Vet just called with an update on my boys

First let me apologize up front if this seems scattered, I've been up since 5 am with just a couple hours of sleep, and haven't eaten anything yet today.

So far she's had great difficulty in getting any poop sample from TK. I guess with all of the diarrhea he's been having, plus throwing up everything he ate this morning his little bottom is empty. But, she did get the bloodwork ran, and TK has a raging infection....white cell count over 27,000! Radar's white cell count is up too, but not nearly as high as TK's is. There are two vets at this "new" clinic, and the one that is treating TK and Radar (Dr. K) discussed all of their history with the other vet, and they both talked to a third vet. There may be a possibility that they could have tritrichomonas foetus, which would explain why flagyl, pancur, and all the other meds didn't begin to touch the diarrhea. Since she's not so sure that the boys have hemobart, but at this point since they did respond so well to the doxycycline previously she is going to get them both started on it again. It's obvious they have an infection that needs to be brought under control. They have a vet tech that is extremely good at reading smears (she wasn't there today) and this person will be going over any poo sample left by the boys overnight tomorrow, plus blood smears.

She is also a bit concerned that because of this newest infection that there could be a possibility that both boys have yet another birth defect........weak immune systems. (This will be something else we'll need to figure out and work on, if this is the case.)

Because at this point it isn't so important as to who's poo is who's, they have put both boys together in one cage. She did say that they were showing some signs of distress at being apart, so at least I feel a little better knowing they have each other for the night now.

I'm still to call them in the morning when I get home from work, to get a new update on how they're doing and what other tests they've run. For now though the absolute earliest TK "may" be able to come home would be tomorrow evening. This will totally depend on what else they may find wrong with TK and Radar, plus how well they respond to treatment.

Missing my boys SOOOO much!

 

glad to hear about the WBC count ...

My first worry would be panleukopenia, but that causes a devastating lack of WBCs. How old are the kittens, and when did they start to have problems? I'll put my mind to it in case i can think of anything -- right now I have something on the stove but let me know a bit of background in the meantime if you can.

 

Sorry another few questions quickly: have they been tested for FeLV/FIV at least twice? Are they vaccinated? Are they on IV fluids right now and getting antibiotics? Did you ever send a fecal test out to a lab, instead of in house? And how long of a course of Panacur? And were they ever on Albon?

 

Debra, I posted on your other thread before seeing this one. Glad to see you've gotten an update - I have no medical advice to give, of course, but am so glad they have the two together - that (I think) is really important.

I'm sure you're so concerned and am sending lots and lots of good wishes your way. Will be watching for your update. Sounds like the vets are very good and really checking out all possibilities.

Emmy & Dude (& Mittsi too)

 

Thanks for the update, Debra... I'm sorry they are so sick. It sounds like you have a wonderful team working on it... and with Jess putting her mind to this, well, you'll have all bases covered.

Please keep us posted... Continued prayers too...

I'm glad they can be together though... there is some solace in that.

 

Thanks for the update Debra.....so glad to know they are both together and not alone.

 

Jess, I'll try to answer your questions as best I can.

Right now the boys are hmmm....6 months old. The initial problem was right from the start, with Radar having diarrhea. It came, it went, it came, it went. Then they both broke with it, then TK's cleared right up, Radar's again came and went. When TK was thought to have hemobart and started on doxycycline he stopped having diarrhea. One week later we started Radar on doxycycline too and his diarrhea disappeared like magic. TK started on this med on October 20th, Radar on October 28th. They both took it for 21 days. All seemed fine, they ate, they played, they grew, no diarrhea.

Then about 3 weeks ago TK has having teething issues.......upper adult fangs grew in, baby fangs didn't want to leave. He got a bit fussy about eating, and started having small bouts of diarrhea and a LOT of gas. Radar was doing ok. Then about 2 weeks ago Radar started having bouts of diarrhea, but again, he too was having the same fang problem so I didn't get too concerned. They continued to eat well, drink well, played well, acting normal.

But the diarrhea didn't stop. This past Wednesday Freon had an appointment so I loaded all 3 up. Vet saw the diarrhea, ran a fecal on Radar alone, and found it to have a ton of bacteria. She gave me 4 syringes (2 apiece) of DiaGel. I gave each boy 1 syringe on Thursday. Friday the diarrhea was the same, so I gave them the second syringes Friday. Radar's diarrhea remained the same, not better or worse, TK's turned drastically worse, going from pudding poo to pure liquid poo shooting out with gas. Still, they ate, drank, and acted fairly normal despite the diarrhea.

This morning the boys ate breakfast really well. This morning I could tell though that TK wasn't acting up to snuff, so I called this new vet and got an appointment for this afternoon. Then, suddenly, TK took a horrible turn for the worse. He vomitted 7 times within minutes. Diarrhea literally dribbling out of him uncontrollably. He finally settled down to nap, so I went to watch tv. TK appeared and demanded to be held.......not at all like him, he likes to play at independence. As soon as he settled into my lap I could feel that he was shaking, shivering very hard. I looked at his gums and they were pale, very pale. I decided to get dressed and call the new vet to see if we could come in early. That's when I saw that TK had thrown up an 8th time, this time it was bright red blood! I called the vet and rushed him in, where he's now hospitalized with Radar.

They've been tested once for FeLV/FIV, and heartworms. All negative. This was when they were about (vet estimate) 8 weeks old. Vaccinated, yes. TK is now on IV fluids for dehydration. Radar is not, they gave him a small amount of sub-q's, he isn't dehydrated. Vet has started them both on doxycycline, since they responded so well to it previously. Radar can't take clavamox. Neither have been on Albon, both have been on panacur (3 days) and flagyl (12 or 14 days, not sure now) and neither helped in previous diarrhea episodes at all. Previous fecals were all in-house, nothing ever found. The new vet will run a fecal "three" ways is what she told me, a float, a direct, and a smear. Previous vet did only floats.

Sorry, I can't type any more right now, this board jumps up and down with each and every keystroke so I can't see what I type unless I stop typing and scroll it!

Ok, switched to Firefox and the board doesn't jump now.

To add: Both boys live inside, no new chemicals brought into the house, no "new" feeds added to their diets, no litter brand changes, no carpet cleaning.........everything is the exact same as it was. My other 6 adult cats are all fine, no diarrhea, no vomitting, all eating, drinking, and acting normally. My dog is same as always. Laundryroom is the back porch so no exposure to those chemicals. Basically, nothing has changed in their environment.

Oh wait, one other thing the new vet reported about on TK's bloodwork. All of it well within normal ranges except the very high white cell count.

 

Hi Debra

So the other cats share litterboxes with the kittens and none have shown signs of illness? What's this about "thought to have" hemobart? What happened there?

I wonder what type of bacteria your vet saw on the fecal. A common source of GI irritation and bad diarrhea is an overgrowth of a type of bacteria called camphylobacter. It looks quite distinctive; some people say it looks like a line drawing of a seagull ... it looks like a thin, wavy-looking stick so it's easy to identify.

The high WBC is due to either inflammation or infection. Generally speaking, antibiotics are used for these cases even though the enemy is unknown. Doxycycline has some anti-inflammatory action so that may be what's helping out in your guys' case (rather than as an antibiotic). Is TK eating right now? I'm a little worried that his current episode is not related to the ongoing chronic diarrhea. It's possible that something else has happened--he's eaten something that's gotten stuck or has an acute intestinal problem called an intussusception. I think it would be a heck of a coincidence but it's certainly possible given his age (foreign body) or history of GI issues (intussusception). I would speak to your vet bright and early tomorrow about these possibilities.

The other things I personally would do if this were my kitten:

--retest for FeLV/FIV. If money is an issue, test just TK, but ideally retest both. Do this right away (tomorrow).
--send out a fecal to the lab to test it by zinc centrifugation, and also have them do a giardia test. The zinc method has been proven to yield better results (finds bugs that regular testing misses). I worked at a vet clinic once that did a lot of rescue. I was convinced that a litter of kittens with diarrhea had coccidia, and did 8 fecal floats and 8 direct fecals before I found a single organism. Coccidia is one example of a parasite that's a bugger to find and a bugger to treat (needs to be pounded with 3-4 weeks of Albon). I'm sure the vet will roll her eyes, but do ask for them to send a fecal out to the lab for the zinc centrifugation and the Giardia test.
--get a breakdown of the CBC. If your vet is doing the test in-house, she may not know what specific type of WBC is high. I assume it's neutrophils, but a 'CBC with Differential', as it's called, will tell you if the high WBC is due to neutrophils or not.
--start thinking about getting an abdominal ultrasound done when this bout is over, and if all else is negative. They can't stay on doxy forever and sooner or later someone has to get to the bottom of this. Have they been neutered yet, BTW?
--get some FortiFlora, GI Balance, or BeneBac gel. Regardless of what else is going on, these poor guys are blowing out all of their normal gut flora. The DiaGel actually kills gut flora ... it's difficult, you know, because you dont' want to kill all the bacteria but you do need to get rid of some of the overgrowth, so the answer ends up being giving both an antibitoic and a probiotic in some cases.

Speaking of that, what is their diet?

Well I hope this is a start. Let me know if I can help further, and if you get any results back. From doing rescue, I have dealt with quite a few hair-pulling, nose-wilting cases of kitten diarrhea and I understand the difficulty. You may remember, too, that Earl had brutal IBD that took some time to make manageable (and by "manageable", I mean "no anal leakage everywhere"). This is unfortunately familiar territory!
Take care, and get some sleep tonight!
Jess

 

Thanks Jess for getting back to me about my boys. I just got off the phone with one of the vet techs and she said that while they do still both have diarrhea it's no longer "leaking" from them, plus TK does appear to be a bit more bright eyed and more alert than he was yesterday. TK is still on IV fluids......they found him to be quite dehydrated yesterday. (Man, that one hurts because I have fluids here at home, but I have a really hard time judging a kitten's level of hydration!)

(One side note: Remember a while back when I was at wits end with Radar having diarrhea? Well, back at that time he too had anal leakage, but his eventually calmed down to just normal diarrhea. TK has been having diarrhea for going on 3 weeks now, sometimes with anal leakage, sometimes not. Yesterday morning he was leaking badly....poor boy would simply sit and ooze poo!)

My adult kitties (6) share litterboxes with the boys here. We have 8 kitties total, and 4 litterboxes. And none of my 6 adult kitties are sick at all, no diarrhea, no vomitting, eating and drinking normally, and behaving normally. Just prior to TK becoming sick Freon was sick in December with vomitting and not eating or drinking, but no diarrhea noted. Freon did this earlier in 09 too so this time I immediately started giving him sub-q fluids, pepcid to settle his stomach, and nutrical to help prevent fatty liver. Within a week he was fine and back to his old self. Shortly after this TK's voice became hoarse sounding, and he developed diarrhea, but it wasn't until yesterday morning that the vomitting started.

What makes me so upset is that I just had all 3 (Freon, TK and Radar) at my old vet this past Wednesday, Freon for a recheck, TK and Radar for diarrhea. The vet found that TK had a temp of 102.6 and Radar had a temp of 102.1 and she wrote it off as "vet stress and car ride" related. Yet the boys weren't stressed, heck, Radar was taking a nap in the carrier!

I wrote that TK was thought to have hemobart because we don't know for sure if he did or not. The outlab test was negative for hemobart, but based on his anemia and not making any red blood cells my vet agreed that we would treat him with doxycycline. I had to take him back in 10 days for a recheck and his anemia was gone, all of his bloodwork was normal. That's when she decided to go ahead and treat Radar too. They both responded very well to treatment.

The new vet wasn't available to talk with me this morning, but she's supposed to call me around noon with an update on what they'd done so far and what else she may want to do. The vet tech mentioned that they want to send out a blood and fecal smear to outlab, I'm not sure exactly what they're looking for. I'll be sure to mention what you've suggested to the new vet.

Oh, the kittens diet? Hmmm....mostly canned food, brands vary, Whiskas, Sheba, 9-Lives, Fancy Feast. Flavors are chicken, turkey, and tuna. They refuse any beef flavored or seafood flavored, with the exception of tuna. We feed outside strays a mixture of canned/dry daily. The dry food is Meow Mix or Friskies. And yes, both boys beg like little devils for this since they too lived outside as babes and ate what they ate, so they get a small amount of this can/dry mix, just once a day. I'd say the dry makes up less than 5% of their total diet though.

And no, TK isn't neutered yet. The old vet didn't want to neuter until they reached at least 5 pounds in weight, and well, they're having a heck of a time reaching that! TK just weighed a squeak under 5 pounds this past Wednesday, Radar seems to be holding at a little over 3 pounds. Yes, their growth seems to be stunted. Every time they get this diarrhea they stop growth. When they were on the doxycycline they started growing by leaps and bounds. Radar isn't neutered yet either, but so far if he has testicles they haven't descended. There is a question as to whether Radar even has testicles, so we're looking at having the vet examine his penis........just haven't done that yet because right now it's more important to get them back on the road to feeling better.

I already have this product: http://www.1800petmeds.com/NaturVet+Enz ... 10803.html

I started giving it at the very first onset of the diarrhea and it didn't seem to make any difference, but maybe I shouldn't have waited for diarrhea. I didn't know that I probably should have been giving it to both boys while they were on the doxycycline!

Again, thank you so much!!!

 

Hi Debra.

I'm concerned they are still so small. I'd make sure they get their FeLV/FIV test today ok?

I don't understand about the hemobart (the new name is mycoplasma, by the way, if you wanted to do more googling). This disease causes RBC destruction so in response the animal desperately increases the amount of RBCs it makes, not decreases. The PCR test is pretty sensitive too so although no test is perfect, I'd be surprised if a cat that was supposed to be in the middle of a hemobart crisis did NOT test positive for PCR.

As for the temperature, even 102.6 isn't that impressive for a cat at the vet's. Personally I wouldn't count it as a fever, esp if the cat wasn't dumpy. Perhaps some people would find it to be an extremely mild fever for a cat, but I think it's hitting the upper edge of normal for a cat under duress (even if they dont' appear to be mentally stressed).

Off to work now. Let me know what happens with the FeLV/FIV test.
Jess

 

Jess,
We checked with the Merck Vet Manual about hemobart when TK's rbc went so low(http://www.merckvetmanual.com/mvm/index ... /10406.htm) and keyed in on this paragraph...

The number of RBC affected varies with the severity of the infection and the stage in the life cycle of the parasite. Blood films should be examined daily for 5-10 days if infection with H felis is suspected because organisms are recognized in only 50% of cats in the acute phase of the disease. During the acute phase, numbers of H felis organisms increase gradually, then disappear rapidly; clearance of organisms may occur within 2 hrs. In chronically infected cats, organisms appear only sporadically and in small numbers.

Debra's vet decided to give the doxy even though his test came back negative. When his pcv was retested, the anemia had gone away so I guess the assumption would be that he was hemobart positive and when the test was actually done showing negative was during that time period when the organism had cleared his system.

Hope this explains why Debra used the doxy for possible hemobart infection.

Dale

 

Thank you Dale! This is exactly why my vet thought it would be a good idea to treat TK for hemobart. And, since after 10 days of treatment his bloodwork went straight back to normal, we assumed that this was indeed what he had. That's why we also treated Radar. And, remarkably, within 24 hours of Radar's first doxy dose his diarrhea totally disappeared! This new vet isn't so sure that diarrhea is a "symptom" of hemobart, but since both boys did respond so well to doxy that's why she's started them both on it again. But, there's a possibility that there is more, something else, working in conjunction to make these boys sick. That's what the vet is working so hard to find.........hope she calls me soon!

 

Coccidia. Probiotics

I recently found out about Ponazuril for Coccidia. It only takes 1-5 days of tx. It's used a lot for kittens/puppies in shelters. It appears to be very safe. http://www.marvistavet.com/html/Ponazuril.html

You can also use Culturelle for a probiotic. Works well for Fiona and Miss Picky Pants doesn't notice this in her food. She hates FortiFlora. You can get Culturelle almost anywhere (Walmart, CVS, etc...) CVS has their own brand that's about $4 cheaper that works well too.

I'm dealing w/a similar issue w/a foster kitten who I'm just keeping during the cold snap. I just got him yesterday after he went to the vet. They did a fecal float, didn't find worms but they have him on Panacur for 3 days, they may have found bacteria. I wasn't there. He also has a URI and is doxycycline too.

Sharyn & Fiona

 

Hi Dale

It's true that mycoplasma used to be very difficult to diagnose because the infection can wax and wane to a great degree even in a matter of hours, as Merck says. PCR is a blessing for these cases because it can detect extremely low amounts of the organism in the blood to the point where there are actually asymptomatic "carrier" cats which test positive. These unaffected cats have such low-grade infections that they never become ill and would never be diagnosed but for PCR. (This is a blessing in another way as now blood-donor cats can be screened for this blood-borne disease.)

The wording in the Merck article is somewhat sloppy as it implies that a cat that is actively infected can be 100% clear which isn't true. The numbers can drop dramatically, but an infected animal is an infected animal. If TK was experiencing an active infection when the blood was taken, I think it is extremely extremely unlikely that his PCR would be negative, even if his cellular infection was "waning" rather than waxing.

(The Merck article is slightly out of date BTW-- I've noticed that some articles are more up to date than others, perhaps they are doing a slow revision. I plowed through a bunch of the mycoplasma research when Karen's cat became ill last year so a lot of it is fresh in my mind still, and I can tell the article hasn't been updated.)

Anyway I hope this helps and doesn't confuse the issue further ...
Jess


PS As I mentioned in another post, doxycycline has anti-inflammatory properties and may help with the enteritis due to that factor alone. It's also possible that it is treating an overgrowth of a bad bug in the intestines, but it isn't a fast-working antibiotic (it doesn't kill bacteria but rather interferes with its ability to reproduce) so rapid, dramatic results aren't usually expected.