Hind leg neuropathy/knuckling in cat-need advice (complicated case)
Posted: Tue May 17, 2022 1:49 pm
Hi there,
I have a almost 17 year old cat who is dealing with left hind leg neuropathy/knuckling and I'm at a loss for what to do. Her case is a complicated one, so please bear with me as I try to provide you with as much information as possible.
She was diagnosed with both large cell and small cell lymphoma in October of 2021. After speaking with an oncologist, we opted to proceed with chemotherapy (CHOP protocol) as I was told the side effects from tx are minimal in cats and her quality of life would not suffer. She tolerated the first two rounds of treatment very well; you wouldn't even know that she had cancer or that she was being treated for it. After the last drug was administered during the third round of treatment, we noticed that she started limping and her left hind leg seemed quite painful. We rushed her to the emergency clinic where she underwent numerous diagnostic tests (CT scan, myelogram etc.) and the neurologist suspected a slipped disc. We were reassured that he could fix this problem and it would be fair to proceed with the surgery as she was considered to be in remission, and he performs this procedure on older cats all of the time. After the surgery was completed, he explained that he didn't find a slipped disc but still opted to do a laminectomy procedure to relieve the pressure/compression in her spine. When we brought her home, she was on heavy pain medication for a few days and was walking on her hocks.
We resumed her final round of chemotherapy one week after her surgery and she continued to do well. Every week we saw improvement; she was no longer walking on her hocks, the limp had almost disappeared completely and she had no pain.
And then it was time for the final drug in her last round of her chemotherapy treatment. As soon as we brought her home, we noticed her left leg was sliding from under her and over the next few days things continued to worsen. The pronounced limp returned along with the pain and this time it was a little worse. We also noticed that she started knuckling.
We had her seen by both the neurologist and oncologist again and the neurologist believes she has peripheral neuropathy secondary to an idiosyncratic drug reaction to one of the chemo drugs as this happened twice after the same drug was given. The oncologist doesn't seem to believe this is the case because neuropathy in cats secondary to chemotherapy is quite rare and on the few occasions that it does happen, it's not usually due to this particular drug. We have recently done blood work and it all came back within normal limits so this is not secondary to diabetes etc. She is also hyperthyroid, but we have that well controlled with medication.
It has been just over four weeks since her last chemo treatment and unfortunately we don't see much improvement with her leg. We have been able to keep her discomfort under control with pain medication. I am frustrated and upset and don't know where to go from here and no one seems to be able to give me any concrete answers as to why this has happened.
Does anyone have experience with neuropathy secondary to chemotherapy treatment? I don't know what else could have caused this.
I know that nerve regeneration can take time but is there anything I can do at home to help with this? I have looked into Methyl B12 which is said to help with neuropathy (at least neuropathy caused by diabetes) but there have also been some studies that imply this could be a contraindication when your cat has cancer. I am waiting to hear back from my regular vet on this matter.
TLDR: My cat has left hind leg neuropathy suspected to be secondary to chemotherapy tx. Does anyone have any experience with this? Anything I can do at home to help with nerve regeneration? I'm worried that because I have seen virtually no improvement in 4 weeks, this won't get any better. Her quality of life is of utmost importance to me.
Thank you in advance.
I have a almost 17 year old cat who is dealing with left hind leg neuropathy/knuckling and I'm at a loss for what to do. Her case is a complicated one, so please bear with me as I try to provide you with as much information as possible.
She was diagnosed with both large cell and small cell lymphoma in October of 2021. After speaking with an oncologist, we opted to proceed with chemotherapy (CHOP protocol) as I was told the side effects from tx are minimal in cats and her quality of life would not suffer. She tolerated the first two rounds of treatment very well; you wouldn't even know that she had cancer or that she was being treated for it. After the last drug was administered during the third round of treatment, we noticed that she started limping and her left hind leg seemed quite painful. We rushed her to the emergency clinic where she underwent numerous diagnostic tests (CT scan, myelogram etc.) and the neurologist suspected a slipped disc. We were reassured that he could fix this problem and it would be fair to proceed with the surgery as she was considered to be in remission, and he performs this procedure on older cats all of the time. After the surgery was completed, he explained that he didn't find a slipped disc but still opted to do a laminectomy procedure to relieve the pressure/compression in her spine. When we brought her home, she was on heavy pain medication for a few days and was walking on her hocks.
We resumed her final round of chemotherapy one week after her surgery and she continued to do well. Every week we saw improvement; she was no longer walking on her hocks, the limp had almost disappeared completely and she had no pain.
And then it was time for the final drug in her last round of her chemotherapy treatment. As soon as we brought her home, we noticed her left leg was sliding from under her and over the next few days things continued to worsen. The pronounced limp returned along with the pain and this time it was a little worse. We also noticed that she started knuckling.
We had her seen by both the neurologist and oncologist again and the neurologist believes she has peripheral neuropathy secondary to an idiosyncratic drug reaction to one of the chemo drugs as this happened twice after the same drug was given. The oncologist doesn't seem to believe this is the case because neuropathy in cats secondary to chemotherapy is quite rare and on the few occasions that it does happen, it's not usually due to this particular drug. We have recently done blood work and it all came back within normal limits so this is not secondary to diabetes etc. She is also hyperthyroid, but we have that well controlled with medication.
It has been just over four weeks since her last chemo treatment and unfortunately we don't see much improvement with her leg. We have been able to keep her discomfort under control with pain medication. I am frustrated and upset and don't know where to go from here and no one seems to be able to give me any concrete answers as to why this has happened.
Does anyone have experience with neuropathy secondary to chemotherapy treatment? I don't know what else could have caused this.
I know that nerve regeneration can take time but is there anything I can do at home to help with this? I have looked into Methyl B12 which is said to help with neuropathy (at least neuropathy caused by diabetes) but there have also been some studies that imply this could be a contraindication when your cat has cancer. I am waiting to hear back from my regular vet on this matter.
TLDR: My cat has left hind leg neuropathy suspected to be secondary to chemotherapy tx. Does anyone have any experience with this? Anything I can do at home to help with nerve regeneration? I'm worried that because I have seen virtually no improvement in 4 weeks, this won't get any better. Her quality of life is of utmost importance to me.
Thank you in advance.