When planning to take a long weekend trip (1st long stretch away from the house since Dec2008. 5 days - 2 driving & 3 visiting) to DC for the purpose of visiting family (Josh's mom Debbie and Becky's sister Megan), we never expected to have one of our 4 kitties get sick. They've had such a long stretch of health and everyone was bright eyed and bushy tailed the day we left so there seemed to be no cause for concern.
After returning home on the 23rd, everyone seemed normal except for Scout. We didn't notice it immediately but after Josh gave the kitties their evening treat, he knew something was up. Normally Scout eats his treats in 1/3rd the time of the other cats, then nudges himself into theirs if we don't stop him. That evening he didn't even attempt to finish his own treats. He ate a few and immediately laid down on the kitchen rug. About 30min after that he gave us real cause for concern. He normally hops about like a little bunny despite his large size. That night he appeared to be attempting to do his normal jump on the couch over my feet then onto the pillows to make his way to the windows for his nightly neighborhood stray cat watch. As he tried to jump over my feet, he didn't even get his back end up high enough to get over before gravity pulled him back down. He looked at us weird then just laid on the floor. At this point, I was really concerned as the last time I saw a cat attempt to jump something that they do every day and fail giving the look of "why did that happen", it didn't end well. Four years back I lost my cat Skitz to acute end stage kidney failure and saw the same kind of sudden fatigue so that made me worry he had kidney issues.
We made an appointment the very next morning for Northern Pike Veterinary Hospital (vet's we've used for years). Scout seemed to be his normal self and let the doc (I don't recall her name as she wasn't his normal doc but when I find out, I'll add it) exam him just fine until she started to push on his stomach. At this point, he started to growl and she had to scruff him. Mind you, this is the cat that never growls ever... As she continued the abdominal exam, he howled out several times in pain with loud cries that we had never heard him do before. On her initial exam, she didn't feel any solid masses but did note he was a bit dehydrated. Considering his reaction to the abdominal exam, we agreed with the doc to do xrays and blood work. They managed to get one xray in before he fought them too much for the second angle so we agree to them giving him twilight for the second and the blood draw. As the vet went over the side xray, nothing screamed sick kitty. He had no bowel obstructions and no kidney stones. It wasn't until the view of him on his back that it became clear as to why he was in so much abdominal pain. His spleen was several times larger than it should normally be and it was pushing his internal organs off to the other side of his body. As the spleen deals with removal of old red blood cells and it's massive increase in size would indicate Scout's body was killing off his red blood cells at a fast rate, she ordered a rush on the in house blood work. His PCV (packed cell volume, haematocrit - indicator of red blood cell lose or increase. It is the blood volume occupied by red blood cells) came back between 8-9 when it should be between 20-30 indicating we had a very sick kitty on our hands. As a double check of the severe anemia, scout had urinated for them during his time there. So they checked his urine for bilirubin levels and found that those were far above normal levels.
Diagnosis at this point was that it appeared that Scout, if not sick from an infectious agent, was having his own immune system attacking his red blood cells such that it resulted in the increase of his spleen to accommodate degradation of a larger volume of red blood cells. He was severely anemic but had a few options. We could at that point treat with steroids to suppress his immune system and give his rbc a chance to get to the right levels but as we don't know if he's fighting an infection, doing so could make him worse. Additionally, with his PCV so low, there was a good chance he could succumb to pulmonary failure due to not enough oxygen. (For those of you without a bunch of biological knowledge, our red blood cells carry oxygen throughout our bodies. So without properly functioning ones, our bodies starve of oxygen and start to shut down.) Her recommendation at this point was that he needed a blood transfusion to give him a fighting chance. But because they aren't an emergency hospital they didn't have the capability so we were referred to AVETS located down the street.
At AVETS, they immediately started him on IV fluids and drew some blood to type him for a match. During consults with Dr. Hafermann, we were informed that his anemia could have 2 sources. He could have an infection causing it that would be treatable by antibiotics if it wasn't viral or he could have issues with his bone marrow with leukemia being the cause of his anemia. Issues with his bone marrow would require chemo and possibly a marrow transplant which we both agreed we would never put him through. After seeing how sick unnecessary chemo made Josh's grandma this past summer as she was living through terminal bone cancer, we didn't want to inflict that pain upon Scout. Needless to say, everyone at that point was hoping for an infectious agent (odd to hear as you normally don't want infection) as that meant we could treat. Despite that, one thing was a definite... Scout needed a transfusion ASAP and we agreed to go through with it.
Following the consult, we got a bit of bad news. Scout has a rare blood type. While most cats are type A, he is type B. And as they don't see enough type B cats, they didn't have any on hand so they had to call around to attempt to find some. As it would take some time to call around, they sent us home.
Once we got home, we decided to clean up the house so that we would have all his favorite things ready. Around 5:30, the doc called about Scout. An in house blood smear revealed results consistent with leukemia as there were immature cells looking like leukocytes and lymphocytes. At this point, we both were in tears as this indicated very little hope. We were asked if we wanted to continue with the transfusion. As we understood that it was more of us as pet owners being selfish to hold onto him, we also weren't home for his early decline. We didn't get to give him the love he needed and we really didn't want him dying in a cage at the emergency vet. So we opted for the transfusion to give us a few weeks to treat him like a king. At that point the vet let us know that they weren't able to find any packs of Type B but that Dr. Crabtree's cat, Scrubs, is a type B and crossmatch was non-reactive so they would proceed with the transfusion. We also requested that they retest him for FeLV and FIV to make sure that the leukemia was regular cancer leukemia and not viral.
Two hours later around 7:30, I called to check up on Scout's transfusion. They said that he took the transfusion really well and was looking like he was feeling better. He also got his appetite back and was gobbling down some chicken. He also tested negative for the FeLV and FIV test. (At some point we hoped he might have been positive as there could have been treatment options but then he would have been putting our other cats at risk. So it was a double edged sword where what was good for Scout was bad for the other kitties and vice versa)
Around 11pm, we called again before going to bed. They let us know that his PCV had improved since the transfusion. It was now at 21 and they would recheck it in the AM. They also told us he was doing good... He was eating and drinking plus meowing when anyone would pass his cage. We were told if his condition continued to improve and he remained stable, we would be able to take him home the next day. They also let us know that the day shift doctor would call us with a progress report sometime the following day after doing her rounds.
The following morning, we called for a progress report on Scout. We were told that Scout was still going well and that they were just going to recheck his labs to see where his PCV was standing.
At 1pm, we received a call from Dr. Hafemann. Scout was looking stable and she felt he would recover and feel better at home. Scout's PCV was 19 and it was normal for a slight drop post-transfusion. As there was no blood loss after the transfusion, she worries that he may have true non-regenerative anemia. Which means our time will be short with him. To confirm this, we scheduled to have his CBC reran in a week's time. If his PCV remains the same or decreases, then it's non-regenerative. If it increases and gets near to 30 then he is regenerative and we have hope. If he's regenerative, they then recommend a bone marrow aspiration to ensure he doesn't have the feline leukemia virus hiding out in his marrow. If he's still negative then it may be possible to treat his over active immune system with medication rather than needing chemo and transplants.
Scout was discharged to us at 4pm. He seemed 10x better than he had the day before. He was bright eyed, meowing and bushy tailed. Upon getting him home, we have noticed that he's still rather weak and prone to heavy breathing spells. We waited on him hand and foot. Feeding him every time he asked with wet food as was having problems crunching the dry food. And taking him out to his little patch of green along with carrying him up the stairs to use the litter box. Slowly over the last 3 days, he's gotten progressively better each day. He's able to walk around and do more without getting as winded. He's been eating like a little piggy again and using the litterbox regularly. Also day by day he's become more vocal. Early meows were short and quick but he's meowing like his old loud kitty self now. And he just began to purr loud enough to hear today. Scout also has more energy. He can make it up on the couch by himself now and this morning even got up on the cat tower (while we were asleep) to sleep in his favorite place... the cat condo! (http://ow.ly/i/gpVU) Plus he's began to eat some dry treats again. And this time when he chews, he's not having half of the food falling out of his mouth. All and all he looks like he may be on the mend. Or so the hopeful side of us wishes he might. But until his CBC next week, we just won't know. Plus with all the results as of today, it would suggest he won't be getting better. And for that reason, we have to curb our hope and just keep him happy as long as we have him here by giving him yummy food, pets, and open windows to sniff the outdoors through.
<Vet bills are listed on The Cause tab>
