Colette Sidonie-Samantha Zytnik – NY, New York
Female, Traditional Balinese
Born 2004 – April 19, 2014
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
Diagnosed with pancreatitis on January 14, 2014
Diagnosed with Urinary Bladder Cancer
(Undiagnosed transitional cell carcinoma) on January 25, 2014
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 2009: 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 firstname.lastname@example.org, 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, 2011: 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.
June 28 – August 19, 2011: 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, 2011: 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, 2011: 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, 2011: Decreased to 0.5ml once daily.
August 19, 2011: 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, 2011: 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, 2011: 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, 2011: 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. olette 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.
January 31, 2012: Oncology. Colette’s CBC was at an acceptable level today and Dr. Lachowicz went ahead with her second chemo treatment.
February 2, 2012: Colette’s eating has begun to taper down. This does not look good. She has been attacking her dish ever since she first started getting prednisolone. Where Colette is concerned there is usually never any leftover kibble in the bowl. There was leftover kibble tonight.
February 3, 2012: Phoned Dr. Lachowicz. Colette did not want to eat and she was practically crying when I administered her IBD meds. By noon she vomited all the water she had had. There was no food in the mix. She also hadn’t had a bowel movement since the day before. Dr. Lachowicz prescribed ¼ tablet 16mg. Cerenia, administered once daily. He said that she was ahead of schedule with post-chemo nausea. The Cerenia seems to have helped, but she still doesn’t want to eat. I waited while she kept going over to the bowl (both wet food and dry) and eating next to nothing.
February 4, 2012: Crisis stage (as far as I was concerned). Colette still kept going over to the bowls and picking. She ate next to nothing and there were also no urine clumps in her litter box. I’m guessing she hasn’t been drinking water either. I phoned Blue Pearl and they contacted Dr. Lachowicz at home. He prescribed ¼ tablet, 15mg mirtazapine, an appetite stimulant, to be administered once every 3 days if needed. Colette looked like she might start eating on her own during the day, so I waited until early evening to pick up the prescription. She did not start eating. I administered the mirtazapine and, since they told me it takes about 12 hours to kick in, I ground down some of her wet food and added some water so I could get some food into her via syringe. She accepted the food (via syringe) without a problem, and started to lap a bit of it from the cup by herself. As of midnight she still hadn’t eaten much. I used the syringe again. I also gave her first dose of prednisolone today. (I had held off the IBD meds since they need to be administered with food.) She started to ask for food and pick at the kibble by herself.
February 5, 2012: The mirtazapine and the Cerenia did the trick! I left bowls out with kibble in them last night and they were empty this morning. I don’t know which of the girls, or, if both the girls, ate, but Colette came to bathroom this morning to ask me to come to the kitchen to feed her. She ate her kibble without any prompting from me. I started out not giving her another dose of Cerenia since was eating, but decided to give it anyway since she didn’t touch the kibble I usually put out after administering her IBD meds.
February 13, 2012: On Tuesday, February 7th, I administered another dose of mirtazapine and later phoned Dr. Lachowicz. The medicine worked all too well. Colette was driving me crazy begging for food. Dr. Lachowicz laughed and told me, “so, feed her!” Ideally, he thought I should be giving her the mirtazapine on Friday and Monday (today). She was so consistently hungry during the week that I didn’t give her the medicine. She began picking at the wet food last night. I gave her the mirtazapine which did the trick. The food was gone 15 minutes after the pill. Update on her IBD. Colette’s stool has been consistently formed and without blood since just after she recovered from her surgery. I phoned Dr. Volel to ask if I should drop her IBD med dosage. Waiting for call back. Colette has the first of her month three (chemotherapy treatment) CBC’s scheduled for tomorrow.
March 26, 2013: Yes, we did drop her IBD med dosages and eventually decided to discontinue giving her Tylan; she didn’t need it anymore. Going forward we went on a schedule that would have eventually discontinued the prednisolone, but as the weather got warmer Colette started pulling at her fur again. There’s something growing ‘out there’ that she seems to be allergic to. This started around April 24th and we tried (once again) over the counter Chlor-Trimeton on her. It didn’t alleviate the itching. April 30th, Dr. Volel put her back on a schedule of 0.25cc prednisolone once daily and kept her daily dosage of about ¾ tsp. Viralys, L-Lysine gel consistent. I stopped keeping careful records after this point so I will be working, going forward, with Colette’s Blue Pearl Veterinary ‘Discharge Orders’, my memory, and various Facebook posts. In retrospect, Colette had a severe reaction with regard to nausea after her second chemotherapy treatment. She rebounded but her appetite was still off for quite a while. In fact, as of this writing, March 26, 2013, she never regained the appetite she had prior to her chemo treatment, but she has maintained her weight , if not grown a bit chubbier since August 2012. (More on this later.)
There are several things that stand out with regard to what has transpired over the past year. First and foremost, I noticed that with each successive chemotherapy treatment, Colette’s IBD seems to have gotten better. She reached the point towards the end of her treatments (over the course of 7 months) where it was no longer necessary for me to photograph and collect stool samples and run them over to Dr. Volel twice a month. The last stool photograph I have is dated 7/23/12. Her stool now still a bit on the dark side but there has been no diarrhea and no visible blood in all this time. I have a bottle of Tylan in my cabinet dated 4/21/12. Her prescription was for 60 capsules. There are 42 capsules still in the bottle. I recently spoke to Dr. Lachowicz about this. He wasn’t surprised that the chemo had improved her IBD condition considerably. His explanation was that the chemo acts on immune system and explained that she needed CBC checks consistently before any carboplatin dosage would be administered (the chemotherapy drug used) because of that.
It was in the period of February through April 2012 that Colette (again) began rejecting the Hills Prescription w/d canned food she was on. It was also during this time that she started rejecting the w/d kibble. It took a while to catch on. The one thing I noticed, finally, was that as we started approaching the last pound or two remaining in the 8 lb. bag I was buying, Colette didn’t want to eat it. And then I noticed, my other cat, Samsara (who has now developed CKD) also wasn’t eating it. Hands full and preoccupied with both cats, I thought Samsara’s eating was off too. Both cats were now getting Mirtazapine. It made them both really hyper. On April 2nd, Drs. Volel (for Samsara and Colette) and Lachowicz (for Colette) decided to try them on Cyproheptadine (1/4 tablet, 4mg). It made them both even more hyper. We put them both back on half the normal (1/4 tablet, 15 mg.) mirtazapine dosage. Then I started to realize that something had probably changed with regard to the kibble. Whereas in the past, I would buy the 8 lb. bag and it would be consumed without issue, that wasn’t the case anymore. I bought the last 8 lb. bag, and attempted to store half of it in my (small) freezer. I needed to throw away at least one pound of it as neither cat would eat it. I switched to buying four pound bags (which is, of course, more costly). I now store about 2 lbs. in the freezer. I’m still throwing away around ½ pound. (Samsara has now rejected the kibble outright, and Colette really doesn’t want to eat much of it either.) But, I get ahead of myself. It was around April that it became clear that we were not dealing with inappetence—it was the food that was the issue. We stopped the appetite stimulants altogether.
April 29, 2012: I wrote on my Facebook page that Colette had completely rejected her wet food and wasn’t having any of the (Purina Veterinary Diets) FortiFlora I bought as a food topper on the recommendation of another IBD Kitty mom. She had recommended it as ‘kitty crack’. Dr. Volel had given the green light to use it, but she really couldn’t see how it would help. The product is mainly a probiotic but it also has a flavor component. (Both cats rejected it.) Purina sells this as “a nutritional supplement for the dietary management of cats with diarrhea”. I recently learned from a Purina representative that the flavor and probiotic components can be separated using a sieve. The flavoring is in small pellets mixed in with the probiotic powder. The stuff is about $20 for a small box—I may as well use it up in the wet food (in place of acidophilus) for my other cat. So began the almost year-long search for food toppers to get Colette to eat. Better than nothing, I ran through my remaining (freeze-dried chicken-based) Whole Life deVour topper. Since that really did cause a bit of blood for Colette I didn’t buy it again and tried something else, Eagle Pack Holistic Solutions, a probiotic powder. It was fine as a probiotic but did nothing with regard to getting either cat to eat. Just this past fall, I found something which works. Colette still doesn’t want to eat much of her kibble, but that’s okay. I found out she can tolerate, without any problems, Stella & Chewy’s raw “Duck Duck Goose” product. I was already talking about using it around November 23rd. Dr. Volel initially had concerns about the product, but accepts the solution since we’ve found nothing else to solve the eating problem. I’m using their dog formula rather than the one for cats due to financial concerns. The dog product runs just under $30/lb. and it contains the necessary taurine. The kitty product is a lot more expensive. I started to use it as a food topper but Colette has migrated me into feeding about 2/3rds patty a day along with her kibble and cutting back on the kibble. The fat content in Duck Duck Goose is quite high, so despite the fact that she’s eating less she seems to have gained weight. There’s still kibble left in her bowl in the morning.
The last major issue that needs to be discussed is the possible resurgence of her breast cancer. On June 1st, I wrote on my Facebook page: “Colette completed her sixth and last chemo treatment on Tuesday. She’s had a bit of a stomach upset over the past couple of days, but, on the whole, she’s doing well. (Yay Colette!) She goes back for a re-check and x-rays in a month.”
June 26, 2012: Dr. Lachowicz wrote in her discharge orders: “Colette looks great! Her exam was fine, and xrays of her lungs look clear. The radiologist will review the images and report on them next week. Please resume/continue her normal routine at home and well recheck her in 3 months.”
July 24, 2012: The routine 3-month recheck didn’t happen in that fashion. I wrote to a friend on July 24, “The x-ray technician found something last month he was concerned enough about that Dr. L. scheduled Colette for another set of x-rays today. No appreciative difference in what the X-ray technician found, but Dr. L. found a new, small nodule which came up along her scar line that wasn’t there last month. It’s still up in the air, but we’re now talking about either another lumpectomy, or perhaps, a radical removal of the lymph system. TBD. I just brought her home about an hour ago, so I’m still registering this new development. Worried, but I’m not going to make myself crazy over it.”
August 7, 2012: Colette underwent ‘radical resection’ surgery, a removal of her mammary duct system. The OncoLink website of the Abramson Cancer Center of the University of Pennsylvania (www.oncolink.org/types/article1.cfm?c=614&id=6023#.UVIQx1eRdjs) provides the following explanation: “… a single surgical procedure in which all affected tissue or potentially affected tissue is excised. The recommended surgical treatment for feline mammary tumors is the radical mastectomy. In this procedure, all four mammary glands on the affect side plus the axillary (arm-pit) lymph node and the inguinal (groin) lymph node are removed. Whem (sic) mammary glands on both left and right chains are affected, two separate radical mastectomies done four weeks apart are required. The suture line following a radical mastectomy extends from the axilla to the vulva. “She was hospitalized overnight following surgery (performed by Dr. Mark Levy, DVM, DACVS) and I elected to have Blue Pearl keep her one more night. She was discharged with a set of routine post-surgery instructions, a prescription for Tramadol, analgesia, 10 mg/ml at a dosage of .47 mls every 12 hours as needed, a Fetanyl patch (continuous release pain medicine to be removed after 3 days), and a prescription for Clavamox antibiotic.
In the days following the procedure her tissue should have gone to the lab for a biopsy. Neither Blue Pearl nor the lab ever found out what happened to it. The tissue was lost. While it would have been good to know the results, it’s not that anything more can really be done for her. Dr. Lachowicz told me that a second round of chemotherapy treatment is generally not done since it’s really not effective, and, for financial reasons, there’s no way I could put her through it anyway. The radical resection surgery exhausted the last of her $7500 grant from Frankie’s Friends. In summary, I had paid for her initial lumpectomy ($500), her first round of CBC’s and chemo treatment (well over $600), and paid a $75 copy each time she received a CBC or treatment ($225 a month for 5 months). After the surgery, I was left with a balance of $257 to pay. I have no additional funds available for anything nearly as expensive.
August 25, 2012: She’s back to being Colette. Her stitches and staples were taken out Tuesday. Wednesday she had her first zoomie around the house. She’s begging for food and putting it away like there’s no tomorrow.”
August 28, 2012: I posted a photo to Facebook showing how relaxed Colette looked. We had the go-ahead to permanently remove the e-collar she had been wearing.
September 19, 2012: Colette went in for a recheck on and, at that time Dr. Lachowicz wrote: “Colette looks great! I have no concerns on exam – her left mastectomy site is healed and normal … and her right mammary chain palpates normally. At this point she should have exams every 3 months for at least 1 year. Recheck lung xrays in 3 – 6 months.”
December 18, 2012: Dr. Lachowicz re-checked Colette and she looked good. He advised me to schedule a lung xray for March.
As of this writing, March 26, 2013, she’s due for that xray. She looks great and she’s been behaving really well. I dropped her prednisolone and L-lysine dosage to 0.25cc prednisolone and ¾ tsp. L-lysine once every other day last month, and let Dr. Volel know that she’s been doing well on the lower dosage. (I expect, though, in another month, to have to increase again when the weather gets warmer and spring shrubbery starts growing.)
Whereas before I had issues with brushing her, she comes of her own accord asking to be brushed—3 times a day! She’s also, lately, been demanding to be picked up and placed in my lap while I’m working at the computer. Sigh. Her methods have something to be desired. She rakes her claws down my leg or arm or hand, continually, until I take note and pick her up (ouch!).
January 13, 2014: Back from taking Colette to the vet. There’s been quite a bit going on in the last few weeks. Colette’s eating hasn’t been good for at least the last 4 months (I’ve been countering this with once-a-week doses of Mirtazapine appetite stimulant: 15 mg, 1/8th tablet—an 1/8 of a tablet only because Colette gets so hyper on it – ideally she should be getting Mirtazapine once every three days, but I haven’t been doing that for the same reason). Lately, her energy level has also dropped considerably which is probably why she has also gained weight. She’s now a chubby 12.2 pounds. I’ve been noticing over the past two months that Colette’s gait is off. It’s like she’s limping but not really. The vet saw it too today but has no comment (yet?) There are other things right now that take precedence.
With regard to her food, I found myself running out of options for her when she started refusing the only two foods she fully tolerates: Hill’s prescription w/d (low-fat intestinal) diet along with Stella & Chewy’s ‘Duck Duck Goose’ raw patties. Thinking that her IBD had been well under control since her chemo, and that she had a moderate tolerance for chicken in the past, I started to give her a bit of the food that my other cat, Samsara, has now been eating since she too tired of the kibble and the duck patties. (Samsara had refused all canned food for over a year, and recently decided that’s now all she will eat. Colette absolutely will not eat the canned version of the w/d diet, and of course, she wants canned food too now.)
Two weeks ago, Colette started vomiting after I gave her the canned food that Samsara was getting. Okay, maybe I just switched over too quick and upset her tummy. I cut the wet food back to just a food topper. Her stool seemed okay, a bit soft but… At the end of the week, two weeks ago, I found myself having to shampoo her rear end because she had soiled herself so badly. I stopped giving her the wet food. Towards the beginning of last week I found drops of blood in the bath tub. (Colette alternately uses her litter box and the bathtub drain when she urinates. She is meticulous about peeing down the drain and wiping her paws off on the shower curtain liner before she exits the tub). Towards the middle of last week when I was grooming I re-checked her rear end for feces and found instead that her fur was stained with quite a bit of blood. I had to shampoo her again. (She’s actually letting me lather her up outside the tub using wet paper towels and washing the shampoo back out the same way). Last week Friday evening she was sitting in my lap and I was stroking her between her forelegs midway between her armpits when I found what felt like a very large pimple. I thought it was a mat at first and tried peeling the hair apart – I only got so far and was afraid to go further because it felt to me like skin underneath. She’s had ‘just’ a pimple on her neck for at least the last three years. I decided to watch it over the weekend. By this morning, the ‘pimple’ had grown and seemed to have sprouted a satellite. Dr. Volel felt it and managed to get her fingernail underneath. She brought out the shaver and by the time she was finished shaving it was clear that it was matted fur!!!!!
We don’t know where all that blood came from…the intestinal tract or the vulva. We’re going to have to watch this carefully. Dr. Volel wants to run full urine and blood tests on an empty stomach. Preliminary tests show there is no indication that the cancer has resurfaced. Dr. Volel is thrilled. BUT: Colette’s CREA and BUN levels are unacceptably high (BUN/UREA= 42 mg/dL against reference range 16-36 and CREA=2.9 mg/dL against reference range 0.8-2.4). Colette has had onset Chronic Kidney Disease for over a year now. The blood test results show she now has full-fledged CKD. Preliminary tests also show her fPL level to be abnormal which indicates there may be something going on with her pancreas. Dr. Volel wants to run full panel tests on both blood and urine. These need to be done on an empty stomach, so feeding stops after 9:00 PM on Wednesday and I have her scheduled for first thing this Thursday morning. In the meantime, the vet has prescribed Azodyl, to be administered once every 12 hours (a priobiotic that actually thrives on urea) in order to try to bring the CREA and BUN numbers down. We were also going to try to switch her over to the Hills Food that Samsara gets, but when I re-checked the ingredients tonight I found chicken (which for sure now, she can’t tolerate). I may have felt silly about the mass turning out to be matted fur, but with everything else going on this really was a timely visit to the vet.
January 16, 2014: What a day (at least for me)! Back to the vet for another round of blood tests and for a urine sample. Just before we left the house, Colette left drops of blood in the bath tub again and I found drips on the bathroom and bedroom floors. I checked her rear end again. She had fresh stains on her fur. (I left them so Dr. Volel could see them). Dr. Volel got the blood sample and rechecked the fpL values. They were still abnormal so she was going to send the blood out to the lab for full results. Now for the urine….Since Colette had already urinated before we left the house and since she tensed up, Dr. Volel couldn’t get urine. We discussed how I was going to get it at home. Actually it turned out to be really easy. I bought a heavy-duty trash bag, cut a piece off and fitted it over the bath tub drain, taping the sides to the walls of the tub. Within an hour after arriving home Colette used the bathtub. I syringed the urine into a freshly washed medicine bottle and headed right back to the Dr. Volel’s office and stayed to wait for in-house results.
First off, Dr. Volel questioned if there had been water in the medicine bottle – a few drops, probably, since I had rinsed the bottle not long before Colette urinated, but not enough to have produced the highly dilute urine I brought in. (I brought in a little more than 8 mL.) Colette drinks an awful lot of water! There was quite a bit of blood in the urine, leading Dr. Volel to believe that Colette has a bladder infection. She sent me home with a liquid Clavamox prescription (Amoxicillin/Clavulanate Potassium Oral Suspension) 200 mg/28.5 mg per 5 mL; 1.25 mL administered every 12 hours , at least till outside lab results come in. Since I found the chicken in the Hills k/d (kidney) canned diet, Dr. Volel checked cans of Royal Canin – no go – it also has chicken and trace amounts of fish oil. We discussed switching Colette over to a pork-based, home-cooked recipe. (Jury is still out – it uses krill in place of fish oil. Colette can’t tolerate fish and seafood.) I re-opened the question of what’s going on with Colette’s gait. Dr. Volel suspects arthritis. We discussed administering vegetable based glucosamine-chondroitin. (I need to search for a product.) We also discussed the possibility that the blood in the urine may be the result of an intestinal tumor.
Next steps: administer the amoxicillan and continue the Azodyl. Blood and urine lab results pending.
January 20, 2014: Via telephone, the lab results are in. There was quite a bit of e-coli presence in the urine indicating a bladder infection. Continue giving the amoxicillan to complete 15 days, then bring her in to repeat tests. Her last dosage should be January 31. Blood results: BUN = 43, CREA=2.9, and particularly worrisome fpLI=13.6 against a reference range of 3.5-5.3. Dr. Voleil suspects that Colette now has pancreatitis, but also said that her kidney values may be affecting the pancreas values, though she still hasn’t ruled out the possibility of an intestinal tumor and suggests doing an ultrasound. We also discussed that Colette has been extremely affectionate and needy over the past few days. Dr. Volel says that’s probably because she hasn’t been feeling well.
January 25, 2014: Took Colette to the vet for an ultrasound and the news is not good. Two years ago Colette was diagnosed with breast cancer. She had a lumpectomy followed by six months of chemotherapy. Two months later her oncologist found a small nodule along the scar line. Her prognosis was still good so I opted to let her undergo surgery to remove both her mammary chains. The cancer is back and this time she’s not going to beat the odds. She has two small tumors located not far from her urethra. They are only partially operable. I’m not going to put her through another surgery. She has been through way too much already. Our vet doesn’t think it would buy her that much more time anyway.
The vet and I briefly discussed acupuncture to relieve some of the pressure on her bladder, but the way Colette gets stressed…especially after last week we both almost immediately ruled it out. She arrived home famished, finished her food and went off to sleep in the sofa. We’re to finish out her Clavamox prescription and I’ll try to keep her comfortable for as long as possible. The time frame? The vet doesn’t know. She could be around for a while yet, but if the growing tumor blocks her urethra she could go very soon. I’m heartbroken, but when her time comes I will let her go with grace, only regretting that she can’t be with me longer.
January 29, 2014: Got a call back from Dr. Volel with the new diagnosis. What Colette has is urinary bladder cancer. She suspects that it is a transitional cell carcinoma. This is the most likely one because of its location. Without a biopsy, there’s no way to diagnose the type of cancer. Because the chemotherapy suppresses the immune system, cells can trick the immune system and slip by without the immune system noticing, so when the cancer resurfaces it oftentimes comes back as a different type of cancer.
February 4th, 2014: (January 25, 2014) Last weeks’ urine results showed Colette had a bladder infection. January 16th, Dr. Voleil started her on Clavamox (Amoxicillin) liquid, 40:5.7mg/ml to be administered in 1.5cc twice daily dosages. I have also continued giving her 0.25cc prednisolone once every other day. I discontinued the Azodyl prescription within days of starting it and called Dr. Volel to inform her. Colette seems to have tolerated it for a day or two and then began having violent GI upsets. I had seen this before with my Samsara. Samsara was given this probiotic to help with her CKD and was vomiting frequently enough that I thought I would lose her. When I spoke to Dr. Volel about Samsara she told me that many cats cannot tolerate Azodyl. I stopped giving it to Samsara and the GI upsets stopped. Colette also has not vomited since I discontinued it. Note: Because of Colette’s new cancer diagnosis Dr. Volel and I are not pursuing any further CKD treatment or pursuing anything further with regard to her high fpLI (pancreas) numbers.
Starting the day before her ultrasound (Jan. 24th), I began to see incontinence episodes, urine drips with blood in them beginning just inside the bathroom and ending in a puddle outside the litter box. The day of the ultrasound, Colette left a puddle on the clinic floor. Milder episodes continued. In the hours following the ultrasound procedure the fur on inside of Colette’s back legs was heavily stained with blood. The staining continued to a lesser degree through the weekend and into last week and the fur on the inside of Colette’s back legs was continually damp. I needed to shampoo her at least once a day. In the meantime, she would not let me give her the liquid Clavamox. I wrapped her in a towel and still found that she would jerk her head away in the last second. Or, when I was able to get it into her mouth she wouldn’t swallow it. We both ended up wearing more of it than she took. This continued until the day of her ultrasound, January 25th. I asked Dr. Volel to switch her over to the pill form: 400/57mg tablets. Dosage ¼ tablet twice daily. Pilling went without a hitch. We finished out the course on the evening of February 2nd.
She has been fairly quiet throughout, sleeping for most of the day. She also has been giving trouble with her eating (except for getting into my other cat, Samsara’s canned food). Note: I’m now letting her get into that food and, of course, her bowel movements have been soft, but so far there is hasn’t been any diarrhea. Dr. Volel recommended again that I give her one-eighth tablet Mirtazapine(appetite stimulant) every three days. In the past, I had been trying to extend the time between doses. I can’t do that anymore. Colette’s gait issues are now attributed to the tremendous pressure on her bladder from both the cancer and the bladder infection. Dr. Volel doesn’t think she’s in pain, but made an analogy to how uncomfortable the last weeks of pregnancy feel. Around January 31, though, I do think there was some pain. Colette usually comes around to ask to sit in my lap every evening while I’m working at the computer. She will not make the jump into my lap by herself and has always insisted on being picked up. I’ve always lifted her under the arm pits, leaving her legs dangling for the few seconds it takes to put her in my lap. I can’t do that anymore. I need to support her under her bottom as she has been meowing in pain. Once I began supporting her bottom everything was fine again. We finished the course of Clavamox on February 2nd and it made a big difference. Colette’s fur is still damp for the most part (light incontinence) and lightly stained, but she’s been more active and interested in being loved and brushed.
February 3rd into February 4th, 2014: We had a setback around 2:00AM. I had not yet gone to bed and Colette jumped onto the toilet seat…her grooming station… asking to be brushed. I hadn’t checked during the day so see if I needed to clean up her backside so I checked then. And thank goodness I did. It was covered in heavy fresh blood. I glanced in the litter box and saw she had just urinated. The urine was a dilute bright red. I washed her up and now what to do? I calmed myself down and realized she wasn’t hemorrhaging. I opted to phone Dr Volel in the morning.
February 4th: Dr. Volel says that Colette’s tumors are bleeding. She briefly talked about aspirating them and then realized that entails surgery. I will not let Colette go through any more surgery. We discussed another course of Clavamox and then decided on Baytril to deal with inflammation and bacteria. Dr. Volel is concerned about the bleeding producing a lot of bacteria. She prescribed a 14-day course, Baytril 22.7, ½ tablet every 12 hours. She also recommended I go on line or telephone to get the Chinese herbal remedy Yunnan Baiyao to control the bleeding, giving me the name of two different sources – I found one had discontinued selling it. The other company services veterinarians but will ship to individuals without prescription via telephone (you need a veterinary account to order on line): TCVMherbal.com: Tel: 800-544-7504. I ordered the product this afternoon. Dosage ½ to 1 capsule, once daily.
A trip to Wikipedia to look up this remedy: “Yunnan Baiyao (or Yunnan Paiyao) … is a hemostatic powdered medicine famous for being carried by the Vietcong to stop bleeding during the Vietnam War. The medicine, developed by Qu Huangzhang in 1902, is designated as one of two Class-1 protected traditional medicines, which gives it 20 years protection. In China, its reputation is equal to that of penicillin in the U.S. It is founded and manufactured by a state-owned enterprise, Yunnan Baiyao Group … in Yunnan, China….” Wikipedia gives further information but warns that the information is unclear and poorly sourced. Herewith, but with obvious qualification needed. I left their exact notes and punctuation intact. “The main ingredients are both steamed and raw Sanqi, roots of Tienchi ginseng also known as “Notoginseng”, Panax pseudoginseng, and Rhizoma Dioscoreae.[clarification needed][dead link] These two ingredients are then combined with astringent herbs that absorb excess bleeding, invigorate the blood[vague] and enhance healing [vague] including myrrh and dragon’s blood a resinous for internal bleeding.[clarification needed][unreliable source?]” I’m sure I’ll have more to say about this later. I’m expecting the product to arrive in the next few days. I gave Colette her first dose of Baytril this evening.
April 19, 2014: I helped Colette to the bridge about noon today. She went very peacefully while I held her. She wasn’t going to rally again. When I reviewed with the vet what had transpired over the last few days, she told me I did the right thing. The house is very quiet and I’m incredibly sad, expecting to see her at every turn. My poor girl had the patience of Job. She endured more in her few short years than any creature should have to put up with over a span of 50 years. Through it all she was sweet (and spicy) at turns. She was a lover and a fighter. I truly believe that is what kept her going. She was a great cat—meticulously clean when it was within her power to be clean, she didn’t destroy things, and I don’t remember a day that went by without her showing me how much she loved me and how grateful she was that I adopted her. She was smart and funny. She was the kind of cat that came running to take care of you when you hurt yourself and yelped in pain. And I have never had a cat that was so incredibly wonderful about taking meds. Maybe it was how we established that relationship (she was difficult for perhaps her first two months with me), but after that, she made it so easy. She never ran away to hide, and lately I’d find her seeking me out within minutes of my beginning to look for her to give her the meds. Fly free my sweet angel. I’ll always love you.