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Doc Sara
Doc Sara, Veterinarian
Category: Cat
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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I have a 21 year old male who suddenly seem to have develop

Customer Question

Hi I have a 21 year old male who suddenly seem to have develop a weird action. He cannot seem to swallow his food. At first it's just dry kibbles that he would have trouble with, after s couple of days it's wet food too. He would eat a few mouthfuls with no issues then by the 8 or 10 mouthful he would start licking his chops a lot by opening and closing his mouth then very visibly trying to swallow for a couple of minutes. If he's successful the gulping would stop after but if not then he would regurgitate a very sticky mucousy glob with or without some of the food. This also happened once with water in the past few days.
I have brought him to the vet for X-rays and blood work yesterday but everything came back as normal as it can be. He does have some existing conditions with his liver and pancreas, and some early renal disease. Nothing came up on the X-rays for his mouth, throat or esophagus. However there's some abnormal white masses in his upper lungs on both sides which the vet can't determine. Blood work shows no elevated white cell counts or fever so it's unlikely pneumonia or a viral infection according to the vet. However the vet still wants to try a course of antibiotics and acid blocker to see if that helps with his condition. I'm just not very sure now if she knows what's going on. Can you advise?
I have been using this vet for over 10 years and want to trust her but it's really hard not knowing for sure what's going on and watching my baby suffer. The list of current medication he's on right now is Ursodiol, potassium, Aventi KS and Cerenia. He had a stroke last September which he recovered from and diabetes around 6 to 7 years back which he also recovered from.
Submitted: 6 months ago.
Category: Cat
Expert:  Doc Sara replied 6 months 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 your elderly kitty is having troubles. I will do my best to help. That's certainly quite a list of health concerns :) Your guy is lucky that he has you and his vet in his corner! What you're describing really sounds like regurgitation. The combination of your description of regurgitation and the abnormal white masses in his upper lungs makes me concerned that he has esophageal dilation. "White" color on an X-ray indicates either soft tissue or fluid - it could be that if there's something blocking his esophagus, there would be a dilation of the esophagus between the obstruction and the mouth. Every time he would try to eat, that dilation may be accumulating more fluid and/or food, and some might also be pushed back out his mouth, as you're seeing. A quick way to check for esophageal dilation would be to have him swallow some barium (which shows up bright white on an X-ray) and take a series of X-rays to see where the barium goes. If the "white masses" that your vet is seeing extend to the chest wall, they may also be able to get a better idea of what the masses are by doing an ultrasound on that area. I'm really glad to hear that his lab work is all stable and the rest of his X-rays were clear. Unfortunately, this combination of signs and X-ray findings make me really suspicious for cancer - such as a tumor blocking his esophagus. If he isn't improving, you may need to decide on whether or not to pursue more aggressive diagnostics. I know that he has a lot on his plate medically - so let me know if I brought up any new ideas or questions with my thoughts. Thanks~Dr. Sara----------------------------------------------------------------------------------------------------------------------------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 6 months ago.
Does esophageal dilation also cause excessive lip smacking and swallowing when he hasn't fed or drank water? Coz he's doing that right now even after the acid blocker (Omeprazole) and antibiotics (Veraflox), it's only been a few hours since I adminster the first dose after his last meal at 8pm but he doesn't seem to be improving... if anything he seem worse coz he lost his appetite now and is hesitant about drinking water as well as he regurgitate every single time now even when he hasn't had anything. And the gulping is more often now and takes longer to subside.
Expert:  Doc Sara replied 6 months ago.
Hi there - the gulping can be related to reflux/regurgitation (like he's trying to swallow and get things down but it's not working) or it can also be a sign of nausea. Cats who are nauseous will lip their licks and swallow quite a bit as well. I don't like your description of him regurgitating every single time he tries to eat and now the loss of appetite. It may be time to either move on for more diagnostics or, if you decide, to consider switching gears to hospice care or humane euthanasia.Please let me know how he's doing and what other questions I can handle for you.~Dr. Sara
Customer: replied 6 months ago.
HiSo we went with the endoscopy after determine if his heart and blood works are ok (he is 21 so it's risky) to undergo such a long procedure under anesthesia. Unfortunately it is a stricture rather than a blockage that can be removed. It's right above the stomach entrance so its most likely due to multiple acid reflux as he dies have chronic pancreatitis and would have vomiting bouts every now and then even under the medication of Cerenia every other day.I was prepared for the worse and told my vet if it's a tumor or cancer to go ahead with humane euthanasia. But it wasn't so they went ahead and did balloon dilation on him. However his esophageal is very stubborn and wouldn't stretch much so after a lot of tiny balloons they only manage to get it to stretch to fit a 8mm scope to view his stomach and found some ulcers in it. So now he's on recovery from the post-anesthesia and on a diet of A/D mix with water and a cocktail of Omeprazole, Baytril, Buprenorphine and Sucralfate.My vet told me that if the esophagus does not constrict back then he should be fine eating blenderized food the rest of his life. And if it does then she would advise against another dilation procedure but vote for a stomach tube surgery instead due to his age.So my questions are...
Is 8mm really ok for survival?
And if the meds he's been given would be your recommendation as well?
And what would your opinion be for a 2nd dilation or stomach tube?
Customer: replied 6 months ago.
Also how long would it take for him to get back to normal coz he's like a limpy noodle right now and it's so unlike him. He's the type that cannot be handle without knowing his preferences as he would bite or swipe you if he doesn't like what you are doing. But I love him that way best coz he's not aggressive to me :) oh he's friendly to everyone (except the vet and staff) and won't hide but he's just the type that cannot be rubbed the wrong way.He was given Alfaxalone induction and constant rate infusion with Alfaxalone, combine with Isofluorane gas.Also his throat is making a rattling sound, vet says it's sore and it's not his lungs do it's ok. How long would it take his throat to heal? coz it's giving him pain when I syringe feed him I think.
Expert:  Doc Sara replied 6 months ago.
Hi there, thanks for your replies - I'm sorry for the delay in response, I just now got online for the day. 8mm can be OK for survival - the key here is really whether he is able to get food past that stricture. If he can't get enough nutrition into him to maintain his weight, then he's going to have to have something else done. Whether that be an attempt at dilation again or placement of a stomach tube is dependent on your veterinarian's feeling on the issue. Esophageal strictures can be notoriously difficult to dilate, so if one attempt had failed, it may be more reasonable to place a stomach tube. The other thing to consider with a stomach tube is whether you'd be comfortable managing it. It's not difficult but it's a whole new level of care when your pet relies on you for his only nutrition. Many owners also would be starting to consider euthanasia, having concerns that their pet's quality of life may not be good enough to merit continued aggressive therapies like a feeding tube. Alfaxalone and isoflurane are both cleared from the body very quickly. It's likely that he received a premedication prior to induction with the alfaxalone which may be contributing to his sleepiness now. It's not unusual for a pet to be a bit lethargic and dopey for 12-24 hours after anesthesia recovery. His gums should be pink and he should be in no respiratory distress. If he's still sleepy today I'd call your vet just to let them know. ~Dr. Sara
Customer: replied 6 months ago.
He started regurgitating again on the 2nd post-op day. I wonder if it's giz he keeps lying down while I syringe feed him but my vet says that shouldn't be the case. She suspects that his esophagus has mobility issues, is that possible? How rare is this kind of case?If I syringe feed him 6ml of A/D mix with water he's able to keep it down till about 3 or 4 hours later and then regurgitate some mucous and foam with a little of the food. And if I feed him 12ml he would regurgitate it straight out in less than 10mins.Is it possible that his esophagus is just taking time to heal and would be able to accept food later as he still has ulcers in his stomach. Or it is possible that it's a neurological issue that would resolve itself over time?He's at the vet right now being tube feed thru the nose. Vet says they will keep him for 3 days to make him take in more nutrients and calories to put on some weight. But she thinks that stomach tube would be the next step and she mentioned that it would require frequent endoscopic procedures to change out the ballons and button valves as stomach tubes are not meant for long time usage. So in that case that would mean putting him through more anesthesia procedures which I'm afraid he wouldn't be able to take coz of his age and pre-existing conditions with his pancreas, liver and kidney. I'm hoping that once he's recovered ftom the post-op and had enough nutrients to be stable that his esophagus would start working again and let blenderized food pass thru with no problems. Do you have any ideas that might be different from my vet's coz it seems your answer seem more accurate than my vet's.I think the multiple stomach tube ops is not an option coz it's way too much suffering for him. So I'm really hoping a miracle would happen and he would be able to take blenderized food on his own with a little help from me. I work from home so it's no issue how many times he needs to be fed, I can sacrifice my time for that. I'm just hoping I can have a little more time with him if he wants to live as it seems like he's trying so hard as well.
Customer: replied 6 months ago.
Oh I forgot to mention that his last puke had a little blood it would seem so I think his esophagus is hurt. The vet doesn't think it is. Attached photo.
Expert:  Doc Sara replied 6 months ago.
Thanks for all the additional information. I'm sorry to hear that he's back in the hospital but glad he's getting the best care possible. That bit of blood doesn't surprise me given the balloon procedure he just had. Unfortunately it doesn't sound like he's able to get the food down through that esophagus though, which means you're probably going to have to consider either stopping treatment and moving on to hospice or euthanasia or trying out the stomach tube. Patients can live with stomach tubes for months - they don't always need frequent changing. You could always decide to stop treatment if the tube becomes dislodged or you are having trouble with it. Gastrotomy tubes can be placed easily with endoscopic guidance, but any procedure at all can be hard on a kitty his age. Also, that stricture may prevent the vet from passing the endoscopic tools needed to place the tube. Jejunostomy tube placement is also an option, but not a great one because it is more invasive to place. You'll have to use your judgement based on his current quality of life. I think that it's doubtful at this point given everything you and your vet have tried that he's going to be able to pass food on his own.~Dr. Sara

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