Please help - cat seriously unwell

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Pixiecatuk

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A bit of background - Pixie is my (I think) nearly 8 years old female cat. She was a rescue and had two homes prior to me. I say I think because I’ve never been 100% sure about her age. She has always been a fussy eater from day one, and a bit of a sicky cat. Her weight has fluctuated over the years, but nothing of concern. She was otherwise healthy until April/May this year.
She started to lose weight and wasn’t eating a lot. This isn’t unusual, but she didn’t start eating properly again. It was a gradual process her losing weight and I eventually took her to the vets early June. My vet is a very experienced vet of 40 years now. He initially suspected an overactive thyroid. Took blood tests and all came back normal except raised globulin and albumin levels. Suspected either a lymphoma or IBD and started her on 5mg of prednisolone and recommended scans. The pred kick started her appetite almost immediately and she was back to her old self. Had scans done - X-ray and ultrasound. No masses etc found, but a slightly thickened stomach lining and bowel. She was okay until around first week of July. She stopped eating again, and although she is mostly a house cat due to a leg injury, she goes into my garden and would go out to eat grass then take herself back upstairs and hide in wardrobe. Vet suggested omaprazole, but unfortunately I couldn’t get the tablets in, so we put pred up to 10mg. Vet has been suspicious of dry FIP but not all symptoms correlate and the test isn’t conclusive. She hasn’t responded to the 10mg, and this has been brought back down to 5mg along with now metronidazole. She had her bloods repeated this week and everything is now normal including her globulin and albumin.
She now weighs only 3.45, is eating very minimal, and today she has started to have problems with her back legs and balance, although she has perked up this evening and the leg issues aren’t so bad.
I honestly don’t know what to do. She is otherwise happy, her eyes are bright, her fur is healthy, her teeth are good, she’s still drinking etc but she’s lethargic and quiet. The vet has offered another scan free of charge to look at the thickened stomach lining again, but I don’t know if I want to do this if it’s not going to give me a conclusive answer as she seems frail. Vet is also hesitant to do biopsies as it’s so invasive and if it is lymphoma or IBD she is already on steroids which is usually first line of treatment.
I am desperate here. My dad died 6 years ago at my parents house when I was living there. I didn’t want to come home as it just reminded me of his death, I then got her and wanted to come home. She is my saviour and I don’t know what I will do without her. I’m not going to be cruel and keep her going for my own sake if she can’t move properly, but I think I would find this easier to process if I knew what it was. My vet is just a dumbfounded as I am and we’ve called her the ‘symptomless cat’ as apart from the not eating, there’s nothing wrong with her. Can anyone give me any ideas as to what it could be? Thank you.
 

daftcat75

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I would not call her symptom-less. She has the hallmark symptom of lymphoma: relentless weight-loss. Even when she was eating with the pred, she was probably still losing weight. Please ask this vet if you can start chemotherapy (brand name: Leukeran, generic: chlorambucil) with her. It's not as scary as it sounds. Cats tolerate chemo much better than people do. Most experience very mild side effects if they experience any at all. My Krista slept a little more on dosing days; not hiding, just sleeping in her normal comfy spots a bit more than other days. That was all I ever noticed as far as side effects.

Your vet might be hesitant to prescribe chemo without a biopsy. But she's not a good candidate for a biopsy--too small, too frail. I had to make this same argument to my vet when Krista was not responding to pred alone. I spelled it out like this:
Since she is not responding to pred alone, as I see it, we have three choices going forward:
1. Do nothing. Clearly that's a horrible choice and doesn't even need discussion.
2. More pred. Pred is difficult enough on a healthy cat. She is not a healthy cat. And if more pred doesn't work?
3. Surgical biopsy. She's a terrible candidate for surgery, especially one that will come with a recovery period and more weight loss.
4. Chemotherapy without a cancer diagnosis. In this case, the drug is less risk than the diagnosis. We should know soon enough if she responds to it. I can bring her in for follow ups to monitor for long-term side effects.
Fortunately, the vet agreed with me and we went with #4. She achieved partial remission nearly overnight. In her case, besides the weight loss, liquid poops were her main symptom. Her poops firmed up in one or two doses. But we battled what I called "poop nonsense" for many more months because I was using one of her inflammation trigger foods to get her pred in her. 🤦‍♂️ Later, a severe ear infection (probably from months of eating a trigger food with her pred) and the surgery required to correct it forced my hand into changing how she got her pred. I had it compounded into transdermal. Without the nightly trigger food, her remission was immediate and finally complete. Sadly, she was far too weak and small at this point. A bladder infection would prove too much for her the next month. Even with my "devil's bargain" (using a trigger food to medicate her), I still believe the chemo extended her life and gave her a better quality of life--for as long as she had. And because you say yours doesn't have any other butt or gut symptoms, then perhaps there are no trigger foods you have to worry about like we did. Perhaps your girl will achieve an immediate and complete remission that Krista and I had to struggle too long for.

I recommend having both the pred and the chlorambucil compounded since compliance is extremely important with both medications. I had the pred compounded into the Twist-a-dose transdermal gel pen. Each full twist on the pen was 2.5 mg of pred. This made it easy to dose up or down as needed and prescribed. For the chlorambucil, I had that one compounded into an anchovy-flavored oil. I also had it concentrated to the highest concentration they sell. That meant that instead of trying to get 1 mL of oil into Krista, with a 10X concentration, I only had to dose out 0.1 mL. I mixed this tiny amount of oil into an equally tiny amount of salmon oil and Krista happily made that fishy oil medicine puddle disappear. Then she got a meal directly after that. We started with twice weekly dosing and moved to a much larger dose every other week. Studies and practice have shown good results with both dosing protocols.

I used Wedgewood for compounding the medicines. You will create a customer and cat profile on Wedgewood. Your vet will call or fax in the prescription. Wedgewood will call you and you can choose the formulations for the prescriptions. You can even speak with a pharmacist if the tech cannot answer your question.
Veterinary Pharmacy

Your cat will likely also need B12 shots to help her re-gain weight. And if her appetite is still soft, she should get subcutaneous fluids so she doesn't get dehydrated. Both of these you can do yourself at home if it's not convenient to bring her down to the vet office. You just need the prescriptions and the equipment which the vet can either sell you or tell you where to buy yourself. A vet tech can show you how to give subQ fluids and shots.
 
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LTS3

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You can seek out another vet for a second opinion. A veterinary internal medicine specialist is ideal. Your current vet has the ability to consult with other vets and with veterinary schools for a consult to get more ideas on what your cat's issue might be. Ask your vet to do this if it hasn't been done already.

She now weighs only 3.45,

Is that 3.45 lbs or kg?

What are you feeding your cat? Cats with IBD and other gastrointestinal issues often have sensitivities to various things commonly found in cat food.

Here's more info on IBD:

 

FeebysOwner

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Hi. I agree with all of the above! But, to add to things to pursue, I would also ask if any of the x-rays showed signs of arthritis given Pixie's old leg injury and her more recent mobility problems. If she is suffering from pain related to this, that can cause lessened appetite.

A good add-on food for some extra calories, although not 'cat nutritious', is plain baby food meats (Gerber Stage 2 or Beechnut). They are a simple food, and can add as much as 80-90 calories a day with a single jar. They are also great to use for getting a cat to take medications. Pills that can be crushed or liquid can be added to the baby food meat to entice Pixie. There are also a host of lickable treats that I also use with Feeby to get her to take her meds.
 
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Pixiecatuk

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Hi - thank you so much for your reply, and apologies for the delay in my reply. I'm recovering from surgery myself - when it rains it pours!

I think you are right re. lymphoma. I have thought this before as it seems to add up, and your girls story sounds similar to hers. I should have added that she has had some B12 shots now to help her. Over the weekend, she has mostly been hiding under the bed sleeping, but around 6/7pm she comes out and is sociable with us. She eats a few bits and also drinks a fair bit too, and last night she was in bed with me all night which was lovely. Her walking still isn't great, but she's mostly ok and seems to be able to go up/down stairs and jump on the bed and sofa.

I have an appointment tonight for her and I'm going to ask him if we can try the chlorambucil on her. I do think the metronidazole has helped her a bit too. I will keep you updated.

Thank you so much again for your reply.

I would not call her symptom-less. She has the hallmark symptom of lymphoma: relentless weight-loss. Even when she was eating with the pred, she was probably still losing weight. Please ask this vet if you can start chemotherapy (brand name: Leukeran, generic: chlorambucil) with her. It's not as scary as it sounds. Cats tolerate chemo much better than people do. Most experience very mild side effects if they experience any at all. My Krista slept a little more on dosing days; not hiding, just sleeping in her normal comfy spots a bit more than other days. That was all I ever noticed as far as side effects.

Your vet might be hesitant to prescribe chemo without a biopsy. But she's not a good candidate for a biopsy--too small, too frail. I had to make this same argument to my vet when Krista was not responding to pred alone. I spelled it out like this:


Fortunately, the vet agreed with me and we went with #4. She achieved partial remission nearly overnight. In her case, besides the weight loss, liquid poops were her main symptom. Her poops firmed up in one or two doses. But we battled what I called "poop nonsense" for many more months because I was using one of her inflammation trigger foods to get her pred in her. 🤦‍♂️ Later, a severe ear infection (probably from months of eating a trigger food with her pred) and the surgery required to correct it forced my hand into changing how she got her pred. I had it compounded into transdermal. Without the nightly trigger food, her remission was immediate and finally complete. Sadly, she was far too weak and small at this point. A bladder infection would prove too much for her the next month. Even with my "devil's bargain" (using a trigger food to medicate her), I still believe the chemo extended her life and gave her a better quality of life--for as long as she had. And because you say yours doesn't have any other butt or gut symptoms, then perhaps there are no trigger foods you have to worry about like we did. Perhaps your girl will achieve an immediate and complete remission that Krista and I had to struggle too long for.

I recommend having both the pred and the chlorambucil compounded since compliance is extremely important with both medications. I had the pred compounded into the Twist-a-dose transdermal gel pen. Each full twist on the pen was 2.5 mg of pred. This made it easy to dose up or down as needed and prescribed. For the chlorambucil, I had that one compounded into an anchovy-flavored oil. I also had it concentrated to the highest concentration they sell. That meant that instead of trying to get 1 mL of oil into Krista, with a 10X concentration, I only had to dose out 0.1 mL. I mixed this tiny amount of oil into an equally tiny amount of salmon oil and Krista happily made that fishy oil medicine puddle disappear. Then she got a meal directly after that. We started with twice weekly dosing and moved to a much larger dose every other week. Studies and practice have shown good results with both dosing protocols.

I used Wedgewood for compounding the medicines. You will create a customer and cat profile on Wedgewood. Your vet will call or fax in the prescription. Wedgewood will call you and you can choose the formulations for the prescriptions. You can even speak with a pharmacist if the tech cannot answer your question.
Veterinary Pharmacy

Your cat will likely also need B12 shots to help her re-gain weight. And if her appetite is still soft, she should get subcutaneous fluids so she doesn't get dehydrated. Both of these you can do yourself at home if it's not convenient to bring her down to the vet office. You just need the prescriptions and the equipment which the vet can either sell you or tell you where to buy yourself. A vet tech can show you how to give subQ fluids and shots.
 
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Pixiecatuk

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Thank you for your reply.

My vet has sent her bloods off and has consulted with a veterinary school in Glasgow (I'm in the UK), I will hopefully find out more this evening when I take her for an appointment.

Sorry - that is 3.45kg. Thank you for the link, I will have a good read. She's so fussy with food and always has been that I will try anything tbh!

Thank you again

You can seek out another vet for a second opinion. A veterinary internal medicine specialist is ideal. Your current vet has the ability to consult with other vets and with veterinary schools for a consult to get more ideas on what your cat's issue might be. Ask your vet to do this if it hasn't been done already.




Is that 3.45 lbs or kg?

What are you feeding your cat? Cats with IBD and other gastrointestinal issues often have sensitivities to various things commonly found in cat food.

Here's more info on IBD:

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Pixiecatuk

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Thank you for your reply.

Tbh I don't think the old injury is related. When she was a kitten (before I had her) she jumped off something and broke the head of her femur. It's never caused her any issues, and the issue seems to be coming from her back right leg rather than the left. I will ask tonight however about this.

Thank you for the suggestions for food too - I will get some baby food and see if she will try it. She's SO fussy, and always has been that it's a nightmare getting her to eat properly anyway, let alone when she isn't feeling great!

Thank you again.

Hi. I agree with all of the above! But, to add to things to pursue, I would also ask if any of the x-rays showed signs of arthritis given Pixie's old leg injury and her more recent mobility problems. If she is suffering from pain related to this, that can cause lessened appetite.

A good add-on food for some extra calories, although not 'cat nutritious', is plain baby food meats (Gerber Stage 2 or Beechnut). They are a simple food, and can add as much as 80-90 calories a day with a single jar. They are also great to use for getting a cat to take medications. Pills that can be crushed or liquid can be added to the baby food meat to entice Pixie. There are also a host of lickable treats that I also use with Feeby to get her to take her meds.
 
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Pixiecatuk

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Just a quick update on Pixie. I didn't mention in my original post that my vet initially suspected dry FIP, but as it's difficult to diagnose/the test is not 100% accurate it would be hard to say. I had planned to go in on Monday with her and ask for try chemo, but we had the test done last week and the result essentially said she had FIP without saying she definitely had it (as they can't say for sure).

Unfortunately on Tuesday she hugely deteriorated. She could barely walk, start to pee on the sofa/floor, stopped eating/drinking, and wouldn't move. I took her to the vets last night and she was gently put to sleep. I can't stop crying and I don't know how I'm going to move on from this. She was so precious to me, she was magical and just the perfect cat. My little best friend, we deserved more time together.
 

maggiemay

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I am so, so sorry for the loss of your little Pixie. You will be in my prayers. You lost someone you deeply loved and it hurts so much. Hugs, sweetie. You did her proud. You loved her enough to put her needs before your own, and that is truly what love is all about.
 

AbbysMom

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Oh behalf of the Cat Site Team, we are very sorry for your loss. :hugs: Threads are closed after such a loss as a sign of respect. If you feel up to it, please consider starting a memorial thread in our Crossing the Bridge forum.

Rest in peace, Pixie.
 
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