Grimalkin
3/86 - 11/6/01
Diagnosed (adrenal) 1997
companion to
Diana

My cat, Grimalkin died in November. She was extremely unusual because she had Cushings. It is not something that a vet, even an internal medicine specialist, expects to see during a lifetime career. Or that's what they kept telling me. I secretly suspect that some of those cats out there with uncontrolled diabetes really have undiagnosed Cushings and I hope Grimalkin's story will help other cat people to recognize symptoms in their own cat(s) and insist on checking out the possibility of Cushings.

DIAGNOSIS
It started with alopecia. The vet thought maybe Grimalkin (then 11 years old, a black cat from a feral colony) had a flea allergy. We got rid of fleas in house and yard. My cats are indoor cats, but I've been known to venture outside and maybe bring in a flea or two. She lost more fur and there were no fleas on her (or on other cats -- the vet didn't comb me with the flea comb). The vet did basic blood work and found some thyroid trouble. I gave her thyroid medicine. The she started urinating outside the cat box and became limp kitty. For those of you that don't know urinating outside of the cat box is considered emergency time for a cat; get to a vet or death is possible within 24 hour. So I got Grimalkin to the vet pronto. She was diagnosed with diabetes and kept several days to stabilize. That seemed to work for a while, but her little body (she weighed 6 pounds) became round. I know some human diabetic have similar problems. When her blood sugar fluctuated her hind legs became weak. And then she went from her normal appetite to being absolutely voracious. (Do I need to explain this?) She had periods of "wild cat" behavior. Her eyes would grow vacant as if she were no longer there and she'd do something so unlike herself -- shred the bedspread, attack another cat (she'd mothered them when they entered my house so her role towards them was mother cat -- attacking them was like trying to kill your own kittens -- not cat-like), bite a human, always something aggressive. After the period of "wild" behavior was over she'd look baffled. She didn't understand. (She never looked baffled after stealing large quantities of food -- which was also new behavior for her.) The next trip to the vet was because the diabetes was not stabilized. I complained about her appetite. Boy, did I complain about her appetitite. And the vet suggested that in addition to stabilizing my bald, diabetic, (and hungry) cat that we test her for a condition that is so rare in cats that it would be astonishing if the test were positive. We tested; the vet tech learned what I meant when I said that Grimalkin had become voratious because Grimalkin screamed at the vet tech whenever she brought in food and gave it to another cat -- not Grimalkin's normal temperment. The test was positive and Grimalkin was all the luckier for it.

TREATMENT
The vet transfered the case the an internal medicine specialist because no one could be sure how to treat a cat with this disorder, but extra training and expertise always help. More tests and Xrays confirmed the diagnosis and showed a nasty tumor on one adrenal gland. In cases like this is is best to remove the tumor and, if necessary, the affected adrenal gland. There wasn't a surgeon in the area (and I live in the San Francisco Bay Area and I think they checked with Davis Vet School too) who had done this kind of surgery. So Grimalkin was scheduled to have surgery with a surgeon recommended by the internist. In preparation for surgery they took ultrasounds so the surgeon could get a better image of what he'd be facing. Grimalkin had surgery. They removed Grimalkin's adrenal gland and they thought they'd removed all of the tumor. The tumor was sent off for biopsy (they said in these cases there's a 50/50 chance of malignancy. And it was malignant. I don't know whether that is good or bad. The tumor evidently grew fast and didn't have much chance to harm other organs. But then again, if it hadn't been diagnosed so promptly it could have invaded nearby organs (like the kidney), or metastized. It still could reoccur and metastized. (Life is filled with uncertainty, and the you die.)

When she was ready to return home (I'd set up a recovery area for her following recommendations in "Cats Magazine" with a few ideas of my own) the internist explained that Grimalkin's cortisol level was so high that we'd have to replace the amount produced by the gland that had been removed and then step down until we'd found what medications and at what levels Grimalkin needed to have a normal level of cortisol. During this time her diabetes could fluctate and I'd need to test her urine from a catch tray (an advantage for cats as they use litter boxes.) I was to adjust her insulin according to the sugar in her urine.

One of the additions to what "Cats" suggested for the convalescent cat was a white tunnel. A sick cat likes to hide and the tunnel gave Grimalkin a hiding place. And it gave me a way to lift her with full body support (like a stretcher) as I was told to do. White gives you a way of seeing oozing that may have happened from the wound. The surgical inscision went around about 3/4 of her body; the stitches needed protection, she needed warmth and so I made her a coat out of artificicial felt fitted precisely to her body and with velcro closure perpendicular to the wound and supporting her tummy. She seemed happier with it. Maybe it gave more padding. In the past (according to a nurse) human surgical patients wore jackets that supported their abdomen -- it didn't help healing, but it did reduce discomfort and improve mobility. So maybe she was just more comfortable moving around. While she had the jacket on she left her stitches alone. (Once while I had it off for cleaning she removed 3 stitches.) The jacket was a definate win. No Elizabethan collar. Since her recovery room was tight quarters an Elizabethan collar would have posed many problems for her (and me.)

During the stepwise decease of meds to cause cortisol production (sorry, but I don't know the name of the meds, but there were two and one began with an "f") Grimalkin quit showing sugar in her urine. A blood test followed. No sign of diabetes. And after that point she had no future sign of diabetes; and I did check urine from time to time as suggested. We continued to step down. I was very ill myself at this time and I'd often take Grimalkin into bed with me and I'd tell that we were a team who would make it through this together. We'd cuddle. Then one morning, overnight, Grimalkin (or part of her) turned black. Internal bleeding? But she didn't seem weaker. Still... This wasn't routine surgery. OK, so another trip to the vet (this time primary vet, who was local.) After examining her carefully he said that it was the stubble of cat fur starting to grow back in. Black, bacause she's a black cat. It was, however, growing in a little sooner than expected. (If they didn't know what to expect how could they know when to expect fur? Or is it just a general rule -- when we shave your cat bald for surgery it will take about the much time to regain fur.) Stepping down. Stepping down. And then one visit the internist told me that the one remaining adrenal gland had started compensating for the missing one. That surprisingly Grimalkin would not need meds for the rest of her life. As had been expected.

Grimalkin developed cataracts, but otherwise had a happy, healthy life for the next four years. Every night she would walk down my leg and settle in to sleeping on my hip; we made it together. Then she developed chronic kidney disease. It's not uncommon in cats, maybe the Cushings contributed some. It's hard to know these things. We had another year together after that.

I make her story available because her experience is unusual. I hear of diabetic cats who are very difficult to stabilize, and I wonder... I remember that diabetic cats used to be tossed outdoors because they weren't using the cat box. And vets thought diabetes was rare in cats. I wonder if a food-stealing cat or a "wild cat" would be refered to a behaviorist rather than those being considered as medical symptoms. I wonder how many cats get given to shelter for their behavior and then get euthanized as unadoptable because their behavior is off. If your cat has the symptoms, maybe Grimalkin's story will help you have hope. Maybe you'll need to insist on testing (and point out to vet how your cat has cushoid symptoms.) There can be good outcomes.