Weird Symptoms.. urgent help?!

kkatmomma2

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Hi, I have a 6 year old indoor cat (short hair), he has been a happy and healthy energetic cat until recently.
Around 3 months ago, during a dental cleaning our vet recommended that he get some teeth pulled before they cause any problems. Upon starting the surgery the vet called and said his teeth were in worse shape than they thought and that he would need all but 1 pulled. Prior to the surgery, he was not showing any signs of dental pain or issues, but we trusted our vet and allowed the procedure to continue. He recovered fine and all was well until the first week of April. He started having little squirts of mostly mucus diarrhea in various spots around the house (out of character) and was acting a little "off". We took him to the vet who reassured us that he appeared well (even though he had lost 3 pounds since his last visit 1 month prior) and not to be concerned. Within a couple days of that appointment, he stopped eating and drinking and appeared very sick. We went back to the vet who ran bloodwork and did some abdominal xrays and said nothing looked abnormal but it sounded like an IBD vs Lymphoma situation. He stayed there for some IV fluids and was started on prednisolone 1.5mg twice a day and to come back if he got any worse. Upon starting the pred, he improved a lot. He perked up and started being more active around the house and was eating and drinking more normally. Upon a routine recheck, our vet was optimistic of a more favorable diagnosis based on how much he improved on the pred. He even gained a pound of weight back! We tried titrating down the dose to once a day, but within 1 day of the decreased dose, he started having the same symptoms again. Our vet upped the dose back to twice a day and told us that this might just be the dose he would need forever. 3 weeks went by and he was doing great- almost completely "normal" and we were relieved.
A couple of days ago, he developed a stuffy nose, a film over his right eye, and some sneezing. Other than those symptoms, he appeared fine- we wanted to get him checked just to make sure we stayed on top of any possible infection since he is on the immunosuppressant. Our usual vet had no openings, so we went to another office that we have heard great things about. Upon that visit, they ran a CBC and a chest xray due to some hard breathing. The CBC came back with low RBC, low platelets (32)- confirmed with a smear, low reticulocytes. A chest xray showed some spots but they were unsure what they were since he is still a younger cat and should not have any. They gave an antibiotic injection to cover in case for the sinus symptoms and referred us to a specialist since all of this symptoms and presentation were odd.
The next day (yesterday) we went to a specialist 2 hours away under an emergency visit. They did not redraw a CBC but used the one from the previous day and had a radiologist do an abdominal ultrasound who found mild pancreatitis, altered wall layering of a segment of jejunum with thickening which may suggest IBD vs. small cell lymphoma, and corrugation of a second region of small intestines suggestive of enteritis.
The vet at this hospital said the next step would be a blood transfusion and to see oncology to have surgical biopsies completed. They said that they believe that it is likely lymphoma based on findings and that it has spread to his lungs and his bone marrow, therefore resulting in the new anemia. They said that even with chemo it was unlikely to be successful due to advanced stages and that doing a blood transfusion would just be a bandaid for a day or 2 and comes with a lot of risks. We opted to take him home.

My question is: does any of this make sense? I thought that large cell lymphoma was more aggressive than small cell and that small cell can be maintained with pred for a little while? He had no masses found anywhere and the ultrasound showed only 1 area of mild thickening. Is there anything that we could be missing that could be causing the anemia/low platelets? A BMP was not done, so I don't know how his other organs are functioning.
I am concerned that I made a mistake not getting the transfusion but it was so overwhelming and the vet was not very compassionate, but I also don't think going 2 hours away again is good for him now? He is still eating and drinking, he is laying around a lot more today and appears weaker than he was before we left yesterday but they made it sound like he could have sudden death at any point and I'm just really concerned.

Any help/advice/experience would be so great.
 

FeebysOwner

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Hi and welcome to TCS, despite what brought you here. I can't offer much, but am curious what kind of specialist you saw? Under confusing situations, a group that contains multiple disciplines of specialists can help because they can confer with one another.

I am thinking that the Pred might have kicked off a viral condition in your cat that has probably been lying dormant. That would explain a lot, and might even be behind these spots in his lungs.

I am surprised, coming from a specialist, that there wasn't a fine needle aspiration (FNA) considered during the ultrasound, which can be done non-invasively to collect any suspicious tissue found for further analysis.

I don't actually know what a BMP is, but the closest I could get to was a pro-BNP to check for cardiac issues. Was a blood Chemistry panel done? That is what is usually run to check organ function.

There are many other speculations to comment on, but let's start here.
 
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kkatmomma2

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Hi and welcome to TCS, despite what brought you here. I can't offer much, but am curious what kind of specialist you saw? Under confusing situations, a group that contains multiple disciplines of specialists can help because they can confer with one another.

I am thinking that the Pred might have kicked off a viral condition in your cat that has probably been lying dormant. That would explain a lot, and might even be behind these spots in his lungs.

I am surprised, coming from a specialist, that there wasn't a fine needle aspiration (FNA) considered during the ultrasound, which can be done non-invasively to collect any suspicious tissue found for further analysis.

I don't actually know what a BMP is, but the closest I could get to was a pro-BNP to check for cardiac issues. Was a blood Chemistry panel done? That is what is usually run to check organ function
Thank you so much for replying! It was a specialty hospital, we had to go through the ER though so we only saw an "emergency vet". We went there under the impression that the oncologists and internal medicine vets would be able to set him as well, but they never expressed that as an option and only told us that if we wanted to do chemo they would give an oncology referral, which made it seem like he would need to come back for a separate appointment.
I have seen some research that says that increasing the pred might help his symptoms again, but I am also concerned that would worsen the viral condition if that's the case?
They mentioned we could do a FNA but that it would be risky given his low platelet count and since there was no obvious mass anywhere. They also mentioned a bone marrow biopsy but said that would be very risky now too. I am worried about being able to increase his platelets but concerned that the blood transfusion was my only option and that's not available now unless we go back 2 hours away. The CBC was the only bloodwork that was run at the other vet prior, they did not do a chemistry panel at this appointment (I was confusing that with a human BMP- sorry for the confusion).
I'm so lost in all of this and just want to help him :(
 

FeebysOwner

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I guess I would find out if anyone else besides the ER doc has looked at all the results, and what other specialties are involved in that group. I would also look for other closer by groups with multiple specialists, I would have to ask why a chemistry panel was not run, there are things in those that could help explain the CBC numbers.
I don't have enough experience with viral conditions to know if there are ones that can be given concurrently with Pred, but a question worth asking.
 

silent meowlook

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Hi. I am sorry you are going through this with your sweet cat.
I am not a vet and the following is just my opinion.

ER vets are just that. Great for emergencies. And in my experience dog emergencies. I would not buy into what they are saying about the bad outcome. You need an oncologist or a very good cat vet.
In your cats current state, he probably would not be a good surgical and anesthesia candidate, in my opinion.
The standard care for small cell lymphoma (intestinal) is Chlorambucil and Prednisolone. Usually the Prednisolone is at a higher dose. My cat started out on 10 mg a day.
See if you can find a vet that will let you start the medications without the biopsies.
Do you have the bloodwork? Could you post it if you do? Do you know how low the hematatacrit was?
When I worked for the specialist, we didn’t consider blood transfusions until they were down around 20.
ER vets have a very doom and gloom attitude and sometimes just aren’t up to date with current cat treatments for more complex diseases.
Hope you are able to find a vet that is knowledgeable and can help you.
 
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kkatmomma2

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Thank you for your response. I appreciate all of the help!
His CBC showed:
-almost all normal wbc counts
Rbc 4.88
Hct 22.7.%
hgb 7.9
Retic-hgb 11.5
Lym 0.30
Eos 0
Baso 0
Platelets 32
Pct 0.06%

the vet said that he confirmed it with a smear, but they did not re run the test at the er to confirm.
they definitely scared me with the idea that sudden death will occur with the low platelet level that he has but I was so overwhelmed and scared of doing the transfusion and having a bad reaction or complication. is the transfusion the only way that he will get better in your opinion? His labs have been great up until this point, so I’m not sure if it is lymphoma if it’s getting worse or if it’s an unrelated issue.
He has been on pred 9mg/day (4.5 x2). I will ask my vet if we can increase the dose since he was initially doing so well on it. I’m worried. He is still eating but does appear weaker and decreased appetite.
 

silent meowlook

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Hi.
So, those blood values are alarming. Please try to get into an oncologist right away or a board certified internal medicine vet. The concern of course is hardly any platelets and the low HCT. I have seen numbers like that in cats with microplasma. A blood parasite they get from fleas. I imagine your cat doesn’t and hasn’t had fleas so other than that, I would think cancer could be the culprit.
With a blood transfusion, which would be warranted in this case, the problem is without knowing what is causing it, it might only buy you a little time.
Please keep him quiet as you can. Feed often and reduce any stress.
i am so sorry you and your cat are going through this. Do try to get him in to see a specialist ASAP.
I don’t think anyone in their right mind would want to stress this cat with doing biopsies. But, I am not a vet and this is just my opinion.
Watch for elevated breathing as this can be a sign the anemia has worsened and there isn’t enough red blood cells to carry oxygen to his body.
 
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kkatmomma2

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We went to the emergency appointment with the hopes of him getting to see an internal medicine or oncology specialist and they didn’t offer consults with them either, which disappointed us because we thought that was the whole point of traveling 2 hours to this specialty hospital :(

Our regular vet wants to repeat the cbc tomorrow morning in the chances that it has improved. I am hoping it does, but I am also concerned about stressing him out or making anything worse. I brought up the idea of the flea borne disease, because a few months prior to all of this he did have a bad reaction to some flea bites.. does this fit his presentation in your experience? Would they test for it or just start antibiotics? He did get a covenia shot the other day for his sinus symptoms.. my vet mention that would have improved his symptoms if it was that flea borne illness. FMH I think is what I researched.
Thanks for your help.
 

silent meowlook

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Hi
I understand your concern about the stress of the visit and the blood draw. I am also concerned because I wonder if he has enough platelets to clot after a blood draw.


Mycoplasma is not something they would routinely test for. usually it can be seen on a blood film under the microscope, but not everyone knows how to find it or I identify it. There is also a PCR test that can be done to identify it.

The treatment for Mycoplasma in cats is usually an extended course of Doxycycline. Cephalosporins (Convenia) is not effective. I have always seen it also treated with steroids as well. More recent literature shows some debate on that.

I guess what concerns me is that your vet said the Convenia would help if it was that. It wouldn’t.

I have posted a link below from HILLS that describes it.

What is Feline Infectious Anaemia? | Hills Vets
 

fionasmom

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Convenia will treat skin conditions, not the underlying cause, such as flea borne illness. Even Zoetis does not claim that it treats those conditions like bartonella and haemobartonella.

I use a specialty clinic in Los Angeles and when I have brought in a pet as an emergency, they are evaluated by the ER vets and then sent over to the appropriate department. In fact, the ER vets back out of the picture pretty quickly once they determine an underlying cause. I don't blame you for being upset after a two hour drive.
 
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