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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 25566
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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She is pulling out clumps of fur and scratching. She has bee

Customer Question

She is pulling out clumps of fur and scratching. She has bee to the vet three times. No fleas. Changed her to a grain-free food. Vet gave her a cortisone shot and follow up with pills. She is looking naked! Ant ideas
JA: I'm sorry to hear that. Using the wrong medication for fleas can be dangerous. You should definitely talk to the veterinarian. What is the cat's name and age?
Customer: Her name is ***** ***** she is about 3 years old. After three trips tp the vet, she is still having problems.
JA: Is there anything else important you think the veterinarian should know about Jane?
Customer: She takes medication Cloprimide and laculose for digestive issues. Could these medications cause problems too?
Submitted: 3 months ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 3 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 3 months ago.

I'm sorry to hear of this with Jane. Please note that a grain-free diet isn't necessarily hypoallergenic. I'm going to post my complete synopsis for cats such as Jane so you have a good overview of what may be responsible for her behavior and what you can do about it...

Pruritic (itchy) cats are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmentals such as pollens, molds, dust and dust mites, and foods should be considered. In rare instances the mange mite Demodex might be responsible.

Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage or a fipronil-containing product such as Frontline or one of the newer prescription products available from Jane's vet even if fleas aren't seen. Cats can be such effective groomers so as to eliminate all evidence of flea infestation. Indoor cats can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. Turning on the heater or as the weather warms at this time of year then hatches the eggs. Flea saliva allergy is usually most evident on the saddle area – the area between the edge of the rib cage and tail. In severe cases, an anti-allergenic prescription corticosteroid such as prednisolone will work wonders for cats allergic to the saliva of the flea. Your other pets may not be allergic to the saliva of the flea.

Environmental allergies are usually addressed with prednisolone as well. In some cats an over the counter antihistamine such as chlorpheniramine (Chlor-Trimeton) dosed at 2mg/cat daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily may be effective.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Jane's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. There are many prescription novel protein diets and the prototypical hydrolyzed protein diet is Hill’s Prescription Diet z/d ultra (I prefer a hydrolyzed protein diet because it removes the possibility of my patient being intolerant to even a novel protein diet.). We usually see a positive response to these foods within a few weeks if we’ve eliminated the offending food allergen. A food intolerance can appear at any age and even if our cats have been eating the same food for quite some time.

We used to diagnose these cats with psychogenic alopecia - a neurotic over-grooming - but have come to realize that most of these cats truly are allergic cats. Feline psychogenic alopecia is overdiagnosed but does exist. Excessive and out-of-context grooming is thought to be an obsessive-compulsive behavior that's triggered by environmental stresses and anxiety. The condition is uncommon in cats, with purebred cats that have high-strung nervous temperaments being possibly predisposed.

This type of alopecia may occur anywhere on the body where the cat can lick but it most commonly involves the medial forelegs, inner thighs, perineum, and ventral abdomen. Hair loss is often bilaterally symmetrical but remaining hairs don't epilate easily. The top differentials are flea allergy dermatitis, food allergy, dermatophytosis (fungal infection), other ectoparasites (mange) and atopy (allergies to environmental allergens such as pollens, molds, dust, and dust mites, etc.).

The underlying cause of the psychological stress (e.g., separation from owner, moved to a new house, animal companion died, new pet in household, formerly outdoor cat denied access to outdoors) must be identified and appropriate environmental modifications made, if possible. A good flea control program should be instituted to prevent fleas from aggravating the symptoms. Use of a mechanical barrier (e.g. Elizabethan collar, T-shirt) for 1-2 months to prevent grooming may help break the habit. Behavior-modifying drugs may help stop the abnormal grooming behavior. In some cases, treatment may be discontinued after 30-60 days of therapy; in others, lifelong therapy is required for control. Drugs that may be effective include the following: amitriptyline, clomipramine, buspirone, phenobarbital, diazepam, and naloxone.

No, I don't believe that her metoclopramide or lactulose should be incriminated in her behavior. Metoclopramide can cause frenzied behavior and disorientation in cats, however.

Please respond with further questions or concerns if you wish.

Customer: replied 3 months ago.
Thank you for the help. Our cat was taken from a foster home where she was around dogs, cats, and other large animals (horses and ?). She was not treated well and was mostly ignored, except being stepped on and tail closed in the door. She has an extremely shaky back right leg, but is a very loving cat. She does bite, but I'm not sure if she is just getting carried away with her love bites. She is a good kitty, and I hate to see her suffer in any way. Thanks for your ideas and information. I will check her flea medication. Cheryl
Expert:  Dr. Michael Salkin replied 3 months ago.

You're welcome, Cheryl. It sounds as if Jane is lucky to have found you. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.