Weight Loss - Cancer? IBD? Euthanasia?

[DesperateMistrustful]

I’m going to try to keep this complicated history as brief as possible, I’m sorry it’s so long. I’ve had a lot of sick kitties over the years but I’ve never had a nightmare like this. I’ve been to every emergency clinic and hospital in the area. We don’t have a regular vet because I fired my last one after learning she declaws cats. I can’t even have a telemedicine appointment with a new one at this time because of VCPR and COVID-19. I am very mistrustful right now and just need to talk to someone even if they are on a freaking cat forum. I want anything that I can bring up with the surgeon tomorrow.

He’s a neutered indoor DSH about 12-years-old.

3/2

• presented to a 24/7 clinic for vomiting bile
• only weighed 11.6lbs which we didn’t notice visually (he’s typically 13-14lbs)
• bloodwork normal
• x-rays revealed incidentally full bowels and a thoracic mass, presumed cancerous. referred to 24/7 hospital #1

3/13 - appointment with hospital #1

• weight loss was rapid and significant since 3/2
• internal medicine specialist noted a heart murmur but echocardiogram deemed him fit for surgery
• abdominal ultrasound revealed a pyloric mass
• surgeon performed an exploratory celiotomy with complete excision of the pyloric mass, no signs of metastasis. histopathology later determined it was a benign leiomyoma. surgeon suspects the mass caused the vomiting but not the weight loss. he continued to suspect the chest mass for cancer/cachexia despite it possibly being an enlarged lymph node.

3/14

• returned home with buprenorphine 0.2ml
• ate normally and started to recover

3/15

• food was rejected, returned to hospital. no abdominal fluid detected.
  • subcutaneous LRS
  • cerenia
  • mirtazapine
• that night he had very loud, gurgling stomach sounds

3/16

• clearly uncomfortable and vomited blood, returned to hospital. he was almost sent home to die until we asked for an ultrasound. ultrasound revealed very large amount of abdominal fluid and a distended stomach.
• hospitalization began for postoperative ileus
  • IVF
  • NG tube placement and aspiration (300ml of fluid)
  • cerenia
  • metoclopramide
  • protonix
  • buprenorphine

3/20

• after research I suspected buprenorphine could be causing the ileus. I had no idea why he was still on it when it should have ended much earlier ($). I called to take him off but the ER vet had the same idea and did it on 3/19.
• he started getting walks around the building to try to stimulate GI
• hearty appetite but no drainage, had to be aspirated every 12 hours

3/22

• aspiration was stopped for 24 hours to, from what I understand, “see what happens.” he vomited up the NG tube.

3/23

• surgery to determine if it was mechanical ileus or otherwise. that morning I rescinded the DNR for the surgery and insisted we see him beforehand despite quarantine measures, surgeon agreed. when we arrived the surgeon told us he’d already started surgery, woopsie, but also his heart had stopped. when they began intubation he vomited, urinated and entered cardiac arrest
• they successfully resuscitated him
• surgery continued and revealed pyloric obstruction, surgeon installed a bypass instead of a j-tube
• surgeon noted spots on liver that weren’t there before (no kidding, he hasn’t had nutrition in 2 weeks). took biopsies of liver, pancreas, small intestines and stomach again.
  • results recently showed no cancer, no pancreatic issues, but extreme inflammation of the small intestine. no treatment recommended “unless necessary”
• would not eat or drink post-surgery

3/26

• continued to not eat/drink. they suggested I force feed him with a syringe and advised against another NG tube. there was fluid in his stomach on ultrasound. I asked how there could be fluid in his stomach with a bypass, some vet I had never even spoken to just said, “yeah that can happen”
• they discharged him (without any discharge papers) despite all of the above. he was very weak and lethargic, stumbled, couldn’t make it to the bathroom.

3/27

• admitted to hospital #2. he was dehydrated, low potassium, low vitamin B
  • NG tube placement (no anesthetic necessary), aspiration of 30ml of fluid
  • liquid food/fluid therapy/IV
  • metoclopramide
  • vitamin B12
  • vitamin B complex
  • cerenia

3/29

• started to eat again, dry and wet
• had a bowel movement(!)

3/30

• discharged from hospital #2 with much more energy

So here’s where we are now. He’s eating very small meals throughout the day but they don’t even amount to a full can of wet food. It seems he’s having difficulty chewing or swallowing which isn’t surprising considering how many tubes have been down his throat. He’s drinking, though I would say less than normal, and urinating. No bowel movement yet.

He presented to hospital #2 at 9.4lbs, he weighed 8.8lbs yesterday, he weighs 9lbs today (I feel like that’s just poop). He lost 2.6lbs total in March. I believe they chased this cancer diagnosis to make money. NO ONE has mentioned hyperthyroidism and whether they’ve checked for it on bloodwork, though from my 3/2 bill it seems the clinic did a T4 slide. NO ONE has said anything about malabsorbtion. NO ONE mentioned IBD until the small intestine biopsy results despite knowing he had history of soft stool. Sure, he could have cancer, but I’m not touching that chest mass no matter what it is--I’m not putting him through anything else--so why don’t we try medication as a last resort on getting his weight back up?

I will be calling the surgeon tomorrow to discuss IBD/hyperthyroidism but if anyone else has suggestions I’m all ears. This is my last shot. I’ve made sure an in-home euthanasia vet is available during the crisis; if he loses anymore weight he’s just going to fade away to nothing. He’s fought so hard and came back to life only for me to put him down days later? Really?

P.S.: I’m leaving out incredibly egregious things that occurred with both hospitals. I think I have a malpractice suit, that is how much I don’t trust hospital #1 or this surgeon. Hospital #2 saved his life but they don’t want anything to do with this, they’re very avoidant about even discussing it. The clinic also won’t discuss anything with me unless I schedule an appointment and bring him in again for no reason ($). I’ve requested his records multiple times from the clinic, they say they’ll send them and never do. I’ve requested his records from hospital #1, they won’t give me anything past 3/19 and claim it doesn’t exist. I said, “No records or notes exist on his second surgery, his cardiac arrest, his nine day hospital stay, his biopsies...?” The receptionist said yes. I said that’s just not possible and she hung up on me. If I were to reveal all the details of this story you would not even believe me, I barely do when I lay it all out. I have nowhere else to go.

 

[Furballsmom]

This link will take you to a site that has a search engine to find a cat-only vet in your area.
Find a Veterinarian and Practice | The Cat Community

Maybe there's something here that might help;

Remote Access to Veterinary Consultation Services Now Available
Best Friends is offering free veterinary consultations for 30 days through our Best Friends Vet Access app when you use the code BFHELPS.
If you need medical advice for your pet but are unable to reach or visit a local veterinarian, please take advantage of this temporarily free service. Calls can be recorded and the service is available 24 hours a day. Please note, the code BFHELPS is valid for 30 days, and the service is $12.99 after that unless cancelled.
Download the app for free.

Here is something that also might help;
Some articles to help you choose the best veterinarian for you.

How To Choose The Best Veterinarian For My Cat?

How To Talk To Your Vet

Or. maybe a university medical veterinarian department can be of help to you if you are able to contact someone.

 

[Mamanyt1953]

Furballsmom gave you excellent advice on finding someone who might be of help, even in this current crisis, especially with a very ill cat, who should be considered an emergency.

I wish I could be of more help for him medically, but...I'm not a vet, and this is what is needed. Just ONE vet you can trust. THAT vet could almost certainly get the records that "don't exist."

Meantime, there is an organization that deals with veterinary malpractice. Now, MOST of their work is with pets who have died as a result, but they're caring, and they are good, and they are connected to attorneys in almost EVERY state. If you want to pursue this, or just to tell your story, they can be reached through joeyslegacy.org. I know the founder, and he's a terrific, motivated man.

Please let us know what you can find out, and how your precious cat is doing. The fact that he is eating on his own at all is somewhat heartening.

 

[DesperateMistrustful]

That cat-only vet link had two results, a vet (who also sees dogs) who I wouldn't see again and another who has reviews about how he doesn't see aggressive cats without freaking out and tranquilizing them. Even though that doesn't apply here I'm appalled to even read that. I don't know what's wrong with this city's veterinary practices. I know with enough bad experiences it becomes you, not them, so maybe I'm asking for too much to want a vet who actually cares about animals.

That app link surprised and excited me, I didn't know VCPR laws were by state. I would have been blindly contacting vets for paid consults in states that aren't under any if I had known. I signed up and talked to someone who made me feel even worse. He asked if anything came up in bloodwork, I was told it was "normal" but I don't know exactly what they checked since no one will give me the records. He reiterated that I can ask for records and send them anywhere I want to go, I repeated that I've asked for records multiple times and there's nowhere else to go right now. He said is there anything else I can help you with? You didn't help me with anything! But he did confirm that if my boy has IBD and is undergoing treatment for it then he wouldn't be losing weight. So again, I will call this awful hospital about it tomorrow.

The only times he hasn't had an appetite were when his stomach was full of abdominal fluid. I don't know if I have the wherewithal to pursue a legal battle and certainly not while I'm still working with them but I may look into that in the future. Thanks to both of you very much for trying and responding to me. I've felt like I'm one step away from a complete mental breakdown for multiple steps now.

 

[Furballsmom]

Thanks to both of you very much for trying and responding to me.

 

[Jcatbird]

Any pyloric muscle overgrowth? Did that get suggested? FIP? What are hormone levels. Cushing s mentioned? Hepatitis, Cirrhosis, kidney issues can all cause fluids in the abdomen. There are so many possibilities here besides Cancer. So many things cause abdominal bloating or fluids. Kitty eats? Gets better? Any suggestions about reducing sodium.
No pneumonia? Blood in the abdomen can be Mallory Weiss tear ,lesions can form. Would that resemble a mass? Maybe seeing if you can get some of these questions answered and buy kitty some healing time after all the tubes.
I know you fired your previous vet for a very good reason but in this case, you must have trusted them before learning of the declawing. Can you appeal to that vet? I know that may be difficult but saving kitty is primary objective. I discovered the declawing with my vet but approached it by discussing the adverse results in the waiting room so that less patients would request it. Also asked vet provide claw caps for sale in the office/ educate patients about serious side effects and suggest alternatives like providing cats scratching posts for sale. In time it worked. My vet now sells alternatives. ( I also dropped flyers and brochures in the waiting room. It’s a wonder they didn’t boot me out but ,turned out, the vet really didn’t want to do that surgery. It was a patient request and income issues)
If you can’t appeal to your previous vet, call a medical college. I don’t know where you are but I got good information from a veterinary school. Call any one you can get even if not in your state.
Merck Vetrinary manual may help you research with the info you have. Any clue you find could lead you to help.
I often resort , out of desperation, to doing google searches to lead me to clues.

I am reading of chest mass, suggestion of hypothyroidism but no definitive answer on either. I am so sorry that I am not a vet so I can’t answer you or really be of help to you but try to have hope and keep trying to find someone, somewhere to answer with clarity. You and your kitty deserve answers. I know you are probably exhausted by now but email, text, call everywhere. Any vet that will respond no matter where they are. If possible, try not to let the suspected malpractice issues in your mind come to light, just your great love and desperation to help your baby. The current state of our world and difficulty in finding help can be your reason for reaching far and wide for information. True enough. Did you try the Bestfriends link? I have had one on one conversations with reps about other matters and found them a great resource. I have not tried the vet link but I hope you can get help. Our hearts and all hope are with you.

 

[DesperateMistrustful]

No pyloric muscle overgrowth was mentioned unless that's why the surgeon couldn't pass anything through the pyloric valve in the second exploratory surgery. The abdominal fluid and pyloric issue only appeared after the first surgery; the surgeon claims (and I agree) that it was a complication of resecting the pyloric mass. My boy only stopped eating after the fluid accumulated and made him feel full. He had a good appetite beforehand but was still losing weight. He's now constantly eating small meals that probably only amount to less than 100 calories a day. The fluid issue seems to finally be resolved with the bypass but it leaves us with the original problem, weight loss, as well as this new appetite and lack of bowel movement. I'm sure he doesn't have FIP. No talk of anything else you mentioned or I simply have no idea if they checked for it.

I privately emailed that vet and strongly urged her to reconsider declawing, that it would actually be more beneficial financially to take a stance against it if that was her concern. She didn't reply to me except to remove the advertisement for it from her site but forgot to take it off Facebook. I left some honest reviews. We only saw her once. Before that I used the clinic that won't talk to me unless I bring him in again.

Thank you for all your advice and time. The chest mass potentially being indicative of hypothyroidism is very interesting. The app was depressing but I've found a list of states that don't require a veterinarian-client-patient relationship and will reach out to both colleges and individual vets in those areas. Willing myself to wake up and fight hard for him tomorrow.

 

[amandag1]

Im so sorry this has been such a difficult time for you and your kitty.
I can sense your desperation and see that youve really done everything for him.
Have you tried different smelly fancy feast canned foods, lickable treats/stews, broths etc?
Sprinkling crushed temptation treats or freeze dried liver on top of his canned food?
Can you ask a vet for mirataz- an ointment transdermal version of mirtazepine ?

 

[DesperateMistrustful]

He's had so many different flavors of wet food that he became picky and stopped eating dry food. He also gets sick of the flavors very quickly and sits there waiting so I open something new but he typically rejects it. He eats best if I don't warm it up and just pile it into a mountain so I really suspect this mouth/throat(?) thing might be what's causing the lack of appetite, that or constipation. When he first came home he only licked at food so I mashed up chunks in gravy and added water, he liked that. Now he prefers pate. I wish I could describe what he's doing. He makes loud chomping, gnashing sounds and he has to turn his head sometimes to swallow. Most of the food falls out of his mouth. He's missing almost all of his teeth (from tooth resorption surgery) but this is noticeably different than usual.

I have mirtazapine tablets leftover from one of his earlier trips. I've thought about giving him one but throughout this entire process he's been very clear in telling us something's wrong and I'm afraid to mask it or make it worse. When they gave it to him he was very hungry but couldn't eat. Haha I'm clearly way too close to this to judge what he needs.

 

[Furballsmom]

Can you handfeed him? Try putting a little pate style food onto the end of a popsicle stick, open his mouth by gently pressing at the hinge of his jaw and scoop the food onto his tongue.

Can you look at things here to see if there's anything that might help? Foods to try and get more nutrition into him?

Any Good Tips To Get Your Cats To Eat? Share Them Here!

 

[DesperateMistrustful]

He doesn't like handfeeding and he really is making an effort to eat. If he starts walking away I follow him and put the food in front of him again, he takes another bite for me. We repeat that process until he leaves the kitchen. He knows he should eat and constantly acts like he wants to eat but then it's just not appealing. I don't see any signs of nausea.

He finally had a bowel movement just now! Most of it was dark and firm. He's definitely constipated and straining in pain but it's very heartening to see. I tried to give him some pumpkin puree, he wouldn't even lick it. More and more I'm thinking constipation/gastro pain is the entire reason for his lack of appetite. I guess we should tackle that first and then focus on unexplained weight loss but I just worry that we're running out of time. He's 8lbs 15oz today but that 1oz loss could have been the poop. I'm tempted to weigh it haha.

I've been waiting all morning for the surgeon to return my call. I have places lined up to contact for remote consultations but I wanted to hear what he says first. Maybe I should just go ahead.

 

[Furballsmom]

He doesn't like handfeeding

Mine doesn't either, but he needs it

 

[DesperateMistrustful]

The surgeon said food can cause inflammation of the intestines. I pointed out he hadn't had food for over a week when the biopsy was taken but he said it doesn't go away that quickly. His focus has been on getting him well since he's been through so much. He's concerned that maybe there's something in his mouth causing discomfort, it could also be an ulcer. I'll investigate his mouth later today for any sores. I informed him of his weight and said I was worried he's running out of time, he said it won't be that fast if he's still eating despite how little he's eating. I will give him mirtazepine tomorrow night if there are no improvements. I brought up malabsorption and IBD, he said he'll call me back next week after talking to the internist about whether we should treat his potential IBD right now. He brought up diet changes but the goal right now is just to make him eat. Recovery from everything he's been through can take up to a month.

Now, as if this story could not get more insane, I asked if his thyroid was ever checked. He looked back in all of the forwarded clinic records and said no, there's no record of a T4 panel. He agreed that would be a good thing to find out. I called the clinic in confusion since as I stated before, it was on my bill from 3/2. I was on hold a long time because they couldn't find the results. IT WAS NEVER PERFORMED. They charged me $58 and never did it, never mentioned it! How in the world could someone less knowledgeable or attentive navigate this situation? How could any "normal" cat guardian make sure their cat is getting the care they need? I'm so sad and angry. This is such a disgrace.

They offered a refund, I said I still want it done. We have an appointment for tomorrow afternoon. I really don't want to take him anywhere but I think this is something we should find out as soon as possible. I'm probably being selfish since I'm desperate for answers and at least this way I'll be able to talk to a new vet. Trying not to get my hopes up but gosh...

Additionally, I contacted a handful of different practices/hospitals/vet universities in WA and CT. I said I want fresh eyes and I'm willing to pay for a remote consultation. AK, CT, DE and WA are states without any VPCR laws according to this 2012 PDF: https://www.avma.org/sites/default/files/resources/vcpr_and_prescriptions.pdf However, someone in WA got back to me and said they can't do it because of VCPR so it must be outdated. I then found this: Breaking news: Federal VCPR rules It looks like reinforcement of VCPR is being temporarily suspended. I might contact someone in my state again next week and send them this.

 

[IndyJones]

Are there any AAHA accredited clinics in your area? I've found ones that have this to be better than some of the other ones.

 

[DesperateMistrustful]

8.8lbs today. He went back to eating and drinking, even woke me up for wet food. Threw up a little digested food this morning but that's kind of the least of my worries. Took the poor boy to the clinic which IS AAHA accredited, hahaha. His thyroid is normal. I asked if the T4 slide has any chance of being a false negative, the vet said it's a very reliable test and the only false readings are when it's really high. That leaves IBD as our last shot unless I'm missing something.

Because of his heart murmur he can't take steroids; they use an immunosuppressant as an alternative in those cases. Atopica is what was suggested. $110 won't even cover a whole month and he might need to be on it the rest of his life but we've spent over $10k so that doesn't seem crazy to me right now. They didn't have any in stock but I can order it. Considering the risks I asked if we should try out the other meds he suggests first and see if they work or if we should just go for it and get this. He said if this is my last attempt then just go for it, he's very sick and deteriorating, but waiting is an option (funny how this is always the answer...sure there's always options but then there's the right option). I take everything that surgeon said with a grain of salt so when he said we could wait on taking him to the clinic I felt like I should listen to my gut about not waiting. On this I don't know, it's unlikely he would get an infection from quarantined humans and two other indoor cats but with our luck lately who knows.

He was still dehydrated so he got another subcutaneous fluid shot and another B12 shot. We went home with an antibiotic (metronidazole), probiotic (proviable) and a very optimistic pallet of I/D food (which he ate a bit of after getting home, so maybe I can switch him over to it if this story has a happy ending).

He had plaque on his few remaining back teeth that needs to be cleaned but this vet assumes the strange mouth sounds/food falling out could just be residual from surgery. That was my first thought, maybe it's just tube irritation or jaw soreness. I'm going to pick up pill pockets tomorrow. I have no idea if he'll eat them but there's lots of medicine to administer now. I'll give him mirtazapine and cerenia alongside the new stuff.

A very nice tech from hospital #2 called just to see how he was doing and that she was thinking of him. I think she wants to find a reason for him to come back in so she can steal him since she loves him so much. It didn't feel like a business mandated follow up call, it was really genuine and sweet. At least someone cares about him. All of the techs at every location have been great really. If only the vets were the same.

I feel we're nearing the end of this journey one way or another. I've been thinking about necropsy, specifically if it would be a mistake. If it tells me that it was cancer or no conclusion is drawn then I'll be okay. If I learn that there was something preventable or treatable that none of these vets or I thought about at all, I will be devastated. Curiosity killed the human.

 

[amandag1]

Im glad he ate a bit... maybe he just needs some time to get over the surgical procedures
Just love on him and let him heal
You are doing all you can
Much love

 

[Furballsmom]

so she can steal him since she loves him so much.

 

[DesperateMistrustful]

Melting down today. I tried everything to get him to take his pills and paste. Hiding it in pill pockets/treats/food (not his I/D food), a pill syringe, crushing the pill into a little liquid but there's just too much of it. He spits out all of the probiotic paste. I feel like a complete failure. I thought I finally got the antibiotic in but I found it under his chin when trying to give him the disgusting paste. I have to put him through this four times a day? How? I have help but we just can't do it, I keep his mouth closed and get him swallowing and he calms down after a few seconds so I let go and...out it all comes. He just lets it sit there in his mouth waiting to spit it out. He doesn't want it in his body at all. I've been all over the internet and this forum reading every tip and trick there is, nothing works.

I called the vet and asked if there's a liquid form since administering liquid is much easier. Of course there is--of course you'd give me the horrible pill form that's more expensive with no question about what he'd prefer. Of course I can't return or even donate these remaining pills. Of course I will pay for the liquid form, of course I will wait until you get around to it because you're busy, of course there's no alternative to the paste and I have to just "go slowly," whatever that means. Of course.

I looked in the box and the future pills are four times the size of the antibiotic pills. There is simply no way. I've wasted over 5 doses of all of this crap. I was only able to get mirtazapine in because it's 1/8 of a pill and it's not even doing anything. He didn't eat yesterday or this morning until around noon. He's only had a few bites of wet food and treats.

Last night he vomited a total of six times, all barely digested dry food. I removed that particular food just in case since it started yesterday morning before he went to the vet. It was a brand hospital #2 sent home just because it was one of the things he ate there. He's been ignoring his regular dry food but I have two new brands on the way.

After vomiting he had extremely stinky liquid poops all over the place. They're very familiar but I hadn't seen it in a while; he had them intermittently during the first couple of years he came into my life until I got him a food his body preferred. It could just be the addition of the fluid shot softening his stool but hm. I attempted to give him the FOR DOGS ONLY cerenia tablet but failed. He hasn't vomited today so I didn't even try, I'd just waste it anyway.

Ordered the atopica. Can't wait to see how much of that bottle gets spit out as I watch my cat waste away.

 

[Furballsmom]

as I watch my cat waste away.

Take him back to the vet and have them administer the meds, or figure out if in the current social distancing situation whether maybe a vet's assistant or mobile vet could stop by and take the cat into their vehicle and administer the meds, use a syringe for the liquid meds, get a feeding tube put in, give subq fluids etc.

I don't know if you're asking a question about the Cerenia, but that is what veterinarians are prescribing for cats. There's also an injectible form of it, --information in this thread may be of help;
Cerenia question

 

[amandag1]

What pills & pills does he have to take?
i have to pill my cat 2-3 times daily and I just use a pill syringe now.
I get him seated comfortably between my legs, then take a small bit a pill dough paste - TOMLYN Pill-Masker (Original) for Dogs and Cats, 4oz
Amazon.com : Tomlyn Pill-Masker (Original) for Dogs and Cats, 4oz : Pet Antioxidant Nutritional Supplements : Pet Supplies

(A small pinch) and then put the Dough covered pill into this syringe -PETHOUZZ Pet Piller Gun Dog Pill Shooter Cat Tablet Soft Tip Syringe Pet Medical Feeding Dispenser Tool for Small Animal Amazon.com : PETHOUZZ Pet Piller Gun Dog Pill Shooter Cat Tablet Soft Tip Syringe Pet Medical Feeding Dispenser Tool for Small Animal : Pet Supplies

watch some videos on how to use it
Dont dispense the pill at the tip of their tongue/ mouth... i basically make sure its all the way back and quickly dispense.
Ive got to my boy 2 pills and a liquid... 2x a day. I leave the liquid for last to wash it down.
Dont give up!
You can do it.