10 month old kitten diagnosed with Plasma Cell Pododermatitis (Pillow Foot)

MikeJ523

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Hello thank you for taking the time to read this. It will probably be a bit long but I appreciate it. Looking for some opinions, or someone that maybe has dealt with this before. Love my little cat to death and want to make sure I am doing the best thing for her. Lola is a 10 month old, 9lb spayed dm shorthair female. She has recently been diagnosed with plasma cell pododermatitis AKA pillow foot. I would like to provide her background and what has been going on with her up to the point where we are now. Maybe all of her symptoms contribute to something or someone has gone through something similar.

I found Lola when she was 4 weeks old. It was a hot summer day and she was running across a busy expressway almost getting hit by a bunch of cars. I knew I had to pull over and get her. I was on my lunch break at work at the time and knew I couldn’t take care of a very young kitten so I called a local animal shelter and they were able to take her and said she would go to foster until she was 8 weeks old. She was pretty dirty, had fleas, and symptoms of a URI mostly very goopy eyes (she could barely see poor thing). I wanted to eventually adopt her and fast forward 4 weeks they called and said she had just returned from foster and was up for adoption in the next couple days after they complete her surgery to have her spayed. We went to the shelter and adopted her right away.

About 2 days after we adopted her, she started throwing up in the evening and it continued into the night. I was extremely concerned and took her to the emergency vet in the middle of the night and nothing was really found there. They thought maybe parasites or inflamed intestines, but all test results ended up coming back normal (blood, fecal tests, xrays). Don’t really have an answer here as to what caused it but she was put on Hills I/D prescription food. When we tried to switch to regular food some time after, the vomiting happened again (although not as serious) so she stayed on the I/D food for a few more months.

We treated her eye infection with antibiotic ointment. There was no sign of conjunctivitis, but green and yellow discharge was coming out of both eyes. It went away and she was much better, but this has been a bit of a reoccurring issue. It is now more so in the form of a white discharge that we clean maybe once a day from both eyes. We recently treated it again and it has helped a bit. Possibility she has FHV, but has not been confirmed. Also was told the tear drainage ducts were probably blocked and could be causing the discharge and crusties she now gets. Vet doesn’t seem overly concerned about it, but can treat as needed with ointment.

Lola has always kind of peed a lot. When she was little it was up to 10 times a day. The vet at the time said it could be that she isn’t quite able to concentrate her urine yet, but as long as it was always in the litter box it is most likely fine. She is now at about 4-5 times a day which I think still might be a bit much. We recently did a urinalysis to make sure things are ok and that came back all normal.

Maybe 2 months ago we noticed a very slight limp and dry paw pads. At this time we now take her to a cat only hospital. We were given an anti-inflammatory to take for 2 days and told nothing was out of the ordinary. A month passes and I notice blood on the floor and an ulceration on her paw. Then notice a couple of her pads are now pretty swollen. Went back to the vet and was now told she has plasma cell pododermatitis. It is in 3 of her 4 pads. Before this all happened we were able to transition her to Purina Pro Plan food so I also wonder if that triggered something. Also really could have just been a coincidence.

The vet wants to try a round of prednisolone for 10 days. 5mg twice a day for 5 days and 5 mg for 5 more days. I am not sure if I feel comfortable giving her the steroids. I am not even sure how much her feet are bothering her as she still runs around like a crazy girl, absolutely loves to play, eats and drinks fine. I know she is maybe in some slight discomfort as she sometimes holds one of the paws up when sitting, and occasionally shakes her legs after jumping and then licks them. She also definitely does not like us touching them either. I guess my question is, would you give your 10 month old kitten a dose of steroids in this situation after what she has experienced so far? I really don’t want to give her something that can make her sick or have any possible long term ramifications. It’s only for 10 days, but my understanding is these drugs can be pretty powerful. Has anyone had a cat that they were able to find a solution without the use of drugs or maybe had some concurrent condition that was treated and this went away? I will do whatever it takes to make her feel better, but would like to have all the information I can get before making the decisions. If you have made it this far thank you again for taking the time to read this.
 
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MikeJ523

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Hi. I think it best to read the link below. If you have questions I will try to answer.
Feline plasma cell pododermatitis
Thank you for the info. I've definitely come across that article and many others. Been doing so much research. It's just not very well known and understood. I think what I am looking for are other peoples experiences with this disease. Also experiences with Prednisolone, especially in younger cats. My cat is still very young and not sure how she will react to it given her history. Guess I wouldn't know until I try. I am told it is very well tolerated in cats, but just seems like a high dosage to start with? I do trust the vet as he has been doing this for probably 30+ years and only focuses on feline medicine. However, I don't know if I like how he comes across as he is very matter of fact and blunt and almost as if he doesn't care (I'm sure doing this for that many years does that to you and I'm sure it's not how he feels), but I do respect his knowledge and experience. He helped my moms kitten with a case of diarrhea that would just not go away and no other vets were able to get controlled. It's a difficult time right now with animal care as it is hard to find a good vet and a clinic that is not completely slammed. It makes it hard to get the level, care and attentiveness that you would hope for. Experienced this with many clinics in my area.
 

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Veterinary medicine is really hard because the vets are expected to know so much about many different kinds of medicine on multiple species. I always recommend feline only veterinarians because at least that reduces it to only one species. Sometimes you need a specialist in internal medicine or dermatology and I think for specific problems you should seek out a veterinarian specializing in that field.

The other problem is that burn out seems to be hitting veterinarians and their staff pretty hard. It seems to be more of a changing in what people will tolerate anymore. I have worked at different vet hospitals for over 30 years, I have worked specialty IM and surgical and feline only as well as GP. Things have changed. When I started vets yelled, through things and you worked late every night and were in early in the morning. You were expected to come in on your day off (I got one a week) and you could expect not to have a job if you said you had plans. I remember a New Years Eve at the hospital in a velvet dress (late 1980's) holding a golden retriever that had separation anxiety and had bloodied his feet trying to escape. I also got yelled at by the vet for calling him and asking if we could sedate him.

Thankfully people won't put up with that crap anymore. Now people want to have a personal life and spend time with their families. They no longer answer their phones when they are off work, and they demand realistic work schedules. They take sick days off and they take personal days These are all very good things. The newer graduate veterinarians accept this because that is how they feel. The older veterinarians don't handle it as well. I am generalizing of course some are okay with it and also older.

That leaves problems, because there is no longer the staff to support veterinarians in the vet to support ratio that prevents a vet from getting burnt out. There are also more restrictions on what support staff can do. When I started working with vets in the dark ages, there was no registered tasks for veterinary technicians. I was called a tech and did everything that you need a license to do now. This is good that people have to be licensed. They should. But for the cost of schooling and the amount of time it takes, most people will not do it for the very low pay they get. Often they aren't making more than minimum wage.

I know when I worked ER recently, I was shocked that we turned patients, real emergencies away constantly due to being "at capacity". That is a new thing. I worked ER many other hospitals for many years and we never turned away patients. It didn't matter how short staffed we were, we still saw them. I remember one horrible night working with just me and a vet and getting 3 different rattlesnake bit dogs in within 5 minutes of each other, then a hit by car and other not as critical patients. There is a limit of course to what can be seen, but at the last ER I worked at recently, honestly it was slow and staff and Veterinarian (not owner) were still turning patients away. I found it sickening.

So, that is part of what is going on in vet medicine right now. Your vet may be burnt out. They may not have experience with this and they may not really be enthused about learning more. I think you should get a second opinion if you can. It doesn't sound like your vet would be all that open to any suggestions for treatment from you.

I have seen it before, and I have seen it resolved. Everything I have read recently recommends giving Doxycycline. first to see if it helps and then if not moving on to an immune modulator. Doxy is not without dangers and side effects just like everything else. It is a hard-core antibiotic and if given in pill form you need to give it in a gel capsule and rinse the mouth with a few mls of water after. If the doxy touches the inside of the throat, it can cause esophageal strictures which is a very big deal in cats.

First order of business would be to check blood work for FELV/FIV. Also, a full not sedated mouth exam should be done since this can be linked to stomatitis in some cats. Not all.

I have seen Prednisolone given to young cats without any major consequences. Of course, it is something you want to avoid in a young cat but you have to do what you have to do. Prednisolone is very well tolerated in cats. 10 mg a day is a high dose, but I have seen twice that prescribed short term with a gradual decrease before.

Sadly, like many cat medical conditions, not much is known about this.

Hope some of this helps.
 

Kris107

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I had a cat with this. Several of his pads healed on their own after some time (no medication), but one broke open. I was at wit's end with blood spots all over the house all the time. The foot didn't bother him too much - didn't obsessively lick it or limp. But we took him to an animal dermatologist and the dermatologist surgically removed the tissue that had popped out and sewed it shut. After that healed up my cat never had an issue with it for the rest of his life.
 
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mrsgreenjeens

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I've always thought antibiotics (doxy specifically) were the first avenue of treatment, then steroids if antibiotics don't work, then surgery if those two don't work. Although I've also heard that it can resolve on it's own.

Since this is an immune system issue, I'm wondering if DMG would be helpful. That is something di and bob di and bob highly recommends for many issues, and I'm thinking it might work since it helps regulate the immune system rather than really stimulate it (which you would NOT want). I think you can call Vetriscience and discuss it with them

Something in the back of my mind is telling me too that food might have something to do with pillowfoot. And you did mentioned you changed up her food. Did that happen around the same time. Is she eating the Pro Plan wet or dry or both? If possible without more health issues, I would try to get her on strictly wet and see what happens. Also, litter could be attributing to this (possibly) is she has an allergy to it. Are you using an unscented litter? I would at minimum use one, and if possible, use a natural litter. If nothing else, while they are ulcerating, it will be less painful.

That's all I've got for the moment.
 
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MikeJ523

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Veterinary medicine is really hard because the vets are expected to know so much about many different kinds of medicine on multiple species. I always recommend feline only veterinarians because at least that reduces it to only one species. Sometimes you need a specialist in internal medicine or dermatology and I think for specific problems you should seek out a veterinarian specializing in that field.

The other problem is that burn out seems to be hitting veterinarians and their staff pretty hard. It seems to be more of a changing in what people will tolerate anymore. I have worked at different vet hospitals for over 30 years, I have worked specialty IM and surgical and feline only as well as GP. Things have changed. When I started vets yelled, through things and you worked late every night and were in early in the morning. You were expected to come in on your day off (I got one a week) and you could expect not to have a job if you said you had plans. I remember a New Years Eve at the hospital in a velvet dress (late 1980's) holding a golden retriever that had separation anxiety and had bloodied his feet trying to escape. I also got yelled at by the vet for calling him and asking if we could sedate him.

Thankfully people won't put up with that crap anymore. Now people want to have a personal life and spend time with their families. They no longer answer their phones when they are off work, and they demand realistic work schedules. They take sick days off and they take personal days These are all very good things. The newer graduate veterinarians accept this because that is how they feel. The older veterinarians don't handle it as well. I am generalizing of course some are okay with it and also older.

That leaves problems, because there is no longer the staff to support veterinarians in the vet to support ratio that prevents a vet from getting burnt out. There are also more restrictions on what support staff can do. When I started working with vets in the dark ages, there was no registered tasks for veterinary technicians. I was called a tech and did everything that you need a license to do now. This is good that people have to be licensed. They should. But for the cost of schooling and the amount of time it takes, most people will not do it for the very low pay they get. Often they aren't making more than minimum wage.

I know when I worked ER recently, I was shocked that we turned patients, real emergencies away constantly due to being "at capacity". That is a new thing. I worked ER many other hospitals for many years and we never turned away patients. It didn't matter how short staffed we were, we still saw them. I remember one horrible night working with just me and a vet and getting 3 different rattlesnake bit dogs in within 5 minutes of each other, then a hit by car and other not as critical patients. There is a limit of course to what can be seen, but at the last ER I worked at recently, honestly it was slow and staff and Veterinarian (not owner) were still turning patients away. I found it sickening.

So, that is part of what is going on in vet medicine right now. Your vet may be burnt out. They may not have experience with this and they may not really be enthused about learning more. I think you should get a second opinion if you can. It doesn't sound like your vet would be all that open to any suggestions for treatment from you.

I have seen it before, and I have seen it resolved. Everything I have read recently recommends giving Doxycycline. first to see if it helps and then if not moving on to an immune modulator. Doxy is not without dangers and side effects just like everything else. It is a hard-core antibiotic and if given in pill form you need to give it in a gel capsule and rinse the mouth with a few mls of water after. If the doxy touches the inside of the throat, it can cause esophageal strictures which is a very big deal in cats.

First order of business would be to check blood work for FELV/FIV. Also, a full not sedated mouth exam should be done since this can be linked to stomatitis in some cats. Not all.

I have seen Prednisolone given to young cats without any major consequences. Of course, it is something you want to avoid in a young cat but you have to do what you have to do. Prednisolone is very well tolerated in cats. 10 mg a day is a high dose, but I have seen twice that prescribed short term with a gradual decrease before.

Sadly, like many cat medical conditions, not much is known about this.

Hope some of this helps.
I can absolutely see this happening from an outsiders perspective. I have nothing but respect for veterinarians, techs and anyone working in this field. It comes with so much sacrifice and sadly not much compensation. It takes a really special person to dedicate their lives to helping animals and making their own sacrifices for the good of them. I worked 12 hour shifts in a critical facility 5-7 days a week and got so burned out I couldn't do it anymore. I still feel the burnout effects years later so I can only imagine what it is like working in animal care and so much more is on the line everyday. I just wish there was something we could do to help and make more incentives for the people helping our animals. If they are all gone and no one is available to help the only ones that are going to suffer are the innocent animals that need help. It's very scary. I just hope all the animal care workers know how grateful we are for them and thank you for spending so much of your life helping all of our animals.

Forgot to mention in my post, but she has been tested for FELV/FIV it was one of the first things we did when we got her. That test came back negative for both. Thank goodness. Also her mouth was looked at as part of the exam when we took her in last. Nothing was mentioned to me about anything out of the ordinary.

Definitely a bit nervous about all these medications that can be given to treat this. They all come with their side effects and problems. Its hard to make a decision and determine do the benefits really outweigh the risks at this point. Thanks for the input on the prednisolone. Do you know if there is any withdrawal effects from a short 10 day treatment at those dosages? I have heard there can be issues with that, but not sure if it is more of a problem when they are on it longer term.
 
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MikeJ523

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I had a cat with this. Several of his pads healed on their own after some time (no medication), but one broke open. I was at wit's end with blood spots all over the house all the time. The foot didn't bother him too much - didn't obsessively lick it or limp. But we took him to an animal dermatologist and the dermatologist surgically removed the tissue that had popped out and sewed it shut. After that healed up my cat never had an issue with it for the rest of his life.
Besides the surgery fix do you happen to know if anything else changed that could have caused it to go away on its own? Maybe something food related, environmental, litter, etc?
 
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MikeJ523

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I've always thought antibiotics (doxy specifically) were the first avenue of treatment, then steroids if antibiotics don't work, then surgery if those two don't work. Although I've also heard that it can resolve on it's own.

Since this is an immune system issue, I'm wondering if DMG would be helpful. That is something di and bob di and bob highly recommends for many issues, and I'm thinking it might work since it helps regulate the immune system rather than really stimulate it (which you would NOT want). I think you can call Vetriscience and discuss it with them

Something in the back of my mind is telling me too that food might have something to do with pillowfoot. And you did mentioned you changed up her food. Did that happen around the same time. Is she eating the Pro Plan wet or dry or both? If possible without more health issues, I would try to get her on strictly wet and see what happens. Also, litter could be attributing to this (possibly) is she has an allergy to it. Are you using an unscented litter? I would at minimum use one, and if possible, use a natural litter. If nothing else, while they are ulcerating, it will be less painful.

That's all I've got for the moment.
I'm wondering if the vet chose to use steroids first because of the risk of esophageal strictures S silent meowlook mentioned above and her being such a young cat.

Thank you for the suggestion I will have to look into that product and do some research. Maybe something like that would be helpful or at least less harsh to give it a shot.

Yes! Me too. I keep coming back to that thought in my head. I swear the first signs started happening after we transitioned her food to the Pro Plan (Chicken and Rice Kitten Formula). She is currently on both wet and dry of it. I wish I could feed her wet only, but it's always a struggle getting her to eat wet food. She will eat it, but we do this dance for like an hour everyday where she will eat a small portion, then come back for more then sniff it and walk away, then eventually she will eat most of it. She has done this with a couple different brands and flavors. But she unfortunately loves eating her kibble. I'm really considering waiting a couple months when she can be transitioned to adult food to see if changing it will have any effect on her condition before doing meds. I'm not really sure if I want to transition to another kitten food right now and then adult food a couple months later with the issues we've had with food in the past. Also around the same time she had gotten her rabies shot. I am not against vaccines at all, but I wonder if the vaccine could have caused some sort of over active immune response as well. Right now I am currently using an unscented litter (Dr Elseys). Have tried some others of this type, but a natural litter may be something to try.
 

mrsgreenjeens

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I think the vaccine could have done this. It's a possibility. Stranger things have happened.

BTW, at 10 months, she is old enough to be transitioned to "all stages" cat food, which a lot of food is. That opens up a lot of avenues for you to try. Have you tried using crushed kibble on top of her wet food to get her to eat more? One of mine is starting to go off his wet food, so I give him freeze dried raw (unhydrated) so he has something to nibble on that isn't full of bad stuff. Dr. Elsey's Clean Protein is touted by several folks here also as a pretty good kibble too if she is a kibble addict.
 
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