12 yr old female and prednisolone for intestinal lesion

rny71

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Hi everyone.. I have a 12 year old female short hair cat that has always been a petite girl.. For most of her life, she was around 8-8.5 lbs.. She had always been in good health, and I've always fed her a diet of free-choice dry food.. Over the years, she had been eating Evo, Wellness, and Natural Balance dry formulas.  Generally, she would be given about twice what I would expect her to eat, and the left over would be discarded.  A few months ago, I started noticing that she was eating less and less of the food that was given to her and took her to the vet after I noticed she was losing weight.  Her weight had dropped to 5.6 lbs, the vet did a physical exam and found nothing remarkable.  An X-Ray revealed a lesion about 4cm in her intestinal area.. Her lab work came back indicating normally functioning kidneys and liver -- but levels for albumin were low.  The vet explained that since her liver enzymes were normal, the low albumin indicated that she was likely losing it due to the lesion. The vet advised that due to her age, the best course of action would likely be to keep her comfortable and treat the symptoms as opposed to aggressively targeting the cause, and I agreed with that. 

The vet prescribed 0.25mL of prednisolone (elixir) to be given once a day.  Additionally, he prescribed 3.25mg of mirtazapine to be given once every 3 days as an additional appetite stimulant. She started the medication about two weeks ago, and immediately noticed a difference with her.  She began eating again, consuming between 180-200 cals/day  (she had reduced her eating to only about 60 cals/day prior).  She began to put weight back on as well.  Also, prior to bringing her to the vet, she had become somewhat withdrawn, preferring to be by herself.  Once she started the meds, within a day or so, her behavior changed dramatically as well -- she seemed very happy and content and much more sociable and affectionate. She also returned to her typical position sprawled out on her side or back, stretching out on whatever bed she decided to sleep on.  (Prior, she had been assuming the meatloaf position most of the time).  I noticed on the days she was given the mirtazapine, it tended to make her more sleepy than usual, and on those days, she ate a little less -- so after consulting with the vet, he said we could stop the mirtazapine, as the desired effect could be hit or miss with it.

After about 2 weeks on the prednisolone, he suggested that we drop the dose to 0.25mL every other day.. The result was like flipping a switch.  She immediately stopped eating, became withdrawn again, and did not want to be bothered.  She returned to the meatloaf position..  I went back to giving the prednisolone daily prior to speaking to the vet, and once again - it was like flipping a switch.. She began eating again, became very sociable and affectionate.  Shes once again back to lying on her side and rolling around on her back, seemingly very content.   I have to speak to the vet again once he returns to the office.

I'm well aware that long-term treatment with the prednisolone can lead to other issues.. I'm also aware that at some point, I'll have to make a decision on how to proceed.  How long is "too long" as far as the medication goes? Is there a middle ground with the prednisolone that gives her a once daily dose, but perhaps a little lower as opposed to every other day with the 0.25mL?  

Thanks for any feedback..
 

stephenq

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Thanks for any feedback..
Some cats can be weaned off Pred and some can't, and those that can't be need the pred badly enough that the need outweighs the long term risks.  It sounds like your cat needs it right now.  This lesion.....just a lesion or a tumor?  I hope the best for your girl.
 
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rny71

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Well, the vet had just described it as a lesion that was about 4cmx4cmx2cm and showed up as a shadow on the X-ray. He said further diagnosis would call for an ultrasound, but advised me that he would only suggest going forward with that if I had wanted to try and persue this aggressively -- but again advised that due to her age, the end result would not significantly add to her life, and would carry a much higher risk of shortening it.
 

mingsmongols

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I can see where hes coming from. An agressive treatment may mean a battery of invasive tests such as biopsies and surgeries, ones that are high risk and what you find might be something you can't treat. While the prednisone may add months to a year or two of a better quality of life. It will get to a point where she's relient on it and can't be taken off but at her age your unlikely to see more of the very long term side effects. That being said if you do want a diagnosis and a treatment plan now is the time to look at your options and come up with a plan for what you want to test for and the treatments available if those tests come back positive. This is a rough decision and while your vet can guide you in the end it is your decision to make on what you think is best for your girl.
 
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rny71

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I agreed with the vet that going forward, an aggressive treatment plan with further tests wouldn't be ideal.. He did mention the next steps would be ultrasound followed by exploratory surgery to biopsy the area and that in itself was enough of a risk, with possible treatment options being both very expensive and not likely to add significant time to her life while also likely not being very happy. I'm realistic about it -- I guess I'm trying to gauge if it's advisable to keep her on the daily dose of pred until the point where the effects of doing so begin to cause secondary issues. As both the vet and I agreed, the goal here is to keep her comfortable as long as we can. I know many people report negative behavioral changes with the pred, and fortunately that doesn't appear to be the case with her at this point. At whatever stage it becomes clear that her quality of life has deteriorated, I am prepared to euthanize her. I don't think many would unnecessarily keep their pet going through an end stage where the pet suffered. I'm keenly aware that her time around is limited at this point and there is not going to be some magical cure for the underlying issue.
 

mingsmongols

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She's eating and back to her old self so that is a definite improvement. I think you have the right goals in mind and are putting your cat first. If she does later on end up having negative behavioral side effects from the prednisone then gabapentin can help with that. It will take away minor pains and anxiety, although she will act loopy on it. Like she's on a catnip high.
 
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rny71

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Thanks everyone for the responses.. After a day or two of acting like she had made a full recovery of sorts, she took a turn for the worst Sunday evening, and became lethargic and stopped eating completely along with several other signs that she had had enough.. She was euthanized this morning.
 
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