Cat Drooling Excessively and Refusing to Eat

[Neco]

But, no NSAIDS should have been given when the vet already knew that paracetamol was given.

Yes, our local vet failed us. I'm well aware of that.

For what it's worth, 1 ml is equivalent to 1 cc.
For every 1 cc you gave her, she got 32 mg paracetamol.
You gave paracetamol 32 mg/ml at least twice, and possibly 4 times. That's approximately 64-128 mg, the first time she was sick. Then the vet gave it to her again this week. Therein lies the problem. IF, in fact, the bottle's content was stating correctly that each ml contained 32 mg. The vet should never ever have recommended it, prescribed it, administered it. No matter the dose, it can cause kidney and liver damage, if fatal hemolytic anemia doesn't occur first.

I have already explained the paracetamol incident to the clinic, and they have been administering IV acetylcysteine and diuretics since. This is a secondary issue at any rate: she was already sick and drooling before the paracetamol.

Kitty is relatively young, and hopefully will recover. However, you still have to find out what caused the initial anorexia, drooling, vomiting, etc. It could have been something relatively mild and self-limiting, but it could also have been fever activity, diseased tooth or absess, heat and severe dehydration, or something more serious etc. This still needs to be investigated. Please also discuss with the vet any potential connection to the first time she was sick about a month ago, and determine if treatment failed then and the condition resurfaced now, or if this is unrelated.

We have discussed everything in detail. The blood tests were carried out, but there were no conclusive results. The bilirubin levels were quite high, i.e. 2.26 mg/dL, the normal range being 0.6 mg/dL max, but there was no evidence of hemolysis, i.e. erythrocyte levels were actually slightly above normal. Glucose levels were also abnormally high, but the vets said that hypergylcemia can occur temporarily under high stress. Luckily, no evidence of permanent tissue damage to the liver and the kidneys was found. No conclusive diagnosis was possible, but we focused on three possibilities: 1) toxicity, 2) coronavirus, 3) hyperglycemic disorder. Neco (my cat) will stay there tonight, and symptomatic treatment will be administered IV. Obviously, retrograde diagnosis for the previous sickness is not possible either.

I will be moving Neco to a state hospital tomorrow, now that the weekend is over, where she can stay longer and more advanced tests can be carried out, such as FIP tests.

Edit: Trombocyte and lymphocyte levels were also lower than normal.

The IV's will help any dehydration and any high temperature. Not sure what meds the vet is giving during hospitalization, but he may want to attempt to feed small amounts in the morning to see if she can keep it down.

The vets reported giving her 5 mL wet food, which she had difficulty swallowing. She will be fed again today, but the anorexia is persistent and she has difficulty eating even small amounts.

Because we don't know the home environment, please check your home for any signs she could have gotten into something, like plants, toxic insects or spiders, bad or rancid food, baits or poison for rodents, make sure you don't give her people-food or snacks, keep all human medications and preps sealed and completely out of reach to her, etc. Look for signs of any leaves or plants nibbled or tipped over, any signs of wrappers or packages ripped or torn, use your best judgment, you know your home best and what to look for.

We also considered this possibility. I checked for nibbled leaves but couldn't find any. I have many houseplants such as cacti which cannot be eaten, carnivorous plants which are inaccessible to the cat, and bonsai trees, which I doubt are poisonous. I have a weeping fig, Ficus benjamina, and a dragon tree, Dracaena marginata, which are non-poisonous according to this list:

http://www.mnpoison.org/mnpoison/pdfs/P ... July04.pdf

I have never seen Neco eating leaves anyway. Her drinking habits concern me more. She has the bad habit of licking wet surfaces, and seldom drinks water from her dish. She may have been exposed to house chemicals in this manner.

Again, thank you for sharing your expertise. I will keep you updated.

[Traci]

Has she been properly vaccinated? (at least with FVRCP)

Has she ever been tested for FELV, or FIV? In the US, we have a snap test that can test both FELV and FIV in one test, only requires a few drops of whole blood, results achieved in ten minutes. Does the vet have this test, or does the hospital have it?

I strongly recommend testing for these if she has never been tested.

The drooling, and newly mentioned difficulty in swallowing: short of what I already mentioned as rule-outs, has the vet considered feline calicivirus? This is a virus that causes inflammation, soreness and ulcers in the mouth, tongue, roof, etc, making swallowing painful and difficult. Could also be a foreign body, ingested somehow, or an esophageal obstruction.

Likewise, it could be due to severe dehydration, but less likely since she's been on an IV. Could be nausea, however.

I asked before but perhaps you missed it. What was her illness a few months ago? Were the symptoms then, similar to the symptoms now? If so, this might be a chronic condition.

Ask the vet or the hospital to consider re-testing Neco's CBC, ruling out anemia, or feline hemotrophic mycoplasma (also known as hemobartonellosis) - this condition can be caused by flea bites, or other parasites, it's a blood-borne disease that causes severe anemia but can be treated effectively if detected properly and treatment initiated ASAP. A preliminary test can be done in the clinic if they have the tools - a blood smear can sometimes detect it - otherwise, a blood sample has to be sent to a lab for testing.

Ask also to possibly test more liver enzymes (if they weren't already included in the bloodwork) and/or a urinalysis, if feasible and if you can afford to. The bilirubin is an indicator of liver function and it may or may not be related to the latest crisis, but worth it to keep an eye on.

Again, if available, test for FELV, and FIV.

As for testing for FIP, it's an option, but whichever vet might do this needs to be highly experienced in order to interpret the results. Neco isn't presently displaying typical signs of FIP (at least at this point), and unless she's allowed to roam outdoors with stray or feral cats susceptible to FIP, there is a low likelihood she would have it. However, a coronavirus can mutate in some cats, into FIP, but this is relatively rare. Not knowing the statistics in your area, it's hard to say.

You said once she had a fever, but no fever when she was taken in yesterday. FIP usually presents unrelenting fevers that generally don't respond to treatment. Hopefully, the lack of an ongoing fever is a good sign.

Your link on toxic plants is primarily geared to human toxicity, and the list is not inclusive. Pet owners should never refer to a human toxicology list because plants and trees affect pets much much differently, particularly cats.

Here's my list, which also is not all-inclusive, however, extensive work went into it, and it's updated regularly:

http://www.cathelp-online.com/emergency ... plants.php

As you can see, dracaena/dragon tree, weeping fig, cactus are included as toxic. Not that it is implied all cats will ingest toxic levels from these, but it must be said that any cat (out of curiosity, boredom etc) could inadvertently ingest parts of a plant or tree and the effects could be detrimental to any number of cats. (again, the dose makes the poison and the physiology of the particular cat needs to be taken into account)

I'm not saying get rid of your plants and trees, but certainly keep them off limits to Neco.

It concerns me when you say she rarely drinks from her dish. Are you sure you're just not noticing? Are you diligent in making sure she cannot access household cleaners, spills, etc? Just a tip, provide a second dish of water in one of her favorite lounging areas - sometimes cats prefer to have more than one access to water.

Can you tell me what you're feeding her? Just a rule-out, but did the vet mention tainted pet food?

Sorry so long, just trying to provide rule-outs, and it's difficult when you're way over there and I'm way over here. Thankfully, it sounds like the vet knows what he's doing.

Hang in there and post an update if you can.

[Neco]

Has she been properly vaccinated? (at least with FVRCP)

She has been vaccinated with Felocell CVR a year and a half ago, as well as rabies. She contracted internal parasites once, from a lizard (we believe) she captured and ate, and underwent a successful Droncit treatment. It's been two years since I found Neco abandoned in a transport kennel. I have no idea what kind of environment she was raised in as a kitten. She was 4-5 months old when I adopted her, I think. She's been indoors only ever since, and had no direct contact whatsoever with other cats. So any virus to infect her should either have a very long incubation period, a vector organism, or the capability to infect without direct contact.

As for other animals, our previous house had a roof terrace where she used to play. This is where she came into contact with lizards and birds. There is a small and very mildly poisonous breed of scorpions (Euscorpius italicus) in our current garden, but she's not allowed outside. We once found a dead scorpion in our house, which made me quite afraid on behalf of Neco. It wasn't clear whether Neco killed the bug or found it dead, but she was around it. The scorpions are less venomous than honeybees to humans and rarely use their stingers, but if she attempted to bite a scorpion, she would likely get stung. Then again, there are no visible lesions in her mouth, and I'm sure she would have screamed a lot when this happened. I was at home all day for the last four days.

Has she ever been tested for FELV, or FIV? In the US, we have a snap test that can test both FELV and FIV in one test, only requires a few drops of whole blood, results achieved in ten minutes. Does the vet have this test, or does the hospital have it?

I assume the hospital should have them. I'll ask.

The drooling, and newly mentioned difficulty in swallowing: short of what I already mentioned as rule-outs, has the vet considered feline calicivirus? This is a virus that causes inflammation, soreness and ulcers in the mouth, tongue, roof, etc, making swallowing painful and difficult. Could also be a foreign body, ingested somehow, or an esophageal obstruction.

The vets mentioned today that there was no ulceration in the mouth, not in this context though. I asked them whether Neco might have ingested a chemical irritant, such as household beach. They said that would have caused ulceration in the mouth. Foreign body ingestion remains a strong possibility, I believe an intestinal radiography should address this question.

I asked before but perhaps you missed it. What was her illness a few months ago? Were the symptoms then, similar to the symptoms now? If so, this might be a chronic condition.

Sorry, I missed it. The symptoms were somewhat different. She was depressed and somewhat lethargic, but accepted food and water in small amounts. There was no drooling. And she usually had high fever. Neco did have a fever this time when the symptoms first began, but the fever calmed down after Meloxicam. In fact, she was about to develop hypothermia (or so I thought) when I took her to the clinic.

Ask the vet or the hospital to consider re-testing Neco's CBC, ruling out anemia, or feline hemotrophic mycoplasma (also known as hemobartonellosis) - this condition can be caused by flea bites, or other parasites, it's a blood-borne disease that causes severe anemia but can be treated effectively if detected properly and treatment initiated ASAP. A preliminary test can be done in the clinic if they have the tools - a blood smear can sometimes detect it - otherwise, a blood sample has to be sent to a lab for testing.

I'm sure they'll repeat the CBC if the other tests are inconclusive.

Ask also to possibly test more liver enzymes (if they weren't already included in the bloodwork) and/or a urinalysis, if feasible and if you can afford to. The bilirubin is an indicator of liver function and it may or may not be related to the latest crisis, but worth it to keep an eye on.

I will ask for an urinalysis tomorrow, that's on my list.

As for testing for FIP, it's an option, but whichever vet might do this needs to be highly experienced in order to interpret the results. Neco isn't presently displaying typical signs of FIP (at least at this point), and unless she's allowed to roam outdoors with stray or feral cats susceptible to FIP, there is a low likelihood she would have it. You said once she had a fever, but no fever when she was taken in yesterday. FIP usually presents unrelenting fevers that generally don't respond to treatment. Hopefully, the lack of an ongoing fever is a good sign.

I very much hope FIP is out of question, I'm only worried because the vets at the clinic mentioned this possibility today. I don't really have the authority to suggest which tests should be carried out.

As you can see, dracaena/dragon tree, weeping fig, cactus are included as toxic. Not that it is implied all cats will ingest toxic levels from these, but it must be said that any cat (out of curiosity, boredom etc) could inadvertently ingest parts of a plant or tree and the effects could be detrimental to any number of cats. (again, the dose makes the poison and the physiology of the particular cat needs to be taken into account)

Thank you, I'll keep this in mind. Though as I've said, I've never seen Neco chewing on plants of any kind.

It concerns me when you say she rarely drinks from her dish. Are you sure you're just not noticing? Are you diligent in making sure she cannot access household cleaners, spills, etc? Just a tip, provide a second dish of water in one of her favorite lounging areas - sometimes cats prefer to have more than one access to water.

She does drink from her dish, "rarely" wasn't perhaps the best word. What I meant was that she prefers drinking from every other container. She usually begs for water when we are drinking ourselves, so I extend a cup to her. She is also very fond of licking wet surfaces, which we are never short of, as we have a large aquarium. I scolded her for this, but she doesn't stop.

Can you tell me what you're feeding her? Just a rule-out, but did the vet mention tainted pet food?

We feed her with dry food and the occasional chicken. We buy the dry food from a local pet shop, in small amounts. The most dangerous food she's ever eaten was raw fish, which she stole several times while I was preparing to feed the aquarium.

[Traci]

Thanks for answering all the questions.

At this point, the best approach is bloodwork, recheck CBC and possibly immune profile (FELV, FIV, mycoplasma, etc) - radiology might detect any foreign obstructions, but if she had a serious obstruction, it would most likely cause excessive vomiting, diarrhea and/or constipation, severe dehydration and extended stomach.

The antibiotic injections might help with any bacterial infections, but amoxicillin may not be the correct choice, maybe clavamox would have been better, but we have to leave that at the discretion of the vet.

Please don't forget a urinalysis, it can detect bacterial infection, inflammation, sometimes even fungal disease.

[Neco]

I am pretty much a nervous wreck right now. I've spent the last two days in labs and clinics non-stop. After every kind of medical test imaginable, there has been a diagnosis of sorts. Neco has haemobartonellosis. This I can live with. However, the second diagnosis is the one that will most likely kill her...

Where to begin? Yesterday was a horrible day. We moved her from the clinic to the hospital, but could only obtain the radiographical results. We spent most of the night at the emergency clinic, where she displayed visibly yellowish gums for the first time. She showed the first positive signs there. Today, a number of tests were carried out, and we were given a long list of prescriptions.

Let me summarise the current situation. Urine: bilirubin present, nothing otherwise abnormal. Blood tests: total bilirubin 8,4 mg/dl. total protein 7,0 mg/dl. albumin 2,7 mg/dl. FIV, negative. FELV, negative. FECV/FIP, positive. Parasitological: haemobartenellosis found. Radiography: not significant. Ultrasonography: hepatic homogenity compromised, granules visible, but no advanced degeneration [as the vet explained.] Gal bladder swollen, but no blockage. Prescriptions: IV feeding will continue with dextrose and Metabolase. Pan-theramycine, Ulcuran. Roferon A, diluted 100,000x, orally administered. (A local vet who does the IV and injections has the full list, so I don't remember all of them. Can update this.)

As for the patient, Neco has shown some improvement. She can now drink water by herself, and seems quite thirsty. She can urinate normally, and a lot, and defecated (for the first time in four days) a few hours ago. Neither constipation nor diarrhea. Very little drooling, except when stressed. We fed her a mixture of A/D cat food and water, 5 mL. No vomiting yet. Just now, I heard her purr weakly while petting her (which made me burst into tears.) Given her improving condition I would have been hopeful, but the FIP diagnosis has crushed my spirits. So far there has been no diarrhea and fever.

Traci, you are a very knowledgeable person and I am a despairing cat owner from the other side of the world. I stumbled upon this website accidentally but I'm glad I did. What should I do? Would you say that the FIP diagnosis is definitive? You said that the more advanced tests for FIP were still problematic. The public hospital did not have any of those, but there is a lab they can redirect us to. I can afford more treatment at this point, though I would maybe like to avoid any procedures that may be very painful and stressing to my cat. I've read somewhere that a combination of immunomodulators and interferons is a promising strategy. Any ideas? Am I asking for a miracle?

I've isolated a room in the house, cleaned every crevice, rubbed the surfaces with disinfectant, and brought everything she needs to that room, as well as her favourite chair and blanket. I'm keeping the room slightly warm. The only thing that gives me so much pain is that she doesn't know all the stress and medications she had to suffer were actually to restore her health. I was afraid she would hate me for putting her through all of this. She has been riddled with injection holes. That's why I was so happy when she purred at me, however weakly.

[Tina B and crew]

Neco...I have no words of advice and hope Traci is back soon with an answer for you on the FIP. Just want you to know I'm keeping you and kitty in my thoughts and prayers for a positive outcome.

[Neco]

Neco's ears feel warm, but my thermometer reads 37.5 C, though perhaps I cannot handle it very well. I switched off the heater anyway. Her body temperature has been oscillating a few degrees but no dangerous extremes today or yesterday. Lethargy and anorexia persists.

I've read this online:

http://www.peteducation.com/article.cfm ... 34&aid=212

1. The cat has a low number of lymphocytes: 1.5x103 cells/µl.
2. The cat has a positive FCoV test result (titer > 1:160).
3. The cat has elevated globulins in his blood > 5.1 gm/dl.
If the cat meets all three criteria, the probability the cat has FIP is 88.9%. If the cat does NOT meet all three criteria, the probability the cat does NOT have FIP is 98.8%.

Neco's readings

1. Lymphoctyes: 0.69
2. Positive, titer unknown to me
3. Not sure, but 4.3 max?

Neco...I have no words of advice and hope Traci is back soon with an answer for you on the FIP. Just want you to know I'm keeping you and kitty in my thoughts and prayers for a positive outcome.

Thank you very much!

And here is a photo of Neco at her favourite spot...

http://s1082.photobucket.com/albums/j36 ... athing.jpg

[Tina B and crew]

Aww...she is precious! Holding her in healing light!

[Cleo]

Neco, try sending Traci a private message as I believe she gets notified by email of them. Hopefully she'll be to the boards soon anyway, but maybe sooner with the private message notice.

I'm praying for you and kitty Neco!

[Traci]

Don't panic on the FIP yet, particularly since you didn't mention how this was "diagnosed" - I assume the vet is only taking clinical symptoms into account at this point. I'll address that further in this post.

As for the hemobartonellosis, can you please find out for me what Pan-theramycine is? Is it a tetracycline class or an antibiotic class?

Here in the US, we treat hemobartonellosis with doxycycline (tetracycline class, in oral liquid form for cats), and additionally, sometimes prednisone (a corticosteroid that reduces inflammation and helps bring platelet counts back to normal). IV fluid therapy is crucial within the first few to several days upon diagnosis, to combat dehydration, to sustain while the cat is too anorexic to eat on their own, and to prevent nausea and IV's are useful to administer medications since most can be injected into the IV line.

Hemobartonellosis can take upwards of 3-4 weeks of treatment because it takes this long for the blood-borne parasite to clear. If diagnosed early, the prognosis is excellent.

I suspect the liver is compromised due to dehydration and not eating sufficiently. The A/D is an excellent choice and one we typically use for encouraging cats to eat, for many conditions. Hemobart and liver problems are among the conditions we love to use A/D (it provides high calories and gets most cats eating on their own again.)

I'm not sure the Roferon A is necessary, and would ask the vet for his reasoning in using it.

Stress must be reduced at all times, so she can heal from both the hemobart and help regenerate her liver. The liver may not be damaged, but there is always the potential for hepatic lipidosis in a very stressed and sick cat. Fluid therapy (IV's), proper nutrition (the A/D initially is excellent for this), antibiotics and prednisone are typical treatments.

Normal feline temperature is 101 - 102 degrees F (around 38 - 39 C). The ears are not a reliable indicator to internal core body temperature. The most accurate way to gauge a cat's temperature is via rectal thermometer, we use the digital thermometers, NOT mercury ones. Neco's current temp should not be alarming, it's within normal range, and actually, the initial fever activity is common in newly diagnosed hemobart patients. The previous drooling might have been due to the first fever, and/or dehydration.

Regarding the FIP "diagnosis", if you can tell me how the vet tested for this, it would help. The lymphocytes can change with hemobart and any anemic condition, so the vet shouldn't assume FIP with the lymphocytes at this point. The PCR/Titer is what we have to pay attention to. If the titer is 1:16 (or 1:1600) or over, there could be suspicion, but other bloodwork markers like the combination of globulins and clinical symptoms need to be taken into account as well.

The problem with the PCR is that it is not exactly specific for FIP alone. It detects exposure to a coronavirus (like FECV, but that doesn't mean it is FIP-specific. The cat could have been exposed to a coronavirus but not necessarily the FIP virus. Again, this is where we take clinical symptoms, response to treatment, other bloodwork markers, and a second or more, titer to use as a guide/tool.

MOST IMPORTANTLY, one should never rely on one titer alone. I had a patient whom three vets determined FIP on a high titer alone, and her symptoms sort of fit, but a second titer revealed NON-FIP. Imagine what that put the owner through! Thankfully the owner chose to treat her initial symptoms and opted for a second titer. Unfortunately, because the blood changes on an almost daily basis, the second titer performed too soon after the first might give inaccurate results. For my patient, we waited 4 weeks, although it might be able to be done in 3 weeks after the initial titer.

Here's a site that explains in general terms about FIP:
http://www.marvistavet.com/html/fip.html

Not knowing what access the vet has to specific titers, it's hard for me to advise, although I'd suggest asking the vet to get online and see if he can get ahold of a lab that utlilizes our PCR tests. This only requires a blood sample, (or blood serum), so it's a blood draw, but not terribly invasive. Unfortunately, blood draws are necessary for most testing.

I will reserve discussing meds used for FIP, unfortunately, the antivirals, interferons, etc, aren't substantiated for effectiveness. There are other meds available to treat palliatively, but what is most important right now is getting the correct testing done (PCR-titer), interpreting it correctly, and getting Neco treated for the hemobart. Please ask the vet if he's experienced in treating hemobart, because again, while our treatments might be similar, they aren't the same. The less number of meds she has to take, the better. Doxycycline, possibly prednisone, IV fluids, nutritional support, antibiotics if necessary, are typical here. Ask the vet why he's using Roferon A

Lastly, I don't want to jump the gun on FIP, there is just as much an equal chance that Neco is not infected with FIP and that possibly, the hemobart is mimicking those symptoms.

Hang in there, post updates when you can, and give Neco a gentle hug for us, we're thinking of her! Thanks for posting her photo, she's so beautiful!!