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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 28573
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Hi My Cat is 17 years old... She has recently started losing

Customer Question

Hi

My Cat is 17 years old... She has recently started losing weight ( approx 2.90 kg ) she is still eating and drinking ( renal diet - pate ) she has a wee & a poo every day - both normal, no blood or diarrhoea. She vomits occasionally ( sometimes 2 times in 1 week - then nothing for several weeks/months - then she'll be sick again ) she has IBS.

She recently had an X-Ray & blood tests, which showed a slight rise in her kidney check (hence the Renal diet) - I forget the Vets exact words, apparently we caught it just in time??

Everything else came back ok - there was some gas in her large intestine - which was passing the food through too slowly, hence the weight loss & vomiting ( backed up food )

She's just had an ultra sound scan, and I get the results on Tuesday 11th Feb.

The vet mentioned pancreatic cancer / cancer ????

She has never shown any sign of being in pain and has no lumps... She's never had diarrhoea

Thank you,

Tricia
Submitted: 3 years ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 3 years ago.
Aloha! You're speaking with Dr. Michael Salkin
Tricia, while pancreatic cancer is a consideration when any 17 year old loses a profound amount of weight, another cancer that arises from IBD is more likely - a small cell lymphoma. While we do expect diarrhea with small cell lymphoma, some cats may only become inappetant or vomit. Her ultrasound was just the ticket. We're looking for changes in her pancreas but also bowel wall thickening suggestive of not only IBD but lymphoma. Abdominal lymphadenopathy (enlarged lymph nodes) would also suggest lymphoma but that finding isn't specific for lymphoma. Changes in her major organs (liver, spleen, e.g.) would be more likely with a lymphoma than IBD. It can be difficult differentiating the two at times and we would then need to scope and biopsy Customer or surgically explore her abdomen - neither of which I would be looking forward to doing at her advanced age.

We need to see the results of that ultrasound. Please return to our conversation with those results and please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.
Thank you Michael. I will let you know what the results say. Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you, Tricia. I'll await your next message.

I'll set a follow up for 3 days from now in case I miss you.
Dr. Michael Salkin and other Cat Specialists are ready to help you
Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you for your kind accept. I appreciate it.

I'll speak to you soon.

Please disregard the info request.
Customer: replied 3 years ago.
Hi Micheal

I got Customer's test results back today.

She now weighs 2.92kg - so has not lost anymore weight :0)

She has not been sick for 15 days now ( on the renal diet )

Wee & poo still normal.


The Vet said:

There is a slight change to her Liver & slight thickening of the bowl wall.

Her lymph nodes are fine - no concern with them.

I've got to take her back in a Month, to have a blood test - to check for any changes.

The Vet said that she is stable, and seemed kinda happy for now.

She wants me to go ahead with the Biopsy - I asked if it was safe for her age & the Vet said it will be a light anesthetic & should take half an hour max

The Vet did mention IBD in conversation?

Thank you,

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you, Tricia, for the additional information. All in all, it sounds good. Can you tell me, please, what her vet is planning to biopsy - her liver?

IBD in conversion means that her IBD is transforming into small cell lymphoma as I alluded to in my initial response to you. Keep me posted, please?
Customer: replied 3 years ago.
Hi

Sorry! It's a lot of information to take in... She mentioned the endoscope, and having a look for any abnormalities - which she will then biopsy??

I feel that the Vet wants a clearer picture of what's going on with her liver & intestines etc.

I wasn't given a print out of her results.

The vet mentioned possible steroid injections, (if needed in the future) depending on the results of the scope.

Sorry, I can't be any clearer.

Do you feet that her health will be manageable, as I'm not one for allowing an Animal to suffer?

Thank you,

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Ah! Good. I was most interested in her intestines. Steroid injections might be of value for an IBD but would only be palliative if small cell lymphoma has arisen. Lymphoma tends to become refractory to steroids within 30 days although some cats benefit indefinitely.

We'll need to see the results of the scoping and biopsy to know how manageable her health will be. I'd be pleased to discuss those findings and their implications with you once you receive the report. I'll set a follow-up for a week from now.
Customer: replied 3 years ago.
Thank you Michael.

Unfortunately, the scope/biopsy costs £800 - so I will need to save. It could be a couple of Months yet.

The blood test isn't until March.

You have been a huge comfort though, it's always nice to have a second opinion.

I will give you the results, I just don't know when. Sorry!

Thank you for everything so far :0)

Kind regards,

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
I understand. I'll check in with you in a month as a courtesy.
Customer: replied 3 years ago.
Thank you Michael, that's very kind :0)

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Speak to you soon!
Expert:  Dr. Michael Salkin replied 3 years ago.
May I have an update on Customer, please?
Customer: replied 3 years ago.
Hi

Of course... What would you like to know? She's waiting for her next feed at the moment.

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Oops. My email check-in malfunctioned. I thought I set it for a month from now. Mea culpa.
Customer: replied 3 years ago.
No worries :0)

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Speak to you later!
Customer: replied 3 years ago.
Hi Micheal

I just wanted to get back to you before Customer's appointment on Tuesday as I want to ask the Vet about having Customer put to sleep.

Since we last spoke Customer has been sick nearly everyday and sometimes 2 times a day - froth & bile sometimes included.

She has gone whole days without a poo or a wee - but when she does they are both normal.

She is refusing to eat the renal diet - so I'm having to give her normal cat food once a day, just so she has some food in her stomach.

She is constantly crying for food.

I can see that she is loosing weight - I can clearly feel all her bones.

In herself she seems fine, but it's breaking my heart - she sits and stares into space throughout the day, and she's constantly changing her position when sleeping.

I have noticed that her walking has changed slightly.

I'm worried that the Vet will try and talk me out of it with offers of medication - but I'm thinking of a year down the line.

Will Customer actually get better or just slowly suffer on with pain relief?

I really don't want her to suffer - it's really horrible watching her being sick all the time.

Thank you

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Oh my. I'm sorry to hear of Customer's decline. I admit that I would need to see current test results to be most accurate for you but just hearing of her quality of life since we last spoke prompts me to have you seriously consier euthanasia.

One thing stands out in your last post: "She is constantly crying for food." This isn't consistent with a cat in either renal or hepatic failure. It is seen, however, with hyperthyroidism which also will cause hypermotility of her gastrointestinal tract and her frequent vomiting. My concern, then, is that hyperthyroidism was underdiagnosed when we first spoke and you mentioned that her blood tests were OK except for a "mild rise in her kidney check".

Any T4 (total thyroid blood test) of 2.0 or higher at her age suggests hyperthyrodism. Please go back and review that test result from 07/14 and seriously consider rechecking the T4 now. Let me know what you find, please.
Customer: replied 3 years ago.
She loves her food, but doesn't want to eat the renal pate anymore. So she is really only getting one meal a day now.

The Vet asked me to stop giving her normal cat food, as it is high in protein.

But I need her to eat.

I just feel at a loss.

I will ask the Vet about her Thyroid test.... But, the Vet assured me that it was fine.

Customer has never allowed me to give her medication, and knows when it is in her food.. So doesn't eat it.

I use to get the Vet to give her worming tablets, as Customer would bite and scratch me, so I don't know how I am gonna give her tablets if needed???

I really don't know what to do for the best, as I feel that whatever the problem is, she will still be suffering????????

I don't feel that it's fair for another year or two of life. If she was younger than maybe, but not 17 yrs old.

Tricia

Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you for the additional information, Tricia. If she were seriously hyperthyroid she'd eat the renal pate'...and anything else that didn't eat her first.

I understand your constraints. If she happened to need thyroid medication it could be applied transdermally - you rub it into the inside surface of her ear flap.

Quality of life is the issue. If she's not able to do "cat things" anymore, if she's not having fun anymore, if she continues to fail and can't be medicated even if we could find something treatable, it's time to consider euthanasia.
Customer: replied 3 years ago.
She can still walk & jump on and off things... She's never really been one for playing, she bores easily. She is an indoor Cat, never wanted to go outside. She does sleep a lot (when she's not asking for food)

Lately she has become very cuddly and will sit on my lap for a short while. She prefers to sit in the same room as you, rather than sit on you. If you leave a room to sit in another, she will follow you in.

So may I ask, do you feel that I should ask for her Thyroid to be checked again or ask about euthanasia? Sorry!

It's just with her Liver & Kidneys changing, the thickening of her bowl wall & the gas in her large intestine I'm slightly confused.

Thank you

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
Yes, Tricia, at her age Customer will have multiple disorders to consider. Even if she were hyperthyroid at this time, treatment won't address all of those disorders and, in fact, treatment would worsen her kidney function.

You have a difficult decision to make at this time, I know. Euthansasia is certainly reasonable. For your piece of mind, ask your vet once again if hyperthyroidism should even be considered at this point.
Customer: replied 3 years ago.
Thank you Michael - I really do appreciate your honesty :0)

I will talk to the Vet on Tuesday, but I do feel that euthanasia is the kindest option now.

Thank you so very much for all your help, it's been appreciated.

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
You're quite welcome. I'm going to check back with you in a week for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.

Customer: replied 3 years ago.
Thank you Michael
Expert:  Dr. Michael Salkin replied 3 years ago.
(mod close)
Customer: replied 3 years ago.
Hi Michael

I just wanted to let you know that I had Customer put to sleep today.

I saw a different Vet, and he agreed that it was the best thing to do.

Customer is at peace now.

Thank you so very much for your honesty and professional opinion. Some times you just need people to give you an honest answer.

I really do appreciate that.

I read up on a lot of other peoples stories, about their Cats, and guessed that eventually Customer would experience similar problems as she got older.

I didn't want to think of her suffering.

Thank you again

Kindest regards

Tricia
Expert:  Dr. Michael Salkin replied 3 years ago.
My condolences for your loss of Customer. She was lucky to have you.

I appreciate your taking the time to let me know. You may receive an inappropriate follow up from the site ostensibly from me. It wasn't and I apologize in advance should you receive it.

Please disregard the info request.
Customer: replied 3 years ago.
Thank you Michael, it's kind of you to say so. She had a good life.
Expert:  Dr. Michael Salkin replied 3 years ago.
Indeed she did.

Be well.