Crick the Medical Mystery Cat
When last I blogged about Crick’s health situation, we were waiting for our visit with the cat internist to try to figure out why her runny nose was getting worse. We ended up getting a scan of her head that showed the tissue in her nose was thickened, so a biopsy was taken for suspected nasal lymphoma. They also saw a mass near her pituitary gland.
The biopsy results were supposed to take a week, but due to issues at the lab, they took more than two weeks. During that time, we noticed weird things going on with her eyes – first it was one pupil fully dilated while the other eye looked normal. Her third eyelid started to be up all the time in one and then she started keeping one of her eyes closed most of the time. I called the vet and they thought it was possible that because her nose was so congested, it can lead to fluid in the inner ear and also mess up the eyes.
One day she seemed to be having trouble seeing – she would walk very slowly with her head close to the ground (a Google search told me that cats with low or no vision often do this to use their whiskers on the floor to guide their way). But then the next day she seemed to be able to see fine.
We finally got the biopsy results and they can back positive for nasal lymphoma. So we got referred back to the oncologist that we saw when she had the giant lump in her neck and who we thought we wouldn’t have to see again since the surgery seemed to have resolved that issue. But it was two weeks until we could get an appointment with her. During that time, she was getting pretty lethargic, wasn’t super interested in eating (and she usually *loves* eating), and she was no longer tolerating us cleaning her nose from all the runniness (prior to that she seemed annoyed by us cleaning her nose, but she started reacting like it was painful).
Then, the weekend before our oncology appointment, she woke up one afternoon from her nap completely blind. She was walking around bumping her little head into walls and table legs and she couldn’t find her way to her water (she’s back on prednisone so she’s very thirsty). So off we went to the emergency room to see if there was anything we could do for her.
The emergency room vet confirmed what we already knew – Crick was blind. And given that cats use their sense of smell to help them navigate the world and her nose was totally blocked, she was operating without her two main senses and so no wonder she couldn’t find her way around. The ER doc gave us some pain meds to give to her so that we could clean her nose and also recommended “steam therapy” – i.e., turn on the shower and put her in the bathroom with the doors closed for 30 minutes to help soften up the crustiness in her nose twice a day. So morning and night I would give her the pain med and sit with her in my lap in the bathroom having a steam. It helped, because it was back to her just being annoyed with having her nose cleaned instead of it seeming painful. And getting her nose cleared a bit helped her find her way around.
At first we had to lead her to food, to the water dish, to the litter box. That last one was a problem, because while we could lead her to the litter box every couple of hours during the day and she could go when she needed to, at night she couldn’t find her way so she’d end up peeing wherever she was – on the couch, on some laundry on the floor, etc.
But slowly she started to learn her way to things – first the water dish (splashing the water in the dish when she was close helped her because she could hear it), then the food dish, and eventually the litter box. But she was still pretty lethargic and not that interested in food and treats.
Finally we got to the day of her oncology appointment. As far as cat cancers go, apparently this is one with a better prognosis than others. Treatment is quite effective in most cats and can buy them a few years of good quality life. Radiation is normally the first choice, as it’s slightly more effective than chemo (works in 75-90% of cats and they get about 2 years of good quality life before recurrence vs. chemo works in 75% of cats and they get 1.5-2 years of good quality life), but cat radiation is not available in BC, so you have to go to either Calgary or Seattle, and treatment is daily for 3.5 weeks. Moving to another city for a month in the middle of a pandemic is just not feasible, so we’ve opted to go with chemo. The other good thing about chemo is that it’s systemic, so if there’s any spread of the cancer, the chemo can also work on that (and if the “mass” near her pituitary is cancer, maybe it will even work on that), whereas radiation is localized so if there’s spread, then you need to do some chemo too.
We had our first chemo appointment last week, where they also flushed out her nose and gave her some antibiotics as the crustiness in her nose seemed to have a bit of an infection. She was sleepy that night from the sedation used to do the nasal flushing, but the next day she was so much better! Full of energy, gobbling up her food (and stealing her brother’s food too), and much more able to navigate her way around the apartment. She even figured out how to get up and down on the couch, the cat tree, and various chairs. She figured out how to get on the bed – we’ve have a step stool next to the bed for ages for her to get up there (as the bed is quite high and she’s not the best jumper) – but hasn’t quite figured out how to get down from the bed (as it’s too high for her to jump down, but she can’t figure out where the step stool is to use it to get back down since she can’t see it). So we have to make sure that we bring her down off the bed if she’s up there for very long, otherwise she’ll end up peeing the bed.
This week we had our second chemo appointment – we’ll do 8 weekly visits, and then it becomes every other week for 8 more treatments. The vet said that if a cat is in the 75% of cats for whom chemo works, we’ll know within a few visits (her improvement in energy and appetite could just be from the nasal flushing and antibiotics rather than the chemo itself – it’s just a bit too early to tell). So we are cautiously optimist that this is going to work. Right now I’m just grateful that she’s in good spirits and is enjoying her food, her treats, her naps, and lots of pets and snuggles.
Oh yes, I haven’t explained the medical mystery part. The vet said that it seems like the giant lymph node in her neck that we thought was feline Hodgkins-like lymphoma but wasn’t must be related to this nasal lymphoma, but she’s never seen that in any cat with nasal lymphoma. Same with the blindness – it’s possible that the nasal lymphoma is pressing on optic nerves or on her brain and causing blindness, but she has never seen that in a cat with nasal lymphoma before.
Also, for the record, we got our nasal lymphoma diagnosis before Lunar New Year and started getting the chemo treatment (and seeing the improvements) after Lunar New Year, so I’m sticking with my theory that things will be better now that the Year of the Rat is over.