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cat needs help !

mycat
October 3rd, 2005, 03:21 PM
Hi,

My cat (at least 12 years old) lost appetite, lost weight, then vomit, and diarrhea. The vets (after lab work, ultrasound, xray) gave him metronidazone & prednisolone for 5 days. It worked. The cat ate and drank a lot after that. He also gained weight.

At the end of 5 days, he prescribed prednisolone only (he suspects cancer). Long term use. Everything is fine for 2 weeks, now the cat loses appetite again, and lose weight as well. Do you have any ideas ?

I plan to ask the vet for metronidazone again. I don't know if this makes sense ?

Also, do you know a good vet in Phoenix, AZ (USA) area ? (in case I need second opinion).

Thanks

PS: here is what I see in the ultrasound report: "Rec FNA, vs trial treatment. Highly suspicious of neoplastic process"

Lucky Rescue
October 3rd, 2005, 05:00 PM
Do you mean metronidazole? If so, this is used to treat some bacterial infections and (as I learned) can CAUSE loss of appetite, nausea, vomiting and diarrhea.

Prednisone causes damage over the long term, but if your vet suspects cancer and this med helps the cat feel better, you might ask him about continuing it.

I"m sorry about your cat.:(

justncase
October 4th, 2005, 02:46 AM
If your vet prescribed metronidazone he may have suspected IBD(Irritable Bowel Disease). Your cat has all of the symptoms of IBD,however, these can also be the symptoms of several other diseases or conditions as well. If with metronidazone there was an improvement and without it the symptoms returned , there is a strong possibility that your cat may have IBD.

CyberKitten
October 4th, 2005, 12:20 PM
It sounds like the vet was trying out this treatment while he suspects cancer. I would talk this over woth your vet and see what else might be tried. Has your vet ordered more tests to know for certain if it cancer? - or did s.he do the labs and you are waiting for results? Did s/he do a biopsy?

mycat
October 5th, 2005, 12:34 AM
Thanks !

The ultrasound result said "highly suspicious of neoplastic process". So the vet think cancer.

Today, she removes fluid from his lungs. 250 cc. Xray show tumor in lung. They will analyze the fluid to see if it cancer, and what kind of cancer is it.

Is there anybody tried chemotherapy ? Could you share your experience, like how successful, what kind of cancers, how soon the cancer is detected, how long is the treatment, cost, pro & con, side effect, how long the life is extended, ...

I am thinking about chemo now. The big constraint for me is it costs so much. The vet est 2000/treatment, and she doesn't know how many treatment needed, or how successful it is.

So please let me know your exp. about chemo.

CyberKitten
October 5th, 2005, 09:01 PM
I read the notes re his suspscion of neoplasm so ascertained he thinks cancer. I do not have any personal experience with a cat who has cancer but I am an oncologist by profession and know that cats, just like people, can live good quality lives even when diagnosed with cancer. It is not nec'ly a death sentence by any means. Vets now have a plethora of resources at their (and your cat's service) and feline cancer is often treated very aggressively. It depends of course on the dignosis and prognosis.

Since at this stage, the vet has not yet confimed a neoplasm, it's hard to actually give you much more info. Recently, someone asked about care for her cat with cancer and this was my response: ( did not even alter the typos, :) )

Many cats with cancer undergo sucessful surgery and do well post op and live comfortably after. Of course, your vet is the only one who can tell you what her specific case is and how she will do. There are several cats with cancer who have web pages and their meomies chart their course of treatment and compare notes. Punkie Louise is one of my favourites:

http://barbarascamera.com/punkie.htm

Cats tolerate chemo much better than humans (also they tolerate strong pain meds better as well) while it sounds as tho you want to try dietary over chemo, dietary can only go so far. Surgery is often indicated in cancer as is chemo -. Kitties tend to lose theiir whiskers rather than their hair during chemo. Some of my human cancer patients have written to Punkie Louise and offered to create some whiskers for her.

Good luck!! There are some great vets who specialize in feline cancer too.

This is the entire thread which may help since others also responded to that discussion:

http://www.pets.ca/forum/showthread.php?t=19221&highlight=punkie+louise

I hope it is not a neoplasm but if it is, I assure you cats can and do successfully fight that process!

Good luck!!

mycat
October 5th, 2005, 10:14 PM
Thanks ! Lots of good info.

What do you think about biopsy and fine needle aspiration ? Which one is better ? Right now, I want to pick FNA because it's less intrusive. Also cheaper (I heard the vet saying around 300 for biopsy).

Are there any risk on doing these things (biopsy, FNA) ?

The referral form she gave me to bring to the oncologist says "probable metastatic neoplasia, hepatomegaly, splenomegaly, lymphanadenopathy, pleginal effusory" (not sure if I can read her writing correct)

Could anybody know these terms means ? I only know vaguely that cancer moves to many other places.

CyberKitten
October 6th, 2005, 12:19 AM
The phone woke me up and I really HAD to check email (yeah, suuuure I did) so this is a very quick response to your questions when I am half asleep. If it does not make sense, ask me tomorrow, <g>

Keep in mind as I asner these that I am knowledgable about human cancer - and while the processes are similar, feline pyshiology is different from that of a human. Of course!

What do you think about biopsy and fine needle aspiration ? Which one is better ? Right now, I want to pick FNA because it's less intrusive. Also cheaper (I heard the vet saying around 300 for biopsy).


Actually, both are types of biopsies. Fine-needle aspiration or FNAB is much less invasiove a biopsy. It is just different from the tradtional biopsies. Most of the debate - and there are hundreds of studies in journals comparing the two (some oncologists seem to want to study the varying types of biopsy till they are blue in the face!) - centers around which one is more accurate. FNAB is used by many in determining breast cancer now for example. The conclusion among most of the docs in my field - and this is my own view too - is that there are some neoplasms (cancers) where FNAB is fine, such as sarcomas - cancer of the bone and in some large muscle mass like breast cancer but soft tissue cancers are often best detected by the the traditional open incisional biopsy,sometimes called core needle. There is one well quoted and highly regarded study for ex that shows an 80% success rate in detection in sarcomas but only a 52% in soft tissue neoplasms.

It sounds like your vet suspects a tumour in the liver or the lung and s/he also wants to find out if it has metasicized - ie the cells have migrated from the initial place it began to another place in the body. I do not know which one is preferable in a cat. I do know if I were a human and my doctor told me she suspcted liver or lung cancer, I would want the traditional one done. If it were YY (my Siamese we are talking about, I's research to find out which one is preferable in a kitty. They have tinier bodies so everything is smaller. The FNAB is faster though and does not - at least with humans, require anesthesia, which is a good thing in a kitty who is not feeling well. I would ask the vet if this were her cat, what would she choose? Is it a she? The vet I mean. <g> I somehow think there is less stress in the FNAB so that has to count for something. It might well be similar to a vaccination - in to get the tissue sample and out. Very fast and you should get the result in the same day, depending on how far the clinic is from a path lab.



Are there any risk on doing these things (biopsy, FNA) ?


There are risks in any procedure. The more invasive biopsies have more risks for obvious reasons - it is minor surgery after all. The FNAB requires no surgery and while there are various risks, depending on where it is done in humans, I do not know how that works with kitties. Likely, there are some risk but I think it is safeto conclude there are fewer.

I hope I have not confused you. It seems the FNAB may well be a good diagnostic tool for vets to use on cats - quick, relatively painless and no anesthesia. Personally, I would spare no cost for my baby and it is not a factor but if you are looking at that, obviously, the less invasive one is cheaper.






The referral form she gave me to bring to the oncologist says "probable metastatic neoplasia, hepatomegaly, splenomegaly, lymphanadenopathy, pleginal effusory" (not sure if I can read her writing correct)

Could anybody know these terms means ? I only know vaguely that cancer moves to many other places.


Now , the definitions:

1. probable metastatic neoplasia
- an abnormal growth of new tissue (can be benign or malignant)
2. metastatic - spread of a tumour from its site of originto dif sites, usually thru bloodstream, lymphatic system, other means
3. hepatomegaly, - abnormal enlargement of the liver, usually a sign of disease (not necly cancer tho)
4. splenomegaly - an enlarged spleen, again can be the sign of probs
5. lymphanadenopathy - enlaerged lymph nodes and vessels (I see a trend here, <g>)
6. pleginal effusory
I suspect she must have meant pleural effusion
Effusion is the escape of fluid (like blood, lymph, etc) into a cavity - often ass with kidney or circulatory probs but here I dare say she (he?) suspects the kidney.The pleural means fluid escaping from the membrane covering the lungs and inner surface of the chest.

(Side note: When I was just starting out in oncology, I was explaining to a teenager about pleural effusion and he mistook it to mean plural (ie more than one) and he told the nurses later in the day that he has plural or fluid excaping from many parts of his body, sighhhhhhh!! We live and learn!!!)

Many conditions can cause pleural effusion, including heart failure and uremia (kidney failure), hypoalbuminemia (low levels of albumin in the blood), infections (TB, bacterial, fungal, viral), pulmonary embolism, and malignancies (metastatic tumors, Hodgkin's disease (what my grandpa died of, sigh!).

I hope this is not too confusing - I have to get back to bed and hopefully to sleep. Let me know tomorrow of you have more quests. When does s/he want to do the FNAB?

Give your kitty a hug for me and :grouphug: to you too!!! This must be stressful - I know how I would feel it were my kitty!!! Take care of yourself!

mycat
October 6th, 2005, 09:50 AM
Thanks a lot !

My (and his) bad year.

I will schedule an appointment with the oncologist this morning.

mycat
October 7th, 2005, 10:41 PM
The lung fluid analysis result come back, but is not certain. It says "Primarily small mature lymphocyte are observed. A lesser number of macrophages and nondegenerate neutrophils are also seen. There have been variably hyperchromatic cytoplasm. Some cell have prominent nucleoli. Most of these cells I consider reactive. This fluid is not definitive for neoplasia. However rechecking for a mass is advised"

The oncologist my vet refers to redo the ultrasound and bloodwork tests.

The strange thing is that the mass in his lung (which before I think a tumor) is not shown up on ultrasound, eventhough on the vet's X-ray, it is there !

So now we don't know what is in the lung.

Since ultrasound cannot see the mass, they cannot get an FNA on the mass (in the lung). They can only get FNA on the liver (enlarged).

Another strange thing is ultrasound of my vet says enlarged spleen, but oncologist's ultrasound says spleen OK !

Because liver is enlarges, and cover the lymph node (also enlarge), the oncologist cannot take FNA on the lymph node (he is not comfortable to do that). So at the end only FNA on liver are obtained.

The oncologist's ultrasound result says: "Liver: suspect diffuse neoplasia (round cell ?). Hepatic LN's: probably same disease as in liver".

So now I wait for cytology and bloodwork result. The oncologist says she suspects lymphoma, but she's also cautious that cytology result may also not sure to pinpoint the problem (sample is too small ?). I don't like biopsy because it's like a mini-surgery, and also costly.

She says if result comes back uncertain, just go ahead do chemo. What do you think ?

The cost is about 3000-4000 and average lifetime is 9-12 months (she said). And there is chance the cancer come back after that time, and at that time, cannot repeat the chemo.

I really don't know what to do now. Should I spend that much amount of money for that short time ?

Another thing I want to ask you is force-feeding OK ? He doesn't eat much (the oncologist keeps the vet's prescription: 2 prednisolone + 2 metronidazone). If I press food (wet, canned food, like paste, no need to chew) into his mouth, then he swallows. I don't want his weight keep on going down. I change many type of dry food, can food. He's not quite interested.

BTW, I strongly recommend who has pet think about pet insurance. The trip to the oncologist is 920$. And the trip to my vet 3 days ago is 420$. And now the chemo cost looming ahead :-((

sigh ...

CyberKitten
October 9th, 2005, 01:32 PM
Sorry to hear you have such difficult decisions to make - these are always hard calls. And I apologize for my delay in responding, I did not see your msg till toady when I looked beyong "New Posts".

There are sometimes times when tumours are hard to see, even on scans. It may be in an unusual location and more scans or an MRI might be needed to see it. It's good they are redoing the bloodwork esp since it seems so inconclusive.

No one can tell you what to do - but you might want to talk with others who have gone thru this with their cats. Maybe the mommy of Punkie Louise? Email her and ask her opinion - she knows many others in similar situations. I guess it comes down to how much quality of life there will be for your kitty. Cats tolerate chemo quite well though there are exceptions. There are also orgs who can help financially (imom.org if they are taking new ppl - they had stopped for awhile) if money is the issue. If you think your cat can defeat the cancer and you can buy her a year of life that has good quality, it would be worth pursuing. Cancer does not have to be a death sentence by any means.

My heart goes out to you - I canjust imagine how difficult this is for you!!