? Gangrene, Cushing's Disease - Skin Turning Purple And Black

[Yoheved79]

I have a 15 year old Male cat who was a rescue and looks very much like a Ragdoll. Even though he has no "official paperwork" he seems to be plagued with a lot of ailments common to that breed.


In August of 2017 he was diagnosed with Small Cell Lymphoma and given 8 weeks to live. I immediately started him on Prednisolone and opted not to do exploratory surgery. Thankfully it was a good choice. After going to 3 different vets, a surgeon and then ended up at a Veterinary Internist's office he was diagnosed with Irritable Bowel Disease and so he remained on the Prednisolone and we agreed to monitor him by having me return in 2-3 months.


Upon my return we did an Echo and found that his heart had enlarged to a dangerous 20 millimeters due to the steroids so we needed to change his regime. We then put him on .25mil of Dexamethasone and .25mil of Furosemide and after several months his heart went down to 15 millimeters. He has been on those dosages for 10 months.


Then 5 weeks ago a terrible Upper Respiratory Infection spread through my house. After 3 visits to the ER over the weekend with my 19 and now 16 year old's which sadly didn't help much I then got them to my Internist and she quickly diagnosed the 16 year old Ragdoll looking kitty named Chai with Diabetes.


I won't go into all the details but no one would really tell me what to do. The Internist prescribed Lantus, 1 unit twice a day and sent me on my way. The next day I went to pick it up and was so confused about everything, when to administer it, how to store the Lantus, buying a Alpha tracker etc. i watched some Youtube videos and have done the best I can to educate myself.


Two days after he was diagnosed I noticed some strange lacerations on his rear feet. It was actually on the heel or area where the "metacarpal bone" meets the plantar pad (so it's the part that does not touch the ground when he walks). I did what most probably would, cleaned it out with a littler peroxide and a dab of neosporin (I know that's probably poopooed by many) and then my thought was it was an ulcer. It seemed to go away a little over the next few days and then it came back, but this time it came back as scaly skin that was flaking and hair was coming out. The area that was now bald had skin that was turning black.


I took my cat to my regular vet and he said that Chai probably has a bacterial infection and he sold me a topical ointment called Dermalone which I applied twice a day for a week. It did nothing. In fact the spots were getting larger, the skin was getting drier, welts started to form all over this area on both his hind feet. The vet then told me he needs to have his skin conditioned so he needs to take Omega 3 oils.


This entire time since these spots surfaced i have strongly urged that these spots are due to poor regulation of his Glucose and incorrect dosages of insulin but no one has really listened to me.


Between yesterday and today my cats tail (the last 3 inches) has also turned black, the hair easily falls out when I gently glide my hand over it and the hair comes off with pieces of dried skin attached. Half of this area is now bald and i noticed when he walks he is now dragging his tail where before he would raise it and his spine seems more curved than normal. Another development today as well is that I started to further investigate all 4 of his feet more closely even the areas where there is fur and sadly i found these jet black spots some the size of a dime all over his rear paws and feet. The hair is still there but if i gently tug on it the hair will come out just as it did on his tail. However none of the skin on his toes have changed color, yet. I also noticed a lot more purplish coloring forming over the past 2 days and this the entirety of of hind feet also feels very bony. He is walking but he seems wobbly in the rear as I would suspect he is in pain. I also noticed that sometimes after eating or after getting the insulin he will lay down on his stomach with his paws in front under his chest and he bows his head down. It's not a position I have ever seen him spend any amount of time in and it again looks like he's in pain.


I contacted my vet because i am freaking out and my gut is telling me his Diabetes is not being regulated correctly. They actually recommended I take him to a veterinary dermatologist and i can't get a Appt with one for almost a month. I was able to make an appointment on Saturday to either have the vet do a Glucose curve over 8 hours or a Fructosamine test, (they are pushing towards the Fructosamine).


Has anyone out there ever experienced this, what are your thoughts as to why his skin is turning purple, black, swelling, hair is falling out on his hind feet and end of his tail, bones in the hind feet feel frail, hunched walked and can't raise his tail...What might you think it is and what would you do because i am worried he's on the path of having his feet and tail amputated due to Gangrene which my vet and Internist said is most likely not the case? I also looked up a little on Cushing's which sounds similar as well but my Internist swears that's next to impossible for him to have that. Any help is much appreciated!?

The photo of his tail I had to use a Flash, please note the spots look Grey, they are not they are just as Black as the spot in the photo of his foot i just couldn't get a good shot without the flash.

Thanks,
Jennifer

 

[PussCatPrince - GA]

Hi there.
Am tagging two users who know about cushings


@Ana & Frosty (GA) .

@Tuxedo Mom

 

[Wendy&Neko]

Hello and welcome. Tagging @Ana & Frosty (GA) who has experience with Cushings.

Are you home testing your kitty’s blood sugars? That’s the best way to keep him safe and help get him regulated. Is prednisolone out of the picture now? Cushings isn’t super common, though we have seen a few here. A small minority of the cases can be caused by steroids. Does Chai have a pot belly?

I think Ana used the same thing recommended by my vet for cleaning sores, which is diluted hibitane.

 

[Yoheved79]

I bought an Alpha Tracker but I'm having challenges with it so I am not doing regular home testing. I tried several times to prick his ear and felt i was just destroying his ears and I was afraid to prick his paws because of the sores all over his feet. I would love to have some dialogue with someone anyone who does daily testing so I could get comfortable doing it so it becomes part of my routine. Can anyone here do that?

As for the Prednisolone he has been off that for 10 months but he's been on another steroid called Dexamethasone during that entire time. My internist did not take him off that once she diagnosed him with Diabetes she just lessened his dosage to .2mil I am of the belief at this point that he needs to come off it completely. Not sure how everyone feels about that. I know my vet and my internist do not agree.
I am not sure if he has a potbelly. His belly hangs it's been that way for many years, but I've not watched it close enough to see if there are any slight differences in the way the skin hangs. When I think of a potbelly I think of a hard ball which he does not have. What should I be looking for?

Thanks,
Jen

 

[PussCatPrince - GA]

@Yoheved79

Being wobbly on his rear legs may be down to neuropathy.

This means that the cat will walk low on the hocks and sores can develop. A planter gait. Whilst healing the skin may have contracted a bacterial infection so your vet may be correct in this.
Neuropathy is caused by unregulated diabetes however.

Sitting in a meatloaf position with the head down can indicate discomfort in some way.

Everyone here can help with home testing.

Is there a strong bad smell about him at all?

 

[Wendy&Neko]

You don't need the expensive AlphaTrack meter or it's expensive test strips.

Almost everyone here tests at a minimum of two times a day, most more than that. If you feed a low carb treat when you test, they will soon look forward to it. Warm his ears first, to make him bleed easier. You can fill a small sock with rice, tie off the end, then microwave it and use that under the ear to both warm it up, and provide support for the poke.

Dexamethasone is also a corticosteroid. You might want to ask your vet about budesonide, which is what my girl took for her IBD. It's more specific to the gut and in many cats does not impact the blood sugar like the other steroids do.

 

[Tuxedo Mom]

Cushing's has been considered a rare disease in kitties but I personally believe that this is due to under-diagnosing. Acromegaly used to also be considered rare in kitties, but with more research it is estimated that as many as 1 in 4 FD kitties are acros. The use of steroids to treat other conditions can definitely be a tipping point in the development of Cushing's.

Home testing is very important to see what sort of response your kitty is getting to the insulin type and dose. Cushing's kitties tend to be harder to regulate because of the excess cortisol the body is producing and finding a dose that keeps glucose numbers in a good range is important to help decrease the effects on vatious organs that the higher cortisol causes.

The cheapest least invasive test for Cushing's is the UCCR test ( Urine cortisol creatinine ratio) This involves collecting a sample of urine AT HOME so there is no stress involved and having your vet send it to an outside lab such as IDEXX. If the results are positive or borderline then other tests are needed to verify the diagnosis. An ultrasound, done by a board certified tech can also be useful. With PD (piuitary affected) Cushing's the liver, pancreas and BOTH adrenals are enlarged, With AD ( adrenal affected) usually one adrenal will be enlarged and shows signs of a tumour.

This may not be Cushing's but hair loss is definitely one of the red flags. Along with hard to regulated FD and often an enlarged belly ( my male kitty looked like he was pregnant with his belly enlargement) ruling out Cushing's is a prudent approach.

 

[Yoheved79]

You don't need the expensive AlphaTrack meter or it's expensive test strips.

Almost everyone here tests at a minimum of two times a day, most more than that. If you feed a low carb treat when you test, they will soon look forward to it. Warm his ears first, to make him bleed easier. You can fill a small sock with rice, tie off the end, then microwave it and use that under the ear to both warm it up, and provide support for the poke.

Dexamethasone is also a corticosteroid. You might want to ask your vet about budesonide, which is what my girl took for her IBD. It's more specific to the gut and in many cats does not impact the blood sugar like the other steroids do.

I unfortunately already invested in the Alpha Tracker and have used it so I don't think it is returnable. Since I already have the Alpha Tracker can I use this device or do you recommend I get something else?

There is an odor to his feet and tail but I don't think it is fowl smelling. I have been putting Duoxo gel on his tail and feet per my vets recommendation. I don't think it's done anything though and it's what I am smelling. I don't know if he has neuropathy is there a way to tell?

I changed Chai's diet immediately. My vet had him on K/D simply because my other 2 seniors were on it. I personally do not like K/D so I took everyone off it and moved them over to Stella and Chewy, Weruva and I tried something called Nomnomnow.com and I love it but it's a hard sell to my picky eaters, of course my young adults with no issues though are willing to eat it. The seniors with issues especially Chai are not getting any dry food. And as luck my have it Chai with the Diabetes is my pickiest eater. He loves things that are freeze dried which is why I researched and found Stella and Chewy's. What low carb treat do you recommend?

When you prick the ear you are always puncturing it completely?

I'm do want to rule out Cushing's so I'll see if we can do the UCCR test tomorrow. I'm taking Chai to do a Glucose Curve with the vet and have her look over his tail and feet. Do you all recommend a fructosamine test in conjunction with a glucose curve or is it really not necessary? I am reading that the fructosamine test really doesn't help with determining what he needs now it just looks at his averages over the past few weeks. Any thoughts?

As for the Alpha tracker and how to use it is there a step by step video or someone I can talk to you. I've read the booklet and still feel lost when I fo to use it. The other day I turned it on pricked Chai 4 times in his ear got an ok sample and the tracker didn't do anything which was frustrating and then I felt terrible about puncturing his ear for nothing and gave up.

Today was the first day since he was diagnosed where I fed him gave him his one unit of Lantus and then 5 minutes later he threw up all his food. I called me vet asking what to do because he started to act weird hiding in spots he typically doesn't go in and acting very lethargic. I tried to get him to eat more and iI had mirtazapine but the vet didn't get back with me so I didn't know what to do. He hasn't eaten anything all day. I tried several different foods even his favorite Freeze dried cat man doo chicken treats and he wasn't interested he's just in his uncomfortable looking position.

 

[Yoheved79]

Cushing's has been considered a rare disease in kitties but I personally believe that this is due to under-diagnosing. Acromegaly used to also be considered rare in kitties, but with more research it is estimated that as many as 1 in 4 FD kitties are acros. The use of steroids to treat other conditions can definitely be a tipping point in the development of Cushing's.

Home testing is very important to see what sort of response your kitty is getting to the insulin type and dose. Cushing's kitties tend to be harder to regulate because of the excess cortisol the body is producing and finding a dose that keeps glucose numbers in a good range is important to help decrease the effects on vatious organs that the higher cortisol causes.

The cheapest least invasive test for Cushing's is the UCCR test ( Urine cortisol creatinine ratio) This involves collecting a sample of urine AT HOME so there is no stress involved and having your vet send it to an outside lab such as IDEXX. If the results are positive or borderline then other tests are needed to verify the diagnosis. An ultrasound, done by a board certified tech can also be useful. With PD (piuitary affected) Cushing's the liver, pancreas and BOTH adrenals are enlarged, With AD ( adrenal affected) usually one adrenal will be enlarged and shows signs of a tumour.

This may not be Cushing's but hair loss is definitely one of the red flags. Along with hard to regulated FD and often an enlarged belly ( my male kitty looked like he was pregnant with his belly enlargement) ruling out Cushing's is a prudent approach.

I unfortunately already invested in the Alpha Tracker and have used it so I don't think it is returnable. Since I already have the Alpha Tracker can I use this device or do you recommend I get something else?

There is an odor to his feet and tail but I don't think it is fowl smelling. I have been putting Duoxo gel on his tail and feet per my vets recommendation. I don't think it's done anything though and it's what I am smelling. I don't know if he has neuropathy is there a way to tell?

I changed Chai's diet immediately. My vet had him on K/D simply because my other 2 seniors were on it. I personally do not like K/D so I took everyone off it and moved them over to Stella and Chewy, Weruva and I tried something called Nomnomnow.com and I love it but it's a hard sell to my picky eaters, of course my young adults with no issues though are willing to eat it. The seniors with issues especially Chai are not getting any dry food. And as luck my have it Chai with the Diabetes is my pickiest eater. He loves things that are freeze dried which is why I researched and found Stella and Chewy's. What low carb treat do you recommend?

When you prick the ear you are always puncturing it completely?

I'm do want to rule out Cushing's so I'll see if we can do the UCCR test tomorrow. I'm taking Chai to do a Glucose Curve with the vet and have her look over his tail and feet. Do you all recommend a fructosamine test in conjunction with a glucose curve or is it really not necessary? I am reading that the fructosamine test really doesn't help with determining what he needs now it just looks at his averages over the past few weeks. Any thoughts?

As for the Alpha tracker and how to use it is there a step by step video or someone I can talk to you. I've read the booklet and still feel lost when I fo to use it. The other day I turned it on pricked Chai 4 times in his ear got an ok sample and the tracker didn't do anything which was frustrating and then I felt terrible about puncturing his ear for nothing and gave up.

Today was the first day since he was diagnosed where I fed him gave him his one unit of Lantus and then 5 minutes later he threw up all his food. I called me vet asking what to do because he started to act weird hiding in spots he typically doesn't go in and acting very lethargic. I tried to get him to eat more and iI had mirtazapine but the vet didn't get back with me so I didn't know what to do. He hasn't eaten anything all day. I tried several different foods even his favorite Freeze dried cat man doo chicken treats and he wasn't interested he's just in his uncomfortable looking position.

 

[Squeaky and KT (GA)]

Check out this info on Plasma Cell Pododermatitis (aka 'Pillow Foot') - sure sounds a lot like what your dealing with. I had a kitten many years ago develop it but it had other problems too and lost it before I really learned a lot about it....no internet back them. (Yep I'm ancient...)

http://www.marvistavet.com/plasma-cell-pododermatitis.pml

It is treatable but it sounds quite advanced...

 

[Wendy&Neko]

It's up to you if you want to continue using the AlphaTrak. Maybe when you run out of strips you can invest in a human meter with cheaper strips. and keep the AT as a backup. That is, if price is an issue with you. Look for a meter than only needs a small drop of blood.

No, you don't poke all the way through the ear when you test. Using 26 gauge lancets may help at first, so you only have to poke once.

Any treat that is just one ingredient, freeze dried meat, is a good one. You can get all sorts of proteins. Freeze dried chicken breast seems to be favourite of many. But if Chai has a particular protein allergy, and hence the IBD, you can get turkey, fish, duck, buffalo, and many others.

Today was the first day since he was diagnosed where I fed him gave him his one unit of Lantus and then 5 minutes later he threw up all his food. I called me vet asking what to do because he started to act weird hiding in spots he typically doesn't go in and acting very lethargic. I tried to get him to eat more and iI had mirtazapine but the vet didn't get back with me so I didn't know what to do. He hasn't eaten anything all day. I tried several different foods even his favorite Freeze dried cat man doo chicken treats and he wasn't interested he's just in his uncomfortable looking position.

That is quite worrying. Without knowing what his blood sugar was when you gave the shot, we can only guess what might be wrong. Any chance you can syringe feed him to get at least something in him now that he has insulin on board? Have you been testing for urinary ketones?

 

[JeffJ]

I didn't read all the postings here.

I continue to use AlphaTrak2 for 3 years now, and it works fine. I use Freestyle Insulinx strips, which I get from ebay for about $0.20/strip. Some find them cheaper on ebay. I have also used Freestyle Lite strips, and gotten the same readings.

Leo has Small Cell Lymphoma (SCL) too. He is on daily prednisolone. And every 3 days Chlorambucil (chemo). The chemo is compounded into a liquid, and he gets an oral squirt of it just before a meal, every 3rd day. It keeps the SCL in remission.

Leo has been diabetic for 3 years, and SCL for 18 months. When we are lucky, the treatments keep them going. SCL can take a kitteh, even if they are getting the correct treatment.

 

[JeffJ]

I would recommend removing the 911 from your post, since these issues don't have to be resolved in the next 2 hours. Thank you.

 

[JL and Chip]

I would schedule an appointment with a veterinary dermatologist even if you have to wait a month. Best to get it scheduled ... you can always cancel if you change your mind. I'd consider an Internal Medicine specialist as well.

Did your regular vet run standard bloodwork?

Is there any possibility that your cat ingested or rubbed up against something toxic? Anything new in your home recently?

There are a number of things that can cause some or all of the symptoms you've described -- some scary, some not. I've seen some of those symptoms with everything from a rare form of skin cancer (Bowen's disease), to Cushings, liver issues, thyroid or other endocrine issues, a really bad case of ringworm, and even mange, to name a few. And that's the short list. Sometimes it takes a specialist to unlock the puzzle.

 

[Becky & Baby Girl GA]

In regards to the ear... are you warming & massaging the ear before testing? I filled a small sock with rice & warmed it in the microwave a few seconds. Test on your wrist to make sure it’s not too hot. Warm & massage the ear towards the tip. The capillaries do grow after about a month or two of testing & I quit having to use heat. I do massage a little to push the blood upwards to the sweet spot. I can’t offer much info on the spots but I’m sincerely hopping someone can find the answers. Best of luck & thank your for taking such good care of your kits!

 

[Ana & Frosty (GA)]

Hi there,

Sorry that it took me so long to respond to this. It was a very busy week at work and I am just now catching up on all of this.

First of all, I just want to say I am really sorry to hear about all the issues your baby is having. My kitty had Cushing’s disease, and had really bad skin tears due to it, so I can definitely tell you what I think based on what I saw on my kitty. I understand that you feel panicked and overwhelmed, but the first step is to take a deep breath.

The black spots in the first picture I have not seen on Frosty, but the second picture where you separated the hair the thin skin looks like Frosty’s. So it may be due to excess corticosteroids.

Now, there’s 2 types of Cushing’s. There’s Cushing’s disease, which comes from the kitty having a tumor either in the brain (Frosty’s case) or the adrenal glands. Both types of tumors produce excess cortisone in the case of Cushing's disease. Another type is Cushings SYNDROME, which has the same symptoms of Cushing’s, but is from being on chronic steroid medication, like your kitty’s case.

I understand that your vet is skeptical about Cushing’s, but despite what she or he has learned in school, it IS possible for the kitty to have it. Since your kitty has been on steroids for a long time due to other issues, he might have Cushing’s SYNDROME . Usually that is treated by reducing or stopping steroids and watching for improvement.

Cushing’s disease is more complex, but I am not sure that this is what we are dealing with.

As for diabetes control, I do not think the wounds are CAUSED by diabetes not being well controlled, but certainly if you have wounds AND diabetes, if diabetes is not well controlled, it can make wound healing more difficult.

I think that your internist is the best person to test for this. Again, I think if anything your kitty may be developing Cushing’s SYNDROME. The only way to really know is to take him off the steroids and see if he improves. I do realize that this may not be feasible because it may make his other problems worse. It’s all about a delicate balance when it comes to managing two conditions that require opposite treatment. That is only something a vet can help with.

I also agree with someone who said it wouldn't hurt to schedule a dermatologist appointment just to have it while you are working with your internist.

I hope this helps a little. Please feel free to ask any questions you may have.

 

[Yoheved79]

Check out this info on Plasma Cell Pododermatitis (aka 'Pillow Foot') - sure sounds a lot like what your dealing with. I had a kitten many years ago develop it but it had other problems too and lost it before I really learned a lot about it....no internet back them. (Yep I'm ancient...)

http://www.marvistavet.com/plasma-cell-pododermatitis.pml

It is treatable but it sounds quite advanced...

Thank you so much for sharing this. I mentioned this to my new vet vet as of Sat, but she was unsure and took photos to send to a dermatologist to see what they might think. She also did a Fructosamine test of which I am hoping to have the results back tomorrow. I would guess there are variations of pillow foot. Chai's paw pads are not swollen though it's the areas all around it that are changing black and swelling. How did you treat it?

 

[Yoheved79]

It's up to you if you want to continue using the AlphaTrak. Maybe when you run out of strips you can invest in a human meter with cheaper strips. and keep the AT as a backup. That is, if price is an issue with you. Look for a meter than only needs a small drop of blood.

No, you don't poke all the way through the ear when you test. Using 26 gauge lancets may help at first, so you only have to poke once.

Any treat that is just one ingredient, freeze dried meat, is a good one. You can get all sorts of proteins. Freeze dried chicken breast seems to be favourite of many. But if Chai has a particular protein allergy, and hence the IBD, you can get turkey, fish, duck, buffalo, and many others.

That is quite worrying. Without knowing what his blood sugar was when you gave the shot, we can only guess what might be wrong. Any chance you can syringe feed him to get at least something in him now that he has insulin on board? Have you been testing for urinary ketones?

I am going to keep the Alpha Trak since I already bought it and I'll see how everything goes over the next few weeks and if I need to invest in something more reasonable as it relates to the test strip pricing I definitely will. I guess I just need to work on my technique, the problem is I'm really having a tough time doing this alone, he's a super docile cat but he's not liking my technique of poking and squeezing his ear. I tried wrapping him in a towel while he was on the counter but I feel like I can't keep him down and do the test with only 2 hands how do you do this successfully with a challenging patient who doesn't want to hold still? Do you ever prick your kitties in the foot instead? and if so where?

I actually have a lot of freeze dried treats in my house because I couldn't get Chai to eat anything but freeze dried foods when he stopped eating last June prior to his IDN diagnosis. He unfortunately doesn't view them as a treat because I have fed them to him for so long. Of course he'd be more than happy to eat something like a Temptations treat which I personally think are disgusting and not something a diabetic kitty should be eating.

So without going into too much detail I made a lot of changes that were not expected, but probably for the best on Sat. Chai's Veterinary Practice was supposed to see him for an all day Glucose curve, but they neglected to tell me that I needed to bring my Lantus with me because they didn't have any insulin there. When I got there (took me 45min) I had to go back home home and get the Lantus, upon my return they told me I should just reschedule for another day. I was livid given Chai's condition (and because I'd been in the car for over 2 hrs), so they said they would do it but could only test at 10am, 1pm and 3:30pm. I asked why they couldn't test every 2 hours and because I questioned the vet's technique, and because I was unhappy with purchasing Dermalone for $97 which did not work 2 weeks ago (along with 10mL of suspension Panacur for $200 which was highway robbery) they told me Chai could no longer be a patient. I also had another appointment at 1:30pm at this practice for another kitty with Mastitis and asked if they would at least have the vet look at Chai during that time slot since I had it and they refused stating I needed to go somewhere else and that i couldn't even bring in my other cat. It was truly humiliating and stressful since it's hard enough to get an appointment on Sat, but now I don't even have a vet. I should have read the reviews better because this practice is great is you need to have your cats nails clipped or you need to give your kitty a lion cut, but it's a joke if you need to do any type of Medical maintenance. Luckily I found a practice about 20min away that specializes in kitties and is also rescue friendly so I knew their hearts would be in a better place than the previous price gaugers. We did test his Glucose while there and it was lower at 189, but he hadn't eaten in 48hrs and I also took him off the Corticosteroid so I am sure that all heavily impacted the drop.

The Black spots are still getting larger and darker and more are developing. I have not been testing his Urinary ketones, can I do that at home? And I am hoping to have the Fructosamine results back tomorrow.

 

[Veronica & Babu-chiri]

Sorry to hear of all your kitties problems but take a big breath and then start dealing with each issue one by one maybe starting with the ones you can address like the testing I get it, is not easy right now ,but it will be, we all have been there is hard at the beginning but it gets easier you need to start testing at least before shooting the insulin to keep him safe, and as you get a bit more of practice get some more middle cycle tests, but one step at a time and eventually you can schedule a curve you actually do at home which will be much accurate than anything the vet can get because he will not be all stressed and in and strange environment.

So far if you can post whatever glucose tests results you have it may help getting an idea of how he's doing and if you could start using the spreadsheet we use here you will find that it is going to help you a lot in keeping track of how he's doing and it will make easier for people here to help you too. This is the link for the spreasheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

For what you describe (not being able to raise his tail, plantigrade walking ) he may be having a neuropathy that is common in diabetic cats but fortunately it can be treated and in most of the cases they recover their normal mobility, you can address with the vet giving him zobaline for that.

And if it were me I would insist on checking him for Cushing's, and while you are at it get his thyroid checked too

Also since you are using Lantus here's the link to the Lantus forum where you will find a lot of information about this insulin and a lot of very experienced people that can help you http://www.felinediabetes.com/FDMB/...ntus-basaglar-levemir-group-start-here.18139/

 

[Yoheved79]

I didn't read all the postings here.

I continue to use AlphaTrak2 for 3 years now, and it works fine. I use Freestyle Insulinx strips, which I get from ebay for about $0.20/strip. Some find them cheaper on ebay. I have also used Freestyle Lite strips, and gotten the same readings.

Leo has Small Cell Lymphoma (SCL) too. He is on daily prednisolone. And every 3 days Chlorambucil (chemo). The chemo is compounded into a liquid, and he gets an oral squirt of it just before a meal, every 3rd day. It keeps the SCL in remission.

Leo has been diabetic for 3 years, and SCL for 18 months. When we are lucky, the treatments keep them going. SCL can take a kitteh, even if they are getting the correct treatment.

It's so hard to manage different diseases at once and then be worried on how one medication can affect another ailment. I'll try the Freestyle Lite strips as well if they're more reasonable. I did Prednisolone for about 8 months with Chai and unfortunately that is what resulted in the Cardiomyopathy so we switched him to the Dexamethasone instead which has not been as harsh on his heart but now I've got all these other effects which could very well be side affects from the corticosteroid. It's so hard to navigate through all of this.

 

[Yoheved79]

I would recommend removing the 911 from your post, since these issues don't have to be resolved in the next 2 hours. Thank you.

I did remove the 911, but i will tell you had someone above not recommended taking him off the steroid I think I'd be in a much different place right now. So I'm so thankful for all the immediate replies.

 

[Veronica & Babu-chiri]

We did test his Glucose while there and it was lower at 189, but he hadn't eaten in 48hrs and I also took him off the Corticosteroid so I am sure that all heavily impacted the drop.

With glucose levels of 189 you do need to test before giving insulin because getting very low sugar levels can be very dangerous, please do try and test before giving him insulin every time

I have not been testing his Urinary ketones, can I do that at home?

Yes you can you need to get the urine test strips, there are some for pets but you can also get the ones for people at the pharmacy and those will work just fine ask for urine dipsticks

 

[Yoheved79]

I would schedule an appointment with a veterinary dermatologist even if you have to wait a month. Best to get it scheduled ... you can always cancel if you change your mind. I'd consider an Internal Medicine specialist as well.

Did your regular vet run standard bloodwork?

Is there any possibility that your cat ingested or rubbed up against something toxic? Anything new in your home recently?

There are a number of things that can cause some or all of the symptoms you've described -- some scary, some not. I've seen some of those symptoms with everything from a rare form of skin cancer (Bowen's disease), to Cushings, liver issues, thyroid or other endocrine issues, a really bad case of ringworm, and even mange, to name a few. And that's the short list. Sometimes it takes a specialist to unlock the puzzle.

I agree, I think getting him in with a Dermatologist is still a really good idea. So i do have an appointment the 2nd week of Dec. In the meantime the new vet is friends with a Veterinary Dermatologist so she took plenty of pictures and I'm hoping she gets some feedback tomorrow or Wed. And I have an Internal Medicine Specialist already. She is the one who diagnosed Chai with IBD, Cardiomyopathy and Diabetes. She ran his bloodwork about 6 weeks ago when his glucose was at 398. She's amazing but the problem is she's only open 4 days a week from 8-3pm and she's usually booked about 3-4 week out so it makes it really hard to get in with her when there is an emergency.

I don't think he would have gotten anything toxic on him. He's an indoor only kitty and none of my other 6 cats have anything or my fosters. I don't use any products that are toxic to pets in my house. No essential oils or anything like that are around either. But I wouldn't rule it out. I will add that I had someone dump 3 cats on me about 4 weeks ago threatening to leave them in my driveway if i didn't take them in, really nice! I guess that's what happens when people know you volunteer and foster from time to time. At any rate, this one kitty has a skin issue. I was told she was mauled by a dog when she was only 4 weeks old and had scarring and that's why the hair doesn't grow behind her neck. At first i didn't think anything of it, but then after she was in my home for two weeks i just looked at her one day and thought uh-oh this better not be ringworm. I took her to my vet who said it was 50/50 and that we should do a culture. I did and 10 days late it came back negative, but i still don't know what it is or if it's something else contagious and they didn't address it with me. No other cats in my house are showing any symptoms of anything accept Chai so I'm unsure. Chai started having ulcerations on his feet before this kitty arrived, but the black spots started to develop after the kitty with the missing hair on her neck was in the house. Also, the other vet (that I parted ways with with) might not have taken a good sample, they were not a good practice so that test may have been a waste of time and money. I don't know. He just pulled out a few pieces of hair from that area for the culture.

How do you pose Bowen's, Cushing's, liver and endocrine issues to your vet and have them work with you to rule those out without them getting offended or thinking those tests are a waste of time? I feel like the vets around me don't want you telling them what you want to investigate. The vet I just parted ways with on Sat. was insulted when I told them I joined this page and she had her office admin tell me that everything I am reading is questioning her education and what she believes is best for my cat and i don't trust her so I shouldn't be a patient any longer.

 

[Yoheved79]

Sorry to hear of all your kitties problems but take a big breath and then start dealing with each issue one by one maybe starting with the ones you can address like the testing I get it, is not easy right now ,but it will be, we all have been there is hard at the beginning but it gets easier you need to start testing at least before shooting the insulin to keep him safe, and as you get a bit more of practice get some more middle cycle tests, but one step at a time and eventually you can schedule a curve you actually do at home which will be much accurate than anything the vet can get because he will not be all stressed and in and strange environment.

So far if you can post whatever glucose tests results you have it may help getting an idea of how he's doing and if you could start using the spreadsheet we use here you will find that it is going to help you a lot in keeping track of how he's doing and it will make easier for people here to help you too. This is the link for the spreasheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

For what you describe (not being able to raise his tail, plantigrade walking ) he may be having a neuropathy that is common in diabetic cats but fortunately it can be treated and in most of the cases they recover their normal mobility, you can address with the vet giving him zobaline for that.

And if it were me I would insist on checking him for Cushing's, and while you are at it get his thyroid checked too

Also since you are using Lantus here's the link to the Lantus forum where you will find a lot of information about this insulin and a lot of very experienced people that can help you http://www.felinediabetes.com/FDMB/...ntus-basaglar-levemir-group-start-here.18139/

AWESOME!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I'll mess around with the spreadsheet and hopefully won't have any issues with it and read through the Lantus thread. Agreed on ruling out other diseases like Cushing's I just need a vet willing to run the tests and I'm struggling with that. And i will call my interest tomorrow to inquire about the zobaline. THANK YOU!!!

 

[Ana & Frosty (GA)]

I did remove the 911, but i will tell you had someone above not recommended taking him off the steroid I think I'd be in a much different place right now. So I'm so thankful for all the immediate replies.

Who recommended to stop the steroids? I must have missed that post.

I would really be cautious about stopping steroids without talking to your vet. I know your kitty has other serious conditions that are being helped with the steroids, and stopping them can cause those problems to flare up. Also, depending on the dose it can be dangerous to stop steroids suddenly - it can push the kitty into a crisis where their blood pressure will suddenly drop and they can collapse and die. It is very important to talk to your vet before stopping any medications. I would recommend discussing this with your internist.

 

[JeffJ]

For a testing process, I have Leo trained. There is a dedicated blanket on the kitchen floor. I come into the kitchen and call him. I get a treat ready, and he is watching me. I call him to the blanket, then test him...then he gets a treat. He knows the treat is coming, so he is always a good boy, and he always comes to the blanket.

 

[Yoheved79]

Who recommended to stop the steroids? I must have missed that post.

I would really be cautious about stopping steroids without talking to your vet. I know your kitty has other serious conditions that are being helped with the steroids, and stopping them can cause those problems to flare up. Also, depending on the dose it can be dangerous to stop steroids suddenly - it can push the kitty into a crisis where their blood pressure will suddenly drop and they can collapse and die. It is very important to talk to your vet before stopping any medications. I would recommend discussing this with your internist.

I'd have to read through this thread and another but someone had mentioned that once they took their cat off the steroid their Diabetes got better. I don't remember any other details, but for some reason that resonated.

When my Internist diagnosed Chai with Diabetes on Sept 25th he was taking .25mil once a day and we did talk about the possibility of taking him off the corticosteroid, but she thought it would be better to keep him on it for the IBD and start him on Insulin to balance things out. She felt very convicted the Diabetes was being caused by the corticosteroid. Then I was running low on Dexamethasone so when I was refilling it about 3 weeks ago she decided to drop his dosage down to .2mil once a day. This entire time he had the black spots they were just getting worse.

I agree that just taking him off the Corticosteroid could have repercussions, but I went to my vet on Sat. they refused to see Chai even though he had an appointment, I was forced to find another vet within a few hours who didn't say anything positive or negative when I told her I took him of the Dexamethasone and today I called my Internists office twice to get the Dr.'s thoughts about what I did and also see what her opinion might be about switching him to budesonide, but sadly they did not return my call. I'd love to speak to these Dr.'s about what's going on so I don't have to make critical decisions on behalf of my pet when this is not my area of expertise, but I feel I'm in the dark and have to make choices because i can't get the medical support I need.

I do know that since stopping the Dexamethasone, he has started to eat again and seems to be in slightly better spirits, but I don't agree this is the best thing, I just don't know what else to really do other than keep trying to get answers from medical practices who are very busy and just don't have time to help. Another reason I came on her for support.

This is all so odd to me because when I had an enlarged lymph nodes in my neck a few months ago everything was very structured. The Dr. put me on Prednisone, I had really bad side affects so we tried a different steroid, then I started having a negative reaction to the antibiotic so I had to switch to a different one and the deal was if the nodes didn't decrease in size in 3 weeks then i would get a CT and do an aspirate. At every point if i needed to get in touch with the Dr.'s office they were available to help me, I never felt left out in the cold. And i just find it challenging to get the same care and concern in veterinary medicine and I don't know why.

 

[Ana & Frosty (GA)]

And i just find it challenging to get the same care and concern in veterinary medicine and I don't know why

I definitely agree and understand. I had the exact same experience when I was dealing with my IM vet, or I should say when she was out of town. No one else could help me or answer my questions. I think the best way to change that is to give the vets our feedback. Since veterinary medicine has evolved a long way, I think prompt call backs should also been part of their practice.

I am glad that you ran the stopping the steroids by a vet and they didn’t seem concerned. As long as there is a veterinary professional at least (somewhat) overseeing it, it should be ok.

I really hope you are able to get to the bottom of what is causing your poor baby to have these skin symptoms. And most importantly, I hope he feels better soon.

 

[Veronica & Babu-chiri]

How do you pose Bowen's, Cushing's, liver and endocrine issues to your vet and have them work with you to rule those out without them getting offended or thinking those tests are a waste of time? I feel like the vets around me don't want you telling them what you want to investigate. The vet I just parted ways with on Sat. was insulted when I told them I joined this page and she had her office admin tell me that everything I am reading is questioning her education and what she believes is best for my cat and i don't trust her so I shouldn't be a patient any longer

When I started questioning my vet I started telling him I wanted him to explain everything in detail, because I had a family member with similar symptoms ( for some of the problems it was actually true my family is not exactly know for being the healthiest one so I was really talking from personal experience but not always) and they had tested him for XX (Cushing's for example) and it had resulted positive so that was why I was asking why was my cat different from a human if humans with this and this and this symptoms were tested for it why wouldn't my cat, and since my family member had had a very bad experience with the disease I really didn't wanted my cat to go to the same ( just make sure humans can also get it, a lot of diseases are very similar between humans and cats ) so I asked if he could please humor me with the test even if it was no good I would appreciate it and after all I would be paying for it, I think giving them the idea that you are saying it from human experience makes them feel you are not actually questioning their vet education

I also started telling him I had done some internet research (not really mentioning that it was in a forum they have the tendency of thinking forums are no good ) and actually showed him published studies by respectable organizations, universities etc, so that he could read them if he wanted so that he could see that it was not me but other vets

 

[Ana & Frosty (GA)]

I would just be honest and say, “look, I wasn’t getting many answers and had to switch vets halfway through all this started.. I felt like I was left to help my cat on my own. I started reading about the symptoms and came up with Cushing’s and _______. I also found a cat diabetes forum and talked to some members and showed them pictures. One cat owner there had a cat with cushing’s and said there were some similarities (thinning skin, hair falling out easily) but some differences (no black spots).Another member suggested another disease that may explain similar black spots.

I know these things are rare, but would you consider testing my cat for it? I am very concerned and I feel like something is wrong.”

That’s what I would do. Honesty is always the best policy between a care provider and patient, and helps build trust.

Oh and EDIT: I am sorry that your vet said that, but to be honest with you, as a provider she has to be open to people googling stuff and getting information, even if they don’t agree with it, online. As human providers, we always encourage our patients to educate themselves and THEN we were there to answer their questions and clarify misconceptions. We can reassure them and say, “hey I, think what you read may not be completely correct”, but we would NEVER say to them “how dare you question my knowledge .” You have every right to discuss various treatment methods with your vet. It’s their role to GUIDE and ADVISE you, and give their recommendations and rationalez But anyone who appears this threatened and offended is either insecure in their knowledge/profession, or is just burned out and don’t care to do their job the right (hard) way. And I think you’re better off not going to such a vet. That’s my advice.

 

[JL and Chip]

I agree with Ana about being careful with stopping steroids "cold turkey." It's usually a wean-off situation (for example, lower doses twice a day, then once-a-day dosing, then every-other-day dosing, then stop). If it's been awhile since you stopped then maybe it's ok, but I am glad you at least mentioned it to a vet.

As for dealing with vets ... there's no one size fits all. I'd suggest you focus on the dermatologist and internal medicine specialists and let them evaluate and make recommendations. In my experience, they often have a series of steps they want to take to collect data and work through the diagnostic process rather than "throw everything at the wall at once and see what sticks." IMHO, the best vets are those who are methodical in their approach AND are excellent and patient communicators who are willing to discuss the situation with me, brainstorm when there are mysteries, and work as a team. I might go in with an idea of what tests I expect them to suggest (this isn't my first rodeo) but it's important to listen to what they suggest rather than demand certain tests. It's ok to say "do you think it could be ringworm?" and explain the three new kitties you took in. Sometimes those added details get overlooked and yet are critical to the diagnostic process.

For what it's worth, Bowen's disease is extremely rare and my kitty was initially misdiagnosed by the dermatologist because of that. They figured it out later that day and were really surprised -- they'd seen the disease exactly once in 30 years before that. As they say, "when you hear hoof beats, think horses not zebras." I've just unfortunately had my share of zebras cross my path, lol. So my advice to you is to NOT bring up Bowen's as it's most likely not that. The dermatologist is the expert and will probably try to rule in/out much more likely sources of the problem before expanding his/her thinking out to rare diseases. And that's quite reasonable. The internal medicine specialist will probably do the same. It's always great when they consult with each other.

And as Ana pointed out, a cat can become "cushingoid" (having the symptoms of Cushings) due to long-term steroid use, which can resolve once steroids are stopped. Cats can also become steroid-induced diabetics, again which can resolve once the steroids are ceased.

Good luck with your upcoming visits and please let us know how things turn out.

Oh, and welcome to the "been fired by a vet" club! Years ago I sought out a second opinion before agreeing to an extensive and dramatic surgery on a horse ... yep, received a letter uninviting me from using the vet clinic ever again. The horse ended up not having the surgery and he lived quite happily for another 21 years. Although I've seen interactions where clients probably DO deserve to be fired, sometimes it's more a reflection on the vet than on us as the animal's advocate. Just always remember to be respectful. Vets don't know everything, but neither do we, and getting info from the internet can be good and bad.