‘Morgan’ B’s Case – 17 y/o FS DSH Grey Kitty

Oct. 11, 2019 – First Visit

Presents for 2nd Opinion for chronic senior cat issues.  Morgan saw her old vet yesterday. She is thin and has had a chronic issue with nasal congestion. The antibiotic injection Convenia  had helped in the past for the chronic nasal congestion but not now. The owner wanted a second opinion on how to treat Morgan and her chronic issues.  She is hyperthyroid and currently on methimazole 5 mg twice daily.  No blood work has been run since July.  The medication was increased in July.

Concerns from Owner: Wt. Loss, Nasal congestion, diarrhea on /off

Appetite was good until nasal congestion.  Morgan eats Royal Canin Sensitive Stomach. Occasionally vomits when she exits the littler box.  Her last weight was 6.0 lbs.

Subjective: Bright, alert, and responsive

Wt = 5.25 lbs

Tongue = pale pink, 

Heart murmur grade 2/6 (once better hydrated)

Abdomen= is doughty

Musculoskeletal= very thin,  body condition score 3/9

Hydration = 10 % dehydrated

Integument =. Very unkept hair coat

Assessment:  

Dehydrated, hyperthyroid, Soft stools, Heart murmur, cystitis

Plan: 

Repeat diagnostics of  blood work ( large panel sent to the laboratory ) and urinalysis run in house..  Hydrate her with subcutaneous (SQ )fluids.  Diarrhea started in May or June. Plan stop all other supplements owner  has tried, to help figure out the soft stools.  Owner has given CBD 1 drop twice daily for pain.

Stop methimazole 3 days and then start back at half dose at 5 mg once daily. Results still pending on the blood work and thyroid (T4) level.

For nasal congestion, begin nasal decongestion Little Noses drops twice daily  for 3 days, then begin just nasal saline drops twice daily.  Also use 2 mg chlorpheniramine antihistamine tablet twice a day if owner can get them in.

Urinalysis performed in the hospital reveals cocci bacteria. Morgan has a urinary tract infection. The urine was sent out to the laboratory for culture and sensitivity.

Senior cats are very susceptible to urinary tract infections due their age, fragility and lowered immune system over.  A Purevax Rabies vaccine  was given to  Morgan to keep her current and because she was in good health overall per the owner.  

Begin Clavamox pending urine culture results. This may help the nasal congestion as well.

Morgan can eat whatever she wants to eat. The special food is not helping as there is likely more going on with Morgan.  Senior cats do best when they eat and eat well! 

We gave Lactated Ringers (LRS) fluids subcutaneously (SQ) 150 mls.  The plan is to treat empirically for the significant dehydration by repeating SQ fluids in 3 days depending on the blood work findings.

Findings from testing :

Blood work reveals Morgan’s blood chemistry is largely normal.  We don’t have kidney or liver disease.  Her thyroid level is normal.  However her complete blood count is very abnormal.

BUN = 26

Creatinine = 1.5

Phosphorus = 5.4

T4 = 2.2

Complete Blood Counts

WBC = 8,100 normal White blood cells

RBC = 2.81.    normal is 7.12 to 11.46   Extremely low red blood cells.

HGB = 4.7      normal iis 10.3 to 16.2.   Extremely low hemoglobin

HCT = 15.7%  normal is 28.2 to 52.7 %.   Hematocrit is Extremely low

Reticulocytes   =  0.2 %

Reticulocytes.  =   6.  Normal range in blood is 3 to 50.

Reticulocytes being elevated above 50 would indicate her bone marrow is trying to fix the anemia by kicking out early red blood cells known as ‘reticulocytes’. They are immature red cells being released early by the marrow.

Reticulocyte response due to severe anemia is absent.  Morgan’s body is not trying to replace the red cells with her bone marrow response.

Platelets =   83,000.    Normal is   155,000 to 641,000. Extremely low as well.

Interpretation of Complete Blood Count

Morgan is severely anemic. Her anemia is so severe, a blood transfusion would be recommended. Red cell levels this low are not conducive for life. However, blood transfusions in senior cats are not without risk. Also it would be best to figure out the cause of the anemia prior to treatment.

Her platelets are also extremely low as well. Platelets in cat blood testing often measure low in number because they are ‘very sticky’ and tend to clump up making the automated counter harder to quantify. This level is still very low. Transfusion is a good option for aggressive treatment. The cause of the anemia and low platelets is still not known. We call this ‘An Open Diagnosis’.

Causes of anemia in a senior cat include:

• Blood loss due to hemorrhage somewhere in the body. Her urine had no blood in it. Her stools are soft but do not have blood as far as can be seen. This is not the cause.
• Bone marrow not making blood cells due to chronic issues. Possible.
• Anemia due to chronic age and Qi/energy deficiency. Likely the cause
• Malnutrition and not ‘building’ blood. Also likely a cause.
• Immune-mediated hemolytic anemia and thrombocytopenia based on Morgan having very low red cell and platelets. Her white cells are normal. This is not common in cats but is on our list of possible causes.

Most common anemia causes in super senior cats:

• Chronic kidney disease (low EPO). Her kidney values are normal!
• Chronic low-grade inflammation / cancer somewhere in the body
• Marrow infiltration by lymphoma / myelofibrosis
• FeLV reactivation or immune marrow suppression

No matter the cause, we have to help Morgan NOW!

Urinalysis culture results:    Enterococcos faecalis  >100,000 colonies per ml

The bacteria in the urine is sensitive to Clavamox antibiotic. This is good news because we have already put her on this antibiotic.

Treatment today on our first visit:    

Gave LRS 150 mls subcutaneously (SQ), 

Start Clavamox antibiotic for the urinary tract infection and it may also help the nasal congestion.  

Begin Little Noses Decongestant for nasal congestion for 3 days, the switch to nasal saline. 

Start Chlorpheniramine antihistamine for chronic nasal congestion.

Oct. 14, 2019 – Second Visit

Phone call report with owner discussing our findings and possible causes of the anemia. The plan is to build up the ‘Blood’ (treat the anemia) with supportive care of Vitamin B12 injections once weekly for a month to start. An iron dextran injection once to twice a month to help build blood. Also continue SQ fluids until Morgan is normal in her hydration as noted by her ‘skin turgor’. Skin turgor involves how loose and relaxed her skin ‘snaps back’ with picked up and pulled away from her body.

The owners were instructed to feed TCVM ‘Blood Tonic’ foods.

Blood Tonic foods include: beef, beef liver, chicken liver, heart, sardines, eggs, parsley, dates, to name a few. Cats will generally like water-packed sardines, egg yolks, liver, and chicken liver. The purpose is to give the body the building blocks to repair the anemia with diet.

The owner notes she can get the Clavamox antibiotic into Morgan but not the anti-histamine. She does feel her nasal congestion is better. The owners wished this conservative approach over aggressive bone narrow evaluation, more invasive and costly work up with a specialist in this 17 year old kitty.

Physical exam on the same day as the phone call.

Objective:

Wt. = 5.6 lbs

Musculoskeletal = wt gain of 0.2 lbs in 3 days.

Integument  =. Coat is less unkept,  skin turgor is better

Assessment

Improved but still dehydrated

Plan:

O notes fleas were found on the dog.  Ok to use Revolution topical on Morgan. Continue water packed sardines and egg yolks. O. notes she does like them.

Gave Vit B12 0.5 mls SQ.

( I always use a higher dose to build Blood.  It will be urinated out if the body has too much.  If this happens, you can see red urine as it is excreted).  Morgan did not do this.

Gave LRS. 70 mls SQ

Oct. 15, 2019

Phone call conversation with Mrs.

O. notes she felt that Morgan would pep up more after the Vit B12 injection.  Discussed that it will take a few more injections to perk her up.  Also we need to repeat the urinalysis to see how the bladder is responding to treatment. Discussed expectations.

Oct. 22, 2019. Third Visit

Fluids and Vit B12 today.

Subjective: 

Brighter ! O notes she is sprier too.

Appetite is 90% better now. Starting to groom herself.

Objective:

Wt = 5.6.  Wt steady

No nasal congestion noted

Integument = coat is unkept

Urinated where she was laying.

Plan

Gave Iron Dextran  0.5 mls Intramuscular to help build blood.

Gave Vit B12 0.5 mls SQ

Gave 100 mls LRS SQ. 

Plan SQ fluids 70 mls to 100 mls in 2 to 3 days.

O notes Morgan is eating egg yolks.

Packed Cell Volume = 20% today.  Remember the HCT was 15.6%.

Continue antibiotics

Hematocrit and PCV basically measure the same thing — how much of the blood is made up of red blood cells.
The difference is mainly how the number is obtained:

• PCV (Packed Cell Volume) — done by spinning a small tube of blood in a centrifuge and visually measuring the percentage of red blood cells. It’s a very fast, manual, in-clinic reading.
• Hematocrit — the same percentage, but calculated by an automated blood machine as part of a full CBC (complete blood count).

Remember when we started 11 days ago, the hematocrit (HCT) was 15.6%. We are slowly building Blood and hydration with our treatment.  Our PCV is now 20%.  We have only given 2 injections of  Vit B12 and 1 Iron dextran injection so far.

October 29, 2019 – Fourth visit

Subjective:  More active, jumping on the window perch

Eating egg yolks, chicken, liver, flounder, sardines, and occasionally sensitive stomach.  Eating well.

Objective:

Wt = 6.5 lbs   Has gained 1.25  lbs

Heart murmur Grade 2/ 6

Hydration: Much better

Assessment:   Much brighter.  Tries to run away. Much better.

Plan:

Check Packed cell and total solids today. 

Treat with fluids or B12 based on results.

Gave iron dextran 100mg/ml, 0.5 mls Intramuscularly

Gave Vit B12 0.5 mls SQ

Gave Phylyte fluids 100 mls SQ

PCV/TS = 25% /6.8.     Packed cell volume up 5%!

Continue antibiotics Clavamox for UTI/respiratory signs.

Plan SQ fluids 70 mls again in 3 days.  Repeat T4 and urinalysis in next several weeks.

November 7, 2019 – Fifth visit

Subjective: Almost back to normal O notes.   Good appetite.

Objective:

Better groomed.

Normal hydration.

Assessment:

Back to her old self!

Gave Vit B12 0.5 mls SQ

Packed cell volume = 32%, Total Solids = 6.6

Eating chicken, livers, sardines, egg yolks and kitten food. Plan urinalysis when bladder is full enough and full blood work next time.

November 15, 2019 – Sixth Visit

Repeat blood work today

BUN = 33

Creatinine = 1.5

Phosphorus = 6.2

T4 = 2.0

Complete Blood Counts

WBC = 10,900

RBC = 6.87   normal is 7.12 to 11.46    Now a little low

HGB= =10.6    normal iis 10.3 to 16.2.   Hemoglobin is now normal.

HCT = 35.7.  Normal is 28.2 to 52.7 %.   Hematocrit is normal now!

Platelets = 339,000   Normal is 155,000 to 641,000

December 10, 2019 – Final Blood work and Urine Check

Urinalysis is negative for bacteria.  Urine culture negative for any bacterial growth.

Packed Cell Volume = 40%, Total solids = 7.0

Why is this such an awesome case?

Morgan B.  Goes on to live another 3 years!! She had a great quality of life as we continued to treat her thyroid disease and other issues that came up as she aged.

We did not have to do any invasive treatments with Morgan.  By allowing her to eat whatever she wanted and by offering rich nutritious Blood Tonic food, the red cells recovering back to normal in 6 visits.  Her red cells and platelets repaired back to normal levels, while her bone marrow originally had no regenerative response at all!   The anemia was solved by Food, Vit B12, and Iron injections.

Vitamin B12 helps with anemia in old cats, energy, and many other issues!

1. Supports Red Blood Cell Formation and Energy Metabolism

Vitamin B12 plays a vital role in DNA synthesis and red blood cell production. Cats that are deficient may show:

• Lethargy or weakness
• Pale gums
• Decreased appetite
• Weight loss
  B12 injections can help restore normal blood cell formation and improve vitality.

2. Aids in Gastrointestinal (GI) Health and Nutrient Absorption

Cats with chronic GI diseases often have low B12 levels because absorption occurs in the ileum (the final section of the small intestine). Diseases that impair this region—such as:

• Inflammatory bowel disease (IBD)
• Pancreatitis
• Chronic enteropathies
  —can lead to cobalamin deficiency.
  Regular B12 injections can improve appetite, stool quality, weight gain, and energy by replenishing stores directly into the bloodstream (bypassing the gut).

3. Supports Nervous System Function

Vitamin B12 is essential for maintaining healthy nerve function and myelin sheath integrity. Deficiency can cause:

• Hind limb weakness or ataxia
• Neurological dullness or confusion
  Supplementing B12 helps preserve nerve health and overall cognitive function.

4. Enhances Liver and Pancreatic Function

Cats with:

• Pancreatic insufficiency (EPI)
• Chronic liver disease
  can have secondary B12 deficiencies. Injections help improve enzyme activity, digestion, and metabolism.

5. Safe and Well-Tolerated

• B12 (cyanocobalamin or methylcobalamin) is non-toxic and water-soluble.
• Any excess is excreted in urine.
• Injections are typically given weekly for several weeks, then monthly for maintenance, depending on the condition.

Common Clinical Uses in Cats

• Chronic diarrhea or weight loss of unknown origin
• IBD or intestinal lymphoma
• Pancreatitis or pancreatic insufficiency
• Chronic kidney or liver disease
• Senior cats with malabsorption or low appetite