Vets Are Stumped. What's Wrong With This Cat?

OhLily

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I have a female, 12-year-old ginger tabby with well controlled diabetes (1.5 units of Lantus twice daily; she has been under treatment for 2.5 years with no complications). While she has seemed to be slowing down lately, her appetite has always been good and her behavior predictable. Her health has been otherwise excellent.

48 hours ago, we noticed she had tachypnea (rapid breathing but no open-mouthed panting) and had stopped eating and drinking. We were concerned it was either heart failure or ketoacidosis, and rushed her to the vet as soon as possible (the next morning). She underwent a battery of tests, X-rays and blood work, which revealed that her glucose level was a bit high, but within normal range for her condition and stress level (300's); no heart murmur; no thyroid issues; nothing amiss on the X-rays except for somewhat white lungs (which the vet thought was in line with her age); heart size normal; nothing visibly wrong with bowels. Fructosamine test also came back OK. They gave her hydration fluids, butorphanol in hopes of calming her breathing temporarily, and also anti-nausea medication to encourage her to eat.

She returned home and the rapid breathing started right up again (probably as the meds wore off), although she seemed happy to be home and had an energy burst. Since then, she has utterly refused all food and water (we have been giving her water via eyedropper). Perplexingly, she seems interested in the food but sniffs it and will not eat. (Something wrong in her mouth?? but why the heavy breathing?) She also engages with us (eye contact, head rubbing, meows) when she has an energy burst -- but the energy soon fades, and she sits down and "zones out," staring at the wall. Her pupils also seem to be continually dilated. She will lay down on the carpet (unusually for her) with her neck stretched out, but doesn't seem to be sleeping well.

We're obviously extremely concerned about her lack of food and water intake, and took her back to the vet for more hydration today. We have tests scheduled with a more advanced vet faciity tomorrow. We just don't understand why she has gone haywire this way over the last 48 hours. On Saturday evening she ate enthusiastically, less so on Sunday morning, and by Sunday PM was refusing all food. No signs of wobbling, head tilting, eye movements, or other neurological things (except the occasional zoning out) - we thought she was dizzy, but has shown no real signs of it. The only constants are the continual tachypnea and the utter lack of interest in even the most delicious food. It's like she has a cognitive interest in food, but has forgotten how to eat or what to do with it. (Putting food in her mouth doesn't stimulate her appetite.) She uses her litter box just fine (though I am surprised she has anything left in her to poop or pee)

We hope to get answers tomorrow, but are so worried (and concerned about her diabetes too, since she cannot get insulin shots when she is not eating). Does anyone have any clues?? Otherwise we face the prospect of watching her painfully waste away, which we of course would never allow her to suffer.
 

ArchyCat

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I have no clue, but please post updates. It's difficult when a loved pet becomes ill. Are you able to track her blood glucose level at home?
 
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OhLily

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Rightly or wrongly, we opted not to track her glucose at home because it was logistically not possible at the time. Because she did so well, we decided to rely on careful observation and control of her food portions, etc. If she gets past this crisis, we will certainly reconsider doing her glucose at home.
 
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OhLily

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We have decided to stop testing our kitty and manage her decline at home. A painful decision, but after $3200 worth of tests and therapeutic care at two hospitals, even the vets at our advanced hospital facility are still stumped. She shows no classic signs of anything. Imaging, ultrasound, heart enzyme tests all show no indication of heart disease, no masses on X-ray, no sign of ketoacidosis. They proposed a last ditch test to explore the possibility of asthma or cancerous cells, but we could not agree to have our already weak cat to undergo anesthesia and a tube down her airway to diagnose something we'd have to euthanize her for anyway (lung cancer).

The only breakthrough was that Lasix calmed her breathing, which made them think heart disease for a while, but there's just no confirmation forthcoming. Everything reads normal for her heart.

The only question now, sadly, is what she will actually die of -- this mystery ailment, or the diabetic crisis that is sure to ensue because we cannot get any insulin into her because she barely eats anything. She has been sent home with a few medications -- Lasix for any breathing crises, an appetite stimulant (limited success and a lot of meowing and restless side effects), an antibiotic in case she has toxoplasmosis, and a medication for any potential lungworm. The latter two are probably wild-ass guesses, though I don't blame the doctors, who seem very thoughtful and genuinely perplexed at our dear kitty's case.

I am weary and heartbroken, time is running out for her, and I just want to say a peaceful goodbye for her at home while she can still enjoy a quiet nap next to us before she is in too much discomfort. She's currently agitated from the appetite stimulant (got her to drink water and eat a kibble or two or a few licks of baby food, but not enough to permit her insulin shots to continue), so another precious day is being lost. I'm sorry I could not find out what was wrong.
 

Weasel21

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So sorry that you and your kitty are going through this. I’m not a veterinarian, but I’m not sure of any reason why lung xrays would be white other than fluid build up in or around the lungs; I don’t think that changes with age. Especially when combined with the evidence that lasix appeared to help. Have the vets tested for pancreatitis? It sounds like that can be a comorbidity with diabetes, and can also cause fluid build up in the lungs.
 

daftcat75

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You don’t have to call it just yet. Have you considered inserting a feeding tube?

My Krista just got one inserted. I was scared of it at first. But she’s got too much fight and too much love to give up. She was in a terrible bind. Her teeth were bothering her so she stopped eating. But her liver and gallbladder went abnormal (not fatty liver yet) which made her a poor candidate for the dental. Well, she threw a fit during the ultrasound for her liver and ended up getting sedated. She got her dental after all—two more teeth extracted and some root fragments from prior extractions removed. But now she’s really stopped eating. So I finally convinced the Drs it was time to insert a feeding tube so that we can start her liver and gallbladder medicines and getting food back in her. I am so relieved now because her mouth can have all the time and space it needs to heal and we can feed her and give her medicine without relying on her appetite, which has understandably been inadequate for awhile now.

Have you checked for pancreatitis?

Have you checked for dental issues? Oral x-rays at least if you don’t feel comfortable with sedation?

If the breathing issues are controlled with medicine and the only other apparent issue at the moment is the anorexia, you can overcome that with the feeding tube. There’s no reason you need to let her waste. At the very least, it buys you plenty of time to send her records off to another vet for a second opinion and more ideas.
 
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OhLily

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Unfortunately we don't live in a big city and we have already taken her to best hospitals in area. I believe pancreatitis was also ruled out.

I don't want to give up on her but a feeding tube seems overwhelming and the 45 minute journey to the advanced hospital in very cold temps has left her a nervous wreck. (Our local vet is unable to do feeding tube) We want to keep caring for her but we also do not want her to be dragged through procedures and medications that make her frightened.
There is also cost to consider as we have already spent almost all the funds we had set aside for her future diabetes treatment. Fortunately we do have financial resources left to continue to care for her right now, including any more medications she may need.

The good news is that she is home now and eating and drinking. We think that getting her back on her insulin regimen is the priority right now, as her hunger and thirst (although helped by appetite stimulant) is probably signs of her diabetes not being controlled after nearly a week of no food or insulin. We are also monitoring her respiration (high-normal right now after a dose of Lasix two days ago). We just want her to spend a calm weekend where she is eating, drinking and resting, and getting back on her insulin. The doctor also gave her an antibiotic for possible toxoplasmosis and we are giving her that.

Her pro BNP results should be back early next week, unfortunately that can really only rule OUT heart disease (not confirm it). In the end it's going to come down to her quality of life, which we are constantly taking under consideration.
 
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OhLily

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PS- Her mouth was checked over and over (difficult because she is extraordinarily resistant to opening her mouth for anyone and always has been, even when healthy). Nothing but mild gingivitis.
 

Jem

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Perplexingly, she seems interested in the food but sniffs it and will not eat. (Something wrong in her mouth?? but why the heavy breathing?)
Heavy breathing can be a sign of pain. Did they thoroughly check her mouth and throat?
 
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OhLily

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Yes, see my most recent post.
 

Jem

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Oh, sorry! I missed that very last one. :doh:
 

white shadow

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Hi OhLily and a belated welcome to the forum !

There's one other online resource you might consider trying......it's a specialized online community dedicated to helping people and cats deal with and manage diabetes. (Many folks know it as the premiere go-to source for all things feline diabetes.)

The Feline Diabetes Message Board has been active for 20+ years and has had thousands of members and their cats. While their focus is FD, the more seasoned members there have an excellent overall grasp of feline health issues. If I were in your position, I'd be putting her case to them.

You'll find them here: Feline Diabetes Message Board - FDMB

I'd say the sooner you consult with them, the better.


Meantime, two things:
- keep us up-to-date on how she's doing
- after you post her story there, come back......and post some pictures for us here:)
.
 

Noirele

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So sorry that you and your kitty are going through this. I’m not a veterinarian, but I’m not sure of any reason why lung xrays would be white other than fluid build up in or around the lungs; I don’t think that changes with age. Especially when combined with the evidence that lasix appeared to help. Have the vets tested for pancreatitis? It sounds like that can be a comorbidity with diabetes, and can also cause fluid build up in the lungs.
I agree that the xray doesn't sound normal. Cats are similar to human when it comes to lungs. White can indicate fluid or pneumonia or even a mass. And there's no way it increases with age.
If she's better with lasix it's fluid for sure, probably from heart disease or pleural effusion from pneumonia.
Anyway, I totally respect your decision to avoid further stress and take care of your kitty at home. But maybe there is some space for therapy.
 
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