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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 24454
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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10+ tuxedo cat, diagnosed with acute pancreatitis, noticed

Customer Question

10+ tuxedo cat, diagnosed with acute pancreatitis, noticed an occasional front leg limp ahead of diagnosis, now tail twitching and sudden head jerks (like a tic). In the last two weeks, she's developed a dark pigmented lesion on the outside corner of her mouth that is not going away but doesn't 'seem' to bother her. It looks like pemphigus in humans a little.
Then yesterday, while sitting on couch, she was trying to clean her muzzle leaning on her right front paw, she couldn't bring her left leg and paw all the way to her face so was making half circle motions to try to get the paw up by her face. Before her face cleaning, she briefly saw her tail twitching and tried to catch it! I've never seen her chase her tail. She seemed surprised she could not raise her paw to get it to her face.
She hides quite a bit under the couch during the day, can jump up on couch to sit in my lap and is hypersensitive to sudden motion and noise. Also she has big dew claw growth that could be a sign of hyperthyroid? Her tail twitch is constant after she gets on the couch, otherwise she's resting or sleeping under the couch. The twitch is at the base of the tail and seems to be involuntary. My question is should I get her tested with an X-ray for osteosarcoma (her symptoms seem a little like last cat I had that died of this) or ultrasound for soft tissue disease. I've never seen this much twitching of head in a cat. Could she be suffering from some type of toxicity or kidney issues? The difficulty with front leg movement sure looks like osteosarcoma. I've no history on this stray and assume from neighbor animal care that she's likely had previous routine vaccines.
Submitted: 1 year ago.
Category: Cat Veterinary
Customer: replied 1 year ago.
I wanted to add that Mimi seems very twitchy and hyper in the last week, ahead of her front leg not working well and since the dark lesion appeared at the corner of her mouth, right side, two weeks ago. Aside from a high lipase test (twice) and slightly elevated BUN (according to one vet), her blood values appear normal. My last cat was dx'd with osteoscarcoma based on an X-ray that showed half of her upper front leg bone near the shoulder was hollowed out by cancer. In fact, she had lost sensation in that arm and could not jump at all. Mimi like my last cat did not like scratching anything except the softest of materials and both get 'stuck' on materials easily as though the claws don't retract well. Mimi is still jumping fine but I suspect she has some pain that is making her jumpy. Due to the pancreatitis she sometimes makes a cry out when she is having a bowel movement though I'm not convinced it's not because of not being able to urinate at times. She seems to urinate two times a day and drinks water every day but not a ton of water. The pain seems to be intermittent. Hope I haven't overwhelmed you with a ton of ambiguous symptoms for the Mimi cat! Thank you for your help- =^:D^=
Customer: replied 1 year ago.
Here is a direct link to a picture of Mimi's mouth lesion: http://i.imgur.com/vsVjRKP.jpgThank you! I hope I get an answer before Turkey Day. I hate leaving her alone for a couple hours when she's not entirely well.
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry that your question wasn't answered in a timely manner. There are so many body systems involved, Mimi will need to have a thorough physical exam performed by her vet who then will present you with diagnostic options.

Tail twitching can indicate an unhappy cat. It's usually a sign for us to "back off". If the twitching is uncontrollable, however, it can indicate simple partial seizures or, less commonly, tremors.

Head jerks (tics) are another indication of simple partial seizures (previously called petit mal) in cats.

If the same leg that is lame is the left leg that she's having trouble with when reaching toward her face, that leg may be arthritic at her age and, yes, neoplasia such as osteosarcoma is a consideration. Careful palpation of the leg and spine is indicated and X-rays may be recommended.

The dewclaw growth needs to be directly visualized and needle aspirated by her vet. The aspirate is then microscopically examined by the vet or our pathologist.

I regret that the photo of the facial lesion is out of focus and difficult to see. It's not representative of pemphigus, however, which invariable causes symmetrical skin lesion on the face. It appears to be well-circumscribed and benign.

Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
Dr. Salkin, thank you for your reply. Can partial seizures be due to any particular systemic disease? Also why do sudden benign lesions show up around the mouth? The lesion has a hair growing through the middle of it that is not very clear, I agree (old Android smart phones have bad lighting for night time). I could try to get a better picture in the daylight and send it to you this evening. I have to go out today for a few hours.I agree that she appears to be having a number of issues following the pancreatitis diagnosis which concerns me that she's going into another 'phase' of a disease. My experience with osteosarcoma is that it is fairly hidden on bood work, with other systems degrading along the way, as the lesion develops and takes over the bone. The cat that died also had a number of other issues including hair balls and gut issues (evident on the X-ray but not defined until she crashed), however, tremors were NOT present. When you look at this cat's eyes, like my old cat, something does not look right. The eyes appear more grayed over and a little asymmetrical in pupil size. She is an older cat so maybe she has cat-a-racts? Her tail twitching happens when she's on my lap where she is definitely comfortable, unless she happens to step down on that sore limb. Clearly she still has nerve sensation in that limb. I do want an X-ray done at this point and maybe that's a good place to start, without a lot of other testing unless nothing shows up on the X-ray. The pancreatitis is clearly causing her pain with defecation and maybe the X-ray will indicate a mass or other problem. One of the vets does only ultrasounds which won't help me find out about the osteosarcoma but might help with pancreas staging.Are there any tests you'd recommend besides the X-ray that might help diagnose her issues? What would dew claw aspirate tell the vet? I was told the dew claw enlargement was simply old age. Does she need a thryoid test? Are there any specific blood tests that won't cost me(###) ###-####bucks just to get a diagnosis? Alas, the blood panels are very expensive and often aren't ordered except as an overall 'view' of the cat's health, minus any specific diagnosing or certain tests to back up suspicion of a problem based on visual examination and symptom history.I apologize for rambling. I'm a little stressed out this week from worrying about cat, Turkey Day preps, and the drive out in the brrr cold! I wish you happy holidays this week- :D
Customer: replied 1 year ago.
p.s. I'd be glad to offer you more money for more in-depth details, if I can do that somehow, maybe by 'asking another' question from the list above? Please let me know- :)
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, they can occur secondary to both metabolic disorders and primary central nervous system (brain) disorders. Skin growths can arise anywhere on the body but are more common in older pets. The significance of a hair being the middle of the growth is unclear. The anisocoria (unequal pupil size) is a clue that her simple partial seizures are due to an intracranial (brain) disorder rather than a metabolic one. Yes, cataracts are a consideration but age-related nuclear sclerosis of the lenses is more common in cats. Baseline testing at her age should include a senior/geriatric diagnostic panel of blood and urine tests. The panel should include a specFPL blood test which is most specific for detecting the presence of pancreatitis. A simple lipase is no longer recommended. X-rays of the limb make sense but ultrasound is more sensitive of an imaging modality for the abdomen than are X-rays. Please continue our conversation if you wish. We can continue on in this conversation at your convenience. I don't believe that you can pay any more money (unless you posted a bonus) unless you opened up a new question which isn't necessary at this time.

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