Cami vet visit 3-21-13

[Sheila & Beau GA & Jeddie GA]

Today was a follow up on her emergency visit two+ weeks ago for new imaging. Dr. Yohn decided the US was not necessary after taking two full body xrays, although she said she did a "quick pass" with the US.

She is pleased with how Cami is doing, that she is not seeing the fluid in her belly anymore, the lung shadows are gone (might have been pneumonia) and that she seemed much "brighter" in appearance and behavior. Cami has gained a little weight (5 ozs).

On the 'not as good' side, the enlarged organs and lymph nodes are still the same and Dr. Yohn can't rule in/out lymphoma at this point. Only a biopsy could rule that in or out (same with FIP, but she doesn't think it is that). This could be a severe, and chronic, inflammatory situation that depressed her immune system and a bacterial infection took hold. The bacterial infection is probably being taken care of from the Baytril (which she will be on another two weeks). She will be on pred for "months" along with everything else I am doing (Denamarin, Pepcid, B12 shots, probiotics and enzymes - and insulin as needed. She said the Animal Essentials Plant Enzymes and Probiotics that I have been using is a very good product and was happy I was already doing that. Cami has been on them since I got her, but I might adjust the dose upwards a bit.

Right now it is a waiting game, while Cami gets all the meds/supplements, to see if she continues to improve or not. I saw her xrays (have copies) and her belly bloat, which looks from the outside/above like she is going to deliver kittens in about a week, is all from the enlarged organs. I have her full blood panel results from two weeks ago that I will pour over looking for clues, but I don't know what I will find that the board certified internist missed. :roll:

Cami has been back on insulin for two days now. :sad:

 

[Grayson & Lu]

Have you thought about an IGF-1 test at MSU? If she's mostly off insulin, it may be a moot point, but it sounds very familiar...

We've got one acro kitty (Ingrid's TC) that has fluids in his belly and gets drained every day or two.... and of course most all of our acros have gi-normous organs.

When Grayson started putting his weight back on (IBD made him look anorexic at 12#)... he started looking like he was pregnant... then grew "saddlebags" on his sides - I even posted a picture to see if anyone had seen it - and EVERYONE's cat had them! Of course now that he's almost 20# again, he kinda waddles, but he can still jump - especially if there's food involved! ;-)

Good luck... hoping she stops needing that insulin again very soon!

 

[Sheila & Beau GA & Jeddie GA]

Lu-Ann, both acro and cushings are constantly on my mind because of the belly bloat and now the enlarged organs, but also she has a prominent chin - it seems to jut out further that I am used to - however, I think she is part Persian and has the older kind of Persian face that is flatter but not pushed in. That would make the chin more prominent compared to the rest of her face and what I am used to. I should try to get a profile pic of her. Also, her back legs seem way longer than her front, but they also seem stiff and are not as curved as my other cats' rear legs. And she has a ravenous appetite, but is not gaining weight. And she is not struggling to maintain BG control and is not on a high dose.

I did ask this vet about both and she said she does not see the body changes or the uncontrolled FD that you would expect. Her blood work shows the markers for inflammation particularly of the liver - high ALT, AST, Amylase, bilirubin and BUN. She has high neutrophils and moncytes and low lymphocytes, and is anemic. Those are the main findings.

 

[Grayson & Lu]

Well the organ growth made me think of Acro. Now there are some folks in the Acro group that have kitties with high dose, but no Acro. Also Acro but not Insulin resistant. Some insulin resistant without being Acro. Keep in mind, that Grayson never LOOKED Acro. He was down from 22 to 12 pounds. He looked anorexic. He was long, but no longer had the Popeye arms that I'd consciously noticed before the weight loss. But the organs were big on the US. Not diseased, just large. Of course you heard about his Tupperware-opening skills, and doing ANYthing for a bowl of Kitt-N-Kaboodle. He was eating 10-12 cans of FF/day (30-36 ounces). So I read all I could, then examined his teeth. There was about a 1/8" gap between his canines. And the picture of him in the breadbox (where I used to hide the kitty snacks) - he looked like a jack rabbit!!! I had also noticed the legs when we were doing a shot.... just the rear ones. So it's not a stretch that she has SOME of the characteristics and not all.

Once G FINALLY started putting his weight back on (holding about 19.6# since Christmas), he has not only the big belly and the little swagger thingy, he also has saddlebags. I presume from the organs. That's why we're going to do another ultrasound soon. But otherwise, he's good. Insulin is down about 60% from his max, weight is up (no longer anorexic-looking!), his appetite is still healthy, but not ravenous, and he's responding to insulin more like a normal diabetic kitty. He also had a staph infection in one ear, that very likely was a huge obstruction to his treatment. FINALLY got that cleared up, and the numbers came right down.

They can really make us scratch our heads, but if you can, I'd say the IGF-1 test would be a good place to start. My vet never imagined we'd get positive results... so it's been a learning curve for both of us. Good luck!

 

[Sheila & Beau GA & Jeddie GA]

Definitely a head scratcher here. Cami has some characteristics of acro and some of cushings (but more acro, I think), but how can she have always been on a very low dose and then have gone OTJ? I am assuming she would still be OTJ if she weren't on the pred. Even now, I am shooting as needed.

The vet said that her liver and kidneys were enlarged and her pancreas and intestines were thickened - based on her US images. I don't know how they determine something is normal or abnormal with US (like enlarged, but normal as you say Grayson's organs are). I guess it's the wall thicknesses or something (except livers and kidneys don't have walls the way intestines and hearts do. And she has enlarged lymph nodes too - would that be an acro or cushing thing?

Right now I think it is the insulin/BG history that is contradicting the usual symptoms of those two diseases. I need to find info on the possibility of low dose/no dose acro/cushings. However, I wouldn't do anything differently, I don't think. I certainly can't afford acro radiation treatment or surgery for adrenal gland removal. It would just be an answer, I guess.

 

[Grayson & Lu]

I know they can measure off of the US - don't know why they couldn't do that from an x-ray as well, but my vet tech said the same thing. If they've got a previous result so there's a baseline, that would be most ideal.

I would definitely check out her teeth. I examined just about ALL of my cats to see if they were snug or separated. Grayson was the only one with a gap. I tried to photograph it, but wasn't able to until I got the vet to help.

When Grayson was first dx with FD, he had been shedding profusely. Looked like a teddy bear had exploded. You couldn't touch him without getting a handful of fur. The floor was a NIGHTMARE!

 

[Sheila & Beau GA & Jeddie GA]

I have never heard of a tooth gap. And you said "between his canines" do you mean the incisors? The canines are the fangs. Is that supposed to be an indication of the growth of the lower jaw - and is it just on the lowers, or both?

Cami has some tartar on her teeth - the reg vet noted it when I brought her in for the rapid breathing, but said "it's the least of her worries right now". She didn't really look further at them and I hadn't brought up acro/cushings with her at all (and doubt she knows about the teeth gap).

I do have an xray from her old vet from last July. Maybe I should take that in. I was trying to compare things on it to the one from last week, but her organs are still hard to see on the recent one.

 

[Grayson & Lu]

Not sure of the official name for them: I call them the fang teeth. Top/Bottom. G has a gap between his. I examined all my other cats and they were tightly positioned. And yes, this is due to the jaw growth.

 

[Sheila & Beau GA & Jeddie GA]

Ok -I see what you are saying - the gap is between the uppers and lowers. Yes, those are canines. I thought you meant a gap between one tooth and the one next to it - and the canines are not next to each other. See - a picture says a thousand words! I will try to check Cami's but she is really getting mad about all the pills so if I touch her mouth I bet she will get really ornery and squirmy.

 

[hmjohnston]

We don't have to worry about that on one side- Sneakers lost those teeth!

Poor Cami, getting meds isn't fun. I hope she understands that this is trying to help her feel better instead of making her more miserable.