First post - looking for guidance with Pemphigus Foliaceous

jhnktr

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Hi all,
I appreciate your willingness to read and potentially help with my situation. Like several, I am dealing with a cat who has a heart-breaking and gut wrenching health issue.

Oliver came into my life 10 years ago this month. He was rescued, by myself, when I observed someone trying to discard him in a trash dumpster. Oliver was literally only around 7 weeks old. Needless to say, he came home with me, and was quickly enveloped in love he's been a very lucky and pampered fella - spoiled rotten. Because he had not weened from his Mother properly, for the first several months he literally nursed himself to sleep on my earlobe every night. He has always been the most exuberant little guy, full over personality and the most loving cat I've ever known. He is ingrained very deeply in my heart.

Oliver always had skin issues that could crop up. Always diagnosed as "hot spots" or environmental allergies. No formal diagnosis was done, and treatments just involved futile attempts and changing food, litter etc to no avail.

Fast forward to this past fall (late Oct 2020) when I first noticed scabbing on Oliver's nose. I kept an eye on it, but when it wasn't improving I decided to take him to his Vet of 10 years in November. The Vet ran bloodwork, which he said indicated he was fine and attributed it to his allergies. He ultimately just gave him a dose of steroid. The flare-up on his nose continued over the next few weeks. The week of Christmas, I was grooming him and noticed bad scabbing and tenderness on two of his claws. There was black crusting that had never been there before. In addition, his ears suddenly had scabs all over them. Of course, because of the holiday week, this prompted an excruciatingly long weekend before I could get him back into his regular Vet.

As fate would have it, the Monday morning following Christmas I called and was told the Vet was no longer seeing Cats. ???!!! Oliver was switched to another Vet in the same practice. I took the appointment, and because of Covid protocol, I could not enter the building. The result was that the new Vet downplayed the skin issues and raised concerns with his kidneys. This Vet was, to say the least, lacking in the demeanor department and IMO not addressing the immediate concern at hand. She did give a shot of Covenia, and prescribed Atopica - again attributing it to allergies alone.

I did not settle for this opinion, and sought that of another HIGHLY reputable (and expensive) Vet. Oliver was seen within a day or request, and the new Vet turned out to be a wonderful change from the previous experience.

Oliver's bloodwork did indicate stage 1 kidney disease. However, the Vet wanted to focus on diagnosing the skin issues which he suspected were auto-immune related. A biopsy was scheduled for a week later. Sure enough, the biopsy confirmed Pemphigus Foliaceous. Although the procedure went well, Oliver's reaction to it did not. He suffered a behavior change. He stopped sleeping with me (which he has ALWAYS slept with me) and generally became paranoid, skittish and less affectionate following the biopsy.

The Vet recommended the start of Atopica (Cyclosporine) asap and some dietary changes for his kidney disease. Needless to say, dosing a cat with Atopica is literally hell on earth. He hates it, fights tooth and nail, spits, drools etc. Most will tell you it must taste horrible - and it is literally traumatic to give it to him. It became such a battle that I was lucky if I could get it in him every 3 days.

Despite 3 weeks of this futile attempt, I saw some improvement. His ears cleared and 2 claws improved. However one claw continued to remain infected. This culminated when just last week, he began holding the paw (his front left) upwards and gradually withdrawing away from any interaction. He was back at the Vet the day after I noticed him holding his paw up and being delicate. That visit was last Thursday (it is now Monday.)

The Vet cleaned the claw, and then gave a shot of Covenia (antibiotic.) He recommended I stop trying to dose him with the liquid Atopica until he could get it (Clyclosporine) in a pill form (I have had good success pilling my cats.) I am awaiting the arrival of that any day. However, over the weekend, Oliver withdrew completely - hiding under a bed 90% of the time, and holding his paw in pain. He was limping, interacted very little and began refusing to walk on hard surface floors - only carpeting. After calls to the Vet over the weekend requesting pain meds, they could only prescribe Gabapentin because of concerns due to his kidney issues. In the meantime, I began dosing him with the Atopica for fear things were progressing and I didn't want to waste any time with his treatment.

Oliver slowly migrated out from under the bed Sunday, and lightly interacting by Sunday night. He still is in obvious pain, but at least acting a little social. Today, he seemed a little better. However when I dosed him with his Atopica today, I noticed his paw had worsened. In just the course of 4 days, the two claws next to the infected one are now inflamed, swollen and have black crusty gunk on them - the obvious source of his horrible pain.

Now that you have read that, here is where I need some mental support. I have reached the point of utter frustration. I dont know what to do. My heart is completely broken, and I don't see any end in sight. I feel I am in a race against time. Knowing that in the course of a few days his other two claws are now infected to the point that he can only limp, I don't know what to do. I, again, have a call into the Vet - but not sure there's much help they can offer outside of what they are already doing.

If any other out there have faced this disease with their babies, does it seriously progress that quickly? In the course of 3 months, he has completely gone downhill. Is this futile? Or am I being impatient? Is there something else I can or should be doing? Am I mis-treating him by letting this continue? Is it normal for the Cyclosporine to take this long to help? How should I be gaging this timeline?

BTW - he is still eating, drinking pooping and peeing as normal. However he has lost a pound through this stressful situation, likely also due to the medicine.

Again, I appreciate any time and insight. I am a VERY protective Daddy who is devastated by this - completely emotionally broken and panicked.

Oliver's Dad
 

crouton

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I’m so sorry you are dealing with this. I have not dealt with this in a cat but I do have a loved human person with pemphigus. It’s very painful and frustrating.

Have you asked the vet if there is anything you can do to prevent infections in the claw? Is it possible he is getting the litter and debris in the sores? Is it possible to try a larger pellet litter like something recommended after cats have surgery etc.

What is the vet cleaning the claw with? Maybe you can do that frequently at home if possible to help him out a bit.

Poor little guy. It must be so painful. There was a cat in a local rescue near me that developed pemphigus and I remember they were treating him with steroidal medicine. Is that an option?
 
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jhnktr

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Thank you for the response.

Because it’s an auto immune disease, as I understand, his body is essentially attacking itself. The sores aren’t really treatable, outside of an immune suppressant. Things like topical ointments will not help. It has to heal from the inside out. Unfortunately that sort of healing can take 4-6 weeks.

The Vet is avoiding steroids because of concern it will further damage his kidneys. In the meantime I’ve been trying to transition his diet to a high- protein prescription food to address his kidney concerns. Over the weekend it’s become a battle to get him to eat hard food - which he always loved. Rather, I have to mix his wet food into a soup which he laps up.

I will have to check to see what they soaked his paw with. That might be a good option. I don’t feel the litter is affecting him, but it is something I can definitely monitor.
 
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