Mystery illness, Possibly Lymphoma, Not Eating

[iPappy]

I'm in a bit of shock. I called my brother's place this morning to ask after Danno and they all said he's fine, he's comfortable, he ate, etc. But when I got there around 11, he was in terrible shape - unresponsive, hot, unable to walk, and with head and neck tremors. I held some food up to his mouth and his head shook and then fell into the bowl - he couldn't raise his head. I got very angry and said we have to go to the ER NOW. I got quite a bit of pushback but eventually slid him into his carrier (he was totally limp), well padded with blankets, and got my brother to drive us to the oncologist early (there's a 24-hour ER attached to the specialist center). I honestly thought Danno was going to die in the car.

I briefly described his symptoms to the oncology tech who met us and she whisked him off to the hospital, thinking he might have neutropenia. I was sort of hoping it was some kind of infection that could be treated right away with antibiotics. But his CBC was all normal. They did a panel that showed somewhat elevated kidney values. He was extremely dehydrated.

They gave him sub-Q fluids, and B12, dexamethasone, and cerenia injections. The vet said it was possible that his symptoms were the result of not having drunk any water at all for 2 days (I'd syringed a few droplets of water, but he hasn't been drinking from his bowl at all) and not eating, but she was concerned about his extremely weak and wobbly back legs. She booked him for an ultrasound tomorrow to gauge the progression of the lymphoma. The original ultrasound suggested possible renal involvement, which can sometimes have a central nervous system progression.

I cried a lot at the vet, but I am trying not to let my thoughts go too far in any direction. We'll know more tomorrow. I will say that after his sub-Qs, etc., he was perkier - he was at least lying with his head up, looking around, on the drive back home. And the vet said he ate all the treats they gave him when he was in the hospital - they even gave us a bag to take home, and he did eat them eagerly. I'd brought a can of A/D with me and he licked a lot of it off my fingers in the waiting room. That's more than he did all day yesterday and this morning.

I stayed at my brother's until about an hour ago, and Danno spent the whole time in his carrier. I took the top off, but he just lay there in the blankets. He initially ate a good portion of FF and some treats, but turned away from all other food I offered him throughout the afternoon. Alarmingly, he'd sort of nuzzle my hand with the treats in it, but not take the treats. It gave me the impression that he smelled them and felt them and that he had a sort of memory of treats but that he didn't know what to do with them at the moment. He responded quite well to my massaging his ears and face, and then curled up in what looked to me to be a comfortable position (not the usual recent uncomfortable slouch) and was just resting.

I spent the afternoon sitting with him and occasionally researching. One particular rabbit hole led me around to Mirataz side effects, which include tremors and other neurological symptoms, especially when combined with ondansetron - both of which I'd given him recently. I'll ask the vet about that tomorrow. A long shot? But I'm desperate. I'd also told the vet that the onset of these symptoms coincided exactly with the first day of the pred taper (first day of no pred), and she said that was a possibility.

If anyone has experiences with any of these symptoms, please share. I'm going back over to my brother's in an hour or so and will spend the night there tonight to observe and be with Danno. All healing wishes very welcome - thanks!

That is scary. I'm so glad you're going to keep an eye on him, and it's good you got there today when you did. What a horrible experience for you both.
I have no experience with those symptoms, or those medications in that combination. I wish I had some more words of wisdom for you, but I will happily send all the healing wishes and prayers I can.

 

[Mac and Cats]

I have zero advice for you, but you are such a good auntie/uncle (sorry, I don't know your gender). I don't mean to be disrespectful, but is it possible for you to convince your brother to let you take Danno home? Or would you not even be able to take him home even with permission? I'm so sorry you're going through this and have been through so much cat trauma since 2020, I am over here shedding tears for you. I'm so sorry for you and Danno and his family. I'm rooting for you. Thank you for helping him.

 

[RussellsMom]

Thank you both - I'm in great need of support tonight, as is Danno. Yes, I am his auntie. And oh, how I've longed just to take him home with me this past month, but my brother won't allow it. Our cat Russell doesn't like other cats, but we've looked after Danno before, when my brother's gone out of town. Our house is arranged in such a way that we can close off two separate halves for the two cats to live separately in. There's a lot of curious sniffing under doors, but no fighting. But as much as I've fantasized about sneaking in to their home and taking Danno home with me to care for him in my own home, I can't.

I'm back at my brother's place now. Danno can't walk at this point - his back legs are so weak he just collapses. The oncologist said if he got worse to bring him in to the ER (in the same facility as the oncology center), but when I called them just now to say we'd like to bring him in, the ER said they didn't have room for him. They sent us a list of other 24 hour vets, but my brother refuses to go anywhere else and gets furious when I press him. I don't understand him and he won't give me a cogent reason. We have an ultrasound appointment at 7:30 tomorrow morning (technically we're to drop him off at 7:30 and they'll see him when they see him) - he wants to wait for that.

I'm thinking, his symptoms are progressing so quickly, I'd want him to be looked at now. Also, there are many reasons why he might have back leg weakness, not just lymphoma progression (what the U/S will look for). But I can't force my brother to go and he's completely shut down. So I'm sitting with Danno and kissing him a lot. He is eating a bit from my hand, and he's responsive.

 

[Mac and Cats]

Thank you both - I'm in great need of support tonight, as is Danno. Yes, I am his auntie. And oh, how I've longed just to take him home with me this past month, but my brother won't allow it. Our cat Russell doesn't like other cats, but we've looked after Danno before, when my brother's gone out of town. Our house is arranged in such a way that we can close off two separate halves for the two cats to live separately in. There's a lot of curious sniffing under doors, but no fighting. But as much as I've fantasized about sneaking in to their home and taking Danno home with me to care for him in my own home, I can't.

I'm back at my brother's place now. Danno can't walk at this point - his back legs are so weak he just collapses. The oncologist said if he got worse to bring him in to the ER (in the same facility as the oncology center), but when I called them just now to say we'd like to bring him in, the ER said they didn't have room for him. They sent us a list of other 24 hour vets, but my brother refuses to go anywhere else and gets furious when I press him. I don't understand him and he won't give me a cogent reason. We have an ultrasound appointment at 7:30 tomorrow morning (technically we're to drop him off at 7:30 and they'll see him when they see him) - he wants to wait for that.

I'm thinking, his symptoms are progressing so quickly, I'd want him to be looked at now. Also, there are many reasons why he might have back leg weakness, not just lymphoma progression (what the U/S will look for). But I can't force my brother to go and he's completely shut down. So I'm sitting with Danno and kissing him a lot. He is eating a bit from my hand, and he's responsive.

I'm so sorry. I truly wish I could do something to help. My sister has a cat with a chronic eye infection and she refuses to do anything to help. I've offered to help figure out a way to do eye ointment and also given her lysine. She just shrugs and says her cat won't allow it. Meanwhile, I'm over her trying and trying and trying again to give cats pills that hate pilling (Like 5 different cats) and I persist even if I'm injured. I've been sent to the ER multiple times over my life due to cat injuries and I still keep trying. So, while my experiences with my sister aren't as severe, I know what you mean. Please keep us updated and I'm thinking good thoughts for you all.

 

[fionasmom]

I’m not going to rule out the less than desirable care he receives when you are not around as the cause of this, but I’m also not going to say that I think that is the conclusive answer.

All kinds of drug interactions are possible, and I can’t speak with any experience as to the interplay of the mirataz, ondansetron and pred.

As I am reading now, this sounds very serious and if you can try to write down all the questions that you have for whomever the next doctor, is that you see you may at least get some clarification about the medications.

I understand the problem with your brother’s refusal to do anything and with his refusal to allow you to take the cat.
Is there anything that you could think to say to him, even if it is not entirely true, that would let him release Danno to you?

 

[iPappy]

Thank you both - I'm in great need of support tonight, as is Danno. Yes, I am his auntie. And oh, how I've longed just to take him home with me this past month, but my brother won't allow it. Our cat Russell doesn't like other cats, but we've looked after Danno before, when my brother's gone out of town. Our house is arranged in such a way that we can close off two separate halves for the two cats to live separately in. There's a lot of curious sniffing under doors, but no fighting. But as much as I've fantasized about sneaking in to their home and taking Danno home with me to care for him in my own home, I can't.

I'm back at my brother's place now. Danno can't walk at this point - his back legs are so weak he just collapses. The oncologist said if he got worse to bring him in to the ER (in the same facility as the oncology center), but when I called them just now to say we'd like to bring him in, the ER said they didn't have room for him. They sent us a list of other 24 hour vets, but my brother refuses to go anywhere else and gets furious when I press him. I don't understand him and he won't give me a cogent reason. We have an ultrasound appointment at 7:30 tomorrow morning (technically we're to drop him off at 7:30 and they'll see him when they see him) - he wants to wait for that.

I'm thinking, his symptoms are progressing so quickly, I'd want him to be looked at now. Also, there are many reasons why he might have back leg weakness, not just lymphoma progression (what the U/S will look for). But I can't force my brother to go and he's completely shut down. So I'm sitting with Danno and kissing him a lot. He is eating a bit from my hand, and he's responsive.

I've been in similar positions while pet sitting, and the vets really can't do much unless the actual owner gives consent for treatment. And that is very frustrating when you feel stuck in the middle.
For now, if Danno is eating (even a little), and is responsive, having an appointment at 7:30AM is the next best thing to emergency. As fionasmom suggested, now would be a good time to write down any questions and concerns you have so you don't forget to mention anything. Also, writing down his medication schedule, your concerns about the mixture of medications and this all starting on the day without prednisone would be helpful. I'm sure the staff would be happy to pass any notes you have along to the doctor so they can get a clear picture of the timeline and happenings thus far.

 

[RussellsMom]

Yes, thank you all. I've started writing down some notes (trying to keep a clear head isn't easy) for the doctor. I did ask about the pred taper and the vet didn't rule it out. But I didn't come across the mirataz serotonin syndrome info until we got home, so I'll ask about it tomorrow.

As for taking Danno in to my home, I've racked my brains this whole month thinking of ways to help and to have greater access to him. The family is such that I'm surprised I've been allowed any access at all - and it's been a constant battle - so I need to work with the way it is now.

Danno got up and went to the other room to use his cat box, albeit with many hind-quarter collapses along the way - but he did manage. And then came back to his cat bed. His fur isn't tufty, and he just had some more FF and Temptations. He won't touch his water bowl.

 

[white shadow]

I spent the afternoon...occasionally researching. One particular rabbit hole led me around to Mirataz side effects, which include tremors and other neurological symptoms, especially when combined with ondansetron - both of which I'd given him recently. I'll ask the vet about that tomorrow. A long shot?

Likely spot on, I'd say. Here are your descriptions from earlier yesterday:

"...unresponsive, hot, unable to walk, and with head and neck tremors. I held some food up to his mouth and his head shook and then fell into the bowl - he couldn't raise his head....she (hospital vet) was concerned about his extremely weak and wobbly back legs."​

And, these are some of the symptoms of Serotonin Syndrome:

"...confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, uncoordination..." Drugs.com - Interactions between your drugs - ondansetron mirtazapine​

The "Tanya's Guide..." site has a good overview of both drugs including the potential for either drug alone or their combination to cause Serotonin Syndrome: Ondansetron Side Effects and Interactions and Mirtazapine and Serotonin Syndrome.

Interestingly, the antidote for SS is another drug used in cats as an appetite stimulant, cyproheptadine.( ! ) Two references for you: Treatment of the serotonin syndrome with cyproheptadine and Serotonin Syndrome (perhaps best for the Vet tomorrow, though, they melt my brain!)

The "Tanya's Guide..." should give you some reassurance too:

"Try not to worry too much. All the cats I have heard about with serotonin syndrome were back to normal within a few days. (A retrospective study) found that resolution of clinical signs ranged from 12-48 h." So any problems should be resolved within 12 hours to a maximum of two days."​

Hope that helps.
.

 

[IndyJones]

I know its kind of sneeky but I would almost be inclined to put a nanny cam up. I just don't know what to suggest at this point. Its not impossable for something like a stroke to come on so quickly like that but still... it seems sketchy.

Saddle thrombus can also cause the back end issues.

 

[RussellsMom]

Thank you, white shadow, it helps A LOT. I've sent an email list of questions, including about serotonin syndrome, to the vet and will ask in person if I can. My brother blew up at me so badly tonight (I woke him to suggest we go to the ER - he wouldn't go) that I'm not sure he'll take me with him to the ultrasound appointment, so I thought I'd email the questions ahead of time.

Indy Jones, I also thought of stroke, but I don't know. His legs aren't cold. And he also has head tremors - it seems more neurological to me-? But yes, I have fantasized about a nanny cam!

 

[IndyJones]

Stroke is neuological, bloodflow is cut off causing neurons to be damaged or die. It can produce different symptoms depending on the area of the brain affected. And it cons on fairly quickly. The cat can be fine one second and acting strange the next. Tremmors is just one of the signs of a stroke.

Vascular Accidents (Strokes) in the Brains of Dogs and Cats

I also looked over that previous post reguarding drug interactions and that certainly also sounds plausible. Drug interactions can have some really drastic effects.

 

[RussellsMom]

Thanks - I didn't know! I will ask the vet today.

 

[iPappy]

Thanks - I didn't know! I will ask the vet today.

Thinking of you and Danno today, I hope you get good news

 

[RussellsMom]

Danno had an ultrasound and x-ray today. They showed that his kidneys have gotten smaller (they were enlarged before) and some masses have shrunk, but others have appeared where they weren't before. The vet kept saying "he isn't in remission" and "he isn't in remission as fast as we'd like" - would that be evident after only two rounds of chemo? But she also thought - though it was not an actual diagnosis - that the lymphoma had spread to his central nervous system and that's why he has such severe weakness and trembling now. She didn't think any of the questions I had emailed were worth looking into and she was very pessimistic about his prognosis.

I asked three main questions: what would be involved in getting a definitive diagnosis (neurologist does imaging and spinal tap - my brother said no); what chemo drug could we try next; and what could we do for palliative care. She said L-spar sometimes does help lymphoma with CNS involvement. She didn't downplay its potential effectiveness, but it was not the direction she was trying to talk us into going. For palliative care, she said we were already doing what we could do with the pred and anti-nausea.

My brother was heading in the direction of the vet (I can't even write the words) but was also relieved when I said if it were my cat I wouldn't be able to bear it if I hadn't tried a relatively simple last treatment. So we tried the L-spar today and are going to wait through the weekend to see how Danno does. The vet was very respectful of this decision and didn't show any reluctance to try it.

I've been reluctant to write this, because I don't want to hear others' experiences with L-spar, unless they're good. I didn't know that much about it, but a fast decision had to be made - I couldn't do my usual research and asking around. I can't bear the thought that I might have hurt him in some way, and I have to hope that this decision was OK. It was either that or... And he's still responsive to cuddles and eats a little, which to my mind are signs of a cat who is not ready to go.

So please, friends, send Danno your best healing thoughts. Thanks

 

[iPappy]

Danno had an ultrasound and x-ray today. They showed that his kidneys have gotten smaller (they were enlarged before) and some masses have shrunk, but others have appeared where they weren't before. The vet kept saying "he isn't in remission" and "he isn't in remission as fast as we'd like" - would that be evident after only two rounds of chemo? But she also thought - though it was not an actual diagnosis - that the lymphoma had spread to his central nervous system and that's why he has such severe weakness and trembling now. She didn't think any of the questions I had emailed were worth looking into and she was very pessimistic about his prognosis.

I asked three main questions: what would be involved in getting a definitive diagnosis (neurologist does imaging and spinal tap - my brother said no); what chemo drug could we try next; and what could we do for palliative care. She said L-spar sometimes does help lymphoma with CNS involvement. She didn't downplay its potential effectiveness, but it was not the direction she was trying to talk us into going. For palliative care, she said we were already doing what we could do with the pred and anti-nausea.

My brother was heading in the direction of the vet (I can't even write the words) but was also relieved when I said if it were my cat I wouldn't be able to bear it if I hadn't tried a relatively simple last treatment. So we tried the L-spar today and are going to wait through the weekend to see how Danno does. The vet was very respectful of this decision and didn't show any reluctance to try it.

I've been reluctant to write this, because I don't want to hear others' experiences with L-spar, unless they're good. I didn't know that much about it, but a fast decision had to be made - I couldn't do my usual research and asking around. I can't bear the thought that I might have hurt him in some way, and I have to hope that this decision was OK. It was either that or... And he's still responsive to cuddles and eats a little, which to my mind are signs of a cat who is not ready to go.

So please, friends, send Danno your best healing thoughts. Thanks

I certainly will be thinking of you and Danno. What an upsetting find today, but I do hope the L-spar helps. I have never heard of it before, so I can't offer any hopeful stories but if the vet thinks it could offer some potential help and Danno is still responding to you, cuddles, and food, I agree. It's worth a try. I really, really, really hope he has a positive response and improves this weekend. You've done so much for this little guy.

 

[fionasmom]

You are doing as much as you possibly can and you are making all of the right decisions for him. I hope that this will possibly be some help.

 

[RussellsMom]

I feel so terrible. I just got the ultrasound/x-ray report from yesterday and the doctor noted on the "Problems" list: "CKD vs. renal lymphoma". Because I once had a cat with CKD who had exactly the same sudden onset of hind leg weakness/collapse and head tremors, I asked in my list of questions yesterday that, because his kidney values keep going up, should we not look into CKD as a possible cause of the neuro symptoms. The doctor (not our original oncologist, who we liked, but whose schedule we keep not coinciding with) didn't address that idea but persistently insisted that it was lymphoma.

I pressed my brother to make the "last ditch" choice for L-spar (Elspar) because he and she were ready then and there to euthanize him. I have been with many cats at the end of their lives and, despite his significant physical difficulties at the moment, I think he wants to live. Today he is struggling very much. He can't move, he won't eat or drink, won't even lick his lips when I put a drop of water on them. He's breathing extremely fast. His eyes and ears are responsive (slow blinks when I blink and say sweet things to him). Now I'm thinking, if he has CKD, we should not have given him more chemo but should absolutely have begun healing his kidneys first. All the ultrasound findings were good. I feel like I may have massively poisoned him with chemo.

 

[RussellsMom]

Maybe we should have just brought him home yesterday to think about things instead of challenging him with more toxins.

 

[RussellsMom]

Now I just got the full ultrasound report. To my mind, everything looks fantastic on it, much better than his first ultrasound. What the hell is going on? Please take a look and share any thoughts:

 

[iPappy]

This is very mind boggling. It's been a few hours since you posted the update, how is he doing now?
You absolutely did not "poison" him. There is no way for you to glance at him and immediately know what is going on with him. (But don't we wish that were the case?) It's all so confusing for you and I really hope he has perked up since your last update.