Bad news possible cancer recurrence OR cholangitis (bile duct inflammation)

[FrothOnTheDaydream]

Man has it been a journey. Very brief background -- in December, Sangria had a liver lobectomy at a specialist hospital to remove a well-differentiated massive (not nodular or diffuse) mass on her liver. It turned out to be bile duct cancer. Good news from pathology was that Sangria's seemed to be less aggressive than is usually seen. There was no metastasis, and there was no lymphatic invasion. Blood work three weeks after surgery showed PERFECT liver values. Before surgery her ALT and GGT were high.

We started her on metro (flagyl) for her IBD and within a few days she stopped eating. We stopped the metro and gave mirtazapine, but she kept going downhill. We brought her to ER and gave her SubQ fluids.

We took her to our specialist hospital yesterday. Blood work is even worse (high ALT, ALP, GGT, and Bilirubin). Her Globulin is back in the normal range, thankfully. She is jaundiced. We did a liver ultrasound and found that her bile duct is inflamed as is the duodenum and the gallbladder. The bile ducts inside the liver are normal, though.

The specialist is NOT hopeful. He said based on her history it is 70% likely to be cancer recurrence and 30% possibly cholangitis. We can treat for cholangitis and see if it works. He said the only hopeful thing right now is there are no mets on the x-ray and last time she did not have inflammation -- just a giant mass.

We got the following:

50mg Clavamox twice per day
15mg Baytril once per day
0.5 dexamethasone once per day
1.88mg mirtazapine once every two days
80ml SubQ fluids as needed
High calorie food

She got shots of these medications last night and today she got her first oral doses. She seems sleepy and not that comfortable, but she ate on her own last night and this morning, stools are firm, and she drinks on her own now too.

Anyone have experience with this? Advice? Shouldn't I be seeing HUGE improvements by now since she had her second dose?

 

[FeebysOwner]

Hi. Sangria has been through a lot! And, I have no direct experience with this, but wondering if you are expecting results from her meds a little too quickly. Most meds, especially antibiotics, take more time than just a day or so. The fact that she is at least eating and drinking some are good signs, as is the stool production. Did the vet give you any advice in terms of changes to look for - and when - relative to the meds she just received?

Until others can come along with more experience and see your post, have you searched this site for other threads? Here is a link to some relative to cholangitis.
Search Results for Query: cholangitis | TheCatSite

Keep us posted please. Hoping to hear that more positive signs are seen in the coming days.

 

[FrothOnTheDaydream]

Hi. Sangria has been through a lot! And, I have no direct experience with this, but wondering if you are expecting results from her meds a little too quickly. Most meds, especially antibiotics, take more time than just a day or so. The fact that she is at least eating and drinking some are good signs, as is the stool production. Did the vet give you any advice in terms of changes to look for - and when - relative to the meds she just received?

Until others can come along with more experience and see your post, have you searched this site for other threads? Here is a link to some relative to cholangitis.
Search Results for Query: cholangitis | TheCatSite

Keep us posted please. Hoping to hear that more positive signs are seen in the coming days.

Thank you for the kind words.

I was assuming that the steroid would work within the first couple of hours. I looked up online how long it takes Dexamethasone to work, and that's what it says. Good news is that she just ate a ton! Again, I don't want to get my hopes up as that might just be the steroid side effect of hunger.

He said one of three things could happen:

- She would respond to treatment for a few days and then decline due to how aggressive bile duct cancer tends to be
- She would respond to treatment and continue getting better over the course of a couple of weeks
- She wouldn't respond at all

At least we know it isn't the third option!

 

[FrothOnTheDaydream]

Hi. Sangria has been through a lot! And, I have no direct experience with this, but wondering if you are expecting results from her meds a little too quickly. Most meds, especially antibiotics, take more time than just a day or so. The fact that she is at least eating and drinking some are good signs, as is the stool production. Did the vet give you any advice in terms of changes to look for - and when - relative to the meds she just received?

Until others can come along with more experience and see your post, have you searched this site for other threads? Here is a link to some relative to cholangitis.
Search Results for Query: cholangitis | TheCatSite

Keep us posted please. Hoping to hear that more positive signs are seen in the coming days.

Good news this morning! Sangria ate all her meals by herself last night and this morning. I know it's probably the steroid and appetite stimulant, but still. She is also alert and playful. I'm not sure if it's my imagination, but her urine seems lighter. The high bilirubin (jaundice) was making her urine almost brown. We have white cat litter to show the colour of her urine. This morning, it's a light yellow.

I really, really want to be optimistic, but I'm terrified that the moment I start thinking positively, she will go downhill. Tuesday is our "cut-off" day. If she is still good by Tuesday, we likely don't have cancer and have cholangitis instead.

 

[FeebysOwner]

I have Feeby's paws crossed for you and Sangria!!

 

[FrothOnTheDaydream]

I have Feeby's paws crossed for you and Sangria!!

PEE IS A NORMAL COLOUR!!! I compared it to my other cat's pee in the litter.

 

[FrothOnTheDaydream]

Update, Feb 19:

Urine is still a normal colour! My wife says that the jaundice has improved a bit, but I can't tell. She eats normally, plays, is alert, and is back to her old self. If we count the day she got her medication in injection form (February 15), this is day 5 of treatment.

I still can't bring myself to feel hopeful or optimistic. I'm scared that she will go downhill. I'm scared that this is just a reaction to the activating nature of the steroids.

 

[FeebysOwner]

All you can do is keep the faith! Even if it were to be the steroids, I believe she can stay on them to continue to help. That will be the next discussion for you to have with the vet.

 

[BellaBlue82]

I can certainly empathize, Casper is currently going through something similar. He is very jaundice, and we have been treating the past two weeks for cholangeohepatitis. His bilirubin was high, but not too extreme. He was also anemic slightly, and it has impacted his SDMA (although his other kidney values were normal.)

He's still on assisted feeding, though the steroids and mirtazipine are helping his waning appetite. TBH at 18 years old, we decided not to be super aggressive if it turns out to be the "C" word.

Paws crossed for you and kitty!! I hope he makes a full recovery.

 

[FrothOnTheDaydream]

I can certainly empathize, Casper is currently going through something similar. He is very jaundice, and we have been treating the past two weeks for cholangeohepatitis. His bilirubin was high, but not too extreme. He was also anemic slightly, and it has impacted his SDMA (although his other kidney values were normal.)

He's still on assisted feeding, though the steroids and mirtazipine are helping his waning appetite. TBH at 18 years old, we decided not to be super aggressive if it turns out to be the "C" word.

Paws crossed for you and kitty!! I hope he makes a full recovery.

I hope that your kitty feels better soon! You're going above and beyond.

Today makes day 7 of treatment, and Sangria is still doing well. The jaundice around her ears is fading!!

 

[FrothOnTheDaydream]

All you can do is keep the faith! Even if it were to be the steroids, I believe she can stay on them to continue to help. That will be the next discussion for you to have with the vet.

Update for Sangria, too!

Blood work with our general vet showed huge improvement. Her ALP is back to normal as is her bilirubin. Her ALT is still elevated, but it's going down and her GGT is just slightly elevated. Globulin is normal again, and her anemia has resolved.

All of this blood work was sent to her specialist, and he was very surprised and cautiously optimistic. He scheduled another visit and ultrasound which we went to last week (at the same time as our other cat's cardiology consultation). Trust me, two cats on a road trip and an overnight stay at an Airbnb was not a fun time for anyone LOL.

We weren't expecting much good news for Sangria as the specialist had been about 70% sure her bile duct cancer was returning. Well, he came back into the room with EXCELLENT news. Her bile ducts are almost back to normal. Her duodenum and gallbladder are back to normal as is the liver itself. He said that we can take cancer off the table!!!! She really, really beat the odds here.

We have to continue double-antibiotic therapy for another two weeks. Steroids will be a minimum of one more month and then we might start titrating down based on what her blood work looks like. We have also been prescribed Ursodiol (a bile acid pill) which she will take once per day for the rest of her life.

I can't tell you how relieved we are. I had very little hope while she was sick.