Mystery diagnosis...any ideas?

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xpaczbaybe
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Mystery diagnosis...any ideas?

Post by xpaczbaybe »

Hi everyone! I stumbled across this site while researching symptoms my cat has been displaying. Wondering if anyone has any ideas or input?

To start, my cat, Burger, is appx 7 years old (he was a stray) and FIV+. On Monday, February 17th he went to the vet for his yearly checkup. I had routine blood and urine run (CBC, Chem, T4, U/A), all were within normal range. He was given a clean bill of health aside from being significantly overweight (21 pounds, at the time). That Saturday, he started acting unusual. I was out of the house pet-sitting that week, and he was staying with my parents. They called concerned because he was hiding in the bathroom and seemed to be in pain. I went home to look at him, and he was definitely painful in the right rear leg, where he had gotten blood drawn earlier that week. I called his vet and described what was going on with him, and she said that it sounded like he was painful due to the bruising from his blood draw, although mentioned that it was odd that he was just starting to show pain now. She suggested keeping an eye on him, and bringing him in on Monday if he wasn't showing any improvement, so she could take a peek at him and give him pain medication. Monday arrived, and while he didn't seem painful anymore, he was very unsteady on both rear legs, walking as though he was drunk. The vet was extremely worried that he was throwing a clot, and we ran x-rays and an ECG. The x-rays showed that his heart was slightly enlarged, and the EKG showed an extreme arrhythmia. Also, while apparently unrelated, the x-ray showed what appears to be a bullet fragment lodged in between two of his lower ribs. I've had this cat for 3 years and he's strictly indoors, so this must have happened in the time before I got him. Due to the location, the vet doesn't believe it's relevant to his current issues. She prescribed 3 medications to give him, and had me follow up with a cardiologist at Cornell University. Our appointment at Cornell was on Wednesday, February 26. At Cornell, they did further testing, including an echocardiogram and an ECG. The results led them to suspect Hypertrophic Cardiomyopathy, but said that the presentation was atypical. They started him on Soltalol to hopefully help eliminate his arrhythmia, and Clopidogrel and Benazepril to help with the suspected clot.

We rechecked back with the cardiologist this past Monday. Since his initial visit, Burger's gait has improved, although his rear legs are still mildly weakened. He is urinating and defecating on his own, although both are completely incontinent. They ran more tests, which showed that his arrhythmia had significantly improved, and blood work. The labs showed that his CK (creatine kinase) level was within normal range (his was 319 - normal being between 73 and 388). The cardiologist then told me that she no longer thought Burger had thrown a clot, as their CK levels will be extremely elevated during and after throwing a clot. She was now starting to think that his problems were neurological, and referred me to their neurologist. The neurologist reported absent tail tone, absent anal tone, absent perineal reflex, and absent sensation in tail (meaning he couldn't feel any pain). He believes that the localization was between the L4-S3 vertebrae, predominantly between S1-S3. He said that those injuries are most commonly caused by trauma such as being hit by a car or having his tail severely pulled, neither of which happened. He said that an MRI would be ideal, but also cautioned against it - due to his heart condition, he likely wouldn't pull through the anesthesia.

As of now, Burger's status was left as a guarded prognosis with an inability to determine the cause of his symptoms. They said that he may eventually regain continence and the sensation to his tail, but there was no way to tell.

If you've made it this far, I applaud you, and truly appreciate it. My question to you all is if any of your pets have experienced something similar to this? If so, did they ever regain sensation and continence? And what did their diagnosis turn out as?

Burger is still a happy kitty, and loves getting his butt-baths and having A+D ointment applied to prevent any urine scalding. I work at a vet hospital, so I am able to bring him along with me to work whenever necessary to have his bladder fully expressed, enemas given (he is currently defecating normally, but has a history of hard, dry stools that he wouldn't be able to pass on his own in his current condition), etc. While obviously I hope for a full recovery for him, this isn't so much about his quality of life (as I said, he still seems happy and is pain-free. Euthanasia is completely out of the question at this point.) as much as it is my frustrations and curiosity. He has seen 2 regular doctors, 3 cardiologists and 1 neurologist, and none were very confident in a diagnosis for him. I am currently looking into phototherapy and acupuncture that an affiliated animal rehab facility offers - while we are unsure if they will help, they definitely can't hurt. I realize that while I'm sure Burger isn't the only cat to have this happen to him, most owners don't pursue treatment or even diagnostics, for various reasons. However, from looking around this site, I'm hoping that one of you may have been through something similar, as I truly feel alone in this situation at the moment.

Thank you in advance for any input or guidance!

-- Amy
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critters
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Re: Mystery diagnosis...any ideas?

Post by critters »

:whale: It definitely sounds like a spinal cord injury, and, frankly, I don't think it really matters whether he pulled his tail or whatever. I've had boys with SCI from HBC, tail pull, and the works, and it is most certainly possible, and I'd even say likely, that he'll improve. There are pee meds that can help as continence comes back; in the meantime, I'd keep expressing, make lactulose my friend, and consider using Cavilon spray, now widely available in 3M first aid products, as a skin barrier (you'll probably want to buzz some hair if you use it; otherwise, hair gets gunky).

Congrats on having somebody LIKE butt baths; I've never been so lucky! :mrgreen:
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CarolC
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Re: Mystery diagnosis...any ideas?

Post by CarolC »

I read your post carefully and will probably have a few comments/links to add later today. My only comment right now is we have a somewhat similar case on the board currently and it is a coincidence because I don't remember too many mystery paralysis cases with cats here. There may have been some, perhaps I am just not remembering. Odd that we have 2 cats who have both had the works in terms of diagnostics, and the same result.

viewtopic.php?f=4&t=18390

:welcome:
xpaczbaybe
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Re: Mystery diagnosis...any ideas?

Post by xpaczbaybe »

i have never heard of Cavilon spray before, I'll look into it immediately, thank you.

I quickly scanned through the other topic, and am about to go back to read it over more thoroughly. From the quick scan, while the rapid onset is similar, her case seems more severe in the sense that he cat is unable to walk. Mine, while wobbly and struggling for the first few days, is able to walk and jump again (i definitely discourage the jumping, although if I don't get to him fast enough he's determined to get on my bed to snuggle. Luckily, my bed is very low to the ground.). While his back end still appears to be weak, I'm extremely lucky that he is not paralyzed. I am envious that the other poster was able to have an MRI performed. I'd LOVE to be able to get a definite answer (hopefully) on what is going on with Burger, but I'm not willing to put him under anesthesia until his heart is stronger.

Thanks to you both for the feedback!
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CarolC
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Re: Mystery diagnosis...any ideas?

Post by CarolC »

I've gone through a list of ideas of things that cause staggering, but none of them quite fit. It might not hurt to do another thyroid test? It sounds like you did the T4 test that was in-office. There is another one that costs more and you have to send it off to the lab, but sometimes it will show something when the in-office test does not. Or at least that was the case 10 years ago, it might have changed since then, I don't know.

It happened at your parents' house, and he's heavy. Perhaps he tried to jump up onto an unaccustomed place and slipped and fell? I'm really betting he fell, or he knocked something over that fell on him. You might ask your folks if they noticed anything knocked over, such as maybe a plant stand or something? I would think if you had a snow shovel with an oak handle and it fell over and landed on him just right, that could really hurt, and nobody would think anything of a snow shovel on its side in the garage. So...anything like that, maybe they can think some more about anything that might have happened that they paid no attention to? I know your folks are saying nothing happened, but they would not be able to watch him every minute. Folding chair, stepladder, anything that might have fallen over or he might have pulled down on himself.

If it was something like that, then I wonder if steroids would be helpful? Were there any steroids in the 3 medications your vet gave before he was seen at Cornell?
xpaczbaybe
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Re: Mystery diagnosis...any ideas?

Post by xpaczbaybe »

I currently live with my parents (moving out on my own next week, actually!), so he's used to where everything is in the house. That being said, while he's still jumping on things despite my best efforts to keep him on level surfaces, I HAVE noticed that he won't even attempt to jump on the washing machine. That's where we had kept one of the bowls of cat food (pretty much the only spot my dog couldn't get to). I wonder if he fell off of that?

As far as expressing him - I had been bringing him to work with me every day to have his bladder expressed initially, but after a week or so of that, his bladder was either empty or extremely tiny. I'm bringing him now once or twice a week (on slow days!) to have the doctors double check his bladder and just assess his overall status; but it seems like he's typically fully expressing his bladder...just not in the box. He's not leaking urine when he's sleeping anymore - instead, after sleeping for hours, he'll get up and start to walk around the house and have a CONSTANT dribble behind him, with some larger puddles in between when he stops walking. This will go on (with me trailing behind him cleaning up the messes) for 20 - 30 minutes, at which point he'll sit down and start grooming himself, and then go back to sleep. It baffles me, because he has enough control over his bladder to not go on his (or my!) bed anymore; but either doesn't make the connection to go to the litter box, or can't feel how badly he has to go...idk?

The initial 3 medications he went on before going to Cornell were all for his heart...Clopidogrel, Lasix, and Benazepril. Not sure if any of those contain steroids? After his echocardiogram, Cornell didn't see any signs of congestive heart failure, so they took him off of the Lasix, and started him on Sotalol for his arrhythmia. Then, after the last visit, they took him off of the Clopidogrel and Benazepril since they no longer think he threw a clot; leaving him on Sotalol and adding in Lactulose (he had previously had extremely large, dry stool; and hadn't had a normal bowel movement in almost 3 weeks. The lactulose has seemed to help GREATLY with that. He's leaving smaller amounts of formed stool around the house...solid enough to clean up easily, but with enough moisture to pass through him).

Something else interesting I've noticed, is while he has no tail tone and no pain sensation in his tail, it's NOT paralyzed. Every now and then as I'm rubbing his back, his tail will flicker...which I initially chalked up to reflexes or something. But then last night as he was walking around the house, he moved his back to a wall and started shaking his tail like intact male cats do as they are spraying. He IS neutered, and nothing came out of him, but it was long enough and consistent enough where I really don't think it was just reflexes. Immediately following, I tried lifting his tail and it flopped back down, and tried pinching it firmly to no reaction. So your guess is as good as mine as to whats going on with him!
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CarolC
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Re: Mystery diagnosis...any ideas?

Post by CarolC »

I would think when you notice him starting to walk and dribble, that would be a good time to express him, maybe you could cut down the cleanup.

If it was my cat I think I would consider steroids. If he had some kind of trauma, such as slipping off the washer and bruising his tail area, they would help reduce swelling and might improve function.

Very cool that he was backing up to the wall and going through the spraying motion! :D
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critters
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Re: Mystery diagnosis...any ideas?

Post by critters »

Hmm. I wonder if this is a case where bethanechol would help? In my experience it makes a spastic bladder worse, but maybe his is floppy? FYI, phenoxybenzamine (PBZ) helps spastic bladders.
xpaczbaybe
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Re: Mystery diagnosis...any ideas?

Post by xpaczbaybe »

i mentioned the medications to my vet - she's unsure if they would help, since she thinks that the reason he's dribbling urine and stool is because he can't feel the "i need to go!" sensation; so it just kind of happens. that being said, she's not opposed to trying them out, either. i have an appointment with a physical therapy specialist on Saturday to give phototherapy a try - she said that she has had success using it on paralyzed animals to help them regain sensation to and control of their bladder and rectum; so she is very hopeful that it will help Burger. Since he is SO hard to give medication to (he gets unbelievably stressed out, fights, foams at the mouth, etc), I think I'm going to give phototherapy a shot first, and if I don't see any improvement then I can try adding the other meds to his daily medicine schedule.

i definitely appreciate everyones input, I can't say it enough. I've worked at a vet office for the past 4.5 years, and I haven't seen a single client even pursue testing for a cat once they are suspected of throwing a clot. There's only been a handful of them, but every single client decided on euthanasia. So going into this situation was terrifying for me as I'd never seen a cat recover from it. I wonder how many other cats would have stood a chance if their owners were willing to even just run some tests. *sigh* This whole experience has been beyond stressful for me, but the stress and the bills will be 100% worth it if he makes a recovery. Any extra time I get to spend with my little man makes everything worth it.
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CarolC
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Re: Mystery diagnosis...any ideas?

Post by CarolC »

I have always worried about clots, too. I bookmarked this post (see the post by Lori Lee) years ago to keep in mind in case it ever happened.

viewtopic.php?f=10&t=3541&p=16970#p16970
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