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Dr. Deb
Dr. Deb, Cat Veterinarian
Category: Cat
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Experience:  I have loved and owned cats for over 45 years.
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Our female 2 year old Tonk started to seem more lethargic earlier

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Our female 2 year old Tonk started to seem more lethargic earlier this week. She had also not been eating of all her wet food (half can in morning and evening) and is typically a big eater. She has dry food available for free feeding as well.
We took her to our cat specific vet who said she looked and acted fine. Suggested 1/4 pepcid as she suspected upset tummy. I collected a urine sample and returned so they could test it. USG was 1.058 and Protein was 2000++++. ph 8.5 and WBC moderate.
She didn't seem to feel better the next day (we did not start the pepcid yet) and took her in to a local place that could get blood results done on site.
Her numbers came back as:
BUN 29.0
CRE 2.0
TCHO 219
ALB 3.5
GLOB 3.6
GLU 101
Na 154
K 4.4

There are plenty of other numbers I can provide if needed. The vet at the hospital prescribed amoxycillin 10mg 2 times per day. He gave us an appetite stimulant as well as a pain med. They were fairly rough with her during the blood draw and she was the most stressed / upset that I have ever seen her.
Got her home at 6pm and gave her the anti bio and app stim. 2am she is voracious. She ate well for a day and then the following morning was back to being meh. She has begun to have loose stool (never before) and I attribute this to the anti bio.
The blood work vet said she is in renal failure and we were devastated. I took the work to our normal cat vet who became rather upset and said NO WAY that she is in renal failure and the number are normal. All of this has been over the last 2 days. She seems more lethargic today, but I have gotten her to eat the wet food. (We feed Wellness can and dry).
I apologize for the in depth "question", but I want to provide as much info as I can.

Best regards,

Adrian
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Deb replied 1 year ago.

Hi Adrian, I'm Dr. Deb. I will do my best to assist you today.

I'm sorry for this concern for Lele and the fact that you were told Lele was in kidney failure.

I absolutely agree that these values do not signify renal failure. Each lab is different but her kidney values are well within a normal range. The fact that she's concentrating her urine this well also indicates that her kidneys are not failing.
She might have a condition called Pyelonephritis, though, which could account for her increased urine protein and some of her signs. This would be an infection in her kidneys which might take several weeks worth of antibiotics to clear.

I probably would have chosen a different antibiotic rather than Amoxicillin though Without a culture and sensitivity, it's difficult to know which antibiotic might be best but Amoxicillin has been around for a long time and there is much resistance to it's use these days. I might have used Clavamox instead or even Baytril although I do know that each vet is different.

Yes, I would attribute her looser stools to the antibiotic. You could give her probiotics such as Forti Flora which may help with this problem although some cats will continue to have looser stools until the antibiotics have been discontinued.

The fact that she's eating a little better today is a very good sign since Amoxicillin can also have the side effect of anorexia in addition to diarrhea (and vomiting in some cats).

I might also encourage you to start the Pepcid on the off chance that she might be feeling a little nauseous. Unless she's hard to pill (which might stress her out), then this is a safe drug.

I've seen some cats with Pancreatitis behave as you describe. I'm not sure if a spec fPL was done which can evaluate the pancreas. But, in most cases, treatment is supportive: ie, fluids, appetite stimulants, anti-nausea drugs as well as pain medication (since we believe that pain plays an important role in why these cats show the symptoms they do).



I hope this helps and that she's feeling better soon. Deb

Customer: replied 1 year ago.

Hi Deb,


 


I greatly appreciate the answer. We lost our previous cat to renal failure and had no idea that she was sick until she presented symptoms and we found out she was stage 4. Obviously, we were heartbroken and it has significantly increased our anxiety regarding Lele whom we rescued from a kill shelter as a 4 m/o kitten.


I am going to provide a follow up urine sample to our regular cat vet tomorrow and make sure she is aware of the meds prescribed at the vet hospital.


 


Thank you again,


 


Adrian & Michelle

Expert:  Dr. Deb replied 1 year ago.

Adrian and Michelle:
You're more than welcome; I'm happy to help.

That's heartbreaking about your other cat but the history is one I see all the time: cats are so masterful at hiding disease until it catches up with them. And, this is most true with kidney issues.

I think a follow up urine may not be a bad idea but the results may be influenced since she's been started on antibiotics already. This is also true for a culture and sensitivity. But if one is done and it comes back with growth, then you'll be able to tell if the correct antibiotic has been chosen.

I hope you'll keep me posted about her. . Even after you've rated (if you do, of course), we can still continue to communicate. I can also send you a follow up email in a day or so to which you can respond when you have the time to do so.

 

Good luck. I'll be hoping that she gets past this very quickly...I'm certain that this is your hope as well! Regards, Deb

Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 6540
Experience: I have loved and owned cats for over 45 years.
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Expert:  Dr. Deb replied 1 year ago.
Adrian and Michelle:
I just wanted to thank you for the rating; it's greatly appreciated.

I'll look forward to updates about Lele and will be sending positive thoughts her way:) Deb

Kindly ignore the information request.
Customer: replied 1 year ago.
My pleasure and thank you again.
Expert:  Dr. Deb replied 1 year ago.
Laughing
Customer: replied 1 year ago.
Hi Dr. Deb,

Took another urine sample in today and it came back pretty much the same. USG 1.056 and protein 2000++++.
She seems to feel better than she has the past few days and her stool was more normal.
Still have her on anti bio.
I am concerned that all the protein in her urine may give us a higher urine gravity than normal as 1g f/dl can increase the grav .003-.005. Given that her particular test is 2k ++++, I tend to wonder about the USG.

Thank you again for all the help,

Adrian
Expert:  Dr. Deb replied 1 year ago.
Adrian:
Did your vet send the urine to a lab or did they use a dipstick test in the hospital? Deb

Customer: replied 1 year ago.
I believe it was a stick.
Expert:  Dr. Deb replied 1 year ago.

Adrian:

Dipsticks are just screening tests and are notoriously prone to false positives; I don't rely on them for this reason.
It could just be that the urine is so concentrated that it's creating a false positive.
At the lab they can do an SSA test and confirm it.
Another test to consider would be a UPC (urine protein: creatinine ratio) which will help indicate whether or not the protein is "real". We often recommend that the test be done at least two times to ensure that it's a repeatable elevation, if that makes sense. We don't necessarily rely on just one value, in other words.
Neither test will tell the source of the protein but will just confirm that it's present.

I might also try to increase water consumption in an attempt to lower the specific gravity to 1.040 or lower and then recheck the protein level (at a lab).

 

A +1 or even a +2 protein wouldn't concern me that much even with a concentrated urine sample but a +4 is high.

Inflammation and/or infection can increase the protein values as well. Deb

Customer: replied 1 year ago.
Ok. I have access to an internal med vet here in Dallas. Perhaps we'll set up an appointment with them and see if we can get more conclusive urinalysis done. Since she is eating nearly all wet food right now, she isn't really touching her water. Skin seems to snap back pretty well.
Thank you again and I will let you know.
Expert:  Dr. Deb replied 1 year ago.
Adrian:
That sounds like a good plan to me.
Clearly she is feeling better if she's eating more and less lethargic...which is good.

I'll look forward to updates. Deb
Customer: replied 1 year ago.
Hi Dr. Deb,

Just wanted to let you know that we have an appointment tomorrow with a diagnostic internal med vet. In addition, I had our home air tested for mold and VOC and got some troubling news. Our home was .6 ppm while the garage built up to 3.8 ppm in less than one hour and back flows into the home. We are taking immediate steps to fix the issue for the good of all of our health, but especially for LeLe as she is much smaller, closer to the ground, and constantly exposed. Given this information, I am freshly concerned over her kidney health yet still confused at the possibility given her USG level.

Kind regards,

Adrian
Expert:  Dr. Deb replied 1 year ago.
Adrian:
I'm glad that you've got an appointment with a specialist; let me know how it goes.

This is very concerning about the mold issue; I can understand why you might be worried about your girl.
While it's still possible for her to be having some problems with her kidneys ( glomerulonephritis, nephritis, pyelonephritis, etc), I don't believe her kidneys are failing. Her BUN and Creatinine are not high enough and her specific gravity is not low enough. It woudl be extremely rare for her to be able to concentrate this high with failing kidneys and to also have blood normal values.. to the best of my knowledge, I've never seen it. (and I've seen a lot of cats with kidney failure). Deb
Customer: replied 1 year ago.
Hi Dr Deb,

Ok. Results are in for LeLe. We could not feed her after 8pm in case the internal med vet wanted to do an ultra sound. Since the only moisture she was getting was through her wet food, I supplemented her water by putting some in a straw and dribbling to the side of her mouth. I gave her water this way about four times yesterday and at 8 pm collected a free catch urine sample and put it in the fridge.
The doc looked over the bloodwork and other urine results and felt as you did regarding any possible kidney failure. He took the urine sample for spectranalysis and called with the results (no ultrasound or bloodwork).
Said she only presented with a trace level of protein, ph was 7.4, and USG was 1.034. He felt that this was a pretty good indication that renal failure is unlikely and she had or has an infection of some sort. He also noted that the urine was slightly dilute and was likely due to the additional water I had administered yesterday.
So here are the urine results in order

1st
USG 1.058
Ph 8.4
Protein 2000++++

2nd
USG 1.050
Ph 7.8
Protein 2000+++

3rd
USG 1.034
Ph 7.4
Protein trace

I wanted to tell you again how much I appreciate your input during this very upsetting time. Your warmth and genuine care for our little LeLe has made all the difference. Thank you again for everything!

Adrian & Michelle
Expert:  Dr. Deb replied 1 year ago.
Adrian and MIchelle:
First of all, thanks for the kind words; they mean a lot to me:)
Second, I'm loving her last urinalysis!!! I personally don't think that a specific gravity of 1034 is dilute but the trace of protein isn't worrisome at all (not to me at least with this specific gravity).

Just goes to show how inaccurate the dipsticks that are done in the office can be!!!

This is extremely encouraging:) Deb
Expert:  Dr. Deb replied 1 year ago.
Adrian and Michelle:
I'm just following up on our conversation about Lele. How is she doing? Deb
Customer: replied 1 year ago.
Hi Dr Deb,

She still seems a bit lethargic off and on and her appetite seems to follow the same trend. I'm going to have another urinalysis done Monday and see how it looks. I am wondering if the 100mg of anti bio 2 times a day may have something to do with it.
She does play and has starting romping again. I'll let you know what the results are on Monday.

Again, I truly appreciate your concern for our little Tonk.

Kindest regards,

Adrian & Michelle
Customer: replied 1 year ago.

I'm worried (imagine that!) that we may have another problem here.

Our Tonk was 12.4 lbs when we took her to the vet the first time 10 days ago. At the specialist, she was 12 lbs and that was 4 days ago. We just weighed here here at home and she is now 11.2 lbs.

As I had mentioned before, her appetite is spotty and she has really kinda slacked off on all dry food. We have gotten her to eat roughly 1 1/2 to 1 3/4 of wet food each day. I am really concerned about lipidosis onset, especially given she was a bit rotund to begin with.

 

CORRECTION

 

I just weighed myself 3 times and then with LeLe 3 times and have her figured for 12.0 - 12.4 lbs.

 

My apologies for the multiple replies. As you can imagine, we are stressed and a bit over anxious about our baby.

Expert:  Dr. Deb replied 1 year ago.
Adrian and Michelle:
I've been off my computer until just now and see your responses to my query about Tonk...and no need to apologize. I'd much rather you be too worried about her than not worried enough!

Home scales are notoriously inaccurate when it comes to weighing cats unless you have a digital scale so I'm not surprised that you saw such a variation.

And, vet scales can be off a little bit as well so the difference between 12 and 12.4 pound wouldn't concern me either.

Antibiotics can certainly affect the appetite and cause it to be decreased but the amount of wet food she's eating sounds like a good amount to me. Lethargy isn't a sign that I associate with Amoxicillin though.

Lipidosis is typically seen when overweight cats stop eating for a while or it can be associated with Diabetes but it doesn't sound like something you necessarily need to worry about at this time.

I will be interested in hearing about her urinalysis results on Monday. Deb
Customer: replied 1 year ago.
Hi Dr Deb,

I am sorry to bother you again after all this time but we have come to trust your advice and you frankly know as much about our Tonk as our local vet.
We were referred to in internal med vet who saw our kitty again last week. She is still not eating UNLESS she has been given a 10mg dose of Tramadol. He took blood and did an ultrasound yet came up with no answers. Her creatinine was 2.1, up from 2.0. Albumin was barely above normal by one point and this was attributed to dehydration. Ultrasound showed nothing other than a slightly misshapen kidney. No real answers.
We are afraid we are going to lose our baby as she refuses to eat after the Tramadol clears her system. This usually takes about 36 hours ( in regards to how long she will have an appetite to going back to not eating at all ). I feel strongly that she is in some sort of pain and the drug diminishes it to the point that she will eat and act relatively normal again.
Urinalysis was good with trace protein and USG on 1.042. Results of urine culture came back negative. Only other newish development is a she has stopped using her box for bowel movements and most times will have a very soft stool when in past it has always been firm and normal.
Again, I am sorry to rehash all of this after a few weeks but we are running out of ideas and have spent a large sum of money to still have no answers. The internal med vet has referred us to a surgical vet for x-ray imaging if we want to go further.
Your care and concern has been wonderful and I reach out to you in the hope you may be able to shed some light on what may be going on and what we could ask our specialist to rule out or test for moving forward.

With kind regards,

Adrian
Expert:  Dr. Deb replied 1 year ago.
Hello Adrian:
This is distressing to hear about Tonk since I assumed she had been doing really well.
A 0.1 increase in her Creatinine wouldn't worry me too much nor would an albumin slightly above normal. Her specific gravity and trace protein are also good news.
Not sure what to make of a misshapen kidney, though.

Why was she put on Tramadol? It's not a drug that I typically see used as an appetite stimulant.
Is the internal medicine vet recommending a biopsy of her intestines?
Is she losing weight?

Deb
Customer: replied 1 year ago.
Hi Dr Deb,

I know. We are really concerned about her and very stressed.
The Tramadol was given by the 1st vet to do bloodwork ( this was the same one who said her kidneys were failing. Not a good experience for our kitty or us. Big time stress when they tried to draw blood as we could hear her screaming during the process and then it was 30 minutes before they brought her back to us ).
I noticed she had a great appetite when on it and have been using it strictly as needed to get her to eat. I suppose he prescribed it in the event she had pancreatitis, but we suspect something may have gone poorly during the blood draw.
That aside, the internal med vet has not really given a possible prognosis nor suggested additional testing besides referring us to a surgical vet for X-ray imaging. Why is beyond me unless he suspects muscle or bone trauma / issue. I truly have no idea and the surgical vet office was somewhat vague as to what they would be imaging or really looking for until we come in for a consult. I am willing to try it as we love this little one tremendously and very much wish to find a cause for her malaise and appetite reduction.
What might your thoughts be regarding the biopsy? Also, since we rescued her from a shelter as a kitten, could FIP be a concern? The specialist said it was doubtful but, to my knowledge, has not performed a test to see if corona virus is even present in her system. ( Which if it is not, I understand would make FIP impossible as it is a mutation of this virus type ).
To summarize, he has performed another blood test and an ultrasound but no other tests suggested as yet beyond referring her for X-ray imaging at the surgical vet next door. If it helps, I can provide you any of the info from her most recent blood lab.

As always, thank you for the continued support and advice.

Adrian
Expert:  Dr. Deb replied 1 year ago.
Adrian:
Thanks for the additional information and clarification.

This is really quite a challenging and frustrating situation, isn't it:(
It's interesting you should mention FIP because as I was pondering her situation after I logged off last night, this possibility did occur to me.

You may already know this from your research but there's a wet form (where fluid builds up in the abdominal or thoracic cavity) and the dry form (which causes pyrogranulomas to develop and is harder to diagnose).
Signs can be vague and can depend on the location of pyogranulomas in the dry form. Mild intermittent fever, weight loss, lethargy, and decreased appetite may be seen. Irregular kidneys or irregular abdominal organs can be detected. The reason I thought of it was because of the ultrasound results of her kidneys and her gastrointestinal issues (diarrhea could be seen if the pyogranulomas affected her intestines).

The problem with previous antibody testing is that it will only tell us that she's been exposed to the corona virus, not that she necessarily is ill from the disease...which I'm sure you already know. But, there's a new test which is more reliable (LINK).
I don't see a lot of FIP where I practice so I don't have a lot of familiarity with this test and haven't had to use it.

The only reason I mentioned a biopsy is because of the change in her stool consistency but I'm not entirely certain that this is the next test to consider since it's fairly invasive. Of course, if she had this done, then the entire abdominal contents could be evaluated and biopsies taken of any suspicious tissue, including her kidneys.
I've seen some young cats develop lymphoma which can affect their kidneys and intestines. A kidney biopsy would be needed to specifically diagnose it, though.
I guess I'm a little surprised that they aren't pursing possible causes of the irregular kidney since clearly this is not considered normal in a cat this age.

I'm afraid that I don't have a lot to contribute and I'm really sorry for that. A consult with the surgeon might be worthwhile. X--rays are certainly non-invasive and might help shed some light on the situation.But, it saddens me to say that I'm getting a bad feeling about this given her age and continued symptoms.

I'm really so sorry that you, MIchelle and Tonk have having to go through this. I truly thought her problems were transient ones and it's more than distressing to hear that they aren't.

Please keep me posted about her. I'll continue to think about her situation and if I have any epiphanies, I'll let you know. Deb
Customer: replied 1 year ago.
Hi Dr Deb,

Thank you for all the time you have spent with us while trying to figure out what may be wrong. My wife and I truly appreciate it.
While FIP would be a tragic diagnosis, at least it would provide an answer and we could make every effort to make her as comfortable as possible as long as was humane. We've loved her and given her the best care and attention we know how and I know that counts for something.
That said, we will continue to hold out hope that this is something transient or at least less final.
I will absolutely keep you informed as we have new information and always welcome any additional thoughts you may have.

With kind regards,

Adrian
Expert:  Dr. Deb replied 1 year ago.
Adrian:
It's my pleasure to try and help your family deal with this problem with Tonk.
It really is the not knowing that can be worse, sometimes, when faced with a situation like this.

There's no question she has had a wonderful life with you; far superior to what she would have had if she'd remained at the shelter and this definitely counts for a huge amount in my book:)

I've seen some miraculous recoveries from cats since they have an amazing ability to heal. So, I'm not going to discount her ability to get past this; there's always hope that she will.

I'll look forward to continued updates and will continue to send positive thoughts her way. Deb

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Dr. Deb
Dr. Deb
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I have loved and owned cats for over 45 years.