First Entry: June 23, 2011
When I first saw Colette’s photo on Pet Finder in mid-October 2008, her pictures showed a pretty girl with a lot of character and
a medium-length coat who was clearly too skinny for her large frame. She was billed by Bideawee as a sweet chatterbox that
had been abandoned at Manhattan (New York City) Animal Care and Control, city shelter, for “no apparent reason”. They said
she would be a ‘good match for an experienced cat owner’.
At the time, I already had two eleven year-old Applehead Siamese females, half-sisters: Marrakech, an un-spayed Chocolate
Point, and Samsara, a spayed Seal Point. Both girls had asthma. From time to time I will be referring to them as “the girls”.
At first request to meet her, Bideawee told me that she had been quarantined and was undergoing treatment for an upper
respiratory tract infection (most likely rhinotracheitis). Several weeks later, I met a very sweet, albeit, slightly soggy girl. They had
just finished giving her a bath and she would not let herself be dried properly. I filled out her adoption papers and asked
Bideawee to keep her over the weekend while she finished out a course of metronidazole they were giving her. Nevertheless, on
adoption day, she was sent home with a course of medicine, along with Enysil-F (L-lysine gel for treating feline rhinotracheitis
virus, herpes FHV-1) and Pet Tinic to treat what was still a borderline case of anemia. The day I adopted her, the adoption
coordinator remarked “thank God, the diarrhea stopped”.
The diarrhea was back with a vengeance over the weekend. It smelled foul and looked like pudding with mucus in the mix. I also
began to notice what looked like blood. Even so, she was constantly hungry. On Friday, October 31, I stopped her meds
(including the Enysil-F and Pet Tinic) and switched her over to a boiled chicken and rice diet. (I thought at the time that the
diarrhea was being caused by the meds.) I called my vet, Dr. Laurence Volel, and scheduled her first visit. Dr. Volel has treated
all my animals over the past 20 or so years.
First vet visit – November 3, 2008: Colette weighed in at 7.5 pounds, quite underweight for her large frame. Dr. Volel checked
her eye and found conjunctivitis. She also ran blood, fecal digestive, and giardia tests. She sent me home with tobramycin
ointment, a course of metronidazole (60 mg, .6 ml once daily), and Tylan (35 mg twice daily). I called the next day to report that
Colette was doing much better, she still had loose stool during the evening (November 3), but it was more solid by the time of my
phone call. She was also quite active. Colette’s giardia (parasites) test result came back negative. Her fecal digestive results
were another story. They showed undigested fats, fibers, starches and muscle.
Four days later, Colette was doing a bit better. Dr. Volel switched her over to Hills Prescription ”w/d” (gastrointestinal, low fat, low
calorie) formula wet food. We added “w/d” dry kibble and Dr. Volel prescribed chlorphenirame 4 mg, ½ tablet twice daily and
Tresaderm 15 ml, in order to address itchiness Colette was experiencing. Dr. Volel repeated the fecal digestive test. She noted
that Colette was acting well. We would begin to try to add regular food after she finished out the w/d prescription food she had.
We finished out 2008 with Colette repeatedly having diarrhea with blood in her stool for the remainder of the year. Late
November, Dr. Volel prescribed a course of #30 Tylan, twice daily and 0.6 ml metronidazole, once daily for 10 days. She noted
that if they didn’t help she wanted to do X-rays and a biopsy. During the period of November 2008 through March 2009, Dr. Volel
administered Profender treatment for parasites, first for Colette only, and then, later for the girls, Marrakech and Samsara, in
order to make sure that parasites were not being passed between them. The girls had no apparent symptoms that would
suggest parasitic activity. It was about this time, at Dr. Volel’s suggestion, I started to add acidophilus or Prozyme enzyme
supplements to the wet food I was feeding all three cats. I noticed a substantial improvement in the number of time the girls bring
up food and now routinely add enzymes to their wet food once a day.
Late December 2008, add vomiting with bile to the picture, along with diminished hunger. Dr. Volel scheduled Colette for a
repeat of FeLV/FIV tests, new X-rays, and a biopsy. FeBart bartonella Results were +1 not infected; (FeLeuk FeLV IFA , FIV
ELISA).
Biopsy results: Moderate to prominent lymphocytic colitia/proctitis consistent with lymphocytic enteritis also involving the colon
and/or an Inflammatory Bowel Disease although inflammation associated with nonspecific bacterial overgrowth or dietary
incompatibilities must also be considered. Neoplastic changes were not found. However, some long standing cases may
undergo malignant transformation into small cell lymphocytic lymphosarcoma warranting appropriate periodic re-evaluation.
January 2009: Along the way, I had also noticed a considerable amount of itchiness. It was about this time that Dr. Volel and I
started suspecting food and environmental allergies. We began switching Colette over to Prescription Diet z/d – Allergy
Formula. I was to call in a week if the change in food didn’t help. Around the first week of January, I questioned Dr. Volel about
running allergy tests on Colette. She was reluctant to do them, didn’t have all that much confidence in them. She explained that
oftentimes the tests return false negatives and positives for various allergens. We dropped the issue pending the outcome of the
change in food.
Eleven days later, the blood in the stool was gone but the stool was as bad as it had ever been. It was a loose mucus mess, best
described as ‘pudding poops’. Two weeks after the introduction of the Prescription Diet, z/d formula, Colette’s diarrhea
deteriorated further; her bowel movements were now liquid. We discontinued the Prescription Diet, z/d, and put her back on the
w/d food. Dr. Volel also put her on prednisolone, 1cc twice daily for 7 days, then 0.75 cc for 7 days.
February 9: Colette was back on prednisolone. This time, presumably, on 1.5cc once every 48 hours, tapering to 1cc every 48
hours and then down to 0.75 cc every 48 hours. The stool began improving but Colette started coughing and sneezing violently.
An amusing caveat, I think, is when I first saw the symptoms, I rightly assumed that they were caused by the prednisolone,
panicked and stopped administering the medicine. As it was a Saturday evening into Sunday, outside of the vet’s office hours, I
needed to wait till Monday to let the vet know.
I phoned Monday and was Dr. Volel ever not happy with me for stopping the prednisolone so suddenly. It was then I learned
about the associated dangers of doing that: adrenal insufficiency or even death. I also first became aware at that point that
Colette also had feline rhinotracheitis Virus (FHV-1.) The 1.5 ml prednisolone dosage prescribed was too high for her—it
suppressed her immune system to the point it allowed her rhinotracheitis virus to surface. Dr. Volel reduced the dosage to 1 ml
and Colette’s rhinotracheitis subsided, as did her diarrhea and the blood in her stool.
Even so, Colette continued having problems with itchy skin, in particular, just above her eye and at the inside opening to the ear
(just at the point where fur growth stops and the skin is exposed). She was so itchy she was traumatizing her skin, and
intermittently had small, self-inflicted lesions.
At the end of January, Dr. Volel agreed do the allergy tests. But first Colette needed to be weaned off the prednisolone, so we
waited out February through mid-March. Her bowel movements were still way too soft, and since she was now off the
prednisolone the blood came back.
February 2009 – Through March 2009: Good news is welcome any way you can get it. Colette’s March 14 medical record
shows that she gained weight. She now weighed 9 pounds, 3 ounces compared with the 7 pounds, 5 ounces at which I adopted
her. Her new blood work also showed she was no longer anemic. During her March 14 vet visit I mentioned that Colette had the
largest bowel movements I had ever seen in a cat. Dr. Volel talked about the possibility of doing tests on her pancreas, but
settled on doing the blood work for her allergy test and sending me home with Profender worming treatment (mentioned above)
for all three cats. (Just in case they were passing parasites around.)
March 23, 2009: The allergy tests, Allercept Test Food and Environmental Panels, were performed by HESKA Veterinary
Diagnostic Laboratories vet support@heska.com, 1-800-464-3752. The test results came back positive for roughly 45 allergens,
most of which are environmental. However, almost none of them (except possibly blue grass and flea saliva) are elevated
enough to be considered medically significant. A score of 150 or above is possibly significant and only may cause problems. I
misunderstood this information. When I began shopping for foods in order to transition her from Prescription w/d to limited
ingredient food, I based my shopping against her food allergen list of brewer’s yeast (score of 37), rabbit, barley, whey, lamb and
beef. The shopping was no small task. I was shocked to learn that pill pockets and almost every dry food product and treat on the
market is made with brewer’s yeast. I finally found one dry food that doesn’t have it: California Natural Chicken Brown Rice
Formula. I also bought several cans of Dick Van
Patten’s Natural Balance Chicken/Liver Pate, Turkey/Giblets, and Salmon formulas, planning to introduce them over time. At the
time, Colette was still itchy and Dr. Volel also put her on 2 mg (over-the-counter) chlorpheniramine, twice a day, to combat her
itchiness.
April – June 2009
This is probably as good a time as any to bring up Colette’s irritability and food preference issues. Since I adopted Colette,
administering medicines orally, brushing her coat, and keeping her anus and rear end clean has been a challenge. She has quite
a temper and will quickly try to scratch or bite. (Thankfully, when you give her a bath, she’s so focused on escape she forgets
about teeth and claws.) She prefers kibble to wet food and will generally take hours to finish the wet food I feed at night. In fact,
not only are my options extremely limited, but she’s a picky eater to boot. Two issues here; one, crushing a pill into food when
feasible (not bitter). You can’t administer medicine in a food that a cat won’t eat. Two, amount of time it takes to consume the
food. This wouldn’t be an issue, per se, but living in a multiple-cat, special-needs kitty household makes this a challenge. My
other two cats didn’t have dietary restrictions, but both were on asthma medication, pills administered twice daily.
I put out kibble that all three cats feed freely from throughout the day, but, in the evenings, I feed wet food. I crush the asthma pill
into Marrakech and Samasara’s wet food in order to avoid putting them through the stress of a second pilling. There was also no
reason to limit the girls’ diet more than necessary. (They were already consuming the same kibble Colette was getting.) I had to
separate them for evening feeding. I feed the girls in the bedroom behind closed doors. How many hours can you keep the girls
locked away? It wasn’t fair.
Most of 2009 was spent trying to phase in the new food. Dr. Volel’s March 9 record refers to blood in her stool when she was off
prednisolone, but her bowel movements were stabilizing — they were still soft and smelly, but they were forming. She was off the
w/d canned food and eating Dick van Patten Natural Balance Chicken/Liver and Turkey /Giblet formulas. She seemed to be
tolerating them well enough, but each time I tried to increase the proportion of California Natural kibble to Prescription w/d kibble
her bowel movements became more loose.
April stands out as the month I started having a really hard time with pickiness and irritability issues. In theory, Colette was on
chlorpheniramine 4 mg allergy medication, one half pill, twice daily. She wouldn’t eat her wet food with the pill in it and I found out
why when I needed to take the medicine for my own allergies: the pill is bitter. She became violent when I tried to pill her so I
administered the chlorpheniramine when I could. Not optimal, but what else could I do? Wrapping her in a towel helped and she
began to calm down. It was also in April of 2009 that she began lingering over her wet food for hours, or rejecting it outright. The
itching and the irritability continued and I found out she couldn’t tolerate fish. I was dealing with a lot of other issues at the time
and perhaps didn’t pay close enough attention to her bowel movements, that they still weren’t what they should have been. I
remember all too well that, until Christmas 2009, I was having terrible integration problems between the girls and Colette. They
were barely tolerating each other.
February 2010: Colette was doing fairly well. Her integration issues were beginning to resolve themselves. In fact, she had
bonded with Samsara. She wasn’t as cranky and she was quite active. Then something changed. I phoned the vet at the end of
the first week of May. Colette had been very itchy since the beginning of spring and had been pulling her fur out. She now had
liquid diarrhea with mucus and a lot of gas. Dr. Volel prescribed a 50% mixture of overcooked rice in her food. If it didn’t help she
would put her on a course of metronidazole. May 24th, another phone call to the vet. Her stool was very loose. I complained about
her soiling herself to the extent she needed to be bathed almost every other day. We put her on a 7–day course of metronidazole
15mL, 0.75ml once daily for 7 days. She responded but a short time later the diarrhea was back.
June 21, 2010: It was time for the vet to check her over. She was soiling herself, pulling her fur out, self-inflicting lesions and
losing weight. She lost over two pounds since March 2009 and weighed just 5 ounces more than when I adopted her. During her
physical exam, Dr. Volel found an enlarged thyroid and a slight heart murmur (a condition that is often found to be concurrent with
hyperthyroidism). Colette’s blood tests confirmed she had hyperthyroidism. At 5 years, 9 months, Colette was the youngest cat
Dr. Volel had ever seen with this condition. Her T3 and T4 results were way too high (T3 of 272 against 40-150 reference range,
and T4 of 15.7 ug/dL against reference range 0.8 – 4.0 ug/dL). She also had very high ALP and ALT scores (ALP of 132
against reference range 10-90, and ALT of 174 against reference range 20-100). Her BUN reading of 30 was at the very top of
the acceptable range. Doctor Volel explains that the ALP and ALT scores will usually elevate with thyroid disease.
Dr. Volel presented me with the options of controlling her condition via medicine or having iodine radiation treatment performed.
She felt that even though the cost of the iodine radiation treatment is high ($2,500), in the long-term it would be more cost-
effective because of Colette’s age. Rather than medicating the condition, radioiodine treatment is supposed to cure it. I agreed.
July 15, 2010: I admitted Colette to New York City Veterinary Specialists for her radioiodine treatment. Everything went as
planned. While she was there she was eating well and letting the vet tech brush her. (The vet tech said she loved getting brushed.
I’m still not sure I want to believe this.) Standard New York City procedure is that the pet is held in quarantine for five days or until
enough radioactive material is expelled from the system to bring it down to legally acceptable levels. At the end of 5 days, New
York City Vet Specialists sent me home with Colette, latex gloves and litter pan liners, a set of handling instructions, and a card
to show the police in case we were stopped. Stopped? Since the 9/11 disaster New York City police are equipped with Geiger
Counters. Legal radiation levels for the release of a pet are high enough to set off a Geiger counter!
July 31, 2010: In the days following Colette’s release from the hospital her body started to go through a readjustment process. A
note in her medical record says I noted she was very itchy. She was giving me a hard time about eating her wet food (Natural
Balance) and I began trying to figure out how to get her to eat. She was still eating a mixture of w/d, (low fat, low calorie) and
California Natural kibble (2/3rds to 1/3rd in proportion, respectively), so I was concerned about her getting the calories she
needed to put on the weight she needed to gain. Her bowel movements started looking better and Dr. Volel and I discussed her
diet again. I re-opened the question about tuna fish. Colette lives for tuna fish. Could it be possible the hyperthyroidism had
been causing the problems? We decided to give it a try. I mixed some into her food and, predictably, she ate very well.
Early August and Colette’s bowel movements started to form into ropes — 5-inch ropes that is. But for the first time since I
adopted her she was beginning to have what approached something that looked like a normal bowel movement. I fed human-
grade canned tuna fish mixed into her wet food. By mid-August we had the answer — she cannot tolerate tuna fish. Dr. Volel’s
August 23rd medical record entry classifies the bleeding as hematochezia. Without the tuna fish, she was giving me a hard time
with wet food and I began to experiment with holistic appetite stimulants and raw, freeze-dried treats. The only ones that didn’t
cause trouble at the time are WholeLife freeze-dried turkey and freeze-dried chicken. The WholeLife treats are very expensive
($7.00 for a one-ounce bag) and hard to find. I tried other brands and they caused diarrhea. They all had one extra ingredient in
common: cranberries.
August 23, 2010: One month, post radioiodine treatment, follow-up visit. Her stool was too soft again (probably due to tuna
fish). The blood tests were now within a normal range: ALT 71, ALP 63, BUN 25, T4 2.1. Urinalysis via cysto collection method,
however, showed blood: 3+ (High) against a negative reference range, and RBC 4-10 (High) against a 0-3 reference range.
During this visit, I presented Dr. Volel with a copy of "Pets at Risk: From Allergies to Cancer, Remedies for an Unsuspected
Epidemic" - by Alfred J. Plechner, DVM, and asked her to review it with an eye for trying Dr. Plechner’s experimental endocrine
replacement treatment procedure on Colette. Dr. Volel promised she would review the book, but she warned me that there is no
such thing as a magic bullet in terms of a cure. (She started reviewing it and last I questioned her, she still wanted to do further
research.)
August 2010 through the January 2011 saw me trying to introduce Evo 95% Venison formula as Colette’s bowel movements
still weren’t where they should have been and she was still giving me an awfully hard time with the wet food. I was supposed to try
to phase it in over a six week period, but it quickly became clear that this wasn’t going to work. On re-checking the ingredient list,
I found trace amounts of fish oil. Since Colette was gaining weight Dr. Volel suggested not forcing the issue with the wet food:
offer it and what she eats, she eats.
February 2011: Off and on since mid-May 2010 I was preoccupied with Marrakech, my Chocolate point Siamese. Her asthma
had become acute and I had to hospitalize her in mid-May and again in August for associated respiratory collapses. Aside from
the thousands of dollars I spent on her hospitalizations, she had been placed on two respiratory inhalers and was racking up over
$300 a month in medicine since June. She was repeatedly having bronchial infections during that time. (I had to have her
euthanized in mid-March due to a rapidly deteriorating bronchial infection complicated by her asthma.)
Colette again had loose bowel movements along with blood and she was soiling herself. Dr. Volel and I discussed doing GI
testing which I recognize is necessary, but after Marrakech’s two hospitalizations, expensive medications and Colette’s
radioiodine treatment, my budget is more than a bit strapped. To top this off, I have been living off my savings—I lost my job in
May 2008 and have been unemployed for these past three years. I had no prior pet insurance, and the insurance companies do
not cover pre-existing conditions. Dr. Volel put Colette on 1.5 ml prednisolone twice a day for 7 days with instructions to begin to
taper off afterwards. We both forgot about her reaction to that high a dosage back in January 2009.
Even though it was more formed on the prednisolone I found bloody stool on the bathroom floor. Colette didn’t make it to the litter
box? Or did she carry it back out on her coat? She was also becoming cranky. (When Colette gets cranky she lashes out
unexpectedly to mock bite or scratch me, and to scratch the girls if they’re in the wrong place at the wrong time.) Dr. Volel put her
back on prednisolone, administered twice daily. Her appetite markedly improved.
The stool was less bloody, but now it was becoming very loose. Dr. Volel prescribed 30 mg Tylan twice daily. There’s a notation
in her chart about an exam and rectal biopsy if the Tylan didn’t help. Colette began sneezing like crazy. Her rhinotracheatis
kicked in because of the higher dosage of prednisolone. The Tylan was helping and she was forming ropes, but they were now
extremely dark in color, almost black and tarry. I assumed the color was a side-effect of the medicine. When I called the vet to
report that the Tylan was helping, I also reported the sneezing and wanted to know when I could adjust/begin tapering off the
prednisolone. Dr. Volel immediately dropped her pred to 1 ml twice daily. I remarked about the dark color of the stool as a “side-
effect” of the Tylan: something along the lines of “gee, that Tylan makes the stool really black!” Dr. Volel became very concerned.
It wasn’t the Tylan at all. Black, tarry stool is due to blood in the stool and is an indication of a host of different conditions,
gastroduodenal ulcers among them. This kind of stool may indicate ulcers in the stomach and/or first section of the small
intestine, according to petMD.com. We scheduled an appointment for Colette for the next day and the vet asked me to bring in
fecal samples.
March 2011: I had already cleaned the litter box before I spoke to Dr. Volel the day before so I couldn’t bring in the very dark
sample. The next day I saw that the color had improved somewhat already. Dr. Volel noted in her record that the bowel
movement was better; no diarrhea, but dark spots on the stool. She also noted that Colette sneezed twice during her visit. This
was pretty much a routine exam. Colette was weighed-- 11 pounds. Yay! I picked up more Tylan and Dr. Volel sent fecal matter
to Antech Labs for a GI Panel. I was given directions to administer the prednisolone twice a day for the next 3 days and then
administer once every other day for a week. Dr. Volel made a note to repeat the GI Panel if the stool was still soft post-Tylan. She
also added a note was added about doing a rectal biopsy.
GI Panel test results: Giardia Antigen (ELISA) – Negative; Cryptosporidium (IFA) – Negative; Ova and Parasites with
Cetrifugation – None Seen. In the days following I began religiously collecting Colette’s stool samples and individually bagging
them, and labeling them with dates and times. I believe around that time I was bringing the collected samples in to Dr. Volel’s
office around once every week or so. From Colette’s chart March 5: “BM soft, spots of blood.” Dr Volel increased Colette’s Tylan
to 3 times a day (once every 8 hours). “Owner to call if worse, then administer metronidazole.”
Dr. Volel took Colette off all limited-ingredient commercially available food and put her exclusively on Prescription Diet w/d
formula, both dry and canned foods. The prednisolone was decreased from twice daily to once daily. Colette’s stools started
improving and her rhinotracheitis started to subside. By this time the Rhinotracheitis had done its damage in the household.
March 8th I brought the girls, Samsara and Marrakech, in for an exam. Samsara was sneezing and clearly had conjunctivitis.
Marrakech had an unrelated cyst I needed to have checked. Samsara was sent home with antibiotics. Marrakech needed
nothing further—that is, until the next evening when she, too, started sneezing and coughing. I ran fresh stool samples in to Dr.
Volel the following day and picked up antibiotics for Marrakech. Not too long before this, I finished a round of medicine for
Marrakech for a bronchial infection. This new infection, complicated by severe asthma, was just too much for her body. After
repeated trips to ER and consultations with Dr. Volel and her ER doctors, I made the decision to euthanize on March 16th.
Much of the next month and a half is a blur. But before I continue, I should mention that over the two years that Colette has been
with me, she has, until just recently, been a playful, active kitty. I’m just starting to notice that she’s slowed down over the last
month or so. She has also started to give me a hard time with the w/d wet food which she loved when I first brought it home. (It
could be the prednisolone or the warmer weather.) I was still administering Tylan and prednisolone, and Colette started getting
more difficult with her brushing routine. I was getting scratched for trying to comb mats out of her fur. April and May were spent
trying to regulate the amount of Tylan Colette has been getting. Colette’s bowel movement just before April 5 deteriorated to the
point of diarrhea with blood in it and she was put on Tylan 30 mg, 3 times a day and given a 7-day course of metronidazole to
which she responded well. I was running in fecal samples collected on a daily basis about once a week to once every week and
a half. Dr. Volel cut back the Tylan to twice a day, then once a day from May 4th through May 7th. After May 7th she was to get
one capsule every other day. That never happened because the stool became loose again on the once-a-day dosage. Around
May 7, I found blood on her rear end and a small pool of blood (about the size of a quarter) completely divorced from the stool.
As of May 7th, Dr. Volel and I have been trying to hold off doing her rectal and intestinal biopsies because of the cost involved.
Colette needs to be off prednisolone for a number of months before the biopsy can be performed. She has already proven that
when she’s off prednisolone her bleeding returns with a vengeance. Dr. Volel and I also discussed using Entocort, a
corticosteroid in place of the prednisolone. (Long-term use of prednisolone can result in liver damage.) Entocort, (at
$300/month), would also need to be weaned before a GI biopsy can be performed.
June 2011: I brought my camera with the stool sample pictures and a checklist of things I wanted checked and needed to
discuss for her vet visit. Colette has been slowing down and hasn’t been interested in playing lately. That, in combination with the
hard time she’s been giving me when I try to groom her, the increased blood on her stool and the pouch I found below her belly
had me worried again. Colette immediately tensed up on the exam table so it was more difficult for Dr. Volel to feel what was
going on. Her ‘diagnosis’ first off is that Colette is overweight! She now weighs 11.4 pounds, increased by .4 lbs. since March
3rd of this year. Oops! Colette and I did too good a job putting some weight on her. I brought my camera with the snaps of the
bloody stool to the vet. Wow, what a difference from bringing just the stool samples. Any blood on the stool turns dark in the
refrigerator and the vet really can’t see clearly what’s going on. Dr. Volel, for the first time, saw the extent of what I’ve only talked
about before. She called the blood “significant”. Dr. Volel increased her prednisolone to 1 ml, twice daily, for the next seven days.
She is still getting 30 mg Tylan twice a day.
Her heart murmur is still there, it has been showing up all along. The frequent matting in Colette’s coat and the fact that she hasn’t
been letting me take care of it were another issue that Dr.Volel noted in her chart. Colette has been difficult in the past, but never
this difficult. Dr. Volel decided to go through with the shave without sedation. She warned me that, because of the heart murmur,
she would stop at the point the Colette became too stressed. She didn’t want to create a medical crisis for her. The vet tech
brought her back a bit wet and told me they really couldn’t get a good job done. She had urinated. (They actually got more done
than I expected.) Dr. Volel also took a new blood sample. I haven’t seen the results yet. As I mentioned earlier, I was concerned
about Colette’s slowing down in the past several months. The doctor thinks I should keep an eye on it, but she’s not terribly
concerned for two reasons: 1. Her age - she’s now 6 years, 9 months old, approaching middle age. 2. She’s been gaining
weight and not retaining water, so there’s nothing new going on.
I’ve cut back on the kibble, let’s see how long this lasts. Samsara, my Siamese, spends most of her day sleeping while, I’ve
noticed in the past few days, Colette spends most of her day scarfing down kibble. The bowls were empty by mid-afternoon and
by evening both girls were driving me crazy. One plus is I’m getting somewhere grooming Colette since I made this change. An
empty bowl and the promise of kibble make it easier to get her to cooperate with being groomed. I have almost all of the mats
out of her coat. I phoned Dr. Volel for my 7-day follow up call regarding how Colette is doing in terms of blood on the stool. It
wasn’t perfect, but it was definitely less and was dark brown rather than red. I was given the direction to administer a second
dose of prednisolone (1 ml) for 3 to 4 days after each time I see the blood. I’ve noticed how hungry Colette is because of this
second dose of prednisolone. I’m finding that if I don’t take the kibble bowl off the floor for periods of time, she will run through
what’s intended to last the day in the space of an hour. I now need to make sure Samsara gets her kibble in the bedroom behind
closed doors.
Keeping Colette from gaining any more weight is not going to be easy. She's eating like a horse if I let her. I’m trying to space out
the kibble throughout the day. The blood on the stool is diminished but not gone. In the meantime, the two daily (l ml) doses of
prednisolone have set off her rhinotracheitis. The symptoms (sneezing and nasal discharge) are mild but they are frequent. On
the other hand, she let me take care of a couple of the more difficult knots in her coat. Dr. Volel reduced Colette’s prednisolone
to 1 ml daily, administered in doses of 0.5 ml every 12 hours. Dr. Volel identified the eating issue as a combination of the side-
effects of the prednisolone and the ‘w/d’ (low calorie) diet.
June 24: The rhinotracheitis is gone. The blood on the stool is greatly diminished and the stool in general is lighter with fewer
dark patches. Colette is still eating like a horse. I also noticed her energy level is improving.
Update: January 30, 2012
June 28 – August 19: We had a rough summer with regard to Colette’s bowel movements. Looking back, some of this may
have been brought on by the heat of the summer months. Colette’s stool see-sawed between well formed movements and those
that were less formed and had a lot of mucus. The amount of blood in her stool also varied quite a bit. She had a couple of really
bad bowel movements with blood coating the entire length of the stool. Dr. Volel adjusted Colette’s Tylan dosage (30 mg) and
prednisolone accordingly, administering Tylan once every eight hours or once every twelve hours. The prednisolone dosage was
based on the condition of the stool and on rhinotracheitis flare-ups, with an eye to tapering its use.
Below, I condensed the information from my summer ‘diary’ entries, leaving the last three intact as they reflect Colette’s condition
at the end of the summer.
Prednisolone Dosage: This schedule was excerpted from very detailed records I kept in July and August. It reflects an attempt to
scale back the prednisolone. I did not keep a record of the two-to three-week periods during which Colette was on 30mg Tylan
once every 8 hours.
June 28-July 5: 0.5ml, twice daily until July 5th and then begin administering 0.5ml, once a day
July 12: 0.5ml once daily for 7 days and then reduce to 0.5ml once every other day.
July 19: 0.5ml prednisolone once a day, administered every other day.
August 9: Setback: stool with a lot of blood. 0.5ml twice daily for 2 days; decrease to 0.5ml once daily (if
improvement). If no improvement, then increase to 1ml twice daily.
August 11: Decreased to 0.5ml once daily.
August 19: Setback: increased to 0.5ml twice daily. Began administering 1 tsp. Viralys (L-lysine gel), via
liquid syringe. (Colette refuses to lap the gel.)
Discussed, but no action taken:
• Doing GI Panel. Held off because of the cost involved.
• Putting Colette on the generic form of Entocort—budesonide. On hold because of the cost.
• Transitioning wet food to Royal Canin canned “z/d” gastrointestinal formula. (Became unnecessary when Colette accepted Hills
Prescription w/d canned again.)
Coat quality: In mid-July the weather got really hot and Colette was pulling at her fur and consistently pulling out fairly large clumps
of it. It wasn’t as bad as July a year ago (when she was treated for hyperthyroidism), but I was finding fur all over the house and I
noticed a balding patch near her shoulder. She also had a self-inflicted a scratch over her eye (she did this often in the period
before she was diagnosed with hyperthyroidism). Dr. Volel thought it was allergy-related and that pulling at the fur alleviates
some of the itchiness. I didn’t see her scratching. Her coat was also matting frequently. With regard to the bald patch, Dr. Volel
explained that prednisolone can make the coat brittle and impede its growth. She cautioned me not groom with the Furminator.
In early August, I showed Dr. Volel a photo of the bald patch: the guard furs hadn’t yet grown in and the downy undercoat had
darkened. Dr. Volel told me that when the undercoat of a seal-point is exposed to the air for a lengthy period of time, the fur will
tend to grow in dark. After August 9th, when our summer heat wave had broken, she seemed to be pulling out less fur and her
coat was matting less badly.
Appetite/eating issues: A side effect of the prednisolone was that Colette was eating like a horse. If I didn’t divide up the kibble
into ½ day portions and take away the food within 5 minutes of setting it down, it would be consumed. August 3 saw Colette’s
eating slowing down since the prednisolone had been scaled back. She was now intermittently rejecting the prescription diet
canned w/d. By August 19th she had rejected the canned food completely. She began eating the wet food again in early
September.
Energy Level: She was lethargic for a good portion of the summer. On August 9th, I noted that the heat wave had broken and
Colette’s energy level improved. She was racing around at least once or twice a day and had regained her interest in sitting on
the window sill.
End of Summer Diary Entries:
August 31: Despite the lysine (Viralys), Colette has been sneezing since August 28. Called the doctor’s office this morning
asking whether or not to bring the prednisolone back down to 0.5ml once a day. I was given the directive to administer 0.5ml
twice daily every other day, and 0.5ml once daily on intermittent days. We increased her Tylan (30 mg) to three times a day.
September 6: Colette’s stool is better—still a bit soft, but on the whole a lot less bloody; my fault, I’ve missed giving the third
Tylan a few times. Even so, she appears to be staying the course. I stopped feeding the wet food (Hills Prescription w/d)
towards the end of August. This evening, for the first time, she sat down next to her kibble (Hills Prescription w/d)—and—refused
to eat it! I put down a bowl of wet food. She took her time, but she ate it.
September 6 – 8: Colette has been eating about 1/8th to 1/4th of a can of her w/d every evening. Since September 6th, I’ve
been waiting for her to reject the kibble—no way. She’s still eating ravenously. I’m finding that if I don’t catch it in time to retrieve it
out from under her, she’ll eat about 1/2 of the day’s portion at one go, and then vomit up about half of it directly afterwards. (I put
that half
day’s worth in front of her so the bowl doesn’t look so empty.) Colette has stopped sneezing. The alternate day prednisolone
dosage and the Viralys seem to have done the trick.
Fall – Winter 2011 through January 2012
I stopped keeping such a detailed record in early September. Colette’s bowel movements had settled into a pattern of being
formed and dark, or dark patched and striped. Sometimes there was blood concentrated at the ends of the stool. We adjusted
Colette’s Tylan and prednisolone depending on where she was at a given time. She went through a few 2- or 3-week periods of
30 mg Tylan every 8 hours. As the bowel movements got better we brought the Tylan down to twice daily. The rhinotracheitis
resurfaced several times during this period too. Dr. Volel addressed this by reducing her prednisolone further (to 0.5 ml once
daily, and 0.25 ml once daily) and continuing with the Viralys (L-lysine) gel, one teaspoon daily. This has definitely helped. And,
while things weren’t perfect, the last bath Colette got for soiling herself was on October 24th.
I also worked out a system whereby I’m putting less kibble per feeding in the bowl and feeding intermittently during the day. I can’t
imagine what I was thinking, pulling food out from under her. I certainly feel less guilty now. I find that the new system also
guarantees that she willingly comes to kitchen for her meds. She knows that she gets fed directly after she takes them. Her coat
looks great; the bald patch has grown in and she’s not matting as badly or as often either. Towards mid-October I felt Colette had
been slowing down again. I also started noticing what, at first, seemed to be a lump on her belly between her hind legs. At first I
wrote it off as matted fur that needed to be taken care of. Then I started to be not so sure about that. (She still gives me a hard
time with the grooming.) On one of my bi-monthly visits (dropping off stool samples and bringing photos) I told Dr. Volel about it.
Late November 2011
Dr. Volel told me to bring her in as soon as possible if I saw it wasn’t matted fur. By November 28th, I was sure it wasn’t matted
fur. Colette had a distended nipple with about a 1/8th inch mass behind it. I brought her in on November 29th. Dr. Volel told me
she wanted to do surgery as soon as possible. We set up an appointment for December 5th for an echocardiogram, blood work
and x-rays. (We needed to scale back the prednisolone to 0.25 ml twice daily prior to surgery (down from 0.5 ml once a day and
0.25 ml once a day), so her Tylan was increased to three times daily. Colette began sneezing. (It never occurred to me that
shouldn’t have been happening on the lower prednisolone dosage.)
December 5-12, 2011: Onset renal failure, onset asthma
Good to go for surgery, but the tests found other things going on: a slight bacterial infection in the lungs, onset asthma, and
elevated CRE levels indicating onset chronic renal failure. How disheartening! Colette’s bacterial infection was treated the with a
10-day course of amoxicillin drops. The sneezing stopped. Ideally, surgery should have been done in early December, but Dr.
Volel was waiting for a blood pressure monitor cuff she ordered in November. By the week of December 12th, the part was
delivered but due to my schedule we put off the surgery until the following week. I wouldn’t have been around enough to keep an
eye on Colette.
December 20, 2011
Surgery went well. Dr. Volel excised the mass with a “clean margin”—she was able to get the entire mass. She sent Colette
home with (what I understand to be) a routine, post-trauma course of amoxicillin Drops and pain killer. The mass, which had
grown from 1/8th inch to ½ inch since the time Dr. Volel first saw it, was sent to the lab for a biopsy. Colette did very well after the
surgery. She was off pain killer in two days and kept her ravenous appetite throughout the healing period. Her bowel movements
were very loose at first, but that was to be expected. Notable is that they were lighter in color and there was almost no blood in
them. An amusing caveat: it was me who wasn’t doing so well while I waited almost five days for her to urinate. Until just recently,
she always urinated down the bathtub drain (without even leaving a ring around the drain). I didn’t see her doing that and there
were no clumps in her litter either. Dr. Volel wasn’t too concerned, but we were coming up on Christmas weekend and I was
jittery. She finally urinated at 2 AM on December 25th! I would have taken her to the ER that day.
December 28, 2011: Mammary gland tumor (MGT) with lymphatic invasion
Post-surgery follow-up and biopsy results. Colette was healing well when I brought her in for her follow-up. Now on to the bad
news: the biopsy results came in; she has breast cancer. According to IDEXX Laboratories (www.vetconnect.com, 1-888-433-
9987):
"This small multilobulated mass from the left side of the ventral abdomen consists of a malignant neoplasm derived from the
epithelial cells of the gland i.e. an adenocarcinoma...." The lab results say that “there are areas where the tumor cells have
“invaded or occluded lymphatics or venules, a finding that makes metastasis a possibility in this case.”
Their Microscopic Interpretation is: “Mass from the left side of the ventral abdomen: Adenocarcinoma of mammary gland with
areas of lymphatic and/or vascular invasion.” The report goes on to say that “feline mammary adenocarcinomas are generally
aggressive malignancies that are invasive and frequently metastasize to regional lymph nodes and distant sites. These tumors
frequently recur when incompletely excised.” They also say that Siamese cats tend to have a higher incidence of
adenocarcinomas compared to other breeds…” Even though Dr. Volel removed the mass cleanly, this is an aggressive form of
cancer and because of lymphatic and venule activity, it’s highly probable that cancer cells have traveled outside the mass. If I
heard her correctly (and you can imagine by this time I wasn’t hearing everything clearly), Dr. Volel said that if the cancer has
spread, untreated, Colette has between three months and a year left to live. She strongly recommended chemotherapy. I
scheduled an oncology consultation at BluePearl, New York City Veterinary Specialists (http://newyork.bluepearlvet.com) for the
following day. Colette was assigned to oncologist, Dr. Joshua Lachowicz, DVM, DACVIM.
December 29, 2011: Oncology Consultation
Untreated, our oncologist, Dr. Lachowicz, places the chance for a new tumor showing up at greater than 50% and estimates that
Colette would have 6 months left to live. With chemotherapy, he extends her life-span to between one and two years. The time
could be further out than that, but, since I adopted her, there’s a huge question mark with regard to how long it was (how many
estrus cycles) between her first heat and the time she was spayed. That plays a big role. I adopted her when she was four years
old. I have no idea if she was a breeding queen before, or if not, how long she went between her first estrus cycle and the time
she was spayed. Dr. Lachowicz is taking that question mark into account in his prognosis.
This is probably as good a place to add this information as any. According to our discharge ‘instructions’: “Feline mammary
gland tumors (MGT) are the 3rd most common tumor in cats. It has been shown that spaying animals when they are young can
decrease the formation of MGT’s in both cats and dogs. Up to 85-90% of feline MGT are malignant. Malignant mammary tumors
in cats tend to metastasize rapidly.”
Ideally, Dr. Lachowicz would recommend a radical resection, putting Colette under general anesthesia to remove (as I
understand it) all of the mammary ducts. More likely than not, this won’t be done. Colette has a heart murmur and was only put
under local anesthesia for a “simple” lumpectomy because of the risk that general anesthesia presents for her. He didn’t rule out,
though, the possibility of additional surgery for her at a future date. He recommended six carboplatin chemotherapy treatments.
Each treatment would be administered once every three weeks, with complete blood count (CBC) tests done once a week in the
two weeks following each treatment. The CBCs are to determine if changes need to be made to the chemo dosage or regimen.
(Chemotherapy treatment can compromise the immune system.) When I questioned Dr. Lachowicz with regard to whether or not
the cancer was related to Colette’s IBD, he told me it was not related.
Colette is (relatively speaking) in good shape and has no apparent discomfort. Throughout, she has maintained her weight at
slightly over 11 lbs. Her bowel movements are at the moment, better than they have been in the 3 years since I adopted her. Now
what to do? The cost of treatment is prohibitively expensive. The estimates I was given range from $564.75 to $598.00 per
course (add about $100 x 6 to this amount, as only one CBC is included in the estimate), provided Colette needs no further
surgery or hospitalization. On the high end of the estimate (without any further surgery or complications), this would be
approximately $700 x 6 treatments, or $4,200.
I’m still not working.
Against my better judgment (financial considerations), I decided to go ahead with the chemotherapy. BluePearl supports Frankie’
s Friends (www.frankiesfriends.com), a non-profit foundation dedicated to saving pets with cancer and other diseases. Dr.
Lachowicz suggested I contact them with regard to getting financial help. Frankie’s Friends looks at your income with regard to
awarding support. (A participating veterinarian needs to make the referral, endorsing the patient as a good candidate for
treatment.) I contacted them and began treatment without waiting for a reply. A week later I had the answer: Colette was awarded
a maximum amount of $6,000 towards her treatment. I am expected to contribute a $75-copay per visit (chemo or CBC), they do
not reimburse for treatment administered before an award is granted, and the funding is limited to cancer treatment only.
Nevertheless, the award is extremely generous and I’m extremely grateful.
January 3, 2012: First chemo treatment
Her first treatment went well. Post treatment, I was advised to watch her for vomiting and changes in appetite. Dr. Lachowicz told
me I could give her ¼ tablet of Tagament if she was nauseous; we also talked about giving her Cerenia if she needs it. The day
after the treatment, I found a large puddle of vomit on the floor shortly after I fed the girls. I assumed it was Colette and gave her a
dose of Tagament. In retrospect, my other cat, Samsara, was having a couple of bad days and vomiting first thing in the
morning—it wasn’t Colette at all.
January 22, 2012
Her old energy is returning and her coat looks good. Directly after her surgery, Colette’s stool was very loose and had a lot of
mucus. Dr. Volel put Colette back on three Tylan capsules a day while leaving her on 0.25ml prednisolone twice daily, the
dosage she had been on prior to her surgery. Just after Christmas, the stool began forming again. It was lighter in color and had
little or no blood. I called Dr. Volel to let her know I dropped the Tylan to twice daily. To date (January 22) her stool is unusually
good. Colette’s week one and two CBCs were good. She’s slowed down on eating her wet food (an old story-she would have to
be losing interest in it just at the moment that you’re watching her for loss of appetite!) but she makes up for it in the amount of
kibble she consumes. She is scheduled for her second chemotherapy treatment on January 24th.
January 24, 2012: Oncology
Colette went home without having received her treatment. Dr. Lachowicz did another CBC today and found her WBC level had
dropped. He did not want the chemo to compromise her immune system. Apparently this is a pattern in cats that he had been
expecting to establish. Colette’s pattern is low WBC in week three after chemo treatment. He moved her to a schedule whereby
she gets chemo once every four weeks and has her CBCs done during week three and four. (The original schedule would have
been chemo treatment once every three weeks with CBCs being done during weeks two and three. Her new chemo date is
January 31.
When I first saw Colette’s photo on Pet Finder in mid-October 2008, her pictures showed a pretty girl with a lot of character and
a medium-length coat who was clearly too skinny for her large frame. She was billed by Bideawee as a sweet chatterbox that
had been abandoned at Manhattan (New York City) Animal Care and Control, city shelter, for “no apparent reason”. They said
she would be a ‘good match for an experienced cat owner’.
At the time, I already had two eleven year-old Applehead Siamese females, half-sisters: Marrakech, an un-spayed Chocolate
Point, and Samsara, a spayed Seal Point. Both girls had asthma. From time to time I will be referring to them as “the girls”.
At first request to meet her, Bideawee told me that she had been quarantined and was undergoing treatment for an upper
respiratory tract infection (most likely rhinotracheitis). Several weeks later, I met a very sweet, albeit, slightly soggy girl. They had
just finished giving her a bath and she would not let herself be dried properly. I filled out her adoption papers and asked
Bideawee to keep her over the weekend while she finished out a course of metronidazole they were giving her. Nevertheless, on
adoption day, she was sent home with a course of medicine, along with Enysil-F (L-lysine gel for treating feline rhinotracheitis
virus, herpes FHV-1) and Pet Tinic to treat what was still a borderline case of anemia. The day I adopted her, the adoption
coordinator remarked “thank God, the diarrhea stopped”.
The diarrhea was back with a vengeance over the weekend. It smelled foul and looked like pudding with mucus in the mix. I also
began to notice what looked like blood. Even so, she was constantly hungry. On Friday, October 31, I stopped her meds
(including the Enysil-F and Pet Tinic) and switched her over to a boiled chicken and rice diet. (I thought at the time that the
diarrhea was being caused by the meds.) I called my vet, Dr. Laurence Volel, and scheduled her first visit. Dr. Volel has treated
all my animals over the past 20 or so years.
First vet visit – November 3, 2008: Colette weighed in at 7.5 pounds, quite underweight for her large frame. Dr. Volel checked
her eye and found conjunctivitis. She also ran blood, fecal digestive, and giardia tests. She sent me home with tobramycin
ointment, a course of metronidazole (60 mg, .6 ml once daily), and Tylan (35 mg twice daily). I called the next day to report that
Colette was doing much better, she still had loose stool during the evening (November 3), but it was more solid by the time of my
phone call. She was also quite active. Colette’s giardia (parasites) test result came back negative. Her fecal digestive results
were another story. They showed undigested fats, fibers, starches and muscle.
Four days later, Colette was doing a bit better. Dr. Volel switched her over to Hills Prescription ”w/d” (gastrointestinal, low fat, low
calorie) formula wet food. We added “w/d” dry kibble and Dr. Volel prescribed chlorphenirame 4 mg, ½ tablet twice daily and
Tresaderm 15 ml, in order to address itchiness Colette was experiencing. Dr. Volel repeated the fecal digestive test. She noted
that Colette was acting well. We would begin to try to add regular food after she finished out the w/d prescription food she had.
We finished out 2008 with Colette repeatedly having diarrhea with blood in her stool for the remainder of the year. Late
November, Dr. Volel prescribed a course of #30 Tylan, twice daily and 0.6 ml metronidazole, once daily for 10 days. She noted
that if they didn’t help she wanted to do X-rays and a biopsy. During the period of November 2008 through March 2009, Dr. Volel
administered Profender treatment for parasites, first for Colette only, and then, later for the girls, Marrakech and Samsara, in
order to make sure that parasites were not being passed between them. The girls had no apparent symptoms that would
suggest parasitic activity. It was about this time, at Dr. Volel’s suggestion, I started to add acidophilus or Prozyme enzyme
supplements to the wet food I was feeding all three cats. I noticed a substantial improvement in the number of time the girls bring
up food and now routinely add enzymes to their wet food once a day.
Late December 2008, add vomiting with bile to the picture, along with diminished hunger. Dr. Volel scheduled Colette for a
repeat of FeLV/FIV tests, new X-rays, and a biopsy. FeBart bartonella Results were +1 not infected; (FeLeuk FeLV IFA , FIV
ELISA).
Biopsy results: Moderate to prominent lymphocytic colitia/proctitis consistent with lymphocytic enteritis also involving the colon
and/or an Inflammatory Bowel Disease although inflammation associated with nonspecific bacterial overgrowth or dietary
incompatibilities must also be considered. Neoplastic changes were not found. However, some long standing cases may
undergo malignant transformation into small cell lymphocytic lymphosarcoma warranting appropriate periodic re-evaluation.
January 2009: Along the way, I had also noticed a considerable amount of itchiness. It was about this time that Dr. Volel and I
started suspecting food and environmental allergies. We began switching Colette over to Prescription Diet z/d – Allergy
Formula. I was to call in a week if the change in food didn’t help. Around the first week of January, I questioned Dr. Volel about
running allergy tests on Colette. She was reluctant to do them, didn’t have all that much confidence in them. She explained that
oftentimes the tests return false negatives and positives for various allergens. We dropped the issue pending the outcome of the
change in food.
Eleven days later, the blood in the stool was gone but the stool was as bad as it had ever been. It was a loose mucus mess, best
described as ‘pudding poops’. Two weeks after the introduction of the Prescription Diet, z/d formula, Colette’s diarrhea
deteriorated further; her bowel movements were now liquid. We discontinued the Prescription Diet, z/d, and put her back on the
w/d food. Dr. Volel also put her on prednisolone, 1cc twice daily for 7 days, then 0.75 cc for 7 days.
February 9: Colette was back on prednisolone. This time, presumably, on 1.5cc once every 48 hours, tapering to 1cc every 48
hours and then down to 0.75 cc every 48 hours. The stool began improving but Colette started coughing and sneezing violently.
An amusing caveat, I think, is when I first saw the symptoms, I rightly assumed that they were caused by the prednisolone,
panicked and stopped administering the medicine. As it was a Saturday evening into Sunday, outside of the vet’s office hours, I
needed to wait till Monday to let the vet know.
I phoned Monday and was Dr. Volel ever not happy with me for stopping the prednisolone so suddenly. It was then I learned
about the associated dangers of doing that: adrenal insufficiency or even death. I also first became aware at that point that
Colette also had feline rhinotracheitis Virus (FHV-1.) The 1.5 ml prednisolone dosage prescribed was too high for her—it
suppressed her immune system to the point it allowed her rhinotracheitis virus to surface. Dr. Volel reduced the dosage to 1 ml
and Colette’s rhinotracheitis subsided, as did her diarrhea and the blood in her stool.
Even so, Colette continued having problems with itchy skin, in particular, just above her eye and at the inside opening to the ear
(just at the point where fur growth stops and the skin is exposed). She was so itchy she was traumatizing her skin, and
intermittently had small, self-inflicted lesions.
At the end of January, Dr. Volel agreed do the allergy tests. But first Colette needed to be weaned off the prednisolone, so we
waited out February through mid-March. Her bowel movements were still way too soft, and since she was now off the
prednisolone the blood came back.
February 2009 – Through March 2009: Good news is welcome any way you can get it. Colette’s March 14 medical record
shows that she gained weight. She now weighed 9 pounds, 3 ounces compared with the 7 pounds, 5 ounces at which I adopted
her. Her new blood work also showed she was no longer anemic. During her March 14 vet visit I mentioned that Colette had the
largest bowel movements I had ever seen in a cat. Dr. Volel talked about the possibility of doing tests on her pancreas, but
settled on doing the blood work for her allergy test and sending me home with Profender worming treatment (mentioned above)
for all three cats. (Just in case they were passing parasites around.)
March 23, 2009: The allergy tests, Allercept Test Food and Environmental Panels, were performed by HESKA Veterinary
Diagnostic Laboratories vet support@heska.com, 1-800-464-3752. The test results came back positive for roughly 45 allergens,
most of which are environmental. However, almost none of them (except possibly blue grass and flea saliva) are elevated
enough to be considered medically significant. A score of 150 or above is possibly significant and only may cause problems. I
misunderstood this information. When I began shopping for foods in order to transition her from Prescription w/d to limited
ingredient food, I based my shopping against her food allergen list of brewer’s yeast (score of 37), rabbit, barley, whey, lamb and
beef. The shopping was no small task. I was shocked to learn that pill pockets and almost every dry food product and treat on the
market is made with brewer’s yeast. I finally found one dry food that doesn’t have it: California Natural Chicken Brown Rice
Formula. I also bought several cans of Dick Van
Patten’s Natural Balance Chicken/Liver Pate, Turkey/Giblets, and Salmon formulas, planning to introduce them over time. At the
time, Colette was still itchy and Dr. Volel also put her on 2 mg (over-the-counter) chlorpheniramine, twice a day, to combat her
itchiness.
April – June 2009
This is probably as good a time as any to bring up Colette’s irritability and food preference issues. Since I adopted Colette,
administering medicines orally, brushing her coat, and keeping her anus and rear end clean has been a challenge. She has quite
a temper and will quickly try to scratch or bite. (Thankfully, when you give her a bath, she’s so focused on escape she forgets
about teeth and claws.) She prefers kibble to wet food and will generally take hours to finish the wet food I feed at night. In fact,
not only are my options extremely limited, but she’s a picky eater to boot. Two issues here; one, crushing a pill into food when
feasible (not bitter). You can’t administer medicine in a food that a cat won’t eat. Two, amount of time it takes to consume the
food. This wouldn’t be an issue, per se, but living in a multiple-cat, special-needs kitty household makes this a challenge. My
other two cats didn’t have dietary restrictions, but both were on asthma medication, pills administered twice daily.
I put out kibble that all three cats feed freely from throughout the day, but, in the evenings, I feed wet food. I crush the asthma pill
into Marrakech and Samasara’s wet food in order to avoid putting them through the stress of a second pilling. There was also no
reason to limit the girls’ diet more than necessary. (They were already consuming the same kibble Colette was getting.) I had to
separate them for evening feeding. I feed the girls in the bedroom behind closed doors. How many hours can you keep the girls
locked away? It wasn’t fair.
Most of 2009 was spent trying to phase in the new food. Dr. Volel’s March 9 record refers to blood in her stool when she was off
prednisolone, but her bowel movements were stabilizing — they were still soft and smelly, but they were forming. She was off the
w/d canned food and eating Dick van Patten Natural Balance Chicken/Liver and Turkey /Giblet formulas. She seemed to be
tolerating them well enough, but each time I tried to increase the proportion of California Natural kibble to Prescription w/d kibble
her bowel movements became more loose.
April stands out as the month I started having a really hard time with pickiness and irritability issues. In theory, Colette was on
chlorpheniramine 4 mg allergy medication, one half pill, twice daily. She wouldn’t eat her wet food with the pill in it and I found out
why when I needed to take the medicine for my own allergies: the pill is bitter. She became violent when I tried to pill her so I
administered the chlorpheniramine when I could. Not optimal, but what else could I do? Wrapping her in a towel helped and she
began to calm down. It was also in April of 2009 that she began lingering over her wet food for hours, or rejecting it outright. The
itching and the irritability continued and I found out she couldn’t tolerate fish. I was dealing with a lot of other issues at the time
and perhaps didn’t pay close enough attention to her bowel movements, that they still weren’t what they should have been. I
remember all too well that, until Christmas 2009, I was having terrible integration problems between the girls and Colette. They
were barely tolerating each other.
February 2010: Colette was doing fairly well. Her integration issues were beginning to resolve themselves. In fact, she had
bonded with Samsara. She wasn’t as cranky and she was quite active. Then something changed. I phoned the vet at the end of
the first week of May. Colette had been very itchy since the beginning of spring and had been pulling her fur out. She now had
liquid diarrhea with mucus and a lot of gas. Dr. Volel prescribed a 50% mixture of overcooked rice in her food. If it didn’t help she
would put her on a course of metronidazole. May 24th, another phone call to the vet. Her stool was very loose. I complained about
her soiling herself to the extent she needed to be bathed almost every other day. We put her on a 7–day course of metronidazole
15mL, 0.75ml once daily for 7 days. She responded but a short time later the diarrhea was back.
June 21, 2010: It was time for the vet to check her over. She was soiling herself, pulling her fur out, self-inflicting lesions and
losing weight. She lost over two pounds since March 2009 and weighed just 5 ounces more than when I adopted her. During her
physical exam, Dr. Volel found an enlarged thyroid and a slight heart murmur (a condition that is often found to be concurrent with
hyperthyroidism). Colette’s blood tests confirmed she had hyperthyroidism. At 5 years, 9 months, Colette was the youngest cat
Dr. Volel had ever seen with this condition. Her T3 and T4 results were way too high (T3 of 272 against 40-150 reference range,
and T4 of 15.7 ug/dL against reference range 0.8 – 4.0 ug/dL). She also had very high ALP and ALT scores (ALP of 132
against reference range 10-90, and ALT of 174 against reference range 20-100). Her BUN reading of 30 was at the very top of
the acceptable range. Doctor Volel explains that the ALP and ALT scores will usually elevate with thyroid disease.
Dr. Volel presented me with the options of controlling her condition via medicine or having iodine radiation treatment performed.
She felt that even though the cost of the iodine radiation treatment is high ($2,500), in the long-term it would be more cost-
effective because of Colette’s age. Rather than medicating the condition, radioiodine treatment is supposed to cure it. I agreed.
July 15, 2010: I admitted Colette to New York City Veterinary Specialists for her radioiodine treatment. Everything went as
planned. While she was there she was eating well and letting the vet tech brush her. (The vet tech said she loved getting brushed.
I’m still not sure I want to believe this.) Standard New York City procedure is that the pet is held in quarantine for five days or until
enough radioactive material is expelled from the system to bring it down to legally acceptable levels. At the end of 5 days, New
York City Vet Specialists sent me home with Colette, latex gloves and litter pan liners, a set of handling instructions, and a card
to show the police in case we were stopped. Stopped? Since the 9/11 disaster New York City police are equipped with Geiger
Counters. Legal radiation levels for the release of a pet are high enough to set off a Geiger counter!
July 31, 2010: In the days following Colette’s release from the hospital her body started to go through a readjustment process. A
note in her medical record says I noted she was very itchy. She was giving me a hard time about eating her wet food (Natural
Balance) and I began trying to figure out how to get her to eat. She was still eating a mixture of w/d, (low fat, low calorie) and
California Natural kibble (2/3rds to 1/3rd in proportion, respectively), so I was concerned about her getting the calories she
needed to put on the weight she needed to gain. Her bowel movements started looking better and Dr. Volel and I discussed her
diet again. I re-opened the question about tuna fish. Colette lives for tuna fish. Could it be possible the hyperthyroidism had
been causing the problems? We decided to give it a try. I mixed some into her food and, predictably, she ate very well.
Early August and Colette’s bowel movements started to form into ropes — 5-inch ropes that is. But for the first time since I
adopted her she was beginning to have what approached something that looked like a normal bowel movement. I fed human-
grade canned tuna fish mixed into her wet food. By mid-August we had the answer — she cannot tolerate tuna fish. Dr. Volel’s
August 23rd medical record entry classifies the bleeding as hematochezia. Without the tuna fish, she was giving me a hard time
with wet food and I began to experiment with holistic appetite stimulants and raw, freeze-dried treats. The only ones that didn’t
cause trouble at the time are WholeLife freeze-dried turkey and freeze-dried chicken. The WholeLife treats are very expensive
($7.00 for a one-ounce bag) and hard to find. I tried other brands and they caused diarrhea. They all had one extra ingredient in
common: cranberries.
August 23, 2010: One month, post radioiodine treatment, follow-up visit. Her stool was too soft again (probably due to tuna
fish). The blood tests were now within a normal range: ALT 71, ALP 63, BUN 25, T4 2.1. Urinalysis via cysto collection method,
however, showed blood: 3+ (High) against a negative reference range, and RBC 4-10 (High) against a 0-3 reference range.
During this visit, I presented Dr. Volel with a copy of "Pets at Risk: From Allergies to Cancer, Remedies for an Unsuspected
Epidemic" - by Alfred J. Plechner, DVM, and asked her to review it with an eye for trying Dr. Plechner’s experimental endocrine
replacement treatment procedure on Colette. Dr. Volel promised she would review the book, but she warned me that there is no
such thing as a magic bullet in terms of a cure. (She started reviewing it and last I questioned her, she still wanted to do further
research.)
August 2010 through the January 2011 saw me trying to introduce Evo 95% Venison formula as Colette’s bowel movements
still weren’t where they should have been and she was still giving me an awfully hard time with the wet food. I was supposed to try
to phase it in over a six week period, but it quickly became clear that this wasn’t going to work. On re-checking the ingredient list,
I found trace amounts of fish oil. Since Colette was gaining weight Dr. Volel suggested not forcing the issue with the wet food:
offer it and what she eats, she eats.
February 2011: Off and on since mid-May 2010 I was preoccupied with Marrakech, my Chocolate point Siamese. Her asthma
had become acute and I had to hospitalize her in mid-May and again in August for associated respiratory collapses. Aside from
the thousands of dollars I spent on her hospitalizations, she had been placed on two respiratory inhalers and was racking up over
$300 a month in medicine since June. She was repeatedly having bronchial infections during that time. (I had to have her
euthanized in mid-March due to a rapidly deteriorating bronchial infection complicated by her asthma.)
Colette again had loose bowel movements along with blood and she was soiling herself. Dr. Volel and I discussed doing GI
testing which I recognize is necessary, but after Marrakech’s two hospitalizations, expensive medications and Colette’s
radioiodine treatment, my budget is more than a bit strapped. To top this off, I have been living off my savings—I lost my job in
May 2008 and have been unemployed for these past three years. I had no prior pet insurance, and the insurance companies do
not cover pre-existing conditions. Dr. Volel put Colette on 1.5 ml prednisolone twice a day for 7 days with instructions to begin to
taper off afterwards. We both forgot about her reaction to that high a dosage back in January 2009.
Even though it was more formed on the prednisolone I found bloody stool on the bathroom floor. Colette didn’t make it to the litter
box? Or did she carry it back out on her coat? She was also becoming cranky. (When Colette gets cranky she lashes out
unexpectedly to mock bite or scratch me, and to scratch the girls if they’re in the wrong place at the wrong time.) Dr. Volel put her
back on prednisolone, administered twice daily. Her appetite markedly improved.
The stool was less bloody, but now it was becoming very loose. Dr. Volel prescribed 30 mg Tylan twice daily. There’s a notation
in her chart about an exam and rectal biopsy if the Tylan didn’t help. Colette began sneezing like crazy. Her rhinotracheatis
kicked in because of the higher dosage of prednisolone. The Tylan was helping and she was forming ropes, but they were now
extremely dark in color, almost black and tarry. I assumed the color was a side-effect of the medicine. When I called the vet to
report that the Tylan was helping, I also reported the sneezing and wanted to know when I could adjust/begin tapering off the
prednisolone. Dr. Volel immediately dropped her pred to 1 ml twice daily. I remarked about the dark color of the stool as a “side-
effect” of the Tylan: something along the lines of “gee, that Tylan makes the stool really black!” Dr. Volel became very concerned.
It wasn’t the Tylan at all. Black, tarry stool is due to blood in the stool and is an indication of a host of different conditions,
gastroduodenal ulcers among them. This kind of stool may indicate ulcers in the stomach and/or first section of the small
intestine, according to petMD.com. We scheduled an appointment for Colette for the next day and the vet asked me to bring in
fecal samples.
March 2011: I had already cleaned the litter box before I spoke to Dr. Volel the day before so I couldn’t bring in the very dark
sample. The next day I saw that the color had improved somewhat already. Dr. Volel noted in her record that the bowel
movement was better; no diarrhea, but dark spots on the stool. She also noted that Colette sneezed twice during her visit. This
was pretty much a routine exam. Colette was weighed-- 11 pounds. Yay! I picked up more Tylan and Dr. Volel sent fecal matter
to Antech Labs for a GI Panel. I was given directions to administer the prednisolone twice a day for the next 3 days and then
administer once every other day for a week. Dr. Volel made a note to repeat the GI Panel if the stool was still soft post-Tylan. She
also added a note was added about doing a rectal biopsy.
GI Panel test results: Giardia Antigen (ELISA) – Negative; Cryptosporidium (IFA) – Negative; Ova and Parasites with
Cetrifugation – None Seen. In the days following I began religiously collecting Colette’s stool samples and individually bagging
them, and labeling them with dates and times. I believe around that time I was bringing the collected samples in to Dr. Volel’s
office around once every week or so. From Colette’s chart March 5: “BM soft, spots of blood.” Dr Volel increased Colette’s Tylan
to 3 times a day (once every 8 hours). “Owner to call if worse, then administer metronidazole.”
Dr. Volel took Colette off all limited-ingredient commercially available food and put her exclusively on Prescription Diet w/d
formula, both dry and canned foods. The prednisolone was decreased from twice daily to once daily. Colette’s stools started
improving and her rhinotracheitis started to subside. By this time the Rhinotracheitis had done its damage in the household.
March 8th I brought the girls, Samsara and Marrakech, in for an exam. Samsara was sneezing and clearly had conjunctivitis.
Marrakech had an unrelated cyst I needed to have checked. Samsara was sent home with antibiotics. Marrakech needed
nothing further—that is, until the next evening when she, too, started sneezing and coughing. I ran fresh stool samples in to Dr.
Volel the following day and picked up antibiotics for Marrakech. Not too long before this, I finished a round of medicine for
Marrakech for a bronchial infection. This new infection, complicated by severe asthma, was just too much for her body. After
repeated trips to ER and consultations with Dr. Volel and her ER doctors, I made the decision to euthanize on March 16th.
Much of the next month and a half is a blur. But before I continue, I should mention that over the two years that Colette has been
with me, she has, until just recently, been a playful, active kitty. I’m just starting to notice that she’s slowed down over the last
month or so. She has also started to give me a hard time with the w/d wet food which she loved when I first brought it home. (It
could be the prednisolone or the warmer weather.) I was still administering Tylan and prednisolone, and Colette started getting
more difficult with her brushing routine. I was getting scratched for trying to comb mats out of her fur. April and May were spent
trying to regulate the amount of Tylan Colette has been getting. Colette’s bowel movement just before April 5 deteriorated to the
point of diarrhea with blood in it and she was put on Tylan 30 mg, 3 times a day and given a 7-day course of metronidazole to
which she responded well. I was running in fecal samples collected on a daily basis about once a week to once every week and
a half. Dr. Volel cut back the Tylan to twice a day, then once a day from May 4th through May 7th. After May 7th she was to get
one capsule every other day. That never happened because the stool became loose again on the once-a-day dosage. Around
May 7, I found blood on her rear end and a small pool of blood (about the size of a quarter) completely divorced from the stool.
As of May 7th, Dr. Volel and I have been trying to hold off doing her rectal and intestinal biopsies because of the cost involved.
Colette needs to be off prednisolone for a number of months before the biopsy can be performed. She has already proven that
when she’s off prednisolone her bleeding returns with a vengeance. Dr. Volel and I also discussed using Entocort, a
corticosteroid in place of the prednisolone. (Long-term use of prednisolone can result in liver damage.) Entocort, (at
$300/month), would also need to be weaned before a GI biopsy can be performed.
June 2011: I brought my camera with the stool sample pictures and a checklist of things I wanted checked and needed to
discuss for her vet visit. Colette has been slowing down and hasn’t been interested in playing lately. That, in combination with the
hard time she’s been giving me when I try to groom her, the increased blood on her stool and the pouch I found below her belly
had me worried again. Colette immediately tensed up on the exam table so it was more difficult for Dr. Volel to feel what was
going on. Her ‘diagnosis’ first off is that Colette is overweight! She now weighs 11.4 pounds, increased by .4 lbs. since March
3rd of this year. Oops! Colette and I did too good a job putting some weight on her. I brought my camera with the snaps of the
bloody stool to the vet. Wow, what a difference from bringing just the stool samples. Any blood on the stool turns dark in the
refrigerator and the vet really can’t see clearly what’s going on. Dr. Volel, for the first time, saw the extent of what I’ve only talked
about before. She called the blood “significant”. Dr. Volel increased her prednisolone to 1 ml, twice daily, for the next seven days.
She is still getting 30 mg Tylan twice a day.
Her heart murmur is still there, it has been showing up all along. The frequent matting in Colette’s coat and the fact that she hasn’t
been letting me take care of it were another issue that Dr.Volel noted in her chart. Colette has been difficult in the past, but never
this difficult. Dr. Volel decided to go through with the shave without sedation. She warned me that, because of the heart murmur,
she would stop at the point the Colette became too stressed. She didn’t want to create a medical crisis for her. The vet tech
brought her back a bit wet and told me they really couldn’t get a good job done. She had urinated. (They actually got more done
than I expected.) Dr. Volel also took a new blood sample. I haven’t seen the results yet. As I mentioned earlier, I was concerned
about Colette’s slowing down in the past several months. The doctor thinks I should keep an eye on it, but she’s not terribly
concerned for two reasons: 1. Her age - she’s now 6 years, 9 months old, approaching middle age. 2. She’s been gaining
weight and not retaining water, so there’s nothing new going on.
I’ve cut back on the kibble, let’s see how long this lasts. Samsara, my Siamese, spends most of her day sleeping while, I’ve
noticed in the past few days, Colette spends most of her day scarfing down kibble. The bowls were empty by mid-afternoon and
by evening both girls were driving me crazy. One plus is I’m getting somewhere grooming Colette since I made this change. An
empty bowl and the promise of kibble make it easier to get her to cooperate with being groomed. I have almost all of the mats
out of her coat. I phoned Dr. Volel for my 7-day follow up call regarding how Colette is doing in terms of blood on the stool. It
wasn’t perfect, but it was definitely less and was dark brown rather than red. I was given the direction to administer a second
dose of prednisolone (1 ml) for 3 to 4 days after each time I see the blood. I’ve noticed how hungry Colette is because of this
second dose of prednisolone. I’m finding that if I don’t take the kibble bowl off the floor for periods of time, she will run through
what’s intended to last the day in the space of an hour. I now need to make sure Samsara gets her kibble in the bedroom behind
closed doors.
Keeping Colette from gaining any more weight is not going to be easy. She's eating like a horse if I let her. I’m trying to space out
the kibble throughout the day. The blood on the stool is diminished but not gone. In the meantime, the two daily (l ml) doses of
prednisolone have set off her rhinotracheitis. The symptoms (sneezing and nasal discharge) are mild but they are frequent. On
the other hand, she let me take care of a couple of the more difficult knots in her coat. Dr. Volel reduced Colette’s prednisolone
to 1 ml daily, administered in doses of 0.5 ml every 12 hours. Dr. Volel identified the eating issue as a combination of the side-
effects of the prednisolone and the ‘w/d’ (low calorie) diet.
June 24: The rhinotracheitis is gone. The blood on the stool is greatly diminished and the stool in general is lighter with fewer
dark patches. Colette is still eating like a horse. I also noticed her energy level is improving.
Update: January 30, 2012
June 28 – August 19: We had a rough summer with regard to Colette’s bowel movements. Looking back, some of this may
have been brought on by the heat of the summer months. Colette’s stool see-sawed between well formed movements and those
that were less formed and had a lot of mucus. The amount of blood in her stool also varied quite a bit. She had a couple of really
bad bowel movements with blood coating the entire length of the stool. Dr. Volel adjusted Colette’s Tylan dosage (30 mg) and
prednisolone accordingly, administering Tylan once every eight hours or once every twelve hours. The prednisolone dosage was
based on the condition of the stool and on rhinotracheitis flare-ups, with an eye to tapering its use.
Below, I condensed the information from my summer ‘diary’ entries, leaving the last three intact as they reflect Colette’s condition
at the end of the summer.
Prednisolone Dosage: This schedule was excerpted from very detailed records I kept in July and August. It reflects an attempt to
scale back the prednisolone. I did not keep a record of the two-to three-week periods during which Colette was on 30mg Tylan
once every 8 hours.
June 28-July 5: 0.5ml, twice daily until July 5th and then begin administering 0.5ml, once a day
July 12: 0.5ml once daily for 7 days and then reduce to 0.5ml once every other day.
July 19: 0.5ml prednisolone once a day, administered every other day.
August 9: Setback: stool with a lot of blood. 0.5ml twice daily for 2 days; decrease to 0.5ml once daily (if
improvement). If no improvement, then increase to 1ml twice daily.
August 11: Decreased to 0.5ml once daily.
August 19: Setback: increased to 0.5ml twice daily. Began administering 1 tsp. Viralys (L-lysine gel), via
liquid syringe. (Colette refuses to lap the gel.)
Discussed, but no action taken:
• Doing GI Panel. Held off because of the cost involved.
• Putting Colette on the generic form of Entocort—budesonide. On hold because of the cost.
• Transitioning wet food to Royal Canin canned “z/d” gastrointestinal formula. (Became unnecessary when Colette accepted Hills
Prescription w/d canned again.)
Coat quality: In mid-July the weather got really hot and Colette was pulling at her fur and consistently pulling out fairly large clumps
of it. It wasn’t as bad as July a year ago (when she was treated for hyperthyroidism), but I was finding fur all over the house and I
noticed a balding patch near her shoulder. She also had a self-inflicted a scratch over her eye (she did this often in the period
before she was diagnosed with hyperthyroidism). Dr. Volel thought it was allergy-related and that pulling at the fur alleviates
some of the itchiness. I didn’t see her scratching. Her coat was also matting frequently. With regard to the bald patch, Dr. Volel
explained that prednisolone can make the coat brittle and impede its growth. She cautioned me not groom with the Furminator.
In early August, I showed Dr. Volel a photo of the bald patch: the guard furs hadn’t yet grown in and the downy undercoat had
darkened. Dr. Volel told me that when the undercoat of a seal-point is exposed to the air for a lengthy period of time, the fur will
tend to grow in dark. After August 9th, when our summer heat wave had broken, she seemed to be pulling out less fur and her
coat was matting less badly.
Appetite/eating issues: A side effect of the prednisolone was that Colette was eating like a horse. If I didn’t divide up the kibble
into ½ day portions and take away the food within 5 minutes of setting it down, it would be consumed. August 3 saw Colette’s
eating slowing down since the prednisolone had been scaled back. She was now intermittently rejecting the prescription diet
canned w/d. By August 19th she had rejected the canned food completely. She began eating the wet food again in early
September.
Energy Level: She was lethargic for a good portion of the summer. On August 9th, I noted that the heat wave had broken and
Colette’s energy level improved. She was racing around at least once or twice a day and had regained her interest in sitting on
the window sill.
End of Summer Diary Entries:
August 31: Despite the lysine (Viralys), Colette has been sneezing since August 28. Called the doctor’s office this morning
asking whether or not to bring the prednisolone back down to 0.5ml once a day. I was given the directive to administer 0.5ml
twice daily every other day, and 0.5ml once daily on intermittent days. We increased her Tylan (30 mg) to three times a day.
September 6: Colette’s stool is better—still a bit soft, but on the whole a lot less bloody; my fault, I’ve missed giving the third
Tylan a few times. Even so, she appears to be staying the course. I stopped feeding the wet food (Hills Prescription w/d)
towards the end of August. This evening, for the first time, she sat down next to her kibble (Hills Prescription w/d)—and—refused
to eat it! I put down a bowl of wet food. She took her time, but she ate it.
September 6 – 8: Colette has been eating about 1/8th to 1/4th of a can of her w/d every evening. Since September 6th, I’ve
been waiting for her to reject the kibble—no way. She’s still eating ravenously. I’m finding that if I don’t catch it in time to retrieve it
out from under her, she’ll eat about 1/2 of the day’s portion at one go, and then vomit up about half of it directly afterwards. (I put
that half
day’s worth in front of her so the bowl doesn’t look so empty.) Colette has stopped sneezing. The alternate day prednisolone
dosage and the Viralys seem to have done the trick.
Fall – Winter 2011 through January 2012
I stopped keeping such a detailed record in early September. Colette’s bowel movements had settled into a pattern of being
formed and dark, or dark patched and striped. Sometimes there was blood concentrated at the ends of the stool. We adjusted
Colette’s Tylan and prednisolone depending on where she was at a given time. She went through a few 2- or 3-week periods of
30 mg Tylan every 8 hours. As the bowel movements got better we brought the Tylan down to twice daily. The rhinotracheitis
resurfaced several times during this period too. Dr. Volel addressed this by reducing her prednisolone further (to 0.5 ml once
daily, and 0.25 ml once daily) and continuing with the Viralys (L-lysine) gel, one teaspoon daily. This has definitely helped. And,
while things weren’t perfect, the last bath Colette got for soiling herself was on October 24th.
I also worked out a system whereby I’m putting less kibble per feeding in the bowl and feeding intermittently during the day. I can’t
imagine what I was thinking, pulling food out from under her. I certainly feel less guilty now. I find that the new system also
guarantees that she willingly comes to kitchen for her meds. She knows that she gets fed directly after she takes them. Her coat
looks great; the bald patch has grown in and she’s not matting as badly or as often either. Towards mid-October I felt Colette had
been slowing down again. I also started noticing what, at first, seemed to be a lump on her belly between her hind legs. At first I
wrote it off as matted fur that needed to be taken care of. Then I started to be not so sure about that. (She still gives me a hard
time with the grooming.) On one of my bi-monthly visits (dropping off stool samples and bringing photos) I told Dr. Volel about it.
Late November 2011
Dr. Volel told me to bring her in as soon as possible if I saw it wasn’t matted fur. By November 28th, I was sure it wasn’t matted
fur. Colette had a distended nipple with about a 1/8th inch mass behind it. I brought her in on November 29th. Dr. Volel told me
she wanted to do surgery as soon as possible. We set up an appointment for December 5th for an echocardiogram, blood work
and x-rays. (We needed to scale back the prednisolone to 0.25 ml twice daily prior to surgery (down from 0.5 ml once a day and
0.25 ml once a day), so her Tylan was increased to three times daily. Colette began sneezing. (It never occurred to me that
shouldn’t have been happening on the lower prednisolone dosage.)
December 5-12, 2011: Onset renal failure, onset asthma
Good to go for surgery, but the tests found other things going on: a slight bacterial infection in the lungs, onset asthma, and
elevated CRE levels indicating onset chronic renal failure. How disheartening! Colette’s bacterial infection was treated the with a
10-day course of amoxicillin drops. The sneezing stopped. Ideally, surgery should have been done in early December, but Dr.
Volel was waiting for a blood pressure monitor cuff she ordered in November. By the week of December 12th, the part was
delivered but due to my schedule we put off the surgery until the following week. I wouldn’t have been around enough to keep an
eye on Colette.
December 20, 2011
Surgery went well. Dr. Volel excised the mass with a “clean margin”—she was able to get the entire mass. She sent Colette
home with (what I understand to be) a routine, post-trauma course of amoxicillin Drops and pain killer. The mass, which had
grown from 1/8th inch to ½ inch since the time Dr. Volel first saw it, was sent to the lab for a biopsy. Colette did very well after the
surgery. She was off pain killer in two days and kept her ravenous appetite throughout the healing period. Her bowel movements
were very loose at first, but that was to be expected. Notable is that they were lighter in color and there was almost no blood in
them. An amusing caveat: it was me who wasn’t doing so well while I waited almost five days for her to urinate. Until just recently,
she always urinated down the bathtub drain (without even leaving a ring around the drain). I didn’t see her doing that and there
were no clumps in her litter either. Dr. Volel wasn’t too concerned, but we were coming up on Christmas weekend and I was
jittery. She finally urinated at 2 AM on December 25th! I would have taken her to the ER that day.
December 28, 2011: Mammary gland tumor (MGT) with lymphatic invasion
Post-surgery follow-up and biopsy results. Colette was healing well when I brought her in for her follow-up. Now on to the bad
news: the biopsy results came in; she has breast cancer. According to IDEXX Laboratories (www.vetconnect.com, 1-888-433-
9987):
"This small multilobulated mass from the left side of the ventral abdomen consists of a malignant neoplasm derived from the
epithelial cells of the gland i.e. an adenocarcinoma...." The lab results say that “there are areas where the tumor cells have
“invaded or occluded lymphatics or venules, a finding that makes metastasis a possibility in this case.”
Their Microscopic Interpretation is: “Mass from the left side of the ventral abdomen: Adenocarcinoma of mammary gland with
areas of lymphatic and/or vascular invasion.” The report goes on to say that “feline mammary adenocarcinomas are generally
aggressive malignancies that are invasive and frequently metastasize to regional lymph nodes and distant sites. These tumors
frequently recur when incompletely excised.” They also say that Siamese cats tend to have a higher incidence of
adenocarcinomas compared to other breeds…” Even though Dr. Volel removed the mass cleanly, this is an aggressive form of
cancer and because of lymphatic and venule activity, it’s highly probable that cancer cells have traveled outside the mass. If I
heard her correctly (and you can imagine by this time I wasn’t hearing everything clearly), Dr. Volel said that if the cancer has
spread, untreated, Colette has between three months and a year left to live. She strongly recommended chemotherapy. I
scheduled an oncology consultation at BluePearl, New York City Veterinary Specialists (http://newyork.bluepearlvet.com) for the
following day. Colette was assigned to oncologist, Dr. Joshua Lachowicz, DVM, DACVIM.
December 29, 2011: Oncology Consultation
Untreated, our oncologist, Dr. Lachowicz, places the chance for a new tumor showing up at greater than 50% and estimates that
Colette would have 6 months left to live. With chemotherapy, he extends her life-span to between one and two years. The time
could be further out than that, but, since I adopted her, there’s a huge question mark with regard to how long it was (how many
estrus cycles) between her first heat and the time she was spayed. That plays a big role. I adopted her when she was four years
old. I have no idea if she was a breeding queen before, or if not, how long she went between her first estrus cycle and the time
she was spayed. Dr. Lachowicz is taking that question mark into account in his prognosis.
This is probably as good a place to add this information as any. According to our discharge ‘instructions’: “Feline mammary
gland tumors (MGT) are the 3rd most common tumor in cats. It has been shown that spaying animals when they are young can
decrease the formation of MGT’s in both cats and dogs. Up to 85-90% of feline MGT are malignant. Malignant mammary tumors
in cats tend to metastasize rapidly.”
Ideally, Dr. Lachowicz would recommend a radical resection, putting Colette under general anesthesia to remove (as I
understand it) all of the mammary ducts. More likely than not, this won’t be done. Colette has a heart murmur and was only put
under local anesthesia for a “simple” lumpectomy because of the risk that general anesthesia presents for her. He didn’t rule out,
though, the possibility of additional surgery for her at a future date. He recommended six carboplatin chemotherapy treatments.
Each treatment would be administered once every three weeks, with complete blood count (CBC) tests done once a week in the
two weeks following each treatment. The CBCs are to determine if changes need to be made to the chemo dosage or regimen.
(Chemotherapy treatment can compromise the immune system.) When I questioned Dr. Lachowicz with regard to whether or not
the cancer was related to Colette’s IBD, he told me it was not related.
Colette is (relatively speaking) in good shape and has no apparent discomfort. Throughout, she has maintained her weight at
slightly over 11 lbs. Her bowel movements are at the moment, better than they have been in the 3 years since I adopted her. Now
what to do? The cost of treatment is prohibitively expensive. The estimates I was given range from $564.75 to $598.00 per
course (add about $100 x 6 to this amount, as only one CBC is included in the estimate), provided Colette needs no further
surgery or hospitalization. On the high end of the estimate (without any further surgery or complications), this would be
approximately $700 x 6 treatments, or $4,200.
I’m still not working.
Against my better judgment (financial considerations), I decided to go ahead with the chemotherapy. BluePearl supports Frankie’
s Friends (www.frankiesfriends.com), a non-profit foundation dedicated to saving pets with cancer and other diseases. Dr.
Lachowicz suggested I contact them with regard to getting financial help. Frankie’s Friends looks at your income with regard to
awarding support. (A participating veterinarian needs to make the referral, endorsing the patient as a good candidate for
treatment.) I contacted them and began treatment without waiting for a reply. A week later I had the answer: Colette was awarded
a maximum amount of $6,000 towards her treatment. I am expected to contribute a $75-copay per visit (chemo or CBC), they do
not reimburse for treatment administered before an award is granted, and the funding is limited to cancer treatment only.
Nevertheless, the award is extremely generous and I’m extremely grateful.
January 3, 2012: First chemo treatment
Her first treatment went well. Post treatment, I was advised to watch her for vomiting and changes in appetite. Dr. Lachowicz told
me I could give her ¼ tablet of Tagament if she was nauseous; we also talked about giving her Cerenia if she needs it. The day
after the treatment, I found a large puddle of vomit on the floor shortly after I fed the girls. I assumed it was Colette and gave her a
dose of Tagament. In retrospect, my other cat, Samsara, was having a couple of bad days and vomiting first thing in the
morning—it wasn’t Colette at all.
January 22, 2012
Her old energy is returning and her coat looks good. Directly after her surgery, Colette’s stool was very loose and had a lot of
mucus. Dr. Volel put Colette back on three Tylan capsules a day while leaving her on 0.25ml prednisolone twice daily, the
dosage she had been on prior to her surgery. Just after Christmas, the stool began forming again. It was lighter in color and had
little or no blood. I called Dr. Volel to let her know I dropped the Tylan to twice daily. To date (January 22) her stool is unusually
good. Colette’s week one and two CBCs were good. She’s slowed down on eating her wet food (an old story-she would have to
be losing interest in it just at the moment that you’re watching her for loss of appetite!) but she makes up for it in the amount of
kibble she consumes. She is scheduled for her second chemotherapy treatment on January 24th.
January 24, 2012: Oncology
Colette went home without having received her treatment. Dr. Lachowicz did another CBC today and found her WBC level had
dropped. He did not want the chemo to compromise her immune system. Apparently this is a pattern in cats that he had been
expecting to establish. Colette’s pattern is low WBC in week three after chemo treatment. He moved her to a schedule whereby
she gets chemo once every four weeks and has her CBCs done during week three and four. (The original schedule would have
been chemo treatment once every three weeks with CBCs being done during weeks two and three. Her new chemo date is
January 31.
| Copyright © IBD Kitties 2008-2012, all rights reserved |
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| Colette Sidonie-Samantha Zytnik – NY, New York Female, Traditional Balinese Born 2004 Diagnosed with feline rhinotracheitis (FHV-1) in September 2008 Diagnosed with moderate to prominent lymphocytic colitis/plasmatic enteritis/proctitis/IBD on December 30, 2008 Diagnosed with hyperthyroidism on June 21, 2010 Diagnosed with light heart murmur on June 21, 2010 Diagnosed with onset asthma on December 6, 2011 Diagnosed with onset chronic renal failure on December 6, 2011 Diagnosed with feline mammary adenocarcinoma on December 22, 2011 |
| Taken 12/08/08 |
| Taken 5/11/11 |
Living With IBD - Colette Z.
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