Signalment
- Age: 5 years
- Sex: male
- Breed: Domestic Short Haired
- Species: cat
Disease Notes
- Certainty: confirmed
- Comments: A beat-up stray tom cat is taken in ~1 yr. ago, torn up leg, multiple wounds and abscesses, no vet care until last week. He apparently heals, fast forward.... He presents last week with LF leg lameness, no open lesions, but there is diffuse metacarpal swelling and the distal radius appears to have osteomyelitis on radiographs. He has the most impressive stud jowls, is extremely fractious, fearful, moderate red-tinged serous ocular discharge OU, and moderate wet brown waxy discharge AU. He has a history of loose stools and a few recent episodes of what sounds like seizure activity that has not recurred since taken off kibble. T is pale as are mucous membranes, dry; P is not possible to obtain. I start him on XFHMY and Hoxey w/ Boneset, also homeopathic Hepar sulph and Gunpowder, omega-3.
Hematology: mildly anemic, elevated MO, depressed pmns and EO, lack of stress leukogram
Chemistry: depressed Cr, BUN, ALB, ALT, AST, ALP, GGT
UA (cysto): 3+ blood/HGB, RBC 30-50/HPF
FIV/FeLV/HW negative
Running TCM Dx: Blood stagnation w/ Stasis Heat and Pathogen invasion, Damp Heat secondary to Qi and Liver Blood deficiency, Spleen Qi deficiency. I have to say I am at a loss on choosing the most appropriate formula(s) to best resolve these imbalances and how far the XFHMY will help beyond why I obviously chose it ahead of reviewing his lab tests. Any input, Steve, is much appreciated! - Final Status: much better as of day 259 of treatment
Treatment and Outcome
Notes:
Mid-Feb, OJ was having trouble jumping, whining when walking, lethargic. I thought Heat toxins may have been enough to injure fluids/blood to create Phlegm, so added Si Miao San on 2/25. Also added corydalis to the hoxsey and Rx Liquid immuno to get the herbs in him. He seemed to improve, not normal self, slow walking gingerly, very goopy eye OS.
On recheck 4/28, worsening pancytopenia, ^CPK. Repeated CBC on 5/7 d/t small sample and clumping: low RBC & pmns, elevated MCV, NRBC, monocytes, low platelets. Negative toxoplasmosis Ab and FeLV PCR, positive PCR for Mycoplasma haemofelis and M. haemomimutum. Owners cannot afford a bone biopsy. He is very fractious, but I finally got a good exam on 5/7. He has moderate pelvic mm atrophy, settles gingerly on hind end, abnormal stature, stiff gait w/ hind end dropped a bit, no obv. swelling/lesions, very calloused pads.
I started him on Doxycycline and Gui Pi Tang and gave the other herbs a rest. On finishing the doxy, OJ is worse clinically, can't walk well, flops down, whines when picked up, hisses when touched (except for head). Had owner d/c GPT and restart other herbs a few days ago and I will be rechecking him today, 6/9. I will run SC/CBC and Crytpococcus Ag. I am at a loss of what else to chase or how else to help this guy.
Diet is largely canned or kibble
Notes:
I finally diagnosed Orange Juice in August with 2 species of Bartonella after culturing the blood, amplifying the pathogens, and then running serology.
He has responded very well to 8 weeks of doxycycline and pradofloxacin (5 mg/kg PO q 12 hr. each, abx chosen based on spp. and symptoms, which included uveitis) and finished treatment 10 days ago. He is back to his old self except the cat still has blepharitis and thick rusty ocular discharge like jelly. I really don't want to continue abx therapy, but the only time the eyes got better was when I put him on 100mg of doxycycline SID back in May before I diagnosed him. This was double the dose given with the pradofloxacin. And, it helped, so I may go back to that dose for a bit longer. BUT, I feel this cat needs some herbal clean up.
Diet is largely canned or kibble