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.
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.
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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.
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.
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)!
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.
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.
The secondary epilepsy statement is woefully incomplete. We discussed ORS and discounted it because you haven't seen blood from her vulva until now.
Quite a list of things - not all of which need to be considered in Mellow...here are the acute diseases I consider:
autoimmune hemolytic anemoia
systemic lupus erythematosus
intervertebral disk disease
acute renal failure
Here are the chronic diseases I consider:
generalized bacterial furunculosis
systemic mycoses (fungal infection)
chronic renal failure
congestive heart failure
cardiomyopathy (heart muscle disease)
chronic hepatitis, cirrhosis
I have to leave my computer for a few hours but I promise to reply as soon as I return if need be.
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.
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.
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.
Hyperthyroidism is considered in polyphagic (increased hunger) elderly cats.
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).
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.
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.
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.
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.
Most likely, yes, as fish are rich in iodine.
It can't. Only the T4 and fT4 can diagnose hyperthyroidism.
No, iodine is restricted only if hyperthyroidism is confirmed and dietary control (only) such as with Hill's y/d is desired.
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.
You're quite welcome.
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.
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.
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)
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.
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.
A simple blood smear looking for atypical cells.
A peripheral vein such as as the cephalic in the forearm.