Angel back from the vet

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Lisa and Angel

Lisa and Angel

Member Since 2023
Is anybody around? Angel is worrying me again an awful lot. Info's in my spreadsheet in remarks, I'll just copy what I just wrote there:

Smaller than average, pretty solid poop at PM+2. Afterwards, super lethargic, weakness in legs, staring into nothingness with a dazed look, "not really all there". Only snaps out of it temporarily if I offer her her favourite treat, even takes a few seconds of holding it in front of her before she recognises it. Won't eat her usual well-loved wet foods. No hypo. No fever (temp 38,9°C), barely even noticed she had a thermometer up her butt. Don't know what's wrong, this is so frustrating.

This is a recurring problem, and we genuinely cannot figure out what's causing it. The last few nights she's had this happen to a lesser degree, but I'd give her some food and she'd perk back up within half an hour. Now it's worse and she's refusing most food.

She's had a basic chem blood panel (all good except for a tiny increase in globulins), a gastro panel for chronic diarrhea (low B12 is being treated, high folate), an abdominal ultrasound (all good), pancreatitis and EPI testing (negative for both), blood pressure testing (perfect), bile acids testing (all good), physical exam (good), urinalysis (all good). By all accounts she is healthy.

If anybody has any ideas, please share.
 
Do you think she might be having a reaction to one of the meds that you are giving her? While I’m not familiar with it, a quick search of side effects for the first one you have in your signature, Pregabalin may be consistent with what you are seeing.
 
Could it be a possible seizure? She may not be showing signs of having them (body stiff or trembling) but what you are describing sounds very much the same way my dog Sculley acted right after she had a seizure. If it is, it may be able to be controlled with medication. Once Sculley started taking phenobarbital, she went from seizures every day to 2-3 a month
 
Christie & Maverick said:
Do you think she might be having a reaction to one of the meds that you are giving her? While I’m not familiar with it, a quick search of side effects for the first one you have in your signature, Pregabalin may be consistent with what you are seeing.
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It's possible... she is on a very high dose. But she's been on it for years and hasn't experienced this before her bowel infection this summer.

Lisa and Witn (GA) said:
Could it be a possible seizure? She may not be showing signs of having them (body stiff or trembling) but what you are describing sounds very much the same way my dog Sculley acted right after she had a seizure. If it is, it may be able to be controlled with medication. Once Sculley started taking phenobarbital, she went from seizures every day to 2-3 a month
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Doubtful, I have another cat with epilepsy and she doesn't show any signs of a seizure (tonic-clonic or more subtle). It's like all her strength is sapped away after the exertion of a bowel movement.
 
How is she doing now? I think you interacted with @JL and Chip recently in a discussion about Solensia, I wonder about that since if I recall that’s a new med for you? Sorry, just throwing out random ideas, I wish I had something more definitive to offer.
 
In the meantime, she's regained a bit of function. Waddled to the water bowl to get a drink, then to the kitchen to let me know she wanted a nibble. Ate a bit, then waddled back to her spot. I hope she'll perk up again with food in her belly like before. The weakness in her hind legs/hips happened before when she crashed with her bowel infection and had a high fever and later hypothermia. Once she regained her strength, the weakness stopped. I don't understand why it's happening again.
 
Christie & Maverick said:
How is she doing now? I think you interacted with @JL and Chip recently in a discussion about Solensia, I wonder about that since if I recall that’s a new med for you? Sorry, just throwing out random ideas, I wish I had something more definitive to offer.
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Posted at the same time:) please see comment above for how she's doing. As for the Solensia... yeah, I'm starting to question that bit too. She's had 1 shot before on November 7th, didn't have these symptoms back then. But it's possible that Solensia could be involved too. Thanks for thinking along.
 
Yeah, it's like her hind legs are suddenly made of jelly... It's not diabetic neuropathy, though she does have that (mainly in front paws though). Her hind end is swaying and lurching and paws sliding away when she walks. It's almost like she's hypo, even though I know she's not.
 
That does sound to me as neurological. Like the brain signals aren’t reaching her back end. Shoot if she were a German Shepherd or other dog that is at risk genetically, I’d be wondering about degenerative myelopathy but even with something like that it doesn’t come and go.
 
Christie & Maverick said:
That does sound to me as neurological. Like the brain signals aren’t reaching her back end. Shoot if she were a German Shepherd I’d be wondering about degenerative myelopathy but even with something like that it doesn’t come and go.
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Yeah that's the weird thing, the coming and going. At the time of the bowel infection, vet said it was simply because she was so weak overall. I mean, she couldn't even thermoregulate, no wonder she had jelly legs. But now? I did up her Memantine today too. Think I'll give her the old dose again tomorrow. Looking at the side effects and overdose signs, that could be the cause too. Sigh... so many potential variables.
 
As expected, half an hour after eating she's starting to perk up again. More alert/mentally present, more appetite, walking better, (wobbly) doing the "begging doggy pose" again for her favourite treat. Have any of you ever heard of this? I can't think of anything that'd involve them improving after food other than a hypo, but she wasn't hypo!

She is drinking a ton though. Like, she's been to the water bowl 4 times in the last 40 minutes.
 
She just ate a bunch of dry kitten food (can't be good for her diarrhea, but this was more important). Drank some more and then laid down to sleep in her cat bed. I think I'll go to sleep too since I'll have to call the vet in 4.5 hours:blackeye:
 
Christie & Maverick said:
Can you snag a before bed test? Since she’s finally dipped into blues, it would be good to get a test in. Sleep well.
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Yup, did and she was 10.9. I'll put it in the ss tomorrow since I'm already on mobile. After testing I gave her a treat (liquid snack) and she frantically ate it up and then got up to eat more. I swear, if I didn't hometest I'd be 100% convinced she had a major hypo. Is it possible for her body to be reacting to these semi lows like a hypo event for some reason? Maybe she's not used to it after the prozinc highs? But then again, she hit a green shortly before switching and she was fine then...
 
JL and Chip said:
Does it typically occur just after pooping?
If so, maybe a vasovagal reaction? I think that can happen in humans. Anyway, just trying to think outside the box…
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Yeah, these last few days IIRC it's always been after she had her evening poop. Vasovagal is something that's crossed my mind too. I appreciate you thinking with me.
 
Hi all, just an update. She was doing better this morning so the ER said not to come. She was bright and alert, ate a whole pouch of gastro wet food and some dry too. Walked fine and had a relaxed sprawl when she went to nap in her fave spot.

But, she's gotten worse again in the afternoon. She's lethargic, hiding away now in my bedroom. Still eats if I bring it to her, in a desperate/frantic manner, but not coming out. Not so dazed as before but not responding brightly either.

Her AMPS was 10.1, she got 2U Lantus, +5 was 9.5. Great numbers, I don't get why she's feeling so poorly now. Maybe she has an infection? No UTI though. I'll check her again soon for a fever. Also haven't caught her peeing recently so I haven't been able to check for ketones...
 
Oh dear, I’m sorry to hear she is still having some issues. I don’t think it is BG related, although I might suggest if you can to check for ketones. The the basic recipe for developing DKA is an insufficient supply of insulin + inappetance + infection or other systemic stresses. I have seen kitties here who don’t have high BG develop ketones.

The other thought would be maybe she is having a bought of pancreatitis? Again, mostly because you are describing that she seems off. See here for the primer on pancreatitis if it helps at all.
 
Christie & Maverick said:
Oh dear, I’m sorry to hear she is still having some issues. I don’t think it is BG related, although I might suggest if you can to check for ketones. The the basic recipe for developing DKA is an insufficient supply of insulin + inappetance + infection or other systemic stresses. I have seen kitties here who don’t have high BG develop ketones.

The other thought would be maybe she is having a bought of pancreatitis? Again, mostly because you are describing that she seems off. See here for the primer on pancreatitis if it helps at all.
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I'm keeping a close eye on her so that I can test her for ketones when she goes to pee!

Could be pancreatitis, though she tested negative for that about a month ago... She's worse now though. If we have to go to the emergency vet I'll ask if they have a snap test available.

She came out of hiding about 10 minutes ago, ate another whole pouch of wet food, cried for more, ate some meat stick treats. Walked pretty well. Now she's eating dry food. She is confounding me. I can't tell if she needs to go to the vet when she's flip flopping like this.
 
Of course Angel decided it was time to dive tonight... I'm so tired:blackeye: but will stay up with her until she's safe again. Other than her (now) low numbers, she's doing better again. Hasn't crashed since her afternoon episode even though she had a right before PMPS. Seems perky at the moment. Gave her a bunch of HC food (wet and dry) after the PM+3 test, but that didn't stop her from dropping further unfortunately. Did the same after the PM+4 test, will test again soon to see what's going on.
 
Just got back from the vet. Got some more bloodwork done, including a hematology panel this time. Which showed she (still) has an elevated white count. Since we've ruled most other things out, she's gotten another course of antibiotics (Metronidazole this time).

Vet thinks/hopes that the weakness is caused by a general feeling of crappiness from the likely-persisting bowel infection/bacterial dysbiosis. Lots of uncertainties, but this seems most likely since there aren't a lot of (non-horrible) options left. No DKA, no kidney/liver damage, no anaemia, no pancreatitis, no blood pressure problems, no hypos. Physical exam was perfectly normal.

IBD is still a possibility, but the vet would've expected that to show up on the abdominal ultrasound. If all else fails we can start her on a corticosteroid, but that's obviously not ideal with her diabetes.

What's left is neurological, perhaps dry FIP or a brain tumor. Her brother died of wet FIP at 16 weeks old. Her mom died of a brain tumor at 14 years and 50 weeks old. Angel just turned 14. I don't even want to think about these possibilities.

She took the first dose of Metronidazole like a champ. I'm really hoping she'll improve quickly.
 
Christie & Maverick said:
Oh poor girl. How were her potassium levels?
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They haven't email me the results yet, but the vet said the only thing that stood out was the elevated white count. Though I just checked the bloodwork she got done in early december and saw that they didn't include potassium levels, so I'll be sure to check whether they actually included them this time around.
 
Lisa and Angel said:
They haven't email me the results yet, but the vet said the only thing that stood out was the elevated white count. Though I just checked the bloodwork she got done in early december and saw that they didn't include potassium levels, so I'll be sure to check whether they actually included them this time around.
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Good plan, here in Canada I get a senior panel, which includes thyroid, superchem with SDMA, CBC and urinalysis. They should still have her blood if they need to add-on.
 
If they didn't test for potassium/electrolytes (not seeing this charge on my bill, so I'm guessing they didn't), I'm heading over there tomorrow and will make them test for it. Because the more I'm reading about low potassium, the more I think this might be what's wrong with Angel.

When she had her bowel infection in July, they did test her electrolytes (and listed it as a separate charge on the bill). She was (just barely) within normal levels, 3.6 mmol/L with reference ranges being 3.5 to 5.8.

Apparently low potassium can be caused by increased urination (check), insulin administration (check), prolonged diarrhea (check), among other things. I feel like an idiot for not being more alert to this. And kind of pissed off that neither of the 2 vets she's seen (different one today from the one in december) thought to test for this!

I have a bag of lactate ringer subq's available, she's gotten the all-clear to receive fluids if I felt like she needed them. It contains potassium. If I give it to her now, will that affect tomorrow's blood test results? The vet didn't get to draw a lot of blood because Angel was being squirmy, so I doubt they have any left.
 
I'm glad you are getting the potassium levels checked. My current kitty (has IBD and small cell lymphoma), went through some ileus a couple years ago when her IBD was not well controlled. We tried reducing her pred dose, but her body said no. Anyway, the result was low potassium (3.4) so wobbly walks, a brief bit of diarrhea (s. boullardi took care of that), and inappetance. Unfortunately lack of food made the potassium level worse. Treatment was potassium supplementation and fluids, and whatever she'd eat. Plus upping the pred dose back to where her body needed it to be.

Can you call the vet and ask about the fluids?
 
This behavior reminds me of something I was just reading this morning about a particular type of seizure. Christie has some good ideas about reactions to medications as well. I’m so sorry this is happening.
 
Lisa and Angel said:
If they didn't test for potassium/electrolytes (not seeing this charge on my bill, so I'm guessing they didn't), I'm heading over there tomorrow and will make them test for it. Because the more I'm reading about low potassium, the more I think this might be what's wrong with Angel.

When she had her bowel infection in July, they did test her electrolytes (and listed it as a separate charge on the bill). She was (just barely) within normal levels, 3.6 mmol/L with reference ranges being 3.5 to 5.8.

Apparently low potassium can be caused by increased urination (check), insulin administration (check), prolonged diarrhea (check), among other things. I feel like an idiot for not being more alert to this. And kind of pissed off that neither of the 2 vets she's seen (different one today from the one in december) thought to test for this!

I have a bag of lactate ringer subq's available, she's gotten the all-clear to receive fluids if I felt like she needed them. It contains potassium. If I give it to her now, will that affect tomorrow's blood test results? The vet didn't get to draw a lot of blood because Angel was being squirmy, so I doubt they have any left.
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Oh my goodness, yes. If she’s having increased urination and also diarrhea (and hopefully not vomiting?) then many of her electrolytes can get out of balance. I’m glad you will have these checked.
 
Wendy&Neko said:
I'm glad you are getting the potassium levels checked. My current kitty (has IBD and small cell lymphoma), went through some ileus a couple years ago when her IBD was not well controlled. We tried reducing her pred dose, but her body said no. Anyway, the result was low potassium (3.4) so wobbly walks, a brief bit of diarrhea (s. boullardi took care of that), and inappetance. Unfortunately lack of food made the potassium level worse. Treatment was potassium supplementation and fluids, and whatever she'd eat. Plus upping the pred dose back to where her body needed it to be.

Can you call the vet and ask about the fluids?
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Unfortunately they're already closed. I think I'll skip the fluids (weren't prescribed anyways, just mentioned to the vet that I had the supplies at home and vet said it'd be fine to give her some if I wanted to), I don't want to influence tomorrow's test results. Was that 3.4 also in mmol/L? 3.4 and 3.6 are so close together. I'm wondering if Angel might benefit from some careful supplementation if it turns out that she's still borderline low, though I get the feeling she's lower now tbh. I'll discuss it with the vet tomorrow.
 
Suzanne & Darcy said:
This behavior reminds me of something I was just reading this morning about a particular type of seizure. Christie has some good ideas about reactions to medications as well. I’m so sorry this is happening.
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Seizures were mentioned as a possibility as well (as a symptom of brain tumor/dry FIP). Really hoping it'll turn out to be something much more innocent like low potassium.

Suzanne & Darcy said:
Oh my goodness, yes. If she’s having increased urination and also diarrhea (and hopefully not vomiting?) then many of her electrolytes can get out of balance. I’m glad you will have these checked.
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I'd been wondering why Angel was still drinking and urinating so much. The specialist vet attributed it as a side effect of the memantine (used so rarely/newly that side effects aren't really known yet, but increased urination was mentioned as a side effect in 1 study on dogs). Diarrhea definitely. Vomited 4 times this week (twice of those being on dec 31st), has not vomited prior and usually never does.

Suzanne & Darcy said:
I have seen other people report this happening to a few other cats on this Board- after straining to poop.
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That's very interesting!
 
I’m sorry Lisa, when I jumped on in the beginning, I had read that you had some lab work done and everything was good. I had thought to ask you then about the potassium levels, since I didn’t see the labs in your SS. Then we started talking about other possible things, and it slipped my mind. That would have saved you another trip back to the vet, but I’m glad at least you can rule out electrolyte imbalances now.
 
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Christie & Maverick said:
I’m sorry Lisa, when I jumped on in the beginning, I had read that you had some lab work done and everything was good. I had thought to ask you then about the potassium levels, since I didn’t see the labs in your SS. Then we started talking about other possible things, and it slipped my mind. That would have saved you another trip back to the vet, but I’m glad at least you can rule out electrolyte imbalances now.
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No worries, it slipped my mind too. And apparently the vet didn't think it was that important eithero_O
 
Since starting the Metronidazole, Angel has been feeling much better. She hasn't had any of these weakness episodes anymore. Walks well. Still sleeps a lot, but is alert and less sluggish when awake. Poops are getting better and less frequent, less stinky too. Appetite is still less than normal but definitely adequate considering the circumstances. She's eating plenty and not losing any weight, just a tad bit more picky than usual. Still drinks a lot, but pees are smaller than before, which is weird.

Numbers have been pretty high and flat, maybe from the antibiotics and stress? No pinks today, so that's an improvement over yesterday. I'm not worried yet, we'll see what her body does when she's done with the Metro (8 day course). I can still increase her insulin dose after 7 days right (in another 2 days IIRC)?

I think the subq fluids have helped too. Her fur looks better and her skin felt easier to tent and shoot somehow compared to the last couple of days.

Edit: spoke too soon about the pinks.
 
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