10 month kitten had fever, not really eating or drinking...thoughts?

ldg

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This sounds like our Tuxie.


The one thing I would say is that if the prednisone doesn't work, they have to consider trying Depomedrol. They are both steroids, but they DO have a slightly different mechanism of action. Tuxie never had a prednisone injection, but we gave it to him orally. Now maybe that makes a difference. And it worked at first, and his RBC went up. But then he stopped responding to it. Our vet consulted with feline blood specialists, and decided to try the Depo, which is the standard of care when dealing with Feline Hemolytic Anemia. Now - that wasn't Tuxedo's diagnosis, but he was a medical mystery (still is). But the treatment for the FHA worked.


I don't know how much you've learned about anemia yet, would you like some quick basics?
 
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loganpenelope

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That's really interesting - yes I don't know about anemia - always welcome good real world info!Thanks!
 

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I hope non of this scares you, but with anemia they can't figure out, it's best to be armed with information.


Basically, anemia falls into two categories: Regenerative and Non-regenerative.

Regenerative anemia means that the bone marrow works, and the body is producing red blood cells.

Non-regenerative anemia means the bone marrow isn't working, and this basically isn't really treatable.


So that's the first thing - is he producing red blood cells? In blood work I believe different measures of the reticulocytes are how they determine this, but Tuxie had to have a bone marrow aspirate to determine if his anemia was regenerative or non-regenerative. (A surgical procedure where they remove some bone marrow, usually from the hip). His problem was that he wasn't producing red blood cells (at the time), so they needed to know if he could.

It was determined he could. With your Logan, it may well be that he is, so they should be able to tell from blood work alone that it's regenerative anemia, and I'm assuming this is the case.


To "jump start" Tuxie's bone marrow, they gave him the same treatment they give people undergoing kidney dialysis: injections of Epogen (erythropoetin). So know that this is an option if it comes to that.


Anemia is determined by the Packed Cell Volume (PCV) or Hematocrit (HCT). These are basically the same measurement - the hematocrit is done with a few drops of blood in a centrifuge, and the PCV is a count of the red blood cells in a 1 ml sample of blood. But they both represent the percentage of red cell volume in the blood.

For cats, GENERALLY "normal" is 30-40.
24 and below is techincally anemic.

High teens is survivable indefinitely if kitty rests (which kitty will naturally do at those levels as they'll be low energy). But do not encourage activity.


Mid-low teens is dangerous and life-threatening, though not immediately.

When Tuxie was at 7, they gave him a few days to live.

The bottom line is at this point it seems they're looking at an autoimmune problem of unspecified nature.

The treatment with the steroids (which is what has stabilized Tuxie long term) is to suppress the immune system response (supress whatever is causing his body to think his red blood cells are like a virus).

Some things you should know when discussing options with the vet if it comes to it.

IF it comes to the point that they recommend a blood transfusion, this is something that needs to be carefully considered. Cats have far more complicated blood than humans, and if I remember correctly, to have a really good blood type matching, there's something like 24 different things that need to match. (I don't remember, but it was totally different than in people). Obviously they don't match all of them... but what this means is that cats are more at risk for not being able to tolerate multiple drug transfusions than people can.

I've read about cats here that had multiple transfusions with no problem. But our vet told us up front that there was the risk that Tuxie might be able to tolerate just one transfusion, so it should be a treatment of last choice.

We're glad we waited until they saw no other option, because he was able to tolerate just one transfusion. What happens, sometimes, in future transfusions, is that their body then sees the incoming blood like it's an invader, and the white blood cells go at it. So when they mix the bood before transfusing it into the cat, it coagulates - so no transfusion possible. If you do get to the point that you're discussing a transfusion, please ask your vet about this.

The point of a transfusion is basically to increase the amount of time to allow other treatments to work.

It sounds like your Logan is in good hands with your vet.


the pred works!
 
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loganpenelope

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Wow thanks so much for all this information. It is REALLY helpful. At least now I feel like I have an understanding of what's going on, even if we don't know what is causing it. I'll be rereading this again for sure. Thank you so much!
 
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loganpenelope

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I'm not sure yet. This morning at about 11:30am, he got the steroid shot. They called at 1:30pm to say that his temp has dropped from 104.1 to 102.1 in the 3 hours since the shot. I believe they intend to do another blood test for RBC before I take him home tonight at 5:30pm...
 

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OH! One more thing. I don't know what Logan looks like, but is his nose pink or are his paw pads pink? You can also tell by looking at his gums.
But take a look at them now - you'll see they look very pale. When he's not anemic (
), they'll be pink, and probably bright pink.

Now - when they're napping or resting, they have some kind of vasoconstriction thing going on that makes them look pale even when they're not anemic, so the best time to look at this stuff is when they've been up and doing something - like using the litter box or eating.

And the pred SHOULD increase his appetite.
It definitely helped Tuxie. Tux was so anemic he'd look at his food and wonder what he was doing there.

At first, we took Tux weekly, though there may have been a little while when he was there every few days. For his epogen shots, we were there every other day for quite a while. In fact, he had other complications going on in the beginning, and we took him every day for about a month as he also needed nupogen shots (to boost his white blood cell count). But for the hematocrit, as things improved, we went biweekly, then monthly. He needed the depo shots every two weeks at first, then every month, then every few months. Now he needs them about once a year. We take him every six months just to be sure - but we keep an eye on his activity level and his "pink."
 

ldg

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Originally Posted by LoganPenelope

I'm not sure yet. This morning at about 11:30am, he got the steroid shot. They called at 1:30pm to say that his temp has dropped from 104.1 to 102.1 in the 3 hours since the shot. I believe they intend to do another blood test for RBC before I take him home tonight at 5:30pm...
I'm sorry, I forgot he was staying there.


I don't know if it'll work that quickly... be great if it would!
 
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loganpenelope

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Wow that last bit of info about the pink was also great. What was the world like 10 years ago or so before forums? lol - I mean, it's really amazing that you can make a post about a mystery illness in a cat, and moments later, someone is giving you tons of world information!
 
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loganpenelope

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Update with Logan -

The finally have figured out what he has:
Immune Mediated Hemolytic Anemia (IMHA)
basically as a result of the FeLV.

The good news - the steroids have brought his temp down to 101.2. Nice.
Still not eating though.

Bad news, his red blood cells were down a bit more from the morning.

He's scheduled for a transfusion first thing tomorrow morning. Hopefully that will go good, and we will continue with steroid treatments.

That's basically the bottom line. The vet said this is definitely a serious condition.

He home tonight, and actually, he's doing really really well. For the first time, he's back to his old self. aside from being weak from the lack of food and 2 weeks of on and off fever, he is alert, not hiding under a bed, he is with us, meowing, affectionate, etc... all of which is great.

Anyway, not much else to do until we see how the transfusion goes. I feel good though, he's always been a strong kitty, so high hopes!

So , for those researching their own problems - looking back over the past 2 weeks:

If you have a fever of unknown origin, and after about 5 days, you're still dealing with it, I recommend doing another blood test by day 4 or 5.

In our case the test for mycoplasma took 3 days to get the results - just to say negative and then lead us to try the steroid, and then the determination of IMHA.

Not that "your" cat might have it, but just in general, it's worth the $50 or so for another blood test to see trends or if anything new has shown up....
 
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loganpenelope

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New Logan Update -

I feel like I'm on an episode of House.

Pathology test says it is not IMHA. He is with specialist now. His RBC has gone down low enough he is getting a transfusion.

Specialist says his marrow is just not producing RBCs.

Although this to me does not explain elevated WBCs and Fever. Still pressing for answers...

Anyway, the good news is at least his fever is back down to 101. Although she attributed this to probably from getting fluids..
 
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loganpenelope

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For those following, I started posting on another site as well. It's tough updating both sites, but if you would like to continue reading more, you can follow this thread here:

http://www.cathelp-online.com/forums...ic.php?t=12391


Quick overview is Logan is now on his second transfusion, trying to keep those RBCs up and deal with other issues as well. It's a tough battle, a push-pull. Seems there is always just enough light to keep going...
 

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I did read through the thread on the other site. I wish I had something more to offer, I don't. Just lots of prayers for Logan. Please update here when you can. Wish we could help.
 
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loganpenelope

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Sorry for the lack of updates. It was a busy weekend with work and such.
Logan has been spending the past 4 days in the ICU section of the hospital. That's possibly a bit more dramatic sounding that it is though. His situation is very tough, but he's not hooked up to all kinds of things. It just means he is checked on hourly, 24/7. (yes, it's expensive, $150/day. And no, I'm not by any means wealthy).

Friday was his first transfusion. His RBC had dropped to 10. Friday night, his RBC was up to 16, but by Saturday morning, it was down to 8. Saturday morning was a tough phone call to get.

There were 3 choices: 1. Give it time, see how his body responds. 2. Administer more aggressive steroids. 3. Do #2, and do another transfusion.

The Dr. said at RBC 8, you're on the line that he could be fine, but also, just like that, if his RBC drops any more, he would be critical. He was using terms like CPR, pumping in RBCs to try to get him back. This was not a scare tactic. I'm trying to simply into one sentence what was a 40 minute conversation with what i feel is a VERY good Dr.

So, we went with #3. A transfusion with more aggressive steroids. Basically, not doing the transfusion seemed to be a half-a** was of doing #2.

So, at the start of transfusion 2, his RBC was 8. By Saturday night is was 15, and by Sunday morning it was 16 and by tonight, Sunday night, it was 17. That' all great news of course.

Sunday night's report also came with a positive he is drinking water on his own and urinating a good amount.

The negatives.

Saturday night - he developed fluid in the lungs. Using a diuretic they were able to reduce some of the fluid. That was causing him some serious breathing issues and he went on oxygen. By Sunday morning, his breathing had gone down to steady and by tonight, Sunday night, he was off oxygen.

The excess fluids and then diuretic has caused havoc with electrolytes and other minerals. Today and tomorrow is spent getting that under control.

Liver - he has started showing signs of jaundice. While assumed to be from not eating, it is not yet known for certain as it could be from other factors with the treatment so far. Tomorrow is another day and we'll know more.

Tomorrow is going to bring forth the eating issue as well. They've been holding off on a feeding tube. I think with the liver issue, but tomorrow they're going to want to put one in.

There are 2 types - one in the side of the neck, one in the stomach. They're pushing for the easier, the neck. That can be removed easily once he starts eating on his own. I don't know much about this yet.

We did go see Logan today. Poor guy - he is obviously weak, but alert. He is tired, and it's really tough seeing him like this. The roller coaster of events is also tough to deal with.

We had a long conversation with the Dr. about suffering and what we're putting him through. What we came to is that one thing he was very surprised at is that Logan's personality, outward demeanor and so doesn't match how "bad" he is supposed to be on paper. He said some cats just look sick, look like they're "done" and so on, and he starts having conversations with owners about the need to "stop" what proceeding.

With Logan, he was very careful to say he does not appear to be suffering. He accepts all the poking and prodding and still purrs. I just wanted to let readers know we have considered this very much.

My thinking is that Logan is only 10 months old. If successful, he can have a potentially long and great life. And there is a difference between suffering and dealing with a tough situation.

Anyway, I'll close with a picture of Logan from about 5 months ago. Here he is looking tough, even though he's the exact opposite


 

ldg

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Oh sweetie, I read your update on the other board as well, and I'm just sending HEAPS of prayers to you and Logan!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! He's really beautiful.




 
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loganpenelope

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Thank you so much! We are getting the love!!
 

ldg

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He may be facing challenges, but he's a very lucky boy to have such a wonderful family.


The important thing is he's right there fighting with you. He's just got to win!!!!! More
 
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