5/16 Billie AMPS 324 +5 184 PMPS 247 Leukeran or Atopica?

http://www.felinediabetes.com/FDMB/threads/5-14-billie-pmps-301-6-157.195594/#post-2190407

Hello all!

Billie's bloodwork came back, and wouldn't you know it, the methylpred really was helping her liver/triaditis. Her GGT was back in normal range...her total bilirubin went from 5.8 to 0.7...ALT went from 800 to 398...ALP and AST also went down significantly. All in two weeks. Unfortunately, we know the methylpred put her into congestive heart failure, so it's not an option. However, she responded to it liverwise, so her IM's thought is that maybe she will respond to another immunosuppresive/anti-inflammatory drug.

Right now, the focus is on getting her heart back to normal with 6.25 mg of furosemide once a day, recheck in a week. But her IM said that if she stays stable over the next couple days, we could try Atopica or Leukeran. I'm going to do more research on both. If anyone has experience or thoughts about either, please chime in!

I know both can have some challenging side effects like inappetance/nausea. I know longterm use of Atopica can increase the likelihood of developing cancer, while Leukeran is a chemo drug...and I know Leukeran has the potential side effect of bone marrow suppression. We really don't know if Billie's liver disease is triaditis (inflammatory) or cancer because we haven't done biopsies, but her IM leans toward triaditis based on the slow progression and the response to pred. But she did say that some cancers respond to pred as well.

Before the bloodwork came back, I was really thinking we had reached the end and wasn't going to try more treatments. But, if her liver values turned around like that, it makes me think she can get better and might want to stay around a while

She is currently sleeping curled up in the tire...which is still on the floor in the apartment, because if Billie wants a tire in the living room, Billie gets a tire in the living room I bought the girls two new super soft cat beds a few weeks ago, and Billie wanted nothing to do with them, but a tire is somehow appealing to her... @Wendy&Neko , I think Neko is the only one who would understand!

Billie is still eating well even with the steroid out of her system. Her respirations are a little elevated, but her effort is normal. She was less lethargic and more active today. She had been staying in the bedroom a lot over the past few days, but today she also hung out in the living room.

Vines and hugs to all!

 

Both Neko and civie Theo were on Leukeran (generic chlorambucil is much cheaper in the US). What dosing is the vet thinking of

 

Glad Billie is still enjoying her tire. No advice, just sending prayers.

 

I'm glad Billie's bloodwork shows improvement and gave you hope. Paws crossed you can find something else that will help without compromising the heart.

Harvey was on Leukeran for about a year. He had inappetance issues, but that could have been the intestinal lymphoma or the CKD, so I can't for sure blame it on the Leukeran. We gave him Cerenia, Ondansetron and Cypro and he ate.

Sending lots of vines for Billie.

 

Thank you for visiting and weighing in! @Wendy&Neko the vet didn’t say what the dosing would be like. I will have to ask. It is so hard to know what might do the most good and the least harm.

Billie is feeling good tonight! Her respirations were at 33 earlier, so much closer to normal. She’s still eating well and has been out and about more this evening, not staying in the bedroom. She actually came to the door when I got home for the first time in maybe a week!

 

Leukeran can definitely cause inappetance. Neko took 4-5 days to get over it (dosed every two weeks), Theo wasn't too bothered by it, just quiet for a day. Ondansetron really helps. Dose before and days or two after. The reason I ask about dosing is that EOD made Neko miserable, but a larger dose every two weeks gave her some time between doses to get over the nausea. But that was dosing for small cell lymphoma, not sure what's appropriate for other cancers. Small cell is also slow to progress, but is in the bowels, not liver.

@Sean & Rufus has experience with Atopica.

 

Rufus was on Atopica for about a month. I just couldn't do it anymore. Benefits - it seemed to help him eat dry food a little easier. I'm guessing he had(s) some tummy pain from food allergies/intolerance/IBD and it reduced the inflamation a bit. It also made him stop the constant licking/chewing/gnawing. His hair grew back. The bad - he was nauseos to begin with, and this put him over the top. Somehow he never lost weight, but it was constant lip licking, having to dose at just the right time so he didn't vomit, I would give ondansetron and cerenia and still would be licking lips all the time and walking away from food. It also made him more lethargic, seemed depressed and didn't interact with us as much. Also, now I can't blame this totally on the Atopica because he has CKD, but his creatinene went from 1.4 to 2.2 and bun went from 31 to 45. I googled "which meds in cats raise kidney numbers" and cyclosporine came right up. On top of that was the cost. The stuff from the vet was costing me $7 a day. It was about half that pricve from Allivet, still expensive. I would spend any amount needed on him though.

So, I just couldn't give it to him anymore. I was reminded by some vets that it could take a month to get it to really work in his system, whatever that means, but he was miserable. Remember all cats are different though. This could be Rufus, and your kitty might do better on it. I hope you find the right meds for Billie If you have any other question, feel free to ask.

 

Thank you so much, @Wendy&Neko and @Sean & Rufus ! I appreciate you sharing your experiences! Sean, I'm sorry to hear that Atopica made Rufus feel so sick. I would have done the same thing and stopped giving it too if it was impacting quality of life like that. I posted in a couple IBD Facebook groups asking about Atopica, and a lot of people had similar experiences with nauseous kitties. I hope Rufus is feeling better!!

If we try Leukeran, which is what I'm leaning toward more than Atopica, the IM vet is recommending 1.75 mg dosed every third day. We're getting it compounded and sent to us, so we would be starting it next week. I'm still hesitant but figured I would order it so it's here. I know I can always stop giving it if it's making Billie feel really sick.

Billie still seems to be going strong. She is eating well and seems more energetic. She's back to some of her old habits, like waking me up by licking my forehead at 3am and running to the door when she hears us coming home She has a cardio recheck on Wednesday.

 

Ask your vet about pulse dosing which is what Wendy did. I tried leukeran for Tiffany but she was really sick by then so I don’t know if the cancer or the drug was the cause. It’s so hard to juggle all these diseases in one cat. Vines and prayers for whichever drug you try works well.