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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 17050
Experience:  I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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If possible can I have an expert in cat medicine and someone

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If possible can I have an expert in cat medicine and someone familiar with the system in UK. Dolly my 10yo british shorthair cat began itching herself just between her shoulder blades yesterday. I havent noticed her doing it before. She had partial FME due to stomatitis and peridontol disease 6 weeks ago previously having 2 depo injections and a convenia injection which failed to control inflammation. I mention this because i fear it may be relevant seeing as Dolly is painful in the injection sight area. However this was all over 2 months ago, the last depo and she has been so much improved from having the right side molars and premolars removed. Pretty much back to normal and on no medication at all. I noticed the itching yesterday and she was more affectionate. I sensed something was up so I treated both cats with stronghold for fleas in case this was the issue. By a few hours later she was more irritable and clearly in pain. Very cuddly but scratching and licking violently and not settling. Odd behaviour although still eating. I took her to emergency vet last night at 11pm. We found some inflamed skin and scratch marks at the sight and thought she must have been hurt by another cat, however I now believe she did the scratches herself as i have seen her manage to reach there. Vet administered metacam and antibiotic injection and we went home thinking it was a fight wound. After a few hours it was clear she was much worse, chasing her around i found she had done more damage and now has an angry inflamed area from her scratchings. Fucidin and steroid cream was given at second visit and after asking we were also given buprenex injection. The vet insisted the cat is more itchy than painful, but that is definitely not the case. I have only seen her this painful once before when she tried to bit out an anal sac abscess! The buprenex has taken the edge off the pain, but will wear off in next 2 hours. Its sunday morning here and I am not sure where i go next. We still dont really know whats causing her pain and irritation and im not sure we can treat it until we do. She has synulox tabs to start tonight but no more pain meds. I am very worried. Could this relate to the injections? She was very poorly after convenia. Should I ask for referral to hospital? I know cats can get sarcomas from injection sites, but the onset was so acute. No temperature noted although high side of normal and vet said she was pushing thermometer out so she may have slight temperature. Please help, I am worried to death. This cat has been through so much lately and had so many different drugs. We also ruled out sarcoma in her mouth after biopsy on a mass came back ok.
Submitted: 6 months ago.
Category: Cat
Expert:  Dr. B. replied 6 months ago.

Hello & welcome, I am Dr. B, a licensed UK based veterinary surgeon and I would like to help you with your wee one today.

First, I would note that if the Depomedrone was given > 2 months ago, it will be playing no role in her current signs. As well, while we can see injection site sensitivity, this is usually much milder then you have reported and would be managed by the strong pain relief treatments she has had. Therefore, I would suspect this was a red herring and not the root cause of her discomfort.

Furthermore, inject site sarcomas are always a concern rare to see in non-vaccine related injections. Furthermore, we'd expect her to have a lump present (which would need time to grow and not be acute) if this were our cause for her signs.

Now to start, while both Metacam & Buprenex are good pain relief, they won't counter irritation/itching. Therefore, while you suspect pain here, I do have to note that it would be advisable to cover for itching since she is already on quite strong pain relief. That way we can make sure (since she cannot tell us) that that is not playing a role. Now since she has had Metacam (so steroids from her vet would require a weaning period from that before use), you could consider trying her on an antihistamine (ie Piriton/Chlorphenamine -2-4mg every 8 hours or Cetirizine - 5mg once daily).

As well, if she was not sent home with Buprenex (or Temgesic, the oral version), then we would want to ring the vet that saw her or even her own vet's out of hours service to have more dispensed to at least get her through the weekend. And if she settles with the above and that continued, we are happy.

Though if her signs persist, then we'd want to plan to see her vet Monday for reassessment +/- further testing. Since she is already being treated for infection and possible pain, we may need to think about xray to make sure there are no visible masses or spinal changes over the shoulders. At the same time, they can determine if feline hyperesthesia syndrome (More Info) is a concern for her. Otherwise, we would need to consider referral to a neurologist for a possible MRI or CT to see if we have a nerve based issue (ie inflammation, compression, nerve sheath tumor) that needs to be addressed.

Overall, the injections that she was given at the start are not likely the cause of her signs. We'd be more concerned about an severe irritation, local nerve issues, or possibly a hyperesthesia syndrome. So, the above would be our approach for the moment with a view to further work-up once her vet is open.

Please take care,

Dr. B.

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If you have any other questions, please ask me – I’ll be happy to respond.

**Afterwards, please don’t forget to rate my service by clicking on the "Rate my Expert' button at the top of the page as this is the only way I am credited for helping you. Thank you for your feedback!: )

Customer: replied 6 months ago.
Many thanks for responding. The information is helpful and addresses some of my concerns. I will no doubt have to take her back to the out of hours again later if she begins to worsen. She has been much more comfortable with the buprenex but i can see her getting a little bit irritable again now. There are lots of ripples down her back. As if itchiness is the cause but i definitely know this is severe pain also. The vet did find a slight swelling in the area of redness but it was deemed to be her microchip as was mobile and in the exact spot when she put the scanner over it. I did wonder if it could be an abscess which wasnt ruled out but just thought it would have presented with a definite lump or swelling. She doesnt seem to be able to sleep at all. Just wandering around staring into space since buprenex. It is just such a very sudden onset, 24 hrs ago she seemed the best she has been for a long time actually. In fact I thought exactly that. I wondered if the stronghold had caused irritation because she definitely seemed to worsen since i treated her at 6pm last night. I wondered if referral to AHT or RVC was worth considering at this time? I assume they have an emergency referral centre. Many thanks. Jessica
Expert:  Dr. B. replied 6 months ago.

You are very welcome, Jessica.

It is quite possible that it is a combination of both, especially as there is unfortunately no rule to say they can only have one issue at a time (it would be lovely from a vet point of view if that were the case). And I would note that we can see skin irritation and reactions from topical flea treatments causing severe agitation for sensitive cats; though usually that will subside after 48 hours and would be expected to respond to anti-inflammatories and our antihistamines.

Anyway, if she is getting irritated as the Buprenex is wearing off, then we would want to ring the vet to see if they will dispense an oral version for her or see her to re-dose and keep comfortable.

Otherwise, usually sarcomas will be well adhered to the underlying issue, so non-mobile and often are quite angry and obvious. And while they didn’t sample to see if it was an abscess or diffuse bacterial cellulitis (which can be less defined), the antibiotics would address it if it were out culprit here. So, we’d hope that the first is less likely and the latter being addressed with the synulox.

Finally, both referral centres do tend to have ER capabilities; though there is a chance they won’t have an on call neurologist or dermatologist (given where they assess this problem to be arising from on presentation). So, they may only be able to just keep her on pain relief until Monday when the specialists are in. And with that in mind, we may want to have your vet ring before sending her or potentially having them keep her in on pain relief or again dispensing some for you so that she is in the comfort of her own home until we can get her properly seen to.

All the best,

Dr. B.

-----------------------------------------------------------------------------------------------------------------

If you have any other questions, please ask me – I’ll be happy to respond. **Afterwards, I would be grateful if you would rate my service by clicking on the "Rate my Expert' button at the top of the page as this is the only way I am credited for helping you. Thank you for your feedback!: )

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