So through yesterday Lucy continued to purr and eat and occasionally slowly
walk to the litterbox or another room. She is very fatigued, probably from her
anemia. Hideyo had said that giving the feline interferon every day seemed
to help Dharma feel better, so I gave Lucy the feline interferon for the
second day in a row yesterday afternoon. In the evening, she was much more out
of
it. Still no fevers though. So at about 10 pm I gave her a dexamethasone
shot that I got from the vet. I was planning, if I thought she definintely has
fip (which is seeming more and more likely) to put her on steroid shots to
make her more comfortable. Well, this is the second time she got a dex shot,
the
other time being Tuesday after getting some fluids drained. Last night, like
Tuesday, she got a fever about an hour after getting the dex shot, and all
the congestion came back to her nose. Although it does not really make sense
according to the vet, I am positive now that the return of fevers and
congestion comes from the dex shots. But, like last time, when I got up in
the
early morning she was at the top of the 6 foot tall cat tree, and purring.
She
has been there all morning. She has meowed a few times, which she normally
did a lot while healthy, and purrs, and has eaten a little, but generally
looks
the same as she did before getting the additional feline interferon and
dexamethasone, only at the top of the cat tree rather than on a cat bed on the
floor. Clearly she got some burst of energy, but I think it is rather
temporary.
So I am trying to decide, now, whether to switch her from oral prednisolone
to dexamathasone shots. I did read in the archives of one of the FIP lists
that a cat with presumptive dry FIP (all the signs and lab work, but no tissue
biopsy) was put on strong dexamethasone instead of pred and after a couple of
months went into remission and is still in remission 2 years later. And
dex gives Lucy at least a small period of energy, clearly, a few hours after
getting the shot. And another potential upside is that if it reduces her
fip-induced inflammation more than the pred, it could give the epogen more of a
chance to work, as epogen apparently does not work well if there is a lot of
inflammation because inflammation causes sequestering of iron, even when iron
is
added (I am giving pet tinic and folic acid). And anemia may be what is
likely to kill her first. Those are the potential upsides of giving
dexamethasone instead of pred.
Here are the downsides: She seems to get temporary fevers from the dex, and
she seems to feel pretty miserable while she has the fevers (and I need to
give her some fluids, which may increase her belly effusion, and put ice on
her, which she doe snot like). So far she had fever last night for a couple
of
hours. Last time the fever came back the following afternoon, so I will need
to see if that happens today. Also, she looks a little bit wired-- her
expression. Then, she seems to get some of her URI symptoms back from the
dex,
like some congestion in her nose. Finally, she is still on clindamycin in case
this is toxo. It is looking less and less like toxo, but I can not find a
way of telling for sure and sometimes the antibiotics do not make a big
difference for a few weeks. Even high doses of pred like she was on is bad
for
treating toxo, but dex is the worst-- when lab researchers induce toxo in
animals
to study it (horrible, I know), they bring out the clinical symptoms (most
animals do not actually get sick just from being infected with toxo) by giving
them dexamethasone. So giving dex is a definite giving up on the abx doing
anything. Also, Lucy is on feline interferon, and it is unclear what being
on dexamethasone would do to the chances of the feline interferon helping her
in any way, whether prolonging life or just making her feel better. Feline
interferon is normally given with some prednisone, but lower dosage of pred
than Lucy has been getting, much less dexamethasone. They do not know why the
feline interferon helps sometimes with fip. In one theory it is anti-viral,
which means that increasing steroids would decrease its ability to work. In
the
other theory it modulates the immune system and therefore controls
inflammation when the immune system is out of control like with fip, in which
case
steroids would work in conjunction with it rather than against it. But all of
the success stories (of which there are only a few) of feline interferon
curing fip or giving long remissions have been with using it in conjunction
with
less pred than Lucy was on. None with dex, though I do not think it has been
tried with dex.
So what would you do? Switch to dex or keep her on the pred? I have never
had a doubt before about this when I thought my cats were in their last stages
that it was the right thing to give heavy doses of steroid shots. It has
always clearly made them feel so much better, even, or perhaps especially,
with
my cat Buddy who probably had dry FIP. But it is less clear for me with
Lucy, both because it is unclear if on the whole it makes her feel better, and
because it may work against some of the other meds she is on (feline
interferon
and abx). Then again, it might help the epogen to work. Without the dex, on
12.5 mg/day of prednisolone, Lucy was still eating and still very purry and
seemed comfortable, just incredibly fatigued. Part of me feels like it is
better to try to help her stay like that, if possible, than give her something
that brings on fever and congestion, even with a small temporary surge of
energy. But part of me feels like, wow, she climbed to the top of a 6 foot
tall
cat tree-- how can she not feel better?
Please let me know what you think I should do.
Thanks,
Michelle
