2/17 Blackie pmps 346 +4 257

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Ele & Blackie (GA)

Ele & Blackie (GA)

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Good Morning, LL
Thank you all for the support and information in our condo yesterday. I just can't tell you what it means to me to have all of that love, prayers and healing vines. I did get some purrs this morning, and my sweet Blackie still put his front paws up when I picked him up this morning and put him on my shoulder. I really hope that he feels better today.

First let me answer some of your questions. Blackie is on Denamarin and has been for more than a month. His Alt levels have been elevated for more than a year, but all other liver enzymes were normal. We did do a sterile u/a and are awaiting the culture. They didn't see any bacteria, but we'll see what the culture shows. As far as meds, Blackie is getting Mirtazapine, Cerenia, Zenequin, Amoxicillin, Prednisolone 1.25 bid and Calcitriol. I have stopped most of his supplements in the hope that he would eat better.

Blackie did not do well last night. Even though he got the Mirtazapine last night, he ate very little and I failed miserably at syringe feeding during the night. He did eat a little more than 1/4 can of FF this morning on his own and I syringe fed 2 Tb of Wellness. I am now worried about ketones, though, with these high numbers and him not eating well. I will pick up ketostix today because the ones I have are almost a year old and I don't think they last that long. I also increased his insulin dose this morning to 3.75.

The other thing that happened last night is that I saw Blackie go outside the litter box. He was sitting at his food & water bowl in the bathroom and was drinking water. Then he stopped drinking and just started peeing on the rug right where he was sitting. His litter box is not even 5 feet away! I don't know what is up with this, but I suspect there's a little dementia going on too.

So today, he is locked up in the bathroom/bedroom with his LB, food and water. I've asked MIL to go over and put him in the LB and see if she can get him to eat. DH said he will try to syringe feed at lunch time if he won't eat. I hope that goes well, he's never done it before.

Thank you again for all your support and love. I really hope that we'll see some improvement soon.

Yesterday: viewtopic.php?f=9&t=36925&start=50
 
Re: 2/17 Blackie amps 387 +2 410

Ele, I'm continuing my healing thoughts and prayers for little Blackie. One positive that you've mentioned was that he did eat a bit more than 1/4 can of the FF, which is a good sign. :) It's something, even if it's small. Am continuing my prayers and healing thoughts. I wish for him to make a full and speedy recovery and soon. He's not only got you worried, but the rest of us as well.
 
Re: 2/17 Blackie amps 387 +2 410

thought of you two all night...and i so wished you weren't going thru what i'm going thru...it's so very hard...and i know you know what i mean...

i really hope you get some answers...and that they're better than you expect...i really do

keeping you both in my daily prayers...
 
Re: 2/17 Blackie amps 387 +2 410 +6 342

DH got Blackie to eat 1/4 can of FFMedleys, but I think it was the 13% ones. Oh well, at least he ate and his number came down some. He wouldn't eat at all for MIL at +4. I'm still praying we'll see some improvement soon.
 
Re: 2/17 Blackie amps 387 +2 410 +6 342

flip_cat Way to go Blackie!! Keep eating.. it does a body good ;-)
Thinking of you both... Ele & Blackie, praying too!!
I hope you are having a good afternoon!
 
Re: 2/17 Blackie amps 387 pmps 346

Hi Ele & Blackie, I hope that the evening and night will go well and that Blackie will eat, use his litterbox, and do all those little things that signify that he is feeling better. Thinking of you and sending vines of comfort.

Many hugs,
Ella & Rusty
 
Re: 2/17 Blackie amps 387 pmps 346

I think of you guys daily - keep hoping that Blackie will feel better. I hope he will have a good night tonight, and rest well. Hugs from Mannie and me.
 
I am trying to give the abs and Cerenia a chance, but Blackie is gradually getting sicker. He won't eat at all now. I syringe fed from pmps to +4. He also peed on himself & the floor again. His belly is huge and he's gained more than 6 oz in 12 hours. He's breathing ok and doesn't seem uncomfortable. I've had him on my lap almost all evening. If he isn't better in the morning, I'll call the vet and see what he thinks.

I hate being such a downer in LL, but I really do appreciate all the prayers and vines.
 
I'm worried about the belly - does the vet know this? Dogs in heart failure sometimes get fluid retention in their abdomen. I'm worried about the pred and the fluids. But breathing is okay so I'm not sure.

When Maverick had FHL and he sat down his sides would poke out and he had a wierd bloated look but this didn't happen overnight.

((((((Ele))))))) ((((((Blackie))))))
 
Fluid accumulation (ascites) in cats: http://www.vetinfo.com/cdifferential.html



Question: What are the causes of fluid accumulation in cats?

Answer: Pat-

These are causes of fluid accumulation (ascites) in cats:

severe liver disease --- cirrhosis is actually fairly uncommon in cats, but it does occur. If there is a problem in the liver really inhibiting circulation through it, such as liver cancer or really severe liver swelling, this could lead to ascites, too.

pancreatitis -- this has to be pretty severe but it can cause ascites and it might also cause the elevations in white blood cell count, hypoproteinemia and electrolyte disturbances. Usually cats with pancreatitis have vomiting associated with the disorder. Cats with this condition probably in pain from it but don't show that well. Administering pain relievers can help a great deal in making cats feel better and is worth doing on the suspicion of pain, in most cases

heart disease--- the most common heart disease that will cause ascites in cats is cardiomyopathy, but other heart or pericardial problems might cause it. This seems unlikely based on the exam findings but has to be considered.

cancer --- I think that cancer is probably the most common cause of ascites in older cats in our practice but I haven't actually tallied up the cases to be sure of this

FIP -- this is primarily a disease of younger cats, in that the great majority of cases occur in cats less than two years of age, but it can occur in older cats sometimes. Usually, there is an increase in serum protein with FIP due to increases in antibody production (globulins). Personally, I would tend to discount this possibility.

Inflammatory bowel disorders -- sometimes, but not very often, inflammatory bowel disorders (IBD), can lead to ascites. This happens when the intestines get inflamed enough that the leak protein, leading to a loss of protein in the blood stream and this leads to ascites if the protein gets low enough. This can happen with internal parasites in puppies and kittens but that isn't too likely in an adult cat.

It is possible to tell a lot from the appearance of the fluid, sometimes. For instance, if fluid is withdrawn and it turns out to be blood, that would be whole different set of possibilities, such as exposure to rat poison, other bleeding disorders, trauma, etc. If the fluid turned out to be pus, then some sort of septic process would be likely. The fluid associated with FIP is usually yellow and very thick. Other problems produce fluid with different characteristics. Sometimes the fluid contains obvious cancer cells, which makes the search for a diagnosis easier. I am assuming from your note that this was definitely fluid and not blood or pus and that there wasn't anything too remarkable about it.

An ultrasound exam is a good idea. It can help to determine if there are tumors and help to determine what the pancreas and liver look like.

I would take the trip to the internist if the ultrasound exam doesn't show a clear answer for the problem, even if it does involve a trip.

I agree with your vet about getting your cat to eat. I wouldn't worry about the protein content of the a/d diet right at this time. If liver can not process ammonia, the breakdown product of proteins, there will be signs of incoordination, blindness, staggering or seizures. If it does turn out that liver disease is present, the diet can be altered.

Feline infectious peritonitis is still difficult to test for accurately. There is a test whose developers claimed was specific for the FIP coronavirus rather than all coronaviruses of cats, but I don't think that the claims have proven to be accurate. I know of no successful treatment for FIP at this time. It is likely that there are ongoing studies of FIP but I wouldn't go to a lot of trouble to find them, just yet. The odds that FIP is the problem are pretty low. It is not very common in households with three or less cats (you didn't mention how many cats you had but I am assuming not too many). Due to the nature of FIP infection, there isn't a great increase in the risk to the other cats in the house even if this cat does have FIP. So for right now, I'd wait for the cytology and the ultrasound results before worrying more about FIP.

Ultrasound exam can often give a pretty good idea of whether or not liver disease is present. It is usually necessary to do liver biopsy in order to get a definite diagnosis of the type of liver disease present, though. This can sometimes be accomplished by an ultrasound guided needle biopsy and sometimes it is necessary to get a sample for biopsy through surgery. Hepatic lipidosis is the most curable of feline liver diseases and the treatment consists of feeding the cat adequate calories until it is well. Cholangiohepatitis is controllable for long periods, in many cats, using medications. Suppurative cholangiohepatitis is sometimes curable by eliminating the infectious agent if it is a bacteria that is susceptible to antibiotics. It is possible to remove a portion of the liver if there is a cancer that seems to affect only a portion of the liver. To the best of my knowledge no one is doing liver transplants in cats, but it is possible someone is.

The high neutrophil count, with no immature neutrophils reported (no band cells), along with a decrease in lymphocytes, is a typical white blood cell picture for stress or from the administration of corticosteroids. Unfortunately, that doesn't narrow the search for a diagnosis in this case. Low calcium is probably occurring due to the low albumin. Calcium is carried in the blood stream attached (bound) to albumin, so when there is insufficient albumin, the total calcium level drops. Usually the ionized, or free, calcium is normal. Low calcium sometimes occurs in pancreatitis due to the calcium getting trapped in the inflamed tissues in the abdomen, though. The low albumin levels can occur with liver failure, inflammatory bowel disorders, kidney failure and cancers that are causing intestinal or liver problems. Usually low sodium levels are due to vomiting. If you are not seeing vomiting, I am not sure what to make the low sodium and low chloride levels. Rupture of the urinary bladder can lead to low sodium levels but that leads to rapid deterioration in a cat's condition, which doesn't seem to be happening and usually the BUN and creatinine are elevated, too. Low anion gap occurs with low serum albumin so the elevation in anion gap doesn't make much sense to me, unless your cat is pretty dehydrated, which would be scary, since that usually makes the protein level even lower, in reality, than the measured level. Sometimes, when there is fluid accumulation in the abdomen, it will lead to a low volume in the blood stream (since the fluid is coming from there, ultimately), even though the total fluid volume in the body is elevated. This might be causing some of the abnormalities in the electrolytes. Correcting the ascites, might help with this. The diuretic (Lasix Rx) might help in this regard.

I'm sorry, but I can't answer the question about vets in Lexington. I am not personally familiar with anyone practicing in that area. I have sent a couple of patients to the vet school in Knoxville and have been satisfied with the care they received but they were all cats with hyperthyroidism needing radioactive iodine therapy.

Again, I would encourage you to go to the internal medicine specialist if the cytology report and ultrasound exam do not give a clear diagnosis. If there is still confusion after the visit to the internist, it may be a good idea to consider going to the veterinary school.

I would lean towards cancer and pancreatitis as my leading differentials but liver disease has to be included in the differential diagnosis and FIP is possible. Some of the cancers that can lead to the signs you are seeing can have a good prognosis. Intestinal adenocarcinoma causing a partial obstruction of the intestine or intestinal inflammation would be removable surgically, in many cases, and the prognosis after surgery is pretty good, for instance. So you don't have to give up if the diagnosis is cancer.

I hope this helps some.

Mike Richards, DVM 4/18/2000

Read more: Differentials in diagnosis
 
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