Help!!! Foxed by a cat...

Re: Help!!! Foxed by a cat...

Louise6732 — Mon, 12 Nov 2012 12:59:49 GMT

Have you checked a blood pressure? Just the tiny inkling of Conn's (hyperaldosteronism) when you mentioned the low K+. BP quick, easy and cheap to do, if is normal then likely not Conns! If high, poss Conns, you can run an aldosterone level (not done it personally but know it can be done)

Louise

Re: Help!!! Foxed by a cat...

Jo Cobbett — Mon, 12 Nov 2012 10:51:50 GMT

Update on this case:

FPLi has come back as high (10.9, ref 0.1-3.5) supportive of pancreatitis (possibly triaditis with the intestinal changes seen on the ultrasound). I'm still not convinced of this as the cause of pu/pd, given that clinical signs of pancreatitis have been mild to non existent. My current plan is to start her on i/d low fat, amoxycillin and meloxicam, and if there is no improvement consider pred instead of the meloxicam.

The ultrasonographer was of the opinion that the pyelectasis could well be secondary to the diuresis of the pu/pd, and that the rest of the renal architecture was not supportive of ongoing pyelonephritis. BUN was 12 and creatinine 158 when last tested.

Re: Help!!! Foxed by a cat...

Martin Atkinson — Thu, 08 Nov 2012 17:06:38 GMT

[quote user="Jo Jones"]The main problem has been the pu/pd, which I thought we'd solved when we culture pseudomonas, but it hasn't resolved with resolution of the UTI. [/quote] Sorry I missed the pseudomonas bit I thought you'd said urine culture -ve but with the USG of 1.020 and the pyelectasia suggests renal insufficiency and pyelonephritis despite the now sterile culture and normal BUN. What is the creatinine?, don't forget it should be a lot lower than normal reference ranges in an older cat. May be worth doing a urine protein/creatinine ratio as well. Whoever gave me the 5* rating had better remove it for now.

Re: Help!!! Foxed by a cat...

Jo Cobbett — Thu, 08 Nov 2012 16:49:22 GMT

[quote user="Martin Atkinson"]

IBD/intestinal lymphoma [/quote]

It also hasn't had any GI signs except the recent 3-4 days history. The main problem has been the pu/pd, which I thought we'd solved when we culture pseudomonas, but it hasn't resolved with resolution of the UTI. The owner also reports the cat spends ages at the water bowl, sometimes 15 minutes at a time, mostly lapping at the water, but sometimes just hanging its head over the bowl. Made me wonder if there was either a behavioural component, or some inability to lap water. But it manages to eat/swallow food ok.

Re: Help!!! Foxed by a cat...

Martin Atkinson — Thu, 08 Nov 2012 16:45:49 GMT

[quote user="Jo Jones"]These were at the front of my mind, but would the cat still be in good body condition and generally well after a 16month history, especially with lymphoma?[/quote] OK IBD then more likely from history but age points more to a malignancy. However as a cautionary tale I had a similar case recently cat not really ill, just vomited regularly and lost a little weight, discussed biopsies but owner always reluctant. After about 18 months the cat collapsed and bled out internally. Ex lap showed rupture spleen as cause of bleed but biopsy of spleen and intestine proved almost total mast cell infiltration, The cat died before any meaningful treatment could be given. It was amazing how well this cat had been despite the apparent advanced stage of this condition. The main thing is not to get too involved with this owner and cat, look at it rationally and make the right decisions based on the evidence not emotional calls. If you've thought this through, then whatever your gut feeling is it is probably right. If you think a biopsy is the right move then recommend it, either full thickness on ex. lap (IMO the best way) or endoscopically. If you're not happy refer it. If they're not willing to go for this put it on preds but explain the limitations. Whatever the outcome the owner will be grateful for your candidness.

Re: Help!!! Foxed by a cat...

Jo Cobbett — Thu, 08 Nov 2012 16:38:43 GMT

[quote user="rachel dean"] had the cat lost wt over the year/ has altered since July? [/quote]

Not sure, when I saw it, that was the first time it had come into the surgery, previously all appointments had been house visits so it wasn't weighed. I put my foot down and told them I couldn't do proper investigations unless they brought it in! Weight in the last week went from 4.48kg (Friday) to 4.21kg (Sunday) to 4.6kg (today)

[quote] what have faeces looked like? [/quote]

normal. It goes outside to go to the loo, but the owners tell me they have been following it out so they could keep an eye on it!!

[quote] if you hadn't been able to get an US scan !! would you just give low dose tumil k, redo electrolytes in 2 weeks and urea/ creat/ and maybe give more steroid for longer course if signs come back? [/quote]

Urea and creatinine and electrolytes have been pretty much normal since July (except for low normal K+ which I assumed was due to anorexia/V+, and probably not indicative of underlying cause). The pu/pd was still a feature (unsurprisingly) after the steroid, so it didn't really clear the signs up.

[quote]otherwise I suppose you go and get biopsies ??? ![/quote]

I agree, this is probably next on my list. Not sure the owner will want to go for it though, she was very upset when I mentioned we may need to sedate for ultrasound if the cat wasn't cooperative enough.

Re: Help!!! Foxed by a cat...

Jo Cobbett — Thu, 08 Nov 2012 16:32:54 GMT

[quote user="Martin Atkinson"]

IBD/intestinal lymphoma

[/quote]

These were at the front of my mind, but would the cat still be in good body condition and generally well after a 16month history, especially with lymphoma?

The signs of small intestinal wall infiltration on the ultrasound was VERY subtle, I would have thought after 16months it would have managed something a bit more spectacular? Or at least convincing!

Re: Help!!! Foxed by a cat...

Rachel Dean — Thu, 08 Nov 2012 16:31:28 GMT

had the cat lost wt over the year/ has altered since July? what have faeces looked like? if you hadn't been able to get an US scan !! would you just give low dose tumil k, redo electrolytes in 2 weeks and urea/ creat/ and maybe give more steroid for longer course if signs come back?

I find sometimes symptomatic treatment just works !!

otherwise I suppose you go and get biopsies ??? !

Re: Help!!! Foxed by a cat...

Martin Atkinson — Thu, 08 Nov 2012 16:30:38 GMT

IBD/intestinal lymphoma spring to mind especially with an improvement with cortocosteroids - intestinal biopsies next. Don't try and fudge the issue just because of the client's relationship with the cat they need to understand the prognosis, gently but firmly talk them through the probable issues and treatment options. If they don't want to go that path then put it on preds - never let anything die without the benefit of the 'roids.