By JILL BAMFORD
NOVEMBER 5th, 2005, the date of the Siamese Cat Club and Rex Cat Club Show in Milton Keynes. As I prepared to leave early for the show, Isaac (CH & PR SHANTIA SELWOOD ISAAC) my eight-year-old Seal Tabby Point Siamese boy was sitting on the chest of drawers waiting for me to throw his toy spider, which I always did before going out. When I left that morning, I had no concerns about any of my six cats. A friend was coming to let the dog out and check them later.
The show was very enjoyable. In the afternoon I rang my friend to check all was well.
She had noticed some pools of water on the floor and suspected the dog, but this was extremely unusual.
That evening being Guy Fawkes Night the noise outside was deafening. On arriving home immediately I noticed Isaac. He was sitting with his tail fluffed up, swearing and seemed upset. Surely it could not be the fireworks as in previous years he had sat on the windowsill watching them. He did not want to eat and later started dribbling a little. Was this the pools of water my friend had noticed?
Isaac appeared to settle and was sleepy so I went to bed not unduly worried. However, at 2am I was woken by loud swearing. Isaac was sitting with saliva dribbling excessively from his mouth, his tail still fluffed up. When I tried to touch him he lashed out. This from a loving, friendly cat made me realise there was something very serious, possibly neurological wrong with him. He was dribbling everywhere, so I got him into the kitchen and sat on the floor, talking to him, drinking tea to pass the remainder of the night. Early on Sunday morning I rang our veterinary surgery’s emergency number and took Isaac in.
On arrival at the surgery Isaac was extremely aggressive towards the vet. She thought he could have a mouth injury and admitted him for sedation and examination.
During that day the vet contacted me three times. She had been unable to find anything wrong with his mouth and was inclined to agree that Isaac may have a neurological disorder. Due to the dribbling he was dehydrated so had been given IV fluids. Blood samples were taken, antibiotics given and drugs to reduce the dribbling. I was asked could he have got hold of any poisonous substance or had any flea treatment recently? The answer to both questions was no, but anything poisonous obviously put my other five cats at risk.
The next day meningitis was suspected as the blood results indicated a severe infection. Isaac remained hospitalised for four days, being given Lincocin by injection and Baytril 15mgs tablets. Gradually the dribbling stopped and he responded slightly when I visited him. When he started to eat a little I was able to take him home. He was very weak, especially down the right side of his body, his legs did not work properly and he was incontinent of urine.
Two days later Isaac appeared considerably brighter but on taking him to the surgery for a check up it was discovered he was again dehydrated. That night he was admitted and given IV fluids. I was able to bring him home the next day – but this had really set him back. He did not know me and seemed oblivious to everything. Over the next 48 hours he did not pass urine so back to the vet we went and she had to manually express his bladder over the sink. He seemed so unwell, I was desperate and it was at this point I asked for a referral.
The previous year Isaac had been referred for persistent unilateral nasal bleeding which was diagnosed as inflammatory rhinitis. Myra Forster-van Hijfte, a European & RCVS Specialist in Small Animal Medicine, had successfully treated him. She is the most wonderful lady, who specialises in Internal Medicine. I asked if Isaac could be referred to her again and this was arranged for the next day.
Myra examined Isaac thoroughly, checking his leg reflexes with a little hammer. The reflexes were poor, he did not like being touched reacting by sniffing excessively, then growling. She suggested an MRI scan to get a diagnosis and also a spinal tap. These I refused – the MRI scan, costing £1,000, I just could not afford. Both these procedures involved a general anaesthetic, which in Isaac’s state I did not want him to undergo. Myra admitted him that day for further examination.
Later she told me in view of his symptoms it was most likely he had a lesion in his forebrain which could be inflammatory/infections, vascular or neoplastic – there was a possibility of a brain tumour. She advised me to continue caring for Isaac as before and to bring him back in a week, but to contact her if there was any deterioration.
Isaac continued having Lincocin and Baytril for a further week. There were tiny improvements – he started washing a little, but remained frequently incontinent. He began to walk about more, becoming agitated if I picked him up. Always very ‘talkative’ he now was totally silent. He found eating difficult, especially chewing and always took a long time. I gave him Prescription A/D Diet mixing water into it for each meal to keep up his fluid intake, as he was reluctant to drink. In addition to other foods pureed I discovered he loved scrambled egg!
On the following Sunday morning Isaac had just had breakfast when I heard this odd ‘bumping’ sound. He was under the table having a epileptic fit, jerking violently, twitching, moving rapidly across the floor. This lasted for about one minute and then Isaac was breathing heavily and seemed confused. He recovered in about ten minutes. I work with people who have learning disabilities, many of whom suffer from epilepsy, so recognised what was happening immediately. He had no further seizures and a few days later I took him to see Myra. She found little improvement in him.
Over the next few weeks Isaac continued much as before, the right side of his body remained weak. Reuben my young red point boy frequently bounced on him with toys. Isaac could not join in, but Reuben persisted and occasionally a tabby paw would attempt to touch whatever had been bought. Reuben was a tremendous help providing Isaac with stimulation.
Some days Isaac seemed agitated, or would start dribbling, but by the beginning of December his incontinence was much better with only the occasional lapse. We saw Myra again and she felt there was a definite improvement. Slowly Isaac continued to make progress. At the end of December he had another two seizures which were not too bad and he recovered well. The following morning he had a major seizure moving rapidly across the room, banging himself against the wall. This was the worst he had suffered so we went to the veterinary surgery.
The vet examined Isaac, then said “We have two choices – I can either send him to Heaven or you can try Phenobarbitone”. Needless to say I chose the latter! Phenobarbitone 15mg was prescribed 1/2 tablet every 12 hours. Isaac did not have any further seizures and saw Myra again at the beginning of January 2006. His right sided weakness had improved but the leg reflexes were still slow to react and he became very aggressive when handled too much. She was also concerned about his epilepsy.
Working full time it was often difficult to monitor Isaac’s seizures. In mid February at 3am he had another severe seizure, rolling from room to room and bashing into the radiator.
The Phenobarbitone was increased to 1/2 am and 1 pm. During March he had two more seizures and in one of these fell off the kitchen worktop into the dog’s water bowl!
Isaac had a mild seizure one morning in April followed later by a severe one, smashing himself into the glass door, ending up behind the toilet. Amazingly he had not injured himself. The vet increased the Phenobarbitone to one tablet twice daily. Blood was taken to check Phenobarbitone levels and liver enzymes as this medication can cause liver damage. The results came back – liver enzymes normal, Phenobarbitone 30 mgs per litre (normal 15-45). The vet said his epilepsy should be reasonably controlled at this level, but two weeks later he had another seizure. Myra then increased the Phenobarbitone to 35mgs per day – 1 tablet am and 11/3 tablet pm.
It was important that Isaac had his medication 12 hourly and on time, so I adapted my lifestyle and would not consider leaving him overnight. Always a good traveller, in May Isaac accompanied me to Cornwall, sleeping contentedly for most of the six hour journey in his basket on the front seat of the car. While we were there he did have a severe seizure, but apart from this enjoyed the change of scenery.
We continued to go to the referral unit every two to three months. In July Isaac suffered a respiratory arrest there following a routine blood test. Fortunately he was quickly intubated and resuscitated by Myra, but this was extremely worrying. His seizures were increasing and he would start growling before a seizure as if he had some sort of ‘aura’. When he did this I was able to get him onto the floor, holding him throughout to prevent him hurting himself.
In August Myra prescribed Potassium Bromide 1/2 x 325mg tablet each day, reducing his Phenobarbitone to 1 x 15mg tablet twice daily. For three days following the medication change Isaac had ‘growling episodes’ – obviously small seizures, four or five times a day. He then had a bad seizure, but after this we had a wonderful seven weeks when he had no seizures at all! The Potassium Bromide caused him to develop a slight cough which just lasted a few months then disappeared completely.
Isaac’s seizures returned and during October there were four days in which he had around fourteen small seizures. His weight dropped to 3.5kg. In addition to his other medication Myra prescribed Levetiracetam– to prevent cluster seizures such as he was having, but Isaac became very agitated and it was stopped. Diazepam 1/4 x 5mg tablet was then prescribed to be given following severe seizures.
Driving back from Cornwall in November with Isaac sitting beside me he suddenly had a seizure. Pulling over into a lay by on the A303 miles from anywhere, thankfully he recovered fairly quickly and we resumed our journey. Later he started vomiting. We went to the vet and he was given Tagamet and Clamoxyl by injection. He was dehydrated; his weight had fallen to 3.3kg and once again needed IV fluids. Diazepam was given on admission to prevent any seizures. He came home the next morning, but had slight diarrhoea – it seemed this was an infection and he gradually recovered.
Throughout November and December Isaac continued to have seizures every few days, sometimes more than one a day. On other days he would have frequent growling episodes and I became used to jumping out of bed in the early hours of the morning if he began growling or having a seizure. He was never left alone for long periods of time and I stopped doing most things that took me away from home, apart from working. After a severe seizure Isaac had Diazepam which made his back legs weak. I had to prevent him jumping up onto things, as he would fall.
We saw Myra at the beginning of January 2007. During this particular week he was having frequent small seizures - about six a day, ending in a severe seizure, one of the worst ever, at the end of the week. Following this he only had one more that month.
At the beginning of February Isaac’s nose began bleeding just slightly. Previously the bleeding had been from his left nostril but now it was the right. He was slightly snuffly with a sore eye so I took him to the vet. Clamoxyl and Dexamethasone were given by injection. Two days later he was sneezing blood so Prednisolone 5mgs twice daily for five days was prescribed. He had responded well to this medication in 2004. Confident that this would sort out the problem, I again took Isaac to Cornwall.
During the four days that we were there he had eight major seizures and I frequently used Diazepam. His nose only bled slightly a couple of times but once home it started again so Synulox 50mgs was prescribed 1 tablet twice daily. Once more I hoped this would cure what I felt was an infection, but it did not.
By the end of February now really worried I took Isaac to Myra. She prescribed a regime of Prednisilone 5mgs, starting twice daily. Isaac was having a bad week with frequent seizures. Two days later at 5.30am blood started dripping from his left nostril, making the bleeding bilateral. A huge nose bleed followed in which he was sneezing large clots of blood. When I told Myra later she was concerned that Isaac may have a tumour, possibly a lymphoma within his nasal cavity, which was eroding blood vessels. As the bleeding was now occurring daily Myra agreed to admit him for a rhinoscopy, X-rays etc to confirm the diagnosis.
She warned me in view of the epilepsy and Isaac’s previous history of a respiratory arrest he was a ‘bad anaesthetic risk’, but I felt whatever the outcome we should go ahead. This was booked for the following Tuesday.
The nasal bleeding continued and by Friday morning Isaac was very snuffly, his nose stuffed up making his breathing noisy. By lunchtime he seemed better and happily ate some food. Later he did not greet me as usual but was sleeping in between two of the other cats unresponsive. I cut up some food, Isaac got out of bed, rolled over and curled up on the floor asleep. Something was wrong, I rang the veterinary surgery and took him in.
We were met by one of the nurses and at that moment Isaac had a seizure in his basket. He was quickly taken into the surgery and given oxygen but just collapsed. The vet was in the middle of a consultation, but came out to attend to him. An X-ray of Isaac’s chest was taken also his blood sugar checked. Again he was dehydrated. We propped him up and put his face into the oxygen mask for about three-quarters of an hour. He had to be transferred to the main surgery in Reigate, but needed to be more stable. The vet warned me that Isaac could have another seizure and die in the car, but he did not and we arrived there safely.
The following morning I was at the Surrey & Sussex Cat Association show running a stall for Cats Protection. I contacted the surgery only to be told that Isaac had been very flat overnight and was in a poor condition. However, during that day he did improve and started responding to the IV fluids and antibiotics given. He came home the next day, no longer snuffly or having difficulty breathing.
There had been almost no nasal bleeding since admission and I was really hopeful that the antibiotics, Baytril 15mgs would cure what I always hoped had been an infection.
Details of the weekend’s events were faxed to Myra and I spoke to her. We agreed Isaac was not well enough to have the rhinoscopy booked for the following day. She warned me the response to Baytril may be short lived and sadly she was right. After just one day at home Isaac became snuffly again and his nose began to bleed. On Wednesday I took him back to the vet who said there was nothing more she could do but suggested I gave him a steam inhalation. This I tried without much success.
The following evening sitting in his covered carrying basket with steam from the inhalation rising Isaac began to sneeze and blood started spattering everywhere. I quickly got him onto the floor. Blood poured from his nose, covering him, the floor and me. His face and both front legs were quickly soaked with blood. It kept stopping and starting for about half an hour. I rang the emergency vet for advice but eventually it did stop. He had really lost a lot of blood and had clots in both nostrils. Gently I sponged his legs and face, but did not do much as he needed to be as quiet as possible.
Two hours later the bleeding started again, thankfully stopping fairly quickly.
Throughout the night Isaac rested but as soon as he got up on Friday morning his nose began oozing. He was so snuffly, he could not breathe but ate a good breakfast despite some blood dripping into his food, and seemed brighter. Worried about leaving him to go to work I was just going when again his nose started bleeding badly. He just sat there, blood dripping onto a wad of kitchen roll until it eventually stopped.
I rang the surgery and spoke to the vet who said there was absolutely nothing more she could do and advised euthanasia. Desperate I contacted Myra who repeated she suspected the bleeding was coming from a tumour. Treatment would not really be feasible. With Isaac’s epilepsy being so severe and unstable (not responding to medication) she advised euthanasia to prevent further haemorrhage and suffering.
I cannot remember what else she said, but she was very nice and as a result of this conversation Isaac died in my arms later that morning.
This decision was one of the hardest I have ever had to make, Isaac had been much brighter that day. All I ever wanted was the very best for him and was determined not to give up because he was epileptic. It seemed so cruel when in addition he developed the severe nasal bleeding that was deemed to be unresolvable. We will never really know the cause of his epilepsy, but I personally feel the most likely cause was an infection with resulting scar tissue causing the seizures.
When you have a cat like Isaac who has special needs you become so very close to them. Following his illness Isaac’s care, needs and medication came before anything else. We travelled together to Cornwall four times and occasionally he came to work, sitting under my desk in his basket when I was unduly worried about him.
I think of him now, enjoying his food, his face covered in A D Diet – he loved it, but after he was ill could never eat properly. His beautiful tabby face looking up at me contented. Still I jump out of bed at night hearing the slightest sound thinking he is having a seizure. I just loved him so much and will love him forever.
My grateful thanks to Myra Forster-van Hijfte at North Downs Specialist Referrals, Caterham, and our veterinary surgeons at the Priory Veterinary Surgeries, Tadworth and Reigate for all the care they gave to Isaac.