Cat occasionally stumbling

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mr_frisky
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Re: Cat occasionally stumbling

Post by mr_frisky »

Yes, on electrolytes, Sodium is high (156 out of a normal range of 146-157), potassium was 3.0 (normal range 3.4-5.6), sodium:Potassium ratio 52 (normal range 26-42), chloride 112 (normal range 111-129).

MPV (whatever that is) is low (6.5, normal range 8-12) in general bloods, but everything else normal.
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Re: Cat occasionally stumbling

Post by Mollycat »

MPV is Mean Platelet Volume and is used to help diagnose (sorry) bone marrow issues. I have no idea if this can cause your issues, but I'm if the vet was concerned they would have spoken to you about it.

Again, a possible clue or connection or something - Molly's crash I mentioned with yellow stuff from both ends - yellow is bilirubin released from the breakdown of red blood cells in the liver and Molly's was higher than expected for hyperthyroidism, leading the vet to speculate on possible underlying liver issues "but let's get the hyperthyroidism dealt with first". We have occasional yellowish pats but nothing like the first crash, and interestingly we no longer get proper furballs, only rare tiny half formed ones. But there seems to be two theses here - we have the same electrolyte imbalance, and we both have some kind of pointer to a blood/liver/marrow something and we both have some kind of hind limb thing. Odd.

As for the electrolyte combination that's exactly what Molly has, low K high S and high Cl. With slight awkwardness that you'd take as a touch of arthritis. They are about the same age, too.

I haven't clicked on any of them but it seems there is a ton of pub-med articles on the relationship between electrolytes and bone marrow issues. My next couple of weeks are very busy but after that I have a quiet week and I suspect I'm now going to spend it learning about electrolytes.
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Re: Cat occasionally stumbling

Post by mr_frisky »

Thanks for your detailed posting, Mollycat.

The potassium level is still low despite a supplement. I suspect he'll suggest an MRI next.

So your cat has similar symptoms, when you say she has a ' hind limb thing'? If so, how long has it been going on for?
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Re: Cat occasionally stumbling

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Difficult to say. Being an indoor cat she is much less fit than a cat that goes outside. She has always landed a bit heavy when jumping down since I had her 8 years ago, but she started showing discomfort and lameness on about 3 or 4 months ago I think and became shy of getting down from the low levels of her cat tree, about 2ft (60cms)

Molly's potassium also remains low after 18 months of daily supplementation. This is what led me to investigate and find that blood potassium is not an accurate reflection of cellular levels. I have taken the opposite approach to you, assumed a lot and guessed even more. It looks like arthritis and being a difficult to handle cat and pushing 15 years old, I have not had any tests done, also partly because when I asked for some tests to be done while we had the opportunity and she was in overnight for a dental 6 months ago they failed to do the tests, meaning that we are now two and a half years post ckd diagnosis and still no urine test to see if she could benefit from potassium and protein binders.

The reasoning behind cutting down her potassium supplement was this - in March, after two years diagnosed early ckd, the vet recommended we now start her on a renal diet. Immediately, her urine output reduced dramatically. Then the lameness started maybe 3 months ago. If she was peeing less, she might be losing less potassium that way, and too much potassium can also cause muscle and nerve issues, and that is why I cut down to every other day. I have no idea if this is right or what her levels are now. But I did notice she is much less hissy and grumpy, and bad temper can also be caused by potassium imbalances.

I also started to give her Devils Claw which is an extract of a South African plant root which I have taken myself in the past and found highly effective, enough to stop regular daily cocodamol. It takes a while to build up and take effect (especially when Cat won't eat much of her food) but now she is definitely jumping further and looking much more comfortable. She has more tummy upsets which could be the renal food experiments or could be due to the Devils Claw.

But the key with Molly is always - if we test for X and the treatment is Y then will she take Y and if not then what is the point in confirming that she has X. All I can say is that having her on a renal diet, reducing the potassium supplement and giving Devils Claw I seem to have found the sweet spot where she is comfortable, happy, not lame, urine output is good, and only occasional tummy trouble that could be all the different foods I'm trying. But I have no idea what any of her bloodwork is and I can't take her to the vets at the moment unless there is some emergency.
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Re: Cat occasionally stumbling

Post by mr_frisky »

That sounds very complex. Have never heard of Devils Claw as a supplement for cats.

Coco doesn't seem to be any different from a few months ago, stumbling once a day or so, but still eating normally, and being social with the other cats. She can jump up or down a few feet, but has a stiffer gait than she used to a couple of years ago. She has been reluctant to jump down from very high spaces for a couple of years, but still does sometimes.

The metacam doesn't seem to be changing anything, although she's only been on it for 5 days.

I'm not really sure of her age, as she was a kitten of my neighbours' cat. I remember her from around 2008. I have photos from 2009 when she looked young and thin. I took her over in 2010 (as my neighbours are clueless and feckless in such matters), just after she gave birth to my other cats. I've estimated 13 for her insurance.

The bloods say she definitely doesn't have CKD.
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Re: Cat occasionally stumbling

Post by Mollycat »

Good that her kidneys are in good shape.

Metacam is a Non-Steroidal Anti Inflammatory Drug (NSAID). Devil's Claw is a tuber root native to southern Africa, at this stage nobody still knows how it works and studies conclude anywhere from little benefit and no harm to significant pain reduction in osteoarthritis with minimal side effects.

Hopefully you can get to the bottom of Coco's issues, I am not doing any more with Molly than watching her symptoms and half-educated guesswork as long as she is happy and comfortable. The electrolyte similarities and lack of response to supplement are interesting though. I hope you get some answers.
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Re: Cat occasionally stumbling

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She has a neurological referral on Tuesday to try and see what's going on. Dreading it.
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Re: Cat occasionally stumbling

Post by Mollycat »

Thinking of you, but surely not knowing is harder than potential bad news?

Has Coco been getting worse, or much the same?
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Re: Cat occasionally stumbling

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Pretty much the same, certainly no worse.
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Re: Cat occasionally stumbling

Post by Mollycat »

Best of luck today for Coco, I hope you get some answers and that the answers have a simple solution.
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Re: Cat occasionally stumbling

Post by mr_frisky »

Thanks. She's there now. The neuro exam showed some minor ataxia in the legs (as we knew).

The neurologist said I can either take her home and monitor her, or have an MRI, which would show the cause (unless it was an infection or stroke).

I opted for the MRI, which may be done today (if they have time). They are also doing a lumbar puncture (spinal tap) while she's sedated.

Poor thing, but hopefully they'll get to the bottom of it.
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Re: Cat occasionally stumbling

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Her electrolyte tests show potassium now at 2.9 mmol (was 3 three months ago, normal range 3.4-5). He phoned me and suggested it could be symptomatic of Conn's syndrome (Primary Hyperaldosteronism), although her blood pressure is fine, so will do an ultrasound of her adrenal glands whilst she's under anaesthetic too.
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Re: Cat occasionally stumbling

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So kind of inconclusive at this stage. Hoping the MRI reveals something.

Interesting about the potassium but as I mentioned before there is a lot of doubt as to whether oral supplements can bring up blood potassium or even whether it's important, as the critical balance is at cellular level, but on the other hand if you're up to looking up some really big medical terms, google ataxia and potassium.

Do keep us posted, fingers crossed.
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Re: Cat occasionally stumbling

Post by mr_frisky »

The MRI showed up irregularities on her spine, which he believes are either multiple tumours or an automimmune disease. They are still doing more tests.

Devastated.
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Re: Cat occasionally stumbling

Post by Mollycat »

oh no I'm so sorry
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Re: Cat occasionally stumbling

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I'm so sorry, fingers crossed they aren't tumours and something that can be managed
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Re: Cat occasionally stumbling

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So sorry - hoping it proves something manageable.
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Re: Cat occasionally stumbling

Post by mr_frisky »

Apparently it's likely to be either lymphoma (don't know which type yet), meningomyelitis or infectious meningomyelitis (possibly FIP).

Samples will rule out or confirm the latter in a week, but the treatment is apparently the same.

It's strange because none of her symptoms are consistent with any of them.

I'm picking her up in an hour and he will answer further questions.
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Re: Cat occasionally stumbling

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Ok, I have her home now.

He clarified: The 'multiple tumours' he mentioned on the phone were two very small white spots on the spinal cord, shown up on the MRI. It is not possible to tell what they are. He suspects the likelihood is, in this order: 1) Non-infectious meningomyelitis (eminently treatable) 2) Lymphoma (despite having no other symptoms) - impossible to tell what type it is, so what the prognosis would be is unknown, but possibly poor 3)Toxoplasmosis (eminently treatable) 4) FIP (only recently treatable but very expensive). Should be able to rule in or out the last 2 when the blood test results come in, although they apparently always say FIP may be a possibility.

He also found a small adrenal nodule, which is 'though to be most likely incidental, with a malignant nodule considered much less likely'.

It seems to have not been possible to make a definitive diagnosis, but the treatment for 1) and 2) are the same, so she has pills.
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Re: Cat occasionally stumbling

Post by Mollycat »

This is beginning to sound a great deal more positive, and a whole lot closer to answers than you began, and with a treatment plan as well let's hope there is some improvement very soon.
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Re: Cat occasionally stumbling

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Sorry it isn't possible to make a definitive diagnosis, but at least you have some treatment options and hopefully they work
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Re: Cat occasionally stumbling

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They have the biopsy results in now (two - one from her liver, one from her spleen). No signs of lymphoma in them, although that doesn't mean it isn't elsewhere.
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Re: Cat occasionally stumbling

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FIP tests negative.
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Re: Cat occasionally stumbling

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FIP negative is good news, too. While it may not be possible to rule out lymphoma, that leaves the more treatable possible causes as the highest probabilities.
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Re: Cat occasionally stumbling

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Glad the FIP test were negative, hopefully that means she will respond to treatment
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Re: Cat occasionally stumbling

Post by mr_frisky »

Toxiplasmosis tests negative, and spinal tap (lumbar puncture) results 'consistent with blood contamination' and 'no neoplastic cells seen'.

She's upping the prednisolone now for 2 weeks, and seems fine so far.
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Re: Cat occasionally stumbling

Post by Mollycat »

Just seen how long this has been going on, you must be exhausted. Fingers crossed she stays fine with it.
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Re: Cat occasionally stumbling

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At least another negative and surely no neoplastic cells rules out certain cancers?
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Re: Cat occasionally stumbling

Post by mr_frisky »

He doesn't think it's spinal lymphoma now (although can't rule it out), although a biopsy is the only way of telling for sure, and he can't take one from her spinal cord without paralysing her.

However, he called me yesterday saying the final test results are in, and he believes it is consistent with Conn's syndrome, meaning the white spot on her adrenal gland is likely to be a tumour, causing the low potassium.

Whereas this can be removed surgically, he recommends she complete her course of prednisolone before he does another ultrasound and surgery. He recommends 3-6 months, with a small chance of metastasis the longer we wait.

She hasn't stumbled for a week and a half or so, and is jumping up now, but this is another blow.

It goes on...
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Re: Cat occasionally stumbling

Post by Mollycat »

Although reading on the internet must be done with extreme caution, I would recommend reading up about Conn's, and this seems a pretty good technical article https://www.iowaveterinaryspecialties.c ... osteronism if you can get through the medical terminology.

On the other hand if Coco is responding well to medication perhaps that gives you more options going forward?

The bit I found interesting from the article above -
... helps to control blood pressure and maintain extracellular fluid volume in response to changes in renal blood flow and electrolytes (Nichols, 2016). It accomplishes this by resorbing sodium at the expense of potassium and naturally, water follows
which actually explains why the one is low while the other is high, and why if that is how potassium is low no amount of supplementation is likely to sort out the problem, just as reducing sodium intake isn't likely to correct that either.
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