Update on Etta and the mysterious nodules/fluid in her abdomen still not sure

[laura mae]

Etta got her 2nd blood test today to see if the thyroid medication was at the right level. She was at one full tablet of methimazole. She initially was at 10.4 on the scale for hyper thyroid and now is at 3. So now it is 1 and 1/4 tab twice a day. She's been perky, social, eating well. Fights me on the medication. Loves her catnip, feisty and her goofy self. The 2nd set of blood test was good on the kidneys, but show troubling changes in hemoglobin, drop in red blood cells and increase in liver enzymes. She had a 10% drop in red blood cells. It was 30 and now 21. So no she has to take Pet-Tinic to up her iron levels.

She had initially been into the vet and then a specialist because she had fluid build up in her abdomen. She got an ultrasound at the specialist and they sent some of her abdominal fluid to a cytology lab for analysis. The non specific finding in the fluid was that it was "modified transudates." It was a pretty non-specific finding showing some activity on cells like neutrophis, mesothelial cells and macrophages. It wasn't activity that suggested "neoplasms" (cancer) but didn't rule it out. It wasn't likely FIP but they wouldn't rule it out. 

The ultrasound showed nodules on the omentum which could be cancer or irritation from whatever was causing her vessels to leak. The specialist suspects cancer and wanted to do an endoscopic biopsy ($3000). An open biopsy at the specialist would be $900 and at my regular vet $500. The only purpose would be to confirm or rule out cancer. I didn't want to do that and have her last weeks spent in pain from an open biopsy of her omentum (the fiberous net of tissue that holds internal organs together).

The specialist put her on prednisolone and pentoxifylline (trental or pentoxil) which is supposed to help blood flow more freely and make it less clotty and so less likely to leak and cause fluid build up. The prednisolone was for the inflammation evident in some of the interaction of the cells. I am at 2 weeks of 4 weeks of this combo of medication.

She also got atenolol for her fast heart beat. 

I did learn a ton about effusions between those tests and now. There was an article on DVM360 from 2009 Cytology of Effusions that explained what modified tranudates means. Basically the protein is a little higher and the cell count is a little higher. The fluid is a little cloudy but fairly clear, sort of orange because of blood. The cytologist thought that it was evidence of maybe a past hemerorrage. And it's on its way to be "exudate."

At that time they did a therapeutic drain of most of the abdominal fluid and took out 1281 ML of fluid. 

In these two weeks, she was getting more fluid in her abdomen but at a much slower rate. They removed 481 ML today. Not all of it so that it didn't screw up her electrolytes.

Her blood test wasn't so good. Hemoglobin low, liver enzymes went from 94 to 200 (but thought to be from the irritation of whatever is going on. Her red blood count is low. The good news is that her kidneys are good. 

The cell activity is similar to what was in the cytology report but now there is "wall to wall cells" and it's milky colored and no longer clear. 

My vet still thinks there is some sort of infectious thing going on because of the color of the fluid and the liver enzymes so she got a shot of covenia again. 

The vet doesn't know. I think to see what the cells look like would take sending the fluids to the special cytology lab again to see if the cells are of a particular shape. The very helpful proceedings paper I looked at talked about how different forms of cancer have different characteristics in the cells that they see.

I don't have the report from my regular vet. The specialist gave me all the paperwork which was helpful in some of the research I've been able to do. 

The pred and the pentoxil were compounded because pilling Etta is a challenge (and she's an easy cat). It's not super easy to get the liquids down her. I've taken to crushing up the atenolol and the methimazole and mixing with water and sucking it into a syringe to give her too because of her expert ability to spit out the pills. Tonight after crushing, I squirted out the dose of the pet tinic and then mixed and sucked it into the syringe so that she didn't have yet another medication to take.

Tonight she had 3 oz can of food with gusto followed up with a dessert of plain boiled chicken.  It's snack time so I'll give her some Natures Variety Lamb which she enjoys. It's all a mystery. I thought I'd update. If you are interested in the article I can post the link since abdominal fluids have affected other kitties too that isn't FIP.

 

 

[darkhorse321]

Hi Laura--I hope your kitty continues to improve.

Oddly enough, we had a kitty with this similar condition---her abdomen swelled with fluid and when drained, it had nodules in it. We never quite understood what was going on as this was the mid 90s. She was also ravenously hungry, but her kidney values were fine (she was 13).  They tested the fluid and the stuff in the fluid was protein I think?

We ended up having to put her down--she was having mild seizures, and very random issues and the sad reality was, she was deteriorating fast. She was dropping weight and could no longer get to the litter box, she'd pee in places she slept (We got her diapers to lay on). She was always a small kitty, and she dropped to skin and bones....within a 2 month span. I think today had this happened, she would have lived longer just given the advancement of vet medicine.

In the end, the vet did an autopsy to find out her liver was shot.  We didn't find out the root cause, but our kitty (a siamese) was the runt of her litter so he suspected it may have been under developed. 

Not sure if that can help your vet with any diagnostics. Today's vet medicine can offer way more than in 1994, but I figured sharing our story might help.

 

[laura mae]

Thanks. Yes, I think  that vets use a lot more people medications now with various cat conditions and there are years of experiences with it, plus newish experimental courses of action.  I suspect with Etta that we just have some additional time but not necessarily a different outcome. No one has said that this is some sort of infection that just needs to get better (although the high cell count suggests that something is infected maybe). She is very skinny now--I can feel her spine. I thought that was due to the thyroid issue, but it did happen very fast. She went from a robust cat to thin in a short time--which suggests something else.

 

[laura mae]

I feel like such a terrible cat guardian. My regular vet said " are you sure you don't want us to do exploratory surgery?" Because the fluid isn't going to disappear until the underlying condition is gone. But if it is cancer (which is the direction the specialist was leaning) I don't really want her spending her last weeks in pain from having had exploratory surgery.  And if it goes like all the other things so far, the results will be inconclusive.

The last blood test showed low hemoglobin and anemia. The pentoxifylline is something that helps blood flow more easily but I also saw that it was something that helped with anemia. I didn't get the lab test sheet, just a verbal run down of the outcome. Her abdominal fluid showed the same sort of cells that were in her first sample but "wall to wall cells." WHAT does that mean?  I hate this.

I am tired. On June 23, Etta's litter mate was put down because the vet found that she had an abdominal mass that was involving her intestines and her liver. From the time she showed signs of illness in her posture and her lack of appetite and her last day, she went down hill fast.  Their mother died of a tumor in her abdomen too ( she had been adopted by a friend).

Etta has re-acquired the fluid in her abdomen rather fast since my regular vet drained some of it. A lot more quickly than when the specialist did it. This is the 3rd week that she has been on the heavy duty dose of prednisolone and the pentoxifylline. She also on the thyroid medication and the atenolol. I only have a few more days of doses for the atenolol and the pred and pentox for 14 more days. The vet has added pet-tinic for the multivitamin to boost her iron and b vitamins. (I crush the thyroid medication and the atenolol  and mix it with her dose of the Pet-Tinic). She hates getting all the squirts of medication but puts up with it.

I'm finding that I think that vets often don't have a clue what the heck is going on and everything is a "let's try this and see if it works."  I have this sense that if I just chose a better vet, that somehow my kitties with their various challenges would have a better chance. I feel paralyzed by the choices of vets. Everyone has reviews now because of Google and Yelp. I think those stories are important but it doesn't help me feel better about the crap shoot quality of vet care.

 

[darkhorse321]

@Laura Mae  You are NOT a bad pet owner!!

Sadly, the reality may be your kitty has a tumor somewhere. My vet told me that littermates and families tend to have the same genetics and thus, same issues. Mom, other sibling both having masses/abdominal issues would likely imply the same for your beauty.

So , why put your kitty through that surgery? Can the vet guarantee your kitty will survive? That the surgery will improve the quality of life in your cat? If the answer is no, then there is no point.

How old is Edda? If she is young, then surgery would be an option due to her youth, but if she is an older kitty---it's just not something I think a vet should even suggest. I'm dealing with something similar wiht my boy right now, and my vets are excellent. We are doing what we can to find out what is wrong, but not going over board with testing because if we DO find out it's something worse, I'm not putting him through chemo or any sort of surgery to remove a mass. He's almost 17. I just want him to be happy and comfortable.

I feel your heartache. Believe me....

I would ask what you can do to make Edda comfortable. Controling pain, helping her eat etc.

 

[laura mae]

 
@Laura Mae  You are NOT a bad pet owner!!

Sadly, the reality may be your kitty has a tumor somewhere. My vet told me that littermates and families tend to have the same genetics and thus, same issues. Mom, other sibling both having masses/abdominal issues would likely imply the same for your beauty.

So , why put your kitty through that surgery? Can the vet guarantee your kitty will survive? That the surgery will improve the quality of life in your cat? If the answer is no, then there is no point.

How old is Edda? If she is young, then surgery would be an option due to her youth, but if she is an older kitty---it's just not something I think a vet should even suggest. I'm dealing with something similar wiht my boy right now, and my vets are excellent. We are doing what we can to find out what is wrong, but not going over board with testing because if we DO find out it's something worse, I'm not putting him through chemo or any sort of surgery to remove a mass. He's almost 17. I just want him to be happy and comfortable.

I feel your heartache. Believe me....

I would ask what you can do to make Edda comfortable. Controling pain, helping her eat etc.

It is likely a tumor. She had nodules on her omentum visible in the ultrasound.  It makes sense that families would have similar issues too.  Etta is 13 and is very underweight now. Bony spine and bony shoulders. She used to be chubby.  So I think not only would there be no improvement with surgery (because it is exploratory and not theraputic to resolve anything) I believe she might not survive it due to her anemia, light appetite and hyperthyroid . The hyperthyroid is getting under control now.

I'm of the same mind to not put her through too much. The prednisolone is helping with appetite. She loves Gerber meat baby food. I've ground up chicken for her too but that apparently isn't as tasty as Gerber's. 

She can't be on the pred and furosimide at the same time. So the fluid stays. Every time I prepare her medicines morning and evening, I hope like crazy it will help. 

I'm sorry about your kitty. Nothing worse than a friend who doesn't feel well.