''Flat'' twitching cat!

Re: ''Flat'' twitching cat!

Gillian Mostyn — Sun, 07 Nov 2010 19:48:54 GMT

[quote user="Hannah Wynne Richards"]I often think this job is 5 x as distressing as a medical GPs They expect to lose 1 in 75 patients every year We expect to lose 1 in 15 [/quote]

Harly comparable Wynne. I'd rather see someone lose 100 cats than one person's mother/brother/child.

Re: ''Flat'' twitching cat!

Martin Atkinson — Sun, 07 Nov 2010 18:28:25 GMT

[quote user="Bob Russell"]

[/quote]

Shit happens, but so do great moments of personal satisfaction. Life is a long journey across the plain of mediocrity with occasional stops at the mountains of ectasy and the valley of despair but we get there in the end. Maybe there's more ups and downs in our profession than most maybe but thats one reason why we love it. The fact that you care enough for you to feel bad about losing patients is another. You accept that you've done the best under the circumstances and move on. If you learn retrospective lessons you apply them to the next case not dwell on what you could or should have done for the last one. For every reason why you would rather not be single handed there's a dozen why you do. One is that I'm, sitting here the quiet of my own surgery and I'm home from home. Off home soon to be with my family and Sunday dinner with a nice red. Tomorrow is another day with more challenges to look forward to. Life doesn't get better than that.

Re: ''Flat'' twitching cat!

Hannah Wynne Richards — Sat, 06 Nov 2010 11:56:15 GMT

I often think this job is 5 x as distressing as a medical GPs They expect to lose 1 in 75 patients every year We expect to lose 1 in 15 -and a definite downside of a single-handed practice is that we actually know the individual patients-so it is a wrench when we lose them

Wynne

Re: ''Flat'' twitching cat!

Richard Fox — Sat, 06 Nov 2010 11:19:33 GMT

Yup that's the life of a vet up one minute and down the next, that's what owners can really understand it that we do actually care!. However don't become a pathologist as you are surrounded by it every day. I probably give terminal diagnoses 5 times a day At least I can't see or know the animal I have got a biopsy from as it would make my job very hard indeed

Re: ''Flat'' twitching cat!

Christopher Saul — Sat, 06 Nov 2010 11:10:19 GMT

I'm sorry that's a bad week we all have em from time to time but that week really sucks for you. I generally also find nice animal, nice owners = negative prognostic indicators

Re: ''Flat'' twitching cat!

Bob Russell — Sat, 06 Nov 2010 11:01:30 GMT

The owners elected to have her euthanased last night. When they came in the cat freaked out in front of them, having been fairly quiet (and severely depressed) through the afternoon.

I had a repeat BUN done before and it was normal so unless this is some form of odd carcinoma producing erythropoietin kidneys are lower on my list. The lab are going to do the toxo titre anyway but at the moment I have stopped the FIP because if positive there is sod all I am going to be able to do for the in contacts. I may reconsider this over the weekend.

The lab had suggested FIP as a possibility.

I was in agreement with the owners to euthanase as to a certain extent I was being stubborn trying to get answers and the cat was extremely unhappy. Had she still been eating I would have held on over the weekend.

Bl**dy awful week - one man practice - two bone tumours in favourite patients, this frustrating case, another old-faithful PTS because he went off his legs. Don't you just love this job. Off to my brothers (without family!!!) for the weekend to drown sorrows. I do sometimes wonder why we do this job. Need to become a dermatologist because very few patients die on you!!!!

Re: ''Flat'' twitching cat!

Christopher Saul — Sat, 06 Nov 2010 10:45:02 GMT

I wonder if this could be a weird FIP? Though cannot explain the polycythamia, maybe it is a true polycythemia vera. A very odd cas indeed (Sorry that isn't very helpful I know)

Re: ''Flat'' twitching cat!

Martin Atkinson — Sat, 06 Nov 2010 10:41:14 GMT

[quote user="Hannah Wynne Richards"]

I would blood let at this point anyway-if the alternative is PTS,

[/quote]

Agreed but not wishing to teach granny to suck eggs obviously replace the blood with crystalloids. Sometimes repeated blood letting is the only way forward with idiopathic polycytaemia vera but if there is no definitive diagnosis with a definite treatment plan, consider some cyclophosphamide as well as corticoids.

Re: ''Flat'' twitching cat!

Hannah Wynne Richards — Sat, 06 Nov 2010 10:30:03 GMT

Although the lab are not convinced it's polycytaemia, the haematocrit is rising rapidly, so I would blood let at this point anyway-if the alternative is PTS, do you really have anything to lose, although it sounds as though you would need to GA/ heavily sedate it, which could be risky, but again , with PTS the alternative, nothing to lose

Wynne

Re: ''Flat'' twitching cat!

Bob Russell — Fri, 05 Nov 2010 14:03:46 GMT

[quote user="Richard Carter"]

don't let it go without dose of dex!!... who knows what inflammation where might respond (although parasitic/viral/bacterial menangitis/encephalitis would love that option and then problem solved)

[/quote]

Great idea but came to the same conclusion yesterday so gave some dex then!!! I am not convinced it made things worse (had broad spectrum antis as well!!!)

Re: ''Flat'' twitching cat!

Richard Carter — Fri, 05 Nov 2010 13:24:16 GMT

don't let it go without dose of dex!!... who knows what inflammation where might respond (although parasitic/viral/bacterial menangitis/encephalitis would love that option and then problem solved)

Re: ''Flat'' twitching cat!

Bob Russell — Fri, 05 Nov 2010 13:18:09 GMT

Behaviour is now getting progressively worse so I think the owners will elect for euthanasia. The cat is not eating now and is not really 'on this planet'. I suspect enough is enough.

Re: ''Flat'' twitching cat!

Richard Fox — Fri, 05 Nov 2010 13:12:39 GMT

Is the HCT still high? Was the HCT correlated with TP or not? Doesn't sound good - have you done a neruo workup or is this obviously CNS d.t. blood parameters?

Re: ''Flat'' twitching cat!

Bob Russell — Fri, 05 Nov 2010 13:08:15 GMT

Not at all good today. neurological signs are getting worse and cat is becoming aggressive. thank goodness we are in the UK and the cat lives in isolation. I was bitten/scratched first thing this morning and a nurse later on (we had to move the cat to clean it out). My worry would have been rabies!!!!!

Re: ''Flat'' twitching cat!

Martin Atkinson — Thu, 04 Nov 2010 18:48:07 GMT

[quote user="Bob Russell"]

Fortunately this cat cannot reach the pedals!!

[/quote]

As an aside, when pro cyclists were really abusing EPO they had to get up in the night several times to excercise to stop their blood from sludging! Before a test for EPO was developed the testers knew they were taking it but couldn't detect it so a ceiling of 50% for HCT was set over which they were prevented from competing until it fell again deemed 'unfit to compete' but couldn't be banned because there was no proof. Bjarn Riis was known as Mr 60% when he won the Tour de France, he's still alive but there are plenty who aren't. Sobering thought. Are you sure the owner isn't a competitive cyclist and the cat has got to his stash of EPO? - only joking!

Re: ''Flat'' twitching cat!

Richard Fox — Thu, 04 Nov 2010 14:47:54 GMT

As an aside acute pancreatitis/pancreatic necrosis arises clinically very quickly :)

Re: ''Flat'' twitching cat!

James Allsop — Thu, 04 Nov 2010 14:26:25 GMT

as non-invasive test may get some more information with abdo scan especially liver, GB and kidneys. Pancreas would be good but I am currently not able to confidently identify a pancreas on my exams. feline specific TLI may help too but cant currently think how cat with cholangiohepatitis/pancreatitis/IBD would present acutely as you describe

Re: ''Flat'' twitching cat!

Bob Russell — Thu, 04 Nov 2010 14:12:22 GMT

Lab are not convinced this is likely to be primary polycythaemia. I am waiting to hear back from the owners whether they want us to battle on, refer etc. Having spoken to pathologist confirmed this is an odd case!!!!

Cat has just eaten a tin of a/d!!!?????!!!! ? ? ? ?

Re: ''Flat'' twitching cat!

Mark Holmes — Thu, 04 Nov 2010 14:06:55 GMT

I had a case of polycytaemia about 18 months ago, blood letting worked really well in the short term. Unfortunately the condition was a hands on condition and he was not a hands on cat so after a few months of battles we put him to sleep. There is some oral medication (hydroxycarbamide) which you can use ifthey will take it. (mine wouldn't) It needs makiing into cat sized doses by special order as it is very toxic and not a good one to go splitting capsules.

Re: ''Flat'' twitching cat!

Bob Russell — Thu, 04 Nov 2010 13:50:57 GMT

Lab suggestions renal disease/renal carcinoma (erythropoetin prodn presumably) /renal hypoxia/embolism/toxoplasmosis/FIP.

Also liver disease / pancreatitis!! More results later if owners agree to it.

Struggling with this one I admit.

Re: ''Flat'' twitching cat!

Bob Russell — Thu, 04 Nov 2010 13:07:53 GMT

Latest:

                          BIOCHEMISTRY
Feline Profile
Total protein              78         g/L            (54.0 -80.0 )
Albumin                    26         g/L            (21.0 -39.0 )
Globulin                   52         g/L            (15.0 -60.0 )
Sodium                     Regret insufficient sample for analysis
Potassium                  Regret insufficient sample for analysis
Na:K ratio                 Regret insufficient sample for analysis
Chloride                   Regret insufficient sample for analysis
Total calcium              2.73       mmol/L         (2.0 -3.0 )
Phosphate                  1.70       mmol/L         (1.2 -2.6 )
Urea                     * 13.2       mmol/L    High (4.0 -12.0 )
Creatinine               * 209        umol/L    High (80.0 -180.0)
Alk Phos                 * 314        U/L       High (0.0 -50.0 )
ALT                      * 92         U/L       High (0.0 -40.0 )
Gamma GT                   6          U/L            (0.0 -10.0 )
Total bilirubin          * 35         umol/L    High (0.0 -10.0 )
Bile acids                 3          umol/L         (0.1 -10.0 )
Glucose                    5          mmol/L         (3.5 -6.6 )
CK                       * 961        U/L       High (0.0 -152.0)
                            Serum slightly haemolysed.

                          HAEMATOLOGY
RBC                      * 13.29      x10^12/L High (5.5 -10.0 )
Hb                       * 22.6       g/dl      High (9.0 -17.0 )
HCT                      * 69.9       %         High (27.0 -50.0 )
MCV                        52.0       fl             (40.0 -55.0 )
MCH                        14.8       pg             (13.0 -21.0 )
MCHC                       32.3       g/dl           (31.5 -36.5 )
Platelets                  245        x10^9/L        (170 - 650 )
WBC                        7.2        x10^9/L        (4.0 -15.0 )
Neutrophils                4.32       x10^9/L        (2.5 -12.5 )
Lymphocytes                2.02       x10^9/L        (1.5 -7.0 )
Monocytes                * 0.86       x10^9/L   High (0.0 -0.8 )
Eosinophils                0.00       x10^9/L        (0.0 -1.5 )
Haematologist Comment      Platelet count confirmed in film. No polychromasia seen
                            Anisocytosis +. Poikilocytes +. Rouleaux ++

                            CLINICAL COMMENTS
There is moderate azotaemia which is consistent with the clinical history of
dehydration, however could also reflect renal disease as an underlying cause of
or secondary to the dehydration and measurement of urine specific gravity is
recommended to assess renal concentrating ability.
The elevated RBC and HCT is most likely to reflect the dehydration.
The monocytosis reflects established inflammation.
There is evidence of cholestasis and hepatocellular injury and dynamic bile
acid testing could be considered to further assess hepatic function.

Humm!

Is eating if you put food in front of him. A little 'out to lunch'.

Re: ''Flat'' twitching cat!

Edward Jones — Thu, 04 Nov 2010 12:44:37 GMT

Could you get a blood protein by refractometer in the end?

Re: ''Flat'' twitching cat!

Bob Russell — Thu, 04 Nov 2010 11:48:43 GMT

Haematology this morning shows HCT 65.86%. Still twitchy. Starting to think polycythaemia. Will wait for results from lab - anyone know of a leech supplier? (sort of tongue in cheek)

Never had a case before. Presumably cardiac cases would have shown up before 2+yrs old. X-ray didn't seem so abnormal considering the level of dehydration etc.

TDDS are struggling with yesterdays samples but hope to get results!

Re: ''Flat'' twitching cat!

Bob Russell — Thu, 04 Nov 2010 10:30:24 GMT

[quote user="Andrew Mellor"]

is it paralysed, paraplegic or just a flat cat? menace reflex etc? is twitching related only to head or is she hyperaesthesic elsewhere also? my boss saw one that presented in a similar way as a second opinion, had no idea supportive treatment and gave jab of synux and dexadresson - cures all he says!! cat was normal aparently 2 days later- and remained that way for about a month, presented the same again, more steroid and it was normal again third time I saw it instead thorough cranial nerve exam localised lesion. eventually died a few months later on way to surgery, pm found lymphoma at localised site and 6 others in cerebral hemispheres which did not seem to be causing any problems! was felv neg too.

[/quote]

Flat as in quiet and depressed - menace exaggerated, leads to twitching. Waiting for labs but has improved dramatically with IVFT. Now just minor tremor of lip and ear.

FeLV and FIV were negative.

Re: ''Flat'' twitching cat!

Utlendigur — Wed, 03 Nov 2010 20:43:17 GMT

The only things I've seen with sudden onset symptoms alongside haematrocrits of that level have been Addisons cases (and one polycythaemia vera case)