[Very Urgent] Advise on Cystotomy vs PU

My 8 year old cat (male, neutered, American short hair) was diagnosed with bladder stones and underwent a cystotomy in February 2024 to surgically remove the stones from the bladder. Unfortunately, the surgeon left behind 3-4 stones in the urethra during the surgery, which were later pushed back in the bladder. These stones blocked him again in May 2024 – he was unblocked via a catheter and the stones were pushed back into the bladder during catherization. He again got blocked a couple days ago and has been unblocked again via catherization with the stones pushed back in the bladder. The X-rays do not show formation of new stones in the last few months and the urinary analysis do not show any crystals.

We are considering three surgical options to remove the sones now: 1) cystotomy 2) PU 3) Cystotomy + PU. Please see X-rays after the cystotomy in February, the one from May and the one from last night and advise on the best course of treatment

A question for Krista Magnifico:

Hello! Hoping to get some advice on recommended next steps for my cat, Sammie, who is being evaluated for IBD vs. small cell lymphoma.

Sammie is 17 years old and is overall quite healthy! Throughout the time I’ve had her, she’s had a history of vomiting a ~once per week or two (sometimes more frequently). Vomit is usually clear, foamy. No other GI issues or health issues otherwise. She is active and energetic, and has not had any health issues until ~1 month ago when I noticed she stopped eating as much as she previously did. She stopped eating her dry food altogether, and seemed to become quite picky with her wet food. I initially thought her teeth may be bothering her because of the avoidance of dry food, so I brought her to the vet.

Vet found that she had lost a couple of pounds, unintentionally. Based on presenting symptoms, vet thought she might have a GI pathology so ordered an abdominal U/S:

Ultrasound, Abdominal Study Outcome:
Kidneys: overall normal size but mild reduction in detail and small mineral foci. Trace pylectasia noted w/out ureteral disension.
GI: Avg SI thickness normal. Mild corrugation is noted in some regions and some ileus (luminal fluid distension up to 4 mm w/ reduced
peristalsis) noted w/out obstruction. No discrete abnormalities appreciated throughout the small intestines.
Caudal abdominal nodes are prominent to mildly enlarged and rounded w/ smooth texture. One irregular cystic structure noted near right
kidney. The mesentery around the ileus segments is mildly hyperechoic.
A:
Intestines most consistent w/ enteritis
Nodes: r/o reactive vs other
Cystic strucure: r/o benign mesenteric vs inflamed node
Kidneys have evidence of chronic disease.

Here are her prior labs:
PRIOR LABS:

7/15/24: Wt loss 0.28 lb; PCV: 40/7.6; Chem18: BUN 41, creat 1.7, K+ 4.3, phos 4.2
U/A: USG 1.019, pH 6.0, rare wbc/rbc; no bact/cryst; cobalamin: 437; folate: 11.2

2/13/24: Wt loss 0.8 lb; CBCcomp: hct 44, diff wnl (clots in sample; rec. resubmit)
Chem25: BUN 40, creat 1.3; T4: 2.8; SDMA <10
U/A: USG 1.025, pH 6.0, rare wbc, no rbc/bact/cryst, rare fine gran casts.

1/19/23: Wt loss 0.4 lb; CBC: (hct 40, diff wnl); Chem25: (BUN 32, creat 1.3)
T4: 1.8; U/A: USG 1.051, pH 6.5, 1+ prot, rare wbc, no rbc/bact/cryst

11/19/21: CBC: (hct 46, diff wnl); Chem: (BUN 34, creat 1.5); T4. 1.9; DGGR lipase 9
U/A: USG 1.053, pH 7.5, rare amorph. crystals, no wbc, no rbc

6/17/22 Wt loss 0.16 (as desired); USG 1.040; SDMA: 11

Most recent A&P:
A:
1) Intestines most consistent w/ enteritis (IBD vs SCLSA); ileus likely cause of decreased appetite.
2) Nodes: r/o reactive vs other
3) Cystic strucure: r/o benign mesenteric vs inflamed node
4) Kidneys have evidence of chronic disease ; in keeping w/ previous lab findings.
P:
1) Rx: metoclopramide 5 mg: 1/4 tab po every 8-12 hrs.
2) Continue vit B12 as Rxed.
3) picked up Mirataz but hasn't started it yet. Rec. give. metoclopramide for 2-3 days and then if not improved appt, start Mirataz.
4) to consider presumptive pred tx vs ex-lap for biopsies.

Sammie is seeming to eat better with the metoclopramide.

My question:
Is pusuing an ex-lap for biopsy recommended vs. empiric tx for IBD with steroids vs. empiric tx for SCL with steroids + chlorambucil.

Thank you!!!

I have a very special and painful case I need help with, I have tried several different veterinarians with no diagnosis or prognosis so far. It may be a long shot, but I was hoping you could help me shine a light on this.

In April I found an extremely skinny stray cat and took him in. I first thought he was malnourished from lack of food for being in the streets, but 4 months in his case keeps unfolding.

He is likely older than 15 years old, but he’s a happy cat with a lot of energy and mobility. He weighs 3kg but he’s a big cat, you can feel every single bone in his spine, although you can’t see them that easily because he has long hair. He’s completely affectionate, loves to be pet, and asks very politely for attention and food all the time.

All we know about his past is he is neutered, he had some teeth surgically removed and he tested negative for FIV and FeLV.

He had a huge appetite when I first took him in, he would eat 100g of food in one meal and ask for more right after. He would sometimes ‘cough’, it sounded like he was choking on some kind of fluid, it doesn’t happen in sequences, but it happens almost every day until today.

He always drank LOTS of water and produced a lot of urine as well. His feces at the beginning were really solid with some mucus.

After a month, he continued to eat plenty and hadn’t gained any weight, that’s when he started to throw up. It started happening a few days a week, usually after spending several hours without eating he would throw up a clear frothy fluid with no content, and then it progressed to twice every day regardless of when he had eaten.

We suspected it could be diabetes or hyperthyroidism, but the labwork didn’t confirm either, it showed regular kidney function with small liver function alterations.

We then introduced prednisolone (2,5mg/day) and changed his diet from a mix of natural home-cooked protein, hypercaloric wet food, protein supplements, and dry food to exclusively Royal Canin Hypoallergenic while waiting for Royal Canin Gastrointestinal Hydrolyzed Protein to arrive in Brazil, keeping Omega 3 (fish oil) 500mg/a day in his diet.

Vomits went away for a while. He kept drinking lots of water and peeing a lot, but his feces got softer (not liquid).

He had periods where he lost his appetite, which we treated with mirtazapine, he reacted after 6 days.

We performed an ultrasound and discovered that basically all his internal organs were compromised. He has severe alterations everywhere. Still, the best specialists I could find couldn’t tell me what was causing it and offer a course of treatment that didn’t involve opening him up to collect tissues for a biopsy.

I personally think it is absurd that a doctor could look at this frail elderly cat who obviously can’t resist anesthesia without serious risks and say that surgery is the only way to go, all to find out for sure if we’re dealing with a lymphoma or an infection. I’m looking for someone to advise me on the most effective course of action. Of course, I aim to reverse his condition, but I understand that given his age and how advanced it is, it might not be an option.

He is currently at 3kg, eating exclusively Royal Canin Gastrointestinal Hydrolyzed Protein with fish oil, and taking prednisolone every day for a month now. His appetite is healthy, he still drinks a lot, pees a lot, and poops regularly but softer. He eats an average of 5 small meals.
Vomits are back down to a few times a week, usually early in the morning before his first meal, and always a clear liquid. He goes and eats right after throwing up so I get the impression he is not nauseous.
He doesn’t seem to be in pain overall.
He’s not gaining any weight regardless of all my efforts.

That is why I’m giving this a shot and trying to get your attention. I hope you have more resources and knowledge that could help me figure out appropriate next steps to give this little guy the best fighting chances I can.

On this link you’ll find a translation of his bloodwork and ultrasound. I had chat GPT translate it for me so forgive me if there are errors.
Link: https://docs.google.com/document/d/1yqcen-TYzyvfBYU-J4t1tCHola1E2otDGDa1H7V032Y

I appreciate any support you can lend me, his name is Valentim which means brave and strong, and I want him to win this fight.

My 1 year old dog (1/2 lab, 1/4 German shepherd, 1/4 boxer) has a large, perfectly round red bump on her face. I have researched and see potential answers but we are currently out of town and cannot take her to the vet yet. She is very important to me so of course I am concerned, but I would like opinions on whether I should be panicking as much as I am according to the photos I provide. Some articles say cancer, others say histiocytoma.

I could really use some advice about my 7 year old cat, Squeak. I posted a comment on Dr. Magnifico’s YouTube video about a cat named Bear that had ear polyp surgery but thought I’d post here, too. I am an emotional wreck right now because yesterday morning I got some very bad news regarding Squeak’s cytology results from a FNA that was done at a specialty hospital. Sadly, my poor boy was diagnosed with malignant melanoma for the 3rd time in two years! I’m heartbroken… The trouble started at the end of December 2022 when I noticed a small lump on his right pinna. My primary vet did a lumpectomy and sent it off to be evaluated. Came back malignant melanoma. Excision was complete with clean but narrow margins. All was well until September 2023 when I found another lump at the base of the same ear. My vet advised me to go for a consultation with an oncologist and it was recommended that Squeak get a TECA-BO done. I was told that this procedure can be “curative” in some cases. The cost was astronomical but I wanted to do the best for my cat. He means the world to me! I began calling specialty vet hospitals to schedule the surgery as soon as possible but none near me were able to fit Squeak in. I finally found one in Pennsylvania and made an appointment for a surgical consultation. The surgery was done on September 25. My boy was a real trooper and recovered well. He did lose the blink reflex in his right eye but it resolved in about 2 weeks with me putting moisturizing drops in his eye daily. I was thrilled with Squeak’s progress and I thought we might have won the fight even though there was no guarantee that he’d be out of the woods now. I had to take money out of my retirement savings to pay for this surgery (it was actually more than $10,000!!) but it was worth it to save my cat’s life. Recently, I noticed that Squeak had been shaking his head and scratching where his incision was. I had an appointment scheduled with my regular vet for a checkup and to get some chest x-rays to make sure all was well. While there, I mentioned about the scratching and head shaking and asked if maybe it was scar tissue causing the reaction. My vet wasn’t concerned and just said “Maybe he feels something.” X-rays were clear and showed nothing concerning. I was told to come back for a recheck in 6 months. However, the symptoms gradually became more frequent and I brought Squeak back to the vet. This time, thinking it might be an infection of some kind, he prescribed Baytril and prednisolone for a course of 2 weeks. There was no improvement and this was very concerning for both the vet and myself. He said that it would be beneficial to get a CT scan to find out what we were dealing with. I was beginning to panic because I had a feeling where all this was leading. I took Squeak to the same hospital where he had his oncology consult. He was examined by a veterinary surgeon first and she did a FNA . Unfortunately, the CT scan could not be done because their machine went down. I got the cytology report yesterday morning. The pathologist’s interpretation was “Lymphocytic proliferation and many atypical multinucleated cells; suspicious for lymph node with metastatic amelanotic melanoma.” The vet that did the FNA said she would consult with an oncologist and get back to me with options for “treatment”. Surgery, radiation and/or chemo was mentioned . Meanwhile, I have been scouring the internet for any information I can get to help me make the right decision about what to do next. I have also posted on numerous cat health forums but only got one response from a vet in Virginia. He said that radiation would be recommended if there was a concern about margins but chemo would not be a good choice for this kind of cancer. He wanted me to keep him posted so I told him about the cytology results. I have not heard back from him yet. Can I please ask for your opinion about all this? I posted this in hopes that Dr. Magnifico would see it because she has done a similar type of surgery for a cat. Can anyone give me some guidance about how I should proceed? I will be discussing this on Monday with my regular vet after he reviews the report that was sent to him. I know I should just calm down but I’m basically a mess! Any information about a way to extend Squeak’s life and keep him comfortable would be SO much appreciated. Thank you!

My son’s dog need surgery. A very expensive surgery. I have been trying to find a place that will help with this with no luck. If my son’s dog doesn’t get the surgery he will need to put him down. There is something wrong with his jaw and now having a hard time eating. Someone plz help me save my son’s dog.

Hi Dr. Magnifico,

Our adopted cat (former stray cat, now 100% indoor) has always shown all of the signs of a nasopharyngeal polyp (about 4 years now). I didn’t know what it was until I saw videos of cats with similar breathing noises and eventually saw your YouTube polypectomy videos.

Three short videos of his breathing sounds (turn up your volume) follow:

Called our vet for a surgeon referral, but they’ll only refer for a CT scan ($2000) before they’ll refer to a surgeon. Surgeon’s websites all indicate that they will only accept appointments by referral from a general Vet, so I can’t just make an appointment for examination by a surgeon (which I’m happy to pay for).

Bottom line, looking for a second-opinion / consult (happy to pay!) on whether it’s really necessary to do a $2000 CT scan *before* being referred to a surgeon for (a probably $2000) surgery. I’d rather just have a surgeon put the cat under anesthesia, go in, look for the polyp, and remove it if they see one. Happy to pay $2000 for just that surgery, even if it turns out there’s no polyp.

Thank you in advance for any response.