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Dr.Fiona
Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience:  16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
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Cat: has been licking a 3 spot bald on her upper hind left leg..mites

Customer Question

My 4 year old Cat has been licking a 3" spot bald on her upper hind left leg. I have brought her to the vet who said it was not mites. She is now wearing a cone and the vet thinks she may be depressed, so she is on antidepressants. Her eyes are always dialated and she has been going to the bathroom in different parts of the house besides her litter. I am very concerned, this is not my Nico, what should do?
Submitted: 6 years ago.
Category: Cat
Expert:  Dr.Fiona replied 6 years ago.

Hi there!

Aw, poor Nico, she sounds miserable. I'd like to try to help you and her, but need a bit more information, please.

When did this start?

Does Nico (or any other pet in the house) go outside?

Does she ever ripple her skin when she is about to start licking her leg?

Is there a raw area where she has licked? Or is the skin soft and smooth?

Is it on the inside of her hind leg, or the outside?

Any chance you have a digital camera and could take a photo?

Has her urine been checked? When did the urinating in odd spots start?

What is the name of the drug she is on?

Fiona (sorry for the inquisition there!)

Customer: replied 6 years ago.
-It began the last week in Jan.
- She is an indoor cat and is my only pet
- she doesn't ripple her skin, but she does pause for a second before licking the spot (sort of the shape of a pork chop)
- It is not raw, but she has licket it to where it's almost bleeding. WIth the Cone on, her fur is beginning to grow back but she does try to get at the spot and can still reach a little 1/3 of the spot.
- It is on the outside of her leg, too close to her back making it hard to wrap. So you could say it's on her hip.
- Her blood was checked but not her urine. That was my next step because I am concerned it may be her kidney. But my vet does not feel that she would be licking the spot.
- I don't remember the name of the antidepressant, but I know it begins with a tri___.
- I can take a picture, but unfortunately I will not be home until later this evening.

We thank you so much for your help!
Expert:  Dr.Fiona replied 6 years ago.

A photo would be very helpful!

Is the skin soft and smooth in the area?

Was there anything particularly stressful to her in the last 6 months? A move, a new room-mate, a new pet, renovations, a stay in a kennel, or anthing like that?

Has she been wearing the cone since the end of JAnuary?

Customer: replied 6 years ago.
The spot is sort of soft. It has a scab right though since it is healing.
She wore the cone for a couple weeks but that's when she began peeing and pooping in random places in the apartment. So I took it off and she began licking again so she has had it on all of last week.
She did go through a huge change. I moved to New York City back in July so, my sister in GA took her until Nov. then she flew her back to me.
She was great for a few months, then I had to take her to the vet for tape worms. We had to ride on the subway, etc. She has moved every year since I have had her and I did not think that this move would make such an impact.
I definitely think that she could be depressed, but I would hate to know it was something else that was being over looked by my vet.
I can take a picture for you but it will be a few hours till I am home. Let me know if you would still like it after hearing all this.

thank you again...
Expert:  Dr.Fiona replied 6 years ago.

How long has she been on the antidepressant?

Were her eyes dilated all the time before she started it?

Yes, I would still LOVE a photo!

Here's how to post a picture:

You need to post your files on your question page, so the expert can see them. On your question page, there is a tool bar above the reply box at the bottom of the page. If the tool bar is not showing, click "show tool bar". Once you have the tool bar showing, here are the instructions for posting your files:

For graphics, click the tree icon and then browse to choose a GIF, PNG, or JPG. Upload and then insert it.

For zip files, PDFs, or spreadsheets, you need to use the link tool. Enter text (like "download this") in the reply box and then double-click to highlight it. The link is the tool to the left of the tree. In the upper right corner is a browse dialog box, which you can use to locate your file. Select it and then insert the link. Use the Preview button if you want to test the link and see if it works correctly.

File size is limited to 1 MB.

 

Customer: replied 6 years ago.
-She has been on the antidepressant for 1.5 weeks
-He eyes became dilated after we began the pill
-As soon as I get home I will take a picture and upload it.
-Do you think I should take the advice from an older vet of hers and start giving her organic food and cranberry juice, incase it is her kidney?
Expert:  Dr.Fiona replied 6 years ago.

It doesn't sound like a kidney problem and I am relucant to suggest cranberry juice (which acidifies the urine) without knowing first what the urine pH (acidity) is.

Some cats will form crystals in their urine. At high pH (alkaline urine) they form struvite crystals. At low pH (acidic urine) they form calcium oxalate crystals. Now, it is possible that she has crystals in her urine and that is part of her problem, but without knowing what kind of crystals, you could make the problem WORSE by giving her cranberry.

Have you ever seen blood in the urine? Does she seem to be in pain when she urinates?

The dilated pupils are almost certainly from the antidepressant and that is a common side effect initially. It resolves after a few weeks, usually. Knowing the name of the antidepressant would be helpful - Elavil? Amitriptylline?

Fiona

Customer: replied 6 years ago.
graphic
Expert:  Dr.Fiona replied 6 years ago.

Ouch! Thanks for the photo! :-) Do you have any more?

Expert:  Dr.Fiona replied 6 years ago.

Can you tell me the name of the antidepressant? And the dose? Does your cat have any more of these linear areas that she licks? The backs of her legs, inside hind legs, or any scabs on the underside of her neck from scratching?

I am going to be going off-line shortly but will be back in the morning to help you! :-)

Customer: replied 6 years ago.
graphic
Expert:  Dr.Fiona replied 6 years ago.

Good morning JackySue,

Thanks for the additional photo. Your poor girl - that just looks so painful! I can only imagine how itchy she must be to do that to herself. From what you are telling me, and from seeing the photos, there are a few things that come to mind for what may be going on with your kitty.

Cats who lick do it either because they are insanely itchy (as with an allergy, mange infection, ringworm or bacterial infection) or as a way of relieving stress.

1. Ringworm: ringworm is not caused by a worm at all, but rather by a fungal infection. It is most common in young cats. Unfortunately, it is contagious to other animals and to humans. Ringworm is treatable with oral medication, or topical creams. I doubt that this is it because it is rarely so "angry" looking and I am sure your vet would have thought of this and tested if he thought it was possible.

For more information about this problem, as well as a photo, you could read here:

http://www.marvistavet.com/html/body_ringworm.html

2. Your cat may have Miliary Dermatitis. This is an allergic skin condition in which the hair loss is typically in the tail head area, and the back legs. The skin is very itchy and the cat chews, licks, and scratches. Kitty may also "ripple" the skin often. The skin has many small scabs and bumps - supposedly they look like millet seed which is where the name comes from.

Here are some links to further information about this condition:

www.sniksnak.com/cathealth/mil-derm.html

http://en.wikipedia.org/wiki/Miliary_dermatitis

Miliary Dermatitis is caused by an underlying allergic condition. The most common allergy is a flea bite hypersensitivity (flea allergy dermatitis, FAD). All it takes is ONE flea bite to cause this problem. It's kind of the same as how some people are allergic to bee stings. For most of us, a bee sting hurts a bit but isn't really a big deal. For others, however, a single bee sting can make their whole arm swell up or even cause an anaphylactic reaction that can be life -threatening.

In the same way, animals who have FAD get insanely itchy over a single flea bite. So, even though you may not see any fleas on your cat, if a single flea hops on, takes a bite and then hops off, this cat could be insanely itchy for weeks!

Here is more about flea control: http://www.peteducation.com/article.cfm?cls=1&cat=1333&articleid=590

For more information about flea allergy dermatitis, you can check out these links:

http://en.wikipedia.org/wiki/Flea_allergy_dermatitis

http://www.pets.ca/encyclopedia/flea_allergy_dog.htm

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2607

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2604

Miliary dermatitis is generally treated with flea control, corticosteroids, or in a mild case with antihistamines and essential fatty acids. You could start this cat on essential fatty acids as they are helpful at decreasing inflammation and improving skin health. Here's a link to one example:

http://www.petplace.com/drug-library/derm-caps/page1.aspx

3. Another allergic problem that cats can have that causes them to lick excessively is a Granuloma: This is an allergic skin condition that causes areas (plaques) of itchy, raw, red skin, often down the backs of the hind legs or on the neck. With this allergic condition, it can be to things the cat is inhaling (dust, pollen) or to proteins she is eating. From what I can see in the photos, this is VERY likely for your cat. It really looks a lot like this because it is LINEAR (a vertical line) not a round patch. That is so suggestive of Granuloma.

http://www.marvistavet.com/html/body_eosinophilic_granuloma.html

http://www.vet.uga.edu/vpp/clerk/Starnes/index.php

Unfortunately, with granulomas it is hard to find out what is causing the allergy and often these cats need corticosteroids to control the problem. In a mild case you might be able to treat with antihistamines and essential fatty acids. You could start this cat on essential fatty acids as they are helpful at decreasing inflammation and improving skin health. Here's a link to one example:

http://www.petplace.com/drug-library/derm-caps/page1.aspx

4. Another possibility is that this is a form of stress grooming. Indeed, what you are describing sounds like it could be feline psychogenic alopecia (FPA), and it sounds like this is what your vet is treating for. With this condition, the cat "barbers" the fur (chews it, bites it or licks it) in one area to the point of baldness (alopecia), or even until there is bleeding. It is often due to an underlying stress. Certainly the strss of the latest move could have contributed.

FPA is a bit like nail-chewing in humans - it is done because it makes the cat feel calmer, as a way of dealing with stress. As with people who chew their nails, it may continue even when it must be causing pain if the skin has become raw.

Some breeds seem to be a bit more prone to FPA (Siamese, Burmese, Himalayan, and Abyssinian) but it can occur in cats of any age, sex or breed

Before your kitty can be diagnosed as definitely having FPA, your veterinarian would need to rule out the other possible causes of hair loss in the belly area. These would be fleas, ringworm, Demodex (mange), allergies and bladder inflammation (some cats like over the bladder area when it is uncomfortable).

There is no specific test for FPA, it is a "diagnosis of exclusion" which means that when we have ruled out physical problems, then what is left is a stress response problem. I am highly suspicious, however, of FPA because it occurred with the stress of changes in the household.

Unfortunately, there is no quick cure for FPA and it is something that one has to "manage" as opposed to "cure." Treatment involves trying to minimize the stress in your cat's life. One of the things that I would strongly recommend is a Feliway Diffuser system. This is a plug-in device that sprays a cat pheromone into the air, helping to calm the cat without drugs. Here's a link to more information:

http://www.catfaeries.com/feliway.html I find the plug-in diffuser to be the most helpful since it works even when you are not there, which is when your cat is most likely to feel stressed and lick excessively.

Also, keep in mind that this may flare up at times of stress for your cat - such as moving, a new room-mate, new pets in the home, and so on. Using the Feliway diffuser at those times may really help your cat to adjust.

If this does not work, your veterinarian could prescribe a number of different "Prozac"-like drugs for cats. As with humans, sometimes it takes a while to find the best medication for relieving your cat's stress, and you might have to try 2 or 3 different drugs before finding what works for your cat. Usually, medications are only used when the problem is so severe that the cat is damaging the skin. It sounds like your vet is doing this already because your cat has licked this area raw. Keep in mind that your cat may need to be on the drug many weeks (6- 8) before you know whether this drug works for her. If it doesn't, you may need to try a different one.

I will include some links to further information about FPA:

http://www.kittens-lair.net/cat-health/lick-dermatitis.html

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2565

http://www.cathealth.com/psychalopecia.htm

http://www.petplace.com/cats/psychogenic-alopecia-in-cats/page1.aspx

So, in summary, there are a number of different things that could be causing your cat to lick excessively. Although I cannot tell you which she has I hope that this has given you some ideas and directions to pursue with your vet. Based on what you are telling me and the photos, I would be suspicious of either Granuloma or FPA. It would be great to add some omega 3 and 6 fatty acids to her food, and to get a fieliway diffuser. I also think that she needs to see your vet to have her bladder checked for infection.
The urinating all around could be be because of bladder inflammation (crystals, infection OR it could also be stress related).

It sounds as though your cat may have idiopathic cystitis. Idiopathic means we don't know what causes it, and cystitis means inflammation of the bladder. So, this name doesn't tell you anything new, does it? This is the stress related bladder problem that I mentioned above.

Idiopathic cystitis is very frustrating to everyone - the owner, the patient and the veterinarian trying to treat it. Although we don't know exactly why it happens, we do know that stress is a major factor.

It appears that in some cats, when they are stressed, they lose the protective P-GAG (polysulfated glycosaminoglycan) layer on the inside of the bladder. Thus, urine touches the inside bladder wall. As the urine is caustic, it creates erosions, ulcerations and inflammation. It hurts. It causes bleeding. The cat feels pain when she voids, so if she voids in her box, she may associate the pain with the box. Next time she may try voiding elsewhere to try to find a place where it doesn't hurt when she urinates (as in her mind the box was the culprit).

Therapy is aimed at reducing pain, increasing the P-GAG layer, increasing urine output so that the urine is not so concentrated and caustic, and reducing stress.

Here is my usual treatment approach to address the issues above:

1. Pain relief - Torbutrol is one option, metacam is another, amitriptyline is another drug that gives pain relief as well as anti-anxiety. This last may be what she is on already?

2. Cosequin to increase the P-GAG layer. This is a dietary supplement that you sprinkle on top of the food.

http://www.amazon.com/Nutramax-Cosequin-Cats-capsule-bottle/dp/B00020BOXU

3. Increase water consumption to help dilute her urine.

Things you can do to encourage a cat to drink are:

- offer water from a very wide flat bowl as cats don't like their whiskers to touch the edges when they drink (which is why lots of cats like the toilet bowl).

- If she likes dripping water, leave a tap dripping for her.

- Offer her the water from a can of tuna, diluted with tap water 50:50.

- Offer bottled water and see if she prefers it.

- Offer chicken broth, diluted 50:50.

- Try a few drops of clam juice in water (sold in grocery stores near the cans of tuna).

- See if she likes water with an ice cube in it.

- See if she likes it out of a cup or martini glass.

- Offer lactose free milk

- Offer Whiskas Kitty Milk

4. Decrease stress by controlling her environment if possible. One thing that I definitely think you should consider is the "Feliway" pheromone spray for your house that I mentioned before. This device looks like an air freshener that you plug into an electrical socket and it emits a pheromone that is meant to calm timid and anxious cats. Here's a bit of information about it: http://en.wikipedia.org/wiki/Cat_pheromone and http://vetmedicine.about.com/od/behaviortraining/a/092804b.htm and http://www.catfaeries.com/

And for more information on idiopathic cystitis:

http://www.hilltopanimalhospital.com/cystitis%20syndrome.htm

I hope this has been helpful. If it has, please hit the "accept" button. As always, feel free to ask for more information if you need it. Thanks and good luck with your cat. She is lucky to have you!

Fiona

 

Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience: 16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
Dr.Fiona and 2 other Cat Specialists are ready to help you
Customer: replied 6 years ago.

Thank you sooooo much for your help!

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