Need advice about cat with brain damage

[LforO]

Hi,

My 3 year old Domestic Short Hair boy was acting extremely weirdly 2 weeks ago. Because of his unbalance, disorientation, circling, partial blindness and poor control of his left legs, I first worried he had a stroke. But the average age for feline stroke is 9 years old. I called the vet, who said it was nigh impossible he had a stroke at that age. After I told him about the cat's behaviour and that he wasn't being himself at all, the vet did say it sounds like a stroke. He asked me to watch him for 24 more hours, and then make an emergency appointment (so my boy wouldn't have to wait for an available appointment).

24 hours made no difference. So we had his appointment. With the social distancing rules, I wasn't allowed into the consultation room with him. After a while, the vet came out and explained he most likely did not have a stroke, in the traditional sense. He did however, confirm there was an issue with the right side of his brain, which is why the left side of my cat wasn't responding normally. Mentally, he's all there, but he just doesn't have the control. Because he can't confirm the cause of what happened, or what precisely went wrong without an MRI or a CT scan (which costs £1500-2000 and I just don't have the means to pay for) the vet said there was some more probable causes, considering his age:
An infection in the brain, possibly caused by a parasite.
An injury (but he's an indoor cat and the vet saw no signs of a fall).
A swelling or inflammation, caused by any number of possibilities.
Or, some underlying problems in his brain. A tumour was possible.

He was prescribed a course of antibiotics, as well as some steroids to reduce any inflammation. The vet gave me extra because he was going to be away for a month. The antibiotics finished earlier this week and I still have about 6 steroid tablets left for him.

He's recovered a lot, mentally and seems much more aware of what's going on around him. He's improved physically, in that he is jumping and running short distances again, no longer turns in circles or holding his head to one side constantly. His left legs still don't respond correctly all the time, so he still stands on the back of his foot sometimes, which I just adjust for him so he doesn't damage his paws. He still slips on them, and they hang off edges when he jumps up or turns around near an edge. Because the legs don't respond right, he tends to tip over if he is sitting and tries to look over his shoulder, partly because of the blindness on the left side, so he tries to look left by turning his head far right sometimes. He loses balance and tips when he tries to wash himself as well. (one of my questions is if I should do something to help him wash, or will that do more harm than good?)

He's always been very frightened and anxious around people other than me. So he usually sleeps next to my back, or under the blanket next to my stomach. Sometimes he's just curled up on the blanket by my feet. He's always refused cat beds or blankets put somewhere else for him. But right after that first day, he would sleep next to the doorframe of my room on the floor. I figured it was because the mattress was too difficult to navigate with his left side. But now that he can jump, and is much more active again, he has started to scratch at the bedroom doors of my mother and father, where he's never been allowed in, and has never expressed an interest in before.

He's just frustratingly persistent, scratching the carpet, the doors themselves, meowing, ignoring me trying to call him back or distract him. And my parents are very annoyed and worried he will damage the doors. I just don't know how to stop him doing this, because I don't want to spritz him with water because he's still not completely the same as he used to be, so I don't know if he will understand what it means. I don't want to alienate him from me. He doesn't play with toys anymore because they get lost in his vision and he either loses interest or forgets he was trying to catch something.

He is also a very small cat (3kg, which the vets told me in the past was good for his size) and never ate huge amounts. Except with wet food or tuna, which he would gobble up as if he was going to lose the chance to finish it. But for the last 5 or 6 days he's been eating what seems like a lot, compared to usual, as well as drinking a lot more. And he has definitely put some weight on, although he isn't fat-looking. How should I figure out if he's eating and drinking healthily, or if there might be a reason for the increase?

Does anyone know why he has changed behaviour two weeks after the problems started, and how I can "rehabilitate" him? It's just heartbreaking to have lost that easy communication and understanding I shared with him. I hope it comes back with time, I just want to know if I can help him get there.

Sorry for the very long post, I'm just at a total loss. Thanks in advance for help and advice!

[fjm]

Firstly, I am sorry you have been through such a frightening and distressing experience, but it does sound as if your cat is making a good recovery to have regained so much function in two weeks.

The steroids may very likely be the cause of his increased appetite and thirst - it is a very common side effect. He may also be peeing more, also a common effect. I would check with your vets if the course of tablets is about to run out, as you may need to continue them a little longer, and coming off steroids needs to be managed carefully. I would not try to restrict the amount he eats - good nutrition is essential to recovery from any illness.

I think if I were you I would confine him to my bedroom with me at night, with a tray and water available. If he is disoriented the smaller area will help him adjust and feel safe. If he scratches at your door you could try protective plastic sheeting, but at least he would not be disturbing the rest of the family, and you would be saved the added stress of their disapproval. You and your cat are navigating a new world - he may never be exactly the same as before, but there will be compensations. It is still early days - give yourself time to adjust to this new normal. It can help to keep a diary tracking the small improvements so that you don't become too discouraged - recovery can continue for months, and the signs you describe are promising.

[Ruth B]

I too feel very sorry for you, that is a lot to have had to deal with and the uncertainty of the future won't be helping.

While I've no real experience of brain injured cats, I do know that brain injury in general can lead to a state of confusion so his scratching at your parents door may just be part of that. I agree with fjm that confining him to your room with a litter tray, food and water available during the nights would be the best option. It would mean he was somewhere he knows is safe and familiar and would save you the stress of hearing him scratch your parents door knowing it is upsetting your parents. He might scratch your own for a bit but hopefully that won't upset your parents as much. If there is room under your door then a thin plastic mat can help save the carpet if he tries to dig his way out. Double sided sticky tape on the door where he scratches might also help stop him doing it. I would also suggest getting one of the cardboard scratcher/loungers for him to put close to the door, so while you are saying 'no you don't scratch the door' you are also say 'yes here is something you can have a good scratch on'

I also agree that his added eating and drinking is likely a side effect of the steroids, the only real way to monitor if he is eating too much is to weigh him. If he will sit on some bathroom scales then that is one option, if you can pick him up then weighing yourself with and with out holding him and doing some quick subtraction is also another good way to get his weight.

If he used to play and seems to want to at times but has problems because of his sight then toys that make a noise might help, balls with bells in are common and he would soon learn to follow the sound, one could be attached to a piece of string so you could interactively play with him and if he did loose it bring it back to where he can see it. Playing with him would probably help him adapt to his new state of life. I would also suggest that while he may be getting around better, it sounds like he can still have problems so some boxes or stools that can act as steps for him to get onto the bed or even the window sill could help him move more confidently, if the window sill is narrow then could you put a small multi level cat tree by it, something he can get up easily and can sit and see outside from. While he may never recover fully, anything that helps him use his brain will possibly lead to some improvement.

[LforO]

Thank you both your answers. I didn't know that the increase of eating and drinking were a side effect of the steroids. That's a huge relief, because I hope it means they are doing some good things.

I can't prevent him from leaving my room at night, because there is no door in the frame (my parents are looking around for one that matches the others, because they fixed up the room 2 years ago), but when he first had problems I did move his food and water, and also litter box, upstairs because I didn't want him to have a single reason to go on the stairs until he stopped circling and slipping down them.

He always treated my room as the safe space in the house, so it is his HQ. I will definitely try to put cardboard scratchers in front of the doors to distract him and keep him away from the doors themselves. He scratches at them like it's life or death to get in there so I hope that the cardboard scratchers will save his nails too.

He has a scratch post with a little ledge on, which I will put by the window. He does have a little footstep for getting on the bed without hassle because the bed is low, so now he just walks up without needing to jump.

Thanks again for the suggestions! I will give it a couple days to see how things go, and I have a phone appointment with the vet on Wednesday about his medication. I'll update you guys on how it goes.

[fjm]

Would a baby gate with cardboard or something to block the gaps make a temporary door? Might be worth a try, and they are often available on Freecycle or Gumtree. It is a good idea to make a list of questions ahead of the phone call with the vet, along with improvements/symptoms you have noted, and if possible email them so the vet can consider them - it is so easy to miss things when talking.

[LforO]

Thanks fjm, I will try that, I think my sister has an old one. I have been keeping a little journal for him since his medication started so I'll have that with me for the phone call.
I'm glad to report that he's been sleeping next to my stomach again last night, just for a while before he wanders around. But I'm glad because it's sweet when he comes for snuggles.

[LforO]

So, yesterday's phone call was just to make an appointment for today. The vet said he's deteriorating because of the lack of improvement. Which sucks because he's leaps and bounds better than at the beginning. But he still has very little sensation and control in his left legs and the vision is still not back in that left eye.
They now want to do bloodtests to see IF they can diagnose the issue. It was altogether going to be around £300. I expressed at the beginning of the issues that I didn't have means for the CT scans and MRIs and things because, like many people, I don't have a job at the moment.
I asked her if there was a bloodtest she would prioritise, which she said would be the toxoplasma test, but after asking her the likelihood of it being that, she said less than half. The other percentage of possibility is all grey area. They have no indication for what could be the most likely issue. So £300, and they told me that there is a good chance they won't find the issue and need to do the scans, or they will find some sign of something that will be untreatable/ huge amounts of money to treat. And then, she said, there come all the questions of quality of life. So I'm at a loss. If I had the means, I would pay for all these tests and scans and whatever else could help.
But today cost £30 and another £30 for the medications (stronger dose of the steroid tablets and some new capsules) which is a huge chunk of my temporary income per month. The vet is a 30 minute drive away, and I have to drive there again tomorrow to pick up the new capsules.
So, in addition to being told he's not improving enough to be considered positive by the vet, I now feel like a stupid thing like money is going to keep me from helping my cat. I feel just awful, and I just keep praying he'll recover more on his own.
He hasn't been using the new scratchers yet, but he has scratched the doors less since I put his ledge next to the windowsill by my bed. Thanks for your help, everyone. It was a comfort

[fjm]

I think with so many unknowns and so much uncertainty there is little point in doing extensive or invasive tests. If there is a chance that it is toxoplasma, which is treatable, would the vet be prepared to prescribe the antibiotic used (Clindamycin) without further diagnostic tests? It would probably be more affordable than the test, and if it makes no difference would rule that diagnosis out.

[Ruth B]

I have to agree with fjm, it is a lot of expense and stress for you and your cat, and with no guarantee of providing a suitable treatment plan to help your cat.

Your cat may not be getting better, but is he actually getting any worse, if he is stable and happy enough with his new normal than i personally don't see a problem. If he is getting worse, and having problems with day to day life, things like eating, drinking, grooming, using the litter tray, moving about then it is time to think about the hard decisions, but if he seems happy enough then I see no problem with letting him carry on as he is. I would suggest keeping a diary, possibly even a video diary to help monitor is progress, it would also give you something to show the vets when you do go to see them. There are several questionnaires available online to help you judge how he is, you fill them in every few days and it can give something of a score as to how good his life is. This is just one I found as a starting point.
https://vetsocialwork.utk.edu/wp-conten ... f-Life.pdf

In the end tests and scans are extremely expensive and there is no shame in admitting you can't afford them. In that case you have to judge by the life the cat is living what is best for them. Remember cats aren't like us, they don't live in the future or the past they live in the now, and they don't dwell on what they used to be able to do. However if a cat can't eat properly, or can't use the litter tray or groom and their coat is left to get messy and matted, that means that the now is is filled with unpleasantness and that is what makes a cat's life miserable.

[LforO]

Thank you both. Fjm, I did think about that too. He recently finished a course of antibiotics, so at his appointment on the 5th I'll ask for that possibility.
And Ruth B, thank you for that link, that is a great plan.

Thank you both for being so understanding. It doesn't feel great to say I can't afford it, when it's for a living creature I love so much, and the vets kind of give you that look when you say that.

He is not getting worse, I confirmed with the vet he is not in any pain. He jumps and cuddles, and follows me around. He eats and drinks and uses the litter box on his own. He might tip his water bowl over regularly but cleaning up water is no hassle to me if it means I don't have to let him go. The only tough part so far is figuring out how to play with him, but we'll get there. So I think he's happy. It means a lot to hear that he lives in the now, and isn't focused on what used to be. Even if I know things in my head, it is a huge comfort to hear it from others.

I have never been a fan of change and uncertainty, and I would feel better knowing exactly what and why and how, but I think I will follow your advice and focus on now, while he is here.

[Mollycat]

It is ok not to be able to afford tests especially if there is a high chance of those tests being inconclusive or there being no reliable treatment. As a matter of fact we are just back from the vets with our dog, he is just under 10 years old and has always had clicky back legs but recently is increasingly keeping weight off one back leg, which vet says is actually several separate issues in 3 different joints. He's OH's dog and OH is happy with pain management and does not want x-rays at this stage. There are many things that we can do but just because we can doesn't mean we should, money is one factor but there are many others. If tests would mean the miracle cure, it would be different.

[fjm]

My poodle, Poppy, was very poorly earlier this year - the vet suspected liver issues and £100 of blood tests confirmed it. The only way of knowing the cause was a major biopsy under anaesthetic, and within hours she was too ill to survive that, so the vets started supportive and symptomatic treatment. I would have been ready (and fortunately able to afford) to go ahead with the biopsy had it been advisable, but as it would have made no difference to the treatment it would have been an unnecessary risk, just on the very slim chance that the problem was operable. Sometimes there is a temptation to continue with exploration just because we have the technology, and to get a little closer to an answer - if it is not to the obvious benefit of the patient and is likely to cause stress or discomfort (including financial stress to the human) it is very hard to justify. If your vet were proposing tests that would indicate which of two mutually exclusive life saving or enhancing paths to follow, with a very high chance of a good outcome, it might be worth considering ways and means - as it is you have absolutely nothing to reproach yourself with in not taking on years of debt and anxiety, and avoiding putting him through the risk of sedation and anaesthesia.

It sounds as if he is very happy - as is Poppy. Like his, her life has changed, and mine with it, but there is still much joy and laughter. And perhaps, like hers, his life will be shorter than it might have been, and there are hard decisions somewhere in the future, but you and he can share all the good moments in the Now.