The ongoing saga of what's wrong with Carey

This may be long, so bear with me if you will!

Carey has been seeing a neuro vet (exclusively) since 4/2002. She became ill
and paralyzed and started exhibiting bizarre behavior (attacking response to
noises). After a bajillion non-conclusive tests, she has been assumed to have
a brain tumor (by matter of elimination of other possibilities - something
several vets agreed on), and has been on prednisone for the entire time, along
with valium until 2/2004, when she was switched to phenobarb (which did improve
the attacking behavior where its virtually nil).

Her urination behavior has gotten dramatically worse over the last year though,
and I don't think there are many places she HASN'T peed. 4 incredibly clean
litter boxes, but she has urinated on every possible texture, surface, and
level, on a regular basis - I never know where I'll find it. She is 7#, down
from her normal 9.5, and her thyroid tests (February) came back normal. She
had been lower, but we managed to increase her weight again.

The neuro vet has been little help, but in April, bloodwork indicated that she
was borderline CRF, so we changed her food. No improvement, and it was time to
start taking her to my regular vet.

We visited my vet on Wednesday. A lot of disturbing and interesting news
there. After reviewing the bloodwork and accompanying paperwork, my vet
indicated that she didn't believe Carey has any kidney failure, but the values
indicated that she's dehydrated. She also said she could feel her thyroid and
can't believe that she isn't hyperthyroid. Great. So, we run a bunch of new
tests (the neuro vet apparently hadn't done a urine test! ) and some results
are back - she definitely does NOT have any kidney failure and her liver is
fine thank goodness. Waiting for the thyroid test, and we've added an FIV test
to the lab's list. When this first happened, I questioned possibility of FIV,
but was pretty sure it had been ruled out. Some other symptoms don't exist.
Can't hurt to check though, right?

I'm pretty ****ed at the neuro vet (as is my vet), but just want to move
forward. All agree that she's a whacko little cat (she's had OCD behavior
since birth - which was 2 days after the rest of her litter) and that something
is definitely wrong in her brain, but we don't know why.

She just turned 11, is happy, purring, snuggling with our other cat, sucking on
the dogs, playful, and has a good appetite (a little TOO good when you're
trying to eat your own food! ;-D). The urination is getting very stressful and
my house is being ruined. We have to wait until all the test results are
back before we switch or add medications, but I'm really trying to be hopeful
that we can find some solution to make us all a lot happier. She's still
dehydrated and we'll probably do some sub-Q fluids to see if that helps, but
I'm trying to figure out WHY she's dehydrated. Any thoughts?

Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

"J1Boss" wrote in message
...

You know, when I started reading this post, my first thought was "did the
vet do an MRI or catscan?"

Sue

Phil and Sue - the answer is no. The reason? Expense and the question:
what
would we do differently if we KNOW rather than guess, given the other test
results at the time, and over time. I won't do brain surgery on her.

You wouldn't be doing brain imaging only to rule in a brain tumor, but also
to rule *out* a brain tumor. In complicated cases, its just as , if not
more important to rule out possibilities.

Once you settle on a diagnosis further diagnostics are usually cancelled.
If the diagnosis is wrong, the actual disease goes by untreated and
progresses when it may have been curable. Also, an erroneous diagnosis can
lead to unnecessary surgery and/or unnecessary or even harmful medications.

If she were my cat and a brain tumor was suspected, I'd sure as hell want to
know for sure either way... but that's me. CT and MRI are both noninvasive
tests.


She may be displaying dissatisfaction with the litterbox - i.e., type
of
litter (clumping, scented, covered box, location).

She uses the litterboxes regularly (and for what it's worth to a cat, if I
see
her using one, I tell her how wonderful she is). A fe different types of
litter, kept amazingly clean. She never has any hesitation at using the
box(es).

She may FLUTD and
associates painful urination with the litter box. FLUTD (IC) and
painful
urination may also explain why she keeps looking for different places
to
urinate.

No obvious evidence of any discomfort or pain during urination. I;ve seen
her
urinate in and out of the box and there is nothing abnormal about her
approach
or attitude or position.

Might be neurologic or behavioral. If all possible physical or medical
causes have been ruled out, the problem might be due to cognitive
dysfunction - which would certainly explain the loss of a previously learned
behavior.

You could try litterbox retraining, however, it might be too stressful for
her in her present condition.


Inappropriate urination has also been associated with hyperthyroidism,
diabetes and intracranial Cuterebra migration.

Diabetes was ruled out initially and continues to be. The hyperthyroidism
is
what is the real question here and the tests should be back early in the
week.
The tests done in February indicated no problem, but I'm second guessing
the
testing at this point.

She could still be hyperthyroid. Systemic disease or other conditions
could
falsely lower T4.

Which is why we're doing a lot more tests.

The T4 should be followed by fT4ED. Both tests should be done at the same
time.


Thyroid glands generally are not palpable in normal cats without
hyperthyroidism.

I know - that's why we're realizing her Feb tests wer not clear and are
testing
again.


Blood (BUN/Cr. PCV and TP or PP) and urinalysis (USG) should be run at
the
same time. Blood and urinalysis together give a better picture of
kidney
function than either test alone.

Once again, I realize this. I had not realized the neuro vet failed to do
so.
The most recent tests were complete and conclusive.

Not if she is hyperthyroid. If her fT4ED comes back high, you'll need to
retest her kidney function after she's been on thyroid meds for 6-8 weeks.
Hyperthyroidism can mask underlying renal disease.



If her thyroid test comes back normal or high normal again, order a
free
T4
by equilibrium dialysis (fT4ED). This test is the most accurate way to
measure fT4. fT4ED is much more accurate and sensitive in assessing
thyroid
function in cats where the T4 might be depressed due to other
conditions
or
systemic illness.

I had asked the neuro vet that this be done last time, and the answer was
the
same. I have a lot better dialogue and ability to reach my regular vet,
so if
anything of the tests is "off", we will get to the bottom of it.

What exactly did the neurologist do???


I would be, too. CT or MRI would be my first step to rule out tumors
and
structual damage of the brain and skull and Cuterebra infection.

See above, why this wasn't done. Combo of advice and personal choice.
From
what I've read about the infection you mention, she has had no outward
signs or
symptoms that the description lists.

In complicated cases, you must rule out all possibilities.


You
didn't mention CSF analysis. Was that done?

Yes, back in 2002. I'd have to look at my records to see if there was
anything
the least bit abnormal, but they felt she mayb have an infection of her
spine
area and that's where antibiotics came in.

That may be something worth investigating more thoroughly. There may be a
problem or disturbance in the spinal pathways involved in the control of
urination.




So far you listed 4 out of 5 criteria for hyperthyroidism.

1. Enlarged thyroid glands
2. Increased appetite
3. Weight loss
4. Inappropriate urination

I realize that. I'm hopeful that we get a clear answer on the thyroid,
because
we obviously all feel it's an issue. Her increased appetite didn't really
occur until she started the valium.


Valium is also an appetite stimulant; it has also caused liver failure in
cats.


She may have concurrent illness, possibly neurological, so I would
definitely order CT or MRI and CSF analysis.

I guess I'm still not convinced of what the MRI will tell us that I can or
would do much about.

As I said, its just as important to rule out possibilities. MRI would
probably rule out or rule in a brain tumor.


I will be speaking with my vet about the ongoing test
results and what we need to do, and will revisit this with her as well.

Thanks for the thoughts. Any more on the dehydration?

Is her diet canned food or dry? Even though cats fed dry food drink 6x
more water than cats fed canned food, their total water intake and turnover
is much less. Most of the water dry-fed cats drink is lost to fecal
moisture.

Have you tried to measure her total water intake (from food and drinking)?
A cat's daily water requirement is about 60 ml/kg or about an ounce for
every pound of body weight.

Phil

"J1Boss" wrote in message
...

You know, when I started reading this post, my first thought was "did the
vet do an MRI or catscan?"

Sue

Phil and Sue - the answer is no. The reason? Expense and the question:
what
would we do differently if we KNOW rather than guess, given the other test
results at the time, and over time. I won't do brain surgery on her.

You wouldn't be doing brain imaging only to rule in a brain tumor, but also
to rule *out* a brain tumor. In complicated cases, its just as , if not
more important to rule out possibilities.

Once you settle on a diagnosis further diagnostics are usually cancelled.
If the diagnosis is wrong, the actual disease goes by untreated and
progresses when it may have been curable. Also, an erroneous diagnosis can
lead to unnecessary surgery and/or unnecessary or even harmful medications.

If she were my cat and a brain tumor was suspected, I'd sure as hell want to
know for sure either way... but that's me. CT and MRI are both noninvasive
tests.


She may be displaying dissatisfaction with the litterbox - i.e., type
of
litter (clumping, scented, covered box, location).

She uses the litterboxes regularly (and for what it's worth to a cat, if I
see
her using one, I tell her how wonderful she is). A fe different types of
litter, kept amazingly clean. She never has any hesitation at using the
box(es).

She may FLUTD and
associates painful urination with the litter box. FLUTD (IC) and
painful
urination may also explain why she keeps looking for different places
to
urinate.

No obvious evidence of any discomfort or pain during urination. I;ve seen
her
urinate in and out of the box and there is nothing abnormal about her
approach
or attitude or position.

Might be neurologic or behavioral. If all possible physical or medical
causes have been ruled out, the problem might be due to cognitive
dysfunction - which would certainly explain the loss of a previously learned
behavior.

You could try litterbox retraining, however, it might be too stressful for
her in her present condition.


Inappropriate urination has also been associated with hyperthyroidism,
diabetes and intracranial Cuterebra migration.

Diabetes was ruled out initially and continues to be. The hyperthyroidism
is
what is the real question here and the tests should be back early in the
week.
The tests done in February indicated no problem, but I'm second guessing
the
testing at this point.

She could still be hyperthyroid. Systemic disease or other conditions
could
falsely lower T4.

Which is why we're doing a lot more tests.

The T4 should be followed by fT4ED. Both tests should be done at the same
time.


Thyroid glands generally are not palpable in normal cats without
hyperthyroidism.

I know - that's why we're realizing her Feb tests wer not clear and are
testing
again.


Blood (BUN/Cr. PCV and TP or PP) and urinalysis (USG) should be run at
the
same time. Blood and urinalysis together give a better picture of
kidney
function than either test alone.

Once again, I realize this. I had not realized the neuro vet failed to do
so.
The most recent tests were complete and conclusive.

Not if she is hyperthyroid. If her fT4ED comes back high, you'll need to
retest her kidney function after she's been on thyroid meds for 6-8 weeks.
Hyperthyroidism can mask underlying renal disease.



If her thyroid test comes back normal or high normal again, order a
free
T4
by equilibrium dialysis (fT4ED). This test is the most accurate way to
measure fT4. fT4ED is much more accurate and sensitive in assessing
thyroid
function in cats where the T4 might be depressed due to other
conditions
or
systemic illness.

I had asked the neuro vet that this be done last time, and the answer was
the
same. I have a lot better dialogue and ability to reach my regular vet,
so if
anything of the tests is "off", we will get to the bottom of it.

What exactly did the neurologist do???


I would be, too. CT or MRI would be my first step to rule out tumors
and
structual damage of the brain and skull and Cuterebra infection.

See above, why this wasn't done. Combo of advice and personal choice.
From
what I've read about the infection you mention, she has had no outward
signs or
symptoms that the description lists.

In complicated cases, you must rule out all possibilities.


You
didn't mention CSF analysis. Was that done?

Yes, back in 2002. I'd have to look at my records to see if there was
anything
the least bit abnormal, but they felt she mayb have an infection of her
spine
area and that's where antibiotics came in.

That may be something worth investigating more thoroughly. There may be a
problem or disturbance in the spinal pathways involved in the control of
urination.




So far you listed 4 out of 5 criteria for hyperthyroidism.

1. Enlarged thyroid glands
2. Increased appetite
3. Weight loss
4. Inappropriate urination

I realize that. I'm hopeful that we get a clear answer on the thyroid,
because
we obviously all feel it's an issue. Her increased appetite didn't really
occur until she started the valium.


Valium is also an appetite stimulant; it has also caused liver failure in
cats.


She may have concurrent illness, possibly neurological, so I would
definitely order CT or MRI and CSF analysis.

I guess I'm still not convinced of what the MRI will tell us that I can or
would do much about.

As I said, its just as important to rule out possibilities. MRI would
probably rule out or rule in a brain tumor.


I will be speaking with my vet about the ongoing test
results and what we need to do, and will revisit this with her as well.

Thanks for the thoughts. Any more on the dehydration?

Is her diet canned food or dry? Even though cats fed dry food drink 6x
more water than cats fed canned food, their total water intake and turnover
is much less. Most of the water dry-fed cats drink is lost to fecal
moisture.

Have you tried to measure her total water intake (from food and drinking)?
A cat's daily water requirement is about 60 ml/kg or about an ounce for
every pound of body weight.

Phil

What exactly did the neurologist do???

Redid blood, but now i'm skeptical that this test was added.

Valium is also an appetite stimulant; it has also caused liver failure in
cats.

Yes, I know both of these things. She's not on valium anymore, hasn't been
since February. Her bile acid test came back fine.

Is her diet canned food or dry?

Canned only. With water added to the extent she'll tolerate.

Have you tried to measure her total water intake (from food and drinking)?

No. I'm not sure isolating her to do this wouldn't alter the results, due to
stress. The dogs and cats share water, although the cats also have a
[virtually untouced] fresh flow unit.


Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

What exactly did the neurologist do???

Redid blood, but now i'm skeptical that this test was added.

Valium is also an appetite stimulant; it has also caused liver failure in
cats.

Yes, I know both of these things. She's not on valium anymore, hasn't been
since February. Her bile acid test came back fine.

Is her diet canned food or dry?

Canned only. With water added to the extent she'll tolerate.

Have you tried to measure her total water intake (from food and drinking)?

No. I'm not sure isolating her to do this wouldn't alter the results, due to
stress. The dogs and cats share water, although the cats also have a
[virtually untouced] fresh flow unit.


Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

Phil asks:

When she urinates, does she void small volumes of urine frequently or large
volumes at normal intervals?

Large volumes at normal intervals as best I can tell. Since I don't know when
she urinates inappropriately at all times, I'd say that probably higher than
normal intervals, but relatively large amounts and it is concentrated normally.


BTW - I didn't mention that she always uses her boxes for defecation.

Did the urinalysis show an adequate urine-concentrating ability (USG
1.030) or a dilute urine (1.030)?

Did her the blood test show an increased PCV and TP?

Don't know these answers - I have scribbled notes from the ophone conversation
and will ask for a written report as well when I get the other test results.

Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

Phil asks:

When she urinates, does she void small volumes of urine frequently or large
volumes at normal intervals?

Large volumes at normal intervals as best I can tell. Since I don't know when
she urinates inappropriately at all times, I'd say that probably higher than
normal intervals, but relatively large amounts and it is concentrated normally.


BTW - I didn't mention that she always uses her boxes for defecation.

Did the urinalysis show an adequate urine-concentrating ability (USG
1.030) or a dilute urine (1.030)?

Did her the blood test show an increased PCV and TP?

Don't know these answers - I have scribbled notes from the ophone conversation
and will ask for a written report as well when I get the other test results.

Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

I don't have all the numbers (and hope I wrote these down correctly), but
Carey's thyroid test was 0.9 (0.8-4 being normal?) and her free thyroid 25
(10-50 being normal range?). Hope those are right. Her urine culture was
negative, her bile acid test normal, FIV negative, kidney function normal.

we're going to wean the phenobabr, then the pred, then start her on something
for her urination behavior. The 3 drugs being considered are amitryptilline,
prozac and buspar, but my vet felt she wasn't a good candidate for Buspar due
to aggression side effects. She's consulting with another vet about these
drugs. Since we have a few weeks of weaning, any thoughts on these drugs?

Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience

I don't have all the numbers (and hope I wrote these down correctly), but
Carey's thyroid test was 0.9 (0.8-4 being normal?) and her free thyroid 25
(10-50 being normal range?). Hope those are right. Her urine culture was
negative, her bile acid test normal, FIV negative, kidney function normal.

we're going to wean the phenobabr, then the pred, then start her on something
for her urination behavior. The 3 drugs being considered are amitryptilline,
prozac and buspar, but my vet felt she wasn't a good candidate for Buspar due
to aggression side effects. She's consulting with another vet about these
drugs. Since we have a few weeks of weaning, any thoughts on these drugs?

Janet Boss
http://bestfriendsdogobedience.com/
http://photos.yahoo.com/bestfriendsobedience