Buddy Learns the ABC's of "ADR"
Buddy is an example of one of our patients who presented as "ADR" (veterinary-speak for "ain't doin' right"). His owners knew that something was amiss with their dear friend, but they weren't quite sure what. Read on to see how veterinary professionals can piece together symptoms to solve medical mysteries.
In the autumn of his eleventh year, Buddy's owners made an appointment for him because he just seemed a little bit off. He would hide from his family for much of the day, and he was quieter than usual, sometimes to the point of lethargy. His bowel movements had decreased in frequency, but he didn't show any signs of abdominal pain when touched. Buddy was also running a fever. He was, however, eating and urinating normally. We began with hospitalization for observation, to administer subcutaneous (under the skin) fluids, and to begin medications to treat his discomfort and fever.
Buddy's fever persisted, he began vomiting occasionally, and he became inappetant; it can be dangerous, of course, for a pet to refuse to eat for an extended period of time. Lab work revealed increased liver values and elevated white blood cells, which, along with the fever, are signs of Inflammatory or Infectious Hepatitis. At this point, we intensified Buddy's treatments with a stronger antibiotic and intravenous fluids. We were able to compare lab work with tests that we had run on Buddy previously, and we could see that he had slight liver elevations in the past, but none accompanied by fever or other symptoms. We consulted with the internal medicine specialists regarding Buddy's past lab work and current condition, and they recommended a liver ultrasound and biopsy to confirm a diagnosis of Cholangiohepatitis and to look for its causes. Because these diagnostics were not feasible for Buddy's family at the time, we began empirical treatment with a maintenance dose of antibiotics and a bile-thinning anti-inflammatory medication. Once his fever and inappetance resolved, he improved greatly, and we're happy to say that, one year later, he has had no additional significant episodes!
Acute or Chronic Hepatitis--sometimes part of Feline Triaditis, or inflammation of the bowel (IBD), pancreas, and liver tissue--can present with swift onset of vomiting and diarrhea, but often is more insidious a presentation characterized by slow weight loss, poor appetite, and lethargy (though, you'll note, Buddy did not suffer from diarrhea during the above incident). If these symptoms are not given attention early on, the cat often comes to the veterinarian in very poor condition, sometimes even jaundiced--yellowed skin, gums, and whites of eyes, just like in humans. In this condition, the cat may need a stomach tube placed for force-feeding. They may tolerate this well, but it requires a short surgical procedure and frequent feedings by very dedicated owners, sometimes for weeks until the cat begins to eat on his or her own.
The medical slang "ADR" is a patient presentation that can result in such a wide range of diagnoses, and unfortunately some of these may be quite serious, as in Buddy's case. You, as your pet's "parent," know your cat best. If you're observant, as Buddy's family was, and diligent about ensuring your cat receives regular wellness exams, you and your veterinary team can often catch these symptoms early and improve your pet's prognosis. So, if you're ever concerned that your cat just "ain't doin' right," give us a call right away!