? 5/10 Asia Have a shot at diagnosing my cat (PLEASE)

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Christie & Maverick said:
I'm sorry Stacy, I wish I could help, if it comes and goes, that must mean something? How was her breathing at the time, facial expressions, eye movement? It's so hard to guess from the other side of a computer, just throwing out some things I've seen in the past. How is Miss Asia feeling tonight?
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She was panic breathing and her face said help me, I’m hurting. No wonky eyes or different sized pupils or anything like that.

She’s feeling okay, I have her on bupe every 6-8 hours so it’s taking the edge off. She’s really hungry and her ears itch a lot (been an issue for months, vets are not concerned).
 
rhiannon and shadow (GA) said:
I hope you get a tech who's willing to explore a little.

When Shadow had hers, I was in the room too and got to see. She had nodes on her spleen, thickened intestinal walls. But other organs looked normal according to them.
It's good to have someone who explores all the possibilities not just one area.
This should give you a direction at least.
I know pancreatitis shows up with the right test even tho' they don't really know that much so far.

but pancreas, liver, spleen, intestine, stomach, kidney....
ultrasound won't give you all the answers but it sure helps point you in the right direction.
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She just had one in January and I was in the room. The tech checked out everything as far as I could tell. Intestinal thickening (IBD) though she’s never really had any symptoms, pancreatitis, and kidney infection. She had some nodules on her liver which they said were not concerning. I think that was about it. Hope they see something this time that explains what is happening right now. She said something about lymph nodes and taking a sample.
 
i've never met a cat that didn't like ears scritched.
You can stick your thumb in there and rub all the inner folds without getting near the eardrum since their ear canal makes a sharp 90 degree turn.
 
I'm so sorry that Asia hasn't been feeling well. Like PussCatPrince, my thoughts also went to a possible hernia or TIA. I hope the vet can sort it out quickly and put Miss Asia on the road to recovery! :bighug::bighug::bighug:
 
Oh sweetie. :bighug::bighug::bighug:

I think the same thing is going on with Gizmo. Last night he had some sort of facial tick going on. I also found what looks like a white head or wart on the side of his mouth, it is just outside the inside it is small but IDK what it is. I give meds every day and haven't noticed it until now. I will try and get a picture this weekend with hubbys help and post it.

At least you can get US next week. I don't even meet with the IM until 05/29 For the initial visit and doubt the US will be then :banghead:.

My gut says it is a kidney infection with Gizmo. He does so much better when he is on AB (diarrhea and increase nausea being the exception). Nothing has shown up on the urinalysis or cultures so trying to convince the vet is impossible. I know Gizmo has panc flares and I think that is going on also but I am 99% sure it is something more.

On the Canna I just get the x-strength and only give 1/2 capsule at a time. That is in stock and I need to get some ordered today too.
 
I have no advice to offer, Stacy. The hernia idea seems to fit with the soft, movable ballon-like mass you've felt. I do recall @Stephanie & Quintus being alarmed at what looked like rolling spasms of some sort that she could see on Quintus' abdomen occasionally while he was sleeping. I have no idea if they're similar but maybe she can weigh in. :bighug::bighug::bighug:
 
Labs came back, in the labs tab on my SS SpecfPL is 50. I thought that number didn’t really mean anything? My vet thinks it does along with symptoms. Nothing else looks weird, creatinine is down, guess that proves the UTI/kidney infection. She’s hiding today. If pain meds are helping, it’s just barely. BG is Hi. :(
 
I'm so sorry she's hurting today...poor baby. I've seen vets have differing opinions about the SpecfPL test. My vet feels that other happenings within the body (like FD and CKD) can influence it so she didn't think it was reliable, but that's not to say it isn't reliable, especially as your vet pointed out, when combined with symptoms and other test results. Many, many prayers that she is feeling better quickly.
 
She’s just laying with her head down, like she’s sleeping, but she isn’t. She’s awake, eyes open. Black numbers don’t help, that makes her feel worse than she already does. This sucks.
 
First, big hugs...

The first thing that came to my mind when I read your description of what happened was thrombi (because of what happened to Tounsi). Did she kick? Did the spasm in her abdomen seem like it could have been voluntary at all? (Can you send me the video?)

Hernia, definitely. Quintus has a median line weakness and some herniation but it seems painless.

Kris & Teasel said:
I do recall @Stephanie & Quintus being alarmed at what looked like rolling spasms of some sort that she could see on Quintus' abdomen occasionally while he was sleeping. I have no idea if they're similar but maybe she can weigh in. :bighug::bighug::bighug:
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I think we're in something different, because what was going on with Quintus was chronic rather than acute, and pretty slow. Never found out what it was but the end of it seemed to coincide with me stopping wet food altogether.

Stacy & Asia said:
Labs came back, in the labs tab on my SS SpecfPL is 50
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So, Quintus has 50 too. It's the limit of what the machine can read (so it's basically HI, off charts).

About panc: he ate and eats fine all through his horrible SpecfPL values. He was 50 at the worst of it (pre-diabetes) last winter. He came back down to 12 or so. He was back up to 50 last blood tests.

What my vet told me about interpretation for that number: symptoms trump labs. Quintus is asymptomatic, largely, though I've managed to argue he probably has another gallbladder infection. I'm not sure I'd count Asia as asymptomatic if she seems in clear pain.

Now, can panc cause acute pain and spasming? Spasming, if it was as I imagine it to be (rapid?), really makes me think of sharp pain, so gallstones or thrombi? Or a mini-stroke as others suggested?

Could you check back to the US results what was said about the gallbladder? Where there any signs of inflammation around the pancreas?

Also, you know what I think -- don't be afraid of NSAIDs.

More hugs, vines, and crossed fingers and toes.
 
Okay, she’s not lethargic anymore since her numbers came down a bit, I think it was the extreme hyperglycemia doing that and not whatever this other thing is.
 
Oh Stacy! I am just getting caught up and I am so sorry your girl isn't doing well. What a mystery and I hope you will get some answers soon! I wish I had some suggestions as to what it could be. I would say maybe teeth, but she is eating right? ugh. I just hate when they are in pain and we don't know what to do for them.

Maybe revisit her last US and have them explain better the findings. Somewhere in all the testing in an answer.

I know she just saw green last night and according to TR you would hold the dose, but clearly she needs some more insulin to combat the higher numbers that the pain in causing. You test enough to deviate from the protocol IMHO.

I do not blame you for not leaving her. Once when I took Bubba to the ER I had them treat him with sub Q, give me meds and would not leave him. They do so much better at home.

Love your way to reduce the bup. I wanted to do the same with Bubba the other day and never thought of syringing out part of it. :rolleyes: Those prefill syringes are impossible to just give part of it. It all or nothing.

Sending major hugs to you and Asia.
 
Stephanie & Quintus said:
First, big hugs...

The first thing that came to my mind when I read your description of what happened was thrombi (because of what happened to Tounsi). Did she kick? Did the spasm in her abdomen seem like it could have been voluntary at all? (Can you send me the video?)

Hernia, definitely. Quintus has a median line weakness and some herniation but it seems painless.



I think we're in something different, because what was going on with Quintus was chronic rather than acute, and pretty slow. Never found out what it was but the end of it seemed to coincide with me stopping wet food altogether.



So, Quintus has 50 too. It's the limit of what the machine can read (so it's basically HI, off charts).

About panc: he ate and eats fine all through his horrible SpecfPL values. He was 50 at the worst of it (pre-diabetes) last winter. He came back down to 12 or so. He was back up to 50 last blood tests.

What my vet told me about interpretation for that number: symptoms trump labs. Quintus is asymptomatic, largely, though I've managed to argue he probably has another gallbladder infection. I'm not sure I'd count Asia as asymptomatic if she seems in clear pain.

Now, can panc cause acute pain and spasming? Spasming, if it was as I imagine it to be (rapid?), really makes me think of sharp pain, so gallstones or thrombi? Or a mini-stroke as others suggested?

Could you check back to the US results what was said about the gallbladder? Where there any signs of inflammation around the pancreas?

Also, you know what I think -- don't be afraid of NSAIDs.

More hugs, vines, and crossed fingers and toes.
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Everything I’ve heard from the many humans I know that had hernias is they didn’t hurt. So if she has one, I don’t think it’s the cause of her pain.

She wasn’t spamming or jerking like a seizure, she just stretched out and froze like that yowling in pain.

I’m glad he ate with panc, I’ve heard that from a few people now. When I look up the panc symptoms, she pretty much doesn’t have any of them except pain and one thing I read said 96% go off their food. Guess Asia just likes to be different. And yes, she’s symptomatic, but of what? What says pancreatitis other than the number and how to explain the ataxia? My vet said panc would not cause the ataxia and she was focused on it being panc, but in the spirit of KISS, why would she have an episode caused by panc immediately followed by an episode caused by something different entirely? That makes no sense to me. Not saying it couldn’t possibly happen, but statistically the odds are both things happened at the same time and were caused by the same thing.

As far as her ultrasound goes, she had confirmed pancreatitis, gallbladder unremarkable, IBD (cancer can’t be ruled out), nodules on liver and pancreas (cancer can’t be ruled out), spleen unremarkable, and a kidney infection.

I’ll attach the report but it might be hard to read depending on how it tries to pack the image file. Notice how they call her end stage CRD and apparently she is not.

D400F3DD-7C7C-4F58-A60E-FB30D085E95C.jpeg
 
Bobbie And Bubba said:
Oh Stacy! I am just getting caught up and I am so sorry your girl isn't doing well. What a mystery and I hope you will get some answers soon! I wish I had some suggestions as to what it could be. I would say maybe teeth, but she is eating right? ugh. I just hate when they are in pain and we don't know what to do for them.

Maybe revisit her last US and have them explain better the findings. Somewhere in all the testing in an answer.

I know she just saw green last night and according to TR you would hold the dose, but clearly she needs some more insulin to combat the higher numbers that the pain in causing. You test enough to deviate from the protocol IMHO.

I do not blame you for not leaving her. Once when I took Bubba to the ER I had them treat him with sub Q, give me meds and would not leave him. They do so much better at home.

Love your way to reduce the bup. I wanted to do the same with Bubba the other day and never thought of syringing out part of it. :rolleyes: Those prefill syringes are impossible to just give part of it. It all or nothing.

Sending major hugs to you and Asia.
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Teeth can always be an issue since she has a history of tooth resorption. Problem is, if it’s her teeth, it’s absolutely, positively below the gum line. If they could somehow get a dental X-ray without having to sedate her, which I know they cannot do, and we could confirm and say that’s the issue, I would take the risk and have the dental because it could be the root :rolleyes: of so many of her issues. It caused wide systemic problems the last time. However, I wouldn’t put her through all that just to find out her teeth were fine, especially since it’s extremely risky to have that surgery with her comorbidities. Rock and a hard place there. And she may eat regardless, she only has 2 molars and her important cat teeth (canines) she doesn’t chew anything and couldn’t if she wanted to.

I understood all the findings of her ultrasound, a lot of unknowns and the only way to know for sure is to do invasive procedures and biopsies, which are not in her best interest given her fear and her age. If she were a much younger cat and had a lot of great years left in her, that would be a different situation, but it would be cruel and selfish of me to put her though all of that at this point. The same with leaving her at a hospital (which they don’t think she needs at this point anyway), the stress, pain and fear that would cause to buy me a minimal amount of extra time with her, it just doesn’t make sense.

I’m not keen to raise the L right now. She’s already having wild high spikes and I don’t want to add wild low spikes to that equation, it seems like that would make her feel more terrible. I’m trying to keep her on a more even keel and shut down these high spikes with the R. If you look what I’ve been doing the past several weeks, the L dose isn’t the problem, it will get her down, but she’s going to spike pink and red regardless of the L dose. I know the basal dose is a good one, it’s just whatever else is going on that’s making her BGs go nuts. I was hoping the pain was causing the spikes and being on more frequent pain meds would make a difference there. Maybe it’s too soon to say that isn’t the case, but doesn’t seem like the pain is the driving factor.

She’s being lovey and cleaning her face right now, so the has improved dramatically.

The bupe thing, I didn’t like how they prefilled the syringes, they weren’t very exact and I couldn’t titrate the dose, what he prescribed initially was too much, I had to make do. He started giving me tiny bottles with a hole the oral syringe could fit in so I could give her what she needed and not less or more. Works much better that way! And yes, at first they suggested I just squirt “some” of the bupe in her mouth and not all of it to give her a smaller dose. I’d love to meet someone that could actually do that. :p
 
Stephanie & Quintus said:
Can you describe the ataxia? All fours, hind, side?
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Just veered to the left with her whole body, she was going for the food dish and went off to the left instead and had to circle back around. I didn’t get that part on video and it happened so fast I don’t have details. It was just right after the yowl episode and then it stopped and she was walking normally again.
 
So, I googled biliary cystadenoma and found this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357131/ -- abdominal pain in 75% of patients in the study. Maybe an explanation? Not sure if these things behave like "kidney stones" and could cause pain when passing or blocking something.

The SpecfPL was high in December, it's high now, and the US description in between also says panc. So... I'd assume she has pancreatitis = an inflamed and unhappy pancreas. (Not really news, right?) And she seems, like Quintus, to be largely asymptomatic with regard to the pancreatitis, as you say, aside possibly for the pain. IF the pain is pancreatitis-related (otherwise, then, she'd be really asymptomatic).

So I would really set panc aside for the time being and search for other causes, unless it's shown somewhere that this kind of violent pain attack can come from panc. (Sorry, I'm aware I'm repeating stuff that's already been said. Just thinking through this out loud.)

Was her temperature taken?

At this stage I'd narrow it down to these possible culprits. The question is then, for each, assuming that's what's going on, what do we do, what can we treat, what will we not do? It might allow you to make a "treatment bet" without more analysis. Treat what is treatable and hope that is it.

- the biliary cystadenoma thingy
- some kind of kidney stone, if it's different
- a blood clot/thrombus
- a kind of stroke
 
Bobbie And Bubba said:
That might rule out tooth pain. When there is a tooth issue, they usually stop preening their face. Instead, they will paw at their face as if to say. "ouch"
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You would think so, but the last time, she was lethargic and very sick for weeks, gave antibiotics and fluids and did all kinds of blood work, she was still eating but not enthusiastically. She was on deaths door, vet was coming to give the pink shot and by some miracle some blood dripped out of her mouth and that’s when we knew it was teeth. They don’t have much luck getting in her mouth. No vet is a match for Asia’s teeth. :rolleyes:
 
Stacy & Asia said:
You would think so, but the last time, she was lethargic and very sick for weeks, gave antibiotics and fluids and did all kinds of blood work, she was still eating but not enthusiastically. She was on deaths door, vet was coming to give the pink shot and by some miracle some blood dripped out of her mouth and that’s when we knew it was teeth. They don’t have much luck getting in her mouth. No vet is a match for Asia’s teeth. :rolleyes:
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She is a tough nut to crack. Bring in the forensic team, YIKES! Sending lots of vines for pain relief and DX.
 
Coming very late here, sorry.
I agree with the Possible TIA. the veering to the left (or right) is typical of any kind of stroke. Don't know where the stomach spasm figures in though. Although, if the TIA (if it is such) could affect the muscles, a spasm might occur from that.
Stoicism is greatly over-rated.
 
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