Is This Just Normal Aging Or Something Else?

[white shadow]

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This must be a huge relief for you and will surely have relieved much stress from Duncan.

One of the actions of the cortisone is to reduce inflammation - that it also appears to have restored vision could provide a skilled diagnostician with a path forward towards determining why this occurred.

"the blood test results...show elevated leukocytes"​

Elevated leukocytes would be expected after steroid administration. By itself, it does not confirm the presence any infection.

It's unfortunate that the blood draw for the testing wasn't done before the first steroid injection.

But, I don't think all is necessarily lost. I believe that a skilled pathologist, maybe even technician, can determine if the leukocytes are raised because of the steroid's action or as a result of infection.

As an aside, hypertension can not be diagnosed nor dismissed by simple examination and observation.
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[Leomc123]

I am thinking, its a brain disorder like a tumour, or maybe a stroke, or high blood pressure that may be affecting his sight. If the pain medications are working for him, the medication may be having an anti inflammatory effect where it is reducing pressure somewhere . What pain medication is he given ?

 

[SelenaG]

It's cortisone, so definitely an anti-inflammatory. A brain disorder or tumour is definitely the number one suspicion at the moment, but it's frustrating that we really can't get a definitive diagnosis because of the lack of specialist equipment.

White Shadow, I agree that the blood really should have been drawn during the first vet visit, before he gave any injections. I have a feeling he was trying to be reassuring by telling me it was just old age, and saying that he was giving a 'painkiller and vitamin supplement' but that was definitely not the outcome! I've read a lot in the last few days so I think I have a better sense of what questions to ask now, but I also feel like unless I ask exactly the right question, I'm just not going to get any answers. And even then, I might not get an answer anyway.

I guess the truth is that the vet care options are pretty limited here, so the treatment may look a lot different than if we were in the US or somewhere else with more advanced vet care.

 

[white shadow]

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Just around available services where you are..........

I just went Googling to see what I might find for vet specialists in Egypt.......one of the 'hits' was this - which is not a specialist, of course - it seems like a clinic, but looks like it has potential: AVC - American Veterinary Center

Would that be a consideration for you? (Check the "Services" page - seems a little better than 'crystal ball medicine'.)

The only concern I see is that all the Vets there have, at most, ~5-6 years post-graduation experience, and all their training is local. The fellow who owns the place (allegedly the inventor of "soft-paws") would seem to be in NY State these days.

I mean, simply reading your account of all that's happened so far has been incredibly frustrating to me....and, I'm 'light years' removed from you! There is another member here on TCS, in Turkey I believe, who once remarked 'It's like village medicine', as in dealing with a village herbalist! I'd be driven mad by it all!


Back in post #14 I wrote this:

In North America, the accredited veterinary schools at the major universities also have "small animal hospitals" where late-term students practice hands-on medicine under the direction of highly skilled instructors and where board certified specialists are available to consult and teach. I have no idea if a similar model exists in Egypt. However, here is a piece from US News & World Report that identifies the top-rated veterinary schools in the region: U.S.News - Education - Best Arab Region Universities for Veterinary Sciences...​

I must have had a brain-freeze moment there....I had wanted to include that, in the US, the small animal hospitals at these schools are open to the public. The benefit of these places is the availability of the latest in technology and access to specialists.

Can you find out if any of the schools listed in the US News article have similar hospitals?


To your last post there, yes, it seems to me that the two Vets you've had so far are not used to being questioned.....sounds like old-school medicine middle-east style.



I was going to just post all of that, but I went back for one last look at Google.....I found something:

"Fallen kitten
A veterinary student (in yellow hijab) at the Cairo University Small Animal Clinic examines a kitten......."
LINK: Veterinary Medicine in the Nile Delta | School of Veterinary Medicine (3rd picture there)​

That link won't give you a link to the school, but, at least we know that there's at least one 'small animal hospital' - at Cairo Univ.

Maybe you could follow that up...I don't think I'd want those 'kids' actually treating my cat, but maybe I could have one of the senior staff/specialists there see him if I started there...???


Hoping something there will help.
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[SelenaG]

Wow white shadow, I really appreciate all the effort you've gone to! I have to admit, this line in the article you linked to made me chuckle: "the clinic sees mostly small animals and camels." Talk about two extremes! Quite what they'd be doing seeing camels at the Small Animal Clinic, I have no idea. Makes you wonder who they see at the Large Animal Clinic!

Regarding the American Veterinary Center it's weird that I haven't heard of them. There are probably 3 or 4 vets that expats in this area use consistently, and that's not one of them. We have a very active community Facebook group where people are always asking for recommendations for different things, and I don't recall ever seeing that clinic mentioned.

It has been very frustrating so far, but at least Duncan is showing some improvement now. I'm just taking it day by day at the moment, and I have another potential vet to try a little further afield if necessary, that was suggested by Duncan's mom. She's sampled most of the vets here at one time or another, including one who advised her to wash her dog in motor oil to get rid of his mange!

 

[white shadow]

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.....patients at the "Large Animal Clinic?

In all likelihood, it would be the likes of these

Spoiler

I'm not surprised about the lack of an informed FB public where it comes to feline health - especially when things get 'complicated' - here on TCS, the majority of newcomers need some tutoring, with most not even knowing that there's such a thing as a cat-only Veterinarian.

In case you missed it, Cairo U is the top-rated vet school in that US News piece.
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[white shadow]

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Put this in your 'back pocket' in case they insist there's an infection somewhere (which there may be). But, that should be accurately determined, not assumed.

I said I thought there was a way to determine if the steroid caused the rise in WBC or it was due to infection. This study seems to lay out the determinants for each: Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis. - PubMed - NCBI I don't understand the terminology - a technician/pathologist would.
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[Kflowers]

I noticed two things with Prednisone 1- it made the cat who took it insanely hungry. She dove from the top of the fridge into the food SO was taking out. She dislocated her leg leaving it apt to slip in and out for the rest of her life. 2- the dog was not given enough warning that he needed to pee and did it while running to the back door. He was an abused rescue and was terrified for an hour after it happened. We changed medicine in both cases.

I"m not saying that you will have either experience, just to be aware of the possibility.

 

[SelenaG]

Finally found a vet clinic with a blood pressure monitoring equipment and took Duncan to have his BP measured this evening. It was 159/119.

The vet wasn't there, just the technician, so I'm supposed to go back tomorrow to see the vet (number 3). Having done extensive reading now (and emailed a vet in Australia - the father of my son's friend) I believe the recommended treatment for hypertension is a drug called amlopidine. I messaged the vet and he doesn't have it, so I'm not sure what his suggested treatment would be. I'm going to check with the pharmacy tomorrow to see if I can get some over the counter.

Duncan deteriorated again quite dramatically overnight so I feel like we have to try something.

 

[Kflowers]

You got it measured that's a start.

 

[Leomc123]

Symptoms of high blood pressure in cats :

• Seizures
• Circling
• Disorientation
• Blindness
• Dilated pupils
• Retinal detachment
• Hemorrhage of the eye
• Blood in the urine
• Protein in the urine
• Bleeding from the nose
• Swollen or shrunken kidneys
• Heart murmurs
• Weakness, either on one side of the body or in the legs
• Involuntary oscillation (rolling) of the eyeballs
• Palpable thyroid gland (when hyperthyroid)

I hope duncan gets better, the peeing could be related to this also.

 

[SelenaG]

In the interests of someone else reading this in the future looking for answers, I'm going to keep posting updates.

I came across a thread on here from last year where the poster was describing very similar symptoms to Duncan, but after their initial post, they never came back to say what happened. I messaged them to try and find out but no response so far.

Anyway, over the last seven days we've had six vet visits with three different vets - plus the unofficial email consultation with the Australian vet. Having had Duncan's blood pressure checked we are now proceeding on the assumption that he has hypertension. I found some amlopidine at the pharmacy and gave him his first dose (which was a challenge. How are you supposed to cut one of those tiny pills into 8 pieces!). Then the vet gave him some IV fluids. He's supposed to go back for more fluids daily for the next four days and continue with the hypertension medication. We're going to stop the steroids for now and see how he does.

Right now he's still alternating between sleeping and being super lethargic, and being driven to pace and push his head into corners. He doesn't have much of an appetite but I did manage to get him to eat a little this afternoon. I also bought a child's medicine syringe, so I've been squirting water into his mouth with that.

 

[white shadow]

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Just a quick note....be really careful with syringing water (or anything) into his mouth.

They aspirate very easily and they (cats) are overly susceptible to an extremely dangerous form of pneumonia, should that occur.
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[SelenaG]

Just a quick note....be really careful with syringing water (or anything) into his mouth.

Good to know. I've really been dribbling it into his mouth and just tiny amounts, so hopefully it's OK. He's been swallowing it OK.

 

[white shadow]

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Good.

Just do droplets....no larger amounts (think of the tiny amounts they take into their mouths on their tongues - quite different from hoomans!)

Best targets are the tongue (across/crosswise, never straight on) or the side pocket (between lips and gums) - just never, ever straight towards the back/down the throat!

(It's "aspiration pneumonia".)
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[SelenaG]

Just another update on Duncan.

After three days of the Amlodipine and IV fluids Duncan's blood pressure has dropped to 110/90! He's showed a dramatic improvement, his vision has returned and he has stopped the compulsive pacing. The speed of his apparent recovery has been remarkable. Yesterday morning he could barely walk in a straight line, was falling over and couldn't make it to the litter tray. He started to appear a little better by lunchtime, and by the evening, when we returned from our vet visit, he went straight to his food bowl, then the litter tray, then settled himself on a chair. It was a dramatic improvement. That has continued today.

I don't want to get my hopes up too much. This has been a rollercoaster so I'm aware things could change just as quickly in the reverse direction, but I'm cautiously optimistic that we might be on the road to recovery.

 

[white shadow]

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That's a huge relief on several fronts!

NOW, of course comes the search for the why....the 'what's causing this?'.

Who, do you feel will be best suited, best 'up' to the task?
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[Kflowers]

I'll get my hopes up a little bit for you guys, then you can get yours up a little bit. In the mean time Duncan enjoy the moment in a way he hasn't for awhile. I"m so glad the vet finally figured this out. Hugs and prayers going to both of you.

 

[SelenaG]

NOW, of course comes the search for the why....the 'what's causing this?'.

Our best guess at the moment is kidney disease. Duncan's creatinine levels were elevated in the blood test, although from the reading I've done it might be a 'chicken and egg' situation. Did the kidney issues cause the hypertension, or vice versa?

I'm glad we've made progress, and at this point I just want to maintain the status quo for a while. Keep giving Duncan the medication and giving him some time to really feel better. He normally gets car sick and doesn't like travelling in a car at all, and over the last two weeks he's probably had more car rides than in the last five years! Nine vet visits in two weeks, with three different vets. Three of those were home visits, but that's still 12 car rides in a very short time. (Plus two more today when we go back to the clinic later to have the cannula removed). I could also do with a rest from the car trips! It's pretty stressful for me, and although it's not far each time, waiting around for the Uber is annoying for both of us!

Duncan's real mom will be back at the end of June, so hopefully he can go home to her. There were several days in the past couple of weeks when I thought that wasn't going to happen, but now I am hopeful that will be possible. Then when things settle down a bit, maybe she'll want to do more investigations.

The quality of vet care here has been a challenge in this case, but at least we don't have to worry about taking out a second mortgage to pay for it! I read some of the threads on here about how much people have to pay or the hard choices they have to make because of financial decisions and it's heartbreaking. Our treatment so far - 9 visits, including 3 at home, multiple injections, four days of IV fluids etc - has so far cost around $140.

Thanks for all the support and suggestions on here, including the links. It was very helpful, because it was my investigations that really led us to this point. I'm just so glad I didn't accept the first vet's diagnosis - the title of this thread!

 

[white shadow]

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I'm so happy for you that you've reached this place and that now you are able to step back from all of this and maintain his new status quo. And, for him, that for now, at least, he can settle back in to very close to what was his life before all this.

Keeping him hydrated now will be important for maintaining his (mostly) new normal. Hopefully the new Vet can teach you the 'skin test' (Assessing Dehydration) and the other specific signs to observe for to keep his hydration level normal. Here's something that may help you, a chart within an article on constipation I came across recently. I'll give you the link for the article as well, as it might be useful down the road:

LINK: http://veterinarymedicine.dvm360.com/all-bunged-unclogging-constipated-cat?pageID=1
(PAGE 2)​

And, on that, if he's dehydrating, the litterbox will reveal clues....more/larger urine clumps and drier, harder stool - keep an eye out for these.

Knowing that housecalls are so easily available must be hugely relieving for you - if he should need it, fluids can also be given under the skin, a much easier process than IV (and something people can even do themselves at home).

There are some serious kudos owing to you for all the behind-the-scenes problem-solving that's brought things to this point.....how appropriate that, "kŷdos"!

We'll be here, when and if.........
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