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Differentials - possibilities that should be considered
Walking on hock or heel on one leg
Leg weakness and gait problems
Fluid accumulation (ascites) in cats
Vomiting
Staggering, loss of eye control
Poor haircoat
for dizziness
For hairloss on abdomen
for weight loss
also see Cat index
also see Symptoms
Cat walking on hock (heel) on one legQuestion: Hi Dr. Mike, Have 25 pound cat who walks on his heel. Left back leg.
Very little support. No pain. Is there a chance massage would help,
as he did walk much better after muscle massage?Send me any info you have.
Thanks very much. Sue
Answer: Sue-
There are a number of possible causes for a cat to walk with the portion
of the leg below the hock (heel) low to the ground. However, it is unusual
for this to occur on one side only except in the case of injury to the
gastrocnemius tendon (the Achilles tendon), the hock joint or the bones,
muscles or tendons below this level. When both sides are affected the
most common causes are probably diabetic neuropathy, hypokalemia (low
potassium levels) and neurologic injuries. It is also almost impossible to rule
out the causes of all sorts of odd signs, such as cancer, toxoplasmosis,
feline leukemia virus infection, feline immunodeficiency virus infection and
feline infectious peritonitis.No matter what the underlying cause is there is a possibility that
massage therapy might be temporarily helpful. Massages help to move trapped
fluid around and to increase circulation to the area being massaged, both of
which can be helpful. There is some pain relief in just being touched
and massage seems to increase this effect. Manipulation of the leg during
massage may also be helping to increase the range of motion of a damaged
joint, such as a sprain of the tarsal (hock) joint, as well.If this sign persists, even if it temporarily improves with massage, it
would probably be a good idea to try to rule out some of the more common
causes of problems, especially diabetic neuropathy in a cat this large.
Mike Richards, DVM
12/1/2001
Leg weakness and gait problems
Question: Dear Dr. Mike,
We have an 11-yr old cat who probably has some Maine Coon Cat blood in her
(she is a pound cat so we don't know for sure). She has had a history of
spraying in the house since she was a kitten. She's been treated very
successfully by the Univ. of Penn. behavioral medicine clinic with drug
therapy. Currently she is taking diazepam and amitryptiline to control her
spraying; this particular combination/dose has worked well for about 2 yrs.Within the past few weeks, Beulah has started spraying and defecating
outside the box, and the problem is getting worse. We took her back to the
clinic for a recheck wondering if her meds needed to be tinkered with. But
the vets were extremely concerned about Beulah's gait. Last fall, we
noticed a weakness in her hind legs or hips; her hips give out and she has
trouble jumping up or going up/down stairs, almost like a stagger. At the
time, we took her to our regular vet, who said it was arthritis and nothing
could be done. However, the Penn vets think it's more complicated than
that. After a neuro consult, they believe it is not an orthopedic problem
like dysplasia or arthritis, and not a side effect of the valium, but
neurological (e.g. she has some atrophying of the hind leg muscles, flinches
when certain parts of her back are touched). They believe it may be a
compressed spinal disc. They believe this may have caused the recurrence of
elimination problems, either b/c she is stressed out by the pain and
decreased mobility, or she is having trouble getting to her litter boxes, or
both.I've read everything on your web site about spinal disc problems in cats and
dogs (there's a lot more about dogs than cats but I assume it's generally
the same). My questions are:1. Are there any other possible diagnoses that should be considered? Could
low potassium cause the hindquarter symptoms?2. Blood tests showed normal except for slight thyroid elevation. Could
this cause the symptoms?3. What diagnostic tests will identify the problem fastest? Is it worth it
to give her an xray (the vet said this may or may not give a definitive
diagnosis)? Would ultrasound or CT scan be better?4. Assuming it is a disc problem, would cortisone therapy be an option
given the lapse of time since onset (I'm really ticked off that my regular
vet missed this!).5. What is the best case scenario if she has surgery? What would happen,
or could happen, if she doesn't have surgery? Are there any other treatment
options?Thank you so much for helping me educate myself to make the best choices for
a truly beloved cat.C.
Answer: C-
1) I think that it is possible that problems other than spinal disc disease
could be causing your cat's symptoms but low potassium levels probably
would have shown up in the blood work (most chemistry panels run at
veterinary teaching hospitals include this ion).2) We have seen rear leg weakness that appeared to improve when
hyperthyroidism was treated but not very often. It is a possible problem
but not a likely one, in this case.3)Magnetic resonance imaging is by far the best test for detecting spinal
disc disorders. I vaguely recall that cats are a little harder to evaluate
due to their size so it would be best to ask the vets at UP, because they
probably know for sure if MRI works well for them in cats. Plain X-rays are
worth taking as a screening option, even though disc problems that are
present may not show up --- because there may be a problem like bone cancer
or even vertebral fractures that DO show up.4) Disc problems in cats are relatively rare (they are reported more often
now than in the past, but they are still not really common in cats). It
doesn't surprise me that your vet wasn't thinking about this possibility,
especially if the neurologic signs are subtle. I could easily see myself
overlooking this problem. There is a lot of controversy over whether or not
corticosteroids are helpful in disc disease. I think that most veterinary
practitioners think they are but there are differing opinions. I would tend
to lean towards non-steroidal anti-inflammatories in a dog but they can be
problematic in cats -- so I might go for cortisones, even now. Especially
if an MRI and surgery are not available options.5). Surgery is probably best for herniated discs causing spinal problems.
The best case scenario is a return to normal or near normal function. In
many patients with disc disease there is a slow progression of the
disability they cause, eventually leading to loss of use of the rear limbs.
This tends to progress even with medical treatment, so surgery is favored
when the problem can be identified and localized. I am basing this answer
on the problems with dogs, because I honestly can't remember a client of
ours opting for surgical repair of a spinal disc problem in a cat.I wish I could help more with this but my experience is pretty limited.
Mike Richards, DVM
4/20/2000
Fluid accumulation (ascites) in cats
Question: What are the causes of fluid accumulation in cats?
Answer: Pat-
These are causes of fluid accumulation (ascites) in cats:
severe liver disease --- cirrhosis is actually fairly uncommon in cats,
but it does occur. If there is a problem in the liver really inhibiting
circulation through it, such as liver cancer or really severe liver
swelling, this could lead to ascites, too.pancreatitis -- this has to be pretty severe but it can cause ascites and
it might also cause the elevations in white blood cell count,
hypoproteinemia and electrolyte disturbances. Usually cats with
pancreatitis have vomiting associated with the disorder. Cats with this
condition probably in pain from it but don't show that well. Administering
pain relievers can help a great deal in making cats feel better and is
worth doing on the suspicion of pain, in most casesheart disease--- the most common heart disease that will cause ascites in
cats is cardiomyopathy, but other heart or pericardial problems might cause
it. This seems unlikely based on the exam findings but has to be considered.cancer --- I think that cancer is probably the most common cause of
ascites in older cats in our practice but I haven't actually tallied up the
cases to be sure of thisFIP -- this is primarily a disease of younger cats, in that the great
majority of cases occur in cats less than two years of age, but it can
occur in older cats sometimes. Usually, there is an increase in serum
protein with FIP due to increases in antibody production
(globulins). Personally, I would tend to discount this possibility.Inflammatory bowel disorders -- sometimes, but not very often, inflammatory
bowel disorders (IBD), can lead to ascites. This happens when the
intestines get inflamed enough that the leak protein, leading to a loss of
protein in the blood stream and this leads to ascites if the protein gets
low enough. This can happen with internal parasites in puppies and kittens
but that isn't too likely in an adult cat.It is possible to tell a lot from the appearance of the fluid, sometimes.
For instance, if fluid is withdrawn and it turns out to be blood, that
would be whole different set of possibilities, such as exposure to rat
poison, other bleeding disorders, trauma, etc. If the fluid turned out to
be pus, then some sort of septic process would be likely. The fluid
associated with FIP is usually yellow and very thick. Other problems
produce fluid with different characteristics. Sometimes the fluid contains
obvious cancer cells, which makes the search for a diagnosis easier. I am
assuming from your note that this was definitely fluid and not blood or pus
and that there wasn't anything too remarkable about it.An ultrasound exam is a good idea. It can help to determine if there are
tumors and help to determine what the pancreas and liver look like.I would take the trip to the internist if the ultrasound exam doesn't show
a clear answer for the problem, even if it does involve a trip.I agree with your vet about getting your cat to eat. I wouldn't worry
about the protein content of the a/d diet right at this time. If liver can
not process ammonia, the breakdown product of proteins, there will be signs
of incoordination, blindness, staggering or seizures. If it does turn out
that liver disease is present, the diet can be altered.Feline infectious peritonitis is still difficult to test for accurately.
There is a test whose developers claimed was specific for the FIP
coronavirus rather than all coronaviruses of cats, but I don't think that
the claims have proven to be accurate. I know of no successful treatment
for FIP at this time. It is likely that there are ongoing studies of FIP
but I wouldn't go to a lot of trouble to find them, just yet. The odds that
FIP is the problem are pretty low. It is not very common in households with
three or less cats (you didn't mention how many cats you had but I am
assuming not too many). Due to the nature of FIP infection, there isn't a
great increase in the risk to the other cats in the house even if this cat
does have FIP. So for right now, I'd wait for the cytology and the
ultrasound results before worrying more about FIP.Ultrasound exam can often give a pretty good idea of whether or not liver
disease is present. It is usually necessary to do liver biopsy in order to
get a definite diagnosis of the type of liver disease present, though. This
can sometimes be accomplished by an ultrasound guided needle biopsy and
sometimes it is necessary to get a sample for biopsy through surgery.
Hepatic lipidosis is the most curable of feline liver diseases and the
treatment consists of feeding the cat adequate calories until it is
well. Cholangiohepatitis is controllable for long periods, in many cats,
using medications. Suppurative cholangiohepatitis is sometimes curable by
eliminating the infectious agent if it is a bacteria that is susceptible to
antibiotics. It is possible to remove a portion of the liver if there is a
cancer that seems to affect only a portion of the liver. To the best of my
knowledge no one is doing liver transplants in cats, but it is possible
someone is.The high neutrophil count, with no immature neutrophils reported (no band
cells), along with a decrease in lymphocytes, is a typical white blood cell
picture for stress or from the administration of
corticosteroids. Unfortunately, that doesn't narrow the search for a
diagnosis in this case. Low calcium is probably occurring due to the low
albumin. Calcium is carried in the blood stream attached (bound) to
albumin, so when there is insufficient albumin, the total calcium level
drops. Usually the ionized, or free, calcium is normal. Low calcium
sometimes occurs in pancreatitis due to the calcium getting trapped in the
inflamed tissues in the abdomen, though. The low albumin levels can occur
with liver failure, inflammatory bowel disorders, kidney failure and
cancers that are causing intestinal or liver problems. Usually low sodium
levels are due to vomiting. If you are not seeing vomiting, I am not sure
what to make the low sodium and low chloride levels. Rupture of the urinary
bladder can lead to low sodium levels but that leads to rapid deterioration
in a cat's condition, which doesn't seem to be happening and usually the
BUN and creatinine are elevated, too. Low anion gap occurs with low serum
albumin so the elevation in anion gap doesn't make much sense to me, unless
your cat is pretty dehydrated, which would be scary, since that usually
makes the protein level even lower, in reality, than the measured
level. Sometimes, when there is fluid accumulation in the abdomen, it will
lead to a low volume in the blood stream (since the fluid is coming from
there, ultimately), even though the total fluid volume in the body is
elevated. This might be causing some of the abnormalities in the
electrolytes. Correcting the ascites, might help with this. The diuretic
(Lasix Rx) might help in this regard.I'm sorry, but I can't answer the question about vets in Lexington. I am
not personally familiar with anyone practicing in that area. I have sent a
couple of patients to the vet school in Knoxville and have been satisfied
with the care they received but they were all cats with hyperthyroidism
needing radioactive iodine therapy.Again, I would encourage you to go to the internal medicine specialist if
the cytology report and ultrasound exam do not give a clear diagnosis. If
there is still confusion after the visit to the internist, it may be a good
idea to consider going to the veterinary school.I would lean towards cancer and pancreatitis as my leading differentials
but liver disease has to be included in the differential diagnosis and FIP
is possible. Some of the cancers that can lead to the signs you are seeing
can have a good prognosis. Intestinal adenocarcinoma causing a partial
obstruction of the intestine or intestinal inflammation would be removable
surgically, in many cases, and the prognosis after surgery is pretty good,
for instance. So you don't have to give up if the diagnosis is cancer.I hope this helps some.
Mike Richards, DVM
4/18/2000
Question: Dr. Mike, We have a 14 year old tabby female. She has always been an indoor cat. The past 3 or 4 years she has had a problem with occasionally vomiting. Some times the vomit has fur in it but most times not. Changing her food would usually stop the problem for a while, but eventually the problem comes back. Now it seems even changing her food does no good. She seems healthy otherwise and is not losing weight, but the problem bothers us because of our concern for her, and also it is a problem with he mess it creates. The vet just says to change her food. Any ideas?
Answer: I would want to check a fecal exam, check thyroid levels and do a general blood panel on any cat of this age with chronic vomiting. Older cats sometimes become more susceptible to roundworm infection as their immune systems become weaker. I recently did a lot of testing on a cat prior to doing a fecal exam and its vomiting cleared up with deworming. I was sort of embarrassed by the fact that I should have thought of the fecal exam first. If worms aren't present, then more extensive testing is necessary. Hyperthyroidism is just too common a cause of vomiting in older cats to overlook it. Some cats don't lose weight early in this disease. Kidney failure is also pretty common and some cats with chronic renal failure will vomit regularly. If these things were not found to be present with bloodwork, it may be worthwhile to consider treating for inflammatory bowel disease (IBD) or to consider asking for referral to a veterinary specialist with the means to diagnose IBD -- usually done with biopsies taken with endoscopy. There are anecdotal reports that soft moist cat foods are beneficial in cats with IBD -- so if you change foods again before doing any other workup you might want to consider trying one of these foods (Happy Cat is the only brand name I can think of but there are more). I really think it is worth trying to get a diagnosis in most cases of vomiting in cats. Discuss this with your vet again.
Mike Richards, DVM
Staggering, loss of eye control
Question: Last Friday, our cat came staggering out to us unable to balance himself, with is turned to one side, and his eyes out of control wandering all over. He is a 1 1/2 year old neutered male, had been fine up to that point, I can't find anything ,which could have poisoned him. Cannot straighten his head to drink out of the bowl when he tries. My vet seems to think he got into poison, and now is brained damaged, but would he have reconized me today if he was brain damaged. Connie
Answer: Connie - A toxin is possible. It wouldn't be my first thought but that could just be my mindset.
I would worry about feline vestibular disorder (sudden onset of balance problems with abnormal eye movements). This usually lasts less than two to three weeks and clears up with or without medication. Trauma is possible (a head injury). Ear infections and ear tumors are possible (tumors do occur in young cats at times). Feline leukemia, feline infectious peritonitis and feline immunodeficiency virus can sometimes cause central nervous system problems, too.
Mike Richards, DVM
A poor haircoat can be a sign of disease. Diabetes, allergies and hyperthyroidism are common causes of dander or oily haircoats in our practice. It may be worth having your vet check your cat if this problem continues.
Question: My 9 year old cat began to seem slightly dizzy a few weeks ago. Our vet prescribed an antibiotic (Clavamax) and Prednisolone; she suspected vestibular something or other after an xray ruled out any physical injury. Kitty did not improve after the 10-day round of antibiotics and we returned to the vet. Another round of antibiotics were prescribed in addition to a daily 12.5 mg tablet of meclizine, which I understand is used to treat motion sickness in people. A blood test revealed only that the cat was not drinking much water, nothing else abnormal. It's been 3 days since we began the motion sickness medication (it was written for 14 days) and the cat is considerably worse. He is highly disoriented, can barely get around without stumbling, and spends all of his time huddled under the bed. He is eating pretty well, altho' he has lost about a lb. between first and second vet visits ten days apart. He has experienced no injuries that I'm aware of (he did go outside before he got sick) and he does not seem to be in pain. I initially thought that he had had a stroke, but the vet did not find any evidence of that based on her examination of his pupils. Is there anything that you know of that could cause this condition that my vet may have overlooked? Thanks, Sharon
Answer: Sharon - The major causes of dizziness are middle and inner ear infections and problems affecting the cerebellum (part of the brain that controls balance and spatial orientation). An ear infection may respond to antibiotics but sometimes surgery is necessary to relieve pressure in the middle or inner ear. Feline leukemia virus, feline immunodeficiency virus, toxoplasmosis and other infectious diseases can lead to balance problems. Cats do sometimes get infarcts in the brain with similar effects to strokes in humans. Cancer can cause these signs, as well.
If your vet is not able to make a diagnosis and you wish to pursue this further it is reasonable to ask for referral to a veterinary neurologist or internal medicine specialist. If you live close enough to a veterinary school to go there it is possible to get opinions from several experts at once.
Mike Richards, DVM
Question: Dear Dr. Mike:
My 12-year-old spayed female cat has been a healthy cat. However, she has developed hair loss on her stomach and backs of rear legs. Is this old age related? There is no scaliness or patchiness. I would like to treat her with vitamin supplements if that would help. I looked through your wonderful webpage for answers before writing. Thank you for this service. You and your staff are very special people!
Answer: The most common causes of hairloss in the pattern you describe are cystitis or other cause of a "burning" sensation in the vaginal or vulvar area, pychogenic alopecia (behavioral chewing or licking of the haircoat) and occasionally allergies. Sometimes in older cats this behavior shows up with hyperthyroidism.
The cystitis problem should have other signs, such as more frequent urination, staying a long time in the litterbox, or signs like that. This is not always the case, though.
Psychogenic alopecia is self-mutilation of the haircoat, usually brought on by stress or boredom. It is most common in cats who are left alone a lot or cats that are part of multi-cat households of more than 3 or 4 cats and are stressed by the situation. It can occur for any reason that the cat feels as stress, though. So it can be hard to definitely rule out.
Allergies usually respond to treatment with corticosteroids and often have other signs, such as scabbiness in the haircoat or hairloss in other regions. Fleas may be present and initiating the allergic response. The only problem with the "treat to diagnose" approach is that corticosteroids can mask signs of other diseases and it is possible to overlook a primary cause (such as cystitis) because the signs are then masked. A good physical exam is important prior to treatment for possible allergies.
Hyperthyroidism usually has the major sign of eating a lot and losing weight anyway. Cats may be more active than they have been in recent years. They often vocalize a lot with this disease (like walk through the house at night crying for no apparent reason).
Your vet can help sort through these possibilities. It could make your cat a lot more comfortable if a primary cause like cystitis is found and treated.
Mike Richards, DVM
Q: I took my cat to the vet yesterday....he has had rapid weight loss and won't eat or drink.....the vet ran a test for cancer and aids but it showed neg...he gave him some tonic and amoxill for infection....what would cause the rapid loss in weight with no pep at all...I feel like I am losing him....please answer me back...... thank you m.
A: You didn't say how old your cat is and the differentials for weight loss do vary some according to age.
Young kittens with rapid weight loss:
parasitism, feline infectious peritonitis, feline leukemia virus, congenital defects involving the liver or kidneys, malaborption or maldigestion syndromes (not enough digestive enzymes for instance)
Young adult cats with rapid weight loss:
cardiomyopathy (more common in male cats), feline leukemia virus, feline immunodeficiency virus, feline infectious peritonitis, hepatic lipidosis (usually secondary to some other illness), diabetes, kidney or liver disease other than hepatic lipidosis, cancer, other systemic illnesses, parasitism
rapid weight loss in older cats:
cardiomyopathy (usually eating less), diabetes (appetite variable), hyperthyroidism (eating a lot and losing weight anyway), kidney failure (appetite variable), cancer (usually eating less), feline leukemia, feline immunodeficiency virus, feline infectious peritonitis, other systemic illness
Your vet will sort through these possibilities, I'm sure. In many cases it is easy to eliminate a number of the possibilities with a good physical exam and history. Some testing is usually necessary to confirm or rule out the other possible problems.
Michael Richards, DVM
Last edited 08/01/05
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