One day in April, 2020 I noticed that Brutus was sitting oddly. I thought he was transfixed by a bug on the floor. I pet him and discovered that he could not raise his head !
He didn’t seem like he was in physical discomfort, his neck area wasn’t tender or swollen, like from a bite abscess from one of the other cats. He was walking around okay, though slowly. He was still interested in food.
It was later in the afternoon so my vet wouldn’t be able to see him. I debated about taking him to to the ER vet – but he wasn’t in acute distress. I knew that he had an area of arthritis on his spine, so I worried that he had a slipped disc or something. I had some gabapentin left over from a previous vet visit. This is often used to relax stressed cats, and can help with pain management. I gave him a small dose, and assumed that IF he was in pain that this would help him a little.
There was no change.
The next morning he went to the regular vet. COVID 19 restrictions had been in place for over a month. The vet clinic would not allow people inside with their pets. You could only hand over your pet to the tech, then they would call you to discuss what was going on with your animal.
I knew from previous cats with kidney failure that acute potassium deficiency (aka Hypokalemia) could induce Ventroflexion – the inability to raise the head. Yet Brutus wasn’t showing signs of kidney failure.
The vet gave him an exam and took a blood sample.
Later they called with the results. Overall it looked pretty okay, although his potassium WAS unusually low – 2.7 in a reference range of 3.5 -5.8 mol/L. The results did not indicate kidney failure, though he was mildly dehydrated. What was causing this severe potassium deficiency ? It was a weekend, so I was sent home with supplies for SubQ fluids, with extra potassium added to the bag. After a day this didn’t seem like this was doing much. I purchased some Potassium Gluconate tablets and cautiously gave him one. I also knew from experience that giving a cat too much potassium could induce heart problems.
I posted to the kidney cats online group I had belonged to for years since potassium deficiency was a common issue. One member responded who had a cat with a condition called Hyperaldosteronism – which is where the adrenal glands start to become very overproductive. This can be idiopathic – no known cause – or due to tumours – benign or cancerous. Because of the hormonal imbalance, the body loses potassium.
I spent the weekend searching online for a possible explanation. Very low potassium levels can be caused by vomiting or diarrhea – which he didn’t have. He didn’t have kidney failure. He was fed a commercial diet. What was going on ? The very low potassium levels were a symptom of something.
The member with the cat with HA suggested that since I knew that his potassium levels were dangerously low that it would be acceptable to give him the recommended human dose of potassium. At this point I felt like I had nothing to lose. By the end of the weekend he was starting to raise his head again. His appetite and behaviour was otherwise normal, though he did seem somewhat slow.
Hyperaldosteronism also presents with very high blood pressure. I hadn’t thought to have this checked.
He went back to the vet on Monday and his blood pressure was crazy sky high ! Like five separate readings within half an hour were between 247 and 257 ! On this basis he was given the blood test for Hyperaldosteronism.
The blood sample had to be handled carefully, and the results would take at least 10 days. He was sent home with medication for his high blood pressure.
The following Monday he went back to the clinic. His blood pressure was slightly reduced but not where it would be expected with the dose of amlodipine. It was still extremely high. Odd.
High blood pressure in cats, like people, has serious consequences including damage to the heart. In cats it can also induce retinal detachment, and blindness. This can sometimes be treated with blood pressure medication, and the retinas will reattach and partial or complete vision can be restored. His vision still seemed normal, but for how long ?
With the vet’s approval I kept increasing his dosage of potassium. He was now able to fully raise his head again after about 4 days of intense supplementation.
He went back the following week for another blood pressure test. Even as his dosage of blood pressure medication was steadily increased, his reading was now in the 190’s. BettER but still dangerously high.
The vet clinic was overwhelmed with all the COVID fallout – from people who were now at home with their pets noticing issues they hadn’t before, to the extra work for the staff between handling pets in a different way to all the extra phoning. Despite this, the vet was great about checking in with me on the phone to discuss whatever was going on with Brutus. She agreed this was very odd, and she had not ever dealt with a cat patient who presented this way.
His potassium was checked and rechecked. I was giving him a large amount for a cat. It was steadily increasing, but had not even reached the acceptable lower limit.
The clinic phoned with his Aldosterone test results. In a reference range of 194- 388 mol/L, Brutus’ result was 4522 !
The vet phoned the lab to inquire if this result was even possible or if there was an issue with the sample ? Nope, the lab said, that cat definitely has Hyperaldosteronism !
In close to 10 years of working in a busy practice, my vet had NEVER diagnosed this condition. I have never personally known anyone with a cat with this condition, despite having been involved with cat rescue, and friends with rescue cats with lots of issues.
Brutus was started on a drug that is an antagonist for the adrenal hormone, which works like a triad with the blood pressure medication and supplementation.
After a few weeks of this medication, his blood pressure was finally under control, and his potassium was at the low end of normal.
If a cat (or person) with Hyperaldosteronism has a growth on one adrenal gland, surgery is the preferred treatment. In cats, this is a tricky surgery that must be done by a specialist. Brutus’ extreme blood results indicated that both adrenal glands were involved (aka bilateral) so medication was the only option.
Now – doesn’t it seem odd that a cat in a household exposed regularly to HUGE amounts of uncombusted gas and diesel vapours, containing benzene, would develop a serious heart condition ? Since airborne vapour exposure to benzene is linked to cardiovascular issues, and tumour growth ?
Certainly cats who do not live next to gas stations are diagnosed with Hyperaldosteronism. But why have the cats in my household developed such unsual health conditions since the station opened in July 2018 ?
My vet couldn’t tell me what to expect with Brutus, except that my care would be “palliative”.
Brutus has been holding steady on his medication regime. He takes 10 pills a day, every day to manage this.
I’m glad he is such a tough guy, and that he is an easy going patient. But I wouldn’t wish this on anyone.
Brutus, a few months after his diagnosis, doing okay.