Help with cat case

Re: Help with cat case

Busybee — Wed, 09 Nov 2011 21:10:48 GMT

Saw cat back today. Owners report she is finding it hard to eat much solid food, and is just about managing on mushed up mince. I was very pleased when I saw her though - she's gained weight, he coat looks miles better and you can barely tell there's a problem with her jaw. There is still very little tone in the mandible and observing her eating, she can obviously lap ok but cannot use her jaws to grab solid food. I repeated the bloods which showed a very normal thyroid level (32 if I remember rightly!) and the ALT and ALP have halved (though are still quite a bit above the upper limit). Amylase hasn't changed. The plan is to keep going and have given the owners some recovery diet and sensitivity diet (which she ate in with us ok) to use alongside the meat and also tuna. If the liver enzymes remain high at the next check in a month, we may investigate this further (though owners are becoming wary with costs) or try on some SAM-e or similar.

Re: Help with cat case

Kate Richardson — Thu, 03 Nov 2011 21:59:37 GMT

Cool, keep us posted

Re: Help with cat case

Busybee — Thu, 03 Nov 2011 21:40:53 GMT

Well cat managed to eat 2 bowls of food overnight last night (one recovery, one sensitivity) on it's own and a bowl of mushed up felix this morning! Still mainly lapping rather than biting but a definite improvement! There is much less ptyalism, the cat is very bright, normal temperature etc. Sent home today on felimazole with instructions to come back end of next week for repeat bloods. Still don't know what went wrong exactly but very glad the cat is nearly back to normal.

Re: Help with cat case

Kate Richardson — Wed, 02 Nov 2011 09:50:24 GMT

Yes I meant a bile acid stim, sorry I didn't make that clear, and any food is fine for this. It doesn't have to be a big meal. I would agree with Evelyn, an oesophagostomy tube is much better than an NO tube, tolerated well and you can actually get a proper amount of nutrition into the cat . The benefits outweigh the ga risk, it is a quick procedure. And use the largest diameter tube you can- 14-16F if you can, otherwise you still won't get much down the tube. Royal Canin Convalescence diet is great for tube feeding.

Re: Help with cat case

Evelyn Barbour-Hill — Tue, 01 Nov 2011 19:36:43 GMT

[quote user="Busybee"]what would be the best food to give considering it has a NG tube in? [/quote]

To be cotton-pickin' honest, I'd junk the nasal tube and put an oesphagotomy tube in.

I wish to point out that I am genuinely trying to be helpful.

Re: Help with cat case

Busybee — Tue, 01 Nov 2011 18:44:46 GMT

I was off yesterday but my colleague reports the cat went very flat and quiet. The liver was scanned but nothing abnormal seen (though the operator admits himself he's no expert!) and a naso-gastric feeding tube put in. Today, the cat perked up again and this morning even appeared able to lap at food and make efforts to pick up meat though not very successfully. I have seen it numerous times just sitting with it's mouth hanging down again though.

We did check the eyes when it came in and there were no obvious lesions, but will try and get a bp tomorrow. Will look at getting more bloods - if we were to do a BA stim (or did you mean static BAs?), what would be the best food to give considering it has a NG tube in?

Re: Help with cat case

Kate Richardson — Tue, 01 Nov 2011 14:59:58 GMT

Hi. Liver enzymes do seem excessively high to just be explained by hyperthyroidism alone, but not impossible, and you don't have an exact value for T4, and given the cat was unwell when presented, the T4 is likely suppressed to a degree as well. I would be looking at the liver in more detail if the cat does not improve as you would like, so consider checking bile acids and an abdominal scan. Also consider concurrent pancreatic disease, so keep the pain relief up.

Another thought would be a cerebral injury secondary to hypertension, so check the blood pressure and retinas for any lesions.

If you are fairly certain this is due to hepatic disease, add lactulose, and if still not responding, triple therapy antibiotics (amoxclav/marbofloxacin and metronidazole). SAMe and B vitamins worth adding to the mix, and possibly anti-emetics if you think the cat is nauseus. Keep an eye on the potassium levels as well.

Hope that helps, and that the cat is doing better already

Re: Help with cat case

Hannah Wynne Richards — Tue, 01 Nov 2011 10:00:00 GMT

Tim What a horrible idea -rabies in UK Having said that with our leaky borders ????????????????

Wynne

Re: Help with cat case

Tim Cheyne — Tue, 01 Nov 2011 09:26:18 GMT

[quote user="mariette asselbergs"]

With rabies it is always nice that you know for sure you (and cat) are OK if it does NOT die in the next few (max10) days

Mariette

[/quote]

Mariette, I am not sure that the old concept of rabid animals dying within ten days is still valid. Can any experienced virologist enlighten us on the possibility of survival and carriers?

Tim.

Re: Help with cat case

Tim Cheyne — Tue, 01 Nov 2011 09:20:47 GMT

With the UK borders opening rapidly, is it not worth front-line vets being vaccinated with human diploid anti-rabies vaccine anyway? I was one of the first to have it many years ago when it was offered at nominal cost by British Airways Travellers Clinics. Do they still do so?

Tim.

Re: Help with cat case

mariette asselbergs — Mon, 31 Oct 2011 22:16:46 GMT

With rabies it is always nice that you know for sure you (and cat) are OK if it does NOT die in the next few (max10) days and IF it dies you have enough time to diagnose and get in-contact people treated. That is IF you think of having that tested, thats why I mentioned it.

Curious to hear how this story ends,Good luck!

Mariette

Re: Help with cat case

Busybee — Mon, 31 Oct 2011 09:55:15 GMT

Thanks for your thoughts everyone!

I think the plan is to put a tube in today, probably an O-tube. David - yes electrolytes (even K+!) were all normal.

Mariette - it had crossed my mind! So I have been careful handling the cat, thankfully it's pretty compliant and friendly so far!

Christopher - no jaundice, not done ultrasound yet, cholangitis a possibility I guess but never seen it present in quite this way. I had a rabies shot in 2010 so I believe I'm covered for the next few months :)

Re: Help with cat case

Christopher Saul — Sun, 30 Oct 2011 23:42:38 GMT

Is the cat jaundiced? Have you ultrasounded the abdomen? Could it have a cholangiopathy ( e.g. neutrophilic cholangitis)? Nutritional support imprtant with these liver cases..... IMO eosophagostomy tube is the easiest and most practical solution to enteral nutrition....

looking back at the previous post, if you are thinking lyssavirus - make sure you get rabies shots if you get bitten......

Just some random thoughts....

Re: Help with cat case

mariette asselbergs — Sun, 30 Oct 2011 16:53:53 GMT

Just to mention it: sitting with jaw open, low tone,has this cat been playing with a sick bat?

If it get paralysed, gets more nervous symptoms and dies in the next 5 days then have the head tested for Lyssavirus.

Mariette

Re: Help with cat case

SteveOwen — Sun, 30 Oct 2011 13:49:07 GMT

Oh, and 100% agree with not giving diazepam - just a little shocked that two people would consider in animal with buggered liver! Makes it difficult to justify health check in dog before presc diazepam for fireworks - if not liver disease, what are you looking for there?!

Re: Help with cat case

SteveOwen — Sun, 30 Oct 2011 13:46:24 GMT

Blend a wet hepatic diet like l/d or new RC hepatic, don't feed high protein a/d or Recovery, even if it less less hassle to syringe or get through tube. PEG tube better than NO anyway.

Re: Help with cat case

Evelyn Barbour-Hill — Sun, 30 Oct 2011 13:08:03 GMT

Trigeminal nerve pathology is a possibility (think Sherlock Holmes).

Like everyone says, the thing to do now is to nourish the cat. An oesophagotomy tube is my favourite. With the best will in the world, I don't think syringe feeding can ever be as satisfactory.

Then when you've removed or reversed the effects of the cat's period of starvation and exposure, re-sample blood and re-assess?

I'm in no way a liver expert, but some of the "hepatic support" medicines would do no harm?

Re: Help with cat case

David Mills — Sun, 30 Oct 2011 10:52:42 GMT

Seems like a complete work up so far. Cat needs a feeding tube with those liver figures- make nutrition your medicine. Electrolytes all normal (esp k+)?

I think you'll be amazed at how quickly it picks up with regular feeding, and it's a 5 minute job to put one in.

Whatever you do, don't use diazepam in this cat with this amount of liver pathology. Unless you want to kill it.

Re: Help with cat case

Busybee — Sun, 30 Oct 2011 10:49:20 GMT

Did consider Key-Gaskell but the cat seems too old and also has few other signs eg. megaoesophagus, certainly not a dry mouth, bradycardia.

Yes, checked under the tongue :) At the moment we are syringe feeding the cat as it tolerates this ok and can swallow but will consider a tube. I have heard of the IV diazepam trick but it still appears to me to be more a physical problem rather than a mental one.

The cat will sit with it's jaw open, there is very little tone in the lower jaw but it appears to be able to move it slightly though not close fully. The mandible doesn't appear deviated and the upper and lower incisors line up normally. On the basis of this I took skull xrays this morning and as far as I can see (bear in mind I'm no expert) both TMJs seem to be in place. Now I'm thinking possible trigeminal neuritis?? I know it's very rare but I'm running out of ideas.

Re: Help with cat case

katie mountford — Sun, 30 Oct 2011 02:55:18 GMT

I have seen liver enzymes this high with hyperthyroidism-it was in a 2 cat household (litter mates) where both were hyperthyroid and both intially had ALTs over 1000 prior to felimazole. BASTs were normal in both these cats and after T4 stabilised 1 cat's ALT returned to WNL but the other remained around the 600 mark. The owner declined further workup so unsure if these cats had concurrent liver disease or if it was 2ary to the hyperthyroidism.

What about polyps-sometimes they can cause URT time retching/squeaky noises?

Re: Help with cat case

Michael Woodhouse — Sat, 29 Oct 2011 23:49:20 GMT

I'm sure you looked under the tongue?

You know the IV Diazepam trick in the cat? I've known a couple of cases like this that once they had a full stomach after the diazepam went from strength to strength.

Needs feeding one way or another, even if you have to go for some kind of feeding tube.

Re: Help with cat case

Nicola Lawlor — Sat, 29 Oct 2011 23:11:39 GMT

Have you considered something like Key-Gaskell syndome here perhaps? Unclear if the cat has any other signs associated but worth a thought at least. Enzymes could be a mix of hepatic lipidosis from 4-5 days away and hyperthyroidism?

Re: Help with cat case

Mark Rowland — Sat, 29 Oct 2011 23:08:40 GMT

Have to say looks like HE to me. i would work up the liver Goodluck