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Maryam | 3 months ago
Hello All, I Posted On Here Earlier This Year Asking For Some Advice About My Cat …

Hello all,

I posted on here earlier this year asking for some advice about my cat who had a very advanced cryptococcosis infection.
Her right lymph node (submandibular) was swollen the entire time, and the left one but to a lesser degree.

She developed anisocoria and horners syndrome, droopy right eye, and she had a mass that felt like bone on top of her eye.
The anisocoria disappeared after 3 days and her pupils were entirely normal again.

Things escalated last week. Her nose has always been blocked, to various degrees, since she developed the symptoms, 1.5 years ago, but it seemed like she was able to get enough air in with some gasping and mouth breathing. I didn’t know how comfortable she was, but I had to try the last recommendation the vet suggested: 150mg of fluconazole a day. She was on this massive dose for 3 months. (4 kg cat)
Previously, she was on 37.5mg for 6 months, her nose and lesions cleared up and she was able to breathe again (most importantly!)
But, in March, a big lump (cryptococcosis mass) exploded into an abscess. It wouldn’t heal. The vet performed surgery to remove it and other lesions nearby. It was an eyesore, I felt so bad for her. She had a cone on for nearly 3 weeks because the suture area got a bit infected. Raised her fluconazole dose to 75mg a day.

Last week, her nose got much more inflamed and distorted very rapidly. It began bleeding and ulcerating, drying up and then bleeding repeatedly.
She looked so uncomfortable and basically slept all day in various positions to keep her head elevated. When near me or when sleeping with me at night, she’d clamp onto my arm or neck with her teeth to keep her mouth open so she could breathe and fall asleep. I can’t fathom how difficult it was to sleep having to make a conscious effort to get air in through her mouth. I understand cats are not “mouth breathers” and can’t fully relax that way.

I took her in to see her vet, 11 days ago, after noticing blood on her paw, and no wound. The vet looked inside her mouth and looked said the fungus was pushing through her soft palate (roof of mouth) into her front teeth. She recommended euthanasia and said she was not going to “get better” in her professional opinion. And that my cat was suffering and it wasn’t ok, I asked outright if her quality of life was ok. She said no. My cat had lost 1 kg since her last visit. This also factored into the vet’s recommendation.

The vet was ready to put my cat to sleep at the time of our consult, but I requested some time to digest and take her home to say goodbye.
Then, 4 days later, I took her in for euthanasia. I wish I had canceled. Am I wrong to feel that she should have died on her own terms?
What she had was like a breathing disability, in other ways she was a strong and vital cat. She was still eating, though appetite decrease by 30 or 40%.
Why did her nose not clear up (while the cutaneous lesions cleared) and in fact get worse after 3 months on a higher dose?
I’m so devastated and confused and wish I could have done more to save her life.
I felt selfish for letting her live this way, knowing there was no hope and I’d just be prolonging the inevitable (probably suffocation).
I am in so much pain recollecting what’s happened.

I wish I had kept her at home and only taken for euthanasia if she had collapsed and refused to eat. Taking her in to have her put down when she still asked to be fed, showed playfulness in some moments, trotting around when it was food time, it felt hasty but also inevitable. I felt I was saving her from experiencing more suffering as the fungus grew.
But, I will never know how it would have gone if I left her. Maybe nature would have performed a miracle, and she would heal, or she would die without my intervention and without pain (like a quick heart attack). I feel so terrible for having made the choice to snuff out her little life when she was still very strong.
She fought the sedative the vet gave, they took her back to insert a catheter and didn’t bring her to me until 40 mins later, saying she was fighting the sedative.
It pains my heart thinking she was in terror during her last hour on earth. When they carried her in, sedated, she looked absolutely petrified and braced. I could see her spirit fighting with all its might.

The vet told me that she had a more thorough examination of her nose and that the masses had hardened/were like concrete all through her nasal airway and that she was breathing through a “pin prick” hole. She said she was never more certain that euthanasia was the right choice.

I am so heartbroken. I still feel like I took her life away too early. Why should it be up to me? I can barely trust myself now.

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  1. Krista Magnifico

    Hello,
    Based on your description and the photos I feel about as confident as I could that this was a cancer in the nose/face/brain and that you did the right thing.

    No matter how much money you would have had, or how many specialists you could have brought her to she was not able to survive or get better with this.

    I am so sorry. I do believe you did everything you could have and that your cat was so lucky to have had someone who loved her as much as you did.

    Sending love and condolences.
    Krista.

    1. Maryam Post author

      Thank you for your input, Dr Krista!

      It never occurred to me that it might be cancer. She had a biopsy done last year (for the cutaneous lesions) and it came back positive for cryptococcosis. They didn’t want to touch her nose or interfere with it, since it was so sensitive. Once she was on fluconazole, her nose response (clearing up) was so rapid, within 3 weeks all the crust, nasal bridge disfigurement and inflammation had virtually disappeared. She was breathing well. That was on 37.5 mg a day.
      When she developed a big ulcer on her side, and then later her nose starting to inflame and ulcerate again, I felt so solemn about it all. Previously she was in what appeared to be a “stall” state with her nose. Upping the dose did not do a thing, imo. It continued to worsen.

      Could it have been fungal AND cancerous? My theory was the fungus developed resistance to the meds, and also was far too embedded to loosen its grip. In months past, I looked up nasal cancer to get an idea what that looks like but it didn’t seem to fit her. Also looking it up because I was so worried about her not being able to get air in, and whether this was humane, while we searched for a cure. Cryptococcosis cases in cats are not well documented online. I have not yet found one where the cat’s nose was so blocked up, from nostrils all the way up, like hers was.

      She was very loved, I am amazed at her resilience and that is what also hurts. She was so intense and sensitive, with immense all-round hardiness. It really felt that whatever was afflicting her was not going away.

      Thank you for your reassurance. I felt I took her life too soon, and also concerned she was not comfortable. It’s challenging to separate what I want and see her /the situation objectively and compassionately.

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Summer | 4 months ago
My Border Collie 2 Years Old Recently Started Staring At Shadows. She Will Just Sit And Stare …

My border collie 2 years old recently started staring at shadows. She will just sit and stare for hours. When the light moves and the shadow is in a different spot she will move with it. What could be going on? I can’t get her to play or cuddle or anything once she starts staring.
I took her to the vet for bloodwork and everything came back normal.

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  1. Laura

    This sounds like an obsessive behavior. I would be working on training and mental work daily in the hopes this can be curbed.

  2. Krista Magnifico

    Hello,
    I would also ask your vet about the possibility of focal seizures and whether a referral to a neurologist might be helpful.

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Genesis | 4 months ago
Hello! I Was Listening To A Lecture On Animal Nutrition, And It Brought Up The Topic …

Hello! I was listening to a lecture on animal nutrition, and it brought up the topic of grain-free diets. I used to feed my dogs the blue wilderness grain free diet. But is grain free safe for my dog? Should my dogs have grain in their diet? They are currently eating team dog and that has grains in it. Thank you!

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  1. Krista Magnifico

    Hello,
    I avoid grain free. I don’t think there is likely any benefit to it while there is still a risk of heart issues. So I just don’t recommend it. Why worry about something that is avoidable?

  2. Laura

    There appears to be a link between diets using legumes to boost protein and dilated cardiomyopathy. Whatever you feed, I would avoid anything with peas or other legumes high in the ingredient list.

    Furthermore, if I’m feeding kibble, I have seen actual stool changes between grain free and grain inclusive. The latter seems to produce smaller, more solid stool than the former. My dogs have all done better on grain inclusive. I have found Purina’s Pro Plan to be the best for my specific dog’s gut – she has had almost no loose stool since we started her on it.

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Josh | 4 months ago
Hello, Firstly Thank You For Making This Site And Sharing Your Message And Trying To Help …

Hello, firstly thank you for making this site and sharing your message and trying to help both Vets and pet owners do better by and for their sake.
The cold weather in Oregon is setting in, I attached some photos I hope help. I’m trying to figure out the best way to identify and treat this issue.
The following are my observations of the marks located at the base of the tail areas side and underside only, surface level circular with some being slightly more crater like. Hair loss and area effects remain the same after what feels like over a month already. Plasma is typical puss in 2 or so spots, no swelling since first observed till present day, skin near effected area looks okay, over grooming of the area likely but not believing this is a source of pain. We live in a farm setting he is a stray I will watch over like my own and treat as such, I’m not against funding anything from big or small for his care but he’s strictly outdoor hunter and sometimes I wont see him for days. Would be most appreciative to any insight in what this might be or how I can help, likewise if there is a wound spray or dewormer I could purchase he is 100% outdoors and I see no signs of worms but he drinks from bird bath dishes. He will allow me to handle him but only so much I’d be much more worried when his patience runs out. I’d say he weighs about 15 pounds and overall health and appearance / dental is amazing. I always offer him a safe clean area and access to the property I will be buying a breakaway collar with a GPS tracker for him, he’s a farm cat my neighbor and me watch after. Would this be something to just give more time to mend? or should I step in and apply or seek help. Thank you! I will 100% be doing a donation, really wish more Vets were like you or highlighted in the community.

EDIT, the donation link via paypal says this is indelible, you can click 1-2 photos below that say Ads to be redirected to those to donate, if you have a place in mind please add it to the response I’d be happy to donate to your place of choice.

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  1. Krista Magnifico

    Hello,

    Thank you for taking care of this kitty. It sounds like he really needs to have a friend in his corner.

    I think that a few things are really important to discuss. One, although the skin wounds are concerning I think that too often pet parents are focused on an exterior (often transient and benign things), and forget about all of the immensely important things going on in the inside. Like, is this cat spayed, neutered or vaccinated? These are the absolute foundations for a healthy pet.

    I also think that your vet can help you understand if this is a parasite issue like fleas?
    I wish I could tell you that this is and give you the answer to help it get better, but, medicine isn’t just looking at a picture. It is about helping the pet from the inside and out.
    I think that you need help from a vet. I think this cat needs to be spayed/neutered and vaccinated. I also think they need an antibiotic and a product to help with fleas.

    Good luck.

    1. Josh Post author

      I will search for a Vet office and bring him in for some treatment or an ER clinic for results. Glad I’m he does not have flees presently, as I comb him and check with flea combs. Those things are terrible as for infestations go and I love Food Grade DiatomaceousEarth for getting rid of that mess. My neighbor is a farmer who lives offsite and does not visit, more or less he picked up this cat some years ago and it only gets put in doors when they spray chemicals on the crops. I was worried with cold weather approaching and any injuries present much less bald spots like this. They either seen this on his tail by now or would have got him help. In his words he is just a friendly stray, pretty sure he is fixed but I will bring him in and get everything covered. He will be okay though I will make sure of it just wanted to get some insight on this. Could be days or sometimes a week or two before I see him day or night, but I will always watch for him and over him. Thanks again for your time and care you give in this field. The donation links did not work for me paypal related / sign up email Have a great day, take care.

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Pam | 5 months ago
Hi Krista My Almost 11 Year Old MC Potcake (who Has Too Many Beings Lipomas To Count) …

Hi Krista
My almost 11 year old MC Potcake (who has too many beings lipomas to count) recently had his senior blood work and urinalysis – everything was normal except an elevated ALP.

The urine was a free catch sample at 4 pm and it was very dilute. This prompted me to remember that he has been drinking a little more (summer) as well as eating a lot of watermelon – and to remind me that he has also had an increased appetite over the last year. I did a specific gravity on a morning urine sample after he had no access to water overnight and he was able to concentrate his urine at 1.025

He has chronic seasonal allergies so his inner thighs have a dark pigment change – this has been present for years – there are no other derm changes and I don’t see a pot bellied appearance but the vet is considering Cushing’s. They suggested an abdominal ultrasound first followed by a low dose suppression test. I would rather do the dex test first before an ultrasound. I’m not sure that I’m convinced that Cushing’s is likely but something may be going on.

Of more concern is that this previously healthy dog coincidentally, a few days after the blood work, had an episode of vertical nystagmus and ataxia – very brief – less than 30 seconds. He’s been fine ever since but its only been a few days – I have been told that vertical nystagmus is less common with Senior Vestibular disease and possibly more likely a central lesion.

any thoughts that you have would be appreciated !
Pam

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  1. Krista Magnifico

    Hello,
    For cases like this I usually recommend the following.
    Ask about diet. See if anything could be influencing water intake. I do a very thorough exam. This includes anal glands. Then I repeat the blood work a few months later (if not drinking or peeing excessively). If the pet is believed to be drinking and urinating more then I think that X-rays, abdominal ultrasound (by a proficient vet) and LDDT are warranted. I don’t have too much preference on order because they usually all need to be done. The biggest thing to talk about before starting all of these diagnostics is that the client must be willing and able to treat for cushings before we start the expensive procedure of diagnostics.

    Good luck

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Genesis | 5 months ago
Update: German Shepherd Diesel. I Would Like To Receive Your Advice Regarding My German Shepherd, Diesel, …

Update: German Shepherd Diesel.
I would like to receive your advice regarding my German Shepherd, Diesel, who has developed a limp. His limp has gotten a little bit better, but sometimes he will limp very badly. I have limited his activity and made sure he isn’t putting any unnecessary stress on the foot. I’ve located the source of his discomfort, which is on his right rear ankle, and it is swollen. There’s no apparent injury to his paw, and I’m concerned it could be a sprain or even a fracture. He was running around in the house on porcelain tiles playing ball, and I noticed him limping on one of his runs. I’m unsure whether to proceed with an x-ray or to monitor his condition for a few more days. Your professional opinion on this matter would be greatly appreciated.
Thank you for your time and attention to Diesel’s situation.

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Petra | 5 months ago
I Have Two Cats So I Didn’t Notice My Cat Is Not Eating. He’s …

I have two cats so I didn’t notice my cat is not eating. He’s very skinny. He refuses his favorite foods. He’s drinking water. He’s greenish looking poo around his anus. Old and dry. I tried to clean it.

We are on one income and cannot make it to the vet. What should I do?

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  1. Krista Magnifico

    Hello,
    There is no way I can give honest and credible advice without advocating that this cat sees a vet asap. There are non profits that can provide financial assistance and some that even have a vet on staff to provide care. This cat needs an examination and some diagnostics.
    Please call your local vets, shelters and rescue groups. Look for help on every local social media platform and keep asking for help. Start a go fund me. The best advice I can give if this.

    We need more information to help you and your cat.
    Please stay tuned. I am working on this very topic

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Carla | 5 months ago
A Question For Krista Magnifico: Hello! Hoping To Get Some Advice On Recommended Next Steps For …

A question for Krista Magnifico:

Hello! Hoping to get some advice on recommended next steps for my cat, Sammie, who is being evaluated for IBD vs. small cell lymphoma.

Sammie is 17 years old and is overall quite healthy! Throughout the time I’ve had her, she’s had a history of vomiting a ~once per week or two (sometimes more frequently). Vomit is usually clear, foamy. No other GI issues or health issues otherwise. She is active and energetic, and has not had any health issues until ~1 month ago when I noticed she stopped eating as much as she previously did. She stopped eating her dry food altogether, and seemed to become quite picky with her wet food. I initially thought her teeth may be bothering her because of the avoidance of dry food, so I brought her to the vet.

Vet found that she had lost a couple of pounds, unintentionally. Based on presenting symptoms, vet thought she might have a GI pathology so ordered an abdominal U/S:

Ultrasound, Abdominal Study Outcome:
Kidneys: overall normal size but mild reduction in detail and small mineral foci. Trace pylectasia noted w/out ureteral disension.
GI: Avg SI thickness normal. Mild corrugation is noted in some regions and some ileus (luminal fluid distension up to 4 mm w/ reduced
peristalsis) noted w/out obstruction. No discrete abnormalities appreciated throughout the small intestines.
Caudal abdominal nodes are prominent to mildly enlarged and rounded w/ smooth texture. One irregular cystic structure noted near right
kidney. The mesentery around the ileus segments is mildly hyperechoic.
A:
Intestines most consistent w/ enteritis
Nodes: r/o reactive vs other
Cystic strucure: r/o benign mesenteric vs inflamed node
Kidneys have evidence of chronic disease.

Here are her prior labs:
PRIOR LABS:

7/15/24: Wt loss 0.28 lb; PCV: 40/7.6; Chem18: BUN 41, creat 1.7, K+ 4.3, phos 4.2
U/A: USG 1.019, pH 6.0, rare wbc/rbc; no bact/cryst; cobalamin: 437; folate: 11.2

2/13/24: Wt loss 0.8 lb; CBCcomp: hct 44, diff wnl (clots in sample; rec. resubmit)
Chem25: BUN 40, creat 1.3; T4: 2.8; SDMA <10
U/A: USG 1.025, pH 6.0, rare wbc, no rbc/bact/cryst, rare fine gran casts.

1/19/23: Wt loss 0.4 lb; CBC: (hct 40, diff wnl); Chem25: (BUN 32, creat 1.3)
T4: 1.8; U/A: USG 1.051, pH 6.5, 1+ prot, rare wbc, no rbc/bact/cryst

11/19/21: CBC: (hct 46, diff wnl); Chem: (BUN 34, creat 1.5); T4. 1.9; DGGR lipase 9
U/A: USG 1.053, pH 7.5, rare amorph. crystals, no wbc, no rbc

6/17/22 Wt loss 0.16 (as desired); USG 1.040; SDMA: 11

Most recent A&P:
A:
1) Intestines most consistent w/ enteritis (IBD vs SCLSA); ileus likely cause of decreased appetite.
2) Nodes: r/o reactive vs other
3) Cystic strucure: r/o benign mesenteric vs inflamed node
4) Kidneys have evidence of chronic disease ; in keeping w/ previous lab findings.
P:
1) Rx: metoclopramide 5 mg: 1/4 tab po every 8-12 hrs.
2) Continue vit B12 as Rxed.
3) picked up Mirataz but hasn't started it yet. Rec. give. metoclopramide for 2-3 days and then if not improved appt, start Mirataz.
4) to consider presumptive pred tx vs ex-lap for biopsies.

Sammie is seeming to eat better with the metoclopramide.

My question:
Is pusuing an ex-lap for biopsy recommended vs. empiric tx for IBD with steroids vs. empiric tx for SCL with steroids + chlorambucil.

Thank you!!!

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  1. Krista Magnifico

    Hello,
    Well let’s all take a collective moment to applaud the work up!! I say this because that’s a breath of fresh air!! I think that a couple things warrant a little further discussion.

    First it sounds like your GP has done a very thorough job,,, but,, done it all in house. Which in some cases is the best we can do. But. Have you been offered a referral to an internal medicine feline practitioner? If you can find someone who is BOTH great. If not go to whoever you can get in with.
    Next have rads been done? And assessed by a radiologist? At least for thorax?
    I know it might sound crazy but also check anal glands. Some of these older cats are so uncomfortable they stop eating
    Add an appetite stimulant. There are numerous options.

    Ask for an internal medicine consult via your lab services. It’s a phone call and It’s free. It has been helpful in some cases. Ask them about budesonide vs. prednisolone if you are going to start treating for INS. Which to be honest I would do over a biopsy for a cat this age with these potential differential diagnoses.
    I also add vitamin B12 and cobalaquin and immuquin to these guys. The other medication I like is cerenia and learning how to give SQ fluids at home for the kidneys. You also need a phosphate binder ( I think?, please inquire), we use naraquin. Maybe ask about azodyl too.

    … and I know it sounds like I am spouting out a lot of meds… but I gave my older cat solensia when she was a nightmare of unhappiness and it really helped.

    And let’s not forget pain meds. Every (EVERY!!! ) single patient deserves them. I like gabapentin 50-80 mg as needed.

    Please keep m posted. Very best of luck.
    Krista.

  2. Carla Post author

    Dear Krista,

    Thank you very much for your response!

    Sammie is eating much better since starting metoclopramide. She is finishing all the wet food we give her, and chases after me when I am preparing it for her! She’s also having bigger sized BMs. We also have her on a weekly injection of B12 for her borderline low levels.

    One point to clarify – we are lucky that Sammie’s vet is a feline-only practitioner. Based on discussions with her, she seems to recommend proceeding with the ex-lap for the biopsy and that cats “bounce back” quite quickly after the procedure. We are hesitant, however, given it seems quite invasive.

    At this point, we are deciding if the is worth it, or just to empirically treat her with steroids for presumed IBS (vs. SCL). Based on your input, it seems you would err on the side of not doing a biopsy in a cat of her age?

    Thanks,
    Carla

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Lucy | 5 months ago
Post Neutering My Vet Diagnosed A Hernia And Did A Second Surgery. They Found That It …

Post neutering my vet diagnosed a hernia and did a second surgery. They found that it was just a seroma. Now they are saying she has another seroma. She is a ragdoll and has a very saggy stomach and I can’t see a lump this time. I don’t believe it’s a seroma. They have told me to bring her in to have a drained. Is it negligent not to go to this appointment?

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Parham | 5 months ago
4 Year Old Male Cat With Urinary Blockage

Hello

My name is Parham Parsa, I found your page on youtube and have read your blog, and for once I saw someone that is actually talking about blocked cats and is raising awareness to this issue and I wanted to thank you for it.

My cat Mercury (4.5 years old, 18lbs) is currently in the hospital for another urinary blockage and I genuinely don’t know what to do, this is his third visit, first time he got blocked was about a year and half ago and he was on the death’s door, his blood work was extremely elevated, he was lethargic and in visible pain. His regular vet unblocked him and transferred him to a vet hospital for further care, this visit cost me about $5K, and after that he was put on a strict urinary diet. Second time was 3 months ago where we noticed him being in pain and struggling once again and we took him to an ER vet and he was unblocked again, despite my persistence of leaving the his urinary catheter in, they took everything out, and send him home that very night, thankfully he remained unblocked until last night. His vet told me that since he is keep getting blocked he should just get the PU surgery and all but refuse to see him, so I took him to the Metropolitan vet hospital and their estimate for getting him unblocked and doing the PU surgery was 7-8 thousand dollars which is wildly out of reach for me at the moment. After reading your blog I have decided that if I find a second job I can afford to have him unblocked and kept in the hospital for observation for a night or two but I don’t know what I can do after that. If you have any suggestion regarding an affordable PU surgery or any other suggestion I am all ears. I’m really sorry for the long email, and looking forward to hearing back from you.

I just got off the phone with his vet at Metropolitan and after they took some X-Rays they saw some large stones in his bladder which they suspect could be the reason for his repeated blockages, and recommended a cystotomy and they said that the balance would stay at 7-8 thousand dollars. As of now my plan still remains to have him unblocked and watched for couple of days but I don’t know what I should do next.

PS.. I have attached a couple of pictures of him to this post. He is genuinely the sweetest and the friendliest cat I have ever met and the idea of me having to say goodbye to him just because I can’t pay for his treatment is is something I cannot imagine.

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  1. Krista Magnifico

    Hello,

    I’m so sorry to hear about your cat. So many of these cats have a similar situation and it leaves their families with such a huge dilemma about what to do and how to afford all that might lie ahead.
    My advice at this point would also be to do the PU surgery and to remove the stones. If you are close to us I would be happy to see him and see if there is anyway we can help. Please call the clinic and leave your number. I will call you back.
    Dr Magnifico

    1. Parham Post author

      Thank you, Dr Magnifico, I will definitely call the office first thing in the morning. And again I want to thank you for bringing awareness to this problem. Your articles about the blocked cat were such a huge help for me in dealing with this issue.