My mother's cat, Jasper, has suddenly taken a turn for the worse. To give you a potted case history, he had a tumour removed from his lower back in the autumn of 2013 and made a good recovery. He was tested and scanned to see if there were any tumours starting internally. The vet said they couldn't be 100% sure because there could be minute cells starting, but it looked clear and he seemed to be well and lively. After a while, we began to notice blood being passed in the urine and the cat was spending long minutes on the litter tray trying to pass urine, or sometimes jumping into the kitchen sink. He was put on antibiotics (injected, to last a fortnight), and after a few days, the blood being passed had reduced to just a few spots. After naother week, though, the blood came back a bit more, in small amounts, and he was put on another course of injected antibiotics. We were told it was probably a stubborn case of cystitis. We were also given Metrecam again, for pain and as an anti-inflammatory, set at 0.3 dosage per day in his food. He often wouldn't eat the food after the drug was administered. So I began to give him the Metrecam by syringe down his throat. He didn't like it, but anticipated a meal afterwards, which I always gave unless his dish was already full, and he would eat a little, but with relish. But my mother's carers often emptied his dish and gave him fresh food, so it was hard for me to keep track of how much he was eating. After a second visit to the vet and another injection of antibiotics, I continued to give him the Metrecam, as instructed, although this time the dose was given as 0.5, even though he had lost a little weight. I was puzzled by this, but did not query it, other than to ask the vet to repeat the amount to me. After a week, puddles of blood began to appear, especially in the mornings, and he was not eating much at all, although I did not know this at the time, since I usually see my mother in the afternoons. I was still giving him the full dose of Metrecam each day. Last Friday he was quiet but seemed very contented and came and sat on my lap, purring. But on Saturday he seemed off-colour. Yesterday, Sunday, he was crawling under furniture, coming out only to try and urinate in the tray, but leaving little except spots of blood. He would walk a little way and then lie down on his stomach or roll on to his side. I became very alarmed and suddenly had the awful suspicion that the Metrecam might have been doing some damage. I then read the enclosed description in the box and was horrified to see strong warnings of adverse reactions such as renal failure and hemorhaging. This morning I went over first thing to take him to the vet's once more and he was in a very sorry state, scarcely able to lift his head. He put his tongue out several times as if lapping, suggesting to me that he was seriously dehydrated. The vets have put him on a drip and wrapped him to warm him, as he is very cold, with very anaemic gums. He has probably starved and not drunk anything either for two days or more. They are holding out very little hope for him, as they have also palpated a gol-ball sized mass in the bladder (which was apparently not there last week after a similar examination). So I have one or two questions: 1) Could the mass in the bladder be stones instead, perhaps blocking the urethra, and if so, can an operation clear them out, or at least remove the blockage? 2) Could the Metrecam, which I administered every day with the very best intentions, even when, unknown to me, he had stopped eating and drinking, have caused this sudden drastic collapse? I thought I was helping him, but I strongly feel that I may have brought on the now excessive bleeding, anaemia and general collapse. The vets are saying his prognosis is very poor, half-heartedly mentioning the possibility of a blood transfusion, but at another animal hospital some distance away, and suggesting that little can probably be done for him even after the transfusion. So we are faced with the prospect of having to have him put to sleep. Jasper is almost 15 years old and has been an affectionate companion to my elderly mother all that time. I want to be sure I am doing the right thing by him. I don't want him to suffer, but also, if the cause is the Metrecam (which my veterinary practice dismisses), can't the adverse conditions be reversed? Please give your professional advice and opinion of the options. Many thanks, XXXXX XXXXX
Hello Janet, I'm Dr. Deb.I recently came online and see that your question about Jasper hasn't been answered. I'm so sorry that you've had to wait for a response but if you still need assistance, I'd like to help if I can. This is an incredibly sad situation with your mom's cat, all things considered.If this had been my case, I would have suspected something a little more serious than just a stubborn or prolonged case of cystitis in a cat this age.The possible explanations are going to be either a bladder stone or bladder cancer, I'm sad to say. An x-ray may have helped rule out a stone but an ultrasound would be the better diagnostic tool to evaluate not only the bladder but the kidneys and other internal organs as well.
To address your first question, yes, bladder stones can be surgically removed; however, he is not currently a good surgical candidate for such a procedure in his debiliated state...but I'm certain that you know this already.Bladder cancer has a much less optimistic outcome since most masses tend to be located at the trigone area (where the urine exits the bladder) and are often not surgically resectable.Question #2: Here in the States, Metacam carries a label which the FDA mandated that warns against repeated doses in cats. I don't believe that such a label is required in the UK or in Europe. Therefore, repeated use of Metacam in cats in somewhat controversial here since it has been associated with renal failure and death, unfortuantely.Often the damage done to the kidneys is permanent such that discontinuing the drug will not reverse this damage, I am very sad to say.Other side effects seen with this drug include anemia, vomiting, diarrhea, inappetance and lethargy as well as behavioral changes. It's not a drug that I ever use in older cats these days although I have done so in the past with no consequences. I was probably just lucky that none of the cats who took it developed significant issues. It's going to be difficult to know for sure how much the drug contributed to his deterioration although it certainly could have played a role. If he has bladder cancer ...obviously the worse case scenario....then his prognosis is not good, I am sad to tell you, even if he has a blood transfusion. Use of Metacam might be implicated in a faster decline but cancer overrides whatever role it might have played, if that makes sense.In my experience, the cats I've ultimately diagnosed with bladder cancer (and it's not always the easiest diagnosis to make in the early stages without an ultrasound) typically will live one month or less after the diagnosis has been made. I've had some success with Yunnan Bai Yao which is an herbal anti-coagulant which can help if this is bladder cancer which is bleeding quite a bit. The dose would be 1/2- 1 capsule once daily. It's available on the internet at the following suppliers: Jing Tang herbal (tcvmherbal.com) or A Time to Heal Herbs ( http://atimetohealherbs.com/ ) or Mayway (800-2MAYWAY).Of course, if he's very anemic, then he might need a blood transfusion first.Personally, if this were my cat and I knew he had bladder cancer, then I wouldn't put him through additional procedures at this point. I would try to make him as comfortable as possible but if he's as debilitated as you indicate, I'd most likely made the difficult decision to euthanize him. I know this would be an incredibly difficult decision but it might be the selfless thing to do, under the circumstances.I know you feel absolutely horrible about the way things have transpired but you were relying on your vet and following their instructions. You couldn't have known that Metacam carries the possible side effects that it does. However, if he has as serious an underlying condition as I suspect, then the use of this drug didn't cause it...it may have caused his decline a little sooner however, but this is something that we'll never really know for sure.However, if he has bladder stones, then one might convincingly argue that Metacam contributed to his current situation. Bladder stones don't cause sudden collapse or anemia or anorexia or a weakened state.I hope this helps although I'm heartsick for both you and your mom about this situatoin with Jasper. Deb
Hello Dr Deb,
Your answer was excellent, no question about that. But I had to make a decision that day, and unfortunately had to leave the college (I'm a teacher) before receiving your reply. I did have Jasper put to sleep.
I was told by the vet when I went in to be with Jasper beforehand, that he had been given pain killers and was comfortable and not suffering. He was unable to move at all, even to raise his head or focus his hugely dilated eyes. I stroked him very, very lightly, and was appalled by his response. He let out the most agonised scream I have ever heard. Obviously, he was not pain free at all. That sound will live with me for the rest of my life.
I have been waiting to get back to you again, because I gather that I can ask a further question, but I understood that it had to be before a rating was given, and before the issue was closed. To do that I need the results of the autopsy I requested to be performed on Jasper. I don't think now that I will get them before Monday. I will be back in touch as soon as I can. Thank you for your help in assessing the situation in such a clear, compassionate and balanced way, which I greatly appreciated. I will be back in touch as soon as I get the report.
Oh, Janet; I'm so sorry to hear about Jasper:( I was afraid that this might be the decision that you had to make although I'm certain that it wasn't an easy one for you and your mom to make.And, to have his last moments with you turn out as you describe is even more heartbreaking. You can ask as many questions about this situation even after you've rated (if you do, of course) but I'm obviously fine with whatever you want to do.I'm glad that I could help although I very sorry for the ultimate outcome.I would be interested in hearing the autopsy results and will respond back to you as soon as I can once you post them. My sincerest condolences to both you and your mom on your loss. Regards, Deb