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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 16179
Experience:  Small animal veterinarian with a special interest in cats, happy to discuss any questions you have.
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Raju: My male cat Raju, age 3Yrs+ is showing signs of losing

Customer Question

hi Doctor: Raju: My male cat Raju, age 3Yrs+ is showing signs of losing muscle. Over the last 3-4 months he has lost muscle from the thigh (hind legs) & shoulders. Raju was neutered around 2 1/2 years ago & has had his vaccinations for rabies & tri-cat
around 6 months back. His eating habits are healthy & prefers to eat raw fish majority of the times although in the last month or so he has started to eat cat dry food (whishkas, Hills k/d food) & home cooked chicken (preferably bones). His ideal weight is
around 4.7--4.9 Kgs however in the last 3 months his weight has increased by 400gms. Raju is a very active cat, he walks a lot inside & outside the house. We leave our cats out 3 times a week. We've a household of 4 cats (3 females & 1 male) all from the same
litter. This is a worrying behavior as he's eating well & is active however losing muscle. He's current weight is 5.3Kgs. We had a done a blood test for all my cats 3 months back & all blood values were normal. Regards, Harsu
Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Dr. B. replied 1 year ago.

Hello again Harsu,

When did he start losing muscle?

Can you confirm that he has put on weight despite losing muscle?

Does he look to have a larger or distended belly?

When was he last wormed?

Any diarrhea?

Is he drinking or passing more urine then before?

Customer: replied 1 year ago.
When did he start losing muscle? Been around 3 weeks now. Prominently visible in last one week.Can you confirm that he has put on weight despite losing muscle? Yes, has put on 300 gms of weight.Does he look to have a larger or distended belly? Do you mean swollen belly or loosely hanging? I can touch my two fingers when I try to feel across his abdomen (closed to hind legs).When was he last wormed? Jan 2015Any diarrhea? No.Is he drinking or passing more urine then before? Not too sure but probably not.
Expert:  Dr. B. replied 1 year ago.

Hi again,

I did mean does the belly look more swollen then usual?

Customer: replied 1 year ago.
No it doesnt look to me .Attached are a couple pics of Raju for your reference.Regards,
HarAsees
Expert:  Dr. B. replied 1 year ago.

Thank you,

Now he does appear to have a subtle degree of muscle atrophy over his spine in photo 4. Otherwise, he looks lean but meeting clinical normal parameters with the other photos. Therefore, since he has none of those issues I asked about, has had normal bloods, and no abnormalities when examined by his vet; then our main concern for this situation would be worms. They are a common cause of weight and muscle loss in cats. And if you have been feeding them raw fish, he would be at high risk of parasites. So, if he's on those foods, he needs to be wormed monthly.

As well, I would note that if we are concerned that he is losing muscle mass, it would be worth having him on a higher protein diet (so the opposite to Sundari). Therefore, you could try giving him kitten food or Hills A/D (when she isn't around) to provide him more of the building blocks he needs to put on muscle. As well, where she should be on Hills K/D, he has no reason to be and that is a waste of food intake for him (since he will be getting less protein per bite then what he needs).

Therefore, in this case and based on his history, worming is absolutely the most important first step here. And if he doesn't settle, you can add in the above diet changes and potentially have a stool sample tested to ensure there is nothing being missed.

Dr. B.

Customer: replied 1 year ago.
Could you advise if we have an specific stool tests that we need to do for Raju ?And would an ultrasound scan be advisable for Raju ?Will get the deworming done.Regards,
Harsu
Expert:  Dr. B. replied 1 year ago.

Hi again,

Unless your vet's exam revealed anything abnormal in the abdomen, an ultrasound wouldn't necessarily be indicated here. As well, if you did have a stool sample tested, we'd just want a full fecal sample tested (so it would check for bacteria, parasites, protozoa +/- viruses) at this stage.

Dr. B.

Customer: replied 1 year ago.
Thank you very much doctor. we were a bit concerned because we had lost Leo (Raju's brother) post a similar slimming down pattern to a sudden attack. This was 6 months back.Hence we were wondering if there could be anything genetic and that we should avoid ?Will go for deworming and protein -rich food.
Expert:  Dr. B. replied 1 year ago.

You are welcome,

There aren't really an genetic issues that we'd expect to cause this for them. As well, a sudden attack sounds more like a possible poisoning or trauma as opposed to a chronic wasting disease. Therefore, I'd not necessarily suspect that Raju could be at risk of what caused Leo to pass.

Take care,

Dr. B.

Customer: replied 1 year ago.
Hi Dr B,Have scheduled an appointment with the local vet for de-worming Raju. They generally give tablets which makes me take him to a clinic. Is there a liquid form of de-worming tablet that I can give to my cats at home?Additionally, how soon/later can we expect to see improvement in Raju post de-worming. If de-worming does not help, what is out next step? Also wanted to ask of the causes why a cat loses/can lose muscle & yet have increase in weight?Regards,
Harsu
Expert:  Dr. B. replied 1 year ago.

Hi again,

If they have a recent weight, you can ring to request wormer be dispensed for you to use at home. And you could request Panacur which can be ordered in a liquid form. You will want to dose and then monitor his weight for the next week or two. If he isn't putting on weight still, then a fecal sample as we discussed before would be the next step. Otherwise, we could start to consider an ultrasound. This could be of use if we have weight gain from something in the abdomen (which could fit with a tumor or fluid build up, even though he is quite young and his vet didn't feel one on exam before).

All the best,

Dr. B.

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Customer: replied 1 year ago.
hi Dr.B,So we had Raju's deworming done on the 7th, and he hasnt shown much improvement as far as muscle gain is concerned.
We have given a fecal sample for test today.We also got an ultrasound done yesterday - the diagnosis says this :
Well distended urinary bladder with irregular thickening of bladder wall with particulate matter, both kidneys show changes
in cortex with no cortico-medullary differentiation, spleen normal,liver and gb normal.And yes while collecting his stool sample we did notice that is pale yellow in colour rather than dark brown/black like the other cats.Also noticed he has been drinking more water than usual past few days.I will try and get a scan done of the ultrasound images so I could share with you. In the meantiime, what would be suggested next course of action ?Rgds,
Harsu
Expert:  Dr. B. replied 1 year ago.

Hello again,

When were his bloods last checked?

Has his urine been watery or dilute?

Customer: replied 1 year ago.
Bloods sample was collected yesterday, will get the results on Monday. Urine -looks a bit concentrated.What do you think of the scan report? I'll send you pics of those shortly.Regards,
Harsu
Expert:  Dr. B. replied 1 year ago.

Good, that is advisable to be rechecked at this point alongside those feces.

Otherwise, you may need to also measure his water intake, but that can be saved until the results are back. Finally, you are welcome to post your scanned reports but do know that I will be away from the office shortly, so there may be a delay in my reviewing them.

All the best,

Dr. B.

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**Please remember to rate my service, as this is how I am credited for assisting you today. Thank you! : ) **

Customer: replied 1 year ago.
Hi Dr.,Please find attached the reports from the ultrasound.Regards,
HarAsees
Expert:  Dr. B. replied 1 year ago.

Hello,

Did the bloods come back?

How are his kidney values?

Has his vet done any urine testing?

Customer: replied 1 year ago.
Will get the blood reports tomorrow, Tue. Have sent a sample for fecal analysis. Will get the reports tomorrow (Tues).No urine test advised by the vet.What do you think of the ultrasound images & report I shared earlier today?Regards,
Harsu
Expert:  Dr. B. replied 1 year ago.

Hi again,

I would question whether we have a urine crystal issue (since there were particulates which would irritate the bladder leading to wall thickening and protein loss), and I am also concerned that we may have a protein losing nephropathy based on what we are seeing with the kidneys. This is why I asked about the bloods (as we need that for context). And depending on the results of those, we may need to think about urinalysis +/- testing a urine creatnine ratio to rule out or at least assess protein loss through the kidneys.

Dr. B.

Customer: replied 1 year ago.
Hi Dr.B,
A few questions :1) Does the urinanalysis test have a pre-requisite criteria such as fasting ?2) A urine culture, a urine creatinine ratio , and any other else should add to this ?3)Urine collection - can it be collected from a floor or a box - ? Raju gets very stressed out in the car so trying to avoid travel, plus he urinates everytime in his box even before we reach the lab.
However if collected from a floor or a box, it may pick some additional germs from the floor or box- what are your thoughts ?4) Can the urinanalysis result be derived via bloodwork as well ? thats just in case the urine extraction is not successful which I have noticed happens most of the times.5) Blood test - do you have a specific one in mind ? asking so nothing is missed.6) What could those particles be ? Or would our tests determine that ? Hoping its not a extreme thing like a tumour growth etc. Let me know what you think.Regards,
HarAseesRegards,
HarAsees
Expert:  Dr. B. replied 1 year ago.

1. Nope, it doesn't require a fast.

2. We'd want those two and the standard urinalysis with microscopic evaluation of the sludge/particulates.

3. No, we need a direct sample from the bladder. Otherwise, we'd have contamination and the results wouldn't be accurate.

4. None of the urine tests can be done via blood. The bloods can just give us an idea if the kidneys are in serious distress

5. A standard hematology and chemistry with at least urea/phosphorus/creatnine.

6. They could be crystals, bladder stone precursors, cellular debris from the kidneys --but this is what our microscopic evaluation would tell us. We could see debris if we have a tumor, but its less likely to be a bladder one if they ruled out growths in the bladder on ultrasound. They kidneys though are another question. Though appreciating if they had a tumor would be something the ultrasonographer would have to confirm. And if they thought that was an issue, then they could have taken a ultrasound guided sample to confirm that.

Please remember to leave feedback (it does not close our conversation), as I am giving you quite extensive assistance here,

Dr. B.

Customer: replied 1 year ago.
Thank you Dr.B.Your assistance and inputs are really helpful as vet science is not very well developed from where I belong and Raju is a son to us :-).
I have worked with you a few times & will definitely provide feedback .I also have some blood sample results for your reference in the meantime.
Please let me know what you think of them.Regards,
HarAsees
Customer: replied 1 year ago.
Here is a clearer image..
Expert:  Dr. B. replied 1 year ago.

It appears that the blood results do not include urea or phosphorus. These are quite important for this situation, so you need to speak to your vet about those being tested. As well, the platelets are low on the blood sample but since this can often be a machine mistake with cats, do make sure they check his platelet levels manually with their microscope.

Dr B.

Customer: replied 1 year ago.
Hi Dr.B,We checked on the platelet count - it appears the low count was a machine issue. Not sure why they missed BUN and phosphorus- tht'll be next.
I have the urine analysis & stool analysis results : (urine culture & the creatinine ratio results should be another couple of days) :URINE ANALYSIS
Physical Properties
Quantity : 10ML
Colour : PALE YELLOW
Appearance : TURBID
P H : 6.5
Sp Gravity : 1.015
Chemical Examination :
Albumin : PRESENT(+)
Sugar : NIL
Microscopic Examination :
Pus Cells : 10 – 15 / HPF
Epithelial Cells : 8 – 10 / HPF
R B C s : NIL
Crystals : NIL
Casts : GRANULAR CAST PRESENT
Bacteria : NIL
Others : NIL
----------------------------------------------------------___________________________________________________________________________
STOOL ANALYSIS
___________________________________________________________________________
Macroscopic Examination
Colour : Yellowish Green
Consistency : Semi Solid
Microscopic Examination
Ova / eggs : Not observed
Cyst : Not observed
Report :
NO GROWTH SEEN IN CULTURE AFTER 48 HOURS OF INCUBATION.
Regards,
HarAsees
Expert:  Dr. B. replied 1 year ago.

Hello,

I am glad to see the stool is clear, despite being abnormal in appearance. In that case, supportive care using a balance diet, probiotics+/- kaolin would help with that.

Otherwise, the urine results do raise some concerns. First,we can see there is protein being lost in the urine. While that isn’t much and we’d not be worried about it alone, to see that with a borderline low specific gravity (concentration) is a worry. The proteins usually increase the specific gravity, so one would have to assume that his urine is abnormally dilute without that influence. As well, as he has had loose stool and could be theoretically a bit dehydrated, the low volume is again even more odd.Furthermore, those casts are a sign of possible kidney issues. So, those urea and phosphorus results are even more important now. As well the urea:creatnine ratio (urine test with urine taken directly from the bladder) would also be indicated as we are not suspicious of weight loss due to a possible early stage kidney disease potentially related to his kidney's morphologic findings on ultrasound.

Dr. B.

Customer: replied 1 year ago.
I will let you know as soon as I get the urea:creatinine ratio results.
In the meantime did you mean his muscle loss is not due to the possible early stage kidney disease ?And how do you feel about the pus and epithelial cell numbers ? Could there be a likely infection leading to kidney change & granular casts ?Regards,
HarAsees
Expert:  Dr. B. replied 1 year ago.

It is quite possible that it is.

It is unclear what they are referring to by pus, I can only assume they mean white cells (the foundation of pus). In that case, infection would be a concern as well. But unless it is in the kidneys or spreading up to them, it wouldn't explain those other findings. Still antibiotic cover at this stage wouldn't be a bad idea.

Dr. B.

Customer: replied 1 year ago.
GM Dr. B,I got Raju's blood, urine analysis, UPC & utlrasound tests done this week. Urine was collected by the vet from the bladder.Attached are his report. Could you please review them & share your opinion.Regards,
Harsu
Customer: replied 1 year ago.
lab reports attached.
Expert:  Dr. B. replied 1 year ago.

Hi again,

The kidney values are all high normal. Since it does take 75% kidney dysfunction before we get abnormal results, those UPC and urine results are quite important here. Especially as your report notes hydronephrosis here (a dilation of the kidney often related to kidney or ureter stones causing pressure back up but could also be a birth based defect). So, this a concern that the kidneys are the source of all our previous concerns and we need to see what those urine tests say relative to early stage kidney disease. As well, it will be ideal to see what urine debris he has on analysis and he may need to be put on a special diet for any stone risk here.

Dr. B.

Customer: replied 1 year ago.
Dr.B,I should have the urine culture reports by later today.Do you see any kind of infection in the fresh urine analysis results I have provided in my previous communication, and how do you feel about the UPC value in the meantime ?
I ask this because Raju has been on an antibiotic called Ziphrax past 2 weeks, and we are wondering if it could cause any adverse impact on the kidneys if used beyond this period. We are also giving him urinary tract health wet food and Urinary S/O from Royal Canine at present.Can the ultrasound results help us with the location of blockage : ureter, kidney, etc ?
Also the ultrasonographer mentioned that the kidneys have changed significantly past 2 weeks . Could you please compare the 2 and let us know your thoughts(previous ultrasound reports provided on Sep 18). Could that mean the kidneys are deteriorating really fast ?Dr.B - I will continue to need a detailed further consulting help from you on this issue. Do let me know if I need to pay an additional amount.Thank you very much.Regards,
Harsu
Customer: replied 1 year ago.
Attached are Raju's culture reports.Regards,
Ashwin
Expert:  Dr. B. replied 1 year ago.

Hi again,

It would be ideal to raise the fee you are paying for the question (you can contact customer service on this), as I have given you an extended amount of aid (much more then your original question price really covers). So, if you can do that or open a new question after leaving feedback for this one, I would be grateful.

Now your results support bacterial presence in the urinalysis but culture doesn’t look to have picked up the agent. You may need to check and see if there is an extended culture in process. Or if he has been on those antibiotics during the time of collection, that may have thrown off these results (and we will just need to treat and recheck the urinalysis at the end of the course). Unfortunately, I cannot comment on the antibiotics you used, as that is not a brand that I am familiar with. But if you can let me know what its generic name is, then I can review that for you.

Otherwise, ultrasound can help find stones +/- blockages if present. Though if the ultrasonongrapher has noted changes, I would believe them on this. My comparing 2 photos just won’t provide as significant analysis compared to the findings of someone who got to scan the kidneys in real time (I do think the second one looks more . Therefore, their view on this has the most weight here.

Finally, thank you for the urine protein to creatinine ratio(UP:UC). It is thankfully normal here (<0.5) and I would consider that valid despite his having an ongoing possible infection (since it would have falsely elevated the results if it were affecting them). Therefore, we'd need to address this infection and then recheck the urine specific gravity in the practice to see if we get it back to normal. If it is, then that is positive despite our likely underlying hydronephrosis causing those kidney and urine changes.

All the best,

Dr. B.

Customer: replied 1 year ago.
I'll speak to customer service & find out how to raise the fee on this thread. We've had a whole lot of Q&A & sharing of reports on this thread. starting a new question will need you/me to keep shuffling between old & new one. Hope it's fine with you.Also, thank you very much for your extended support. Coz of your knowledge & help, I've been able to get this far, put questions to my vet, make suggestions for tests & do follow ups. I'll continue to need your guidance to pursue this further.The urine culture reports from 24th Sept did not show bacteria. 24th sept sample was collected 4-5 days post starting Raju on antibiotics.Makes me think if the infection reported in urine analysis test but not in culture is something else other than bacteria? Is it normal for bacteria to been seen in urine analysis but not in urine culture?With all the tests done so far, are we able to conclude the underlying medical condition that Raju has ? Can we establish a course of treatment?Below is the composition of the antibiotic (ZIPRAX-50 Dry Syrup) I've been giving to raju for 2 weeks now. Should I continue to give the antibiotic? If so, for how long? Hope it does not impact the kidneys.In addition to the antibiotics (ziprax), I've been giving Raju for 2 weeks now a) Renalof b) Royal canine Urine S/O dry food c) Royal canine 'sterilized -healthy urinary system' wet food.Can above medication, diet impact the test result ?Medicine Details:a) ZIPRAX-50 Dry Syrup
http://beta.ciplamed.com/content/ziprax-tablets
Each 5 ml (after reconstitution) contains:
Cefixime, IP, as a trihydrate equivalent to
Anhydrous Cefixime ............. 50 mgb) Renalof:http://www.catalysisvet.com/veterinaria/renalof.phpRegards,
Harsu
Customer: replied 1 year ago.
GM Dr. B,Awaiting your response.Regards,
Harsu
Expert:  Dr. B. replied 1 year ago.

Good morning,

Either is fine, as returning to old conversation threads is not difficult.

It is unlikely that the bacteria seen on the urinalysis is anything else. The point of their examining the urine under the microscope is to identify what is there. The lack of conclusive culture results is more likely a reflection of the bacterial population being killed or reduced enough by those few days of antibiotics to prevent proper growth in the lab. So, in situations like this, we need to finish our antibiotic course and potentially reassess the urine at that point. And with that finding and the other results, we currently have to consider that we have a bladder infection which could be affecting the kidneys but we have an underlying complication of hydronephrosis (which may be birth defect derived or secondary to a stone that hasn’t been yet confirmed).

So, again the antibiotics need to be continued (though for the length of treatment I would leave that to your own vet’s discretion). Otherwise, the other medications/food can be continued and these would not be affecting our results. The Cefixime is fine to use for bladder infections and since his bloods and UPC were ok, we’d be safe to use it for him. Again we’d want to potentially do our rechecks in a few weeks post treatment. But overall it sounds like we are on the right track generally but need to monitor him overall as well as those kidneys.

Take care,

Dr. B.

Customer: replied 1 year ago.
have discontinued the antibiotic after 10 days, & the vet has advised to go for Cystaid Plus instead.http://www.petdrugsonline.co.uk/cats/healthcare-and-wellbeing/urinary/cystaid-feline-plusWe will repeat the urinanalysis test this Monday so the results are not impacted by the antibiotic.
My concerns :
1) can Cystaid Plus really replace the antibiotic and help stop the infection/inflammation from spreading into the kidneys too?
2) Will the urine culture results be impacted if Cystaid Plus is being administered at the same time ?We have also been recommended to use Azodyl for kidney support.
What is the extent of hydronephrosis you think in case of Raju ? And what best can be done so it does not spread further.Regards,
HarAsees