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ginger cat w/ rare anemia disease (seemingly Feline Infectious Anemia)

gingerbeastie
March 9th, 2010, 12:42 AM
This is a long story and the details seem very important but I hope there is enough room to include all that I want to include....

(story told via emails of mine to a vet in Los Angeles area)

(email of 9-15-2009)
Since February this year our cat (who is about 12 years old, orange and white tabby with white on face, chest, belly, legs, was a wild mountain cat for the first 5 years of his life) has had several anemia bouts, let's say he's had 6 or 7 episodes. He never had this problem in the prior 7 years that he's been in our family. He'd always been a very active cat and never exhibited any symptoms that we noticed.

Each time his health fails he's treated with doxycycline, and he comes back from what appears to be the brink of death. He recovers well and is playful, eats well, eliminates well, gets pink in the places he should, etc. Each time he's gone off the doxycycline he then deteriorates, the last time his health deteriorated very quickly after stopping the doxy, within a week or so. Prior to that it would take a month after taking doxy before he deteriorated noticably (but this last time he took only 40mg of doxy per day whereas before he took 100mg or 50mg ooxy).

The first time he was anemic (hematocrit at 16%) we did a blood test that showed his reticulocytes were very high (around 100,000 as I recall), at least the bone marrow is able to grow red blood cells.


Since the end of July he's on a new amount of doxycycline, per body weight, so he's taking about 60mg of doxycycline once per day. And, for the first time, he's also been taking 5mg of prednisalone per day. He's doing great, again very playful, interacting, eating well, etc.


Tomorrow our cat will have a PCV test so we can tell if he tests within normal range (i.e. no anemia). If the red bloods are normal amount then he'll go off the doxycycline (yet again) but the vet plans to keep him on the prednisalone, possibly for life. (and if the pcv is fine tomorrow then he'll also have minor surgery, unrelated to the anemia, to remove a couple of bad teeth and possibly a couple of small skin growths on his white nose and his back, didn't want to do any surgery unless his red blood cell situation was good and even still I'm sa bit concerned about surgery).


There's been no test that confirms FIAnemia in our cat, but it seems likely that's what he has. When his health deteriorates some of the signs are pink turns white, greatly lethargic, heavy breathing and sometimes no appetite. Also, when the doxycycline is terminated he can lose his meow due to swollen lymph nodes. All nodes swollen, then clavamox is given to him and he recovers his meow and lymph swelling subsides.


Can you give any input on this situation? Any ideas on treatment, can you refer us to an infectious disease veterinarian, do you know of online information? I have read the online information on your webiste . Do you have experience with the type of anemia our cat appears to have?


We like and respect our current vet, he's been the most able so far and has a good attitude. But like all 5 veterinarian's our cat has been to none of them have treated this condition before so we're considering getting expertise with this condition.

I'll appreciate anything you can share, if there's more information you'd like to have please let me know,
Sincerely,
-----------------

(below email of 11-9-2009)
We've had a long delay in further treating our cat (3 months of doxy and prednisalone instead of 2) but tomorrow he's scheduled for that PCV and then the minor surgeries if PCV shows no anemia.


Still concerned about how to test and treat. Per my 9/15/2009 email (below) he's had several bouts of this anemia since February this year and they've been awful and very hard on our puss.

We understand that with FIAnemia even doing a PCR test might not show the bacteria involved. So we question why do the PCR test? And if we do have the PCR and it comes back negative should we do other tests to see if this is immune mediated or something else?

It's a confusing illness, and apparently rare. Any referrals to infectious disease veterinarians, or other? Have you ever treated a cat with the type of anemia I've described?


Again, we appreciate any information you can share. And if you're interested for your own purposes I could let you know how our cat does over the coming weeks as he recovers from surgery and comes off the doxycycline yet again (prednisalone is decreased, was at 5mg daily but last few weeks decreased prednisalone from 5mg to 2.5mg daily, and our vet says his plan is to keep our cat on 2.5mg every other day for life).
---------------

(email of 1-4-2010)
Thank you for getting back to me so quickly when last I emailed. Gave me something to inquire of the veterinarian who is treating our cat.


Our veterinarian explained that the PCR test gives false results frequently, and I guess is unreliable on the whole (what do you think?). He said that the test could result in negative for autoimmune but many times there is an autoimmune condition. I think he said positives are questionable as well (will ask him again). Do you still think the PCR is a good next step?

Finances are a factor for us as well, we've already spent much on our dear cat, while financially and medically concerned for ourselves, we're trying to carefully choose medical directions, as carefully as we can determine.


We'd also prefer to take medical actions when things are more certain, if possible. Reluctant to do a splenectomy or anything invasive or aggressive without understanding enough. If you want to answer (and I understand if you don't, everyone has busy lives), it seems to me your words in your last email (below) imply that a bug could be hiding out in the spleen? Could a bug be hiding out elsewhere, like in the bone marrow and other places? In other words, we remove the spleen but that doesn't solve the problem, then what? Apologies in advance for my too limited medical knowledge and understanding.


When last I wrote we were taking puss to the vet for PCV next day, turned out that cat was at 24% and vet wanted him higher (in the 30's) so the minor surgeries were not done that day. Since then puss on 65-76mg of doxycycline once per day and 5mg of prednisalone once per day. We had been giving him only about 50mg per day of doxy and I had reduced the prednisalone to 2.5mg per day for a couple of weeks prior to the vet appointment, so since early November we've beefed both back up to see if makes a difference. We're doing the PCV again today and depending on the results might do the minor surgeries as well today (remove at least one tooth, remove a skin tag rear spine area). Nervous about doing any surgery due to the anemia and the anemia condition. Your thoughts?


Are you aware of any other meds and dosages that might help? Any other testing or exams? Links to information on feline anemia that might shed light? Specialists in this condition whom we might consider visiting? What do you think we could do next? The PCR? Other? Realize these are bigger questions and you haven't seen the feline patient, but worth asking anyway as we're eager for more information. Sure worried about our cat having been almost a year on doxycycline and amost 6 months on prednisalone.


Hoping to figure out this condition this year and get our pussycat cured (or at least managed better and so that he doesn't have to be on strong meds all the time).


Thank you again for your last reply and if you can offer anything further we sure appreciate it. Goodness in 2010,
--------------

(email of 3-7-2010)
3-7-2010 Sunday
Hello, and thank you again for getting back to me with more on our cat's rare anemia condition. We sure appreciate it.


It's been over a year now of trying to treat him and keep him well. And lately there's been trouble with his health again.


In your last email you mentioned that your reference lab has a new PCR test. Which lab do you use? Seems like vets in LA basin area use Antech, is that your lab also? What is the name of the new PCR test? And is it widely available?


Please reply soon if you can (but we understand if you don't). Due to cat's current health status (described below) we're very eager to know about the PCR test you described.


As for the spleen issue, another thank you for the description. I haven't had where-withall to research, I don't quite understand yet, is it the case that all red blood cell destruction occurs only in the spleen? Also, is there risk in leaving all red blood cells in the system, what if some other thing infects them and cat's spleen is gone and no longer removing those infected red blood cells?


This health condition has been hard on all concerned, we're eager to have good effective treatment and a healthy cat!
And eager to know about the new PCR test you mentioned.
Sincerely,

P.S. More status on our cat's health, just in case you can respond to more than the above. But if you can respond to at least the above please do!


When last I wrote (below, early January) our cat was doing fine but had needed minor surgery for months. So we were going to do a PCV to see if cat still anemic and if not then do the minor surgery.


We did the PCV, his hematocrit was 36%, which is good, so we went ahead and did the minor surgeries (early January). A small cyst removed on his back, skin cancer on nose removed (started growing back relatively quickly, after about 2 weeks), and 3 bad teeth removed. He came through the surgery fine and did very well, as he has done since last July.....until about a week ago.


Last Sunday (2/28) we noticed he was less active. By Monday (March 1st) he was not interested in his usual food (canned or dry) and we had to work with him to get him to take his prednisalone (via Pill Pocket, which he'd been eating happily for months). He wouldn't eat the doxycycline at all. And he was less energetic, we had to buy more canned and dry food brands and switch them around to get him to eat. He wasn't as far down as he'd been the several times February 2009 through July 2009 (down times coincided with taking him off the doxycycline to see if he could live without it), but still not himself. This week he has been slower, stiffer, sometimes he seems confused. During this week we continued to just give him the prednisalone and about 1/3 to 1/2 his normal food supply, until yesterday, Saturday 3/8, when we took him to the vet because he wasn't getting better and wasn't taking the antibiotic.


Yesterday the vet said leave him off the 68mg daily doxycycline, keep him on the 5mg daily prednisalone, and give him an antibiotic new to our cat, orbifloxacin (Orbax, 22.7mg tablet, give 1/2 the tablet every day). Cat wouldn't eat the Orbak yesterday or today so today we force-fed him the Orbak (mixed in water, small syringe). He continues to eat the prednisalone (in a Pill Pocket) fine so far.

Cat could be anemic but to us it also seems like he may have another bug, different than the anemia-bug. It has happened a couple of other times in the last year, that while taking doxycycline he lost his meow, so he was put on Clavamox as well as the doxycycline and within a few days his meow was back and he went off the clavamox but stayed on the doxy and all was well.

Vet found yesterday that cat's rear lymph nodes are large (about 4 times normal size). Current idea is to see how he does on Orbax (orbifloxacin) and if lymphs still swollen in a few days then do a lymph biopsy and a PCR (and a cbc). Our vet hasn't heard of a new PCR test and I believe it's fair to say that our vet is still skeptical about results from PCR showing anything definitive except cancer. Our cat has suffered from the anemia disease for over a year, with some downfalls, and now another one which isn't related to taking him off doxycycline because he was on doxy, not off it, when he started to go downhill. In any case, his condition sure doesn't behave like cancer. Does it? And to us it seems like this time he suffers from something other than the anemia condition (but possibly the anemia condition as well, don't know his hematocrit). He may yet again have two bugs going on at the same time. Maybe.


What do you think about our anemia prone cat taking Orbax? Do you think, given the anemia condition that seems to be FIAnemia, that in addition to the new Orbax the cat should also be put back on doxycyline? Do you think PCR and lymph biopsy (and cbc) are a good next step?
------------------

That's the story via emails with a vet.

Update is that today, 3-8-2010, our cat refused the orbax AND this time he refused the prednisalone as well, so we had to forcefeed both. He's moving around but still more lethargic, not himself. And not eating much at all now. Just maybe 40 dried food bits today and a forkful total of canned food.

Very worried.

Does anyone have experience with this odd form of FIAnemia that doesn't lay low after a couple of months of doxycycline treatment? Anyone have suggestions?

Can you help?

Please help all that you can. Thank you. :candle:

growler~GateKeeper
March 9th, 2010, 01:13 AM
Hi gingerbeastie welcome to the forum & sorry for the health issues your cat has :(

Your situation sounds similiar to one that another member 14+kitties is having with her cat Brownie:

Brownie's update (http://www.pets.ca/forum/showthread.php?t=67379)

Brownie's vet visit (http://www.pets.ca/forum/showthread.php?t=68152)

I'll pm her the link to this thread to be sure she sees it.

Have you had an abdominal ultrasound done to check the size of the spleen and to check for abnormal internal inflammation/cell growth that could possibly be cancerous areas as it has been mentioned by one of your vets?

Is your cat on any supplements holistic, herbal or conventional? ie immune support, feline vitamins etc

gingerbeastie
March 9th, 2010, 07:57 AM
Tuesday 3-9-2010


Thank you growler! And hello to you. Good of you to help, will reread those links and think this over more.


growler, our cat is not on holistic supplements. He was on an iron supplement for most of the time since he developed the anemia, Petinic and Hi-vite, but he hasn't had that since he started lacking appetite (inappetence) just over a week ago.


The vet has mentioned cancer but his anemia condition has gone on for over a year so to us this doesn't seem like cancer. ??? Also his white blood cell count hasn't been high. (will probably do bloodwork again soon, cbc, and will see current white cell status). Also, unfortunately expense is a huge problem so we're trying to do carefully selected diagnosis. Thank you, growler, for the good diagnostic ideas, will keep them as possibilities as this awful health collapse goes along.


Our cat probably has mycoplasma (feline infectious anemia), a rare one that doesn't go away with doxycycline treatment or at least didn't go away last year between February and July, however, upon consideration last night, we're thinking our cat isn't suffering from anemia this time, as much as he did last year, and that his main problem may be adrenal gland problem/failure/shutdown/atrophy/etc.


He has gotten weaker since this illness started just over a week ago, and may be weakening daily (and will weaken if he doesn't eat more) but he's stronger than when he has had an anemia downfall (last year, last downfall was in July), and he's pinker than when he has a bad anemia.


For just over a week now, however, his appetite has been falling (inappetence), yesterday was his least appetite. He stares somewhat vacantly (glassy eyed, dull, a haunted look). Not sure if his temperature is low but it isn't high (at vet's Saturday it was normal). He is drinking more water than usual and probably urinating more as well.


An adrenal gland problem could result from taking longterm corticosteroid (in this case prednisalone). He's been on prednisalone about 7 months now.


We also wonder that, if it turns out he doesn't have an adrenal gland problem (or maybe even if he does also have an adrenal gland problem), does he have a different bug than the anemia. Perhaps the prednisalone has allowed another bug to rise (or maybe he's just got another bug). We'd hope the orbax (orbifloxacin) would treat anything buggy but maybe it can't treat something that our cat has developed In the past when he's had something besides the anemia (and couldn't meow) the antibiotic clavamox resolved the bug symptoms and was only needed for a brief time (two weeks at most of clavamox).


In summary, we now have two guesses/worries about cat's current problem (of not eating much, not wanting to take his meds, drinking more water, seemingly urinating more, getting up like he wants something or wants to do something but then too tired or ? and lays back down again, glassy staring, vet's discovery that rear lymph nodes are very swollen). The guesses are that the adrenal glands are going downhill and/or that he has a bug different than the anemia.


Leaning toward the adrenal gland problem/atrophy/shutdown/etc. but it's a guess. And he could still have a new bug different from the anemia. And he could be, or soon start, suffering from the anemia also.


Will talk with vet today and maybe take dear puss in to see him today for blood work.


Does anyone know if blood chemistry would show adrenal gland problem/failure and if so what chemistry is involved?


Does anyone have any experience with adrenal gland atrophy/shutdown problems and what the symptoms would be?


We've read up on various to do with adrenal glands but very tired here (and me still sick with a cold) and with so much to read up on and think, well, it's getting jumbled and lost to some degree, and some things we haven't found on the internet at all.


Appreciate all replies, even if you don't have health information relevant to our dear paws. Just wish we could help our cat get well again! Feeling sad and upset.

hazelrunpack
March 9th, 2010, 10:36 AM
I can certainly understand why you'd feel sad and upset! :grouphug: omg, you've been through the wringer with poor kitty!

I'm afraid I don't have much experience with cats. But there are specific tests they can run to see if adrenal insufficiency is in play, at least there are in dogs.

Have you tried a specialist with a veterinary teaching hospital? We've often found that VTH personnel can get to the root of a problem simply because they've seen so many cases of everything under the sun. Perhaps a referral there could get you some answers? In our experience, though, their services can be pricey, at least in the States.

I'm so sorry you're going through all this. Your cat is obviously very well loved and you are an :angel:

:goodvibes: for a diagnosis and effective treatment for your little one

:grouphug:

14+kitties
March 9th, 2010, 11:18 AM
Oh man! Your first post seems so much like my almost 3 year old Brownie it is unreal. :( Except my guy can't get over the anemia. He was also tested for hemobartonella and it came back negative all three times. One of the vets looking after him says he has auto immune disease which, IMO, means she isn't sure what's wrong so is labeling him with it. The other vet was the one to test more thoroughly for that parasite.
I wish I had some magic answers for you. My guy has been on Doxy twice and is on a continuing course of prednisone to keep up his appetite. He started the Pred at one 5mg tablet a day for ten days and is now on 1/2 tablet a day. His appetite is still good but he tires quickly. I had not heard of orbifloxacin before you mentioned it. Maybe not available in Canada. Brownie is also on Amino B-plex .5 ml a day. He started that at .5 mls twice a day for about two months. He was on a product called LiverTone for about three months. It isn't available through your vet but you can find it at some good pet stores. Not sure if your guy's liver is affected? Brownie's is as well as his spleen. I give him Denamarin once a day.
I also feed him fresh raw liver alternating between chicken and beef, right now he likes the beef, and as much good quality canned food as he will eat. He is eating Performatrin Ultra and seems to be liking it. I cook him chicken breasts and give him as much as he wants to eat.
And finances, I understand completely! :grouphug: I work part time and have a few other kitties besides. :rolleyes:
I will keep your kitty (name?) and you in my prayers. It is heartbreaking to see them go through this and not be able to help. :grouphug:

gingerbeastie
March 9th, 2010, 10:13 PM
Dear online pet angels,


Thank you deep from my heart for taking your time and energy to help and support our ever-dear pussycat. That you have given of yourselves generously and kindly to a cat and person strange to you is just a wonder of being truly human. Thank you, dear folk. Your kindness is such a gift.


Our ginger-cat is dear, wonderful, amazing and greatly brave, strong and intelligent. If you knew him you'd know that he's especially deserving of great love, admiration, involvement, enjoyment, and efforts for his health and welfare. He'd be deserving even if another cat ,yet he's always been a bit wild, like the dear wild mustang horse in my life for almost 30 years (passed away in 2002), there is a wonderful brilliant shine that comes with animal outdoor experience, bravery, and heart.


We've been lucky to know this wonderful gingery guy, nothing less than lucky. Sometimes in life, good luck happens (hard to remember sometimes, or a lot of times, hold that thought if you need it). And our good luck was learning to be with and enjoy this special cat-being. Our first cat together and we'll forever remember him grandly and always wish he was with us.


As I type, under a blue and gray and whitish-in-the-west evening sky, surrounded by pines and cedars, in the mountains that ring the Los Angeles basin (the so-called "saints", all named starting with "San") our ever-dear and sweet puss lies next to me on his sleeping pad at my desk. He's beautiful. He grabs at the heart. Well, at my heart.


And I am crying as I write. I don't want to disturb you, and I know you don't have the sadness and loss that I'm feeling for this particular puss, but likely you've had deep sadness and loss, with beloved pet-family as well, and perhaps sharing these words helps in some small way.


Today dear cat was diagnosed with kidney failure. Most important, it means he will leave us too soon. Too too soon. Too soon for deeply connected hearts.


The veterinarian, who is a kind and good man, believes that putterpie has lymphoma after-all. Today he did some blood work, which doesn't tell us if he has lymphoma, and a needle aspirate on a rear lymph, which should tell us. Will know the needle aspirate results tomorrow.


By way of perhaps helping someone in the future, with specific medical info, our cat's comprehensive and chemistry diagnostics of today (sometimes called a comp panel and a chem panel) shows that he has a creatinine level of 6.5 mg/dl and a BUN (amonia) of 101+ mg/dl. Phosphorous is also too high at 11.6 mg/dl. Calcium is into the high range (at 13.4+ mg/dl).


Kitty is clearly in the woods... and the prognosis isn't good. He probably has little life left with only about 10% of his kidneys working.


I don't know why if he has lymphoma his white blood count would be a tad lower than range, his is 5.34, 10.9/L (normal range is 5.5 - 19.5). I would have thought it would be high.


14+kitties, and others who may have been experiencing anemia with their cats, this information about gingercat may hit you hard. I'm sorry. I think it's a good idea to share and want to return to someone some of the goodness that you've given me. Even if it's a hard kind of goodness. Try to remember that there could be better news for you and your puss. I so hope so.


If puss has lymphoma then vet says there's no reason to put him on diuresis (small town, veterinary dialysis not available). No reason, to paraphrase vet, because if the lymphoma has hit the kidneys as hard as they've been hit then there's no recovery from that. But if cat doesn't have lymphoma then diuresis appears to be our next step. Perhaps it would give him a little more life (plus subcutaneous "sub-q" hydration at home afterwards - catterclaws is not going to like that at all, nor will his family).


Coincidentally, I have a friend who has been successfully treating her kidney-failing cat for a year or so now, with sub-q and such. I'll be contacting her to learn more if our dear gingerbeastie doesn't have lymphoma. And maybe even if he does. I guess I'm not sure if there is any benefit to kitkat in treating with sub-q if he has lymphoma and such bad kidney condition.


Have cried lots today and tonight, tears for dear wee beastie who came into our lives and our hearts and our desires. We didn't want a cat at the time, our lives had become and still are greatly pressured and stressed, and cat didn't really want people either, but we gradually became part of each other's life and love until the intensity was such that we loved and adored him, he loved us and a secure home, and Sir Pinkerton Paws was sleeping in our bed with us (even though my mate initially said no cat beyond the kitchen - silly, snaggletooth knew it and eradicated that boundary and most boundaries effectively and completely, and my mate grew to love and adore this wily, fun, delightful, loving, smart, sensitive kittykat).


So we prepare to lose him. Ahh, more tears of love. They come so hotly and stream from my eyes. And clog my nose. As my mate said, we will hold onto hope for gingery's survival in spite of the apparent truth, for that is the deepness of love. And that kind of love makes an important difference... and sometimes brings extra life.


Thank you kind folk again. May you and your human and critter families be safe and happy together. May you all be well as long as possible. The shortness of life for all creatures takes the breath away, may you keep closeness and find depth and goodness with those you love dearly.

:candle:

hazelrunpack
March 9th, 2010, 10:25 PM
:grouphug: I'm so sorry, gingerbeastie.

Here's another thread you might want to read through--it's long, but very informative. http://www.pets.ca/forum/showthread.php?t=45017 Growler has been treating her cat, Duffy, for CRF since late 2007 and Duffy is doing well!

:fingerscr for the aspiration results tomorrow! And :goodvibes: for your kitty!

growler~GateKeeper
March 9th, 2010, 10:39 PM
Does anyone know if blood chemistry would show adrenal gland problem/failure and if so what chemistry is involved?

There is some great info here on common issues with the adrenal glands: http://www.cat-health-guide.org/adrenal-glands-in-cats.html

If it is a problem with the adrenal gland from steriod use, you may possibly be looking at Hypoadrenocorticism aka Addison's disease. There is a test for ACTH (the hormone secreted by the pituitary gland) to see if it responds normally. Other tests would check blood & urine for kidney function as Addison's is sometimes misdiagnosed as CRF ~ Creatinine, Blood Urea Nitrogen, Urine specifc gravity, protein in urine.

They may also check the glucose level and cholesterol and run a stress leukogram if the adrenal glands are producing too much hormones.

I think it wouldn't hurt to do run the PCR ~ IDEXX Labs and I'm sure most others, have this DNA test for Feline Hemotropic Mycoplasma, that is apparently far more accurate than a regular microscope blood smear.

The IDEXX RealPCR FHM Test uses a fluorescent probe that matches a unique segment of the organism’s DNA, making the test highly specific for the pathogen. The test can detect very small numbers of organisms, at a level not detectable by microscopic examination. Because the test detects only DNA, it cannot detect other non-DNA substances that could be visually mistaken for feline hemotropic mycoplasmas in a cytological examination. The specificity, sensitivity and speed of real-time PCR make this technology far more accurate and reliable for diagnosing FHM than microscopic identification

The kidney numbers are definately high :grouphug: I would say absolutely give the subq's a try, the added fluids will help him to at least feel better and usually improves appetite as it flushes the toxins from the body.

I started my CRF cat on Azodyl (http://www.vetoquinolusa.com/pages/pro_azodyl.html) in Dec and it has helped to drop her numbers, I would recommend that as well.

I see you've been given the link to my thread, within the first post there is a link to a summary of tips, treatments, foods, supplements available.

This link is also in that thread which has been invaluable to me http://www.felinecrf.org/index.htm

:goodvibes: for the aspiration results :grouphug:

Dr Lee
March 10th, 2010, 11:53 AM
Hey everyone. 14+kitties asked me for some input so I hope that I have something helpful to say. I have read through the thread but there was a lot of information there and don't want to get anything wrong so I am going to keep some statements general. If there is anything I can specifically help with, please PM me! :D

Feline Infectious Anemia.
As you are all probably aware it is a bacterial infection that used to be called Hemobartonella felis and was first discovered in Africa. Later, through DNA mapping, it was discovered that the bacteria is actually a type of mycoplasma. It was then renamed to Mycoplasma haemofelis. However we have also recognized a second type called Mycoplasma haemominutum. This second type, while usually less virulent, if combined with the feline leukemia virus FeLV can promote the virus' cancer inducing abilities. Because many infectious diseases cause anemia, the diseases now, more accurately called feline hemotropic mycoplasmosis.

Diagnosis problems.
Typically the best way to diagnose bacterial infections is culture. "Grow it to Know it!" However due to the lack of cell wall in Mycoplasma haemofelis , it cannot be cultured. This makes it difficult. :frustrated:

Here is an excerpt from Feline Hemotropic Mycoplasmosis (Infectious Anemia) from the VIN Pet Library by Dr Wendy Brooks:

"Most reference labs scan all feline blood samples under the microscope looking for the characteristic appearance of infected red blood cells (see graphic at the top of the page). Unfortunately, the number of organisms cycles in a matter of hours such that the number of infected cells can change from 90% to 1% in a matter of 3 hours. This makes it easy to miss infected cells, even in a grossly infected cat.

Luckily, PCR technology has made diagnosis easier, although carrier cats can still slip by. Unless organisms are actually seen on a blood smear, the PCR test is the type of test to request. PCR testing uses a technique that amplifies small amounts of DNA, such as parasite DNA, allowing for detection of tiny amounts. Through this type of testing, it has been discovered that up to 10% of healthy cats are carriers of this organism and that testing is best done while the cat is not on antibiotics. PCR testing is able to determine not only whether the cat is harboring mycoplasma organisms but can determine which species the cat is infected with." -Wendy C. Brooks, DVM, DipABVP

Treatment is Two Fold.
1) Antibiotics: Doxycycline (or Tetracycline) or a Quinolone (enrofloxacin (baytril), marbofloxacin, orbafloxacin, etc.) While Baytril has know risks with cats at levels above 5mg/kg, there is concern that the other quinolones may also have similar retinal effects at high levels. Caution must always be used for a variety of reasons. With that said, they can be a great option for some cats.

2) Suppressing the immune system from destroying its own red blood cells (RBC) while the antibiotics do there job

3) Supportive care is always a component. Blood transfusions if indicated, nutritional support, etc....


Statement from the Pet Library handout with Dr Brooks, "Happily, prognosis is fair if the diagnosis is made in time as cats generally respond well and quickly to treatment."

So with complicated cases.
The Recurrent Case.
Blood sucking parasites such as fleas, ticks, lice, and mosquitoes can transmit the disease with fleas being likely the highest risk factor. Furthermore cats with immune disorders are more likely to get infected as they cannot fight the infection. Renal (kidney) disease is also a concern.

The Persistent Case.
For these I worry 1) are they just recurrent cases (i.e. getting re-infected versus those not able to get rid of an infection), 2) is there a different disease going on (could the cat have started with two anemia causing diseases and while the mycoplasma is gone, the presence of anemia makes us think that it is still present?) and 3) there is another concurrent disease going on. And less likely 4) cat not getting correct dose of medication (either by prescription, spitting it out, not getting dosed) or not getting it long enough.


The severe anemia conundrum.
The destruction of the RBCs with Mycoplasma haemominutum is largely due to the cat's immune system destroying it. Thus pets that have serious metabolic/endocrine/organ failure disease often may not have the immune system needed to create such a response. So if a cat has Stage 4/4 renal disease and is in renal failure, then if there is anemia present after the pet has been appropriately treated with antibiotics - I would wonder if the anemia was from the renal disease. Is the anemia a NNN anemia (non-regenerative, normocytic, normochromic) or a regenerative anemia? It would be hard for such a debilitated cat to 1) actively and severely destroy its RBCs and 2) to have a strong regenerative response.

It is important to rule out other diseases such as FIV, FeLV, FIP, etc... If we think it is truly a Mycoplasma haemominutum that is not responsive to standard therapy, then I would consult a Veterinary Specialist - either internal medicine or a University Veterinary Infectious Disease specialist or Immunologist, someone like Dr Dobbs.

Renal (Kidney) Disease.

It is important to be aggressive with this. So many cats can lead active, happy long lives with renal disease if managed. Growler mentioned Azodyl which is an "enteric dialysis". The company also makes Rubenal which is a medicinal rhubarb and reduces inflammation within the kidney that occurs secondary to the reduced kidney function. Epakitin is a safe nutriceudical mediation that reduces phosphorus. An ideal phosphorus (US units) is 4.5. Anything above 6.0 can cause problems.

Here are links to my site. You can read about it, buy it and go to the official website, all in one.
Azodyl (http://acerlux.com/productsyoushouldknow/azodyl.html)
Epakitin (http://acerlux.com/productsyoushouldknow/epakitin.html)
Rubenal (http://acerlux.com/productsyoushouldknow/rubenal.html)


Also kidney diets are important (whether commercial or homemade). They should have sodium and phosphorus restriction, DHA supplementation, potassium supplementation and have balanced protein. Always avoid milk and dairy products if possible as they are high in phosphours.

gingerbeastie
March 10th, 2010, 01:10 PM
Many thanks, growler, and 14+kitties and hazelrunpack. Soon I'll reread much of the information provided and thank you for the supportive kind words (and emoticons) as well.


Not much time-energy right now. We're working hard for dear wee gingerbeastie, haven't given up even though we're terribly sad and prognosis poor.


Lymph needle aspirate results haven't arrived yet, but expected soon. Seems that knowing if the condition is lymphoma or not will help us make care decisions.


Meanwhile have made an appointment with vet in west Los Angeles, for this afternoon (must pack!), a vet hospital center with specialists in internal medicine. Not sure specialists are warranted or even what we want to put our cat through in terms of medical care. Also have inquiries out to another LA area vet, might go there instead as vet seems great and costs would likely be cheaper than vet hospital center.


Thank you all for such goodness that's within you.


Before posting the above I checked the thread and see that Dr. Lee has also replied. What a nice surprise. Thank you Dr. Lee! Thank you 14+kitties!


I'll read Dr. Lee's and the other postings carefully, but right now I have to pack (in case I go to LA) and get ready in general. I'll look into specialists more before I leave to LA if I can (and if I don't leave to LA today). Pussycat doesn't seem to have much time left, and it seems urgent to get him on the diuresis at vet's.


As long as I'm writing more, growler, or Dr. Lee, or anyone, do you agree that with puss's kidney situation that diuresis is urgent and mandatory?

Dr Lee
March 10th, 2010, 01:39 PM
With severe kidney disease, the pet is typically not able to drink enough to keep up with the vast amount of fluid loss. If the blood values are rising and dehydration is occurring, then the kidneys (and the pet) can get much worse if hydration is not dealt with. Also when the phosphorus and calcium are elevated together they can cause mineralization within the kidney and other parts of the body (called dystrophic mineralization. A basic formula is to multiply the calcium times the phosphours. If the product is greater than 70, then the pet is at risk for dystrophic mineralization. Here's the formula for the given values is 11.6 x 13.4 = 155.44

So dehydration, elevated kidney enzymes, imbalanced minerals, and assumed clinical signs are present - yes IV fluid diuresis is warranted. Obviously fluid therapy needs to be monitored closely in the face of anemia. Additional blood testing will be needed at the hospital.

Please keep us informed

gingerbeastie
March 10th, 2010, 02:29 PM
3-10-2010 Wed.

Thank you, Dr. Lee. Good of you to reply and so quickly!

Information just in: Pussycat doesn't have lymphoma according to the needle aspirate results. No Lymphoma! Giving us more hope.

But the situation is still complicated to us.


The anemia and the renal failure aren't because of lymphoma.
And the anemia problem appears separate from the renal problem - when kitty was first diagnosed with anemia (in February 2009) his creatinine and BUN levels were fine, as was everything else except the anemia related numbers.


So it appears he has an anemia condition with no known cause AND the kidney failure (also with no known cause, could be due to the kidney's simply failing, but in any case the treatment will begin with diuresis plus meds plus feeding).


Not sure what to do about the anemia condition yet. Seems, though, that our first thing to do is get puss on diuresis at vet's, and hope he comes out of that well. However, we're concerned that the anemia condition is in play (with hematocrit at 25%). Wonder will puss continue downhill on anemia so much that even the diuresis isn't going to help?


Then after hospitalization take him to internal medicine or infectious disease specialist who might diagnose the cause of the anemia condition.


Or take him today to the internal med specialist and then tomorrow put in hospital for diuresis? Might be good to get specialist input prior to the hospitalization. Not sure if I can make the LAngeles appointment with internal medicine specialist today...time is flying...

Dr. Lee? Anyone?

Dr Lee
March 10th, 2010, 02:38 PM
The presence of anemia is not a contra-indication for fluids. Just means that the anemia needs to be monitored while on fluids and proper care be taken. I agree that getting an internal medicine specialist involved as soon as possible is a great idea. However keeping her off fluids prior to the internal medicine specialist is not going to likely help them with their diagnostics and could put the pet at additional risk. If fluids are needed, then I would pursue supportive care and involve the specialists as soon as you can.

gingerbeastie
March 10th, 2010, 03:08 PM
Another big thank you, Dr. Lee.


And we'll do just that. Taking puss in for diuresis (iv hydration) shortly! Hopefully puss will survive the diuresis and come home and then we'll deal with the anemia.


Going to be very very (very) hard to leave him at the vet's. He's only been left for part of a couple of days in a strange place in all these years, and he's a very territorial cat. Plus he wants outdoors every day. No kennel staff after 8pm either. Sigh. Just have to do this, endure separation pain to try and save him.


Dr. Lee (and any others who want to give thoughts), we're concerned about intraveneous being hooked up to puss all night with no one there. Do you think better to disconnect him at night (and leave catheter in) or leave him connected (with the idea that the worst that can happen is the iv comes out during the night and staff addresses it in the morning)? Vet says they will hook him up all night, so we'd have to request otherwise.


Not going to LAngeles now as local vet will do diuresis (vet says maybe 4 days at vet's - does that sound a typical diuresis stay?). Was told by LA vet hospital that cost would be more than what our local vet will charge, and to get to diuresis as soon as possible so it's better locally than trip to LA.


Hoping for gingerbeastie :candle:

14+kitties
March 10th, 2010, 03:14 PM
Sending lots of :fingerscr:goodvibes: for your kitty. I hope the steps you are taking will help. Thank you for being his :angel:

growler~GateKeeper
March 10th, 2010, 06:48 PM
Dr. Lee (and any others who want to give thoughts), we're concerned about intraveneous being hooked up to puss all night with no one there. Do you think better to disconnect him at night (and leave catheter in) or leave him connected (with the idea that the worst that can happen is the iv comes out during the night and staff addresses it in the morning)? Vet says they will hook him up all night, so we'd have to request otherwise.

I would leave him on the drip overnight he needs those extra hours of hydration/system flushing.

Personally :2cents: I would have him transferred to a nearby Emergency Clinic for monitoring overnight from the time your regular vet closes until they open in the morning. I realize this might not be an option either by location of ER clinic or financially speaking. Last summer my CRF grrl needed a weekend stay in ER to deal with an allerigic reaction / acute pancreatitis attack and while it was expensive I wouldn't have done anything differently.

So glad to hear lymphoma has been ruled out :highfive:

hazelrunpack
March 10th, 2010, 08:43 PM
That is good news about the lymphoma, gingerbeastie.

:goodvibes: for a successful diuresis treatment! :grouphug:

gingerbeastie
March 11th, 2010, 02:31 PM
Dr. Lee, could you specify monitoring of the fluid therapy for anemia? You wrote "Obviously fluid therapy needs to be monitored closely in the face of anemia. Additional blood testing will be needed at the hospital.". Our vet says no blood tests until 3 or 4 days after treatment. Is that too long? Also, cat's blood work was done now 5 days ago (Saturday past), which means he could have been more anemic upon admission to vet hospital yesterday (and he did look more anemic, not as pink). Vet says not unusual for diuresis to make pets anemic, he said expects hematocrit to lower to 15% or so. Your thoughts?


Plan is that puss will stay at vet hospital, treatment 24 hour diuresis, until Saturday (3/13). Vet says 3 days of diuresis in his experience is too little and 4 or 5 days is just right. Thoughts?


Anyone have a recommendation to an internal medicine or infectious disease specialist in the Los Angeles, Calif area? If possible please tell why?


growler, your words make good sense. And puss is on 24-hour diuresis, but no humans on site overnight. Unfortunately we needed to go with the local vet hospital (local vet is a good vet and has given us lots of time for questions and comfort-level ever since we brought pussypaws to him for treatment for anemia last year). Time was of the essence, and human energy and financial. Still, thank you, for the good information and good guidance. So good to share experiences, it can help in small and big ways.


Thank you 14+kitties and hazelrunpack, kind support also helps in small and big ways.



PUSSYCAT STATUS: (hope below and above help someone/some pet or other creature someday)

Puss was admitted to local vet hospital for diuresis yesterday afternoon. This morning on phone I was told he's doing well. Will visit him shortly. And get more detail on his experience at hospital and treatment and plan.


We requested the quietest cage we could find, and that no dogs be put in cages next to kitty's. Dogs would create great pressure and upset for him. But it's a small room and clearly the scent of dog is around, one dog was in a cage and there will be others.


Couldn't put cat in highest cage due to iv drip needing gravity, so settled for middle level cages and the one against the wall (meaning only one pet on the side of him instead of two).


Also put kitty's pad from home in his cage. And made sure there was freely available water and food (though he isn't eating due to the kidney failure and we don't think he will voluntarily at the vet's even if he starts to do better, though will be happy if he does eat!).


Worried that with bandaged leg he can't urinate easily enough or properly. That must have and must still upset him. Diuresis causes frequent urination, if he gets dirty and can't use the litterbox properly he'll be upset and possibly demoralized. It's about all he can do besides drink water.


Talked with vet about getting puss back on the doxycycline instead of leaving him on the recently prescribed orbax (orbifloxacin). Don't know if the doxy is the right thing or not (we don't know why he has anemia, though it behaves like feline infectious anemia). We only know it's what has worked before, though was it working when the kidney failure occured? Yesterday we lowered at home the 5mg prednisalone per day to 2.5mg per day. Vet said he's planning to do same at hospital. Don't know if this is good or bad or ?


Dr. Lee or others, what do you think about doxycycline versus orbax, or some other med idea? The anemia complication is very worrisome to me.



People Status:

As I wrote to my aunt today:
-------------------------------
Hate, truly hate, that kitty is in hospital and wants to be home. He's such a sensitive and smart creature, and greatly centered on us. His first day there was yesterday, he tried to come home with us, limping and dragging from back of his hospital cage, because of his heavily bandaged and awkward leg (iv site). Meowing to us to take him away from that place and to be with us and to go home again. He'd been curled frightenedly and quietly in the corner of the cage, wide-eyed and upset, when he saw us he tried to tell us what he needed, which was to be with us and come home with us. We talked with him, we told him that we're trying to get him healthy again, that he wasn't eating at home, that we loved him, but ultimately we had to walk away. I've been in tears and was then, too.


I know kitty had terribly rough time at vet's last night (and no people around all night into morning). Poor kitty, so alert due to his genes and feral life in the mountains and forest, so trusting of us, we always respond to his needs, they are so few and so simple and he asks with trusting ease and expectation. And intelligence and sweetness. As (mate) says, he's our cat and we're his people.


Very upset.... trying to be braver and calmer. Trying, trying. If he makes it he'll come home Saturday probably. Trying to wait.


Trying to go forward on some things, need to do, must do, but kitty's need to be home weighs so heavily. So heavily. So painfully. And there's much to do for him even while he's hospitalized. More understanding, communication, etc.


Weighs heavily and painfully...pussycat has no idea why he's being forced away from his home and his people. Why we would do that do him. Terribly painful for him and for us.


...I'm having allergic reaction due to time at vet's (to vet's 3 times in 5 days). Must remember to wear a mask (for allergy) when I'm at vet's.


Very tired, very stressed. ...yet we push-push-push somehow anyway for our dear puss.


Hoping hoping hoping for dear gingerypaws. Fear rises, upset, try to reduce. Be brave at vet's, for kitty and for (mate) (and is better for me if I do because upset and fear block clearer thinking and going forward). Be brave, be focused. And go forward on rest of urgencies.


So much to face, to study, learn, try and understand. If he makes it out of kidney failure and comes home there will be much to do. Including diet and nutrition change (learn more), subcutaneous hydration done at home (will have to learn how), and urgently pursuing the anemia condition again.


At least have found someone in Los Angeles to see him for anemia. Though not assured with that person's qualification's as they were only recently specialized in internal medicine (board certified). My be good at specialty anyway...may try and find another. But maybe too tired and worn down to do so.


May not be able to afford anemia collapse, if kitty has now or after release from hospital...
---------------------------------------------


Must remember to be strong, BRAVE! Be brave. Be brave. Be brave. Less tears, more strength. For all concerned...especially for puss and mate, even for the vets and the vet staff.

hazelrunpack
March 11th, 2010, 03:24 PM
Aw, gingerbeastie, you take too much on your shoulders. :grouphug: You'll make yourself ill, and then you won't be any good to anyone. :grouphug:

Remember, most of this is out of your control. Life is what it is and the best you can do is accept it and do the best you can. Time enough to grieve after kitty is gone--and you may have many months left with him! :goodvibes: He's not thinking about dying--he's too busy living! It's hard, but the strength is there inside you--he needs you to be strong again for a little while.

I wish you strength and peace of mind and lots of quality time left for gingerkitty! :grouphug:

growler~GateKeeper
March 11th, 2010, 10:43 PM
Our vet says no blood tests until 3 or 4 days after treatment. Is that too long? Also, cat's blood work was done now 5 days ago (Saturday past), which means he could have been more anemic upon admission to vet hospital yesterday (and he did look more anemic, not as pink). Vet says not unusual for diuresis to make pets anemic, he said expects hematocrit to lower to 15% or so. Your thoughts?

As with anyone with anaemia you don't want to draw blood too often/too close together as it is removing important Red Blood Cells (RBC) that the patient may or may not have difficulty replacing depending on whether or not the anaemia is regenerating. Better to allow the body a few extra days to produce more RBCs, as well it will give the body time to flush out the fluids so if they test electrolytes & kidney numbers at the same time you'll have a more accurate number.

A link to some info on Anaemia, this is from the CRF site I mentioned above, it is not written by a vet but by a woman who has had several CRF cats http://www.felinecrf.org/anaemia.htm


Plan is that puss will stay at vet hospital, treatment 24 hour diuresis, until Saturday (3/13). Vet says 3 days of diuresis in his experience is too little and 4 or 5 days is just right. Thoughts?

Given the numbers you posted I would say 4-5 days sounds right.


growler, your words make good sense. And puss is on 24-hour diuresis, but no humans on site overnight. Unfortunately we needed to go with the local vet hospital (local vet is a good vet and has given us lots of time for questions and comfort-level ever since we brought pussypaws to him for treatment for anemia last year). Time was of the essence, and human energy and financial. Still, thank you, for the good information and good guidance. So good to share experiences, it can help in small and big ways.

As long as he does good overnight on his own & you are comfortable with the vet & staff then it doesn't really matter whether it's a local or ermergency clinic he's at :)

Your vet & staff sounds like they are attentive to your concerns :thumbs up


Also put kitty's pad from home in his cage. And made sure there was freely available water and food (though he isn't eating due to the kidney failure and we don't think he will voluntarily at the vet's even if he starts to do better, though will be happy if he does eat!).

You can also bring in a worn but not yet washed tshirt that has your scent on it, for him to lay on.

Speak to you vet about bringing Ginger's favorite treat to add as topping to tempt him to eat. Some vets will also allow & encourage you to come feed him in clinic, sometimes all they need is a little tempting with the food on your finger to get them to eat.

Most cats like chicken so something like PureBites Chicken Treats (http://www.purebites.com/ProductsCatEng/productschicken_cat.html) crushed on top of the food, or many grocery stores have Barbequed chicken pieces in their deli section you can purchase, remove the skin & use as a topper on the food or as an encouragement/appetite stimulator treat.

During the above mentioned weekend ER stay that my grrl had, I brought in BBQ chicken to encourage her to eat as it's one of her favorites. She actually wouldn't eat the chicken but would eat the catfood off my finger, and with the vets permission the chicken helped to get the cat in the cage next door eating. :)

Worried that with bandaged leg he can't urinate easily enough or properly. That must have and must still upset him. Diuresis causes frequent urination, if he gets dirty and can't use the litterbox properly he'll be upset and possibly demoralized. It's about all he can do besides drink water.

Most cats will learn fairly quickly how to get around that as they are fastidious creatures, if he does go outside the box the staff will clean him up & wash the bedding fairly quickly. My grrl was actually laying on her catheter with that leg tucked in as she usually does :laughing:

Dr. Lee or others, what do you think about doxycycline versus orbax, or some other med idea? The anemia complication is very worrisome to me.

I'll leave this for Dr. Lee as I have not had to use either one.

As for subq fluids it's not as complicated / scary as it may sound, I've been giving fluids for close to 2 years now. A good step by step guide here also not written by a vet but a couple who had a CRF cat: http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html

:goodvibes: for good results :grouphug:

gingerbeastie
March 12th, 2010, 12:21 AM
Thank you for encouraging words, hazelrunpack. It's a rough time here. Still trying to be brave, only cried on way to vet today and a tad in wait area. I'm too tired and too tired of crying to continue to cry as much as I have been, but I'm so worried and my heart is breaking, tears or no.


Kitty just isn't cut out for being without us and being confined and bossed around at hospital. Very upsetting. We two have rescued several cats and dogs (and found nice homes for them), I greatly loved my childhood cat who lived 18 years and was also dignified and very intelligent, and so gentle. But this very wild and wooly gingerpuss with his great self reliance, intelligence and spunk has been an amazing cat. We could barely touch him the first two years of knowing him, for a long time we could barely see him as he would flash past in search of food and water, deliberately remaining mostly hidden. Yet we made friends, and family with him, because we learned to respect his ways and he learned to trust us and not fight us (though we have always had to be careful not to pet him near shoulders or neck, and not startle him and keep away from his large sharp claws).


I think because he's also the first "house pet" we could have (we lived in a house for the first time, and absolutely no rescue organizations wanted him and he is the only cat I've never found a home for so he became ours and visa-versa), and because he learned to trust us so much after being so distrusting, that the roughness of hospitalization and life-threatening illness is so terribly upsetting.


Doesn't help also that we've had serious health issues to contend with the last 3 years. Our own serious health crisis and problems, and health collapse of loved ones leading to deaths (sister, mother, a couple of friends). It's been 3 years filled with medical crisis and related horribleness. And I ache that puss has gone downhill and that he suffers at the hospital and that his prognosis isn't good and even if he survives this treatment the health road ahead for him is difficult at best and jeopardized.


But I was braver today and tried to stay there.


Pussycat Status today:
As bad and as good as I imagined. Puss alert, but so unhappy, in a sort of shock. Dogs barking and nearby, frightening him. Won't eat voluntarily. Jumpy at sounds of cages and walking by. Does have some fight left in him and is resisting vet tech feeding attempts (though they have fed him anyway, which he needs). When saw me puss did not act normal happy and loving self, seemed dazed, a bit shakey, growled when I went to pet him in cage (I gently pet him anyway, though also tried to give him some say-so).


They say he has to stay stationary, in a small cage, would not disconnect his catheter so he could hobble around a bit. He's an active outdoor cat usually, very hard on him to stay put in that cage. And cope with small area, messy hygiene (some food on him due to force-feeding), and wrapped leg making everything awkward for him.


When I stroked gingery's cheek he did lean into my hand, which was nice, felt I could offer him something, something of our happy relationship, if not of our trust.


He urinated in the tiny litterbox shortly after my arrival. He urinates just a bit at once, but tech says enough given the diuresis.


Stayed with him for two hours or so, talking most of the time to puss. He's used to sitting or napping near one of us while we're on the phone, hearing our voices, thought it might help relax him.


He did want out of cage at first, but gave up when I would only hold him. He doesn't like to be held much, not surprising that he didn't want it now. He did seem soothed at times by my voice, presence, and occasional petting (he's not big on petting either, but he loves to lay on our chests and laps and legs and be near us, and likes occasional nose bridge kisses and nose to nose).


Lips and nose look whiter, not pink enough. I believe the anemia is increasing. Told staff about his anemia status and history, tech will ask vet tomorrow if they should take a PCV tomorrow (hematocrit). I may insist, though hate to put paws through more tests and maybe should wait another day.


We don't know why he has anemia for certain (though strongly suspect FIAnemia/mycoplasma/haemobartonella) and the anemia was increasing as he went into the hospital. Has the anemia reared up due to the kidney failure or are the normal anemia meds not working anymore (doxycycline and prednisalone)? Should we take him off the diuresis while he's strong enough to make a trip to a specialist, while the anemia hasn't taken him down into near death (as it has before)? Yet there's another reality here. We're tired, money is a problem, under other stresses.


hazelrunpack, due to our circumstances I think what you shared is true, most of this is out of our control at this point I don't like to be in that place, but I'm stressed, not medically trained, and tired of thinking, researching, considering. Tired of pushing veterinary folks to remember our cat's case and not confuse it with others or forget important details, etc (all medical people in the USA are overworked with too few professionals per patient). Tired of medical complication in general, and of loss. And you are right, if I and we don't take care of ourselves enough (which we haven't done in too long) we might go too far down ourselves (and have too many times) and be of little use to puss anyway. Such a rough place to be, but must be endured.


May dear gingery get some sleep tonight, some peace. May we be able to bring him home soon, so he can know that we were trustworthy, that we did not leave him in a place he desperately didn't want to be and that scared and hurt him so. So he can experience that we did intend to bring him back to his home and that we want him with us and that we're still family together. It may be that we just get him home to die, but that seems far preferable to leaving him to die confined and with strangers, hobbled in strange surroundings, and not at his safe and loving home.

:candle:

gingerbeastie
March 12th, 2010, 12:27 AM
growler, I wrote my post then read yours. Went ahead and posted mine because too tired to think through yours just yet.


Thank you for such important information. I'd have a much hard time finding it without your help, likely a fair amount of it I wouldn't find. I'll reread your post (and others above it) and try and absorb, tomorrow. Maybe tomorrow I'll feel stronger again. For gingerpaws, and for you online who have offered such terrific help.


Good night :candle:.

hazelrunpack
March 12th, 2010, 12:38 AM
I'm glad you got a visit in today, gingerbeastie :grouphug: I hope he gets to go home soon! :goodvibes:

Love4himies
March 12th, 2010, 06:48 AM
Sending lots of :goodvibes: for your kitty :grouphug:

gingerbeastie
March 12th, 2010, 03:21 PM
This beautiful blue-sky sunny morning we brought gingerydear home...to live some last good feelings and then to die. To pass more peacefully than at a veterinary hospital, and at home.


And if it isn't more peacefully (though it already seems so) then we're believing it will be more his choice in any case.


We got him home and he walked out of his carrier, weakened of course, in the front yard area, back to the homeland that he knows and enjoys so well. Where he was born, where he survived on his own for years, and where he has lived since. His eyes were big as we pulled into the drive, he knew he was home. Thank thank thank goodness.


No longer suffering medical treatments, free to move around easier...better.


Breathing faster and harder than usual (yesterday he wasn't breathing fast and hard), and all conditions worse now so he's not able to do much. But he soon lay down in his leaves by the lilac tree, a favorite tree that shows just tiny spring buds. He loves napping there, sometimes it's been under a growth of purple lilac which is pretty with his gingery and white coloring, and today there was warm soothing sunshine that pleased him. At one point, he stretched out on his side, lifted his head to us, stretched legs forward in his usual relaxation position and then rested.


After about an hour, when he was warmer than he wanted, he moved into the shade caused by limbs and roof.


Then he wanted to be on the old worn deck outside our bedroom, so mate lifted him to deck ramp and he walked to a far edge of the deck, with sunshine.


It's a good spot for puss, and I can watch him. He wanted to be there, away from us near the lilac tree where we sat in chairs talking about dear puss and spring coming. He wanted some privacy I'm sure, and a rest on the deck.


We are so relieved that he made it home again, that he's alert enough to know his home. He's dying, and coping with enough to not need us emotionally, but again when I stroked his check he pushed into my hand and closed his eyes. Dearest pussycat.


Thank goodness we could both with pussy today. We both collected him from the veterinarian's, we both brought him home, we both had a morning with him. Thank goodness the snow is gone and the weather is fine (lots of cold, rain and snow this year), so that paws could be in his own outdoors. Where sounds and sights are familiar, sometimes comforting, and where no one is overwhelming him or hurting him.


STATUS:
Today the vet determined that there was nothing more he could do for putterypie. And that he would advise putting him down, and what did we want to do.


The hydration (dieuresis) wasn't working, ,much fluid is now in cat's chest (i.e. the kidney's can't process the fluid fast enough, i.e. kidney's very bad), which vet determined with xray. It's not that they gave more than normal hydration, they were giving him 30ml per day and apparently that's normal, but it was too much for kitty's condition and biology. Vet also noted the heavier breathing. And that the pcv test taken today shows 18% hematocrit/pcv. Which is worse than the 25% hematocrit of Saturday (6 days ago). His kidney chemistry is not worsened I think, but I think between the fluid in his chest and the anemia increasing he's likely to die from that instead of kidney failure. Plus he's not eating, hasn't had much for days, so as I understand that it means he could develope a liver problem (fatty liver) and die from that.


We hope, pray, that kitty passes comfortably rather than the hard passings that are possible with kidney failure and other that ails him. Like all of you good and kind pet-family people, we hope our dear gingerbeastie goes quietly in his sleep. That would be so much better for paws. But we know it might not go that way, he may not have the death we prefer for him and think he'd prefer, the peaceful death that he's so deserving of and is best for him, so if he lingers in a bad way we may have to take him back to the vet for actual biological death. We'll wait as long as we can, and as long as we think pussycat wants.


He's still on the deck. His world around him. Us, too. He's breathing slower, now that he lies still, still faster than normal but a bit slower and not as heavy. He looks better than at the vet. Like he's recovered some calm and dignity. His passing is ongoing, we're deeply sad and wish he didn't have to go or struggle at all. Yet he is alive with us now, and now and forever we love deeply our dear, wee, wonderful and delightful ginger putterypie.

14+kitties
March 12th, 2010, 03:27 PM
:grouphug: :cry: No words. :cry::grouphug:

hazelrunpack
March 12th, 2010, 04:50 PM
:grouphug: I'm sorry, gingerbeastie. :cry:

Did you talk to the vet about possibly coming out to the house to help kitty cross over? We've done that in the past and our babies always seemed so much more comfy there. And it seems right, somehow, that they ended their days where they'd spent so much of their lives...

mummummum
March 12th, 2010, 06:54 PM
Such a valiant struggle.

Like Hazel, I too had a Vet come to the house when it came time for my last grrrl's final moments. It made a world of difference to the both of us. :grouphug:

growler~GateKeeper
March 12th, 2010, 10:42 PM
:cry2: I'm very sorry to hear Gingerkitty's passing is near :2huggers:

I wish the prognosis was better :( I agree having your vet come out to your place to help him cross over would allow him to spend his last moments where he is most comfortable.

Gingerkitty won't be forgotten ~ The Spirit Lives As Long As Someone Who Lives Remembers You. :candle:

gingerbeastie
March 13th, 2010, 07:52 PM
:goodvibes: growler,
:goodvibes:14+kitties,
:goodvibes:hazelrunpack,
:goodvibes:lov4himies,
:goodvibes:mummummum

and :goodvibes: Dr. Lee.


Thank you all, including for your last postings about vet's coming to the home for euthanasia. That would be such a preferable passing for dear gingerpuss, compared with elongated suffering or going to the vet's.


Status:
Gingery is going quicker now, since this afternoon. He's letting go of life much more, we think he's close to being ready to die.


We're waiting a bit but know we don't want him to have elongated suffering (death is usually suffering of some sort, unless one is lucky enough to go in one's sleep). We brought him home already in debilitated condition, now we're hoping he might pass tonight, at home, at his home, with us nearby. We hope tonight, while we wish he would never leave us.


He spent morning hours on his porch spot, then later on the patio table. Colder today, put towels both places for him to rest on, and he did.


Who knows how he was able to jump onto the patio table. It tired him greatly but he did it, and napped peacefully there in the morning sun that had broken through.


I could watch him from the window, while on phone, but so suddenly he was missing. I dashed around outside, not under the patio table, not in the shed he favors, not under the oak tree. I was truly shocked to find that he'd gotten under the fence and was napping, so beautifully, so contentedly, in a spot near his beloved "lion's den".


It's really just a young very bent cedar but it's one of his much loved places, where he can find shade and sun, with a sense of camouflage, a place he had not been in for months due to weather and due to neighbor dogs running loose. The neighbors moved recently, no more dogs, and today gingerpaws reclaimed his place there.


It's beyond our fence, which means he got into his wild that he loves so much (unfenced). And he looked beautiful and just right in his den-place.


A sad reality about the den area is that it's actually on a wildlife path. For dogs, raccoons and coyotes especially. When I arrived to paws circuitously (I couldn't go under the fence) I told him what a good pussycat he was and how much I knew he loved to nap there. I put a towel around him as it was cold, and stayed with him ten minutes or so, just to give him a chance to be in one of his beloved and free places.


I know beyond doubt that he wanted to stay there. And he might have stayed all day into night, and passed away there. But I just couldn't leave him at risk and gently as I could I carried him home to safer ground.


To his pad on the desk. Before he went out today I put a hot pad under a towel that was under his sleeping pad, so after the colder porch and patio and lions den he had more warmth, with curtains open and a view of trees and sky. He drank water from the little bowl near his pad for a long while. Then he rested and slept on his warm pad, once sitting up in his "sphinx position", legs stretched forward, surveying his own outdoors with a bit of sunlight bathing him. Such a lion, such a beauty.


Pussertonpie has been going down since coming in from his outdoor den. I almost knew that his time at the den would be his last time outdoors. It felt important to give him a bit of time there and not rush on so fast with daily efforts. I can't describe how peaceful and healthy he looked there, all gingery and fluffy, almost pink (even with the severe anemia, I swear I saw pink on his nose). How I wished he could be healthy... like he was just over two weeks ago.


As is turning out it seems, his den time today will be his last time in his great outdoors. His outdoors, where he has surveyed, napped, hunted, lived, explored, played, fought, joined us so many times (even for walks with us), where he probably was born, and where, before he joined our family, he even mated. His great and beloved outdoors.


He wanted off the desk in the late afternoon, while we sat nearby on the bed he lept from it's height to the floor. It was a hard landing, and upsetting, but it told us, he told us, that he wanted privacy.

He slipped quickly away and under the bed and then bed headboard, which is a piece of furniture really, underneath the board where it's dark and inaccessible. Again, we felt we couldn't leave him there (spiders, cold, etc), so mate constructed a private place for him, under the desk. Boxes and towels giving him privacy, but towels and pad and heating pad giving him some level of comfort we hope. Water nearby, litterbox, too...thought we think he's so weak and letting go of life now that he won't use either ever again.


It's been another day of tears for our dear gingerpie. Such a lifeforce is passing, one that really didn't want to go and always expected life. Always could heal himself before this anemia condition, always could become strong again on his own even without people, could find water and food and shelter and cope with wild animals, a life that has been grandly filled with energy, power, dignity, peace, intelligence, bravery, caution, and playfulness and sweetness.


And tears for ourselves as well. For losing such an endearing and amazing being. For losing a special dear one who has made our lives much better and much happier and who we absolutely don't want to lose ever. We'll hold dear wee gingerbeastie dear, and amazing, forever forever forever.
:candle:

hazelrunpack
March 13th, 2010, 09:48 PM
:grouphug: You're in my thoughts and prayers.

growler~GateKeeper
March 13th, 2010, 11:03 PM
I'm so glad he got to enjoy the sun on his face & the comfort of "his den" today. :2huggers: :goodvibes:

gingerbeastie
March 14th, 2010, 05:29 PM
This isn't the post I wanted to make, but it's what's coming. We're going to lose dear gingerpaws very soon. I've been writing about pussycat's day, which has been a good one in the sense of him going to favorite places and having choice in putting himself there. But it's time to help him die quickly now, and not let him go through another night of dying suffering.


He cried quietly to himself, a little mew sound, when he couldn't walk back up a slope and get out of the shade. He cried a bit when I picked him up to carry him, that sweet wee mew sound. It's time. He can no longer urinate properly, he hasn't eaten enough in 2 weeks, and nothing in two days, and he has 3 conditions that are killing him and hurting him.


It's awful and we're upset, but we are going to take pussy to the vet's for euthanasia, at 5pm. Vet says especially with debilitated cats it's better to be done in his office where there is light and staff to help him. This is not our usual vet but is someone who we took putterypie to in the first 6 months of his anemia illness and whom we liked fine.


Worrisome that this vet doesn't do catheter. He says it's more painful to place a catheter than do an injection, he isn't a fan of catheters, and he's confident about the injection, even with a debilitated dear cat. He also will only to the barbituate overdose, no muscle relaxant or sedative from what we understand. So this is concerning and even upsetting, and might lead to a bit of last suffering for paws, but he's suffering so now and we don't want to take him on a long car ride to an emergency place that is open on a Sunday, where maybe many animals are in distress. With our local vet our kitty will be the only patient (though there may be some animals in the clinic cages elsewhere), it's nearby, and teh vet feels strongly that the injection will be quick and easy on puss. Like anesthesia. We so hope this is the way it goes for dearest dearest beloved Kiki-cat.


If you have comments or advice for us, given what we're going to do, the injection and not catheter, please give them. Anything that could help us is deeply appreciated at this terrible yet so important time. And we understand if you have strong feeling about iv catheter.

Please let our cat go as quietly and smoothly and peacefully as possible.
:candle:

hazelrunpack
March 14th, 2010, 05:41 PM
:grouphug:

I wish I had answers for you, gingerbeastie. :fingerscr someone will come along shortly.

:candle:

growler~GateKeeper
March 14th, 2010, 06:08 PM
I've only had a cat euthanized by catheter, there was no sedative or muscle relaxants as she was already quite weak at the time. Her passing was quick & painless, though for her they did have a hard time finding a vein for the catheter :( (I could hear her meowing in the back :cry2: while they were putting it in :() in that situation I think it might've been more traumatizing by injection only. Once the catheter was in & she was returned to me she was calm again & we were given a few final moments together before the vet came back in to administer the euth.

I've had a dog euthanized by injection only and it was quick & painless, he was a large breed so the veins were easier to find.

I think in this situation if your vet is not comfortable using a catheter it may make the procedure more difficult for GingerSnap and you as s/he is not "well practised" with this method.

I would recommend for you to be in the room with GingerSnap when he passes, as difficult as it is, that will help give you closure and make him more comfortable knowing his family is near by.

:goodvibes: :grouphug:

Love4himies
March 14th, 2010, 06:09 PM
OH, I am so sorry :cry: :cry: :grouphug:

mikischo
March 14th, 2010, 06:51 PM
My thoughts and prayers are with you and your dear kitty. In his weakened state the injection alone should be very quick and painless.

I went through this 10 months ago with my dear Mickey, as have many others on this board. We are here for you.:grouphug:

Macomom
March 14th, 2010, 07:30 PM
My thoughts and prayers are with you and gingercat. :candle:

14+kitties
March 14th, 2010, 10:02 PM
:grouphug: My heart is breaking along with yours. I am so sorry. :grouphug:

mummummum
March 15th, 2010, 06:59 AM
:grouphug: My thoughts are with you and yours Gingerbeastie.:grouphug: