? Black may be approaching end - opinions on labs?

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The only other thing I can think of is cancer but labs don’t even show inflammation. Has he ever had an ultrasound?
 
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tiffmaxee said:
The only other thing I can think of is cancer but jabs don’t even show inflammation. Has he ever had an ultrasound?
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They didn't offer an ultrasound which I thought was weird. Once the vet saw the TBIL and ascites he went straight to euthanasia.
 
tiffmaxee said:
It’s absurd that we need to have to go to Dr. Google but read this.
https://wagwalking.com/cat/condition/ascites

X-rays, ultrasound could help diagnose but it will be costly. Could he anything from cancer to heart disease.
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That's more or less what the vet said, which is why he didn't want to go any further. He didn't think the heart was bad because he didn't detected a murmur and it sounded fine, so he thinks it's a liver "something" but didn't offer to do an ultrasound, he basically told me if I want that i'll have to go to an emergency (in this case, VCA)
 
VCA gets a bad rap but not all are the same. My wonderful vets sold to a corp that then sold to VCA. They are just as they used to be prior to the sale except the prices are even higher and they were always high. It’s a very busy and lucrative practice so they are able to run the office as always. Other VCAs are a nightmare.
 
tiffmaxee said:
VCA gets a bad rap but not all are the same. My wonderful vets sold to a corp that then sold to VCA. They are just as they used to be prior to the sale except the prices are even higher and they were always high. It’s a very busy and lucrative practice so they are able to run the office as always. Other VCAs are a nightmare.
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The VCA by me does seem to be...a nightmare. It's my last resort.
 
If the ultrasound reveals a 'mass' don't get freaked out and think cancer. On two cats and a dog an ultrasound led to a needle biopsy. Two were inconclusive and one led us to believe our dog would be dead by Christmas. Almost a year later we found out the dog had a stomach cyst. Thanks again VCA.
 
Noah & me (GA) said:
If the ultrasound reveals a 'mass' don't get freaked out and think cancer. On two cats and a dog an ultrasound led to a needle biopsy. Two were inconclusive and one led us to believe our dog would be dead by Christmas. Almost a year later we found out the dog had a stomach cyst. Thanks again VCA.
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I think the issue is that they take his age (18 1/2) and just think it's not worth treating.
 
Leroy fell out of a third floor window into a snow bank, hit by a car and broke his jaw, walked across a tea light candle and just flickered a bit. Then took connecting flights over 6 hours to his new home here. He lived just past 23. Every cat is worth some kind of treatment, "forever" doesn't mean until it's no longer convenient. You knew that already and we know you'll do what's best. It's obvious to everyone you love Black and he knows it too.
 
zerovector said:
Initially when I started him on insulin, he gained weight (1.5lbs) and his fur looked better. Nevertheless, his numbers never stopped bouncing, then I started noticing a reversal in his weight. He finally made it back to the weight he stared at when we began insulin, and then I noticed another thing - his skin was yellow. I rushed him to the vet.

The vet, while thorough and knowledgeable, didn't have the best bedside manner. He believes Black is in some kind of end stage liver failure. The recommendation was immediate euthanasia. I didn't want to do this, because in regards to his quality of life so far it's fine. He's eating (he always has a strong appetite), drinking, using the litter box, enjoying cuddle time with his favorite person. He doesn't seem to be suffering. That being said, this is the list of symptoms and key lab notes

Ascites (not enough that I could see it, this was discovered via x-ray)
Jaundice
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TBIL - 12.7 u/l
ALT - 406 u/l
RBC - 5.81 10¹¹
HGB - 8.6 g/dl
HCT - 24.78%
AMY - 1315 u/l

The vet indicates that there is no way out for him at this point. It just also felt cruel to end him right then and there without being able to spend any time with his favorite person. I am crushed over this, and am not sure what to do.
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Can you please provide the reference range for these labs? I would like to see it. I cannot believe, from what you describe, that this is the end for your cat. I have had cats with very high liver enzymes who benefitted from a liver supplement. Liver enzymes came down within a month and continued to drop into normal range. Please don’t give up on your cat yet. I have more to say, but I am still ruminating on your message so I will post another time. Sorry it took me so long to respond. I just saw this tag. It’s not enough that one of my cats has heart failure but today I have been at the vet all day with another cat who cannot use the right side of his body. It never rains, it pours.
 
zerovector said:
I will. I'm taking him to a walk in vet at 1:30 and will request an ultrasound.
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I am glad for an ultrasound. But I have also had cats who have had “suspicious “ or “hyperechoic” and also “hypoechoic” findings in their organs- particularly their liver…. Which led to a biopsy that fortunately did not reveal cancer.
 
Suzanne & Darcy said:
Can you please provide the reference range for these labs? I would like to see it. I cannot believe, from what you describe, that this is the end for your cat. I have had cats with very high liver enzymes who benefitted from a liver supplement. Liver enzymes came down within a month and continued to drop into normal range. Please don’t give up on your cat yet. I have more to say, but I am still ruminating on your message so I will post another time. Sorry it took me so long to respond. I just saw this tag. It’s not enough that one of my cats has heart failure but today I have been at the vet all day with another cat who cannot use the right side of his body. It never rains, it pours.
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It's okay - here are the full labs from Friday

https://i.imgur.com/GlpLYPD_d.webp?maxwidth=640&shape=thumb&fidelity=medium
 
Suzanne & Darcy said:
I am glad for an ultrasound. But I have also had cats who have had “suspicious “ or “hyperechoic” and also “hypoechoic” findings in their organs- particularly their liver…. Which led to a biopsy that fortunately did not reveal cancer.
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This place also didn't dovan ultrasound - he also thinks Black is on borrowed time because of how bad of a shape he's in
 
Suzanne & Darcy said:
But is he on borrowed time? Is he in bad shape? You say he is still eating well? It doesn’t make sense.
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He is eating very well, but despite all that he's lost weight, he's extremely jaundiced, his TBIL is through the roof and no one knows exactly what caused it but seems to be complete, or near complete livet failure
 
zerovector said:
He is eating very well, but despite all that he's lost weight, he's extremely jaundiced, his TBIL is through the roof and no one knows exactly what caused it but seems to be complete, or near complete livet failure
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If my cat were still eating and supposed to be in liver failure, I would start him on Nutramax Denamarin supplement immediately before I gave up.
 
Back from the vet. I was given some hail mary treatments, but he doesn't feel black has much more than a week in this state. I was prescribed the following -

B12 shot
Denamarin
Cobalequin (I'm not sure why)
Ursodiol (primary biliary cirrhosis)
also Subq fluids.

I should mention, Black absolutely hated subq fluids. I do his BG numbers all day and he has no issue, he doesn't mind shots - but that needle gauge is enormous and he didn't like any part of the process. I've been asked to do this twice a day. I've never seen him struggle against something like that, he's the mellowest cat you could ever ask for.

Ultimately I don't know more than I did this morning except that the last vet's assessment of 3 days may have been too short, this vet thinks a week at best.

Did a T4 for the fun of it, it's normal as it always is.
 
I think the Ursodiol is also a good idea for gallbladder. As for sub-q fluids - the vets use hugs needles- I call them harpoons. The gauge they use is very large. I never use larger than 19 at most. I prefer 20 gauge needles for that. It takes a little longer to flow, but it’s worth it. Warming the fluids also helps.
 
zerovector said:
I wonder if I can get those in time. Now he seems confused after the vet visit.
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:bighug: May I ask what prompted the vet visit? Was it the Jaundice? I’m sorry that I missed the previous condo, I think? I belong to a group for cats with chronic kidney disease and there’s many a time when we have to just tell people to “ignore the numbers and just look at the cat” or “treat the cat and not the numbers.” So all that means is to ignore what the vet says about how much time he has left. Nobody knows him as well as you do. They don’t know what he is like at home. We see cats on that group with really bad lab work who “shouldn’t be doing so well with those numbers.”
 
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May I also ask how much fluid you are giving him? How many mL? Is it Lactated Ringers solution?You said twice a day? How much does he weigh?
 
zerovector said:
I wonder if I can get those in time. Now he seems confused after the vet visit.
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Can you go to the vet and ask them to give you some smaller needles- 20 gauge and 19 gauge. Placing the fluids in a large bowl/pan of hot water - keeping the ports and fluid lines out of the water - can warm them and make it more comfortable. Always run some out of the line (first you have to get the non-warmed fluid out of the line anyway) and be sure to test the temperature of the fluids on the inside of your forearm to make sure they feel warm but not hot. With some of my cats, I can give them a dish of favorite food or treats at the same time as they are getting fluids. Also, the higher you hang the bag the faster the fluids will flow.
 
If this is the end why didn't they give him something for pain? You don't have to get him so stoned he'll fall down the stairs but in my view it's unethical to say "this is it" when they know damn well it's painful.
 
Suzanne & Darcy said:
:bighug: May I ask what prompted the vet visit? Was it the Jaundice? I’m sorry that I missed the previous condo, I think? I belong to a group for cats with chronic kidney disease and there’s many a time when we have to just tell people to “ignore the numbers and just look at the cat” or “treat the cat and not the numbers.” So all that means is to ignore what the vet says about how much time he has left. Nobody knows him as well as you do. They don’t know what he is like at home. We see cats on that group with really bad lab work who “shouldn’t be doing so well with those numbers.”
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Jaundice and weight loss. He recovered 1.5 lbs when we started him on insulin but he lost it all in the last month and a half, but it was really the jaundice that prompted me to take him in
 
Suzanne & Darcy said:
May I also ask how much fluid you are giving him? How many mL? Is it Lactated Ringers solution?You said twice a day? How much does he weigh?
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He weighs 6.5 lb, and judging by the bag it looks like it's 100 mil twice a day. The bag looks like it's saline I'm not exactly sure what exact fluid it is it doesn't say in the paper work
 
zerovector said:
He weighs 6.5 lb, and judging by the bag it looks like it's 100 mil twice a day. The bag looks like it's saline I'm not exactly sure what exact fluid it is it doesn't say in the paper work
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Hmmm.... it's odd that the bag says nothing... usually it's going to say the kind of fluid on there. I'd call the vet and ask. My opinion, and I am not a vet, but I have been through this with other cats before ... unfortunately too many times... anyway, my opinion if that a cat who is 6.5 lbs should not be receiving 200 mL per day. That is too much fluid for a cat of his size. That was about the weight of my Tabitha who the vet said really needed that much because of her kidneys... well, she got a pleural effusion as a result. We tapped off the fluid but it was just too much for her heart to handle. The fluids in the pleural space came back in a few days (well... of course they did because the vet said to keep on giving the 200 mL!!) I would not take the risk with his heart. Maximum I would do is 100 mL per day -- maybe more like 75 mL to start. She had dilated cardiomyopathy that had never been identified. I had to put her down. Maybe I should have tried pulling the fluid off again and then decreasing (or even stopping fluids) but, in her case there were a few other things going on that I could not fix, so we decided to let her go. I would have really appreciated it, though, if her last few days hadn't been so difficult because she couldn't breathe well with the fluid on her lungs... I am glad we had the fluid tapped though because it gave us a few more days with her where she was really happy.
 
Suzanne & Darcy said:
Hmmm.... it's odd that the bag says nothing... usually it's going to say the kind of fluid on there. I'd call the vet and ask. My opinion, and I am not a vet, but I have been through this with other cats before ... unfortunately too many times... anyway, my opinion if that a cat who is 6.5 lbs should not be receiving 200 mL per day. That is too much fluid for a cat of his size. That was about the weight of my Tabitha who the vet said really needed that much because of her kidneys... well, she got a pleural effusion as a result. We tapped off the fluid but it was just too much for her heart to handle. The fluids in the pleural space came back in a few days (well... of course they did because the vet said to keep on giving the 200 mL!!) I would not take the risk with his heart. Maximum I would do is 100 mL per day -- maybe more like 75 mL to start. She had dilated cardiomyopathy that had never been identified. I had to put her down. Maybe I should have tried pulling the fluid off again and then decreasing (or even stopping fluids) but, in her case there were a few other things going on that I could not fix, so we decided to let her go. I would have really appreciated it, though, if her last few days hadn't been so difficult because she couldn't breathe well with the fluid on her lungs... I am glad we had the fluid tapped though because it gave us a few more days with her where she was really happy.
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Well that's just it to me - he only prescribed fluids because I said in passing Black had been constipated in the past. I am unsure how wise it is to give subq to a cat that already has ascites.
 
zerovector said:
Well that's just it to me - he only prescribed fluids because I said in passing Black had been constipated in the past. I am unsure how wise it is to give subq to a cat that already has ascites.
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Did he say that Black is dehydrated? If you pull up his skin on the back of the neck/scruff does it stay there for a long time? Some of this will happen with any older cat whose skin has lost elasticity, but if it really seems to take a long time to go back down, he may be dehydrated. If you are able to touch his gums at all, the test is to see if they feel tacky. If so, he may be dehydrated. If not dehydrated and already he has fluid on the abdomen, I don't think I'd give the fluids either (again just personal opinion.) Constipation is not good, of course, I would try a pinch of Miralax once a day to see if it works -- if not, you can give more and/or twice a day. If he's not pooping daily or is pooping very hard little round balls then he is constipated.
 
Here's the page from felinecrf.org on fluids. There's so much good info here. If you scroll down it will tell you things like "how much is too much" and how to check for signs of overhydration. I'm very uncomfortable with that 200 mL recommendation! I'm very proud of you though, for being a good advocate for Black and not just blindly accepting what the vet said!

Now tell me, how is Black today? Eating? Snuggling? Purring? Drinking? Peeing? Pooping?
 
Suzanne & Darcy said:
Did he say that Black is dehydrated? If you pull up his skin on the back of the neck/scruff does it stay there for a long time? Some of this will happen with any older cat whose skin has lost elasticity, but if it really seems to take a long time to go back down, he may be dehydrated. If you are able to touch his gums at all, the test is to see if they feel tacky. If so, he may be dehydrated. If not dehydrated and already he has fluid on the abdomen, I don't think I'd give the fluids either (again just personal opinion.) Constipation is not good, of course, I would try a pinch of Miralax once a day to see if it works -- if not, you can give more and/or twice a day. If he's not pooping daily or is pooping very hard little round balls then he is constipated.
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He actually stopped pooping every day maybe a year ago, but he became constipated when I switched him to chicken + ez complete. I started giving him psyllium husk and pumping with his chicken and that helped. I also finally found a low carb low phosphorus canned food he likes so he's eating that too and I haven't seen any constipation since
 
Suzanne & Darcy said:
Here's the page from felinecrf.org on fluids. There's so much good info here. If you scroll down it will tell you things like "how much is too much" and how to check for signs of overhydration. I'm very uncomfortable with that 200 mL recommendation! I'm very proud of you though, for being a good advocate for Black and not just blindly accepting what the vet said!

Now tell me, how is Black today? Eating? Snuggling? Purring? Drinking? Peeing? Pooping?
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He's sleeping right now around 9 he'll start hollering for food
 
Suzanne & Darcy said:
try a pinch of Miralax
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Miralax is the brand name for what some of us call PEG, polyethylene glycol, a laxative safe for cats. Daniel gets his mixed in with probiotic yogurt, lactose free if you can find it, and it's a big treat for him.
zerovector said:
He actually stopped pooping every day maybe a year ago
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If for some reason the food you're giving him that works stops working or new meds make him constipated again the PEG/yogurt is always there for you as another option.
It's been at least three days since this vet recommended immediate euthanasia. Some people are just not suited to their jobs.
 
Suzanne & Darcy said:
Here's the page from felinecrf.org on fluids. There's so much good info here. If you scroll down it will tell you things like "how much is too much" and how to check for signs of overhydration. I'm very uncomfortable with that 200 mL recommendation! I'm very proud of you though, for being a good advocate for Black and not just blindly accepting what the vet said!

Now tell me, how is Black today? Eating? Snuggling? Purring? Drinking? Peeing? Pooping?
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It looks like it's 50ml every 2x a day of Sodium Chloride.

He also hasn't gotten out of his chair today, by now he's usually roaming the halls requesting food very loudly.
 
He's eating now, but not so enthusiastically. I've noticed he's lost muscle mass because when I pick him up for his insulin shot I can feel his ribs :(
 
And do you have any FortiFlora to sprinkle on his food or parmesan cheese or Bonita flakes (if he likes fish). These can help stimulate them to eat more. Also warming the food a bit first can help.
 
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