Possible cancer in diabetic kitty and what to do

chicagocats

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Gus has been losing weight for the past 10 months and just not himself. I dreaded that it might be cancer. His white blood cells have continued to drop since last spring. At one time they were in the 5000 range and he is now at 1800.

His creatinine levels went from 2.7 to the mid 4 range and his bun is now 75 when it used to be 40. He is in the 13 pound range when he had always been 14-16 pounds.

Additionally - he has needed less and less insulin.

Xrays didn't show any bone marrow loss or changes. My vet said we can do an ultrasound to see if he has kidney or intestinal cancer. She said they can often tell by the thickening of the walls of the intestine if they have cancer.

On top of all this: Gus is going to be 16 this spring. He also has IBD (inflammatory bowel), flareups of pancreatitis, a mild heart condition that doesn't require medication, some sort of weird focal ticks/seizures which seem effected by certain foods, but they are never cured by changing food, and arthritis - which he is on supplements for (he couldn't tolerate adequan).

My vet said our treatment options are limited because of all his problems - mainly that he is diabetic. He is on 1/3 of the normal dose of budesonide because it causes his blood sugar to spike. He has been on predisone in the past and he blood sugar soared into the 400s and he didn't look good. My doctor doesn't like the prospect of putting him on predisone.

At this point my vet said we can order a special saline solution with less salt (because of the heart condition) and do fluids twice a week to help his kidneys. She did say his hydration right now is really good considering his numbers. Her other recommendation was an ultrasound to try and figure out what type of cancer, if any. My concern is that even if we figure it out, he doesn't seem to be a candidate for predisone, chemo or surgery.

Gus has had a lot of problems tolerating medications and supplements. We did start him on Welactin (fish oil). He got sick today after giving him a full dose yesterday. I'm going to cut it back to half a dose like I gave him the first two times. He has gotten sick on other fish oils.

He is also on a probiotic and pepcid.

Gus is the best soulmate I've ever had and I want him to have the best quality of life for as long as possible, but I don't want to prolong or cause him any pain. I'm unsure if I should go ahead with an ultrasound or not.

Any advice is greatly appreciated. Thank you.
 

mrsgreenjeens

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Gosh, it does sound rather complicated, but I guess the good news in all this is that he is requiring less insulin.  I mean, that IS good news, isn't it? 

It definitely sounds like there is something going on with his kidneys, but why does your vet suspect cancer...because of the WBC count?  The way I understand it, higher values are indicative of possible cancer  (or other things), and lower numbers may be indicative of viral infections or massive infections
(and I don't know what the lab they used is using for their "norms" .  Anyway,  I have a cat with kidney disease, but she doesn't need sub-q fluids yet.   Our Vet simply wanted us to try to find foods low in phosphorus because she drinks enough water everyday so that she's not dehydrated.  Did your Vet discuss diet at all, or is phosphorus somehow related to diabetes?   If you need help with finding low phos food, here is a great chart:  http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

I'm guessing since he has IBD, you've already got him on a good grain free canned food?  And I'm guessing he's on pepcid because he's throwing up froth (which is often a sign of kidney issues, but could also be a sign of other things, even stomach ulcers)

What did your Vet advise as far as the ultrasound?  IF you did find cancer, would you do anything about it?  Do you absolutely trust your Vet to know what is best or is this someone who is new to you and Gus?   These are questions only you can answer, and then you must make your decision based on your answers. 

Believe me, I know what you are going thru, as I lost my soul cat,
Sven
, to kidney disease almost two years ago.  But he lived for three years with it before he finally told me he'd had enough
.



Maybe someone else will come along who also has a cat with multiple health issue and will be able to help guide you better.
 
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chicagocats

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Thank you so much for your response Sally.

Years ago Gus got sick and the vet I was going to at the time was stumped so she gave him a shot of antibiotics and he got better - but his numbers were all normal at the time - he was acting off and not eating normally. I told my current vet and she said that wasn't her first choice, but the last time we spoke she mentioned the antibiotics as a possibility.

The problem with cancer and infection is that they can cause either low or high white blood cell counts. Her reason for suspecting cancer is the spike in BUN and Creatinine levels coupled with low white blood cell and weight loss.

The vet I'm with now is at a cat only clinic. She is very good and has turned to other vets at the clinic when she is stumped by Gus. She said he is often the topic of discussion because he has been so sensitive to treatments.

His phosphorus and calcium are all normal. In fact - everything is normal except Creatinine, BUN, weight and white blood cells.

His urine culture showed nothing. Is it possible for him to have a kidney infection and a normal culture? Maybe there is some other infection lurking?

And yes - he is on grain free and has been for almost 6 years.

He is on pepcid because he has so many sensitivities. He got sick on the fish oil the other day so I have to cut back. He gets sick from certain foods even when they are grain free. He is on a probiotic and budesonide which really helps a lot with the gut issues.

I'm just unsure if I should go ahead with a shot of antibiotics or do the ultrasound or just go with fluids and try to make his life comfortable.

-Rachel and Gus
 
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chicagocats

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And Sally - I'm sorry about your CRF kitty Sven. It is gut wrenching going through this as you know. Making "that decision" is what I've been dreading. I want to have clear answers. It sounds like you had that with Sven and you knew when nothing else could be done. It isn't any easier, but at least you know it is out of your hands and no amount of money, love, or medication will change things.
 

mrsgreenjeens

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And Sally - I'm sorry about your CRF kitty Sven. It is gut wrenching going through this as you know. Making "that decision" is what I've been dreading. I want to have clear answers. It sounds like you had that with Sven and you knew when nothing else could be done. It isn't any easier, but at least you know it is out of your hands and no amount of money, love, or medication will change things.
Thank you for your condolences
.  At least with my guy, it was clear cut in that he ONLY had kidney disease, and he let me know when he was ready to go, so there was really no decision on our part.  I had always told him I would let him go when he let me know he was ready, and by golly, he did just that
.  I can laugh about it now, even though I am tearing up as I type this. 

Anyway, back to business.  My current kidney cat, Callie, also has normal phosphorus and calcium numbers, just has elevated BUN and Creatinine, but our Vet still said to lower the Creatinine she needs to eat foods that are low in phosphorus, because it's phosphorus that does something in the kidneys that causes the creatinine to be high if they aren't functioning at 100%.  So....I scour that food chart for food that are high in protein, med to high in fat, low in carbs and low in phos.  Not easy to find, and especially not easy to find that she will eat 
.   But she's 14 and my hubby and I both agree that it's quality of life that's important for her, not quantity, at this point.  So if she wants to eat cheetos, that's ok with us (thankfully, she doesn't 
)

So, with Gus, did they do a Urine Specific Gravity Test?  You said they did a Urine Culture, but not sure that is the same thing.  I'm guessing it is, and it came back normal?  Wow!  If that's the case, then I have no idea what the heck is going on, because our Vet said even though Callie's numbers were high, if her Urine Specific Gravity Test came back normal, then we didn't need to worry.  Unfortunately, it didn't come back normal.   Now with Gus, I don't have any idea whether or not he could have a kidney infection and the culture come back normal.  I honestly wouldn't think so, but what do I know
.   Why is your current Vet kind of opposed to trying an antibiotic to see if that works?  What else would she do?  IF you had the ultrasound and did find cancer, what would she advise, since she doesn't think Gus would handle chemo or surgery or steroids? 
 
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chicagocats

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I'm pretty certain they do the gravity test every time they do urine labs. She told me there was very little sugar in his urine and that his diabetes was well controlled. She also said that his urine was pretty diluted because he drinks a lot of water and I add water to his food.

I've spoken with someone I know on another site and she is in a similar situation with her kitty. She said she did the ultrasound and all it showed was thickening - but that could be IBD or lymphoma. The vet now said the only way to really know is a biopsy.

If I do the ultrasound for Gus it will show thickening of the intestine because we already know he has IBD. It has showed up in the past.  If Gus has some other form of cancer or a large mass then the ultrasound would be useful in diagnosing it, but otherwise, it won't. It's a crap shoot.

The other person said they are putting her cat on Metronizadole - which Gus was on years ago. I am going to talk to my vet about this and see what

her opinion is.

Are you doing fluid therapy for Callie? Is she on any medications?

I agree with you about the food issue - there is a point where you have to let them enjoy life because all the restriction in the world isn't going to ultimately change things. It might extend their life a little bit, but as you pointed out - quality matters a lot.

I never knew it would be this hard or that I would fall in love with him this much. I still remember so clearly adopting him and his sister 10 years ago and how it was instant attraction. We were just meant to be together.

I know you and everyone here can relate to this. We all get to this point eventually. It is just really hard. I would much rather deal with behavior problems like my cats jumping on the counters or mauling the furniture. What I wouldn't give to have those problems instead of life and death health issues!
 

mrsgreenjeens

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Hmmm, well, isn't Metro usually used to control diarrhea from either IBD or parasites?  Does Gus have issues with his IBD?

Well, I still don't know what to advise you about the ultrasound.  Even if you have it done and there is a mass, I guess the question is, really, would you do anything about it?  You stated above that because of his other health issues he would be hard to treat, BUT, if there were something that could be done, if your Vet could figure out a way, would you do it?  I think you just really  need to sit down with your Vet and figure out the pros and cons of getting the Ultra Sound and whether or not it's beneficial.   Would he have to be "put under" for the ultra sound?  Is that pretty dangerous for an older diabetic cat, even though his diabetes is under control?  I really don't have any idea.

I will tell you right off the top of my head I can think of two cats here on TCS who had Lymphoma and had chemo.  I don't think either of them were as old as Gus, but one survived and is actually thriving long past the time frame he was given even if he had the chemo.  The other, sadly, did not survive, however, as I recall, it wasn't the Lymphoma that took his life. I think he ended up dying of kidney disease brought on by one of the medications, or something like that ...sorry, can't quite recall
.   I don't remember ever reading about any cats with kidney cancer.

Anyway, as i said, I think you and your Vet just need to lots of discussing to determine next steps, if any.  I keep re-reading your initial post and see that he's just not himself and is losing weight, so it's not like you want to just do nothing
.  You know, you'll think I'm crazy, but have you thought about an animal communicator?  The cat I mentioned above that is thriving after chemo had a "meeting" (via phone or email) with an animal communicator BEFORE starting chemo to determine whether or not he wanted to go thru with it
.  If you want to consider this avenue, I can give you the name of the person they used and you can contact her.  She does this long distance and several people here have used her for one thing or another.  She may not be able to tell you what's wrong with Gus, but she may be able to tell you what HE wants to do about it.
 
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chicagocats

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Thank you so much Sally for all your support. We don't know each other, but you have helped me a great deal as I try to deal with this. It is greatly appreciated!

Gus is doing better since being on the Wellactin supplement. He is more mobile - jumping into his window seat - and more social - spending time in the living room again.

He is still not himself though - very tired and lethargic. His appetite is pretty good - 6-9 ounces of wet food a day.

I've tried fluids twice with different gauge needles and that didn't go well. I've got an order in for a smaller gauge. When I turn on the drip and he feels it, he runs.

I sent an email to my vet today about where to go from here. The ultasound would only be helpful if he has a big mass that can be seen clearly. If he has any cancer in the intestine we won't be able to tell because he has IBD and that has already caused thickening along the walls.

I've done some research on low white blood cells and possible reasons. My vet had suggested doing a more extensive test on his blood cells that analyzes the count of each type of white blood cell. I will see what her response to my email is.

I wish answers were more clear cut. There are several paths to go down and they all seem murky - they may or may not provide answers. My biggest concern is that Gus could have an infection and that could be treated. If it is cancer then it can't be treated, but I don't want to possibly let something go that could be treated because I didn't follow through.

Thank you again for all your help and for listening to me.
 
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