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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 30310
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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From the last 2 weeks, my cat Raju has been showcasing a

Customer Question

From the last 2 weeks, my cat Raju has been showcasing a behaviour very unusal of him. He gets this 'episode' that lasts 45 secs to a min where he starts to twitch his skin at the back (slightly towards left side), followed by fast licking/cleaning of his fur on the left thigh multiple times followed by quickly moving around with slightly bent posture as if he's scared/worried of somebody/something. I've noticed this episode happens few times of the day & appears to be out of the blue. I say that coz other cats in my house are normal while Raju is in this state.Attached is a video I capture towards the end of the episode. He can be seen twitching his skin. I'll try to get full video of the act next time.To add more background, it started almost 2 weeks back after Raju had a fight with another male cat in my society. Since then he has been alert, scared indoors & outdoors as well & is less confident when going out. He's become more of an introvert from quite the opposite he actually is. Since the incident, he's been eating well, ideal weight is maintained, motions are fine.Raju is 5yrs old male. He's neutered & is very a active cat among the lot. He eats fish & goes outdoors thrice a week for 3-4 hrs each. I've 4 cats in total (1M, 3F) all from the same family.Please help me identify the possible cause & how to get around it.Regards,
Ashwin
Submitted: 1 month ago.
Category: Cat Veterinary
Customer: replied 1 month ago.
Video linkhttps://youtu.be/YVVQ-qJHGRw
Expert:  Dr. Michael Salkin replied 1 month 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 1 month ago.

Thank you for the video. Give me a moment to take a look, please...

Expert:  Dr. Michael Salkin replied 1 month ago.

Excellent video, Ashwin. It demonstrates feline hyperesthesia ("rolling skin syndrome") nicely. You've asked a simple question but the answer is anything but simple. I need you to review the synopsis of feline hyperesthesia here: http://www.vet.cornell.edu/fhc/Health_Information/HyperesthesiaSyndrome.cfm?gclid=CjwKEAjwsYW6BRCTzvu5y8DPhi0SJABnGLlHvpLl_sZF6DG9I70lLI7WTVkxH017DayAYXp-yAXtJxoCIM_w_wcB

and then please return to our conversation with further questions and concerns.

Customer: replied 1 month ago.
Thank you Dr. Michael.Raju does have some but not all symptoms listed on the link. Given the mention of seizures, what're the symptoms I should watch out for?Additionally, help me with medication I should keep handy in-case he needs to be administered one. He's 5.5kg in weight.Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Seizures aren't likely, Ashwin, although they're mentioned as a possible cause of this behavior. In my experience, itchy/painful skin is most likely the cause and that can arise from a flea saliva allergy, atopy (allergies to environmental allergens such as pollens, molds, dust, dust mites, etc.), or a food intolerance or trauma. It's enticing to incriminate his fight that might have injured that area and made it more sensitive. Please look carefully through his haircoat for any evidence of scratches or bites that may be still unhealed. Let me know if see anything of that nature.

Customer: replied 1 month ago.
Hi Dr. Michael,Raju has another incident yesterday morning where he salivated for a minute or two. I've got pics attached for your view.He was resting in his bed & got alarmed by door bell which led to him salivating a lot for a minute.Can this be an indication of heart issue? He was back to normal in 10 mins. I've also examined his coat as you suggested, however he doesn't have unhealed scratch or bite.Will take him for a blood test tomorrow. Would you recommend some specific tests?Regards,
Ashwin
Customer: replied 1 month ago.
Expert:  Dr. Michael Salkin replied 1 month ago.

Perhaps he was momentarily nauseated. Hypersalivation is a nonspecific sign. I wouldn't think of his heart. A basic diagnostic panel of blood and urine tests is reasonable.

Customer: replied 1 month ago.
Would you recommend any natural remedy/solution to keep him calm/reduce anxiety levels ?
Expert:  Dr. Michael Salkin replied 1 month ago.

I prefer not to give cats anything that isn't absolutely necessary. Just dosing them stresses them.

Customer: replied 1 month ago.
Hi Dr. Michael,Attached are Raju's blood test report. Let me know of what you think.His urine culture reports will come in 4 days.Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Thank you, Ashwin. His urine is quite dilute which is unusual for such a young cat. Bacteria were found in his urine as well. If the urine were obtained by cystocentesis (percutaneous aspiration of his bladder through his abdominal wall), the bacteria indicate a urinary tract infection. If the urine were obtained from the litter box, the bacteria might only be a contaminant. Please tell me how the urine was colelcted. His total thyroid is elevated which indicates hyperthyroidism but I've never diagnosed hyperthyroidism in a cat of his age although it has been seen in cats as young as 4 years of age. Is there any chance that he's older than 5 years of age?

Customer: replied 1 month ago.
Urine was collected using a syringe from is abdomen. The sample was collected after he had food in the morning.His TT4 value in Aug 2016 was 2.2 μg/dL. Attached are his reports from Aug 2016. Can the thyroid value be influenced by stress? Raju's exact age is 5 yrs 2 months. Any other tests needed to determine/confirm thyroid issues. What are the symptoms of thyroid problem? Is it time start medication?Raju's USG has been in the range of 1.015 --1.020 as far back as 2015 on wards. He has/could have a possible early CKD. If you look at our previous chat/s I've discussed Raju's case with you at length. We were not able to narrow done or rule out a CKD for Raju inspite of all the tests that could be done at my vet's clinic. SDMA is not yet available in India.
All of his previous reports have USG value in the range stated above.You can go through his reports attached to previous cases or I can send them again if you like.
His Sgot, Alkaline p04, cholestrol & Triglycerides are on higher side. What do you think about it?Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Bacteria, then, indicate a urinary tract infection which should be treated for 7-10 days with an appropriate antibiotic such as amoxicillin/clavulanate. Urinary tract infections involving the kidney(s) can cause the production of larger than normal amounts of dilute urine. It would be interesting to see if he can concentrate his urine better once treated.

No, stress shouldn't cause such an increase in the T4. If he's truly hyperthyroid, that's another reason for increased thirst/increased volume of urine but I would also expect his losing weight in spite of overeating, symptoms of gastrointestinal distress such as vomiting and/or diarrhea, tachycardia (increased heart rate), and a palpable thyroid nodule. If there isn't such supporting evidence I wouldn't jump to treat him for hyperthyroidism at this time.

Any increase above normal in the alkaline phosphatase (AP) is considered abnormal in cats. It usually indicates hepatic disease. The SGOT isn't useful in cats and the cholesterol and triglycerides aren't of concern unless egregiously elevated.

Customer: replied 1 month ago.
Raju's Alkaline p04 values have been high for sometime now. I see that in the previous test reports of last 2 years. What needs to be done? What's the impact of increased p04 values?I'll share the urine culture report once I have it & we can discuss about the UTI medication.Do these test results indicate root cause of hyperesthesia?Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Hyperthyroidism can agitate my patient and so it's certainly a consideration in a hyperesthetic cat. It can also elevate liver enzymes such as the AP.

Customer: replied 1 month ago.
What impact does the increased alkaline value might have? Any impact on liver function?Given Raju's thyroid value has more than doubled in a year, when would be right time to start his treatment? What medication is available for hyperthyroidism for cats?Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

It's an indicator of biliary stasis (sludging). It doesn't cause a liver problem; it's the result of a liver problem. Oral or transdermal methimazole is the usual treatment. The prescription diet Hill's y/d can normalize some cats without the need for methimazole. Finally, radioactive iodine therapy can be curative but I don't believe that that therapy is available where you live.

Customer: replied 1 month ago.
I doubt radioactive therapy is available in India, although I'll check with my vet. Any medication for thyroid for cats?He's also getting semi-loose stools (see pic).Attached is Raju's UPC report. UPC value is very high. Can it be due to UTI? How can we address it?Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Yes, methimazole as I mentioned above. Diarrhea (and/or vomiting) is consistent with hyperthyroidism. The elevated UPC in conjunction with dilute urine is worrisome for a glomerulonephropathy - the glomeruli (filtering organs of the kidneys) would be damaged. Infection, however, can cause a postglomerular proteinuria and so after a course of antibiotic, the UPC should be rechecked.

Customer: replied 1 month ago.
What'll be the dosage for Methimazole? Raju's 5.4kg in weight. Can I start y/d dry food along with this medication? Is it safe for my other 3 cats to also be given y/d diet?Can UTI cause hyperthyroidism or the vice-versa? His thyroid value in Aug 2016 was 2.2.Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

Methimazole is usually initiated at 2.5 mg twice daily. Yes, you can feed that food too but it's not appropriate for your other cats. No, there's no relationship between a UTI and hyperthyroidism.

Customer: replied 1 month ago.
Do you think a freeT4 (fT4) or T3 suppression test needed to confirm hyperthyroidism in Raju? Can methimazole be given as injection under the skin? If so, what'll the dosage?Given his high UPC value, does Raju have a case of Azotemia or Uremia?How can we address glomerulonephropathy concern?Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

A fT4 is a good idea as it's more accurate than the T4 alone. The T3 isn't usually helpful in these cats.

No, it's not an injectable drug.

No, azotemia/uremia implies elevated blood urea nitrogen. If uremic, the elevated UPC is a negative prognostic indicator. You'll need to determine the cause of the glomerulonephropathy. Read what the lab posted as potential causes of the elevated UPC.

Customer: replied 1 month ago.
Morning Dr.Michael,Which of the attached medicines would you recommend for treating Raju's UTI ?
I have attached pics of the composition.Thank you,
Expert:  Dr. Michael Salkin replied 1 month ago.

The amoxicillin/clavulanate at 1.5 mL twice daily for a week.

Customer: replied 1 month ago.
Dr. Michael,I am not able to find y/d diet yet in the market.How long should I wait before I start him on methiamazole tablets? OR Will it be safer to give him a 2.5 mg single dose a day? Not sure how much of help will it be to control his thyroid.Regards,
Ashwin
Expert:  Dr. Michael Salkin replied 1 month ago.

The Hill's y/d is a prescription food that only a vet can prescirbe. If his vet wants to initiate treatment with methimazole, the lowest dose should be 2.5 mg twice daily as 2.5 mg once daily rarely suffices. His vet needs to make the decision to treat as that vet will be monitoring Raju.

Customer: replied 1 month ago.
Attached is Raju urine culture report. No bacteria was found.What should we do for high UPC value? Will giving him antibiotic help with UPC?
Expert:  Dr. Michael Salkin replied 1 month ago.

Recheck the UPC at least once. We usually need to see 2-3 elevated UPCs to make the call for excessive proteinuria. If the next UPC is also elevated I would check his blood pressure. If elevated, treating for hyperthyroidism may suffice to lower the blood pressure and stop his excessive protein loss through his kidneys. There's no need for an antibiotic because his urine culture was negative.

Customer: replied 1 month ago.
Will it be good to feed him royal canine renal or urinary so dry food?..does it help in reducing protein loss?
Expert:  Dr. Michael Salkin replied 1 month ago.

No, an ACE inhibitor such as enalapril can reduce protein loss, however. I don't restrict protein in the diet in order to reduce protein loss. That's controversial and cats have a high protein requirement.

Customer: replied 1 month ago.
Morning Dr.Michael,Raju salivated again sometime back. He was resting on his bed and then suddenly jerked and moved away from his bed, and starting nodding his head like they do when there is something stuck in his mouth and then licked in his saliva.Also, I noticed that his Na and K on the reports are on the higher side- should we be concerned about this ?
Expert:  Dr. Michael Salkin replied 1 month ago.

As long as both are in the normal range, I'm happy. I regret that I can't know the significance of that behavior, Harsu.

Customer: replied 1 month ago.
how long would it take for thyroid medicine to take effect per your experience ? Do you think 2-3 weeks is a good timeframe
for it to come down to a normal value..Thank you !!
Expert:  Dr. Michael Salkin replied 1 month ago.

Yes, 2-3 weeks post-initiation of the methimazole is when we recheck the T4 - and fT4/free T4 if that's available where you live. You're quite welcome.

Customer: replied 1 month ago.
Can methimazole elevate or complicates CKD or renal issue? I was reading something around it on the web.
Expert:  Dr. Michael Salkin replied 1 month ago.

Yes, because effectively treating hyperthyroidism will reduce the blood pressure in the kidneys. That can be desirable in hypertensive cats but can also reduce blood flow enough to compromise kidney function. If my patient also suffers from renal insufficiency, I'll leave them mildly hyperthyroid. Raju's bood tests don't indicate renal insufficiency...only excessive proteinuria.

Customer: replied 1 month ago.
Can hyperthyroidism mask BUN & Createnine values, make them look normal when they might not be? Also, doesn't his urine gravity values indicate a possible ckd ?Assuming Raju has CKD or early CKD, what'll be a safe dose of metimazole so as it doesn't negatively effect or elevate the kidney issue?
Expert:  Dr. Michael Salkin replied 1 month ago.

Yes. Yes. 2.5 mg twice daily.

Customer: replied 1 month ago.
Okay. Based on our conversation & reports so far, what would you recommend the treatment plan for Raju to be?
Expert:  Dr. Michael Salkin replied 1 month ago.

That's for you and your vet to decide. I would recheck his UPC 2-3 weeks after the last test, check his blood pressure, and initiate dosing of methimazole at 2.5 mg twice daily.

Customer: replied 1 month ago.
Initiate dosing of methimazole post the next UPC test or start now ?
Expert:  Dr. Michael Salkin replied 1 month ago.

I'd prefer waiting to see what the next UPC test shows first.

Customer: replied 1 month ago.
Do you see any risk in waiting until next UPC tests? What if his thyroid values elevate further during wait period?
Expert:  Dr. Michael Salkin replied 1 month ago.

No, 2-3 weeks isn't critical.