Lymphedema?

[Meeb1]

Does anyone have any experience with feline lymphedema? Our 4-year-old male indoor neutered cat has over the past two months been lethargic and doesn't want to jump. He has lost a lot of weight (he was quite heavy before, but now his back is bony), and his hind legs are disproportionate. We thought at first that the right leg was atrophying, but now it seems it's the left leg that's problematic. It's lumpy and I just today noticed a large scab. The progression seemed as follows:

~two months ago: Lethargy; not wanting to jump/difficulty jumping (just not as active as he used to be), felt warm (especially ears and belly); had blood tests done - no diabetes, but antibiotic prescribed for fever
~one month ago: noticed weight loss, skin on belly looked kind of purple still warm, still lethargic; more tests - ruled out feline leukemia; put back on anitibiotics. He started to hide at this point, and was very upset when hindquarters/belly were touched.
Over past few weeks: severe limp; you can tell the difference in the hind legs just by looking. Left leg "knotty" - hard, flat lumps and dry skin. Like I said, we currently has a scab that is about 1" in length on his upper left leg. Lower leg just looks thicker than the right. Upper right leg looks like it's caving in. Similar lumps on lower abdomen, though no visible scabs.

He is eating well (though slightly less) - normal body functions. The vet has said this (after x-rays and an abdonimal ultrasound):

> Lymphedema left pelvic limb and mammary chain
> cutaneous nodules
> medial iliac lymphadenopathy

He has perscribed a quarter of a baby aspirin every three days. Recommendations include aspirations of the lymph nodes and maybe even biopsies, etc.

My question is, should we just put him down? I don't know if the testing (if we choose to proceed) will help him at all. He seems pretty miserable, and I'm miserable that he's been like this so long. I guess I don't want to poke and prod him unless there's a real chance for survival and improved quality of life.

Many thanks to anyone who may have some experience with this...

[Traci]

What you posted re your vet's comments are only comments on the symptoms, not the cause. Other than FELV, was your kitty tested for FIV? Was an immunology profile sent to an outside lab to rule out infectious, immune-mediated, fungal, etc? If not, I'd seriously consider it. SLE and protein-losing enteropathies, inflammatory conditions, allergic reactions, etc are also conditions I'd want to rule out.

A fine needle aspiration may not be a bad idea to determine what type of cell make up is found on the fluid, this could differentiate infectious vs bacterial or fungal infection vs trauma vs immunological etc. If the aspirate cytology is inconclusive, a biopsy would be an appropriate approach.

I strongly advise you seek a second opinion promptly with a feline-only specialist, opt for a full feline serology, and discuss the aspirate cytology. I don't see a reason to consider euthanasia, you need to persue additional diagnostics to get multiple conditions ruled out (there are several that can cause these symptoms). Most forms of lymphedema are not painful per se, unless there is an underlying condition going on left undetected and untreated. Don't give up on your kitty, get a qualified feline-specialist to re-evaluate your kitty promptly.

[Meeb1]

Traci, thanks so much for the quick reply.

Check was tested for FIV back in July. Not sure about the immunology profile and everything else. I will ask this afternoon.

We dropped him off this morning at his vet, who will be doing the lymph aspirations and skin biopsy. We will pick him up this afternoon, bring the poor thing home (he is just pathetic coming off anesthesia - this will be the third time in two months), and wait three (or more!) days for the test results. I feel like we're going to have all these lovely numbers and a dead cat.

He's just not fighting us anymore. He used to cry and growl when we went to the vet, but today he just lay there, his third eyelid about halfway up. Didn't make a sound. I can tell he's miserable, and I don't know what to do to help relieve his pain while we wait to see what this is. Should I just leave him alone? Massage him? Apply heat/cold to his swollen belly and leg? I gave him a quarter of a baby aspirin yesterday (as directed), so maybe that will help. Any ideas?

This is killing me! I just don't see how he can bounce back from this, and I don't even know what "this" is after two months!

I've looked, but I don't see any feline specialists in Louisville, KY. Does anyone have a recommendation? If so, you can e-mail me at Meeb1@aol.com.

Thanks again for the help. My heart goes out to everyone who has gone through this - I wouldn't wish this feeling of helplessness and sadness on my worst enemy.

[Traci]

Massaging and compresses are probably not recommended, your vet needs to get to the source of the problem in order to treat it effectively.

I advised seeing a feline specialist because they are more likely to have more experience and are more aware of medications that can help reduce the symptoms, manage or control them. Your vet should be doing this for you, he can consult any veterinary university for either a referral or a consult, etc. My guess is your vet doesn't have enough experience with this condition, so you need to see a specialist who is. A specialist can also help your vet interpret the cytology/biopsy and recommend the best course of treatment.

I'm also not sure the aspirin is the best approach, a specialist can recommend treatment options that may include wound care, antibiotics and even surgical approach if necessary (not saying kitty would have to have surgery, but it would be an option if the condition warranted).

Don't give up on your kitty, I suspect you are more stressed than kitty is. Although while the weight loss is concerning and should be addressed immediately by your vet, your best bet is with a feline specialist. Request this of your vet promptly.

[Meeb1]

Well, they did the biopsies and aspirations, but our vet pretty much said he's a dead kitty. Even by the time we get the results, if it's cancer, I'm sure it will be too late. They gave him a massive dose of an antibiotic, just in case it is an infection, but I just don't know. Test results should be in by Friday.

He's not eating right now (could that be the antibiotic/anesthesia?), but seems to be moving around OK. He's breathing normally, though it sounds a teeny bit raspy. He keeps getting up, but I'm sure it's because it hurts.

Our vet was shocked (his words) to see him in this condition.

I guess what I've learned is to get tests (any tests; all tests) done as quickly as possible. It kills me that whatever this is has been eating him for a couple months, and we haven't been able to anything but watch.

Please say some prayers that maybe it's just a really bad infection and the stronger antibiotic will kick in and knock it out. But I guess the real prayer is that, one way or another, he won't be in pain anymore.

[Traci]

The anorexia could be the anesthesia, if he isn't interested in small amounts of food by now, contact your vet.

Please, seek a second opinion from a feline specialist TODAY. Didn't you talk to your vet about this?

[Meeb1]

Well, the tests are back and it's highly malignant mammary blah blah - breast cancer. In a 4-year-old male cat! I am getting copies of the results mailed to me.

Unfortunately, I'll have these numbers and it won't matter since Check died exactly a week ago. I wish I had known the severity of it and gotten tests sooner. Now I know....

Thankfully (I guess), it spread pretty quickly and he didn't suffer as long as he could've. And who knows? Maybe treatments would have put him in more pain. Anyway, I am grateful that he's no longer suffering, and I'm really grateful that I have 3.5 years of memories, some beautiful pictures and a perfect image in my head of a loving, amusing and unique companion.

Thanks to everyone for their help and prayers!

[Traci]

Male mammary adenocarcinomas are extremely rare, and even rarer would be the metastic rate to limbs,, such as you described, as well as his young age. Was your kitty of siamese breed or ever treated with Ovaban? (for behavioral or urine-marking puposes) Was the biopsy sent to a qualifed pathologist with confirmation as opposed to "suspicion"?

I'm so very sorry, my heart goes out to you. If it was in fact, mammary adenocarcinoma, the condition may have been impossible to treat and it sounds like you did everything you could.