Tuesday, June 29, 2010

Sticky urine and foamy vomit. Welcome to my world.

A Japanese client brought in her cat today because she thought that he was walking funny and that his rear end was painful. The client was sitting in the waiting room with the cat, a big fuzzy black Persian, on her lap. We called her into the exam room, and as she was carrying him to the room, unbeknownst to her (and us), he had started to urinate. By the time we all noticed, he had left a nice little stream on the floor. We quickly placed him on the exam table, where he deposited a bit more. Before we wiped it up, I sucked up some of it into a syringe, just in case we needed a sample later on.

I began to examine the cat when my assistant, Kamilla, who was cleaning up the urine stream in the hallway, informed me that the urine was sticky. I grabbed the syringe with the urine, and put a drop on a urine dipstick. In ten seconds, the pad turned from green to brown. Brown means sugar. Diagnosis: diabetes. Another good example of how you don’t always need fancy equipment or tests to make a diagnosis. Interestingly, the cat did not have any of the classic signs of diabetes. He wasn’t drinking a lot, urinating a lot (not counting the river he created on our floor), ravenously hungry, or losing weight. I would have performed bloodwork on him regardless, since he was 13 years old and we hadn’t seen him in two years, and I would have detected that he was diabetic when the results became available tomorrow, but the sticky urine led me to the diagnosis today. Kamilla gets credit for that diagnosis. Thankfully, I had my Japanese technician Hiromi with me to help explain the home care of diabetic cats.

[In case you were wondering, the painful rear end turned out to be an anal gland abscess that was about to rupture. The cat had a sizzling hot fever (104.4 F), and he cried when you touched his rear end on the left side. We sedated him, pierced the area with a scalpel blade, and boy oh boy, you should have seen the pus flow! Be grateful that I didn’t videotape it.]

A second interesting case had to do with Billy, a cat that we diagnosed with lymphoma a few weeks ago. I believe I mentioned him in a previous blog post. His case of lymphoma was odd. It was in a single lymph node. This is an unusual presentation. I consulted with an oncologist colleague of mine, and she said that lymphoma in a single lymph node is often seen in cats with FIV. This cat’s history fit the bill – he used to go outdoors all the time and get into fights with other cats. I asked the client if I could run the test, and she said okay. Sure enough, he tested positive. In fact, the FIV spot on the in-house test turned positive even quicker than the positive control. The client is now trying to decide whether to continue with the chemotherapy or not. Cats who have lymphoma and are FIV positive will go into remission, just like cats who are negative for FIV, however, their remission doesn’t last as long. She’s not sure whether it is worth putting her cat through chemotherapy if his remission is likely to last only a few months. Tough decision.

This morning I checked my e-mail, and was delighted to receive three photos of cat vomit. One of my clients’ cat had vomited three times last night, and my client was compelled to photograph the vomit spots and pass them on to me. I don’t imagine there are too many jobs that involve receiving cat vomit pictures. All in a day’s work, I guess.
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