'Sick' kitty - ideas?

[beowulf]

I could use the Cat Pride COTH wisdom.

I have a 10 y/o kitty who has had on/off skin issues for the last six years. We went through a few different vets with few different moves. We tried elimination diet, allergy tests, and dermatologists with no answers besides “it’s possibly environmental / it’s possibly stress / your cat could be allergic to human dandruff”. She has also had occasional UTIs through out the years that they chalked up to environmental as well.

Her most recent check up was early December. I sent her in because I was leaving to help a relative for 2 weeks, and I noticed she had slowed down a bit, including eating habits. She has always been a “lick the plate clean” cat but lately has been leaving her wet food after a few bites. She will act hungry and would eat human food if I let her. Vet ran a CBC/blood test/kidney panel and reported most values were “fairly normal” except her lymphocytes values were high. I never got definitive numbers.

This is an indoor cat only. No recent outdoor exposure, so tickborne diseases are unlikely. They advised coming back in a month to re-run the panel and cautioned I may be looking at some form of cancer.

The reason I sent her in the second I noticed this is because this was the first symptom of aggressive lymphoma with one of my dogs.

So it’s been a month, and her check up was slated for Friday. She started throwing up her food last weekend. Not the “I ate too fast” throw up but the very liquid type - and it’s only her kibble. She isn’t throwing up wet food. I called the vet. They had to reschedule my appointment because it was a “tech” appointment and not a “vet” one.

She’s going in tomorrow. Vet want to run X-rays because they think it is an obstruction. Is this normal? She hasn’t lost weight and doesn’t have diarrhea. She doesn’t play much and doesn’t have a habit of eating anything that isn’t chicken. I guess I am used to things in the horse world where there is some agency with diagnostics. I’ve gone through with this vet pursuing their every diagnostic whim, and have never gotten definitive diagnostics. I’m starting to feel a bit frustrated by the experience.

WWYD?

[DMK]

Since x rays are about the cheapest thing you can do, I’d be just fine with that. I’m guessing they are ruling out the possibility of a partial obstruction (think hair tie… Irresistible to cats) where the water based wet food can get around but not the kibble

[beowulf]

Are they cheap? I just had her x-rayed over the summer (a topic that probably deserves its own entire thread) and it was $400 - that’s more than it cost me to pull bloodwork.

It surprised me considering I had my whole entire horse’s spine x-rayed for $260.

I don’t mind paying for diagnostics if they’re necessary, the money isn’t really part of the question. The question is more, are these necessary diagnostics? I’m not a vet, so I don’t know. I only know what vet-med I know through working with a horse vet.

I’ve more or less lost some faith in my practice. In the spring, they discovered a heart murmur during her yearly check up. Vets said she needed to see a cardiologist, so I scheduled her with one of the visiting specialists. $1200 later, cardiologist says he doesn’t hear or find anything on some very exten$ive ultrasounds.

The cat is sick - clearly. I’d love some answers.

[Simkie]

I agree that I’d green light the radiograph, but I’d also expect to see nothing. An obstruction can be life ending, though, and in a pretty terrible way, so good to cross it off the list.

Cats are such weird stoic little creatures, and it seems we know less about them than other animals we live with. That seems to mean that they can be “off” for a long time before we’re able to figure out WHY.

My go tos for inappetent cats are famotidine & mirtazipine. Add nausea, and I add zofran and occasionally cerenia. We’re very rarely able to determine the cause, unless it’s really bad. Here, I’d wonder about a pancreatitis (a chronic, slow burn style pancreatitis, rather than the “holy cow, this cat is going to die” acute style). I also think kitties develop gastric ulcers far more often than is recognized.

I very much share your frustration in spending gobs of $$ for no answers. I think it has more to do with how little we really understand about kitties rather than competence of a specific vet practice.

[beowulf]

Are these things I can request? I’ll definitely write these down, thank you.

I have such a good relationship with my horse vet where I can ask for any drug I think the horse needs, and he greenlights it. With the cat vet I’ve sensed some push back. Part of it I can understand. I’m sure they deal a lot with people who think they know better than them.

It is frustrating how little we know. I always feel for the cats - they are so misunderstood… and you are right, they are so stoic that often times when they take a turn for the worse it is too late.

[JB]

I’d start with a test for toxoplasmosis to at least rule that out. You can also do xrays, and even a dose of barium to see if there’s a blockage that isn’t showing up on xrays, if needed

And yes, test for something like small cell lymphoma, which can be done by ultrasound first, and then a biopsy if needed for validation.

We had a cat who had both, not sure which precipitated which. The Toxo was easily taken care of.

Her small cell intestinal lymphoma was also “easily” taken care of with chlorambucil chemo, which cats tolerate very well. It’s not all that cheap, not that the meds themselves are $$ (it’s pretty cheap actually), but regular blood work in the beginning is needed to make sure her body handles the drugs, and then you start reducing frequency of blood work

I agree with famotidine (generic Pepcid, so OTC), and mirtazipine (Rx, pills, or transdermal gel) can be great. But you do need some reasonable idea what’s causing all this. Poor kitty, jingles!

[Alex_and_Bodie_s_Mom]

Jingles to you both! The struggle to get a definitive answer can be so frustrating.

Just a thought - did they listen to her lungs while she was there last time? Slowing down, not eating, and losing weight were the first signs that my kitty was in congestive heart failure (of course, those are all super-generic symptoms). X-rays showed the fluid in her lungs.

I would second putting her on the mirtazipine (the transdermal gel if you can get it; it’s a total miracle) until you have a clearer idea of what’s going on. It will at least calm her stomach down a little.

[Simkie]

@beowulf

Are these things I can request? I’ll definitely write these down, thank you.

Famotidine is OTC. I like the generic pills from Walgreens because they’re teeny. Quarter a 10 mg (regular strength, not extra) and drop 2.5mg into wet food once or twice a day. The small Walgreens tabs don’t need to be crushed or anything, they’re so wee. Larger pills will need to be crushed, but it seems to be tasteless & well accepted.

The rest is RX:

Mirtazipine is an old people anti depressant that has great effect as an appetite stimulant. My horse vet actually prescribes it for me for my kitties. I give a quarter of a 7.5 mg tab (just shy of 2 mg) every other day or twice weekly. These are also small enough to drop into wet food, but can also be crushed, seems to have no flavor.

Zofran (generic: ondansetron) is a people anti emetic and cheap now that it’s gone generic. I always have some around the house from my own surgeries or whatever but vets have prescribed when I’ve asked. Quarter a 4 mg tab, give 1 mg once or twice daily for nausea. Usually if they’re nauseous they’re not eating, so I wrap in a scrap of pill pocket (just enough to cover) and pill them.

Cerenia (maropitant, no generic available) is a veterinary anti emetic. It’s a substance p inhibitor so is also effective on visceral pain & may have some anti cancer activity. Vets like this a lot for nausea, but I’ve just never found it effective alone. But I do like it paired with zofran–they seem to work really well together. Dosing has changed in the last few years, I’m not sure what current recommendations are off the top of my head. This one is really where I go last, when I think there may be some visceral pain or when zofran alone just isn’t cutting it.

With what you describe, I wouldn’t explore deep diagnostics as they’re just so likely to show nothing for the $$$$$. A quick plain film to rule out an obstruction isn’t too unpalatable (although 400 bucks seems a bit nuts) and I’d just treat with some combo of the above & see where it goes.

[Catherine616]

The X-ray is a good idea and “relatively” inexpensive. I have found both with horse and small animal vets I am most comfortable with practical ones who diagnose step by step rather than “throwing the book” at a problem. If that is at all helpful.

[DMK]

Yes, I meant that in the deep dark $$$ hole of diagnostics, x rays and ultrasound are your cheaper first steps, because blood work only gets you so far…

[DMK]

I’m the same way, but the internets are loaded with people who crucify their vets because they didn’t try X procedure first so it’s probably not a bad idea to have the “I’m OK not going on a zebra hunt” conversation with the vet if you don’t already have that relationship/understanding.

[beowulf]

Sorry, I am definitely not trying to crucify my vet. I’m a little unhappy with a few misdiagnoses, but I still recognize the job they do is tough and I appreciate my vets. You guys have all made me feel much better about all of this, thank you.

[DMK]

Totally didn’t mean you, I was replying to another post!

[shiloh]

All suggestions as for diagnostics are right on, IMHO. However, the no definitive answers would frustrate me as well. I do keep in mind that some doctors are better at providing more definitive answers than others, but tap dancing around and going well, it COULD be or it MIGHT be is not helpful. If you are going to say that then tell me why you say that. You may need to communicate that you need more info than they are providing you, that you prefer your answers to be more “structured,” shall we say. I don’t mind some faffing around when it comes to me but with my pets, I can’t take beating around the bush. I read your posts and feel you are rather more than disenchanted with your small animal service. Maybe time to find another?

Crossing my fingers and jingling for kitty!

[StB.YM]

Do you know what her platelet count was? If its below normal, it may be colitis caused by allergies.

I went through very similar issues with my cat for years, with ineffective recommendations from her vet, until I switched to my current vet who figured it out in one talk. My cat’s symptoms were frequent vomiting (at her worst, 2x per day, eventually with projectile vomiting), hairballs, scratching and excessive licking to the point where she was covered in small scabs, and diarrhea.

We tried a couple different treatments with her current vet until we settled on a medication that worked for her. Right now she’s on a combination shot of a steroid (can’t remember the name - maybe started with a “t”) and ovaban. Her vet also had us switch to a spray style flea repellent (Vet-Kem Flea, Tick and Bot Spray). She’s indoor only, and we’ve never seen a flea in the house or on her, but apparently she’s horribly allergic even the smallest amount of flea presence (even if its a dead flea). She gets one spray once a week and with her shot, can go 2-3 months before her symptoms reappear.

She does go off her food when her symptoms are starting to show up again.

[StB.YM]

@Alex_and_Bodie_s_Mom

Just a thought - did they listen to her lungs while she was there last time? Slowing down, not eating, and losing weight were the first signs that my kitty was in congestive heart failure (of course, those are all super-generic symptoms). X-rays showed the fluid in her lungs.

If mine completely stops eating - even her most favorite food in the world (kibble) - I know its her heart (she also has CHF). Usually its accompanied by fast breathing and rapid heart rate. If she just goes off her wet food, I know its her allergies.

@Simkie

(although 400 bucks seems a bit nuts)

This is also what I paid for my girl’s chest X-ray in December, though I was only charged $200 for the follow up X-ray.

[4horses]

Given the age of the cat, it does sound highly suggestive of either inflammatory bowel disease, small cell lymphoma, or pancreatitis.

I had a cat with lymphoma. He made it 1 year after starting treatment with chlorambucil. I don’t know if it was small vs. large cell lymphoma. The medication made him comfortable but it spread to his kidneys. He originally presented as having an obstruction.

[Angela_Freda]

Teeth are ok? No infection, loose teeth, etc?

Glucose was ok? Meow, my diabetic acromegaly had a brother who was basically feral, and kept having periods where he couldn’t keep anything down, except canned food which I gave him just to keep him hydrated and to stimulate his appetite.
He died, and I am pretty certain what he was suffering was actually ketoacidosis.

[js]

Agree, get the x-ray’s. We lost a cat several months ago at age 8, he had several large tumors in his abdomen, x-rays confirmed what the vet thought; it was something completely unexpected considering his age. Try giving really creamy foods like the meat Baby Foods.

[beowulf]

Thank you all for the thoughts and experience – and sorry for your loss, @Angela_Freda, @4horses and @js

Kitty was dropped off this morning at the vets. They are going to do radiographs, urinalysis, complete blood cell count. They are sedating her to do the exams.