Cat with vestibular disease

[whc216]

About three weeks ago, my 9 years old cat suddenly acted weird. He constantly hunched over, paused and stared at me. He was eating food, drinking water, and going to litter box fine with nothing looked bad. After 1.5 weeks, I finally brought him to the vet and we did blood work and urine test, and nothing looked too bad, except his liver value is bit off (but not too off); From the result, the vet recommended B12 and another short-term medication, perhaps IBD (bowel disease) so this medication can be used to rule out. However, nothing has improved after few days, and I felt like he has vestibular disease just the way he acted (kept rotating one side, and loosing balance). About 2 weeks since I first noticed the symptom, I saw him more obvious sign of head tilt and shaking head mildly, so I brought him to another vet, and the vet said he has vestibular disease. We got small number of steroid but the vet recommended me to get some consultation from neurologist. I booked for the neurologist and that won't happen until end of next month. Now, I am still trying to figure out what is going to my cat and hopefully get some advice who has experienced similarly?

It has been 3 weeks since I first saw my cat's behavior change. Since, there is one behavior I kept seeing from him, and from the search, it seems to be more like a focal seizure. He just lowers his neck, pauses there awhile and have some facial twitch and seems out of focus. I've seen this symptom since I notice this behavior change. I am bit frustrated how the neurologist appointment won't happen over a month from now. I am trying to figure what I can do meanwhile to make him better. Also if anyone has experienced similar as mine? I saw that vestibular disease usually recovers 2-3 weeks, but since I passed 3 weeks, it worries me a lot. On the other hand, he eats and uses litter box fine as usual.

 

[daftcat75]

My Krista woke up in the middle of the night, fell off the bed, and threw up. She stumbled around on her hocks like she was too weak or too dizzy to get back to her feet. I was convinced that steroids had finally made my cat diabetic and I was witnessing a hypo-glycemic event. In any case, I rushed her into the ER at 3am. They ruled out my theory with a quick blood test and told me that she would need to see a neurologist to get a better understanding of what was going on. They also told me that if I left her overnight, she could see a neurologist in the morning. But if I picked her up, she'd have to go through the front door to the neurologist and that would be several weeks to her next appointment. The neurologist was wonderful and knew exactly how to explain things. She told me, "this could be one of four things and we won't know which until she has an MRI:

1. Brain tumor
2. Stroke
3. Infection, or
4. Idiopathic (don't know what caused it)"

In Krista's case, it turned out to be a very bad middle ear infection. I brought her home for one night and agreed to bring her back the next morning for a surgery to drain her middle ear infection. The alternative would be months of antibiotics because the inner ear is technically outside the body, and not very reachable by systemic (internal) antibiotics. Both the MRI and the surgery were quite $$$. But they were both well worth it. If that's all that was wrong with Krista, she probably would have made a full recovery. As it was, she also had GI lymphoma. A bladder infection would prove too much for her chemo/steroids suppressed immune system. So I can't speak to the long-term recovery other than she was doing great before that infection.

So....

The long and the short of this is that you should probably expect to pay for an MRI ($2000 in expensive Bay Area, California) to be certain of what you're treating. If that's out of your reach, the neurologist may be able to formulate an A-B (or A-B-C) plan where they agree to try a plan A first and monitor before shifting to a plan B or C.

Since Krista's wasn't true vestibular disease, I couldn't tell you treatments and timelines. I guess what I really came here to say is that, even though it's a wait for the neurologist, if you can afford the MRI, that's going to be the best first step to knowing what you're really dealing with and where to go from there. Fingers crossed his neurologist was as wonderful as Krista's was.

 

[mrsgreenjeens]

Here is a thread about vestibular disease that you might find helpful: Head tilt (feline idiopathic vestibular disease? )

Often there is a reason for it, like a middle ear infection, which can be treated with antibiotics. Since you can't be seen by the neurologist for quite some time, you might ask the Vet if they would be willing to prescribe some just in case that's what it is. OR, see if that Vet will contact the neurologist and ask them to get you in sooner. That helps since it would be a referral.

 

[whc216]

My Krista woke up in the middle of the night, fell off the bed, and threw up. She stumbled around on her hocks like she was too weak or too dizzy to get back to her feet. I was convinced that steroids had finally made my cat diabetic and I was witnessing a hypo-glycemic event. In any case, I rushed her into the ER at 3am. They ruled out my theory with a quick blood test and told me that she would need to see a neurologist to get a better understanding of what was going on. They also told me that if I left her overnight, she could see a neurologist in the morning. But if I picked her up, she'd have to go through the front door to the neurologist and that would be several weeks to her next appointment. The neurologist was wonderful and knew exactly how to explain things. She told me, "this could be one of four things and we won't know which until she has an MRI:

1. Brain tumor
2. Stroke
3. Infection, or
4. Idiopathic (don't know what caused it)"

In Krista's case, it turned out to be a very bad middle ear infection. I brought her home for one night and agreed to bring her back the next morning for a surgery to drain her middle ear infection. The alternative would be months of antibiotics because the inner ear is technically outside the body, and not very reachable by systemic (internal) antibiotics. Both the MRI and the surgery were quite $$$. But they were both well worth it. If that's all that was wrong with Krista, she probably would have made a full recovery. As it was, she also had GI lymphoma. A bladder infection would prove too much for her chemo/steroids suppressed immune system. So I can't speak to the long-term recovery other than she was doing great before that infection.

So....

The long and the short of this is that you should probably expect to pay for an MRI ($2000 in expensive Bay Area, California) to be certain of what you're treating. If that's out of your reach, the neurologist may be able to formulate an A-B (or A-B-C) plan where they agree to try a plan A first and monitor before shifting to a plan B or C.

Since Krista's wasn't true vestibular disease, I couldn't tell you treatments and timelines. I guess what I really came here to say is that, even though it's a wait for the neurologist, if you can afford the MRI, that's going to be the best first step to knowing what you're really dealing with and where to go from there. Fingers crossed his neurologist was as wonderful as Krista's was.

Thank you so much for your reply! In fact, I read some of your post before I posted here, so thank you so much for sharing. Yes, MRI is definitely on my plate if I have to, but I won't be able to see the neurologist (since I didn't go through ER) next 5 weeks, and it makes me worry if it will make it worse. Meanwhile, I do plan to check up with my vet next week. For your case, was Krista sometimes twitch her head? Sometimes, depending on which area I pet my cat (near ear), he twitches or shakes head, something abnormally than he used to, and not sure if it signals some pain. Also if it went antibiotic route, what kind of medication would Krista had to take? I am not sure during this wait period, I should ask vet about this? I currently got Prednisolone 5mg and orbifloxacin - once per day. Today has been 6th day since I started and not much progress yet.

 

[whc216]

Here is a thread about vestibular disease that you might find helpful: Head tilt (feline idiopathic vestibular disease? )

Often there is a reason for it, like a middle ear infection, which can be treated with antibiotics. Since you can't be seen by the neurologist for quite some time, you might ask the Vet if they would be willing to prescribe some just in case that's what it is. OR, see if that Vet will contact the neurologist and ask them to get you in sooner. That helps since it would be a referral.

I did not know referral! I will reach out to my vet tomorrow. In case of middle ear infection, do you know what kind of antibiotics they prescribe? I currently got Prednisolone 5mg and orbifloxacin - once per day. Today has been 6th day since I started and not much progress yet. Thank you!

 

[daftcat75]

Thank you so much for your reply! In fact, I read some of your post before I posted here, so thank you so much for sharing. Yes, MRI is definitely on my plate if I have to, but I won't be able to see the neurologist (since I didn't go through ER) next 5 weeks, and it makes me worry if it will make it worse. Meanwhile, I do plan to check up with my vet next week. For your case, was Krista sometimes twitch her head? Sometimes, depending on which area I pet my cat (near ear), he twitches or shakes head, something abnormally than he used to, and not sure if it signals some pain. Also if it went antibiotic route, what kind of medication would Krista had to take? I am not sure during this wait period, I should ask vet about this? I currently got Prednisolone 5mg and orbifloxacin - once per day. Today has been 6th day since I started and not much progress yet.

I don't know that I had Krista pre-surgery long enough to characterize how it might have been bothering her. I rushed her to the ER when she stumbled off the bed and could not get back to her feet. They kept her overnight and I picked her up the next day. Since I knew from the neurologist and the MRI that we were dealing with an infection, I pretty much left that ear well enough alone and just focused on her comfort for that night before dropping her off the next morning for surgery. She spent one night at the hospital before I picked her up. Then she spent two weeks on activity restriction in a dog pen until the surgeon gave her the thumbs up to rejoin gen pop. She got several hours each day outside the pen under strict supervision to make sure she wasn't running, jumping, climbing, or any of the other forbidden activities (to insure that her incision did not re-open.) Most of that time, she just wanted to climb onto my chest and purr her head off while taking scritches.

Krista was already on pred so that didn't do anything extra for her. But, in her case, I wouldn't expect it to since it was infection and not inflammation or tumor at the root of it.

Krista took marbofloxacin and the specialist wanted her to take it for a minimum of a month. But at about 25 days give-or-take, the specialist okayed her to go off of it because it was affecting her appetite. And with Krista's lymphoma, her ability to maintain her weight (and hopefully, one day, re-gain it) was the number one factor for how long she could continue to fight the good fight.

If your boy has an ear infection, it may take a very long time to resolve on antibiotics alone because the inner ear is technically outside of the body. But it's not like I have any other recommendations without an MRI.

 

[daftcat75]

Krista after her consultation with the neurologist and before her surgery.
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And
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Krista just a few days after her surgery. She's walking better already.
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A little more than one month post-surgery
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[mrsgreenjeens]

I did not know referral! I will reach out to my vet tomorrow. In case of middle ear infection, do you know what kind of antibiotics they prescribe? I currently got Prednisolone 5mg and orbifloxacin - once per day. Today has been 6th day since I started and not much progress yet. Thank you!

The antibiotic is based on what type of bacteria are found, so it's impossible to say EXACTLY what would work, but the marbofloxacin that Krista took is often used for this, based on the cytology results.

Why is your little one on orbifloxacin? I have not heard of that being used for ear infections, per se, but it is used for respiratory infections. Do they think he might have a URI?

 

[whc216]

The antibiotic is based on what type of bacteria are found, so it's impossible to say EXACTLY what would work, but the marbofloxacin that Krista took is often used for this, based on the cytology results.

Why is your little one on orbifloxacin? I have not heard of that being used for ear infections, per se, but it is used for respiratory infections. Do they think he might have a URI?

I am not sure. The vet prescribed these for general antibiotic purpose so I gave him as it is. Should I ask for something more ear related focus?

 

[mrsgreenjeens]

Well, you could talk to your regular Vet about the chances of it being a middle ear infection vs neurological and also tell them it's 5 weeks until you can see the neurologist to see if they will refer you to get in quicker. If they think an more ear specific antibiotic might help, then they will prescribe it. Be sure to emphasize that you are talking about an infection deep in the ear, not a general ear infection. They should know what you are talking about.