Cat with Mystery illness

Hi, I could use your help figuring out what my cat can possibly have: I took my cat into the emergency clinic a few days ago. She suddenly had an exaggerated swallow (similar movement to a hiccup), but no difference in breathing. I tried to syringe feed her water and she struggled to drink it (I occasionally do this and she’s okay with it). They took X-rays and couldn’t find anything in her throat or body. They sent us home with Omeprazole for 5 days in case it was acid reflux. If that doesn’t help, they suggest an ultrasound. It’s been 5 days and she still often has the exaggerated swallow and raspy breathing. Often, not continuous. Other details: - still occasionally had an exaggerated swallow while on the Omeprazole. - No change in playing, eating/drinking, using the bathroom. - had soft stool the night before symptoms started, and I gave her half a packet of Fortiflora and 1/8 of psyllium husk powder (not the first time)

Hello - and what an interesting case.  Few mystery cases remain mysteries when someone looks the right way with the right tools - but because they dont yet know what theyre going to find, its hard to reliably pick up the most helpful tool first time, especially when its not a common symptom theyre investigating.   X-ray is fairly easy and has a bonus of outlining densities against the lungs / throat / helping to rule out heart problems, so I can see why they picked that first in an emergency.  X-ray shows some foreign bodies but not always soft ones.  Husk sounds to be a difficult one to spot. Ultrasound can need a skilled clinician and a good question for your vets would be what are the pros and cons of going there next (eg what sort of thing would it show / what might it miss).   Endoscopy (a camera on flexible tube that goes down the throat) can sometimes be exceptionally useful and might see things that dont show on x-ray (I once saw someone pull a blade of grass from a cats throat that way) , but once again requires a skilled operator, expensive equipment- and generally a GA.   However, it may be possible that nothing is down there and that the problem might be neurological eg an interruption to the nerves supplying the larynx, or a cough caused by eg heart failure etc.   Your vet, who has seen the case and knows all the specifics, will have a plan to try to get to the bottom of it.   Some clients benefit from asking questions such as, what could this be?   What have we ruled out?  What shall we rule out next?  If it isnt that,what does that leave?  Is referral an option?  - no straight answers there, Im afraid, but I hope that something is interesting to you.

Hello - I am going to answer that again, as my first response was unclear.  First, there are many possible explanations for what you describe, ranging from pancreatitis to regurgination, to lung and heart problems, to laryngeal foreign bodies, lumps and polyps, viral infection, to neurological defecits and even rare manifestations of thyroid disease.  A full examination including listening to the chest, feeling the area and neurological checks will hopefully have left your vet with a list of suspicions / possibilities (differentials) and they will be trying to rule each out in turn. Chosing the best diagnostic test to start with is difficut- your vet will want to rule out the more urgent possibilities, but also the most likely ones first and potentially prioritise the easiest and least expensive tests to some extent.   These rarely coincide in one investigation eg radiography is easy to perform and soft tissue and gas can be distinguished easily (useful in the neck); it can help to detect heart, lung and airway changes.  However, a peice of grass in the airway or a damaged nerve would be less visible using radiography, in which case endoscopy might be more useful.  However, endoscopy sometimes requires a specialist.

It is an art and a science to prioritise the test that will make most difference to the patient.   I can understand a decision to start with radiography; with hindsight it appears that this wasn't helpful although thats not quite true - it may have ruled out some concerning items from the list, but now more tests may be required to find the true cause of the symptoms.  Your vet obviously has more information available to them than I do, and I suspect that their concern is less likely to be, 'what could it be' and more, 'how can we tell the correct cause from the others, most efficiently?'  as well as, 'how can we take care of the patient / stop them from getting worse in the meantime?'   I find that owners benefit from understanding the differentials list and its always ok to ask your vet where they're up to / what is the next thing to rule out.   Specialist referrals can sometimes be helpful.  Please will you let us know what is found?