Getting sick kitten diagnosed

[Seren]

Hey there. Our 11 week old kitten got sick over the weekend and we're still kinda sorting this out. We have a 3 year old cat as well, but she's never had anything go wrong really, so we're a little inexperienced with how to handle this all.

We've had the 11 week old (Aris) since she was 3 weeks old. Everything's been going well so far. Though at her second set of shots last Friday, it did look like she pretty much hadn't put on any weight in the last month. But not sure if that was a problem since everything else seemed to look fine, she's been healthy, energetic, eating normally, producing normal stools, etc.

Sunday afternoon Aris started gagging and throwing up, though she stopped eating so even though the vomiting continued through the evening and into the next morning, there wasn't anything TO throw up since she wasn't eating. The one stool she had produced since that started was partially solid and partially diarrhea. She was not very energetic at all. We tried both solid and soft food, but she would not touch it. We didn't have any kitten milk replacer left from when we were bottle feeding her, or I would have tried that too. :/

I brought her to the vet first thing Monday morning, the stool sample in tow. She was looking pretty weak at that point, she had been huddled on the bathroom floor while I got ready to take her to the vet. We let her stay at the vet through the day yesterday, while I pretty much clung to my phone at home pining for an update. :p They were able to force feed her, and she didn't throw it up, though the vet said she produced a very "mucusy" diarrhea after I left.

They wanted to keep her overnight last night though they are not staffed from 8 pm on through morning so we opted to take Aris home and keep an eye on her through the night and bring her back this morning. We fed her twice through a small feeding syringe (hills a/d diluted with water), which she ate just fine, though when my fiance showed her the plate with the diluted mix on it, she did not show any interest in eating it on her own. Oddly after we put her down she went into the kitchen and settled down next to her dry food bowl and just stared blankly at the food for a while. She wasn't too improved last night, though at least with some food in her, she appeared to have a little more energy.

Oof sorry I know this is wordy, just trying to give a good background. Aris has been given antibiotics, she's only minorly showing signs of improvement so far, but it's only been a day so not sure if that's good or bad. Though I guess the possibility of a foreign object is less likely since she hasn't been vomiting since yesterday morning. The vet mentioned the possibility of doing blood work or xrays, but.. I don't know.. the vet seemed reserved to push either one and said that it could be a parasite or virus and that wouldn't show up on either test anyway. We could wait and see or we could test and either would be fine. She said if Aris had still been throwing up, she would be pushing one or the other, but because she was showing signs of improvement that we could try and wait it out a bit too.

I guess because there wasn't a real opinion to do one over the other, I'm not sure if those would be tests necessary at this point. I don't have problems with the cost. They definitely aren't cheap, but if it's needed, it's needed. But I couldn't tell from that conversation if they were needed. Would it be overkill/knee-jerking at this point to order those tests, or would it help her get better faster? How common is it to be a virus or parasite compared to things needing an x-ray or blood test? I'm leaning towards giving the go-ahead with the tests (the blood results wouldn't be back til tommorrow morning regardless of when the blood is drawn so I have through the day to sort out what I think she might need), just not sure if that's overreacting over one and a half days of being sick.

I really wish we had an idea of what was wrong with her too. I've been such a nervous wreck waiting for updates hehe. :p Sorry for the long post.

[Traci]

Is this the only vet available to you? If not, see a new vet promptly.

An x-ray should be done to rule out potential obstruction. A stool exam (float or smear) should be done to rule out intestinal parasites or bacteria such as e-coli, campylobacter, salmonella, etc.. Giving you the option and then saying let's wait and see with a young kitten is risking it.

What is her normal diet (brand, type?)...do you feed her anything outside of that diet? Does she get into things she isn't supposed to?

[Seren]

A stool exam was done, both with the stool I brought in and some taken from her (is that a smear?). I was told they both tested "negative." But I guess I should have asked for what, because I was under the impression from these updates that parasites, bacteria, viruses, etc were all unable to be detected and simply had to wait and see, and from your reply that doesn't sound like the case. Or maybe I misunderstood her, I'll ask for clarification when I get the next update.

Her normal diet is Science Diet kitten dry food. Occasionally for soft food she gets usually Science Diet Savory Cuts (Kitten Feline Growth). A majority of her diet is dry food now. All of the syringe feeding since she started feeling unwell has been Hills A/D.

We do not feed her anything outside of her diet. About the only thing she might have been able to get at would be the older cat's adult food (also SD), but I've only caught her poking at it a couple of times since she's gone on dry food and urged her away from it. Plus the adult usually eats her food pretty quickly. But it is possible. That's about the only possibility I can think of. We are careful not to leave our own food around for her to get at and she's NEVER been allowed to try any.

There are other vets in the area. We're pretty new to the area and don't know many people yet. This is our second vet since moving because I just really didn't get a good feeling about the first one from our visit to get the 3 year old's shots. This one works with the local humane society and was an establishment I felt much more comfortable with, they seemed more professional and experienced. But nothing had gone wrong yet. But I'm not sure how to go about finding another. I feel so ignorant about this all heh. We used the same vet from the time we got Callie (our older cat) until the time we moved, everything went so well. And from our first two visits to these folks, everything seemed great. Now I have no clue what's going wrong, and about the only information I've got to lead towards any diagnosis is that bit about obstruction being less likely since she's not vomiting now. And maybe I'm just impatient and paranoid or whatever, but I hate the idea of just waiting this out.

Oh well I'm rambling now. Thank you for the reply, I'll start looking into what other vets are in the area right away.

[Guest]

When I got an update later on in the day I felt a lot more comfortable because it felt like suggestions and guidance were being given, as opposed to what it seemed initially to be mentioning possibilities neutrally and kinda leaving it to clueless ol' us to figure out what we thought she needed. So she got her blood work last night and is getting the x-ray today. If we don't seem to get a conclusive possibility about what can be wrong from those though, I'm going to take her to the original vet we used before moving for a second look. It's a bit of a drive but I'm more comfortable with that than playing vet lotto.

I got some clarification on the stool exams too, the negative WAS for parasites, I guess some parasites are just more difficult to detect from that so a negative might not necessarily mean they are ruled out. If I understood that correctly. I still feel like a bubblehead trying to make sense of this all.

All in all, she's showing little sign of improvement. Still not very energized, still producing diarrhea (which has been showing some green though we're not sure what that means), still not eating on her own. Though she is actually showing interest in food, she sits by her food bowl a lot, she seems to poke her head in a lot, she sniffs at soft food with interest, just isn't doing much. But still on Monday if you showed her food, she didn't want to be near it. She did nibble on some dry food last night and this morning had one piece of SD soft food. She seemed to be in a better mood yesterday too, she actually wanted to be held a lot and has been very affectionate, which is her usual disposition but was not present on Sunday/Monday. She spends the days at the vet, where they feed and hydrate her (they've been giving her antibiotics and such too), then we take her home at night to watch over her and give her a few syringe feedings, then bring her back in the morning.

Hopefully we know more soon. I'm not even sure if the minor signs of improvement are great to see or if she should have been showing more recovery by now.

[Traci]

Well, diarrhea can be debilitating, both anorexia and dehydration which can lead to even more problems. I would ask the vet what type of fecal exam was done. A float is usually used to help detect parasites...a smear to detect various forms of bacteria. The fecal exam can be tricky at times but more than one may need to be done, I would suggest getting another fecal done or even asking the vet for a fecal culture. The greenish diarrhea could indicate bacterial infection, but it could also indicate a toxin or other problem as well.

Was her mouth fully examined for potential oral problems, like loose or broken teeth, etc? If not, ask about that right away.

You said she had vaccinations last Friday...did she happen to have any sudden or direct adverse reactions immediately following them? (i.e., vomiting, fever, withdrawal) If so, make sure your vet understands this and makes a prominent note of it in kitten's health records for future reference.

I would be curious what the x-ray reveals if anything, and the results on labwork....can you post what your vet finds? If the x-ray doesn't reveal anything significant, please ask about a second stool exam and/or culture, it's entirely possible she has an infection that the current antibiotics aren't targeting (giardia, salmonella, etc won't respond to general antibiotics, they have to be specific for the purpose). I would also suggest testing for FELV/FIV with a snap test at your vet's cliinic, it only takes 10 minutes for results.

If x-rays, bloodwork, etc are inconclusive, don't hesitate to see your old vet promptly, he may have more experience and may be able to pick up on something your current vet is missing.

[Seren]

Thanks, I appreciate your reply. I've been trying to look around for info just to educate myself on the possibilities, what more can be done, and it's not always easy to find what I'm looking for. So I don't think I can explain how much hearing another perspective means.

Well, diarrhea can be debilitating, both anorexia and dehydration which can lead to even more problems. I would ask the vet what type of fecal exam was done. A float is usually used to help detect parasites...a smear to detect various forms of bacteria. The fecal exam can be tricky at times but more than one may need to be done, I would suggest getting another fecal done or even asking the vet for a fecal culture. The greenish diarrhea could indicate bacterial infection, but it could also indicate a toxin or other problem as well.

She did have two separate fecal exams the first day she was brought in -- one with a sample I brought in with me and another taken from her after she got there. Though would a test from a sample at a much later time be better for producing potentially differing results?

Was her mouth fully examined for potential oral problems, like loose or broken teeth, etc? If not, ask about that right away.

I *think* her mouth was looked at the first day, though I'm not positive, nor am I sure how thoroughly. I will ask about that.

You said she had vaccinations last Friday...did she happen to have any sudden or direct adverse reactions immediately following them? (i.e., vomiting, fever, withdrawal) If so, make sure your vet understands this and makes a prominent note of it in kitten's health records for future reference.

The first time she got her vaccinations she spent the entire night crabby and sulking, a bit listless, but feeling just fine the next morning. I noted that at Friday's visit. When she came home Friday she was sulky and withdrawn again a bit, though only for an hour or two this time, then seemed to be energetic and happy again. I mentioned that on Monday when I brought her in.

I would be curious what the x-ray reveals if anything, and the results on labwork....can you post what your vet finds? If the x-ray doesn't reveal anything significant, please ask about a second stool exam and/or culture, it's entirely possible she has an infection that the current antibiotics aren't targeting (giardia, salmonella, etc won't respond to general antibiotics, they have to be specific for the purpose). I would also suggest testing for FELV/FIV with a snap test at your vet's cliinic, it only takes 10 minutes for results.

If x-rays, bloodwork, etc are inconclusive, don't hesitate to see your old vet promptly, he may have more experience and may be able to pick up on something your current vet is missing.

I got the results back today though the vet that has been working with our kitten was out today so I spoke to another vet who left a few notes for the vet we've been working with. There wasn't anything really that seemed to indicate some direction, but hopefully the regular vet has some thoughts.

As for the x-ray, the noteworthy stuff was gas pockets around the small intestine and colon. Though it sounded like those might or might not indicate a problem.

The labwork.. an assortment of things seemed high or low in range, though the vet I spoke to seemed to indicate that some of those things could be due to her age, and not necessarily a problem. White blood cell count was high, I recall. Liver count was low I think? FELV and FIV are specifically mentioned on the bloodwork report as being negative, though not sure how a snap test compares to that.

Avoiding the spam that looks normal and looking at the stuff flagged high and low (with the reference range -- which I guess is supposed to be "average"?), the results were:

CHEM 27
----------
Alk. Phosphatase -- 280 (H) (Ref: 0-62)
ALT (SGPT) -- 148 (H) (Ref: 28-76)
AST (SGOT) -- 90 (H) (Ref: 5-55)
CK -- 561 (H) (Ref: 64-440)
AMYLASE -- 168 (L) (Ref: 505-1285)
BUN -- 11 (L) (Ref: 15-34)
CREATININE -- 0.3 (L) (Ref: 0.8-2.3)
GLUCOSE -- 66 (L) (Ref: 70-150)
B/C RATIO -- 36.7 (H)

CBC BASIC
--------------
WBC -- 20.1 (H) (Ref: 4.2-15.6)
MCV -- 40 (L) (Ref: 41-58)
LYMPHOCYTES -- 19 (L) (Ref: 20-55)
MONOCYTES -- 9 (H) (Ref: 1-4)

AUTO PLATELET -- 101 (L) (Ref: 170-600)
Remarks: Slide reviewed microscopically. WBC and RBC morphology appears normal. Scanning of the blood smear revealed adequate platelet numbers. Due to clumping and/or large platelets the automated platelet number cannot be acurately determined. No hemobartonella (now called mycoplasma) seen.

ABSOLUTE NEUTROPHIL SEG -- 14271 (H) (Ref: 2500-12500)
ABSOLUTE MONOCYTE -- 1809 (H) (Ref: 0-850)
ABSOLUTE BASOPHIL -- 201 (H) (Ref: 0-100)

--

FeLV ANTIGEN (ELISA) Negative
FeCoV (FIP) ANTIBODY Negative
FIV ANTIBODY Negative

--

Sorry that might be too much info for results. :p Oh well, looking forward to the regular vet's interpretation of it all.

[Guest]

Oh and the vet today though did recommend I do the tests to rule out liver shunt which is really rare for cats I guess, but something about the liver count made that a possibility. I dunno, I need to remember to take to the regular vet about that too. :p

[Traci]

Actually, I'm wondering if the labs are accurate, they look pretty sporadic to me, indicating a possible mishandling of serum, non-calibrated analyzer, or letting the blood rest for too long before testing. Some of the enzymes can be slightly altered due to young age (neonates), but these results aren't truly normal for a 3-month-old kitten.

The liver enzymes are concerning and I agree, I would look further into ruling out liver shunting (portosystemic shunting), especially given the lack of weight gain, and now the anorexia. Did the vet say anything about the serum being icteric? I'm also wondering why there is no Total Protein or Bilirubin noted on the results. One thing you can ask for is testing the ammonia level and repeating the liver enzymes to rule out liver shunting (would also include bile acid testing when suspecting liver shunting)

The WBC and hematocrit combined might suggest bacterial infection or slight anemic response to a possible viral agent. It could be unrelated or secondary to liver function problems. If your regular vet suggests testing for liver shunting, be prepared for several liver enzyme tests including bile acids, possibly an ultrasound. Extrahepatic shunts can generally be surgically corrected, whereas intrahepatic is difficult and doesn't carry a good prognosis.

I hope this isn't shunting, but if it is, it's best to get a handle on it NOW rather than wait. As long as kitten is healthy enough to endure surgery and it is done by a professional vet surgeon, the outcome can be favorable.

If it isn't shunting, I would rule out intestinal obstruction, malabsorption, bacterial infection possibly in GI tract, and lastly, exposure to an ingested toxin (human pills and meds, plants, chemicals, etc)

Please talk to your regular vet first thing in the morning and get a head start on additional diagnostics where necessary.

[Seren]

I'm also wondering why there is no Total Protein or Bilirubin noted on the results.

Oh oops I had just listed the stuff that was higher/lower than normal and then the negative results at the bottom. My bad. :p

As for the total results... hee my fiance saw me typing all of them out and shook his head at me and nicely scanned them for me instead. :p

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[Traci]

Thank you, that is helpful. Based only on labs and kitten's symptoms, I would proceed with primarily testing/ruling out liver shunting, and ruling out bacterial infection...your vet might want to do a fecal culture or blood culture, but I think the liver function testing should take precedence. Toxoplasmosis is also a possibility, but your vet can utilize that test at any time if he thinks it is warranted.

So, in the immediate sense, ask about testing ammonia, bile acids, fecal or blood culture, and ruling out either endo or ecto-parasitic infection. I'm assuming the x-ray didn't show anything unusual on the liver, such as shape, size, abnormalities at this point?