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Thursday, July 23, 2009

A Kitty's Mysterious Wrists

Here's one of the most interesting cases I've seen, sent in by Denise. This is the set-up and history.

My daughter's kitten, Skeeter who wax 6 pounds the other day at the vet, is 10 mos old, female, not spayed yet. She is from a litter of 8, she was #7. Her and her itsy bitsy sister #8 [both were super tiny] survived with our help and have done very well, very healthy, gorgeous fur, happy and very playful. No problems at all - till now. As for nutrition, free food with Diamond Natural's Kitten food till about two months ago when I switched them to Purina One. About a week-1/2 ago Skeeter started walking with a slight gimp on the front, very slightly but I noticed it and kept an eye on her. Then I noticed that she was starting to walk leaning to her wrists, sloping if that makes sense. Both her front legs look very much looks like a dog with carpal hyperextension. We took her to the vet today, they took xrays, and were not sure what to tell us. They told us: Possibly genetic, possibly due to her being so tiny at birth, possibly an injury to both front wrists from jumping off the counter like felines tend to do. They mentioned they could have been broken, I just don't see that and would not know when that could have happened. Our cats are like our kids and loved, and spoiled rotten. No answers from the vet though, they seemed a bit perplexed and that is not comforting because we do not know what route to take now. We are getting a little desperate, because she is pretty uncomfortable and the way it showed up. So fast. She favors the left more and being just 10 mos old that is so sad. We do not want her to suffer. The slope seems to gradually increase, even in just a week. She is not as active now, sleeps more and I can only think it's due to the uncomfortable-ness(?) of the wrist joints.
If it's surgery to fuse a bone to both wrists, to correct this like in hyperextension, is this normally successful for a long happy life, in cats? I read it is for dogs, but can't find anything about cats. And - by the xrays, if you see the problem, how long do you think we have, to raise the money for surgery, before she suffers immensely from this.

Denise, congratulations. You have now stumped four vets, one of them a board-certified internal medicine specialist. This was an odd case, so I ran it by a few other vets I know to make sure we were covering the right bases. The general consensus is that this is an extremely odd case, one that everyone is having a hard time figuring out.

First, I don't see evidence of a fracture in any of the x-rays (to the other readers, she provided several). The case also looks like carpal hyperextension (like you mentioned), which doesn't have to be related to a fracture. This doesn't rule out trauma, just not likely a fracture. Many of the other possibilities are very unlikely due to Skeeter's age and other health status. For example, diabetes can lead to neurological problems that can cause a similar stance in the hind legs. However, it really doesn't normally affect the front limbs, and a kitten her age simply shouldn't have diabetes. I was able to come up with several possibilities.

1. As your vet mentioned, jumping from a high location could cause trauma. This can affect the tendons and ligaments, not just the bones. A situation like this can get progressively worse as more and more damage is done every time she walks. Even though it is not in the bone, a situation like this may require surgery, including fusion of the wrists. A young cat can learn to walk well with fused wrists and can indeed live a long, normal life. It's a bit tougher for a cat since they're normally so flexible, but the can adjust.

2. Nutritional or metabolic diseases can lead to deficiencies in certain minerals or electrolytes that can lead to damage like this. It would be a very rare occurence, but this is already a strange case. I would recommend having your vet run a full blood panel including electrolytes to see if there are any noticable abnormalities.

3. Neurological disorders can manifest like this, but it would be very strange to affect such a specific location and evenly in both limbs. The internal medicine specialist asked several questions about this, including whether or not she was tested for feline leukemia, as it can lead to neurological issues. If your vet hasn't done this recently, have it done or repeated. Even if the test was previously run and was negative, run it again. Sometimes this virus can take some time to develop to the point of being detected. This is a small possibility, but one that can be tested for in your vet's office in a matter of a few minutes.

4. A developmental abnormality is definitely a possibility. However, by 10 months old most of the bone and soft tissue growth is completed. If this was a genetic disorder leading to improper growth, we would expect to see it sooner. However, since this is an usual case, there are instance where the soft tissues will grow at a different rate than the bones, potentially leading to situations like Skeeter. If this is the case, she should grow out of this within the next month or two.

In the end, this is a very tough and unusual case. If this was seen in my office, I would recommend having a consultation at a specialty referral practice or veterinary school that has several specialists. That way you can have both an internal medicine specialist and an orthopedic specialist evaluate the case. But prior to that have your vet run the blood tests. This doesn't appear to be serious or life-threatening, but I would pursue this as quickly as possible because of her discomfort.

Denise, I really wish you the best with this, and wish I could give you a more definitive answer. Please let me know how Skeeter turns out, as I'm very curious. And since I have readers who are vets, I would be appreciative if any of you could add any differing viewpoints or opinions.