Cat With Crf, Ibd/lymphoma And Maybe Chf

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Good grief, writing that title was depressing. After bloodwork in August my 16.5 year old cat, Zelda, was diagnosed with CRF and we have been givingher sub-Q fluids at home, 50ccs every other day. She had an ultrasound that showed either IBD or small-cell lymphoma. I declined the endoscopy the internist suggested because my oncologist said a false negative was possible and treatment would be similar, starting with prednisolone.

Two weeks into sub-Q therapy and 3 days into pred therapy, we brought Zelda to the ER because she seemed so weak and they said her kidney values had not changed, but she was very dehydrated. After talking to out vet, we changed the fluids to 50ccs every night.

A week after increasing the fluids, we went to the vet because Zelda had not been eating. An x-ray showed fluid in her abdomen. He said this could be a result of CHF and we should get an EKG to be sure. So, I am asking for help from anyone who has been down this road before---

Can a week of steroids cause the fluid in her abdomen? Can too many sub-q fluids? Is this only indicative of CHF? Even if we do the ultrasound, is it realistic to think she can be treated for CRF, CHF and IBD/lymphoma? How can I get her to eat again? Trying babyfood and every brand of cat food. She mostly likes to lick the broth.

I need help deciding what to do. The vet said I have 3 options--put her down, give her palliative care, or take her for the EKG. What do I do? Not ready yet to put her down. Vet said she is not in pain and happy to be pet.
 
  • Thread Starter Thread Starter
  • #2

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Sorry--a correction. When I said EKG I really meant to say echocardiograph (ultrasound)
 

Mamanyt1953

Rules my home with an iron paw
Staff Member
Forum Helper
Joined
Oct 16, 2015
Messages
31,182
Purraise
67,778
Location
North Carolina
I am so, SO sorry that this is happening to your cat, and to YOU. I wish I knew more of the answers to your questions, but I do have something that might be of help.

The Feline Quality of Life Scale Helps You Determine If It's Time to Say Goodbye to Your Cat | Catster

This can help you decide when it is time to make the Hard Decision, and takes our overwhelming emotions out of the equation. See where you are now, and go from there.

No matter what your decision, know that you are no longer alone with this. We are here, and we care.

 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
16,391
Purraise
7,131
Location
Arizona
To answer your question, yes, a cat CAN be treated for IBD/possible small cell lymphoma, CRF and maybe CHF. With heart issues and kidney issues though, it's definitely a balancing act because too many fluids cause issues for the heart, and too few fluids cause toxins to build up in the kidneys. But people have managed, at least for awhile. Honestly, for any cat with CRF, you are already simply giving palliative care, as there is no cure. If she is already on fluids, that means she is at a later stage, late stage 3 or possibly stage 4 :frown:

Now, the steroids CAN cause salt retention, which can cause fluid build-up, and they can also cause low potassium. Low potassium can cause weakness like you mentioned above, and is VERY common in kidney cats. It can also be deadly, especially in combination with heart issues, so it's critical to keep on eye on it. Look for signs like Zelda walking on her hind hocks versus her feet. Here is a list of symptoms of low potassium:

Symptoms of Low Potassium Levels



Here are the most common symptoms of low potassium levels. Rather confusingly, two of them (twitching and lethargy) may also be symptoms of high potassium levels.

As you can see, since potassium is important for nerve and muscle function, the symptoms seen usually affect nerves or muscles. When the muscles are severely affected, it is known as hypokalaemic polymyopathy.


The good news is, low potassium can easily be fixed! Here is where I got the above information, and how to treat it: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - All About Potassium Of course, you need to confirm if that's really an issue.

I would ask my Vet if they can check for heart issues with a Pro BNP test. It's a simple blood test that can detect heart disease.

Here is another section of the website from above that discusses heart disease. IF the test comes back that Zelda does have it, then it would take the front seat to the kidney disease, because if her heart stops beating, then all bets are off. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Heart Problems

As far as her appetite goes, is she on any appetite stimulant, or any anti-emetic or antacid? My last kidney cat needed an appetite stimulant AND antacids in order to eat, plus I learned to feed her 8 or 9 very small meals through the day and night. I also discovered that she needed her food switched out OFTEN. What she liked one day she hated the next, but a few days later she would eat it again. And I added about one tablespoon of water to every single meal (she only ate wet food) to get even more liquid into her, but this might not work for Zelda, depending on the results of the ProBNP.

I'm sure I didn't cover half of your questions, but this is plenty to keep you occupied for the moment. I truly recommend reviewing the above links, then let us know what questions you still have and we'll try to answer them. Unfortunately, there are plenty of us here who've been (almost) where you are. I've had three kidney cats myself.

:vibes::vibes::vibes::hugs:
 
  • Thread Starter Thread Starter
  • #5

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Thank you both so very much. It really was kind of you both to reply and it is so appreciated. I have been reading all the links carefully. I did not mention this, but Zelda had the ProBNP test about a month ago before starting sub-Q fluids and it came back normal.

I decided to take her off the steroids myself (she has only been on them a couple of weeks) and she is eating much, much better today. Feels like the fluid is still in the abdomen though.

I spoke to the internist and basically, the internist will not treat her unless I hospitalize her overnight, get an ultrasound and an echocardiogram. She said too many sub-q fluids will not cause the ascites, nor will steroids. (I told her I saw a research article that said steroids can cause ascites in the first week in some cats. She said she had never heard of that.) She said she now suspects some type of aggressive carcinoma, either instead of or in addition to the small cell lympohma/IBD. I don't know what to do. I did not hospitalize her today but I did ask my primary care vet to send the bit of fluid he took out of her abdomen off for analysis. I do not want to hospitalize her if she has aggressive cancer that will mean she has only a few weeks to live. I don't know, I don't know, I don't know. Internist said I should either euthanize her RIGHT NOW, or hospitalize her. But today she is eating and enjoying pets. It does not seem right.

I will post here the primary vet's notes and bloodwork. He took an X-ray that showed the fluid, which 100% was not there a week agao, and he also feels her heart looked enlarged (despite a normal ProBNP test). Any comments are welcome. The primary vet gave me anti-nausea pills and I am giving her Pepcid AC. He won't do anything else without a full workup. I can't even get one of them to say whether I should keep giving sub-Q fluids while the fluid is in her abdomen.

-------------------------
P may have crackles in the lungs secondary to fluid overload, plus increased respiratory effort on PE. Does sound like purring, but has too much synchronization to the breathing, therefore I'm concerned - would recommend radiographs to check. Inappetance may be driven from exhaustion given increased respiratory effort vs. worsening of CRF on pred. Recommended checking renal values to ensure that it hasn't acutely worsened. O ok. Radiographs: 3 view thorax Conclusion: Cardiac silhouette subjectively enlarged with increased sternal contact. Air bronchogram present in the cranial lung field bilaterally. Mild perihilar edema present. Severe peritoneal fluid with gas-distended abdomen and mild digesta present. Abdominocentesis yielded mildly yellow fluid, elevated viscosity, mildly couldy. CHEM 10: BUN 30.3 Creat 2.1 (0.8-1.8) Glob 4.9 (2.8-4.8) PCV 18% TP 7.8 Discussed with O that BW showed that renal values are not dramatically different, but PCV continues to drop and globulins are elevated. Anemia is likely due to either renal disease or chronic disease, but darbopoietin should be considered once fluid has been addressed, due to slow action. Radiographs revealed abdominal fluid, gas filled stomach, mild pulmonary congestion and possible cardiomegaly. Explained that since the abdominal fluid isn't blood, it may be cardiogenic vs. intestinal/neoplastic in origin (since renal values are not dramatically worse). Recommended O either consider euthanasia today vs. palliative care focused on restoring appetite vs. hospitalizing for CVCA work up to see if ascites or if fluid may be intestinal in origin. Hospital may recommend fluid removal but I would want to know more about the origin before removing it myself.
 
  • Thread Starter Thread Starter
  • #6

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Also forgot to mention--GI panel was done about 2 weeks ago (B vitamins, etc) and it came back normal. Ultrasound a month ago showed intestinal thickening, caused either by IBD or small cell lymphoma. No tumors were seen then.
 

PushPurrCatPaws

TCS Member
Top Cat
Joined
May 22, 2015
Messages
10,061
Purraise
10,250
... I did not hospitalize her today but I did ask my primary care vet to send the bit of fluid he took out of her abdomen off for analysis. I do not want to hospitalize her if she has aggressive cancer that will mean she has only a few weeks to live. I don't know, I don't know, I don't know. Internist said I should either euthanize her RIGHT NOW, or hospitalize her. But today she is eating and enjoying pets. ...
Hi Zel, I am so sorry you are going through this!

Right at this immediate point in time, you really need to get the test results back for the fluid, and then the vet & internist can consult with you again about possible options. I am glad she is eating today! :hearthrob:

Take one step at a time until more can be known... :grouphug2:
 

Mamanyt1953

Rules my home with an iron paw
Staff Member
Forum Helper
Joined
Oct 16, 2015
Messages
31,182
Purraise
67,778
Location
North Carolina
. I do not want to hospitalize her if she has aggressive cancer that will mean she has only a few weeks to live. I don't know, I don't know, I don't know. Internist said I should either euthanize her RIGHT NOW, or hospitalize her. But today she is eating and enjoying pets. It does not seem right.
I'm with you. Which is why I gave you the "Quality of Life" link. That way, you will be able to track this, and far better than a vet who sees her for a few minutes at a time, and under stress, at that. WHO SHE IS AT HOME will be the best indicator of when it is really time.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
16,391
Purraise
7,131
Location
Arizona
Hi Zel, I am so sorry you are going through this!

Right at this immediate point in time, you really need to get the test results back for the fluid, and then the vet & internist can consult with you again about possible options. I am glad she is eating today! :hearthrob:

Take one step at a time until more can be known... :grouphug2:
Totally agree with this. That abdominal fluid is key right now.
 
  • Thread Starter Thread Starter
  • #10

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Thank you all so much. I am trying to hang on for the fluid analysis before deciding anything. But I have to decide in the meantime, do I give her sub-Q fluids or not. I have not given her any since Wed. night! I am thinking CHF is the most likely cause of the fluid buildup and so I should not give her more by way of sub-Qs. But am I destroying her kidneys? The vets won't tell me what to do without hospitalization which I am not doing. I am looking at the Quality of Life scale and believe it is not her time yet. She greets me, can walk, and is eating better than she has in days, though small quantities each time. She drinks fine. She purrs when pet and likes being with us still.
What would you do about the sub-Qs?
 

PushPurrCatPaws

TCS Member
Top Cat
Joined
May 22, 2015
Messages
10,061
Purraise
10,250
..., do I give her sub-Q fluids or not. I have not given her any since Wed. night! I am thinking CHF is the most likely cause of the fluid buildup and so I should not give her more by way of sub-Qs. But am I destroying her kidneys? The vets won't tell me what to do without hospitalization which I am not doing. ...
What would you do about the sub-Qs?
Zel, I don't understand why the vets won't help or instruct you what to do in the meantime, while you wait for the fluid results? I'm afraid we are not vets here and cannot really tell you what to do about the fluids. We do not know Zelda's situation at all and, besides not being vets, we wouldn't want to tell you to do fluids or not to do them, as we don't know if it could harm Zelda.
:redheartpump: My heart really goes out to you. Do you think you would want to call your primary vet again to maybe talk some more things through, for the moment?
:vibes: :vibes: :vibes:
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
16,391
Purraise
7,131
Location
Arizona
Well, I just checked "my bible" (Tanya's website that I referenced above), and according to it, Zelda is only in stage 2 kidney disease, so it's not the most critical issue right now, by "normal" standards. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - How Bad Is It? Question is, is Zelda's case normal? Is she drinking a lot of excess water? You mentioned that when you took her in, she was very dehydrated. I don't think that's typical for Stage 2, but there could have been extenuating circumstances for that. Anyway, typically cats don't even receive sub-qs until they reach the latter portion of stage 3 or early stage 4, so not sure what's going on.

With our three kidney cats, sometimes we'd miss entire weeks of giving fluids. Sometimes the pharmacy would be out of the fluids, sometimes we just gave the cats a break, etc. When we gave them a break, we might not start up again unless they started acting like they felt bad. Usually that meant they stopped eating and started hiding. I'm not advocating folks do that necessarily, but just musing that since you don't have any direction from your Vet, you can probably PAUSE the fluids until you are able to get a straight answer from someone in authority.
 
  • Thread Starter Thread Starter
  • #13

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Thank you both for sticking with me and helping me through this weekend. My primary care vet has said this is beyond his capabilities now, because of all the issues and referred me back to her internist. The internist wants me to hospitalize her or put her down, period. I asked her about whether or not to give sub-qs and she said either could be dangerous. Giving them could push CHF, if that is what it is. Not giving them could shut down her kidneys. (Wouldn't putting her down be the most dangerous?!?) She was pretty dismissive and I felt there was a monetary motive. The big issue I would like solved is why has the abdomenal fluid accumulated. Everything I have read is heart, cancer, or a small possibility of steroids. I have a consult with an oncologist in a week. I am thinking I will get her an echocardiogram as soon as I can. I am trying to do this as economically as I can too.

I have kept Zelda off the fluids and I cannot tell a difference. If anything, she is eating better. So glad to hear you gave breaks for your cats mrsgreenjeans. Makes me worry less. I stopped the steroids too, just in case that was the cause of the abdomenal fluid. I guess I would say Zelda is not normal in that she has IBD or lymphoma in addition to the CRF and potentially CHF. He breathing is for sure faster and shallower than normal, which I think points to CHF.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
16,391
Purraise
7,131
Location
Arizona
One more comment. Our Vet told us THE most important thiing is that they eat. Period. So eating better is a very good sign in my humble opinion!
 
  • Thread Starter Thread Starter
  • #15

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
I am keeping her on both Pepcid and an anti-nausea drug too. Maybe those also help. She has always been a very petite cat, but a week ago she was 5.5 lbs and now she is 3.5 pounds, which is so alarming.
 

PushPurrCatPaws

TCS Member
Top Cat
Joined
May 22, 2015
Messages
10,061
Purraise
10,250
Z Zel , I am getting pretty worried about Zelda, I hate to say. Is her breathing consistently faster than normal as of now? And if so, for how long? Her weight worries me too and I am glad she is eating, but my "spidey sense" (e.g. my instinct or intuition radar) makes me really worried about her at this point, as the posts in this forum thread progress.

I need to ask (having a lot of experience in the use of Prednisolone steroid with my own kitty), did you taper off of the steroid a bit slowly EVEN IF she was on it for just a few weeks? Like, did you go to every other day instead of every day, and slowly taper of that med? If you did not & you abruptly went off of it without consulting the vet, it could be causing an adrenal/pituitary imbalance in her until her body/adrenal glands can rebalance themselves. (Two weeks IS a short time on a steroid, and so chances are good she'd be fine but you have better chances with that if a cat is healthy otherwise -- it is just at her age and with her issues, I am a bit worried about it.)

You wanted people's opinions and this is why I trying to honest... if it were my kitty, I would hospitalize her asap and pray for the best result, hoping that she can be stabilized and that they can figure out the issue. I understand fully about costs and I see that you don't really trust the internist, so I am not sure what to suggest. Just to give you a TON of hugs and hopeful, caring thoughts. If you feel the oncologist will be your best bet in a week, all my support for your difficult decision! I know how hard this is, I have been through some rough times with cats of my own in the past.
:( :hugs:
 
  • Thread Starter Thread Starter
  • #17

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Thanks PushPurr. I am worried too. Her breathing has been faster than normal for about a week. I did not notice it. My primary care vet saw it and thinks it is from the abdomenal fluid--that is part of what made him suspect there was fluid. You can kind of see her breathing from her flanks if you know to look. So there has been no change in her breathing since stopping the pred. I did not taper off no--she was on it for 13 days.
I do value honest opinions, definitely. That is why I am here. So thank you. I am planning to see what the fluid comes back with tomorrow and try to get her an ECG and go from there. That is what they wanted to do at the hospital, along with an ultrasound.
She is walking up and down a flight of stairs ok. She ate maybe half a can of cat food today.
I think part of why I stopped sub-qs and steroids is the internist felt she would not make it through the weekend and so we were thinking we might have to put her down and it did not make sense to put her through treatment. But I would say she is doing better off the sub-qs.
Thanks for all the support and caring! It means a lot!
 

Mamanyt1953

Rules my home with an iron paw
Staff Member
Forum Helper
Joined
Oct 16, 2015
Messages
31,182
Purraise
67,778
Location
North Carolina
I don't know if this is even possible for you, but is there a University near you with a Veterinary Medicine School? Now, this will almost certainly NOT be cheaper than a regular vet, and could be more costly, but...they will be practicing cutting-edge medicine with the latest in diagnostic techniques and equipment. They would probably be a good bet for some more definitive answers.
 
  • Thread Starter Thread Starter
  • #20

Zel

TCS Member
Thread starter
Young Cat
Joined
Oct 4, 2018
Messages
25
Purraise
15
Here is the latest update. I spoke to my primary care vet and he said the fluid analysis gave us no additional information. It was totally inconclusive and said possible reasons included heart disease, cancer, liver disease and FIP. He felt the last 2 were unlikely. He also said, as you warned me PushPurr, that I should give Zelda 2 more steroid pills spaced 48 hours apart because weaning is better. He said if her breathing gets quicker, that is a sign the fluid is pushing on her too much. So far, her breathing has not changed since he saw her. Oh, and he also said he has never seen steroids cause fluid build up.

I got an appointment for and ECG on Wed. morning. I am trying to do this in a step-wise way.

MamanyT, I am in DC. So the closest vet school would be Virginia Tech. I think it is about 4-5 hours away.
 
Top