Willy might have cancer / high-grade lymphoma Treatment thread

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silent meowlook

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The first things that come to mind with excessive thirst and drinking are kidney disease and diabetes. With him, I would lean more towards kidney. But, with both of those, there is also increased urine output and you said that hasn’t changed. I am assuming that you are witnessing him drinking more and not that he is spilling it.
Does he get tap water or bottled. Sometimes if drinking city tap, there can be a change in what is put in the water, but that is pretty doubtful.
How is his hydration? To check for dehydration, you can do a skin turger test where you lift the skin from above his shoulders and see if it snaps back or remains tented or somewhere in between. Also sunken eyes and a tacky feel to the gums.

Another reason for increased water consumption would be if you had switched from canned to dry food. Or, increased the amount of dry food in his diet, if you feed dry at all.

I would think that they will want to run some blood work to check his electrolytes and chemistry to check for liver and kidney function.
If the liver and kidneys aren’t functioning properly there can be the start of a buildup of toxins that will cause the cat to drink more so they can dilute them.
He is on steroids right?
That can also cause an increase in drinking but would also cause more urination.
I am sure that you would know if he was urinating elsewhere.
He seems to be feeling well, right? I would think for any of the above problems you would notice a change in behavior because you are on top of what he is doing.
I also have to wonder if one of the foods he gets has changed its formula. But also pretty doubtful that would be the cause.

When you say drinking allot, how much? Is he hanging out at the water bowl? Is his chin always
 
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The first things that come to mind with excessive thirst and drinking are kidney disease and diabetes. With him, I would lean more towards kidney. But, with both of those, there is also increased urine output and you said that hasn’t changed. I am assuming that you are witnessing him drinking more and not that he is spilling it.
Yes. I have been home almost entirely 24/7 since his last chemo dose 1.5 weeks ago. I scoop his litter multiple times a day (for my health as well as his; I may have a slight immunocompromisation so I mask/glove-up and scoop his litter at least twice a day). I have noticed no difference in his output.

And I also have not noticed him going to the litter box during the day any more frequently than usual.

And his poop looks healthy and firm. That may be unrelated but I always look at his poop because he has been constipated, dehydrated, had diarrhea, etc... basically has had many episodes over the years where his poop was indicative of his issues at the time. So I know what healthy poop looks like, and I know what his usual urination frequency looks like. None of those have been abnormal.

Does he get tap water or bottled. Sometimes if drinking city tap, there can be a change in what is put in the water, but that is pretty doubtful.
I get where you are coming from. This would be extremely doubtful to me, also, but I drink tap water almost exclusively, and so had Willy for 9 years of living in the city area of Milwaukee (and the last place he lived, which was with my mom, was only 5 minutes from where I live now, so same water). But this is nonetheless not a bad idea for me to look up and try to find info about online.

How is his hydration? To check for dehydration, you can do a skin turger test where you lift the skin from above his shoulders and see if it snaps back or remains tented or somewhere in between. Also sunken eyes and a tacky feel to the gums.
I know all about this test. I even performed one before posting today. I saw no signs of dehydration.

Another reason for increased water consumption would be if you had switched from canned to dry food. Or, increased the amount of dry food in his diet, if you feed dry at all.
He is on 100% dry right now but this is not a recent change. If you go back into earlier parts of my thread, you'll see that I have been trying to give him as much wet food as possible, but he is just not going for it in recent months. So he's been on almost all dry when starting chemo. And 100% dry since.

He used to eat wet food, but simply won't anymore. Even after starting him on mirtazapine, he refuses 95% of wet food (he was raised on 100% dry, BTW).

Also, my oncologist recommended just getting calories into him, and didn't really care about which food it was. If my cat is a dry-food addict, as she said, feed him as much dry food as he will eat as he goes through chemotherapy.

So he is on Hills ONC primarily right now (as he was a Hills-dry fan for several years before). He eats it very well. I try to give him wet treats (like the cat broths) sometimes but he largely refuses them.

I would think that they will want to run some blood work to check his electrolytes and chemistry to check for liver and kidney function.
If the liver and kidneys aren’t functioning properly there can be the start of a buildup of toxins that will cause the cat to drink more so they can dilute them.
I really trust both my vet and veterinary oncologist, and I've reported this to both of them, so I will see what they say when they get back to me. Willy's next chemo appointment is in 1.5 weeks.

He is on steroids right?
That can also cause an increase in drinking but would also cause more urination.
I am sure that you would know if he was urinating elsewhere.
Methylprednisolone, which was started because I was having increasing difficulty pilling him daily with prednisolone.

Willy has NEVER ONCE, EVER urinated or defecated outside of the litter box, even after finding him in extremely rough shape around 1 year old.

He seems to be feeling well, right? I would think for any of the above problems you would notice a change in behavior because you are on top of what he is doing.
He's been perfectly fine otherwise. No change in anything else besides for water intake.

also have to wonder if one of the foods he gets has changed its formula. But also pretty doubtful that would be the cause.
I've been using the same Hills ONC bag for a few weeks. The increased thirst only started within the last week, but really spiked over the last 2-4 days.

When you say drinking allot, how much? Is he hanging out at the water bowl? Is his chin always
Did you mean "is his chin always wet?"

No, and he isn't spending ALL his time at the water bowl. But this is what I've observed:

(1) Whenever he goes to his water bowl, he sits there for like 5x as long as normal. Not continuously drinking, but will drink a regular amount, then stop... then continue to sit there for 30 seconds... then take another long drink... then sit there... etc.

(2) He sometimes will be finished drinking, then will jump up on my lap for a rest (he's hugely a lap cat). After being on my lap for one minute, sometimes he will jump off to take another drink. He's never done that before.

(3) I hear him drinking in the middle of the night sometimes, but I'm obviously not always awake where I'd observe 100% of these occurrences.

(4) Chin is never wet from water (I think?) but he drools a lot. And he has dental disease, which was diagnosed by my general vet right before she did the biopsy surgery that led to his cancer diagnosis.

Edit: Dental disease is something I intend to get treated if he is healthy enough for it. At the moment we are focused on the chemotherapy, obviously. I have a previous post about my frustrations with his dental health, as I don't feel I got the right info from my vet (previous vet to the one I have now).
 
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I am curious to see what your vet thinks tomorrow.
So I received callbacks from both an oncology tech from the hospital, as well as my vet.

Oncology basically said it could be a side effect of methylprednisolone. Even if it hasn't happened before, and it's been a couple of weeks since he received the injection, side effects can come and go over the course of a month as the intramuscular injection is absorbed. Beyond that, I'd have to bring him in for blood work, prior to his next chemo appointment (which is 10 days from today), to know anything more.

My vet advised me that she wouldn't consider it an emergency, and that she thinks it should be fine to wait for his next chemo appointment. She agreed that one likely explanation is the steroid. But she also gave me a list of things to make sure they check for when he goes back in and has his initial exam before the chemo dosing: kidney function, blood sugar, and urine test.

She said she would be highly surprised if they did not test all the appropriate things anyway, as she has a positive opinion of the hospital and oncology department there. But was just giving me advisement about what she would check for if treating Willy.

She also advised me to isolate him from the litter box for a little while prior to his next appointment, so that he doesn't pee right before the appointment and have no urine in his bladder. Nobody from oncology has ever suggested that, and I don't know if they test urine by default, so I will try to prevent Willy from peeing right before the appointment, and ask about it when I bring him in.
 

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So I received callbacks from both an oncology tech from the hospital, as well as my vet.

Oncology basically said it could be a side effect of methylprednisolone. Even if it hasn't happened before, and it's been a couple of weeks since he received the injection, side effects can come and go over the course of a month as the intramuscular injection is absorbed. Beyond that, I'd have to bring him in for blood work, prior to his next chemo appointment (which is 10 days from today), to know anything more.

My vet advised me that she wouldn't consider it an emergency, and that she thinks it should be fine to wait for his next chemo appointment. She agreed that one likely explanation is the steroid. But she also gave me a list of things to make sure they check for when he goes back in and has his initial exam before the chemo dosing: kidney function, blood sugar, and urine test.

She said she would be highly surprised if they did not test all the appropriate things anyway, as she has a positive opinion of the hospital and oncology department there. But was just giving me advisement about what she would check for if treating Willy.

She also advised me to isolate him from the litter box for a little while prior to his next appointment, so that he doesn't pee right before the appointment and have no urine in his bladder. Nobody from oncology has ever suggested that, and I don't know if they test urine by default, so I will try to prevent Willy from peeing right before the appointment, and ask about it when I bring him in.
They want to take a fresh sample. Neither of my cats will use the perler beads the vet supplies so they take the urine right from the bladder. Maybe they are looking for bacteria. If it comes out the normal way the naturaly occouring bacteria can contaminate the sample.
 

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So I received callbacks from both an oncology tech from the hospital, as well as my vet.

Oncology basically said it could be a side effect of methylprednisolone. Even if it hasn't happened before, and it's been a couple of weeks since he received the injection, side effects can come and go over the course of a month as the intramuscular injection is absorbed. Beyond that, I'd have to bring him in for blood work, prior to his next chemo appointment (which is 10 days from today), to know anything more.

My vet advised me that she wouldn't consider it an emergency, and that she thinks it should be fine to wait for his next chemo appointment. She agreed that one likely explanation is the steroid. But she also gave me a list of things to make sure they check for when he goes back in and has his initial exam before the chemo dosing: kidney function, blood sugar, and urine test.

She said she would be highly surprised if they did not test all the appropriate things anyway, as she has a positive opinion of the hospital and oncology department there. But was just giving me advisement about what she would check for if treating Willy.

She also advised me to isolate him from the litter box for a little while prior to his next appointment, so that he doesn't pee right before the appointment and have no urine in his bladder. Nobody from oncology has ever suggested that, and I don't know if they test urine by default, so I will try to prevent Willy from peeing right before the appointment, and ask about it when I bring him in.
Glad you got timely responses. Also glad things seem to be going pretty well and that you and the vet agree on the course of action. Hoping for things to continue going well.
 
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They want to take a fresh sample. Neither of my cats will use the perler beads the vet supplies so they take the urine right from the bladder. Maybe they are looking for bacteria. If it comes out the normal way the naturaly occouring bacteria can contaminate the sample.
My vet specifically suggested that I make sure the oncologist tests his urine to look for glucose levels in it. I assume having to do with diabetes? I didn't ask her the "why" of it, as I was writing down all her suggestions to convey to Willy's oncologist at his next appointment.
 

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My vet specifically suggested that I make sure the oncologist tests his urine to look for glucose levels in it. I assume having to do with diabetes? I didn't ask her the "why" of it, as I was writing down all her suggestions to convey to Willy's oncologist at his next appointment.
Does your Vet not communicate with the oncologist? You can just get the records printed out and bring them to your Vet if she does not request records herself..
 
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Update: 13 days post-chemo (2nd dose)...

The excessive thirst seems actually to have dissipated somewhat. It was just a period of like 4 days throughout which Willy was drinking excessively. Yesterday, he drank a bit less, and today his drinking was about the same as his normal baseline.

I am going to assume, at this point, that it was due to the methylprednisolone, and as the intramuscular injection gets absorbed over the course of a month, its absorption can happen in varying amounts from day to day. So side effects can come and go as it works its way into his system as an extended-releaae drug.

But I am still going to mention all the things that my vet suggested I ask my oncologist to check at Willy's next appointment.

Does your Vet not communicate with the oncologist? You can just get the records printed out and bring them to your Vet if she does not request records herself..
Yes, they do communicate, but my vet is very busy, and she's done me favors before (like when she cathed Willy to resolve his urinary blockage, she did so because I would have had trouble affording a hospital stay). I'm assuming she's not staying up to date with Willy's oncology case from day to day, as she has other patients of her own to deal with.

So I am just calling her whenever I have a question like about Willy's recent excessive thirst.
 

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Update: 13 days post-chemo (2nd dose)...

The excessive thirst seems actually to have dissipated somewhat. It was just a period of like 4 days throughout which Willy was drinking excessively. Yesterday, he drank a bit less, and today his drinking was about the same as his normal baseline.

I am going to assume, at this point, that it was due to the methylprednisolone, and as the intramuscular injection gets absorbed over the course of a month, its absorption can happen in varying amounts from day to day. So side effects can come and go as it works its way into his system as an extended-releaae drug.

But I am still going to mention all the things that my vet suggested I ask my oncologist to check at Willy's next appointment.



Yes, they do communicate, but my vet is very busy, and she's done me favors before (like when she cathed Willy to resolve his urinary blockage, she did so because I would have had trouble affording a hospital stay). I'm assuming she's not staying up to date with Willy's oncology case from day to day, as she has other patients of her own to deal with.

So I am just calling her whenever I have a question like about Willy's recent excessive thirst.
This thread will provide excellent records for you to see what is/was going on and when if your regular vet needs to know something. I'm sure the vet can get records from the oncologist, or, maybe they are sent directly to his file at his GP's. I'm glad the excessive thirst has calmed down.
 

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Update: 13 days post-chemo (2nd dose)...

The excessive thirst seems actually to have dissipated somewhat. It was just a period of like 4 days throughout which Willy was drinking excessively. Yesterday, he drank a bit less, and today his drinking was about the same as his normal baseline.

I am going to assume, at this point, that it was due to the methylprednisolone, and as the intramuscular injection gets absorbed over the course of a month, its absorption can happen in varying amounts from day to day. So side effects can come and go as it works its way into his system as an extended-releaae drug.

But I am still going to mention all the things that my vet suggested I ask my oncologist to check at Willy's next appointment.



Yes, they do communicate, but my vet is very busy, and she's done me favors before (like when she cathed Willy to resolve his urinary blockage, she did so because I would have had trouble affording a hospital stay). I'm assuming she's not staying up to date with Willy's oncology case from day to day, as she has other patients of her own to deal with.

So I am just calling her whenever I have a question like about Willy's recent excessive thirst.
Good on all points and iPappy iPappy has an excellent suggestion there.
 
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Update: 17 days post-chemo (2nd dose)...

Willy is continuing to do well, hence my lack of updates. A few details:

His next chemo appointment is in 4 days (as this was a 3-week interval between treatments, this time).

Increased thirst has continued to come and go since the last time I posted.

He has started to shed a little, which I think is a good thing? From my understanding, that doesn't mean that his hair is falling out from chemotherapy, but rather new hair is growing in, causing the shedding. Correct me if I'm wrong.

Appetite has been fine as I've continued my every-other-day dosage of Mirataz. And on the off-days, I clean his ear with a moist cotton ball, in preparation for the next dose (as I can only use one ear, due to his right ear causing him pain when I manipulate it).

In the meantime, more paper-shredding antics have ensued.

(BTW, I've been asked by more than one TCS member if I am sure he is not eating any paper, and I am quite positive he is not, other than the occasional small bit he may accidentally swallow. With the amount of paper shreds he leaves on the floor, I am quite confident he is spitting 99% of it out. However, I should make a point to ask my oncologist and vet about the safety of this kind of play, with his particular health conditions.)
 

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Update: 17 days post-chemo (2nd dose)...

Willy is continuing to do well, hence my lack of updates. A few details:

His next chemo appointment is in 4 days (as this was a 3-week interval between treatments, this time).

Increased thirst has continued to come and go since the last time I posted.

He has started to shed a little, which I think is a good thing? From my understanding, that doesn't mean that his hair is falling out from chemotherapy, but rather new hair is growing in, causing the shedding. Correct me if I'm wrong.

Appetite has been fine as I've continued my every-other-day dosage of Mirataz. And on the off-days, I clean his ear with a moist cotton ball, in preparation for the next dose (as I can only use one ear, due to his right ear causing him pain when I manipulate it).

In the meantime, more paper-shredding antics have ensued.

(BTW, I've been asked by more than one TCS member if I am sure he is not eating any paper, and I am quite positive he is not, other than the occasional small bit he may accidentally swallow. With the amount of paper shreds he leaves on the floor, I am quite confident he is spitting 99% of it out. However, I should make a point to ask my oncologist and vet about the safety of this kind of play, with his particular health conditions.)
All in all, a good UPdate. Thanks for sharing with us.
 
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Update: 1 hour after 3rd chemo appointment...

I just got Willy home after his third chemotherapy dose. All good news, in fact so good his oncologist came back into the waiting room while they were in the middle of testing, to excitedly tell me how happy she was with results.

As I mentioned before, my main concern was his very elevated thirst. His energy and behavior have been normal, his appetite has been good even without as much Mirataz as I previously had to dose him with... but he's just been drinking so much water. Urine output has been the same, but poop has started to look a little dehydrated... hard and in small pieces.

They were worried that he might have become diabetic, so testing his blood sugar was a very important test this time. If he had become diabetic, it could have changed the whole course of his treatment.

But his blood sugar was not only normal, it was "great" according to the doc. Kidney and liver function were also well within good-range. And all tumors have had notable shrinkage.

So, we went ahead with another round of 10mg lomustine, and 40mg/mL methylprednisolone dose.

The only slight concern was slightly low white-cell count, but remember he is only 3 weeks from his last dose. So the only conclusion the oncologist drew from that was that a 4-week interval is best for him. So his next appointment is exactly 4 weeks from today.

After getting home, he's been mostly hanging out on my computer desk chair, vigorously cleaning all the bad smells off of himself, while refusing to look at me. But trust me, this will only last 10 more minutes at most. He never holds grudges for very long.

Late edit: I also forgot to mention, weight was stable from 2nd chemo appt. to this one, which is another good thing.
 

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Update: 1 hour after 3rd chemo appointment...

I just got Willy home after his third chemotherapy dose. All good news, in fact so good his oncologist came back into the waiting room while they were in the middle of testing, to excitedly tell me how happy she was with results.

As I mentioned before, my main concern was his very elevated thirst. His energy and behavior have been normal, his appetite has been good even without as much Mirataz as I previously had to dose him with... but he's just been drinking so much water. Urine output has been the same, but poop has started to look a little dehydrated... hard and in small pieces.

They were worried that he might have become diabetic, so testing his blood sugar was a very important test this time. If he had become diabetic, it could have changed the whole course of his treatment.

But his blood sugar was not only normal, it was "great" according to the doc. Kidney and liver function were also well within good-range. And all tumors have had notable shrinkage.

So, we went ahead with another round of 10mg lomustine, and 40mg/mL methylprednisolone dose.

The only slight concern was slightly low white-cell count, but remember he is only 3 weeks from his last dose. So the only conclusion the oncologist drew from that was that a 4-week interval is best for him. So his next appointment is exactly 4 weeks from today.

After getting home, he's been mostly hanging out on my computer desk chair, vigorously cleaning all the bad smells off of himself, while refusing to look at me. But trust me, this will only last 10 more minutes at most. He never holds grudges for very long.
Hoping that those two minutes pass by very quickly :flail:
Very glad to read this excellent UPdate! That has to be the best news for your holidays! :clap::redheartpump::creampersian::redheartpump::agree:
 
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That has to be the best news for your holidays!
Indeed, it is. I have much other to worry about which isn't relevant to this thread, but Willy potentially taking a more complex turn in his care over the holidays was my biggest worry. It alleviates a lot.

I think I mentioned before that a large component of Willy's increased thirst could be environmental. My apartment is in an older building with radiator heat, that I cannot control the temperature of, other than turning the valves completely ON or OFF.

If I leave them on all the time, it gets beyond-hot in here sometimes, and the air gets crazy-dry. If I turn them on and off periodically, I have some control, but that requires constant babysitting of the valves throughout a night. If I leave one on in one room, and one off in another, it still doesn't quite balance out, and still requires micromanagement.

And it all depends on the temp outside. When it's, say, 30-40 F, you can get by with keeping them off most of the time, by absorbing residual heat from other units around you. When it's 20 F, you have to turn on your own every once in a while to keep it decently warm. When it's 10 F or below, you basically always have to keep yours on, but then always keeping it on makes it INSANELY hot at times. It can be 5 F outside and 90 F in here.

I have occasionally had all my radiators blasting on a really cold day while cracking one window open by an inch or two. That can do the trick sometimes.

It's basically not easy to try to keep the humidity at decent levels in my apartment. I have read tricks about putting large metal bowls of water on top of your radiators, so that as they get really hot, the water evaporates. I've also tried humidifiers, but I have a large open-design apartment with high ceilings, and I have never gotten humidifiers to work well enough, without springing for some indistrial-sized one.

Anyway, my whole point is that this may be the real cause of Willy's increased thirst. But my only apprehension with immediately accepting that is that we've lived in this same apartment for 8 years, and he never drank as much water over a Wisconsin winter as he is doing this year... and this has been the mildest Wisconsin winter so far that I can remember, in a long time.
 
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Indeed, it is. I have much other to worry about which isn't relevant to this thread, but Willy potentially taking a more complex turn in his care over the holidays was my biggest worry. It alleviates a lot.

I think I mentioned before that a large component of Willy's increased thirst could be environmental. My apartment is in an older building with radiator heat, that I cannot control the temperature of, other than turning the valves completely ON or OFF.

If I leave them on all the time, it gets beyond-hot in here sometimes, and the air gets crazy-dry. If I turn them on and off periodically, I have some control, but that requires constant babysitting of the valves throughout a night. If I leave one on in one room, and one off in another, it still doesn't quite balance out, and still requires micromanagement.

And it all depends on the temp outside. When it's, say, 30-40 F, you can get by with keeping them off most of the time, by absorbing residual heat from other units around you. When it's 20 F, you have to turn on your own every once in a while to keep it decently warm. When it's 10 F or below, you basically always have to keep yours on, but then always keeping it on makes it INSANELY hot at times. It can be 5 F outside and 90 F in here.

I have occasionally had all my radiators blasting on a really cold day while cracking one window open by an inch or two. That can do the trick sometimes.

It's basically not easy to try to keep the humidity at decent levels in my apartment. I have read tricks about putting large metal bowls of water on top of your radiators, so that as they get really hot, the water evaporates. I've also tried humidifiers, but I have a large open-design apartment with high ceilings, and I have never gotten radiators to work well enough, without springing for some indistrial-sized one.

Anyway, my whole point is that this may be the real cause of Willy's increased thirst. But my only apprehension with immediately accepting that is that we've lived in this same apartment for 8 years, and he never drank as much water over a Wisconsin winter as he is doing this year... and this has been the mildest Wisconsin winter so far that I can remember, in a long time.
Well, it's the mildest and the radiator is on, adding up to less humidity, right? Makes sense to me. A former friend from NY had the same situation in her building with the radiators. I guess it's common where winters get quite cold and there are a lot of units to heat. I guess that, given the style of your unit, you're just going to have to make sure Willy has plenty of water available. His tests are all very good at this point, so yeah, all those "much other to worry about" *and oh, do I empathize.* can take center stage on the stress-ometer. :sigh:
 
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Well, it's the mildest and the radiator is on, adding up to less humidity, right? Makes sense to me.
Actually, no. Air is MUCH, MUCH drier in here when temps outside are coldest. Because there is a building-wide thermostat somewhere that decides when to kick the heat on or off based on the outside temperature. So when it's coldest outside, it kicks in much more frequently.

As individual tenants, we can choose whether to turn our individual units' radiator valves on or off. So we are basically all-in, or all-out in accepting heat that the whole building provides (and it's free, not included in rent, which is the only reason why any of this is still bearable).

When it's very cold outside, building heat kicks in all the time, and you have to truly babysit your radiator valves in order to keep your apartment warm but moderate. Like constantly get up from the couch, turn the valve off for an hour, then get up again and turn it on, etc.

My point was that this is a mild winter in Wisconsin thus far. Heat has been running in my building, and air has definitely gotten drier, but it's nowhere near what it gets like when outside temps are approaching 0 F.

We've had multiple winters like that, and I am afraid to touch light switches. Guaranteed shocks everywhere. Even when petting Willy! I have shocked him numerous times and he thinks it's coming from me, and gets a little annoyed for a while.

But I've already made a long story longer. My main point is I am positive the environment -- dry air -- is a contributing factor to Willy's thirst. But then he is also on a steroid -- methylprednisolone -- and is older than he ever was during previous winters.

Since he is definitely not diabetic, I am not continuing to worry about this. Just explaining why I was so worried before getting a diagnosis today.
 
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