Should we keep diagnosing?

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Aryia
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Should we keep diagnosing?

Post by Aryia » Sat Nov 22, 2014 2:11 pm

Long story short, my three-year old adopted female cat China started drastically lose weight. After we found a vet which we liked, her X-ray showed pleural effusion. The vet palpated one swollen lymph gland near her throat and her CBC panel didn't show anything serious. She tested negative for feline leukemia and her tests don't support the possibility of FIP either. We decided to go ahead with a chest tap to get a fluid analysis done and the results unfortunately stated that it was neither bacterial or fungal which would've been a little easier to treat. The most likely condition my vet suspects right now is lymphoma and the next step would be to aspirate China's liver which is slightly enlarged (but is normal and healthy otherwise). The vet also didn't quite rule out that the fluid may be chyle.

We (my boyfriend and I) love China and we really want to make the best decisions for her, though I am feeling a little helpless right now since the prognosis for lymphoma does not sound good at all. I'm not sure how chemotherapy would work with cats, but I'm personally not a believer of delaying the inevitable if it means China would be miserable during the process.

I'm also not a fan of putting her through more stress if it will not help her get any better. I will be meeting with the vet again soon to discuss her options, but for the time being I'm awake and can't sleep or stop thinking about this so I would love to hear opinions. Would you keep diagnosing for a definite answer if prognosis doesn't look good? Lymphoma is uncurable and I'm unsure about China's quality of life if we do decide to treat her for it. She's always been a solitary cat and doesn't enjoy receiving attention. If the fluid does turn out to be chyle instead, the vet explained to us that a lot of times the cause will be undetermined and it would mean China would need chest taps for the rest of her life.

Right now she just seems tired. Even after the chest tap she seems uncomfortable and doesn't want to lie down, instead insisting on sitting or laying while keeping her head up. She's usually so tired that she falls asleep in that position for a couple seconds before waking up again. She had a severely decreased appetite but we've managed to find some food that she will eat now and other than a little heavy breathing (no panting or open-mouth breathing) she seems fine. She is super thin and fragile at this point though, she is 5 lb instead of the recorded 8 lb during a visit in Feb 2013.

I don't know what to do. Emotionally I'm hoping to find a condition that is actually curable, at the same time I don't want to put her through unnecessary diagnostic tests if there is no hope for her. What would you do if this were your cat? Are there any signs you look for to make a decision?

*Sorry I said it was going to be short, it turned out not so short. And I also apologize if it's not very coherent. I'm worried sick and can't think straight.

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Crewella
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Re: Should we keep diagnosing?

Post by Crewella » Sat Nov 22, 2014 3:12 pm

I'm so sorry you're going through this, you must be worried sick. I'm afraid I have no experience of this condition, but if it helps, my gut feeling would be the same as yours - not to keep putting her through tests and treatments unless your vet can convince you that she will get a decent quality, and length, of life as a result of it. Hopefully, someone will be along soon that has more experience.

Good luck with the vet, and give her a gentle fuss from me. xx

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Kay
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Re: Should we keep diagnosing?

Post by Kay » Sat Nov 22, 2014 10:28 pm

it is a real dilemma you have - difficult to find a cure without a firm diagnosis, but finding a diagnosis is obviously problematical

the only possibilty, perhaps, is a referral to the nearest veterinary hospital, where better test facilities, and greater expertise at diagnosing difficult conditions, should be available, if you think she could cope with it, and you can afford it

but don't beat yourself up about it - many of us opt to go for quality rather than quantity of life - and you are the expert in judging how much more China can take - and she is clearly very frail now - she doesn't know she is ill, and putting what is best for her rather than you is something you will find the strength to do

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Re: Should we keep diagnosing?

Post by Aryia » Sat Nov 22, 2014 11:05 pm

Thank you for the kind words.

Maybe it was the effects of the sedation they put her on, but I noticed her become a lot more active this morning. For the first time in the last couple weeks she's actually exploring around the house and acting more usual (and I've had some sleep so I'm not freaking out so bad anymore). Though she's unusually needy still which is highly unusual for her, when she rests she insists on being between the keyboard and monitor which she usually never does because she doesn't really enjoy being pet a lot. Now when we gently stroke her fur she will do a happy tip-of-the-tail wag, which is pretty unusual too, usually she just put up with the petting and would leave soon after.

What are some signs that her quality of life might be declining?

The costs of treatments are definitely a problem since I'm a newly graduated college student on the job hunt and my boyfriend still is in college. But if there is any chance of her receiving 1-2 years or more of good quality life, I don't think I'm ready to give up on her quite yet. The problem is, it's been hard getting a total cost estimate from our vet. She's a nice person and it looks like she cares a lot about China, but she seems to like doing cost estimate step wise as opposed to showing us what the costs "could be". For example, depending on how much we have to afford in order to correctly diagnose lymphoma I am unsure if we would have money left for her chemotherapy and logically it would be unrealistic for us to keep diagnosing if her possible conditions are all too costy for us to treat. That being said I requested that she meet with us to come up with a master "diagnosis/treatment" plan to see how affordable her treatment is.

I have done a lot more research about lymphoma last night and it seems the prognosis for small cell lymphoma isn't as bad as I initially thought (large cell lymphoma being more serious), though statistics vary between sources. A lot of sources seem to state that their cats actually led decent life during chemotherapy and during remission, which is definitely a point I have taken to a liking. Without a cost estimate I'm really sitting in the dark though, considering diagnosis is always the hardest part but treatment does not sound cheap either.

As for chylothorax, from what I've been reading it seems that it's idiopathic 50% of the time, meaning the source can't be found. I am assuming this would mean China would require chest taps every couple days/weeks/months depending on how fast the fluid returns.

Thank you again for replying, reading your responses regarding her definitely makes me feel like I'm doing something (yes I'm becoming pretty desperate) that might determine how to help her best. If you know of any cases of lymphoma and chylothorax I definitely wouldn't mind hearing how they turned out (especially lymphoma cases in younger cats which seem quite rare).

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Kay
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Re: Should we keep diagnosing?

Post by Kay » Sun Nov 23, 2014 12:02 am

you might find some of your questions answered on this site http://felinelymphoma.org/cms/" onclick="window.open(this.href);return false;

I have found Yahoo groups invaluable for advice and support in the past, and I would certainly give this one a try

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Lyn from Australia
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Re: Should we keep diagnosing?

Post by Lyn from Australia » Sun Nov 23, 2014 3:48 am

I can understand your dilemma to some extent. I have a cat who at one stage was thought to have leukaemia - I knew that the tests to diagnose her illness would probably kill her because she is so timid and stresses easily, so I chose not to get a diagnosis, but just do serial blood tests for 3 months. I also had to bear in mind that despite the expense of treatment, that treatment is very stressful and is NOT curative. It's turned out that the decisions I made were were for the best, because as it's turned out she seems to have fully recovered from whatever was ailing her and her blood tests are all normal. She would have gone through all that testing for nothing. Of course had her condition deteriorated I could have had her euthanased when she became obviously ill and uncomfortable. I was very lucky. You know your cat and I think your heart will tell you what to do for her and when. Best of luck and please keep in touch.

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Re: Should we keep diagnosing?

Post by Walesgang » Sun Nov 23, 2014 8:35 am

Sorry to hear of your situation.

My cat, Luna was diagnosed with lymphoma 3 years ago.

The diagnosis was made with biopsies of the tumours from a number of sites (behind the knees and her throat).

We decided to give chemo a go. We thought that it was the only chance she had. As Kay suggested we joined the feline lymphoma Yahoo group. Although mainly people in USA animal oncologists post there so it is useful.

Luna coped really well with the treatment, and initially the tumours responded well. Unfortunatly, her remission was short, and we had to let her go. At the time we were glad to have had the short extra time with her. I am not sure what I would do if faced with the situation again.

Good luck to you and your kittie.

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Re: Should we keep diagnosing?

Post by Aryia » Tue Nov 25, 2014 3:15 am

She's been doing better over the weekend. The night after her chest tap she was awful, but once morning came around she actually walked around the house for the first time in a long while. She seems to sleep a lot more comfortably these couple days and I'm glad for it.

The cost estimate for her ultrasound-guided liver aspiration came in. And the total is $600-800 depending on whether she'll need sedation/anesthesia and some other things which I will have to ask the doctor about.

This is really a large sum for me and I'm having trouble getting the doctor to tell me specifics about her prognosis/further treatment plans (I'm having trouble reaching her mostly, the receptionist answers the calls/e-mails and only provides cost-estimates on a step-by-step basis). What I really want to know is what further diagnosis she might need and how much her treatment might cost. Is it usually this hard to find out and do any of you know of a price range? (Aka how much did treatment cost per month for lymphoma?) The reason I need to know is.. if I go broke diagnosing her and can't afford her treatments, then there's really no use to diagnosing her to begin with is there?

*I will head over to yahoo as well, thanks very much for the tip!

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