Large liver and spleen.

Dr. Marie replied:

I'm sorry to hear that Wyatt is not doing well. You didn't ask an actual question so what I will do is help to interpret what the results tell us. However, there really isn't anything specific in any of these results.

We don't worry about ALP level being lower than normal.

For the neutrophils, we don't really look at the percentage but rather the absolute number. Do you see something x10^9/L? This number will tell us more about whether there is inflammation and possibly infection present.

A normal Spec fPL tells us that pancreatitis is unlikely.

On the xray we can see that the spleen and the liver are a little enlarged but we don't know why. It's normal to see gas in the stomach and small intestine, especially if the appetite has been decreased. I'm not worried about a round bladder. The trigone is just part of the bladder.

The ultrasound confirms that the liver and spleen are bigger than normal but it doesn't give us an idea as to why. The pancreas has some cysts in it. Now, it's possible that this is something serious like a cancer, but usually if that is the case then we should see an increase in the Spec fPL. Those cysts may just be nothing. "No ascites" means that there is no fluid in the abdomen and this is a good thing.

I'm a little concerned about the two enlarged mesenteric lymph nodes. When lymph nodes are enlarged it usually means that there is either infection or cancer.

I'm not sure what the indented area on the kidney means. The dilation of the pelvis of the kidney doesn't really tell us much either. It's not uncommon to have debris int he urine. It could be some inflammation, or crystals but probably isn't connected to his current problems.

Now, I can't officially interpret these results for you. Your vet will be the best resource for you as far as that is concerned. However, I can give you my thoughts. I'm concerned by these facts:

-The spleen and liver are enlarged
-There are two big lymph nodes in the abdomen
-There were lymphocytes found on the aspirate of the spleen

This makes something like lymphoma a possibility. Lymphoma is a cancer that could be affecting the spleen and the liver and the lymph nodes as well. Many cats with lymphoma can do well with chemotherapy.

There are other possibilities. An infection could possibly produce these symptoms and if this is the case then antibiotics would be very helpful.

Inflammatory bowel disease could possibly be the cause as well but is less likely.

Let me know if that helps, or if you have more questions.

Dr. Marie.


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Dr. Marie replied:

Thanks so much for the bonus...it is greatly appreciated!
It is a tough call to decide on how to treat from here. I won't be able to tell you for certain what to do, but I'll give you my thoughts on what I would be recommending if this was a case of mine.

So most likely we are dealing with either lymphoma or some type of IBD (that is also affecting the pancreas.) If this is IBD then yes, steroids will likely help significantly. Steroids help to shrink inflammation. If they work for Wyatt then your vet will likely keep him on them long term. Eventually the goal would be to get him on the lowest effective dose which is often just given every other day.

Now, what if this is lymphoma? If it is, we may see some improvement on steroids. The steroids can shrink some of the inflammation associated with the cancer and he should feel better. However, if this is cancer then the improvement will just be temporary and he will start to get sick again. This could be in a few weeks or a few months.

If you are at all considering chemotherapy, then it could be harmful to start steroids first. Many chemotherapies don't work well if steroids have been on board to start with. Many people get frightened by the word "chemotherapy" but cats actually handle this really well. There are a few drawbacks though. First of all, we would need a diagnosis and this means taking a surgical biopsy of the spleen. Also, to get chemotherapy you may need to see a veterinary cancer specialist. Neither of these are particularly hard on Wyatt, but you will need to decide whether the extra cost is feasible for you.

If you are not willing to pursue chemotherapy, then most likely giving steroids is a good idea. (Ultimately though you need to go with the advice of your vet.)

I think it was worthwhile stopping the antibiotics to see if they were the cause of the appetite loss. However, as there is a slight increase in neutrophils it may be worthwhile to start them up again. High neutrophils can mean infection. (But they could also just be there because of inflammation from cancer.)

Cases like this are difficult because we don't know exactly what we are treating. I hope this information helps, but let me know if you have more questions.

Dr. Marie.

Dr. Marie replied:

I think infection is really not that likely from what you have described. Checking his neutrophils could help but it could also add more confusion. If they are still high then we don't know if they are high because of infection or ongoing inflammation. There are really two ways to go here: 1. cover him with antibiotics just in case, or 2. just do the steroids and if he is getting worse or if the fever is returning then start antibiotics.

There really is no other way to confirm lymphoma. Sometimes we can get a diagnosis on the initial aspirate, but if the pathologist is recommending a surgical biopsy then unfortunately this is the only other option if we want a diagnosis.

One other thought I had was that you could ask your vet for a referral to a veterinary oncologist (cancer doctor) if there is one in your area. These doctors have the most experience with helping differentiate between lymphoma and other conditions. However, they are likely to want the biopsy as well.

Dr. Marie replied:

Oh dear. This doesn't sound good. It is likely not the medicines that are causing him to refuse to eat. None of these really should upset his stomach. In fact all of these meds should really help his appetite.

The Mirtazapine is usually a really good appetite stimulant and I get really concerned when a cat refuses to eat even after having this.

I think we are getting to the point where we have some hard decisions to make. Your vet will likely give you some options but from what I see here you have three options:

1. Be proactive and do an exploratory surgery to determine for certain if we are dealing with cancer. There is a small chance that we might find something on surgery that could be surgically repaired. Or, it may be obvious that he has significant cancer problems and euthanasia could happen on the table. Or, we could take biopsies so we can get a diagnosis and possibly pursue chemotherapy.

2. Continue with the medicines and see if he improves.

3. Talk to your vet about inserting a feeding tube. This sometimes will help to get a cat eating again if we can get some nutrition into him.

4. Start thinking about euthanasia.

From what you have written it is not looking good. I wish I had better advice for you.

Dr. Marie replied:

This is always a tough question to answer. Unfortunately in almost every case if a cat is not doing well I recommend euthanasia rather than letting them die naturally. Cats can hang in there for a very long time without food. I have seen cats go weeks without food and by the time they were brought in for euthanasia they were in very bad shape and had suffered for weeks.

Additionally, if cats are really sick we often don't have a nice peaceful death at home. We will commonly see seizures, repeated vomiting and severe breathing issues as the end nears. It is not pleasant.

I'm so sorry to be so graphic, but I have seen it many times that someone has tried to avoid euthanasia and then comes rushing in with an animal in horrible distress.

Your vet will help you decide if it is time, but if it is, hopefully you can manage to do euthanasia. Many vets will do home euthanasia if this is something you wish. Or, if you feel that you simply cannot be present the vet will be ok with doing the euthanasia without you present. This is ok as well. Wyatt will likely be well sedated and will not know what is happening.

Dr. Marie replied:

The fPL is quite high. This tells us that there is *something* going on with the pancreas. However, it could be pancreatitis or it could be a pancreatic tumor.

The ALT is a little high, but it's really not that bad.

The glucose is quite high as well. We sometimes see high glucose with stress, but it could be that he is developing diabetes. I have seen some animals develop diabetes because of a severe pancreatic problem. Your vet will likely want to check a urine sample to see if there is glucose in the urine which will tell us about diabetes.

He is also quite anemic (low on red cells.) This could mean a number of things...possibly bleeding into the abdomen or that his body simply isn't making enough.

It's hard to say where to go from here. It is good that he is eating better. I would likely keep doing what we are doing and recheck some bloodwork in another week if this were my case.