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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15678
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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Is the 'vegetable based' flea repellant pennyroyal in the

Customer Question

is the 'vegetable based' flea repellant pennyroyal in the cat litter made by midas products and named biocatolet -
Submitted: 3 months ago.
Category: Vet
Customer: replied 3 months ago.
because my cat is sick he has eaten quite a lot of this Cat litter called bio-catolet - it was 48 hours ago now and hes had quite a few symptoms however as hes been quite sick anyway lately i just put it down to that at first - i just checked the contents on the bio-catolet webpage which include a vegetable based flea repellant. i cant find any information on what that actually is and am wondering if my cat has pennyroyal poisoning.
Expert:  Dr. B. replied 3 months ago.

Hello and welcome, I am Dr. B and would like to help you today.

What signs did he have before eating the litter?

What signs does he have now? Any vomiting, appetite loss, belly pain,etc.?

Are his gums pink, pale, or yellow tinted?

Customer: replied 3 months ago.
Hi Dr B
It's a very long story really....
He's 10. Came to me 2 months ago. I officially adopted him as he chose me over his previous owner some time ago.
He's been treated for pancreatitis just after i got him and just before that he had an infected tooth out. He had weight loss for some months and personality change which my vet has put down to feeling ill. Im a people nurse and have had cats for over 50 years...he was very cranky and purry- bitey. After the hospital admission for pancreatitis he had they said a bad drug reaction resulting in intense itch and so hes had awful hair loss and open sores on sholders and around neck. Treated for fleas and mange.... He wasn't insured and I've spent 2000 pounds which is not an easy amount
I think he has a neurological disorder but my vet hadn't paid attention to those symptoms...lack of coordination. Agoraphobia. Licking rough surfaces. Eating cat litter. Anorexia. Lethargy. Running back to his bed if you take him to another room. Lack of interest. He's on oral steroids. He was picking up a little bit last week. He gained half a kg. Was eating better...needs a lot of prompting. Has a little vest on to protect the sores from scratching and they have healed now but he's had a negative abdo ultrasound. Neg cxr. Neg skin biopsy. I've called a halt on further spending. He was on mirtazipine as appetite stimulant but had some partial seizures.
All this before eating cat litter on friday night....
Last Friday he went for a review and a b12 injection it was good news and he was discharged with a steroid reduction regime. He was very distressed though by going. And ate a lot of this Bio cato let overnight. He had a few bowel movements with paper in them on saturday and just a time one just now. I've been giving him lactose and syringing electrolyte replacement. He's Licking a bit of gravy off the food. He's very weak. He had a partial seizure on saturday walking round in circles head straining over one shoulder and appearing to be unseeing Looked like another in the night. Not so much since except sort of vacant fearful expression and tense and hunched. He sleeps mainly. I don't know what to do because I don't trust my vet and feel I've spent enough money. His gums are pinker than they were. No obvious pain. Breathing ok.
His last pancreas test was just outside normal at 4.5 and was about a month ago.
He was mainly an outdoor cat and not much access to indoors unless his previous owners were at home. He's been a fighter and had a lot of metacam which is what the vet said his drug reaction was to.
I'm sorry it's so long.
Many thanks
Expert:  Dr. B. replied 3 months ago.

No worries, Helen.

Let me have a wee read and I will post in full afterwards.

Dr. B.

Expert:  Dr. B. replied 3 months ago.

Hi again Helen,

First, I have to say that you have been very thorough and sound to be helping him as much as you can do so. Though I do have a few questions for you to just give me a bit more information on this situation:

What direction does he circle? Which side is he tilting his head to?

Does his vet think the Mirtazapine is causing these?

Did his vet check bloods? Any anemia, liver abnormalities, or kidney ones (since he had the Metacam)? Was he every tested for FIV or FeLV?

Expert:  Dr. B. replied 3 months ago.

Hello again,

As I have not heard back from you, I have started trying to tease out what is going on with your poorly lad and thought I would post my thoughts thus far (especially as I'd hate to miss you when I go to see my own patients this afternoon).

First, I do just want to touch on your initial question about the litter ingestion and Pennyroyal. It is a concern if he is eating litter with this in it as it is known to cause vomiting, diarrhea, and can damage the liver. As well, litter eating is always risky, since it can cause gut blockages. And this can appear with the same GI upset signs along with gut damage, paling gums, black stools or lack of stools, and sometimes need to be addressed surgically. So, his eating this is quite serious and if we were seeing those signs then we’d really want to consider having a check (perhaps with an alternative local vet if you aren’t happy with your current vet) for this situation at this stage.

That said, we also need to question why he is eating litter in the first place. For a cat that has to have appetite stimulants and steroids to eat a bit, this is a red flag that something is being missed. This is because litter eating is a pica behavior. Its often triggered by anemia (often related to low iron), so we’d want to review bloods done or consider a recheck of this (while looking at the liver values with the pennyroyal concern). Otherwise, I do have to warn that we could also see this –as well as the seizure activity, circling, head turn, and wobbliness – with brain based issues. The main ones we’d have to be concerned about would be Toxoplasma but also brain based bleeds, inflammation, masses, or diffuse viral/bacterial meningitis. Furthermore, considering all of his signs together (the skin included), this also raises worries of possible underlying FIV or FeLV. So, if these have not been checked for, we’d want to do so at this stage. And again since owners and their local vets do need to be a good team working together for a pet’s health, if you have lost faith in your vet, it would be ideal to see an alternative one (even if it means a wee trek).

Overall,m the pennyroyal could cause gut upset and could damage the liver. So, it is a concern. Though given his other signs, I suspect his litter eating behavior is a sign of a bigger issue. So, the above would be our main concerns here and what we’d need to look into for

Please take care,

Dr. B.


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 3 months ago.
Darn it
I just lost connection and lost a very long reply I was about to send
You've been really helpful....I have to do some other things now but would like to answer your questions later but am I getting a feeling our consultation is at an end?
Expert:  Dr. B. replied 3 months ago.

Hi again,

No, no worries.

I will need to be away shortly to see my own wee patients but our chat will remain open as long as needed ( leaving feedback won't close it either so no worries there). So it's fine to post when you can and I will check back for that this evening after I return. :)

Dr. B

Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15678
Experience: General practice veterinary surgeon with extensive experience in a wide range of species.
Dr. B. and 3 other Vet Specialists are ready to help you
Customer: replied 3 months ago.
Hi there - i didnt sleeplast night worrying about him which was good in a way because i found you
so im keeping this brief and hoping i might get a chance to call you -if its only 13 pounds theres so much to say
if i call you does that end the email chat?
im at my wits end really B - i am a carer for my elderly mum - she needs 24 hour care and has dementia among other things - i cant spend any more money on this darling boy as i can see now that it will buy him only a shortish time - and im struggling to cope with him and mum - my spiritual beliefs are not keen on euthanasia but if i were to go that route it would need to be at home and i would like to talk to you about making sure it would be done in a very peaceful way - no squirming and crying out as he anticipates more pain
he has literally come back worse from every vets trip - he gets so trauma'd by going - so my nurse side says treat him - keep trying - my human side says hes had enough messing about - i feel sick at the thought of ending his life prematurely and just as sick at having to watch him die - im just driving myself crazy not knowing what to do
we had a new central heating boiler fitted today and some more its been a bit mad here
and another voice says i should do more all the time - hes been a bit brighter today but hes dehydrated and refusing drinks syringe fluids and meds this evening although hes licked a bit of gravy off the lumps of food - hes been quite relaxed with a few episodes of digging and licking at the inco pad and the tense thing with head twisting back to left and a bit of intense scratching
Customer: replied 3 months ago.
im going to bed soon i really am
just to answer some of your questions -
he only did circling once this saturday and i think to left which is mainly the way the head twisting goes
my vet doesnt know about anything thats happened since friday but is expecting a phone review on this coming friday
mild anaemia im told - all bloods done about 4 weeks ago - liver and kidneys ok - slight raised blood sugar which with mild anaemia i was told to expect following pancreatitis
he had about 3 or 4 vit b 12 injections including one on friday - to treat the anaemia
he tested negative for fiv in october
im dreading talking to my vet - shes very sweet but very inexperienced having qualified last year and she works in a large smart shiny veterinary hospital - she doesnt really listen to me except when i say something she wants to hear - shes caring dont get me wrong - but not very holistic in her approach and she will just ask me to bring him in and then he will get upset and ill agree to all sorts of things which upset and hurt him and cost a fortune - then im left twith the same problem of caring for him and him not really improving muchim just wondering if my tack has changed and its a new question - i hope not - i dont know if the cat litter had pennyroyal in it and i couldnt find out from the company website - the only thing he has of those symptoms is poor appetite and constipation - he had a small poo this morning which wore him out
he seems... is it tonic.... on stimulation - if i pick him up or try to attend to him he goes a bit curled up and tight - his claws curl out and he appears to be clinging but i think its involuntary
anyway he is more relaxed today in general and im off to catch up on my sleep - i hope we have more time to explore some concerns but im clearly cash depleted - whatever its been a delight to have someone help me by listening carefully and i very much thank you
hes having a thing just now and its almost like involuntary spasm than seizure - just curling tight with his back a bit tight and his head pulling to left then jumping up suddenly ad licking a paw or scratching frantically at his neck
well im sorry its not as brief as i planned - i hope your wee patients this afternoon got as much expert help as i have - they are lucky to have you :)
Customer: replied 3 months ago.
good morning to you dear vet angel
having read through last nights tired persons dirge to you i have to report the lactulose took effect in an impressive way overnight - i slept relly well and went in to check him at 5.30am...... - hes had a shower since and still smells terrible.... - hes sitting on my knee purring - hes chatted to me a bit today and i managed to get a steroid in him - he looks 100 per cent better - still weak and wobbly but he washed a bit after his shower and stretched a little just - i wish you could meet him - i named him Tam when i thought he was a stray to discover his previous name was Tom - but character wise he should be called jack sparrow.......
im sorry if i sounded negative of my vet - shes a nice kind person - its my own frustration and helplessness plus still being astounded by what ive spent
if hes going to become a creaking cranky gate i can afford tests and such little by little - now i know his guts arent necrotic we have more time - im still considering your suggestion of changing vets but in a sense we have come this far and maybe i need to learn how to communicate with her better - anyway ill love you and leave you for now - even chatting like this helps my thoughts get ordered - hope its not raining with you :)
Expert:  Dr. B. replied 3 months ago.

Good morning to you too,

I do apologize for already being asleep and away from my computer when you posted last night. As well, I cannot offer a phone call service via the website, but am happy to discuss your lad here as needed. And while this isn’t the original question, I would say it is part of the original discussion since as I noted initially this sounded to be a much deeper situation then a simple pennyroyal exposure. And I am actually in the midst of reviewing everything you have posted, so I will be a wee bit but then will post all my thoughts in full. :)

Dr. B.

Expert:  Dr. B. replied 3 months ago.

Hi again,

Actually, it isn't raining yet, which is a surprise since it was pouring yesterday. :S

Anyway, I appreciate that costs are an issue, but if he were my patient, I ‘d be thinking about rechecking those bloods. If he had a mild anemia then and is showing pica behavior now, I’d just be worried that that has worsened. As well, it would give us a chance to check the liver values after his litter ingestion and recheck the FIV if he goes outside (since infection can occur at any point and the test only represents that point in time). And just to note, the mildly elevated glucose isn’t often significant since glucose levels increase in cats that are stressed (which being poked with needles for blood tests certainly will elevate that).

Further to that, I would suggest considering seeing an alternative vet, either at that practice or another one. I didn’t take what you said as negative at all. Its just I am concerned that Tam’s situation is a challenging one –potentially with more than one issue afoot. Therefore, it may just be better to have a vet that listens, has worked with cases like this before, and therefore will have a better grasp on this situation and thus able to treat more effectively. And you may even want to see if home visits are an option, since that would get around the stress he has had with this whole situation.

With all that in mind, we’d hope to get a better grasp on his situation. If the anemia is worse, they may need to alter his steroid dose (which we may need to do for the continual itching signs) or consider an anabolic steroid (as this stimulates marrow production of red blood cells) instead. As well, since he isn’t responding to their treatment, if a skin based irritation is suspect, we may need to think about Atopica (an immune modulating drug). Though I have to say that the more you tell me about him, the more the skin signs and twitching sound hyperaesthesia syndrome ( . It is not a very common condition in cats, so it may be something not even on this young vet’s radar. So, it may be worth speaking to them about this or having a senior vet assess him. And if that is suspect with what they have found on exam, then he may be best trialed on Gabapentin to see if we can reduce these signs for him. You may even be able to have his vet dispense either of these based on their concerns from previous exams when you speak to them next (since they have recently seen him for this issue).

Finally, just in regards ***** ***** mention of euthanasia, we'd hope that we aren't at that point but it is always s a difficult choice that needs much thought. We do use it in veterinary medicine to allay suffering and give our pets mercy when we cannot treat their illnesses. And I have to say that while it is a difficult choice to make it is a very good one to have access to, especially as we cannot even offer that final peace to people in similar situations. So, it is something to keep in mind and just to note if we did go down that route, you can request a home visit from his vet and request sedation (so just one intramuscular injection) to make him sleepy so that he does pass without any stress or worry when the final IV injection is given.

Please take care,

Dr. B.

Customer: replied 3 months ago.
this is so helpful - thank you so much - would you have any objections to me printing out your reply and showing it to my vet - i know she had been consulting with her senior colleagues but they have never spoken to me directly so may not be hearing a full picture of events - i already mentioned hyperaesthesia syndrome to her as his behaviour is so problematic i did some research - and she didnt really answer me....except to say one of their nurses was doing a behavioural course for dogs....
then depending on her response to your suggestions i could stay or leave - there are a few other vets around at a similar distance - i dont want an out of the frying pan into the fire situation occurring - this is where Tam was registered with his former owner although i had a gut feeling it wasnt the right place....
Expert:  Dr. B. replied 3 months ago.

You are very welcome, my dear.

I think that is absolutely fine to do. Perhaps even see if Tam can be seen by both together (that way the senior is getting the whole picture and the younger vet is still part of the process, and able to learn from it). And see how you go, but if your gut says this isn't the right place then I would trust that. Because again you need to be working as a team (listening to one another, working together, etc) to ensure you are able to do the best possible for Tam. :)

Best wishes,

Dr. B.

Customer: replied 3 months ago.
this was last week when he was picking up.......
Expert:  Dr. B. replied 3 months ago.

What a lovely lad, though he has the same impressed face my own cat has when I take photos of her. ;)

Though he looks like he could use a bit more weight, so further to what we have discussed it may be worth offering a calorie rich diets (ie Hills A/D, Royal Canin Recovery diet, even canned kitten food) or supplementing with a liquid diet (ie Clinicare, Catsure) or paste supplement (ie Nutrical) to just get more into him per bite even if we cannot get much in. And as well these will all be easy on his mouth if he has any discomfort there (just since dental issues can sometimes effect appetite in cats his age).

All the best,

Dr. B.

Customer: replied 3 months ago.
a few more things i havent mentioned and another quick question please :)
hes had a lot of problems with swallowing on and off- i thought he might have a throat cancer at one time like another lovely cat i had once - but its intermittent - they found i cant remember what its called a few words together which i understood to be a common untreatable but manageable cat stomatitis which was diagnosed when he had his tooth out in april - i know it comes and goes by how he responds to tableting - while he was ill since the weekend its been bad again - he wont let me look understandably - he had a GA for all those tests a couple of weeks ago so they put a tube down then so must have seen his larynx - he was very sore after that too - last week when he was better he was swallowing really well again - could he have an allergy to the vit b12 injections i wonder or is it likely to be mechanical due to eating paper pellets on this occasion - also his eyes also since the cat litter eating episode quite often have a slightly wild unseeing look - with quite big pupils and thats more pronounced when he has the spasm do's
we added in piriton about a week ago and it did seem to help with the itch but perhaps more due to a noticeable sedative effect as he still did scratch some
hes not had any for a few days while hes been so flat as he wasnt itchy and reluctant with pills - hes had 2.5mg of prednicare this morning - he was on 2.5 bd but since i was asked to start going down to once a day in a week and he refused last night im thinking to start reducing now - just wondering if i should leave off the piriton - it was me who suggested an antihistimine and after trying him on cetirizine myself my young vet changed to this
his shoulders and back of neck are much better with his vest on but not the neck so much - ill try and send some pics
many thanks Dr B :)
Expert:  Dr. B. replied 3 months ago.

Hi again,

I am not quite sure what you mean by the throat condition’s term. Rhinotracheitis? Since you mentioned stomatitis, did you mean gingivostomatitis? Had they mentioned viral agents with this like herpes of calicivirus? Both viruses could give us gum issues and herpes can inflame the throat (though swallowing issues can also be related to nausea in kitties as well).

Now its rare to see B vitamin allergies, but if they intubated him while he was under that could irritate the trachea. As could the litter irritate the esophagus.Though the pupil dilation doesn’t fit with the litter ingestion unless he is quite stressed or in discomfort with it. Otherwise, we’d be thinking that the dilation is due to the other underlying issues.

In regards ***** ***** our approach will depend on how he is doing generally. If he hasn’t really responded to them, then we may need to have his vet decide the next plan of attack before we make any changes. Or if you found the antihistamines useful, you could use them as he is being weaned down from the steroids. You can use Piriton as instructed or half the dose if he is very sedate. Otherwise the Cetirizine is fine to use in cats (I tend to lean to it myself since it’s a once daily treatment of 5mg; thus reduces the amount of tableting for them). So, they are options if they help and may balance the weaning of the steroids.

Best wishes,

Dr. B.

Customer: replied 3 months ago.
oh no - i just wrote a long answer with questions - went off to read about hyperaesthesia - came back and its all gone....
hello again
i think the throat thing was feline gingivostomatitis - but i dont recall mention of herpes
im wondering how to get toilet and bed separate again - it works when theres litter in one tray - he has 2 trays - he loves to sleep in them - but still gets in a mess - well it doesnt work with litter as he eats it - and i know it sounds a bit unconventional but why not use cat biscuits as litter - then he can eat as much as he likes and its somewhat absorbent....yes i know it doesnt sound right but i cant imagine there is an edible cat litter on the market - he eats catsan crystals and woodchip - he comes running at the sound of cat litter - i noted uncontrolled urination in the hyperaesthesia symptoms - it does sound like he has it doesnt it? that thing about having the back touched he often tried to bite me if i stroked him - he is much calmer with his vest on too - and he literally came back from hospital with the running around and breaking things, and the intense scratching- its almost like he cant really walk - only run - and every time hes been to the vet its like hes got post traumatic stress - he has had a frustrating time for the last 6 months - he wanted so much to be my cat and i thought he was a stray but i didnt live here then as mum had a stroke in october - i moved in permanently in april after a failed attempt at her living in a nursing home in cumbria where i used to live - anyway
his owner didnt mind him coming round but asked me not to feed him and to block the shed up so he couldnt go in but i know he didnt always go back to her - he used to be so upset when i had to ask him to leave and it broke my heart from my side too - crazy as it sounds it was a reason i decided to come back with mum - one reason at any rate
so then he became officially mine and instantly his world changed into a sick cats world with everything different - i just hope he knows its not me making him suffer
he was very moody before he got sick- i rarely could pick him up without him biting me and it made me wonder if he had some pain - i was thinking arthritis or a brain tumour
i repeatedly texted his owner saying i thought he was ill
he often seems really down and very responsive to mood - i see him visibly perk up if a friend comes round and he hears me chatting -
anyway im rambling a bit -
so im going to take a printout of our chat and leave it for my vet to read and digest before i speak to her on friday - i hope she sees its positive - she a good keen dedicated hard working woman in a very busy practice - and shes been kind to me to and the best she was one friday afternoon when i was close to tears and she apologised and told me i could tell her to mind her own business but had i thought of getting some respite - i loved her for that human touch - there was so no need to apologise - and i did get a short break
anyway much of this is background and i aologise if you have better things to do - i think i have a sense that you dont get paid for this work or minimally - i rejoice in your very good fortune and kindness
Expert:  Dr. B. replied 3 months ago.

Good evening,

First, I would note that if you are going to provide your vet with our discussion, you may be best to just send along the medical discussions we had or make a list of those issues we discussed. Otherwise, she may misinterpret your feelings on her experience as a young vet and be hurt. So, you may want to copy/paste what we have discussed into a word document and cut it down to the important issues we need to consider for Tam.

Anyway, if he doe shave feline gingivostomatitis but not the dental disease to support the level of inflammation, then those 2 viruses I noted would be concerns. And if he does have this, it would be another reason for pain relief (like Gabapentin or Temgesic) since sore mouthed kitties tend to eat poorly and have weight loss issues too. So, that is a base we’d want to cover.

Otherwise, with the concerns of bacterial contamination with feces, I am not sure edible litter would be the way forward. Though you could try shredded newspaper as a safe alternative that he perhaps won’t be so keen to eat.

In regards ***** ***** hyperaesthesia suspicion, he does sound like one of these kitties; especially with the unexplained skin signs that aren’t responding to steroids (as often true itchy skin conditions tend to). And it may be that the light pressure of the vest calms that discomfort. And his biting you when handling could certainly be related to this or to underlying joint discomfort. So, if Tam were my patient, it is an angle I would really be trying to cover for him; especially since the conventional treatments for skin itchiness haven’t managed to soothe his signs for him.

Please take care,

Dr. B.

Customer: replied 3 months ago.
Good morning Dr B
its a good plan to copy and paste - i was thinking it might upset her even though it wouldnt be my intention
its just occurred to me that we havent really mentioned the pancreatitis - and i think thats been the main angle with the side angle of the skin that my vets have been focussing on -is there anything to think about here?
i think the steroids are to cover both those bases - and since theres been improvement in both we are trying to get him off them - would he need to be off them before starting gabapentin and are there any side effects of gabapentin? or are the steroids of any value as a long term option..
...also do you think ascribing the skin signs to a metacam reaction might have been a mistake? i think the scabby neck he might have had already and its been worsened by the shaving from his investigations and so forth
reading through the notes it sounds like a summary might be
do bloods... liver, anaemia studies, fiv, anything else, - ? any tests for herpes or calcivirus and do they need to be done if gabapentin is a good way of managing the soreness - im inclined to leave bloods for a week or longer as hes eating and picking up again as that stress is likely to knock him back once more - even for a home visit - it would be good to get his weight back up as each knock back drops it down.....
he sat on my knee purring while i was kneeling on the floor this morning so i held on to him - got up stretched up to a cupboard for a mug for some tea - he stiffened in my arms, growled, went to bite my arm in a very sharp fast movement - and then was unhappy and unconsolable until i put him down but it as though he isnt aware hes doing it - its not like its coming from a bad motivation with an angry cat...
i also have another potential difficulty i dont know if you have any ideas
im going away for 4 nights back for 3 and away for 4 again in 3 weeks - so a lot can happen
hes very high maintenance and mums carers cant be expected and dont want to deal with him - the vet will board him but as we know its very upsetting for him - hes not up to date with vaccs so kennels are out - ive a very laid back friend who will come in and ive arranged to pay her but shes a bit -' oh if he goes out he'll come back...' so im not sure if i could relax and shes not as cat savvy as she thinks she is
ive composed an email asking the friend who im staying with if i can bring him but especially due to the incontinence it seems an unreasonable request...and its a lot of travelling for him - 3 hours each way...
anyway mum is stirring.....
good wishes :)
Expert:  Dr. B. replied 3 months ago.

Good morning,

The chronic and relapsing pancreatitis is an interesting addition to his history. I had been under the impression that he had had a full recovery, but it sounds that isn't the case. Now it is a condition reported to be excruciating in people and is known to cause poor appetites, belly discomfort, sometimes vomiting in cats. So, I am glad he responds to the steroids, but if pancreatitis is still though to be grumbling along, then we’d really want him on stronger pain relief (ie Gabapentin or even Buprenorphine). Furthermore and especially if he relapses when off the steroids, we do usually need these cats on an easily digestible/low fat diet; so that may need to be considered if he isn’t on one already. As well, while I don’t like mentioning more testing, if he has a persistent pancreatitis, we’d want to be having his vet scan the pancreas (potentially a job for a senior vet since it is tricky to do) with teir ultrasound since we can see pancreatic abscesses and tumors cause pancreatitis like signs that wont’ settle.

And as I noted its interesting to have a chronic relapsing pancreatitis added to Tam’s situation. The reason is because as I noted it tends to be an uncomfortable condition. And it is quite possible that if he is sore with that, his skin/itching behavior could be related to a displacement behavior. This is a behavior where cats target another site because they cannot address or remove pain elsewhere (its an odd pattern of irritation here but I'd still be a wee bit suspicious). Its akin to cats with cat bite abscesses on their back ends or anal gland issues hissing at their bums. So, it is possible that his general discomfort/agitation is related to underlying pain or the pancreas issues may just be lowering his general pain tolerance threshold. So, since we have this and he cannot tell us it is causing no bother, I’d be leaning to our pain relief trial even more.

In regards ***** ***** Metacam, I do think it was a red herring. If we are going to see sensitivities to that drug, it tends to be GI upset (vomiting, diarrhea, stomach ulcers in overdose cases) and not skin issues. And if there was already irritation and the shaving left razor burn, then that is more of a fit for the signs.

As for summary of what we’d like to do, a basic blood test (CBC/chemistry) would let us check the anemia, liver, and kidney functions. FIV/FeLV tend to be tested together and usually can be done at the same time. We could also check for herpes/calicivirus (ideally with virus isolation for calicivirus and PCR testing for herpes) but I would delay testing for those if his mouth is better just now (just since herpes is intermittently shed and testing is best done when they are in the early stages of an acute flare up). That way we avoid false negatives and needing to retest in the future.

Though further to all of that or if you wish to take a slower approach, we’d want to discuss hyperaesthesia and a potential trial on the Gabapentin (which he can have with the steroids and is well tolerated if needed for the long term, only potentially causing a bit of sedation initially) with his vet. And I do think that is a worthwhile avenue for him since the biting you sounds to be him telling you that you were causing him discomfort (which could be related to his joints, pancreatitis –which is very sore for them, or the hyperaesthesia we are concerned about). As well, if they have just seen him recently, they may even be willing to dispense the drug and let you trial it first before bringing him back in.

Finally, the travel situation is a difficult one and truly our best option will be what you think will cause him the least stress. If he can be kept in (ie cat flap shut) while the friend is watching that may be best. Though if he isn’t too put out by travelling and you can restrict him to a room, en suite bathroom, or even a big dog kennel where you are staying; then he may be best with you.But it is very much a decision that needs to based on what you think he’d tolerate best.

Take care.

Dr. B.

Customer: replied 3 months ago.
this all sounds very do able - thank you very much - and to risk repeating myself i cant thank you enough for your unprecedented help and support at what has been my/our hour of need -
the pancreatitis is a bit of an unknown as it wasnt picked up until he came to me and he was clearly unwell for some months before with weight loss and decreased appetite and did seem in pain on handling - and it interests me that you mention his joints because hes had an intermittent lameness on his rt front shoulder as long as ive known him - and he has had fight injuries which his previous owner had treated - but since he spent more time away from that home i dont think his illness was picked up at all - so i do think he has some joint pain but would that be arthritis or did it say something in the hyperaesthesia info about joint pain
so he went into acute pancreatitis main symptom vomiting and greenish foul smelling poo about a week after i adopted him and was kept in for 2 nights with iv fluids antibiotics and ketagesic is it called - the blood pancreas yes or no test said yes it was abnormal and then a couple of weeks or so later it was 4.5 (we didnt do this test in the acute stage) and 4.5 is a chronic level - im told - but it could maybe be a resolving level...? no one knows how it will unfold im told it could be relapsing - severely or less - or he may never have again - he did have an abdominal ultrasound about 3 weeks ago and i was told the pancreas wasnt easy to see in cats but is usually very bright and shiny if its inflamed which wasnt so - initially i was told about the special diet but someone said recent research has suggested that any diet is better than none and the thing is to keep them eating - he is very very finnicky - not when hes well of course - and even now hes still eating about a quarter of what i offer him although i offer him food about 6-8 times a day - i weighed him with me on the human scales and hes 4kg - at vets he was 4.4 laast week which would figure with his poorly state following litter ingestion
he had another shower this morning as hes very smelly bless him - and ive seen him sitting in the rain before - i think it suits him quite well - he cant get out of the cubicle so he doesnt struggle and i dont have to restrain him - i wouldnt say he enjoyed it but ive seen him strongly object to less - and he spent the morning in the bathroom with the fan heater on washing himself and hasnt had his vest on at all and now hes fallen asleep very relaxed looking on the shower mat - theres a wee picture although its not very good
have you heard of a new craze product called stinky stuff? - one of mums carers has liveries on her farm and the horse women as she calls them are using this for insect repellant and hair regrowth - its an interesting looking product with a little about use in cats but horses and dogs for sure - one site explaining the vile smell mentioned butyric acid - present in milk and sweat glands - and its billed as smelling like vomit, toenails, sour milk....Clare thinks it smells like garlic - the base can be mixed with oil for hair regrowth or shampoo for infestations or used as a spray for repellant - forgive me if you know all this already - just wondering if you have anything to say as i think shes bringing a bit up for us to try
also - the gabapentin - id be amazed if the vets will give it me without being seen - i think their overheads in this spaceship like hospital must be very high as any opportunity to generate an invoice is taken - but i can try as he is so much better away from the vets in general - is it a drug that needs any blood monitoring - kidneys liver etc - im keen to give it a go sooner than i am keen to have him bled again because i agree with you i think some of his difficult behaviour is pain and some is that hes almightily fed up
id like to take him with me on hol although he'll be on his own for the day time i think he might be relieved to have a break from me mithering him to death - he travels ok - its just he thinks hes going to the vets and yes yvonne might have an outbuilding of some sort
its been a peaceful morning as mums not feeling so good and has gone back to sleep - tams looking brighter - its not raining - so i hope your morning has been as good
take care too :)
Customer: replied 3 months ago.
another thought....
if he actually does have some sort of brain lesion...would the gabapentin help or hinder?
this afternoon hes been doing a funny thing with his back legs when hes been standing - hard to describe - as though he has something he has to raise his leg out of - such as if he had trousers on and was trying to get his leg out but his foot stuck in the fabric...hes always worse in the evenings - like my mum....
Expert:  Dr. B. replied 3 months ago.

You are very welcome, Helen.

I am glad that I can be of aid for Tam.

Yes, if they do spend a lot of time away from home, it is easy to miss health issues. Especially since cats (as prey species despite being the bane of wildlife) are notorious for hiding ailments until they are too advanced to do so. And arthritis and joint discomfort are commonly missed in cats. In fact,there was actually a study that found so many elderly cats have underlying arthritis when examined via autopsy, yet so many are missed clinically because cats cope or change their life styles to it instead of running about like usual and ending up lame like dogs do. So, it could play a role here on its own or be part of a hyperaesthesia situation. And if he still has residual pancreatic pain that too can accumulate with the rest to make him feel sore and unwell.

So, a pain relief trial with out be ideal and again Gabapentin is good for nerve pain so ideal with our concerns but they could also use the Ketogesic (Ketoprofen, in the same family as the Metacam) in place of steroids as an anti-inflammatory. And I’d note that the neither would be of harm to use if we did have any type of brain lesion and could reduce its effects if we did have one. Plus it isn’t a medication where we need to monitor dosing levels or organ function with bloods when using. So, hopefully if they have just seen him recently for this they will be flexible with you.

As for the pancreatic scan, I am glad it has been done and they have hopefully ruled out abscesses and masses on it. They are right that it isn’t an easy organ to scan but it is good if they have been able to do so confidently and rule out problems there (hopefully also ruling out any of the nearby organs being overly large and squashing the pancreas –another way the organ can get upset and not settle). And I agree that my number one rule on cat feeding is that it has to be something they will eat. From there low fat is ideal for pancreas kitties and I do find that many do like the Royal Canin Sensitivity Control food (even my healthy cat used to steal it from my poorly one) if you did want to try one.

In regards ***** ***** stinky stuff, I will have to look into it as I’ve not used it myself. Though if it smells like and could have garlic, we may need to avoid it since garlic is quite harmful for cats. Otherwise, I am sure he’d be fine on his own during the day and if he would be less stressed with you then that may be the way forward. And I cannot say what he was doing with his leg, he may have been a bit stiff but if he does it again and you can video that to post on youtube I am happy to have a look and see if I can decipher it for you.

Best wishes and a peaceful evening,

Dr. B.

Customer: replied 3 months ago.
Hi Dr B
thanks for your last reply - not sure if going to salsa class was a peaceful evening since im not really up to speed... but it created a diversion for a while :) and helped me sleep - it also showed me how immersed i am in this microcosm of sickness - but its not for ever so...what doesnt kill you makes you stronger they say - anyway....
ive emailed a selection of salient points to Tams vet and will likely be catching up with her later - im interested to know how she takes my online exploration - shes been quietly patient so far :D
his gait is very funny when he moves about which isnt much - but maybe its an improvement because if you recall it seemed at one time as though he could only run not walk
his throat seems problematic ish - not with eating but tableting - he hissed when i tried today - so i conceded - but he was pretty upset after - he had been nicely settled up until then - cosy and relaxed in his bed - ive made a little video which doesnt show the hind leg movement much but gives you a feel for his movement - ive not uploaded to you tube before - can i do this without it being made public property? - i suppose its to big a file to attach here -
my salsa friend had a similar time to me a few years ago when her partner was in hospital close to death, his beloved dog had a stroke and some weeks of increasing sickness so she had lots of empathetic advice - and while she kindly offered to be my euthanasia buddy as someone had for her - should the time come - she recalled how her partner had very many side effects on gabapentin....i really only have one person who i know of who had it and had a very good experience of the cessation of intractable nerve pain - and ive no experience in animals - i still think its worth a try though and i know you said initial sedation is usually the main effect
anyway the suns just come out and Cath one of our carers is here soon
hope the sun is shining with you :)ahh - the vets just called me
she doesnt think hes having pancreatic pain - not sure why...maybe because of what they saw on the scan - she mentioned that a senior vet had been present at the scan and i could sense a bit of defensiveness
she didnt seem to agree that she had seen him while hes been having the hyperaesthesia symptoms - she did seem cagey so im glad i edited the original - she had spoken to her colleagues and none of them had heard of gabapentin being used in that way - she said they would normally use amitryptiline - however looks like shes met me half way or a quarter maybe - as shes leaving me 5 days supply at 25mg bd - she also said it can give them similar symptoms to the ones we are trying to treat and that its a low to moderate dose
Caths here so i can go and pick them up.....i will be happy to hear any thoughts you have - take care
Customer: replied 3 months ago.
i just thought - i dont know about you but id rather give him half that dose and another week off going to the vets -
also i wanted to ask you how long it will take to see if the gabapentin is it like paracetamol as in it happens straight away - or like prozac as in it takes a few weeks - because if its the latter its a bit pointless going to see her in a week - she did say it can give them liver problems too.....
i really have always felt with this vet that we are antlers locked - its not good is it...
Expert:  Dr. B. replied 3 months ago.

Good afternoon,

I must be brief as I am about to pop away from the weekend.

Now that is good that she doesn’t feel that he is sore with his pancreas, but with his signs I’d not just assume it. In fact, since he cannot clearly tell us what is bothering him and since cats often hide pain, if he were my patient I would be of the mind to use a pain relief treatment trial to make sure that isn’t the case. If he had no change, we’ve not lost anything but if we do find a positive response then we will all be relieved for that. So, I would still lean to doing so even if he may have been stoic when she examined him.

Furthermore, I’d note she could use Amitryptiline but since he has so many possible focuses of discomfort, I do feel that Gabapentin would be a better option. As well, since you had asked, our cats do tolerate Gabapentin quite well with again the initial sleepiness being the only side effect I have seen with my own patients. It tends to be fairly quick acting (though I cringe for you to mention Paracetamol since it is so toxic to cats it rings my alarm bells just to see it there ;)), so while I’d not expect a 100% response in a day, we’d hope to see some response over a week of treatment. Furthermore, while high doses could harm the liver, if they have done bloods before and know his liver is fine, we’d not be overly worried about that.

And since her colleagues and she haven’t heard of its use (it is a recent addition to our treatment options for this so perhaps they are not up to date), I would suggest a peek @ Cornell Vet School’s information on the topic : @

Though if she will meet you half way, it is worth trying to see if we can get him more comfortable (since that is our #1 goal).

Otherwise, I appreciate she hasn’t seen signs of hyperaesthesia when examining him but as you will be aware it flares-up and is intermittent. So, unless she was with him 24 hours a day, she may not be seeing what you are. Therefore, we may need to think about videoing what he is doing (his odd postures/gaits too). That way we can all see what you are seeing and be on the same page. And that would be the best option if she can only base her clinical opinions on what he is doing when she sees him (which could be masked by his stress).

In regards ***** ***** throat, he does sound sore. If it is when he is having the steroids, we may need to consider having them swap to a long acting injectable steroid to continue to treat but allow the throat to settle. Or you can crush the tablets to mix with water and syringe (you can pop the tip between the cheek and teeth to give) if it will be easier for you both.

As for YouTube, I believe there is an option to restrict viewing and then the website should give a link for you to then give to me. After we have discussed it, you can then delete the video if you wish to.

Best wishes,

Dr. B.

Customer: replied 3 months ago.
Thanks very much and have a good weekend
The paracetamol was a human example rest assured :)
Would it be best for me to leave you in peace until next week now...I don't know how it anyone taking over from you or shall I go solo over weekend
Expert:  Dr. B. replied 3 months ago.

You are very welcome, my dear.

I know that you did, but its one of those ingrained "buzz words" that send vets into a tizzy. ;)

In regards ***** ***** further replies, you are welcome to post and I will reply when I can. Though if you needed a reply quicker you can choose to open a new question for a colleague.

Best wishes and a peaceful weekend,

Dr. B.

Customer: replied 3 months ago.
Hi Dr B - it says youre online now - are you about?hope you had a pleasant weekend
Expert:  Dr. B. replied 3 months ago.

Good evening,

I am just now (like to have a quick check when I can to make sure all is well with everyone) ;)

A lovely weekend to you too,

Dr. B.

Customer: replied 3 months ago.
im in a bit of a quandry Dr B
Tam picked up quite a bit - his funny walking and balance seemed better and his demeanour more cheery and gentle - i got him a little harness and took him outside for 10 mins yesterday and this morning - im concerned that confining him - a predominantly outside cat is going to be contributing to his illness - he enjoyed it but i know he was annoyed he wasnt free - so i took him for longer this afternoon and he was even more so - and i think that overstimulation wasnt so good - he was out with me about half an hour mainly grumbling about wanting to go through the fence and when we came in and i took his harness off he shook himself fell over and went into seizure - lasting about 30 secs conscious and flailing around unable to get up - continent and yowed a little - it happened twice more in about half an hour - very short lived and no chance of videoing
now i havent given him the gabapentin yet which i know you will be thinking is daft but im on my own with mum and ive not wanted to rock the boat while hes been perkier and happier - he was upset about tableting as i said and not much better when i crushed the tablet ad mixed with water and syringed it - he gagged - so yesterday i gave it him in butter which was a little easier - i was going to give him it today but after the seizures which seemed triggered by even me coming in and stroking him on one occasion - ive been afraid to give him anything for fear of setting him off - when i was a very junior student nurse i saw a patient die of status epilepticus and ive recalled that recently - so im leaving him quietly for now - i think he may have had one in the night too as his litter tray was upside down - its so horrible - then i have people asking if he should be put down and my mum being a bit agitated and confused all in all the peaceful weekend is waning.....and then i read cats like him shouldnt live in stressful envirnments ....
i saw online that gabapentin is started at 3mg per kg which is 12mg - and one site said once a day so im confused as the dose ive been given is 25mg bd - hes had a lot of perceived or real side effects from other drugs so im afraid to give it him in truth - im sure it is just having no-one here to discuss things with -
have you anything to say except give him the gabapentin and dont be a wuss? :D
Expert:  Dr. B. replied 3 months ago.

I am sorry to hear that he has signs of seizure activity. It is possible that his ongoing issues are overstimulating him as much as stressors at home. Though it does again mean we have to be wary of brain based issues. Still while I understand your reluctance,I would be keen for you to start the Gabapentin now especially. As we have discussed it is a medication for nerve pain but it is also used to help reduce seizures in animals (its multi-purpose use is why you are seeing such a dose range variation). Though 3mg/kg is the base dose for seizure treatment, were 1.25mg/kg is the low dose for pain issues. So, I would defer to the dose his vet has prescribed but you could try the lower one (5mg) first if you are worried about adverse signs despite this being even more a proper option for Tam.

Take care,

Dr. B.

Customer: replied 3 months ago.
ok thank you - ive got 50mg tablets which arent scored so i have syringed a crushed piece which by the time some of it is lost maybe he will have had 10mg
oddly enough the tussle we had with tableting tonight didnt seem to overstimulate him
hopefully it will be helpful and tomorrow i can start to increase until its 25mg bd
thanks and goodnight
Expert:  Dr. B. replied 3 months ago.

You are very welcome,

That sounds like a good place to start and hopefully we can get Tam a bit more comfortable and stable for us.

A lovely and peaceful evening for you both,

Dr. B.

Customer: replied 3 months ago.
good morning :)
just an quick update to say i know its early days but he seems a different cat altogether more like his old self since the 2 smallish doses of gabapentin - i tried a bit of the stinky stuff in an oil base on his neck and back a few days ago - and it does seem very good - the hair is growing back and he hasnt been so itchy there but hes very itchy on his sides still which are protected by his vest so im just wondering if piriton can be given with steroids and gabapentin - not that i really want to add more pills in - he also seems to be eating a bit more and hes more thirsty definately - hes more relaxed and not so wobbly - i think ill leave taking him out for now - thank you so much
Expert:  Dr. B. replied 3 months ago.

Good afternoon Helen,

I am glad to hear that he is perking up. If he is stillirritated a bit, I would suggest ringing his vet about any wiggle room on hissteroid dose (though that may be making him a bit more thirsty); just sincegiving Piriton with Gabapentin can make them dizzy/wobbly/etc and thus bestavoided since we are making some progress. Otherwise, you could also speak tothem about using a hydrocortisone spray on the flank skin as his vest willprevent him licking it off

Keep up the good work,

Dr. B. :)

Customer: replied 3 months ago.
Hi Dr B
Sorry the phone slipped and I pressed the call me button by accident.
Hmmm.....well his funny walk has gone, his appetite is the best it's been since he was well... his itch is very bad though.....I couldn't get a steroid into him at all last I gave him 5mg this morning....the wiggle room is I guess that he was on 5mg bd at one point but the steroids never really helped with the itch. .piriton is the only thing which really made a difference even cetirizine didn't. ..
His belly fur which was shaved ages ago for the scan still hasn't grown back.....
His confidence is no better. He can't jump and his balance is improved from sunday but still wobbly....the gabapentin gives him some relaxation for a few hours but it seems to wear off but I've only just given 25mg this evening ...I've been settling him on it at 12.5mg bd for 4 doses....he looks a bit drugged up.....
I'm taking him with me to lakes all being well in 2 weeks and I'll. Get a review with his vet soon....
It's alL go here...Mum sick suddenly just now....she doesn't really want any fuss and I don't really either but I may have to ring someone but as I said it's not like in the old days ...once your in the system you end up flowing through the guidelines regardless of what anyones
wishes might be...
So I'm just writing to you while I sit on her bed wondering if I leave her in peace or involve the services....
I was never much good at decisions...
Well goodnight to you ...I'm sure you'll be tucked up in bed...not sure if much point in me's been a tough time lately I have to say....
She's gone to sleep now so I think I will too....sorry for using you in a slightly unconventional.way but you are an angel so it will be ok
Goodnight god bless as the carers say
Although I'm buddhist but that's ok as all headed in the same direction
Many thanks dear Dr B
Expert:  Dr. B. replied 3 months ago.

Good morning, my dear.

I am very sorry to hear that things have been so difficult at home with your mother.

In regards ***** ***** I am glad to hear that his appetite and walking have responded so well, but that itchy skin despite a large of steroids is understandably frustrating. Especially since its quite odd for the Piriton to help but not the steroids (since its usually the other way around). If you did wish to do so, you could try him on a low dose of the Piriton (2mg) to see if he settles. Of course, if he becomes wobbly/dizzy, we’d have to stop that since that is our concern with using it alongside the Gabapentin.

Otherwise, it does depend how long ago that hair was shaved but if he has been struggling to keep weight on and eating poorly, then that is likely why the coat hasn’t regrown. Especially since in times of nutritional compromise, the body redirects nutrition to critical organs and the coat often suffers.

Finally, with the Gabapentin, the drugged up/sedation signs do tend to pass once they get a bit of a tolerance. Though you could give it every 8 hours at the lower dose first to see if we at least keep him comfortable stably at the lower dose.

Best wishes,

Dr. B.

Customer: replied 3 months ago.
Hi Dr B
Good evening. Hope your week.has been meaningful...I'm sure it has...
I don't know..... it's out of the frying pan into the fire...Poor Tam....He's put some weight on...was quite perky this morning after drugs...
Piriton didn't help yesterday. He was flat and miserable and itchy. I've had to superglue his jacket to reinforce it or he would have holes in his shoulders again which is so sad as the fur is finally growing
New difficulty .....diarrhoea .....
He's not very house trained and can't use cat you can guess it's a new challenge :o He's in the kitchen and doesn't move out of there at all
He does seem better overall so thats likely how I just avoided diarrhoea ending up in a kitchen storage basket but too late to catch it in litter tray :s...
Is this a gabapentin side effect?
Is there anything we can do...yvonne is a good friend but I'm pushing my luck....
He's much more of a handful now he's slightly better
His balance has been better and he even jumped a couple of times while gab in his system
But I've held it back this evening
And mum has a really bad chest infection.....
I'm trying to keep a sense of there any good information or encouragement on looking after chronically sick cats anywhere apart from the samaritans ;) I can hear him scratching now
Also clearly we don't know for sure what's going on with him....I'm wondering will we know if it is hyperaesthesia or a tumour or some other thing....I don't feel lots of tests is the way forward either financially or for Tams happiness
I can see this could all go on for some time....if we survive my summer break then I can't see that's not too much of a problem...I'm here with's a deeply challenging situation which my spiritual path relishes and when I can keep hold of that we cope reasonably
So im so grateful for your empathetic wise and sensible approach
I'll probably book with our vet for Monday as I'll have no gab left then...but I don't know how to prepare for that to guard against unnecessary rests and set him on a helpful course....I think I can smell diarrhoea
Wishing you a lovely evening
Customer: replied 3 months ago.
Tests not rests of course :)
Expert:  Dr. B. replied 3 months ago.

Good morning Helen,

It does sound like a mixed bag of good and a bit of frustration. To start, Gaba doesn’t usually cause diarrhea. So, I’d be more suspicious that the steroids (with their immune dampening effects would be playing a role with this). In regards ***** ***** to reduce this for him, you can try adding probiotics (ie Fortiflora), and fiber (ie 0.25tsp of unflavored Metamucil or canned pumpkin) into his diet to see if we can reduce this for him. There are also OTC probiotics/kaolin products for pets that can be used to slow diarrhea (ie Protexin Prokolin, Propectalin, etc). And these can be bought OTC at vets or even sites like Amazon. So, those are worth using here.

Otherwise, in regards ***** ***** it is tricky and we are trying to do so via his treatment response (which being more of a handful and jumping on the counter now is definitely positive ). Because otherwise, diagnosis of brain lesions require MRIs and hyperaesthesia tends to be a diagnosis of exclusion (when you have ruled all else out). So, that can mean a lot of testing to then assume it is. So, we have cut to the chase with the Gaba but do have to appreciate that we are treating on the basis of clinical suspicion in the hopes of avoiding all those tests. Still, again while the diarrhea is an annoyance and we may need them to tweak his steroids if he is still that itchy, his mobility actually sounds improved (which we’d hope it continues to as he regains muscle mass in his back end) and that Gaba is making a positive difference even at this early stage.

Therefore, testing-wise, we have 2 options. We can do everything like I noted for a diagnosis. Or you can have a heart to heart with his vet about his positive response and continuing the treatment to see if he continues to improve. At the same time, they can work with you on the steroids side and if the diarrhea doesn’t settle with the aforementioned supportive care a stool sample could be tested or they could try broad spectrum antibiotic treatment to see if they can get that blip settled for him.

Have a lovely day,

Dr. B.

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