Our cat, Tsofli, was recently diagnosed with a case of hemolytic anemia.

One of the things that made us worry was her compulsively licking the balcony tiling, which is a strange behavior, that even our vet couldn’t reason about with certainty.

That’s why we wanted to share our experience, hoping that it may help other cat owners.

To save you some time, if your cat recently has:

• Started licking the floor (indoor or balcony) continuously,
• Been eating less than normal (anorexia),
• Paler than normal gums or nose, and/or
• Started getting tired easier,

Then:

Take them to the vet as soon as possible and get a blood test to check for anemia.

It can probably be life-saving to diagnose it as early as possible and start the suggested treatment after consulting your vet.

Below I will be detailing our story, what symptoms we saw, what was the situation when we went to the vet, and how her treatment went about. I will also include some cute photos of her, to make it worth your time.

Don’t worry, the story has a good ending, as she is now well past over it, though we still need to monitor her in the future for a possible relapse.

The first symptoms

Our cat, Tsofli, is a stray that we adopted since she was 6 weeks old, and we didn’t know anything about her family/medical history.

She is a medium-to-long-haired calico cat, and a highly energetic one. Not one day passes without at least 1 hour of running around, chasing her, and playing with strings and cat toys.

She was 1.5 years old in September 2021 when the symptoms started.

The first sign that something was not right was when she started eating less and more sparsely throughout the day. She used to have a rather high appetite and would run to eat from her bowl when called.

Naturally, we thought that she just stopped liking the specific food brand we fed her at the time. We tried switching to a different brand and then to wet food, but still, she would look at the food, smell it and ignore it pointedly. We also tried changing her bowl, putting it in different places, and cleaning it more frequently, to no avail.

Around this time, we took her to the vet for a regular visit for deworming and asked him about it, but he also said he could not detect anything worrying when he examined her. They suggested it could be a passing behavior or maybe a small wound in her mouth that could hamper her eating habits.

Strange behaviors

Meanwhile, another weird behavior emerged: when we went out on the balcony with her, she would immediately start licking the floor, especially the gaps between the tiling:

Looking around the web for this behavior, I couldn’t find anything concrete. Most articles would be about pica, a condition where the cat starts eating non-edible stuff. But that couldn’t be it; she didn’t try to eat or lick anything else.

There were also some forum posts that it could be attributed to dehydration or low calcium levels, which she may try to replenish by licking the cold and humid concrete surface of the balcony. Again, not helpful, as we tried adding more wet food and even getting her to eat some yogurt (which was unsuccesful, of course).

Then, another strange incident, when, while she was chasing one of her favourite cat toys, she abruptly stopped, and started panting with her mouth open. This was worrying enough that we planned another visit to the vet the next day.

Second vet visit

At this point, Tsofli was being anorexic for the past couple of weeks. We had two incidents of her being winded while playing, and she would also run to the balcony as soon as I opened the door and start licking the floor.

The second visit to the vet started with a regular examination. The vet asked us if she was playing normally (a good sign for cats), and we replied yes; apart from the two incidents, she would still run around and engage in play.

However, he noticed her nose and gums being paler than normal, and then her fur looking less shiny than before.

He went ahead and ordered a blood test to see her blood levels. Tsofli is not easy to handle when on the vet, so she was administered an anesthesia shot, to be able to draw blood from.

Devastated

The blood test results were absolutely horrible: her blood cell count (HCT) was really low: 7%, while the normal range is 28-45%.

The vet was actually surprised that she was still standing and playing: with such low hematocrit, she should be very lethargic and hardly moving at all. Her natural high energy would keep us from diagnosing the issue earlier.

He ordered tests for FIV (feline immunodeficiency virus) and feline leukemia, which thankfully came back negative.

However, the case of severe anemia remained. Tsofli would immediately need an emergency blood transfusion to survive and stabilize.

Panic mode

Hearing the news was like being hit by a truck.

We couldn’t imagine that something was so wrong with Tsofli. The vet’s words that, if we hadn’t taken her for the visit that day, she may not have survived the night, still ring hollow.

He came in contact with a bigger clinic in a city near us and asked if they had cat blood available, which they did, thankfully. We got her in the car, in a semi-drugged state, and drove as fast as possible to reach the clinic.

There, we were told that she would be put up for a blood transfusion, to replenish her red blood cell count, as a saving measure. She would need to stay the night there, as the procedure would take around 4–6 hours. There was also the possibility that her body could reject the donor’s blood or have an allergic reaction to it.

We left her at the clinic and drove back home, still shocked and worried about the turn of events. A long night was ahead, with little sleep and googling things like “cat anemia”, “bartonella”, “FIV”, and other terms we had heard that afternoon, in trying to make sense of what had happened.

Diagnosis

Fortunately, the blood transfusion was successful; her body accepted the donor’s blood, so she had at least escaped the immediate danger.

However, when we went to pick her up from the vet the next day, we got the full diagnosis:

Tsofli had a case of hemolytic anemia, or more specifically, immune-mediated hemolytic anemia (IMHA).

Hemolytic anemia is a condition in which the red blood cells in the body are destroyed faster than they can be replaced, resulting in a deficiency of red blood cells and oxygen in the body. It can be a serious and potentially life-threatening condition if left untreated.

It can be caused either primarily, when the cat’s immune system is not working properly, or secondarily, from a trigger like stressful events, blood parasites like Haemobartonella, toxins, etc.

Afterward, we would attribute it most possibly to a parasite infection, probably from a mosquito or flea bite. We also think that her licking the balcony floor, was her way of saying that she feels weak and is not getting the required energy from her food.

Our life and Tsofli’s, of course, for the next few months, had changed abruptly.

Treatment plan

To treat the anemia, the vet prescribed a double pill regimen:

• Antibiotics (doxycycline) to try to contain the possible parasite infection.
• Corticosteroids (prednisolone), to suppress her immune system, so it stops killing her healthy red blood cells.

The doses for both treatments would start high and decrease every 3–4 weeks, each time after performing a blood test on her, to check her progress and status. We would need to continue on this treatment plan, until her blood cell count return ed to its normal range.

As expected, she was visibly stressed from the whole experience.

We took her home, where for the first time in a while, she would devour the contents of her food bowl. This was a huge relief after the long non-eating period, but we still had a long way to go.

As is the case for humans, corticosteroids can be a hell of a drug when administered for longer periods of time. We would need to monitor her closely for side effects or reactions like stool blood or excessive vomiting.

We just hoped that she would respond to the treatment.

Pilling a cat: not fun

Thus began our struggle with giving her the pills:

Any YouTube video or post describing pilling a cat with words such as “You simply need to…” or “Try this easy method…” is blatantly lying. Tsofli goes into fight mode when we try to cut her nails, so we knew it would be an uphill battle.

What we tried and didn’t work:

• Mixing the pill into her wet food (she would detect it and stop eating).
• Chopping down the pill to a powder-like state and adding it to her food (again she would smell it and avoid it).
• Pushing it onto the back of her tongue. My girlfriend would apply a Krav Maga technique to hold her down, and I would pry her mouth open with both hands, and throw the pill into it as fast as possible. This worked after a few tries, but it was an immense struggle, to say the least.
• Using a pill popper for cats. Same as above, but at least my hand would be spared of her bites. The pill popper we got, was also a bit finicky to handle, and the pill would sometimes fall out.

Another factor making it more difficult was the fact that we would need to do this every 8 hours (3 times a day), and we needed to be both present for the above methods.

This could prove too stressful for her and us, so we searched for an easier solution.

The best cat product in the world

It’s this one:

These pill pouches from Royal Canin saved us. I cannot recommend them enough, as it was so easy to just slip the pill into the pouch and give it to Tsofli. She really liked their taste and would devour them without even noticing the pills.

It was so easy to give her the pills now, that we would eventually be able to trust other people with the task, for when we would be travelling and missing from home.

If you are a cat owner, go ahead and order a couple of pouches to stock for an emergency, as they can be hard to get. There are surely other brands that offer a similar product, so just get what’s easier for you. They can be a bit expensive compared to other cat snacks, but they are well worth the investment!

Recovery

For the next 6 months, we would stick to treating her with antibiotics and corticosteroids, hidden inside the magical snack pouches.

Every 3–4 weeks, we would get her to the vet for a blood test to check her progress. We would then reduce her dosage little by little, until we could be sure she was past the anemic phase. We also had to be careful to keep her stress levels low and make sure she was getting enough rest.

During this period, and due to the high dosage of corticosteroids, Tsofli would experience some side effects, most notably:

• Big appetite for both food and water. This was a good sight, as we knew that loss of appetite in cats is almost always a bad sign.
• She was more lethargic and less keen to play with us or her toys. This was a bit difficult for us to see, as she was always a highly energetic creature, but it was understandable as a side effect from her medication.
• Her hair was shorter and would not regrow for a while. Especially her right hand, that was shaved to perform the blood extraction, would be noticeably more short-haired than the rest of her. A friend would suggest that she looked like she always has one of her sleeves rolled up 😄.

After a few months, her blood count levels seemed to be stabilizing in the expected normal range. Here is a graph of her progress:

You can see that she responded almost immediately to the treatment, and within a month or so, her red blood cell percentage would be in normal levels.

She would also gradually stay up more and start engaging again in play sessions.

Day by day, week by week, we saw small wins accumulate, so she would resemble again her former healthy self.

A fight won

Our small cat turned out to be a big fighter.

After almost 8 months of treating her with the medication, in April 2022, we were told by the vet to stop it and do a final blood test, which came out in the normal range again.

Tsofli’s immune system was now working fine and not killing her blood cells, so this was considered a full recovery. After stopping her pills, her hair grew back into its normal length. Since then, she would play, sleep, and eat again as before.

We were relieved and elated.

For a few weeks, I would still give her the pill pouches she loved as snacks, this time without anything inside them.

Monitoring and the future

As is the case, we still have to monitor her for a possible relapse. This means that if she changes her eating habits, or presents any weird symptoms again, we should take her to the vet for a blood test.

However, we are more than happy that she escaped a life-threatening situation. Tsofli is an absolutely important part of our day-to-day, and it would be crushing if something happened to her.

In writing this post, I hope it helps anyone currently googling around strange behaviors or symptoms of their own cat.

I know I couldn’t find a helpful answer to my searches back then; maybe if I had, I would get her to the vet sooner. Anyway, what’s done is done, so let me just reiterate this, so that the internet spiders get it for sure:

If your cat starts licking the floor or your balcony’s tiling, eating less, and looking less energetic, visit the vet as soon as possible and get a blood test to check for anemia.

If that’s the case, we wish you a complete and speedy recovery.