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nekovet
nekovet, Cat Veterinarian
Category: Cat
Satisfied Customers: 16179
Experience:  Hello, I am a small animal veterinarian. I am happy to answer any questions you may have on any species.
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I noticed my elderly cat (17+ yo) staring into the space a

Customer Question

Good day! I noticed my elderly cat (17+ yo) staring into the space a lot more these days and she seems a bit senile. A home vet came about 2 weeks ago and examined her in general (because she was very hostile and we could not get her blood etc to find out more). Vet said the general condition of my cat is ok, except she is a bit slim. Heart & lungs have no strange noise and body from vet's touch & feel seems not bad. Organs' size seems fine too and no lump can be felt at this stage.
JA: OK. To minimize me, please click the down arrow at the top right corner of this box.
Customer: Understand
JA: I'll do all I can to help. What is wrong with the cat?
Customer: Good day! I noticed my elderly cat (17+ yo) staring into the space a lot more these days and she seems a bit senile. A home vet came about 2 weeks ago and examined her in general (because she was very hostile and we could not get her blood etc to find out more). Vet said the general condition of my cat is ok, except she is a bit slim. Heart & lungs have no strange noise and body from vet's touch & feel seems not bad. Organs' size seems fine too and no lump can be felt at this stage. I gave my cat 0.1ml Temesgic yesterday as she has some pain & weak hind legs. She seems a bit sedated afterwards, eyes opened and looked alert but I feel she was a bit "confused"
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Customer: She ate as usual overnight. This morning she seems to be in that state a bit still. The oral administration of Temesgic was given 18 hrs ago. My cat has a history of CRF, although blood test 5 months ago showed only UREA slightly higher than normal (previously both CREA & UREA were both on very high reading)
JA: The Veterinarian will know if your cat will be able to digest that. What is the cat's name?
Customer: MM is her name
JA: Is there anything else the Veterinarian should be aware of about MM?
Customer: Her potassium level was low per blood test in end May (when she was at the vet and had 5 teeth extracted) and was given Kaminox of 2ml per day
Submitted: 1 month ago.
Category: Cat
Customer: replied 1 month ago.
I also noticed her muscles tweaked, these days especially around her eye area. Not sure if it is me facing her too close and my breath affected her or what. Is there any risk of her having a stroke please and how I can tell?
Expert:  nekovet replied 1 month ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today. I do apologize that your question was not answered before. Different experts come online at various times; I just came online, read about your situation, and wanted to help.

Again I do apologize that my colleagues could not aid you sooner. If you would still like assistance, can you tell me:

Did her vet check a blood pressure (using a blood pressure cuff)?

Had she been on any treatment for her kidneys between those 2 results?

Any appetite change or vomiting?

Are her gums pink or pale/white?

Customer: replied 1 month ago.
Thank you Dr B for your prompt reply.I did not know if MM's blood pressure was checked at end May in clinic. But I expected it would be as she needed to go under anesthesia in order to get the teeth extraction done. Blood work was done (with only CREA reading slightly above normal and K is low - see attached picture) and even T4 was checked (passed).For the 2 home vets visits in end August and mid Oct, no blood pressure was taken.No meds was given for MM's kidney issues. The only "related" supplement given for her kidney issues is Kaminox. Vet prescribed 2ml/day but normally I can only give 1-1.5ml/day. Her toilet routine remains quite stable, 2-3 times for urine and almost daily for poo. Used to have difficulty with her big business, likely due to week hind legs muscles. But now better, with Kaminox and also some commercial brand probiotics I bought.We tried to give MM prescription kidney diet, but she did not like. So we now give her just commercial brands' food, both wet and dry. She is not a big fan of wet food but is willing to eat a tiny bit. Her food consumption, based on the labels of the pet food and my own research of calories intake for a cat of her size (approx 3kg) ranged from 55% - 75% of the suggested portion.She does not vomit very often. I noticed she did last Friday, just some clear liquid with foam. Not much hair inside. But she was quite short of breath afterwards. She had that sort of reactions before, as we noticed she had some seizures (rare these few years). Hairball gel is given once a week. There are so many different schools as to how often such gel shall be given. I am confused!MM's gum looks pinkish. Not too pale. Z
Sometimes her paws may look a bit very light pink, but not to the extent of white/pale.I noticed she kept scratching her ears and some hair on the back of ears was lost. I'm monitoring the situation and see if it will get more serious.Temesgic administration was about 24 hours ago and I slowly see MM more active. But at her age, she sleeps/naps/just rests quite a lot. She seems to have hesitated jumping up to wardrobe of about 1 meter from ground just now. But sometimes she can easily do it.MM always has quick respiration since she was a kitten. I have seen her with a bit more heavy breathing after moving around (even not very intense), eating, being woken up suddenly or when we helped her exercise her legs etc, with movement seen from her throat area - but she used to be very chubby and now skinny. May be that affects how I see. Or very rarely even nostrils will have obvious movement. But I have been measuring her breathing (observing her ups and downs in chest/belly movement) since May. If MM is in deep sleep, her usual rate per minute is 18 (15 very rarely) to 24 (max 27).Please let me know what you think, Dr. B. Your view and assistance are highly appreciated.Cheers!PC
Expert:  nekovet replied 1 month ago.

Thank you, ***** *****

I will have a quick read of your full reply and the bloods and will post shortly (do disregard the auto-call offer).

Speak to you again soon,

Dr. B.

Customer: replied 1 month ago.
Great, thank you for your prompt response! I look forward to hearing from you!CheersPC
Customer: replied 1 month ago.
Dear Dr. B,Here are pictures of MM's gum & paws, both taken 5 days ago.Kind regardsPC
Expert:  nekovet replied 1 month ago.

Hi again PC,

First, that is a shame they didn't check her blood pressure at her home visit. And I would double check if they did check her blood pressure (especially when she was conscious) since that isn't always standard practice in all clinics. The reason I ask about that specifically is because the staring behavior can be associated with high blood pressure in elderly cats. This can be a primary issue but can also be linked to thyroid disease (a concern if she is thin and eating well) or kidney issues (which hopefully are less likely here). Though I'd suggest that you could collect a urine sample (usually we can do so by keeping them overnight in a non-carpeted room with an empty litter box) to take into the local vet to determine if her kidneys are working as they should and to also rule out a bladder infection (just since that too can cause odd behaviors like this).

Otherwise, I am glad to see she is on the Kaminox since low potassium can cause weakness and lethargy in cats. Though with that on board we'd hope that that potassium level is back in normal range for her. And its positive to hear that her stools/urinations are normal for her. And just to note in regards ***** ***** diet, that is not uncommon in our cats. That is why I often have owners with diet fussy cats just aim to feed a low protein/sodium/phosphorus diet (looking to the levels in the renal foods as a guide) based on those brands that their cats like and reliably eat. That way we don't risk starving them because of their stubbornness. Though I'd note that if she is not eating as much as she should (use her weight stability as a guide here, as opposed to the food labels recommendations since they do tend to be a bit high), you could try adding Nutrical paste or offering a liquid diet (ie Clinicare even has an older cat/kidney preparation) to help her meet her nutritional needs. But again if her weight is stable that is a lesser concern here.

In regards ***** ***** vomiting, we will want to keep an eye on that for her. Especially since wall staring is a lesser known sign we can see when cats are nauseous (where they are focused on the nausea instead of the world around them). So, you can keep adding a bit of cat hairball treatment to daily routine (ideal for the moment) to just push anything in the stomach out the other way or if we see more vomiting we could also trial her with an OTC antacid like Pepcid (More Info/Dose @ http://www.petplace.com/article/drug-library/library/over-the-counter/famotidine-pepcid)

Finally, the Temegesic situation sounds to be another issue aside from the staring/odd behavior. Though we need to tread with care in light of this. The reason is because her prolonged sedation with this raises worries of decreased metabolism of the drug. So, I appreciate she wasn't keen to let her visiting vet take a blood sample, but again this would be a reason to check urine to rule out kidney issues relapsing but we may need to have her liver values checked on bloods if that is normal.

Finally, her breathing rates you noted are both fine, we are happy as long as they are <30 breaths per minute. And I do suspect the intermittent jumping issues are related to underlying arthritis (which they can have good and bad days with that just as people do. Though you could alternatively try glucosamine, chondroitin, omega 3 fish oils or Duralactin as non-sedating options to support that.

Overall, it sounds like we have a few different concerns with MM. The staring and her Temegesic situation does raise questions of underlying blood pressure issues, nausea, and possible kidney disease recurrence. Otherwise, we'd also have underlying arthritis concerns for her.

Kind regards,

Dr. B.

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Customer: replied 1 month ago.
Thank you Dr. B for your really quick reply! I am very grateful for your help!I am asking re: blood pressure measurement and I will only hear later. I will update you if I hear anything different. In end May T4 test was done and MM passed. So are you suggesting MM should have it checked again because the blood test result can change quickly, despite less than 6 months have passed?Thank you for your suggestion on Nutrical paste and Clinicare. I tried to give MM Tomlyn High Calorie Nutrition Gel but she does not like it, probably the taste or the texture too thick. For Clinicare, is it something easily obtainable from pet shops please? I am in Asia and may not easily find such supplies. But will try.I have not really weighed MM since last clinic visit in May. But the general feeling is her weight has increased. Sometimes she looks a bit more full around her waistline but sometimes the curve came out. I guess it is quite common for a lot of cats to have such variation, even just visually?When MM had her teeth extracted, the vet did mention MM was slightly slower than other cats in waking up from the anesthesia. That might be the metabolism or liver issue you mentioned, but I think the May blood work (done before the operation I believe) did not really indicate anything alarming for her liver?Just to clarify - the way I measured the breathing rate of MM, ie when she is in deep sleep rather than just quiet down from activity, is the correct way to do and should be indicative her having a “normal” breathing as she is within a good range?For supplement options, do I get them from pet shops (any brand you normally use please?) or we can use human brands (eg glucosamine or Omega 3) with significantly less dosage?Do you think MM should get another blood test, despite last one was less than 6 months, and even a ultrasound or x-ray to check her organs generally (although the vet felt and touched MM quite thoroughly 2 weeks ago and said her organs size seems fine and no lumps felt)?Please also let me know if you think there are other issues after seeing the pictures I sent.And may I know how much water should a cat of 3kg (is it very light for an elderly DSH of 17+yo?) consume and urinated daily please? Is it like a formula of 45ml/kg and 28ml/kg, respectively?CheersPC
Expert:  nekovet replied 1 month ago.

You are very welcome,

Please do let me know if the did and if that was normal at the time. And the way you measure her breathing rate is perfect, since it will be elevated if we were to measure when she is being active.

As well, I have to say that if it has been ~6 months, we may need to recheck that for MM. Bloodwork is like a photograph. It only represents that period of time, so it is possible that her organs' functions (liver or kidney) have changed. And I do think its worth a check with her slow recovery from the Temgesic. And an ultrasound (more than an x-ray) would also be a consideration if we wanted to rule out diffuse (as opposed to palpable masses) tumors or organ chances.

Though just to note, if you think she is gaining weight (I had the impression she was thin and losing from your history, but it can be tricky to eyeball them at home when you see them every day), then thyroid issues are lower on our list of concerns for her. Though we'd still want to keep an eye generally and if her weight was in question you could measure her waist line with a measuring tape every few week to see if that is really changing.

In regards ***** ***** Clinicare, it is OTC online but I am not sure about distribution in that area. Though do see if you can find some that can be shipped to you. Or in a pinch, since her kidney values were better at the last check, we could try kitten food as a means of getting more into her per bite.

For the supplements, we can use OTC human ones (though Duralactin is a specific pet brand that can be ordered online) or those carried in your local pet shop. For fish oil (Omega 3 +6), I've no preference on brand for cats. So, just a standard one and we'd usually give 40mg per kg of their body weight daily. For glucosamine/chondroitin supplementation, I tend to use Seraquin or Flexivet for my patients but OTC human ones are fine too with this. Normally we give kitties 50mg glucosamine + 15mg chondroitin a day per 10 pounds of body weight.

As for fluid intake, cats tend to need 48ml per kilogram of their weight daily. There isn't a measure for urination requirements, but we just want that to stable for her. Its changes (often increases and dilution) that prompt us to consider organ issues. And otherwise, in regards ***** ***** paws, they look fine though we cannot really monitor perfusion/anemia by their color as we can with the gums.

Best wishes,

Dr. B.

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Customer: replied 1 month ago.
Thank you very much for your prompt reply again, Dr. B.No blood pressure was taken as it required calming down my cat for 5-10 mins before it can be done. There is no way that can be achieved ..On Clinicare, may I know how I can tell if MM is allergic to dairy protein (as it seems it is not a product for cats with such allergy)? Or I can give a small amount to see reaction?From the picture of the gum which I sent, do you think it shows any sign of anemia please? Or it is too difficult to tell?Kind regardsPC
Expert:  nekovet replied 1 month ago.

Hi PC,

If a cat is dairy sensitive, they may have gut upset and diarrhea but I rarely see them react to Clinicare even if they are sensitive to cows' milk. So, you can try a bit and see if she has any issue. Otherwise, they do need to calm but we can take a few readings in a row (or through the day if they are in a clinic setting) to at least get an idea if it is high for them. Finally, I cannot see a picture of her gums, just one of her paw pads and her blood work. Do you want to try posting that one again for me?

Cheers,

Dr. B.

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**Please rate me by clicking on the **stars** at the top of the page as this is the only way the site credits me for helping you. Thank you!: )

Customer: replied 1 month ago.
Thank you Dr. B. Here comes the gum picture again.Kind regardsPC
Expert:  nekovet replied 1 month ago.

Thank you,

Unfortunately, the photo isn't great (the only appreciable place we can look at there is the lower gum by her front canine) but she looks slightly pale in that photo. If you can just lift her upper lip and take a picture of the gum above the teeth, that would be ideal for us to have a peek at.

Dr. B.

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Customer: replied 1 month ago.
Hello Dr. B, sorry for not being in touch. I have no luck taking a pic of MM's gum near her upper teeth. But from a peak, I do not think the gum is very pinkish. Her last blood test in May indicated her RBC seems OK, although not on the high side of normal range. Vet did not raise any issue on anemia.I managed to take MM's urine sample to check readings relating to kidneys issues. The vet came back with mainly 2 findings: USG of 1.025 and blood of ++ noticed. No bacteria nor WBC (if I recalled the term I heard correctly) was found under microscope. USG is definitely indicating kidneys issue, as the vet mentioned. But I did tell the vet that MM's USG since 2009 and the last urine check in end May had been at 1.022 level. So this time is kind of an improvement. Blood in urine did cause me concern but so far I did not notice any frequent rush to toilet without any urine. I did remember one vet mentioend (probably at least 2 or 3 years back) that there were some small crystals seen from x-ray or ultrasound of MM's bladder (or UT?). I noticed MM may meow a bit after her toilet routine, and sometimes she can only urinate in a 2nd attempt after going into her toilet. Not sure if it is due to pain, or toilet condition as she is sometimes quite picky.Weather here has started to turn cooler with a temperature drop of 5,6 Degree Celsius suddenly, so not sure if that has impact on behaviour. I have tried to let MM feel less stressful as she is quite easily stressed - especially we had home vet come 2.5 weeks ago and I had battled with her on antibiotics feed and Temesgic administration. She is very sensitive and takes quite a while to get back to her usual self usually.Kind regardsPC
Customer: replied 1 month ago.
Hi Dr B, just noticed that you are online. Please let me know your thoughts on my last message re: MM.Kind regardsPC
Expert:  nekovet replied 1 month ago.

Good evening PC,

I was in the midst of composing a reply and also trying to finish my reports for my own patients.

No worries if MM isn’t up for giving us a photo, but we do need to keep an eye on the gum color for any further paling. Now in regards ***** ***** USG, if they found blood remember that can falsely elevate this number. So, we’d really need to question why they saw blood (ie kidney infection, urine crystals/bladder stones, bladder cancer) and address the root cause. Therefore, you may need to see if they checked for crystals, tumor cells, or renal casts in their microscopic analysis or have them send urine to a lab if they cannot do so in-house. And it is worth doing that since her cries with urination could be due to discomfort from something like crystals (and its often subtle for females as they don’t’ tend to block like males).

Kind regards,

Dr. B.

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**Please rate me by clicking on the **stars** at the top of the page as this is the only way the site credits me for helping you. Thank you!: )

Customer: replied 30 days ago.
Thank you Dr. B for your prompt reply. I really appreciate it.You mean if blood was found in urine, the USG figure can actually be pumped up? No vet has mentioned that to me before, so I would appreciate if you would be able to share your thoughts on this briefly.The vet who looked at the urine test report did not mention anything further under the microscope check. She did say, however, she does not think bladder cancer is the likely cause at the moment based on what had been checked under the microscope. I asked if we should have another urine test may be later in the week. The vet suggested that I let MM rest / relax a bit for like 10 days as MM tends to be very emotional and the home vet visit in mid Oct (followed by the oral administration of drugs - which had been a real battle for both of us!) could have stressed her. Of course monitoring MM is a must so I can let the vet know if there is anything strange.MM's appetite fluctuated but I sense that she tends to eat more voluntarily when I am not around (as I currently work from home and do see MM a lot). So I will just let MM be her usual self in a more relaxed mode for a few more days before any further things are to be done.I have been trying to see how MM reacts to external stimulation such as laser dot from laser pointer, sunlight reflection from glass surface and even opening of drawers which she really wants to sneak in. She has been very responsive and her eyes kept chasing and trying to catch the lights and even rushed to the open drawers. So I guess MM is still OK.Kind regardsPC
Expert:  nekovet replied 30 days ago.

Good morning,

That is exactly the concern, since protein or red blood cells present in the urine for any reason will falsely elevated the USG. So, it is possible that it is still 1.22 but that the blood is making it read higher when tested.

Otherwise, its tricky to interpret what the vet has done and seen under the microscope. Especially without knowing if they just examined the sample plain or used a stain (sedistain, diffquick, etc) to actually stain cells present. If they did not, then its possible to miss things like cancer cells. So, while I certainly hope there aren’t any nefarious cells present, its worth having at a later point and sent to the vet lab for a full analysis (where specialists vets will be thoroughly checking the sample for all of our concerns). And waiting 10 days is fine as long as MM is stable and is doing those kitty activities she has always been keen to do (since if she were withdrawing due to illness, she’d not do them).

Best wishes,

Dr. B.

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**Please rate me by clicking on the **stars** at the top of the page as this is the only way the site credits me for helping you. Thank you!: )