Cat with 2 cancers?

10y/o NM DSH Originally diagnosed with hyperthyroidism after presenting for anorexia, vomiting, diarrhea. Treated with radioactive iodine. T4 stabilized. Same symptoms still occurring, U/S performed. IBD vs Lymphoma, triaditis, cholangiohepatitis, multiloculated liver nodule. Intestinal biopsies were obtained along with mesenteric lymph node, pancreas, and liver. Histopath came back with small cell intestinal lymphoma, intestinal mast cell tumor, multifocal lymphoplasmacytic pancreatitis, and chronic cholangiohepatitis. Put on chlorambucil & prednisolone. Was doing pretty well on the combo. Got megacolon multiple times, tx with cisapride, lactulose, etc. He started eating normally, gained weight, back to normal happy personality. About a year later he started losing weight again, then was having mini jerk like reactions when loud noises were made. He then had a grand mal seizure. Keppra kept it under control after going to the ER. Blood serum icteric at that time, ER doc didn’t do anything for his liver. Few days later now he is icteric. Next day cardiac arrest. What happened? Hepatic encephalopathy? Hepatic lipidosis? Did the cancer spread? I’m trying to piece it all together. I didn’t get a necropsy on my boy and I’m just going in circles. His oncologist said he doesn’t think it’s the cancer spreading but I don’t see how that’s entirely possible. Would anything have changed had he gotten a feeding tube, liver protectants, etc. on that day his serum was icteric since his skin wasn’t yet?

Hello - and first, I'm sorry to hear what happened to your boy.  It sounds as though it was a shock, even on the day.  As we know, the natural first stage of grief is shock, with denial, followed by an urge to seek understanding; to question and reorganise the facts in our heads.  That is part of the universal process of dealing with grief.  (More to follow)

Red blood cells die normally, all the time, throughout a cats' life - red blood cells aren't long lasting.  They are broken down into bilirubin (a yellowish chemical) which is broken down again into smaller waste products by the liver.  Sometimes, this doesn't happen - perhaps the circulation to the liver isn't good enough that all the bilirubin makes it back to the liver, or perhaps there is liver failure and the liver cells are not working, or perhaps an abnormal level of red blood cells were being broken down at that time for some external reason.  Ironically, post- mortem pathology can be very helpful in understanding which of these broad categories is appropriate in a case and in shedding brighter light on the situation, but it is also true that this is not the right thing for every human and every cat and your vet will understand entirely that you elected to decline this.  However, it does make it hard to explain what really did happen.

What we do know is that the bilirubin levels in the blood built up, and that jaundice (high yellow colouring d/t high levels of bilirubin in the blood) set in.  This can be worse with dehydration;  Was he on fluids?  Sometimes fluids help to reduce the colouring and any secondary effects of being jaundiced.  However, even assuming that the cat did have fluids,  he would still have had a lot going on that wasn't resolving and fluids cannot be given forever simply to keep a creature alive, quality of life can be more important than quantity.

Of course I'm giving you a lot of general information but nothing is getting me past the fact that I simply don't know what the mechanism of cardiac arrest was in this particular cat at this time.  Without a post mortem exam, it is difficult to tell you what caused it and thereby whether or not it was preventable - or postponable - eg with fluids or a feeding tube or liver protectants.  Your vet, who was there and supervising the case, may be able to get closer to the answer than I  currently am.  Your second question then, might be whether this could have changed the longer-term outcome. It is perfectly okay to ask to talk this through - a lot of information is given to you when a pet dies but we also know that a lot of owners will later need to go through it again.  This is ok.  There is also a website that might interest you called the Ralph Site, set up by vet Shailen Jasseni while greiving for his beautiful cat, Ralph.  This can be a mine of support and useful information after a traumatic death. If there is any more that we can help with here, please do let us know.

Hi! Thank you for your responses. Yes he was on fluids, but not enough. I wanted to do a necropsy, the only reason I didn’t is because I was moving shortly after he passed and for me it was either the decision of necropsy or watching the cremation with the company my clinic worked with that I wholeheartedly trusted. It was a really hard choice to make. I’m just so lost as to what happened. I wish I knew if a feeding tube, liver protectants would have helped. I was so wrapped up and shaken up by the fact he had a seizure that my vet tech brain wasn’t working and only my pet owner brain was. I just hate that I didn’t get the goodbye I wanted and that he didn’t die with me. Do pets go unconscious once they have agonal breathing?

A cancer spreading might fit the signs rather convincingly, mightn't it?  In which case a feeding tube might have prolonged things, but not made the cancer better and even at best, slowed the progression to some extent.  I don't think anyone really knows at what point dying animals or people lose awareness.  On a different subject, I wonder how the guilt is serving you - what is this feeling of guilt doing for you that makes you want to hold on to it?  It sounds to me that you did the best you know for your friend right along and that he was treated with love.  Everybody but the most evenly emotionally balanced people, when a loved one passes, beats themselves up for what they think that they could have done better.  It's human nature to doubt yourself, but that feeling you've got - that love with which you worried and tended and made decisions - was important and your patient / friend would have known that.   The Ralph Site but also Vetlife, if you're in our line of work, are likely to prove good people to talk to.  Your best is always enough.

I certainly think that once they are agonal breathing, a pet is less aware of what is going on around them.

I have to think it was the cancer spreading, I really can’t come up with another explanation. My guilt is all consuming because I am a tech and I couldn’t think straight enough to be able to tell the doctor to give him a feeding tube and tx his liver. He was my first cat and got me through a lot of hard times. I took him to a different ER than I normally went to that was really awesome and I’m so guilty that I didn’t take him to the ER I trusted, it was just further away. He got subpar care and I promised him he’d never get that. I also feel a ton of guilt for not euthanizing to be able to be there with him. I just can’t help but think if I could have got a year more or even just a few days to be able to say goodbye. Thank you for those recommendations, I’m going to look into them right now!!

Hello again; some time has passed now so I just want to say that I hope you are doing okay, and found the peace that you sought - and also to comment that it sounds very much as though your cat would have understood that he was loved.