Cat hindlimb paresis

Re: Cat hindlimb paresis

Martin Atkinson — Thu, 08 May 2014 15:48:45 GMT

[quote user="Toby Birch"]

[quote user="Neil Wheadon"]Use a lactate monitor, take a blood sample from the back legs if you can get it and compare to a jugular sample. If much higher there will almost certainly be a thrombus. Not all cats show pain and recurrance is likely. Neil

[/quote]

Differential blood glucose is also good especially if you don't have a lactate monitor. Just the same but numbers the other way round. I find it helpful to put some figures on things and seems to give the owner something to help them understand.

I had a similar one from a cattery a couple of weeks ago.

[/quote] Erm...isn't the whole point there is no blood supply to the hind legs if it has ATE and if there is then it doesn't or at least not enough to cause its legs to be totalled, or am I missing something here?

Re: Cat hindlimb paresis

Toby Birch — Thu, 08 May 2014 13:51:22 GMT

[/quote]

I had a similar one from a cattery a couple of weeks ago.

Re: Cat hindlimb paresis

Martin Atkinson — Thu, 08 May 2014 12:19:22 GMT

No doubt the diagnosis is correct and long term prognosis pretty grim and I feel that if cats recover with aspirin/heparin/cartrophen whatever it is despite the treatment not because of it, these are not clot busting drugs so we give them on a wing and a prayer, they will just decrease the risk of further episodes. However if the legs are still viable i.e not going gangrenous then it is in order to hang on in there.

Probably not relevant to this case now and I have posted this before but I did once successfully surgically remove a saddle thrombus from a cat that was presented in acute onset ATE and it lived for another 10 years before it recurred and its new vet (not surprisingly) refuse to repeat my heroics.

Unfortunately in these cases you are damned if you do and damned if you don't. If you don't do much and/or euthanase the cat the owner will come back and say they had done anything it and paid for it and if you do everything they'll refuse to pay because they didn't ask for it and bollock you for bumping the cat.

However it is the cattery that is responsible for payment as they requested the treatment so liaise with them, they should be insured for this kind of thing.

Re: Cat hindlimb paresis

Charlie Lyon — Tue, 06 May 2014 22:34:13 GMT

Just to clarify the main reason for perusing treatment was because the owners were on holiday. Usually I give a very guarded prog. That said we had a cat that went on for a year after treatment at our own surgery and have a current one that was referred that is doing well (at the moment anyway). Therefore not always a hopeless prognosis and I think trying when either the owner is desperate to try and pain can be managed or in this case owner is uncontactable is reasonable to try treating and insurance made that more of an option as knew costs were covered without talking to the owner first. It's difficult to euth an animal without the consent of the owner without it being obvious the animal is suffering.

Re: Cat hindlimb paresis

Anthony Dennison — Tue, 06 May 2014 15:53:31 GMT

I know of a cat that was treated successfully for an ATE using cartrophen. It had another episode and despite having euthanasia strongly recommended, it recovered from a 2nd thrombus after treatment with cartrophen. When it presented a 3rd time, the owner kind of realised and agreed to euth.

Re: Cat hindlimb paresis

Kate Richardson — Tue, 06 May 2014 10:25:16 GMT

[quote user="Charlotte Lusted"]I did see heparin as an option but not able to do in house clotting and with the bank holiday cannot send bloods away so got a bit scared[/quote]

I have never done or monitored clotting times in these cases and have used heparin in all I have gone on to try to treat, so don't be scared.

[quote user="Michael Woodhouse"]My personal view, insured or not, is these cats must really be suffering and I advise euthanasia at the earliest opportunity.[/quote]

I agree with you Michael to a degree, and I always talk seriously about euthanasia at presentation. I certainly I don't think being insured is a reason on its own to decide to treat but finances are one factor in making that that decision. The degree of pain is variable; most present with an initial acute painful episode then the degree of ongoing pain can be very variable. I would only try treating cats that had minimal to no pain or it was easily controllable with analgesics. The degree of pain the cat presents in is the main deciding factor for me plus taking into consideration the recurrence rate and the fact that ideally a cardiac investigation is necessary and these cats will require ongoing treatment and monitoring. I saw a case 2 weeks ago of a forelimb TE- cat showed pain at home, by the time the owners brought it in the pain was minimal and we did try treating as the cat was so happy and relaxed and the owners were prepared to undertake long term follow up and treatment. Unfortunately it didn't recover and we did euthanase it, but I and the owners felt justified in trying as the cat was not distressed. The difficulty in Charlotte's case is the owners were away- I don't know if she was able to contact them or not, but if the cat was comfortable and there was some movement of the hindlimbs, I think she was justified in attempting treatment as long as the cat remained comfortable, eating etc.

Re: Cat hindlimb paresis

Bob Russell — Tue, 06 May 2014 10:24:11 GMT

My suspicion is these are more painful than cats tend to communicate! I am afraid I am reluctant to put them through much once I am confident of the diagnosis.

Treatment does not seem that fair in most cases and even those that appear to do well don't do well for long.

Another advocate for early euthanasia until someone comes up with better treatment options!

Re: Cat hindlimb paresis

Charlie Lyon — Tue, 06 May 2014 10:18:14 GMT

Have managed to finally get in touch with the owners today, permission to euth given

Re: Cat hindlimb paresis

Neil Wheadon — Mon, 05 May 2014 22:34:05 GMT

Use a lactate monitor, take a blood sample from the back legs if you can get it and compare to a jugular sample. If much higher there will almost certainly be a thrombus. Not all cats show pain and recurrance is likely. Neil

Re: Cat hindlimb paresis

Michael Woodhouse — Mon, 05 May 2014 22:23:19 GMT

[quote user="Charlotte Lusted"] The cat is insured thankfully so do have some freedom to try and treat him.[/quote]

My personal view, insured or not, is these cats must really be suffering and I advise euthanasia at the earliest opportunity.

Re: Cat hindlimb paresis

karen jones — Mon, 05 May 2014 21:47:57 GMT

I now usually advise euthanasia early in these cases as they are so unsuccessful to treat

Re: Cat hindlimb paresis

Charlie Lyon — Mon, 05 May 2014 16:29:25 GMT

I did see heparin as an option but not able to do in house clotting and with the bank holiday cannot send bloods away so got a bit scared. Good call re Doppler, we do have one so will see if I can pick anything up. The cat is insured thankfully so do have some freedom to try and treat him. Thanks for the advice

Re: Cat hindlimb paresis

Kate Richardson — Mon, 05 May 2014 12:52:34 GMT

I would say your diagnosis is spot on and sadly very poor prognosis especially given such a low rectal temp on presentation. The other thing to take into consideration is that these cats have underlying cardiac pathology and there is a high risk of recurrence. The only other treatment I would have used is heparin- but not sure time wise if it is of any benefit now. If the cat is comfortable and well supported otherwise ie nutrition and you have some evidence of hindlimb function then you can only give it more time but be careful with the fluids as you have already found if will be very easy to overload this cat. If you have a Doppler blood pressure monitor they are useful for trying to detect any blood flow. Also monitor electrolytes and muscle enzymes plus renal parameters closely as if you start getting reperfusion it can cause massive devastating electrolyte changes and muscle breakdown products which can cause severe renal damage. Have you been able to contact the owners at all? Prepare them for big bill and unfortunately not a good prognosis. Be prepared to euthanise the cat if welfare dictates. Sadly it is highly likely that will be the end outcome despite your efforts.