Jimmy Exhibits Aggression While Receiving Gabapentin

We have been using gabapentin with Jimmy since September, along with buprenex he receives for pain, to relieve anxiety and pain-litter box use, post surgery, flare up of a UTI, etc. But we have run into an unexpected complicatioin.

He had a massive UTI in November where he was urinating huge amounts of urine colored dark red with blood because the bladder was severely irritated. The emergency vet did not give him fluids-a typical protocol is to give sub q fluids to help ease the bladder irritation which helps remove irritants and bacteria. They did give him Onsior, a pain reliever. It slightly improved his condition. The next day, he saw the regular vet who gave him fluids. This helped the Onsior kick in and improve his condition. We also increased the gabapentin amount from a daily .50ml twice a day to 1ml three times a day to relieve pain and irritation. The vet gave him Veraflox antibiotic for 14 days. 

Eventually, he recovered. We titrated down the gabapentin to .60ml to three times a day and he seemed to respond very well. 

Except late January 2026, he became combative. He received higher amounts of gabapentin than normal for vet visits because he became too angry and could not be properly managed. We gave him 3.0ml two hours before we left for the vet office. While calm enough to be put in his carrier, at the vet office he became angry and reactive and lost patience to be handled after 20 minutes. So, we increased the amount to 4ml at three hours before the visit and still he was reactive. 

When I researched what is the cause, it turns out that while rare, gabapentin can cause aggression in cats after a long time use. And four months apparently is long enough. His cardiologist suggested trazadone but that is contraindicated with Prozac that he takes. This means that I must titrate down the gabapentin to twice a day and then see how he responds, hoping it eases his aggression at home, and maybe leaving the larger amounts administered for vet visits able to work well as they once did.

Roxanne Passed Away in 2025 From Multiple Health Issues Crashing Her Body

We had a difficult year with Roxanne in 2025. She developed gastro issues in 2024 and was seen by an internist in October 2024 who put her on steroids suspecting that she had inflammation of her GI tract, possibly lymphoma, combined with CKD was causing inappetence and being run down and a whole set of symptoms that did not make sense. 

She began eating a lot due to steroids and drinking a lot. Then she began to drink excessively into November and getting her chest wet (from putting herself into the water bowl) and began to seem tired and was not moving around the house as much as normal. Then she began to not eat as well as she had been and her weight began to slowly drop. There were many signs that she was not doing well. In early December I took her to the vet for blood work updates. Her formerly NORMAL blood work was sky high off the charts, showing CKD stage FOUR and diabetes, and internal damage. Her body could no longer handle the steroids and the steroids had damaged her kidneys.

Glucose: 403-September was 93, normal high is 175.

Creatinine: 1.9-normal is below 1.6.

BUN: 44-normal is below 35.

Her cholesterol and triglycerides were in the hundreds.

Urine had glucose and protein indicating that the kidneys could not filter properly and items were spilling into the bloodwork, and that her body had so much glucose that it was not being filtered by the kidneys but spilling over. 

We quickly titrated the steroids down for the next two weeks. I increased her fiber source of psyllium and Forta Flora to help absorb the cholesterol and triglycerides (high cholesterol and triglycerides are due to kidney/liver/diabetes/steroids.) And I increased the fish oil which was also recommended to help. 

We fed her Royal Canin Glycol Balance diabetic food as well as Hill's KD and other renal diets until February when her glucose levels appeared normal again.

We put her on vitamins, and hand fed her five times a day at 50ml per meal. Her weight kept falling. Cyproheptadine was not working for appetite stimulant, nor was Mirtazapine unless she felt better. The vet put her on fluids weekly, then twice weekly, then three times a week by spring. Fluids helped her feel better and to eat something on her own. She also periodically received B12 shots which provided a boost of energy for the body. She was also on a B complex vitamin but the shots provided a more accessible boost when injected into the blood stream. 

She had vomiting and diarrhea. We gave her ½ tab cerenia a day which stopped the vomiting. Rice water and Forta Flora helped curb the diarrhea. 

She was given Zenequin antibiotic to help with gastro inflammation. Eventually, that was dropped (she did not tolerate Baytril and neither did Elizabeth. It made them lethargic, uncomfortable, and did not increase eating) and in the spring she was given Veraflox. 

She needed blood pressure medication as her blood pressure rose over 180 in February 2025. We put her on amlodipine, a half tab once a day and she did really well for a while. Then at the beginning of March 2025 she started to trend over 160 so we put her on one whole tab once a day. Eventually, her blood pressure came under control and would remain until September. 

Eventually, by March, her CKD had improved to CKD 2 and the diabetes had cleared up likely due to improvement of CKD levels. By spring, she seemed to do better even though she was rarely eating on her own. But she did seem to move about the house more and was more alert and involved. When the weather was decent, she wanted out so I would put her in her tent. 

Then by summer, she had weight loss despite hand feeding; she was drinking large amounts of water until she was soaking wet; and her red blood cell count began to fall. She had been receiving fluids twice a week, then by July three times a week. 

Then suddenly September, she stopped eating on her own, began to sleep hiding underneath furniture, and appeared weak. Blood test results showed extremely low RBC-red blood cell count, hematocrit, and hemoglobin all extremely low-anemia; sodium extremely low, chloride low, bicarb high, etc. Her kidneys were likely failing. She developed sudden diabetes again per the blood test. She urinated lake size amounts of urine because the kidneys were not concentrating the urine. She was severely dehydrated but drank copious amounts of water to replace what the body was expelling. Her gastro ultrasound showed a mass on her liver which the vet suspected was cancer. She was referred to Jimmy’s oncologist (a week away). The next day, she could barely move and was suddenly wet on her chest and that was odd. Then later we saw her trying to drink from a bowl with her head on the rim of the bowl. (This is the body's way of trying to get more water when the kidneys stop functioning). So I called the vet and we took her for more fluids. Only the vet looked at her and was shocked by her appearance and told us to take her to the hospital as she believed she was suddenly crashing. 

Unfortunately, Roxanne was crashing-her physical system was in severe decline. Everything seemed to implode. The emergency room doctor said her red blood cell count was almost nonexistent. Her kidneys were faltering, causing the diabetes. Her pancreas, liver, and GI tract were inflamed and failing. It was a biological chemical reaction that could not be stopped. Fluids were not stabilizing her. A blood transfusion would give her a few more days but they suspected she would be back again crashing and that she could not leave the hospital during that time. She was barely moving. 

We chose to put her to rest that evening. We did not get a necropsy because we sort of knew what went wrong and since Katharine’s necropsy (she died February 2024) did not point to ONE reason for the cause of her sudden crash and death-it showed what we already knew to be possible culprits but did not explain how they came together to cause her death-I was afraid that the same would happen with Roxanne’s-that it would leave us with more questions and no answers. Of course, now, months later, I wish we did know more about what was going on. 

What I wished I had known:

1) To increase her RBC would have possibly saved her life or saved it longer. Elizabeth’s red blood cell count fell badly enough fall of 2025 and a different vet put her on Varenzin-a red blood cell boosting medication. It greatly improved her RBD, hematocrit, and hemoglobin after being on it a month. We continue to monitor. Severe anemia crashes the body in various ways. 

2) That steroids should not be given to cats with CKD, that they cause further kidney damage and can lead to diabetes which wrecks havoc on the kidneys and other systems. Which is why I refuse to give Elizabeth steroids for her gastro issues.

3) A week before when I noticed she was not doing well and she began hiding under furniture and not eating, I should have taken her then to the vet but her annual appointment was scheduled and I thought I could wait. 

Roxanne came to us in the summer of 2016 as a neighborhood cat neglected by her owner. We eventually learned where Rox lived. She was out all day and night-and likely liked it-but began to hang out in our yard and on our deck and asked for food. She then began to come into the back room off the deck. By September, she was spending the night in the back room. When she seemed sick later in September, I messaged the owner about taking her to the vet, but the owner said that she had MOVED. And did not seem bothered that she moved without Roxanne. So, we moved Rox into our home. The following summer, I bought a huge pet tent so that she could be safely out and most of 2017-2024 she spent time outdoors in the tent, sharing space with one or two others (Katharine, Bette, Elizabeth, Baby) each time. 

She loved sitting in windows and had her favorites to view the outside world. She could be found in various beds, cat beds, the cat trees but almost always under a blanket or behind our pillows.  She loved to get on the counters, opening cupboards and hiding out, getting into opened closets and NOT letting us know for a couple of hours until we heard her crying or rattling the doors. She was always crying at the bathroom door to be let in. She loved to rattle our French doors in our dining/kitchen/living room to be let in a room, then cross over to rattle another door to be let out, only to circle back and rattle the door to be let back in. She chewed on everything. She chewed cloth wand toys, licked feather toys, chewed up cat toys, ate cords and charger cords. We had to encase so many electrical cords to lamps and electronics in plastic tubing or wraps that she could not bite through. She licked plastic sheeting/plastic wrap/plastic surfaces. She loved her outdoor tent but really wanted to be set free. She had the perpetual look of amazement and surprise and mischievousness in her eyes. She had a cute pink nose, and a classic black and white Tuxedo look. She was smaller than the others. She did not like being held or petted and tried to avoid touch. She did not cuddle up with us but would be in bed with us as long as we were not touching. She loved feather wand toys and catnip toys. She was the sweetest of sweet girls. 

Enjoying the tent

When she first appeared on our deck

Staying in the back room when she wanted to sleep inside at night

She climbed a tree summer 2016

Often found under blankets

LOVED the top of the cat tree

She loved drinking from my small cups after I took my pills.

Checking the outside

Coming to the back door in 2016 to be let in

When she would climb the top basement storage shelf.

Watching the Roku fish tank.

Pink nose

"What are you doing in the bathroom?"

More On Elizabeth's CKD and Gastro Issues

At the risk of repeating information from an earlier post, this is a Facebook post from March 2025 about Elizabeth. The information is slightly different.

Facebook March 2025:

Elizabeth developed CKD in March 2024 and we struggled through most of 2024 with stabilizing her issues. She would not eat. We used cyprohepatidine and mirtazapine and Mirataz ear gel to stimulate her eating. When she was feeling sick, neither medication would work to make her eat. The Mirataz ear gel did not really work well but it did greatly irritate her ears. They became red, dry, scaly and we had to stop using it by the end of the summer. We began hand feeding her and continue to do so as needed. We struggled to keep her weight above 11 lbs. I put her on numerous supplements and vitamins as I did for Myrna Loy for her heart and for kidney support (see Vitamins and Supplements and Goop mixture here at the blog in word searches, Medication tab, etc.) The vet started her on once a week fluids from March to June. Then we began twice a week fluids. We also put her on Zenequin antibiotics because the fall gastro ultrasound showed that her kidneys were inflamed. Finally, by November, she began to eat something on her own, and 1/4 of Mirtazapine pill once a week helped her begin to eat on her own.

 Blood work from the fall currently shows slight improvement in kidney blood values. She is more of a CKD stage 2/3 than stage 3/4 now. She continued to do well until late January when she stopped eating on her own. We fed her by hand four times a day-40ml per time because only 30ml or so makes it into her mouth. Her weight remained stable. 

In March she began eating something on her own and began responding again to Mirtazapine which helps her eat enough on her own that we hand feed her 20ml four times a day-as long as her weight remains over 11.10 lbs. I give her 1/4 Mirtazapine once a week. It tends to wind her up a bit but eventually she settles down and eats. We do not want her to lose weight and fat and muscle mass. We have seen cats before lose weight and get below 10lbs and get very sick and go into end stages of life, and pass away once they begin to lose fat and muscle mass. She is also on Zenequin (originally Baytril which she did not tolerate)-first for one month, then two weeks on, and two weeks off. This was recommended for her inflamed kidneys and gastro issues. Elizabeth has a leaky tricuspid valve that appeared in 2024 and we continue to monitor. But she has no CHF or HCM issues. 

UPDATE: Zenequin stopped helping Lizzie in 2025. By the fall, the vet put her on Veraflox and added later Metronidazole for gastro issues.

At her February 2026 cardiology appointment, it was discovered that Lizzie now has developed left atrial dialtion but shows no signs of CHF or other complications. We will continue to monitor and she returns to cardiology in four months. 

She is not on medication for her heart nor for blood pressure as that remains decent at 140-150 on average. 

September 2025 Elizabeth Has a Cancer Scare and Surgery

September of 2025, Elizabeth had her annual physical. The doctor discovered a huge lump in her chest, near the nipple. This typically indicates breast cancer for cats. Yes, they can get breast cancer. So, we got an appointment to see Jimmy’s oncologist (for his lung cancer which I previously posted about) and surgery and a CT were arranged for the same day. 

She had surgery in late September. She recovered quickly since it was not as deep as Jimmy’s. She was not on fentanyl patch like he was so she was not as bonkers. She was confined for two weeks, not the four he was. She wore the same sweaters and onesies that he did and was not bothered by them. She did not sleep in the litter box like he did. I spent the day and night with her in the small guest room. After two weeks she could roam the hall and be in the larger bedroom. We used the same baby gate at the top of the stairs, and the same pet stairs in the larger room for her as we had with Jimmy. After three weeks, her regular vet looked her over and said the incision had healed well enough that she couldn’t rip it out if she licked it so the sweaters could come off. (And she didn’t lick it afterwards.) 

She did not feel well a few days after surgery. She was lethargic and not eating and developed diarrhea eventually. I took her to the regular vet who gave her fluids and rechecked blood work. It just took time to recover but she seemed better after receiving fluids.

The lump was not in the nipple-a good sign for not being cancer; it wasn’t in the chest wall or muscle-another good sign. It was a large non-cancerous cyst. She had a deep long incision-not as deep as Jimmy’s lung surgery incision-but low along the belly, under the right arm. 

Unfortunately, the CT did show a lump in Lizzie’s lung, possibly lung cancer. But she had an updated xray this February 2026 and the lump is still very tiny. Too small to remove but since it is not growing, they doubt it is cancer. Further xrays in the next few months, and a recheck with oncology in August (with possible CT follow-up) will be needed to keep an eye on it.

Facebook posts:

9/23/25 Elizabeth has a CT and surgery today to remove a lump from her chest. We'll know more later.

9/24/25 Elizabeth is home. Don't be alarmed by the surgical site. It's lower than Jimmy's lung surgery surprisingly. I guess I hadn't realized how low it would be. She refuses to wear a collar but we do have the sweaters and the newborn onesies that Jimmy wore so hopefully she keeps those on and doesn't bother the surgical site. She's restricted for a week in the room. And then she can have partial mobility to the upstairs. And then after two weeks she can go up and down the stairs if she is good and the surgical site is good. Then after three weeks she can go up and down the stairs throughout the house into the basement and climb the cat tree. So slow steps just like with Jimmy. She's not on a fentanyl patch so she is not acting loopy and weird like Jimmy did.

9/26/25 Lizzie – wasn't feeling that great on Thursday and wasn't eating. We gave her ondansetron the anti-nausea medication. That didn't make her eat. We gave her mirtazapine an eighth. (It is a good appetite stimulant but the cat must be feeling well/healthy enough for it to work.) That did not make her eat. We hand fed her 25 mL of food every couple of hours. And 6 mL of water. That helped spur her to feel better. And maybe it also helped the medication to eventually kick in. She finally started eating on her own late in the evening. But we had spent the entire afternoon and evening hand feeding her to keep up with her nutrients and her energy. Because her body needs more energy post surgery than you might imagine and we can't have it eating up her physical reserves.

She goes back this afternoon to the vet for a blood recheck and more fluids. She was getting fluids twice a week for her kidney disease but had been on fluids Tuesday and Wednesday at the hospital. And they thought she wouldn't need more fluids until Monday her regular visit. But maybe she needs them sooner. 

9/28/25 How to stop diarrhea-information in the story: 

Lizzie is doing well. Her blood test came back. We took her in on Friday. She's stable. She still has CKD3 so we need to continue to monitor. But she's stable. Her red blood cells are good and strong. Potassium is strong her electrolytes in general are good and strong.

She was not eating yesterday however and she has diarrhea. Perhaps from anesthesia. We hand fed her after she wasn't eating for a few hours. We can't let her go without eating for a long time because she's in recovery from surgery and her body needs the energy. And you should never let a cat go more than four or five hours without eating. Unless they've eaten a huge breakfast of course. But if your cat woke up and nibbled and then didn't want to eat something for a few hours there could be something wrong.

So we hand fed Elizabeth and then we also gave her water by mouth. I gave her 25 mL of Hills KD because it's easy to syringe. And 6 mL of water. We did this every three hours. Because she had diarrhea and she wasn't feeling well I didn't want to force a lot of food on her at once. 

To get rid of the diarrhea of course a probiotic works well and we use is Forta Flora by Purina but that's added to the food and she's got to want to eat the food. Instead I use my go to solutions which is sweet potato or pumpkin baby food or pumpkin purée. You have to make sure these are no salt no sugar no spices no flavoring.

Pumpkin purée in the vegetable aisle is not the same as pumpkin pie filling. You want to avoid pumpkin pie filling. No spices no flavorings no sugar no salt hopefully. 

You could add a tiny bit of salt and I mean only 10 grains to what you give if your cat doesn't have HCM, or high blood pressure. Salt is a necessary electrolyte; it helps the body retain fluid, increasing blood pressure. Vomiting and diarrhea depletes fluid and therefore electrolytes like salt and makes you dehydrated. This makes you weak and nauseous. And severe dehydration creates vomiting and diarrhea, an endless cycle. 

I syringed up the pumpkin and gave her 9 mL of pumpkin purée (or baby food pumpkin or baby food sweet potato.) I also did feed her by hand tiny pieces of banana. Banana you can mash it up and add it to the food if they're eating. If they're not eating you can try to give it to them by mouth if that's the only thing you had around at the time. 

The best solution to solve diarrhea is to boil rice in a lot of extra water. It has to be enough rice so that you get the fiber from the rice. And it has to be enough water so that the rice doesn't soak up all of the water. Then you drain the rice out or you scoop the rice out while reserving the water. You let the water cool and then you syringe up and you give about 9 mL of this to the cat. I repeat every 2 to 4 hours depending on how upset is the gastric system. So I gave it to Lizzie this morning and I gave it to her this afternoon and she's doing much better and she's been eating on her own today also. 

So we will continue to take it one day at a time. We did put up the baby gate at the top of the stairs and we let her out of the bedroom so she's got the hallway. She's not allowed to go up and downstairs or to climb so she can't have the other bedroom. 

10/15/25 Lizzie considered fully healed shirt off she can now roam the house freely. 

Lizzie slept on my desk if I was working.

Lizzie in post surgery sweater.

Jimmy Had Dental Issues 2025

Jimmy had a few problematic teeth last summer but we had to wait until he recovered from his April lung surgery and got through most of his chemo treatments during the summer before making sure he was ok to have dental surgery. He had one broken upper canine that was chipped at the bottom but which exposed the nerve. He had a resorption lesion on a molar that we knew about. He had lost many teeth to resorption over the years. 

He had two surgeries-in August and then in October because they could not complete everything in August because of his heart rate increasing and his blood pressure dropping. He saw the cardiologist before each surgery and got the ok to have surgery. 

He also had lesions in his mouth and we were concerned that they could be a sign of cancer-secondary to his lung cancer. The lesions were growing and were bleeding. The dentist determined the cause was other teeth hitting the gums where teeth were missing, causing an irritation. Grinding down the lower teeth, and then in October removing another bad tooth, would help the lesions to heal. 

At one point, his regular vet heard extra heart beats and he was eventually put on heart medication. I’ll post about that in a separate post.  

He recovered fully from both dental surgeries but eventually became run down after the October one. There are various factors that could have caused this: his heart medication, recovery from chemo, the stress of anesthesia on heart patients (he does not have HCM which would have likely not allowed him to have anesthesia because it causes stress on the heart and can lead to severe CHF.) He had been on ondansetron until the end of September for chemo (it relieves nauseousness post chemo) so we decided to continue it and he remains on it. It helped him feel better and to eat well. He eventually recovered. 

Because he only has one canine and six teeth overall, he had to slightly mush his Royal Canin Glycol Balance chunky food, and we also began to give him Hills’ Glycol Support stew and pate’ which he does also love to eat. He is prediabetic since 2011 and food is one way to keep his glucose levels in check. He does not need medicine for diabetes so far. (The food listed is what we use and is not a paid endorsement nor is Chewy-you can buy it at the vet's office or order from anywhere online with a prescription from your vet.)

Facebook post

8/20/25

Jimmy Stewart-last Wednesday saw the dental surgeon for a cleaning and biopsies of lesions in his mouth. We were afraid that those were cancer because lesions often primarily are signs of cancer, along with bleeding gums, loss of appetite, drooling, and bleeding from the lesions. 

Because he is a heart patient (but not HCM) he received from his cardio an anesthesia protocol-a list of medicines to avoid, what to use, and instructions on how to handle any issues. 

She extracted a tooth, grinded down other points that were bothering his mouth, cleaned, and biopsied. He has a canine tooth that is broken and will need to be removed at a later date this year. His blood pressure was falling towards the end, so they did not do the canine extraction. 

BUT-the lesions are NOT CANCER! Biopsy showed inflammation. All of his issues cleared up immediately with the extraction and cleaning (not the lesions themselves per se.) His appetite came back. He seems more comfortable. 

She thought his problem teeth caused the lesions because of where they were placed in the mouth next to the problem tooth or above the problem tooth. (He's had many teeth removed or lost through resorption lesions-the root melts away-not a rot or a broken part. Some teeth had aggravated the gums over the area.)

So we are relieved. He has his last chemo tomorrow for his lung cancer (removed in April). He'll have another CT in January as a follow-up. 

Our summer has been busy with cat health issues and some for us so I've not had the time to write but I hope to catch up soon.

10/18/25

Jimmy had his hopefully last anesthesia procedure. He had two teeth removed today. A broken upper canine. And a molar that was resorptive in the back lower jaw. 

He had low blood pressure at one point and because he has a slight heart condition instead of giving him fluids because that would be bad for the heart they instead gave a medication which increased his blood pressure. I do not know what it is. 

He now has only six teeth remaining. One upper canine to lower canine. One molar on the lower jaw on one side and two molars on the lower jaw on the other side. 

He's of course recovering in the bedroom with me the smaller guest bedroom with the very low bed and cat beds. Since Lizzie was released from confinement now it's his turn. But tomorrow he gets to be released. 

He's a little loopy. He's sleeping next to the litter box or standing on me because he's not a lap cat. But he does want to be petted. 

Upper left canine and lower right molar removed.

Upper left canine missing

You can see the chipped upper left canine before removal.

Elizabeth Spent 2025 Battling Gastro Issues and That Continues

So, Elizabeth. She has had CKD-kidney disease-since March 2024. She has spent two years being mostly hand fed, going through few times of eating without assistance. She has had to be fed five times a day at 50ml of canned food at a time-or less if she is eating enough during the day. Her weight was down to almost 11lbs this fall, and then we got it up to 12lbs in order for her to maintain a level that leaves room for any future weight loss before we must be aggressive with hand feeding. (We need to prevent fat and muscle loss and muscle wasting which can happen with CKD.) For more on CKD, check out the comprehensive site "Tanya's Comprehensive Guide to Feline CKD" blog guide.

We use Hill’s KD canned because it is very easy to syringe up in a 10ml syringe and then to gently feed her. It takes about ten minutes. You cannot rush pushing food into their mouths. They can’t choke or inhale. Too much food and they spit it out. When she developed gastro issues in 2025, we had to feed her Hills’ ID which is not as easy to syringe up. But too much ID and her CKD increased; too much KD and her gastro issues increased. So, late in 2025, we began to mix almost half and half KD and ID canned food in one Tupperware dish, then spend a day or two feeding her from it (how quickly it goes depends on how much and how often we need to feed her via syringe.) Some days I try to do 2/3 ID and 1/3 KD; then 2/3 KD and 1/3 ID; then half and half or something akin to it. 

She receives a ¼ Mirtazapine pill once a week. When her gastro system is doing well, she responds and will eat enough for a few days on her own with little hand feeding from us. But we do feed her 3 times a day at 30ml to 40ml per feeding depending on her needs. She often eats overnight which is a good sign. What is not a good sign is when she does not eat overnight or the Mirtazapine does not respond well and she barely eats despite it. 

She has gone through these bouts of not feeling well. She has had bouts of diarrhea since the fall since she had surgery (more on that with another post.) Since she does not eat enough on her own, I have been since the fall, giving her daily by mouth with a syringe, a packet of Forta Flora mixed with 2ml of water or rice water (more on that in a moment) which she receives in the afternoon. She receives it in the afternoon because she is on an antibiotic and stomach supplements (antacids, fiber) tend to interrupt the absorption of antibiotics. That seems to help her. Rice water-1/2 cup of rice and three cups of water boiled until the rice is cooked but just cooked and the rice is not left to soak up the water; I scoop out the rice with a slotted spoon, put that into a container and freeze it, drain the water into a plastic container, and I should have enough for a week; any more than that and I put it into a container and into the freezer-works fast and is easy to make. (It can spoil so that is why I make sure I have enough for a week and put the rest in the freezer.) I give her 6 to 10ml of rice water twice a day depending on if she has diarrhea or how much she has (is it soft, liquid, more than once a day, etc.) If her bowel movements are solid, then I can skip it for a few days. But I have to monitor it closely so that it does not return too severely. (Diarrhea is uncomfortable, causes a loss of fluid and in the fluid a loss of electrolytes which makes the body feel run down and then that depletion of sodium [which regulates the body] causes more diarrhea [and vomiting if a cat or human is vomiting] and can lead to other gastro issues like stomach acid, ulcers, bleeding in the lower GI, etc.) 

Why does she have gastro issues? She has IBD, at times pancreatitis, a thickened GI tract, and some liver issues. This means she has inflammation. But because she has CKD, she really should not have steroids. And she recently developed a minor heart issue so I do not want to risk her heart health by giving steroids. Yes, her gastro system would likely improve with steroids but then the rest of her would likely severely fail-her kidneys would tank (we saw that in December 2024 with Roxanne-more on her later; and we know that heart disease cats cannot have steroids due to the risk of CHF, and once CHF kicks in, the race is on to stop the heart from failing.) 

I can tell when she is not feeling well by how she looks or appears to be uncomfortable, and does not eat. She is on medication to help her. She has taken Veraflox antibiotic for two months this past November 2025 into January 2026 but it worsened the diarrhea. It can cause gastro upset with prolonged use (we did not see that in Jimmy when he was on it for a month.) She has been off of it now for three weeks and her diarrhea cleared almost immediately. Typically, it’s given for 14 days on and then off but the vet wanted to use it longer to help her organs be less inflamed and infected. It can lead to higher levels of glucose, liver values AST, ALP, ALT (some of which we saw in her bloodwork and Jimmy’s blood work), as well as an elevated white count (not sure why.) Additionally, she is on Metronidazole which we hope is helping. Also, she had been on Visbiome probiotic-the capsule was opened and the powder was added to water and given by mouth since she was not eating. But that also increased diarrhea; it too can cause gastro upset. When ceased, the diarrhea lessened. Her ultrasounds however, do not show improvement regardless of antibiotics or fiber.

Lizzie

Jimmy Had Chemo Summer 2025 Post Lung Surgery

In May 2024, when Jimmy’s left shoulder developed an egg size lump-which was later removed and found to be not cancerous-the CT at the time showed he had a small lump in his right lung that looked like a small “curved vessel”.  By March 2025, it was a small marble size nodule. He then had surgery April 2025 to remove it. Test results came back positive for cancer. 

But he had clean margins-meaning they removed the part of the lung lobe that had the cancer. Chemo was not necessary but I was afraid that if we were not aggressive when we could be while he was medically stable with his heart and kidneys, that the cancer could spread or return. 

So, in May, for once a month for four months, ending in August 2025, he had chemo. He had to be slightly NPO-he could eat a small amount in the morning but nothing past 10 a.m. He had chemo around 3 p.m. The process was less than 15 minutes but we were usually there for about 30 minutes as they wanted to make sure he tolerated it well. He never needed anesthesia although some cats do. In that case, he would have had to have been NPO-nothing to eat in the morning at all. I did have to make sure he was not vomiting once we were home and that he recovered well during the month. He never had vomiting or gastro issues like humans do and he ate well and moved around well. But he did become more exhausted as time went on but nothing that was concerning. 

He was given ondansetron to take twice a day-a medication that helps with chemo treatment nausea. He continues to take the drug still. He was expected to take it for a few weeks after his last session which was late in August but when we tried to remove it in December, he ate less. While a cat may not seem to be sick from chemo, does not lose their hair or vomit from it, they can still be nauseous, and are physically worn out. Listed below is the March 2025 CT report and the April 2025 lung cancer test results. 

His March 2025 CT scan report prior to surgery to remove the lung lobe and nodule:

“Mar 18, 2025

Thoracic CT, pre-contrast and postcontrast, transverse, dorsal and sagittal images:

Lungs: Within the 6th IC space ventrally, there is a well-circumscribed, mildly irregular nodule, approximately 1 x 1 x 1 cm, larger than on the previous study. This is suspected to be within the caudal aspect of the right middle lung lobe, previously thought to be within the right caudal lung lobe.This is near the pleural surface and adjacent to the cardiac silhouette. There is mild enhancement of the pulmonary nodule. 

Heart and pulmonary vessels: Definitive cardiac abnormalities are not identified. Unremarkable pulmonary vessel size and shape. Mediastinum: No masses. Unremarkable trachea and esophagus.

Sternal lymph nodes are mildly enlarged with mild contrast-enhancement. Tracheobronchial lymphadenopathy is not identified. Pleural space: Significant abnormalities are not identified. 

…

CONCLUSION:

Solitary right mid-pulmonary nodule, increased in size compared to the previous study, new sternal lymphadenopathy. This is suspected to be within the caudal aspect of the right middle lung lobe, less likely cranial aspect of the right caudal lung lobe. Metastatic neoplasia is the primary differential. A primary pulmonary tumor or granulomatous mass is not ruled out.

…

CONCLUSIONS:

Nodular hepatopathy. Rule out vacuolar hepatopathy, chronic hepatitis, less likely metastatic neoplasia. Subjective focal small intestinal thickening...

Discussion: Jimmy's CT scan revealed that he continues to have a single pulmonary nodule that has increased in size now measuring ~1cm. There are no other pulmonary nodules noted. Mild sternal lymphadenopathy is a non-specific finding. Although a single nodule of this size could be consistent with metastatic disease (unknown primary), I am more suspicious of a primary tumor. If this represented metastatic disease I would expected more nodules over the last several months. The most common primary lung tumor in the cat is called a bronchoalveolar carcinoma and arises from the cells that line the lung. The majority of bronchoalveolar carcinomas in the cat are high grade and tend to grow quickly and metastasize quickly. My suspicion therefore is that if Jimmy does have a primary lung carcinoma then it is more likely to be low grade given that it is growing relatively slowly (~1mm monthly). However, the reality is that we never know the answer to this question without removal of the mass and histopathology. This may represent a less common tumor or even a benign tumor (although this is considered less likely in the lung). 

The treatment of choice for primary lung masses is surgical removal via lung lobectomy. I did have our surgery service evaluate the CT scan and they would approach this tumor laterally (approach between the ribs) versus having to perform a median sternotomy. If surgery is something that you are interested in then we can set up an in-house surgical consultation where the surgeon calls you at home to discuss the surgery. They can provide an estimate and can even schedule him if you would like. 

Alternatively, if surgery is not desired then we could continue to monitor this mass with pulmonary radiographs to continue to assess its growth rate over time. This is a more palliative approach but not unreasonable especially in cats as they age.

…”

Lung Cancer Test Result:

“ Jimmy's histopathology results were consistent with a diagnosis of a pulmonary adenocarcinoma that has been removed with complete surgical margins. The removed lymph node only revealed evidence of reactivity (lymphoid hyperplasia) and multifocal lipogranulomas; no evidence of any lymph node metastasis which is great news. There is no consistent grading system for pulmonary adenocarcinoma in cats however based on the mitotic rate (9 per 10/hpf) and mild/moderate atypia I would consider this tumor to be of low/intermediate grade. 

Per our original conversation; there is not a lot of information on low/intermediate pulmonary adenocarcinoma in cats since most cats diagnosed with this cancer have rapid progression. The overall metastatic rate of this disease is thought to be >50% in cats and many cats have evidence of metastasis at the time of diagnosis. 

In Jimmy's case; we watched this mass grow quite slowly over a several month period and there was no evidence of any movement therefore it is reasonable to believe that surgery may be curative or provide long term local control. At the same time, it would not be completely wrong to consider further intervention with chemotherapy since we are definitiely in a position of the unknown. I think both are reasonable directions. 

If we decided to consider a monitoring schedule then our plan would be to perform a physical exam and recheck thoracic radiographs once every 3 months for 1 year and then twice yearly. This can be performed here or with your primary veterinarian (whichever is most convenient). 

If further intervention is desired then I would recommend that we consider using a drug called carboplatin. Carboplatin is an IV chemotherapy agent that is given once every 4 weeks in cats for a total of 4 treatments. Carboplatin tends to be well tolerated in the cat with a side effect rate of ~10-15%. Possible side effects include: lethargy, inappetance, nausea, diarrhea and/or bone marrow suppression. Side effects usually occur 3-5 days following therapy, persist for 1-4 days and then resolve. Medications can be provided if needed and dose adjustments can also be made (most side effects are dose related). An estimated cost of carboplatin is ~$900 per treatment. Recheck thoracic radiographs are performed at the time of the 4th treatment to look for any evidence of metastasis in spite of therapy. 

Overall, I am very happy with these results. We know that this mass was growing quite slowly and has been removed with complete surgical margins. We are just hampered by the lack of data in cats for this type of cancer therefore it is hard to predict the future in Jimmy's case. He may do absolutely fine without further intervention and he is an older cat with other co-morbidities. At the same time, I cannot be completely confident that metastasis will not form in the next 6-12 months. Please do not hesitate to call with any questions or concerns.”

We began carboplatin chemotherapy protocol May 2025 until August 2025. He had follow-up xrays in August. 

“We are so proud of Jimmy! He looks amazing! His physical exam was unchanged and his recheck thoracic radiographs did not reveal any evidence of regrowth or spread of his pulmonary carcinoma which is great news! Jimmy's complete blood count from yesterday was ok for chemotherapy and Jimmy received his fourth and final carboplatin treatment in the hospital today as planned. At this time I recommend that we place Jimmy on a monitoring schedule consisting of a physical exam and recheck thoracic radiographs once every 3 months until we hit the year from surgery and then twice yearly after that. Please do not hesitate to call with any questions or concerns.”

There was one concern on the xray:

“ Aug 20, 2025 

Three-view thorax, three images:

There are metallic clips near the hilus associated with lung lobectomy.

Discrete pulmonary nodules are not identified.

Within the right mid thorax, there is a poorly defined soft tissue opacity…

CONCLUSION:

Right sided lung lobectomy.

Pulmonary nodules are not identified.

Poorly defined right mid thoracic soft tissue opacity. Rule out atelectasis, fibrosis. Poorly defined neoplastic re-growth is not highly suspected. This can be re-evaluated at scheduled follow-up imaging with the oncology service. **This is most suspicious for fibrosis.”

We were concerned that this was a return of cancer or fibrosis. Fibrosis is when tissue in the lung is damaged-from disease, the environment, or cancer-and scar tissue builds up. If too much tissue builds up, the lungs cannot produce oxygen and the patient eventually suffers from not being able to breathe nor send oxygen to the rest of the body, heart, kidneys, muscles, etc. 

However, his recent February 2026 checkup with oncology showed that the fibrosis is decreasing and healing so that it is likely post-surgical scaring that will hopefully improve but it is not yet worsening. When I spoke to his cardiologist about this in September 2025, she said that the lung-the rest of the lung and the other lung lobe-can compensate for fibrosis as long as there is enough of a lung remaining that is not scarred. And that she has seen cats with far worse fibrosis than Jimmy’s and do very well. 

So, as of February 2026, we are breathing a sigh of relief for now regarding his lungs. He returns in May for another checkup with oncology at which time they will schedule another CT with contrast if he is able to have anesthesia. And he will have a cardiology checkup prior to that to determine if he can.