Hair loss/skin/coat/pancreatitis issues?

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William's Mom

William's Mom

Member Since 2015
William's got a lot on his plate.

He had an fpl that came back with a value of 20, and he has been losing and pulling hair and licking at his sides to the point of making it raw. His skin looks a bit enflamed, as well, even on areas that still have fur, but there are bald spots on his shoulder, sides, and recently he started working on his arm and chest. Poor little man is wearing a shirt I made for him so he can't lick it all to death, but it's causing him more distress to not be able to groom normally. I know that it may be associated with the pain (although his pancreas is not in his chest or arm, so who knows the meaning of that!) and I do have a dose of the opitate pain med they gave me left, but I really hate giving it to him because he becomes so sedated and, when he isn't, he's a bit aggressive on it. He has a normal appetite most of the time, so I can't be sure if he's nauseous or if he's got an excess of acid, but I do have Cerenia, pepcid (Famatodine sp?), cyproheptadine and the list goes on (with the exception of any steroid). I'm not administering all of those at the moment, but they're on hand.

The stress of all this makes it so hard for him to come down in his numbers and I know that bringing his blood glucose down would help all this, and helping all of this would bring down his blood glucose. I'm so very sad about the whole thing. He was so happy and healthy and, suddenly, we're here.

Any suggestions would be welcome.

Thanks,
Vanessa
 
Hi Vanessa,

I've just been reading William's spreadsheet notes. This caught my eye ...

12 June 2015

big scrape/lesion appeared day after vet. he's been licking it and making it worse. Techs snagged him? He freaked out because of inflammation at shoulders and bit tech and they got rough with him. Skin seems very fragile and tears easily.
Click to expand...

... and made me think of this:

Hyperadrenocorticism (Cushing's disease)

I looked into it before Saoirse was first diagnosed, but she didn't have the thinning skin problems. It's a rare thing in felines, by all accounts.


Here's a picture from the above article:

cushings.jpg



Is that anything reminiscent of where William has the inflammation/hair loss? It might be something to discuss with your vet, if only to rule it out.

Another clinical sign is abdominal distension although this can occur with diabetes, too.

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Another possibility is food allergies. From my reading, I believe that food allergies can manifest through skin irritation around the head and neck area. You can get blood tests done for allergies, but the results are rough pointers rather than black 'n' white guides to a treatment plan. The other thing to do is try an exclusion diet with a novel protein source (one that William has never eaten before). Your vet should be able to advise you on a protocol, and you can get recommendations here for foods to try.

I think Saoirse's problems started when she was switched to Royal Canin urinary dry diets. She started losing fur from her tummy shortly afterwards, and I think this was probably because it was irritating her GI tract (all of this is based on hindsight, sadly). See her profile page for more of her history. Saoirse has had her blood tested for food allergies and intolerances, and the results came back positive for a number of things, notably soy, egg, and milk but she also showed a response to other proteins (e.g. duck).

My own feeling is that the food set up the irritation. Unfortunately because the vet treating her at the time misdiagnosed the fur loss as a psychological rather than physiological problem I think that the GI inflammation eventually led to her developing pancreatitis with diabetes as a sequela of same (and probably the damage to her kidneys followed :(). The general view from the vets is that, alongside the chronic pancreatitis, she has low-grade IBD.

What helped Saoirse? First up, as soon as I switched her to a species-appropriate, grain-free diet (no vegetable proteins) the fur on her tum started growing back immediately. Secondly, the pancreatitis responded to supportive meds to a degree but it took me a long time (9 months!) to find a food that she could eat without too much digestive distress. Trial and error was all I could do. It was the only thing that has improved her Spec fPL in any significant way since her Dx in June 2014. She doesn't hide as much now, thank goodness. She also seems to have been helped by the addition of an antihistamine to her regular meds. (She started sneezing a few months back, and the antihistamine had the unexpected additional benefit of stopping her increasing tendency to mewl after eating many of her meals. Who knew?) The mainstay of her treatment is ondansetron. She has been taking this pretty much constantly since she had the major pancreatitis flare last year. Frankly I think she owes her life to it. Vitamin B injections helped Saoirse a great deal.

Saoirse's current regimen is as follows:

Ondansetron 2mg BID (1mg BID did her for a while, but I think her early CKD may be playing into her need for the slightly higher dose).
Famotidine 2.5mg SID (used to only need an occasional dose of famotidine, but again the CKD is influencing the frequency of administration of this drug).
Piriton 1mg BID
Nutramed ½ capsule per day (an anti-inflammatory neutraceutical containing boswellia (good for IBD), milk thistle, and maritime pine bark).
Hepatosyl 50 BID (SAMe and silybin supplement for liver support - seems to have improved her fasting blood glucose levels, too).
Pronefra (for CKD - phosphorus binder)
Vitamin B Complex (again for CKD because of excess peeing - B vitamins get lost)

I feed Saoirse small, frequent meals (about 10 meals per day - approx 150-200kcal total). It is easier on her digestive system and it helps to even out her blood glucose levels. I feed her from a raised bowl. There is useful information on nausea and pancreatitis treatment at the following links:

IDEXX Pancreatitis Treatment Guidelines

Nausea page - Tanya's Site

It's worth noting that when Saoirse had her scans done a few months back, she had post-shaving alopecia. Her fur started to grow back when I introduced the B Complex supplement.

Hope some of the above helps you and William, Vanessa.
 
Oh, thank you for your thoughtful response!

Fortunately, William doesn't look as bad as that poor kitty. I'm going to imagine for the weekend at least that it isn't Cushing's. It is very rare from what I understand?! I know from my own life that that doesn't mean it can't happen, but... I have read a few articles saying that dermatitis and acquired fragile skin disorder (something like that) can also result from diabetes (as well as prolonged steroid use, Cushing's and handful of others), so that comforts me a bit, there's just nothing on how to treat it. I suppose just to get bg back to normal ranges. Which he's not. I will look into it if it continues. His skin doesn't seem to be quite as fragile as then, but he has licked it raw on the side of his belly. It's a really difficult place to keep him from getting to.

Since posting I have spoken to my stand in vet (usual vet is out of town until 8/11) and she suggested I start him on an antihistamine that she had him on before when he was having a reaction to Convenia. If I recall, his skin might have settled down when he took it, but there were so many things coursing through him at that time, its nearly impossible to tell what was effecting what. An allergy to food is certainly a possibility since this began not long after I changed his diet to Purina DM. I've been wanting to change foods for a while, now. Problem is that's the only wet food he'll consistently eat, so I've got the food battle to look forward to, again.

I'm going to look into the nutramed. That seems like it would be a gentle addition to the regimen. And I'll see if being more consistent with famotidine and Cerenia make any measurable difference. Oh, and I gave him a b12 shot yesterday. But that's different from the complex... And I forgot about the elevated bowl! I keep meaning to do that and then... I don't. I sometimes hold his bowl up in front of his silly little face when I need to make sure he eats before a shot, or something, and he seems to be happier about eating at that height... really takes his time with it...very spoiled. ;)

Much to think about, read and put into a syringe. Thank you so much for your help. It really takes the edge off!
 
Here's a link to details of Nutramed.

Also, here is the TAMU B12 dosing protocol. It's similar to the IDEXX pancreatitis treatment recommendations, but it covers extended maintenance treatment, too. I've got some Zobaline methylcobalamin on order for Saoirse. I'm hoping it will give her a bit of a boost (without the sting!).

I forgot to mention that I have been giving Saoirse an omega fatty acid supplement, too (Coatex). I've tried several but this is the only one she can just about tolerate with a bit of coaxing. It's good for hair and skin, and is anti-inflammatory. I've suspended it for the time being because I'm trying to acclimatise her to the Pronefra (not going well - I think it's upsetting her tum).
 
Unfortunately, Nutramed looks like it's not available in the US. Too bad because the capsule/powder form is perfect. We have a similar product here that my now gone girl, Mona, was on, but they're really large tablets that can't be broken up and William isn't as tolerant as she was about meds, especially pilling. I'm going to keep looking, though.

When I was wracking my brain last night about what to do, I remembered omega-3's and bought and gave him a dose today. Forgot to mention that. He thinks it's absolutely disgusting and I had tried and given up on them before, so I put it in a syringe and it wasn't too difficult to get it down. You'd think they'd like the fish flavor, but my cats are repulsed, insulted, even, by the mere suggestion.

Sorry Saoirse is now dealing with kidney troubles, as well.
 
I didn't see that link to the allergy thread before. Again, thank you for all your help! Now I just have to get his regimen in order and stick with it. I've been trying things and moving on to others and flitting around before I get an opportunity to see what works.
 
Pity about the Nutramed. :(

Saoirse doesn't like the fishy-fishy oils, either. The Coatex has only a feint trace of odour by comparison to some of the omegas on the market. Virbac do a supplement called Complederm. There's very little odour off that, and it has a good ratio of omega 6 to omega 3. Saoirse can't cope with it because it contains sunflower oil and that seems to disagree with her, but she did eat it OK the one time I gave it to her so it must be a bit more palatable.

Re Saoirse's CKD, it has been caught early (just about stage II but recent labs and BP are good). If I can sort out the phosphorus binding that will be a help. Unfortunately the only food she seems to be able to tolerate has stupid levels of phosphorus in it.

With the pancreatitis in play, and possibly other food issues, it's generally a good idea to maintain a detailed journal of treatments and clinical signs and also to only change one thing at a time wherever possible.
 
Here's another Omega 3 supplement. It was mentioned on Tanya's support group earlier this week. I'm thinking of ordering some for Saoirse. Apparently the capsule is quite small.

Moxxor Omega 3

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Just bookmarked a page with that on it earlier. Had never heard of it before. Maybe it was a page you directed me to? Don't know anymore- I feel like I'm down a rabbit hole researching feline health more often than I'm not, lately!
 
Oh, that's a fabulous picture, Vanessa! William's got a beautiful face - speaks to a lovely nature. And he's workin' that tee! :cat:


(((William)))

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