New member here referred to this site from another cat forum.
.About a week ago we noticed our indoor/outdoor cat wasn't feeling well. She is 3 years old. Basically she was lethargic and no appetite. Took her to regular vet one evening and he noticed a lump under her jaw closer to the ear. He did a needle aspirate and just looked under a microscope and he thought it looked bacterial. She also had a fever of 105. She got a shot of Ketofen and liquid clavamox. The shot helped her fever because she seemed back to normal.
The next morning she was back to being lethargic. We kept giving the clavamox to see if the antibiotics would start working and maybe clear up an infection. After 2 days of no improvement and little to no eating, I took her to the E-vet. Her temp was still high over 104 and preliminary thought a swollen salivary gland. She was admitted over night and testing began....... X-rays, Ultrasounds, Blood work, needle aspirates. She was hospitalized for nearly 4 days now and her fever had only come down once with medication.
A second small lump was found the second day below the larger first one. Liver function and kidney functions showed normal on tests. Blood work only revealed high white blood cells and slight anemia. Ultrasound was performed and showed slight enlargement of the spleen and also some small lympnodes around the stomach, so they took a sample from the spleen and that test wasn't conclusive enough to make a diagnosis. All tests have been inclusive in being able to diagnose lymphoma
We decided on surgery to remove the lymphnodes in her neck, Doctor said surgery went well and the lymph nodes looked infectious NOT cancerous!! but a biopsy would be done. This would explain the high fever she has had that doesn't seem to break. Doctor thought the fever should be gone after removal of those nodes another reason for the surgery.
What a roller coaster this has been. We just want her to feel better and whatever the diagnosis ends up being we'll go from there. I'm am HOPING she has an infection that just needs some powerful antibiotics (Although she has been on 2 during her stay at the hospital) and that dang fever just won't break. She has had no vomiting or diarrhea, just fever, lethargy (probably from fever) and loss of appetite.
She came home 3 days ago prescribed baytril, clavamox and metacam. We have NO improvement and on the second day home we took her to her regular vet and he wanted to do another CBC. Her white cells doubled from 32,000 at the hospital and her fever was 105. We cannot get this fever under control and she is miserable. We are hoping for the biopsy results to come back Monday for a diagnosis. I think they feel its lymphoma but all their tests have been inconclusive.
We have to really entice her to eat and drink and she doesn't eat much even trying syringe feeding. She has no energy and we're trying to make her as comfortable as possible until we get an answer. Right now she is taking Clindamycin, clavamox and metacam. The metacam is every other day. SHE IS NOT RESPONDING TO THE MEDS!
What else can I ask the vet to do? Any idea what her systems sound like? No specific FIP test was done and they said from the looks of everything they don't think its FIP. FIV and FLeV were negative. We don't have much time with her the rate she is going and we have spent to much money to call it quits now.
Attention Traci: Could use your advice
Re: Attention Traci: Could use your advice
When bloodwork was done, did either vet think to send off an immunology profile? (this tests for Coomb's, feline mycoplasma (AKA Hemobartonellosis), tick disease, anemia-related conditions, etc - it needs to be sent to an outside lab, results usually achieved in 4-7 days although vet can ask the lab to expedite the results) - This should have been done as part of the workup first, and especially since other tests revealed little to nothing. So, please call whichever vet you are most trusting in (I'd recommend the ER vet), and ask about this, get it sent off IMMEDIATELY.
Is your kitty spayed? If not, I assume the vets ruled out pyometra or uterine infection?
Did either vet check for puncture wounds? I ask because your kitty is allowed outdoors, and a puncture wound could have gone unnoticed. Although, an abcess would generally respond to clavamox (although amoxicillin is usually prescribed for mild abcesses).
Likewise, ask the vet about an injection of ampicillin (Polyflex), IF there is a suspected internal infection that may have resulted from a bite wound or puncture they haven't yet discovered.
Did the vets rule out insect, spider or snake bites? Oftentimes, these injuries can cause a fever but usually also cause some amount of swelling at the site of the bite.
Was kitty's oral health checked? Sometimes diseased teeth or oral abcesses can also cause fever and swelling. Likewise, so can calicivirus, was it ruled out? (here too is where they can use the sample for immunology and include calicivirus or other viral testing)
I'm rather surprised the vet chose to remove the lymph nodes without a specific pathology report to suggest it.
In view of this, I would strongly suggest taking kitty back in, PRONTO, drawing enough blood for a complete feline immunology profile to be sent to the outside lab, have the vet ask the lab for expedited results, and then ask the vets to consult a feline specialist on your behalf. As a matter of fact, I'd ask for that consult immediately, based on tests and other diagnostics that have already been done. Either vet can consult with a specialist via phone, or VIN (an online veterinary network with specialists in their field), and should only be the cost of a phone call (many vets don't charge for this, but find out if your vet does - either way, it's good practice to consult specialists when multiple testing isn't revealing, specialists can often get the vet in the right direction and give expert advice).
It's possible that the lymph nodes are reacting to some sort of infection, whether bacterial or viral in nature, remains to be determined, this is where that immunology profile (including that very important mycoplasma and tick disease rule-out) comes in. Please talk to BOTH vets about this immediately, and discuss methods to get kitty eating again - be prepared that tube-feeding may be necessary, although I hope not because kitty isn't really a good anesthetic candidate right now, and she shouldn't be subjected to another "surgery" right now. With an infection, you can't risk infection at a feeding tube incision site (not to mention risk of infection with any surgery). Try using Hill's Prescription Diet A/D in her syringe feeding, add canned tuna in water or canned white chicken in water to her regular food to help entice her. Also ask the vet about cyproheptadine, an appetite stimulant - but it may not be a good choice unless the fever is already reduced and back to normal before using this medication - your vet can advise you more.
Hope this helps, please don't delay, get that immunology profile sent out immediately and get that professional consult ASAP. Please update us when you know more, and hang in there!!
Is your kitty spayed? If not, I assume the vets ruled out pyometra or uterine infection?
Did either vet check for puncture wounds? I ask because your kitty is allowed outdoors, and a puncture wound could have gone unnoticed. Although, an abcess would generally respond to clavamox (although amoxicillin is usually prescribed for mild abcesses).
Likewise, ask the vet about an injection of ampicillin (Polyflex), IF there is a suspected internal infection that may have resulted from a bite wound or puncture they haven't yet discovered.
Did the vets rule out insect, spider or snake bites? Oftentimes, these injuries can cause a fever but usually also cause some amount of swelling at the site of the bite.
Was kitty's oral health checked? Sometimes diseased teeth or oral abcesses can also cause fever and swelling. Likewise, so can calicivirus, was it ruled out? (here too is where they can use the sample for immunology and include calicivirus or other viral testing)
I'm rather surprised the vet chose to remove the lymph nodes without a specific pathology report to suggest it.
In view of this, I would strongly suggest taking kitty back in, PRONTO, drawing enough blood for a complete feline immunology profile to be sent to the outside lab, have the vet ask the lab for expedited results, and then ask the vets to consult a feline specialist on your behalf. As a matter of fact, I'd ask for that consult immediately, based on tests and other diagnostics that have already been done. Either vet can consult with a specialist via phone, or VIN (an online veterinary network with specialists in their field), and should only be the cost of a phone call (many vets don't charge for this, but find out if your vet does - either way, it's good practice to consult specialists when multiple testing isn't revealing, specialists can often get the vet in the right direction and give expert advice).
It's possible that the lymph nodes are reacting to some sort of infection, whether bacterial or viral in nature, remains to be determined, this is where that immunology profile (including that very important mycoplasma and tick disease rule-out) comes in. Please talk to BOTH vets about this immediately, and discuss methods to get kitty eating again - be prepared that tube-feeding may be necessary, although I hope not because kitty isn't really a good anesthetic candidate right now, and she shouldn't be subjected to another "surgery" right now. With an infection, you can't risk infection at a feeding tube incision site (not to mention risk of infection with any surgery). Try using Hill's Prescription Diet A/D in her syringe feeding, add canned tuna in water or canned white chicken in water to her regular food to help entice her. Also ask the vet about cyproheptadine, an appetite stimulant - but it may not be a good choice unless the fever is already reduced and back to normal before using this medication - your vet can advise you more.
Hope this helps, please don't delay, get that immunology profile sent out immediately and get that professional consult ASAP. Please update us when you know more, and hang in there!!
..........Traci
Re: Attention Traci: Could use your advice
Thank you for the reply. Kitty went back to the ER-vet today for some basics. CBC checked: Shows mature neutrophilic leukocytosis overall count 37.6K with 30.7K granulocytes and 4.8 monocytes (whatever that means)
Worsening anemia 18.8% platelet count is low but there is significant clumping, platelets appear adequate based on slide review.
Temp: 104.6, we are still waiting on histopathology results. Cytology showed pyogranulomatous inflammation but no bacteria (What ever that means as well) These are the most recent updates. I'm trying to find out about an immunology and if it was done while she was hospitalized.
Worsening anemia 18.8% platelet count is low but there is significant clumping, platelets appear adequate based on slide review.
Temp: 104.6, we are still waiting on histopathology results. Cytology showed pyogranulomatous inflammation but no bacteria (What ever that means as well) These are the most recent updates. I'm trying to find out about an immunology and if it was done while she was hospitalized.
Re: Attention Traci: Could use your advice
It looks like she is reacting to some sort of virus, and when we talked about getting an immunology profile sent for feline mycoplasma, etc, I would ask the vet to also add on the FeLV and FIV. While you said she was negative for the latter, do you know if the FeLV and FIV tests were done at the clinic? If so, they were probably done with snap tests, which means, they might be faulty tests with inaccurate results. While we like to think our snap tests are reliable, occasionally, a batch might be faulty, or, not specific enough. If you include the FeLV and FIV on the immunology profile, the results might be more accurate (better sensitivity).
The fact the fever is not reducing, nor responding to agressive antibiotics could mean this is viral instead of bacterial. It could also be one or the other, or both. Viral infections usually don't respond to antibiotics.
There's also inflammation of some sort, that MIGHT indicate a secondary bacterial infection going on somewhere, but could also indicate tissue or organ involvement (i.e., like the spleen). I would ask your vets to discuss the potential use of prednisone and possibly the use of doxycycline in the case of mycoplasma or other infections, but ideally, those infections should be identified correctly first. Please discuss them though, because sometimes we have to treat AS IF we assume a certain condition while waiting on bloodwork or lab results. Especially when inflammation and anemia are present, the use of prednisone can oftentimes be helpful, and the doxycycline can treat many a bug in the blood. You do NOT want this to progress where the anemia worsens that may require blood transfusions.
I think I would get a board-certified feline specialist's opinion RIGHT NOW - ask your vet to consult with one immediately. The specialist can direct the vet on which tests are most paramount at this point, and whether or not to assume viral vs bacterial (in which to choose the most effective medications). Don't wait on this, the more inflammation that occurs, and the more the fever is unrelenting, and the more the WBC's rise or blood counts are out of whack, the riskier it gets.
Please let us know when you know more.
The fact the fever is not reducing, nor responding to agressive antibiotics could mean this is viral instead of bacterial. It could also be one or the other, or both. Viral infections usually don't respond to antibiotics.
There's also inflammation of some sort, that MIGHT indicate a secondary bacterial infection going on somewhere, but could also indicate tissue or organ involvement (i.e., like the spleen). I would ask your vets to discuss the potential use of prednisone and possibly the use of doxycycline in the case of mycoplasma or other infections, but ideally, those infections should be identified correctly first. Please discuss them though, because sometimes we have to treat AS IF we assume a certain condition while waiting on bloodwork or lab results. Especially when inflammation and anemia are present, the use of prednisone can oftentimes be helpful, and the doxycycline can treat many a bug in the blood. You do NOT want this to progress where the anemia worsens that may require blood transfusions.
I think I would get a board-certified feline specialist's opinion RIGHT NOW - ask your vet to consult with one immediately. The specialist can direct the vet on which tests are most paramount at this point, and whether or not to assume viral vs bacterial (in which to choose the most effective medications). Don't wait on this, the more inflammation that occurs, and the more the fever is unrelenting, and the more the WBC's rise or blood counts are out of whack, the riskier it gets.
Please let us know when you know more.
..........Traci
Re: Attention Traci: Could use your advice
We lucked and got an appointment tomorrow with an internal medicine specialist. Have to travel a bit for it but this is our last effort for an answer. Hope she has enough life left to go through this.
Re: Attention Traci: Could use your advice
Be sure to have your vet and the ER vet fax all of kitty's records to the specialist, so that he has all the records for review and is familiar with kitty's current health records and current treatment/medications.
Again, anything you can do to keep her eating, try the A/D mixed with water for syringe feeding, - even Hills Rx I/D would be good, it's easy on the stomach.
Also, make sure you discuss with the specialist the immunology profile etc, this is really important. Please let us know how it goes tomorrow, am wishing kitty and you the best, and ultimately a clear diagnosis that is going to be treated effectively!
Again, anything you can do to keep her eating, try the A/D mixed with water for syringe feeding, - even Hills Rx I/D would be good, it's easy on the stomach.
Also, make sure you discuss with the specialist the immunology profile etc, this is really important. Please let us know how it goes tomorrow, am wishing kitty and you the best, and ultimately a clear diagnosis that is going to be treated effectively!
..........Traci
Re: Attention Traci: Could use your advice
Good luck just1cat. I'll be interested in what the specialist has to say. Please follow Traci's advice - she's great and knows her stuff!
Traci - I rarely disagree or contradict you because you're so good at what you do, but I have to disagree with your interpretation of the WBC results of "mature neutrophilic leukocytosis overall count 37.6K with 30.7K granulocytes and 4.8 monocytes". This is definitely indicative of an extreme amount of inflammation, but that high of a percentage of neutrophils would be more likely to indicate a bacterial process rather than a viral one. A higher lymphocyte percentage would be more likely in a viral infection. Although, immature - as opposed to mature neutrophils - are ususally much more common in a bacterial infection, this has been going on for a while, so having only more mature cells present makes sense. Of course, a cancerous process (heaven forbid!) needs to be ruled-out too.
Traci - I rarely disagree or contradict you because you're so good at what you do, but I have to disagree with your interpretation of the WBC results of "mature neutrophilic leukocytosis overall count 37.6K with 30.7K granulocytes and 4.8 monocytes". This is definitely indicative of an extreme amount of inflammation, but that high of a percentage of neutrophils would be more likely to indicate a bacterial process rather than a viral one. A higher lymphocyte percentage would be more likely in a viral infection. Although, immature - as opposed to mature neutrophils - are ususally much more common in a bacterial infection, this has been going on for a while, so having only more mature cells present makes sense. Of course, a cancerous process (heaven forbid!) needs to be ruled-out too.
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.
Re: Attention Traci: Could use your advice
I'm guessing secondary bacterial infection, possibly not primary - although it could be the other way around as well, primary bacterial with an active virus. It sounded like anemia was present, or may be developing - if a mycoplama for example comes back positive (as in active infection), that might explain both processes (although the vet could have at least done a blood smear for suspicion). The fever is telling, in that it is not responding to antibiotics, and remains high enough to be concerning. It could also be a multiple-condition thing going on, but concerning due to the unrelenting fever, inappetance, no response to antibiotics. Where the inflammation is coming from, I don't know, but xrays and ultrasound apparently didn't detect suspicious organ involvement (although a subsequent ultrasound might), so if this were my cat, the obvious next step would be immunology. Also, they're still waiting on a histopath.
..........Traci
Re: Attention Traci: Could use your advice
I will let you all know what we find out. The histopath didn't come back yesterday liked we hoped, hopefully today. The ER vet seems to think something bacterial but cultures came back negative. She was on antibiotics prior to the culture so that may have skewed the test. I forgot to mention the vet felt a small node under chin Sunday when we took her in. It wasn't previously swelled during all this treatment.
The cat "kitty" has been a trooper through all this. I just hope she has some life left in her to get through a few more days of tests results and such.
The cat "kitty" has been a trooper through all this. I just hope she has some life left in her to get through a few more days of tests results and such.