Mittens C.

Mittens1Miss Mittens C. – Cherry Hill, New Jersey
Female, Dilute Calico, Domestic shorthair
June 1, 1996 – September 1, 2010
Diagnosed with IBD in January 2007
Diagnosed with small cell gastrointestinal lymphoma on December 23, 2008
Diagnosed with hypothyroidism in January 2010
Diagnosed with kidney disease/renal insufficiency in May, 2010
Diagnosed with grade 3 heart murmur in May 2010

First Entry, May 1, 2010: Miss Mittens was diagnosed with small cell GI Lymphoma on December 23, 2008 after an endoscopy and ultrasound. There may be a link Mittens3between IBD and GI lymphoma. I’ve been told that when a cat has IBD, there can be abnormal cells present. In some cats the abnormal cells simply stay abnormal but in other cats can it turn into cancer. GI Lymphoma has many of the same symptoms as IBD and both can be hard to diagnose. I’ve noticed from talking to other cat owners whose cats have GI lymphoma that their cats were thought to have IBD prior to getting GI lymphoma. Many cases involved chronic vomiting and constipation. However, my observations are anecdotal and not scientific or factual evidence. In Miss Mittens’ case, her IBD symptoms were not ones commonly associated with IBD. In summary, her main symptoms were chronic severe constipation, chronic high liver enzyme values, a voracious appetite and weight loss. She never vomited or had diarrhea. Miss Mittens and her sister Kaci were 9-1/2 years old when I adopted them on January 29, 2006 from their owner, who was dying of cancer. Unfortunately, I was unable to learn anything about their overall health prior to adopting them or any medical history other than the medical history for the first year of their lives. However, as far as I could tell, Miss Mittens seemed healthy.

Max_2.2Diet: My primary concern when I first adopted them was Kaci, who was vomiting every day. I took Kaci to a series of veterinarians as I tried to find answers to why she was vomiting every day. I was told Kaci could have IBD but other than that, nothing the vets did helped eliminate the vomiting. I finally consulted a holistic veterinarian who told me to change Kaci’s diet and eliminate all dry food and feed only grain-free canned food. I spent the month of July changing both cats over to a diet of canned food only. During the next several months, slowly but surely, Kaci’s intestinal inflammation healed and her vomiting decreased and is now infrequent. Both Mittens and Kaci continue to eat nothing but grain-free canned foods to this day.

Early Symptoms – Elevated ALT Value and Severe Constipation: The first indication that something wasn’t right with Mittens was in blood test results in October 2006. One of Mittens’ liver enzyme values, the ALT, was slightly elevated at 137 (normal range is 10-50). Everything else was normal. The vet said we’d take a wait and see approach and retest her liver in 3-6 months. Around that time, Miss Mittens also started getting constipated. In December 2006, Mittens became severely constipated. She was hospitalized for two days and had four enemas. During the first week of January 2007, Mittens was again hospitalized for two days and given three more enemas. While hospitalized in January 2007, she had more blood tests and the only abnormality found was her ALT value which had elevated to 130. I was told not to worry about it, that it was probably caused by the stress on her liver from her constipation. I was told Mittens had IBD. That surprised me because I thought IBD involved vomiting and/or diarrhea and not constipation. The vet told me that wasn’t so. Mittens began taking lactulose to alleviate her constipation. She took 5-6 ml. of lactulose daily for the next two years. She’d have large bowel movements with mega-sized stools every 2-3 days. Without lactulose, Mittens was unable to have a bowel movement.

2007 was mostly uneventful. Mittens’ appetite was good but she always seemed to be hungry. If she wasn’t fed exactly when she wanted to eat, she’d pace and howl at the top of her lungs and often had temper tantrums where she’d pound on the doors and walls with her paws. That was definitely not normal behavior but I blamed it on her being spoiled!

April 2007: During an exam in Mittens had x-rays taken of her intestines and no blockage or abnormalities were found. Her blood test results were normal with the exception of the ALT value, which had elevated to 347. A week later, Mittens got sick and stopped eating. The vet took more x-rays and blood tests. Her intestines were inflamed, she had a fever of 104 and she was very constipated. She was given an enema at the hospital and subcutaneous fluids. Her fever went down and they let me bring her home that evening. I was again told that Mittens had an inflammatory bowel disease. She took metronidazole for three days for the intestinal inflammation. The blood test results were good and her liver enzyme values, including the ALT, were all normal. Assuming that Mittens fully recovered from her illness, the vet said she was good to go until her next check up in November. When Mittens went for her senior wellness exam in November 2007, the vet didn’t feel she needed another blood test at that time. She weighed a little over 12 lbs.

May 2008 – August 2008: IBD, Cholangiohepatitis or Liver Cancer? Mittens went for her senior wellness exam on May 10, 2008. I was very worried about her. She didn’t look good and I knew something wasn’t right. She looked like she’d lost weight, she was becoming picky about her food, her coat was dull and she was losing the fur above her right ear. The vet did an exam and complete blood panel, including a thyroid test. Mittens weighed 10.8 lbs. Her blood test results came back a few days later and everything was normal, including the thyroid, except for the usual culprit, her liver enzyme values. Her ALT value was moderately elevated (605) and her AST value mildly elevated (149). Her vet was concerned because her liver enzymes had been going up over the past year or so. She wanted Mittens to have an ultrasound with a liver aspirate and biopsy. We feared that something was wrong with Mittens’ liver and the vet thought she might have cholangiohepatitis.

May 27, 2008: Mittens had an ultrasound and the specialist called me called me afterwards. She explained that she was only giving me a verbal report on her findings and leaving explanations and how to proceed for my vet to explain. Mittens’ liver was mildly inflamed. She did a needle aspirate on the liver (liver cytology) and sent the cells to the pathologist. The gallbladder looked okay, the pancreas was mildly inflamed, the intestinal lining was thickened and abnormal looking and the lymph nodes near her small intestine were enlarged. Her findings were consistent with Mittens having (1) cancer or (2) IBD, esp. in light of Mittens’ chronic constipation problem. The specialist said Mittens’ constipation was part of the profile of inflammatory bowel disease. She said the lab results could take up to 2 weeks. I was shocked to hear that she might have cancer! My vet was away for the next few weeks and I had plenty of time to obsess and worry myself sick over it.

My vet called me when she received the lab results from the liver biopsy. The lab found inflammation of the liver consistent with cholangiohepatitis. However, when the lab looked at the cells and added in the ultrasound results and her blood test results, it looked more abnormal than they normally see with chronic cholangiohepatitis. They couldn’t make a firm diagnosis of cholangiohepatitis or rule out cancer without a broader selection of cells from different areas of the liver. They suggested a surgical biopsy for a definitive diagnosis. My vet said she still thought Mittens probably had bacterial cholangiohepatitis, which was treatable. If it was cholangiohepatitis, Mittens would respond to treatment. I was terrified that Mittens might have liver cancer and didn’t want Mittens to have a surgical biopsy if it was avoidable. The vet said if Mittens had liver cancer, the prognosis was very grim. My reasoning was, why subject Mittens to a surgical biopsy when, if she has cholangiohepatitis, the treatment will help and if she has liver cancer, it was a hopeless situation anyway? So I nixed a surgical biopsy and agreed to the treatment for cholangiohepatitis. No one suggested I consult an internal medicine specialist and I didn’t know I had that option. The possibility of lymphoma was also never mentioned.

Mittens started a course of treatment that lasted several weeks. She took two antibiotics, amoxicillin and metronidazole twice a day along with Denosyl (SAMe) once a day. She had a blood recheck 4 weeks later and her liver values were back to normal with the exception of her ALT value. Her ALT had dropped from 605 to 200. Still too high but moving in the right direction! It seemed as if the antibiotics were working. Mittens continued to take the antibiotics for the next few weeks but reduced the Denosyl to three times a week. When the medications were finished, Mittens seemed much better. Problem solved? So it seemed. However, around the end of October 2008, Mittens started going downhill. Although she was eating like a pig, I could see she’d lost weight. Back to the vet we went in November. She now weighed 9.8 lbs. More blood tests were done, including a thyroid test. When the test results came back, everything was normal but her ALT value, which had elevated to 400. Her ALP value was also elevated. Her vet didn’t know why she was losing weight, why her liver enzymes were once again elevated, didn’t know what to do for her and said there was nothing more she could do. I made the decision to find a new veterinarian. After I had located a new veterinarian, I made an appointment for Mittens and had her records were faxed to our new vet. I would soon find out that Mittens had neither cholangiohepatitis nor liver cancer.

On December 3, 2008: I took Mittens to our new vet. Mittens weighed in at 9.3 lbs. The vet read her medical records along with her ultrasound and biopsy results from June and told me it was bad news. She said she strongly suspected that Mittens had cancer although she absolutely couldn’t rule out IBD or triaditis without a surgical biopsy. I asked why Mittens had appeared to respond to the treatment for cholangiohepatitis. The vet said Flagyl was both an antibiotic and anti-inflammatory and might have reduced Mittens’ intestinal inflammation. She gave me two options: she could do a surgical biopsy or I could take Mittens to an internal medicine specialist. The vet urged me to take Mittens to a specialist. She said internal medicine specialists see these cases every day whereas she didn’t. She told me not to wait too long to make a decision. She also told me that Mittens’ teeth were in very bad shape and she needed a dental and probably needed a few teeth extracted, but the other “problem” needed to be taken care of first. Three days later, I made my decision. Mittens would see the internal medicine specialist my vet had highly recommended. I made an appointment for Mittens to see him on December 16.

December 16, 2008: Mittens saw the internal medicine specialist. Mittens now weighed 8 lbs. He said there were two possibilities: IBD or lymphoma. He suspected it was lymphoma. He believed an endoscopy and ultrasound would be enough for diagnosis and the best option short of surgery. I made an appointment for Mittens to have the endoscopy and ultrasound done on December 18. On December 17, 2008, the doctor’s nurse called with Mittens’ blood test results. Her blood cell count and clotting factor were normal, her T4 value was in the low normal range, but her ALT value was even more elevated than it had been in November, her AST value was well above normal and now her bilirubin was elevated way above normal range. They wanted to also do a liver biopsy.

December 18, 2008: Mittens had the endoscopy and ultrasound. The doctor called me after the procedures. Mittens’ endoscopy, ultrasound and liver biopsy went well and they got good cell samples from her intestines and liver and sent them to the pathologist, along with samples to test for bacteria. The ultrasound findings showed a mildly inflamed liver with no abnormalities; a mildly enlarged pancreas; enlarged lymph nodes and abnormal thickening of the small intestine, all consistent with chronic IBD or GI lymphoma. As for the endoscopy, the doctor said he saw what he thought he’d see but wanted to wait until he had the lab results before giving me his diagnosis. I did not feel optimistic.

December 23, 2008: Mittens’ doctor called with the biopsy results. Mittens had small cell Gastrointestinal Lymphoma. The cancer was in her intestines only and did not involve her liver. He said cats with this kind of lymphoma respond well to chemotherapy. Her life expectancy was 1-1/2 to 2 years. Mittens’ doctor prescribed the chemo drug Cytoxan (cyclophosphamide) and prednisone. Mittens would be taking those medications for the rest of her life. What is called remission in cats and dogs is not the same as remission in humans. The cancer is not cured. No one wants to put a cat or dog through the painful and very stressful ordeal needed to cure the cancer. Mittens’ veterinarian would be in charge of her treatment in consultation with the specialist. My veterinarian called and discussed Mittens’ diagnosis and treatment, the drugs she’d be taking, how they worked and their side effects, what to look out for and when to call her immediately. Mittens would be taking 5 mg. of prednisone 2x a day and 25 mg. Cytoxan (cyclophosphamide) 2x a week. She’d need a CBC every three weeks. The vet was also concerned that taking prednisone long-term can cause diabetes and said we have to keep track of that too. At that point, Mittens was still losing weight, her appetite had decreased, she had very little energy and she was sleeping all the time and had stopped grooming herself. I’d see her sitting on the floor, hunched down into herself with her head drooping. She looked weak, sick and frail. It was heartbreaking and all I could do was pray that the chemo would be successful.

December 28, 2008: I gave Mittens her first chemo pill. I was terrified when I gave her that first pill. In my mind, I kept saying “I’m giving my cat poison!” There’s no playing around with the chemo medication, trying to find an easy and/or “palatable” way to give it to her – it’s a big blue pill and has to be given whole and put directly on Mittens’ tongue and swallowed. I don’t mess around with the Cytoxan or prednisone – I put the pills directly on her tongue and make 100% sure she swallows the pills. Afterwards, I syringe a little water into her mouth and then give her a little food. Fortunately, Mittens never had any negative side effects from the Cytoxan.

January 2009 – October 2009: After about 2 weeks on chemo, I could see a change in Mittens for the better. I noticed she’d stopped deteriorating. Her appetite improved. She stopped losing weight. She started interacting more with me and her sister Kaci. She was perkier and became interested in what was going on around her. I wrote in Mittens’ diary on January 14, 2009 that when I got home from work that evening, Mittens came running down the stairs at top speed to greet me! I was stunned . . . could chemo work this fast? Apparently yes! On February 2, I wrote that Mittens played with her toy called Da Bird. I couldn’t remember the last time she’d had any interest in playing with her toys. However, it was still an up and down situation during the first month.

Mittens went for her first CBC in January 2009 and the results were good, as were all her CBCs during 2009. Week by week, Mittens improved. Her eyes became brighter, her appetite increased, she had more energy and began to resume more of her old activities. There were still a few bad days but the good days began to dominate. On March 25, I wrote in Mittens’ diary that she and I played a game with a cork ball and she’d chased it all over the house and ran up and down the stairs to chasing it. On March 26, her CBC results were still good and I was told she wouldn’t need another CBC for six weeks. By the end of April 2009, I knew that Mittens was truly feeling better. In May she had a physical exam and blood tests and all was well. The prednisone has made Mittens perpetually hungry and she has a gargantuan appetite. She began gaining too much weight during the summer of 2009 and is now overweight. To my eyes, she looks fat and puffy and you can tell she’s not well. However, all in all I guess it’s a small price to pay considering she’s alive! But I do worry about her being overweight and pray she doesn’t become diabetic. There are a few other downsides. Mittens never lost her whiskers but her fur has become very thin and the shine has never returned. She used to love being brushed but no longer tolerates it. She still loves long petting sessions though! What I worry about the most is her teeth. Her teeth bother her and she has trouble chewing her food. Some days it’s worse than others and it’s painful to watch her try to eat and chew. I feel that her teeth are causing her a lot of pain and if it wasn’t for that, she’d feel 10 times better than she does. I asked my vet three times during 2009 if Mittens can have a dental. My vet checked with the specialist and he said no.

October 2009: At the beginning of October, I found a small lump on the right side of Mittens’ throat. Alarmed, I took Mittens to the vet on October 6. My vet didn’t know what the lump (nodule) was but said it was not on a lymph node and not related to her lymphoma. We did blood tests, including a thyroid test so we could rule that out. The vet said if thyroid issues are ruled out, then she wanted to do an aspirate on the lump. I got Mittens’ blood test results on October 8. Other than a few minor things, the vet said her test results looked good, including the thyroid. So I scheduled the aspirate for the next day. The vet took three tissue samples and sent them to the lab. My vet called with the lab results on October 14. The cytology was good but the lab was unable to make a definitive diagnosis. Mittens would need a surgical biopsy. I thought, “Here we go again!” My vet consulted with Mittens’ specialist and he gave the green light for the surgery. He was pleased with her last blood test results and wasn’t too concerned about her going under anesthesia. So I scheduled Mittens for a surgical biopsy. Mittens had surgery on October 26. The surgery went very well and the vet was able to completely remove Mittens’ tumor. The vet didn’t know what the tumor was but said it was a solid mass of tissue. She sent the tumor to the lab. Mittens took the painkiller Buprenorphine twice a day for 3-4 days and Clavamox for two weeks. It took about a month before Mittens to spring back from the surgery. Because she’s on chemo, the fur on her throat took about 3 months to grow back in. Her voice changed too. Prior to surgery, Mittens had a deep, throaty and very musical voice and she could be as loud as any cat I’ve ever heard. Since her surgery, her voice is very thin and high-pitched. She shrieks and screeches and sometimes sounds like a rusty hinge!

November 4, 2009: I got her biopsy result. It was both good news and a complete surprise to everyone. The tumor was a thyroid mass and it was benign. The biopsy results were sent to her oncologist for his comments. The next day, Mittens had her stitches removed. Why Mittens had a tumor on her thyroid when she didn’t have hyperthyroidism was a mystery to both Mittens’ vet and her oncologist. The doctor said he’d seen the same thing on a few other occasions but it was rare. It was possible that Mittens might be on the threshold of developing hyperthyroidism. We now have to keep an eye on her thyroid and she’d need a thyroid test every three months
for at least one year.

December 13 2009: I noticed that Mittens’ left eye was bothering her. It was very watery and leaking out around the edges of her eyes and she was keeping it half closed. There was no sign of redness. Over the next week or so, her eye appeared to get better on its own. Then the same problem developed in her right eye. I took her to the vet on December 30. The vet examined both her eyes and put some yellow-greenish stuff in them and examined them with a special light. There were no scratches or other bad things but she did have mild conjunctivitis in both eyes. I was told conjunctivitis can be caused by a bacteria, virus, herpes or allergy. The vet didn’t know what was causing the conjunctivitis and said it was hard to tell unless it’s chronic. She gave Mittens an ointment for her eyes. The conjunctivitis did not clear up with the antibiotic ointment and I took Mittens back to the vet on January 5. She was given another antibiotic ointment called Terramycin. That did the trick and her eyes cleared up. The vet mentioned something about a possible herpes virus causing the eye problem and told me to give Mittens 500 mg. of L-lysine every day for two weeks and see if it helped. If it did, then she should take a maintenance dosage after that. The L-lysine did help and Mittens takes a maintenance dose every day. While at the vet, they did a CBC. When I got the results, I was told everything was normal except the hematocrit, which was low. Mittens would have to back at the end of the month so they could do a blood test to re-check the hematocrit value and also a T4 test for her thyroid.

January 26, 2010: Mittens went to the vet for the hematocrit re-check and a T4. Two days later, I got the results. The good news was that her hematocrit had stabilized and was normal. The less-than-good news was the T4 result. The lab considers anything in the range from 0.8 (lowest) to 4.0 (highest) as normal. Mittens’ result was 0.2 (hypothyroidism). Because of Mittens’ cancer, my vet said she was going to talk to a specialist.

Sick Kitty Syndrome: My veterinarian consulted an internal medicine specialist about Mittens’ low thyroid hormone level and called me on January 30 after the consult. The surgical removal of the tumor from her thyroid gland may have caused Mittens’ hypothyroidism. Or there was also another possibility. I didn’t quite understand the medical explanation I was given, but what I did understand (or think I did!) is: Mittens has *sick kitty syndrome* caused by her cancer and chemo treatment. Her immune system is very weak, her body is fighting a chronic disease and it doesn’t want to waste energy. The thyroid hormone regulates metabolism and energy. One thing a chronically sick kitty doesn’t need is an active metabolism that *wastes* energy. Her body may be conserving energy by lowering the thyroid hormone. So what do we do about it? The specialist advised us to do nothing. I was told to keep a sharp eye on Mittens and monitor her for diminished appetite or loss of appetite along with unexplainable weight gain, extreme lethargy and/or skin infections. If those symptoms appear, I was told to let the vet know immediately and then Mittens would have to take medication. And that’s where we stand now. Mittens will be 14 years old on June 1 and will have made it to the 1-1/2 year mark. She’s scheduled to see her vet on May 4 for a physical exam and complete blood work, including a CBC and T4. There are a few other issues too. I’ve noticed that she’s drinking more water than she used to. Since her surgery in October, she no longer needs to take lactulose (which is a good thing). However, she often has very soft, loose stools and has scooted on the carpet a few times and I’ve had to bathe her. She’s stiff and slow and may have arthritis. And of course, I’ll once again ask if she can have dental.

May 9, 2010: Diagnosed with Grade 3 Heart Murmur on May 4, 2010
Diagnosed with Renal Insufficiency (early stage kidney disease) on May 6, 2010

May 4, 2010: Mittens went to the vet for her semi-annual checkup, blood work and urinalysis. I told my vet my concerns about Mittens: the change in her bowel function; increased consumption of water; once again becoming picky about food yet always wanting to eat; problems chewing; and general malaise. The vet was concerned about the change in bowel function. It’s the first change since starting chemo and she said it may be significant and could indicate a worsening of the lymphoma. She recommended an abdominal ultrasound so we can see what’s going on inside of Mittens. The vet also found a grade 3 heart murmur. The heart murmur is a new and unwelcome development.

May 6, 2010: My vet called with the blood test results: Mittens’ thyroid level is still low (hypothyroidism); she is mildly to moderately anemic; her calcium is elevated; her creatinine is elevated at 3.4 and the BUN is slightly elevated. My vet says she has early stage kidney disease and called it renal insufficiency. So, in addition to the lymphoma, the hypothyroidism continues, she has kidney disease and a grade 3 heart murmur. My vet strongly urged me to have the abdominal ultrasound done as soon as possible. We need to know if Mittens’ lymphoma is getting worse, if there is still time to change her chemo medication or dosage, and if the thyroid and kidney problems are caused by her cancer getting worse or whether they’re separate issues. Having her teeth taken care of is on the back burner. Meanwhile, Mittens is to start eating prescription food made for cats with kidney disease. I went to the vet today and picked up a sampler pack containing 4 brands of k/d canned food: Royal Canin k/d (2 flavors), Purina k/d and Science Diet k/d. I’m keeping my fingers crossed that she’ll like and eat at least one of them! These new developments are very upsetting and have me feeling totally overwhelmed. I think I’m still in shock! Mittens will have an abdominal ultrasound followed by a consultation with her internal medicine specialist on May 12. Hopefully her vets will find out what they need to know about her cancer, sort out the cancer, kidney, thyroid and heart issues and have come up with a prognosis and plan of treatment for her.

May 26,2010: On May 12, Mittens went for both her abdominal ultrasound and examination by her internal medicine specialist. The results of the ultrasound were good. The lymphoma seems very stable, there’s no evidence of additional cancer or other problems. When Mittens saw the internal medicine specialist, he said Mittens will continue with her original chemotherapy treatment. As for her kidney insufficiency, he thinks Mittens’ kidney disease is unrelated to her cancer. Although the prednisone might be exacerbating her kidney function, he doesn’t want to change anything and lose ground with the cancer. He advises that she eat a kidney diet, if possible. If the kidney dysfunction progresses, she should get subcutaneous fluids at home – 100 ml every 2-3 days initially. She is to have her kidney function checked in 2 months. Regarding her low thyroid function, although he normally does not treat it, in Mittens’ case he prescribed levothyroxine because low thyroid function can affect kidney function when the kidneys are already showing signs of insufficiency. She will have a T4 on May 28 to make sure her thyroid function does not become elevated too high. He checked her blood pressure and it was normal (142). Because of her heart murmur, he took chest x-rays and it was revealed that she has a mildly enlarged heart with enlarged pulmonary vessels. This may indicate heart disease. He wants her to have an echocardiogram and consult with a cardiologist within the next 2 months. Finally, as for a dental, the answer is still no! Mittens will see her regular veterinarian on May 28 for a thyroid check and discussions about her treatment and scheduling the echocardiogram.

July 3, 2010: On June 15 Miss Mittens saw the cardiologist and had an echocardiogram and EKG and the results were good. Even though she does have a heart murmur (a/k/a physiologic flow murmur) and something called systolic anterior mitral valve motion (SAM), which could develop into Hypertrophic Cardiomyopathy (HCM), at this time, there’s no sign of heart failure and no need for heart medication. If the heart murmur changes in quality, she would need a re-check. If her breathing changes or she starts breathing with her mouth open, that could indicate heart failure. The prednisone she takes every day could be bad for her heart over the long term and could lead to HCM or heart failure but then again, it might not. The cardiologist told me we need to treat Mittens for the disease that she does have and not the disease she could have. So we’ll continue to treat her cancer as her primary disease and she’ll continue to take all her chemo medications, including the prednisone. Miss Mittens is much improved since she started taking the Levothyroxine. Overall, she’s looking and acting much better and seems to be feeling much better. The only problem is, she’s starting to become constipated again and I’ve had to start giving her lactulose but she’s not accepting it like she once did. She’ll be going for a blood test to recheck her kidneys and a T4 test in about 2 weeks.

August 19, 2010: The numbers on Miss Mittens’ blood test on July 20 were not good. Her kidney values – creatinine and UREA — were much higher than they were in May. Her white blood cell count was low but basically unchanged from earlier tests. The most alarming thing was the rapid decrease in her red blood cell count. The hemocrit value had rapidly dropped to 15% (severely and anemic). There really isn’t any treatment for severe non-regenerative anemia in cats other than Epogen (erythropoietin) which would be given subcutaneously or by IV every 2-3 days in the beginning and may take more than two months to work. The big problem from my point of view: Epogen is a human recombinant product. I read on one vet website that 20% of cats form antibodies to the drug. Another vet website said 1/4 to 1/3 of cats receiving Epogen will produce antibodies against it in six to eight weeks. Forming antibodies to the drug is fatal. All things considered, the treatment would be too stressful for Miss Mittens and I decided against it. Her vet consulted with Mittens’ specialist and it was decided that she would continue taking her chemo medications and he suggested subq fluid treatment, which she will get in the hope that it will make her feel better. Mittens has been through quite a lot over the past two years and I have decided not to not put Miss Mittens through any heroic treatments that will cause her major stress in an effort to add a few more months to her life.

August 28, 2010: Miss Mittens has been going to the vet for subq fluid treatments twice a week for the past 2 weeks. Each time she goes for the subq fluids, they weigh her and each time, they’ve told me she’s lost more weight. In the middle of June, she weighed around 12.6 lbs. She now weighs about 9 lbs. Miss Mittens had blood tests done this morning for her kidney function and blood cell count and her vet called me this afternoon. Her hemocrit value went up to 20 (a teensy bit of good news) but her creatinine value rose to 7.0 (end stage kidney failure). Her vet said normally she would insist on hospitalizing Miss Mittens at this point and administering IV fluids but we’ve agreed not to do anything heroic. Miss Mittens’ appetite is good and she’s eating well except for loss of appetite on the day after getting subq fluids. Outwardly, she looks better than she has in months and shows no signs of being severely anemic or having severe kidney disease nor does she show act like she feels very sick. Her vet is slightly mystified about that. Most cats with kidney disease don’t take prednisone and/or levothyroxine and perhaps either the prednisone or levothyroxine are helping her feel better? Her vet doesn’t really know. Miss Mittens will now get subq fluids 3 times a week and her vet is giving her an appetite stimulant to take in case she doesn’t want to eat after subq treatments. Her vet has talked to me four or five times during the past month and has let me know that the end is very near for Miss Mittens. I know Miss Mittens is terminally ill from the kidney disease and will not be with us much longer and when it’s time, I will not let her suffer. My heart is breaking from grief.

September 1, 2010: Miss Mittens suffered a lot during the past week and over the past 2 days it was unbearable to watch her in such distress. She was very fragile, worn out, uncomfortable and in pain. She was eating almost nothing. She was very weak and couldn’t get comfortable anywhere and could not sleep for more than a few hours at a time. Although she’d have times during the day, esp. the mornings, when she’d perk up a little and even eat a little food, by the late afternoon, she would be drooping and lose all interest in food. Other than coming to me for long petting sessions and comfort, she had pretty much pulled away into herself. I had stopped giving her the chemo medication as it clearly wasn’t working and there was no point. She was also not being taken to the vet for fluids any longer as they were also not helping and it was just too much stress for her. I brought her to the vet’s and I was with her to the end and her crossing was very peaceful. She went gently to sleep. Her face was serene and beautiful at the end and I know she is at peace. She is an angel now and free from all her pain and suffering.

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