Re: Mobility issues on 16yr old cat

[Guest guest]

Have you thought about Trixsyn? Mona L. Gitter DVM. CCRT If you give. 110%, you get back 1000%

Hi All,I have a few questions re: a mobility consult that we did on a 16 yr old Himalayan MN. The primary reason for the referral was due to lameness and weakness in the hind end, especially the L hind per O. The refDVM also informed us that the cat has a history of UTI's, renal disease (stage 2) chronic and that the cat also has lymphocytic lymphoma (intestinal) which has been treated (on and off) with Chlorambucil and Prednisolone since 2007. In addition, he also has severe bouts of SIBO and is often inappetant and was diagnosed with Spondylosis (thoracic through to sacral per O). Currently, he is off of the Chlorambucil (for about 1 month) and current medications include: Prednisolone 10mg SID, Metronidazole 1/4 tab SID, Lactulose 1.25ml twice/wk, recently started Eprex

due to anemia, is receiving Cartrophen injections and Supplements are: Omega-3s (salmon oil), Recovery (started 1 mo ago), Renal Advanced and Potassium supplement. O's concerns are weight loss in the past couple of months (does feed Hill's a/d and is often syringe fed), he has had a recent UTI that was treated with antibiotics and is clearing up. Will be resuming Chloambucil once he is stronger. But O's main concern is the mobility issues with the hind end, especially the L hind. O reports that it is worse when he first gets up, walk crooked. Also struggles when getting into the litter box and his L hind will slide out when he is on hardwood floors. He is an indoor cat, but O does take him outside on a harness to allow him some fresh air. He walks "crouched" and tends to hold the L hind a little more abducted. Our assessment found that he is resents extension of the L shoulder,

has excellent PROM in both hind legs and there is mild discomfort on palpation of the T-L spine caudally. There is a CP delay on the L hind, but feel that it is more due to muscle weakness as all nerve reflexes were normal. He is thin, current weight is 2.5kg, but felt that there is slightly more muscle atrophy in L hind, Gulick measurements found a difference of 0.3cm. Following out assessment, it was determined that there is osteoarthritis, spondylosis and generalized muscle wasting resulting in weakness.We have currently sent the O home with the following txex: PROM of forelimbs, 3-legged stands, walking up stairs, use of laser pointer ~1' up the wall, obstacle course and encourage a stand whenever the cat is sitting. Are there any other txex that we should be doing, the cat is very compliant and the O is very dedicated. The

other question that I have is re: supplementation, the O is quite happy to add additional supplements as he is quite tolerant to pilling. I remember some information from awhile back on the use of Coenzyme Q10 and L-Carnitine in dogs... I was wondering if there is any information out there for dosing in cats, has anyone tried it. Due to the circumstances with this cat I am thinking that it may be of benefit. If anyone has any other ideas that would be greatly appreciative.Thanks in advance, Brickett AHT, MSc, CCRA, CMT

[Guest guest]

,

Wow, is his name Lucky? Multiple medical problems and degenerative disease,

many possible pain generators as well as the illness associated with the

different medical issues. Intestinal lymphoma can really make cats sick, on top

of the CRF and its associated anemia. You are pushing a heavy cart uphill!

The lymphoma, UTIs and CRF can all be generating viscerosomatic pain. The djd

in the spine can be a source of pain and then some hint of neuropathy. I would

closely examine all joints and all muscles for pain. In addition to Cartophen

and Omega 3 FA, I would consider gabapentin 5-10mg/kg q8h and amitriptyline

0.5mg/kg q12h. I might even use buprenorphine 60 micrograms/kg q12h sublingual

for several days in attempt to reset the chronic pain process. I would use

physical medicine to address the myofascial pain if present - dry needling or

therapeutic laser - 6-9J for each painful area.

Additionally, I am not an internist but a/d is usually contraindicated in CRF

due to the high level of protein and its potential for increasing BUN and thus

further decreasing appetite. While it is better that they eat something rather

than nothing a renal diet would be preferred, k/d, nf or royal canin renal

diets.

Rick Wall, DVM

[Guest guest]

I agree with Dr. Wall, this kitty could use analgesic therapy. I would also

suggest starting Adequan due to limited side effects, and potentially

acupuncture. Sounds like the cat might be an acupuncture challenge, any

thoughts from the acupuncturists?

>

> Hi All,

>

> I have a few questions re: a mobility consult that we did on a 16 yr old

Himalayan MN.  The primary reason for the referral was due to lameness and

weakness in the hind end, especially the L hind per O.  The refDVM also informed

us that the cat has a history of UTI's, renal disease (stage 2) chronic and that

the cat also has lymphocytic lymphoma (intestinal) which has been treated (on

and off) with Chlorambucil and Prednisolone since 2007.  In addition, he also

has severe bouts of SIBO and is often inappetant and was diagnosed with

Spondylosis (thoracic through to sacral per O).  Currently, he is off of the

Chlorambucil (for about 1 month) and current medications include: Prednisolone

10mg SID, Metronidazole 1/4 tab SID, Lactulose 1.25ml twice/wk, recently started

Eprex due to anemia, is receiving Cartrophen injections and Supplements are:

Omega-3s (salmon oil), Recovery (started 1 mo ago), Renal Advanced and Potassium

supplement.  

>

> O's concerns are weight loss in the past couple of months (does feed Hill's

a/d and is often syringe fed), he has had a recent UTI that was treated with

antibiotics and is clearing up.  Will be resuming Chloambucil once he is

stronger.  But O's main concern is the mobility issues with the hind end,

especially the L hind.  O reports that it is worse when he first gets up, walk

crooked.  Also struggles when getting into the litter box and his L hind will

slide out when he is on hardwood floors.  He is an indoor cat, but O does take

him outside on a harness to allow him some fresh air.  He walks " crouched " and

tends to hold the L hind a little more abducted.  Our assessment found that he

is resents extension of the L shoulder, has excellent PROM in both hind legs and

there is mild discomfort on palpation of the T-L spine caudally.  There is a CP

delay on the L hind, but feel that it is more due to muscle weakness as all

nerve reflexes were normal.

>  He is thin, current weight is 2.5kg, but felt that there is slightly more

muscle atrophy in L hind, Gulick measurements found a difference of 0.3cm.

 Following out assessment, it was determined that there is osteoarthritis,

spondylosis and generalized muscle wasting resulting in weakness.

>

> We have currently sent the O home with the following txex: PROM of forelimbs,

3-legged stands, walking up stairs, use of laser pointer ~1' up the wall,

obstacle course and encourage a stand whenever the cat is sitting.  Are there

any other txex that we should be doing, the cat is very compliant and the O is

very dedicated.  The other question that I have is re: supplementation, the O is

quite happy to add additional supplements as he is quite tolerant to pilling.  I

remember some information from awhile back on the use of Coenzyme Q10 and

L-Carnitine in dogs... I was wondering if there is any information out there for

dosing in cats, has anyone tried it.  Due to the circumstances with this cat I

am thinking that it may be of benefit.  If anyone has any other ideas that would

be greatly appreciative.

>

>

> Thanks in advance,

>

> Brickett AHT, MSc, CCRA, CMT

>