the hard time you and Emily are faced with. It is so awful and such a helpless feeling when our fur babies are faced with a illness we know nothing about. With giving medications to the cat’s can be very hard to do this I do know. I have fixed the pills into wet cat food or made some calf liver to hide the pill I mashe it and make a firm little ball. I had one cat that cheese worked great. I had many feral cta’s that people dropped off and getting them into a crate for vet checks wasn’t easy but they all learned that … I was their food and many allowed me to pick up and pet. And , learned I cared. I had them male or female fixed… and put a little shed for them to go in in harsh winter months (with heat)….. Emily is so lucky to have you as I have learned not all cat’s are lucky… As 20+ cats were dumped in my yard… I did all I could feeding a watering keeping them healthy by vet checks and having each fixed. Cat’s are so loving and smart. I wish the very best for you and Emily.p.s. my husband and I both carry scares from scratches by the care we gave and we would do it again… each are special that have loving families… but those who do not have a family deserve care too…. all animals teach us so much and become part of our heart. Lynn& Hayley

[Linda]

Hi Pam. I think Mary sent you my contact information. I am in Tampa. Please feel free to e-mail me or call anytime. I don’t know where you live but from what Mary mentioned, I think you’re close by, not sure.

I agree with Sheena about giving the prednisone with food and perhaps it helping poor little Emily’s tummy. I do that with my dog, Sadie.

Also, apparently Patrice has recommended Dr. Holland. I sent Sadie’s blood to her to run the tick borne tests. She’s awesome. Sadie, thankfully, was negative to all. But it’s a great measure, to be sure.

I think we went to the same acute care hospital. They did well with Sadie, but there was no question as to what her problem was. She was there for three days and the cost was extrodinary. I know what you’re dealing with. We are back with Sadie’s regular vet and we talk to them when necessary – I figure they owe me!

I have thought so much about you and Emily and so sorry this is happening. I’m right here, if you need me.

Love and hugs, Linda and Sadie

[Pam]

Thanks to all for your responses. To update you, Emily had a splenectomy and exploratory surgery with removing tissue for biopsies on August 5th. She returned home on August 7th.

The weekend prior to that she had seemed to decline and was eating less. I found that her PCV dropped to 22, and she still had a fever. At the time the vets I consulted with were telling me the surgery seemed like the best option for her. The week prior to this her infectious disease panel all came back negative so there was no answer there. She didn’t eat at all August 4th through August 7th. Once back home from surgery I began giving her an appetite stimulant the evening of August 7th and she then began to eat! She eats moderately many small meals.

The results of the August 5th biopsies show no cancer and no lymphoma. I think Mary is sending the report to Sheena and Patrice. There was Lymphatic Portal Hepatitis but liver values were not bad. So they still do not know what is causing her anemia, other than possibly immune mediated, but again they all want to know what would cause this.

They were thinking removing the spleen was going to stop the main source of attacks on her red blood cells. Her PCV is still at 22 one week after the surgery. I don’t know if that means the splenectomy did not help or if it’s too soon for that to make a difference.

She seems stable and content for the most part but of course she is still recovering. I don’t know what to think. The specialist at Blue Pearl Hospital tells me the only other test would be a bone marrow biopsy, but that was suggested over a month ago by my regular vet, and the Blue Pearl specialist kept telling me that it wasn’t needed because the spleen aspirate reflected what was going on in the bone marrow. I don’t want to put Emily through a bone marrow test now.

They have her on 5mg of Prednisolone a day for now. I wonder if this is a standard treatment for IMHA ? I gather none of the doctors know what to do and we are at the experimental stage with meds.

Thanks again, Pam & Emily

[admin]

Hi Pam, Linda and Lynn.

I’m sorry I didn’t see these responses until now. Lynn – you are awesome for saving all those cats. Thank you for all you have done. Thank you Linda for your offers of help. It is really much appreciated.

Pam – I have just sent the report to Sheena and Patrice to see if anything jumps out at them. Patrice is the queen of spleens so to speak, and I hope she will be able to give you some indication as to your question about the splenectomy and PCV staying the same.

There are very many causes for an immune mediated condition. I am wondering if the hepatitis is related in any way. IMHA/NRIMA can also result from toxins, infection, vaccination, stress, and no doubt many other causes. I know that there is some question of anemia of chronic disease, but of course this depends on identifying the chronic disease. I completely understand why you went ahead with the surgery. Emily didn’t eat for days, which I am sure you know can be dangerous for cats (risk of hepatic lipidosis) and you had little choice but to take her in. I’m so happy she is feeling reasonably well and managing to eat at least some of her food, and I am certain she is very happy to be resting at home with you.

From what I have read, 2mg/kg/day seems to be a fairly standard dose of pred for immune mediated anemia, so Emily is on roughly half this. I would ask your vet if the 5mg is an immunosuppressant dose – Mable is on the same dose for a mild skin allergy. Have the vets talked any more about chlorambucil or another immunosuppressant, or are they wanting to focus on the pred alone? I still wonder if it might be worth trying Emily with a stomach protectant too. I’m not sure if a liver protectant would be beneficial or safe with the hepatitis but I would definitely ask about this.

I’m so sorry that there are still no answers, but I suppose at least things are being ruled out. I don’t know how you have remained so patient, as this must be so very worrying and frustrating for you. I think it is worth asking the specialist why they want to do a bone marrow biopsy now when they didn’t before, and why they now think it might show something different to the spleen biopsy. And, again, listen to your instinct. If you don’t want to opt for a bone marrow, don’t, and trust what your instinct is telling you. Emily is your dear cat and no-one knows what is best for her more than you do. As you know, Molly had a bone marrow biopsy. I don’t regret it particularly and I am neither for nor against them per se, but I think each case is different and if it feels wrong for Emily, then it probably is, for the moment at least.

With our best wishes,

Mary and Mable x

[Vally]

Hi Pam, I’m sorry too to hear that there are no answers. I can’t image how frustrated you must be feeling. I’m glad she’s eating a bit.

Hoping Patrice and Sheena can spot something.

Vally & Bingo
xxx

[Pam]

Mary, over the phone the specialist at Blue Pearl had said she wanted to cut the pred down to 5mg every other day to see what the effect of that would be. She also stated that an option could be medicating with Chlorambucil and Pred or doing a bone marrow biopsy in case something is hiding in the bone marrow. Maybe she was just throwing ideas out there. The fact that she wanted to test cutting the pred dose down before actually seeing that Emily improved at all seemed questionable to me.

Emily has an appointment for another recheck at our local vet this Wed so I will ask about the idea of Chlorambucil plus Pred or of increasing Pred alone. I’m not sure what could a bone marrow biopsy tell us now. Would this be the only way to check if she has Feline Leukemia in hiding in the bone marrow?

I can see that Emily eats better on the day she gets the Mitazapine. She is more active and affectionate then. Then his gradually winds down. On the 2nd day after the pill she hardly eats at all.
Pam