S.O.S. - Kinney has anorexia/anemia

Kyle's eating strike explained.  Tonight he pooped out about 2 feet of paper ribbon looking quite shocked to see it following him.  I have no idea where he got it.

Oh, good (?)  I'd be a little concerned that he might still have some ribbon inside him, but then I'm a worry wart.  If he again goes on a hunger strike, or has difficulty popping, I'd be tempted to take him to the vets just to make sure there isn't anything in his stomach that shouldn't be.

I just had to say that I have been following this thread and I wish all the best for Kinney. What a stressful few months this has been for you both! I am going through a bit of a struggle with one of mine right now, but it doesn't come close to what you're dealing with. My thoughts are with you. You've got a great support team here.
 

Oh I understand now, you had mentioned how he dislikes pills, but I did not make a connection to the pepsid. You can always get the round generic pink 10 mg ones and a pill cutter and cut them in half. Then cut the half into a couple pieces and put into wet food. It's a very small size and tasteless so he probably won't notice (or i should say he wont mind since cats notice everything lol) esp being on pred and therefore eating a lot. This is a simple option if u decide to give it to him.
That is so funny about the paper ribbon! Thank heavens it was just paper and came out!

So, I bought a digital scale yesterday and started experimenting with the two brothers, Kyle and Kegan on raw (another thread on that experience).  Everyone got weighed last night and Kinney has gained a half a pound.  Oh, that I had LDG's zeal and enthusiasm when Lazlo was gaining his weight back ounce by ounce!  In my case, I am so afraid to get my hopes up.   Yet, in many respects Kinney is back to normal - eating regularly again, not sleeping much, stopped eating kitty litter and even leaping for toys last night. 

His only medication is his syringe of pred and I have gotten better at just grabbing him unawares and pushing it into him.  I cannot imagine having to pill him regularly - he is very clever at avoidance.  You would think the weighing experience last night was some death chamber trap or something!  I was able to tape a box to the scale and after being congratulated for sitting in it, he is getting his weight taken every few hours now by himself.  Up to 8.2 pounds from 7.5.

I went over to my vet's office today to pick up yet more cans of A/D (Kinney likes it a lot) and use it as an excuse to ask my questions.  It seems like everytime I stop over there, there is some horrible emergency going on.   Today was some dog with colitis squirting everywhere and they had to knock him out to treat him with a distraught Mom wringing her hands.  Who would think a vet's job is so horrible?

I also switched everybody over to a Nutro Natural Choice Grain Free and everybody seems to like it great, so no problem with that.  Nothing like a sick animal to make you reconsider eveything.   After reading LDG's thread on feeding, I have made a 25 mile radius taking inventory or what all the local stores carry.  Am I hoping for the best or preparing for the worst - I am not sure..

Anyway, the vet's response on my recorder was that I needed to go to an oncologist - he is afraid to monkey with anything.  Unfortunately, he is pointing me back to the same ER that did Kinney's transfusion and ultrasound in the first place and I was not crazy about their institutionalized bedside manor.  They really separate the owners from the process most completely with long waits inbetween waiting for answers.  When I was reading LDG's and BarbB's threads of their experiences, it seemed that they were always pushed back to the place of the original ultrasound - which was my fear.  The vet was saying they would probably want to re-ultrasound him to see if the pred had shrunk "the mass" before proceeding.  Very logical, but I would have liked it better if I could have been there as it was going on, rather than sitting over at Denny's.

I will labor and fret over whether I should just suck it up and take him back there (it isn't too far which is a plus), or start over somewhere else.  I am only out the price of their original ultrasound so far ($330).  I guess that is my only tie back to them.  They do have two oncologists on staff over there and are apparently highly thought of by my vet as well as having a good reputation in the media, but I would have wanted to be a little more a part of the process than the two minute consult I got picking Kinney up that fateful day one week ago.  It seems like it has been months since then.

Dr. Clifford is at least a one and half hour drive in heavy traffic on the PA turnpike (either place) and then where would I be if he had his exploratory surgery performed there instead?  Staying in a hotel or something?  Clock is ticking..

What about contacting Dr. Clifford's new clinic - letting them know that he was referred by a former patient with a great outcome, but that they are a long distance away - perhaps they could recommend an oncologist that is closer to you? :dk:

And if you don't like the institutional atmosphere of the ER place you went, don't go back there for the ultrasound. I understand the logic of having the ultrasound done by the same tech on the same machine, but I think it's much better to have it done where you will most likely be having Kinny treated, if you go that route. Having the initial appointment and ultrasound will be a good way to see how comfortable you are with a potential new place, anyway.

I won't duplicate the excellent advice LEG and others have given you except to say never give up on your little one and truly,with chemo and fighting for his life, you just might be surprised. I admit as a human pediatric oncologist who treats small babies to teens with cancer that one sees amazing results!!! If you loved one does not react well to certain meds, there are other ones that just might help him. You never know until you try it right? Also, if you have the resources to give him a good quality of life, cats often surprise us. Unlike humans,they do not fret the loss of hair Thomas be nauseated but there are excellent meds for that now too.

Have you consulted a vet oncologist? I find it disturbing that the vets who treated yr kitty did not seem to consider how difficult not eating is on a cat's liver,kidneys and other organs and why this diagnosis took so long. But I also realize you know now and that is good. All cats are unique and while they loath change, they do well with cancer treatments,sometimes better than humans and i think you had if you can afford it or attain help, get him absolutely the best care!!You are in my thoughts and I hope he does defy those other doctors!! GOOD LUCK!!!!!!

Thanks Abisiobhan for the inspiration. 

Kinney never stopped eating completely, and since he is primarily a kibble eater - it was really a stretch to get him to even eat canned food.  I knew better with regard to syringe feeding and have done it with other cats I have had, but he is not a good patient!  I tried several times to gingerly syringe feed him and he would have none of it.  It wasn't until after I saw him bound up in a towel at the ER that it clicked with me how I might have taken the bull by the horns and get some food in him.  I am sure I could have saved him quite a bit of deterioration by getting food in him.  Truthfully, I have been amazed that everything still works now that he is eating well again.

My old cat Kevin would allow me to stick him with needles, put drops in his eyes and ears, and push food and pills in his mouth without complaint - I swear he would eat just because I asked him to.  Kinney, on the other hand seems totally insulted at being handled hardly at all which I have to factor in.  From what I have been reading in the case histories, there is quite a bit of pill pushing and syringing that might be required.

I will have to be led down the garden path one step at a time, I'm afraid. 

Dan, I know what you mean as far as working with a cat who will protest every step of the way. One of my cats who was diagnosed with chylothorax disease was like that, as well as another kitty we had years ago with IBD. Both regarded being given pills as equivalent to someone trying to kill or poison them. In fact with both of them I had the experience of them hiding in the morning so as not to have to take a dreaded pill. And in both their cases my husband and I made a quality of life decision based on the severity of illness and their fear as opposed to them living in a constant state of apprehension. Even Toby got to where he would recognize the movements associated with going for chemo (he HATED the car) and would hide, albeit he never found a good place (under the dining room table, or under an open chair in the living room). But Toby was very good with his medicines and responded well to them- in short we could tell her was happy and doing better so we pushed forward. I do think you need to factor the pill thing in and I think you will know if it gets to a point where he is just unhappy all the way around. With Toby even with chemo, I gave him ONLY one pred a day, the pepsid one or two times a day (which you can crush and hide in wet food or butter), and cerenia one pill for for days after each chemo treatment. That was pretty much it. In the very beginning we gave him Sucralfate too, and some of the stuff from the homeopathic vet because he had so much inflammation and blockage and was nauseated. Once we began an actual treatment course, I stopped whatever he wasn't interested in and focused on him eating and taking the above mentioned critical meds. I still put what liquids etc. I could into his food but even tapered that off just to make sure he kept eating.

All the good things going on with your boy is from the pred, including the not sleeping much, slightly hyper, eating a lot. It is kind of like putting your kitty on speed except it makes their tummy empty, hence the eating. I am REALLY glad he is feeling a lot better. The stuff you wrote in bold up there made me nod with a wry smile   so I will use the emoticom as I know how you feel, for sure, esp what you said about reconsidering. 

Based on what you describe about your boy, I still think surgery is something you might want to explore, as there is the possibility you will be in and out with your boy. This is where an oncology consult would be worth your while IMO. You would benefit as well with the oncology consult as far as monitoring the dose of pred and whatever other medications you may need. 

What I did with Toby was go to the far away vet for the critical stuff and to use a local vet for sourcing the regular meds, fluids and palliative care items. For you and Kinney this would mean Dr. Clifford or whoever you chose would do the big stuff and be project manager for Kinney but their office could call over script refills and such to your local vet and also your local vet could see Kinney even for a blood panel or xray. 

Most docs would want a baseline ultrasound to start with as part of starting to treat your boy but after that I don't think you'd be having a lot of them, especially if you are not going to actively treat your boy and switch protocols. Even with Toby on chemo, since the oncologist was not giving me the option to switch protocols on her recommendation we only did one ultrasound after starting chemo. I elected to do one more at the end of his life basically to confirm that I had no further options to prolong his life in a meaningful way and to make sure I knew that it was his time and not just some opportunistic illness that might be overcome with meds. 

Since you read Toby's thread, I'm sure you know my thoughts about not taking him THERE, that bureaucratic-type place. If you have misgivings in your gut, you should follow them. I did a lot of second guessing of my gut and forced myself to stick with the vet's recommended place even after I was very put off somewhat early on. That is why I think LDG's recommendation is worth it, bc he is tried and true so to speak, and you don't get much better than that. Not sure if his pricing would change with moving to another place but if that is a consideration, you might ask them for info up front or even ask about a phone consult as you live far away etc. All they can say is no. 

...let's not forget. Kinny may not even need chemo. He may just need the surgery. :cross:

Yes LDG, that is what I was thinking too. I just wanted to say that about Toby's meds to underscore that, even in my worst case scenario, he was never on a huge pill regimen other than what the homeopathic vet gave me before he went on chemo and those were enhancing things, not critical path meds.

Now that my email alerted me to this thread reply lol, it gave me another thought which is that Kinney's dislike of pilling should be discussed as part of any consult in the same emphatic way that we are discussing it here, because it will weigh in heavily for any treatment he is given. 

Dan I also wanted to say that your earlier observation about Kinney's being syringe fed wrapped in a blanket and your thought about why didn't I just do it- I understand that too, I have thought the same thing for that as well as other things I have learned to do to help cats. It is a process that a lot of people go through with their pets or in my case, with rescues as well. The tough love thing is hard for a lot of people to wrap their head around right away. I think it is human nature to really fear making a mistake or screwing up and also a dislike of doing something their pet or rescue really objects to, and it is human nature to take considerable pause about diving into the deep end of the pool with a can of food and syringe, or a needle and bag of fluids, or a trap and food for a cat that needs TNR- all of these are a large step above what people think about when they think of a pet or animal in need of help, and I think it is because we wouldn't think of doing this for a person who is ill, we think of it as for a doctor or vet or someone more trained. Anyhow I just wanted to say that. I needed help from my cat sitter who is a vet tech, as well as the vet techs at my cat's vet to show me what to do, and others in rescue, as well as people on this board and you tube to make that jump to the next level and do these various things on my own, and it happened over time. If it had been a case of Kinney might die if you do not do x or y thing, you would have done it I'm sure of that. It is just that you need to see it and learn about it and need time to take it all in, at least that is what it was like for me. 

Thanks for the replies.  I happened to turn my cell phone back on today after a long hiatus and there was a msg. from the big ER place asking me how Kinney was doing and to call them back about my experience.  I will certainly do that.  I wonder if going on an outpatient basis is less stressful than being an ER customer?  Still hate to think of going back there again unless I have to.  I am just afraid I will be chained to them then.

I will call around to the various oncologists and see what kind of responses I get.  There are three oncologists that are closer to me, and a fourth at the original ER I went to that did Kinney's intitial bloodwork and xray.  That was Hickory Medical Center and it is a much friendlier place, although smaller.  The owner is an oncologist.  I have been there four times in various emergencies and never felt bad about any of the experiences.  It was just my vet pushed the other place.

My good friend Barbara goes to the clinic where Dr. Clifford is practicing now in Malvern, Pa. although she lives much closer to it.  The drive for me on the PA turnpike would be a white knuckle experience for sure.  I used to have to go out there for work and the roads are always jammed up.   Speaking of Barbara, her former cat Bootsie had lymphoma (not intestinal) and her personal vet would do the ultrasounds in her office with Barbara watching on the screen, also the chemo was administered while she sat there with him.  Bootsie lived till 22yo.  It seems that her experience was totally atypical.

When I got back late today, Kin still hadn't had his medicine - so I hid it in my pocket and sprung it on him by surprise.  boy, you wouldn't believe what a big deal he makes out of getting that one syringe-ful of medicine.  It's even chicken flavored, for pete's sake.  A very bad patient!

Tried putting one tiny cube of raw in his bowl tonight along with his A/D and Wellness chicken mix and he "buried" the bowl just from the smell of the one tiny cube.  I had to laugh...

I too have been following this thread; Dan32, you are amazing.

Just my two cents worth about pilld:  if the medication is for humans, the pharmacist can compound the medicine into a flavored liquid.  If the medication is for veterinary use only, the pharmacist *may* be able to compound the medicine with the vet's approval.  This varies from state to state, although I know Pennsylvania permits the first case scenario.

I can't pill Ritz so get all my medications compounded into a flavored liquid.  I mix it in baby food.  Ritz likes tuna/chicken flavor Flagyl, but will also gladly slurp down bubblegum flavored Prozac. 

Ritz:  Kinney's pred is compounded into a suspension.  I can see it allows for a very precise dosing - where from what I gather the usual thing is either a 5mg or 10mg pill, not 7mg as he is getting now.  I've had great luck over the years with my compounding pharmacy making up either topicals or suspensions.  I have a dismal history with pills - I even have a pill shooter.  I can't imagine chasing Kinney around the house trying to get him to swallow a pill.  Even as it is, he knows that his medicine is due this afternoon and he is keeping a watchful eye on me.  Bad patient!

Todays developments are that my vet called me up (last time was on my recorder) and we had a talk about where to go next.  I told him how I felt about the big ER and asked if he had any alternate referrals.  It was a calming chat, but I am not sure any conclusions were achieved.  He mentioned two other oncologists I had found on the acvim.org/petowners/FindaSpecialist website, but was not familiar with them.

After that, I called back to speak with the patient co-ordinator at VSEC (the ER) and the admitting vet came on the line.  She was saying that probably the pred has shrunk his lymph nodes and duodenal mass, so that going in after a tissue sample now may not be so easy?!?!?  She was suggesting that the next step was probably re-doing the ultrasound to see what is going on internally and possibly if his lymph nodes were still enlarged taking a needle aspirate at that time.  If his lymph nodes were no longer enlarged, then the needle aspirate would be difficult to obtain.  I guess if they suspect lymphoma, the lymph nodes are where they want the sampling from and not his poor little duodenal mass - if it is still there.

Also, some talk of just starting chemo without the tissue sample on the assumption that it is lymphoma.  I do not like that answer.

Or, take him off the pred so that it all comes back so they can re-locate the problem.

I stressed to her that at this time, I am mostly wanting a definitive diagnosis of whether he has malignant cancer or not..  I feel like it would give me something to decide upon.  But as I suspected, here we are back to the same place again that did the original ultrasound tying me to them possibly more and more.  She volunteered that his original ultrasound could be made into a CD if I wanted to start with another doctor somewhere else.

As a side note, she gave a definitive yes to the Pepcid issue at 5mg daily, and that it did not have to be separated from the pred dosing, although at this point probably his ulcer has shrunken already.  Were I to decide to persue that, it would be my plan to also have that made up into a suspension and give him BOTH at the same time - squeeze and squeeze.  I understand Pepcid is quite bitter.  I cannot imagine trying to corral him twice daily.  Were it any other cat but this one.  I hate to use up my medicine credits, if you know what I mean...

So, a vague and inconclusive day.

I just crunched on a pepcid pill. It's bitter.

At this point, if anyone wants to do anything, you'll need a new ultrasound, he's been too long on the pred without anything else being done (sorry!). And yes, the steroids can interfere with the diagnosis. So I'd find an oncologist that hopefully you like - maybe at the Hickory Medical Center? - schedule a consult, and perhaps take that CD the ER vet offered with you.

Dan, yes I also find the PA turnpike on the eastern side of the state to be rough, and you know as someone living in Chicago, I spend a lot of time in stopped traffic and multiple lane traffic and fast traffic. But that part of the turnpike, yeah, it's pretty crazy, not just traffic but also high stress driving conditions. So, yeah, I know what you mean! I always thought maybe it was just that I'm not used to that area. I grew up with twisty curvy hilly roads LOL but yes the eastern PA pike can be daunting augh. 

LDG tx for doing that with the pepsid, I have only tasted the coating I guess, augh! I apologize for giving the wrong advice :-(, I didn't know it was bitter. 

On the treatment Dan, yes this was our issue with Toby, that we could not begin treatment until we had a diagnosis, and that we could not begin giving the prednisolone, but in Kinney's case I seem to recall they gave him a lot in the ER and sent you home with a week's supply.  Also I recall your vet saying the aspirate would not be a good idea as it would be difficult to get a specimen and surgery would be the next step most likely.

I can tell you that in our case the aspirate (guided needle ultrasound) didn't work, even with Toby not on prednisolone, and also one of the reasons they wanted to just open him up was so that they could take samples from all over. In the case of Toby we finally said yes just do it, and as it turned out, the lymphatic fluid did not show cancer but samples from other parts of his intestines did. And this is where I would have a dialogue with your vets, i.e., if we are talking about a mass in the duodenal area, then are they expecting it to be either large or small cell intestinal lymphoma? And if they were able to do a successful aspirate, is there any chance that there could be lymphoma elsewhere but not in the mass? Also I would ask if they have any idea whether the duodenal mass is in fact a tumor or could it be a mass of lymphatic tissue as in Toby's case? 

If the duodenal mass is a tumor, even in a situation where it is shrunken, why couldn't they go for an aspirate, and also I'm just curious, even before treatment with prednisolone, why would the other vet have suggested that an aspirate was not the way to go? I can only surmise that the vet who recommended against the aspirate either thought it was a hard place to get to, and/or was recommending the most logical step, that it would need to be removed and the only way to see if it was operable would be to get a look at it. 

Sorry this is more questions than answers. Augh. Another of my questions would be whether surgery to view/remove/biopsy the mass would be contraindicated at this point or not. I think their biggest concern would be that steroids makes it harder to heal after surgery, and not as much the shrinking of the mass- considering they see masses of all sizes in animals, and it doesn't have to be x size to be removed. 

Dan, I forgot to add, yes vague and inconclusive :-( that is what this was like for us too. In the end we realized if we wanted answers we'd have to let them open him up. It took us a bit to get there, where we were more upset at the idea what if we did nothing or it got to be too late. 

Also on the pepsid, you can ask about mixing the two suspensions together, i.e. maybe you can bring the pred suspension in and they could add the pepsid to that(?) Worth asking! Or if it has to be kept separate, maybe you can use one syringe when administering assuming it is not too much fluid all at once?

I kept looking at my list of oncologists and couldn't decide anything.  I finally drove over to Tabby's Place in Ringoes, NJ today - a nationally known no-kill shelter with so many hard to cure kitties.  I have volunteered there in the past and know the owners - dedicated cat people where no cat is too sick to take in.  They take in incurable kitties from all over the country.  I really trust their opinion highly.  They pointed me back to VSEC in Levittown, Pa. and said the lady oncologist "was brilliant".  They thought I would like being an outpatient much better than the ER facility.

So, I already have VSEC's opinion on the matter from yesterday's phone call (re-ultrasound him), so I guess it will be back to them again.  I know that Tabby's Place does not have money to burn and takes extremely good care of their kitties - so I am sure they wouldn't be steering me wrong.  VSEC is fairly close mileage wise.  I'm still not sure where this is heading...

You can all see I am not good at making snap decisions. 

What a great idea! I'm so glad you had help making an informed choice.

Obviously I can't speak to that treatment center, but if it's anything like the ER facility here, your experience outpatient should be quite different than the ER experience. Here, it's mostly the same vets on rotating duty for ER, but they have their regular vet practice there as well. The ER part is run on a separate system with different staff than the treatment practice. One of our best vets is at that practice, and they helped us rescue many kitties. I hope it's like that for you, where the ER experience is just unrelated to the normal outpatient practice. :cross:

Alright, made an appt. back at VSEC for a re-ultrasound tomorrow to see how his mass is doing.  Spoke with the admitting doctor again who said they will see if any of his lymphs are enlarged and if so, try and do a needle aspirate (they still don't know what this is) or possibly some other organ like his liver if that is enlarged.  If they think there is something to aspirate, he has to be re-admitted back to the ER to test for clotting factor first before they do it,

Otherwise if his swelling has all gone down - maybe take him off the pred to make his symptoms re-occur.  Since coming off pred is usually done in stages, that approach could take awhile.  Then what, do a third ultrasound?  Oh, pewk!

Wouldn't it just be wonderful if we tapered him off the pred and he was just OK.  Am I just being a fool?

I have to go on some blind faith here - otherwise feeling sick to my stomach.  He has been pretty much back to his old self and gained over a pound of his weight back.  It would be easy to just let him sail along on the pred, but I suppose that is not any kind of long range solution.

My immediate concern is not to feed him after midnight for his 2PM appt tomorrow, so I will separate him tonight into the guest room so that my other two boys can have their breakfast.  It will also make it easier to catch him tomorrow.  Meanwhile, Penndot has placed barricades up at my driveway so I have to drive way around to go south.  Just in case any of this would be too easy.