? Penpen has jaundice and serious kidney problem, he may die soon

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PH&MonkeyPenPenFaFaTiger

PH&MonkeyPenPenFaFaTiger

Member Since 2020
UPDATE: I AM DEVASTATED by the fact PenPen is dying, I dont want to give up. I am looking for ways that may let him survive.

Sorry guys my writings may be chaotic since I am devastated now.

half hour ago, PenPen extremely high SDMA which is 36 that may indicate very advance stage of CKD, which indicate impair GFR and kidney function.
Also, the vet found that there is a large tumor in the belly，and the ear become yellow which indicate icterus. The vet suggested that he is likely to die soon, and therapy may not help. Further examination like ultrasonic and x rap need to be carried out. We will take penpen to vet tmr. I dont know if it is Liver disease or Hepatic lipidosis or whatever, since I have not talk to the vet directly yet, I am urgently calling him in the hope that he can tell me more detail

Here is the blood test
https://drive.google.com/file/d/1VTqVPZc10upfiucAiucjHEUWk4KD-h5A/view?usp=sharing

I also want to add that I have blood test two months ago from PenPen, and everything is perfectly fine, I dont know why it happen so suddenly.

If there is no way and very minimal chance I can save him, I would just let him go asap to reduce suffering. But I want to look for information to see if there is hope, what can I do now?????????? I can take work leave and accompany him full-time to see what I can do.

He still dont eat at all and my Mom is syringe feeding him every hour. I will go back to see PenPen like 6 hours later. I NEED HELP urgently, please tell me what to do FDMB


Post 6 hours ago-------------------------------------------------------------------------------------------------------------------------------------


The issue is Pen-Pen has no appetite at all for 2 days already no matter what food we provided him. To cope with this problem we syringe feed him diluted Dr. Lisa's recipe. However, 6 hours ago he started to vomit the food and I am extremely worried he does not eat enough. So I buy kitten can food in the hope that the mushy texture will be easier for him to take and absorb.

I have booked a vet 5 hours later to do a blood test and x-ray check.

Behaviorally he is less affectional than normal and withdraws himself in some dark corner of my home. He was diabetic and went to remission one year ago. His current BG is around 70, which is a normal range for cats.

What can I do FDMB? I have googled some solutions but still want to hear what do you people think. Like any special way to cope with it.[/QUOTE]
 
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PH&MonkeyPenPenFaFaTiger said:
The issue is Pen-Pen has no appetite at all for 2 days already no matter what food we provided him. To cope with this problem we syringe feed him diluted Dr. Lisa's recipe. However, 6 hours ago he started to vomit the food and I am extremely worried he does not eat enough. So I buy kitten can food in the hope that the mushy texture will be easier for him to take and absorb.

I have booked a vet 5 hours later to do a blood test and x-ray check.

Behaviorally he is less affectional than normal and withdraws himself in some dark corner of my home. He was diabetic and went to remission one year ago. His current BG is around 70, which is a normal range for cats.

What can I do FDMB? I have googled some solutions but still want to hear what do you people think. Like any special way to cope with it.
Click to expand...
My thought is perhaps pancratitis for which the vet will perscribe fluids (sub q's), an anti nausea medicine, and a pain medicine. I'm glad you are bringing him in today. In the meantime is good you are assist feeding. Could be have eaten a dangerous houseplant?
 
At this point, we'd be guessing about what's going on. It could be pancreatitis, or PenPen may have a dental problem that's making it hard to eat, a urinary tract infection -- in other words, it could be anything. Make sure the vet gets a full set of labs and that our vet checks PenPen's teeth to make sure there's no inflammation or a broken tooth.
 
JanetNJ said:
My thought is perhaps pancratitis for which the vet will perscribe fluids (sub q's), an anti nausea medicine, and a pain medicine. I'm glad you are bringing him in today. In the meantime is good you are assist feeding. Could be have eaten a dangerous houseplant?
Click to expand...

Thanks. No dangerous houseplant.
 
None of PenPen's liver enzymes are elevated. The vet needs to check his thyroid for hyperthyroid.

All of the other kidney values, excluding SDMA, are in normal range. You need a urinalysis to see if there are any abnormal values.
 
The kidney values look fine. Certainly not end stage. Did they do the snap test for pancreatitis? Did they check for hyperthyroidism (which can also raise sdma).? It's something else. It can also be caused by injesting a toxin such as a poisonous plant. Did they give the cat any fluids or anything?? Did they give him anything for nausea to try to get him eating? Let me tag a member who is good at reading labs. @Marje and Gracie
 
I am so sorry PenPen is so unwell.
Did they do a snap fPL or a SpecFPL to test for pancreatitis.
The high SMDA with the other kidney functions normal is strange.
What other investigations have they done? I think some ultrasounds or X-rays may help you know what is the matter.
Have they given anything for nausea such as cerenia or ondansetron? They may help a bit.
Please keep up posted :bighug:
 
Hi Peter,
I am not experienced with reading blood results in cats but I will tag @Marje and Gracie but she may not be around much at the moment.
I can see there are a few issues with the red blood cells and the platelets are on the low side. You need to be guided by the vet with these.
Did you get some antinausea medications?
 
Is he laying in a ball.... like a slipper or does he lay stretched out? It really sounds like it could be pancratitis to me. Ask if they tested for that.
 
JanetNJ said:
Is he laying in a ball.... like a slipper or does he lay stretched out? It really sounds like it could be pancratitis to me. Ask if they tested for that.
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They did. This is on the bottom of the first page of blood work.
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Peter -
The issue with the Snap pancreatitis test is that it's a "yes/no" value. In testing for pancreatitis, if the inflammation is either waxing or waning you may not get an accurate reading. The Spec fPL is sent out to a lab and gives a value. It's a bit more helpful.
 
Thanks for the help everyone, after few days of mess, Monkey is finally getting an ultrasound tmr after 12 hours later.

X-ray show that it is likely there is a tumor in his spleen or lymphatic system. Tmr ultrasound will show a more accurate diagnosis. Currently, he is taking appetite-enhancing pills, painkillers, some meds relating to liver, anti-vomiting pills, and antibiotics.

Penpen shows a marginal improvement in his well-being but still hides in some dark corners all the time. Last year I have saved my cats from life-threatening diabetes and CKD... but this time I really don't know. The vet sounds pessimistic.


I want to ask why does he move his mouth and tongue in this way when we approach him to force-feed?


Any idea?
 
PH&MonkeyPenPenFaFaTiger said:
X-ray show that it is likely there is a tumor in his spleen or lymphatic system.
Click to expand...

First, my thoughts and prayers are with you. I am sorry that this is happening. If it is his spleen, the spleen can be removed. I had a cat years ago (2005) and they removed the spleen & then we treated him to manage the mast cells. He survived for several years after the surgery. This was despite the fact that he was 10 years old, also needed a lung lobectomy & had underlying HCM (enlarged heart) for years. So, keep some hope :bighug:. Outcome will depend on whether or not other organs are effected, but maybe they wont’ be.

PH&MonkeyPenPenFaFaTiger said:
I want to ask why does he move his mouth and tongue in this way when we approach him to force-feed?
Click to expand...

This looks like classic nausea. He shows interest in eating it which is really good, but then nausea sets in (lip smacking & turning away). Do you have access to ondansetron to treat the nausea?
 
Tomlin said:
First, my thoughts and prayers are with you. I am sorry that this is happening. If it is his spleen, the spleen can be removed. I had a cat years ago (2005) and they removed the spleen & then we treated him to manage the mast cells. He survived for several years after the surgery. This was despite the fact that he was 10 years old, also needed a lung lobectomy & had underlying HCM (enlarged heart) for years. So, keep some hope :bighug:. Outcome will depend on whether or not other organs are effected, but maybe they wont’ be.



This looks like classic nausea. He shows interest in eating it which is really good, but then nausea sets in (lip smacking & turning away). Do you have access to ondansetron to treat the nausea?
Click to expand...

Thanks, good to know the spleen can be removed. And good to know your story. :bighug: I am still considering what approach should I take towards my cats. I will update his result tmr.

Regarding to ondansetron, I will check the name of his meds.
 
PH&MonkeyPenPenFaFaTiger said:
Thanks, good to know the spleen can be removed. And good to know your story. :bighug: I am still considering what approach should I take towards my cats. I will update his result tmr.

Regarding to ondansetron, I will check the name of his meds.
Click to expand...

I will be thinking about you and praying for some hopeful news! Sometimes there is hope even when it seems there is none.

Ondansetron tends to treat nausea better than Cerenia. Cerenia works better for vomiting. Please review all of his meds with the vet just to make sure there are no issues with other meds he is already being given as well as to take any other underlying medical issues into consideration. That is the safest approach.
 
Bron and Sheba (GA) said:
I’m glad Monkey is ok but so sorry Pen Pen is still not OK. Please let us know when you hear the report.
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the offcial report will come out tmr... but it seems that is.that prettY sure there is a tumor in both lymph and spleen....also there is abdominal fluid....the vet tell us we can do examination on abdomonal fluid, is this useful?

also vet said penpen is dehydrated, so he prescript sub q, and also suggest hosptializing him may be benefitial.

mY question is penpen not vomiting the can food we force feed him. Also, he is having subQ. so does hospitalizing him a good idea? I would not want Penpen to be stressful in a new environment.

also since he has kidney problem, i may want him to eat can food that is low phos, 60% protein and 40% fat to lower the protein content. so i buy wellness core wet food, is that a good idea?
 
PH&MonkeyPenPenFaFaTiger said:
also there is abdominal fluid....the vet tell us we can do examination on abdomonal fluid, is this useful?
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Yes, that could be very useful and will tell you if the fluid contains cancer cells or not.

PH&MonkeyPenPenFaFaTiger said:
mY question is penpen not vomiting the can food we force feed him. Also, he is having subQ. so does hospitalizing him a good idea? I would not want Penpen to be stressful in a new environment.
Click to expand...
Are you saying PenPen is not vomiting? Does the vet think the subQ fluids will be enough to correct the dehydration? You need to be guided by the vet on this.

PH&MonkeyPenPenFaFaTiger said:
also since he has kidney problem, i may want him to eat can food that is low phos, 60% protein and 40% fat to lower the protein content. so i buy wellness core wet food, is that a good idea?
Click to expand...
With kidney issues he needs to eat food that is low in phosphorus.
HERE is a link to low phosphorus canned food. Look for food that has a phosphorus level of 250 to 200mg or less of phosphorus/100 kcals.
 
Bron and Sheba (GA) said:
Yes, that could be very useful and will tell you if the fluid contains cancer cells or not.


Are you saying PenPen is not vomiting? Does the vet think the subQ fluids will be enough to correct the dehydration? You need to be guided by the vet on this.


With kidney issues he needs to eat food that is low in phosphorus.
HERE is a link to low phosphorus canned food. Look for food that has a phosphorus level of 250 to 200mg or less of phosphorus/100 kcals.
Click to expand...

yes sorry my writing maybe chaotic. Yes Penpen does not vomit... so he takes all the food we feed him.

i am thinking if the cancer is death scentence or not. just read online that if lymphoma is not treated, then it can only survive for few weeks, if treated, the life may only last half year.

What should i do? i am trying to get more info to make decision
 
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Bron and Sheba (GA) said:
Yes, that could be very useful and will tell you if the fluid contains cancer cells or not.


Are you saying PenPen is not vomiting? Does the vet think the subQ fluids will be enough to correct the dehydration? You need to be guided by the vet on this.


With kidney issues he needs to eat food that is low in phosphorus.
HERE is a link to low phosphorus canned food. Look for food that has a phosphorus level of 250 to 200mg or less of phosphorus/100 kcals.
Click to expand...

just found out my can food has 260mg of phos..
 
AMOXYCLAV 50mg tab antibotics 1 tab twice per day
MIRTAZAPINE 2mg cap appetizer 1 cap once per two days
CERENIA 16MG TAB 1/4 cap per day (not eating now since Penpen does not vomit)
SAMYLIN one tab per day
TEMGESIC painkiller 1 to 2 times
 
Lymphoma can be treated in many circumstances. I’m not really experienced with lymphoma but if that is the diagnosis I will tag people who are experienced.
 
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vet said that the report suggest something the same as what said last time ..
@Bron and Sheba (GA). Does anyone understand the diagnosis? I still can't understand how serious it is and if it is worth treating it... but now I am trying to carry out the further examination.
 

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I found the second page hard to read as it was blurry. Can you resend it and see if it is clearer please Peter?
From what I can gather, they want to get a sample of the free fluid in the abdomen as that will help them with a definite diagnosis. I think that is a good next move.
At the moment they are not sure of the diagnosis.
If it is still inconclusive after they get the result of the free fluid, they want to do a biopsy of the intestine to see if it is a lymphoma, which can be treated in many cases.
I’m going to tag @Wendy&Neko to see if she can add any more information.

How is PenPpen doing? Is he eating yet on his own?
 
Bron and Sheba (GA) said:
I found the second page hard to read as it was blurry. Can you resend it and see if it is clearer please Peter?
From what I can gather, they want to get a sample of the free fluid in the abdomen as that will help them with a definite diagnosis. I think that is a good next move.
At the moment they are not sure of the diagnosis.
If it is still inconclusive after they get the result of the free fluid, they want to do a biopsy of the intestine to see if it is a lymphoma, which can be treated in many cases.
I’m going to tag @Wendy&Neko to see if she can add any more information.

How is PenPpen doing? Is he eating yet on his own?
Click to expand...

I am asking the vet to resend too... but I am still waiting for them....

The report was sent to another hospital (my regular vet) and I am asking them if they can offer the suggested tests including fluid analysis and biopsy, again, still waiting for a reply, and trying to call them multiple times to see if Penpen can get a spot as soon as possible.

Penpen is heavier after he received subQ start from Thursday. However, he is not eating anything on his own. I wonder is that a sign that it is his time to go. But whatever I will still try to book for further examination.
 
Here comes the Abdominal Ultrasound Report


History
The patient is presented for evaluation of weight loss and a palpable swelling in the
abdomen. Hyperbilirubinemia and elevation in SDMA are noted on bloodwork.


Findings
Peritoneal cavity: anechoic free fluid noted cranial to the liver and in lateral gutters, [FF
pockets up to lem]


Liver: there is mild hepatomegaly with rounding of caudal lobar margins that extend
just beyond the level of the stomach, The hepatic parenchyma has normal echogenicity
and echotexture. No specific lesions are noted,


Gallbladder: the gallbladder is normal size with anechoic contents. The gallbladder wall
is smooth and of normal thickness. There is no billary dilation. 'GB wall 0.7mm]


Spleen: there is marked splenomegaly with extension of the splenic tail caudally to the
level of the urinary bladder. No specific lesions noted.


Kidneys: the kidneys are normal size and symmetrical with good corticomedullary
definition bilaterally. Renal pelvises and proximal ureters are unremarkable. [LK 4.16%
2.13em. RE 3.84» 2.43mi]


Adrenals: the adrenal gland: are high-end of normal size range with normal structure.
{LAdr cr O41. ed O-4t6cm, RAdr not measured but subjectively normal}
Urinary bladder: the urinary bladder is full with anechoic urine. The bladder wall iz
smooth and the proximal urethra is unremarkable. (IB wall 1.8mm)


Gastrointestinal tract: the stomach is empty. There is marked thickening of the muscularis layer in the ileum and to a lesser degree through the jejunum. Layering and thicknesses of the stomach, duodenum and color are within normal limits. The pyloric duodenal junction and ileocolic junction are visualized unremarkable.


(stom 0.22cm, duod 0.29 cm, jej 0.23cm, ileum 0.45 cm, colon 0.14cmuod 0.29 cm, jej 0.23cm, ileum 0.45 cm, colon 0.14cm)


Pancreas: the area of the pancreas and its surrounding mesentery is unremarkable (Lpanc 0.54 cm, RPanc 0.68 cm)


Abdominal lymph nodes: diffuse gastric, mesenteric, and colic lymphadenomegaly (jej L.Ns up to 2.8cm, Colic LNs up to 0.65cm, gastric up to 1.3cm)


Pertinent Findings and Discussion


Free fluid: fluid analysis is recommended. Given other findings today, a neoplastic effusion is possible.


Hepatosplenomegaly: differentials include congestion, inflammation, infection, reactivity, and neoplasia. Marked splenomegaly is a concern for neoplasia in a cat. Disseminated lymphoma is a top consideration is this case. FNA cytology is recommended.


GIT: thickening of the small intestinal muscularis layer is most commonly seen with inflammation (IBD) or GI lymphoma. Sampling of the associated lymph nodes may be diagnostic. If results are inconclusive, full thickness surgical biopsies may be required for a definitive diagnosis.


Gastrointestinal lymph nodes: differentials for lymph node enlargement include reactivity, inflammation, and neoplasia. FNA cytology should assist with diagnosis. Alimentary lymphoma is a top differential
 
Bron and Sheba (GA) said:
I think you have to be guided by your vet with PenPen as to the further investigations Peter.
Is PenPen getting any regular cerenia or ondansetron for nausea?
Have they suggested a feeding tube?
Click to expand...

Penpen is getting cerenia regularly.
They mentioned a feeding tube, but not suggested...
The vet just gave us the do the examination "if we want".

I am thinking, even we do all the examinations and figure out the problem and try to treat him. We need to do one biopsy, highly likely to remove his spleen, be hospitalized and do chemotherapy for few months...in exchange for a life of like half to one year... money is not the biggest concern ... I am just thinking if I have the right to decide that to Penpen. Penpen would be really scared of it. He is an 15 old cat and the risk of above operation may be high and very uncomfortable...
 
PH&MonkeyPenPenFaFaTiger said:
Penpen is getting cerenia regularly.
They mentioned a feeding tube, but not suggested...
The vet just gave us the do the examination "if we want".

I am thinking, even we do all the examinations and figure out the problem and try to treat him. We need to do one biopsy, highly likely to remove his spleen, be hospitalized and do chemotherapy for few months...in exchange for a life of like half to one year... money is not the biggest concern ... I am just thinking if I have the right to decide that to Penpen. Penpen would be really scared of it. He is an 15 old cat and the risk of above operation may be high and very uncomfortable...
Click to expand...

Whatever you decide to do Peter, I know you will do what is best for PenPen. You have been wonderful with PenPen and Monkey.
I think you need to take it one step at a time and find out first what it is that is causing the problem.
With the chemo, it is usually a tablet that cats take at home and it often isn’t a big deal. And depending if it is lymphoma for example, a lot of lymphomas can often be treated very successfully.
 
Bron and Sheba (GA) said:
Whatever you decide to do Peter, I know you will do what is best for PenPen. You have been wonderful with PenPen and Monkey.
I think you need to take it one step at a time and find out first what it is that is causing the problem.
With the chemo, it is usually a tablet that cats take at home and it often isn’t a big deal. And depending if it is lymphoma for example, a lot of lymphomas can often be treated very successfully.
Click to expand...

I am trying to book fluid analysis and urinalysis for next Friday earliest. The vet offered me to do biopsy about 10 days later but I have not decided yet because I afraid Penpen would be too uncomfortable. But also without biopsy it seems that we can never know what is happening to Penpen.

So, my current plan is to observe if Penpen eats on its own again and socialize again which show that he may want to live longer, then I will consider doing a biopsy.
 
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