Fluid In Cat's Chest - Advice Needed

[Antonio65]

Although you have no answers right now, I think you can at least be at peace that you have...and will continue to leave "no stone unturned" as we say here.

Like the vet said while scanning Pallina's abdomen, "It's impossible to say that you neglected your cat's health, you did everything was possible to do so far".
Tomorrow at 11 am I will listen to a new vet and his advice and point of view.
Tomorrow it'll be snowing, they say. I hope they're wrong, traffic gets crazy when it's snowing and I have to go to a place that I don't know. Today's been a bright and mild day, it seems impossible that we'll have snow tomorrow.

 

[Antonio65]

I received the reports for the blood test and the needle aspiration.
The CBC report is perfectly fine.
The chemistry shows high liver and kidneys levels
ALT 312 (was 336) [10-60]
ALP 272 (was 239) [10-150]
GGT 4 (was 34) [0-10]
BUN 42.7 (was 41) [10-30]
Crea 2.2 (was 2.0) [0.5-2.0]

The citology for the needle aspiration says:
Tissue sample with traces of blood, good cellularity and cells preservation. Some hepatocyte aggregates are visible. Most of them contain good amounts of small cytoplasmic vacuoles, optically empty (possible lipidic material), normal looking nucleuses. Some lymphocytes are adjacent to the aggregates.
Cytologic framework consistent with a suspected hepatic lipidosis at its early stage.

I wonder why Pallina should have a HL, she has no visible symptoms of that.

This morning I should have taken Pallina to the IM specialist. He could have explained me some hidden aspect. I have just received a phone call from his assistant to let me know that he's sick and can't be at the practice today... I've been waiting for this day for 8 days. I have no words...

EDIT: Yesterday they gave me a sample of Pallina's chest fluid to hand the IM vet and run a specific test... What now? I have it in my fridge... Will it still be good in a week or more time?

 

[Antonio65]

I ended up re-booking at the same vet. New appointment on next Tuesday, 4 pm.
It would have been much handier for me a morning appointment, though. I never liked appointments in the afternoon, I'm less ready to any kind of question and Pallina could be tired, she usually sleeps in the afternoon

I asked the doctor who took my call whether the fluid sample I'm storing in my fridge will still be good on next Tuesday. He said that probably it won't and if they think it's not good for a test they will draw some fresh fluid from Pallina's chest.
I have already stated that I won't allow any new needle in her chest, because she gets very stressed by this and if they want to run that test, they will have to use what they already have.

I do hope they won't play more tricks on me

 

[artiemom]

Oh, Antonio, this really stinks... no, the fluid will not be useful for anything, next week.

Too bad this new Vet is so far away. It would have been worth it for you to just drop off the fluid for the testing.. sigh...

((hugs))

Yes, your vet is correct. You are doing so much for Pallina. You are overturning each and every stone you come across ~~ in some places, even ones that are buried in the sand...

I have no words of advice, guidance... just words of support and love..

 

[babiesmom5]

The medical process can indeed be frustrating. This is true for both pets and people. I could write a book on this topic...and I am sure so could you!

The good news is that you are making progress toward a diagnosis. You now have some clues. The bloodwork shows ALT and GGT decreased a bit, but the ALP continues to increase.
As you recall in the articles I referenced, ALP is quite specific for cholestatic disease in cats.

Dr. Twedt in the IDEXX article of vets roundtable discussion of diagnosing liver disease said at the bottom of page 7 "It is unusual to see high ALKP in cats except for cats with Hepatic Lipidosis". This coincides with your report "Cytologic framework consistent with a suspected Hepatic Lipidosis at its early stage".

So why should Pallina have HL when she has no visible symptoms of that? Be GLAD that she has no visible symptoms of HL at this point. If she was showing visible symptoms such as jaundice, the HL, and liver damage would be much more advanced.

The liver is an organ that can repair and heal; often be restored to normal function. So liver damage is not necessarily permanent; BUT it is important to catch any disease in early stage.

As for why Pallina developed HL, you have to look at the entire gastrointestinal system. The liver, pancreas, spleen, stomach, intestines are all in close proximity. When one organ in the body has inflammation present, or disease, it puts a strain on the surrounding organs and/or other organs that rely on it to function. One feeds off another. For instance, if the liver is overworking, the pancreas will start to overwork, kidneys, bowels etc--like a "chain reaction". The same goes for diseases that are present before HL, such as kidney disease, pancreatitis or IBD. Pallina does have some IBD and a history of pancreatitis, so this inflammation no doubt puts strain on other nearby organs such as liver.

It is good you have been giving Pallina the liver supplement. Without it, the HL could be worse by now. Is the supplement called Denamarin or Denosyl? That is one that I know of that helps repair damage to the liver and helps bring down liver enzymes.

You might also ask Vet about Actigall (Ursodiol) which is a choleretic. It improves the flow of bile through the tiny ducts into the gall bladder and from the gall bladder into the intestines. By doing this, it facilitates the removal of toxic bile acids as well as toxins excreted into the bile from the body.

So I hope all goes well with your new appointment on Tuesday at 4 pm. Personally I like afternoon vet appointments as cats are more subdued then...nap time. They are less likely to throw up or have an accident in the car. No fun!

One question...did you get snow yesterday?

 

[Antonio65]

Oh, Antonio, this really stinks... no, the fluid will not be useful for anything, next week.

Too bad this new Vet is so far away. It would have been worth it for you to just drop off the fluid for the testing.. sigh...

Thanks so much, Cindy, for your words of support, they mean so much for me!
As for the quoted part, if the vets will consider that sample useless for the test, then I won't allow them to draw fresh fluid from Pallina's chest!
She gets overly stressed by that procedure and remains unsettled for a couple of days. She's still recovering from the last drainage, I won't allow this again after a short period of time.

 

[Antonio65]

As you recall in the articles I referenced, ALP is quite specific for cholestatic disease in cats.

Yes, B babiesmom5 , and two days ago I asked the ultrasound scan vet if there was any sign of cholestatis and he said no.

Be GLAD that she has no visible symptoms of HL at this point. If she was showing visible symptoms such as jaundice, the HL, and liver damage would be much more advanced.

As a matter of fact this morning Pallina is feeling a bit sick. She vomited some stomach juices with a small hairball before 5 am.
She didn't want to eat when I opened a fresh can of her favourite (and only) food. I gave her a shot of Ranitidine at 6:30 am, she ate something later, then I gave her the usual 1/4 pill of diuretic and at 9 am I gave her 1/8 pill of Cypro. She ate 3/4 of her bowl 30 minutes later, but now she's still meatlofing on the sofa.

Pallina does have some IBD and a history of pancreatitis, so this inflammation no doubt puts strain on other nearby organs such as liver

That's fine, but I don't know how to help her...

It is good you have been giving Pallina the liver supplement. Without it, the HL could be worse by now. Is the supplement called Denamarin or Denosyl? That is one that I know of that helps repair damage to the liver and helps bring down liver enzymes

I used to give her Denosyl until June, then its import to Italy has been discontinued and I'm now giving her a similar product called Glutamax (it's being made by a factory which is 4 km from me).
Glutamax® Forte palatable tablets
The same company would import Denosyl until June, then it seems that their license expired.

In the past I had used this one
Epato® Plus, alimento complementare per cani e gatti
Pallina has always had slightly high liver levels. I found, though, that this product wasn't really effective.

You might also ask Vet about Actigall (Ursodiol) which is a choleretic.

I will ask the new vet about this on Tuesday. I have read, though, that as a side effect it has a worsening of liver conditions, leading even to diarrhea and jaundice

One question...did you get snow yesterday?

No, no snow yesterday until 9 pm... it's snowing today, though, but it should clear up tomorrow and be bright and dry on Tuesday

 

[Antonio65]

Is the supplement called Denamarin or Denosyl? That is one that I know of that helps repair damage to the liver and helps bring down liver enzymes.

I wonder if it is worth switching from the current liver supplement to Denamarin that I found it is available over here.
Pallina is still little interessed in food today, though yesterday in the afternoon her appetite woke up visibly.

 

[babiesmom5]

I was not familiar with Glutamax Forte, as I am with Denamarin...so I did a bit of research to compare the properties of both.

It appears Glutamax Forte is used primarily for dogs. This is not to say some medications used for dogs cannot be used "off label" for cats. They can. Case in point,Cerenia-label says for dogs, but is often used "off label" for cats. I use it for my cats.

I note both Denamarin and Glutamax Forte have "Silybin" as an ingredient. Silybin is an active ingredient of milk thistle, an anti-oxidant which helps protect liver cells and helps promote liver cell regeneration. This is a good ingredient.

However ONLY Denamarin contains SAMe, a potent anti-oxidant. ONLY Denamarin is known to be effective in increasing the amount of glutathione, which acts as a detoxifying agent of the liver and helps repair liver damage, thus bringing liver enzymes down. It can also help with digestion and absorption of nutrients from diet as well.

In my opinion, (and you know I am not a vet), I believe Denamarin is the superior product.
If I had a cat with liver disease, I would want Denamarin.

You might also want to look into Vitamin B complex/Folic Acid/ Vitamin K1. The liver is the source for storage and activation of B vitamins. When a liver is inflamed, cat will become deficient in them. Intestinal absorption of Vitamin K1 is decreased due to less food intake so your cat might benefit from supplementation. Ask your vet.

I don't know if Hills L/D for cats with Liver Disease might be worth trying. I think it is fairly new and have not tried it. It is pork liver based and contains added amounts of nutrients that a diseased liver needs and also lower amounts of sodium to minimize fluid buildup. Again, you could ask your vet.

Morning nausea, vomiting, or inappetence is often a problem. Cats go all night without food so acid and bile builds up and they are nauseous or vomit. I have found what helps is giving anti-nausea medication at night pre-emtively. I had to do this with one of them last night.

Like you, we take things here day to day. Mornings can sometimes be rough. I hope Pallina comes around soon. Light, on my lap, sends loud purrs.

 

[Antonio65]

B babiesmom5 , I know that many meds are for dogs but are prescribed to cats as well.
Fortekor is one of them. Now the box says cats and dogs, but until a few years ago it was for dogs only.
And I have other examples.

However ONLY Denamarin contains SAMe, a potent anti-oxidant. ONLY Denamarin is known to be effective in increasing the amount of glutathione, which acts as a detoxifying agent of the liver and helps repair liver damage, thus bringing liver enzymes down. It can also help with digestion and absorption of nutrients from diet as well.

In my opinion, (and you know I am not a vet), I believe Denamarin is the superior product.
If I had a cat with liver disease, I would want Denamarin.

When I learned that Denosyl was no longer imported in Italy, I called the company who would import it, they have their offices 4 km from me. I asked them what they had in substitution and they adviced me on Glutamax Forte.
They didn't tell anything about Denamarin, which has their label too, just like Denosyl had
My vet didn't tell me anything about it either...
Anyway, I will switch to Denamarin as from tomorrow, when the pharmacy opens.

You might also want to look into Vitamin B complex/Folic Acid/ Vitamin K1 [...] Ask your vet

Pallina had been taking Vit K in tablets for 6 months, 1/4 pill once a week, as per vet instructions.
It was mainly prescribed for her high clotting times, with zero results!
http://www.drnpet.info/en/alimenti-...tti-vitamina-k1-l-carnitina-fosfatidilcolina/
I've been thinking about vit B complex. Lola would take 1/4 pill everyday to compensate for her CKD, and I think she had wonderful results.
I will ask the new vet on Tuesday.

I don't know if Hills L/D for cats with Liver Disease might be worth trying [...] Again, you could ask your vet

My vet talked about Hill's L/D on the phone two days ago, but said that it has a not so good taste and usually cats dislike it. Because Pallina is very picky with her food, we chose not to upset her habits.

Morning nausea, vomiting, or inappetence is often a problem. Cats go all night without food

Usually Pallina does not empty her bowl before midnight, so something is left for her at night. And sometimes, like this morning and yesterday, I found some food left in the bowl early in the morning. If she was hungry at night, she could have eaten what was in her bowl

Pallina is here on my lap while I'm at the PC
She purrs back, if I force her to

 

[Antonio65]

As we use to say over here, the night brings suggestions.
I woke up this morning (it's Monday already here, 8:45 am) and I remembered that last night I wrote this in the Artie's thread
Artie and his Issues

I remembered that some months ago, very likely before I went to Belgium for the I-131 treatment for Pallina, for some reason Pallina got blocked in her bowel movements.
Sha has always been regular in the litter, she never missed a day in her life.
So when I didn't find her poop in the litter for two days in a row I got concerned and gave her about 2 ml of liquid paraffin (I'm in doubt whether it was lactulose, but I think it was paraffin). I was extremely careful, as I have always been, but she fought a lot and some drops of paraffin choked her. I was absolutely scared that she was going to die that night, or that she could get a pneumonia ab ingestis. She recovered quite well, the next day she was fine, but for weeks she had a raspy voice and even after 4 or 5 months sometimes she still has a rough meow instead of her usual sharp and melodic kitten meow.
Could this be a reason for her chest fluid?
I didn't even remember that episode, it came up to my mind this early morning...

 

[babiesmom5]

I can see how you could question this after the paraffin/choking incident, and now chest fluid, but I do not think this is the case. Here is why.

No doubt Pallina's throat was irritated by this choking incident and it caused raspy voice for a time. This should have cleared up in a day or so.

What can cause raspy voice for a longer period of time is "Trachetitis" caused by irritation of the trachea by the tube they put down a cat's trachea during anesthesia to keep the airways open. Has Pallina had any anesthesia since the paraffin incident?

I can understand your fear of pneumonia ab ingestis following this incident. We call that over here "aspiration pneumonia". It is same thing. Pets get it. People get it. Same reason.
Aspiration pneumonia occurs when a cat has inhaled foreign matter into its lungs which is bound to irritate the sensitive tissues lining the lungs. Or the cat vomits and inhales some of its stomach contents (which are very acidic), and it irritates the lungs. This vomit may contain bacteria from the small intestine, which can cause a secondary infection in the lungs.

While I have not dealt with "aspiration pneumonia" in cats, I have in humans. Patients in the hospital who have "dysphagia" (swallowing difficulty caused by esophageal problems caused by strokes, neurological disorders, cancers etc), are high risk for aspiration pneumonia. They choke on any liquids, so everything has to be thickened to puree consistency so it can go down the throat in a "bolus" manner. When they get aspiration pneumonia, the symptoms are same as regular pneumonia--rapid heartbeat, increased respiratory rate, green or yellow nasal and/or lung discharge and fever.

Cats with pneumonia show same symptoms. Does Pallina show any of these symptoms? I believe you had a cytology analysis of her chest fluid. If I remember correctly, the cytology report showed chest fluid contained small, medium and large lymphocytes. I don't recall any bacteria being found. Pneumonia (whether aspiration or infectious type) usually shows some sort of bacteria or virus in the sputum.

With any sort of pneumonia, chest x-rays, in both people and cats, show some type of infiltration. Yes, pneumonia often causes fluid in chest, but you would see other other obvious signs of respiratory distress as well. She would be very, very ill by now.

So, please excuse my long answer to your question, but in my (humble) opinion, Pallina's chest fluid does not have any correlation to the incident your described.

Perhaps, if you are concerned, you could pose this question to your vet tomorrow.

 

[Antonio65]

B babiesmom5 , thanks for the professional explanation!
I had read it and treasured it and used with the new vet during the specialistic visit yesterday.

This vet is a well-known (probably countrywide) specialist in cats, he writes articles on the web and has a wide experience in infective diseases. I knew him by name, I had read some of his articles in the past years. I also called him on the phone 5 years ago to have some explanations on FeLV contagion and spreading. He was extremely kind on the phone on that occasion, as he was yesterday.

Well, the new vet wanted to know everything about Pallina, I don't know if I told him everything, but I tried to be as precise as possible. I showed him all the reports of the last 6 months, a thick pile of paper. He read them all, then he re-read them.
Yesterday I also got the reports for her total bilirubine, 0.77 mg/dl [0.0-0.3]. Both my vet and the new vet said it isn't the case to take action at the moment.
Then he visited Pallina and made three x-rays. He found that Pallina has some arthritis and feels some pain at her hind legs. As a matter of fact I had the same idea, since she was limping a bit in the last few weeks.

This vet told me that it is normal for a cat to have some fluid in their chest, and that draining it all is wrong. The average amount is 10-30 ml, and it is functional to the breathing process and lungs and heart health. He said that a cat can easily survive without problems with up to 120-130 ml of fluid in their chest and still not showing breathing issues.
He confirmed that Pallina's problem is nothing infection-related and absolutely no lymphoma-related.

From the x-rays he saw that Pallina's cranial lung lobes are atelectatic, that means that these parts of her lungs are not filled with air anymore, they're like compact tissues, fibrotic. These lobes are reduced in size as well, and have some empty space around them. This causes them to "swing" in her chest and this gives inflammation which, in turn, leads to fluids build-up.
The condition is not reversible and hopefully it should not progress, though this is not sure.
So far Pallina is compensating and not suffering for air reduction, just because she is elder and not very active, but should she be more active or be under stress, then she could be panting.

What has caused this condition, though, is unknown and it seems it cannot be determined for sure. Usually it happens after a pneumonia, which Pallina never had, she's been totally healthy until her HT showed up. Or it happens following a mechanic trauma, which she didn't have. The weirdest thing is that even if she had a trauma this couldn't have involved both lungs the same way.
He also said that sometimes I-131 could lead to this result if there are methastatic areas in the chest, but the scintigraphy showed that Pallina's chest was clear!
Absolutely impossible that the episode of the paraffin who was going to choke her in July may be the culprit.
So the origin of the problem might remain a mistery.

The fluid sample that my vets drew from her chest on last Thursday during the scan was still fine for the test of electrophoresis of the proteins. So he's going to test it.

The new vet also assessed that Pallina is dehydrated due to the diuretic she's taking and he said that he's going to change the med to another one. Which one will be determined by the urinalysis he is going to do on a sample of urine he took from Pallina's bladder during the visit.
He said that the diuretic I'm giving her (benazepril hydrochloride + spironolactone) works fine only when the proteins in the fluid to be expelled are below 3 g/dl, Pallina has 4.4 g/dl. This makes the fluid thicker and not drainable. The diuretic, so, calls water from the blood and tissues, leading to a dehydration of the patient.

He also said that Pallina hepatic lipidosis isn't worrying at the moment, she's eating, so no problem.
I told him that she used to eat 2 cans a day, but now she struggles to eat 2 cans even with her dose of cypro. He said she's fine like this. Although her weight dropped from 5.6 kg to 3.2 kg (12.3 lbs to 7 lbs) in a few months, this is her normal weight, because Pallina is small sized, she was overweight when she was fine.
The quick weight loss might have also triggered some liver reactions.

He said that he has never seen a similar case before, and at the moment he doesn't know how to help me and Pallina. He will also give her a cortisone med, but he still has to figure it out which one. He held all the reports I took him and wanted all the scanned images taken during the Belgium hospitalization.
He shoud call me later today or on Thursday morning.

Meanwhile he said to keep pilling Pallina as usual and he gave me a sample bottle of supplement pills for her liver. It's a supplement very similar to the Denamarin, but it's produced over here, because Denosyl and Denamarin are no longer imported to Italy.
He said that her liver levels are higher than the range, but not worrying.
No other supplement or vitamins should be required at the moment.

He was astonished that I had so many weird and rare cases in my home... I have talked with him about Lola and her troubles.
Lola had two rare or extremely rare issues. Pallina has been hyperthyroid in the apathetic form (which is uncommon) and now this.
He said I have defeated all medical stats!

The visit lasted an hour and 40 minutes, I paid 140 euro for the visit, the tests and the 3 x-rays.

Last night I gave Pallina 1/8 pill of Cyproheptadine (0.5 mg) and she ate a lot, but this morning she didn't want to eat, though she was following me around the house waiting for her dish of food. As soon as I gave her her bowl she turned away. I wonder if I have to increase the dose to 1/4 pill, or to give her 1/8 pill twice daily.
She's always feeling cold. She wasn't like this last year.

 

[Antonio65]

He was astonished that I had so many weird and rare cases in my home... I have talked with him about Lola and her troubles.
Lola had two rare or extremely rare issues. Pallina has been hyperthyroid in the apathetic form (which is uncommon) and now this.
He said I have defeated all medical stats!

Sometimes I wonder if I am the reason behind these troubles...
Probably I'm not good enough at taking care of cats?

 

[artiemom]

Sometimes I wonder if I am the reason behind these troubles...
Probably I'm not good enough at taking care of cats?

Antiono, ABSOLUTELY NOT TRUE!!! DO NOT TELL YOURSELF THIS! DO NOT EVEN THINK IT!!!

You are a wonderful Dad to your kitties... I know you are feeling so down, that your mind is playing tricks on you.. you are doubting yourself...

Seriously??? No one but a loving, devoted cat guardian would travel all over Europe, seeking the best care for their precious little ones....who reads medical articles, understands them, insists on special testing... Who else would do that???
You are truly exceptional!

I mean it!! NEVER DOUBT YOUR CARING, NEVER DOUBT YOU LOVE FOR YOUR BABIES,

PLEASE DO NOT DO THIS TO YOURSELF....

You are overtired, physically and mentally exhausted... I know exactly how you feel... I have been there, felt that way, and actually beginning to feel that way again...

But You, Antonio, Never question your care of your babies....

On another note, It sounds as if this New Vet is really the person to help you and Pallina...

Sending ((((hugs)))) , love, and encouragement....

 

[foxden]

Antiono, ABSOLUTELY NOT TRUE!!! DO NOT TELL YOURSELF THIS! DO NOT EVEN THINK IT!!!

You are a wonderful Dad to your kitties. .. I know you are feeling so down, that your mind is playing tricks on you.. you are doubting yourself...

Seriously??? No one but a loving, devoted cat guardian would travel all over Europe, seeking the best care for their precious little ones....who reads medical articles, understands them, insists on special testing... Who else would do that???
You are truly exceptional!

I mean it!! NEVER DOUBT YOUR CARING, NEVER DOUBT YOU LOVE FOR YOUR BABIES,

PLEASE DO NOT DO THIS TO YOURSELF....

You are overtired, physically and mentally exhausted... I know exactly how you feel... I have been there, felt that way, and actually beginning to feel that way again...

But You, Antonio, Never question your care of your babies....

On another note, It sounds as if this New Vet is really the person to help you and Pallina...

Sending ((((hugs)))) , love, and encouragement....

Antonio65
I have NEVER seen anyone so dedicated to their cats as you. Many members here go to great lengths to find alternative appropriate, life-changing and extraordinary care for their fur babies.

You have traveled the continent and "gone the extra mile" (or kilometer) and unparalleled steps beyond.
As artiemom said above, you have learned about the medical conditions diagnosed, insisted on special testing, and followed up with superior care for your furry loved ones.

It is clear to anyone who has read your threads that you have dedicated yourself to providing the best care available for your cats.
Please do not doubt your care and love for your cats.
You are trying to reconcile the diagnoses you received from different veterinarians. That IS difficult, and it is not surprising that you are overwhelmed by the conflicting information.

It is unusual that you have had such unusual medical conditions with both Lola and Pallina. The REASONABLE explanation is that these conditions were only diagnosed after you chose to persevere and obtain exceptional medical care for your girls. These conditions are rarely observed by vets because most owners yield to terminal diagnoses from veterinarians without pursuing alternative treatments.

Do not doubt your ability to care for your girls. Your persistence to obtain the best care available for Lola and Pallina shows your dedication and commitment to them.

Know that I am with you in spirit. I have learned so many things from the information you have provided.
I am inspired and humbled by your devotion to provide such exceptional care for both Lola and Pallina.

 

[artiemom]

The only other thing I can add, is this:

Lola and Pallina were sent to you for a reason.....The reason being is that God, or the Universe (whatever you believe), KNOWS exactly who will love, and go to the ends of this earth to provide the best care and love to these SPECIAL little ones and sent them to you.....

Never, Ever, doubt yourself.... Please...

love,
Cindy

 

[babiesmom5]

Thank you for the detailed update on your Tuesday vet visit. It sounds like it was a very good one. This vet conducted a thorough and comprehensive evaluation studying all the records, asking questions and digging deep into Pallina's complex medical history. This vet has an open mind; he is willing to listen, explore alternative treatments, and "think outside the box".
You have found a "keeper"!

I am glad he thinks the liver issue of not of high concern at the moment. It is good he is giving you a sample of supplement similar to Denamarin.

The lung issue sounds similar to a pulmonary fibrosis. No doubt there is a degree of inflammation present, so a cortisone should be helpful. They tend to promote fluid retention, so no doubt your vet wants to research one which minimizes this effect.

As for arthritis, many elderly cats suffer from this, especially in the hips. You might ask your vet about "Cosequin" which is a mix of glucosamine and chondroitin, two natural compounds derived from cartilage of animals which help decrease inflammation in the joint and replace lost cartilage. It helps reduce swelling and eases pain and discomfort and has no side effects. It should not counter any other medications Pallina is on. I had a very elderly cat on this years ago and it helped her a lot.

Now, as to your self-deprecating comment as to your fitness for caring for cats...I say you are BAD!

English is a funny language, full of contradictions, double or even triple meanings to the same word. There is "formal English" and there is "slang English".

The late pop singer Michael Jackson had a hit album entitled "BAD". It was #1 in 13 countries and got him 6 Grammy Award nominations of which he won two. This album sold 35 million copies worldwide and is one of the best selling albums of all times!

So just like this hit album--you are BAD--which really means AWESOME!

 

[Antonio65]

Seriously??? No one but a loving, devoted cat guardian would travel all over Europe, seeking the best care for their precious little ones....who reads medical articles, understands them, insists on special testing... Who else would do that???
You are truly exceptional!

I have NEVER seen anyone so dedicated to their cats as you. Many members here go to great lengths to find alternative appropriate, life-changing and extraordinary care for their fur babies.
You have traveled the continent and "gone the extra mile" (or kilometer) and unparalleled steps beyond.
[...]
Know that I am with you in spirit. I have learned so many things from the information you have provided.
I am inspired and humbled by your devotion to provide such exceptional care for both Lola and Pallina.

The only other thing I can add, is this:
Lola and Pallina were sent to you for a reason.....The reason being is that God, or the Universe (whatever you believe), KNOWS exactly who will love, and go to the ends of this earth to provide the best care and love to these SPECIAL little ones and sent them to you.....
Never, Ever, doubt yourself.... Please...
love,
Cindy

My dear friends,
I feel overwhelmed by your compliments and words, I can't find the right words to thank you for your encouragement.
Yes, I read a lot, try to remember and understand because I want to know what is going on and what could happen to my cats, and I want to understand and keep the pace with the vets when they talk to me.
I can't deny that more than one vet has asked me if I'm a doctor and how I do know so many things, terms and procedures. Two of them had asked me if I wanted a job as a vet assistant I do hope they were joking! Taking care of a pet's life isn't a joke and requires much more than a passion and some basic information found on the web.

artiemom , I always thought that someone has sent me my cats because they were in special needs. As I had written in my tribute threads for Tom and Leo on their anniversaries, I felt that they were given to me for a reason. Nevertheless I couldn't save them...

foxden , thanks for following me and telling me that you have learned some things from me, but I do have learned twice as much from TCS, I read nearly every new thread to try and learn new things.

So it's me that has to thank you all for being an incredible source of knowledge!

 

[Antonio65]

This vet has an open mind; he is willing to listen, explore alternative treatments, and "think outside the box".
You have found a "keeper"!

I hope he is, so far I haven't heard from him yet... Still waiting to get the reports and his comments on them and the new meds Pallina needs.
I do hope he contacts me today, before 5 pm... I'm planning to call him around 4 pm.
Tomorrow is a religious holiday here, then Saturday (the new vet is closed on Saturdays) and Sunday.
My pharmacy can get last order at 5 pm to be able to have a prescription med ready before 7 pm, they close at 7:30 pm, like all shops in Italy. This pharmacy is small sized, but generally has almost all meds, especially for vet use. In the case they don't have something, they can order it and have it in 2 hours time.
The pharmacy is open on Sat too, but I fear that because this Sat is "pinched" between two holidays, they caould have a reduced service.
We have a thing here, we call it "the bridge", when a working day is between two holidays (a holiday and a Sunday or vice versa) most people do not work on the day in-between, so making "a bridge"

I am glad he thinks the liver issue of not of high concern at the moment. It is good he is giving you a sample of supplement similar to Denamarin.

Yes, he said to give Pallina both supplements, the one I'm already giving her and the new one.
He said that in order to consider a condition as pathologic, the values should be three times higher than the max, so if a range is 10-70, it will be pathologic if the level is 210.

The lung issue sounds similar to a pulmonary fibrosis. No doubt there is a degree of inflammation present, so a cortisone should be helpful. They tend to promote fluid retention, so no doubt your vet wants to research one which minimizes this effect.

Yes, it's a fibrosis, whose origins are still unknown, and probably they will remain so. Above all I hope it doesn't spread, or Pallina will suffocate

As for arthritis, many elderly cats suffer from this, especially in the hips. You might ask your vet about "Cosequin" which is a mix of glucosamine and chondroitin, two natural compounds derived from cartilage of animals which help decrease inflammation in the joint and replace lost cartilage.

Lola suffered from arthritis too... Poor sweet angel, she had an ailment for each letter of the alphabet
She would take two pills (well, 1/4 of each) daily similar to Cosequin (which she didn't like), they were CondroStress 3.0 and Alevica
Condrostress® (+) - Supporto del metabolismo articolare in corso di osteoartrite
Alevica® - Supporta la corretta funzione nocicettiva
both are made by an Italian brand and they were absolutely great in curing Lola's pains.

Now, as to your self-deprecating comment as to your fitness for caring for cats...I say you are BAD!

English is a funny language, full of contradictions, double or even triple meanings to the same word. There is "formal English" and there is "slang English".

I do love your language, you don't know how much I love it!!!
I keep learning it everyday.

The late pop singer Michael Jackson had a hit album entitled "BAD". It was #1 in 13 countries and got him 6 Grammy Award nominations of which he won two. This album sold 35 million copies worldwide and is one of the best selling albums of all times!

So just like this hit album--you are BAD--which really means AWESOME!

Alright, I missed this hidden meaning of this word