2007 - Stella Blue and Pemphigus Foliaceus

Home - - - Stella the Cat's Page

I spent a month deciding to make this page.
I don't want to document Stella Blue's
final time on the internet.
That would be disrespectful.
My cat is not a project.
(Well., actually she is, but that's another story.)

Anyway, this may be of value
to other cat owners, so I'll do it.

November 2007: Stella is almost 13 years old,
and isn't as active as she once was. She has always been a fussy eater, and for years
she ignored canned food and ate dry food.

Well, I also fed her a lot of raw meat and fish, which made her turn her nose up at Fancy Feast for the next few days. She'd give me a look that said,
"I *know* that you have access to
filet mignon, shrimp and tuna."

One day her black nose turned scarlet
(not pictured,) and I realized that
I hadn't refreshed the water bowl for days.
She hadn't eaten for nearly a week.

I've given this cat a dozen hugs a day
since she was four weeks old,

but it had become difficult.
She was moving between the back of the closet
and under my bed. Not a good sign.

I put some food and water right next to her,
in the closet, and she didn't hesitate to chow down and drink a half cup of water. Something was really wrong, if she was starving and dehydrated but didn't want to walk 40 feet
for food and water.

So I pulled her out and set her on the windowsill
for good light and some macro pictures.

Above, you can see a brown crust
forming on her nose. Her nose is normally black. She also had a light nasal discharge.

To the left you can see that her fur
is very patchy on her ears.

At this point I'm counting days since she last behaved "normally." It had been nearly a week, and I was seriously concerned.

The next few pictures
are horror pictures.

Under full sedation, the Vet cleaned her up and removed all the lesions. This involved removing her fur, taking biopsies, and cleaning the skin down to where it would heal without necropsy or infection.

 

I also had him clean and fix her teeth. He found a broken tooth, and removed it. That was unrelated to Pemphigus, but I was optimistic that everything would turn out fine and
Stella would be around
for a few more years.

Pemphigus Foliaceus is an autoimmune disorder, where the immune system begins to attack the "glue" that holds cells together in middle layers of skin. Apparently, people develop it, as well as dogs and horses. I'd never heard of it.

As the cells disorganize and die, the body attempts to excrete them through pores. This creates a crusty discharge.

It starts on the nose, ears, and paws. I didn't know this at the time, and have no pictures of her paws. But this explains why she decided to lie down and starve. Apparently, it hurt too much to walk over to the food.

Her ears appear to be healing,
but I'm watching for new problems.

We want the Prednisolone dosage as low as possible, but don't want the autoimmune response to start up again.

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Home - - - Stella's Page

Here's a picture of her hind paw.

This had to hurt.

It shows why
she didn't want to walk.

A few days before this incident escalated into crisis, she had come upstairs to sleep at the foot of the bed. I could tell that something was wrong because walking across the blankets seemed to be painful. That was actually when I started tracking food and water consumption, because she'd already been acting odd.

This is the last
horror picture.
You can see the lesions on her front toes.

Normally, her nose is black. Loss of pigmentation on the nose is another symptom
of this disorder.

Note the way her whiskers are extended
on "full alert."
She's coming out
from full sedation.
She wants to get up
and move, but her body won't respond, and she's really pissed off about it.

After two weeks,
she's galloping around
the house like she's
five years old again.

Steroids.
Maybe *I* should try
some of this stuff.

The cat door is blocked off. She's now a full time indoor cat. It doesn't seem to bother her, although at least once a day she'll sit by the door and hope that I'll let her go outside.
That is not going to happen.

Maybe in the spring, we'll go play on the lawn again, like when she was a kitten.

7 days later.

The treatment for Pemphigus Foliaceus is a massive steroid overdose, which shocks the immune system. She also received a course of antibiotics and a topical ointment
for her ears.

We did a four day treatment of 5 mg doses of Prednisolone, and then cut back on the dosage. But within 48 hours of cutting back, Stella began to develop new lesions on her ears.

We did another week of overdoses of steroids. The dosage, according to my internet reading, was about three times the recommended maximum dosage for her body weight.

To celebrate, she got a smorgasbord of raw Tuna, Salmon, and Yellowtail.
Anything she wanted.
Just Eat. Just drink.

During this recovery period,
I stopped to think. I'd been working too much and hadn't paid any attention to anything other than work.

I hadn't cleaned my house in five months. I hadn't sailed in five months. I hadn't played with the cat for five months.
I hadn't done anything but work for five months.

Stressed cats get sick.

This has actually made me reconsider what I do for a living, and whether it's worth doing.
Two summers in a row I've left my boat at the dock and worked seven days a week.
Is that a life? Is this job worth it? I don't mind working to build a business, but I'm starting to feel like I'm sacrificing my personal objectives for someone else's benefit.
Did my cat pick up on my personal angst? This is a very smart and sensitive cat.

A month later -

Here's a pic of her attacking a new Catnip Dynamite toy, which was worthless until
I smeared it with homegrown killer bud.

The Prednisolone dosage is down to 2.5 mg every day. That seems to be keeping the Pemphigus in remission. She'll be on medication for the rest of her life, and it's important to keep the dosage as low as possible
to avoid side effects.

She's back to being playful,
and more sociable than ever.

 

Stella's behavior has changed a bit. She likes to hang out
in this box in the living room, where she first stumbled after the trauma at the vet. She'll jump up onto my bed
and say goodnight, but won't sleep in that room.

She now prefers canned food to dry food. That's fine with me, because she's also stopped throwing hairballs.
The wet food really helps that.

I haven't moved her food back into the kitchen.

Her paws appear to be fine.

I don't see any new lesions
or crustiness.

It's good to have my cat back!

The fur on her nose and paws
is coming back gray.

She can wear a touch of gray.
It kinda suits her anyway.

 

Finally, there's always the question of what triggered this autoimmune response.
There's documentation that some humans have a genetic predisposition for this, but no studies on cats.
(Note, when I look at the pictures of Stella's Aunt Sherpa, at the bottom of the Stella Blue page, I see that Sherpa's paw is swollen. At the time I took those pictures, I felt that she had a problem.)
Over the years, Stella has developed an allergic reaction to fleas.
Perhaps that triggered it, since both are severe skin reactions.
Perhaps it was long term exposure to all the chemicals in the new carpet, installed in 1998.
Perhaps it was because I let her run free outside, where she was exposed to unknown chemicals and toxins.

I actually haven't read anything that names a definitive cause.

Update December 11 --
Okay, a cat on steroids is very demanding.
(grin)

Update Christmas 2007 --
She's doing well, is very playful and wants to spend more time than normal sitting on laps.
She has some odd bumps on her back, but we'll let that go for now.
We went outside together. She reviewed the territory that she ruled for the last 13 years,
and smelled everything, but when I said "C' mon Stella, let's go inside" and headed for the door,
she broke into a trot and beat me home.
Good Cat.

There's no place like home.

February 25 2008 --

2.5 Mg of Prednisolone has not been working, but has kept her quality of life up. However, she suffered a major relapse and I've been hand feeding her. Lesions were bad enough that standing up caused her to momentarily lose control of her bladder. We're going to move to 5 Mg a day.
That's an overdose, and will eventually cause liver, kidney or diabetes problems.
But it we don't do it, this Pemphigus is going to kill her through starvation within two weeks.
I'm also going to have to give her a bath for the first time in 13 years. That will be interesting.

March 2008 --

5 Mg wasn't working. Her vet suggested 10 Mg for two days to shock her immune system into submission. That worked, but now it's a balance between major toxic dosages and moderately toxic dosages. We're experimenting. I gave two months notice with my employer,
since when Stella dies I intend to move into a new phase of my life.

May 2008 --

I have two weeks left to work, and Stella Blue is not doing well.
Her toes have been so inflamed that she walks on her heels, keeping her toes off the ground.
She can't retract her claws. She has no fur on her ears or tail.
I have two weeks left to work, and have major work related things to bring to closure.
I put Stella Blue on 10 Mg a day, for seven days. That is six times the maximum dosage for her body weight. However, it will keep her alive and kicking for two weeks, and then I'll
pull the dosage down to non-toxic levels and let nature take its course.

June 2008 --

10 Mg a day really knocked this down, and I had my cat back for a while. However, it was also toxic, and her fur has been falling out (without Pemphigus skin lesions.) On May 15 I quit working, and cut the dosage to 5 Mg a day. Still an overdose. I'll try and work down to 2.5 Mg a day, which is a tad more than the maximum dosage for her body weight.

It's not working, and lesions are back.

July 10, 2008 --

Stella is gone. See Stella's Page...

I began tracking Prednisolone dosages and symptoms in February 2008,
although we started the treatment in November.
I was documenting this primarily to help the vet, although he didn't ask me to do it.
It also helped me keep track of what I was doing,
and to track progress vs. relapse.
Perhaps the real value was to help me avoid being wracked with guilt
in the days following Stella's passing.
I have made it available in .mht format. Click here to download.

 

We didn't get all the stitches out of her nose. At the vet, she turns into a screaming banshee, and we were only halfway done before she put a stop to it.

So we have to go back next week.