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Dr. Joey
Dr. Joey, Board Certified
Category: Cat
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Experience:  15 yrs in practice, specialist canine/feline medicine
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Cat with a diagnosis of lymphoma. Symptoms being managed and

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Cat with a diagnosis of lymphoma. Symptoms being managed and cat has low red blood cell count but genuinely seems to want to eat but when he does he seems to do this with his front teeth and the food can fall out his mouth. Swallowing does not appear to be a problem. He showed previous signs of this when he had an ear infection recently but symptoms resolved as infection cleared. Vet checked ears recently and said they were ok. Any ideas if this might be related to something else. We want to give him the best quality of life that he can have in remaining time. Do you think this could be related to teeth or gums or his jaw? The symptoms stopped post the ear infection but have returned.
Submitted: 3 years ago.
Category: Cat
Expert:  Dr. Barbara replied 3 years ago.

Dr. Barbara :

Hi, Welcome to JustAnswer. I'm a licensed veterinarian and I'll be happy to help. I'm so sorry to hear that Sam isn't feeling well, and has lymphoma. Regarding his eating, this could be due to the lymphoma, to the medication he is on for the lymphoma, due to sore teeth and/or gums, or due to other organ disease (especially kidney disease).

Dr. Barbara :

I do have a few questions to ask in order to assist you more thoroughly. . .

Dr. Barbara :

1. Where is Sam's lymphoma located? Is it just in the intestines, or are his peripheral lymph nodes enlarged?

Dr. Barbara :

2. Has your vet thoroughly examined his teeth and gums in the back of his mouth and said that these are not the cause?

Dr. Barbara :

3. What medication(s) is Sam on?

Dr. Barbara :

4. Has your vet run a blood profile to check his organ function (liver, kidneys, etc.)?

Dr. Barbara :

Your answers should be quite helpful. I'll be checking back here frequently.

JACUSTOMER-ucgb3u6z- :

-His lymphoma was in his Colon and was removed in May and his lymph nodes were not impacted.

JACUSTOMER-ucgb3u6z- :

-His teeth were examined a month ago but the symptoms did not appear to be present at that time.

JACUSTOMER-ucgb3u6z- :

-Prednisolone and Fortecore for kidney disease. His kidney function is impaired but early stages of deterioration.

JACUSTOMER-ucgb3u6z- :

-Yes- this showed a deterioration in kidney function and his red blood cell count had dropped to 15.

Dr. Barbara :

Thanks so much for your response. I think it is highly likely that Sam's problem lies with his kidneys. As the Bun, Creatinine and phosphorous build up in the blood because the kidneys aren't removing these as they should, these become toxic to the body, inflaming the stomach lining which causes nausea and decreased appetite. These toxins can also cause oral ulceration of the gums and tongue and lining of the mouth, which of course can also decrease the appetite.

Dr. Barbara :

Another major function of the kidneys which decreases with disease of the kidneys, is their production of erythropoetin which stimulates the bone marrow to produce red blood cells. With this decrease, the cats become more and more anemic.

Dr. Barbara :

Fortunately, there are several things to do to help our cats with chronic renal failure to feel much better.

Dr. Barbara :

The first goal is to decrease the toxins. This is done with fluid diuresis (pushing fluids), and by helping Sam eat a diet formulated for cats with kidney failure. Your vet will have these, and there are several so Sam can choose which one he likes best. Of course, it is important to do a gradual switch to any new food. Also, if Sam won't eat the new food entirely, then mix as much of the new food in with his old food that he will eat. This will also decrease the proteins and phosphorous that he is ingesting.

Dr. Barbara :

Fluid therapy can be done with IV fluids in the hospital, but if Sam would feel better with subcutaneous fluids which you can be trained to give at home, this would avoid his having to be in the hospital. I have lots of clients that give fluids once to five times weekly. . .whatever the cat needs. Most clients have balked at this at first, but all learned to do this procedure quickly and painlessly (for all involved :)! ).

Dr. Barbara :

Erythropoetin which the kidneys normally produce, can be given by injection at home. . .again very learnable. At first you give this 3 times weekly, but then you'll decrease to once or twice weekly and can be off of this sometimes for awhile.

Dr. Barbara :

For awhile until the fluid therapy can decrease the toxins, Sam may also need stomach protective drugs and an antinausea drug. . .this just depends upon his needs.

Dr. Barbara :

Sorry to be so windy! In direct answer to your questions: Yes I do think that his decreased appetite is due to his gums and mucous membranes of his mouth. Also, I really do doubt that this is due to his ears.

Dr. Barbara :

I have an appointment that I have to run to, but I will be back online in a couple of hours. I imagine that you will have several questions, and I do want you to know that I will be back. Dr. Barbara

JACUSTOMER-ucgb3u6z- : His appetite and fluid intake is good. He is just struggling with the physical act of eating as the food falls out his mouth. He has not lost weight recently and he is in the very early stages of renal failure and has kidney food. Any advice as to whether this could be a problem with his mouth as it looks this way. He wants to eat but a lot does not get swallowed and falls out his mouth. This seems to be a mouth or jaw problem not a swallowing problem. It manifested before when he had an ear infection but settled when this was treated. Could it be linked to his jaw?
Dr. Barbara :

Hi,

Dr. Barbara :

It would be possible for him to have a jaw problem that is painful. . .but not very likely. This would likely require sedation for a full examination of his mouth and for skull xrays if the exam indicates this.

Dr. Barbara :

Has your vet told you why Sam is so anemic? This is often in older cats due to chronic kidney failure and that is why I headed in that direction. When an animal is anemic it is due to RBCs (red blood cells) not being produced in the bone marrow, being destroyed in the circulation. . .like blood parasites, or loss through bleeding tumors, or trauma. Sam's anemia is pretty severe.

Dr. Barbara :

Also, cats really tend to hide their illnesses in order to not be preyed upon. . .this is part of their nature. So, often people think their cats want to eat and can't, as opposed to the appetite actually being decreased by some disease. Cats in this way accomplish exactly what they intend. . .they seem healthy and therefore poor prey. This might be what is going on for Sam?

Dr. Barbara :

Good morning,

Dr. Barbara :

I've been thinking alot about Sam and wonder how he is doing? Have you had your vet look at his mouth? Does he have oral ulcers and inflammation?

Dr. Barbara :

Dr. Barbara

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