Monday, March 24, 2008

Follow the Yellow Cat Road

Greetings all from the wonderful but stressful land that is veterinary school. I apologize for the absence (yet again), but as I'm sure is obvious, I've been outrageously busy and I'm a noob in regards to blogging. Since my last post, I have completed a few rotations such as soft tissue surgery, ophthalmology, and neurology, but I am now beginning my second round through internal medicine. I say second round because all small animal students are required to endure two medicine rotations and not because I failed the first time. As an aside of good news before I scribe another tale of veterinary medicine, I found out last month that I PASSED MY BOARDS!!!! (one), and I now have a job lined up back in not only my home state, but in my home town as well. While these are great things, the reality and potentiality of graduation and actually being a doctor have really set in.....and I have completely checked out mentally. This is not interfering in my dedication to the care of my patients by any means, but I can't stop thinking about my graduation date. My classmates even set up one of those countdown clocks in the hallway where all the senior students complete all their paperwork. So for the next 6 weeks, I am just in cruise control to say the least.

Now as promised from my last post, I would entail my first experiences dealing with "the yellow cat", and you get the added bonus of hearing how I received two yellow cats at once, actually to great benefit to my learning experience. By yellow, I mean that the cats' skin was actually yellow in color, and not that the cats were easily scared or timid. The proper term for this condition is called "icterus", though you may have heard the term "jaundiced" used in the past regarding people, particularly newborn babies, who have yellow skin. In animals, the reason why their skin turns yellow is due to liver dysfunction of some sort. When red blood cells are broken down and turned-over by the body in a normal fashion, they release hemoglobin (the oxygen-carrying molecule) into the bloodstream. It is the liver's job to remove this from the blood and convert it into a molecule called "bilirubin" which is then excreted into the bile via the gall bladder, then into the intestines, where it can be broken down and reprocessed. However, if the liver is not working or there is a "traffic jam" somewhere along that path, bilirubin builds up in the blood and actually turns the skin yellow. The actual discoloration of the skin itself is not bad, but what it reflects can be life-threatening.

In cats, if you see yellow skin, it is most likely due to one of two diseases. The first disease explanation will hopefully provide some advice to cat owners since it can easily be prevented. The first cat of the pair I saw was a relatively obese cat where the owners said that they noticed the cat's appetite declined over the past week, the cat appeared dull and depressed, and the skin became yellow. We worked up the cat's case by giving the cat IV fluids, offering it all sorts of delicious foods, and analyzing bloodwork, which showed there was liver comprimise. I had a suspicion from the beginning that this cat had a disease called hepatic lipidosis. When obese animals go for an extended period without eating, the body naturally reacts by mobilizing other body tissues to provide nutrition and energy. Proteins usually are processed first to an extent, but then the body starts using up it's fat stores which have to be processed by the liver cells. For whatever reason, the liver cells of cats cannot handle the load of fat that gets mobilized and they get easily overwhelmed, causing a "fatty-liver". This not only affects the health of the liver as the cells get swollen with fat, but a diffuse traffic-jam (as mentioned before) occurs.

Now what I wish to get across to all you cat owners, is that if you can prevent a fat cat from becoming anorexic, please do so. What I did not tell you about this cat is that it had a very stressful history. In recent months, the owners 1) added a new cat to the home, 2) had a child, 3) had construction going on in their home, and 4) recently went on vacation. Oh, and I forgot to mention the cat was blind for different reasons. Sounds like a recipe for stress to me, how about you? I want to emphasize that these owners did nothing wrong, nor were they aware of this possibly happening to their cat. Strangely enough, the way to treat these cats is to get them to eat and they generally have a good prognosis if they start eating on their own. Sadly, even though we placed a tube to place food directly in the cat's stomach, it crashed one night and we lost it :(. The owners thankfully consented to have a necropsy performed and I was correct; it had hepatic lipidosis.

The reason why I said getting two of these cats was a good learning experience was because the second cat had the other common cause of yellow skin in a cat. This one did not have a stressful history, but rather became acutely anorexic and just overall ill. Unfortunately for this cat, it had what is loosely called the "cholangiohepatitis complex" where the "traffic jam" in the gall bladder and its related ducts (aka the biliary system). There is always some inflammatory component in the biliary system in this disease, but the reason why is not always entirely understood. Also, when that bile backs up, it is also toxic to the liver so you get a hepatitis as well. Overall the incidence and prognosis of this disease is not studied well, but animals tend not to do well with this disease because it requires a long recovery and hospitalization time that many owners can't handle either emotionally or financially. Liver disease as a whole is very frustrating because there isn't much that we can do to help. The liver has a tremendous health reserve, so once they present in poor health with elevated liver blood values, it's bad news because it usually means 3/4 of their liver is shot. We applied all the right liver protecting medications and supportive care that is needed in these cases, but the owner did not want to see their cat suffering for so long and elected euthanasia.

I hope these stories did not bore you too excessively, nor do I hope they just made you depressed. I hope you got some important information out of them, namely make sure your cats keep eating and if they become yellow take them to a vet pronto. For my next post (which I'm hoping won't be long from now), I'll move onto my soft tissue surgery rotation which had some neat cases, but unfortunately mostly dealt with cancer. Till next time...

15 comments:

Eva Whitley said...

Oooh, fascinating.

I don't know if you remember Stoney when he was clomping around the house with the purple cast on his leg, but what really drove up the vet bill was following the vet's instruction to keep him crated...which led to his getting depressed because he couldn't wander around the house and he couldn't spontaneously come up to us for a pet...which led to him not eating...which led to more time in the hospital because he wouldn't eat.

Finally, I figured he should at least die happy, so I let him wander around the house again, whereupon he starting eating again. I could have saved us close to $1000 by ignoring the vet. I guess that's not fair, they were trying to do best by him but it's scary how quickly cats can get sick when they stop eating.

Anyway, I thought you'd like to see this: http://ladysprite.livejournal.com/332585.html

Diane said...

Hi O,

If you currently process credit cards in your veterinary practice, you are probably already aware of the Visa/MasterCard rate increase. Rates should only increase by 5-10 basis points (0.05%-0.10%). If you see an increase of anything more than that, contact your merchant service provider and negotiate a better rate.

Thanks,

Diane
diane@paymentmax.com

The Foodist said...

Hi O;

If your currently sending money to spam responses on your blog, you can just go ahead and cut me a check as well.

All payments will be retroactive with a low low 22.1% interest rate payable only upon my death or dismemberment by an elephant while on safari in Africa with a party of no less then 3 but no more then 5.

Thanks!
-Steve
www.gimmemoney.com
ps- welcome back to blogging noob

Anonymous said...

So, my cat has the yellow skin and was a healthy slightly chubby 8 year old cat. She is now "sad" sleeps most of the day and will generally not eat or drink on her own. I am force feeding water about a tablespoon three times a day and she only perks up occasionally. What do I do if she has fatty liver and I don't have a lot of money for a vet? Is there a way to get her going again?

Bub and Bubs said...

Hi O,
How are you doing? My name is Bhae Pascua and I am currently looking for an apprenticeship in equine medicine and bovine medicine. I am wondering if you could help me. Thank you very much.
Regards,
Bhae

Kirsten Keith said...

Hello,
Today we took our cat to the Vet and found out that he has something wrong with his liver because he too has yellow skin. We are waiting for the vet to call us back on the blood work they did, but we are very sad for our family member. He will not eat on his own, and anything he does eat, he throws up. He seems to be in good spirits though. He loves being around his family.
I was intrigued to read about the stress history of one the yellow cats you worked with. 2 of the 4 stress situations are exactly what our cat went through. Hopefully our cat will live through this.
Thank you for sharing your knowledge online for those of us who have no clue as to what is wrong with our best friends.

Anonymous said...

My cat has turned yellow but he's still eating and isn't depressed. He has dark red gums so I don't know how he can eat really but he's keeping his weight up. I can't afford thousands of dollars of vet fees.

Michelle said...

Thank you so much for your posting. Your first story sounds eerily similar to my cat’s current situation. She has also had some recent stressful experiences and has become almost identically what you described with the yellow skin. This gives me hope that my poor kitty, Star, that I love dearly and has been my best friend for 10 years will pull through this. She goes in Monday morning for the feeding tube as you described. I truly hope this works because I am just not ready to lose her yet. Thank you again.

liz said...

I Really appreciate your help. I think my cat has the second yellow cat disease. Thank u soo much for your information. I just saw the yellow skin this morning but he has been sluggish for about a week. Thank again for your info and good luck with your career !!

Danielle said...

Don't knwo if you still read this blog of yours, but if you do, please email at danimar07@gmail.com. I have a very pressing vet question to ask cause i need mroe info before taking my 18 year old cockatiel to the vet

selfreliantguy said...

I'm fascinated by your job. I love how you describe things that happen in details.

Angela said...

Thank You for sharing your knowledge with all of us. My cat is 14 years old and has always acted like 1 year old, she has turned yellow while we were away from home for 1 week. I took her to Vet on Fri and they told me to get her to Animal ER for blood transfusion which was way to costly, so I took her home and started the doxycycline and she is eating baby food well and drinking well, we are taking it day by day. Today is Monday and she seems to be fine, I believe God will let her stay with me a little longer!

my cat farted gemini said...

my cat gemini is turning yellow as well but the vets just say he isnt gonna make it unless he eat. like there is nothing wrong with him.. i have beeen feeding him cat milk 9 ml every hour. he has had bowel movements and he pees wouldnt that mean his liver is still working.. i want to hold on to hope but i dont want him to suffer can anyone tell me if its too late to save his liver or if i should have him "put down" it would kill me inside if he could be saved but i didnt try.. please help

chase.jenkins said...

My cat has been sick for about a week I've been doing research about what maybe wrong with it. It used to be kinda fat but she got around good but recently she hasn't been eating and going off hiding and she is really skinny now I can feel her bones and her skin is yellow would it be one of these pls reply. Thankyou.

chase.jenkins said...

My cat has been sick for a week or so she was fat but since she has been sick she is now so skinny I can feel her bones. She is also yellow all over (her skin, paws, mouth etc..). If you have an idea to help with this please do so I love this cat with all my heart pls and thankyou.