Wednesday, March 3, 2021

Because My Cat's Can't Have Normal Issues-Now Horner's Syndrome Appears

 Jimmy Stewart has seemed to have issues lately with his left eye. I began to notice that it seemed to be sinking or receding and not as out there as the right eye. Then Monday he presented with both eyes being watery and runny and he was squinting. He went to the vet Tuesday and there are no ulcers, scratches, and his eye pressure-checked for glaucoma-was normal. The vet said the eye is receding, the pupils do not match, and the furry skin around it is beginning to droop over it. She thinks this might be due to Horner's Syndrome an issue that has many causes but presents with the symptoms of receding eye, droopy lids, constricted pupils; can also lead to color changes in the ears, increased warmth feeling of the ears. 

These are caused by damage to the nervous system that controls the head, the SYMPATHETIC nervous system. There are two branches or trunks of nerves-sympathetic and parasympathetic. They push/pull the eyes and eyelids. The path of the nerves travels from the brain along the spine to the back of the body. Any damage to the body along the way, or in the brain, or in the head, ears or eyes, can damage the sympathetic nerves. This damage can be caused by tumors, cancer, diseases, even physical injury in the legs or hitting the head against something. For dogs, pulling on a collar when being walked on a leash can damage the area around the neck. 

You must treat the underlying cause of Horner's Syndrome if one can be found. Most causes or problems will clear up without intervention depending on cause, and the eyes will improve. If symptoms get worse or doesn't respond to treatment, an MRI or ultrasound may be next to look further into the body. 

The vet thinks Jimmy might have an ear infection because of his reaction to having his ears checked. She gave us an antibiotic ear cream to use for ten days. If the infection clears up, his eyes should improve. If the eyes do not, then maybe the MRI or try a new medication. It's one of those confounding "keep an eye on it" (no pun) and hope for the best. 

But of course my cats can't have something normal. How often does one hear or read about Horner's Syndrome? 

Here's an article the vet game me to read:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951369

Saturday, February 20, 2021

Jimmy Increased Urination Out of the Box, Increased Glucose Levels, Increased Blood in Urine, Hypercobalaminaemia

April 2020: End of April, Jimmy went out of the litter box in various areas of the house. So, he saw the vet for blood work and an ultrasound and some possible issues emerged. He possibly has: prediabetes, pancreatitis, liver disease, early kidney disease. Here's a review of his history and test results. At the end, I will list what steps we are taking.

Brief history: he's on Prozac for litter box use since 2010 which worked perfectly. He did have incidences about four times a year but on pads near the boxes. The prozac stopped the random spraying. But then the incidences began again about 2014. Testing showed he was prediabetic when his glucose level shot up to 320 (175 is high normal) and the fructosamine test was high, and he had glucose in the urine (should not be present in the urine at all.) Glucose in the urine creates the feeling of a full bladder, can create an irritation in the bladder, and cause the cat to want to suddenly, to urinate anywhere possible. We changed his diet to a lower carb diet-a pate, as the gravy version was high in carbs (to make the gravy) and carbs add to glucose.  This diet change was enough to bring down his glucose levels, and improve his furctosamine levels, and he has not had glucose in his urine.

This decreased the random urination until 2016 when a new cat Roxanne came into the house. Increasing the dosage of the Prozac helped but didn't stop the incidences. He began to go out of the box at least once a month. It seemed like clock work. I could not stop it-was he getting into dry food (too many carbs); was he eating other food fed to other cats that he shouldn't; was he eating too much or too little-did it effect his glucose levels; was it the herpes virus? We tried soothing supplements-Solequin, and another one I cannot recall BUT they seemed to make the problem WORSE and I think it was because they interfered with the Prozac. We tried spraying Felaway calming spray which helped but did not stop the incidences. By 2019, signs of possible kidney issues emerged in the blood work. A scan showed possible changes in the kidneys. Taking him off of Solequin and other supplements that interfered with Prozac, and increasing the dosage of Prozac helped but did not stop the urinating out of the box. He has for two years, gone at least once a month out of the box, typically on pads near the boxes. But he began going 2-3 times a month in other places since January. 

End of April, Jimmy went out of the litter box in various areas of the house three times in two weeks. 
So, he saw the vet for blood work and an ultrasound and some possible issues emerged.

In his urine:
He had urine protein at 30 mg/dl, when a year ago it was negative. 
He had blood in the urine at 50 Ery/μL when he has only had minor amounts before-due to taking a sample with the needle.
He had 1 Billirubin mg/dl when last year it was negative
He had Urobilinogen 4 mg/dl when last year it was normal
He had Red Cell count 22 /HPF when last year it was 1. 

His bloodwork:
Cobalamine: >1000-Determines if he's absorbing nutrients; might indicate IBD or disease/cancer if higher. The vet thought this was fine but the specialist thought it was too high.
Folate-16.5 ug/L-normal and if not might indicate IBD or disease/cancer.
PLI-pancreatic lipase-test for pancreatitis or cancer-1.9 ug/L-normal
Phos-4.9 up from 3.9 last year
Calcium 11.2 up from 9.3 last year
Albumin 4.1 up from 3.5 last year
ALT 194 up from 48 last year
Fructosamine 209 up from 175 in 2014-steadly climbing in the last four years
(The remainder of the CBC/CHEM panel was normal.)
Vitamin D-is high at 162 (normal is 150)
Cancer marker test:
TK1-5.1-too high would be over 7.5
f-HPT-43.3-normal range, too high would be over 64.9
Neoplasia Index-2.1-normal, too high would be over 5.5.
With the high normal TK1, they assume pancreatitis which matches the ultrasound findings.


His ultrasound:
"Bladder-...small...normal wall thickness, few hyperechoic floating particles in lumen consistent with cellular clumping as previously noted. No masses or calculi.
Kidneys-...Diffuse hyperechoic change to parenchyma...Mild blunting of calices...
Spleen-Normal in size. Diffusely hyperechoic, homgeneous parenchyma. Normal vascular pattern.
GI-...normal muscosal thickness...no mass....
Pancreas-...R limb prominent with mild mottling...Focal hyperechoic change and tissue thickening seen in mesentery associated with R limb.
Liver-Normal...homogeneous parenchyma with slight bulge to the capsule...
Other-No lymphadenopathy

Findings...fairly similar to those from (last year)...cellular clumping...bladder most consistent with mild hematuria. Kidneys...very mild scarring or low grade nephritis (as last year.)
Open etiology for the hematuria. FLUTD/FIC may be etiology for hematuria and intermittent inappropriate urination...mild, chronic pancreatic inflammation and scarring and mild subclinical hepatic lipidosis. Past vomiting 11/2019 may have occurred...bout of pancreatitis. Care must be taken to avoid high fat diets that may precipitate pancreatic inflammation.

*(She noted that the cobalamin was high. The regular vet said it was fine.)
Serum B12...consider decreasing or discontinuing supplementation if still being administered.
*(She suggested antibiotics even though no UTI was noted in urine. The vet said no to antibiotics without an issue showing up in blood or urine.)
Consider antibiotic trial with recheck UA to see if hematuria improves...
Ideally limit diets to low fat diets...W/D, I/D..."

The high cobalamin noted by the vet could be hypercobalaminaemia. In humans it is associated with hepatic and neoplastic disorders and the same might be present in cats. Here is one study:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236818/

"In humans, hypercobalaminaemia is associated with myeloproliferative disorders and with a wide range of solid neoplasms including liver, mammary, prostatic, pulmonary, gastric and pancreatic tumours. It has, therefore, been suggested to be a non-specific marker for cancer. Associations have also been made with various non-neoplastic liver diseases and with kidney disease in some studies. To date, its significance has not been investigated in veterinary species. Therefore, the aim of this study was to determine whether disease associations exist for hypercobalaminaemia in cats.

...Among the remaining 156 cats with cobalamin measurement, complete medical records available, and no history of cobalamin supplementation, the serum cobalamin was greater than the reference interval in 44 ...Of the 33 hypercobalaminaemic cats with a definitive diagnosis, 15 were diagnosed with neoplasia, and 8 were diagnosed with non-neoplastic liver disease. Of the 15 hypercobalaminaemic cats with neoplastic disease, liver involvement was confirmed in 5 cases (2 cats with lymphoma, one cat with a metastatic splenic plasma cell tumour, one cat with a pancreatic carcinoma and one with a biliary cystadenoma)...Therefore, the current assumption that hypercobalaminaemia does not have clinical significance in veterinary species should be questioned, and prospective studies should be considered to confirm these preliminary findings...Hypercobalaminaemic cats in this study were also more likely to be diagnosed with liver disease, and similar associations are seen in humans...Possible mechanisms include leakage into the circulation following hepatocellular injury and impaired hepatic uptake of cobalamin. An association with hepatocellular injury is less likely, given that there was no correlation between serum ALT activity and cobalamin concentration. The association between hypercobalaminaemia and hepatobiliary disease in cats is intriguing, since hepatobiliary disease is also associated with hypocobalaminaemia...This discrepancy might reflect the tendency for concurrent gastrointestinal, pancreatic and hepatobiliary pathology in cats, having counteracting effects on serum cobalamin. Indeed, only 9 of the 17 hypercobalaminaemic cats with confirmed liver disease in this study had a disease confined to the hepatobiliary system. Alternatively, it could reflect differing effects of specific hepatobiliary diseases on cobalamin metabolism...there are effects on cobalamin metabolism as a result of changes in hepatic function caused by the PVH..."

Sunday, February 7, 2021

Baby's Necropsy Report-Death Caused By Acute Pancreatitis Attack

Baby's necropsy report shows she died of complications from an acute pancreatitis episode. She did NOT HAVE TRUE HEART DISEASE although she had mild changes to her heart due to age. Her liver had signs of decrease function due to the overall decline in her body function. The kidneys were STABLE despite CKD, and she was not in end stage CKD. She DID NOT HAVE CANCER. We finally got a copy of her initial test results-the reason she had the biopsy in the first place-and she did NOT have lymphoma. She did NOT die of any of her known illnesses. She did NOT have any complications from her known illnesses that led to her demise. (Except pancreatitis which was diagnosed as IBD even in January.) She did NOT have any clots in her legs and no skeletal signs of damage so the pathologist does not know why she was lame unless it was due to severe dehydration that caused weakness. 

Pancreatitis can kill our pets? Yes, and humans. A severe flareup can lead to shock, blood loss, enzymes released basically can eat away at the fat in the pancreas causing severe damage; as the body shuts down, all other organs are affected. This is why keeping track of pets' vomiting and diarrhea, getting a PLI blood test, keeping up the weight by eating on a consistent basis (normal weight), and giving necessary medications (antibiotics for example) is key to avoiding or decreasing pancreatic or even IBD flareups in order to maintain a healthy GI tract, and avoid deadly acute attacks. Here's one study that showed many of the same signs that were exhibited in Baby:

 "...Dehydration (127/157 cats; 84.7%), lethargy (114/157; 72.6%), and anorexia (97/157; 61.8%) were commonly observed. Other signs, in decreasing order of frequency included vomiting, owner‐reported weight loss, hypothermia, tachypnea, icterus, inappetence, abdominal pain, diarrhea, and fever (rectal temperature, >39.5°C; Table 1). Lethargy was more frequent (P = .003) in nonsurvivors compared to survivors. Fever (P = .042) and weight loss (P = .034) )...Putative etiologies of pancreatitis (21 cats; 13.4%) included recent general anesthesia (10 cats; 6.4%), trauma (6; 3.8%), hemodynamic compromise secondary to heart failure, urinary obstruction or gastrointestinal foreign body (4; 2.5%), and organophosphate intoxication (1)...weight loss was negatively associated with outcome.32 Lower BCS at presentation and occurrence of weight loss are frequent findings in FP,11132428 possibly representing a protracted disease course...Duration of clinical signs before presentation plays a role in development of a negative energy balance, and results of the multivariable logistic regression analysis suggest the longer the duration, the higher the risk of death...increased frequency of azotemia in nonsurvivors, which previously has been associated with hypothermia in cats...withholding food is no longer recommended, and PN alone has been shown to compromise intestinal barrier integrity, increasing the risk of bacterial translocation and promoting mucosal atrophy and proinflammatory responses...failure to eat voluntarily during hospitalization was a significant risk factor for death...intrahepatic bacteria were noted in 41% of cats with inflammatory liver disease,59 which is clinically relevant, because hepatic and pancreatic inflammations are common comorbidities in cats, because their collecting ducts join anatomically before entering the duodenum..."

Something happened at the vet hospital to cause pancreatitis, and then they ignored her decline and that she was weak when they released her. They continue to say that she was too sick and that's why she declined (I want to point out that their initial exam said she was 8/9 body condition, and that the ultrasound found nothing seriously wrong.) It's their way of ignoring what they failed to do-to follow proper protocol, if they have any-to keep track of all patients' conditions at all times. They also excuse themselves by saying that I told them she often doesn't like to eat when away from home-which is true. BUT how does that absolve them of all medical care and responsibility for her care and condition? It does not. She got an acute attack of pancreatitis which they triggered, ignored, didn't notice and therefore, didn't treat nor did they alert me to her condition. 

I spoke to the pathologist and here is the explanation from the report listed below: 

Her body declined because it was not able to compensate for all that was happening due to the acute attack of pancreatitis. She was possibly going into DIC-"...can lead to massive bleeding in other places." Many illnesses or issues can lead to DIC and pancreatitis can cause DIC. She would have needed blood transfusions (which the ER tried to find for her-they tried to find a donor-and couldn't; it turned out a local vet hospital near us actually carries blood.I didn't find out until after she died. The pathologist said she would have likely needed more than one and that she may have been too far gone for it to work.) She was leaking internally as she declined, leading to organ failure and some fluid in the abdomen cavity and the lungs and pericardial sac: "whole body tricavitary effusion". The thickened heart seen grossly was not apparent histologically, meaning she did not have HCM nor any heart disease. She had necrosis of the pancreas abdomen fat because the pancreatic enzymes eat the fat, break it down, damaging the pancreas further. The body's systemic response to pancreatitis, can lead to shock which she may have been or had begun to experience. The duodenum can release bacteria into the pancreas and that could have caused the early onset of inflammation. Fluids, pain meds and a feeding tube are the only and best methods for support and treatment for pancreatitis. But Baby wasn't responding. She had mild heart changes due to age or CKD but did not have HCM. She had liver changes due to either the heart, or as her body failed, or if she had been hypotensive for too long, or if she her body lacked oxygen to the liver. The pulmonary edema was not CHF or heart failure. Could have been from fluid therapy that the body couldn't handle as it declined, leading to the "tricavitary effusion".

From the actual necropsy report:

"...

Microscopic Description

Representative routinely stained sections of brain, heart, lung, trachea, kidney, liver, spleen, adrenal gland, thyroid, pancreas, stomach, small and large intestine are examined. Autolysis (destruction) was at least mild in all tissues and moderate in sections of intestine.

In sections of pancreas, there is regionally extensive necrosis of pancreatic acini (dead cells of digestive enzymes.)  There are low numbers of inflammatory cells infiltrating the supporting stroma between acini, primarily neutrophils, lymphocytes, and plasma cells. The supporting stroma is moderately expanded by edema. Within the pancreas, there are multifocal expansile nodules composed of proliferative pancreatic acini. Peripancreatic fat is infiltrated by large numbers of variably degenerate neutrophils. Extensive regions of peripancreatic and mesenteric adipose are replaced by pools of variably mineralized necrotic material and degenerate inflammatory cells (fat cells were dying and they release calcium.)

In the sections of left ventricle, there are occasional regions where there is variation in myofiber size, with a small number of cardiomyocytes appearing shrunken, with loss of cross striations and pyknotic nuclei. The interstitium in these regions is expanded by variably loose fibrous connective tissue. In sections of liver, there is moderate to severe centrilobular hepatic cord atrophy and sinusoidal congestion. Central veins are often dilated. In both kidneys, there are aggregates of lymphocytes and plasma cells infiltrating the interstitium. The interstitium is multifocally replaced by fibrous connective tissue. A small portion of glomeruli are shrunken and sclerotic. All other examined tissues are histologically unremarkable.

Morphologic Diagnosis(es)

Pancreas: Severe acute necrotizing pancreatitis, steatitis and saponification of fat; Exocrine nodular hyperplasia Heart, left myocardium: Mild multifocal interstitial fibrosis and cardiomyocyte degeneration
Liver: Centrilobular congestion and hepatic cord atrophy
Kidney: Moderate multifocal lymphoplasmacytic interstitial nephritis, fibrosis and occasional glomerulosclerosis

Final Diagnosis(es)

1. Severe acute necrotizing pancreatitis, steatitis, and saponification of fat
2. Mild degenerative heart disease and secondary hepatic chronic passive congestion  
3. Chronic kidney disease

Comments

The most significant findings histologically was the severe necrotizing pancreatitis. The most common cause for necrotizing pancreatitis in cats is ascending bacteria from the duodenum. While no bacteria were observed in the examined sections, once the pancreas becomes inflamed, release of digestive enzymes can drastically exacerbate the condition. The changes in the heart were overall mild, however, there was evidence of decreased cardiac function in the liver (chronic passive congestion). The findings in both kidney are supportive of chronic kidney disease. The There was no evidence of a neoplastic process in any of the examined tissues.


..."











Wednesday, January 27, 2021

Baby Struggled a Week in the ER Before Her Life Ended


Baby Jan 18, 2021

Below are a compilation of posts to the Facebook page regarding the week Baby struggled in the ER before we had to choose to put her to sleep.

Baby had gone to a local vet hospital for an upper and lower GI ultrasound biopsy which required anesthesia. She went in strong and normal; came out weak, lame, severely dehydrated, anorexic, etc. Her temperature and blood pressure had fallen during the procedure so she had to remain one more night at the hospital. When she was brought to me on Saturday, no one said that she was weak, or lame, or severely dehydrated. When I got her home, she presented as weak and lame, barely able to move to the litter box, barely able to drink, and after a bite of tuna, refused all other foods. I took her to the ER on Monday. She died the following Saturday.

Baby Jan. 23, 2021






January 18, 2021 (Sunday-Monday 12:08 a.m.)

Baby isn't doing well and has not recovered from procedures under anesthesia on Friday. We have been mitigating the issues and I will call the vet tomorrow. I may need the ER if they can't see her.

Monday morning and Baby hasn’t improved. She’ll have to go to the vet or the ER. But I won’t know until about 9-930 when I can speak to someone somewhere. It’s been very difficult for me-as if I’m important. I’m not. It’s been difficult for Baby. But that feeling returned of being overwhelmed and not knowing what to do and having to go back and think about what I did when Myrna was sick. First, the feeling of trying to figure out what is wrong and what does she need. Not eating? Feed her by hand. Every two hours. Not drinking? Give water by mouth. How much? As much as she’ll tolerate. Then, that feeling of uncertainty returned-is this enough? What else does she need? Paralyzed by fear can happen. It’s panic and fear that arises in difficult situations that can cause us to not think. Our brains go spinning and the clogs don’t land on clear thoughts and solutions. We stand there saying over and over “What to do!??” Experience finally pops up and reminds us we’ve been here before and we know what she needs-food, water; check paws for warmth or cold; check breathing rate; urinating even if out of the box? What symptoms can wait for the regular vet the next day as long as I continue to feed and water by hand? What can’t wait and requires the ER-breathing rate is key, and passing urine are key, pain level is key. Depends on what procedures or issues occurred. Then experience tells us what is working but that she hasn’t recovered as she should have. A sense of determination and calm and focus set in. She will need the vet .

Baby-turns out she’s not recovering from her three day hospital stay and I took her to an ER today. Not eating, drinking, and barely mobile. We’ve hand fed her via syringe since Saturday night. But it wasn’t enough. She’s severely dehydrated and weighs over a pound less than she did a week ago. No updates yet.

Baby will remain in the ER overnight for IV fluids and diagnostic tests. X-rays possibly, an ultrasound, blood pressure check for rear legs, x-rays for rear legs and x-rays also to show if there’s any internal blockage or leaking of blood into her system. They said that sometimes with anesthesia kidney patients because she has CKD, can develop clots or issues regarding kidneys and that can cause the kidneys to go into decline.

The ultrasound and x-rays for Baby show nothing is wrong per se with her kidneys. Severe dehydration has increased the blood values. No clots are seen. Putting in feeding tube via the nose, giving pain meds and nausea meds, and IV fluids. But the lymph nodes and pancreas are inflamed. They were not on Friday. It’s possible the lameness, weakness, are caused by severe dehydration and anorexia. But what caused those? What happened during the procedure Friday? Why was she released Saturday in this condition? She will be in the ER until Wednesday or so.

I'm concerned that Baby may have or might develop hepatic lipidosis-liver failure where the liver converts body fat into energy and expends it. Hand feeding her helped provide some fat and nutrients. As the liver burns off fat, there's not enough to send to the brain to allow the brain to function. As the brain declines, so does the body. This is why you cannot let a cat, regardless of how sick from HCM complications, or any cat sick from any complication, go longer than a few hours without eating. You must begin hand feeding to keep up nutrients.

Wikipedia: Hepatic Lipidosis


January 19, 2021:

Baby has been on a feeding tube since last night and is receiving supportive care. She hasn't yet improved. They said it will take time. I allowed myself to be pressured into getting more extensive biopsies, which meant longer anesthesia period, which the hospital wanted to do when they saw her last April and did minimal biopsies (which did not show cancer).
I was against it for the cost (which ended up being $1000 more than estimated in April), and for the fact that regular biopsies didn't show cancer-and Praise the Lord I refused to have her opened up which they wanted to do.
I knew we had to give her care and feed and water by hand when she came home weak on Saturday. This wasn't the quick recovery she has shown before. And she had lost weight since Thursday.
Lessons learned: One-extensive anesthesia may not be well tolerated in cats. Two-if regular biopsies don't show cancer, do what you can for your cat with antibiotics, and steroids (for non HCM cats and after the cardiologist has cleared the cat.) Don't worry about getting larger biopsies. DO NOT be pressured by vets for procedures that might help "prove" they are sick when other procedures or tests show they are fine or fine enough or sick. Blood work is one thing, surgery another. If you feel it's not right for your cat, maybe it's not. Sure-it depends. And I'm not ruling out surgery or larger biopsies in general. But I wasn't sure about this for Baby and I wish I had listened to my concerns. Sure-we DO NOT always know what's best for our cats. We do not always understand what is necessary for the vet to make a determination. But we had all of the previous blood tests and simple biopsy information for Baby already. That should have been enough especially since the vet on Friday said everything looked fine. Of course-the biopsy results might come back differently. But look where Baby is now-struggling for her life. If I hadn't had the biopsy done, she would be at home now, safe and healthy.

Baby-steroids started last night; will give additional meds to help stomach digest food to absorb nutrients because the food isn’t moving along; her cardiologist-shocked by her appearance-said heart is fine, no changes that caused any issues or decline or clots. They still think dehydration caused many issues. But she’s not yet recovering despite fluids. But she is keeping down food.
And they will watch for hepatic lipidosis but her liver values are normal; ultrasound normal; bilirubin is 7 and normal is 5 so tiny elevated; kidney values are better with hydration and still higher than normal but within normal CKD range that shows kidney function.

January 20, 2021:

Baby showing signs of improvement overnight-she got up and drank water. Next step-eating on her own enough for the feeding tube to come out. But also, the food in her stomach must move along more than it is.
They suggested transferring her to MSU when more stable. I don't care to transfer at this time. Is there anything more only MSU can do for her? And it's a bit further away.

The vet hospital where Baby was Thursday-Saturday called me back and yelled at me for leaving messages demanding answers. FIRST they said voice messages were rude (I was firm in my wording, questions about care, not rude) and that they "don't appreciate it"; then they were condescending and unhelpful and claimed THEY are not the problem, that Baby with multiple issues-despite leaving the house perfectly fine on Thursday-is just too sick. And that she left them perfectly fine. She's in the ER because of that and NOT because they did anything wrong or neglected her-per the spokesperson. He did not diffuse the situation by being understanding or compassionate. Nor are they willing to take something off of the bill to help cover some ER costs (I thought it wouldn't hurt to ask.) Instead, he was angry and scornful. He said I wasn't being civil. And that I need to seek care elsewhere-NO PROBLEM THERE.

Baby update: more alert and still drinking water. Sitting up while all four legs are down-not up on her feet-and they move her from time to time if she hasn't moved. But there's some crackling in her lungs so keeping an eye on her asthma. And blood in her urine and bladder. Doing ultrasound checks for what's going on and will know more later. They'll call me tomorrow morning or this evening if it's serious. Could be an infection or stress or...? Anything. Food in her stomach is moving along, digesting which is good news. Still on IV fluids and pain meds and such of all sorts.

January 21, 2021:

Baby-unchanged. I can’t visit due to COVID restrictions they have. I asked if I could visit since she’s been in so long and they said no. If I could visit daily she might perk up. They want us to transfer her to the State vet school hospital (not the one from last week.) I’m waiting until the biopsy results come back. They also said we need to think of end of life care and when it might be time to put her to sleep. I’m waiting for biopsy results before thinking about that but I do know I want her home for either palliative care we can give or to spend time with her. I might be able to make visiting vet arrangements with her normal vet practice, even for end of life. For now, she can’t come off of fluids and such and be home.

January 22, 2021:

There is no improvement for Baby. Still stable and drinking but not eating and described as very depressed. She has more gurgling noises in her lungs, possibly due to her asthma-which they are treating-but she doesn't have any signs of CHF.
We called the State vet hospital and they said-given that it is getting late today (almost 1 p.m.)-that we transfer her on Sunday night and then she'll be transferred to the hospital Monday. Or we bring her into the hospital first thing Monday morning.
Yes, their ER is open 24/7 but not the specialists or diagnostics outside of xrays and simple ultrasounds. There's no reason to move her from one ER to the next for the entire weekend. I'm taking her Vitamin D supplement up to the ER since she's not had it for a week now. She's insufficient-last reading was in November at 68-should be about 100. It's grasping at straws to think it might fix her but it is a vital component for her overall health.

Did I say this already? When I took Baby to the hospital on Thursday expecting she would be back Friday, I spent two days at home without her. And during that time and then of course going into the weekend because Baby stayed until Saturday, I missed Myrna our former HCM cat the most that I have in the last five years since she died, except for the months following her death. Not sure why and not a good omen. I was worried about Baby before I knew I should have been.


January 23, 2021:

Today at 12:35 am Baby girl died after a week in the ER. We chose to end her life because she was declining and today her platelets dropped too far. She never really improved although there were some good signs. But not enough. A necropsy will be performed and maybe answers will be found. She was feisty, demanding, particular, ornery, intelligent, funny, playful, sweet, loving, and a guard cat ready to attack all dogs and squirrels. 2005-2021.


January 25, 2021:

The initial gross anatomy report from the necropsy for Baby has been released. They saw left ventricular thickening and say she had HCM. They also noted severe pancreatitis. The remainder of the report will take a week.

This is confusing. She saw her regular cardio in July and had no changes, no heart disease, no HCM. She had dental surgery in November and had no issues.

When the cardio at the vet hospital for the biopsy said they heard a murmur and saw myocardial changes, why did they say she was ok to go ahead with the biopsy? Her cardio on Tuesday said the pushed fluids into Baby's body made it difficult to assess the heart completely but that she hadn't seen any troubling areas.

Did Baby's severe and sudden pancreatitis likely caused the body to fail and be unresponsive to treatment? Her heart rate, etc. was normal, and none of the classic symptoms of HCM presented and called for medications such as ACE inhibitors, beta blockers, etc. Nor does this explain the drop in platelets as far as I know.

No more biopsies for any of our cats regardless of age or condition. They are too dangerous when done by unscrupulous vets. We'll treat the symptoms of whatever comes up and do xrays and ultrasounds but no biopsies. You try to find out all that you can to beat an issue, to stay ahead of the possible issues, to meet something head on and it doesn't stop someone from killing your cat.

I don't mean not to do all that we can for our HCM cats. But they don't have invasive procedures for HCM. It's the other diseases that we apparently try to do all we can to prevent, to decrease, to stop and in the end, to no avail when we think they are safe and it turns out they are not.

Monday, January 18, 2021

Baby Dental Surgery November vs Upper/Lower GI ultrasound January-She's Not Doing Well

 We've had a busy summer and fall into winter with the cats. Either there were some minor health issues or they spent the summer and fall going to the vet for annual check-ups and shots. 

Bette had a bladder cystitis blowup this fall which meant a trip to the vet. I could tell she didn't seem well. Sure enough, her urine and blood work showed the inflammation. The vet prescribed antibiotics.  She's done well since.

Jimmy was at the vet this summer for box accidents. He continues to be monitored for diabetes and still has out of the box accidents once a month, sometimes two. We have him on a special low carb diabetic diet, Royal Canine Glycol Balance, mixed with Tiki Shredded Chicken, mixed with a bit of canned CD (to help the bladder that has seen some minor inflammation). No dry food (carbs). His accidents are in the oddest of places: against the washer, on the linoleum, against a dining room chair (which are covered in plastic, which is covered over with pads, which is covered with a cloth chair cover. First the chairs were covered to keep them clean. Then he began going on them so that prompted the plastic covered by cloth. Only, the urine would run through the cloth, down the plastic, onto the floor. Now it's plastic, pads, cloth.) He'll have one accident, then be fine for two to three weeks or a month before the next. And typically in a new spot. He's on Prozac which is compounded with a sugar free substance. We developed a behavioral technique where we praise him when we see him use the box (if we see him use the one on the first floor) and then let him have access to the second floor bedrooms or into the living room. He's not allowed into either spaces unless he's used the box. 

Katharine has spent months now on steroids for IBD. She wasn't eating well enough this summer and began to lose weight. Blood work PLI/Cobal/Folate test showed inflammation, possible IBD. Steroid prednisolone was prescribed for a period of time before we titrated down her dose. But we have been allowed to go slowly. I decrease the dose by .005ml every two weeks or so depending on how well she maintains eating after the dosage is decreased. She has gone from .4ml to now .1. She has been at .1ml for a month because she has not been eating well and has lost weight after going from .15 to .1ml. This week I had to give her Miratz-Mirtazapine in a gel form-the appetite stimulant because she lost weight and was not eating. We may need to increase her dose again. 

Baby-Baby sees the vet every few months for blood pressure checks due to hypertension caused by CKD-kidney disease. In 2019 and in April 2020, she saw specialists to review her many issues: CKD, hypertension, hyperaldosteronism, mast cells, lymphoma/IBD/pancreatitis, Bowenoid in situ sarcoma skin lesions. She had her annual check up in November and dental surgery in November to remove two teeth. The small front tooth was broken, and a molar had a cavity. She recovered from anesthesia without issue. She ate and drank and used the litter box once home and only seemed to need the one day to bounce back. 

HOWEVER-the specialist at the animal hospital wanted to do a larger biopsy of her lymph node that was enlarged, as well as get more samples of her intestines to test for lymphoma vs IBD/pancreatitis. That was scheduled for last Thursday/Friday January 14-15. 

Upon initial exam, they discovered a heart murmur and did a cardio echo which showed mild changes in the heart but no heart disease. They did a regular ultrasound. The enlarged lymph node was no longer enlarged so it is unlikely that she has cancer. Also, the mast cells found in 2019 are likely not cancerous because that is an aggressive cancer and she would have died by now. Mast cells can also appear with severe/chronic inflammation like IBD. The rest of her appeared almost the same in 2021 as in April 2020. They kept her overnight and did the biopsy on Friday. They took samples to test but they do not believe she has cancer of her intestines. 

BUT-the anesthesia was not well tolerated. Baby's blood pressure dropped during surgery to 90-normal is 120 or more. Her body temperature dropped during surgery and had not returned to normal by 4 p.m. when they called to say she could not come home. Her body temperature returned by Saturday and she was released in the afternoon. They also performed an enema-water solution pushed into the butt with a hose and up into the intestinal tract-under anesthesia. When they released her, they said she was in stable and good condition but that she hadn't eaten. 

HOWEVER-when I got her home, she was NOT in good shape. She was LAME in the rear legs, gurgling out of her nose, wouldn't eat, kept crying in pain, etc. I removed the bandage on her leg and that helped her walk better but she still had trouble walking and she was also walking in a curved line. Eventually, I administered her Buprenex at .2ml (up from .15) which eventually helped her sleep; and gave her blood pressure med which they have failed to give her; and after trying to get her to eat, began giving her tuna juice by mouth. She had not eaten for them and had not eaten a full meal since Wednesday. Subsequently, she has lost one pound since a week ago. She kept going to the water bowl and trying to drink. 

On Sunday, today, she was going to the water bowl and NOT able to drink but has been laying there instead. She is not using her box but is going on soft surfaces. She appears unable to climb into a box. We have set up a flat box which she was able to use. She is walking better than she was Saturday night. We have been feeding her A/D mixed with a bit of water, fed to her with a 3ml syringe, for 12ml total every 2-3 hours. We have also given water by mouth. She is not active; she appears uncomfortable; she does seem restless although Buprenex helps calm her. Her breathing rate is about 36 which is normal. But WHY isn't she bouncing back from this as she so easily did after dental surgery in November? WHY isn't she eating despite Cerenia, cyproheptadine, and Mirataz? WHY is she in pain or uncomfortable? WHY is she having trouble with her rear legs and is unable to climb? 

The notes from the vet said she presented on Thursday with rear leg lameness and pain at the initial exam. She did NOT have any trouble with her legs at home or at the regular vet a week ago when she went in for blood tests. IF she had rear leg lameness, they failed to tell me, and then failed to try to figure it out and fix it. What if something happened during the surgery to cause leg pain or lameness? Did they cut off blood supply-although her paws were warm to the touch. Did they damage a nerve? Did they cause pain when they inserted the tubes for the enema and lower GI? 

I will call her regular vet tomorrow, Monday, to see if they can see her. If they can't, I may need to take her to the ER but that's a tough call to make. She isn't well but nothing appears life threatening. Except that she isn't eating and drinking and with the sudden weight loss, she could be low on electrolytes and nutrients; she could have internal damage that I can't see and may need xrays or an ultrasound. But she should have bounced back by now. As for the changes in her heart, I will call the cardiologist to see if they can see her sooner than the February appointment she already has. 


Wednesday, April 29, 2020

Baby UTI-Common for CKD Cats

Baby woke up today urinating blood. The vet said she has a raging UTI with plenty of bacteria. She had shown no previous symptoms. This is the third one in a year. With the previous two, she was lethargic and seemed unhappy and ill. But she wasn't urinating blood nor having small ones in the box like today. At the Internist last week, her urine was fine. Did they give her an infection? 

The vet has her on Zeniquin, an antibiotic, for 14 days.
At vet

Tuesday, April 28, 2020

Katharine Hepburn Possible Gastro Issues-More Tests in the Future are Needed

During COVID quarantine, my cats thought it would be a really good time to come down with other issues. Three cats-Jimmy, Baby, and Katharine have been to the vet during this time.

Katharine has been seizure free since May 2018. She sees the cardiologist annually due to a heart murmur and has no issues or causes. But since she went on phenobarbital in May 2018, she has had issues eating. She has been on increasing doses of Mirtazapine appetite stimulant ever since. Now she takes a weekly dose. She is also very low on vitamin D. She has gone from one drop a day to five. Since she and Baby are both on vitamin D, I give each a .1ml dose-which as well as I could figure, is close to five drops. They will be retested in a few weeks and we'll know more then.

In March her gastro test results-for cobalamin/folate and PLI-came back with possible IBD or pancreatitis. Baby had close to the same results and was put on Metronidazole. Katharine was not and somehow it slipped through the cracks, likely because the COVID virus shut down the state just as we got back the results. Being too busy in general, and then dealing with Baby's CKD vet appointments, I forgot to tell the vet I was ok with Katharine going on the medication. So, we will discuss this tomorrow when another cat goes to the vet for his latest issues.

Katharine's cobalamin was normal; PLI was normal; but folate was too high, possibly indicating an infection or issue. Given the other two were normal, pancreatitis was not indicated per the vet's notes. It could also mean she's absorbing too much of the nutrient which means there's another issue.

Her kidney values are good. SDMA is 5, creatinine is 1.5, BUN is 22. Potassium is good at 4.3 but with supplementation (which we've been giving her since May 2018 because no one could find a cause for the seizures. Insufficient electrolytes was a possible cause, and potassium was easy to give by mouth using Renal K.) I need to check her hyperaldosteronism next time. As we learned with Baby, when potassium is low, a cause could by hyperaldosteronism. Given that Katharine is on a potassium supplement, her level should be higher than it is-or possibly should be higher.