A third problem appears...
At age 14, Zeke was still doing well at his yearly checkup. The results of blood work, urinalysis, a total T4 concentration, a fecal examination, and blood pressure measurement were normal. However, several months after this checkup,
Zeke had a sudden onset of episodes of collapse, which could have been either seizures or syncope. Each episode was short,
and he recovered quickly. The episodes seemed to occur in association with excitement, especially at feeding times. Blood
work, urinalysis, a total T4 concentration, and blood pressure measurement were repeated, and the results were still normal. The results of an FeLV antigen
test and an FIV antibody test were also negative.
We performed a cardiac evaluation, which included thoracic radiography, six-lead electrocardiography, and echocardiography.
Cardiomegaly was noted on the thoracic radiographs, but no evidence of pulmonary congestion was present. The electrocardiographic
findings were normal. The echocardiogram revealed marked hypertrophy of the left ventricular free wall and obstruction of
the left ventricular outflow tract by the interventricular septum, consistent with a diagnosis of hypertrophic obstructive
We thought the left ventricular outflow tract obstruction was the cause of the syncope (collapse episodes). Zeke began receiving
atenolol (12.5 mg daily) to address his cardiac disease, as beta-blockers are the drug of choice when some component of left
ventricular outflow tract obstruction is noted. He continued to receive prednisolone (2.5 mg once daily) and the low-residue
intestinal diet. He returned several weeks after this diagnosis was made for a physical examination. He had improved while
receiving this therapy, and his syncopal episodes had resolved. He continued to return every three months for follow-up examinations.
At Zeke's annual comprehensive checkup at age 15, his health problems included obesity (body condition score of 4), inflammatory
bowel disease, and hypertrophic obstructive cardiomyopathy. He was clinically doing well. The results of blood work, urinalysis,
a total T4 concentration, and blood pressure measurement were normal. His follow-up cardiac evaluation (six months after the initial
diagnosis) showed no progression of his cardiac disease. We repeated blood work, urinalysis, a total T4 concentration, and blood pressure measurement six months later, and all values were normal.
And a fourth problem develops...
At age 16, Zeke was again presented for his checkup. No unusual clinical signs were noted by the owner or found on physical
examination. He was still overweight (body condition score of 4). This time when blood work, urinalysis, a total T4 concentration, and blood pressure measurement were performed, two striking abnormalities were present: a marked hyperglycemia
(> 350 mg/dl) and glucosuria. A fructosamine concentration was also elevated. We diagnosed diabetes mellitus.
Cats with inflammation of their intestines often have ongoing inflammation in their liver and pancreas (triaditis). We did
not think the low-dose corticosteroid therapy being administered to control Zeke's inflammatory bowel disease caused the diabetes
mellitus. We prescribed intermediate-acting insulin therapy (Humulin L—Eli Lilly). We chose this insulin because of its effectiveness
in cats, in my experience. Good control was obtained with a moderate dose (3 U) of this intermediate-acting insulin twice
a day. Zeke's cardiac evaluation was stable, showing no progression of his heart disease. Zeke did not exhibit any insulin
resistance from the concurrent use of corticosteroids, so no changes were indicated in his other drugs or diet. He remained
overweight but was at a stable weight.
... but Zeke is still going strong
So here we are with Zeke at age 16. He has multiple health problems—obesity, inflammatory bowel disease, hypertrophic obstructive
cardiomyopathy, and diabetes mellitus. These problems are being successfully managed with medical therapy. The owner diligently
brings Zeke in for follow-up checkups. A blood glucose curve was performed to determine Zeke's nadir. He now returns monthly
for a blood glucose check at his nadir, as well as a fructosamine concentration measurement if needed. Echocardiographic examinations
are performed every six months. The guidelines as outlined by the AAFP/AFM Panel Report on Feline Senior Care have helped
us reach the goals of managing and monitoring chronic disease, preventing disease progression, and providing a good quality
of life for Zeke. He still enjoys running to his food bowls for his meals, with no recent syncopal episodes reported.
Cynthia J. Stubbs, DVM, MS, DACVIM
North Georgia Veterinary Specialty Care
3550 Lawrenceville-Suwanee Road, Suite 112
Suwanee, GA 30024
This article is adapted from Dr. Stubbs' 2005 CVC proceedings paper.