Traci, are you available?

[felinexpress]

Traci, it's MA and I need a bit of help with an email I just received from a friend. I lost your contact info in my great computer crash (don't ask) then hubby has gotten incredibly ill. At any rate, if you can offer some advice for this person- it would be apprcciated-


I hate to bother you like this, but I'm at a loss for ideas here.

My most feral-like cat, Eightball (12), has some interesting things going on. I had him at the vet 3 weeks ago for a full blood panel and urine screening and his blood work was normal. (I brought him in when he peed out of the box and he did have a UTI, but that is not why I write.)

He's been slowly losing weight over the last 4 years - down 4 pounds in total (13 to 9). His coat has taken on a scruffy appearance and his skin is very dry. Repeat blood work never shows anything wrong.

He's showing clear signs of a cognitive disorder. He was always friendly with other cats and scared of people and that has slowly reversed in the last year. He now randomly picks fights with the other cats (not consistent, as one minute he is snuggling and grooming with them, and the next he growls and smacks them). I can see by the reaction from my other cats that they recognize something is amiss with him. My long time friend who has only seen the back end of him as he fled was over recently and he sat in her lap (a jaw dropping moment). My neighbors (with their noisy kids) were over last weekend and he was in the living room with them. Never happened before. At the vet 3 weeks ago, he sat still for the exam - another first as we have always had to sedate him just for them to do an exam (he was sedated for the blood draw).

About 6 months ago he had a seizure - there was a possibility of a stroke but didn't have an MRI to prove it. It's not happened since then that I've witnessed, although admit that I've been gone during the day at work.

Last night was the strangest. I just got to bed and he was the only cat to follow me (weird in and of itself). He was snuggled next to me when he started to growl. I looked around and there were no other cats in the room, nor in the hallway outside the room. When I asked him what was going on, he stood up, walked across the bed, and started to wave his paw in the air as if he was playing with a wand toy. He did this for about a minute. It looked to me as if he was hallucinating. My mom died of cancer, and when it hit her liver, the blood flow decreased to her brain causing odd behaviors and hallucinations. I can't get that out of my mind.

I would guess that if he had cancer there would be something off in his blood work. It's been a very long time since I've dealt with cancer and don't recall much of that. If he's having strokes it would explain the cognitive issues but not the weight loss. His littermate died of cardiomyopathy at age 8, and while they heard a murmor at the vets 3 weeks ago, it stopped once they did sedate him to draw blood and urine. The vet did say that cats that are stressed can have irregular heart beats. A heart issue would explain the weight loss and scruffy appearance. And cancer would explain it all.

This is not a cat that can be medicated. Even though he has mellowed with age, his behavior is not consistent enough for me to restrain him long enough to medicate. While he is friendly to me, he still hides, particularly when he senses I'm trying to constrain him to do things like put him in a carrier or give him meds.

Separating him from the other cats would be unfair to everyone in the house. I wouldn't have enough time to give him the attention he needs, as he is in my lap more often than the rest of the cats combined and isolation would kill him. Spending time alone with him would take me away from the others, and I have 5 other seniors to deal with right now. Steve has his hands full with the 3 dogs and the 3 cats that are “his”.

I know this sounds like I'm asking you for vet advise, but I'm really looking for ideas on questions to ask my vet. I honestly struggle with what I would do if I had a diagnosis. Strokes are untreatable. Brain tumors are basically inoperable in cats. And other cancers would require medications that I would probably not be able to consistently administer. He's 12 years old, born feral, still acts feral at times and all of this could simply be chalked up to old age in a cat that had a poor start in life.

Can you tell by now that I'm struggling with where to go from here? I think I’m too emotionally attached to look at this objectively so am looking for another set of eyes on the problem. What would you do if you were me?


Traci, what I would do if I were her, is what I am doing now. I am turning to an old, dear friend for advice on which way to travel-


Thank you-


MA

[Traci]

If the vet heard everything she's said in your email here, and hasn't pursued this further, then she needs a new vet. No vet in his right mind, after listening to this account would deny further testing is necessary.

Since I don't know what bloodwork was done, I don't know it if was in fact, complete bloodwork. Was a thyroid panel done? Was full urinalysis done? Was complete chemical blood profiling done (not just a certain panel), and was a CBC with differential done? Were xrays ever done? How about an ECG or EKG and blood pressure check? Was an ultrasound ever offered her? Viral testing?

How was it determined a seizure may have been a result of a stroke? Was there any indication in subsequent bloodwork to suggest that? Was it a seizure or something else? The two are entirely different conditions. Was complete bloodwork and xrays done at that time?

Was oral health, eyesight and hearing evaluated? The mention of cognitive disfunction could indeed be any of these three things.

Cancer does not always show up in bloodwork. Although bloodwork is a good tool to aid in diagnostics, it is not a sole diagnostic. Xrays and ultrasound and other diagnostics are necessary if there is even the slightest suspicion of cancer, no matter where the suspect location in the body. An MRI could also be useful, but xrays and ultrasound are usually diagnostic first (of course combined with physical evaluation and bloodwork).

The behavior changes could be due to pain and discomfort from an undiagnosed condition, not necessarily cognitive disfunction although that still needs to be ruled out. Both cats and dogs will show agressive or strange behaviors when they are suffering pain or discomfort.

12 years of age is not old, and she should not assume this could be chalked up due to age. Something is amiss and it demands further diagnostics. Bloodwork isn't enough, a heart workup, xrays, ECG/EKG, blood pressure monitoring, thyroid function testing, urinalysis are the most common and useful diagnostics.

The weight loss may or may not be concerning, since she's talking about a 4 year period. However, combined with all the symptoms, it is concerning. The weight loss could be a result of anything from anorexia to insufficient metabolism, to a vital organ disfunction (and yes, to cancer, but make no presumptions without full diagnostics).

She didn't mention anything about his appetite, food fed, whether or not he's vomiting or has diarrhea, has normal urine and bowel function etc, or anything about his activity level, daily activities etc.

The mention of hiding however, is indicative of pain or fear or withdrawal due to illness or fear of something in the environment.

The dull and dry skin and coat could be anything from thyroid condition, to pain in which he is reluctant to groom, to insufficient diet, to dehydration caused by organ disfunction.

A murmur that disappears during sedation isn't possible. A murmur is a murmur, should have been graded (usually from I to IV) and will be present until it's properly and medically addressed (that is, when it is detected in an older adult cat or an adult cat with an underlying condition. Kittens for example, may have murmurs that usually and naturally resolve on their own before adulthood) . If there was in fact a murmur present, then the first diagnostic in order is a combination of xrays, ECG and blood pressure check. The thyroid is as equally important to test. It sounds to me like the vet THOUGHT he detected a murmur when one wasn't really present, or that he didn't follow through and check again, and request a re-check at a later date). It also bears mentioning that blood pressure checks should be done in a method that takes 3-5 readings in one exam appointment, and calculated to get the median reading. Some vets only do one reading which could be missing the entire blood pressure rate. Please keep that in mind when you get a new appointment and do in fact, request a proper blood pressure check.
When I mention the importance of thyroid testing, it's because sometimes heart disease and thyroid disfunction often go hand in hand with some cats, so that's why these diagnostics and repeat checks are necessary. Likewise, kidney disease and thyroid function also go hand in hand for most cats. In other words, when there's a primary health condition going on, in a compromised state, any secondary health condition can occur.

She doesn't need to seperate him, nor fear medications. Again, something is amiss and it's not going to resolve without diagnosis and treatment. There are various ways to medicate a cat without stressing the cat too much, the owner has to dedicate herself to following through with treatment in order for a resolution of symptoms. The vet should be explaining all of the options available.

Don't assume kitty was hallucinating due to the event of growling and pawing at the air. Many times, cats do things like this that we can't explain. It could have been waking from a dream, a response to something uncomfortable or painful, or just about anything.

I'm not saying that cognitive disfunction shouldn't be ruled out, it should be, but if it is apparent, chances are, it's from an underlying cause that needs to be diagnosed properly.

The bottom line is that she either needs a new vet who is dedicated to getting to the root of the cause, or that she has to pursue additional tests to diagnose specifically in order to treat effectively. There are a miriad of symptoms in this case and each needs to be addressed individually. This requires the proper diagnostics.

The following diagnostics are essential in a case like this:

Complete comprehensive chemical blood profile. (to determine all vital organ function and endocrine function)

Urinalysis. (to rule out infection, diabetes, kidney problems)

CBC with Differential. (to determine viral, bacterial, electrolytes, WBC and RBC and platelet or clotting problems)

T3 and Free T4 Thyroid testing. (evaluates total thyroid function)

Xrays. (to examine vital organs, size and shape, abnormalities, or masses)

ECG and/or EKG and blood pressure checks. (to evaluate heart function, blood flow, blood pressure)

Follow with ultrasound if above inconclusive. (to detect hidden problems, abnormalities)

Potential for immunological profile. (to rule out viral, fungal, immune-mediated, blood-borne parasites, etc)

If cancer of the brain or spine are suspected, or even sinus issues, an MRI.

Of course, a comprehensive exam should include oral, eyes, ears, neurological function.

I'm not saying every single one of the above tests need to be done. I'm saying these are the steps in diagnosis, and often necessary for detecting unusual problems. My guess is the vet isn't qualified or dedicated enough to get to the true cause of the problem, or the owner may be declining additional diagnostics. Some vets wrongly tell owners "it just happens with age", but this is B.S. and totally unacceptable.

See a feline-only vet , immediately (this week, the sooner the better!), who is dedicated to finding out what's going on. Do not wait on this, get an appointment immediately. Have all of kitty's health records, xrays etc, past and current, faxed to the new vet so he/she can review; this can help save costs in repeat tests that have already been done. Be prepared that the new vet will require additional diagnostics, but they will be necessary in order to get to the specific problem.

Don't give up on kitty, he's totally depending on the owner to get him diagnosed and treated properly. We owe it to them, they give us years of comfort and joy and in their senior years, we owe them even more and must be responsible for detecting disease and treating the best we can for them. Get a feline-only vet, immediately and discuss everything you've discussed here, don't leave anything out, take notes and discuss them thoroughly so nothing is missed. Chances are, the current vet isn't experienced enough or dedicated enough, whereas a new vet may pick up on what he/she has missed. It may be something relatively simple to treat, or it may be more involved, the only way to determine for certain what condition you're dealing with is additional diagnostics.

Hope this helps, let me know, ok?

[felinexpress]

You are such an amazing woman- I will let you know the outcome. Take care of yourself-

Here is her answer

Just to clarify - they did run the thyroid tests after they heard the murmor and those were also normal. They passed on recommending an EKG once they could no longer hear it once he was sedated. It was a grade I. The full urinalysis showed bacteria at the time.

My friend asked me if he had cataracts, as she saw a bluish tint in his eyes. I asked the vet to examine his eyes when I was in 3 weeks ago and she didn't see anything there.

Eightball has always hidden from people and even from me when he senses that I'm going to do something he doesn't like - he reads my mind very well. That is completely normal behavior with him. The fact that he doesn't hide from strangers all the time is the new weird behavior.

My vet clinic has 2 vets that are very different in philosophy. One is the best surgeon that I've ever encountered and a good general practicioner, and the other goes down the path of holistic support. They are good for most of the issues that I bring to them. But their entire office gets very nervous around "feral" cats, and there are times that Eightball is rushed through because of that fear. They seem to do much better with dogs than cats, but isn't that true of most GP vets?

But I hear Traci and please thank her for taking the time to respond. I do have a cat specialist that I work with from time to time and will give that office a call.

[Traci]

Please tell her not to undermine this situation. It is obvious that something is amiss, it could be a primary, secondary or multiple-problem. Combined, these symptoms are not normal for a healthy 12-yr old adult cat.

MA, you know how I feel about "holistic", and holistic vets. First order, in my opinion, avoid the holistic vet at all costs (paticularly with this case). No amount of wishful thinking, herbs, supplements, homeopathics, etc etc are going to help. If the two vets work in the same clinic, I would be very wary of bias, so it's not truly getting a second opinion when you're seeing two in the same clinic. You need a vet who has more experience in felines, and who is obviously feline-oriented, not afraid of feral cats or fractiousness, and obviously going to dedicate to getting to the health problem.

The fact that someone thought they heard a murmur then claimed it disappeared while under sedation concerns me, and should concern the owner. This isn't good practice to ignore such a thing, particularly when an older adult, heart disease always needs to be ruled out. The very least they should have done was re-check heart and lung sounds the next day, or at a very near future appointment.

Feline-ONLY vet or feline specialist only, please. And again, I do stress the urgence here.

[felinexpress]

I will convey both of our concerns to her right now Traci. I can only be the messenger. It is up to the person on the other end to act, but I feel confident that Amy is going to see a feline specialist this week.