Is spontaneous recovery possible?

aryia

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One of our cats, China has gotten super sick a couple months ago. China is only three years old (almost four) and was adopted from SPCA when she was 5-6 months old. We noticed that she lost a lot of weight, she was down to 4 pounds 5 ounces from a healthy 8 pound something at one point. She's been seen at several vets, I won't go into detail but her diagnosis was very delayed since we never realized how serious her condition was due to sloppy examinations and poor cat handling. We noticed that the new home we moved into was flea infested (and subsequently both of our cats) in June/July and she received two treatments of Advantage II.

She received a blood test on 11/20 which showed that she was slightly anemic, slightly high WBC count, high lymphocyte, low platelet, high BUN and slightly high Potassium. She also received an X-ray in which we found she was suffering from pleural effusion. She had an enlarged nymph node near her neck. Her liver showed slightly enlarged. There were slight irregularities within the lungs/kidneys as well though the doctor couldn't be sure what exactly it was. At this point she weighed 4 pound 15 ounces, and wouldn't eat (apart from occasional boiled chicken and temptation treats).

The following day 11/21 she received a chest tap which removed 150 cc of fluid. The fluid analysis showed a high lymphocyte count, no infectious  organisms (fungal or bacterial). She tested negative for FeLV and FIV. At this point the vet suspected lymphoma or FIP. China started eating better after her chest tap, we discovered that she would take By Nature wet food which was good and she ate about 50-70g a day.

On 11/26 she received her ultrasound with FNAs of her liver, her spleen and lymph nodes. The ultrasonographist took a quick look at her heart and reported that the right side was enlarged. Her spleen, liver, several lymph nodes and pancreas were enlarged, the pancreas was nodular as well. There was a small accumulation of sand in her urinary bladder. The FNA came back showing hemophagocytic syndrome consistently. We added on a FIP titer test, which came back positive but with a relative low titer count. The ultrasonographist also performed a chest tap which removed about 60 cc of fluid.

On 12/4 she had her red-blood cell count taken and it was 5% lower than the reading on 11/20. She received another chest tap which removed 45 cc of fluid. After the chest tap she weighed 4 pounds and 6 ounces. The chest tap wasn't performed by her regular vet since she was out of town, instead the other vet (same clinic) pulled us into the clinic to basically tell us that China would be too anemic next week for a chest tap to help her, and since they had no idea what was going on with her she was implying we should euthanize her. We went home, devastated and angry. The same day they were pushing us for more tests (heartworm, another series of tests for sarcoma, blood test, which we all declined since none of it was treatable in any way).

It's 12/22 now and I feel like China is answering my Christmas wish. She's been eating 150g+ of Wellness wet food every day, her appetite is amazing. She's at 5 pounds 6 ounces today, she's gained over a full pound the past couple weeks. She is having no trouble breathing (unlike the vet predicted). She is more active, she has started coming down from her hiding spot, she has energy to torture us again, she is trilling and rubbing her head against us and the other day she was even interested in playing once again. I don't want to get my hopes up, because all the data that we have points towards the fact that she is a seriously ill and I don't know how I feel about taking her back to a vet that has clearly given up on her. We still notice irregularities with her. She stopped licking rocks and trying to eat her litter (she started this behavior when she became anemic and I'm assuming she's no longer anemic if her behavior stopped). She goes to the litter box regularly though her urine output is still very large and she occasionally (once every two days) retches like a hairball is about to come up but none have come up for a while.

So I guess my question is... is it possible that cats can spontaneously get better without any treatment?
 

anne3007

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From what I understand, she hasn't has a diagnosis? It's not very clear what's wrong?

Trying to eat litter can be a sign of anemic, that's true.

I was wondering, did the vet did a urine test, checking urea and creatinine?

Anything happened when these symptoms started? You're saying she received two treatments of Advantage. Did this all started after giving that, or was she already sick before giving this?

It's hard to say if your cat can spontaneously get better without any treatment if there is no clear diagnosis.

You've seen several vets. Were they from the same clinic? Maybe you can go to another vet from another clinic for a second opinion. Some vets really have no idea what they're saying. Don't lose hope. It's good to hear you do anything for her :)
 

anne3007

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* I meant, a blood test, checking urea and creatinine
 
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aryia

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After $2000+ worth of tests, she still never received a diagnosis. We are unsure when China started losing weight. She's a super long fur kitty who likes her privacy so we don't pet her very much, she acts spoiled like she's a princess and gives us a dirty look whenever we make her fur dirty by touching her. I would like to think that I would've noticed her that skinny when I gave her a bath in July/August when the flea infestation started, I definitely wouldn't have given her flea treatment if I noticed anything wrong with her. Our vet believes that the stress from the fleas could've triggered her illness (especially if her illness is actually FIP).

We initially had her seen in September at a regular vet, but the assistants/vets didn't seem to understand how to handle sick cats. China was super defensive (growling but no scratching or biting) most likely because she wasn't feeling well, and the assistants there responded super hard scruff. Neither were we informed of how serious of an issue her weight loss was, so we brought China back without further diagnosis and tried to bring her weight up with dietary changes.

When we noticed her breathing become labored in November we took her to a cat-only clinic. The vet here ran multiple consults with other vets in the area including specialists and OSU (Oregon State VTHM), all of which came back with different diagnoses and a very guarded prognosis. 50% of pleural effusion is idiopathic (without a cause that they can find) and hemophagocytic syndrome is rarely observed in clinical cases. Our vet even offered us a free necropsy, which really makes me feel like no one has a clue and everyone is only curious about what is medically going on in China.

The only tests that are left to run (if I remember correctly) are for sarcoma, more advanced FIP testing, and heartworm (which is unlikely in my opinion, I haven't seen a single mosquito in years). None of the three are treatable and diagnosis is very costly which is why we declined. Her symptoms aren't very distinct for any of the diseases either (except for FIP which can do a number of random things). For some reason the vet also needs to take blood from her jugular and I know China gets super stressed each time we go to the vet, given that her illness seemed to have triggered when she got stressed from the fleas, I don't know how I feel about taking her back to a stressful situation especially when none of the vets in the area seem to think she is savable. Oddly though, a urine test was never done and no report that came back ever suggested a urine test either. I've always been super curious about that too.

So I'm just confused. I don't want to raise my hopes but here she is, eating, playing, and being mostly normal when everyone was certain that she should be euthanized two weeks ago.
 

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So I'm just confused. I don't want to raise my hopes but here she is, eating, playing, and being mostly normal when everyone was certain that she should be euthanized two weeks ago.
It IS very confusing, and yes it's possible for a patient to spontaneously get better if they have a self limiting illness or one they can overcome in time, although typically we think more about contagious illnesses in this category like viral and bacterial infections.

FIP doesn't get better so her recovery would just about rule that out.

Small cell lymphoma would not get better without treatment.

There various types of "itis's", pancreatitis, tri-itis, etc don't always have specific causes.  Was she tested for pancreatitis using the PLI test?  

It might help to get a fresh set of eyes on this and have her entire vet record sent to another practice and have them do a consult with you.

You are right that heartworm is difficult to diagnose, and while there are no treatments for it, cortisone shots can support a cat in crisis. Coughing is a VERY common symptom in heartworm.   It's also true that cats can and do recover from heartworm on there own in some cases and more often then dogs do.  But a cat with heartworm can have a relapse anytime within about 2 years of contracting it, and while areas with lots of mosquitos are a risk factor, being in an area with few mosquitos doesn't mean a cat can't get it.  Links below.

http://www.vcahospitals.com/main/pe...e/animal-health/heartworm-disease-in-cats/273

https://www.aspca.org/pet-care/cat-care/heartworm

Please keep us updated and best of luck!
 

anne3007

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Could the Advantage treatment possibly the cause of all this?

I don't think so though, but since the symptoms started at the same time.. ?

I am wondering, however, if her kidneys are ok. I don't know why the vet didn't do a boodtest and checked her kidney levels ( urea and creatinine) ?
It could be something else, but I have had two cats with kidney failure. One with severe kidney failure. Common syptoms are:

- Eating less , bad apetite, losing weight

- Drinks more than usual, pees more than usual (which is very typical for kidney failure)

- Anemia, weakness

- Sores in the mouth, bad breath

- Dehydration (although they drink a lot)

- Under temperature

- Vomiting

- Less grooming
- Fatigue

There are different types of kidney failure. (Acute, chronic)

Perhaps I am totally wrong but I am just wondering if the vet thought about this. Some cats with kidney failure are doing well for a couple of days, later on they are very very sick, a few days later they are back normal again and then again there's a relapse..
Hope her kidneys are ok. Elevated blood urea nitrogen (BUN) and creatinine are both indicative of renal failure.
You can always do a urine check. China doesn't have to go to the clinic. There is special cat litter called Katkor. You can take a sample of her urine

Hope things will be clear soon.. good luck!
 

stephenq

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Could the Advantage treatment possibly the cause of all this?

I don't think so though, but since the symptoms started at the same time.. ?
The depth and length of the symptoms suggest it isn't connected to the Advantage treatment but I trust the Vet considered this ?
 
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aryia

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Could the Advantage treatment possibly the cause of all this?

I don't think so though, but since the symptoms started at the same time.. ?

I am wondering, however, if her kidneys are ok. I don't know why the vet didn't do a boodtest and checked her kidney levels ( urea and creatinine) ?
It could be something else, but I have had two cats with kidney failure. One with severe kidney failure. Common syptoms are:

- Eating less , bad apetite, losing weight

- Drinks more than usual, pees more than usual (which is very typical for kidney failure)

- Anemia, weakness

- Sores in the mouth, bad breath

- Dehydration (although they drink a lot)

- Under temperature

- Vomiting

- Less grooming
- Fatigue

There are different types of kidney failure. (Acute, chronic)

Perhaps I am totally wrong but I am just wondering if the vet thought about this. Some cats with kidney failure are doing well for a couple of days, later on they are very very sick, a few days later they are back normal again and then again there's a relapse..
Hope her kidneys are ok. Elevated blood urea nitrogen (BUN) and creatinine are both indicative of renal failure.
You can always do a urine check. China doesn't have to go to the clinic. There is special cat litter called Katkor. You can take a sample of her urine

Hope things will be clear soon.. good luck!
Her creatine levels are within normal, but the ultrasound showed slight enlargement of her kidneys. From the ultrasound, a lot of her organs were enlarged and stressed which indicates failure (right-sided heart, kidney, liver, and especially her pancreatitis). The weirdest of her symptoms, which is throwing off all the vets is the hemophagocytic syndrome though. When her liver, lymph nodes and spleen were aspirated, it showed that her immune system was eating her red blood cells (hemophagocytic syndrome) which in turn was causing her anemia. We noticed that she started licking rocks and eating litter around the time she became anemic and recently all her rock-licking and litter eating tendencies slowly just disappeared. The rate at which she was becoming more anemic was supposed to have put her in breathing distress two weeks ago (which is when the vet implied we should euthanize her), but to my amazement her breathing never got any worse.

Our vet was kind of stuck. She wanted to try a steroid treatment to stop her immune system from killing her, but steroids are very dangerous for a patient going through heart failure. We were going to try steroid treatment as a last resort, but it never came to that.

The vet believes that the stress from having fleas triggered her illness. This would be possible in cases such as FIP, where her health just plummets the second FIP flares up. When the vet looked at her blood test, her organ values were pretty much normal, which is unusual for a cat that lost 50% of her body weight and wasn't eating. She was in specific looking for signs of hepatic lipidosis since China wasn't eating properly at the time. I think the length of time between the advantage treatment (last one in August/September) and the vet visit (November 20+) was enough for the vet to believe that advantage couldn't be the primary cause of all this. I think the most trouble my vet was having was figuring out which symptom originated first. Her symptoms were all over the place, pleural effusion is semi-rare in cats (and apparently a very grave prognosis by itself) and on top of it hemophagocytic syndrome is almost never seen clinically at least. Along with her right-sided heart failure, irregularities in pancreas, liver, spleen, lymph nodes, kidneys and on top of that, her high lymphocyte levels contradicted almost any diagnosis.

We will have to take China in to the vet eventually again I assume. I'm just not sure when the right time is. The vet will always say "right away", but everytime we take China into the vet it just seems like we're stepping into a pit of hopelessness. They sedate her for everything and put her under anesthesia for anything more than a blood-draw or X-ray which isn't any good for her system either seeing how her liver and kidneys were already stressed. Last time we were charged an "aggressive cat charge" because another vet at the clinic handled the procedure since the doctor we usually see was out of town. They claimed that China drew blood, though I know my cat. She's fussy but when she bites her teeth have never punctured, and at the time she was It doesn't help that I'm a recent college graduate and that the thousands of dollars for diagnosis tests put me into a lot of financial stress, which is why I would like to avoid diagnosis tests that won't benefit China.

As for a "second" opinion, do you know of any vets that will do the consult through e-mail/phone? I would prefer to have her case seen by a vet who hasn't worked on her case yet. Our doctor has consulted with almost every vet in the area that has a lot of experience with cases such as hers.
 
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aryia

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It IS very confusing, and yes it's possible for a patient to spontaneously get better if they have a self limiting illness or one they can overcome in time, although typically we think more about contagious illnesses in this category like viral and bacterial infections.

FIP doesn't get better so her recovery would just about rule that out.

Small cell lymphoma would not get better without treatment.

There various types of "itis's", pancreatitis, tri-itis, etc don't always have specific causes.  Was she tested for pancreatitis using the PLI test?  

It might help to get a fresh set of eyes on this and have her entire vet record sent to another practice and have them do a consult with you.

You are right that heartworm is difficult to diagnose, and while there are no treatments for it, cortisone shots can support a cat in crisis. Coughing is a VERY common symptom in heartworm.   It's also true that cats can and do recover from heartworm on there own in some cases and more often then dogs do.  But a cat with heartworm can have a relapse anytime within about 2 years of contracting it, and while areas with lots of mosquitos are a risk factor, being in an area with few mosquitos doesn't mean a cat can't get it.  Links below.

http://www.vcahospitals.com/main/pe...e/animal-health/heartworm-disease-in-cats/273

https://www.aspca.org/pet-care/cat-care/heartworm

Please keep us updated and best of luck!
During the ultrasound-guided FNA, the vet chose not to aspirate her pancreas in fear of causing it to be even more inflamed. And no, a PLI test was never run. I think what I will do is nurse her back to her healthy weight before taking her into the vet again (or before if she starts showing signs of declining health again).

As for the heartworm, even if it is heartworm we wouldn't be able to give her cortisone shots without the dangers of possibly putting her into severe heart failure and other than that I've heard of no approved treatments apart form supportive care which is what we're doing right now anyways, which is why we've opted out testing for it.

She just came down right now and started wrangling her favorite mousie toy. She's been having a lot of fun again the past couple weeks, though it kills me to limit her activity in case it might hurt her recovery.

I almost forgot, Merry Christmas to everyone! And thank you all for your responses.
 

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Have they checked for haemobartonellosis?

The reason I am asking is that she was healthy up until exposure to fleas. If she has no exposure to outdoor cats than this must be something she was exposed to. Cancer is unusual in younger cats. Heartworm again is unusual in an indoor cat...

Any exposure to rodents?

In people hemophagocytic syndrome can occur due to exposure to viruses such as Epstein Barr virus.
 

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See if this helps
wwwnc.cdc.gov/eid/article/6/6/pdfs/00-0608.pdf

It appears a variety of infections may cause this. I would make a list of the infections listed in this document and see if there are related infections in cats... herpes virus for example.. or tick borne illness or parvovirus.

It is a shame this has not been better researched in cats. Assuming it is not cancer I would think it is important to identify the causative organism.
 

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I am happy that your cat is feeling better, even if you have no idea why it's happened. I know what it's like to have a vet act like your pet is more of a scientific curiosity than a member of your family (when my rabbit was being treated for glaucoma). On one hand, you want to know what's going on with China; and if there's anything that will help. On the other hand, you're worried that stressing her out may ruin the progress she's made and may still yield no answers.

I have no idea what could be wrong with poor China, but if it were me in your shoes, I would see if a vet would look over her case without needing to see her like you're thinking, and if nothing comes from it or no one will do it, I would just keep an eye on the cat and if China gets worse, take her back in. At this point, since she's improving, I would be reluctant to take her in so soon since she becomes soooo stressed out from the vet visits. I wish you all the luck with China!!
 

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OK thanks for the detailed update.  ALso note that if you should contemplate the PLI test in the future, its most accurate when done during a flare up.  Keep us updated and sending vibes :)
 

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As for a "second" opinion, do you know of any vets that will do the consult through e-mail/phone? I would prefer to have her case seen by a vet who hasn't worked on her case yet. Our doctor has consulted with almost every vet in the area that has a lot of experience with cases such as hers.
The Cornell School of Vet medicine does a consultation service. During the stated times, you call them and discuss what you need with the "front desk" person for free. They describe how it works. Basically you email them all the info, a Vet looks it over and arranges a time to do a phone consult with you for the fee they mention on the site $55 which sounds highly reasonable.

http://www.vet.cornell.edu/FHC/health_resources/camuti_service.cfm
 
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aryia

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Have they checked for haemobartonellosis?

The reason I am asking is that she was healthy up until exposure to fleas. If she has no exposure to outdoor cats than this must be something she was exposed to. Cancer is unusual in younger cats. Heartworm again is unusual in an indoor cat...

Any exposure to rodents?

In people hemophagocytic syndrome can occur due to exposure to viruses such as Epstein Barr virus.
I looked up haemobartonellosis and it seems like the way to diagnose it is to find parasites in a blood smear? I believe her blood work contained a blood smear (for platelet count?), there wasn't anything unusual noted with it though I'm not sure we were looking for parasites at that point. I do believe haemobartonellosis would've showed up on the three FNAs that were done (which showed her red blood cells being gobbled up by macrophages) and the doctor noted that there were bacterial, fungal or parasitical cells present in the three FNAs or the fluid analysis done from her pleural effusion chest tap fluid.

We did acquire rodents (rats, mice, gerbils) starting in June/July which coincides with the time that the fleas started. We never figured out if the apartment (we moved in first of April) or the rodents brought in the fleas, but during August the fleas were all over our bedroom (inside the carpets, we could catch hundreds in a week just with our bare hands, it was horrible) but the rooms we kept the rodents in never got flea infested so we assumed that there was an existing flea infestation in the bedroom. I did mention the fact we got the rodents to the vet but I felt like she didn't dwell on the idea that the rodents could've transmitted something for very long at all. China has never had any direct contact with any of the rodents though and they are kept in separate rooms from each other, so she only has limited exposure to them. I will do some research on Epstein barr as well.

She hit 5 pounds 10 ounces on the scale, still ways off from her healthy weight but she is steadily gaining about 1.5-2 ounces per day. I know metabolism in cats is different but how much weight do emaciated gain on average per day/week?
 
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aryia

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The Cornell School of Vet medicine does a consultation service. During the stated times, you call them and discuss what you need with the "front desk" person for free. They describe how it works. Basically you email them all the info, a Vet looks it over and arranges a time to do a phone consult with you for the fee they mention on the site $55 which sounds highly reasonable.

http://www.vet.cornell.edu/FHC/health_resources/camuti_service.cfm
Thank you, I will give them a call and see if they'd be willing to take her case. A lot of times I call a vet and they're not willing to do any work unless they can physically see the cat.
 

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Thank you, I will give them a call and see if they'd be willing to take her case. A lot of times I call a vet and they're not willing to do any work unless they can physically see the cat.
there's no reason why they wouldn't take your case as they specialize in phone consultations.  Just make sure you call during their stated days/hours which are very specific.  Please let us know how it goes, and i would love to know how the actual consult goes and how you liked it.

In fact you could do all of us at TCS a big favor.  You will be the first person I know of on here who has actually used the service, and it would be a great service to TCS if once its done, if you would start a new thread and review the service for us.  Would you be willing to do that?

Thanks

Stephen
 
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