How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Karing Your Own Question
Dr. Karing
Dr. Karing, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 429
Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
24928096
Type Your Cat Veterinary Question Here...
Dr. Karing is online now
A new question is answered every 9 seconds

Karing only please. I would like to ask a question about.

This answer was rated:

For Dr. Karing only please.
Hello, I would like to ask a question about William Henry. The vet did a full blood work and toxo titer with phenobarb level and urinalysis. He lost around a pound since June and isn't as playful. He seems to sit down like something is hurting his back end. His vet called just now to say that everything was "perfectly normal". His red blood count and hemoglobin was out of the normal range at 6 and 9.9. She said that it was probably the blood sample. Eosinophils were high. His phenobarb level was 53. She said to reduce his phenobarb to 1/2 a pill twice a day from a whole pill twice a day (1/4 grain). He was on a half a pill twice a day for a long time, but then had a seizure, so she increased it to 1/2 in the morning and whole in the evening. That was a couple of years ago. She then increased it to a whole pill twice a day following a blood test that showed a level that was slightly low ( can't remember the number). He has been on the whole pill twice a day schedule for well over a year. My question is: is it too much of an adjustment too fast to go down to half a pill twice a day? I want to get his level down but I'm nervous about cutting it in half all of a sudden. Also, even though the vet is telling me that the anemia doesn't mean anything, I'm wondering if it is something to worry about. He was eating a lot of butter from the table for several months around Christmas and I didn't stop him. Could all that vitamin A from the butter have messed up his ability to produce red blood cells? I know if they eat a lot of liver it can mess up their body like that. Thanks.
Hello,I'm Camille, and I’m a moderator for this topic. I sent your requested Expert a message to follow up with you here, when they are back online.
If I can help further, please let me know. Thank you for your continued patience.
Best,
Camille

Hi Catherine,

It's difficult to say if there is any significance to the low RBC and Hb levels. Eating butter would have no effect on red blood cell levels. Can you tell me what his HCT (hematocrit) was? The hematocrit value is the primariy value to assess if you are concerned about anemia.

Cats often get elevated eosinophil levels and it can be a non-specific indicator of inflammation with allergy and parasite infections being common. Very high eosinophil counts are more concerning. What was the eosinophils count?

A phenobarbital level of 53 is very high: this could definitely account for lethargy and it isn't good for his liver. A dose reduction is definitely in order. Dropping back down to 1/2 pill of the 1/4 grain every 12 hours is exactly what I would do especially since he did well on that dose for so long. It is important to recheck phenobarbital levels again in about 2 weeks or so (i.e. 1 month maximum) to make sure is is within the therapeutic range. Somewhere between 20 and 30 is ideal but levels as low as 15 can be adequate for many cats. I know you told me that William Henry was receiving a higher dose of phenobarbital earlier this year due to a prescribing error and his levels got really high then. After he his dose was reduced, did they recheck the levels again?

If you want to send me the entire lab report, then I may be able to provide more information. What did the vet say about William Henry's rear end pain? Did she recommend x-rays? Does he still have a low grade fever? Is he still having issues with constipation? Are the toxo titers already back? What were the IgG and IgM values?

Customer: replied 5 months ago.
I will get the lab results for you. She did not want to X-raY him at the appointment but said on the phone yesterday "I'll do that if you want him put through that, but I can't find anything wrong". She said she would have to sedate him. I have had cats X rayed many times and never had to sedate one. Made me feel like the bad guy again, though. I forgot to ask about the toxo test but I'm calling her this morning. She's always in a hurry and I always forget things. She didn't look in his mouth. She didn't take his temperature. She said he was fine over and over and whisked him off for blood and urine. I heard him screaming for 20 minutes. The tech came in and got his carrier and then brought him back in his carrier and slammed him down on the table, scaring him. The vet never came back in the room after that. Do you think this (peak) phenobarb level of 53 has caused anemia or damaged him? They did recheck after the overdose and it was 38. I wanted it lower but the vet insisted it was a good level and wanted to recheck in 6 months. I think it has been 7 months, but I have been so busy with the other cats that I let it go a month longer than planned. I'll get the results and attach them ASAP. He is pooping. It is hard and dry but I'm giving him more laxatone and trying to get it better. He is eating but not as much as usual. He is hanging near Calleigh all the time and trying to get her to groom him like she used to. She's trying. I'm so glad you answered because I was thinking of giving him a whole dose this morning and bringing him down more slowly but I'll stick with half a pill again this morning. We will recheck level in 3 weeks. He did have a seizure on this dose several years ago, which is why it was increased, but I'd rather take a chance on that than have him over medicated. Another thing I should mention is that his weight was put in the computer wrong last time and he actually weighs 11.5 so he lost about a half pound instead of two pounds. He was 13.2 in 2014. He stayed right around 12 for all of 2015 and in June of this year.
Customer: replied 5 months ago.
I asked for the results this morning and the vet came out to give me these and attacked me verbally. She is very angry that I want these and accused me of not trusting her. She said she knew I was going to just go and ask another vet about him. Then she said how mad she was that I didn't have Calleigh's biopsy done by a different vet at her practice since I wanted it done earlier than she could do it. I took Calleigh to the vet closer to home and it was more convenient to do it on that Monday since I was off work that day rather than wait until Wednesday. My feelings are so hurt. I have seen this vet for over 25 years. I like her and I didn't want to do anything to upset her. She was told by a friend of ours that I was going on line for an opinion and she said that was crossing the line. I'm so upset about this but I still have to wonder why William is anemic. I attached 5 pictures of test results. Thanks.
Hi Catherine,
I'm at a conference and have limited computer access: as a result, this response is being typed on my iPhone so hopefully the formatting won't make it a difficult read.William Henry's lab work looks great overall. His hematocrit has dropped 9% since it was last checked which is the only thing that causes me to raise an eyebrow. I would recheck this in about a month or two. As long as the value doesn't continue to drop, there is no cause for concern. My biggest suspicion is that this may represent a shift to a low grade anemia of chronic illness. It is a very nonspecific finding in cats that have ongoing illness of any variety. There is no specific treatment required: it is simply a symptom related to a variety of other processes. It can resolve if the chronic "illness" is addressed.It could be related to the excessive phenobarbital levels: only time will tell. Generally, a specific cause is never identified for low grade non-regenerative anemia (which is not present but I suspect may be developing). Again, just monitor to see if the values continue to decrease.Second opinions are very commonplace. It is very unprofessional to express anger toward a client who seeks another opinion. I'm sorry you were treated that way especially from a vet you have such a long relationship with. You know my opinion of the care being provided by your current vet so I won't elaborate there. Suffice to say that you love your cats more than anyone else, and if you believe you need more input regarding their healthcare than no one can argue with that.I hope William Henry starts to feel more comfortable, but I just don't know what your vet's plan is to make that happen (aside from degrading his pheno dose).To avoid sedation, I'd do a lateral x-ray to check for constipation. Based on that, I'd consider a stool softener if indicated and also a trial on Adequan for joint pain. A glucosamine supplement for joint pain is a less aggressive alternative (no Rx required): consider Nutramax Feline Cosaquin (flavored powder) or VetriScience Glycoflex 2 chewable treats. Remember too, a more feline friendly vet practice may be able to take x-rays of William Henry without sedation.I hope this is helpful. Let me know how things are going and if you have other questions.
Customer: replied 5 months ago.
We've been up all night with William Henry. He's been throwing up all night (7 times from 3am to 5:30am). He seemed better the last couple of days- active but not playful. He was eating more. Today I knew he wasn't feeling well all day and night. He finally pooped a few minutes ago and that might have been the problem. It was full of hair. I'm just not sure. I'm giving him one teaspoon of laxatone a day. He is full of fleas and constantly grooming. I combed over 20 off him tonight. I treated Eva and Calleigh with Revolution. Jammie's vet won't be in until Monday, and I have asked if he can have it for him. I combed 60 off him today. William's vet is out until Monday, so I can't get a revolution for him until then. Years ago my mom's cat had an infectious anemia from fleas (haemobartonella). The cat almost died. I figured out what it was from looking in the Cornell Book of Cats. The vet tested for it and sure enough I was right. My mom credits me to this day for "saving" her Hank. She loves that cat more than she loves me lol. I doubt that is what William has, but what do you think? I'm afraid to suggest anything to his vet, as huffy as she is with me for "not trusting her". We are just exhausted from all these problems. Thanks for listening.
Hi Catherine,
I'm so sorry to hear William Henry was ill last night. Sounds very likely it was due to constipation. X-rays are ideal to evaluate for anatomic causes of constipation such as joint disease, lumbosacral disease or tumors compressing the colon to name a few. If none are identified, then a trial of Miralax (1/8 teaspoon in food once or twice daily) and possible diet change are indicated. Diet changes can be aimed at increase soluble/insoluble fiber and/or hypoallergenic/high protein low carb. It varies which works best.I wouldn't wait until Monday to get Revolution. You can get Frontline over the counter at Walmart or another retail center. Fipronil is the only active ingredient in Frontline and genetics of Frontline are made for cats with fipronil only which are fine too. Feline infectious anemia is not on the radar right now for William Henry. He is not truly anemic so testing for that would have no advantage at this time. Simply have his HCT rechecked in a month or so. Actually, a heavy flea infestation alone can lower the hematocrit a lot and maybe that is what caused his 9% drop, If you are using Revolution for all your cats and still seeing large numbers of fleas, then it is time for a change. Cheristin is a newer product, very safe and very effective. It is a flea only treatment and can be used along with Revolution to get heartworm, ear mite, intestinal parasites, etc.Your vet should have noticed the large numbers of fleas at William Henry's last visit and offered advice.Anyway, I hope he feels better soon. Keep me posted.
Customer: replied 5 months ago.
Thanks so much! My mom brought me some Revolution that she had so I'll go ahead and put it on him. He's going nuts with the itching. We haven't had any fleas until I started letting Calleigh out a month ago. Hopefully revolution will take care of it on all of them. Thanks for all this really good information. I'm worried about his weight and appetite. He isn't tearing through the house like usual, or ripping up cardboard boxes with his teeth. He just wants on my lap. He's still sitting down easy. We have an appointment for a recheck of phenobarb level and HCT but I don't want him sedated for an X Ray, so I'll take him to Animal Care Associates if I have to. The probiotics seem to be helping Eva. She likes the chunky chicken. She is feeling better with the Revolution, too. She's been interested in what's going on and she spent a long time in the yard with us yesterday. Jammie and Calleigh have been playing outside, chasing each other and rolling around in the dirt. It's bittersweet, but I'm glad Calleigh is still enjoying life. I'm nervous about leaving for a week on the 13th with all the care they are needing. Thanks again for helping us through this difficult time.
Customer: replied 5 months ago.
Hello. Are you still available to talk to me about some black scabs I'm seeing today on Eva's upper lip? All the vets said the squamous cell was not contagious. I'm so worried.
Customer: replied 5 months ago.
I can't get a good picture. The black on her nose is normal but the black scabs on her lip are new.
Customer: replied 5 months ago.
Trying to get s good picture.

Hi Catherine,

I can't really tell what's going on from the images. Squamous cell carcinoma is definitely not contagious so please don't worry at all about that.

Are you sure the areas are scabs or could the black on the hair at her upper lip just be something she could have gotten into outside?

I would suggest looking to see if the skin is red or irritated in appearance and see if she seems uncomfortable or not. In the absence of any redness, swelling or pain, I'd simply monitor this for a few days. Send a better image if you can.

By the way, how is the rest of the gang?

Thanks,

Dr. Karing

Customer: replied 5 months ago.
Thanks. I took her the vet today for fluids and she looked at it and isn't worried. Eva has lost another few ounces in the last 3 weeks, so I'm worried. William Henry's vet says she is no worried sbout the anemia, but I sure am. He died t play anymore. One day he was racing through the house and the next he was sick. Now he sleeps and doesn't want to eat as much. I'm doing laxatone and he is pooping. He's going to be retested for hematocrit and phenobarb level on the 21st. He sits very gingerly. The back end problem came on so suddenly it doesn't seem like arthritis. Calleigh is holding her own and very playful. She went out all day yesterday and we couldn't get her in until 11pm. A mother cat and 5 6-week old kittens showed up on my doorstep. It's freaking her out, so I'm keeping her in. All the other cats stay in unless I'm with them. I've tried all day yo locate a rescue that will take the kittens and mom but no one will. The vet said she put down two litters today for the same reason. All the shelters are full. I'm so stressed out. Kittens are so healthy and all long haired beauties. I hate to have to have them killed. The mom is so sweet. Very exotic looking brown and orange tabby/tortie with spots and striped. One of the kittens is identical to her. Two are blonde and one is a gray tabby. One is black with a white spot under his chin. So sad. If I had known Calleigh was going to do so well for this long, I would have had the tumor debulked or removed. Now I feel terrible about that. I can't win.
Customer: replied 5 months ago.
Spellcheck is killing me. He doesn't play anymore.

William Henry is likely sleeping more and not playing due to discomfort in his rear area. If you don't want to sedate him to check his hips/pelvis, then you could do a trial on Adequan for arthritis. Arthritis can become exacerbated by some activity (e.g. missed jump, falling) and present as an acute problem: this is very common. However, based on his history of consitpation, I would suggest adominal x-rays to be certain there is nothing else that requires attention: pressure on the colon from organ enlargement or a mass as well as check the lumbar spine. It is unlikely abdominal x-rays views will require sedation.

I'm so glad to hear Callieigh is doing well. You definitely made the right decision for her: the surgery was too aggressive based on the poor prognosis associated with this cancer.

Those poor kittens: that's so sad. Are they friendly? If so, I'd call local animal hospitals. Often some of the staff are willing to foster kittens. It doesn't hurt to ask.

Customer: replied 4 months ago.
I will look for the email that went to my junk mail in order to make payment. I have been out of town for work. I would like to ask you about Calleigh. She is having more trouble eating and seems to be in pain now. We are doing metacam every other day but she seems more distressed when we give her buprenex, so I haven't given her consistent doses. I took her to her vet to see if she needed an antibiotic for the odor in her mouth. He didn't think so, but he wants me to take her to MedVet in Ohio for a consultation about radiation. I thought that he and I had decided that the stress and possible bad effects of that would outway any benefit. I even talked to a radiologist at Cornell about it. Now my vet is bringing this up and is talking about some kind of gamma knife treatment. I feel stressed that we have not done what we should have for Calleigh. I asked my vet to call a doctor that I talked to in Tampa that does some sort of immunotherapy with a vaccine. I read about it in Dr. Mercoloa's site. My vet didn't want to make the call. Do you know about that? The website is ifx-vet.com. What do you think about radiation? The tumor has invaded the right side of the tongue. Thank you.
Customer: replied 4 months ago.
The mother cat and kittens are at my neighbor's. She is going to keep the mom and two kittens. Three kittens need homes but my neighbor has been unable to socialize them. I'm getting worried that the window to tame them has passed. My neighbor has been afraid to force ghem to be held. We don't really know what to do to tame them. They come up to people but won't be touched. My neighbor said today that she is throwing in the towel. I'm afraid they will not find homes now. We are both out of ideas.
Customer: replied 4 months ago.
Jammie is haveng bad coughing fits. We tried another round of Clavamox but it didn't work this time. My vet says there is nothing she can do. He plays like crazy and is eating well. He lost a half pound though since August. He now weighs 17.5 pounds. My vet says the weight loss is the beginning of the end. I'm overwhelmed with all of this, as you can probably tell. I just hope there is nothing I should be doing for his congested wet cough. Thanks.

Hi Catherine,

I'm sorry to hear Calleigh is uncomfortable. If there is an odor, then I would suggest antibiotics. It is not unusual for tumors to become infected as they progress: this is especially true in an environment full of bacteria such as the mouth. Convenia is a good choice as it is broad spectrum and injectable so it generally does not cause any GI upset (nausea or diarrhea) like some other antibiotics can. One injection lasts 2 weeks. In addition to Metacam for pain, since buprenex is not tolerated well, you could consider adding Tramdol or Gabapentin. Like buprenex, both have the potential to cause sedation so keeping Calleigh indoors would be necessary.

I am not familiar with ifx.vet but did review the site and have limited knowledge of those kinds of treatments as they apply to humans. I did some quick research and learned from an oncologist that the clinical benefit of this therapeutic is not well defined as no peer-reviewed data is available to date. Also, this therapeutic is not currently approved or licensed by a regulatory agency. As a result, I would not recommend this as it could be harmful. I can see the argument for trying something "experimental" in the face of terminal disease but you would need to get your vet on board and accept the possibility that the treatment could harm Calleigh. I would not recommend radiation for the reasons previously discussed (i.e. stress, side effects and minimal increase in survival time). I would expect the response to be even poorer since the tumor has advanced. However, I would encourage seeing the specialist about further pain control should your vet decline to provide other options.

Continuing to socialize the kittens through feediing is the best way to get them used to humans. If they are hungry enough, over time they should allow people to get closer and eventually accept hand feeding. I would urge your neighbor to keep trying since the job is much harder as they get older. At this age, they will come around if effort is put forth daily.

Poor Jammie, he'd been doing so well with no coughing.... A half pound weight loss in a 17.5 lb cat is not very significant. Instead of your vet throwing his/her hands up, they should offer some options. I disagree that nothing can be done. His x-rays were suggestive of bronchiolar disease. I'd repeat them to assess for changes, but if the bronchiolar pattern persists, then a short course of oral steroids along with starting inhaled steroids (i.e. Flovent) is the next logical step since antibiotics failed. Having an inhaled bronchodilator on hand may be wise too (i.e. albuterol): however, this is not a stand alone treatment. I'd suggest taking him to the specialist ASAP. Coughing cats do need to be promptly treated to help avoid a respiratory crisis. You can read more about administering inhaled medication to cats here: https://www.trudellmed.com/animal-health/aerokat

I hope this info helps. Just let me know if you have other questions.

Take care,

Dr. Karing

Customer: replied 4 months ago.
Thank you. This is so hard. We have an appointment for Calleigh at Medvet Monday. I just gave her the metacam but I really don't know if she is swallowing it or drooling it out. I tried to wipe her down so the other cats don't get into the drug. Jammie is bathing her a lot. I just wish we didn't have to wait a week and drive 3.5 hours each way to get help for her. I too thought she should have convenia last Monday. We have an inhaler for William Henry and I told Scott we might have to be ready to use it on Jammie if he has a crisis. I'm worried about leaving him all day on Monday when we take Calleigh to Ohio. His vet said "it's the tumors in his lungs". The radiologist only saw one mass that I know of, so I'm not sure why she said "tumors". I'll have to arrange taking him to another vet or to Medvet as soon as we get Calleigh under control. This is a very tough week for me at work, but I'm off for two weeks after that. The holidays are making it hard, too. Calleigh is sleeping in her litter box, so I know she hurts. William Henry is feeling better. His hematocrit went up some. I didn't get the numbers. His phenobarbital peak level was 25. We figure he might have a seizure on this dose but he feels much better and is playing again. We are giving him Lax'aire every day. His stool is hard and full of hair. He eats a little pumpkin. Eva seems ok. She had a bad bout of constipation one day last week, but we finally got her to go after 5 hours of walking all over the house and yard and giving her lax'aire and then laxatone. We couldn't get miralax down her. Her weight is going down every time she goes for fluids. She is eating her chunky chicken and is back on her regular dry food. Thanks for your support.
Customer: replied 4 months ago.
MedVet agrees that radiation or any other treatment would not be advantageous for Calleigh. We will continue pain control and have started Clindamycin that was given to us there. She seems better today and managed to eat some. I might ask my vet for Convenia instead of continuing Clindamycin because I feel like it is upsetting her tummy and tastes bad. We aren't consistent with the buprenex so I hope she isn't addicted to it. If she is resting or seems comfortable, I'm not giving it to her on time. Jammie's vet wants to do a round of oral steroids. She does not want to do inhaled steroids. When I asked why, she only stated financial reasons. I told her I already have the airoKat and don't care about the cost. She still insisted on oral. I doubt I can pill him. He is impossible to pill. I would end up in the emergency clinic having them pill him. I'm still trying to decide what to do about that. I thought the inhaled drug like fluticasone would be better for him, but as usual the vet has another idea. I'll review your earlier advice about having him evaluated at Medvet. The vet that saw Calleigh suggested we bring Jammie to their internal medicine department. She thought the cough could be separate from the mass. She said masses can hang out for a long time with no problem and rarely cause a cough. Thanks again for all your help.
Catherine
Customer: replied 3 months ago.
I haven't figured out how to compensate or rate the last answer. I called the customer service number and was told I would receive an email, but I have not. I would like your opinion on prednisone vs predisolone in treating Jammie. I am ready to start the medication now, but noticed I was prescribed prednisone. I have heard several times over the years that predisolone is preferable. It's always something like this with the vets I have! Why can't they just be on the same page with what I'm comfortable with! I'm still concerned that if Jammie has a fungal infection this will make it worse, but I guess we have to try something.Thank you.
Catherine
Hi Catherine,
About 30% of cats are unable to convert prednisone to the active metabolite prednisolone. For this reason, prednisolone is always the preferred choice in cats. There is no downside to using prednisolone: the cost is comparable to prednisone.Unless his chest x-rays have changed dramatically, then fungal infection is unlikely. A steroid trial is reasonable, but if you find it effective for Jammie, then consider Flovent inhaled as ideal for long term use to avoid steroid related side effects such as diabetes.Thanks, *****
Customer: replied 3 months ago.
Thank you! I asked my vet about it this morning and she said "I need to stop googling things". I insisted on prednisolone and will get it today. 2.5 mg twice a day for one week and then once a day for one week and then every other day. He weighs almost 18 pounds and is fat. I hope that's the right dose, and tapering appropriately. I hate being in this position. I'll end up at Medvet with Jammie soon. I'll make sure we get the inhaled steroids if needed. Calleigh stopped eating yesterday and I'm not sure she can drink, but is trying. We gave her milk with syringe last night and she took it well. Her vet will come to my house as soon as we can schedule it. Thanks again for helping us through this awful time.
Customer: replied 3 months ago.
I really don't know why everything has to be so difficult. I went to pick up the prednisolone and it was compounded into a huge capsule. The pharmicist said he couldn't believe it was for a cat. There's no way I can give it to him. I don't understand why this happened because my other vet prescribed predisolone for Calleigh and they had it in small tablets right there in the office. I didn't have to go through a pharmacy. None of the drug stores around here have it in any other form except liquid and I know I can't give him liquid. Also, now I'm worried that the dose is wrong because the prednisone dose was 2.5mg twice a day, but the prednisolone dose is 5 mg twice a day. I wish I could just trust my vet, but I can't.
There are plenty of online pharmacies that carry 5mg prednisolone tablets:
https://www.google.com/search?q=prednisolone+tablets&client=safari&hl=en-us&prmd=sinv&source=lnms&tbm=shop&sa=X&ved=0ahUKEwjV2MKr1KzRAhUI8IMKHXfDBLEQ_AUIBygB&biw=320&bih=460&dpr=2There is no dose adjustment necessary between prednisone and prednisolone so I can't explain why your vet changed the dose. However, 5mg pred twice a day is what I would suggest for Jammie's weight anyway. The dose can be tapered gradually after there is a positive response. The lowest effective dose is ideal long term to avoid negative side effects, but inhaled steroids are still the lowest risk for long term management.I'd suggest requesting a written Rx for prednisolone so you can get the manufactured tablets or request prednisolone chews from a veterinary compounding pharmacy.Alternatively, dexamethasone tablets could be used instead of prednisolone.You would probably be best served to go to a different vet because there have been numerous instances where your current vet is unwilling to run diagnostics or provide treatments that you want/need for your pets.
Dr. Karing, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 429
Experience: General veterinarian with a special interest in internal medicine and emphasis on individualized care.
Dr. Karing and other Cat Veterinary Specialists are ready to help you