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Preparing For The End? How Far Should I Go With Diagnosing/treatment? Intestine, Heart, Lung Issues

Discussion in 'Cat Health' started by SambaLove, Jun 30, 2019.

  1. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
    Hello, cat loving friends
    I am hoping to gain some words of advice and support during this difficult time. I love my baby and it pains me to see her ill. Thank you for reading this account of her illness and grateful for any support/advice you can offer. Pictures at the end.

    Cat baby: Samba, Calico, 16.5 years old, has brightened my home since she was 6 weeks old.

    My cat has shown signs of being sick for 2 weeks now.
    She may have been presenting symptoms but I was too busy to notice. :(

    About 4 weeks ago, I noticed she urinated on my bed, which she has NEVER done. I figured she might be unhappy that her litter box wasn't as clean as it's normally been or I haven't been keeping up with cleaning her water fountain.

    2 weeks ago- She started vomiting and continued to vomit every 10- 20 minutes. When she started open mouth breathing after vomiting, I immediately took her to the vet. The vet diagnosed her with a UTI and send us home with antibiotics.

    To sum up the last 2 weeks:
    Symptoms:
    - She stopped eating for 4 days with only minimal water intake. She just licked her wet food and licked her water cup.
    - Noticeable fast or difficult breathing (AT TIMES but not while sleeping)
    - "Looking sad" and weak, slow walking at times
    - Curling up into a "sitting up" ball with the back of her hair standing (Is this a sign of pain?)
    - When she started eating 4 days later, very picky eater would only eat her canned food, only when it was a freshly opened can...would not eat refrigerated food or food warmed up in the microwave.
    Treatment
    - Subcutaneous fluids on 3 separate occasions
    - Anti-nausea meds during this time
    - Appetite stimulant
    - Antibiotics for UTI

    Test performed & Findings: Chest X-ray, Full Blood work, Urinalysis, and Ultrasound of the abdomen.
    - Diagnosis/Findings: Nodule in lungs, Heart Murmur, one Kidney significantly smaller than the other (perhaps only one kidney working), High Kidney values, and most a thickening in a section of her intestines, loss of boundaries of this intestinal track

    Follow up recommendations: An echocardiogram to assess the condition of her heart. A biopsy of her intestine to see if my cat has inflammatory bowel disease, small cell lymphoma, or malignant cancer. Possible treatment: Steroids to treat inflammatory bowel disease without the biopsy. *Vet recommends an echocardiogram to assess if the heart can tolerate the steroids first.

    Concerns:
    Is she in pain? How can I help alleviate her pain while we wait for her cardiologist appointment?
    Should I have her undergo further testing, surgical biopsies? Worried about causing her more discomfort and trauma with more vet visits.
    Biopsies and echocardiogram- Very expensive and could I even afford the treatment?
    Is her illness curable? How much more time would I be extending her life for?
    Should I focus on palliative care?
    IMG_5142.jpg IMG_5124.jpg IMG_5153.jpg IMG_5239.jpg IMG_5243.jpg IMG_5271.jpg
     
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  2. FeebysOwner

    FeebysOwner TCS Member Top Cat

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    Hi. Samba looks like such a sweetie. I am so sorry for all of her potential problems. Besides some obvious kidney issues, did the rest of her bloodwork come out OK? Does the vet have any idea what might be the source of her pain? You can always ask if there is some mild pain relief they could give her.

    It would appear that she might be experiencing some pain. But, she is still eating, so that is a good sign. As far as the food, when you open a can, could you put the remaining portions in a baggie or a sealed plastic container to be refrigerated for later use? Then set the remaining portion in a saucer of warm-to-hot water just to take the chill off. See if that replicates a fresh opened can. If not, get some Gerber baby food meats (no garlic/onion/etc.) and mix that with the left over canned food.

    Is she using the litter box OK? Has she stopped vomiting? Is her breathing better?

    I'd keep her eating whatever you can get her to eat - as well as drinking as much as possible since she has had to have sub-q fluids. You could add a bit of canned tuna water to her water to help entice her to drink. Or, you can learn how to give sub-q fluids to her and continue with that if the vet thinks that will help.

    If it were me, I would get her the echocardiogram to see if she can handle some steroids, and forgo the biopsy for now.

    Bless her sweet heart - and you! Please keep us posted.
     
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  3. denice

    denice Advisor Staff Member Advisor

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    What a sweet looking cat. I agree with getting the echocadiogram and foregoing the biopsy. Knowing where you are at with her heart would help both with the steroid and giving fluids on a regular basis. How long before she can get in for the heart check?
     

  4. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
    Hi denice,
    I find out about how soon I can get in on Monday. I hear the earliest appointment for an echocardiogram is on 2-3 weeks. Why do suggest forgoing the biopsy?Thank you so much for your supportive message.
     
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  5. FeebysOwner

    FeebysOwner TCS Member Top Cat

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    I think the reason is because if the echo shows Samba can handle the steroids, she would be in a better position to maybe entertain a biopsy thereafter.
     
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  6. LTS3

    LTS3 TCS Member Staff Member Forum Helper

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    IBD is certainly treatable:agree: Many people opt to just treat for IBD without doing an expensive biopsy. Steroids would help with the inflammation. Other medicines may be needed until the symptoms are controlled. Anti-nausea such as Cerenia, antibiotics, antacids, appetite stimulant, etc. The vet will determine what would be best for your cat. Diet will definitely help. What are you currently feeding your cat?

    Here's some inf on IBD:

    IBDKitties – Helping Save Lives…One Paw at a Time
    Feline IBD
     
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  7. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
    Hi FeebysOwner,

    Thank you so much for your advice and suggestions!! I greatly appreciate it.

    She is using the litter box regularly, or more regularly now. Finally seeing stool in the litter, the first time in 2 weeks today. She vomited twice since she stopped 2 weeks ago. She seemed to be in pain after using the litter box today.
    Also, she is drinking water and her breathing seems to slow/stabilize/normalize a bit when she sleeps but deep and fast when awake most of the time.

    She is also eating again...only wet food and only a little at a time.

    Why do you suggest forgoing the biopsy? Not only is it expensive, $2,000-$5,000 but also would it provide information about what steps I could do next? I am confused. I want to do the best for her...

    Bless you for your kind words and support.

    Samba's mom
     
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  8. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
    My vet said that if I start her on steroids, a biopsy later would not provide accurate results of what is going on in her intestine...so if her heart can handle steroids, a biopsy later would not be advisable.- according to my vet. Have you heard anything like this before?
     
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  9. FeebysOwner

    FeebysOwner TCS Member Top Cat

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    Yes, I have heard that before, tbh. Ask your vet how long after the steroids that the biopsy would be viable. I have also heard that with short term steroids, a biopsy can be done after a period of time and not have the steroids affect the results.

    I think wherever the pain is coming from is causing some of her issues - like the breathing and even diminished eating. Not to make things any worse, but could some of her pain be from arthritis? Especially since you mentioned it after she used her litter box. Also, how was her stool? It is very curious that she hasn't produced much for nearly two weeks?? Maybe, not arthritis, but some constipation??

    I would also ask your vet about ways to treat this as IBD if you choose to do steroids. If it is IBD and not lymphoma, you would have a running jump on resolving things for her while you wait for the steroids to 'wear off'.

    Take a look at the info that @LTS3 provided about IBD. If nothing else, it would help you to raise questions to your vet about options.
     
    Last edited: Jun 30, 2019
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  10. daftcat75

    daftcat75 TCS Member Top Cat

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    It sounds like the vet wants to check her heart, then decide a course for her gut. If her heart appointment can’t happen in 2-3 weeks, then neither can steroids or a biopsy. So what to do for 2 to 3 weeks?

    I recommend reading this page. Jump ahead to the part about diet and ibd or even the Introductory Diet section. Read the page a few times. It’s meaty. Try the meat stock to heal and seal her gut. Perhaps you transition to a raw diet. Or perhaps it won’t be needed. You may make the steroids and biopsy unnecessary.

    https://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment

    “If it is not clear if the cat has IBD, food allergies or food intolerances, then the introductory diet is suggested in order to heal and seal their gut lining. The reason food allergies and food intolerances occur is due to what is called a "leaky gut," when the gut lining has been damaged by abnormal microflora.¹⁵ Foods do not get the chance to be digested properly before they get absorbed into the bloodstream through the damaged gut lining, and cause the immune system to react to them. Trying to identify which foods your cat reacts to is likely to be impossible. Foods leaked into the blood when only partially digested may cause an immediate reaction or a delayed reaction a day, a few days or even a couple of weeks later. As these reactions overlap, you can never be sure exactly what the cat is reacting to. Testing for food allergies is notoriously unreliable.¹⁶ As long as the gut wall is damaged and stays damaged, you can juggle the diet forever and get nowhere.

    From my clinical experience, it is best to concentrate on healing the gut with an introductory diet. Once the gut wall is healed, foods will be properly digested before being absorbed, which will remove most food intolerances and allergies.”
     
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  11. jcat

    jcat Mo(w)gli's can opener Staff Member Moderator

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    If it were my 16-year-old cat experiencing multiple health issues, that's what I'd do, rather than subjecting her to the stress of multiple tests and medications. At that age, quality of life trumps quantity, IMO.
     
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  12. daftcat75

    daftcat75 TCS Member Top Cat

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    If she's eating again and using the litterbox, none of this sounds hopeless.

    She probably is in pain from some of what you describe. But where? I'm not sure. Ask the vet if you can get a small prescription for buprenorphine. If you have a compounding pharmacy nearby, get that converted to a transdermal gel. It will be so much easier than the buccal (cheek) liquid that has to be absorbed in the cheek and not swallowed. If Samba looks more comfortable, returns to more of her old self after a couple of bupe doses, then you know she is in pain.

    Was pancreatitis tested for? It's a non-standard blood test, usually Spec fPLI, and usually you have to ask for it because a lot of vets overlook this or don't immediately suspect it. Your treatment becomes a lot more urgent if she has pancreatitis as that disease process is actively damaging the pancreas and affecting her quality and quantity of life on a meal by meal basis. It's also painful and could be the source of the pain. Call the vet and ask if this was tested. If not, take her back in to get this tested. This is not one to be overlooked.

    IBD or lymphoma? Since the biopsy is invasive and will come with a recovery time, I prefer to assume IBD, begin treating that, and if you're getting nowhere on that, then you can try the lymphoma treatment. I also believe IBD can be treated without steroids. See the introductory diet I posted above. Heal and seal the gut with a nutritious meat stock and then it's up to you if you want to continue with a raw food diet. You have two or three weeks until the heart appointment before you can even look at steroids. Take this time to make the steroids not necessary.

    As for the kidneys, I don't know enough about kidney disease to comment on this one. Though I have heard from others on these forums that cats with kidney disease can continue to live for many years with the disease well-managed through diet and fluids (extra moisture in the fluid and subcutaneous when needed.)

    I'm not a vet but my plan for Samba would be:

    1. Call the vet and ask whether pancreatitis was tested. Get this tested. If she has this, this changes your priorities. Pancreatitis becomes priority 1.
    2. Ask for a small amount of buprenorphine and compound it into a gel if you have a compounding pharmacy nearby. Do this with your vet's support. If Samba is in pain, you'll need to come up with a more long-term solution.
    3. Make a meat stock by simmering meaty bones in a stock pot with water for several hours. Tap the marrow out of the bone. Remove the meat and bone from the stock but retain the liquid especially the fatty and gel-like bits. Feed this to Samba over several days until her vomiting clears up. The link I posted above gives more details about how and how long.
    4. I can't make any recommendations on the kidneys. I don't have enough knowledge or experience there. If she's eating dry, I'd discontinue that. I would also add a little extra warm water to whatever wet you are giving to get more moisture in her. I would also change her feeding schedule to more meals of a smaller size. This has the benefit of keeping fresh moisture flowing through her kidneys more often. But it will also help her gut too. For cats with IBD (or digestive disorders), I would recommend smaller meals more often anyway.

    So there's a fair amount you can be doing for her today and while you are waiting for the heart appointment. In the absence of pancreatitis, my "I am not a vet!" guess is that the condition and eventual decline of her kidneys will probably be the limiting factor on quality and quantity of life here. This is what you should discuss with your vet. But there are also numerous resources for CKD cats that you can also explore to get educated and possibly other opinions.
    Starting here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat
     
    Last edited: Jul 1, 2019
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  13. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
    Hello DaftCat75!!!

    I am SOOO grateful for your suggestions and advice!!! Thanks a million!!!

    For pain: The vet recommended giving her small doses of this sedative: Gabapentin, 1/2 ml every 12 hours or as needed (she had prescribed this for her ultrasound since she was "difficult" to hold) After 2 days she seemed to be behaving a little more normal ...but still not behaving completely normally. I notice that right after I give it she "lays low" and possibly sleeps for a bit...but she still looks like she is in pain. Later in the evening, about 12 hours later, she seems to have more energy and hops up on things like she used to...

    Also different and noteworthy is: her hair is spiking up (like when a cat is scared) *Picture of this below. What could this mean? IMG_5239.jpg

    Feeding/Introductory Diet: I made the chicken stock according to your directions and the website you sent...but she is not eating it! :(

    She actually hasn't eaten it since I added it to her food bowl (over 14 hours ago but still drinking water) Any tips to get her to eat the introductory diet?
    I added some broth to her wet food in one bowl and some pieces of chicken with a bit of the marrow. She smelled it and wouldn't touch it...

    Thanks so much, DaftCat75! Your tips are so helpful!!

    Samba's Mom







    Was pancreatitis tested for? It's a non-standard blood test, usually Spec fPLI, and usually you have to ask for it because a lot of vets overlook this or don't immediately suspect it. Your treatment becomes a lot more urgent if she has pancreatitis as that disease process is actively damaging the pancreas and affecting her quality and quantity of life on a meal by meal basis. It's also painful and could be the source of the pain. Call the vet and ask if this was tested. If not, take her back in to get this tested. This is not one to be overlooked.

    IBD or lymphoma? See the introductory diet I posted above. Heal and seal the gut with a nutritious meat stock and then it's up to you if you want to continue with a raw food diet. You have two or three weeks until the heart appointment before you can even look at steroids. Take this time to make the steroids not necessary.

    As for the kidneys, I don't know enough about kidney disease to comment on this one. Though I have heard from others on these forums that cats with kidney disease can continue to live for many years with the disease well-managed through diet and fluids (extra moisture in the fluid and subcutaneous when needed.)

    I'm not a vet but my plan for Samba would be:

    1. Call the vet and ask whether pancreatitis was tested. Get this tested. If she has this, this changes your priorities. Pancreatitis becomes priority 1.
    2. Ask for a small amount of buprenorphine and compound it into a gel if you have a compounding pharmacy nearby. Do this with your vet's support. If Samba is in pain, you'll need to come up with a more long-term solution.
    3. Make a meat stock by simmering meaty bones in a stock pot with water for several hours. Tap the marrow out of the bone. Remove the meat and bone from the stock but retain the liquid especially the fatty and gel-like bits. Feed this to Samba over several days until her vomiting clears up. The link I posted above gives more details about how and how long.
    4. I can't make any recommendations on the kidneys. I don't have enough knowledge or experience there. If she's eating dry, I'd discontinue that. I would also add a little extra warm water to whatever wet you are giving to get more moisture in her. I would also change her feeding schedule to more meals of a smaller size. This has the benefit of keeping fresh moisture flowing through her kidneys more often. But it will also help her gut too. For cats with IBD (or digestive disorders), I would recommend smaller meals more often anyway.
     

  14. SambaLove

    SambaLove Thread Starter TCS Member Kitten

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    Jun 30, 2019
     

  15. daftcat75

    daftcat75 TCS Member Top Cat

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    IBD is pretty common in older cats but it can appear in younger cats too. There's just so many inappropriate food ingredients that get added to cat food that can wreak havoc on a cat's gut. Ultimately, it gets overrun with the wrong gut bacteria which changes the gut permeability ("leaky gut") and partially digested food proteins leak into the bloodstream. The immune system, never expecting to see these partially digested food proteins in the blood, mounts an attack against them and that's how IBD can lead to food allergies. The introductory diet is supposed to heal and seal the leaky gut.

    Can you try a fish stock? If you were previously idealogically opposed to feeding fish to cats, now's not the time for that. Feed her what she will eat to get her through this and then you can guide her back to a better diet when she's eating more freely on her own again.

    I haven't tried the introductory diet with Krista. Chicken and salmon are her two no-go proteins and she doesn't like beef. It didn't occur to me that I could make a turkey stock for her because at the time I didn't know that turkey was even a protein she could have. When I was getting Krista through IBD, I used products from these folks and mixed them into tuna based food (mostly Tiki Cat because they are free of a lot of the filler ingredients that were bothering her like the gums and thickeners):
    Vitality Science | Natural Remedies For Dogs And Cats

    They have great customer service and can help you with product selection if you wanted to go that route. But it may be hard to administer these if she's not eating.
     
    Last edited: Jul 2, 2019
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  16. Kflowers

    Kflowers TCS Member Top Cat

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    Hair spiking up can also occur when kit doesn't feel like grooming as much as usual. If you brush her, be careful to do it very gently until she puts on a little more weight.

    If the test won't effect the treatment plan, I would think you could wait to have them done.
     

  17. fionasmom

    fionasmom TCS Member Alpha Cat

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    You have to make the best decision you can for your baby, so this is based on my experience. Ask about any risk from anesthesia or anything that might be vaguely surgical, if it goes in that direction. I am in the palliative care group after two bad experiences with insisting on treatment for older cats ( and one dog years ago).
     
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  18. daftcat75

    daftcat75 TCS Member Top Cat

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    Btw, I don't believe gabapentin is strong enough pain relief. I believe it's more "pain don't give a f***" than actual relief. Another option you might ask your vet about is a fentanyl patch. It would give your cat 5 days of very effective pain relief. I don't know what it might do to her appetite though. It's an option to speak to your vet about. At this point, I would strongly recommend the pancreatitis test because pancreatitis left undetected and untreated can result in failure to digest food and inability to regulate blood sugar. Her recovery will be that much harder with EPI or diabetes. I think a prescription for an appetite stimulant and an anti-nausea drug may also be appropriate if she's not eating enough on her own. You can get mirtazipine formulated as a transdermal gel. I don't know if there is a transdermal option for anti-nausea. I had to get Krista through pancreatitis by pilling her or hiding it in food. It wasn't until very recently that I discovered the joys and ease of administration of transdermal meds.
     
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  19. LTS3

    LTS3 TCS Member Staff Member Forum Helper

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    A lot of IBD cats are super sensitive to chicken. Try feeding novel proteins like rabbit or venison. Bone broth can be made with any meat and bone. The cooked meat can be shredded and offered as a treat.

    If your cat isn't eating anything at all, ask the vet to prescribe an appetite stimulant and medicines to control the nausea and vomiting and digestive tract inflammation.

    The spiky hair is piloerection, kind of like goosebumps for people. It happens in cats who are not feeling well.
     
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  20. Purrrfectttales

    Purrrfectttales TCS Member Young Cat

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    I think a lot of your questions are very valid and well thought. I honestly think the best person to have that conversation with is the vet. Asking those ^^^ questions and discussing prognosis, pain, and treatment options with the vet will be much more helpful. I've personally seen some animals being kept alive in unsurvivable states due to a grieving owner. I know it is very difficult to let go but I think if it comes that time you may want to ask yourself are you doing this for her or for you?

    I had to go through this decision recently with a (human) family member. They were in a coma and the situation was not survivable. Personally, while it hurt very much to let go I know it was the right choice. She would not have wanted to be kept on a ventilator suffering just so that she could be "alive."
     
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