Traci, Meet the Newcomer

[Traci]

MA, may I ask that you not leave anything out in your posts? Just read your blog and you stated the vet is giving indication of FIP or cancer. While they are potentials, he's not taking everything into account and if he's simply assuming, you really should be seeing another vet. Hopefully this isn't the one who was also mis-diagnosing Fiona.

I cannot believe he doesn't realize that indolent ulcers at this level of severity, takes a considerable amount of time to show response. Not to mention the numerous other issues(malnourished, dehydrated, the skin problem etc). I hope he's at least experienced enough to diagnose indolent ulcers vs calicivirus - I can't tell just from the picture, but it's hard to detect the common postules.

Did he even give her sub-q fluids when she was at the clinic yesterday? If not, that's borderline neglect. This isn't aimed at you, but half of those lab values could be contributed to severe dehydration. (she has no muscle mass, she has no fat reserves, where's her water going to go, she's eliminating it and other fluid losses through her urine!)

[felinexpress]

Traci,

I really need your help if you are willing? I need a list of coherent questions to ask the vet about Shell tomorrow. Right now my brain is mush and I am afraid I am going to miss something important. In the middle of all this Shell chaos is Mike and his condition. They have found a suspicious mass in his kidneys and so I am trying to deal with that, get the company in here to fit him for a wheelchair and get him to PT so my brain is pretty much imploding here. If you could help me this one last time, I would be so grateful. I know I have no right to ask- especially after getting snippy with you for which I apologize here on the forums.

[Traci]

1) What are the blood and urine glucose levels?
(we need to rule out diabetes - she is drinking/urinating a lot of urine)

2) Are ALL liver and kidney enzyme levels within normal limits?
(this seems strange in light of malnutrition and dehydration)

3) Are we certain these are indolent ulcers and not calicivirus?
What is the university consultant's opinion on another depo medrol injection?
(can't see postules evident - just want to be certain) and (would like that confirmation before depo medrol is given again, concerned about depo medrol given in the face of potential diabetes)

4) Does she have a urinary tract infection, or, was glucose high in the urinalysis results?

5) What is the degree of dehydration?
Can you please give her sub-q fluids, without compromising her fragile skin condition?

6) Is there a possibility there is a thyroid problem?

7) FIP doesn't seem consistent at this point, I want to focus on the oral ulcers, her nutrition, her hydration, and if she continues to improve, will consider testing for cushings and/ an xray in the very near future to rule out organ or internal abnormalities.

Please keep me updated, including his comments, any further test results, or what the consultant's opinion is. If possible, ask your vet to consult with the university before continuing depo medrol - make sure that calicivirus isn't the problem instead of indolent ulcers - the specialist should be able to steer the vet in the right direction for confirmed diagnosis.

ETA: Take a paper and pen with you and write down his comments, his answers, and options/meds etc, this is always a good method to keep reference or a log of sorts so you can keep track of vet visits/meds and treatment given, dates etc.

[felinexpress]

OK, I will be as thorough as I can with you Traci, please understand, I am beyond exhausted. Here goes. I left Shell at the clinic for a few hours to give my vet time to work with a clinic in Dallas that is doing great things for cats with stomatitis and other oral issues. Before I left her, we went over the lab results - but I didn't get a copy of the results yet- things were just moving swiftly and I forgot. But Diabetes has been ruled out completely.

Liver and Kidney values all in normal range-he couldn't get urine from her because her bladder when he aspirated it was the size of a shriveled walnut.

He has swabbed for the calicivirus, I should have the results by tomorrow.

UTI unsure, again no urine draw

Thyroid has been ruled out

FIP not even in the picture right now. She has no symptoms pointing that way. I did ask if her mouth infection is the cause of the spike in her WBC, protein etc... He said maybe, but she also might have something internally going on. But right now, her mouth is the priority.

Under the guidance of the specialist at the Dallas Clinic, Shell was mildly sedated, her ulcers lanced and drained and then injections given directly into the ulcers themselves of just a touch of cortisone and then an antibiotic. Please don't ask me what antibiotic- when i went to pick her up they were swamped and I didn't even get to talk to the vet. But I trust him to do the right thing (and I don't say that about many vets around here!)

Shell is home, in her cage with the door shut, her eyes are open, she is breathing, she is warm she is wrapped up in a snuggie and not moving much. He is going to call me in two days unless there is a major problem then I am to call the clinic immediately and take her right in no matter what time it might be. I have checked on her three times in the hour she has been home, and I have rubbed her chin and she leans into the scratching and seems to be okay. I see no discharge from the mouth, no blood, no drool.

That's what has happened this day for her and I am thinking positive thoughts for her now and hope you will do the same.

[Traci]

Thanks for the update. In the immediate sense, please mix her food with water so she can lap it up rather than chew, it will be easier for her in the next day or two. She'll let you know what she prefers.

I'm glad to hear he did the consult.

I'm curious, what great things is Texas doing? I haven't heard of any major progress/treatment in treating indolent ulcers. Stomatitis however, depending on the inciting cause, is another story.