Tuxedo is at the emergency vet

[Dianne]

I'm so very sorry, Barbara. I don't know how much time is left. It is difficult to predict time if the pet has a very strong will to live. I think you understand what I mean. They can beat the odds a bit longer if they have a strong will. I think you are wise to bring him home where he is comfortable.

Hopefully, someone who has had more experience will come along later. I just wanted to offer my support to you and Tuxedo.

You helped me extend time with Lucky from January to September because of your feeding advice...and I thank you. I thought he was going to stop eating and die in January/February, but your advice helped me extend his life.

Thank you again.

Dianne

[Cindidoxiemom]

Barbara,
I wish I had some information to help you and Tuxedo. I think your plan sounds well thought out, humane and dignified for both you and Tuxedo. I will continue to pray for Tuxedo, and I know you will give him a loving end just as you provided a loving beginning and life.
Hugs,
Cindi

[Diana R.]

Barbara:

I am so sorry about Tuxedo. I went through something very similar with my diabetic 16 year old cat Mac who I lost to heart failure in July. He had been diabetic for six years. I brought him in the emergency vet for hypoglycemia. After I brought him home, I kept checking his glucose levels and he was not needing insulin for days with normal readings. The blood panel showed he had kidney disease. I started giving him fluids. Unfortunately, he started having trouble breathing and his hind leg was swollen. An ultrasound of the heart showed hypertrophic cardiomyopathy. There were no signs of this in terms of heart murmur etc. As you may know heart disease requires restricting fluids. After being in the hospital for several days I brought home only to have him go into heart failure again. I do not know if Tuxedo is showing any of these signs so that an ultrasound of the heart might be advisable. With hemolytic anemia, I know possible causes for cats could include immune mediated diseases and I don't recall if you mentioned this in your post but did they check for red blood cell parasites like hemobartonella---it is a mycoplasma that looks like a cracked egg on miscroscopic exams of red blood cells. Another cause is toxcity (like zinc). I wish you the best. Diana R.

[Christine]

Oh Barbara, I am so sorry about Tuxedo. How fortunate he is to have shared his life with you as his protector, provider and mom. I am praying for miracles large and small for both of you.

Love,

[BethT]

Hi Barbara,

I am so sorry to hear the bad news about Tuxedo. I do not have any experience with this type of cancer but have had three cats die of cancer so I understand where you are right now. I too went the treatment route with the cancer cats and I know now that I would not do that again unless there was a real chance for extending the life significantly. I thought I was doing that for my little cat Speck who died in July after an amputation surgery and here she had a heart issue that caused her death 2 days after the surgery. She was 14. I also have two other senior cats with cardiomyopathy. One is holding her own but the other is in early heart failure. So now we are adjusting meds to see if we can stablize him. Anyway, I am thinking of you and Tux. It sounds like you are doing everything that you possibly can to help him. You wil be in my prayers. Beth

[CarolC]

Heating pad - I have a hospice kitty right now who sleeps beside me at night on a heating pad turned on low. She loves her heating pad.

Periactin - I have done force feeding previously but with this kitty the vet prescribed Periactin and it stimulates the appetite and beats the heck out of force feeding. Not all cats respond to it many do. You give the pill and the cat simply becomes very hungry and eats a good meal. I learned on a yahoogroup that you only need to give a little, and some cats have side effects if you give the full dose. Several people there give 1/16th tablet. I am unable to cut and administer such a small bit, but I give 1/8th tablet and that works nicely.

Taurine - if your cat will only eat Gerber baby food, you can mix taurine into it. Taurine comes in capsules from the health food store. I tasted it and it is virtually tasteless. Separate a capsule and pour about 250 mg into the baby food and stir it.

Baby brush - if your cat becomes so skinny that he is hard to pet because of the bumps, you can buy a soft baby brush and brush him. It feels good to them because you can brush pretty hard, and is great for a cat not grooming well. When shopping for a brush, try to find one that fits an adult hand.

Litter box - they tend to still try to go to the box but may stand in it and miss, so putting a puppytraining pad under the box will save your rug.

Claws - when they are very weak they are unable to strop their claws properly and you may notice the claws catching in the carpet because the old sheaths are not being removed. This is annoying for the cat, if you can do something about it. It is hard enough for a weak cat to walk without the claws catching on the rug.

Falling - If your cat likes to go on the kitchen counter but falls off, you can pull the drawers out a few inches and lay a long 1 x 8 board on top of the drawers under the ledge. It gives a margin of safety for when he slips off the counter.

Fluids - here is a website that may not have been up last time you did sub-q:

http://www.weirdstuffwemake.com/weird/s ... juice.html

Diana R. mentioned fluids/cardiomyopathy/etc. which reminded me of something that happened with my sick (FIV) cat several years ago (the one I was force feeding). She went into congestive heart failure for no known reason. They gave her IV lasix and put her on a heart med and the condition resolved. If your cat is very weak, watch for signs of congestion in the lungs, especially if giving fluids. I am giving fluids twice a day instead of one big dose--safer and more comfortable for her.

Yes, home is better.

[critters]

I'm sorry too. I think you're right to bring him home, but I don't think I'd do senior food with a skinny kitty; senior foods are usually lower in fat and calor, whereas he needs more. Just a thought...

[Dianne]

Litterpan: We used a large, rectangular, flat, oil drip pan from AutoZone, or Pep Boys. They are made by Blitz. It was easy to rinse it off when kitty used it. There is NO lip, no litter, to step over getting in or out.

Bedding: We put the heating pad on low (in cool weather) with the pad covered by another blanket. It provided gentle warmth without any hot spots. We used the heating pad for months without any problems.

Watch your other cats to see if they attack the weaker pet. I had to separate my 3 cats when they began attacking the ill pet. Lucky moved to a quiet corner of the garage to prevent injury from the others. The garage had an insulated door and was warm even in the winter./Dianne

CarolC, I like your idea of adding Taurine to baby food...I'll keep that in mind in the future.

[Barbara Boehmer]

Thanks to everyone for their responses and suggestions. This is a combined response to various responses on multiple forums and emails. I spoke to the vet again today. She said that, based on the results of all of the various tests, Tuxedo most likely has some sort of bone marrow leukemia that is causing the highly regenerative anemia. She said that hemolytic anemia and hemobartonella have been ruled out because there was no rise in the bilirubin, so there is no need for a coombs test. She also said that a transfusion of whole blood would be better than oxyglobin and that steroids like prednisone or prednisolone or dexamethasone would probably do more harm than good, as they suppress the immune system. She said that antibiotics would be just a drop in a bucket against the main problem, but might help with some of his other minor problems, and probably would not hurt, so we will start him on clavamox, which is a broad-spectrum antibiotic. He had his fluids and pepcid this morning and ate some food and is taking a nap on the couch next to his buddies.

It initially appeared that he had non-regenerative anemia cause by the crf, but that is not the case. The crf is moderate, but the anemia is severe, with a separate cause.

[Barbara Boehmer]

I am having a very difficult time obtaining blood and a transfusion for Tuxedo. I have been shuttling Tuxedo back and forth between the day vet and the night and weekend emergency vet clinic. Last Sunday, the vet at the night and weekend clinic said they could order blood for the transfusion once his blood type was known. When I spoke to their staff on Wednesday evening (two nights ago) they confirmed that they could order the blood and do the transfusion there. When I spoke to the day vet Thursday morning (yesterday), she said they got the blood type results back and he is a rare type B. She said that she has never done a transfusion by herself and would prefer that the night vet order the blood and do the transfusion. She faxed a request for them to do that. I called Thursday night (yesterday evening) to confirm that they would order it. They said I would have to call back Friday evening to speak to Debbie, because she was not there and is the only one that does the ordering. I called back tonight (Friday) to speak to Debbie and they told me that she was already gone, because she only works during the day, doing clerical work when they are closed, which they did not tell me previously. They said they left her a note about ordering the blood, but said that she did not order it, because it is expensive, and would not arrive until the middle of next week, and she did not know if the cat would still be alive then. They said that they can't order on weekends and the next opportunity for Debbie to order it would be Monday. I asked to speak to the vet that told me Sunday that he could do it and they said that he won't be in until Saturday morning and probably won't be able to come to the phone, since he is the only vet. I figure I will call to speak to him tomorrow, then call to speak to my day vet and explain what is happening with the night vet, then try to figure out what to do. It is outrageous that my cat may die prematurely, simply because some inept clerical staff at the night vet failed to order the blood for his transfusion. Does anybody have any other ideas?

[CarolC]

Does anybody have any other ideas?

Call local trauma centers and see if they have any on hand

http://www.pandecats.com/x/blood_type_i ... bility.htm (list of type B by breed)

Maybe call a Rex, Persian or Himalayan breeder or rescue and ask where they get it in an emergency, or what vet they use for their cattery. Their vet may have a donor cat on staff living at the clinic. My vet keeps a donor cat at the clinic, but I don't know the type.

Persian breeders

Himalayan breeders

Cornish rex breeders

Devon rex breeders

Find out what time the vet starts his rounds Saturday morning and be waiting in the clinic in person to talk to him before he starts.

Offer to prepay for the blood and pay a surcharge for quick delivery

There may be a sign posted telling where to file complaints to the state regulating agency, tell them there will be a complaint.

[GabrielDeafBlindPupFamily]

Barbara, I am so sorry for Tuxedo's diagnosis. I know where he wants to be, and that is home with mama. You can give him more quality of time left than any medicine in the world. You are his world. As long as he is with you, there is nothing more that he wants.... Best to you today, and tomorrow and for all the best days of Tuxedo's life yet to come. Every day is precious.

[critters]

How about the old idea of trying to match your kitties? Maybe ordering is "better," but using one of your kitties is certainly better than the nothing Tuxedo has now. Personally, I'd feel better "keeping it all in the family" anyway. Good luck!!!!

[Barbara Boehmer]

Tuxedo is doing a little better today. His condition, the suspected diagnosis, and recommended course of treatment keep changing. Since his recent problems have been with diabetes, kidney failure, anemia, and suspected cancer, I have posted on various forums. I have received a lot of emails indicating some have read some of my posts and not others, suggesting that we test for things that have already been ruled out, or try things that were once thought might help, and have subsequently been determined to be inappropriate at this time. So here is a recap and update, all in one, beginning with a general summary paragraph, followed by more specific chronological details, then where we are currently.

Summary:

Tuxedo is a former diabetic with chronic renal failure (currently moderate) and chronic anemia (currently severe). It has been determined that the anemia is highly regenerative, so things to stimulate regeneration, like epogen (procrit), won't help. It is thought to be caused by something cancerous, such as bone marrow leukemia, not something autoimmune, therefore steroids would make it worse, not better, and any chemotherapy to treat the cancer would worsen the kidney problem and kill him quicker than doing nothing, therefore any tests to determine the exact type of cancer would be pointless, and possibly too stressful in his condition (such as bone marrow biopsy). Various blood and urine tests have been done by 2 vets at 2 facilities, a day vet and a night and weekend emergency vet. There is no "teaching hospital" nearby and there isn't anything more that could be done by a specialty vet at a far-away facility. The day vet has consulted a specialty vet over the phone to determine what tests to run and how to interpret them. I do not completely understand all of it and may not be explaining it thoroughly, which may be why some of it does not seem quite right. He does much better at home (happier and eats mores), so I am giving him subcutaneous fluids, pepcid, and clavamox at home, and monitoring his blood glucose periodically (in case the diabetes returns).

Chronological details:

Tuxedo was diabetic for 4 or 5 years. He did fine on humilin lente insulin. When they stopped making it, we switched to protamine zinc insulin and had a difficult time determining the correct dosage. We eventually determined that we were seeing a rebound syndrome, and he actually needed less insulin, not more. We ultimately suspected that he had ceased being diabetic, either temporarily or permanently, and stopped giving insulin two weeks ago. His blood glucose has been normal (141 this morning) ever since.

He has a history of mild chronic renal failure and mild chronic anemia. Even though he is no longer diabetic, he is skinny, dehydrated and lethargic, so we did a blood and urine test and found moderate renal failure and sever anemia, resulting in hospitalization at first the emergency clinic, then the day vet, where they gave i.v. fluids and fed science diet k/d, and did various tests on his blood and urine, ultimately determining that his anemia is highly regenerative, meaning that his bone marrow is rapidly producing red blood cells, but they are being killed off by something as fast as they are being produced, based on the reticulocyte count. They ruled out a number of causes, based on things like no rise in bilirubin, but are unable to determine the exact cause. They believe that it is probably some type of bone marrow leukemia, something cancerous, not an autoimmune problem.

It was thought that a blood transfusion would help temporarily. I was having trouble coordinating blood typing and transfusion between the day vet and night and weekend emergency clinic. The day vet did typing and found out thursday that he is a rare type B. I spoke to the clinic vet today and he said he could order the blood and have it on tuesday, but he wanted to know what the latest packed cell volume was first, saying that a transfusion might not be appropriate at this time. I took Tuxedo to the day vet and found that the packed cell had gone up slightly (a good thing). It was originally 12, went down to 8 during i.v. fluid treatment, (which dillutes it, so it may have actually been the same), and it is now 13.5 or 14.3 (two tests with different results done at some time), meaning that his bone marrow is producing red blood cells slightly faster than they are being destroyed at this point.

I got the day vet to call the night vet and confer with one another. They decided that it is best not to do a transfusion right now. The night vet can order the blood and do it if need be at a later date. The night vet also has oxiglobin in stock if he suddenly gets worse. I am to call the day vet Tuesday and let her know how he is doing. She may want to re-check the kidney levels. Doing a bone marrow biopsy might tell us exactly what he has, but the testing might weaken him too much, and any treatment for anything that the test might tell us he has, such as what type of bone marrow leukemia, that would be treated with chemotherapy if that were his ownly problem, would not be done because it would worsen his kidney condition, and that would kill him quicker than not doing anything. Steroids are not appropriate, as they would be to suppress immune responses in immune mediated conditions which he does not have; They would make things worse by weakening the immune system.

Current treatement and condition:

I am giving him 1/4 pepcid tablet (2.5 mg) every morning, 1 clavamox pill twice per day (a broad-spectrum antibiotic that can't hurt and might help other minor problems), 100 ml lactated ringer's solution subcutaneously every morning, offering him science diet k/d canned food, which he is refusing, letting him eat what everybody else is eating, like iam's hairball formula high-fiber dry cat food, mixed with nutro maxcat senior dry cat food (lower in phosphorus, sodium, protein, no by-products so it is better for crf) and iam's canned cat food, checking his blood glucose once per week on saturday mornings, and checking for glucose in the urine every time I see him pee and can get a test strip underneath him quickly enough. He is eating, drinking, pooping, peeing, sleeping on the couch or grass in the enclosure when the weather is nice or by the water dish. Today he was doing a little more sitting in my lap and beginning to purr again. I think he may have gotten worse due to not eating well between when we took him off of tagamet and when we started him on pepcid. The clavamox may also be helping. I will call the vet tuesday, let her know how he is doing, and we may recheck the kidney levels and packed cell volume. It is believed that what he has is utlimately fatal and the best we can do is slow it down and make him comfortable.

[Christine]

Barbara, bless you and Tuxedo...Recently, I had a real problem with Bailey not eating and I tried Boost in the Vanilla flavor (first thought about Ensure, but they were out) She loves it and when nothing else will work, she will lap that up even with her supplements and powders mixed in. I realize Tuxedo has a lot more going on and that might not be helpful, but if your vets agree, might help build him up nutritionally. Still in our prayers.

Love,