5 Year Old Cat, Eyes Stay Dilated, 4 Vets, Slew Of Tests, No Diagnosis, Cat Dying

catman925

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Ok sorry for the super long title but wanted to let you know what you're getting into in reading this.

My neighbor, who just happens to be the lady that got me started in cat rescue some 6 years ago or so and is a super sweet person has a 5 year old male cat that is currently on his last legs.
My neighbor has already shelled out thousands and has gone through 3 vets so far plus 1 specialist. Lots and lots of tests and medications, but nobody has a clue as to what is wrong with him. My neighbor is at the point of finally giving up, but I asked her to give it just a tiny bit more time and said I would try to locate information for her and promised to ask around to at least get as many eyeballs and brains looking at the symptoms in the hope that someone, somewhere has seen these symptoms before and may have some sort of an answer at least.

The vets she has gone to so far (including every on-duty vet at one clinic (8) scratching theirs heads at it) has come up completely empty as to what is the cause. My neighbor is ready to put him down this week. She loves her cat, his name is "Lucky" and up to a few months ago, he was a perfectly healthy, energetic indoor/outdoor 5 year old cat.

So, if you feel up to it, please please take a look at this cat's symptoms and history of treatment and if anything jars your brain or you recognize something or have had experience with anything, please respond to this post ASAP. Like I said, my neighbor is thinking of putting the cat down in the next few days and to me, it just seems horrible that she doesn't at least have a reason for it. Any responses, suggestions, any questions, or even just some prayers out to here will be greatly appreciated. I, myself have no formal veterinarian training other than what is needed to address normal health problems in relation to doing TNR cat rescue and taming and fostering feral kittens. I am however fairly adept at finding requisite information online and am quite capable of doing deep in-depth research on things. On this though, I'm coming up empty.

I'll try to answer any questions as quick as I can and will update as things progress.

I thank you in advance :gingercat2:
-Art


"Lucky" - 5 yo indoor/outdoor DSH
- perfectly healthy until app. 3-4 months ago
- symptoms started with very labored gurgly breathing and URI symptoms:
Gurgle came from his sinuses area and not from his lungs (asthma ruled out). These symptoms were addressed with a Convenia injection and a Depo Medrol injection and the gurgly breathing has not returned.

Current Symptoms:
- eyes are always dilated, progressive blindness
Eyes are always dilated and he has been progressively losing his eyesight. He is now mostly blind. This symptom began about 1 month ago and was sudden onset (overnight I think but I'm not sure). My neighbor says he does not have any seizures, although she said he does curl his hind paws often. Not sure if this could be an indicator of a seizure or not. I had a friendly feral at one point that also lost his eyesight in one night and had the continuously dilated pupils starting the next morning. We determined that cat had a brain tumor. He was also having regular seizures. We treated him with occasional hormone injections until he was starting to have multiple seizures throughout the day and because of costs involved plus unlikelihood of a positive prognosis, we had to put him down. He was also a very young cat.

My neighbor's cat isn't having seizures (at least not anything similar to the feral cat that had the brain tumor).

My own initial (and still continuing) thinking is this has to be related to a neurological issue such as a brain tumor or cancer. Lucky has been x-rayed and no issues have been detected. He has also had an ultra-sound. Again, no problems detected in his head.

- other symptoms:
His other symptoms are in my experience all normal indicators that he has given up and is dying. These include:
  • lethargy
  • refusing to eat or drink water, even with appetite stimulant. (have started syringe feeding)
  • "far off look" in his eyes (fading)
  • unresponsive
I'll update this list as I learn more


Treatments and Findings
from 3 vets:
- Urinalysis SDMA test: positive for kidney disease
- 3 Convenia injections so far
- 1 Depo Medrol (hormone) injection. (this cleared up the gurgly breathing which has not returned)
- 3 fluids injections so far
- 2 blood panels: showed 3.2 creatinine (high)
- Radiology of head and body (no problems found)
- Toxoplasma titer test (negative)

from specialist:
- hydration
- blood pressure (normal)
- ultrasound showing possible small mass on kidneys
- needle biopsy on kidney - cytology "inconclusive"
- appetite stimulant (up until this weekend, this did get him to eat on his own but only until the drug wore off. Have started syringe feeding)
- retinas checked (normal)
The specialist initially didn't even address the dilated pupils until my neighbor pressed the issue as it was the only reason she agreed to see the specialist in the first place. Specialist checked retinas and could not come up with any reason for the dilation.


Okay, that's the list so far. My neighbor is currently not at home, but she's supposed to be returning this evening. I'll discuss with her about other possible symptoms etc that aren't included here yet.

Again, I thank you for any help, love or questions you can give. I just have a feeling that somebody out there has an answer or at least a good direction we can pursue. I'm having my neighbor hold off on letting her cat go for just one last possible chance, just in case.

much purrraise to you all :clapcat:
-Art
 

bodester413

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This is so sad. I feel so bad for him. Only five years old.

Does your neighbor let him outside at all? Could he have maybe eaten a poisonous plant or come across a mouse that someone poisoned?
 

susan denning

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What did the vet say about the SDMA test being elevated? My first thought was end stage kidney disease, but the creatinine doesn't sound super high? Also, it doesn't sound like something that would develop that fast.
 
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Margret

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Cats can have long, happy lives with blindness; it's the kidney problems that most worry me. Has your neighbor been taught how to give subq fluids?

I agree that the dilation sounds like something neurological, but without more symptoms I don't see any way to identify it or do something about it.

Margret
 

1CatOverTheLine

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C catman925 - Regarding Lucky's mydriasis: it sounds as though you're saying that his pupils are dilated and fixed - that is, wholly non-reactive to changes in lighting, is that correct?
.
 
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catman925

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This is so sad. I feel so bad for him. Only five years old.

Does your neighbor let him outside at all? Could he have maybe eaten a poisonous plant or come across a mouse that someone poisoned?
he didn't have any of the symptoms for poisoning (vomiting, diarrhea etc) so I'm guessing probably not that
 
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catman925

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C catman925 - I'll take a stab at this and ask if any of these veterinarians have ruled out anterior uveitis.
.
his pupils are wide open. the specialist looked at his irises and said they were completely normal. he doesn't show any of the other symptoms for anterior uveitis either
 
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catman925

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C catman925 - Regarding Lucky's mydriasis: it sounds as though you're saying that his pupils are dilated and fixed - that is, wholly non-reactive to changes in lighting, is that correct?
.
yes. he's blind as well they told me. I saw him last night. he looks entirely normal with the exception of his pupils and the lethargy. no discharge from the eyes, no sneezing or labored breathing. purring even although my neighbor says he is often "out of it".

I ask them to watch out for signs of seizures cause to me, that would indicate brain trauma or tumor.

I've also told them to use unflavored Pedialyte for water for now to keep his fluids up. They had been instructed to give him 20oz of water per day which seems to me to be excessively high. Normal water requirements is around 3-4 oz (or 1 cup) per day yes?
 
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catman925

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What did the vet say about the SDMA test being elevated? My first thought was end stage kidney disease, but the creatinine doesn't sound super high? Also, it doesn't sound like something that would develop that fast.
I'll ask them about what the vet said about this. other than lethargy, he doesn't show symptoms for this though (vomiting, diarrhea or poor body score). His weight is normal
 
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catman925

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Cats can have long, happy lives with blindness; it's the kidney problems that most worry me. Has your neighbor been taught how to give subq fluids?

I agree that the dilation sounds like something neurological, but without more symptoms I don't see any way to identify it or do something about it.

Margret
they were not taught to give fluids although I have told them to get unflavored Pedialyte and substitute that for water.

we also talked about having a blind cat and I did tell them they get along just fine. it's the other symptoms that really bother me ("out of it", refusing to eat/drink)

they were instructed to give him 20oz water/day. is that normal for cat with kidney disease?
 

Furballsmom

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20 ounces? Are they trying to flush his kidneys?
Not to state the definitely obvious, but the problem with outdoor or indoor/outdoor cats is there's no way to know all the nasty things they can come into contact with, including just applied fertilizer, pesticide, gasoline, antifreeze and who knows what else in sidewalk gutter water, etc all of which would have shown up in the toxo test, right? But what if he was exposed to something seriously nasty that he breathed in rather than ingested? That's what this sounds like to me, but, I don't know....
 
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catman925

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20 ounces? Are they trying to flush his kidneys?
Not to state the definitely obvious, but the problem with outdoor or indoor/outdoor cats is there's no way to know all the nasty things they can come into contact with, including just applied fertilizer, pesticide, gasoline, antifreeze and who knows what else in sidewalk gutter water, etc all of which would have shown up in the toxo test, right? But what if he was exposed to something seriously nasty that he breathed in rather than ingested? That's what this sounds like to me, but, I don't know....
yeah, I once lost a cat that drank antifreezes. it was horrible. I'm thinking it is kidney disease, since sudden onset blindness can occur from it
 

Furballsmom

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Yeah, thats true. I guess the gurgly UTI threw me off, but as you know that doesn't necessarily correlate to, or have anything to do with, what's going on now. So many variables. In any case, can they get him eating and treat him or is the owner out of options?
 

zygote

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Like catman925, I suspect kidney disease. While a creatinine value of 3.2 isn't awful, it's high enough that you could start seeing symptoms. Has the cat had a full senior bloodwork panel done? I ask because I'm concerned about high phosphorus (a common cause of poor appetite in kidney cats, can be solved with a phosphorus binder in the food) and anemia (a cause of lethargy, can be solved with meds, not as familiar with this).

I'm surprised the blood pressure was normal. It's often elevated in cats with kidney disease, and would explain the blindness. Has it only been tested the one time? How long ago?

It's hard to say more without knowing the full bloodwork, but if kidney disease is really the culprit, there are a lot of solutions to improve quality of life.

EDIT: While kidney disease sounds unrelated to the original breathing issue, it's possible that he was already on the way to kidney issues and the original infection and/or treatment accelerated it.
 
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catman925

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Like catman925, I suspect kidney disease. While a creatinine value of 3.2 isn't awful, it's high enough that you could start seeing symptoms. Has the cat had a full senior bloodwork panel done? I ask because I'm concerned about high phosphorus (a common cause of poor appetite in kidney cats, can be solved with a phosphorus binder in the food) and anemia (a cause of lethargy, can be solved with meds, not as familiar with this).

I'm surprised the blood pressure was normal. It's often elevated in cats with kidney disease, and would explain the blindness. Has it only been tested the one time? How long ago?

It's hard to say more without knowing the full bloodwork, but if kidney disease is really the culprit, there are a lot of solutions to improve quality of life.

EDIT: While kidney disease sounds unrelated to the original breathing issue, it's possible that he was already on the way to kidney issues and the original infection and/or treatment accelerated it.
I'm now pretty convinced this is definitely all kidney disease related. all the research I've seen so far show information that covers all of his symptoms. I haven't seen anything about causing the URI and gurly symptoms yet but you could be right.

The high level of toxins in his body can cause him to be stumbly and appear drunk which could be his "far off" look. The sudden onset of blindness could also be causing him disorientation simply because he hasn't had time to adapt (his full blindness occured within one week after his pupils dilated which occurred just recently).

His lethargy, refusing food/water, disorientation, frequent urinating all are direct symptoms of kidney disease.

My neighbor has an appointment tomorrow morning with her most recent vet.

Here are some links to where I've found most of this info plus based on my research, my own recommendations I gave her. She is going to give this info to her vet tomorrow.

Chronic Kidney Disease (Cornell University)

Kidney Disease in Cats - Dr. Stephanie Globerman - Paws Whiskers & Claws, The Feline Hospital

Feline Kidney Disease: Yes, There's Hope! | Ask The Cat Doctor

Cat Kidney (Renal) Problem Symptoms, Causes, and Treatments

Kidney Disease in Cats | Grafton, WI | Best Friends Veterinary Center

My recommendations:
- Low protein diet (Hills k/d wet food or other brand for kidney treatment) (the low protein takes some strain off of the damaged kidneys, the diet food helps replace phosphorous and others)
- Benzapril/Amlodipine for high blood pressure and hypertension (blindness). High blood pressure also causes strain on the kidneys.
- no dry food at all, only wet. Lots of water (the 20oz per day does indeed look to be correct since the cat is losing so much of his fluids from frequent urination).
- Pedialyte to help with fluid loss and help replenish electrolytes, potassium.

I also told her the blindness can be reversed if the kidney disease is treated. Both the blindness and kidney disease need to be treated as quickly as possible for better outcome. I also told her, based on what I've seen that a cat with kidney disease can live happy, normal lives if the disease is managed correctly. The research says their lives can be extended by 5-10 years. The kidney disease will eventually do them in as it's incureable, but if she manages his protein intake, his dietary needs and his fluid intake (including possible subQ fluid therapy), her cat could return to normal and live a good number if years still. There are a number of tests (included in the links) her vet can perform to determine the underlying cause of the kidney disease as well as many treatment options and medications. I told her her vet will need to determine what treatment is appropriate for her cat.

Hopefully, we can see a positive direction (from her vet as well) from all of this. I'll post an update from what her vet says tomorrow.

Thank you for all your suggestions and interest so far. You guys are really helping. :hyper:
 

zygote

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Sorry catman925, for some reason I missed that you were the OP!

Fingers crossed the vet can get to the bottom of this. If kidney disease is confirmed, all of those suggestions you list are right on the money (depending on what the vet says about this specific case, of course). My cat was stable with very good quality of life for over a year on daily sub q fluids and amlodipine. In the end it was cancer that she died from.

I'm confident that with this new vet and you in her corner, your neighbor will figure it all out!
 
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