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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 25246
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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I live in Penang, Malaysia. Your advice to me are very

Customer Question

Hi, I live in Penang, Malaysia. Your advice to me are very important because I could not find a good vet here. Please excuse my long message. My cat is already 16, female domestic short hair. She was spayed at 10 months old but got serious wound infection. Her platelet has been far below normal since she was about 2 years old but with no obvious problem throughout these years. She had an x-ray last July and her heart is little enlarged for her old age, urine test last Dec. was normal. Blood test done in Feb 2016, everything was okay except the usual platelets low and there was a low T4. And recently she drinks more water than usual.
A week ago, she started travel to her litter box many times nonstop, then some normal stool passed out. But after the poo she continues going in and out the box until I saw some pink water, but the liquid was no smell of urine so I thought it was her intestine problem. The vet gave her antibiotic. For the following 2 days everything seems normal, can eat can pass urine which has strong smell. Then after two days, the same thing happened again, traveled to litter box many times until pink water passed out and the next 2 days seems normal again.
Yesterday morning problem comes again, after the hard time inside the litter box; I saw a 2 cm blood clot, like jelly passed out. I checked her bottom, it was actually from the vulva. The vet did a x-ray on her yesterday and said her bladder is enlarged and he referred me to another vet to get a ultra sound image. The second vet said the bladder seems fine but her heart and kidney is enlarged. My cat last night seems fine and pass normal urine. However today, now is 2pm, I do not see her attempt to go toilet. I am very worried the problem will come back very soon. Is it something about her heart or low platelets or low T4? Or just a bladder infection or eaten toxin grass from outdoor? The vet tried to take blood from her yesterday but she struggled. If you need any x-ray or blood test report to refer to, I can email to you. Thank you very much to spend time reading the message and I earnestly hope to see your reply very soon. I greatly appreciate for your advice.
Regards
Lorita
Submitted: 7 months ago.
Category: Cat
Expert:  Rebecca replied 7 months ago.

Hello Lorita,

I am sorry to hear you are worried about Mellow. My name is Rebecca. I am a veterinarian and will do my best to help.

If the pink water and blood clot came from her vulva, and since she is spayed, this must be from her bladder. It sounds like the antibiotics are helping so far. I see a urine test was done in December, but has one been done since this recent problem? Doing a urinalysis would be my next step if the last one was December.

If the antibiotics continue to help with the problem, I would do a urinalysis before you finish the antibiotics, or shortly after you finish. If the problem comes back while she is still on antibiotics, a urinalysis is the first thing I would do.

Let me know what other questions you have.

Expert:  Dr. Michael Salkin replied 7 months ago.

I'll follow up for Rebecca for you. She gave you good advice about treating with antibiotics at this time. A geriatric bacterial urinary tract infection is likely to be the cause of her hematuria (blood in the urine) and stranguria (frequent attempts to urinate little or no urine). A broad spectrum antibiotic such as clavamox/clavulanate should be considered for 7-10 days and her urine checked two days after the course of antibiotic is completed to see if her urinary tract has been sterilized.

The ultrasound appears to have ruled out urinary stones and cancer in the bladder but her enlarged kidney needs clarification. Does it look as if the kidney is cancerous? hydronephrotic (urine is accumulating around the kidney)?

She may suffer from an enlarged heart (cardiomyopathy/heart muscle disease) but such a finding isn't related to the changes in her urinary tract. Decreased numbers of platelets are a common finding in cat blood tested on automatic machines which don't account for platelet clumping - a common finding in cat blood. A hand count of the platelets is likely to find that there are adequate numbers of them. Primary hypothyroidism (as evidenced by a low T4) is very uncommon in cats. When a low T4 is seen in cats it's most often due to non-thyroid disease which is suppressing the T4 but the thyroid gland itself is normal. No, eating toxic grass is an unlikely cause of anything you've mentioned.

Please continue our conversation if you wish.

Customer: replied 7 months ago.
I have to leave now but I still got questions to ask and some reports of my cat to show you. Can we continue the topic tomorrow around this time? Thanks
Expert:  Dr. Michael Salkin replied 7 months ago.

Certainly. Please return to this conversation rather than opening up a new one. You can bookmark this page for ease of return.

Customer: replied 7 months ago.
Hi Dr Salkin , My cat is on her 3rd day of antibiotic for bladder infection since she passed out the blood clot. She seems doing fine for these two days with 3 to 4 times urination. I collected her urine this morning and sent it to the vet for testing. No blood, no crystal, no protein was found and ph normal. I am happy with that but on the other hand, very worries about where exactly the blood came from and will it reoccur. The vet it might be cancer of bladder or Kidney.
As I have mentioned, my cat had a very bad internal wound infection after her spayed many years ago. Sometimes I would suspect the surgery was not done completely and the blood is from her uterus and her meows for these few days are short and often (in heat or anxious?) Does the hormones explain why her T4 dropped from the upper range to a very low reading? I also worry her supper low palates contribute to the problem of internal bleeding.
I have enclosed my cat blood test which was done in Feb., 2016. A X-ray image taken on 30 May 2016 after excretion of blood clot. I also enclose a photo of the pink water out a week ago and a photo of the blood jelly she excreted on Monday morning. Thank you very much
Expert:  Dr. Michael Salkin replied 7 months ago.

Lorita, I appreciate your efforts but the .jpgs arrived the size of postage stamps and when enlarged lose resolution to the point of being unreadable. The X-ray reveals a urine-filled bladder but otherwise is unremarkable.

I'm pleased to hear that she's doing well on the antibiotic. Be sure to continue it for 10-14 days and then have her urien rechecked two days after the course of therapy is over. Yes, she may suffer from the ovarian remnant syndrome. When even a tiny bit of ovary is left post-spaying, cats will continue to cycle in and out of heat. That can be confirmed by checking her vaginal cytology while she's bleeding. The vaginal cells typical of estrus (heat) are easy to identify. Any systemic disorder can decrease the T4. Remember what I said about the low platelets. They may not be actually low. A hand count of the platelets is essential.

Please continue our conversation if you wish.

Customer: replied 7 months ago.
Hi Dr Salkin, unremarkable means no enlarged, no tumor? can you see the kidney and heart? If it is ovarian remnant syndrome, why this is the first time she bleeds and the blood clot is a ovary tissue left behind? But it looks like new clots. she had many times of blood tests and with different labs, but every time the platelets is low. Do you mean every time the platelets crumpled together,
Customer: replied 7 months ago.
Is doing a ultra sound imaging can help to find out the cause? what is the diet for kidney or bladder patient. thanks.
Expert:  Dr. Michael Salkin replied 7 months ago.

The image isn't good enough for me to see anything more than very large structures. No, I couldn't see kidneys. The heart is small and obscured by the elbows; in other words, positioning for the X-ray was improper.

It wouldn't represent the ovarian remnant syndrome if this is the first time you've seen bleeding from her vulva. Urinary tract infection or neoplasia in the urinary tract or vagina are the primary differential diagnoses. Yes, platelet clumping is always expected when evaluating the peripheral blood of cats. Yes, ultrasound is the most sensitive imaging modality for a cat's abdomen. Bladder issues don't require a special diet. Renal insufficiency, however, is addressed by protein restricted diets.

Customer: replied 7 months ago.
Hi Dr Salkin, My cat Mellow seems doing fine these few days, she has normal urine but has no poopoo since Monday. The last time she had poopoo was when she excrete the blood clot from inside.
Another thing I notice is, while she is sleeping or resting , she would suddenely wake up and running to me, meows very loud and fast. Is she having a nightmare or somewhere painful?
Customer: replied 7 months ago.
A
Expert:  Dr. Michael Salkin replied 7 months ago.

Thank you for the update. If she hasn't been eating normally, it's going to take a few days for ingesta to form feces and then her to defecate. Her behavior could indicate both of those ideas of yours. It could also indicate a complex partial seizure (also called psychomotor seizure)!

Customer: replied 7 months ago.
What is phychomotor seizure? Sound scary! But She can walk firmly and doesn't like seizure. When I pet her to comfort her, she will purr and rub her head to my leg. Is it something like in heat? Hormones in balance?
Customer: replied 7 months ago.
it normally happene at night time, 2 to 3 times.
Customer: replied 7 months ago.
Possible the blood clot was from elsewhere rather than bladder?
Expert:  Dr. Michael Salkin replied 7 months ago.

Psychomotor seizure is described as abnormal focal or asymmetric sensory or motor activity affecting any part of the body and which may be associated with autonomic signs, (salivation, vomiting, e.g.) and is associated with a change in mentation (mental status) and/or behavioral abnormalities. Sleep is the most common post-ictal (post-seizure) symptom.

I can't imagine where else a clot would come from.

Customer: replied 7 months ago.
What problem will lead to psychomotor seizure? What should I do to to stop this happening?
Expert:  Dr. Michael Salkin replied 7 months ago.

Intracranial (within the skull) problems such as brain tumor - an important differential diagnosis at her age; extracranial (outside the skull) problems such as metabolic disorders involving the liver or kidneys. Practically speaking, I wouldn't do anything as she doesn't appear to be badly affected.

Customer: replied 7 months ago.
I found this in the net, do you think possible?
secondary epilepsy is common in cats, and appropriate diagnostic tests are necessary to determine the underlying cause[3]. It can occur secondary to oestrus, organophosphate toxicity and ingestion of numerous toxins. Ovarian remnant syndrome (ORS) is a rare cause of breeding problems and recurrent oestrus in speyed female cats[1].ORS is characterised by the presence of signs of heat and marked elevation in estrogen ('heat') hormone in the blood.ORS can be caused by incomplete removal of ovarian tissue during ovariohysterectomy due to surgical inexperience[3] or the presence of an accessory ovary
Expert:  Dr. Michael Salkin replied 7 months ago.

The secondary epilepsy statement is woefully incomplete. We discussed ORS and discounted it because you haven't seen blood from her vulva until now.

Customer: replied 7 months ago.
Do you mean if it is a problem origin from the ovary or the spay surgery, it should have been happened long long time ago?
Expert:  Dr. Michael Salkin replied 7 months ago.

Correct.

Customer: replied 7 months ago.
You have mentioned " When a low T4 is seen in cats it's most often due to non-thyroid disease which is suppressing the T4 but the thyroid gland itself" what problem will suppressing the T4?
Expert:  Dr. Michael Salkin replied 7 months ago.

Quite a list of things - not all of which need to be considered in Mellow...here are the acute diseases I consider:

bacterial bronchopneumonia

sepsis

autoimmune hemolytic anemoia

systemic lupus erythematosus

intervertebral disk disease

polyradiuloneuritis

acute renal failure

acute hepatitis

acute pancreatitis

Here are the chronic diseases I consider:

generalized demodicosis

generalized bacterial furunculosis

systemic mycoses (fungal infection)

lymphosarcoma

chronic renal failure

diabetes mellitus

congestive heart failure

cardiomyopathy (heart muscle disease)

chronic hepatitis, cirrhosis

gastrointestinal disturbances

megaesophagus

I have to leave my computer for a few hours but I promise to reply as soon as I return if need be.

Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 25246
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
Expert:  Dr. Michael Salkin replied 7 months ago.

Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.

Customer: replied 7 months ago.
Dr Michael, one more thing would like u to advise. My cat expelled the 2 cm blood clot on last monday, at the same time she passed out some stool while pushing so hard. Since that day, already a week, she has no sign of pooing. She eats less than usual but should I be worry about this? I gave her laxatone and probiotic already but nothing help.
Expert:  Dr. Michael Salkin replied 7 months ago.

If she isn't eating as much she isn't forming as much stool. She's also likely to be dehydrated at her age and would benefit from the administration of subcutaneous fluids which should facilitate defecation. Finally, any number of systemic illnesses can slow the motility of the gastrointestinal tract. Laxatone was a good idea.

Customer: replied 7 months ago.
Do you mean one week no sign of passing faeces is not a thing to worry so much. Give her more fluid and Laxatone to see how she is doing for another few days?
Expert:  Dr. Michael Salkin replied 7 months ago.

It's certainly of concern but it's not as worrisome if she isn't trying to go rather than trying to go with no results. In that case, enemas are indicated.

Customer: replied 7 months ago.
Let's see for another two days. Thank you
Customer: replied 7 months ago.
I just notice one thing. My cat in fact has increased appetite , she just went to her bowl of food 4 times in 10 mins, eat little bit every time. I always think there is something happening with the T4.
Expert:  Dr. Michael Salkin replied 7 months ago.

Hyperthyroidism is considered in polyphagic (increased hunger) elderly cats.

Customer: replied 6 months ago.
Hi Dr SalkinMy cat seems to be better for a while and last week she pee once in the sofa but othertimes is okay. These 3 days she looks tired and no appetitor and I brough her urine to test and came back a little bit trace of blood , PH more acidic and trace of protein. I always worry about her extremly low blood platate will lead to internal bleeding or what is the cause of the blood in urine and why it is recurrence so often?
Expert:  Dr. Michael Salkin replied 6 months ago.

The most common cause of recurrent hematuria at Mellow's age is an incompletely treated geriatric urinary tract infection. I also need to conside that a urolith (urinary stone) has formed or there's a transitional cell carcinoma involving her bladder and/or uretha. if she were bleeding due to low blood platelets I would expect to see bleeding elsewhere such as in her gums or under the skin (petechiae, ecchymoses).

Customer: replied 6 months ago.
Incompletely treated geriatric UTI? In fact we did a urine test after she completed 10 days of baytril treating her previous haematuria a month ago. The result came back last time was sound and good. A month after, today this urine test got blood trace again .Urinary stone is same as bladder stone? How to diagnose and what is the treatment? My cat can't undergo surgery because of her old age and low platelets. Blood test can tell of having transitional cell carcinoma ? Thank you for your advise again.
Customer: replied 6 months ago.
Hyperthyroidism will lead to bladder stone? How do you find Hills Prescription diet y/d for feline hyperthyroidism would help?
Expert:  Dr. Michael Salkin replied 6 months ago.

Relapses of UTIs in geriatric patients is all too common. It would be prudent to see how Baytril affects her once again. Yes, the bladder is in the urinary tract so a bladder stone is a urinary tract stone. A urinary tract stone isn't necessarily in the bladder, however. No, carcinoma is detected by ultrasound or an X-ray with dye. No, there's no relationship between hyperthyroidism and urinary tract stones. Many cats with hyperthyroidism respond satisfactorily to Hill's y/d.

Customer: replied 6 months ago.
But this is what I found in the net "Bladder stones can develop as a result of certain metabolic disorders. Diabetes mellitus and hyperthyroidism can lead to urinary tract infections, which can contribute to the formation of bladder stones."
Expert:  Dr. Michael Salkin replied 6 months ago.

Diabetes mellitus certainly predisposes to urinary tract infection and infection must precede the formation of a certain types of stone - struvite. Hyperthyroidism, however, isn't known to predispose to urinary tract infections.

Customer: replied 6 months ago.
In penang, we only has human lab for testing T4 or FT4 in animals, F3 and TSH testing is not available for pets. Is T4 test alone able confirm hyperthyroidism?
Expert:  Dr. Michael Salkin replied 6 months ago.

In most cases, yes. Hyperthyroidism is considered in elderly cats acting younger than their age, that are polyphagic (increased hunger) yet losing weight, may have increased episodes of vomiting and/or diarrhea, are tachycardic (increased heart rate), may be polydipsic (35% of hyperthyroid cats drink excessively), and may have a palpable thyroid mass.

Customer: replied 6 months ago.
Actually, most of the time, the vet like to give Baytril , she might took 5 course a year whenever she has infection. Will her body get resistant to Baytril? Today is only the urine test, the vet didn't give her medicine, tomorrow she is having a blood test and probably the vet will give her antibiotic
Customer: replied 6 months ago.
everybody says my cat doesn't look like 16, her coat is shiny and soft but getting more skinny recently, especially losing muscle mass at her hip, two sides of abdomen, thirsty and always asking for snacks
Expert:  Dr. Michael Salkin replied 6 months ago.

Yes, bacteria can become resistant to Baytril just as to any antibiotic. It would make sense to test for hyperthryoidism in any geriatric cat as part of a senior/diagnostic panel of blood and urine tests. I understand that such a panel isn't available where you live, however.

Customer: replied 6 months ago.
cuttlefish high in iodine? she loves cuttlefish
Customer: replied 6 months ago.
how urine test can diagnose hyperthyroidism?
Expert:  Dr. Michael Salkin replied 6 months ago.

Most likely, yes, as fish are rich in iodine.

Customer: replied 6 months ago.
means I should take out fish in her diet and replace with chicken/turkey/beef.....
Expert:  Dr. Michael Salkin replied 6 months ago.

It can't. Only the T4 and fT4 can diagnose hyperthyroidism.

Expert:  Dr. Michael Salkin replied 6 months ago.

No, iodine is restricted only if hyperthyroidism is confirmed and dietary control (only) such as with Hill's y/d is desired.

Customer: replied 6 months ago.
I can get FT4 and T4 in my area (human lab) , but I don't know why the vet always says it is not accurate.Do you mean even hyperthyroidism is not confirmed, go on with
Hill's y/d is no harm?
Expert:  Dr. Michael Salkin replied 6 months ago.

It depends upon how the T4 and fT4 testing is done. The human lab would need to be consulted.

If hyperthyroidism isn't apparent in the T4 or fT4 and there isn't enough clinical evidence of hyperthyroidism, there's no reason to restrict iodine as you'd be doing with Hill's y/d. Your vet will have to make that call.

Customer: replied 6 months ago.
Alright, thank you very much and feeling less stressful after talking to you. Hope everything will be fine.
Expert:  Dr. Michael Salkin replied 6 months ago.

You're quite welcome.

Customer: replied 6 months ago.
Hi, My cat started on Baytril for few days . She didnt eat much for these few days and didnt sleep much, walking around and laying around with eyes open. I brough her to the vet and did a inhouse blood test and a ultrasound . The vet said he found a mass attached to the bladder wall and suspected a tumor. He also said my cat didnt sleep because she is in pain but I dont see her in pain, even somtimes play hide and seek with me. He also said her kidney function is not good and withdraw Baytril to augmentin. Please advise. Moreover, is there any drug that make my cat rest and sleep?
Customer: replied 6 months ago.
Is this side effect od baytril
Expert:  Dr. Michael Salkin replied 6 months ago.

I'm sorry to see that mass effect - a transitional cell carcinoma as I mentioned earlier (timestamped July 5 5:40 AM my time) is likely. Her creatinine is minorly elevated and consistent with her age. Baytril is ordinarily well-tolerated by cats.

Customer: replied 6 months ago.
do you mean her restlessness is likely due to pain but not the side effect of baytril? Should I continues the baytril or change to other antibiotic?Do you think I should let her do a bladder scope to confirm the tumor. If it is tumor, any treatment ? The vet suggest to give morphile to stop the pain and it can also stop the grow of tumor, but it can further damage the kidney,I dont know how to balance off.
Expert:  Dr. Michael Salkin replied 6 months ago.

Pain makes more sense than a side effect of Baytril - which is usually neurologic. I don't see a reason to switch antibiotics. A nonsteroidal antiinflammatory drug (NSAID) such as meloxicam can slow progression of these tumors. Surgery shouldn't be a consideration considering her prognosis and age. Morphine doesn't stop tumor growth. Low dose buprenorphine is a better choice than morphine in cats if we want to see if pain is present.

Customer: replied 6 months ago.
Is meloxicam a pain killer as well? If it can do both , control growth of tumor, It is the better choice over brufenorphine? What is a low dose for a 3.1kg?
Expert:  Dr. Michael Salkin replied 6 months ago.

Yes, it's analgesic due to its antiinflammatory action. It's a better choice than buprenorphine because buprenorphine has no effect on a tumor. Meloxicam is dosed at an initial dose of 0.2 mg/kg and 0.05 mg/kg daily thereafter in cats. (3.1 kg x 0.2 mg/kg = 0.62 mg; 3.1 kg x 0.05 mg/kg = 0.16 mg)

Customer: replied 6 months ago.
Side effect of meloxicam ? The vet here is very concern about her kidney function. As a matter of fact, is this ultrasound image clear enough to confirm the dignoses or should I go for other supporting tests before using the meloxicam?
Expert:  Dr. Michael Salkin replied 6 months ago.

The ultrasound image is strongly suggestive of a mass. Biopsy would be necessary for confirmation but I can't see putting Mellow through a general anesthetic and abdominal exploratory for such a procedure. Meloxicam is generally well-tolerated by cats but repeated doses of it is controversial in cats because renal failure and death have been associated with it. When dosing has been lowered (we were overdosing cats), however, the benefits of treatment often outweigh the risks.

Customer: replied 6 months ago.
Thank you very much for your clear advice tonight, help us a lots in the dark.
Expert:  Dr. Michael Salkin replied 6 months ago.

You're welcome.

Customer: replied 6 months ago.
Is there a blood test cancer maker for pet in US? Any possible to send blood sample to US for testing? If the mass is not tumor, what else can it be, blood clot? These two days Mellow seems better and even play with me. I don't see her painful but the appetites still low.
Expert:  Dr. Michael Salkin replied 6 months ago.

No, there's no such test. Cancer is diagnosed by biopsy or seeing cancer cells in peripheral blood. The ultrasound wasn't indicative of a blood clot.

Customer: replied 6 months ago.
How to perform test to see cancer cells in peripheral blood?
Expert:  Dr. Michael Salkin replied 6 months ago.

A simple blood smear looking for atypical cells.

Customer: replied 6 months ago.
Blood taken from which art?
Expert:  Dr. Michael Salkin replied 6 months ago.

A peripheral vein such as as the cephalic in the forearm.

Customer: replied 6 months ago.
part?
Expert:  Dr. Michael Salkin replied 6 months ago.

I understood.

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