Going for a second opinion - anything I should ask the vet to look for?

Okatoma

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Hello,

My 10-year old cat Walden has been having trouble with his back legs. I took him to the vet about 2.5 months ago and haven't been able to figure out a treatment that's effective, so I'm planning to take him for a second opinion. I'll give some background about his condition below - I'm looking for any thoughts or advice about things I should ask the vet to potentially consider.

About 3 months ago, I noticed Wally was having trouble climbing up on things. He was using his forelegs to pull himself up on the bed / couch and wasn't jumping anymore. His gate was also a little off, with a hunched back, especially if he had just gotten up from lying down. I don't know if this is related, but I also noticed his personality was changing - he's always been a dominant cat and a bit of a bully, but he was turning even more short tempered and grumpy. I thought this was due to a recent move and temporary downsizing - I had relocated and moved into a tiny apartment while I looked for a house and it's very small for 3 cats. Now I wonder if it's because he wasn't feeling well even then? Now, he has noticeable muscle loss in his back legs, can barely walk more than 10-20 steps at a time, and sinks onto his hocks after a few steps. He walks really hunched over and tends to sleep with his back legs stretched out straight (making me think there might be something wrong with his hips?).

The background to this story actually starts 5 years ago. When Wally was 5 he had the same problem - I noticed he gradually lost the use of his back legs and the muscles started to atrophy. I took him to the vet then and he was diagnosed with dry FIP. He apparently had a very high feline coronavirus titer count and combined with the apparent neurological damage, the vet suspected FIP and recommended I put him down. I didn't, for some reason. I said I wanted one more weekend with him and I'd call an emergency vet if he took a turn for the worse over the weekend. Instead, he started walked and eating again that weekend, and eventually made what looked like a full recovery. A second vet I took him to a month after his FIP diagnosis said that she suspected he had a feline coronavirus infection and some kind of spinal injury at the same time and had never had FIP, but had made a full recovery.

With this history, I took him to a vet as soon as I noticed the difficulties with him jumping/climbing again. The vet confirmed he had muscle atrophy in his back legs and difficulty walking, but did X-Rays and said she didn't find anything that she thought would account for his symptoms. She said that he had one disc that seemed a little out of place at the top of his tail but didn't think it would cause the walking problems he's experiencing. She didn't do a coronavirus titer count but consulted an expert who ruled out the possibility of dry FIP returning from remission 5 years later, so thought that would be an unneeded expense. She did a standard blood work panel (I go to a VCA clinic, if that's insightful for what a 'standard blood work panel' means) as well and didn't find any other potential medical causes for his hind limb weakness in that bloodwork.

She first prescribed gabapentin which she said can help address neurological issues. There were no noticeable signs of improvement. She did say he didn't seem like he was in much pain and the medication was mostly to address the nerve issues. I don't know if that 'not in pain' was for my benefit or true... About a week after the gabapentin ran out, he seemed to be getting worse, so she prescribed a steroid (prednisolone) and it was a miracle drug. Within 12 hours of taking the first pill, he seemed almost back to normal, and continued to do well the entire course of the steroids. About 3 days after tapering them off, however, he started to get worse and now he can barely walk again.

Unlike 5 years ago, there's no sign of a fever and he's doing well besides not being able to walk (5 years ago he was really sick - a fever, stopped eating, stopped using the litterbox for about 2 days). Even unable to walk well, he's still eating well and using the litterbox this time so it's not as bad as it was back then. He also still plays with the other cats (though in a stationary way) and with toys on a string, etc. I'm going to take him back to a vet and was wondering if anyone has had similar mysterious symptoms in a cat, and if so if you have suggestions about things I could/should ask the vet to consider? Any insights are appreciated!
 

tatonka1233

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Have you done any PT for Wally? Pt may help reduce the amount of atrophy in his legs. I would ask your vet if they have some PT treatment plans for him. I hope everything turns out alright for Wally.
 
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Okatoma

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Have you done any PT for Wally? Pt may help reduce the amount of atrophy in his legs. I would ask your vet if they have some PT treatment plans for him. I hope everything turns out alright for Wally.
Thank you! I haven't but it's definitely a good idea, especially once I'm sure there's nothing hurting him! I respect my vet, but I also worry that there might be more wrong that the vet isn't picking up on. But that's a great idea to ask my vet about possible PT, and question any potential second opinion vets about how they feel about alternative approaches to medication. I've wondered myself about massage or acupuncture or other alternative healing techniques since the western science doesn't seem to be identifying an effective treatment so far.
 

tatonka1233

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Thank you! I haven't but it's definitely a good idea, especially once I'm sure there's nothing hurting him! I respect my vet, but I also worry that there might be more wrong that the vet isn't picking up on. But that's a great idea to ask my vet about possible PT, and question any potential second opinion vets about how they feel about alternative approaches to medication. I've wondered myself about massage or acupuncture or other alternative healing techniques since the western science doesn't seem to be identifying an effective treatment so far.
I had seen one of my friends cat go from a healthy, walking cat to a sad, kinda depressed cat that couldn't walk. Somehow the cat had hurt herself while jumping up on a chair. Her vet recommended PT treatments after several medications did not work. Everyday my friend would sit on the floor with her cat and gently push her legs up into her body, like a cat normally does when they sot and walk, and do other various exercises. Eventually her cat made a full recovery and is now doing everything that she could do before. You just have to make sure that when you start PT, for the first few weeks do each exercise for a short amount of time. Once Wally has grown used to you doing that to his back legs, you can go for longer periods of time holding it in place just so he gets the muscle built back up. It is kind of like when we workout, the shorter we exercise, the less "burn" we feel. But then the longer we do an exercise, the more "burn" we feel. I hope this help you. Please update me on everything with Wally.
 

FeebysOwner

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Hi. I guess I would ask about the disc issue and if there are better ways to determine if he might have nerves being affected by that disc. It is possible that he did, somehow, injure himself and disrupted the disc and surrounding tissue, causing inflammation. The successful use of the steroids would suggest to me a possible reduction in that inflammation, which enabled him to move about better. Maybe another sort of anti-inflammatory might be helpful, if not more steroids. Or, it could be progression of disc degeneration - by very virtue of his age, but I think anti-inflammatories could be helpful in this case as well.
 

neely

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I took him to the vet then and he was diagnosed with dry FIP. He apparently had a very high feline coronavirus titer count and combined with the apparent neurological damage, the vet suspected FIP and recommended I put him down. I didn't, for some reason. I said I wanted one more weekend with him and I'd call an emergency vet if he took a turn for the worse over the weekend. Instead, he started walked and eating again that weekend, and eventually made what looked like a full recovery.
Good for you for not giving up on Wally! :rock:

I'm wondering if he could have some issues with arthritis especially since you mentioned he is 10 yrs. old. Our cat has some, but not all, of the same symptoms you described due to arthritis in his back end. One of the things our vet who is a feline specialist recommended was laser therapy treatment. This article may have some helpful information for you - scroll down to Acupuncture & Laser Therapy: Arthritis Treatment for Cats

And another article that discusses the use of laser therapy in cats and why it is underused:
Why Fewer Cats Have Laser Therapy - Catwatch Newsletter

Best of luck, I hope you find the right treatment for Walden, (Wally). :alright:
 

PushPurrCatPaws

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I agree with FeebysOwner, about the disc inflammation and how he showed signs of improvement while on pred. Your vet sounds great, but I do wonder if a radiologist read the x-rays (versus "just" the vet reading them). That is, a radiologist might better understand what is going on with that spine and disc... they often see things with their more-trained eyes that normal vets may not pick up. I would really talk with your vet about her ideas regarding the possibility of continued use of pred for your kitty -- maybe you can find the "goldilocks dose" of pred that will ease the inflammation yet still not interfere too drastically with his overall health, at his age. I have a cat on long-term pred, and I just make sure she continues to do well by doing vet visits and bloodwork at least 2-3 times per year, etc. I always give her pred with a meal or a moderate snack, per my vet.
 
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