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A few months ago, we lost our vet who made house calls and…

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A few months ago...

A few months ago, we lost our vet who made house calls and took our ten year old cat - who had never been outside at all - to a new vet's office. We believe she picked up fleas at their office. Additionally, we asked about a possible allergy because the skin on her spine is very dry and flaky, and she has lost quite a lot of hair. She does not groom that area, but likes to have the "furminator" brush used on her back. The vet gave us the prescription drops for the back of her neck for the fleas - which we never saw, but she was scratching a lot and intensely grooming herself all the time --- but he was unconcerned about the hair loss. He prescribed Canin food for her because the reason for the initial visit to him was a urinary tract infection, and xrays showed kidney stones, which the new food apparently dissolved within a matter of weeks. So now we have the hair loss problem and very flaky skin along the spine. We really don't want to take her back to the vet, because it's incredibly stressful for her, even with the feliway.

Veterinarian's Assistant: 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?

Phoebe

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Phoebe?

This was the second UTI in about six months. Our first vet, as well as the second, treated it with steroid and antibiotic injections. The second also xrayed, and then prescribed the Canin specialty food. This new food has greatly reduced the incidence of Phoebe's extreme vomiting.

Submitted: 8 months ago.Category: Cat Veterinary
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Answered in 12 hours by:
10/5/2017
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 34,224
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago

I'm sorry that your question wasn't answered in a timely manner. I'm going to post my entire synopsis of the pruritic cat for you. A flea saliva allergy is a concern but you'll see other consideration for Phoebe's condition as well...

Pruritic (itchy) cats are suffering from an allergic dermatitis in the great majority of cases.. 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 and is diagnosed with skin scrapings examined microscopically. Skin infection (pyoderma) is under-diagnosed. Phoebe's vet can perform a cytology (microscopic exam of a small sample of Phoebe's skin surface) looking for abnormal numbers of either bacteria or yeast.

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 her vet even if fleas aren't seen. It would be prudent to switch to one of the newer flea products in a different class of insecticide such as Activyl (indoxacarb), Cheristin (spinetoram), Comfortis (spinosad), or Vectra (dinotefuran & pyriproxyfen). These are all prescription products available through her vet. You can purchase the oral Capstar (nitenpyram) over the counter in pet/feed stores, however, which will kill any fleas on Phoebe within minutes of your dosing her. Be sure to treat your premises with an over the counter area treatment spray that contains an insect growth regulator (IGR) such as Siphotrol Area Treatment Spray containing the IGR methoprene. The IGRs don't allow flea eggs and larvae to develop into adult fleas and so the life cycle of the flea is broken. 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 glucocorticoid (steroid 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 Phoebe'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. Food intolerance is not as steroid-responsive as is either a flea saliva allergy or atopy.

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.

Please respond with further questions or concerns if you wish.

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