Bette Recovers Ability to Walk/Use Litterbox with Steroids-Must Monitor

Bette again has responded quickly to prednisolone given twice a day (as opposed to once daily) and can now fully walk and go to the bathroom without issue.

But much like HCM, this is a disease that will grow and get worse over time. And much like HCM, we must monitor her daily for signs of the disease and complications, and monitor her ability to walk and use the litter box.

We are not allowed to increase the prednisolone in the future because more than 2ml a day will lead to immune suppression which might occur regardless. Immune suppression can lead to an increase in viruses taking hold (but she's indoors and on lysine for Herpes so that might reduce the probability.) But long term use can also suppress her response to vaccinations which can be a concern although she is an indoor cat. (But the distemper virus is air borne and can be brought indoors on us as well.)

Other long term effects of prednisolone for cats is not the same for dogs (dogs have more possible issues) but it can lead to edema-fluid retention similar to humans, or over eating (and she needs to lose one pound as it is. She's 12.3 and really should be about 11 lbs especially given her mobility issues.)

Here's one of many links you can find online about prednisolone. 

AND as a reminder-STEROIDS CANNOT BE GIVEN TO HCM/heart disease cats (and dogs.) It causes fluid retention, is contraindicated with diuretics. Bette does not have HCM.

Medications she is currently on:
*Valium 1/2 tab of 2mg tab BID (twice a day)-since 2010 for litter box issues.
*Prednisolone-1ml BID-steroid

*Buprenex pain medication - .15 BID-for a few days for her right leg pain to get her past this recent issue. We will do at least once a day going forward to see if she's in a lot of pain and if less of it affects her ability to be comfortable for now. I can increase it as needed. This is a less severe pain medication. The neurologist suggested gabapentin which we have used on other cats for other issues and it is too difficult to control. It makes them loopy even at very low doses.
*Cisapride-once a day for now-a medication to help her expel fecal matter. Works internally not at the rectum but might help here body prep the matter to push it out. We can do it BID but for now just once in the a.m. to get her past her recent issue. She has had normal bowel movements since Saturday. Is that the prednisolone or the cisapride?

*Cerenia four times a week to control pancreatitis.
*Chlorpheniramine-anti histamine for her eye/skin inflammation she began to have in 2021. Four times a week.
*Gels: lysine, Methigel (urine), Laxatone (to help her gastro mobility) four times a week

Bette Davis Develops Nerve Sheath Tumor Rear Along Spine

Bette Davis was seen in January for rear leg lameness, immobility of the tail, and difficulty going to the bathroom. I posted about it at that time. She was treated with antibiotics and prednisolone. By the end of January, she had finished the course and had fully recovered her mobility and ability to go to the bathroom. But two weeks later in February, she developed bathroom issues so was put on prednisolone 1ml once a day. That worked fine until March when March 6 she suddenly showed signs of rear leg lameness again. We had an appointment for Wednesday March 8 by which time she had gotten weaker, had again developed bathroom issues-inability to urinate or defecate fully. This time we opted for an MRI because she could have spinal cord or vertebrae injuries or lymphoma-although her gastro scan did not show signs in her organs of lymphoma (although it can appear elsewhere.) Both respond to prednisolone to reduce inflammation. 

Today, March 9, was the MRI. Unfortunately, she has cancer but one we did not think about-Nerve Sheath Tumor. It is growing along the nerve on the left side of the spine but growing into the right side of her rear limb which is why she is weak in the rear legs but has significant discomfort in the right rear leg. It has also made her numb in the rear end and rectum area, making it difficult to urinate and defecate. 

The solution short term is to increase the prednisolone to 1ml BID for the rest of her life. She cannot increase the amount of the prednisolone even as she might grow weaker and have more difficulties going to the bathroom because then immune suppression issues will develop, leading to other various health issues that are even more serious. 

Radiation is a possibility but expensive: the vet estimated $7-10k. We have been referred to Oncology at the state vet school and might hear from them next week. At the consultation, we will learn more. How will we pay for it? From savings, investment account from which we can borrow without penalty, CareCredit, credit cards. But how often will she need treatment? And we have four others, three of whom are her siblings and the same age with their own issues (Katharine has HCM now.)

There is no surgery possible as far as we know for her tumor.

Diapers and rear leg lameness might also be in the future. There are plenty of cats on social media that do both and seem to live happy lives. BUT with her nerve cancer, pain will be an issue and pain meds will be needed in the future. BUT it is likely not life threatening the vet said and she could live a normal rest of her life existence. But then again, he gave her a year before her life was impacted and that is when people tend to put cats to sleep. 

We prefer not to do that especially after we lost Baby by putting her to sleep without fighting for her life (in 2021 she had been in the ER for a week dying of acute pancreatitis and I failed to bring her home to either try to get her to recover or let her die at home.) I don't want to run the risk of letting Bette go too soon just because taking care of her isn't easy, just because she can't easily move around if she can manage. I must decide how I want things to end for her so that I'm prepared. I was so prepared for Myrna's death in 2015 after six years and nine months of facing the fact. But I was so caught off guard with Cooper (who lived five months after being diagnosed with heart disease) and Baby that I still feel a lot of shame and heartbreak.

Here is one link to one explanation. You can Google for others if interested. 

"...Nerve sheath tumors (NSTs)...are benign or malignant mesenchymal tumors and they originate from periaxonal Schwann cells (schwannoma) and fibroblasts (neurofibroma/neurofibrosarcoma). Due to its mesenchymal origin the terminology for NSTs is diverse and a wide range of names has been used in the literature, e.g., neurinoma, schwannoma, neurofibroma, neuro(fibro)sarcoma, neurilemmoma, neurogenic sarcoma, and neurofibromatosis. Currently the most widely used name is nerve sheath tumor...NSTs may occur in every large or small nerve in the body...grow outside the dura mater (extradural) they may extend along the pathways of the nerve roots into the intervertebral foramen. Once inside the spinal canal they may develop an intradural-extramedullary component or even an intradural-intramedullary component (Figure 1). Clinical signs include severe, unexplained, and intractable pain, thoracic or pelvic limb lameness, monoparesis, ataxia and proprioceptive deficits. Early diagnosis and an aggressive surgical protocol maximize the possibility for complete tumor resection sparing the limb. NSTs have a high rate of recurrence, and the overall prognosis is considered poor..."