Mak Case Overview

Annette Louviere - Georgia

Cases/Abstracts - Winner

As a third year veterinary student, my best study aid has always been my own cat, not that this is something to brag about.  Since a young age Mak has never had a “simple problem” and his latest riddle is no exception.  For the purpose of preserving length in this case overview, I will leave out specifics of medication dosages he is not currently receiving; however, every medication administered to Mak fell within Plumb’s Veterinary Drug Handbook dosage recommendation for felines.

 Mak is a 6-year-old male neutered Siberian cat.  From a young age he gradually progressed to daily vomiting episodes; however, prior to vet school my main concern was to contain the catastrophe that was his left eye.  From his first introduction as a tiny kitten, Mak has battled ophthalmologic conditions ranging from deep corneal ulcerations to eosinophilic keratitis.  It wasn’t until I was a veterinary student that the CVM Ophthalmology Department diagnosed Mak with herpetic stromal keratitis OS.  While his left eye is a chronic condition, it is currently contained and doing well enough to not need treatment; this has allowed me to focus on to his other issue – chronic/progressive vomiting. 

Using food trials and laboratory workups performed during this past year, Mak was diagnosed through exclusion with inflammatory bowel disease and/or gastritis.  Treatment started with a new round of hypoallergenic food trials, each lasting several months, combined with metronidazole and, eventually, Cerenia as needed to control vomiting episodes.  When his vomiting returned after discontinuing Cerenia, B12 shots were implemented as an additional trial.  Again, no change in the frequency of vomiting episodes.  At this point he began showing signs of food aversion as well as significant weight loss and his diet was changed to another hypoallergenic food brand.  Metoclopramide was added as an anti-emetic as well as a gut motility enhancer.  This seemed to work for 2 weeks; however, on the third week he began vomiting again.  During the same week, dark stools were also noted and the possibility of gastric ulcer(s) forming was discussed with his general DVM.  His treatment protocol was adjusted as well as his diet (again, due to food aversion).  He was placed on Iams Intestinal Plus diet and his medication protocol changed to: metronidazole, Cerenia, Pepcid, and amoxicillin.  The antibiotic was started as an empirical treatment for Helicobacter felis infection.  After 10 days on this treatment plan, Mak became anorexic.  Lab work was performed and radiographs were taken.  The abnormalities shown on his full chemistry, CBC, T4, and UA were as follows: 

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