Depressing news about my cat

[seniorkitty]

A little background of what has been going on about my cat's health.
About 5 years ago, my cat developed some rashes/scabs on his mouth,nose, and ear regions.
We took him to the vet and they decided that he probably developed an intolerance to the protein in his food. He had been eating predominantly the same protein (chicken) for most of his life. He was 8 at the time. They gave him some antibiotics, and steroids for 2 weeks. They also had me switch to a limited ingredient diet that didn't have any chicken. My cat liked duck so he went on duck. They also said it wasn't good to have him on the same protein for too long so I have been switching between duck, turkey, and beef LID diets. After this, he was find for about a year. After a year, the rashes and scabbing returned but only on his front paws. I returned to the vet (a different one this time as we moved to a different city) to find that they thought it was an autoimmune disease (Pemphigus Foliaceus). They gave him antibiotics and a different steroid this time in a shot version to see if it would go into remission. It did. For a short period of time, his rashs and scabs disappeared but then returned again about 6 months later. The pills he was taking at the time was Prednisolone 5mg every day and then 2.5mg everyday, and eventually we were able to keep it at 2.5mg every other day. It worked for awhile, but about 5 months ago, the rashes/scabs returned worse than ever. My vet recommended we see a dermatologist. All the while, I had gone to 3 different vets all saying it was pemphigus foliaceus and that he needed to stay on steroids for the rest of his life.

Currently, we went to the dermatologist who also said it was pemphigus foliaceus. He changed the steroids to Dexamethasone, gave him a shot of antibiotics, and also put him on Chlorambucil. His reasoning was that overtime such a long period of time, my cat has probably developed a resistance to the steroid he was on and needed a different type. On one hand, it did work. My cats paws are slowly getting back to normal. On the other hand, he had some major troubling side effects. He lost weight even though he was eating, he had some major diarrhea and flatulence. I explained the side effects to the doctor, he said it was fine and to continue with the meds saying they were reasonable side effects of the medication he was on. The last time we went in, we had a blood test done. (We had one done last November and everything came back okay) This time, his glucose levels seemed high so they had a fructosamine test done as well which also came back high. Now they want to do even more tests saying he has diabetes. I'm not sure what to do anymore. I feel like we have just been pumping medication after medication into my poor baby without any definitive results. He looks absolutely miserable. Just lays there all day with no energy. His diarrhea and flatulence has gotten better since I started giving him probiotics (Doctor never said anything about it until I did my own research and asked if I could give it to him thinking it would help and it totally did). The doctor also said it could be stress related but wanted to do the testing anyway. (They made my cat bleed a lot when they took him blood. We did blood tests before and that never happened.) I'm not sure what others think. Should I get another blood test when he isn't so stessed out from a different vet? Are fructosamine tests better than a regular blood test? They made it seem like a Fructosamine test would give us all the answers but now they're saying they're not sure and need more testing. I'm at a loss. Even the person I spoke to over the phone said they didn't know for sure. Anyone have any advice or experience with this?

 

[LTS3]

Short term steroid use can cause diabetic-like symptoms including elevated blood glucose levels. Long term use can cause diabetes and insulin may be needed.

A fructosamine test is similar to the AC1 test for Human diabetics. It gives the average blood glucose levels over the past few weeks and is what vets use to make a diagnosis of diabetes along with the typical symptoms of excessive drinking and peeing and hunger and weight loss. Since your cat is taking a steroid, the vet shouldn't automatically jump to a diabetes diagnosis.

Protein isn't the only thing that can cause skin rashes and such in cats. Fillers and gums and other things common in many cat foods can also cause reactions.

You can ask your vet to consult with a veterinary school for more help on your cat's skin issue. Vet schools offer courtesy consults for vets. There is a vet only forum your vet can also post for more advice on, VIN.com

There is some info on Pemphigus Foliaceus here:

Pemphigus Foliaceus in Dogs and Cats - Veterinary Partner - VIN

veterinarypartner.vin.com

Did the dermatologist take a skin biopsy to make a diagnosis?

 

[seniorkitty]

No, the dermatologist said because of the age of my cat (he is 13 years old) and the location of the suspected pemphigus (in the nail beds) he didn't think it was a good idea. The likelihood of an infection apparently wasn't worth doing a biopsy. He said he was 99.9999 % sure and I had taken him to 3 other vets before him and all of them said for sure it was pemphigus. I'm not too sure that it is but the steroid did help. I'm concerned with the side effects of the new medications he is on but I'm not sure what to do. Do we continue doing more testing? Do we wait and see what his glucose levels are if he stops the medication? He seems worse on the medication than when he wasn't on them but the vet and dermatologist keep pushing to keep him on them.

So is a Fructosamine test not 100% in telling whether a cat has diabetes or not then? Is there such a test that can tell 100% if it is diabeter?

 

[Mamanyt1953]

It is not when a cat has been on steroids. It should be used in conjunction with other physical symptoms, as LTS3 said. There really is no test that can "weed out" the steroid effect.

 

[seniorkitty]

Interesting. Because everything else has been pretty good. He is drinking and urinating normally. His diarrhea was an issue but has been much better and his bowel movements have been normal now that he is off the antibiotics and has taken probiotics. He did lose a bit of weight over a period of time (1.5 pounds over a period of 6 months) before the bloodwork. His appetite is normal. I just dont want to keep doing more tests if it wont tell me anything which is what I feel like I've been doing. I've been going to the vet getting tests and getting "represcribed" for the same medication since they were not giving me "refills.

 

[fionasmom]

I am sorry that you are faced with all this frustration and discomfort for your cat. I have had 2 diabetic cats, both on insulin, and firmly believe that should be treated, given that the fructosamine is high BUT in your case I have to agree with what was already said...the steroids are definitely a wild card here.

Both of my cats had all four symptoms of diabetes....hunger, thirst, peeing, and weight loss in one case. The other girl was very heavy. The absence of those symptoms is a concern in giving a diabetes dx.

You were already referred to a dermatologist if I am understanding this...maybe it was not a referral though. Your other two options, as mentioned are teaching hospital, or broad based referral clinic with a number of specialists.

 

[LTS3]

One of of my cats occasionally needs a course of steroids for his IBD / asthma. The high dose always causes diabetic-like symptoms. As the dose is decreased, the symptoms slowly go away. I have tested my cat's blood glucose levels at home and levels were just slightly elevated in the diabetic range but nothing to worry about. A fructosamine would show the same thing but I know my cat is not diabetic, it's the steroids that is causing the symptoms and elevated blood glucose levels. When he's not on steroids, his blood glucose levels are on the lower end of the normal range and urination and appetite are normal.

 

[seniorkitty]

Thank you so much guys. He is eating normally, and how bowel movements are similar except for the diarrhea. It has gotten almost 100% back to normal after stopping the antibiotics, and putting him on probiotics. I just wish I had used probiotica before but the vet didn't say anything until I mentioned whether it would be a good idea to have him on probiotics for the loose bowels. He is also peeing and drinking water pretty normally. My other big concern is that he has lost a bit of weight and is a bit lethargic but according to my vet, before the blood work, they told me those were side effects to the drugs he was taking and that I should continue giving it to him. We are slowly tapering the dosage from 1 time every 24 hours to 1 time every 48 hours, and now we are at 1 time every 72 hours. My gut tells me that his levels were high due to steroids, and also from the stress of all the loose Bowels and flatulence he had. It really bothered him a lot and going to the vet over 4 times in a course of 5 weeks definitely did NOT help. He hates the vet. Plus, they also told me to give him rice for the diarrhea before we did the probiotics. Would it be safe to wait a couple weeks since his stress levels and dosage of steroids is now lower and redo the fructosamine test? Also, I looked at the feline diabetes forums and was wondering if I should try home testing his glucose levels at home to see if they are now normal?

 

[seniorkitty]

Also, does anyone have any experience to Chlorambucil? I'm concerned about that drug in particular. I guess being a "chemotherapy" drug just really scars me.