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Rhapsody's neurology consult

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  • Jim Sinclair
    Neurologist suspects brain inflammation: meningitis or encephalitis. Noted ataxia, poor oral tone (which I can relate to his difficulty getting and holding
    Message 1 of 5 , May 9, 2013
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      Neurologist suspects brain inflammation: meningitis or encephalitis. Noted
      ataxia, poor oral tone (which I can relate to his difficulty getting and
      holding crunchy treats in his mouth), protruding tongue, squinting eyes,
      and history of those episodes of severe ataxia (or possibly seizures) which
      have recently been associated with respiratory episodes but first happened
      (without noticeable respiratory component) when he was less than six months
      old.

      Neurologist and internist both want to start prednisolone. Cardiologist was
      consulted and says it's okay, given the mildness of his heart condition and
      the severity of respiratory and suspected brain inflammation. Neurologist
      wants to recheck in 2 weeks, and may add an anticonvulsant at that time if
      he has more episodes of acute ataxia or dyspnea.

      Ideally she would also like to do an MRI and spinal fluid test, but that
      would cost even more than the alveolar wash did, and keep him under
      anesthesia longer.

      She doesn't think he has a brain tumor because nerves are affected
      symmetrically on both sides of his body. She doesn't think it's FIP,
      doesn't think it's cerebellar hypoplasia, doesn't think it's some cell
      storage disease she described but didn't tell me the name of, just said if
      he had it he wouldn't still be alive.

      Jim Sinclair jisincla@...


      [Non-text portions of this message have been removed]
    • honeybee100
      Jim, I ve only read parts of Rhapsody s story and it s clear you are being incredibly diligent in trying to help him. I don t recall seeing that he had been
      Message 2 of 5 , May 12, 2013
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        Jim,
        I've only read parts of Rhapsody's story and it's clear you are being
        incredibly diligent in trying to help him.

        I don't recall seeing that he had been tested for cryptococcus fungal
        infection, but maybe he has been tested and I missed it. It can be
        tested with a blood test.

        I once took in a rescued cat where the finder thought he'd been hit
        by a car because of abnormal walking and/or balance. The finder had
        taken him to a general DVM but at this moment I don't recall what
        they said, or if they'd done bloodwork or anything. I only had the
        cat a few days. He seemed to be doing better and then one morning I
        found him dead. I had a necropsy done because his sudden death took
        me by surprise. It turned out the cat had cryptococcus that had
        spread to his brain. Of course we had no idea how long he'd had the
        crypto.

        Just thought I'd mention crypto in case it hasn't been checked. I
        think toxoplasmosis can cause similar, but I think you already ruled
        that out. My apologies if these things have already been discussed.

        I wish you success in helping your handsome boy.
        Melissa

        On May 9, 2013, at 9:12 AM, Jim Sinclair wrote:

        > Neurologist suspects brain inflammation: meningitis or
        > encephalitis. Noted
        > ataxia, poor oral tone (which I can relate to his difficulty
        > getting and
        > holding crunchy treats in his mouth), protruding tongue, squinting
        > eyes,
        > and history of those episodes of severe ataxia (or possibly
        > seizures) which
        > have recently been associated with respiratory episodes but first
        > happened
        > (without noticeable respiratory component) when he was less than
        > six months
        > old.
        >
      • Jim Sinclair
        ... I don t recall if that s one of the things he was tested for either. I will ask. Thanks. Jim Sinclair jisincla@syr.edu
        Message 3 of 5 , May 13, 2013
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          On Sun, May 12, 2013 at 1:34 PM, honeybee100 <honeybee100@...> wrote:

          > I don't recall seeing that he had been tested for cryptococcus fungal
          > infection, but maybe he has been tested and I missed it. It can be tested
          > with a blood test.

          I don't recall if that's one of the things he was tested for either. I
          will ask. Thanks.

          Jim Sinclair jisincla@...
        • Jim Sinclair
          ... infection, but maybe he has been tested and I missed it. It can be tested with a blood test. Good call, Melissa! I just talked to the neurologist s tech.
          Message 4 of 5 , May 14, 2013
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            On May 12, 2013 1:34 PM, "honeybee100" <honeybee100@...> wrote:

            > I don't recall seeing that he had been tested for cryptococcus fungal
            infection, but maybe he has been tested and I missed it. It can be tested
            with a blood test.

            Good call, Melissa! I just talked to the neurologist's tech. I had, as
            instructed, given Rhapsody another dose of prednisolone yesterday after
            three days off, and called this morning to report no recurrence of last
            Friday's zonkedness. The tech relayed instruction from the neurologist to
            resume daily pred for two weeks, then return for recheck and begin reducing
            pred dose. I then asked about cryptococcus. She immediately replied that
            that's one of the possibilities the neurologist is concerned about, that
            she's mentioned it to the internist, and that it's not one of the things
            Rhapsody has been tested for. She said she will discuss it further with the
            neurologist on Thursday.

            You say it can be tested with a blood test. If the blood test is positive,
            is it treatable?

            Jim Sinclair jisincla@...


            [Non-text portions of this message have been removed]
          • Jim Sinclair
            ... So, she just called to check how Rhapsody is doing with the pred, and she said the neurologist and internist had discussed the possibility of cryptococcus.
            Message 5 of 5 , May 17, 2013
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              On Tue, May 14, 2013 at 1:52 PM, I wrote in response to Melissa:

              > I just talked to the neurologist's tech.... I then asked about cryptococcus. She immediately replied that
              > that's one of the possibilities the neurologist is concerned about, that
              > she's mentioned it to the internist, and that it's not one of the things
              > Rhapsody has been tested for. She said she will discuss it further with the
              > neurologist on Thursday.

              So, she just called to check how Rhapsody is doing with the pred, and
              she said the neurologist and internist had discussed the possibility
              of cryptococcus. They aren't ruling it out completely, but they both
              think it's very unlikely that Rhapsody has it, because if he did have
              it, he wouldn't have survived this long with it.

              We have an appointment to see the neurologist again on May 29, after
              two weeks plus two days on prednisolone.

              Jim Sinclair jisincla@...
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