older cat will not eat

[Traci]

At this point in time, is the itching now only localized to the ears? Or is it in fact, affecting her face, neck or other parts of her body?

What gives you the impression she's "all doped up"? The meds you've listed don't have such effects. Are you now giving her something else?

The dermatologist is right in saying that cats rarely develop such allergies later in life, except for food allergies, which can occur at any time in life. And bacterial infection, and fungal infection, and viral infection.

I'm assuming that at some point in diagnostics, testing for mites or parasites have been ruled out? Has either vet mentioned the possibility of mites in your home? This is a little-known problem to most owners, in that, mites are everywhere, in the cupboard, in the food, in your home, in your bed, in the dust that flies around in your home that you can't see, etc. I'm not saying this to scare you or disgust you, but sometimes, mites are the culprit.

Although it is unfortunate, it does take a rather large number of diagnostics to come to some conclusion when you're dealing with allergies or other dermatologic problems, it's just the way it is. I don't mean for that to be taken lightly, it is because dermatologic problems are among the top of the lists that are frustrating for vets and owners alike. There are literally hundreds of things one has to rule out, various types of bacteria, various types of yeast, various types of ingredients in the diet that might be culprit, and various internal things that can cause dermatological problems. Each and every one also requires a specific diagnositic and when you look at the total picuture, it indeed does look like, and IS a frustrating problem.

But, don't get discouraged. The dermatologist probably knows what he's doing, but wants to rule out all of the variables so that nothing is missed. Just think, if there was an endocrine problem, for example, and the vet wasn't looking for endocrine issues but rather focused strictly on the skin condition, he could be missing a vital issue that went undetected and remained untreated all the while he was too focused on something specific. Some internal conditions have the potential to affect the skin, so those things too must be ruled out, particularly in a senior cat. Viral, bacterial and even fungal in nature are also things that have to be ruled out.

Is it possible the initial diagnosis of ringworm was incorrect or misidentified? The symptoms you provided sound more like a food allergy to me, or maybe even something that's called Eosinophilic Granuloma Complex, which can affect various areas of the body. Some types of the condition affect only the inside of the mouth or around the outside of the mouth, other types affect the neck, shoulders and even the abdomen and hind quarters, still other types affect the entire body. Both food allergies and EGC can wax and wane just like you describe, sometimes cats go for months without a flare-up and to the causal observer, it might appear seasonal when in fact it's not.

I would also strongly suggest kitty is re-tested for hypo or hyperthyroidism, which can also manifest the exact same skin symptoms you describe. Ask the vet about using BOTH the T3 and T4.

Don't forgo getting kitty back to the dermatologist, you don't have to make decisions at that point, just listen to what he's saying and try to understand the diagnostics and treatment options involved. If he wants to try a certain med, ask him to explain what type of results to expect and what would be the next step etc. Unfortunately, it DOES require steps, and when there is no favorable response to treatment, you have to try something else. By NOT trying and by NOT treating, you are only adding to her misery and because she has CRF, you can't take that risk. Please understand that any primary condition, such as CRF, can always predispose the kitty to secondary health problems, like the skin problem. There could be other things going on too that haven't been considered or tested for, like endocrine problems, viral or fungal infection, etc. Ask the dermatologist what his true suspicions are based on kitty's health history, her current CRF status, her diet, tell him truthfully every thing you feed her at home. If you give supplements or any alternative-stuff, tell him what they are. If you give treats, tell him what they are, you get the picture.

Don't be opposed to trying a new veterinary diet, or supplementing her current diet with a hypoallergenic diet fed a few to several times a week. Ask for his opinion on that. What if kitty responded favorably to a hypoallergenic or veterinary diet, wouldn't that be fantastic? Again, you don't have to use one veterinary brand, there are about 4 brands to choose from with different ingredients. I can also recommend one that has helped two of my cats considerably, both have EGC, and feeding Hill's veterinary feline Z/D has kept the EGC at bay. Flare-ups are a fact of life, and they may reoccur despite my best preventative efforts...but without the diet, they would be having multiple flare-ups on a frequent basis. If you tried this for your kitty, and only fed it a few or several times a week in place of her normal diet, she may be less likely to get bored with it.

(No, I don't work for Hill's, but I've worked with their products and see the results in our clients' cats)

I know you might be tempted to give up due to the frustration, but....don't. Please remind yourself that kitty has given you the best years of her life, you now have to repay her in kind to do what you can to help her. It is more likely that the vet visit stresses YOU out more than it does she, since you are so frustrated. The vet understands your frustration and probably truly wants to help your kitty, he doesn't like seeing kitties with problems and he doesn't like seeing the frustration in the owners.

[Tigerlily]

She scratches her chin and neck some, but nowhere near as much as she digs inside her ears. The other main symptoms are lots of head-shaking and ear-flicking, and buildup of dark debris. Her ears are the obvious source of most of her itchiness.

When I mentioned being doped up, I meant in the future, not now. I was envisioning her being out of it, on some med prescribed to calm the itching, which is merely treating the symptoms, not getting to the real problem. When, and only when, it gets really bad now I give her 1/4 to 1/2 of an original formula Claritin and it really drags her down. It also seems to upset her tummy, so I don't want to have to do that for the rest of her life just to give her relief.

To my knowledge, the only testing done on her ears was a culture her regular vet did on the debris she cleaned out. It turned out to be mostly yeast and I gave her fluconazole for it, but she was also on the antibiotic zeniquin at the time, so I don't know which one helped the most. Or if neither one made a difference, and the condition merely waned on its own, like you said.

I suppose parasites could be the problem. Anything is certainly possible. Her thyroid is within normal range, or it was a month ago. She's due to be retested in another 2 months. I don't think it was likely that the ringworm was misdiagnosed. Last year, on the first visit to the dermatologist, he immediately knew it was ringworm. He took skin and hair samples for a culture, of course, and it was positive. Fluconazole cleared it up, her fur grew back, and the itching subsided until it returned this spring. But as I said earlier, this year she has not lost any of her fur. And her ears are also worse.

I will print out your suggestions and take them with me on Sat. There is a lot to digest here and a lot of possibilities to run by him. I would definitely not be opposed to trying the hypoallergenic foods. If one of them turned out to be something she liked, and it helped her, that would be 2 blessings in one!

I'll report back next week. Thanks so much for the words of encouragement.

[Traci]

Re: the Claritin. I doubt this would ever help an ear infection, much less any other skin infection. Since it is an anti-histamine, it WILL have undesireable side effects, and those effects can go either way for the cat....some cats get highly agitated on these meds, others get sedated, neither is good for the cat, and your vet should have come up with something safer, or omitted the use of an anti-histamine altogether.

Again, ask about the possibility of a pseudomona, something is not getting detected, nor treated appropriately. The diet could also be a major culprit.

[Tigerlily]

Interesting info about the Claritin. I knew it was not a cure of course but was told that occasional use was OK to temporarily calm the itching. I never gave it to her on a regular basis because I didn't like the effect it had on her. Anyway, You're right for sure - something is not getting detected. Will keep you posted.

[Tigerlily]

Back from the dermatologist visit. After reviewing Lily's history, food intake, etc. his assessment is that her allergies are environmental. He cleaned her ears and prescribed Conofite Baytril Dex ear drops and Simplicef for an infection he found on places on her neck where she has been scratching also. He also said to swtich to Zyrtec instead of Claritin, which he says he doesn't like for people let alone animals. I haven't tried that yet. Her ear scratching has decreased drastically since the cleaning but she wants no part of the drops and I'm having a hard time getting them in. He said they would keep the debris from building up and lessen the itching, but I may never know if I can't administer them.

He mentioned allergy testing and giving her monthly injections. That cost was astronomically high and the injections would take 6-8 months to start making a difference. He didn't really push that option too much though and said if it were his 15 YO cat with CRF, this is the conservative route he'd take, at first anyway. He wants to see her again in a month and will re-evaluate her at that time.

As I've mentioned before, all of this may treat the symptoms but without allergy testing we'll never know what she's allergic to. After it gets cold, and the allergy season has passed, she may be fine, but it will start all over again next spring I'm sure.

[Traci]

You will have to get a handle on administering the drops, because if you can't give them, she is not going to benefit.

Use the tips I gave you prior to gently restrain her in order to give the drops.

[Tigerlily]

Getting better with the drops, but I have a question about their content inasmuch as one of the components is a cortosteroid.

In 2008 when the allergies first arose in conjunction with the ringworm, her former vet gave her a steroid injection, which proved to be extremely detrimental. It caused her glucose to skyrocket, giving her the temporary diabetes, not to mention raging diarrhea.

The eardrops I'm using now are a combination of Conofite Baytril and Dex, which as I understand it is dexamethasone, a steroid. The dermatologist assured me that, applied topically, it should not have the effect on her system that the injection caused last year, but realistically do I need to worry about her gucose levels and the effect on her kidneys?

I'm also concerned about her accidentally rubbing some of the residue from her ear into her eyes. She scratches and rubs her ears a lot after I put the drops in and will sometimes wash her whole face. So far this hasn't happened but I did read that that the Conofite in particular can be an eye irritant.

Thanks for all your help.

[Traci]

When you're administering any type of liquid, whether ear wash solution or medicated drops, you need to always ensure that any EXCESS liquid is blotted lightly with a cotton ball to prevent any from getting to the eyes or other part of the face. It doesn't mean wiping dry whatever you have just applied, it means making sure no excess can get to the eyes and face and mouth. Drops, when done correctly, usually enter inside the ear canal, and most excess is removed by kitty shaking her head once or twice immediately after application of the drops, but you have to use a cotton ball and gently dab at any excess that is around the upper inside ear and any excess outside of the ear.

No, the dex in the drops should not affect kidneys or be a precursor to diabetes. But again, make sure excess liquid is dabbed away from the ear so she doesn't ingest any.

[Tigerlily]

Here I am with another question. This discussion has certainly come along way from help with an older cat who won't eat!

Lily's diarrhea has returned, if you technically consider one very soft BM a day diarrhea. I think I mentioned in one of my earlier long posts that all her life she has had short bouts of loose stool, less frequently when she was younger and now more often. Since she's so prone to that, it seems like medications will sometimes bring it on. I don't know whether to blame the Simplicef or the eardrops, or neither.

I know it sounds crazy but back in 2008 when she had the bad reaction to the steroid injection, the vet at that time prescribed topical drops instead, like now, and yet the diarrhea still persisted. He just couldn't believe that eardrops would cause diarrhea, but I stopped using them and it went away. And now it's deja vu all over again.

So far, she only has the one BM a day, but it's runny. I will say that, so far, she doesn't act sick, and her appetite is good at the moment. Is a runny stool a compromise we're going to have to live with while on these medications? I know sometimes things like this are a trade-off. I am mindful of the possibility of dehydration of course, but as I said, right now she only has the one BM a day. Of course, that could change at the drop of a hat.

[Traci]

Are you being consistent with the type of food you've been feeding her this last month?

Did the dermatologist talk to you about her diet or offer the hypoallergenic trial diet?

Did you ask him about the possibility of EGC?

Is Lily, by chance, a white or light color cat?

There's only one chance in a million that the ear drops are causing diarrhea or soft stool, my guess would be the food, or overgrowth of bacteria in the GI tract, or stress. CRF kitties, and cats with primary health conditions are more susceptible to stress, and stress in turn can elicit secondary problems.

However, any oral antibiotic can cause soft stools or diarrhea, and if Lily is still on a course of antibiotics, you should notify the vet and rule out the possibility of the antibiotic as the culprit. The vet would then recommend ceasing that particular antibiotic and choosing a different one, or not giving any at all, depending on the resolve of the ear condition.

Since she has CRF, it's important to understand that acid in the stomach, alterations in calcium, phosphorus, sodium and other elements can get out of whack at any time, her electrolytes might also be out of whack. Are you giving sub-q fluids at home? You might want to ask your vet if sub-q's would benefit Lily at this point.

I still contend that it would be worth it to consider the hypoallergenic diet, again, this can be given a few times a week or more often, and you still need to rule out the FF as a possible culprit for a food allergy or sensitivity. Give the Z/D a try, it comes in both canned and dry forms, my cats prefer the dry, but get a bit of both, give it a chance and see if Lily reponds to it. Ask your vet first, so she can determine her daily requirements, the nutrient content, etc as you need to make sure the protein and phosphorus levels aren't too high for the CRF. Again, combining two specific diets can help both conditions, your vet has to help you with that.