Instant itching, odd behavior, difficult diagnosis
Question: Dear Dr. Mike,
About one month ago, my indoors kitty, Estee, (1 year old this month) began 'itching' uncontrollably (or at least looking like she's itching). This was not gradual...it happened in just an instant one morning. The signs exhibited were "twitching" back hairs, vigourous shaking of the head, scratching at the ears, flicking of the tail, and frequent 'paw shakings' as if to get something shaken off of them (she has shaken all paws at one time or another during this period, but mainly the back paws). My first thought was that she had been bitten or stung by something. She seemed to lick her trunk, tail and genital area alot and with vigor. Many times, after she would finish licking, she would run as if to 'get away' from what was bothering her. This was very disturbing and happened very frequently! She is the only animal in the house and there are absolutely no signs of fleas. She had a few (4-5) when I adopted her from the Humane Society, but those were quickly taken care of. Even at that time, she never exhibited such exaggerated symptoms.
There have been no drastic changes in the household as of late, other than changing her kitty litter. (I've done this before, but have since gone back to the old litter). She saw a squirrel that climbed onto the outside of the window screen and became quite excited, but she has witnessed this before without any repercussions. I took her to an emergency doctor who stated that it sounded like a 'rogue' flea, but couldn't find any parasites on her. Since then, Estee has undergone a complete CBC (twice), Blood Serum, Feline Leukemia, Feline Immune Deficiency, and Xrays, all resulting within normal limits or negative. The head shaking had been (and still is) so frequent that I have continually asked for the doctors to examine her ears, but have been told they are 100% clean and clear. Treatment thus far first has consisted of a steroid shot, (she developed a fever of 104.2 within 5 days of the shot and a complete loss of appetite...it has since gone down to a high normal level of about 102 and she has regained somewhat of an appetite, but nothing like before). She was then placed on Valium (1 ml twice daily, which made her completely lethargic and was taken off of within 5 days), Clavacol antibiotic (1 ml twice daily for 2 weeks), given a bath, and a dose of Revolution for possible parasites. Now, it is almost one month later, and she still licks alot (though not quite as vigorously, but very frequently) and her head shaking has calmed down a tiny bit but it still quite noticeable, even when she is gathering her food into her mouth when eating. She almost seems like a different cat, refusing the old food she used to eat and has ceased with alot of her normal and playful ways...much less energetic and 'healthy looking'. I've had 2 opinions, and other than the possibility of liver shunts (which neither doctor feels is the cause due to her normal blood levels) and a brain lesion (which she seems to have no outward signs of), my doctors have come right out and stated that they are stumped with what this could be and how to properly treat it!!
Do you have any advice? My mom said that she witnessed when the kitty was only 4 months old, a little of the paw shaking back then, but it was extrememly infrequent (she never saw any of the other symptoms). I never noticed this, though, except when her paws get wet. Could this be some kind of a quirk in her system? I feel so bad for her and just need to find a reason for all of this!! I lost my beloved cat of 7 years (just days before getting Estee) to a horrible cancerous tumor wrapped around his heart, so I am not prepared or strong enough to see another 'baby' go thru this! Your help will be greatly appreciated!
Kim
Answer: Kim- I am hopeful that Estee has continued to improve. I can put together a list of some disorders that might have the signs that you are seeing but I have to admit that I think I would be as perplexed as your veterinarians are and am not confident that any of the things on this list really explain what you are seeing, as most of them would cause only part of the signs and should have other signs, but just in case something rings a bell for you or your vets:
Feline hyperesthesia syndrome -- an unusual condition in cats in which they are very sensitive to touch and sometimes appear to be in unexplained pain. May be due to defects in the spinal muscles (current theory). Sometimes has a waxing and waning course.
toxoplasmosis (usually acquired from raw or undercooked meat in housecats, prey in outdoor cats). Some cats with this exhibit behavior changes and seizures that might fit what you are seeing
feline ischemic encephalopathy -- usually there are severe behavioral changes, including a decrease in mental acuity and often aggression, but sometimes the behavioral changes associated with this condition are more subtle. The current theory is that this disease occurs due to migration of Cuterebra (a fly) larvae.
hepatic encephalopathy -- liver shunts are the major cause
brain tumor -- hard to prove, as your vets have pointed out
feline infectious peritonitis (FIP) - can cause vasculitis or neuritis that can lead to odd signs. Is hard to rule out but is less likely with the improvement you have seen
seizure disorders
flea allergy dermatitis - the ER vet was right that one or just a few fleas can cause severe reactions but usually there is a good response to cortisones
food allergies -- can cause severe pruritis
spinal disc disease- not too common in cats, but with the availability of MRI testing at some vet schools the incidence appears to be higher than what we diagnose in practice
demodectic mange (possibly other mange mites)- these can cause severe itchiness. Demodecosis can sometimes be found with skin scrapings and sometimes requires skin biopsies.
hyperthyroidism -- this can cause behavioral changes but would be REALLY unlikely at this age
hypertension- - we see cats with the ear twitching and general unrest that have hypertension but at this age there would likely be an identifiable underlying cause, like congenital kidney disease
ringworm -- can be very itchy in some cats and may not cause enough visible skin disease to be obvious -- a toothbrush culture (rubbed through the hair) to find it is reasonable in almost any skin disease in a cat
viral skin disease (calicivirus, herpesvirus, FeLV)- more and more it seems obvious that the viral illnesses, especially herpes virus and feline leukemia virus can cause severe skin disease and herpes virus may just cause neuritis that causes pain or itchiness, without much obvious skin disease. Usually this will clear up but it can take a long time, especially since cats with this seem miserable.
I really do hope that Estee has just gotten over this problem, but if not, the ringworm, food allergies and mites might be worth making a diagnostic effort for. Your vets will know how to rule out these problems. It seems reasonable to test for a liver shunt to me, too. Feline hyperesthesia syndrome is difficult to diagnose but if the other stuff is ruled out it might be worth considering as a possibility. I don't know if you would want to pursue muscle biopsy and more advanced testing but if you would, a referral to a veterinary neurologist might be the best approach to figuring out if this is the problem.
Mike Richards, DVM 10/9/2001
Sneezing, excessive self grooming
Question: I have a few questions regarding my cat. The cat is 4 1/2 years old . She is constantly licking herself. She did this about a year ago and was on ovaban for ten days which seemed to have cured the problem. A few weeks ago she was sneezing, drinking water, and eating excessively also. She seemed to do the sneezing after eating the Science Diet cat pellets which I have now replaced with Friskies. This seems to have stopped the sneezing episodes. She also doesn't drink as much water or overeat now. She's been on the Science Diet food for a number of years. Could this have caused the sneezing? I think this cat experiences a lot of stress also. She loves it outside but the outside cats are mean to her. She's scared the whole time she's outside unless I'm with her. She tends to spend most of her time indoors now. She always followed my dog around inside and outside which may be stressing her too now that he's gone. Could she have a more serious problem causing the allergies? Would a blood test help determine why she's always licking herself? Is it hard to obtain a blood sample from a cat? Do they have to be sedated?
Thanks again for your time!
Answer: Susan-
Cats that groom excessively often do have an underlying disorder causing itchiness. Fleas are probably the most common problem, followed by allergies (inhalant/atopy, food, contact), bacterial skin infections, ringworm (fungal skin infections) and psychological causes (psychogenic alopecia, obsessive-compulsive disorder). It can be hard to figure out how strongly to consider the psychological causes without trying to rule out all the other causes. In some cases, response to therapy is a reasonable way to rule in or rule out some of these problems. Megestrol acetate (Ovaban Rx) works for both itchiness and suspected psychological causes but has the potential for serious side effects with long term use. It is probably safer to use corticosteroids for itching than megestrol acetate, but there are veterinarians who feel that the reverse is true. Good flea control is absolutely essential as a first step in working through skin disorders in which itching is suspected. Then testing for allergies might be worthwhile but the best tests for this are intradermal skin tests, in which small quantities of the allergens in your area are injected into the skin. We refer our patients to a veterinary dermatologist for this testing. If the increases in drinking and/or urination continue it would be a good idea to consider blood and/or urine testing to rule out diabetes and kidney problems.
I would be pretty surprised if the Science Diet was causing sneezing by itself, but the size or shape of the food might be more aggravating to a problem such as periodontal disease or other problem that will sometimes lead to sneezing.
I think that stress can contribute to many problems and that pets often suffer from stress when another pet in the household dies. This would be particularly true of the psychologic causes of excessive grooming. If there really seems to be a good chance of a psychologic cause rather than a physical cause, medications such as amitriptyline (Elavil Rx), fluoxetine (Prozac Rx) or clomipramine (Clomicalm Rx) may be helpful.
I hope that things have improved some since you wrote.
Mike Richards, DVM 2/3/2001
Question: dear Dr Mike,
our black cat KeeKee, who arrived here four years ago and stayed and therefore whose age is not quite known, but who is getting up there in years(8? 9? 10?) and who tested positive for leukemia four years ago has been for all appearances healthy since. as an outdoorcat he was quite the hunter, and very strong. on several occassions dragging full-sized rabbits through his cat door....upon neutering he has taken increasingly to indoor living. lately he sticks his tongue out partway a lot. i often see him sitting around like that. my husband thinks he does that because he's happy. but to me it seems he might not be in control of it. I am wondering if youve ever heard of this or seen it. and if it might be some kind of indicator of some condition or other...
thanks for your time if you get around to this...I realize you may have a thousand more pressing matters.
Lily
Answer: Lily-
Before I get to the part where I tell you the things that might be wrong, I have to be sure to say that if KeeKee seems normal in all other respects it is very likely that he is normal and that your husband is right --- or at least that there isn't a harmful cause of his tongue sticking out habit.
Now that we got through that part, there are some things that can cause the tongue to stick out or to enlarge, which might make it stick out, too.
Acromegaly, which is a hormonal disease that affects a small number of cats in their lifetime, makes the tongue enlarge in some patients and it may stick out slightly when this occurs. This is disease in which there is too much production of growth hormone and it causes increased drinking and urination, increased appetite, enlargement of the head, separation of the teeth (they move apart as the jaw grows), heart disease and other symptoms. Since you don't report any of these signs, I am hoping that none are present.
There are several reports on cats with feline leukemia that include observations of tongue sores, which might cause the tongue to stick out. In addition, there are some anecdotal observations of cats with feline leukemia sticking their tongues out, with no mention of cause. There is a chance in these cats that they would have done this, anyway, and that the feline leukemia virus just happened to be present.
Several diseases that can affect the central nervous system can cause the tongue to stick out or to fall out of the mouth on one side or the other (this doesn't usually happen in cats because their tongue isn't as mobile as a dogs). Toxoplasmosis, feline infectious peritonitis and feline immunodeficiency virus are possible diseases that can cause neurologic signs in cats.
It is possible for tooth problems, gingivitis and pharyngeal problems to make it more comfortable for a cat to keep its tongue held out rather than in the mouth. Usually by the time this happens there is some evidence of difficulty swallowing or discomfort while eating.
If KeeKee develops something that really seems like an illness to you, then it would be a good idea to see your vet as soon as possible. I am pretty sure that you are not seeing anything like this at this time, based on your note. So I think it would be OK to wait for the next routine visit to ask your vet about this problem unless I am wrong about the lack of other signs, currently.
Mike Richards, DVM 1/18/2001
I have an 11 yr. old cat named Natasha. She has had oxalate stones removed about 2 yrs ago. Since then there have been a few urinary problems that have since been cleared up w/Amoxicilin quite a long time ago. She is now on the food CD-0 & is doing fine. However, I recently (about 4mos ago) adopted a new cat (Sugar) who is 3 yrs old. They are far from the best of friends. Natasha only urinates 1x per day. She started to hold back her urine, so every morning I take her into a separate room (alone) so that she can eliminate in privacy & no sign of blood. However, she is drinking tons and tons of water. I know that the CD-o is a low sodium diet, but it also should increase water consumption. However, the water consumption seemed to have quadrupled since the addition of the new cat. Coincidence? Nerves? I dropped off a urine sample, but it was not clear enough to check for crystals (too much litter go in it). However, the Vet thought the concentration was good. Whatever that means. She will not use the No Sorb litter. I am dropping off another sample today, but I think that It also may or may not be clear enough. All other behaviors seem normal. She is also very over weight, about 14lbs. She drinks (I believe-hard to say w/2 cats) approx. 3/4 of a bowl of water (average size plastic bowl). Should I be concerned about liver, kidneys, diabetes or am I just over-reacting? I am a bit of a "nervous Nelly". I try not to take her to the Vet as she seems to be traumatized each time. Not sure if it traumatizes me or her.
Anyway, please give me your input on the above. Your professional opinion would be greatly appreciated.
Thanks a bunch! Shari
Answer: Shari-
Drinking water excessively is a sign of diabetes, kidney insufficiency (failure), hyperthyroidism, hyperadrenocorticism (Cushing's disease) and can occur with several other illnesses in cats.
A clean urine sample is a good way to start sorting through these possibilities. If the urine specific gravity is greater than 1.030 to 1.035 in a cat it is considered to be concentrated enough to show that the kidneys retain their ability to concentrate urine and are functioning fairly well. If there is no sugar in the urine, diabetes is very unlikely. Cushing's disease often causes low urine specific values in dogs but this is not always true in cats. Many cats with Cushing's disease have glucose in their urine, though. So a urine sample is very useful. Some cats will urinate in an empty litter pan, or one with only a very small amount of litter, allowing the pan to be tilted and a pretty clean sample to be obtained.
Since there should be no sugar at all in the urine, it is possible to rule out diabetes more easily than the other disorders. It is OK to take about a teaspoonful of wet litter, mix it with a teaspoonful of water, swirl well and pour off the water on top. Test this for sugar. If there is any sugar at all on two or more samples, then diabetes should be confirmed with additional lab work. If there is no sugar, diabetes is very unlikely. Cushing's disease is usually suspected in this case when diabetes is difficult to regulate, although if there is a high suspicion of this condition it may be a good idea to try to rule it out through lab testing.
Alternatively, blood samples can help to rule in and rule out all of these diseases. For hyperthyroidism and hyperadrenocorticism blood work will eventually be necessary to confirm or rule out either disorder.
Once in a while excessive water drinking is a psychological problem but it is best to rule out all possible medical causes before starting to consider this possibility.
Hope this helps some.
Mike Richards, DVM 8/24/2000
Cat with fever of unexplained origin
Q: One of my cats has spiked a temp of 106 on two separate occasions this week..All bloodwork is normal..
Test pending-Toxoplasomosis Hemobart...?-Negative
Was placed on Antirobe and pred...Bloodwork has been repeated on two other occasions during the week and still all normal...urine normal..
Vomited and was taken off the Antirobe has not had it for two days now and as I sit here typing he came into the room and vomited..
Temperatures seem to go down after about an hour and he seems to feel fine-when he has them you can''t touch him or he'll scream, he squints and shivers....1/2 baby aspirin-sub Q fluids is given...during the temp spikes.
I am afraid I am going to go through this over again only this time with my cat...
Keep in mind that I have three four month old kittens that I rescued...they did develop upper respiratory after but all seem fine now..
Both my adult neutered cats have been tested for everything, vaccinated for everything, year and a half old and are strictly inside cats...year and a half old...
Have you ever heard or seen of any of this....any comments, ideas suggestions...I do not say no to any tests or bloodwork in the treatment of my animals and am willing to pay the price to find out but it just doesn't seem to work out that I get anything by strange animal problems and I am truly paranoid. I am in my vet's office on the average of once a week..I am even afraid not to go for things such as a broken toenail...
Any comments...This is my first email, sorry for the length but I tried to give you as much history as I could.
Thank you and I hope to hear from you soon.
Tina
A: Tina-
Let me start with your cat, to be sure I got the note right on age and sex. I think that you have a 1.5 year old male neutered cat with fever of unexplained origin. If this is correct, the major differential diagnoses that I can come up with are 1) feline infectious peritonitis (FIP) 2)polymyositis 3) cardiomyopathy 4) blood parasites 5) pancreatitis.
FIP is worrisome because of the new kittens since they are a potential source of viral illness. Cardiomyopathy and haemobartonellosis (a blood parasite) are more common in young male cats and can both cause fevers, sometimes without much other sign of illness. Polymyositis is painful and causes fevers. I have only seen a few cats with this but they really didn't like to be touched when they were having problems (it seems to be episodic -- they were worse at some times than others) and they do have fevers. Pancreatitis is more likely in an older cat but is a frustrating source of fevers with few other clinical signs and it would cause vomiting and pain on being picked up.
All of these diseases are a little hard to specifically diagnose. A high degree of suspicion for them helps and your vet sounds as if he or she is maintaining that. You may have to make several visits before a clear enough clinical picture emerges for your vet to feel comfortable with a diagnosis. Or, as often happens, this may be a transient problem that won't get diagnosed --- but that would be good news.
Mike Richards, DVM 8/1/99
Q: Dear Dr Mike
Our nine year old, part Burmese, female cat is typically quite animated and demanding -following us around the house when we get up or come home and rolling on the floor in front of us trying to entice us into petting her. Lately she seems to be spending all of her time curled up in her favorite place sleeping, ignoring our calls to come and play. All of her bodily functions seem to be normal, she is eating and drinking the usual amount and she does not feel especially warm to touch. I have even placed out more bowls of water for her convenience.
This has gone on for about a day and a half, yesterday afternoon she perked up when we had company but by the evening she returned to the couch to sleep (and was still there this morning). I am wondering if it is the unseasonable heat and humidity or if is a result of a run in with a possum a week ago. She (and her 2 house mates) cornered a possum that started to hiss at them. As far as I could tell none of the cats received any bites or cuts as a result of this so I did not haul them into the vet. We have also used ant spray in the house (not areas they can easily get to) but have kept the cats out of the area until it was dry or wiped up as instructed on the label.
She is an especially jealous creature and has persistently vied for our attention during the last three years - but now there is no interest (there have been no new additions to the house recently). She will respond when you sit with her and pet her but nightly habit of sleeping with us has ceased and I am very concerned. Do you have any ideas?
many thanks - Elizabeth
S I wrote to you back in May about her sister who was hit by a car and received a head injury- Misha seems to have almost completely recovered. She has a bit of a lump where the fracture was and she is a bit more reserved than she was before the accident but she is still the same cat. We are amazed and thankful that she is still with us. Thanks for the great advice about bringing her home to assist in her speedy recovery!
A: Elizabeth-
Heat can definitely cause lethargy in cats. It is very confusing in really hot weather when pets have this sort of behavioral change because this obviously can also indicate an illness. It is probably best to consider having her examined by your vet if the lethargy continues more than 48 to 72 hours, even if other signs seem to be OK. There is a good chance your vet won't find a problem but at least that would be reassuring.
I'm glad that Misha is recovering well.
Mike Richards, DVM 7/15/99
Q: My cat charlie has been ill now for about a month and a half, without much sign of hope of this problem going away; aside from the fact he is still here with me. He is only 9 months old. He has had all his shots. I took him and his brother Ted in to my home after a friends cat had kittens. I also have three girl cats. All cats under the age of four. Eveyone else is fine and healthy. Little Chucky vomited occasionally and I noticed he has diarrhea. He is a small cat to begin and lost weight. Skin and bones. I took him into the vet, naturally. The hospital kept him there for a week doing tests and at first he was on IV. Two Leukemia test were negative. X-rays turned up nothing unual. He had a fever. His blood work was all normal except that his white blood count was VERY high (4700). Stool samples showed nothing. Urine samples showed nothing. The doctor thought it might be an absess in his intestines. The white count went down then it went HIGHER (5400). Then blood work was sent out to a special lab for a pathologist to examine. The results were the blood was fine except the white count which was even HIGHER AGAIN (7200). The diagnostic = possible Salmonella poisoning. Tested white count and is was down(6400) and the fever gone. They sent him home with me and oral medication Tribressen (30mg). He vomited a few times and the diarrhea continued. After a week at home Charlie and I went to see the vet for white count retest, sent to the pathologist's lab. His fever was back, and he'd lost a little more weight, but not much. The result was the white blood count was the HIGHEST yet (9900). The vet still thinks it is an absess. I have stopped giving the Tribressen because the vet wants to do blood cultures. We see the vet on Friday. The vet has been very puzzled at the results and is obvisously concerned for Chuck's well being. Money although it is costing me a fortune ($1,200 Can. already) isn't a concern. But I'm getting frustrated at the fact Charlie's health is up and down, and that he has been sick so long. He eats ok one day and eats hardly anything the next. Spends a lot of time sleeping in his bed. Seems gloosy eyed, with wide pupils all the time. I'm sure the vet is doing everything he can think of to do but I was wondering if there is anything further I could suggest. I really love Charlie and all my cats. I would hate to lose one so young. Thank-you for your time and this wonderful source of helpful information. Barbara
A: Barbara- I am a little confused by your message. A total white blood cell count of about 5000 to 17,500 wbc/cc (varies from lab to lab) is normal in a cat. I am wondering if you left off the last zeros in your question (55,000 to 99,000) or if you are referring to a specific white blood cell such as a band neutrophil. The total white blood cell count is ALL white blood cells. The differential white blood cell count is the portion of the total count represented by each type of white blood cell that can be differentiated by appearance. In general, neutrophils and lymphocyte make up the majority of the white blood cells, with neutrophils predominating. Lymphocyte counts in the range you mention would be unusual but not startling. Neutrophil counts in these ranges would be normal. Eosinophils, band neutrophils, monocytes and basophils are a smaller percentage of the total. If any of these last four cell types numbered above 5000/cc it would be pretty startling. And potentially very confusing. If you can determine what the counts you mentioned refer to, exactly, I will be happy to try to find references for problems relating to them.
The most common cause of persistent high fever in cats is probably feline infectious peritonitis. This is hard to test for because of problems with test accuracy but it might be worth running a titer just to get an idea of the potential for infection. Feline immunodeficiency virus will occasionally cause persistent fevers, too. Salmonella would be hard to cure and would possibly cause the symptoms seen so ruling it out is a good idea.
It does sound like your vet is working hard at this. I hope he or she has come closer to a diagnosis with the new test results. Mike Richards, DVM
Q: Dear Dr. Richards, Have you ever heard of a cat's fur changing colors in isolated areas due to a medication, treatment or test being administered???
My grandmother is extremely concerned that her cat Eloise's fur has changed from black on her back to a reddish brown. This happened after a visit to UC Davis to determine if she might have inflammatory bowel disease. Eloise's brother - Peter - died a year ago, and my grandmother is quite distraught at the prospect of losing her other "child". She asked me to find out anything I could about it using the internet. Can you help?
Thank you, Sincereley, Rene
A: Rene-
It might be a good idea to have the cat's serum protein value checked. Inflammatory bowel disease can lead to difficulty absorbing protein or vitamins and low serum protein can cause a reddish discoloration of the haircoat.
It wouldn't surprise me if some medications can do this, too. I just don't know of any, offhand.
Mike Richards, DVM
Q: Dear Doctor: I am excited to have found you! I have a 13 year old spayed, vaccinated, indoor, female Siamese cat. She has been sick now for 7 months. My life is not my own anymore as I hate to leave her alone. Her problem is vomiting. She has gone from 8 pounds (which her vet said was the ideal weight for her) down to 5 pounds. She is bony, with her rib cage visible, the back end is bony and her muscles have decreased in size. She will go for about a week without vomiting but does not seem to gain any weight, only appears to be round in the belly. Her stomach/intestines, make a rushing, gushing sound that can be heard above the T.V. When she vomits, it is a large amount of dark brownish, greyish, black liquid that has a horrific odor. Her stools are small in size, hard, blackish grey and are almost crumbly. She is hungry all the time, drinks the same amount of water as before, but is not feeling well enough to play with my other Siamese cat (who is a healthy 8 pound 10 year old spayed female). She still goes to her scratch post several times a day for her ritual. To date she has had 2 barrium x-rays that were negative. Then a complete blood screen was done with all tests showing normal, healthy levels. Her PVC count was 40. This was in May 1997. The doctor tried Clavamox with no results. Then he tried Prednisone...with no results. She has been dewormed...negative. Her vet then wanted to do a visual exploratory as there is no clinics in our area that provide endoscopic examinations. However the morning of the surgery he did routine blood work and found her PVC count to be 28.... dangerously low for an exploratory he said so it was cancelled. He then did a blood screen for FIP/FELV/FIV and that too was negative. She eats well but does not seem to be getting any nourishment from the food. When she vomits (sometime 3 to 4 days in a row) it is like she is bringing up fecal matter. We love our cat so much and would really appreciate any suggestions you may have. Her diet consists of wet and dry. She always used to eat Fancy Feast been in gravy, but since this vomiting, she won't eat that anymore but will eat other brands. She also loves roast chicken breast which my vet said was OK to give her. I will watch for any answer you may find in your heart to give.
A: Mrs. L- Please talk to your vet about the possibility of hyperthyroidism. In older cats the blood values can be in the 'normal' range and still be too high for a particular cat. It sometimes takes specialized testing to determine if this problem exists, such as free T4 testing or T3 suppression testing. While this may not be the problem, the signs are pretty suggestive of this disorder and it should be eliminated as a possibility. Your vet probably has considered this and may even have done the necessary blood testing already. If so, I can't see much room for making suggestions with the workup being done.
Mike Richards, DVM
Q: Lucy is our almost 6 month old kitten, and she has diarrhea. It seems like it goes away for awhile then comes back. But i was looking over some articles about this and they say if there is blood in the loose stools then that may be deadly. im not sure but i think i saw blood on my kittens bottom. Please tell me what this might mean as soon as possible. she is due to get fixed soon and i dont want any problems. i already lost one cat due to kidney failure and i dont want to loose this one. thanks Jackie
A: Jackie - Diarrhea can be caused by many things. Parasites such as hookworms and roundworms will cause diarrhea, sometimes bloody diarrhea (hookworms). Coccidia and giardia are protozoa that live in the intestinal tract and will also cause chronic bloody stools if they proliferate or if there are times of stress. Most of the time, medications will clear both conditions. Irritation to the bowel can cause bloody stools and again, medications will clear this up. If your veterinarian has not performed a fecal exam, that's the first thing that should be done. This will rule out intestinal parasites such as hookworms and roundworms. Giardia can be difficult to find on a fecal so if the fecal is negative and your cat has not been treated for giardia, would advise treating anyway. The medication won't hurt your cat if she doesn't have giardia but it will certainly make her feel better if she does. Kidney disease is one cause of diarrhea in cats but 6mos. is young for kidney failure. Blood tests should be able to rule in or out this problem. I would have your vet perform a complete physical, fecal exam included, treat for intestinal parasites if any found, and treat for giardia if this has not been done. If the diarrhea persists, further diagnostics should be done to determine the underlying cause (bloodwork, intestinal biopsies, etc.) I would start with the simple things first and go from there. Good luck.
Mike Richards, DVM
Q: Dr. Mike: My cat, BooBoo, has been sneezing since last night. I don't think it's an upper respiratory problem because he's eating and acting normal. BooBoo is three years old and very healthy. If he is sneezing because of allergies, I don't believe he's ever had them before. If his behavior changes or he stops eating, I'll take him to the vet. However, I was wondering if you can tell me if sneezing can sometimes be a minor problem that I shouldn't worry about unless his behavior changes. I'd appreciate any help you can give me. Marian
A: Marian - Sneezing is not necessarily a problem in cats. It can be related to allergies, upper respiratory disease, and even having a foreign body in the nose (i.e. piece of grass). Usually upper respiratory diseases have other signs associated with it such as nasal or ocular discharge and can lead to inappetance and lethargy if clinical signs are serious. Cats can have allergic disease in which the only clinical sign is periodic sneezing otherwise they feel. The owner does not notice any changes in eating or behavior. If the sneezing continues, you may want to talk to your regular veterinarian about a possible diagnostic plan to determine the underlying cause. But is he feels fine, I probably wouldn't worry too much about it.
Mike Richards, DVM
Q: Dear Dr. Mike, My cat Smokey, an 8-10 year old longhair domestic, has been having attacks where she has major arguments with her tail. She growls, hisses, sometimes bites and occasionally runs in circles. This can last from anywhere to a few minutes to 40 minutes. She has been on phenobarbital 15 mg. 2x a day which really hasn't had any effect other than perhaps the attacks have shortened. I do have pain pills which I give her at night at that seems to help more. Sometimes when I pick her up I feel a quivering in her hind quarters. Do you have any suggestions on a direction that I could take to relieve her symptoms? Any ideas as to what may be causing this? Thank you in advance for your help. Sandy-
A: Tail chasing may be due to physical problems causing pain or discomfort in the area of the tail or it can be a behavioral problem.
It is best to rule out tail injuries, anal sac impaction/infection, skin disease in the tail or tail head region and spinal cord problems before assuming that the problem is behavioral.
If these things seem unlikely based on physical findings it may be helpful to consider behavioral therapy for the tail chasing. It is always helpful to have the advice of a behaviorist when considering behavioral therapy but it can be difficult to find a good behaviorist in many areas of the country or world. At present, tail chasing is most often thought of as an obsessive/compulsive disorder and is usually treated in that manner. Anti-convulsants have not proven to be really effective in control of this problem. The most commonly recommended medication for obsessive/compulsive disorders is clomipramine (Anafril Rx). Several other medications have been reported to be helpful in some instances, including amitriptylline (Elavil Rx) and fluoxetine (Prozac Rx). Your vet can help you choose an appropriate medication if seizure control medications don't work. Just as an aside, seizure control medications have been advocated for this condition, so even though newer information suggests they are not all that effective your vet may have had some positive experiences with them in the past.
The fact that pain control medication seems to help would encourage me to look for a medical cause but the prevailing opinion is that most of these type problems are behavioral.
Michael Richards, DVM
Q: Dear DR. MY MALE CAT HAS HAD OILY FUR FOR A YEAR NOW .He is 10 years old ,eats a special vet brand of cat food for the prevention of magnesium or crystal blockage of the urinary tract. he urinates once or twice a day .he was overweight for a few years and the vet told me it is dangereous for him ,so she took a blood test and found that he was borderline diabetic so she suggested for me to feed him low calorie cat food .since I fed him this ,he has lost weight and looks better. HE APPEARS TO BE HEALTHY the oily skin appears to have reduced itself since he is on a diet .from what information you gave me ,it appears as if he was or is headed towards diabetes. The vet told me maybe if I get his weight to go down ,he might avoid having to get needles everyday for diabetes .
A: With the additional information, you do appear to be correct --diabetes would certainly be the most likely problem with his history. It will often cause an oiliness of the skin. I am not sure why that happens, but it probably has something to do with the skin not getting adequate nutrition due to the diabetes.
It is often possible to control diabetes for some time in cats with dietary changes. Your vet seems to be doing a good job in this regard. It is important to continue to monitor the blood sugar. It is hard to recommend an exact schedule for doing this but it would probably be a good idea to monitor it at least 4 times a year. If signs of the problem recur, like an increase in skin oiliness, drinking and urination or weight loss, then checking as soon as the signs are recognized would be good.
You seem to be very interested in maintaining the health of your pets, so I'm sure you'll do a good job.
We have had one cat that had both diabetes and hyperthyroidism, so if response to the diet seems good based on blood sugar levels but you see problems like weight loss and haircoat changes anyway, don't forget that he can have more than one problem. It looks like you and your vet have him on the right track --hope that all this continues to work out well for you.
Mike Richards, DVM
Last edited 01/30/05
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...