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- Sep 26, 2022
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Background: My cat, Tuvok, is 15 years old with Small Cell Lymphoma (treated since 01/2021 with Chlorambucil/Prednisolone. Prednisolone stopped March 2022 due to increased blood glucose).
A few weeks ago his appetite was slightly down. I figured this was likely because we had to switch from Mirataz transdermal to liquid Mirtazapine (doesn't seem to work as well, but his ears became allergic to Mirataz). He was still eating the same amount of food in a day, but was taking longer. Then 2 weekends ago he pretty much quit eating. My husband and I syringe feed him a little food mixed with his meds twice a day so when he quit eating we started giving him food. I emailed his oncologist that weekend to let her know and see if she could get us in on Monday (9/12). We were seen on Monday afternoon and we scheduled an ultrasound for Tuesday. Tuvok was antsy and they were only able to get enough blood for her main tests. They said they would grab more on Tuesday to run the pancreatitis test, and his thyroid test.
Monday night his oncologist emails us to tell us his liver enzymes are elevated and his bilirubin was 1.8.
Tuesday (9/13) he goes in for his ultrasound and more tests (we dropped him off in the morning and get a call in the afternoon). The pancreas does look inflamed and the liver is bright. We were told it looks like he has pancreatitis and hepatic lipidosis (shocking since he was getting some food every day). His oncologist suggested we work with an Internal Medicine doctor as she would be better informed on these topics. His oncologist also let us know his pancreatitis test would come back within the next few days. That afternoon we get to go in and see an internal medicine doctor (he does have one at this hospital, but she doesn't work on Tuesday). His new internal medicine doctor says she wants to hospitalize him. I ask for what as he is very easily stressed and I do not want to stress him out at the hospital. After she meets him she says he doesn't need to be hospitalized, but we need to come back tomorrow for more tests. She sugested a feeding tube as well, but at this point we want to try to syringe feed him since we do it daily anyway. She says she wants to see his liver numbers improving (is that normal to expect improvement overnight?!?!) we agree and go home.
On Wednesday (9/14) we go back and his numbers have gone down. Bilirubin is already at a .8. She says no need to hospitalize and no feeding tube but she wants him back on Thursday again as his phosphorous is now getting a bit too low. We decide we do want a feeding tube as it is too stressful to syringe feed him such a large amount.
On Thursday (9/15) he goes in to receive a feeding tube and gets phosphorous. We pick him up Thursday evening.
Friday (9/16) he goes in for another checkup with his orignal internal medicine doctor (his new one is off on Fridays). His phosphorous is low, but steady and he is able to take phosphorous supplements at home. His liver numbers are down again.
Saturday (9/17) we notice he sounds so stuffy and gurgly. He tried to eat cat food but couldn't swallow. We call and they say its likely irritation from the breathing tube during surgery. We take him in to be checked to be safe. He is given the all clear.
Monday (9/18) he goes back. Liver numbers are still down. We are told to give him a week off because he is stressed. By Wednesday (9/20) we notice he is incredibly stuffy/sneezy/etc and we call to let her know. She gives him an antibiotic for his upper respiratory infection (he gets them often with stress). Around this time his feedings have increased and he is no longer showing interest in trying to eat food on his own. We are less than a week in with the feeding tube and I know it takes time for him to get better so we are not too worried. But we keep track of this/his constipation and let his doctor know.
Today (9/26) we had a followup. He is still constipated (though he did poop on Saturday) and his doctor says she isn't too worried as cats tend to poop less with a feeding tube. When we mentioned he lost interest in trying to eat on his own she said maybe it has to do with the fact he is getting too much via his tube. We ran lab work and we were sent on our way. We received a call this afternoon and she said his liver enzymes are back up and now his bilirubin is up to 2.8!!! She said she wants him in tomorrow for a followup ultrasound and fine needle aspirate on his liver. She mentioned it could be cancer. I am STRESSED and upset.
I have read on this forum that sometimes numbers get worse before they get better. Is this true? I asked his doctor and she said that isn't a thing and said it's weird for his numbers to do this. Should I expect him to improve within 2 weeks? It's been less than 2 weeks that he has had a feeding tube! Is it a good idea to do more testing or is it too soon? Are there other tests or things we should have them look out for that could cause this?
What should I be doing at home? We have him on Denamarin (though I haven't been able to give it to him more than an hour before food) and Milk Thistle at home as well as giving him fluids a few times a week. We had to stop the buprenorphine as he was having too much of a reaction taking that and the Mirtazapine. Is there a pain killer that would be better and not cause a reaction? He doesn't show the obvious signs of pain (he sleeps with us, he stretches out/sleeps on his back, wakes us up in the morning, still jumps up to look out the front window, etc) but I know he isn't feeling great since he is sleeping a lot more. Am I missing something? Is there more I can do?
I know this is a lot of information. I just feel so sad and I want to hear about other experiences. I keep reading this disease takes time to heal and the process can be a wave, but his doctor made it seem like his numbers should only constantly improve. I am just not sure.
I also wanted to ask about supplements/vitamins. His doctor has suggested no such vitamin or supplement. I was the one that asked about Denamarin. I feel like it would be better for me to bring things up on my end. She seems to do treatment in one way and doesn't really adjust for each patient. I can ask for things, but I am not sure what to ask for.
A few weeks ago his appetite was slightly down. I figured this was likely because we had to switch from Mirataz transdermal to liquid Mirtazapine (doesn't seem to work as well, but his ears became allergic to Mirataz). He was still eating the same amount of food in a day, but was taking longer. Then 2 weekends ago he pretty much quit eating. My husband and I syringe feed him a little food mixed with his meds twice a day so when he quit eating we started giving him food. I emailed his oncologist that weekend to let her know and see if she could get us in on Monday (9/12). We were seen on Monday afternoon and we scheduled an ultrasound for Tuesday. Tuvok was antsy and they were only able to get enough blood for her main tests. They said they would grab more on Tuesday to run the pancreatitis test, and his thyroid test.
Monday night his oncologist emails us to tell us his liver enzymes are elevated and his bilirubin was 1.8.
Tuesday (9/13) he goes in for his ultrasound and more tests (we dropped him off in the morning and get a call in the afternoon). The pancreas does look inflamed and the liver is bright. We were told it looks like he has pancreatitis and hepatic lipidosis (shocking since he was getting some food every day). His oncologist suggested we work with an Internal Medicine doctor as she would be better informed on these topics. His oncologist also let us know his pancreatitis test would come back within the next few days. That afternoon we get to go in and see an internal medicine doctor (he does have one at this hospital, but she doesn't work on Tuesday). His new internal medicine doctor says she wants to hospitalize him. I ask for what as he is very easily stressed and I do not want to stress him out at the hospital. After she meets him she says he doesn't need to be hospitalized, but we need to come back tomorrow for more tests. She sugested a feeding tube as well, but at this point we want to try to syringe feed him since we do it daily anyway. She says she wants to see his liver numbers improving (is that normal to expect improvement overnight?!?!) we agree and go home.
On Wednesday (9/14) we go back and his numbers have gone down. Bilirubin is already at a .8. She says no need to hospitalize and no feeding tube but she wants him back on Thursday again as his phosphorous is now getting a bit too low. We decide we do want a feeding tube as it is too stressful to syringe feed him such a large amount.
On Thursday (9/15) he goes in to receive a feeding tube and gets phosphorous. We pick him up Thursday evening.
Friday (9/16) he goes in for another checkup with his orignal internal medicine doctor (his new one is off on Fridays). His phosphorous is low, but steady and he is able to take phosphorous supplements at home. His liver numbers are down again.
Saturday (9/17) we notice he sounds so stuffy and gurgly. He tried to eat cat food but couldn't swallow. We call and they say its likely irritation from the breathing tube during surgery. We take him in to be checked to be safe. He is given the all clear.
Monday (9/18) he goes back. Liver numbers are still down. We are told to give him a week off because he is stressed. By Wednesday (9/20) we notice he is incredibly stuffy/sneezy/etc and we call to let her know. She gives him an antibiotic for his upper respiratory infection (he gets them often with stress). Around this time his feedings have increased and he is no longer showing interest in trying to eat food on his own. We are less than a week in with the feeding tube and I know it takes time for him to get better so we are not too worried. But we keep track of this/his constipation and let his doctor know.
Today (9/26) we had a followup. He is still constipated (though he did poop on Saturday) and his doctor says she isn't too worried as cats tend to poop less with a feeding tube. When we mentioned he lost interest in trying to eat on his own she said maybe it has to do with the fact he is getting too much via his tube. We ran lab work and we were sent on our way. We received a call this afternoon and she said his liver enzymes are back up and now his bilirubin is up to 2.8!!! She said she wants him in tomorrow for a followup ultrasound and fine needle aspirate on his liver. She mentioned it could be cancer. I am STRESSED and upset.
I have read on this forum that sometimes numbers get worse before they get better. Is this true? I asked his doctor and she said that isn't a thing and said it's weird for his numbers to do this. Should I expect him to improve within 2 weeks? It's been less than 2 weeks that he has had a feeding tube! Is it a good idea to do more testing or is it too soon? Are there other tests or things we should have them look out for that could cause this?
What should I be doing at home? We have him on Denamarin (though I haven't been able to give it to him more than an hour before food) and Milk Thistle at home as well as giving him fluids a few times a week. We had to stop the buprenorphine as he was having too much of a reaction taking that and the Mirtazapine. Is there a pain killer that would be better and not cause a reaction? He doesn't show the obvious signs of pain (he sleeps with us, he stretches out/sleeps on his back, wakes us up in the morning, still jumps up to look out the front window, etc) but I know he isn't feeling great since he is sleeping a lot more. Am I missing something? Is there more I can do?
I know this is a lot of information. I just feel so sad and I want to hear about other experiences. I keep reading this disease takes time to heal and the process can be a wave, but his doctor made it seem like his numbers should only constantly improve. I am just not sure.
I also wanted to ask about supplements/vitamins. His doctor has suggested no such vitamin or supplement. I was the one that asked about Denamarin. I feel like it would be better for me to bring things up on my end. She seems to do treatment in one way and doesn't really adjust for each patient. I can ask for things, but I am not sure what to ask for.