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Doc Sara
Doc Sara, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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My cat is presenting these symptoms and I'm very nervous

Customer Question

My cat is presenting these symptoms and I'm very nervous about HCM. Shes almost 3 years old.
Lack of appetite- this has developed in the last 36 hours and is very uncharacteristic for her. She wouldn't eat her regular wet or dry food yesterday morning.. But she would eat tuna. The vet gave me a can of recovery food and also a food she said was highly palatable. She ate almost the whole can of the latter this morning, but still wouldn't touch her dry. She is peeing in the litterbox normally. She hasn't had a bowel movement but was an every other day pooper anyway.
Lethargy- she's spending most of her time resting. She will play when I engage but not really on her own. She's not moving around as much.
Weight loss- she lost a quarter of a pound, but hadn't been weighed in a year so I don't know how quickly that occurred. I had been noticing more of a waistline.
Breathing- I originally brought her in because I thought she was breathing abdominally. The one vet agreed that she was a bit, the other vet at the practice said she wasn't overly alarmed by it. Her resting breathing rate is normal. No open mouth breathing or panting.
She had an ekg and a chest X-ray. There was no fluid in her lungs or around, and her heart was normal sized. Her ekg was allegedly normal, despite a few blips when she moved around. I'm concerned about HCM because it wouldn't show in these tests. The radiologist recommended prednisone because mild asthma might not show in an X-ray, and my other cat has asthmatic symptoms as well. This kitty has done the asthmatic cough a few times before, but not regularly whatsoever. They also reccommended dust free litter, which I already use Worlds Best. She's going in for blood work this afternoon.
Any advice or veterinary opinions would be helpful; I'm very worried but my vets don't seem to be. If the blood work yields that protein that can appear with heart disease I would drive her the 2 hours for an echocardiogram.
Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Doc Sara replied 1 year ago.

Hi there, I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with cats and dogs. I'm sorry to hear that Khloe hasn't been feeling well - I'll do my best to help.

The signs that you're seeing, unfortunately, are very vague - meaning that they can be attributed to just about any disease in the book. The one exception to that is the potential breathing issue. With a labored breathing pattern, asthma would be at the top of my list if I don't hear a heart murmur or see anything abnormal on the chest films or EKG. HCM doesn't usually cause vague "unwellness" - most cats with HCM are actually completely non-clinical (asymptomatic) until they experience a crisis like a thrombolic event (saddle thrombus) or go into heart failure. Most HCM kitties who are asymptomatic are picked up by a heart murmur on the physical exam. So the general lethargy and decreased appetite aren't common signs with heart issues, although they're not impossible. I'm glad to hear that your vet has done a thorough job so far of working her up. If you're interested in the Pro-BNP blood test to help differentiate cardiac from respiratory disease, make sure that you mention it to your vet if it's not been discussed so far. It's not a test that is routinely run in some practices. It can certainly help point you in the right direction but keep in mind that it's an imperfect test and can have some false positives. Ultimately if she doesn't improve or she gets worse, then you may be headed to the referral hospital for more than just an echo - for inappetance an abdominal ultrasound can be helpful as well. Some blood work to check her kidneys, liver, sugar, and red and white blood cells is definitely a good idea to investigate such vague signs.

If your vet is convinced enough that her heart is OK, they may consider doing a trial of prednisone to see if she improves when treated for asthma. Pred is also a potent appetite stimulant, so it could help with her appetite as well. The down side with pred is that if there is significant heart disease, it could make her worse. That's why we always want to work up the heart first to be sure that it's OK.

I hope that this helps give you something more to consider. Please let me know what other questions I can handle for you.

~Dr. Sara

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Customer: replied 1 year ago.
She's actually on pred right now. The first night I gave her pred and lung dewormer, then the next morning she wouldn't eat... Should I stop giving the pred until I fisnnout more about the heart?
Customer: replied 1 year ago.
she's going for bloodwork tonight. Her resting breathing rate is 22 breaths per minute on average.
Customer: replied 1 year ago.
Now I'm worried that maybe she does have a heart issue and the first prednisone pill pushed her over the edge?
Customer: replied 1 year ago.
She's had a total of only two prednisone pills right now.
Expert:  Doc Sara replied 1 year ago.

22 is a normal respiratory rate, so if she's not labored with that breathing, I'd follow your veterinarian's dosage schedule for the prednisone. It won't be long until you have a chance to speak with them anyway. It's unlikely that one dose of prednisone would push her over the edge, especially since her respiratory rate is normal. If she seems to be breathing differently at home than she does in the hospital, take some video while she's at home for your vet to review when you go in with her this evening.

Please let me know what questions I can answer for you.

~Dr. Sara

Customer: replied 1 year ago.
I sent a home video in first before I ever went in. She's breathing abdominally, not at an increased rate. The vet said it wasn't alarmingly abdominal, but that it was a bit. I've given her a total of 2 prednisone.
Expert:  Doc Sara replied 1 year ago.

I'm so glad that you thought of the video for your vet - that is so helpful. Cats with heart disease are typically going to have an increased rate and effort to their breathing. The best person to advise you on how to give the prednisone is going to be the vet who did her exam, saw her radiographs, and prescribed the medication. Two doses is not likely to have caused a major issue if you're not seeing worsening of the signs. If she has asthma, then the prednisone is exactly what she needs. What questions can I handle for you?

~Dr. Sara

Customer: replied 1 year ago.
Just returned from the vet, in a week she dropped from 5.26 kg to 5.16kg. They're doing a full blood test including b12, the test for the heart protein, and feline leukemia and AIDS..... She's had full vaccines her whole life, what's the likelihood she has either of those horrible diseases?
Customer: replied 1 year ago.
She had a normal temp of 38.6 Celcius, her heart rate was 160 beats per minute. She did eat her kernels for dinner tonight.
Customer: replied 1 year ago.
Her respiratory rate seems to be a bit slower as she is resting on the back of the couch. She just timed at 20 breaths in a minute; just sitting with all 4 feet under her and her eyes closed...
Expert:  Doc Sara replied 1 year ago.

I'm glad to hear that she's calmed down and they got some diagnostics cooking. It's unlikely that she contracted FeLV or FIV as an indoor only cat but it's always ideal to check in case they got it from their mothers or were exposed before coming into your home.

~Dr. Sara

Customer: replied 1 year ago.
What are the symptoms of these diseases? I keep getting lost down the rabbit hole of Internet research and I am becoming increasingly stressed and upset.
Expert:  Doc Sara replied 1 year ago.

It's probably best and least upsetting to await the test results, as they'll likely be negative anyway :)

Feline leukemia and feline immunodeficiency virus are viruses that interfere with the function of the immune system, so these cats usually succumb to bacterial/viral infections that cats with competent immune systems would fight off more easily. Feline leukemia virus can also cause a form of leukemia (bone marrow cancer), which is how it got its name.

~Dr. Sara

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My goal is to provide you with the most complete and accurate “five star” answer. If my answer isn’t what you were expecting, it’s incomplete, or you have more questions PLEASE REPLY to let me know what information you are looking for BEFORE giving me a negative rating! If my answer has been helpful to you, please show me by giving me a favorable rating. Thank you so much :)

Customer: replied 1 year ago.
I know there's no cure for either... I just can't figure out what would cause this weight loss and tiredness. She did eat this morning and tonight, so that was good.
Expert:  Doc Sara replied 1 year ago.

I'm glad to hear that she's eating. All that you can do at this point is await the diagnostic results - try not to fret too much in the mean time :)

~Dr. Sara

Customer: replied 1 year ago.
Would the weight loss be associated with asthma at all? She ate a ton of breakfast today.
Expert:  Doc Sara replied 1 year ago.

Some cats with asthma do lose weight, yes. I'm glad to hear that she ate :)

~Dr. Sara

Customer: replied 1 year ago.
How can I tell if she is muscle wasting?
Expert:  Doc Sara replied 1 year ago.

Muscle wasting is a physical exam finding that we learn by experience feeling what "normal" muscle mass feels like. Typically muscle wasting is most obvious over the top line, as their spine and hips become more prominent.

~Dr. Sara

Customer: replied 1 year ago.
Her hips have definitely become more prominent, and her waist is more defined. She was 5.45kg a year ago, just over a week ago she was 5.26, then a day ago she was 5.16..... I'm worried she's lost this initial weight rapidly, but at first the vet didn't say much about it because she had wanted her to lose weight anyway; but not if it was rapid obviously.
Customer: replied 1 year ago.
Ok so her blood work just came back. She's clear of leukaemia and AIDS, her organ function is normal. Her red blood cell count was a little high but the vet said it is likely caused by stress.The pro bnp test was 136..... The lab said between 100-270 is abnormal, under 100 is normal. The vet said that because it's just slightly above what's considered "normal", that could be a normal value for her. The lab said that in order for the heart to be causing respiratory signs it would have to be at least 200. Should I consider driving her 2 hours for a cardiac ultrasound? She gets very very stressed about the vet.
Customer: replied 1 year ago.
Also her b12 was in the normal range but on the low end of normal.
Customer: replied 1 year ago.
Additionally there was a recommendation for a T4 test but my vet said she's never seen a 3 year old cat with hyperthyroid, but I have read that untreated hyperthyroid can cause heart failure. Not sure what to do. Can I send you the lab report?
Expert:  Doc Sara replied 1 year ago.

My experience with the pro-BNP test is that it frequently falls into that very unhelpful "gray zone" like your cat. Unfortunately, in that case it's really not helpful. Since all of this started, what are her symptoms? Truthfully a weight loss of 0.29kg in a year's time doesn't really concern me if the pet is acting well. In fact, one bowel movement or one trip to the litter box to urinate can easily account for a 0.1kg weight loss. Also scale error can account for that drop from 5.26 to 5.16 - you can weigh your cat three times in a row and get slightly different numbers each time just like you do on your own scale at home. What did your vet advise you to do? If she truly has respiratory issues, then your next step is either to try the full course of prednisone that your vet prescribed or to move on to airway sampling an a cardiac ultrasound at a referral center. If she's back to eating well and her breathing is OK, then those things are likely overkill. It's never wrong to run a thyroid - but I've never seen a cat that young develop thyroid disease in my experience either. You certainly can send pictures of the reports, however I don't know that I'll be able to tell you anything different than what your vet is telling you - it sounds like they are doing a very good job.

~Dr. Sara

Customer: replied 1 year ago.
Her symptoms have been what I thought to be slightly abdominal breathing. My vets office has two doctors; the first agreed that yes her breathing was a bit abdominal. The second said that it wasn't really that alarming to her, according to the video. Her rate isn't elevated, usually between 20-24 breaths per minute, depending on what she's doing. She's also been resting more and seems to be less interested in playing, although my other cat is dominate over her and she isn't the one to initiate play. The weight loss has been noticeable through her hips and waistline. There has been a few incidents of the classic asthmatic cough attack that I've seen over the past 6-8 months at least, but only a handful of times.
The vet actually said not to give the prednisone because there has been a connection made between steroids and heart problems in cats... I'm going to try the lung wormer again, but the night I gave her a pred and the dewormer resulted in her going off of food the next day, so I'm apprehensive.
Customer: replied 1 year ago.
Attached is the pictures of the lab report.
Customer: replied 1 year ago.
The end of the second page suggests hyperthyroid, hypertension, and azotemia. I don't know what those last 2 are, but are they worth looking into?
Expert:  Doc Sara replied 1 year ago.

An occasional cough here and there doesn't concern me too much as long as they're not in distress, turning blue, etc. Again, a weight loss of 0.3kg may or may not really be all that significant, especially since you said that the vet really wanted her to lose weight to begin with. It also sounds like the jury is out as to whether she actually has a breathing issue according to your vets. It would certainly be reasonable to continue to monitor her, as this all may blow over. If it doesn't, then you know what your next steps are going to be.

Looks like the pro-BNP interpretive results would be that she might have heart disease, but even if she does it's not likely causing any sort of respiratory symptoms. Overall her profile looks very boring/normal.

Hypertension is high blood pressure and azotemia is kidney disease, which she does not have based on her blood work. Taking a blood pressure measurement is considered "standard" in many hospitals for cats just as in people. It could be that she's got a high BP, but it's difficult to tell true "hypertension" from stress in cats. It'd be unlikely to be an issue in such a young cat.

~Dr. Sara

Customer: replied 1 year ago.
Would the fact that she might have heart disease be enough to go get a cardiac ultrasound? If its caught early would that be best from a management perspective?
Expert:  Doc Sara replied 1 year ago.

My own personal cat - if there is truly any respiratory distress, then the cardiac ultrasound is a good idea. However, if there is no disease or it's very mild, then there's likely to be no medication recommended. The type of medications and management used would depend on what exactly the echocardiogram revealed - but most likely either no medication or one to two medications tailored based on the findings of the cardiac ultrasound.

I'm headed to bed now but will be back in the AM :)

~Dr. Sara

Customer: replied 1 year ago.
I should add that she only has a bowel movement every couple of days... She just went into the litter box and dug around a bit, then left.
Customer: replied 1 year ago.
Ok so she was just playing with my feet, which lasted about a minute and all of a sudden she coughed a bit and had to sit back. She laid down and I noticed she was breathing heavy, not panting or open mouthed but still more abdominal and heavy. This would be classified as exercise intolerance right?
Customer: replied 1 year ago.
Is there the potential for it to be heart worm?! She gets vaccinations every year but I read that cats can get heart worm even if indoors.... The vet never said anything about it but geez, it's been hard to pinpoint these symptoms .
Customer: replied 1 year ago.
Or more specifically heart worm associated respiratory disease (HARD). It's worth noting I live in Ontario and it's been winter here for months.
Customer: replied 1 year ago.
my cats are strictly indoors.
Expert:  Doc Sara replied 1 year ago.

It's not unusual for a cat to only have a bowel movement every other day - that's OK.

This could be HARD but I'd consider it unlikely, as Ontario is a bit cool for mosquitoes that transmit the disease. There is a blood panel that can be run to check for heartworm.

An occasional cough isn't all that concerning to me. Does your vet have her on any type of medication at all? I think I'm getting to the point where there's not much more that I can help you with here. I don't know that I have any more useful info, haha. You know your options - either try treatment prescribed by your vet and take a wait and see approach or go on to have more diagnostics done.

~Dr. Sara

Customer: replied 1 year ago.
Just a lung dewormer to start. I just thought it was strange that she immediately had to stop playing like that...
Customer: replied 1 year ago.
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Customer: replied 1 year ago.
sorry didn't mean to press the phone call request thing.... Anyway I gave her a packet of lung dewormer and sure enough this morning she wasn't really interested in her food again. I had to make her eat some highly palatable wet food, but she wouldn't touch what she's been eating the past couple of days, wet or dry. I mixed the dewormer with a different kind of food even, could it be causing her inappetance?
Expert:  Doc Sara replied 1 year ago.

I've personally never seen a dewormer make a cat inappetant, but if you've noted a pattern then I would discuss it with your veterinarian so that they can prescribe a different medication.

~Dr. Sara