The Left Fielder

Although still rather young in my career with much to learn, I feel like my clinical confidence after the first year of practice is quite strong. My beginning in a rural practice exposed me to a rather unique caseload and allowed me to flourish early on. This statement is being said in a primarily euphemistic manner, given that most new graduate veterinarians may consider my experience a “trial by fire”. If you know, you know. My excerpt rests on one of my recent cases that forced me to take a step back and put on different hats (primary veterinarian, internist, criticalist, parasitologist, pathologist). Resources available for this case were typical of a primary care veterinary facility.

The patient is a two-year-old, male intact, domestic shorthair that was presented to the clinic on March 3rd, 2026 for a four-day history of lethargy, hyporexia, a non-weight bearing-right hindlimb lameness, lack of grooming, and weight loss. This feline patient was originally outdoor-only but was brought inside and still undergoing the transition to a fully indoor lifestyle. The weight loss was quantified over ten days prior to the visit at two total pounds of total weight reduced. An intermittent heart murmur was observed eleven days prior at the surgical intake for an orchiectomy procedure, in which his procedure was postponed. The pro-BNP levels were normal (24 pmol/L) and confirmed an incidental or physiologic murmur. The only noted historic medical condition was a flea infestation/flea allergy dermatitis. There were no current medications being given, although he had received a Revolution Plus in January of 2026.

Due to the vast generalization of these clinical signs, I always find the best approach is to take these cases one step at a time starting with a thorough physical exam. Baseline vitals included 106.9 F, 144 bpm (heart rate), and 28 bpm (respiration rate). The patient’s exam added mild periodontal disease and tapeworm segments. Although these findings were helpful, they raised more questions than answers. An array of diagnostics and treatment options were presented to the client to establish a spectrum of care. These options included referral to a 24-hour facility for overnight monitoring and treatment, day hospitalization with diagnostics and supportive care, or humane euthanasia (given the pet's condition). The owner elected to proceed with day hospitalization and treatment due to cost limitations.

Initial diagnostics included CBC/Chemistry/UA, but the owner declined abdominal radiographs. The bloodwork revealed a mild anemia (HCT 26.1%; HGB 8.5 g/dL; RBC 4.98 10^6/uL), hyperproteinemia (8.6 g/dL), and hyperglobulinemia (6.1 g/dL), while the urinalysis (Method (cystocentesis), USG (>1.050)) uncovered an astounding UTI (TNTC cocci) with a mild concentration of white and red blood cells (0-2/hpf & 2-4/hpf, respectively). There was not a reticulocyte value on the CBC, restricting the ability to further identify the anemia. The hyperproteinemia and the hyperglobulinemia included FIP and Toxoplasmosis onto the differential list. I recommended additional tests to confirm or deny the presence of Toxoplasma or FIP (Feline Infectious Peritonitis), but the owners declined these diagnostics and opted to empirically treat.

With the owner having all the options presented, we continued to hospitalize for a day stay and treating supportively for the diagnosed concerns (UTI, pyrexia, cestodiasis). The supportive and empiric therapy was applied as follows:

• IV Fluid Therapy (LRS): 60 mL/kg/day for three hours, then 40 ml/kg/day for the remaining three hours of the day

• Meloxicam - 0.1 mg/kg - SQ once

• Profender - Topically once

• Clindamycin – 11.9 mg/kg - PO Q12H for 14 days. First dose given in hospital

• Clavacillin – 15.2 mg/kg - PO Q12H for 10 days. First dose given in hospital

The remaining antibiotics were to be finished out at home, as prescribed.

Strict monitoring parameters and recommended recheck appointments were discussed with the owners, as well as emergency clinic contacts provided (in case of decline at home). These included a one-day call for update from the clinical team, a two-to-four-week fecal sample for send out analysis, and a fourteen day recheck urinalysis to monitor the urinary infection.

Even as a confident primary care veterinarian, I still have complex cases that challenge my knowledge, skillset, and clinical capabilities within the practice setting. Currently, as well as in my future years of practice, I can still learn from these cases. This case taught me the term “urosepsis”, as the most likely culprit for the pyrexia and lethargy. I also continue to learn that all questions will not be answered, as in the possible inclusion of Toxoplasmosis and FIP with this case. The patient continually improved following the visit. Experiencing this case and others like it, especially the ones with positive outcomes, keep the magic of clinical practice alive.

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