Testing, testing…stumped


The Saturday afternoon call was about Slippers, a two-year-old cat. “She didn’t come home last night,” her mom reported. “She returned this morning, but didn’t eat and acted oddly.” “Oddly how?” I asked.

“Skittish, quiet,…and foaming at the mouth.” That phrase immediately evokes rabies. The movie Old Yeller, with its vivid images of dog turned vicious. Folk tales filled with slobbering, rabid wolves.

It’s true: excessive drooling is often a sign of rabies, which is a severe, almost invariably fatal virus usually spread via the saliva of an infected animal. Symptoms may include all kinds of altered behavior, from unusual shyness to extreme aggression. Because it is contagious to people, extreme care must be taken whenever we have even the slightest suspicion of rabies, but to date, there has never been a case on the Island and Slippers was current on vaccinations, so I wasn’t worried.

“Plenty of things can make a cat drool,” I said. “A bee sting or spider bite in the mouth. A toothache. Anything that tastes bad. Even an upset tummy.”  Her owner decided to watch her and schedule an appointment if she didn’t improve. That night I drifted to sleep thinking, “she probably feels better already.”

An hour later, awakened by another call. Not Slippers, but Elisha, a 14-year-old cat,  diagnosed last year with hyperthyroidism. One of the most common endocrine abnormalities in older cats, hyperthyroidism is usually caused by a benign but hormone-secreting tumor of the thyroid gland. Symptoms often include excessive eating, drinking, and urination, combined with weight loss, and sometimes unusual behavior. I once diagnosed a case whose only sign was that the cat had suddenly started lying down in puddles in the driveway.

“Sorry to bother you so late,” his owner said. “Elisha was outside and killed a rabbit, then raced inside all agitated and panting with his mouth open. He looks uncomfortable and freaked out.”

Could Elisha walk? Was he limping? Were his gums pink? Was there blood anywhere? Any coughing, vomiting, diarrhea, difficulty breathing, seizures? As we talked, Elisha calmed down. “Maybe he was stung by a bee, “ I suggested, “or bitten by the rabbit.” Within an hour, Elisha’s owners reported his symptoms were gone, so I went back to sleep. For an hour, ‘til the next call.

“Slippers really isn’t right,” her owner said anxiously. “She’s had four episodes running madly around the house and drooling.” I shook myself awake and said to bring her right over.

Slippers had a high fever and was dehydrated. She was lethargic, barely moving on the table.  At one point she blinked her eyes in an odd, twitchy fashion and began to drool, but it passed quickly. I drew blood, gave fluids, and prescribed antibiotics for infections such as tick-borne diseases. “Maybe the odd behavior is a reaction to the high fever,” I theorized.

But then, just as we were finishing, Slippers became frantic and I witnessed firsthand what the owners had been seeing at home. This was not a fever reaction, nor a typical seizure like epilepsy. With the fever, sudden onset, and bizarre behavior, this was almost certainly some kind of infection affecting her brain. It might be bacterial, or protozoal, even parasitic, but we had to include viral, and specifically rabies, on our differential. Even though Slippers was vaccinated. Even though it would be a first for the Vineyard. Dispensing anti-convulsants along with the antibiotics, I sent her home with instructions to keep her confined, minimize human exposure, and consider taking her to a specialist in the morning.

Over the next week, Elisha, the hyperthyroid cat, had occasional episodes of agitation, panting, and acute distress lasting up to an hour. When he arrived for an exam I noticed his heart rate was elevated and he had lost weight. “Is he getting his thyroid medication faithfully?” I asked. Not so much. Apparently in the rush of summer, Elisha had missed a significant number of doses.

Hyperthyroidism increases a cat’s basal metabolic rate. The medication lowers it back to normal. Elisha’s bouts of bizarre behavior might simply be uncontrolled hyperthyroidism, his body jazzed up like a person on cocaine or speed. I suggested medicating him without fail and see if the episodes resolved. I gave them a handy device called a Pet Piller and taught them all my tricks for medicating kitties. (Thus will read my epitaph: “She sure knew how to pill a cat.”)

Slippers, on the other hand, was getting worse fast. Impossible for her owners to medicate, she had scratched them repeatedly, and, with the possibility of rabies, however remote, anxiety levels were running high. They brought her back and forth for me to treat but despite our efforts, her condition deteriorated. An agonizing decision was made. Slippers was suffering, the episodes increasingly intense, her prognosis poor. We had to let her go, and we had to be sure it wasn’t rabies.

While making arrangements for testing, I spoke with West Tisbury Animal Control Officer Joannie Jenkinson. She too had been dealing with a cat with bizarre and aggressive behavior. For a moment I was afraid. I was pretty sure Elisha just needed more medication, but what about Slippers, and this other cat?  They both went outside and lived within a few miles of each other. Could the cases be related? Had a rabid bat, skunk, or raccoon somehow gotten here, tangled with these cats, leading to the first rabies outbreak on the Vineyard?

My fears were soon laid to rest. Elisha’s symptoms resolved with regular thyroid medication.  Case solved. The other cat? Their veterinarian didn’t find anything medically wrong and the cat’s behavior improved. Slippers’ rabies test came back negative. That brought a big sigh of relief to all of us who had been exposed, but only small comfort in the face of losing such a young and beloved cat. So what was the cause of her severe and tragic illness? I wish I knew. All I can say for sure is that it wasn’t rabies.