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Cat: Calvin
male, Orange SH

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Calvin's Case Study  

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Story: Calvin was presumed to have some sort of inflammatory bowel disease for the past five years because he ate well but was skinny. His primary vet indicated that we might need to treat it if his weight decreased or he developed other symptoms, but he always ate well and appeared to be a healthy but skinny 11 lb. cat. He acted completely fine for his 10 years of life.

Suddenly, in one day, Calvin developed serious gastrointestinal symptoms. He was vomiting multiple times per day and began to have severe diarrhea. We took him to the vet who gave him some subcutaneous fluids, and she indicated he probably would be better the next day and that we should just keep an eye on him. The next day, he was leaking stool that was the consistency of water and had lost two pounds, in spite of the previous dayís hydration. We went back to the vetís office, where a different vet was on duty who admitted him. He was in terrible shape. They put an IV into him and withheld food while putting him through countless tests.

Upon an ultrasound examination, signs of an inflammatory bowel disease were identified, no obvious signs of lymphoma were seen at this point, and the radiologist noticed a blocked ureter. Calvin had emergency surgery to remove his kidney and to place a food tube in his esophagus. When they removed the kidney, they also biopsied his GI system. Four days later, a diagnosis of GI lymphoma was made, although the cell type remained vague. I brought in a very sick kitty with intractable diarrhea, and $5000 later, I had a kitty with one kidney with intractable diarrhea.

Calvin was put on Metroniazole upon admission, but later treatment with Predisolone 10 mg. per day had to wait until he healed a week from his surgery. His immediate survival, with all of the diarrhea, was very much touch and go. He was sent home on this medication regimen, along with Lukeran 2mg every 48 hours to hopefully induce a remission. Calvin gained weight with his tube feedings but suddenly started to deteriorate again after about two weeks of therapy (intractable vomiting). Another ultrasound then revealed visible signs lymphoma, and more thickness in his bowel that was there jut a few weeks before. The chemotherapy regimen was not working.

Outcome: Updated May 6, 2009 - This is just to update Calvin's condition since I submitted his story in January. The Leukeran and Prednisone regimen seems to have helped Calvin achieve remission of his gastrointestinal lymphoma. He is now on two medications rather than six and has stabilized, at least for now. He appears to be in no pain but occasionally has days in which he is less energetic. He has gained nearly three pounds (up to around 11 from a low of 8.3), but he's still a skinny kitty. We do occasionally need to give him an appetite stimulant called Mirtazapine, which works extremely well but proved dangerous when he received a whole pill (eight times the prescribed dose) when one of his care givers mistook it for his chemotherapy. He had a very poor reaction to the overdose and was rushed to the vet, who consulted animal poison control. An antidote was recommended (cyproheptadine) that helped us support Calvin through the three days it took for him to clear the Mirtazapine overdose. It can be very challenging to be consistently and flawlessly on top of all of the medical needs of a very sick animal.

So Calvin experienced another brush with death--this time as a result of an error but managed to pull through. It's rather amazing to see him running around the house, rolling and meowing for his meals after having come home from the vet with a Fentnyl patch on for a weekend that would be in place a few days before we were to have him euthanized.

The take away message for me is to not underestimate the possibility of remission of feline lymphoma with this treatment protocol, even when the catís condition is very poor. I would not have allowed Calvin to suffer for a long time without improvement, but after the start of chemotherapy and the steroid, he really did improve to the point where it's no longer detectable by observing him that he is even sick. I acknowledge that this gift of time is temporary and that at some time in the fuzzy future, Calvin will again experience symptoms that will likely lead to a need to end his suffering. Until then, he seems to be enjoying life and struts around at the vet when I take him in for follow up visits. It was very sweet at our last visit when the kitty oncologist brought other vets into the exam room to look at Calvin. One of the other vets who helped care for Calvin when he was dying picked him up, kissed him and told him what a sexy kitty he was. We are so indebted, in every sense of the word, to the vets who helped him through the crisis. Calvin is alive and temporarily well, but the entire ordeal has cost well over $7000. I guess must be the going rate for miracles of this variety.

Outcome: As of January 11, Calvin is on a tetracyclic antidepressant to increase appetite and decrease nausea, an antacid twice a day, Prednisone 10 mg., Lukeran 2 mg, every other day, a Fenanyl patch that needs to be changed by the vet every three days, an anti-nausea medicine that is injected once per day, and another oral anti-nausea medication that is given every eight hours. He weighs just under nine pounds. He does not appear to be in much distress today and is eating again. I am basically permitted to do anything he needs to keep him comfortable. His single kidney appears to be functioning. The vet is saying that he is basically at the end stage of his lymphoma, and based on how things have been going, that seems like a pretty accurate diagnosis. I now have to decide when the right moment is to have him put to sleep as to avoid all unnecessary suffering but not make him go while he still wants to eat and play. Keeping him stable is taking a lot of time, money and effort, and itís hard to accept that itís all palliative. His vet bills have exceeded half of my present yearly income. I will update this site about his final outcome when things shift once again.

- By Kristen Calvin's Mom -
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