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My cat has been diagnosed with Feline Leukemia. She doesn�t look or act sick. My vet said I should put her sleep because this is a fatal and contagious disease. I refused and he said the only hope was to put her on steroids like Prednisone. Is that safe and is it the only treatment available?

NO, it is not the only treatment available but other treatments will be discussed elsewhere. Until recently, steroids were the only treatment available to veterinarians to offer their clients who�s cats tested positive for Feline Leukemia. They would be used until the Leukemia or some other opportunistic disease would overwhelm the cat and then they would die or be put to sleep. Feline Leukemia is a virus. It is not related to human leukemia, but it does share very similar traits with the human HIV or AIDS virus. It is not transmittable to humans. It attacks the immune system of the cat and destroys its ability to fight off everything from simple upper respiratory infections (URI) to cancer. To be fully informed on whether and when to use steroids, you must first understand what they are, where they are produced in the body and what they do to and for the body.

What are steroids?

Steroids are complex molecules containing carbon atoms in four interlocking rings. They are important in body chemistry. Among them are the male and female sex hormones, such as testosterone and estrogen and the hormones of the cortices of the adrenal glands, including cortisone. Vitamins of the D group are steroids involved in calcium metabolism. The cardiac glycosides, a group of compounds derived from certain plants are partly steroids. Sterols, including cholesterol, are steroids. Cholesterol is the main building block of steroid hormones in the body: it is also converted into bile salts by the liver.

You mean the body produces its own steroids?

Absolutely!! The adrenal glands are part of the endocrine system of the body. There are two, one for each kidney. The adrenal glands sit atop the kidneys and secrete hormones into the blood, which carries them to various parts of the body where they exert their effects. Each adrenal gland is actually a gland within a gland: the outer shell, or cortex and the inner core, or medulla. The medulla secretes two closely related hormones, epinephrine and norepinephrine. Epinephrine increases heart rate, blood pressure and blood glucose levels. Also called adrenaline, this is the substance used in the "fight or flight syndrome". Norepinephrine has much weaker effects on blood sugar and heart rate, but is a powerful vasoconstrictor. The cortex is more complex and secretes a number of hormones. Approximately 30 hormones, all steroid, have been extracted from the adrenal cortex. In general they can be grouped in three categories:

1) Glucocorticoids, which among other cations stimulate the conversion of proteins to
carbohydrates.
2) Mineralocorticoids, which regulate sodium and potassium metabolism.
3) Androgens, which have male sex hormone activity.

Hydorcortisone is the most potent glucocorticoid, and aldosterone is the most potent mineralocorticoid.

This is all great, but which one of these does my Vet want to give my cat?

The steroids used most commonly fall in the Glucocorticoids group. This is where the drugs such as Hydrocortisone, Prednisone and Prednisolone fall. Some common brand names of these drugs are: Medrol, Decadron, Delta-Cortef and Aristocort.

What will steroids do for, or to, my cat?

Hydrocortisone affects the electrolyte balance by promoting retention of sodium and excretion of potassium and increasing the urinary excretion of creatine and uric acid. It inhibits the activity of the lymphatic system, produces lymphopenia and reduces the size of enlarged lymph nodes. There is a decrease in circulating eosinophils, and antibody production decreases.

What the heck does that mean?

Simply put, it suppresses the bodies defenses. It reduces the number of circulating white blood cells and antibodies. Steroids are anti-inflammatories. They can reduce itching, joint pain and reduce, temporarily, swollen lymph nodes. The disadvantages are: slow wound healing and inhibition of the anterior pituitary production of ACTH and the consequent atrophy (shrinking) of the adrenal cortex. Hydrocortisone therapy should never be discontinued abruptly but tapered off gradually to allow time for recovery of the adrenal cortex. Adrenal insufficiency may still be encountered in periods of stress, such as trauma or surgery for as long as two years following the discontinuation of the drug if it has been used long term. Except in emergency situations, hydrocortisone and all other glucocorticoids are contraindicated in cats with kidney problems and herpes simplex of the eye. Use with caution in cats with diabetes, heart problems, convulsive disorders or infectious diseases. Prolonged steroid use can cause diabetes and ulcers. It has also been found that steroids can cause personality changes.

This drug sounds horrible! Why would he want to put my cat on something that can cause all these problems?

No drug is all bad or all good. Small amounts of steroids can stimulate the production of red blood cells, helping avert a very common problem in feline leukemia cats, anemia. It also decreases the number of circulating lymphocytes. But there is a price to pay. With the suppression of the immune system, your cat will be vulnerable to common health problems. While it may help an immediate problem, it does not address the main problem, which is the leukemia itself.

So, should I put my cat on Steroids?

Before putting your cat on steroids, you need to know if your cat has a problem that steroids will help. Is your cat anemic? If so, have you tried to correct is using other methods first such as increasing iron and vitamins in the diet? There are now drugs on the market that will help stimulate the production of red blood cells without the side effects of steroids. Does your cat have swollen lymph nodes? These are usually most noticeable on the neck and back legs. How big are they? There are also drugs that will help put the cats own immune system in hyperdrive, so to speak, that may make the lymph nodes return to normal, as long as cancer (lymphosarcoma) has been ruled out. Has your cat been tested for Hemobartonella? This is a protozoan that destroys red blood cells. Does your cat have fleas? A heavy infestation of fleas can kill kittens and make adults anemic. Do you live in an area heavy with ticks? There are diseases ticks carry that can cause anemia. Before using steroids, always rule out all other problems. Steroids do not address the problems that feline leukemia cats have, they only mask the symptoms, for a while. For emergency use, short term, they can be beneficial. Prolonged use can cause serious problems and other medications and a good vitamin enriched diet should be added as the steroids are slowly withdrawn. The important thing with any medication you give your cat is that you be informed about what it is, what it will do and the side effects. Your cat depends on you to make the right decisions for him. We don�t always make the right ones, that is only human. But we do need to make informed, educated decisions about what is right for them. Every cat is different, with different needs. So we need to choose wisely for them to help keep them as healthy and happy as possible.