View Single Post
  #11  
Old May 27th, 2012, 10:21 PM
Barkingdog Barkingdog is offline
Senior Contributor
 
Join Date: May 2012
Posts: 2,949
Quote:
Originally Posted by Lycan709 View Post
Lycan

1 Yrs. 2 Mos. Shorthair, Domestic Neutered Male 5 kg (05/24/2012)

Thank you for bringing Lycan in for examination yesterday, May 24, 2012. At the time of examination,
Lycan was receiving phenobarbital (15 mg tabs) 1/2 tablet once daily.

After completing my distant, physical, neurologic, orthopedic and dilated ocular fundic examinations, the
following were revealed:

Lycan was bright, alert, and appropriately responsive to external stimuli
Lycan's body condition score was approximately 5/9
Lycan was reluctant to move in the examination room to fully evaluate his gait. Lycan was shy and
nervous.Of the little movement I did observe, I could not appreciate and gait abnormalities.

Lycan's body temperature was 39.3 deg C, his heart rate was 200 bpm, no heart murmurs or
arrhythmias were detected. Femoral pulses were present in both hindlimbs and of appropriate
character, there was no evidence of pulse deficits. Mucous membranes were pink with CRT < 2
seconds. No observable oral ulcerations or masses were present. Head, neck, and body were
symmetric with no abnormal postures. Lycan had full voluntary range of motion of his head and
neck. No pain response was detected upon dorsal palpation along his spine. Thoracic ausculation
revealed increased breath sounds though it was difficult to discern if these sounds were referred
from the upper airways. No findings consistent with peripheral lymphadenopathy. No masses
detected on abdominal palpation. Lax patella bilaterally but unable to luxate.
Neurologic examination did not reveal any significant findings. Cranial nerve examination was
unremarkable. Tactile placing was present and appropriate for all four limbs. Patellar, cranial tibial,
and sciatic notch-stimulated reflexes were present and appropriate for all four limbs. Voluntary tail
movement was present. Anal reflex was present and appropriate.
Orthopedic examination was unremarkable.
Dilated ocular fundic examination unremarkable. No evidence of keratic precipitates or iridal
discolouration.
History from you included a description of progressive clinical signs beginning with periodic eyelid
tremor, to stretching, spasm of hindlimbs at rest. Clinical signs began to involve forelimbs. Video
recordings evaluated by me revealed lycan having hypertonicity of hindlimb during walking after
episode, difficulty jumping up fully onto objects, hypermetria of left hindlimb. Lycan has been alert
and responsive during these episodes. Clinical signs have progressed in frequency and severity. You
indicated that last night, Lycan abnormally began wrecklessly running around the house for
approximately 2 hours(atpyical for this cat). You also indicated that he was vocalizing more
frequently. You indicated that you have not detected any vermiform skin/muscle movements.
Lycan's clinical signs have worsened despite phenobarbital trial by your veterinarian.
Lycan's appetite has, at present, remain unchanged.
Given my clinical examination findings, and taking into account Lycan's clinical history and video
recordings of his episodes, I am concerned that he has a disease process involving multiple regions of
his central nervous system. It may be possible that he has primary muscle disease also, however,
though this may not account for his seemingly recent change in behaviour (i.e. wrecklessly running
around and increased lethargy).


Given this, and taking into consideration Lycan's clinical history and age, etc, the following disease
processes are considered:

Infectious disease (e.g. FIP (feline infectious peritonitis), FeLV/FIV, Toxoplasma, etc)
Inflammatory disease (e.g. immune-mediated disease)
Neoplasia (i.e. cancer -primary vs. secondary)
Metabolic disease (involving whole body and brain, and/or muscle)
Myopathic disease (primary vs. secondary)
As such, I recommended the following diagnostic work-up:

CBC, serum biochemistry, urinalysis
Infectious disease testing (FeLV/FIV testing, Toxoplasma testing)
3-view chest and abdominal radiographs (x-rays)
CT of brain and cerebrospinal fluid collection and analysis (pending results of above tests)
+/-electrodiagnostics of nerves and muscles +/-muscle and nerve biopsy
After discussing my clinical examination findings, the rationale behind the diagnostic plan, and the
various disease processes being considered, you elected to pursue non-invasive testing first. You
understood that diagnostic testing is a process and that in completing these diagnostics we may not have
a definitive diagnosis (esp. with regard to FIP). You also recognized that without performing appropriate
diagnostic testing and determining a cause for Lycan's clinical signs it is impossible to offer an accurate
prognosis.

Chest and abdominal x-rays did not reveal any significant abnormalities (see radiology report).

FeLV/FIV tests were negative.

Urine was unable to be collected (bladder too small for collecting urine)

CBC and serum biochemistry did not reveal evidence of underlying systemic disease (not always present
with certain diseases involving the central nervous system). There was no evidence of active muscle
disease (e.g. no change in CK enzyme).

Toxoplasma test results are thought to be available early next week.

At this time, I recommend waiting until we have the Toxoplasma test results available, then bring Lycan
here for re-examination, and have a discussion of what, if any, further diagnostic tests you may want to
do further.

As mentioned, I am suspicious of Lycan having infectious or inflammatory disease. One of the
considerations is a disease known as Feline Infectious Peritonitis (FIP). Please review information
provided regarding FIP.

Please monitor Lycan for any change in his behaviour, how he moves, etc. Please try and video record
these behavioural changes. It is not uncommon that patients, especially feline patients, to act differently
in the clinic environment compared to how they act at home.

Please seek immediate veterinary attention should Lycan's condition suddenly deteriorate or if you have
questions or concerns about Lycan. Be certain to take this information with you should you seek
veterinary attention.

It has been a pleasure meeting and working with you and Lycan. I have sent a copy of these discharge
notes to your veterinarian and I have also spoken with her personally.

Still don't know?! Go ahead and do risky tests that could potentially kill him?! Spinal taps/brain fluid analysis is dangerous and has a significant fatality rate (according to Neurovet). Or just let him live in peace, what he has left to live?!
"It is not uncommon that patients, especially feline patients, to act differently
in the clinic environment compared to how they act at home."
This is so true with my last dog who had cancer and stopped eating! I brought him to the vet and told the vet my dog was not eating the canned food they told me to feed him. The vet left the room and came back with the same food I had at home and my dog ate it!! My vet said this is very common with sick pets , they will eat in the vet office to show the vet "see I am fine now can I go home?" When I brought my dog back home he did not eat any food the that night or the next day.
Reply With Quote