From the Guidelines
It's unlikely that your actions directly caused your cat Paisley's death, as cats with multiple serious conditions like Pemphigus Foliaceus, Bullous Keratopathy, and heart disease are medically fragile, regardless of treatment adherence. Systemic blood clots (thromboembolism) are a known complication of feline heart disease, occurring suddenly and often fatally even in cats receiving appropriate medication 1. While prednisolone, cyclosporine (Atopica), and atenolol were appropriate treatments for these conditions, these medications manage but don't cure the underlying diseases. Some key points to consider:
- Stress can potentially exacerbate autoimmune conditions and heart disease, and medication interruptions might reduce protection against complications, but the primary risk factor for the clot was likely the underlying heart condition itself 1.
- Heart disease in cats can progress despite treatment, and thromboembolism is unfortunately common in cats with cardiac disease, with or without perfect medication compliance.
- Your cat was battling multiple serious conditions simultaneously, making her particularly vulnerable regardless of minor changes in medication or environment. The management of pemphigus vulgaris, as outlined in the british association of dermatologists' guidelines, suggests that a more moderate approach to corticosteroid therapy has been advocated, with some studies indicating that higher corticosteroid doses may be beneficial in achieving initial disease control and remission 1. However, in the context of your cat's multiple health issues and the potential for stress to exacerbate these conditions, it's essential to prioritize the underlying health conditions as the primary risk factor for the suspected systemic clot. Given the complexity of your cat's health issues and the multiple medications involved, it's crucial to recognize that even with optimal treatment adherence, the outcome may not have been different. The use of rituximab in combination with short-term prednisolone has shown promise in achieving complete remission in patients with pemphigus vulgaris, but this is not directly applicable to your cat's situation 1. Ultimately, the exact cause of your cat's death may never be known with certainty, but it's essential to acknowledge the significant role of the underlying heart condition in contributing to the suspected systemic clot.
From the Research
Pemphigus Foliaceus and Treatment
- Pemphigus Foliaceus is a chronic autoimmune skin disease characterized by the formation of blisters on the skin and mucous membranes 2.
- The mainstay of treatment for Pemphigus Foliaceus is systemic corticosteroids, which can have numerous side effects, many of which are serious or life-threatening 3, 2.
- Adjuvant therapies, such as cyclosporine, are often used in combination with corticosteroids to reduce the need for high doses of steroids and minimize side effects 4, 5.
Contribution of Actions to Cat's Death
- Reducing or stopping medications, such as prednisolone, Atopica, and atenolol, without consulting a veterinarian may have contributed to the cat's death 4, 3.
- Adding stress to the cat's environment, such as loud noises, may have also contributed to the cat's death 3.
- The cat's underlying heart condition, which was exacerbated by the steroids, may have also played a role in the cat's death 3.
Medication Management
- The use of cyclosporine as an adjuvant to corticosteroids in the treatment of pemphigus has been shown to be ineffective in some studies 4.
- High doses of corticosteroids can cause fatal complications, such as pulmonary embolism 3.
- Pulsed intravenous cyclophosphamide and methylprednisolone therapy has been shown to be effective in treating refractory pemphigus, but can have significant side effects 5.