Ginger
Sunday, August 3, 2025 at 11:08 PM
Subjective
Chief Complaint
Ginger is a cat named Ginger, presented for evaluation and management of mast cell cancer in the spleen and liver.
History
- Biopsy and aspiration confirmed mast cell cancer in the spleen and liver.
- Ultrasound noted thickening of the small intestines.
- Blood work shows mild anemia.
- X-rays from the primary vet were full-body but lacked detailed chest imaging.
Additional History
- History of vomiting and decreased appetite two weeks ago, resolved after treatment.
- Currently eating and drinking well, urinating and defecating normally, and acting more like herself.
- On medication for hyperthyroidism (methimazole) and steroids (prednisolone).
- Owner reports mild lethargy compared to years ago and occasional heavier breathing.
- Previous history of scratching behavior resolved after moving from Texas to Florida.
Objective
Vital Signs
- Temperature: WNL
- Weight: WNL
- Heart Rate: WNL
- Respiratory Rate: WNL
- Capillary Refill Time: WNL
- Body Condition Score: BCS 4-5/9
Physical Exam
- Eyes: Clear with no discharge
- Ears: Clean with no discharge or erythema AU.
- Oral: Moderate dental hardware noted.
- Cardiovascular: Normal heart rate, sinus rhythm, no murmurs. Strong and synchronous pulses bilaterally.
- Respiratory: Increased lung sounds bilaterally.
- Abdominal: Distended abdomen observed.
- Lymphatic: No peripheral lymphadenopathy.
- Coat and Skin: Healthy hair coat and skin, no ectoparasites seen.
- Musculoskeletal: Ambulation normal, no lameness observed.
- Neurological: Normal neurologic exam with normal mentation. No proprioceptive deficits or overt ataxia; normal cranial nerve exam.
- Neck and Thyroid: Left-sided thyroid slip noted.
- Reproductive and Urinary: Normal external genitalia, no discharge or inflammation.
- Mammary: No significant findings
- Rectal: Not examined
Lymph Nodes
- Mandibular Lymph Node: normal on exam
- Prescapular Lymph Node: normal on exam
- Axillary Lymph Node: normal on exam
- Inguinal: normal on exam
- Popliteal Lymph Node: normal on exam
- Other Lymph Nodes: normal on exam
Assessment
Ginger has confirmed mast cell cancer in the spleen and liver. Differential diagnoses include potential gastrointestinal disease (e.g., inflammatory bowel disease or small cell lymphoma) based on intestinal thickening noted on ultrasound. Ginger is currently stable on steroids but may require further intervention to address the cancer and any underlying conditions.
Plan
- Perform chest x-rays to evaluate for metastasis or other abnormalities, including potential heart failure or lung involvement.
- Consult with a surgeon regarding splenectomy and potential liver biopsy during surgery.
- Discuss chemotherapy options post-surgery, including Palladia or CCNU, depending on the owner's ability to administer medication.
- Review blood work and consider repeating if necessary.
- Continue current steroid tapering schedule (1.5 mL once daily, reducing to 0.75 mL next week).
- Evaluate the need for intestinal biopsies during surgery based on consultation with an internal medicine specialist.
- Proceed with splenectomy surgery in mid-July, aligning with the owner's travel schedule, unless deemed urgent.
Client Discharge Note
Thank you for bringing Spike in today. We appreciate your commitment to his care and well-being.
Summary
Spike was evaluated today due to reduced appetite, lethargy, and mild weight loss over the past 7–10 days. On examination, he was quiet but alert, with no signs of trauma or overt illness. We noted mild dehydration, retained shed on his tail, and a slight reduction in body condition. His enclosure husbandry was reviewed, and it was determined that his UVB light is outdated and likely contributing to early metabolic concerns. While no masses or coelomic abnormalities were palpated, further diagnostic workup is recommended to better understand the cause of his reduced appetite and lethargy.
Key Topics We Discussed
- UVB Replacement: Spike’s UVB bulb is over 9 months old and should be replaced immediately. We recommend a Zoo Med Reptisun 10.0 or equivalent, positioned within 10–12 inches of his basking area without obstruction from glass or plastic. Proper UVB exposure is critical for calcium metabolism and overall health.
- Hydration Support: Mild dehydration was noted. Spike received subcutaneous fluids today. Please continue daily warm soaks (10–15 minutes) to promote hydration and assist with the retained shed on his tail.
- Nutritional Support: Begin offering a commercial critical care diet via syringe if he is not eating. We recommend 1–2 mL orally twice daily until his appetite returns. A shift to a more balanced diet—including dark leafy greens and gut-loaded insects—is strongly advised once he is eating on his own.
- Diagnostics: We recommended blood work (CBC and chemistry panel), radiographs, and a fecal exam to rule out infectious, nutritional, or organ-based causes of his signs. These diagnostics can be scheduled during a recheck or under light sedation if needed.
- Environmental Assessment: Ambient temperatures and basking gradients should be checked at home using a digital probe thermometer. The basking area should consistently reach 95–100°F, with a cooler zone around 75–80°F.
- Weight Monitoring: Spike’s weight has dropped from 480g to 450g. We encourage weekly weight checks at home using a kitchen scale to monitor for further loss.
Follow-Up Communication
We will follow up with you in 5–7 days to assess Spike’s response to the current plan and determine whether further diagnostics or treatments are needed. Please do not hesitate to reach out sooner if his appetite worsens, behavior changes, or if you observe signs such as straining, open-mouth breathing, or extreme lethargy.
Thank you for entrusting us with Spike’s care! We’re here to support you every step of the way.
— Dr. Lena Morris