PEOPLE | PETS | COMMUNITY

Saving Sunni: Animal Emergency & Specialty and the Case of the ‘Great Pretender’

When Skyler Cesarone returned home from a business trip, his house was eerily quiet. Skyler, 36, shares his home with his best friend, a tabby named Sunni, and his feline family member didn’t greet him at the door as usual.

“I travel a lot for work and was just returning home from a week-long trip to Edmonton, Alberta,” Skyler recalled.

Sunni didn’t greet Skyler at the door like he normally did.

“My friend had been going to the house in the mornings and evenings to take care of him. I returned late on a Sunday evening. I dropped my bags off in the bedroom, then came out to the living room to see him bundled up in a blanket on the couch.”

Sunni made the effort to pop his head out to acknowledge Skyler’s return.

“I unraveled him from his nest, and he went to stand up, but plummeted off the couch. His dead weight hit the floor,” Skyler said.

“I think this startled him (and me!) quite a bit. He began to flail around and really struggled to regain his footing. I was horrified! I immediately called my buddy to see if he had been behaving normally that day (I typically receive daily reports regarding Sunni), and to check in to see if he might have gotten a different food, or treats, or anything – I just wanted answers. He confirmed that everything was just fine, so I scoured the house to see if anything was amiss.”

Skyler had adopted Sunni as a four-month-old kitten the summer of 2011, a season befitting his namesake. A friendly, happy, gregarious cat, Sunni had always lived up to his name. “Sunni lives to eat,” Skyler said, laughing, “but his ability to brighten up a room rivals the allure of any treat. My friends and family ask how Sunni is doing before anything else. He’s very affectionate, loves people, and consistently greets guests just like a dog would. If only he did the dishes!”

Skyler and Sunni

Sunni also loves to play fetch and has conditioned Skyler to throw his toy down the hall. “It’s chuck the toy, rinse, repeat,” Skyler said. But today, Sunni could barely lift his own head. Skyler was perplexed.

“I couldn’t locate anything out of place,” Skyler recalled, “so I monitored him closely and then took him to Northgate Veterinary Clinic, ten minutes before they opened the next morning. Dr. Park conducted some tests on Sunni, revealing an extremely low body temperature, low blood pressure, and very low electrolyte levels. After trying to rehydrate and care for Sunni, Dr. Park recommended a visit to Animal Emergency & Specialty (AES) to seek further treatment and to help identify the culprit for these symptoms.”

“Sunni was transferred to AES from one of our referring veterinarians,” recalled Mark O’Hanlon, DVM, owner of AES.

“When we arrived, we were promptly greeted by the staff at AES,” Skyler recalled. “Upon initial observation, Sunni could barely stand up. He looked like a cat with cerebellar hypoplasia: he had no balance, no equilibrium, and couldn’t move more than a few wobbly inches. It was hard to watch!”

“Our Emergency Team immediately got to work giving life-saving treatments to stabilize Sunni and performing tests to address the underlying cause of his symptoms,” Dr. O’Hanlon said.

“After our board-certified critical care specialist, Dr. Christin Reminga, took charge of Sunni’s care, she requested a specialized test called an ACTH stimulation test to confirm her suspicion that Sunni was experiencing an Addisonian crisis. Because Dr. Reminga had already begun treating Sunni for Addison’s disease, he was on the mend by the time test results confirmed the diagnosis, about 12 hours later.”

Addison’s was a surprise diagnosis for everyone.

Sunni at Skyler’s desk.

Addison’s disease (hypoadrenocorticism) is caused by inadequate production of hormones due to a dysfunction of the adrenal glands, which are located near the kidneys. Adrenal hormones are essential to healthy body function. If left untreated, Addison’s can lead to serious health problems and even death.

“Any diagnosis would’ve surprised me at that point; his symptoms had already stumped a few veterinary professionals,” Skyler recalled.

“Because Addison’s is most common in young to middle-aged female dogs and rarely seen in cats, our Team was surprised that the ACTH test confirmed that Sunni has Addison’s disease,” Dr. O’Hanlon said. “Luckily, our ER doctors and critical care specialist have ample experience diagnosing Addison’s in dogs, so when Sunni’s comprehensive blood panel showed abnormalities typical of Addison’s, it immediately warranted their consideration, despite Sunni’s species. Addison’s disease is so rare in cats that veterinarians can easily go their entire careers without ever seeing a feline patient with Addison’s disease. Surprisingly, Dr. Reminga has diagnosed two cats with Addison’s in one year, Sunni being one of them! She does not expect to see another feline case for many years, if ever again.”

AES provided reassurance throughout Sunni’s treatment.

“I’d never been to an emergency vet before,” Skyler said. “Based upon the detailed intake charts that the staff did on Sunni, Dr. Reminga ran a test based on a hunch. She explained to me that she recalled that in veterinary school she took a course which delved into triggers and unique causes for rare diseases and afflictions in mammals,” Skyler said.

“The dangerous combination of very low electrolytes along with a slowed pulse and body temperature sounded familiar to her, but could it be? Dr. Reminga knew that this disease – more common in humans and even dogs – was not at all common in cats. The telltale signs are high potassium and low sodium electrolyte values. I found all this out at 6:15 the next morning, after Dr. Reminga had spent the evening with Sunni. Sunni was subsequently treated and began improving towards normalcy with every hour. I was thrilled. They kept him in there one more night for observation and then I was able to take him back home the following day. By that time, he was essentially back to his spirited, bright, and playful ways – I was completely amazed by all of this: he was convulsing on the floor a handful of days earlier.”

Thanks to the excellent care he received at AES, Sunni recovered, and moved with Skyler to Canada a little over a year ago.

Jordan, Sunni, & Skyler

“I asked my younger brother Jordan if he wanted to ride out there with Sunni and me. He agreed and we loaded up a big ‘ol GMC Yukon with all our gear and hit the road to Toronto, Ontario. Jordan rode shotgun as the navigator, along with his assistant Sunni—ever watchful on the center console.”

Life with Sunni today is happy once again. “He has a lot of room to bound around and do his thing, and maintains all his great aforementioned qualities. He continues to revel in meeting any new friends I have made in the great country of Canada,” Skyler said.

“I don’t know much about Addison’s, short of the fact that it can really sideline you if previously undiagnosed! I believe President Kennedy had Addison’s disease, which to me is just short of a miracle, considering his exploits on a PT-109 boat in the Pacific Theatre. One of his many noteworthy accomplishments and becoming of a true Commander in Chief.”

Sunni seeing the sights

Skyler loved the care that Sunni received at AES. “The sheer amount of empirical knowledge that their veterinarians require to formulate a diagnosis, versus simply being told or directed to ‘where it hurts’ or ‘what’s ailing ya’ is almost as miraculous, like Dr. Reminga’s scholarly hunch on Addison’s as Sunni’s root illness,” he said.

“As suggested by its moniker, ‘The Great Pretender,’ Addison’s disease can be tricky to diagnose because its symptoms can be vague, wax and wane over time, and resemble many other illnesses,” Dr. O’Hanlon said. “Common symptoms include lethargy, loss of appetite, vomiting, diarrhea, increased thirst, excessive urination, weight loss, depression, tremors, and muscle weakness. Patients are often misdiagnosed as having inflammatory bowel disease (IBD), infections, parasites, renal failure, urinary blockage, pancreatitis, etc.

“Consequently, many pet parents do not become aware of the disease until their pets end up in the emergency room in an Addisonian crisis, like Sunni. Pets in crisis may present with multiple or acute forms of the symptoms above, collapsed, or unresponsive. Thankfully, with hospitalization and treatment including intravenous (IV) fluid therapy and glucocorticoid steroids, along with supportive care, many pets in Addisonian crisis show rapid improvement, also like Sunni!

“Because there is no cure for Addison’s disease, life-long adrenal hormone replacement and electrolyte monitoring will be necessary. Long-term care typically involves an oral medication daily or a subcutaneous injection (shot) every 25 days, plus glucocorticoid supplements. Monitoring electrolytes through regular blood tests will be important, especially when beginning treatment. The key is to partner with a family veterinarian or internal medicine specialist to find the lowest effective doses of appropriate medications.

“Because stress can exacerbate the symptoms of Addison’s disease, families with Addisonian pets will need to take special precautions – either to avoid stress or increase medications during stressful times. Stress can take many forms, both physiological (like illness, injury, surgery, overexertion, etc.) and emotional (including unfamiliar environments or people, loss of a furry or human companion, changes in routine, or even a new toy). As with people, what one pet might find stressful and how much stress a pet may be able to tolerate will vary.

“Properly diagnosed and managed, the prognosis for pets with Addison’s disease is excellent. Although the necessary financial, emotional, and time commitments may seem daunting at first to families with Addisonian pets, advancements in veterinary medicine are making life easier. With a little help from their families, pets with Addison’s disease can live long, happy lives!”

Sunni overseeing Skyler while he works

Skyler added: “Pets are absolutely timeless—respect, love, and actively make them a part of your family and you will have a true friend for life.”

Dr. O’Hanlon and the staff at AES are happy to hear about Sunni’s recovery.

“We wish Sunni continued good health and happiness in Toronto!” Dr. O’Hanlon said.

To learn more about AES, visit their website here.