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 MEET
SOME OF OUR PATIENTS: “Casper"
We first met Casper when he was 4 years old in 1998, a magnificent
glossy black Siamese cross. He had inherited the delightful
wedge-shaped skull, fine boned legs, whippy tail and distinctive
voice of the Siamese, but the rest of his body definitely took
after the chunkier, rotund Domestic Shorthair! He does have
a large frame, but his weight gradually crept up over the intervening
years until, in October 2003, he tipped (and nearly broke) the
scales at 9.44kgs.
His health had always been very good, as had his appetite,
but the reason for his visit on that day was because he hadn’t
eaten anything for a number of days, and had vomited after drinking
the previous day. On presentation, Casper wasn’t giving anything
away. His temperature was normal, mucous membranes in his mouth
a nice normal pink colour and no tender areas when we palpated
his abdomen. The vet couldn’t feel any obvious abnormalities
in there, but it wasn’t too easy to feel owing to his size,
so we gave him treatment suitable for a cat with a gastric upset
but warned the owner that unless he made a quick recovery, more
tests may be required to diagnose exactly what was going on.
The next day, he still wasn’t wanting any food, although the
vomiting had stopped. A blood test came back as normal but we
still had a decidedly unhappy cat who by now was definitely
saying “ouch” when the front part of his abdomen was palpated,
and the vet could feel a swelling in this area. We suspected
that it was the pancreas that was affected – so a tentative
diagnosis of pancreatitis (an inflammation of the pancreas)
was made. The pancreas is a small organ very near to the liver
which, amongst other functions, produces and stores large amount
of enzymes that help with the digestion of food. Normally these
enzymes are stored in an inactive form but occasionally they
can become active actually within the pancreas, leading to pancreatitis.
Pancreatitis in other species commonly causes a lot of pain
and vomiting, but in cats, these symptoms can be uncommon. The
clinical signs are varied, such as lethargy, loss of appetite,
vomiting and abdominal pain, diarrhoea, dehydration and hypothermia
and can often be attributed to other conditions. Certainly,
not every case has every symptom so diagnosis often relies on
an exploratory operation to actually have a look at the pancreas.
 We
decided to treat Casper for pancreatitis and within days he
had responded very well; he had regained his appetite although
he had lost a small amount of weight and now weighed 9kgs. All
was quiet for a month but then he started to vomit again. His
appetite hadn’t been as good as before the episode of pancreatitis,
and there was a suspicion that his mucous membranes had a slight
yellow tinge to them – jaundice. His weight had plummeted to
7.3kgs – a loss of over 20% of his total bodyweight. Another
blood test confirmed that his liver was now having problems.
Casper was slightly dehydrated and so was admitted so we could
get fluids into him by an intravenous drip. After a couple of
days on a drip, he was brighter and his bloods showed a slight
improvement. However, his appetite was nonexistent so an exploratory
operation was performed. Surgery revealed no obvious problems,
apart from a very pale fatty looking liver (a normal liver is
a reddish-brown colour). A biopsy revealed his liver to be affected
by hepatic lipidosis.
Overweight cats can develop a massive accumulation of fatty
products in the liver particularly if they have been anorexic
for a couple of weeks. In the past this disease, hepatic lipidosis,
was considered fatal but the process can be reversed by simply
feeding the cat. The sick cat is unlikely to want to eat so
we have to introduce a fine indwelling tube into the nose and
down the back of the throat or through a small incision on the
side of the neck to give small regular meals. These tubes are
tolerated remarkably well by cats which is fortunate because
assisted feeding may be necessary for weeks or months to rectify
this disorder. While Casper was under the anaesthetic, we decided
to place a pharyngostomy tube. A small incision was made to
the side of his neck and a plastic tube was inserted through
this opening into the back of his throat and then carefully
down the oesophagus stopping just short of the stomach. Casper
tolerated the tube very well but he did have a tendency to vomit
if he caught a smell of food. It was hard to distinguish if
the vomiting was due to a physical cause or a psychological
cause – because eating cat food had caused him pain in the past,
due to the pancreatitis, it was possible that the two things
were linked in his brain and so the vomiting came about as a
reflex action due to the anticipation of severe pain.
However, he was soon considered well enough for his owners
to try him at home. Very quickly, they mastered the technique
of how much food and how often and for a few days, all was well,
but then the tube appeared to have blocked so he was brought
in for a new tube to be reinserted. Unfortunately, just a couple
of days later, things took a dramatic turn when he suddenly
started to salivate excessively and make loud crying noises
and the pupils of his eyes became very dilated. He was rushed
to our emergency service and more bloods taken which showed
a large increase in blood ammonia (a by product of digestion
that is found in normal cats’ blood but at low levels). This
was another sign that his liver was still very poorly, and it
was this high ammonia level that was causing the neurological
symptoms (hepatic encephalopathy).
 Within
a few days of treatment for this complication, Casper started
to look brighter and a subsequent blood test showed that the
liver was starting to recover a little. Also, he was, for the
first time for a long time, starting to lick at a little food.
The improvement was short-lived as the hepatic lipidosis recurred.
This time, things weren’t as straightforward and he developed
complications including pneumonia and severe dehydration. By
this stage Casper was well on to his twelfth life, never mind
nine lives, and the owner was facing the prospect of losing
him if he didn’t quickly respond to the treatment. Once again
though, he started to rally after 24 hours, and after a few
days in the clinic, he was well enough to go home.
In the weeks that followed, Casper continued to make very good
progress. The tube had to be replaced a couple of times but
his appetite continued to grow until he was eating a reasonable
amount (with the help of an appetite stimulant). Finally, 7
months after the onset of his problems, the day came when the
owner felt confident enough to try a couple of days without
any medication and Casper’s tube was removed. His appetite has
continued to increase, and at his last checkup, his weight was
creeping back up from an all-time low of 4.1kgs in March to,
in June, 6.5kgs. Casper has been very lucky to recover from
this problem and we're delighted to see him back to normal but
his owner is under strict instructions to ensure he remains
a shadow of his former self!
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