Neuro disorder/Brain damage

jellybeans

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So I tend to write essays when I'm looking for advice, so I'll start this post with my question, and then below you can read my cat's history thus far if it interests you.

Question:   Has anyone here ever had a cat with a neurological disorder?  It was only mentioned to me as a vague possibility, but lately I'm not sure.  She doesn't seem to like her head or spine touched.  She shakes her head every now and again, especially after I pet her there.  And I notice her back twitching a lot lately, but not in the feline hyperesthesia fashion of twitching and then flipping out, running, and frantically grooming.  Just... twitching.

I'm curious as to whether or not anyone knows if I should be worried about brain damage or anything.  If she was hurt before I got her, would brain damage take this long to show up?  Should I expect it to get worse over time?  Or should I not even worry about brain damage because she's not walking around in circles and having seizures, etc.?

I mean one thing I've thought about is nasopharyngeal polyps, which might explain the head shaking and lack of eating (due to polyps in the middle ear and throat).  I guess I'll find out when she has her endoscopy!!  Thoughts?????

HER HISTORY---------

About 4 months ago my 2 year old cat fell into routinely turning down food.  After she became dehydrated and rushed to the vet, I believe they wrongfully diagnosed her as IBD.  There had been a few puddles of vomit in the weeks prior, but mostly just clear liquid hair ball vomits.  A few times I found a bizarre dried vomit outside the litter box on the mat, which I guess is concerning also, but I digress.

I took her too a specialist finally about a month ago, as I wasn't comfortable settling for IBD.  The medications piled on fast and it took a long time to get her off of them, particularly prednisolone.  I just wanted to get a second opinion.  The specialist wasn't really convinced it was IBD either.  He wanted to do an endoscopy, but I had to wait till she was off the steroids.

Fast forward a few weeks, steroids are done, she's been stable and hydrated and on a 100% wet food diet, but the vets find she has a vaginal e coli infection (which is unrelated to her overall health.  She likely got it when I accidentally wiped diarrhea into her vagina...).  So we start antibiotics and forego the endoscopy once again because I can't fast her for it when I need to feed her with the antibiotics.

During all this, her eating is actually stable.  I have to coax her along, but it's manageable.  She was having 4 meals a day, and coming off steroids hadn't puked or had diarrhea in quite some time.  (She never did puke/diarrhea chronically to begin with, and now isn't at all apart from diarrhea with the antibiotics).

Half way through her antibiotics treatment, she completely turns down food again.  I probably rushed her to the emergency a little unnecessarily, as I tend to be a cat hypochondriac since all of this non-eating nonsense, but it turns out it was for the better.  I brought a fecal sample and they found she had round worm.  So I started her AND her sister on Panacur to be safe.

Now, finally, ALL medications are done.  I have them down to 3 meals a day.  They're on a new food because I think she's averse to the one she refused while on antibiotics.  The past week and a half she's been eating really well, which has been a relief, but she's still not herself.  I'm always terrified that in the back of my mind she's going to start walking away from her bowl before finishing again, which ended up happening today.  It wasn't a huge deal, I added a little water and she finished.  But I'm familiar with the signs of her giving up.

And she's still pretty absent.  She's been following me around a bit like she used to.  A little more talkative like the good ol' days.  But she's very unapproachable and sullen.  She used to be my loving affectionate cat.  Chirp and trail behind me everywhere I went.  She would always push herself into my hand as I petted her head.  She would arch her back and stiffen her tail as I moved down.  And now she just lurches downwards at my touch.  There's no aggression or growling.  She just doesn't seem like she wants to be touched.  And when I pick her up, she lets out a little whine.  (She used to just grumble and look at me with disdain in true kitty fashion, but now she makes it sound like it's actually ruining her life when I hold her instead of just being a drama queen).

I know the specialist vaguely mentioned a neurological disorder potentially being the culprit, as during the climax of her illness she was off balance, drooling, falling over herself, but the vets I was taking her to at that time just kept blaming nausea and IBD.

Aaaaand this brings me to my question up top  :)
 
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goholistic

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What else has been ruled out? How is her oral health and ears? What tests have been done (CBC, x-rays, ultrasound etc.)? Where they normal?
 
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jellybeans

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What else has been ruled out? How is her oral health and ears? What tests have been done (CBC, x-rays, ultrasound etc.)? Where they normal?
Most of her tests to date have been done in the interest of an IBD diagnosis.  They started with blood work, then did an X-ray, then ultrasound.  She had a urinalysis done to find the vaginal e coli.  And then the fecal exam I mentioned to find the roundworm.

The blood work came back fine.  X-ray showed an indiscriminate thickening of the intestinal walls, and that's when she was prescribed prednisolone.  But then afterward she had an ultrasound and the ultrasound showed nothing of interest.  The urinalysis showed perfect urine specific gravity or something, which I assume translates into healthy kidney function.

So far every test has shown that I have an otherwise healthy cat, basically.  We just can't figure out why she won't eat.  And since she's so mopey and averse to being touched, I guess now is where I start to question neurological or psychological disorders.... which really scares and upsets me  :(

Oral health seems fine.  I can go in her mouth without too much trouble and brush.  She doesn't really trust me right now though ever since the Panacur.  Both my cats don't seem to trust me as much with handling them after that struggle  :/

One vet mentioned she had early/mild gingivitis starting, which is why I'm trying to start brushing teeth!!

Ears have never been checked but I plan on asking them to do a thorough exam in addition to the endoscopy.  I've looked inside them and I feel like there's a really dark wax along the same ridge leading into the canal in each ear, but maybe it's just her skin colouring?  My other cat has one ear with this potential dark wax, and one ear that looks nice and clean, so I have no idea if its wax or just normal ear colouring.
 
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goholistic

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Thanks for the helpful details. Did the blood work she had check T4 (thyroid function)? Has she been tested for FeLV and FIV? There is a blood test by Idexx called "Feline Serology 2" and has to be sent out to Texas A&M University. It tests for cryptococcus, FeLV, FIV, feline coronavirus (FCoV), and toxoplasmosis. I am mentioning some of these things specifically because there can be neuro-type symptoms. Although, quite honestly, from what you describe it doesn't sound neurological in nature to me. But I am not a vet.

Cats are really good at hiding pain and discomfort. It's instinctual. When they do show signs, sometimes they are signs that we don't associate with pain or discomfort, like purring or trembling.

Dark ear wax can be a symptom of an ear infection, so definitely have this checked.
 
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jellybeans

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Thanks for the helpful details. Did the blood work she had check T4 (thyroid function)? Has she been tested for FeLV and FIV? There is a blood test by Idexx called "Feline Serology 2" and has to be sent out to Texas A&M University. It tests for cryptococcus, FeLV, FIV, feline coronavirus (FCoV), and toxoplasmosis. I am mentioning some of these things specifically because there can be neuro-type symptoms. Although, quite honestly, from what you describe it doesn't sound neurological in nature to me. But I am not a vet.

Cats are really good at hiding pain and discomfort. It's instinctual. When they do show signs, sometimes they are signs that we don't associate with pain or discomfort, like purring or trembling.

Dark ear wax can be a symptom of an ear infection, so definitely have this checked.
I don't actually know if her blood was checked for thyroid function, but hyperthyroidism has crossed my mind.  I plan on having another blood test done tomorrow anyways, just because her last one was end of March and who knows what could have changed.  I will request a T4 test!

She's negative for both FeLV and FIV.  I've never heard of the Feline Serology 2 test, but perhaps I should request it?  I live in Canada--would the results still have to be sent to Texas?

I'm actually good at recognizing her purrs.  She definitely has a distinct purr when she's in discomfort.  I haven't heard it in a couple weeks anyways.

She unfortunately had pretty crazy diarrhea last night, which I'm guessing is why she started getting iffy about food earlier in the day.  She wouldn't eat last night afterwards, but I guess you're supposed to withhold food when a cat has diarrhea anyways.  Ate well this morning because she was so hungry, but this afternoon she's starting to wane again.  Puts the fear of God in me.  (Also she got it on her lady parts again so now I'm paranoid she'll have to go back on antibiotics for another 2-3 weeks like last time....)

When stuff like this happens, suddenly IBD becomes a possibility to me again.  But it just doesn't make sense to me how she can be fine for a week or two, then have diarrhea and be turned off from the food she's on for life.  There's only so many different foods I can offer her!!  For the past week and a half she's been on a GI wet food and has eaten it on her own volition.  Best week and a half of 2014.  Now what 
 

goholistic

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Yes, get a "Total T4". I don't have whole lot of experience with worms in cats, but I'd probably be asking if another fecal should be done to make sure that roundworm has been taken care of.  
  I don't know how it works being in Canada with the special TAMU blood tests, so you'll have to ask your vet. You could bring up cryptococcosis and toxoplasmosis and see what the vet thinks. Maybe there's a special testing facility I don't know about in Canada.

IBD is definitely a possibility and it can be very up and down and unpredictable. I can see how your vet is leaning towards IBD, but I would personally feel better ruling some specific things out if I could afford it.

What medications and supplements is she currently on? A good human-grade probiotic might help with the diarrhea.
I know the specialist vaguely mentioned a neurological disorder potentially being the culprit, as during the climax of her illness she was off balance, drooling, falling over herself, but the vets I was taking her to at that time just kept blaming nausea and IBD.
When she was at the "climax of her illness", can you describe what you mean? What was her condition / symptoms at that time that make you say it was the climax? Was she vomiting, anorexic, diarrhea, etc.?
 

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Don't know if this will help. It's the main lab in Ontario, as far as I can tell. There may be a comparable test.

https://www.idexx.com/smallanimal/reference-laboratories/testmenu.html

If there is, you will know exactly what to ask the vet for.

Edit: Oops. There are 148 pages of tests. You'll have to use their search engine to narrow it down.

Also, if all else fails: http://www.ovc.uoguelph.ca/hsc/en/aboutovchealthsciences/Neurology.asp

(I'm sorry, I don't know what part of Canada you live in. There may be a vet school/clinic closer to you.)
 
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jellybeans

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Yes, get a "Total T4". I don't have whole lot of experience with worms in cats, but I'd probably be asking if another fecal should be done to make sure that roundworm has been taken care of.  
  I don't know how it works being in Canada with the special TAMU blood tests, so you'll have to ask your vet. You could bring up cryptococcosis and toxoplasmosis and see what the vet thinks. Maybe there's a special testing facility I don't know about in Canada.

IBD is definitely a possibility and it can be very up and down and unpredictable. I can see how your vet is leaning towards IBD, but I would personally feel better ruling some specific things out if I could afford it.

What medications and supplements is she currently on? A good human-grade probiotic might help with the diarrhea.

When she was at the "climax of her illness", can you describe what you mean? What was her condition / symptoms at that time that make you say it was the climax? Was she vomiting, anorexic, diarrhea, etc.?
I will definitely bring up those tests tomorrow.  I remember writing off toxoplasmosis for some reason or another a few months back, but I don't see why it can't be a possibility.  I'm actually quite worried now...  If she has it, and the bacteria are dormant and turning into cysts in her brain or whatever, does that mean she could have issues for life?  So stressful!! 

Currently, she's on nothing.  She's been on Zantac, Cerenia, Mirtazapine, Prednisolone, Clavamox, AventiClav, some other antibiotic I can't recall, Panacur... and I think that's it!  I have mirtazapine on the ready incase she absolutely starts refusing to eat again, but that's it.  I'm scared to use it though because last time it made her really agitated, even though she'd used it successfully for a couple weeks earlier in the year.

As for probiotics, she is having Florentero every night.  I don't know whether or not it's helping, but it certainly isn't hurting.  Who should I inquire about human grade probiotics too?  Is there a difference?

The climax of her illness was end of March through middle of April.  Everything was so up in the air and I was bringing her to emergency every 3-4 days.  I would come home from work and find her hiding and crying.  Then as soon as I made eye contact she'd become extremely agitated and start screaming at me.  A couple of times she lost her balance and started drooling.  One time I had her on my lap stroking her as she groomed herself, and then I went to check on her sister (who was quarantined in a quiet room following her surgery to correct an intestinal obstruction, because I'm just that lucky!!) and when I came back out she was standing at the door, hunched and screaming at me quite aggressively.  That was frightening.  Every time I brought her in, she needed to be rehydrated, as I couldn't find a food that was acceptable to her and prior to all this she was a 75% dry food cat, so it took some adjusting.  She was very thin.  I could feel her spine and I think she weighed 6lbs at her lowest.  She should be about 9lbs, and as far as I know, she's up to 8 now.  She hasn't been weighed in a few weeks though.

It was just a nightmare.  That's why I call it the climax!  I don't recall any vomiting or diarrhea during this time, to be honest.  I know she would puke once a week and have diarrhea every other week after she started steroids though.  I can't say for sure the steroids are the cause though.  After starting her on 4 meals a day the vomiting disappeared.  It's a toss up as to which instance is the coincidence!!
 
Don't know if this will help. It's the main lab in Ontario, as far as I can tell. There may be a comparable test.

https://www.idexx.com/smallanimal/reference-laboratories/testmenu.html

If there is, you will know exactly what to ask the vet for.

Edit: Oops. There are 148 pages of tests. You'll have to use their search engine to narrow it down.

Also, if all else fails: http://www.ovc.uoguelph.ca/hsc/en/aboutovchealthsciences/Neurology.asp

(I'm sorry, I don't know what part of Canada you live in. There may be a vet school/clinic closer to you.)
I live in Alberta.

Am I supposed to choose all the tests I want for her or are they recommended??  I would have no idea where to begin haha

Thank you for the links  :)
 

goholistic

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Oh! That test menu that @cocheezie linked to above was the one I was looking at. They have a Canada-specific site, but I couldn't find a Canada-specific test menu, so maybe the test menu is the same.  
  I'm sure you could order "á la carte" tests if you wanted to test for just a few things. It seems a lot of the neuro panels include FeLV and FIV by default, so you'd be paying for that even though you don't need it.

Now that you have described her behavior during her climax, it does seem a little weird of her to be displaying such aggression. Did her pupils get real big, too? I wonder about seizures or some kind of condition that would have brain involvement like we discussed. Were you giving her mirtazapine during that time? I remember giving my super sweet Sebastian mirtazapine during a pancreatitis flare, and he turned into an absolute terror. Not so much towards me, but he was violently attacking the other cats like prey. Sudden aggression can be a sign of pain, too, however.

Have you considered consulting with a veterinary neurologist like the one @cocheezie linked to above? They might have a better idea on how to proceed and what to look for. An MRI provides a lot of detail, but they are super expensive. Only a neurologist would be able to tell you if that is worthwhile.

One thing I am going to mention, and I certainly don't want to scare you, is Feline Infectious Peritonitis (FIP). It affects primarily kittens and young cats. The "dry" form can wax and wane, continue on for months. Signs are vague and there is no clear-cut diagnosis. The decline can be subtle and slow. It is fatal.  
  Some signs include loss of appetite, weight loss, dull coat, diarrhea, eye inflammation, neurological symptoms, etc. According to Cornell, "About 15 percent of these cats develop neurological problems, such as imbalance, head tremors and seizures." (Source)  Here are some more links about FIP:

http://www.vet.cornell.edu/FHC/health_resources/brochure_ftp.cfm

http://www.icatcare.org/advice/cat-health/feline-infectious-peritonitis-fip

http://www.vetmed.ucdavis.edu/ccah/local-assets/pdfs/PedersenFIPinterview9-10-08.pdf

http://www.littlebigcat.com/health/feline-infectious-peritonitis-fip/

I really hope it's not FIP. 
 
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jellybeans

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Oh! That test menu that @cocheezie linked to above was the one I was looking at. They have a Canada-specific site, but I couldn't find a Canada-specific test menu, so maybe the test menu is the same.  
  I'm sure you could order "á la carte" tests if you wanted to test for just a few things. It seems a lot of the neuro panels include FeLV and FIV by default, so you'd be paying for that even though you don't need it.

Now that you have described her behavior during her climax, it does seem a little weird of her to be displaying such aggression. Did her pupils get real big, too? I wonder about seizures or some kind of condition that would have brain involvement like we discussed. Were you giving her mirtazapine during that time? I remember giving my super sweet Sebastian mirtazapine during a pancreatitis flare, and he turned into an absolute terror. Not so much towards me, but he was violently attacking the other cats like prey. Sudden aggression can be a sign of pain, too, however.

Have you considered consulting with a veterinary neurologist like the one @cocheezie linked to above? They might have a better idea on how to proceed and what to look for. An MRI provides a lot of detail, but they are super expensive. Only a neurologist would be able to tell you if that is worthwhile.

One thing I am going to mention, and I certainly don't want to scare you, is Feline Infectious Peritonitis (FIP). It affects primarily kittens and young cats. The "dry" form can wax and wane, continue on for months. Signs are vague and there is no clear-cut diagnosis. The decline can be subtle and slow. It is fatal.  
  Some signs include loss of appetite, weight loss, dull coat, diarrhea, eye inflammation, neurological symptoms, etc. According to Cornell, "About 15 percent of these cats develop neurological problems, such as imbalance, head tremors and seizures." (Source)  Here are some more links about FIP:

http://www.vet.cornell.edu/FHC/health_resources/brochure_ftp.cfm

http://www.icatcare.org/advice/cat-health/feline-infectious-peritonitis-fip

http://www.vetmed.ucdavis.edu/ccah/local-assets/pdfs/PedersenFIPinterview9-10-08.pdf

http://www.littlebigcat.com/health/feline-infectious-peritonitis-fip/

I really hope it's not FIP. 
So, update.  She had the endoscopy today and the specialist said everything in her stomach and esophagus look up to snuff, but her pharynx is apparently showing quite an unusual thickening.  He did a biopsy of it and the stomach just incase.  He said that the problem with her pharynx could contribute largely to her inappetance, which would have been a relief to hear 4 months ago.  I imagine if she has pharyngitis, feeding her dry food 3 meals out of 4 wasn't really ideal for her.  Is it at all possible that this is my answer, and all her other symptoms since then have been side effects of medications, dehydration, and stress?

I cannot remember exactly when mirtazapine played into everything, but I'm pretty sure she was first prescribed after one or two episodes of screaming and coming in for dehydration.  However, the drooling and lack of balance started after mirtazapine I'm pretty sure, and since I'd taken her off it, aggression, drooling, and balance have all normalized.  So I can't really say what is what.

If it helps any, most of the screaming fits gave me the impression that she was in extreme discomfort, and was responding to my stress.  These are my first two cats ever, and until recent months it has been a complete piece of cake (they were always so chill and never finicky or fussy about anything).  I know seeing her get so uncomfortable really freaked me out and I'm very high-stress, so I'm sure a part of her screaming was just responding to my crying/screaming/panic.  There were a few weeks I grew very detached from her emotionally as well, as I couldn't handle what was going on.  I would give her her medicine and move on.  Not much affection on my behalf, always watching out for her but avoiding eye contact whenever she looked at me.  From what I've been reading I probably made her feel really unhappy...

The only really bizarre aggression fit was the time I went to check on my other cat.  The shift in her behavior was just so sudden.  I gave her some food thinking she might be hungry, and it calmed her down, but then she threw all that food up several hours later!

FIP has been on the back of my mind since I first read about it.  I try not to worry too much, but I guess you never know.  If dealing with her pharynx doesn't clear things up then I guess it's something to look at more seriously...

And I can definitely afford to take this in a neurological direction, it's just something I'm really cautious to do.  I'm only 22 and I'd done a really good job of saving up a ton of money for school/travelling/or whatever else I decide to do, so I've been using that on taking care of her because I never got insurance for her.  I still have a lot left, I just haven't set a boundary yet for how much I'm willing to spend.  I love her to pieces and the thought of losing her and having her sister be lonely all day when I'm gone and my own emotional sanity of dealing with this alone... it's just so much to think about.  AND I just lost my job, so I don't have an income at the moment  :(

I've really been putting off responsibilities to my future in favor of pretending that spending all my money is surely going to fix this.
 
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