The Enigma (219/365)

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August 7, 2015 – They say cats are enigmatic. Puzzling and contradictory characters.

Other synonyms of enigma can also include problem, conundrum, mystery, riddle, and quandry.

Any or all of these could apply to Loki at the moment.

In early June Loki had a vet appointment. Nothing earth shattering, just an annual visit but we wanted to get him in anyway since he’d been over grooming his belly and seemed itchy. He’s always had skin issues and we feed him a hypoallergenic diet to keep it under control. If he eats the wrong thing he gets ulcerous granulomas around his ears. I usually clean them up and put some Polysporin on and they clear up fairly quickly. But this was different and warranted a visit. The vet agreed it was unusual and suggested putting him on an antihistamine, part of a chlorpheniramine tablet twice a day, and see what happened. Simple, cheap, and easy with a food motivated cat.

While there we also opted to get him a rabies shot, not because he is an outdoor cat, but because twice we’ve had bats fly into our house. So since the outdoors seems to be inclined to come in, we thought it a safe thing to do.

And also while there, the vet suggested Loki get a geriatric panel done on his blood just to know what his current baseline was like, particularly since I’d questioned his thyroid with the itching and twitching.

A few days later the vet called with a concern, Loki was unusually anemic and had an astronomically high lymphocyte count. He said his thyroid hormones were ok, his liver and kidney enzymes were normal, and he wanted to run panels for feline immunodeficiency virus and feline leukemia virus, as well as run a test for free T4 levels, would we approve the extra charges.

Yes, of course.

A few more hundreds of dollars later and everything came back negative.

In the meantime, I mentioned this to the vet I work with and her immediate words were “Oh, I’m so sorry…”

The only logical conclusion to the results was leukemia; bone marrow cancer.

I was beside myself with grief. Loki is our little love muffin. The sweetest cat you could ever imagine encountering. He loves everyone, is afraid of no one, and is the most interactive cat you could ever meet. He’s less like a cat and really more like a dog in many aspects.

We were devastated, but I was also a bit argumentative with the vet. Loki had just been in for an allergic reaction to something, and he’d just been vaccinated for rabies. A severe allergic response could lower erythrocyte levels and the rabies vaccine could easily have caused escalated lymphocyte counts. He conceded the second point, but then told me just HOW low Loki’s erythrocyte counts were, and I had to agree that allergies weren’t likely the reason.

We agreed to wait and run a second complete cell count in a few weeks time, to give things time to settle down. In the meantime we continued with the chlorpheniramine to give his system time to recover from whatever was making him itchy.

Six weeks later, when all company had come and gone, we went in and had another blood sample drawn.

And we waited.

And when the results came back the vet told us that his red cell counts had become worse. There was no doubt in his mind, it was leukemia and the anemia seemed to indicate that it was aggressive and he’d probably only have months to live. He wanted to send a sample of the blood off to a lab in Ohio for flow cytometry to get a better picture of what exactly we were dealing with, it would be expensive, would we approve the costs.

Yes, of course.

It was impossible to rationalize the results when I looked at Loki. He seemed the basic picture of health. Eating normally, drinking normally, normal litter routines and contents. No blood in any stool or urine. Loving as ever, basically the same cat as ever.

I decided to take him off the antihistamine as he’d been on it for about 8 weeks and wondered if whatever had been bothering him had resolved itself.

The next day the clinic called and said that the blood sample for flow cytometry needed to be no more than 24 hours old prior to being submitted, could we bring him back in for them to draw another sample?

Yes, of course.

So off we went for another poke and we were told that it would be 3-5 working days before the results would be available. Our vet was off until Friday, and then gone for the long weekend.

In the meantime I had neglected to tell anyone that I’d found a lump on Loki’s flank and was concerned it could be related somehow. The vet called me back and said he thought it was unrelated, that ti was probably just a fat deposit, and that Loki had leukemia, but that he’d see him at the end of his shift Friday if I wanted to bring him in.

I did.

So last Friday we went in, assuming we’d have the cytometry results, but they weren’t back yet. The vet did find the lump, and didn’t know what it was. We sat down with all the blood tests and started to go through them. It turned out that when they’d drawn the most recent sample someone had rerun the complete blood cell counts again, even though it hadn’t been requested. And the results were puzzling.

Although his red cells were still very low, they’d come up a touch, and his lymphocyte numbers were now in a normal range. More interesting was that his reticulocytes were up…meaning that his bone marrow is still producing red cells, so whatever the anemia is, it is not non-regenerative. That’s a surprise, and a good one. I also noted that his thrombocytes were elevated, and to me that means injury as they are involved in clotting. The vet thought it insignificant.

He told us that he thought the cancer was not as aggressive as he’d anticipated, and that putting him on prednisolone would probably see him with us for a couple of years yet. We were elated by that, we’d thought we were coming in for a death sentence.

But the lump?

Is it cancer? Is it a fatty tumour? Is it a haematoma? A haematoma might explain the red cell loss. We still had to wait for the cytometry results to see what the cancer was like and then schedule an ultra sound to investigate the lump. The vet was to be off this week, back Friday, but the clinic was to schedule an ultra sound when the technician made her weekly visit.

And so we waited.

And we heard nothing.

And we were both too terrified to poke the hornet’s nest.

So we continued to wait.

And Loki ate, and drank, and pooped, and peed, and slept, and loved, and played.

And then today, while I was out and about, a text came from Kirk.

“It’s not cancer”

I called the vet and got the rundown. The flow cytometry results were basically normal. There was not a trace of lymphoma or leukemia in his blood. The lymphocytes are perfectly normal in nature and abundance. He was glad we’d had the test run, even at the cost, because he would have started the treatment based on the presumptive diagnosis.

Ok, so it’s not that, then why is he anemic and what’s up with the lump? Don’t get me wrong, I’m happy, but I spent too many long hours over too many long years staring through a microscope reading blood smears and doing differential cell counts to blow it off that quickly, and I want to know what’s going on with his screwball blood counts.

Not sure, could still be cancer, but if it is, it shouldn’t be related to the low red cell counts unless he has been bleeding somewhere, and there’s been no indication of that, unless the lump turns out to be a haematoma, in which case maybe he fell off something and hurt himself internally when we weren’t around. It might explain the elevated thrombocytes too.

Or, possibly it’s something viral. We tested for the two common infections of note in cats, and because both came back negative, viral causes were ruled out. But a viral infection could definitely cause the physiological responses that were manifesting. I’m wondering if there is an autoimmune response at play. I forgot to mention that and bring the granuloma issue into the conversation.

It may not be lymphoma or leukemia, but there is clearly something going on and he’s not out of the woods yet.

So back he goes to the vet on Wednesday for an ultrasound, and another hefty vet bill.

And we wait…..

And I just noticed that he has a granuloma coming up in front of his ear….we thought he was dying, he’s been getting too many treats…time to go clean that up and put some Polysporin on it.

We feel like we’ve been through the emotional ringer, and I’m not yet sure it’s over, but at least it’s not what we thought it was….

Loki, the expensive enigma.