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. 

Baby-More Lesions, Higher CKD Test Results; the Importance of Monitoring Kidney Function

Baby has ongoing illnesses: CKD, Bowenoid in situ-cancerous skin lesions, hyperaldosteronism, and possibly mast cells/lymphoma of the gastro system (cancer) or simply IBD.

While she does not have heart disease, many of the same tests are ones that HCM cats should have to test kidney function; and the same medications and supplements that she takes for CKD are ones that HCM cats should also take to help and protect the kidneys while they struggle to do the load of the work of diuretics to rid the body of fluid buildup, and help the heart function better. For more on medications and supplements, please read the Med tab here at the blog.

Baby's vitamin D is too low, also. We were told to increase her dose from one drop a day to five drops a day. I figured out that .1ml is about equivalent to five drops more or less. Instead of putting it in her food and hoping she eats it, I give it to her by mouth. She is also taking B vitamin complex at 1.0ml a day; 3ml of water/bicarb a day (stomach acid).

CKD:
Baby has kidney disease. We have been trying to fight this and help her since May 2019. She has had scans and tests from her regular vet, a cancer specialist, a vet hospital, and recently, an Internist. The results are the same-she has CKD and there's nothing we can do about it. And no one can tell me what she should be on or not on or take more of or less of, except for two specific medications.

What they have said is this: she needs blood pressure medication Amlodipine; she needs Spironolactone to try to control her hyperaldosteronism; she needs to eat only kidney disease diet food to help control the disease; she does and now does not need her inhaler Albuterol twice a day; she does not and now does need her Buprenex once a day; she should not use Forta Flora because it's not good for kidney disease; she needs Mirtazapine, an appetite stimulant to help her eat.

Her blood tests results have increased despite giving her supplements and medications to control the disease. 

The urine specific gravity keeps falling-currently at 1.012-which means kidneys are not able to concentrate urine, which means the glomular filtration rate is falling likely due to fewer nephrons working properly, a sign of poor kidney function.

The SDMA-a test for kidney disease-is now 31 in April, up from 29 in February.
BUN-now 38 from 32 in February.
Creatinine-now 2.8 from 2.7
Phos-now 4.7 from 4.0-despite using a phosphorous binder

But the Internist believes her CKD is fine for now, to be expected. I'm the only one not impressed.

Hyperaldosteronism:
The Internist now thinks that Baby's hyperaldosteronism is secondary to CKD and not the other way around. Her gastro/kidney scan in April did not reveal any changes in her adrenal glands and no presence of any nodules that would lead to a diagnoses of cancer to cause hyperaldosteronism. She believes it is due to underlying chronic stimulation of her RAAS system, the system responsible for balancing water and blood pressure in the body.

Skin Cancer:
Baby also has skin lesions-Bowenoid in situ-which are cancerous. If they are not removed, they can become malignant. She had them removed in November, and March; and more will need to be removed in May. They continue to pop up in new places which are hard to find under her long, thick hair. They must get rather large like a knot before I am able to tell that a lesion vs. a regular knot, is present.

Gastro Issues:
The folate level for Baby has increased again and will need to be retested in a few weeks. She took Metronidazole for IBD in February after her cobalamine/folate test showed elevated levels.

BUT she does have mast cells and possibly lymphoma of the gastro system. They could do another needle punch biopsy but they believe that may not lead to a large enough sampling to determine if cancer exists. They want to do an upper and lower GI where they could take out a large sample. It's invasive but not open surgery. But it also costs around $3100. We are not sure that at this time-with everyone's jobs on the line due to the COVID-that we should proceed with this. Also, I need time to set money aside in our budget. So, perhaps late summer/early fall.

Meanwhile, we will give her Mirtazapine so that she eats; monitor her overall health for any signs of an increase of CKD; and take her back again in June to have everything repeated.

When our HCM cat Myrna Loy had some CKD with heart disease, I was able to handle it-which did show up near the end due to diuretics and failing heart-by pushing more supplements and vitamins, and iron. None of that is having the same effect on Baby's results as they did for Myrna. The difference is that Myrna didn't have CKD as a primary disease, just an organ that was affected by her heart disease. But Baby has primary CKD which does not want to respond to most of what I am trying to do. While heart disease gave me the sense of a more pressing issue, one that needed constant monitoring, one that could suddenly strike Myrna and cause an issue-CHF, heart attack, thrombosis-CKD alone does not have the same sense of urgency. But I find it far more frustrating. With Myrna, we saw results for the first few years when her heart disease was stable. With Baby, nothing, except the blood pressure medication. But even that isn't working as well. Her BP was down to 120 from 240 in May 2019 but is now up to 140, high but not yet a concern until it reaches over 160. Then her medication will be changed or increased.

Signs of Feline Heart Disease May Be Lymphoma

Signs of heart disease could actually be lymphoma/cancer. 
Open mouth breathing
Cough
Loss of appetite (anorexia)
Weight loss

There are additional symptoms for gastro or skeletal related lymphoma such as vomiting, diarrhea, weight loss-symptoms which can also be related to heart disease/medication complications. I think only blood work would show if the white blood cell count is off and an ultrasound would find any mass in the body. But I found it interesting that symptoms can point to heart disease but not be heart disease. I'm sure an echo and xrays would likely show no signs of lung congestion or heart disease.

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