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The Internist Speaks
When we saw our vet with Lucy last Friday, we talked about the fact that we still had an appointment with the Oahu internist today, and needed to decide whether to cancel it. Because Lucy was still on the tailend of not seeming great after the previous weekend's drama, our vet at first suggested we might want to take Lucy to Oahu, but then after consulting with a colleague, simply suggested that we talk with the internist if and only if we were able to acquire a phone appointment.
So Kimberly put in the work playing phone tag with people at VERC in Oahu and finally got word back that the internist was willing to do a phone appointment.
As Lucy did better and better from Friday on, increasingly eating huge amounts of food (often approaching 240 kCals when our goal is 150-180 a day) and jumping up to get it and generally showing more energy as she climbed up and down cat trees, we were uncertain of the utility of the appointment. But, we respected our vet's request for that second opinion, we remembered the week of good eating before the downturn that resulted in our trip to Oahu (though we now attribute that, right or wrong, to taking Lucy off anti-nausea drugs), and we decided we didn't want to inadvertently burn bridges with VERC by cancelling very late (but still outside of their 24-hour limit).
So we did that today as a brief (45-minute!) interruption to my work day.
It was not the happiest phone call we've had lately.
First up, I don't think there was an internist in the office when we took Lucy in. Which was our WHOLE POINT in taking her out to Oahu. But Dr. S. idly mentioned that she'd been out at the time due to familial obligations. I mean we felt like we got good care at VERC, including a diagnosis, but ...
Second, on that diagnosis ... Dr. S is unconvinced. She says that the ultrasound wasn't actually defining for liver infection and she says that it's less likely because of something about liver enzymes and the lack of a high white blood cell count. The only thing that makes her think maybe is that Lucy threw up the night things went bad, and that can apparently "shower" the liver with bad juju. So, she places the odds at 50/50 that what we're doing is right and will result in a well kitty. (Man, that is is a far cry from the "very certain" response we got from Dr. C at the clinic when we asked about how strongly he felt about the diagnosis.)
She says that if Lucy has a relapse or if we finish up the course of antibiotics and she's still not eating, then the odds are it's either Inflammatory Bowel Disease or Small Cell Lymphoma, which are both intestinal diseases and could fit with the fact that Lucy has had various intestinal problems her whole life.
At that point we'd most likely put her on Chlorambucil, which is a chemotherapy drug (I think one that we'd previously given to Cobweb, many moons ago, when they incorrectly diagnosed her with cancer) and see if that does the job. With the other option being a trip out to Oahu for an endoscopic biopsy to verify what's going on. (Well, maybe, apparently it can be hard to get great results with endoscopic, but that's all they'd suggest for a cat Lucy's age.) Dr. S. says that a biopsy is the gold standard, but really seemed to stop short of explicitly saying we should do it.
So, ugh.
We'd increasingly thought we were on the right track, especially with Lucy's improvement these last several days. So to learn that we could EASILY finish out another month of this and have a sick cat again and be not quite back where we started was ... disheartening.
Our vet is supposed to get a report on all of this, but I haven't seen a copy of it yet.
And for now all we can do is wait and see how things go.
So Kimberly put in the work playing phone tag with people at VERC in Oahu and finally got word back that the internist was willing to do a phone appointment.
As Lucy did better and better from Friday on, increasingly eating huge amounts of food (often approaching 240 kCals when our goal is 150-180 a day) and jumping up to get it and generally showing more energy as she climbed up and down cat trees, we were uncertain of the utility of the appointment. But, we respected our vet's request for that second opinion, we remembered the week of good eating before the downturn that resulted in our trip to Oahu (though we now attribute that, right or wrong, to taking Lucy off anti-nausea drugs), and we decided we didn't want to inadvertently burn bridges with VERC by cancelling very late (but still outside of their 24-hour limit).
So we did that today as a brief (45-minute!) interruption to my work day.
It was not the happiest phone call we've had lately.
First up, I don't think there was an internist in the office when we took Lucy in. Which was our WHOLE POINT in taking her out to Oahu. But Dr. S. idly mentioned that she'd been out at the time due to familial obligations. I mean we felt like we got good care at VERC, including a diagnosis, but ...
Second, on that diagnosis ... Dr. S is unconvinced. She says that the ultrasound wasn't actually defining for liver infection and she says that it's less likely because of something about liver enzymes and the lack of a high white blood cell count. The only thing that makes her think maybe is that Lucy threw up the night things went bad, and that can apparently "shower" the liver with bad juju. So, she places the odds at 50/50 that what we're doing is right and will result in a well kitty. (Man, that is is a far cry from the "very certain" response we got from Dr. C at the clinic when we asked about how strongly he felt about the diagnosis.)
She says that if Lucy has a relapse or if we finish up the course of antibiotics and she's still not eating, then the odds are it's either Inflammatory Bowel Disease or Small Cell Lymphoma, which are both intestinal diseases and could fit with the fact that Lucy has had various intestinal problems her whole life.
At that point we'd most likely put her on Chlorambucil, which is a chemotherapy drug (I think one that we'd previously given to Cobweb, many moons ago, when they incorrectly diagnosed her with cancer) and see if that does the job. With the other option being a trip out to Oahu for an endoscopic biopsy to verify what's going on. (Well, maybe, apparently it can be hard to get great results with endoscopic, but that's all they'd suggest for a cat Lucy's age.) Dr. S. says that a biopsy is the gold standard, but really seemed to stop short of explicitly saying we should do it.
So, ugh.
We'd increasingly thought we were on the right track, especially with Lucy's improvement these last several days. So to learn that we could EASILY finish out another month of this and have a sick cat again and be not quite back where we started was ... disheartening.
Our vet is supposed to get a report on all of this, but I haven't seen a copy of it yet.
And for now all we can do is wait and see how things go.