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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 27400
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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Two months ago my cat lost the use of her back legs, she was

Customer Question

Two months ago my cat lost the use of her back legs, she was hospitalised and treated and is back home and on steroids, she still has a limp in her front right paw that is gradually getting better. The vet said it was either a bacterial infection, in which case she will continue to improve, or a brain disease, in which case she will relapse.

However, I took her for her check up today, her body condition has deteriorated (she's quite boney) and her stomach is swollen, which the vet says is Ascites but the reasons are as yet unknown and we can't even tell if it's linked to her original condition. Her heart sounds good so he's ruled that out, but thinks it's possible it's the liver.

Now I'm faced with a decision, and I really don't know what to do.
a) Have her checked out, blood tests, scans, biopsy's etc. which will put her at risk due to her condition
b) keep her home and let her live out what weeks she has left & have her put down when her quality of life goes down

She's only 11, if she were 18 I would go with option B) no questions... her appetite has really gone down but other than that she walks around fine, she's alert, she's happy and purry. It seems madness to give up on a cat who's seemingly healthy on the outside and enjoying life. I don't have a crystal ball, but I do need something to help me make the decision... statistics of some kind. What's the outlook for a cat when it gets to this stage? I don't want to put her through unnecessary trauma but I don't want to give up on her without doing my homework.

I know you cannot tell me anything about *my* cat... but what information do you have about this generally, what statistics can you give to me?
She was already a slender cat, which I know increases the risk of dying under anaesthetic, she was just 4lb... what are the chances that she survives that? And then what are the chances of discovering it's something treatable? Are the odds for or against her?

I really feel I need to make a decision in the next hour, if I choose treatment then it needs to start as soon as possible.
Submitted: 2 years ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry for the delay in responding to you. Your question came in very early morning here when few vets were available. I'm going to be quite straightforward with you.

An 11 year old who has become cachexic (wasted) and has an abdominal effusion is a critically ill patient with a grave prognosis. An initial work-up for such a patient should include obtaining fluid for analysis by needle aspiration of her abdomen. Examination of the fluid can give direction for further investigation; for example, we might find a transudate suggestive of heart, liver or kidney failure, we might find a modified transudate suggestive of malignancy, and we might find blood, pus, infectious agents or any combination of the above.

Examining an aspirate, ultrasounding the abdomen, and biochemical testing is going to tell you why Mollie is so ill but the likelihood of cure is near nil although palliative care might be available if her effusion has arisen secondary to protein loss through her kidneys or bowel or lack of protein production from her liver. It's important to recognize, however, that severe kidney, liver, or bowel disease will be present if such protein loss is found.

I'm sorry to sound so discouraging but I need to tell you what Mollie and you are up against. Please respond with further questions or concerns if you wish.
Customer: replied 2 years ago.

What is a transudate?


 


This is so hard to hear this because I look at her and she seems mostly healthy, she's not particularly lethargic, you can feel her bones a little but cannot see them, she still purrs when I cuddle her, she can jump up on the furniture... and yet it appears I should be saying my goodbyes?


 


It's an impossible decision to make, one part of me feels I should accept I am losing her and just keep her home where she feels safe and can live out the rest of her days happy... another part feels that doing that would be giving up on her and that she needs me to give her a fighting chance.


 


I think I will take her to the vet, it breaks my heart to leave her there but maybe with test results the worst case scenario is that we can give her the medication she needs to keep her comfortable at least - then I can say I have done my best for her.


 


Are you saying that the cause would definitely be cancerous and the chances of a cure from that are near nil... or is there a very small chance that the cause could be non cancerous and therefore more easily treatable?


 


Do you think I am doing the right thing by sending her in for more tests, or is it quite a selfish thing to do?


 


Sorry to ask so many questions, it's just me, and I have nobody else to help me make this decision... it's hard to know at what point you should give up on your best friend & let them go.

Expert:  Dr. Michael Salkin replied 2 years ago.
A transudate is a collection of fluid with low protein concentrations and cell count and is typically clear and colorless. We need to differentiate a transudate from a modified transudate from an exudate. Our pathologist does this for us and gives us direction to pursue the diagnosis more exactly. I'm pleased to hear that she's going to see her vet who should obtain fluid from Mollie's abdomen in addition to running biochemical tests. I understand your concern for her but I believe not knowing is worse than worrying about what could happen and, yes, there's a possibility that you'll be able to address her condition in a palliative manner although cure is unlikely.

No, the fluid collection isn't necessarily due to a cancer in her abdomen but a cancer certainly is a concern at her age. Please continue our conversation if you wish. I'm here to answer all of your questions.
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 27400
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Cat Specialists are ready to help you
Customer: replied 2 years ago.


Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you for your kind accept. I appreciate it. I don't see a message posted, Holly. I'd like to have an update on Mollie.
Customer: replied 2 years ago.

vet but it's really useful to me to have a second opinion. Thank you also for being so frank with me, if I'm too optimistic about things I take the blows much harder, I'd much rather know how it is so that I can prepare myself to some degree.


I took Mollie back today and left her for tests. I've realised I did not take in everything I was being told on Saturday (I was a bit in shock considering I thought she was recovering well). He was talking about this 'mass' inside of her, which I had forgotten about, and how part of the tests would include a biopsy, which would mean an operation, and if they were able to they will remove the whole thing, they'll take that call during the operation.


Today she had blood tests (normal) and x-rays (chest normal, stomach inconclusive - too much fluid to see). She was also able to eat a bit more food today (in fact at 5am she woke me up with the sound of her raiding the kitchen for food - I shot out of bed and fed her, just excited that she wanted something).


Although I accept there is a general risk with anaesthetic anyway, I have instructed the vet not to go ahead with the biopsy tomorrow if her health deteriorates to such an extent that the risk would be far too high... but with her chest x-ray results and her appetite today at the moment she's good to go.


This is stretching me financially but I have really tried not to take that into account when making decisions. Today I have been putting a load of stuff on Ebay!


What I would like to know is: a) Are there questions that I should be asking with regard to the operation, in order to find out the credentials of the person doing the operation (will it be the vet himself? Do vet's act as both GP and surgeon?) b) Is this operation a little premature? I'm curious to know how he can be so sure that there is a mass inside her stomach when he said it was hard to even feel her organs... I had envisaged a series of tests before moving into an operation... I don't think he's even taken a fluid sample (but again, there was a lot to take in)


Many thanks Holly

Expert:  Dr. Michael Salkin replied 2 years ago.
I can only imagine that the vet has been able to palpate a mass in Hollie's abdomen. As I mentioned above, an effusive abdomen certainly can arise from a tumor in a cat of Hollie's age. If, indeed, this is true it's going to represent a malignancy the great majority of the time and so proceeding into surgery shoud be done with low expectations.

In most cases, Hollie's vet will be trained to perform such a surgery. If the vet isn't comfortable performing such a surgery or you would prefer having a specialist surgeon involved, such a specialist can be asked to come in or you can bring Hollie to that specialist. $$$

An aspirate of that fluid absolutely, positively must be examined. Be sure to ask if that has been done. Please continue our conversation if you wish.

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