BH is still in big trouble after returning from a 3 day ER stay last night - liver and ??

[silent meowlook]

Hi. That HCT is low. You do not want that to get any lower. You don’t want it this low. It is low, really low. Not trying to scare you. Keep her as quiet as you can with no stress. Every ounce of energy she has should go towards making more blood cells.

Is she currently getting fluids other than in the tube?

Have you discussed the low HCT with the vet? What did they suggest?

For vomiting, can you use Odansetron?

What I do with the staggering of meds. I get up early. First thing do sucralafate. Wait 2 hours then proceed with the rest of treatments starting with food.

If the time you get home from work is 12 hours from when you got up, give sucralafate, wait 2 hours, feed and other treatments. Wait 2 hours, give Denmarin. Wait an hour and feed again. Wait another hour or two and feed again.

 

[FeralHearts]

Hi. That HCT is low. You do not want that to get any lower. You don’t want it this low. It is low, really low. Not trying to scare you. Keep her as quiet as you can with no stress. Every ounce of energy she has should go towards making more blood cells.

Firstly - thank you for this. It helps. A lot.

I am trying - drugged the Charlie for that.. hard to keep her low stress with all the things I have to do to her. She takes it extremely well but I can't imagine it doesn't stress her to some degree all this poking and prodding and drugging and feeding.

Is she currently getting fluids other than in the tube?

No as she is really hydrated. She's drinking like a fish out of water as well. Which, I know is part of the illness but boy does she drink.

Have you discussed the low HCT with the vet? What did they suggest?

Yes, we were in there tonight for a blood check and bandage change. We are concerned. It's why we changed the treatment and I will be bringing her in on Friday for more bloodwork. The vet is impressed with how she is acting though as well... but yup - concerned.

For vomiting, can you use Odansetron?

I can ask her vet. Is it less hard on the liver than Cerenia?

What I do with the staggering of meds. I get up early. First thing do sucralafate. Wait 2 hours then proceed with the rest of treatments starting with food.

I can do that. I would need to get up an extra hour but I'm okay with that.

I'm up early but also work early. If I get out on time, which lately I have been making sure I do for her, I figure 9 -10 hours between work and getting there and back etc.

If the time you get home from work is 12 hours from when you got up, give sucralafate, wait 2 hours, feed and other treatments. Wait 2 hours, give Denmarin. Wait an hour and feed again. Wait another hour or two and feed again.

It would be close to that , yes.

I'll have to take a nap somewhere in there as that will be me on 4-5 hours sleep. While I wait for that last feed I can nap and get up for that last feed and go back to bed. Doable. Hard but doable.

 

[silent meowlook]

I hear you. With Cheetah and Ohmypaw’s needs, I get up at 4:30 or 5:00am every morning. Don’t work till 8:30, and it’s an hour drive. So, yeah, it’s annoying at times, but the alternative is not acceptable. I also have to allow time to talk myself into going to work.

 

[FeralHearts]

I hear you. With Cheetah and Ohmypaw’s needs, I get up at 4:30 or 5:00am every morning. Don’t work till 8:30, and it’s an hour drive. So, yeah, it’s annoying at times, but the alternative is not acceptable.

Exactly - not acceptable. *nods*

I've got a slightly less drive than you thankfully. If all goes well 30 minutes one way. So only an hour both ways if it's smooth. WInter is coming though... yuck!

I also have to allow time to talk myself into going to work.

LOL yup . Know this one.. but as I say that - also grateful for it too. Catch 22.

Until we win the lotto though - then we can bask in their glory all day!

 

[silent meowlook]

Exactly - not acceptable. *nods*

I've got a slightly less drive than you thankfully. If all goes well 30 minutes one way. So only an hour both ways if it's smooth. WInter is coming though... yuck!




LOL yup . Know this one.. but as I say that - also grateful for it too. Catch 22.

Until we win the lotto though - then we can bask in their glory all day!

Win the lottery? I would hate to see how my cats would up their health costs to match my winnings. I just know I would have 6 million dollar cats.

 

[F+V]

That's very encouraging liver and kidney numbers! BH is a big cat, isn't she? Mine weighs 5kg/11lbs now and vets often say she's a muscular lady, though my girl prefers to be called meowdel.. Lately she's been steadily putting on weight because normally she's around 10lbs (4.5-4.7kg).

And you are a super human! I don't think I can manage everything like you do now.

 

[FeralHearts]

That's very encouraging liver and kidney numbers! BH is a big cat, isn't she? Mine weighs 5kg/11lbs now and vets often say she's a muscular lady, though my girl prefers to be called meowdel.. Lately she's been steadily putting on weight because normally she's around 10lbs (4.5-4.7kg).

Yes, very encouraging - that being said those red blood numbers need to be corrected ASAP. In life, balance is important - in the body it's equally. Sadly often times - and this goes for a lot of thing - you fix one thing and break another until you can find that delicate balance between them. Medicine often does this - cure ones - harms another. It's such a delicate balance.

Actually she's a very small cat. Charlie, my boy is a very long cat with long legs, 16 pounds but not remotely fat or overweight. He's just really long. BH and her sister are both really small cats. Half his size. He's a small dog next to them LOL.

LOL Meowdel! That's good she is putting on some weight!

And you are a super human! I don't think I can manage everything like you do now.

XOXOXO thank you.

Honestly you could - you really could. When push comes to shove you would be amazed at what you never thought you could do - and do.

I thought I was good at time management.... this has taught be a whole over level of that!


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[FeralHearts]

This why illness sucks. After several a very good days - we struck another bad. Not sure why.

Got her home from the vet - happy happy joy joy... she was tube fed and then went on an eating binge steals her sisters food - twice.

I thought that was great.

Last night she crashed again - she didn't leave my bed all night and today she's slept all day. Might be the medication as she did get doses of gaba close together, might be she over ate - is that a possibility? The sucralfate? Though she's had that before. I didn't start the
Omeprazole until this Am for the sake of timing. Could be the illness... I don't know.

Last night was also her B12 shot.

I think it was a lot for her. We shall see.

Not drinking or eating.

 

[silent meowlook]

You do have the tube. You can feed her that way. You have to be careful that she doesn’t overeat.

 

[FeralHearts]

Yes, tube still there. After she was tube fed last night she snuck off - and as she hasn't been eating went food -and was just fed - I wasn't expecting her to go on a binge.

So I screwed up (and I'm okay with taking accountability this isn't a "omg tell me I didn't do this" moment - I can own it) and that's probably why she doesn't feel well today.

Alright, so now that I know she will eat this particular food like she's starving and it was wet food. I'm going to have to really watch it - and her - big time with what she is intaking on her own.

How badly was that mess up that she overate?

 

[silent meowlook]

Whoa! Back up. I don’t condone any violence or abuse. That includes you beating yourself up about something that isn’t your fault.

First off, cats, remember they don’t follow any rules or read medical books. So, we don’t actually know if this is the cause of her not feeling well. Any change in behavior is worth phoning your specialist about. They have seen her and know her the best outside of you.

Just my opinion. With the feeding tube in place, I think it is important for you to feed the same canned food that she was prescribed and give meds as directed. If this was my cat, I would not deviate from a schedule and would be as consistent as possible with the times and amounts. If she was mine, I would be afraid of any change in amount of food or type of food could cause a setback. Just for now anyway until she is doing better in both blood work and mentation. I would keep the amount down to 45 cc that I syringe fed and not go up to the standard 60cc amount.

If she was mine, I would limit activity to make sure all her energy goes into getting better.

I would also be careful to factor in the water tube flushes and liquid medication in the total volume given.

 

[F+V]

Yes, very encouraging - that being said those red blood numbers need to be corrected ASAP. In life, balance is important - in the body it's equally. Sadly often times - and this goes for a lot of thing - you fix one thing and break another until you can find that delicate balance between them. Medicine often does this - cure ones - harms another. It's such a delicate balance.

Actually she's a very small cat. Charlie, my boy is a very long cat with long legs, 16 pounds but not remotely fat or overweight. He's just really long. BH and her sister are both really small cats. Half his size. He's a small dog next to them LOL.

I couldn't agree more; new issue keeps popping up as I fix the old ones, and when you have multiple cats that's an endless cycle! These days I feel like I'm going out of my way to detect something to fix, because until this year I would only take them to the vet once a year for a check-up.

We have a big boy too. Like Charlie he's not fat but weighs almost 17lbs now, though his ideal weight is probably around 15lbs. He used to be allowed to go outside during the day but is now trapped inside, hence the extra pounds. He's heavier than my sister's two cats combined

 

[FeralHearts]

Whoa! Back up. I don’t condone any violence or abuse. That includes you beating yourself up about something that isn’t your fault.

First off, cats, remember they don’t follow any rules or read medical books. So, we don’t actually know if this is the cause of her not feeling well. Any change in behavior is worth phoning your specialist about. They have seen her and know her the best outside of you.

LOL well it kind is. The timing works. It was about an hourish after her binge, so it does make sense. Although true it may not be it at all. Walks and talks like a duck - probably not a rabbit. I hit myself a little to make sure I don't do this again. Even if I was not the cause of it

No, they don't but they should follow the rule of not being allowed to be sick.

I'll let the vet know friday what transpired for sure. I might send them a little email tonight for an update.

Just my opinion. With the feeding tube in place, I think it is important for you to feed the same canned food that she was prescribed and give meds as directed. If this was my cat, I would not deviate from a schedule and would be as consistent as possible with the times and amounts. If she was mine, I would be afraid of any change in amount of food or type of food could cause a setback. Just for now anyway until she is doing better in both blood work and mentation. I would keep the amount down to 45 cc that I syringe fed and not go up to the standard 60cc amount.

Yes :-) That's what we are doing with the exception that the vet wants her to try eating on her own nad progress.

When she began eating on her own, I forgot to note this, we reduced the intact of the tube to 3 time a day 30-45ml feedings (mostly 30) depending on how much I thought she ate on her own.

I think you are right though... I need to be more consistent with the food offering etc., that and really,really watch. I was too excited that she was eating and let her eat too much right after that feeding.

Tough lessons to be learning.

If she was mine, I would limit activity to make sure all her energy goes into getting better.

I listened to you last night about this and am really watching that.

I would also be careful to factor in the water tube flushes and liquid medication in the total volume given.

Agreed. 110%.

This has been such a learning curve. Hopefully I get better at it and not end up doing her harm while trying to help.

Slow and steady. Slow and steady.

Thank you so much for all this advice and help. I really appreciate it. It's incredibly valuable to us.

I couldn't agree more; new issue keeps popping up as I fix the old ones, and when you have multiple cats that's an endless cycle! These days I feel like I'm going out of my way to detect something to fix, because until this year I would only take them to the vet once a year for a check-up.

Yes it is. This year that hadn't been a month where one of the furkids wasn't at the vets. I thought that was bad. Universe said "Oh you think that's bad ... how about once or twice a week missy!" *shakes fist at universe.* 'I cry fowl!"

The older they get through - the more this is the case.

We have a big boy too. Like Charlie he's not fat but weighs almost 17lbs now, though his ideal weight is probably around 15lbs. He used to be allowed to go outside during the day but is now trapped inside, hence the extra pounds.

A little chub is a good thing! :-) Just not to much.

He's heavier than my sister's two cats combined

There is always one in the family! More to love!

 

[Meowmee]

So sorry you and poor BH are going through this. I have not read everything here so I could not figure out exactly if it is cancer etc. I was wondering when I saw the blood work why they did not put her on epogen? Hct/pvc is very low... is it non regenerative anemia? Two of my kitties were on epogen for crf/anemia, Wizard also had lymphoma. Tess had a blood transfusion from Byron at one point which helped her... I think pre epogen. At that time epogen was only just starting to be used in kitties I think.

 

[FeralHearts]

Update: No real improvement - though she at least did get up yesterday for a pee and wandered to get some water. She was drinking like a fish out of water previously. She is looking frail though which is breaking my heart.

I am near convinced this is her stomach as after I feed her she is making uncomfortable noises and looks uncomfortable for a bit after.

She will go for bloodwork tonight and I will see if they can give her some sub-q fluids. Normally she is really hydrated and it's not an issue but I think this might help.

I don't know if what happened on Tuesday triggered it - or caused it (I hope not) or if it's just the timing.

So sorry you and poor BH are going through this. I have not read everything here so I could not figure out exactly if it is cancer etc.

Thank you so much Meowmee You aren't the only one. Sciences best guess is saying it's bile duct liver cancer but it's not reacting like cancer and doesn't look quite like cancer but through experience they are saying that is what it is. It's also been said it was caught early and I'd hate to see what late looks like if that's the case.I have no doubt they took the best pieces possible when they biopsied.

The biopsy report is hereost #58. Liver Biopsy It reads like an attempted murder mystery - which is/might/ turn into a murder mystery. It was done by a very well respected Pathologist out of Guelph. Through Histovet. Decades of experience.

I was wondering when I saw the blood work why they did not put her on epogen? Hct/pvc is very low... is it non regenerative anemia? Two of my kitties were on epogen for crf/anemia, Wizard also had lymphoma. Tess had a blood transfusion from Byron at one point which helped her... I think pre epogen. At that time epogen was only just starting to be used in kitties I think.

I don't know. I know it was improving and then, from what it looks like, all the meds we had to put her on improved her liver, and killed the red blood cells. So we've made adjustments. Her doc might be trying to sort out which one it is. She is going in for bloodwork tonight. The last bloodwork was from Tuesday night. We are looking to see if this changes we made have helped or if things stay the same.

We've put her on an antacid and sucralfate (since Tuesday) to see if there is a GI bleed / ulcer from the high doses of pred or another med. We've significantly reduced the pred too.

I will email her doc and ask about epogen. Thank you for that.

 

[silent meowlook]

Ask your vet about Simethicone. I have mine compounded at Wedgewood Pharmacy. It is for gas.

 

[FeralHearts]

Ask your vet about Simethicone. I have mine compounded at Wedgewood Pharmacy. It is for gas.

Thank you so much.

I just email her Doc and update with her status, and about Simethicone and Epogen. I have also ask if we can do some sub-q for her as I think it'll pick her up.

Her Doc I know was double booked today by us as she was just getting blood so we weren't worried. Hopefully she can swing this too.

 

[FeralHearts]

She is walking around. Slowly.. and without a lot of energy but she went up one flight of stairs to my room and drank a bit from the bowl and fountain... then two flights of stairs to the recroom to the other watering area and took some drinks.

Then back to bed .... after a pit stop at the landing on the stairs to regain some energy.

Her energy is low - but that is our little warrior princess!!! She is trying.

Edit to add: PS - The lovely Nurse A has managed to arrange with the wonderful Doc an earlier visit so she can see her - and I've managed a way to sort out a way to do that on my end. PHEW

*fingers crossed*

She's uncomfortable and there may be some pain too - even with the gaba I gave her this morning. :-( but boy is she trying.

 

[Meowmee]

Exactly. One day at a time.

I can't say I didn't break down after I got off the phone though.

This is the report. It was done by a very well respected Pathologist out of Guelph. Through Histovet.

"I am looking at a total of eight histologic sections from the two different liver biopsies that
you submitted. One of the two, in particular, has almost complete white discoloration that is very
unusual for liver. The other biopsy looks more like normal liver.

Microscopically, these biopsies do indeed divide themselves into two groups. Four of the
eight look like relatively normal liver with abnormally prominent portal triads reflecting a
combination of biliary hyperplasia and mixed neutrophilic inflammation and fibrosis causing
thickening of every portal triad. The hepatocytes themselves remain normal. The combination of
cholangiolar proliferation, fibrosis and mixed neutrophilic inflammation is most commonly seen as
a sequel to biliary obstruction predisposing to cholangiohepatitis.

The significance of this lesion pales in comparison to what I see in the sections from the
piece of white liver. The white discoloration is created by massive proliferation of fairly well-
differentiated bile ductules. There is a little bit of relatively normal liver at the periphery of the
section. Because you described the lesions as multiple, I am going to interpret this as bile duct
carcinoma even though, in this particular section, the bile ductules achieve quite a high degree of
architectural sophistication. I have never actually diagnosed a bile duct adenoma in a cat.

Whenever I diagnose true neoplasia of the biliary tree, it is always carcinoma. We also see cystic
hyperplasia of bile ducts, but it looks very different from what I am seeing here.

There is no way to prove that the cholangiohepatitis and the bile duct carcinoma are
causally related, but the bile duct carcinoma certainly has the potential to cause biliary obstruction
and therefore create the repetitive inflammatory and proliferative lesions that I described in all of
the portal triads.

DIAGNOSIS:
1. FOR THE MULTIPLE WHITE NODULES, METASTATIC BILE DUCT CARCINOMA
MULTINODULAR WHITE
2. CONCURRENT SUPPURATIVE CHOLANGIOHEPATITIS WITH PERIPORTAL FIBROSIS
AND CHOLANGIOLAR PROLIFERATION"

I am so sorry about that. I can’t believe how detailed his report is. I think Angie had some sort of adenoma carcinoma in that area too, but it was only discovered after her death on the necropsy. They were sure that she had some type of lymphoma from an ultrasound at that point, though she had been given convenia, which caused her to become severely anemic, so there was no hope of possibly treating it if it had been diagnosed beforehand.

 

[FeralHearts]

Okay good news... PCV test - from 15% to 18%the changes her Doc made are working. She'll have her full blood work on Monday so we will know about the liver and other exact numbers then.

She is going a bit Jaundiced again and I think that's because she's not pooped since Tuesday!. Vet is aware. I'm thinking she will do so tonight sometime. She needs to poop.

She gained a slight bit of weight 10.1 pounds today so up 2 ounces.

Meowmee for now she said no on the Epogen as she is doing things and attempting with her bone marrow.. but thank you for that as it gives me more knowledge and tools.

S silent meowlook it no to the Simethicone right now too. She thinks the GI issue is a bleed that needs healing, most likely from all the meds but it's on the table on reserve. So thank you.Side note: Apparently they use to use this in bunnies all the time!

I am so sorry about that. I can’t believe how detailed his report is.

Thanks you. He did a really good job on that report.

It sucks though as we weren't expecting that result at all. Nothing, was and has, been what any of them expected to see. They expected fatty liver and an object in her tummy. They ended up with something completely different.

PS - I did not mean to do a stick tongue out emoji on my link to the biopsy post LOL I think it mistook my letter for that lol.

I think Angie had some sort of adenoma carcinoma in that area too, but it was only discovered after her death on the necropsy. They were sure that she had some type of lymphoma from an ultrasound at that point, though she had been given convenia, which caused her to become severely anemic, so there was no hope of possibly treating it if it had been diagnosed beforehand.

*hugs* I'm so sorry for what happened to you and Angie. It's heartbreaking. *hugs more*

There is a big note on my file about no convenia. After everything I've read and seen people. My exception will be if there is no other choice - and even then there had best be a good reason for it.

When BH was feral and something bit her leg and another place gave her a convenia shot without letting me know. I get why they did it. She was feral and they didn't know that I was/am able to pill her and that she came several times a day. It wasn't an issue. So it made sense they did it. Often it doesn't though and had they asked and not assumed - they would have know - that being said, I full appreciate and understand they were doing what they felt was best.

If it makes you feel any better - while SCL (small cell lymphoma) can be treated - bile duct cancer like this is not treatable. You can try surgery but it's major, dangerous, a lot don't make it off the table - and worse the cancer usual has already spreads- or comes back and that's if you're lucky. I decided that was not in her best interests. Her Doc agrees.

Her vet found one reference that was similar to BH's case. 270 days survival. I'm absolutely ignoring that. 110%. As S silent meowlook says, "cats don't read" and "she doesn't know she's sick don't tell her.".

Our goal for her is to slow this down, control symptoms, and most importantly - give her as long - and as comfortable life as we possibly can. It's proper palliative care IMHO. Something Mia didn't get the chance of, which will always weigh on me. This is what I wanted and hoped for her as well. I'm sad we couldn't get there for her - but glad we can do this for BH.

Now I go to bed for a couple of hours, get up, liver pill her, go back to bed for 2 hours and get up and feed her. It's certainly a lot of timing things!

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