My pet has the following symptoms:
As hard as it is for me to write this, I feel that by sharing my experience, and my mistakes, I may help someone out there facing similar illness in their beloved cat-friend-child. My ~12years old Bengal friend, Gus, has always been a high energy and very affectionate cat - like a little boy. (We got him from a cats foster-home in 2012) He had a little bloody diarrhea episode on 26th Dec 2018, which made us take him to a VCA specialty clinic for a checkup (doctors at this clinic referred to as 'A' in below) They did a complete blood-work/ultrasound which was unremarkable for most part. His ultrasound showed some thickening in intestinal walls, and a possibility of a hypoehoic mass (darkened region on ultrasound) between his pancreas and spleen. They didn't find it to be too concerning at that point, and sent him home with some antibiotics. The meds helped and he was back to his normal solid-poop self. However starting 2nd week of Feb, we started noticing a little bulge in his abdomen, which I ignorantly attributed to him possibly eating more and gaining weight. (Mistake #1: Knowing how athletic a cat he was, I should have not imagined him gaining belly-fat, and taken him in for a check-up right away).
Over next week, I changed his diet a little (he was always fed canned wet food, Wellness for most part) to use high-protein/less-fat, but his abdomen kept getting bigger over next week. I finally took him to a vet (this doctor referred to as 'B' in below) for a checkup on 21st Feb. Gus had gained about 3 pounds since Dec, and Dr. 'B' confirmed that he had fluid in his abdomen. Dr B drained about 3/4 pounds of fluid out and sent it for cytology, as well as, did a complete blood work (CBC, and renal profile). The blood work was good, except for the WBC being slightly higher than upper range). Dr. 'B' suspected FIV, but since the drained fluid was more pink in color and not milky, he wasn't sure. The cytology report two days later confirmed that it was not FIV. There was no clear diagnosis in the cytology report except for a possibility of some kind of neoplasia (cancerous growth) due to uneven RBC sizes observed in cytology test. At this point, looking at Gus' previous ultrasound report from Dec, Dr. B suspected that the hypoechoic mass noticed behind his pancreas back then could have been some kind of cyst, and if that was the case, he'd recommend taking it out surgically. We took Gus back to clinic 'A' on Mon 25th Feb for another echo/ultrasound. The echo was excellent, no issues in the heart. The ultrasound turned out to be better than before - no signs of hypoechoic mass behind his pancreas, but there was still some thickening noticed in his intestinal walls, and the radiologist at 'A' also noticed some nodules like formations in there. Based on these findings, the vet at 'A' suspected a possibility of some kind of neoplasia/lymphoma, and recommended doing a needle-biopsy on live for further evaluation, followed by starting Gus on Predinsole steroid tablets. They also recommended not to drain all of fluid in Gus' abdomen out, as that might have put pressure on his heart. I consulted with Dr. 'B' about this, and Dr. 'B' stressed that doing an exploratory biopsy surgery on Gus would be a better option than the needle biopsy as that may not get the affected tissue sample. I was so paralyzed in my mind that evening that I agreed to Dr. B's recommendation of invasive biopsy surgery (Mistake# 2 !), without making him discuss the pros/cons of the invasive surgery, vs. starting with steroid/anti-biotics treatment, and impact on Gus's remaining quality of life. Dr. B claimed that the biopsy surgery was not a big deal, and was as simple surgical procedure as neutering a cat. In hindsight, if I had known that the surgery could make it harder for Gus's immune system to fight on two fronts (the possible lymphoma, and healing surgical wounds), and that the prognosis would be no better than simply starting him on steroid treatment advised by 'A', I would have said no to the invasive procedure. But I just wasn't thinking clearly at that fated Monday evening. The Dr. 'B' arranged the surgery on Tue the 26th Feb, and asked me to not feed Gus after midnight. I dropped Gus off at ‘B’ around noon. However, the surgery didn’t start until around 4pm that evening. Originally Dr. B was planning to keep him overnight at his clinic for observation of his recovery, but then he changed his mind around 7pm and asked us to take Gus home as he wasn’t willing to eat. I picked Gus up around 7:30pm and took him home with only instructions to give him Entyce syringes if needed. Dr. ‘B’ seemed to have just assume that Gus would start eating at home, and didn’t give us any guidelines on force-feeding him. Gus was extremely weak and wobbly that night, and just laid on his side with eyes open all night. It seemed that he was in pain, and still not willing to eat. I did not try to force-feed him worrying that he might vomit, imagining that his symptoms must be effects of the anesthesia. (* Mistake# 3!). Gus did drink lots of water next morning, but still no willingness to eat. I took him back to ‘B’ for a follow-up checkup, and ‘B’ simply sent him home with another buprenorphine, and cerenia injection. Gus had not eaten for more than 36hrs at this point, but ‘B’ did not have any concerns. We trusted ‘B’ and did not still try to force-feed Gus all day. Gus did lick about 0.5oz of wet food from my fingers, but that was it all Wed the 27th. Gus remained very weak and laid on his side with eyes open for most part all day/night again. Worried that he had eaten so very little in almost 50hours, I took him to ‘B’ again on Thu 28th morning. Dr. ‘B’ still did not say anything about force-feeding him, did not bother to do any follow-up blood work on Gus, and sent us home again with another higher dose buprenorphine injection, claiming it’d help him sleep. He also gave us a buprenorphine syringe to give to Gus after 12 hours. Gus condition did not improve much all day. We got him to lick more food off our fingers, but still not much – maybe another 4 oz or so all day. Gus kept drinking lots of water throughout the day. I gave buprenorphine syringe to Gus around midnight, and it seemed that oral dose helped him a bit, and he did sleep that night. Gus seemed just a little better on Friday morning. I decided to force-feed him with a syringe, and he did not seem to mind too much. He was walking around a little, and went to lay by our another cat (a 14yrs old tabby), and got a tongue-bath from her as well. We started feeling better that he was recovering a bit, and that his weakness/no-appetite was probably just surgery after-effects. But that evening Gus had a urinary incontinence episode on the bed. We consulted with. Dr. B that evening, but Dr. B ignored the urinary incontinence episode. He focused on the fact that the biopsy report had indicated strong possibility of spreading Carcinoma in Gus’ intestines. Dr. B said that he had already consulted with his oncologist vet friend, and recommended starting chemo, Carboplatin infusion directly into Gus’ abdomen, starting Monday. I said yes – again without forcing Dr. B to give me pros/cons of the treatment, or asking to consult with the oncologist ourselves for any alternate options. (Mistake# 4!). Dr. B also suggested to start Gus on ¼ of ‘Mirtazapine’ tablet to help with his appetite next morning. So, on Sat morning, I force-fed about 2.5oz of Hill’s prescription diet A/D food to Gus, and mixed 1/4th Mirtazapine tablet in that food. A few minutes after eating, Gus started having some light tremors in his body, and his head was shaking visibly. In panic, I had the after-hours/weekend service page Dr. B. Dr. B called me back an hour later, and suggested to wait-and-watch, unless the tremors got worse. At this point Dr. B wasn’t still too concerned about our observations that Gus’ weakness had increased, and he was visibly having hard time walking to the water and/or litter box to pee. Still no advice on checking Gus’ blood-work to make sure that the biopsy surgery hadn’t deteriorated his condition, and no concerns about our mention of Gus’ progressing weakness. The after-effects of Mirtazapine sub-sided after a couple of hours, but it still hadn’t helped Gus with the appetite. I continued to force-feed Gus on Sat/Sunday (about 4oz of a/d food each day). What I was unware of at that point was that we should have been feeding a lot more quantity of a/d food to Gus. The online published guidelines (I found later) are about 2000 calories a day for ~12 lb cat, which would have been almost two cans of a/d food every day. On Sunday, Gus’s weakness had worsened, but trusting Dr. B’s feedback so far, I, once again did not rush Gus to emergency clinic for a check-up (Big Mistake# 5!). On Monday, the 4th March morning, Gus had lost weight, muscle mass, and was wobbling in getting to the litter-box. I was very worried at this point, but was hoping that Dr. B would check on him before the chemo appointment that afternoon. I took Gus in around noon to Dr. B. I was informed by his staff that he was running behind due to some urgent calls that morning, and he might not have time for a consultation before the chemo procedure on Gus. Once again, trusting Dr. B judgement, I agreed to whatever Dr. B suggested, and they took Gus in. As I was worried about Gus not eating, and had just found out about esophagus feeding tube from online browsing, I asked Dr. B’s staff to ask Dr. B about possibility of feeding tube for Gus. Three hours later. Dr. B asked me to his consultation room, and said that the carboplatin chemo/fluid-drainage/feeding-tube was all done, and Gus was recovering from anesthesia. He then mentioned that the fluid-drainage indicated lot more blood in the fluid than a week before, and that Gus’ CBC blood-work (that was done by him during past three hours) indicated severe regenerative anemia, with Hemocrit being only about 11%. The CBC Idexx report indicated lots of new immature RBCs being generated, and strong possibility of Hemolytic anemia, possibly due to his intestinal carcinoma spreading all this while in last week. He said that at this point Gus needed immediate blood transfusion to get to the point where any other treatment could be undertaken. While Dr. B was discussing all of this, he was also wrapping a bandage around Gus’ neck, and then he taped the hanging feed-tube folded-upward on that bandage. I went out for a few minutes to call work for time-off, and inquire clinic ‘A’ about blood-transfusions (was quoted $3300 with no guarantee of Gus surviving the transfusion process). I made up my mind to take the chance anyway, and went back in. At this point Gus had started vocalizing and becoming agitated, trying to jump off the kennel. His jaws were chattering and he was exhibiting chocking like symptoms. Dr. B was just standing there discussing how it might be too late for blood-transfusion, ignoring Gus’ loud vocalizing. In panic, I asked Dr. B technician if anything could be done to alleviate Gus choking condition, and he finally put an oxygen mask to Gus’ mouth, which seemed to calm him a bit. But his body was still convulsing. Dr. B started to check on his pulse, and said that his pulse was sinking. I told him that Gus seemed okay before the neck bandage was put on, and asked him to loosen it, He did that, but it didn’t help Gus. In my panicked state, I forgot to ask Dr. B to also loosen the feeding-tube that was taped upward tightly to that bandage… To this time, I have a lingering feeling that the feeding-tube’s getting taped up was what was Choking Gus, because my later browsing the Internet indicated that the death due to not enough red blood-cells carrying oxygen (hypoxia) is supposed to be relatively painless – like fading away in sleep!! I’d never know for sure! Seeing how Gus’ body was convulsing on the table, his hind legs frantically kicking, I desperately wanted to ease it, and asked Dr. B (who was just standing by, not suggesting anything – I guess, vets, having seen many deaths, get hardened enough to not be bothered by vocalizing/pain/suffering in pets on death-bed) about if we could give him any anesthesia. Dr. B then shaved Gus’s neck and gave him euthanasia injection, all this while Gus’s body suffering, fighting, struggling! I watched him pass way over next minute – that seemed like an eternity to my in-shock mind! I had never wanted Gus’s last time to be so full of suffering – When there was time for Gus to go, I wanted the vet to come to our home for euthanasia, and I had hoped, based on Dr. B’s feedback the last week after biopsy, that we should have at least two weeks, and more likely two months with Gus, after chemo treatment started. I was so in denial about Gus’s condition all last week – and seems like that every decision I took was the wrong one for Gus. Should have listened to the vet at ‘A’ and started Gus on steroids, rather than accepting Dr. B’s recommendation of biopsy surgery, that Gus never recovered from. I still don’t understand how Dr. B could have gone ahead with Chemo/fluid-drainage that fateful Monday morning, when he say how weak/fragile condition Gus was in. Why didn’t he wait for the CBC results before putting Gus under anaesthesia for chemo? Was it purely for the thousands of dollars that those procedures generated that day, or was it because he was rushed that morning, or maybe he truly believed it to be the best course of treatment at that point. I’d never know – I should give benefit of doubt to Dr. B. After all, me being responsible for Gus, I am the one who should have been more through about evaluating pros/cons of invasive procedures on Gus’ quality of life. I should have gotten a second opinion before agreeing to biopsy. I should have rushed Gus to emergency clinic after noticing his weakening condition last weekend. If I had done that, possibly the blood-transfusion would have saved him for now. In the end, it was the sequence of my decisions that not only ended up shortening remaining time Gus had, but also made it a horrific painful last moments for that little magnificent friend.
Sorry about the lengthy paragraphs. I sincerely hope that no one out there has to go through something like this – and that this would help someone in evaluating the invasive options more thoroughly.