I still remember it like it was yesterday. The day back in 2004 when I looked at my then 3-year old orange and white tabby cat Jasper and thought “Uh-oh.” Nothing looked blatantly wrong, exactly, it’s just that I knew something wasn’t quite…right.
Up until that day, Jasper had always been a healthy, rambunctious, playful little guy with a mischievous sense of humor and a penchant for hiding things around the house. Sweet and affectionate, he loved to snuggle up against our necks and lick our noses, purring loudly, then drape himself across us with looks of utter contentment.
It was his facial expression I noticed that day. What I call his typical “kitten face” was not there, replaced by a look I hadn’t seen before. When I began scrutinizing him with the laser focus of a concerned cat mom, I noticed that his hair coat also seemed a little dull. Was I imagining things?
The next day, Jasper vomited after breakfast. Taking no chances, I took him to see his regular vet, who examined him but was unable to find anything out of the ordinary. We drew blood to be safe, and she suggested a hairball remedy.
When Jasper’s bloodwork results came back normal, it only made me more perplexed. Always the first to show up for dinner, he was now picking at his food. I took him back to the vet again, only to be told they couldn’t find anything wrong with him.
The next morning, I was alarmed to see Jasper attempting to climb the stairs, but unable to make it past the third step. Every movement looked like it was causing him excruciating pain. This time when I took him in, the vet referred me to an Internal Medicine Specialist, and we got an appointment immediately.
Racing the Clock
When Jasper and I first met Dr. Keven Gulikers, I had no idea what a crucial role he would come to play in our lives. Dr. Gulikers was soft spoken, thoughtful, and insightful, with the best bedside manner of any vet I had ever seen. After examining Jasper head to toe, he ordered x-rays and an abdominal ultrasound. Within the hour, results were in.. and they were heartbreaking. Jasper had enlarged lymph nodes throughout his abdomen, and the initial diagnosis was intestinal cancer.
Dr. Gulikers wanted to run additional tests to confirm the cancer diagnosis, as he wanted to make very sure that’s what we were dealing with. He sent us home with prednisone, a steroid medication used in animals with cancer to alleviate pain and inflammation by suppressing the immune system. I gave Jasper his first dose that night.
The next day, poor Jasper was dramatically worse. He was listless, could barely move normally, and didn’t want to eat. I was monitoring him closely at home; his heart sounded normal, there was no fever, and he had no other symptoms that would point to what was causing these mysterious symptoms. I was alarmed at how quickly he seemed to be deteriorating. Not wanting to subject him to another stressful ride in the car, I left him with my husband while, in desperation, I drove back to the hospital to talk with the doctor.
Dr. Gulikers met with me immediately. I was distraught, knowing that we didn’t truly have a definitive diagnosis and seemed to be running out of time. I told him the prednisone had made Jasper worse instead of better. We spent almost an hour brainstorming… it felt like a surreal episode of “House, MD”. Spinal tumor? Neurological disease? Nothing seemed to fit.
Dr. Gulikers noted that we had run almost every test possible, except one. A fungal titer.
A titer is a blood test used to check for the presence of infection by measuring the amount of antibodies the body is making against a foreign invader. The blood sample is continuously diluted by 50% (1:2, 1:4, 1:8, 1:16, 1:32) until it no longer tests positive. The higher the ratio numbers, the worse the infection.
Miraculously, the hospital still had some of Jasper’s leftover blood from previous tests, and we immediately overnighted what was left to a specialty lab. However, it was going to take 3 full days to run the test.
Time to Decide
The next morning, Jasper couldn’t move around on his own. I couldn’t bear to see him in so much pain. We had attempted to manage his pain with a medication called Torbugesic, but his body had such a bad reaction to it that we had to stop using it.
My husband and I stayed home from work that day and spent the entire day with Jasper, loving on him and saying our goodbyes. Any pet parent who’s been in this situation knows exactly how devastating it is. I called the hospital that afternoon and made an appointment for 6:00pm to have his pain and suffering ended for good.
At 5:30, I quietly told him “Come on baby, it’s time to take a ride.” To our utter astonishment, Jasper stood up, walked steadily on his own to the back door, then happily started watching the birds in the back yard and purring! It was the most he had been like his regular self in days. I looked at my husband and said, “We’re not doing anything yet.. he needs to be examined one more time.”
When we got to the hospital, the technician took his temperature and asked if he had been running a fever. I said no, I had taken his temp the night before and it was still normal. She took one look at the thermometer and said, “Well, it’s not now!” Overnight, Jasper’s temp had spiked to 104.5 degrees (normal body temperature for cats is around 101.5 degrees). It was then I knew that we were most likely dealing with an infection.. and an infection could be treated!
Jasper was immediately admitted to the Intensive Care Unit, where he was given IV fluids, antibiotics, and antifungal medication. On his second day in the hospital, his fungal titer came back, and it was 1:64 – the highest ratio possible for a positive fungal test. We finally had the diagnosis we had been waiting for.
“The Great Imitator”
Valley Fever is caused by a fungus called Coccidioides immitis, an organism that lives in soil mainly in the arid, hot regions of the western and southwestern United States and Mexico. Whenever the soil is stirred up, these fungal spores are released into the air, where they can be inhaled by both humans and animals.
Once inhaled, the fungus can take hold in the respiratory system. It grows and releases hundreds of endospores that travel throughout the body, resulting in a systemic infection (meaning the microorganisms are found in both blood and tissue). This affects the entire body: the lungs, heart, bones, joints, organs, eyes, skin, and neurological and lymphatic systems. Valley Fever is extremely dangerous, and can cause overwhelming infection leading to seizures and heart failure. Dogs and cats diagnosed with this disease often receive a guarded to grave prognosis for recovery.
Valley Fever is called “The Great Imitator” because it mimics so many other diseases (like cancer). Symptoms are hard to diagnose until it’s almost too late. Symptoms in cats can include weight loss and muscle wasting, loss of appetite, depression, draining skin lesions, difficulty breathing, lameness, eye inflammation, and neurological symptoms.
In hindsight, this is why Jasper worsened so quickly while on the prednisone – the drug suppressed his immune system, allowing the fungus to grow even more rapidly and unchecked. His enlarged abdominal lymph nodes (which mimicked intestinal cancer) were actually caused by his body desperately trying to fight off the fungal infection.
Valley Fever is usually more easily diagnosed in dogs, but is rare in cats. It often progresses slowly in cats over a long period of time, and affected cats may not show any symptoms until the infection has spread so significantly that it becomes terminal.
Valley Fever is aggressively treated with anti-fungal medication (Fluconazole has the fewest side effects) for at least 6 months, and often for a year or more. During this time, blood tests are done and additional titers performed every 3 months until the tests are negative (or at the lowest acceptable level) for the fungus. Relapses are common, especially if medication is not given for a long enough period of time.
The Long Road to Recovery
Jasper was in the Intensive Care Unit for 6 days, receiving excellent round the clock care. At one point his fever spiked to 106.2 degrees – the highest temp I had ever seen in clinical practice – prompting the doctors to place ice packs on his IV lines to cool the fluids that were running into his body.
We visited him multiple times a day, holding him in our arms in quiet exam rooms so he could sleep, away from the noise of the beeping monitors and bustle of the ICU. During this time I was constantly assessing him, wondering if we were doing the right thing by attempting to give his body time to recover. After the third day of treatment, I had my answer – that distinct look in his eye that I knew well from years of working with critically ill dogs and cats. The look that told me he was fighting tooth and nail, that he wanted to come home. In amazement, we watched as he recovered day by day, getting stronger, until finally we were able to do something we had only dreamed of – bring him home.
On the day of Jasper’s release, Dr. Gulikers shaved a small spot between his shoulder blades (where he couldn’t lick) and affixed a Fentanyl patch (a narcotic pain-relieving skin patch used in human cancer patients) to manage his pain over the next 3 days. He came home with antibiotics, Fluconazole, special food, and bags of IV fluid and needles so I could administer subcutaneous fluids under his skin to keep him hydrated.
I don’t know who was more thrilled the day Jasper came home, us or him! Every day he continued to improve, until one day, many weeks later, I finally saw it again.. his “kitten face.” That’s the day I finally let myself exhale and have a good, long cry.
Ongoing Treatment (and Lessons Learned)
Jasper’s infection was so severe that he remains on Fluconazole twice daily, and will be on it for the rest of his life. He’s on the lowest dose possible to minimize any challenges to his liver, and he has bloodwork drawn periodically to monitor his liver function (which at age 14, so far, thankfully, has been great). His first negative titer came back 6 months after his hospitalization, and it’s been negative ever since.
Because Jasper’s case was so unusual (most animals with an infection as severe as his do not survive), he was written up in several veterinary medical articles, and Dr. Gulikers featured his case in numerous presentations to other veterinarians highlighting how tricky a Valley Fever diagnosis can be. We were lucky. Because Jasper was so young, strong, and healthy prior to his infection, he had a better chance than most for experiencing a full recovery.
We were able to learn many valuable lessons from this experience. First, know your pet and trust your instincts. No one knows your pet like you do… his demeanor, facial expressions, attitude, and interactions with you and other pets in your household. If you think something is wrong, trust yourself and get it checked as soon as possible. There’s no such thing as being too cautious when it comes to the health of our pets.
Second, if you know something is wrong and you don’t get the answers you’re looking for, don’t take “I Don’t Know” for an answer. Keep searching, get that second opinion, do research using credible veterinary sources, and don’t give up until you know exactly what you’re dealing with. Find a veterinarian who will listen and fight for your pet’s life as hard as you will.
And although not all cases will turn out as well as Jasper’s, if you are fortunate enough to find top quality veterinary care, with a little luck, faith, and determination, your pet just might be the next medical miracle.
1 Photo: Centers for Disease Control/Flickr/Creative Commons License
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