@catnapper137 steroid was probably cortisol or hydrocortisone
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Stubborn Skin Allergy
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His whiskers are curled and go in different directions. They've been that way for as long as I'm aware. He does scratch at that area so there could be infection. His fur has never grown back on either side of his whiskers, which could be from scars. I believe that was all self inflicted and not from fighting. When he is super itchy, he will scratch non-stop and where he is sitting there will be a pile of fur, flaked off skin, and blood.
At this point we have still not narrowed down the actual thing(s) he is allergic to. They're trying to tread the symptoms as best as possible while figuring it out. Antihistamines have not been suggested by any of the vets so far.
Their suspicions are 1)flea allergy or demodex mites, 2)food allergy, 3)something environmental.
I'm going to call my vet this evening and ask about all of your suggestions. I don't want to try too many things at once because then we won't know what is actually working, if anything.
At this point we have still not narrowed down the actual thing(s) he is allergic to. They're trying to tread the symptoms as best as possible while figuring it out. Antihistamines have not been suggested by any of the vets so far.
Their suspicions are 1)flea allergy or demodex mites, 2)food allergy, 3)something environmental.
I'm going to call my vet this evening and ask about all of your suggestions. I don't want to try too many things at once because then we won't know what is actually working, if anything.
It sounds stupid, but have you ever attempted to wash the cat by plenty of fresh tap water ? Few times in a row, at say one hour interval.
I keep my attention to her whiskers. They tell us something about the cat history, the only thing is to figure out what.
====
I am very figures-oriented, sorry if I bother by my questions.
You said cat scratches herself a lot. All cats scratches themselves. What does it mean "a lot"? How many seconds, how many times /24 hours? Have you seen her, or just imagine she did it?
You said "alergia". Alergia is a cover-word, could have tens of meanings (from reaction to some meds - say)
My daughter use to have an "alergia" . Her physician did nothing, but reccomend me to avoid to dusty places or to expose her to much to sunshine. He told me to wait and see, alergia will cure by itself, if not triggered by dust or something similar. I never gave any anti-allergic med to my daughter, following this physician's advise and she is pretty well now.
=====
I have a scientific background, then I am much more oriented towards facts and findings, that are objective by their intrinsec nature. I trend not to believe any subjective view, in absence of figures (science is about figures). Some (including human or veterinary doctors) may feel nervous being dragged on such quantified territory, though. But biochemistry is my (now old, but who cares?) profession and this is how we see things, no offence.
So, what the lab said about agents? Do you have an antibiogram? Have the lab check fungi?
====
Few primary data about your meds:
Atopica is symptomatic med (it is even presented like this) based on cyclosporin, which modulates (lower) the T-cells activity (from cell-layer immune system).
Convenia is third-generation cephalosporin, similar to beta-lactam antibiotics. This is licensed very recently (2006) for use in cats.
Both have a lot of side effects and precaution-requirements. So make sure you know very well the health of the cat in order to comply with all restrictions.
Bravecto is a persistent systematic insecticid which is deposited mainly in fat and which cannot be metabolised - it is eliminated as such through feces.
To me this cocktail looks pretty frightfully. If not well controlled, alergia may go deeper in the body, making even more damage.
===
You said antibiotics. What antibiotics did you gave the cat in the first place? For what period of time? Did you give them yourself to the cat?
The last insecticide was prescribed by the same vet who prescribed the antibiotics or by some other vet?
I keep my attention to her whiskers. They tell us something about the cat history, the only thing is to figure out what.
====
I am very figures-oriented, sorry if I bother by my questions.
You said cat scratches herself a lot. All cats scratches themselves. What does it mean "a lot"? How many seconds, how many times /24 hours? Have you seen her, or just imagine she did it?
You said "alergia". Alergia is a cover-word, could have tens of meanings (from reaction to some meds - say)
My daughter use to have an "alergia" . Her physician did nothing, but reccomend me to avoid to dusty places or to expose her to much to sunshine. He told me to wait and see, alergia will cure by itself, if not triggered by dust or something similar. I never gave any anti-allergic med to my daughter, following this physician's advise and she is pretty well now.
=====
I have a scientific background, then I am much more oriented towards facts and findings, that are objective by their intrinsec nature. I trend not to believe any subjective view, in absence of figures (science is about figures). Some (including human or veterinary doctors) may feel nervous being dragged on such quantified territory, though. But biochemistry is my (now old, but who cares?) profession and this is how we see things, no offence.
So, what the lab said about agents? Do you have an antibiogram? Have the lab check fungi?
====
Few primary data about your meds:
Atopica is symptomatic med (it is even presented like this) based on cyclosporin, which modulates (lower) the T-cells activity (from cell-layer immune system).
Convenia is third-generation cephalosporin, similar to beta-lactam antibiotics. This is licensed very recently (2006) for use in cats.
Both have a lot of side effects and precaution-requirements. So make sure you know very well the health of the cat in order to comply with all restrictions.
Bravecto is a persistent systematic insecticid which is deposited mainly in fat and which cannot be metabolised - it is eliminated as such through feces.
To me this cocktail looks pretty frightfully. If not well controlled, alergia may go deeper in the body, making even more damage.
===
You said antibiotics. What antibiotics did you gave the cat in the first place? For what period of time? Did you give them yourself to the cat?
The last insecticide was prescribed by the same vet who prescribed the antibiotics or by some other vet?
What are the specks of brown on the last picture?
Does he have black bits of "dirt" under his chin?
What do these areas smell like?
Does he have black bits of "dirt" under his chin?
What do these areas smell like?
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@Solomonar I have never actually bathed him, but I have wiped him down with a warm, wet washcloth.
Last week he was scratching almost constantly. This week, to put a number on it, maybe 20-30 minutes of every hour is spent scratching. I have never actually timed how long he scratches, so that is an estimate. And obviously I am not with him 24/7.
We still have not been able to pinpoint what is causing the allergic reaction.
As far as specifics on the lab work and medications, I'll have to get back to you on that when I have a chance to look through his records this evening.
@Brian007 The specs are flaking skin/scabs/dried blood. It is not "flea dirt". It smells metallic, like blood. There's no foul smell.
Last week he was scratching almost constantly. This week, to put a number on it, maybe 20-30 minutes of every hour is spent scratching. I have never actually timed how long he scratches, so that is an estimate. And obviously I am not with him 24/7.
We still have not been able to pinpoint what is causing the allergic reaction.
As far as specifics on the lab work and medications, I'll have to get back to you on that when I have a chance to look through his records this evening.
@Brian007 The specs are flaking skin/scabs/dried blood. It is not "flea dirt". It smells metallic, like blood. There's no foul smell.
Ok, good.
We like to be thorough!
We like to be thorough!
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@Brian007 & @Solomonar Here is his vet history. I'm typing directly from the vet's notes, and hopefully the "big words" mean more to you than they do to me 
6/27/16 - Finally able to catch him after spending a year getting him to trust me.
6/28/16 - Took to local vet. She noted "Along face, abdomen, sides of back legs - alopecia, erythematous, scabbed, scaley, dermatitis. Looks self inflicted from licking and scratching. Entire face has same look. Allergic in nature." "Chronic dermatitis. 20mg Depo (steroid) and 30mg Convenia. Flea treatment applied."
7/15/16 - Vet noted "No scabs on skin now. Still some redness around neck and face. Still scratching. 20mg Depo, 30mg Convenia".
8/05/16 - Returned to vet due to excessive scratching, hair loss under eyes. Vet noted "redness under eyes and face. Discussed possible food allergies. 20mg Depo, 32mg Convenia."
9/2/16 - Returned to vet due to excessive itching. Vet notes: "Begin Science Diet z/d food. No other food or treats. 20mg Depo. If no improvement with food, will start Atopica"
9/26/16 - Vet notes "Begin Atopica 9# dosage. 20mg Depo. Cannot continue Depo, will need to find alternatives".
11/7/16 - No improvement. Began trying Purina hydrolized died. Vet notes: "Severe lichenification and erythema on chin and ventral neck, also noted scaling on shoulders, ears have hyperpigmentation at base bilaterally, very pruritis, hair thinning along ventral abdomen as well; no fleas or flea dirt noted." "Tape cytology: 3+ neutrophils, lager cells with "corn flake shapped" cytoplasm and smaller nucleus"
"Biopsy results: 2 bisected punch biopsies with similar findings. The superficial epithelium is mildly hyperplastic with occasional hyperkeratosis. There is scattered superficial dermal edema. Surrounding blood vessels in the superficial dermis there are mast cells, eosinophils, and fewer lymphocytes and plasma cells. There is rare crusting superficially." "Biopsy comments/interpretation: Superficial perivascular eosinophilic and mastocytic dermatitis with chronic epidermal hyperplasia. This is an inflammatory lesion with the predominant infiltrate composed of eosinophils with mast cells which orient around vessels and adexa. The primary differential for this lesion is allergic hypersensitivity; this includes environmental (contact) hypersensitivity, arthropod bite/insect hypersensitivity (eg fleas, flies), or food allergy - these cannot be distinguished on histopatholoty. There is no evidence of infections agents with routine stains. There is no evidence of immune - mediated skin disease." Recommend referral to dermatology specialist."
Vet gave the following medications to administer at home: Clindamycin drops, Prednisonlone.
11/28/16 - No improvement. Vet made referral to Univ. of Tennessee Vet. School. Discontinue all medications until after 1st appointment.
All vet notes from this point are from UT and not local vet. Their process is to have a 4th year student and a licensed vet at each appointment. We have seen several different students and vets.
12/15/16 - Vet notes: "Abnormalities: 1)Yellow mucoid discharge from both eyes (mild), 2)Brown ceruminous debris in both ears (mild), 3)Hypotrichosis and marked crusting of the face, neck, ear pinnae, 4)Forlimb alopecia, erythema, lichenification, 5)Ventral alopecia, erythema, lichenification".
Diagnostic findings: Dorsal and ventral neck skin scrapes - neg. for ectoparasites,
Skin cytology: Ear Pinnae: occasional yeast; Ventral Abdomen: nuclear streaming, 1+ yeast, TNTC cocci; Ventral neck: 3+ cocci, occasional years and nuclear streaming.
Ear Cytology: Right and left neg. for bacteria and cocci.
Treated with 32mg of convenia.
Possible allergens: 1)fleas, 2)demodex mites, 3)food, 4)environmental
Medications: Advantage multi every two weeks. Keep all other pets on flea control. Dexamethasone, .4ml 1x/day for 3 days, then every other day.
12/29/16 - Vet notes: "Alopecia, comedomes on chin. Diffuse alopecia of abdomen"
Skin scrape: superficial skin scrape between his shoulder blades and a deep skin scrape of his chin to look for mites. Both were negative.
Skin Cytology: Abdomen demonstrated too numerous to count yeast. Chin demonstrated occasional yeast. No bacteria on either cytology.
Fungal Culture: looking for the presence of dermatophyte fungus, results pending.
Urine glucose: negative
Treatments: Convenia 32mg.
Medications: Dexamethasone .4ml 2x weekly, Advantage Multi every two weeks, MalAcetic Ultra applied to chin and abdomen 2x daily.
1/27/17 - Vet notes " Chin - mild crusting, worse on the right. Ears - mild amount of light brown waxy exudate, normal tympanic membranes bilaterally. Abdomen - evidence of hair regrowth"
Skin cytology - Impression smear of chin showed 1+ neutrophils and occasional cocci
Medications: Dexamethasone .4ml once or twice a week; Advantage Multi every two weeks; MalAcetic Ultra once a day on chin and abdomen; 2% Chlorehexidine on chin once a day.
2/24/17 - Vet notes: Chin and neck - crust, erythema, ulceration; Ears - mild amount of light brown waxy exudate; Head - alopecia, lichenification, hyperpigmentation; Abdomen - erythema, ulcerative lesions; Forelimbs - caudal alopecia, erythema.
Skin cytology - Impression smear of chin showed 3+ cocci bacteria and eutrophils
Tape cytology - Abdomen showed occasional 1+ neutrophils
Skin scrape - Neg for superficial mites.
Treatment: Convenia .47ml
Medications: Apoquel - 1/4 tabled orally every 12 hours; Dexamethasone as needed, but not until a few days of Apoquel; Bravecto (discontinue Advantage Multi), MalAcetic Ultra on chin and abdomen every other day.
Food: Begin Royal Canin Select protein: Rabbit & Peas
2/28/17 - Per phone call with UT vet; since minimal improvement with Apoquel, discontinue for a few days and monitor.
Let me know if I need to clarify anything. You said you like thorough
6/27/16 - Finally able to catch him after spending a year getting him to trust me.
6/28/16 - Took to local vet. She noted "Along face, abdomen, sides of back legs - alopecia, erythematous, scabbed, scaley, dermatitis. Looks self inflicted from licking and scratching. Entire face has same look. Allergic in nature." "Chronic dermatitis. 20mg Depo (steroid) and 30mg Convenia. Flea treatment applied."
7/15/16 - Vet noted "No scabs on skin now. Still some redness around neck and face. Still scratching. 20mg Depo, 30mg Convenia".
8/05/16 - Returned to vet due to excessive scratching, hair loss under eyes. Vet noted "redness under eyes and face. Discussed possible food allergies. 20mg Depo, 32mg Convenia."
9/2/16 - Returned to vet due to excessive itching. Vet notes: "Begin Science Diet z/d food. No other food or treats. 20mg Depo. If no improvement with food, will start Atopica"
9/26/16 - Vet notes "Begin Atopica 9# dosage. 20mg Depo. Cannot continue Depo, will need to find alternatives".
11/7/16 - No improvement. Began trying Purina hydrolized died. Vet notes: "Severe lichenification and erythema on chin and ventral neck, also noted scaling on shoulders, ears have hyperpigmentation at base bilaterally, very pruritis, hair thinning along ventral abdomen as well; no fleas or flea dirt noted." "Tape cytology: 3+ neutrophils, lager cells with "corn flake shapped" cytoplasm and smaller nucleus"
"Biopsy results: 2 bisected punch biopsies with similar findings. The superficial epithelium is mildly hyperplastic with occasional hyperkeratosis. There is scattered superficial dermal edema. Surrounding blood vessels in the superficial dermis there are mast cells, eosinophils, and fewer lymphocytes and plasma cells. There is rare crusting superficially." "Biopsy comments/interpretation: Superficial perivascular eosinophilic and mastocytic dermatitis with chronic epidermal hyperplasia. This is an inflammatory lesion with the predominant infiltrate composed of eosinophils with mast cells which orient around vessels and adexa. The primary differential for this lesion is allergic hypersensitivity; this includes environmental (contact) hypersensitivity, arthropod bite/insect hypersensitivity (eg fleas, flies), or food allergy - these cannot be distinguished on histopatholoty. There is no evidence of infections agents with routine stains. There is no evidence of immune - mediated skin disease." Recommend referral to dermatology specialist."
Vet gave the following medications to administer at home: Clindamycin drops, Prednisonlone.
11/28/16 - No improvement. Vet made referral to Univ. of Tennessee Vet. School. Discontinue all medications until after 1st appointment.
All vet notes from this point are from UT and not local vet. Their process is to have a 4th year student and a licensed vet at each appointment. We have seen several different students and vets.
12/15/16 - Vet notes: "Abnormalities: 1)Yellow mucoid discharge from both eyes (mild), 2)Brown ceruminous debris in both ears (mild), 3)Hypotrichosis and marked crusting of the face, neck, ear pinnae, 4)Forlimb alopecia, erythema, lichenification, 5)Ventral alopecia, erythema, lichenification".
Diagnostic findings: Dorsal and ventral neck skin scrapes - neg. for ectoparasites,
Skin cytology: Ear Pinnae: occasional yeast; Ventral Abdomen: nuclear streaming, 1+ yeast, TNTC cocci; Ventral neck: 3+ cocci, occasional years and nuclear streaming.
Ear Cytology: Right and left neg. for bacteria and cocci.
Treated with 32mg of convenia.
Possible allergens: 1)fleas, 2)demodex mites, 3)food, 4)environmental
Medications: Advantage multi every two weeks. Keep all other pets on flea control. Dexamethasone, .4ml 1x/day for 3 days, then every other day.
12/29/16 - Vet notes: "Alopecia, comedomes on chin. Diffuse alopecia of abdomen"
Skin scrape: superficial skin scrape between his shoulder blades and a deep skin scrape of his chin to look for mites. Both were negative.
Skin Cytology: Abdomen demonstrated too numerous to count yeast. Chin demonstrated occasional yeast. No bacteria on either cytology.
Fungal Culture: looking for the presence of dermatophyte fungus, results pending.
Urine glucose: negative
Treatments: Convenia 32mg.
Medications: Dexamethasone .4ml 2x weekly, Advantage Multi every two weeks, MalAcetic Ultra applied to chin and abdomen 2x daily.
1/27/17 - Vet notes " Chin - mild crusting, worse on the right. Ears - mild amount of light brown waxy exudate, normal tympanic membranes bilaterally. Abdomen - evidence of hair regrowth"
Skin cytology - Impression smear of chin showed 1+ neutrophils and occasional cocci
Medications: Dexamethasone .4ml once or twice a week; Advantage Multi every two weeks; MalAcetic Ultra once a day on chin and abdomen; 2% Chlorehexidine on chin once a day.
2/24/17 - Vet notes: Chin and neck - crust, erythema, ulceration; Ears - mild amount of light brown waxy exudate; Head - alopecia, lichenification, hyperpigmentation; Abdomen - erythema, ulcerative lesions; Forelimbs - caudal alopecia, erythema.
Skin cytology - Impression smear of chin showed 3+ cocci bacteria and eutrophils
Tape cytology - Abdomen showed occasional 1+ neutrophils
Skin scrape - Neg for superficial mites.
Treatment: Convenia .47ml
Medications: Apoquel - 1/4 tabled orally every 12 hours; Dexamethasone as needed, but not until a few days of Apoquel; Bravecto (discontinue Advantage Multi), MalAcetic Ultra on chin and abdomen every other day.
Food: Begin Royal Canin Select protein: Rabbit & Peas
2/28/17 - Per phone call with UT vet; since minimal improvement with Apoquel, discontinue for a few days and monitor.
Let me know if I need to clarify anything. You said you like thorough
OP should ask the vet before using any OTC Human allergy medicine to be sure that it is safe to give and what the correct cat dose is.
Has food allergies / sensitivities been ruled out? That can use itchy skin.
Yes, of course they should check with their vet, that is the whole purpose behind this particular thread. However, it is a well-known and widely used veterinary medicine, that I have found very effective for a number of reasons. I don't post random information
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@LTS3 - Nothing has been ruled out yet. We tried Science Diet z/d, followed by Purina Hydrolyzed, some Blue Buffalo grain-free limited ingredient canned food, and now we're on Royal Canin Select Protein Rabbit & Peas.
After spending some time with him this evening he is scratching less. In about an hour's time, he only scratched at his ear/cheek twice for about 10-20 seconds each time. His skin is still VERY red. We discontinued the Apoquel last night per the vet's instructions. He did get a dose of the Dexamethasone last night. So the decrease in scratching is likely either due to that, to the Bravecto, or to the food.
After spending some time with him this evening he is scratching less. In about an hour's time, he only scratched at his ear/cheek twice for about 10-20 seconds each time. His skin is still VERY red. We discontinued the Apoquel last night per the vet's instructions. He did get a dose of the Dexamethasone last night. So the decrease in scratching is likely either due to that, to the Bravecto, or to the food.
Ask your vet about antihistamines as soon as possible. I'm amazed that none have been given at any point. Scratch now has both fungal and bacterial infections, which were not present in June. I expect the reason to be down to way too much steroid use. He has been given antibiotics for 8 months, which is a truly ridiculous length of time, especially considering bacterial infections (multiple) are present.
I suggest you ask your vet for some antimicrobial wash and bath Scratch in it daily. And insist on antihistamines. I can not see why any more convenia should ever be given to Scratch again. It doesn't look as though the bacterial infections are out of control, so either stop antibiotics altogether then wait and see what effect the wash and antihistamine has. And vacuum his space. Then if he still needs (needs as opposed to treating the infection by other means) antibiotics insist on a different type.
Look into nutrition and think about adding pro and pre biotics to his diet.
I recommend behaviour training too, as he's so caught up in his itch scratch cycle that even when the itch (histamine) is reduced he'll still likely scratch out of habit. You need to keep his claws away from his skin. I guess this means someone will have to hang out with him all the time to distract him by play or petting.
Get a Feliway diffuser plug, which emits friendly, cat de-stressing pheromones. Maybe ask your vet about some anti-anxiety medicine. But also get him some cat calming drops, containing valerian. You can buy these on Amazon.
I suggest you ask your vet for some antimicrobial wash and bath Scratch in it daily. And insist on antihistamines. I can not see why any more convenia should ever be given to Scratch again. It doesn't look as though the bacterial infections are out of control, so either stop antibiotics altogether then wait and see what effect the wash and antihistamine has. And vacuum his space. Then if he still needs (needs as opposed to treating the infection by other means) antibiotics insist on a different type.
Look into nutrition and think about adding pro and pre biotics to his diet.
I recommend behaviour training too, as he's so caught up in his itch scratch cycle that even when the itch (histamine) is reduced he'll still likely scratch out of habit. You need to keep his claws away from his skin. I guess this means someone will have to hang out with him all the time to distract him by play or petting.
Get a Feliway diffuser plug, which emits friendly, cat de-stressing pheromones. Maybe ask your vet about some anti-anxiety medicine. But also get him some cat calming drops, containing valerian. You can buy these on Amazon.
@catnapper137 That's an excellent piece of documenting, by the way. Did you do that yourself?
It shows that he has mast cells gathering around the other blood cells, they release histamine. This short article explains the process quite clearly:
http://www.wisegeek.com/what-is-a-mast-cell.htm
The presence of these cells is why I'm 100% certain antihistamines are needed.
It shows that he has mast cells gathering around the other blood cells, they release histamine. This short article explains the process quite clearly:
http://www.wisegeek.com/what-is-a-mast-cell.htm
The presence of these cells is why I'm 100% certain antihistamines are needed.
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Could be food allergy? It took me months to find out my cat was allergic to fish. She had huge raw skin patches and bloody stools. She can't have anything with any seafood in it. Cats can be very sensitive- corn, grains, soy, etc are in most commercial foods.
It's been present from the time when he was a stray. So, a food allergy is the least likely culprit. My bet is on either flea bites or another wee mite common to both the outdoors and indoors. Just one flea bite was all that was needed to start the cycle of histamine release, itch, scratch, then inflamed dermatitis, and repeat.....
"Fungal Culture: looking for the presence of dermatophyte fungus, results pending."
Maybe I didnt catch it, but in the list there is no result mentioned of this fungi test.
Form prescribing the Dexamethasone , which has a clear contraindication in systemic fungi infection, it looks like fungi were ruled out. On which basis?
At this very moment, we do not know whether there is a fungi or not. We only assume it is not fungi. But be aware, if there is fungi and you give the cat antibiotics, that can worsen the situation.
===
I did not see any thorough check on food alergens, or at least some "suspects" - there is not such a thing "allergy to food", but to a certain protein which is in the composition of a particular food, or in many brands of food (say for instance, three brands are using turkey meat, if the allergen is rtelated to that meat, then changing from one brand to another will make no difference).
In my view, from the info in the list, there is no basis to rule out food allergy (read allergy to a particular component)
To be clear, an example: one human cannot be allergic to the breakfast, but could be allergic to some components in the eggs, and then no matter in which particular food human will find eggs, that will trigger the allergy.
Cooking reduces the allergenic nature of foods by breaking down the proteins responsible for allergic reactions – if the protein causing the allergy (called the allergen), is broken down by heat, then the allergic antibody (IgE) no longer recognizes the protein, and the allergic reaction doesn’t occur. This is in the theory, but given the very small amount of allergen to trigger the reaction, the process of the industrial food cannot be a 100% guarantee.
There is also a Galactose-alpha-1,3-galactose Allergy, which means that the allergy is triggered by any mammalian meat. In humans, blood tests are also commercially available to test for the presence of allergic antibodies to galactose-alpha-1,3-galactose. Whether this also in cats, I do not know but it would be worth checking.
On the other hand, if we talk about meat allergy in the cirtcumstgances above, these do not include fish or shrimps.
As long as the cause of the allergy is not spotted, I am afraid there would be no clear improvement. If there is an allergy. We do not know, we just assume (there is no proof).
=
Flea bites - rejecting the fleas from the present time, as a cause of the disease, does not mean it was not the original primary cause in the past - for we do not know the first sign of cat's scratching. As a logical way of thinking, if no bites => no scratch. But this is valid only in humans, because we can instruct a human not to scratch him/herself no matter how itchy his/her skin is.
===
Brielfly, I can not see a diagnostic based on objective tests or conclusive observation. It is a trial and error approach, which could be rewarding, but I would have feel more confident from having a clear diagnostic or at least a 50% confidence in the assumptions.
Perhaps this comes from many vets looking to the cat, it is very difficult for a person to re-build the entire story of a misterious disease from few notes.
===
Allergic Rhinitis - this matches very well the eyes problem and also the difficulty to find the precise allergen, because the allergen is in many cases airborn (either seasonal or not). there is no info on this possibility on the list. Perhaps it was ruled out during examination, I do not know.
Maybe I didnt catch it, but in the list there is no result mentioned of this fungi test.
Form prescribing the Dexamethasone , which has a clear contraindication in systemic fungi infection, it looks like fungi were ruled out. On which basis?
At this very moment, we do not know whether there is a fungi or not. We only assume it is not fungi. But be aware, if there is fungi and you give the cat antibiotics, that can worsen the situation.
===
I did not see any thorough check on food alergens, or at least some "suspects" - there is not such a thing "allergy to food", but to a certain protein which is in the composition of a particular food, or in many brands of food (say for instance, three brands are using turkey meat, if the allergen is rtelated to that meat, then changing from one brand to another will make no difference).
In my view, from the info in the list, there is no basis to rule out food allergy (read allergy to a particular component)
To be clear, an example: one human cannot be allergic to the breakfast, but could be allergic to some components in the eggs, and then no matter in which particular food human will find eggs, that will trigger the allergy.
Cooking reduces the allergenic nature of foods by breaking down the proteins responsible for allergic reactions – if the protein causing the allergy (called the allergen), is broken down by heat, then the allergic antibody (IgE) no longer recognizes the protein, and the allergic reaction doesn’t occur. This is in the theory, but given the very small amount of allergen to trigger the reaction, the process of the industrial food cannot be a 100% guarantee.
There is also a Galactose-alpha-1,3-galactose Allergy, which means that the allergy is triggered by any mammalian meat. In humans, blood tests are also commercially available to test for the presence of allergic antibodies to galactose-alpha-1,3-galactose. Whether this also in cats, I do not know but it would be worth checking.
On the other hand, if we talk about meat allergy in the cirtcumstgances above, these do not include fish or shrimps.
As long as the cause of the allergy is not spotted, I am afraid there would be no clear improvement. If there is an allergy. We do not know, we just assume (there is no proof).
=
Flea bites - rejecting the fleas from the present time, as a cause of the disease, does not mean it was not the original primary cause in the past - for we do not know the first sign of cat's scratching. As a logical way of thinking, if no bites => no scratch. But this is valid only in humans, because we can instruct a human not to scratch him/herself no matter how itchy his/her skin is.
===
Brielfly, I can not see a diagnostic based on objective tests or conclusive observation. It is a trial and error approach, which could be rewarding, but I would have feel more confident from having a clear diagnostic or at least a 50% confidence in the assumptions.
Perhaps this comes from many vets looking to the cat, it is very difficult for a person to re-build the entire story of a misterious disease from few notes.
===
Allergic Rhinitis - this matches very well the eyes problem and also the difficulty to find the precise allergen, because the allergen is in many cases airborn (either seasonal or not). there is no info on this possibility on the list. Perhaps it was ruled out during examination, I do not know.
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@Brian007 - Thank you! I kept all of the discharge notes from each vet visit and just copied from there.
I have sent an email to my vet asking about the antihistamine and your other suggestions and haven't heard back yet, but I will post when I get a reply.
As far as his behavior, he has been scratching less yesterday and this morning. He only scratched twice last night and I didn't see him scratch at all this morning. His skin still looks inflamed. His eyes have cleared up completely, but he is still squinting a little occasionally.
For the convenia, it's my understanding that a full does is a 30mg injection followed by another two weeks later. So I suspect they will give him another at our next appointment on March 10. I will also ask why they keep giving that antibiotic when it doesn't seem to have helped.
I already have Feliway for Multi cat households - one on each floor of the home
@CatDaddy007 - We've been trying different food options for several months. So far nothing has completely cleared him up. I will say that when he was a stray, the food I fed him had the 1st ingredient listed as corn (terrible, I know, but I was feeding a lot of cats and needed something cheap). Once inside, the litter I used was a corn based litter. Once I realized the correlation, I changed his litter and he did show some improvement, but nothing extraordinary. So he may have an allergy or sensitivity to corn, but something else has to be causing it as well.
@Solomonar - On the fungal culture, I don't believe I ever got the results. I will ask when we go back on March 10. He is still receiving the MalAcetic Ultra to combat any yeast.
For food allergies, nothing has been ruled out yet. We have run out of the samples of the Royal Canin wet food (we still have some of the dry) and my order has not arrived yet. So I've been giving him the Blue Buffalo grain-free limited ingredient can food to supplement until our order arrives. I don't think I've mentioned this, but he only has 9 teeth. He had 13 when I initially got him to the vet, but four were rotten and had to be pulled. Vet said it is either from poor nutrition or bad genetics. So I hate to only give him dry food, even though he seems to eat it fine.
That being said, and having stopped the Apoquel, I think the reason for his improvement is likely the Bravecto, meaning that fleas or mites are behind all of this. I did give him a dose of the Dexamethasone Tuesday evening, so that could be the sole cause of him feeling better. No clear answer at this point; it really is trial and error.
I have sent an email to my vet asking about the antihistamine and your other suggestions and haven't heard back yet, but I will post when I get a reply.
As far as his behavior, he has been scratching less yesterday and this morning. He only scratched twice last night and I didn't see him scratch at all this morning. His skin still looks inflamed. His eyes have cleared up completely, but he is still squinting a little occasionally.
For the convenia, it's my understanding that a full does is a 30mg injection followed by another two weeks later. So I suspect they will give him another at our next appointment on March 10. I will also ask why they keep giving that antibiotic when it doesn't seem to have helped.
I already have Feliway for Multi cat households - one on each floor of the home
@CatDaddy007 - We've been trying different food options for several months. So far nothing has completely cleared him up. I will say that when he was a stray, the food I fed him had the 1st ingredient listed as corn (terrible, I know, but I was feeding a lot of cats and needed something cheap). Once inside, the litter I used was a corn based litter. Once I realized the correlation, I changed his litter and he did show some improvement, but nothing extraordinary. So he may have an allergy or sensitivity to corn, but something else has to be causing it as well.
@Solomonar - On the fungal culture, I don't believe I ever got the results. I will ask when we go back on March 10. He is still receiving the MalAcetic Ultra to combat any yeast.
For food allergies, nothing has been ruled out yet. We have run out of the samples of the Royal Canin wet food (we still have some of the dry) and my order has not arrived yet. So I've been giving him the Blue Buffalo grain-free limited ingredient can food to supplement until our order arrives. I don't think I've mentioned this, but he only has 9 teeth. He had 13 when I initially got him to the vet, but four were rotten and had to be pulled. Vet said it is either from poor nutrition or bad genetics. So I hate to only give him dry food, even though he seems to eat it fine.
That being said, and having stopped the Apoquel, I think the reason for his improvement is likely the Bravecto, meaning that fleas or mites are behind all of this. I did give him a dose of the Dexamethasone Tuesday evening, so that could be the sole cause of him feeling better. No clear answer at this point; it really is trial and error.
My guess - which is a real guess at this time, and please do not take it as nothing more that a guess- is to blame genetics.
For some reasons, this cat's immune system seems to have difficulty in delivering a balanced response to the allergens. His saliva itself has negative impact on the skin, so once the allergy is triggered, saliva keeps it running. Or, alternatively saliva is not sufficiently active to stop bacteria growth (genetic lack of some enzymes like lysosim).
For the same conclusion testify the eyes condition and bad teeth, as well as the location of scratches and the whiskers un-common shape.
I would do a saliva test if available and put a Cone on the cat (since compulsive licking could be at the origin of this skin condition - seen from the fact that when you are with the cat, she licks herself less).
These may not harm the cat anyway and are not against any other advise or treatment, but just a fresh perspective.
====
To explain myself:
When the cats licks her wounds, tongue papillae scratch the skin like a sandpaper. The lizozyim in the saliva acts as a bactericide and stops bacteria growth. If the lisozym is not there or if it is in inusfficient quantity, then the wound aggravates and get larger as the cat keeps licking.
Absence of the lizozym means that the bacteria in cat's mouth act freely and infect beneath the gum , increases dental plaque and finally cause teeth damage and loss.
The same applies to eyes - if the saliva has not sufficient bactericid, then when she wet her eye by the paw wet in her saliva, saliva go to the eyes and micro-traumatisms get infected. It could be very well his tears not having bactericid effect.
===
Again, this is my guess, my pure personal hypothesis. It is a guess, based on logic and on regular procedures being of low impact so far.
It could be very well something very different. But as long as we are on the trial and error realm, why not consider this hypothesis as well?
For some reasons, this cat's immune system seems to have difficulty in delivering a balanced response to the allergens. His saliva itself has negative impact on the skin, so once the allergy is triggered, saliva keeps it running. Or, alternatively saliva is not sufficiently active to stop bacteria growth (genetic lack of some enzymes like lysosim).
For the same conclusion testify the eyes condition and bad teeth, as well as the location of scratches and the whiskers un-common shape.
I would do a saliva test if available and put a Cone on the cat (since compulsive licking could be at the origin of this skin condition - seen from the fact that when you are with the cat, she licks herself less).
These may not harm the cat anyway and are not against any other advise or treatment, but just a fresh perspective.
====
To explain myself:
When the cats licks her wounds, tongue papillae scratch the skin like a sandpaper. The lizozyim in the saliva acts as a bactericide and stops bacteria growth. If the lisozym is not there or if it is in inusfficient quantity, then the wound aggravates and get larger as the cat keeps licking.
Absence of the lizozym means that the bacteria in cat's mouth act freely and infect beneath the gum , increases dental plaque and finally cause teeth damage and loss.
The same applies to eyes - if the saliva has not sufficient bactericid, then when she wet her eye by the paw wet in her saliva, saliva go to the eyes and micro-traumatisms get infected. It could be very well his tears not having bactericid effect.
===
Again, this is my guess, my pure personal hypothesis. It is a guess, based on logic and on regular procedures being of low impact so far.
It could be very well something very different. But as long as we are on the trial and error realm, why not consider this hypothesis as well?
