April
28, 2006 CASE OF THE MONTH Good old Demon. I first saw him in March of 1986 as a 3 month-old kitten (born Friday, December 13, 1985!) Do the math - he’s now 201/3 years old, equivalent to a human of over 100. He has had his share of geriatric problems - chronic kidney disease, hyperthyroidism, and pancreatic insufficiency. All of these maladies have been successfully treated over the last three years. In early March, he experienced a sudden inability to walk. His forelimbs couldn’t support his weight. Initial blood tests showed mild deterioration of his kidney function, but no other obvious problems. The sudden onset of his symptoms suggested a stroke (vascular accident in the brain). We did an echocardiogram (Ultrasound of his heart), looking for evidence of dilated chambers, which could contribute to a blood clot. The cardiologist reported mild right atrial dilation but commented this was unlikely to contribute to thrombosis (blockage of a blood vessel). I didn’t believe his dismissal of a stroke. His deterioration continued despite aggressive supportive care until he was flat out and unable to raise his head to eat, although his appetite remained good. He either had to be assisted to urinate or experience bladder “overflow” release raising the danger of urinary tract infection. Because of his advanced age and other geriatric problems, his prognosis was guarded. I explained to Ms. Buck that predicating how much recovery there would be from a stroke this severe was difficult, and in thirty years with cats I had seen everything between 0% and 100% improvement. He remained in The Cat Practice for eight days treated with Bufferin, Cortisone and other drugs. In three days there was some improvement in coordination and strength, but that rapidly disappeared. Despite the extremely guarded prognosis, Ms. Buck elected to take Demon home, although he couldn’t move or control urine or defecation. She had her hands full with his medications, physical therapy (working and massaging his muscles), and cleaning and feeding him. Ten days following the initial incident, he experienced a upper respiratory infection (runny nose and watery eyes) and was given antibiotics. There was no improvement for nearly three weeks, but slowly he began some voluntary movement. Eventually he could stand unassisted. Then he could walk two steps and collapse, then five steps, then voluntary urination and defecation returned and he was able to get into and out of the litter box. At last reports, he had walked at least one hundred feet at once, secretly climbed a spiral staircase, and was doing well. I had pointed out that years ago the great stage actress, Patricia Neal, was felled by a similarly catastrophic stroke and within a year was back on Broadway, but the credit goes to ms. Buck for her perseverance, and dedication to her “Sweet Demon”. Many people would have given up during the three weeks in which he showed no improvement. William Sullivan D.V.M
CASES: DEMON BUCK | DANTE ROSENFELD | FRED BARGA
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