Fever & Lethargy with no other symptoms - Neg for FeLV, FIV & HW

[jazee]

I hate this. Such a stressful part of being a pet owner. My American Shorthair, 12 years old, indoor cat, no other cats, about 12 days ago started eating less and less. Then he got noticeably lethargic and strangley I could start hearing his claws start to catch as he walked around on our closed loop carpet which hadn't happened before. Did the full panel of blood tests and everything looks normal. His temp was 103.3 which isn't a major fever as I read that fever is considered above 103.5 for more than one day but still he was high on the range. Vet gavbe him fluids and an antibiotic shot 4 days ago and some appetite stiumlant meds to rub on the inside flap of his ear. He perked up the days or two after he came home and of course ate more than before but after a couple days he appears to have regressed to where he was before I took him to the vet.

No watery eye or sneezing or anyting to indicate any sort of upper respiratory distress. He's still able to jump up on the bed but I can tell his energy is waining with each hour/day he's not eating normal. We did go on vacation about 3 weeks ago and had a cat sitter, so they could have brought something in with them from another household. He tested negative for FelV, FIV and HW.

Since I'm not the type of pet owner that is readily willing to shell out hundreds or thousands of dollars as if this animal is a human being, I opted to forgoe the Xrays until we see how things went. So obviously next step is to go back to the vet and get Xrays (and probably some fluids.) As my understanding is a fever without other symptoms of a cold/virus could be caused by cancer unfortunately.

As other pet owners know that have gone through these things, this is extremely stressful. If anyone has any insights or advise, I'm all ears.

 

[jazee]

Oh and he's using the litter box as normal. He did have a bladder stone 3 years ago that had to be removed, but he's not yowling in the box or peeing elsewhere in the house.

 

[silent meowlook]

Can you get a copy of the blood work and post it here? Usually, vets will e mail you the blood work. Are you still giving the Mirtazapine on the ear? Is there any chance he stopped eating or didn't eat well when the pet sitter was there? If it was my cat, my next step would be an ultrasound with an internal medicine specialist. But that will cost money. An Xray will only show so much and can't show the finer details of the surface of the internal organs. It is a waste of time and money to get it done by anyone other than a specialist because it is very objective. To try to save costs you can ask your vet for a bag of fluids and have them teach you how to give them at home.

There are allot of could bees. It could be pancreatitis, which you would need a specific test to detect. Sometimes it can be seen on ultrasound. It could be hepatic lipidosis from when you were away if he didn't eat well. It could be other things. There is no way of knowing without doing more testing to find out why.

If you don't want to spend the money to find out why, and I do understand, you can try to treat the symptoms which are not eating well. I personally wouldn't do another antibiotic injection because you don't know that it is an infection, unless the blood work showed it. Also, the common antibiotic injection is Convenia. Not the best for all things, just convenient because you don't have to give him meds at home.

 

[FeebysOwner]

Hi. I would get a urinalysis - that is also a common test, along with the blood work you had done, for any cat at least annually. I suspect the fluids are probably what perked him up, so you might consider some more fluids. Did the vet say he seemed dehydrated? What did the vet say about his claws clicking on the carpeting as never before? And did that stop with treatment from the vets?

Being dehydrated can cause both fever and lethargy, so fluids are probably a good idea. But that doesn't help to explain what is behind the dehydration, which could also have been caused by the lack of eating (and drinking?). And, as far as I know, a fever isn't really a good indicator of cancer. There are other viral conditions that can lay dormant for years in a cat and then show up with flare ups as they age as their immune systems become less robust, e.g. herpes for example. There are other immune mediated diseases that could be the culprit as well. These types of things would be more likely treated with auto-immune support meds/supplements. Ask your vet about this aspect too. Pancreatitis also mentioned above is another possibility which can be tested for. The best treatment for this condition is fluids and ensuring adequate food intake. Sometimes, it can be aided by pain meds too.

I would ask what the vet expects to look for in x-rays and if it would be more beneficial to proceed right to an ultrasound instead, as mentioned above.

EDIT: I do want to add that an ultrasound is non-invasive, as are x-rays. But there is a caveat with the ultrasound - if it should identify any 'suspicious' tissue, make sure that there is an opportunity to perform a fine needle aspiration (FNA) cytology during the ultrasound. This too is non-invasive and merely involves drawing out, via a needle, cells related to any suspicious tissue seen. It does cost more but does not have to be done if there is no tissue worthy of looking at more in-depth. But, allowing for it to happen, if need be, will likely eliminate the need for a follow-up ultrasound in the near future.

 

[jazee]

Really appreciate the insight. Just out of curiosity can I expect the ultrasound to be much more expensive like twice the cost than radiographs? I think they wanted around $275 is for radiographs (not more than $300.) I'm also going nuts trying to get an accurate temp reading with my ear themometer. Understandably I'm getting readings all over the map from 99 to 105.4 on one reading switching between ears. I think obviously on the low ones I'm being scared of putting it in too far. But I'm getting better at it and just did another two right now and got it in pretty far into his ear and it was 103.5 and 103.6. But I got two readings earlier this morn amougst taking 5 that were both 104.8. From what I've read seems cat temps can vary quite a bit wider than humans throughout the day? Definitely has a fever but how severe is a little fuzzy. I'm agonizing over picking up the phone and taking him back ASAP versus give him another day or two and see how it goes as far as eating, drinking and moibility. It's been about 10 days since he's been noticeably lethargic but still walking, meowing and still can jump up on the bed. Is there really much of a chance he could have a cold/virus with no upper respiratory symptoms that will just resolve in a few more days? I know if their temp hits 106 they need to go in ASAP, but what about how long is it okay for them to go with drinking nothing to very little? A day, couple of days?

 

[jazee]

To expand. Vet didn't have a response to the claws getting stuck and fluids and appetite meds didn't make a difference. He's not wobbling and can still jump on the couch/bed but he definitely is walking slower but it may be that he is just low on energy. No limp or shaking his paws or anything. Oh forgot, the vet wasn't able to look in his mouth. He's a timid cat but at the vet he's a wild animal and is very difficult to handle. I couldn't get that good of look in his mouth but definitely the teeth in the front half look fine. We sort of ruled out the tooth problem as he's not eating the mushy wet food that he normally loves either.

I forgot the appetite meds yesterday but gave it to him this morn along with a little salmon oil with CBD which I've had around for a while but always kept it in the fridge. I put it on his fur when he's being obnoxious begging for food so he licks it off and stops bothering me. No begging for food anymore right now! Wish he would!

My gut is telling me I would like to monitor another 2 or 3 days as long as I can get him to eat and drink at least a moderate amount. Seems like a waste of a trip to go into the vet just for fluids and anti-inflammatory for the fever and not do the ultrasound. But on the other hand, the things the imaging would help diagnose I assume it isn't going to make a big difference if he is treated 2 days or 7 days from now?

Tough decisions. So maybe next step is fluids, anti-inflammatory for the fever, pancreatitis test and fluid bag? If no improvment and negative on the test then go for the ultrasound?

Also, we are having unusually crappy weather here with cold, low-pressure, rainy weather. He is always a bit more lethargic and sleeps more when the weather changes like this so I'm hoping he's at the turning point instead of going downhill and other factors are just making things seem worse than they really are. But that explanation may be a bit of a hopeful reach to be honest.

 

[FeebysOwner]

I think you are OK with your plan as long as you don't continue to see decline. It is possible the antibiotic injection could take some more time to help - some of them can last at least 14 days, so you could see some additional improvement.

You could call and ask the vet about that, just to see what they say. When you call them, also ask about the low T-4 count, and if/how it could factor in. It is not terribly low, but a low T-4 could explain some of his lethargy. Is he on any meds for hyperthyroidism? You can also ask the cost of an ultrasound, and the FNA (if needed), just so you know what you might be dealing with.

 

[daftcat75]

Can you ask the vet for a can or two of Hills A/D? Or more if he likes the stuff. This is exactly what Hills A/D is good for--getting a sick cat to eat. If he likes the stuff, and most cats do, you can mix it with his regular food as A/D alone is rather rich. He may simply want the A/D right now. If that's the case, let him have it. Keep trying a mix with him as well as he starts to feel better. Because it is rich, only give him small amounts at a time to start.

There's a completely unhelpful diagnosis for what your cat is going through right now: fever of unknown origin. It means they can't find any good reason for it. My Betty went through one of these after an endoscopic procedure. The specialist assured me that procedure is minimally invasive and rarely has complications. Her regular vet was less convinced. She thinks those biopsy snips might be harder on a cat than they are saying. In any case, after going through two ER visits including all the imaging, the vet sent me home with a course of antibiotics (Veraflox.) Within one dose, she was feeling better. We finished the course as instructed and never did learn what was ailing her. I'm usually very much against antibiotics. But sometimes they're necessary. And if cost is a concern, a course of antibiotics is going to be less than X-rays by at least 1/3.

 

[jazee]

I think you are OK with your plan as long as you don't continue to see decline. It is possible the antibiotic injection could take some more time to help - some of them can last at least 14 days, so you could see some additional improvement.

You could call and ask the vet about that, just to see what they say. When you call them, also ask about the low T-4 count, and if/how it could factor in. It is not terribly low, but a low T-4 could explain some of his lethargy. Is he on any meds for hyperthyroidism? You can also ask the cost of an ultrasound, and the FNA (if needed), just so you know what you might be dealing with.

No meds for hyperthyroidism. She did explain that she wasn't overly concerned about the low T-4 and the report has the reasons on it. Seems if he doesn't get better, then maybe proceeding with a freeT4 ot T3 suppression test would be warranted. The vet seems to think imaging is the best next step if he doesn't get better. I remember the previous vet also recommending ultrasound instead of xrays for confirming the bladder stone.

As far as the pancreatitis. Seems an ultrasound is useful in diagnosing that but not fullproof. Seems there's a rapid test and an outbound lab test for pancreatitis. I'm just trying to figure out the order of things to do or what to do at the same time if he doesn't improve.

I have my own 10 panel test strips for urine but it's been at least 6 months since I did one on him. I wanted to be able to check his urine levels myself after he switched to the C/D prescription diet after the bladder stone was removed to make sure I'm minimizing the chance he'll get anothe one. I'll get out the non-absorbing litter but it may be some time before he pees as he just pee'd this morning and is not drinking yet. I can then bring that sample in for the vet. I'm not sure though if it's worth paying for a urinalysis though if the test strip doesn't indicate anything is obviously out of range?

 

[FeebysOwner]

As far as the pancreatitis. Seems an ultrasound is useful in diagnosing that but not fullproof. Seems there's a rapid test and an outbound lab test for pancreatitis. I'm just trying to figure out the order of things to do or what to do at the same time if he doesn't improve.

The fPLI test is a better determinant for pancreatitis than an ultrasound. That is why I thought your plan seemed reasonable.

I'm not sure though if it's worth paying for a urinalysis though if the test strip doesn't indicate anything is obviously out of range?

I am not sure of all the differences between the urine strips and a lab testing process, but certainly can't hurt to ask the vet if this is an option to start out with.

 

[jazee]

Can you ask the vet for a can or two of Hills A/D? Or more if he likes the stuff. This is exactly what Hills A/D is good for--getting a sick cat to eat. If he likes the stuff, and most cats do, you can mix it with his regular food as A/D alone is rather rich. He may simply want the A/D right now. If that's the case, let him have it. Keep trying a mix with him as well as he starts to feel better. Because it is rich, only give him small amounts at a time to start.

There's a completely unhelpful diagnosis for what your cat is going through right now: fever of unknown origin.

Yes I read about that fever of unknown origin. AKA, Fever with High Vet Costs amounting to no solution. (lauging and crying.)

We're on the same page. The last few minutes my main focus is trying to think what can I give him for food and hyrdration that he simply can't resist! LOL. Like all cats, he like mushy soupy stuff. It's like I need something very rich in calories with high water content. I need to pick up some Gabapentin for him if he's going to do imaging and they asked if I wanted to just have some on hand as he's to panicked and strong to handle him at the vet for imaging without sedation. Maybe I'll ask about the A/D and pick some of that up with the Gaba so I can try to get some calories in him and and ready to go if he doesn't improve.

 

[silent meowlook]

I’m sorry, I can’t reply, but wanted to say that the ear temps are useless. You will do better with a regular digital under the arm.