Seeking ideas for t...

Seeking ideas for tests to request for cat's appetite issues & other health concerns  

Originally Answered: Seeking ideas for tests to request for cat's appetite issues & other health concerns
Hi fellow feline lovers! I have a bit of a health puzzle I’m trying to solve with one of my cats, and having worked with his vet on as many tests as are feasible and finding no answers, I’m now hoping the hivemind might have some ideas. There are a lot of important details, so this is quite a long post. There’s a “too long; didn’t read” paragraph next for those that don’t have time to read the full thing.
TL;DR: 4 year old neutered male cat – indoor only (prior leashed and supervised excursions outside), exhibiting anorexia and weight loss. History of severe anemia, enlarged spleen and pancreas, hepatic lipidosis, heart murmur. Tested negative for toxoplasmosis, giardiasis, and cytauxzoonosis. Health under control now, but disinterest in food has returned. Already talking with vet. Looking for additional ideas or similar experiences.
Pickle is about 4 years old, we adopted him from a local shelter where he was being fostered with a bunch of other kittens and cats. He’s extremely social, loving, and rather petite. He’s fully black except for a few white hairs on his chest. He had been very healthy until this year. In early spring, he seemed to be bored – excessive vocalizations and just acting anxious, so I decided to try taking him on daily leashed walks so that he could explore while still being safe. We had him on a flea/tick preventative, and he’d had all his vaccinations. Shortly after we started walks, he started losing weight and not eating as much. It took us a while to notice, because we have another cat, so food was being eaten, we just didn’t realize that one cat was doing the majority of the eating. At his most recent vet visit he had weighed in at about 12lbs. When we realized something was wrong and got him to the vet he was about 7.5 lbs. Looking back I feel so bad that we didn’t catch it sooner – the weight loss wasn’t fast – it probably happened over the course of 2 months, and he acted perfectly normally otherwise. He became a tad more clingy around the time we noticed – sleeping on us, being extra cuddly, but nothing that made us think, “something is wrong.”
When we weighed him at home we called his vet to see what his last weight was. We told them he wasn’t eating as much, and they told us to bring him on in. The vet did an ultrasound and blood work. Turns out, if we hadn’t gotten him there that day we might have lost him. He was severely anemic, had an enlarged spleen and pancreas, his liver enzymes were elevated, had a fever, and he started hyperventilating. Their first guess was lymphoma. We were absolutely shocked. Our vet essentially said he needed emergency care that they couldn’t provide, so they called a vet hospital/university 2 hours away to confirm they could provide the care he needed and sent us to them. We immediately left the vet and drove to the hospital. They met us outside and took him in (we couldn’t go in because of Covid). They did an intake workup and determined lymphoma wasn’t likely the case (sigh of relief), but they suspected possibly a tick borne illness or parasite. We drove home, they started giving him blood, IV fluids, and antibiotics, and kept him for a week. They did tests for toxoplasmosis, giardiasis, and cytauxzoonosis. Cytaux is what they were *sure* it was. They were absolutely convinced because he was exhibiting classic symptoms and his bloodwork was in line. They also said that cytaux often killed quickly – which would explain why he went from seeming fine to being on death’s door. This is when we also learned that tick and flea meds only kill the ticks and fleas after they’ve bitten and have had time to transmit disease and parasites. (No more adventures outside!)
All of his tests ended up being negative. Since he was declining so rapidly, they began treatment as they ran tests. They pretty much had to carpet bomb him with antibiotics. Once his anemia was under control, he was rehydrated, and he had begun eating again, we got to bring him home. There was one more test they said we could try, but it was risky. They had also heard a heart murmur – which no vet had ever heard with him before – and heart murmurs make anesthesia more dangerous. They said they could do a liver and spleen aspirate test to get a better look at the cells in those organs to possibly see why they were inflamed. But they said with his murmur and his fragile condition, he had a 50-60% chance of surviving the test. Considering his improved bloodwork and improved eating, we hoped that the plethora of antibiotics had just knocked out whatever it was, and didn’t feel like the odds were good enough to risk a test that might not even give us the answers.
It took two months of anti-nausea and appetite stimulants to keep him eating. Once we weaned off, he continued eating well throughout the summer. We’ve weighed him weekly, and he generally stays between 11.2 and 11.6 pounds. He eats about a can and half of wet food + ½ cup of dry food daily. This past week we noticed he seemed to be eating less. He gets picky with food sometimes – the type of dry food we use has two flavors, so usually switching between the two every few weeks keeps him interested. He’ll eat a meal or two well, but just nibbles otherwise. He’s probably getting about ¾ his normal amount of food in… just seems uninterested. His weight had been consistent for months so we stopped weighing him religiously until last week when I worried he looked a little smaller. He weighed 10.5 on Saturday. He’s back up to 11.1 now, but he seems uninterested in food. He’s not running from the bowl or throwing up. He’s drinking water and using the bathroom fine. He doesn’t feel fevered, and his gums/eyelids don’t look anemic. I’ve pressed on his sides and belly to check for pain, and he doesn’t react negatively. We’re monitoring his food intake closely and weighing him daily. The vet said if he eats less than half of what he should or begins to drop weight daily to bring him in. The drive to the hospital and stay were extremely stressful (for him and us). He absolutely hates cars – meows every 15 seconds the entire time and pants. I don’t want to put him through that again if we can avoid it. It was also about $6,000. I would do it again in a heartbeat – I’m so thankful for the care he was able to get, and the folks at UT Vet in Knoxville were absolutely amazing. In the hopes of avoiding another hospital stay though, I’m looking for ideas. Thoughts on what this could be. Specific tests we can ask for at our local vet. I’m probably being paranoid since we missed signs last time, but I’m wondering what else this could be. What could we have missed at the hospital?
Thanks so much for reading this huge amount of information and for whatever ideas you can give us! I just want my sweet little guy to be happy and healthy.

Dr. Joanna Woodnutt, MRCVS
Originally Answered: Seeking ideas for tests to request for cat's appetite issues & other health concerns

Hi there,

This is a tricky one, and I'm not sure I'm the best person to respond, but since nobody else has had a go I might as well try! I have to say that it sounds like he had excellent care, so it may be that he's going to be one of those 'mystery cases' that never really gets solved. Given what you've mentioned I wonder if there are two issues at play here - the main underlying issue, and then the inappetence causing the fatty liver, enlarged pancreas etc.

My first thought is IBD. It's a tricky disease, and it's now thought that IBD and intestinal lymphoma are part of a spectrum of disease. The waxing-waning nature and disinterest in food, along with the weight loss, are suggestive to me - although the anemia doesn't fit unless he's extremely malnourished. How are his poops? Other things that bounce around my head right now include a persistent foreign body (not enough to be an emergency, just enough to make him nauseous), or something viral (lots of possible candidates).

My second thought is that you don't mention any imaging - ultrasound or x-ray, or something more advanced - unless I've missed it in the essay (lol!) so I would definitely be looking at imaging (ideally ultrasound) to get more of an idea what's happening with him. You've also mentioned bloodwork, but not specifically what was done - I would be checking FELV and FIV if they haven't already been checked.

Either way I would urge you to talk to your vet if he starts going downhill at all.  It sounds like a referral to a hospital with an internal medicine specialist is the best option to get to the bottom of this. A university may be the best option!

Hopefully some of the other vets on here have some more ideas for you.

Please let us know how your little man is getting on! 

Best Wishes,

Dr Woodnutt


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