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Feline Acne
Acne is a skin disease of cats that primarily affects the chin. Most owners present their cats to the veterinarian for evaluation of a “dirty chin.”
Prevalence
Acne is a fairly common skin disorder of the cat. It is not confined to a particular age grouping and may occur in a cat of any age.
Clinical Signs
Acne lesions are most often on the chin and lower lip. Sometimes, the upper lip may also be involved. Without close examination, the cat may appear to have a dirty chin. It is more difficult to see the lesions if the cat has a dark haircoat.
The typical lesion is a comedone (“blackhead”) and, occasionally, superficial pimples are seen. With progressive involvement, the hair follicle may become plugged with secretions and rupture into deep layers of the skin. If this happens, the chin becomes swollen and very angry in appearance. The cat becomes sensitive and resists touching and treatment.
In severe, long-standing cases, scarring and cysts may be observed.
Causes/Transmission
The cause of feline acne remains unknown; realistically, it is likely that there are multiple causes. Some of the possible causes include:
1. Poor grooming habits.
2. Abnormal production or composition of sebum, which is a waxy or oily substance produced by glands in the skin.
3. Clogging of the hair follicles when hair is not properly shed.
4. Defects in keratin production. Keratin is a protein which gives the skin it’s protective coating.
In humans, acne is related to hormone levels and the presence of bacteria in the skin. A clear association between hormones, skin bacteria and development of acne has not been demonstrated in the cat.
Diagnosis
Acne is most often diagnosed based on its characteristic appearance, sometimes called a "dirty chin."
In order to eliminate other possible causes of an infection on the chin, several diagnostic tests may be performed. In most cases these are not necessary but, when indicated, typically involve scraping of the skin to look for mites and a culture for bacteria and/or fungi.
Treatment
Topical treatment is usually adequate for most cases of acne; severe cases may require systemic (oral) therapy.
Treatment begins with clipping of the chin. This permits deep cleaning of plugged follicles and application of medication to the lesions. Because the cat's chin may be rather sensitive, sedation may be required to accomplish adequate clipping and initial cleaning.
Treatment is continued at home. The pores of the skin are opened with the application of heat. A wash cloth is placed under hot water, and the excess water squeezed out. This hot pack is placed on the chin for 2-4 minutes. When it is removed, topical medication is applied. There are several effective medications available, and their choice is partially determined by the presence of absence of infection.
If infection is present, antibiotics or antifungal drugs may be given orally.
Topical and oral Retin-A (vitamin A) have been tried, but the response is variable and the medication can be very irritating to the skin.
Prognosis
Acne will recur in many cats. At the first sign of return, begin hot packing the chin and applying the topical medication. If this does not control the problem, you cat needs to be re-examined by your veterinari
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Aging Changes in Cats
Aging is a natural process that we all experience. However, it brings with it some changes that are not particularly desirable. Forestalling and controlling certain aspects of the aging process are possible if appropriate intervention is undertaken in a timely manner. The purpose of this document is to inform you of some of these methods for slowing the aging process.
The Cat as a Senior Citizen
Cats age at a different rate than humans. During the first year of life, a cat achieves adulthood. Therefore, that first year is equivalent to about 18 human years. After that, the cat ages in a fairly linear fashion. Each year then becomes the equivalent to about 5 human years. Based on that scheme, a comparison of feline and human years is as follows:
Feline Age ----- Human Age
01 year ----- 16 years
02 years ---- 21 years
03 years ---- 25 years
04 years ---- 29 years
05 years ---- 33 years
06 years ---- 37 years
07 years ---- 41 years
08 years ---- 05 years
09 years ---- 49 years
10 years ---- 53 years
11 years ---- 57 years
12 years ---- 61 years
13 years ---- 65 years
14 years ---- 69 years
15 years ---- 73 years
16 years ---- 77 years
17 years ---- 81 years
18 years ---- 85 years
19 years ---- 89 years
20 years ---- 94 years
Based on this aging scheme, any cat over 10 years of age is deemed a “senior” cat.
Common Changes in the Aging Cat
Many senior cats get a bit lazy in their grooming habits. They often begin to develop mats in their hair coat. Therefore, frequent (1-3 times per week) brushing is important. Brushing collects the dead hair that would normally be removed by grooming, and it breaks down tangles before they become mats. However, occasionally it will be necessary to cut out a mat. Be very careful with scissors or clippers because many elderly cats have very thin skin that cuts or tears easily.
Senior cats also lose the desire or ability to sharpen their nails regularly. The nails become very thick because the dead nail tissue is retained. Failure to sharpen nails can also result in the nail curling backward into the footpad. This will be most uncomfortable and will result in lameness and bleeding. The key to preventing these problems is to cut your cat's nails at least once each month.
Dental disease is common in older cats. The two most common forms of dental disease are tartar buildup, with resulting periodontal disease, and deep cavities near the gum line.
Tartar Buildup Tartar buildup is common in cats of any age, but older cats often have heavy tartar buildup due to years of dental neglect. The tartar irritates the gums, pushes the gums away from the roots of the teeth, and fosters growth of bacteria. Bacteria not only affect the mouth but they are also carried by the blood stream to other organs, most notably the kidneys. Tartar buildup and periodontal disease are very treatable with proper cleaning and antibiotic therapy.
Cervical Line (Neck) Lesions Cavities that form at the gumline (gingiva) are called cervical line lesions. As they form, they may become covered by the gums; the gum then continues to proliferate over them. The cat’s mouth is very painful when that tooth is touched and it may have difficulty eating. The only realistic treatment is extraction of the tooth. Attempts have been made to fill these cavities, but invariably these teeth undergo further deterioration and need to be extracted a few weeks to months later.
Geriatric cats do not usually lose their eyesight, although it can become diminished, especially in dim lighting situations. However, the irises (the colored part of the eye that opens and closes) often begin to get a mottled appearance at about 15 years of age.
The ears often are afflicted with two problems. Hearing loss and outright deafness occur in many cats over 16 years of age. It is permanent. Excessive wax production is the more common problem. Many older cats have very waxy ears that need cleaning about once each month. A wax solvent may be used; it is put in the ears the first few days of each month or possibly every other month.
Arthritis occurs in the spine or legs of some geriatric cats. It causes them become reluctant, or even unable, to jump on and off furniture; they may be hesitant to climb stairs. We are limited in the drugs that can be used safely in arthritic cats, so a close examination and discussion of options is important.
Senior cats also develop certain diseases with increasing frequency. The most common of these are diabetes, chronic kidney failure, hyperthyroidism, high blood pressure, and cancer. Each will be described briefly.
Diabetes (more correctly called diabetes mellitus) is a disease caused by the failure of the pancreas to produce adequate insulin. Insulin is required to move blood sugar (glucose) from the blood into the cells. It results in excess urine production, increased thirst, weight loss, and a ravenous appetite. Although these signs should be present in all diabetic cats, some of them may be missed. This is especially a problem when cats go outside because they may eat, drink, and urinate outdoors. If you have several cats and they all eat and drink together, increased thirst or urine production in one cat will easily be missed. Longhaired cats can loose a substantial amount of weight without detection, so weight loss can also be overlooked. If you suspect that any of these signs are occurring, you cat needs a blood test to determine its blood glucose level. It is most accurate if your cat has not eaten for at least 6 hours. This is a treatable disease.
Chronic kidney failure is the result of many years of slow deterioration in kidney function. Kidney infections, certain toxins, and congenital diseases may be part of this deterioration process, but aging is the major factor. Something has to wear out first, and in many cats it is the kidneys. Cats in kidney failure are actually producing an excess amount of urine in an attempt to remove waste products that are accumulating in the blood. This results in increased thirst. Gradual weight loss is also common, and loss of appetite occurs as the disease progresses. It can be diagnosed with some simple blood and urine tests. It is manageable if treatment begins before the kidney failure is advanced. While the process can be slowed and the cat made to feel better, the kidneys are not restored to normal.
Hyperthyroidism is due to an enlargement of the thyroid gland. This gland controls the body's rate of metabolism so metabolic functions are accelerated. The first sign is weight loss followed by an increase in appetite as the cat tries to "catch up." As the disease progresses (over several weeks to months), increased thirst and urination, vomiting, diarrhea, hyperactivity, and lack of sleep may also occur. It is diagnosed by feeling for thyroid gland enlargement and some simple blood tests. The good news is that 98% of the time, the enlargement is not due to a cancer; therefore, this is a very treatable, and curable, disease.
High blood pressure, more accurately called hypertension, is fairly common in senior cats. Most of the time it is secondary to either chronic kidney failure or hyperthyroidism. However, it appears that a few cats may have "essential" or "primary" hypertension. This means that there is not an underlying disease; essential hypertension is common in humans. This disease is suspected in cats with the two underlying diseases and is diagnosed by measuring the cat's blood pressure. Because the cat's arteries are so small, a special instrument is required. The most common one used is based on the Doppler principle. Hypertension is very treatable.
Cancer is another common disease in senior cats. There are so many forms of cancer that it is impossible to list specific clinical signs. The signs will be determined by the parts of the body that are affected. Therefore, weight loss, anemia, lethargy, loss of appetite, vomiting, diarrhea, difficulty breathing and coughing are all possible. However, it is unlikely that all of those would occur in any one cat.
Detection of Geriatric Diseases
Early detection is the key to successful treatment of all of these diseases. Most of them can be controlled or cured if diagnosed early enough. We recommend a panel of tests for our senior patients. These tests begin with a thorough history of your cat's past and present health. Next, a good physical examination is performed. Finally, we perform a blood and urine panel that includes specific tests for diabetes, chronic kidney failure, and hyperthyroidism. Blood pressure is determined. If any of these tests have questionable results, other tests are added including chest x-rays (radiographs), ultrasound studies, and possible biopsies of suspected abnormal organs. If you wish for your cat to have this Geriatric Panel of tests, please schedule it with one of our receptionists.
Traveling With Your Cat
You should consider several factors before traveling by plane with your cat:
It is impossible to overemphasize the need to consult with the airline well in advance of your trip. This is essential if you hope to avoid last minute problems. Here are some basic tips for airline travel with your cat:
1. Determine whether the airline has requirements for “acclimation.” In the event that you are unable to secure a direct flight, the pet carrier may be left outside the plane for a period of time. To avoid liability on their part, many airlines require a letter from your veterinarian stating that the pet is acclimated to a minimum or maximum temperature (must be given in precise degree, e.g., 20 F) for a defined period of time.
2. Consult with the airline regarding baggage liability. In some cases, this can include your pet. If you are sending an economically valuable pet, you may need to consider additional liability insurance.
3. Have your cat examined by your veterinarian in advance of the trip, especially if it has been more than a few months since the last checkup. This is especially important for geriatric cats. Travel by plane can pose a risk for cats with pre-existing medical problems, such as heart or kidney disease. Also, some short-faced breeds of cats (Persians, Exotic Shorthairs) do not travel well in some situations.
4. Be sure that you have written proof of current vaccinations and, where required, a health certificate. These cannot be obtained “after the fact.” You must be able to present them on demand.
5. You should also inquire about possible requirements to quarantine your cat should you be traveling outside the continental United States or to a foreign country.
6. Take direct flights and try to avoid connections and layovers. Sometimes, this is easier to achieve if the trip is planned during the week. The well-being of your cat could be a source of concern if the baggage connection between flights should be missed.
7. Some airlines will allow one pet in coach and one in first class, with some provisions. To find out whether there are limitations on the number of animals present in the cabin, you should advise the airline if you plan to travel with your cat in the cabin. Check on the cage dimensions so that there won’t be a problem stowing the carrier beneath the seat.
8. Consider in advance all medications that you might need for your cat. These might include heartworm preventive (a new product for cats), flea preventive, and heart or kidney medications. Also, give thought to any special diets that your cat may need and whether they can be obtained at your destination.
9. If there is any chance that your cat will be out of the carrier, give thought to an appropriate collar or harness and keep a leash with you. If possible, the collar should have a small pet identification tag. Order forms are available in most veterinary clinics.
At the time of your flight:
1. Do not tranquilize the cat unless you have discussed this with your veterinarian. As a rule, cats don’t tolerate medicines well and giving over-the-counter or prescription pharmaceuticals can be dangerous.
2. Make sure that the carrier has permanent identification, including your name, phone number, flight schedule, destination, and phone number at the point of destination.
3. Feed the cat before you leave home. Water should be available at all times, including inside the carrier. If you have a geriatric cat with marginal kidney function, it is important that the cat not be deprived of water. Discuss this with your veterinarian. Try to secure a direct flight with no layovers. The cat should have fresh water after arrival.
Consider the following when purchasing a carrier for the airline flight:
1. The cage should provide sufficient room for the cat to stand up and turn around easily, but not so large that it can be tossed about inside during turbulence. Remember size constraints if the carrier is to go on board.
2. The walls of the carrier should be strong enough to prevent the sides from being crushed. Also, the flooring of the cage should not allow urine to leak through the bottom. An absorptive underpad (designed for bedridden people with bladder control problems) can be placed in the bottom. See your pharmacist for these.
3. The cage should have sufficient openings for good ventilation.
4. The cage must have sturdy handles for baggage personnel to use.
5. The cage should have a water tray that is accessible from the outside so that water can be added, if needed.
Pet stores, breeders, and kennels usually sell cages that meet these requirements. Some airlines also sell cages that they prefer to use. Check with the airline to see if they have other requirements.
Try to familiarize your cat with the travel cage before you leave for your trip. Let your cat play inside with the door both open and closed. This will help eliminate some of your cat's stress during the trip.
Some considerations for your point of destination include:
1. Be sure that your hotel will allow cats. Many bookstores carry travel guidebooks with this type of information. AAA members can purchase Traveling with Your Pet: The AAA PetBook which gives an annually updated list of motels and hotels that welcome pets, emergency animal clinics, advocacy groops, and pet-sitter associations.
2. Give thought to litter pan provisions and food bowls for the hotel room.
3. Place a “Do Not Disturb” sign on your hotel door so that housekeeping will not inadvertently let the cat escape. Plan to have your room cleaned only when you are present.
4. It is probably best to leave the cat in the carrier or inside the bathroom whenever you plan to leave the room.
5. Should your cat get lost, contact the local animal control officer.
Advance planning is the key to a safe trip with your pet!
Allergies in Cats
Overview
One of the most common conditions affecting cats is allergy. In the allergic state, the cat's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed. Those overreactions are manifested in three ways. The most common is itching of the skin, either localized (one area) or generalized (all over the cat). Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing. Sometimes, there may be an associated nasal or ocular (eye) discharge. The third manifestation involves the digestive system, resulting in vomiting or diarrhea.
Types of Allergy
There are four known types of allergies in the cat: contact, flea, food, and inhalant. Each of these has some common expressions in cats, and each has some unique features.
Contact Allergy
Contact allergies are the least common of the four types of allergies. They result in a local reaction to the skin. Examples of contact allergy include reactions to flea collars or to types of bedding, such as wool. If the cat is allergic to those, there will be skin irritation and itching at the points of contact. Removal of the contact irritant solves the problem. However, identifying the allergen can require some detective work.
Flea Allergy
Flea allergy is common in cats. A normal cat experiences only minor irritation in response to flea bites, often without any itching. The flea allergic cat, on the other hand, has a severe, itch-producing reaction when the flea's saliva is deposited in the skin. Just one bite causes such intense itching that the cat may severely scratch or chew itself, leading to the removal of large amounts of hair. There will often be open sores or scabs on the skin, allowing a secondary bacterial infection to begin. The area most commonly involved is over the rump (just in front of the tail). In addition, the cat may have numerous, small scabs around the head and neck. These scabs are called miliary lesions, a term which was coined because the scabs look like millet seeds.
The most important treatment for flea allergy is to get the cat away from all fleas. Therefore, strict flea control is the backbone of successful treatment. Unfortunately, this is not always possible in warm and humid climates, where a new population of fleas can hatch out every 14-21 days. When strict flea control is not possible, injections of corticosteroids (or "cortisone" or "steroids") can be used to block the allergic reaction and give relief. This is often a necessary part of dealing with flea allergies. Fortunately, cats appear relatively more resistant to the side effects of steroids than other species. If a secondary bacterial infection occurs, appropriate antibiotics must be used.
Inhalant Allergy
The most common type of allergy is the inhalant type, or atopy. Cats may be allergic to all of the same inhaled allergens that affect us. These include tree pollens (cedar, ash, oak, etc.), grass pollens (especially Bermuda), weed pollens (ragweed, etc.), molds, mildew, and the house dust mite. Many of these allergies occur seasonally, such as ragweed, cedar, and grass pollens. However, others are with us all the time, such as molds, mildew, and house dust mites. When humans inhale these allergens, we express the allergy as a respiratory problem; it is sometimes called "hay fever." The cat's reaction, however, usually produces severe, generalized itching. In fact, the most common cause of itching in the cat is inhalant allergy.
Most cats that have an inhalant allergy are allergic to several allergens. If the number is small and they are the seasonal type, itching may last for just a few weeks at a time during one or two periods of the year. If the number of allergens is large or they are they are present year-round, the cat may itch constantly.
Treatment depends largely on the length of the cat's allergy season. It involves two approaches. Steroids will dramatically block the allergic reaction in most cases. These may be given orally or by injection, depending on the circumstances. As stated previously, the side effects of steroids are much less common in cats than in people. If steroids are appropriate for your cat, you will be instructed in their proper use.
Some cats are helped considerably by a hypoallergenic shampoo. It has been demonstrated that some allergens may be absorbed through the skin. Frequent bathing is thought to reduce the amount of antigen exposure through this route. In addition to removing surface antigen, bathing alone will provide some temporary relief from itching and may allow the use of a lower dose of steroids. Antihistamines are usually of little value in the cat, but can be tried.
The second major form of allergy treatment is desensitization with specific antigen injections (or "allergy shots"). Once the specific sources of allergy are identified, very small amounts of the antigen are injected weekly. This is all in an attempt to reprogram the body's immune system. It is hoped that as time passes, the immune system will become less reactive to the problem-causing allergens. If desensitization appears to help the cat, injections will continue for several years. For most cats, a realistic goal is for the itching to be significantly reduced in severity; in some cats, itching may completely resolve. Steroids are not used with this treatment protocol, except on an intermittent basis. This therapeutic approach is recommended for the middle-aged or older cat that has year round itching caused by inhalant allergy. This approach is not used with food allergy.
Although desensitization is the ideal way to treat inhalant allergy, it does have some drawbacks and may not be the best choice in certain circumstances.
1. Cost: This is the most expensive form of treatment.
2. Age of Patient: Because many cats develop additional allergies as they get older, young cats may need to be re-tested 1-3 years later.
3. Success Rate: About 50% of cats will have an excellent response. About 25% get partial to good response. About 25% get little or no response. The same statistics are true for people undergoing desensitization.
4. Food Allergies: Although tests for food allergy are available, the reliability of the test is so low that it is not recommended at this time. A food trial remains the best diagnostic test for food allergy.
5. Time of Response: The time until apparent response may be 2-5 months, or longer.
6. Interference of steroids: Cats must not receive oral steroids for 2 weeks or injectable steroids for 6 weeks prior to testing; these drugs will interfere with the test results.
Food Allergy
Cats are not likely to be born with food allergies. More commonly, they develop allergies to food products they have eaten for a long time. The allergy most frequently develops in response to the protein component of the food; for example, beef, pork, chicken, or turkey. Food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress. We recommend testing for food allergy when the clinical signs have been present for several months, when the cat has a poor response to steroids, or when a very young cat itches without other apparent causes of allergy. Testing is done with a special hypoallergenic diet. Because it takes at least 8 weeks for all other food products to get out of the system, the cat must eat the special diet exclusively for 8-12 weeks (or more). If positive response occurs, you will be instructed on how to proceed. If the diet is not fed exclusively, it will not be a meaningful test. We cannot overemphasize this. If any type of table food, treats or vitamins are given, these must be discontinued during the testing period.
Because cats that are being tested for inhalant allergy generally itch year round, a food allergy dietary test can be performed while the inhalant test and antigen preparation are occurring.
INSTRUCTIONS: Those instructions that are specific for your cat have been checked:
___ 1) An injection of steroids was given. Relief should be apparent within 12-24 hours. If not, please call. The cat should feel better and itch less for about one month. If an increase in water consumption or urination occurs, please report this to us for future reference. These side effects are common with steroid administration and will go away in a few days without treatment. Return for further evaluation when the first signs of itching recur.
___ 2) Begin oral steroids when the first signs of itching return. Give ____ tablets every other evening. Adjust dosage upward or downward to the lowest effective dose, with a maximum dose of __________ permitted. Stop giving the medication every 4-6 months to see if there are times of the year when therapy is not needed. Report any increase in water consumption to us at once.
___ 3) We have dispensed oral steroid tablets. Prednisone is most commonly used. The specific drug being dispensed for your cat is labeled on the bottle. Give ____ of the ____ mg tablets every other day for 3 doses (6 days), then ____ tablets every other day for 3 more doses (6 more days). Continue this downward progression (___________________________________) until the first signs of itching recur. At that time, go back to the next higher level and report that level to us (so we can be sure it is a safe level). Stop giving the tablets every 4-6 months to see if there are periods of the year when they are not necessary. When itching returns, begin immediately at the maintenance dose. If that does not stop the itching, increase the dosage slightly (to a maximum of ___ tablets) for a few doses, then return to the lower dose. Report any increase in water consumption to us at once. (This may occur at the initial dose but should stop on the maintenance dose.)
___ 4) Your cat is to exclusively eat a hypoallergenic diet. If it will not do so readily, mix it 25:75 with the current diet for several days, then gradually increase the special diet to 100%. If this does not work, contact us for an alternative plan. Discontinue any chewable treats or vitamins. Table food is not allowed. Offer only distilled water to drink, if that is possible.
___ 5) Your cat has a flea allergy or has enough fleas to make the other allergy problem worse. Flea control is very important and should include treating the cat and its environment. Bear in mind that flea allergies often accompany other types of allergies, especially inhalant allergy.
___ 6) Your cat has a bacterial skin infection secondary to allergy.
The following are recommended:
a) Antibiotics are to be used for the next _____ days. If the infection is not gone by the time the medication is completed, call for a refill or for a change in medication.
b) The medicated shampoo, _____________________, is to be used every _____ days. Allow the shampoo to stay in the hair coat for a few minutes before thoroughly rinsing the cat.
c) The topical medication, _____________________, is to be used ______ times daily for __________ days.
Anemia in the Cat
Anemia is defined as a reduced number of red blood cells or hemoglobin, or both. It is a clinical sign, not a specific disease. It is a significant finding because red blood cells, or erythrocytes, are needed to transport oxygen to the tissues. When the total numbers of red blood cells are reduced, there can be insufficient oxygen delivery to vital organs.
Red blood cells are produced in the bone marrow, or hollow core of the bones, by specialized cells. Before being released into circulation, the precursor cells must undergo a specific sequence of steps to reach full maturity. Once released by the bone marrow, the red blood cell lives about 60-70 days in cats. Interestingly, the red blood cell lives much longer in dogs, about 120 days.
Prevalence
Anemia is probably the most frequent laboratory abnormality involving the blood cells. It is a relatively common finding in cats of all ages and breeds.
Clinical Signs
The most easily observed sign of anemia is a loss of the normal pink color of the gingiva (gums). Anemic cats also have little endurance so they seem very weak or tired. Pale gingiva and lethargy make us want to perform some tests on blood to document anemia. Sometimes, anemia can cause the heart rate to elevate and a heart murmur to develop. If the anemia is caused by red blood cell destruction, the skin may have a yellow tint (jaundice or icterus). When certain cancers are the underlying cause of anemia, the lymph nodes, spleen, intestines, or liver might be enlarged.
Diagnosis and Evaluation
Initial Tests
The initial tests performed on blood are needed to determine the severity of the anemia and the ability of the bone marrow to respond to the anemia. The most common test for anemia is the packed cell volume (PCV); it is also called the hematocrit. A blood sample is placed in a centrifuge to separate the red blood cells from the plasma (the liquid part of the blood). This takes only a few drops of blood and can be performed in about five minutes. The normal PCV of the cat is 25% - 45%; anemia is defined as a PCV below 25%.
A more complete assessment of the red blood cells can be calculated by very sophisticated instrumentation; a number of specific measurements can be provided. These include hemoglobin, as well as the diameter and volume of individual red blood cells.
Responsiveness of the bone marrow to the anemia is evaluated by the reticulocyte count. The reticulocyte is a young adult red blood cell. It has not quite completed all of the steps to maturation. A rough index of the reticulocyte numbers can be gleaned by examining a blood smear. The precise count is easy to determine by mixing a small amount of blood with a special stain and then re-examining the blood smear. It is generally preferable to have a reticulocyte count that reflects the ability of the bone marrow to respond to the anemia; this is called a “regenerative anemia.” When the marrow appears unresponsive based on reticulocyte numbers, this is called a “non-regenerative anemia.”
Additional Tests
Several other tests are usually indicated for complete evaluation of the cat with anemia. These are described below.
A careful study of the blood smear is important to look for parasites that might be causing red blood cell destruction and abnormal cells that could indicate leukemia. A test to look for immune-system destruction of red blood cells, called a “Coombs Test,” may also be done at this time.
A bone marrow biopsy or aspirate is a procedure that recovers a small sample of cells from the bone marrow for evaluation by the veterinary pathologist. Studying these cells can give valuable information about the cause of some anemias and the condition of the bone marrow. Sometimes it is prudent to give the bone marrow a few days to respond to the anemia if there is a suspicion of recent blood loss. When this is the case, a bone marrow aspirate may be temporarily postponed. In some situations, it is clear that the anemia is long-standing and a bone marrow evaluation should be done as soon as possible.
A biochemical profile and urinalysis are other important tests for anemic cats. These tests evaluate organ functions and electrolyte levels. They will often provide important information about the total health of the cat. A fecal exam is also important for identification of parasites in the intestinal tract that might be causing blood loss.
Finally, an anemic cat should be tested for the feline leukemia virus and the feline immunodeficiency virus because these viruses are important causes of anemia.
Causes/Transmission
Several tests are important for an anemic cat because there are many diseases that cause anemia. These are grouped into 1) diseases that cause blood loss, 2) diseases that cause hemolysis (red blood cell breakdown), and 3) diseases that decrease the production of red blood cells.
The main causes of blood loss in cats include:
Trauma or injury that severs blood vessels or internal organs
Parasites such as fleas, ticks, and hookworms
Tumors of the intestinal tract, kidneys, and urinary bladder
Diseases that prevent proper clotting of blood
The main causes of hemolysis in cats include:
Autoimmune disease
The feline leukemia virus
Blood parasites
Chemicals or toxins
Neoplasia (cancer)
The main causes of bone marrow suppression in cats include:
Any severe, chronic disease
Very poor nutrition or nutritional imbalances
Autoimmune disease
The feline leukemia virus
The feline immunodeficiency virus
Chemicals or toxins
Neoplasia (cancer)
It is noteworthy that while iron deficiency anemia is a common finding in people, especially women, it is uncommon in cats and only occurs secondary to some form of chronic blood loss.
Treatment
If your cat's anemia is so severe that it is life threatening, a blood transfusion is needed. This may be performed immediately after a blood sample is taken for testing. The main purpose of a blood transfusion is to stabilize the cat long enough that a determination of the cause of the anemia can be made. Although we cannot determine the bloodtype of cats prior to the transfusion, transfusion reactions are quite uncommon.
Further treatment will be determined once the underlying disease has been diagnosed.
Prognosis
The prognosis is dependent upon identification of the underlying cause and a positive response to appropriate therapy. Sometimes, the prognosis cannot be given for a few days because all of the diagnostic tests may not be completed.
Obstructive Lung Disease of Cats: Asthma and Bronchitis
Overview
Obstructive and allergic lung diseases affect many cats and are sometimes called asthma, bronchitis, or bronchial asthma. Unfortunately, these diseases are not easily classified and probably represent a variety of lung disorders. They do share a common finding of “hyper-responsive” (over-reactive) airways.
When the airway of the cat is sensitive to certain stimuli, exposure to these agents leads to narrowing of the airways. The inciting agents are usually direct irritants to the airways or things that provoke an allergic response in the respiratory tract. Regardless of the cause, the end-result is the same: muscle spasms in the bronchi (breathing tubes), buildup of mucus, and accumulation of cellular material. In particular, the inability to clear the bronchi of this material leaves the cat susceptible to secondary infections.
The cat is most stressed during the period of expiration (exhaling). The difficulty with expiration is typical with obstructive disease of the lung. Air may become effectively trapped in the lungs, causing them to over-inflate. In some cases, this trapping leads to development of emphysema in the cat.
Contributing Factors
Obstructive lung disease is most common in cats from 2 to 8 years of age. Female cats and Siamese cats seem to be more susceptible.
Clinical Signs
Coughing and respiratory distress are the most commonly reported signs with obstructive lung disease. Coughing is a significant finding since there are relatively few causes of coughing in the cat. Also, many cats assume a squatting position with the neck extending during these coughing episodes. Wheezing is easily heard with the stethoscope and is sometimes so loud that it can be heard without a stethoscope. Occasionally, sneezing and vomiting are noted.
Causes
As mentioned above, this group of diseases is characterized by hyper-responsive airways. The small breathing tubes (bronchi and bronchioles) can react to a number of stimuli, such as:
1. Inhaled debris or irritants - dust from cat litter, cigarette smoke, perfume or hairspray, carpet fresheners, and perfumes in laundry detergent
2. Pollens or mold
3. Infectious agents - viruses, bacteria
4. Parasites - heartworms, lungworms
Diagnosis
Several tests may be performed to achieve a diagnosis of allergic lung disease in the cat.
1. Minimum data base (complete blood count, blood chemistries, fecal exam and urinalysis). These tests help to assess the general health of your cat and may provide clues as to the underlying cause. One particular type of white blood cell, the eosinophil, is commonly associated with allergic events and may provide support for a tentative diagnosis of asthma. Also, in cats in certain geographic areas, special tests will be performed on stool samples for evidence of lungworms.
2. Heartworm test. This is not indicated for all cats, as heartworms are rare in some parts of the country. In areas where they are common, however, strictly indoor cats are still at risk.
3. Feline leukemia and feline immunodeficiency virus tests. These tests are helpful in determining the overall health of your cat.
4. Thoracic radiography (chest X-ray). Characteristic changes in the lungs are common on x-rays. Also, the x-rays can be suggestive of heartworms in some cases.
5. Bronchoscopy, cytology, and airway lavage (washing). Bronchoscopy is a procedure that allows us to look down the airways of the anesthetized cat with a fiberoptic scope. After a visual examination of the airway is completed, the lining mucus of the bronchi may be sampled with a small brush. The mucus can be examined under a microscope (cytology). Finally, a small amount of sterile saline can be flushed into the airways to retrieve samples of material from deep in the lung. This material can be cultured for micro-organisms and can also be carefully studied under the microscope. The sediment can be evaluated for evidence of lungworms.
In some cases, an underlying cause cannot be identified, despite a thorough diagnostic workup. Even when the underlying cause is not identified, many cats can achieve a reasonable quality of life with medical management.
Some owners decline the complete workup for a variety of reasons. In such cases, it may be acceptable to treat the cat with a course of corticosteroids (cortisone) since most asthmatic cats respond very favorably. However, these medications can complicate the management of cats harboring secondary bacterial infections; therefore, prophylactic antibiotics are reasonable in cases where a workup cannot be performed. In addition, cats that are coughing due to heartworms often improve with corticosteroids. Without heartworm testing, they may go undetected.
Treatment
Successful management of allergic lung disease employs several therapies.
1. Any factors known to trigger or aggravate breathing problems should be avoided. In some cases, this may mean trying different brands of cat litter, eliminating cigarette smoke from the home, etc. The list above (see “Causes”) details some factors that should be considered. It is important to pay close attention to environmental factors that may aggravate the condition.
2. Bronchodilators. These drugs are used to open the airways and allow the cat to move air more freely. They should be used faithfully and as directed to obtain maximum effect.
3. Corticosteroids. Corticosteroids have a beneficial effect on decreasing inflammation, dilating the airway, and decreasing mucus production. In many cats, they are given daily. When the cat does not take tablets well, long-acting injections can be given. These drugs have potential for some side effects, but this problem is much less in cats than in humans.
4. Emergency treatment may employ bronchodilators, oxygen, rapid-acting glucocorticoids, and epinephrine. When the cat has heart disease, the attending veterinarian should be advised since epinephrine is best avoided.
Prognosis
Cats with obstructive lung disease are usually manageable. Sometimes “cure” may be achieved if a specific underlying cause can be identified and treated. Extreme respiratory distress constitutes an emergency, and the cat should receive immediate attention.
INSTRUCTIONS: Those instructions that are specific for your cat have been checked:
___ 1) An injection of corticosteroids (cortisone) was given. Relief should be apparent within 12-24 hours. If an increase in water consumption or urination occurs, please report this to us for future reference. These side effects are common with steroid administration and will go away in a few days without treatment. Return for further evaluation when the first signs of respiratory distress or noisy breathing return.
___ 2) Begin oral corticosteroids. The specific drug being dispensed for your cat is labeled on the bottle. Give the tablets per label instructions. Report any increase in water consumption to us at once.
___ 3) Begin oral bronchodilators. The specific drug being dispensed for your cat is labeled on the bottle. Give the tablets per label instructions.
Bladder Stones in Cats
(Urolithiasis)
Bladder stones, more correctly called uroliths, are rock-like collections of minerals that form in the urinary bladder. They may occur as a large, single stone or as dozens of stones the size of large grains of sand or pea gravel.
Although the kidneys and urinary bladder are both part of the urinary system, kidney stones are usually unrelated to bladder stones. When stones are found in the urinary tract, more than 90% of the time, they are in the bladder.
Contributing Factors
There are several different types of uroliths in cats. It is important to determine the mineral composition of the stones, when possible. Depending upon the type of stone, various risk factors may contribute to urolith formation. Diet, water intake, urinary tract infections, and urinary pH are all-important considerations.
Prevalence
For the most part, urolithiasis affects male and female cats with equal frequency. One particular type of stone (calcium oxalate) reportedly affects male cats more commonly than female cats; also, Burmese, Himalayan, and Persian cats may have a higher incidence of this stone. Some types of stones are more common in younger cats (struvite, or magnesium ammonium phosphate), whereas others tend to occur in more mature cats (calcium oxalate).
Bladder stones are responsible for about 25% of all cases of hematuria (blood in the urine) and dysuria (straining to urinate) in cats.
Clinical Signs
The two most common signs of bladder stones are hematuria and dysuria. Hematuria (blood in the urine) occurs because the stones mechanically irritate the bladder wall, causing bleeding from its fragile surface. Dysuria (difficulty urinating) occurs when stones obstruct the passage of urine out of the bladder. Large stones may cause a partial obstruction at the point where the urine leaves the bladder and enters the urethra; small stones may flow with the urine into the urethra and cause an obstruction at its narrow point.
When an obstruction occurs, urine cannot pass out of the body and the abdomen becomes very painful. Your cat may cry in pain, especially if pressure is applied to the abdominal wall. The cat may make frequent trips to the litterbox in a futile attempt to urinate.
Even if there is no obstruction occurring, hematuria and dysuria may be significant; the irritated bladder is quite painful. When bladder stones are removed surgically, many owners tell us how much better the cat feels.
Causes/Transmission
There are several theories of bladder stone formation. Each is feasible in some circumstances, but there is probably an interaction of more than one of them in each cat. The most commonly accepted theory is called the Precipitation-Crystallization Theory. This theory states that one or more stone-forming crystalline compounds are present in elevated levels in the urine. This may be due to abnormalities in diet or due to some previous disease in the bladder, such as infection with bacteria. When the amount of this compound reaches a threshold level, the urine is said to be “supersaturated.” This means that the level of the compound exceeds its ability to dissolve in the urine, so it precipitates and forms tiny crystals. These crystals stick together, usually due to mucus-like material within the bladder, and stones gradually form. As time passes, the stones enlarge and increase in number.
Growth will depend on the quantity of crystalline material present and the degree of infection present. Although it may take months for a large stone to grow, some sizable stones have been documented to form in as little as two weeks.
Diagnosis
Most cats that have bladder infections do not have bladder stones. These cats will often have blood in the urine and will strain to urinate. Therefore, we do not suspect bladder stones just based on these clinical signs.
Some bladder stones can be palpated (felt with the fingers) through the abdominal wall. However, failure to palpate them does not rule them out because many are too small to be detected in this manner.
Most bladder stones are visible on radiographs (x-rays) or an ultrasound examination. These procedures are performed if stones are suspected. This includes cats that show unusual pain when the bladder is palpated, cats that have recurrent hematuria and dysuria, or cats that have recurrent bacterial infections in the bladder.
Some bladder stones are not visible on radiographs. They are said to be radiolucent. This means that their mineral composition is such that they do not reflect the x-ray beam. These stones may be found with an ultrasound examination or with special radiographs that are made after placing a special dye (contrast material) in the bladder.
Treatment
There are two options for treatment. The fastest solution is to remove them surgically. This requires surgery in which the abdomen and bladder are opened. Following two to four days of recovery, the cat is relieved of pain and dysuria. The hematuria will often persist for a few more days, and then it stops. Surgery is not the best option for all patients; however, those with urethral obstruction and those with bacterial infections associated with the stones should be operated on unless there are other health conditions that prohibit surgery.
The second option is to dissolve the stone with a special diet. This avoids surgery and can be a very good choice for some cats. However, it has three disadvantages.
1. It is not successful for all types of stones. Unless some sand-sized stones can be collected from the urine and analyzed, it is not possible to know if the stone is of the composition that is likely to be dissolved.
2. It is slow. It may take several weeks or a few months to dissolve a large stone so the cat may continue to have hematuria and dysuria during that time.
3. Not all cats will eat the special diet. The diet is not as tasty as the foods that many cats are fed. If it is not consumed to the exclusion of all other foods, it will not work.
Prognosis
The prognosis is dependent upon the type of stone, presence of infection, location of the stones, presence of concurrent stones in the kidneys, and any other factors that complicate the health of the cat. In most cases, with appropriate therapy, a favorable outcome is expected.
Prevention
Prevention is possible in many cases. As described above, there are at least four types of bladder stones, based on their chemical composition. If stones are removed surgically or if some small ones pass in the urine, they should be analyzed for their chemical composition. This will allow determination of the appropriate diet; hopefully, this will minimize the chance of recurrence. If a bacterial infection causes stone formation, periodic urinalyses and urine cultures should be performed to monitor response to treatment.
Breeding Cats and Raising Kittens
Breeding cats and raising kittens can be an extremely rewarding experience or it may produce frustration and failure. The following information is provided in order to increase your chances of success.
The Feline Estrus Period
The female cat (queen) comes into heat (estrus) many times each year. The heat period lasts about 2-3 weeks. If she is not bred, she will return to heat in 1-2 weeks. This cycle will continue for several heat cycles or until she is bred. The period of time that she is out of heat will vary depending on geographic and environmental factors, such as temperature and the number of daylight hours.
Signs of Estrus
The signs of heat are different in cats as compared to dogs. Cats have minimal vaginal bleeding, usually not even enough to be detected. Changes in behavior represent the most notable sign. Cats become very affectionate. They rub against their owners and furniture and constantly want attention. They roll on the floor. When stroked over the back, they raise their rear quarters into the air and tread with the back legs. They also become very vocal. These behavior changes often become obnoxious to owners and may be interpreted as some unusual illness. In addition, queens in heat attract intact (non-neutered) male cats. Tomcats that have never been seen will appear and attempt to enter the house to get to the female.
Breeding
Male cats are more successful breeders when they are in familiar surroundings. Therefore, it is preferable to take the female to the male's home for breeding. The timing for breeding cats is not highly critical or complicated because cats are induced ovulators. This means that the act of breeding stimulates the ovaries to release eggs. Therefore, the female's eggs should be present when the sperm are deposited in the reproductive tract at breeding. Most female cats require 3-4 breedings within a 24-hour period for ovulation to occur. Once ovulation has occurred, the female cat will go out of heat within a day or two.
The Pregnant Queen
Pregnancy, also called “gestation,” ranges from 60 to 67 days and averages 63 days. Most cats deliver (queen) between days 63 and 65. The only way to accurately determine the stage of pregnancy is to count days from the time of breeding. If possible, the breeding date should be recorded. The mother should be examined 3 weeks after breeding to confirm her pregnancy.
A pregnant cat should be fed a kitten formulation of a premium brand of cat food for the duration of the pregnancy and through the nursing period. These diets are generally available through veterinary hospitals or pet stores. Kitten diets provide all the extra nutrition needed for the mother and her litter. If the mother is eating one of these diets, no calcium, vitamin, or mineral supplements are needed. (The kitten formulation is necessary to provide the extra nutrients for pregnancy and nursing).
During pregnancy, the mother's food consumption will often reach 1.5 times her level before pregnancy. By the end of the nursing period, it may exceed 2 times the pre-pregnancy amount. Do not withhold food; increasing the number of feedings per day is helpful in allowing her to eat enough for her needs and those of the kittens.
Preparation for Queening
From the time of breeding, many cats show behavioral changes. Most develop an unusually sweet and loving disposition and demand more affection and attention. However, some may become uncharacteristically irritable. Some experience a few days of vomition ("morning sickness"), followed by the development of a ravenous appetite that persists throughout the pregnancy.
During the latter stages of pregnancy, the expectant mother begins to look for a secure place for delivery. Many become uncomfortable being alone and will cling closely to the owner. At the onset of labor, many nervously seek a place to make the "nest" or birthing place. If the cat is attached to her owner, she may not want to be left alone at the time of delivery. If left alone, she may delay delivery until the owner returns.
Prior to the time of delivery, a queening box should be selected and placed in a secluded place, such as a closet or a dark corner. The box should be large enough for the cat to move around freely, but have low enough sides so that she can see out and so the owner can reach inside to give assistance, if needed. The bottom of the box should be lined with several layers of newspapers. These provide a private hiding place for the expectant and delivering mother and will absorb the birthing fluids. The upper, soiled layers may be removed with minimal interruption to the mother and her newborn kittens.
Labor and Delivery
Most cats experience delivery without complications; however, first-time mothers should be attended by their owner until at least one or two kittens are born. If these are born quickly and without assistance, further attendance may not be necessary, although it is desirable. If the owner elects to leave, care should be taken such that the cat does not try to follow and leave the queening box.
The signs of impending labor generally include nervousness and panting. The cat will often quit eating during the last 24 hours before labor. She will also usually have a drop in rectal temperature below 100o F (37.8 C). The temperature drop may occur intermittently for several days prior to delivery, but it will usually be constant for the last 24 hours.
Delivery times will vary. Shorthaired cats and cats having slim heads, such as Siamese, may complete delivery in one to two hours. Domestic body type cats (having large, round heads) generally require longer delivery times. Persian and other domestic body type kittens tend to be very large and have sizable heads that make delivery more difficult. It is not unusual for Persians to rest an hour or more between each kitten. Rarely, a cat may deliver one or two kittens, then have labor stop for as long as twenty-four hours before the remainder of the litter is borne. However, if labor does not resume within a few hours after the delivery of the first kittens, examination by a veterinarian is advised. If labor is interrupted for twenty-four hours or more, veterinary assistance should definitely be obtained.
Kittens are usually borne head first; however, breech presentations, in which the kitten is delivered tail end first, occur about 40% of the time and are also considered normal. Each kitten is enclosed in a sac that is part of the placenta ("afterbirth"). The placentas usually pass after the kittens are born. However, any that do not pass will disintegrate and pass within 24-48 hours after delivery. It is normal for the mother to eat the placentas.
If the delivery proceeds normally, a few contractions will discharge the kitten; it should exit the birth canal within ten minutes of being visible. Following delivery, the mother should lick the newborn's face. She will then proceed to wash it and toss it about. Her tongue is used to tear the sac and expose the mouth and nose. This vigorous washing stimulates circulation, causing the kitten to cry and begin breathing; it also dries the newborn's haircoat. The mother will sever the umbilical cord by chewing it about 3/4 to 1 inch (1.9 to 2.5 cm) from the body. Next, she will eat the placenta.
If the kitten or a fluid-filled bubble is partially visible from the vagina, the owner should assist delivery. A dampened gauze or thin wash cloth can be used to break the bubble and grasp the head or feet. When a contraction occurs, firm traction should be applied in a downward (i.e., toward her rear feet) direction. If reasonable traction is applied without being able to remove the kitten, or if the queen cries intensely during this process, the kitten is probably lodged. A veterinarian's assistance should be sought without delay.
It is normal for the female to remove the placental sac and clean the kittens; however, first-time mothers may be bewildered by the experience and hesitate to do so. If the sac is not removed within a few minutes after delivery, the kitten will suffocate, so the owner should be prepared to intervene. The kitten's face should be wiped with a damp wash cloth or gauze to remove the sac and allow breathing. Vigorous rubbing with a soft, warm towel will stimulate circulation and dry the hair. The umbilical cord should be tied with cord (i.e., sewing thread, dental floss) and cut with clean scissors. The cord should be tied snugly and cut about 1/2 inch (1.3 cm) from the body so it is unlikely to be pulled off as the kitten moves around the queening box.
Newborn kittens may aspirate fluid into the lungs, as evidenced by a loud raspy noise during respiration. This fluid can be removed by the following procedure. First, the kitten should be held in the palm of one's hand with the face cradled between the first two fingers. The head should be held firmly with this hand, and the body should be held firmly with the other. Next, a downward swing motion with the hands should make the kitten gasp. Gravity will help the fluid and mucus move out of the lungs. This process may be tried several times until the lungs sound clear. The tongue is a reliable indicator of successful respiration. If the kitten is getting adequate oxygen, it will appear pink to red. A bluish colored tongue indicates insufficient oxygen to the lungs, signaling that the swinging procedure should be repeated.
It may be helpful to have a smaller, clean, dry box lined with a warm towel for the newborn kittens. (A towel can be warmed in a microwave oven.) After the kitten is stable and the cord has been tied, it should be placed in the incubator box while the mother is completing delivery. Warmth is essential so a heating pad or hot water bottle may be placed in the box or a heat lamp may be placed nearby. If a heating pad is used, it should be placed on the low setting and covered with a towel to prevent overheating. A hot water bottle should also be covered with a towel. Remember, the newborn kittens may be unable to move away from the heat source. Likewise, caution should also be exercised when using a heat lamp.
Once the delivery is completed, the soiled newspapers should be removed from the whelping or queening box. The box should be lined with soft bedding prior to the kittens' return. The mother should accept the kittens readily and recline for nursing.
The mother and her litter should be examined by a veterinarian within 24 hours after the delivery is completed. This visit is to check the mother for complete delivery and to check the newborn kittens. The mother may receive an injection to contract the uterus and stimulate milk production.
The mother will have a bloody vaginal discharge for 3-7 days following delivery. If it continues for longer than a week, she should be examined by a veterinarian for possible problems.
Problems During Delivery
Although most cats deliver without need for assistance, problems do arise which require the attention of a veterinarian. Professional assistance should be sought if any of the following occur:
1) Twenty minutes of intense labor occurs without a kitten being delivered.
2) Ten minutes of intense labor occurs when a kitten or a fluid-filled bubble is visible in the birth canal.
3) The mother experiences acute (sudden) depression or marked lethargy.
4) The mother's body temperature exceeds 103o F (39.4 C) (via a rectal thermometer).
5) Fresh blood discharges from the vagina for more than 10 minutes.
Difficulty delivering (dystocia) may be managed with or without surgery. The condition of the mother, size of the litter, and size of the kittens are factors used in making that decision.
Premature Delivery
Occasionally, a mother will deliver a litter several days premature. The kittens may be small, thin, and have little or no hair. It is possible for them to survive, but they require an enormous amount of care, since they are subject to chilling and are frequently very weak and unable to swallow. Some may be able to nurse but are so weak that they must be held next to the mother. Kittens that do not nurse can be fed with a small syringe, bottle, or stomach tube. The equipment and instructions for these procedures are available from a veterinarian. Premature kittens must be kept warm. The mother can provide sufficient radiant heat from her body if she will stay close to them. If she refuses, heat can be provided with a heat lamp, heating pad, or hot water bottle. Excessive heat can be just as harmful as chilling, so any form of artificial heat must be controlled. The temperature in the box should be maintained at 85 to 90 F (29.4 to 32.2 C), but the box should be large enough so the kittens can move away from the heat if it becomes uncomfortable.
Stillborn Kittens
It is not uncommon for one or two kittens in a litter to be stillborn. Sometimes, a stillborn kitten will disrupt labor, resulting in dystocia. At other times, the dead kitten will be born normally. Although there is always a cause for this occurrence, it is often not easily determined without an autopsy that includes cultures and the submission of tissues to a pathologist. This is only recommended in special circumstances.
Newborn Kittens
The mother will spend most of her time with the kittens during the next few days. The kittens need to be kept warm and to nurse frequently; they should be checked every few hours to make certain that they are warm and well fed. The mother should be checked to make certain that she is producing adequate milk.
If the mother does not stay in the box, the kittens' temperature must be monitored. If the kittens are cold, supplemental heating should be provided. During the first four days of life, the newborns' box should be maintained at 85 to 90 F (29.4 to 32.2 C). The temperature may gradually be decreased to 80 F (26.7 C) by the seventh to tenth day and to 72 F (22.2 C) by the end of the fourth week. If the litter is large, the temperature need not be as high. As kittens huddle together, their body heat provides additional warmth.
If the mother feels the kittens are in danger or if there is too much light, she may become anxious. Placing a sheet or cloth over most of the top of the box to obscure much of the light may resolve the problem. An enclosed box is also a solution. Some cats, especially first-time mothers, are more anxious than others. Such cats may attempt to hide their young, even from her owner. Moving from place to place may continue and will endanger the kittens if they are placed in a cold or drafty location. Cats with this behavior should be caged in a secluded area. This type of mother has also been known to kill her kittens as a means of "protecting" them from danger.
Troubleshooting with the Newborn Kitten.
Kittens should eat or sleep 90% of the time during the first 2 weeks. If they are crying during or after eating, they are usually becoming ill or are not getting adequate milk. A newborn kitten is very susceptible to infections and can die within 24 hours. If excessive crying occurs, the mother and entire litter should be examined by a veterinarian promptly.
When the milk supply is inadequate, supplemental feeding one to three times per day is recommended and should be performed on any litter with 5+ kittens. There are several commercial formulae available that are made to supply the needs of kittens. They require no preparation other than warming. They should be warmed to 95 to 100 F (35 to 37.8 C) before feeding. Its temperature can be tested on one's forearm; it should be about the same as one's skin. An alternative is canned goats' milk that is available in most grocery stores. The commercial products have directions concerning feeding amounts. If the kittens are still nursing from their mother, the amounts recommended will be excessive. Generally, 1/3 to 1/2 of the listed amount should be the daily goal. Supplemental feeding may be continued until the kittens are old enough to eat kitten food.
If the mother does not produce milk or her milk becomes infected, the kittens will also cry. If this occurs, the entire litter could die within 24 to 48 hours. Total replacement feeding, using the mentioned products, or adopting the kittens to another nursing mother is usually necessary. If replacement feeding is chosen, the amounts of milk listed on the product should be fed. Kittens less than 2 weeks of age should be fed every 3-4 hours. Kittens 2-4 weeks of age do well with feedings every 6-8 hours. Weaning, as described below, should begin at 3-4 weeks of age.
The First Few Weeks of Life
For the first month of life kittens require very little care from the owner because their mother will feed and care for them. They are born with their eyes closed, but they will open in 7 to 14 days. If swelling or bulging is noted under the eyelids, they should be opened gently. A cotton ball dampened with warm water may be used to assist opening the lids. If the swelling is due to infection, pus will exit the open eyelids and should be treated as prescribed by a veterinarian. If the eyes have not opened within 14 days of age, they should be opened by a veterinarian.
Kittens should be observed for their rate of growth. They should double their birth weight in about one week.
At two weeks of age, kittens should be alert and trying to stand. At three weeks, they generally try to climb out of their box. At four weeks, all of the kittens should be able to walk, run, and play.
Kittens should begin eating solid food about 3 to 4 weeks of age. Initially, one of the milk replacers or cow's milk diluted 50:50 with water should be placed in a flat saucer. The kittens' noses should be dipped into the milk 2 or 3 times per day until they begin to lap; this usually takes 1-3 days. Next, canned kitten food should be placed in the milk until it is soggy. As the kittens lap the milk, they will also ingest the food. The amount of milk should be decreased daily until they are eating the canned food with little or no moisture added; this should occur by 4 to 6 weeks of age.
Milk Fever
Eclampsia or milk fever is a depletion of calcium from the mother due to heavy milk production. It generally occurs when the kittens are 3-5 weeks old (just before weaning) and most often to mothers with large litters. The mother has muscle spasms resulting in rigid legs, spastic movements, and heavy panting. This can be fatal in 30-60 minutes, so a veterinarian should be consulted immediately.
Dietary Requirements of the Growing Kitten
Diet is extremely important for a growing kitten. There are many commercial foods specially formulated for kittens. These foods meet their unique nutritional requirements and should be fed until 12 months of age. Kitten foods are available in dry and canned formulations. Dry foods are less expensive and can be left in the bowl for the kitten to eat at will. Kittens will eat small amounts as often as 12 times during the day. Canned foods offer a change and are just as nutritious.
We recommend that you buy FOOD FORMULATED FOR KITTENS. Adult formulations are not recommended since they do not provide the nutrition required for a kitten. Advertisements tend to promote taste rather than nutrition so one should be careful that their influence on purchasing habits is not detrimental to one's cat. Table food is not recommended; although often more appealing than cat food, balanced, complete nutrition is usually compromised. Dog food should not be fed to cats since it is deficient in vital nutrients and the amount of protein required by kittens and adult cats.
We recommend that you buy NAME BRAND FOOD. It is generally a good idea to avoid generic brands of food. In the United States, we recommend that you only buy food that has the AAFCO (American Association of Feed Control Officials) certification. Usually, you can find this information very easily on the food label. AAFCO is an organization that oversees the entire pet food industry. It does not endorse any particular food, but will tell you if the food has met the minimum requirements for nutrition, which are set by the industry. Most of the commercial pet foods will have the AAFCO label.
Vaccinating the Kittens
Kittens are provided some immunity to feline diseases before and shortly after birth. The mother's antibodies cross the placenta and enter the kittens' circulation. Some antibodies are also provided in the mother's milk. These "maternal antibodies" protect the kittens against the diseases to which the mother is immune. This explains why is it desirable to booster the mother's vaccinations within a few months prior to breeding.
Although very protective, maternal antibodies last for only a few weeks; after this time, the kitten becomes susceptible to disease. The vaccination program should be started at about 6 to 8 weeks of age. Kittens should be vaccinated against feline enteritis (distemper or panleukopenia), respiratory viruses (feline herpesvirus and calicivirus), and rabies. If the kitten will be allowed to go outdoors or to be in contact with cats that go outdoors, leukemia virus vaccine should also be considered. Your cat's needs will be discussed at the time of the first visit for vaccinations.
Maternal antibodies are passed in the mother's milk only during the first 1-3 days after delivery. If, for any reason, the kittens do not nurse during this important period of time, their vaccinations should begin about 2 to 4 weeks of age, depending on likely disease exposure. A veterinarian can make specific recommendations for each particular situation.
Deworming the Kittens
Intestinal parasites ("worms") are common in kittens. Symptoms include general poor condition, chronic soft or bloody stools, loss of appetite, a pot-bellied appearance, loss of luster of the haircoat, and weight loss. Some parasites are transmitted from the mother to her offspring and others are carried by fleas. Some are transmitted through the stool of an infected cat. Very few of these parasites are visible in the stool, so their eggs must be detected by the veterinarian with a microscope.
A microscopic examination of the feces will reveal the eggs of most of these parasites. Generally, this test should be performed at the time of the first vaccinations. However, it may be performed as early as 3 weeks of age if a parasite problem is suspected. Treatment is based on the type of parasites found, although some veterinarians elect to treat all kittens because they know that fecal tests can be falsely negative. Your veterinarian should be consulted for specific recommendations for your kittens.
Cardiomyopathy in Cats
Cardiomyopathy literally means "disease of the heart muscle." This is a disease that occurs in purebred and non-purebred cats of any age. Males and females are equally affected. There are three distinct forms and a
variation of one of them. Each will be discussed separately.
Anatomy and Function of the Heart
The cat's heart is comprised of four chambers: the right and left atria (singular: atrium) (the top chambers) and the right and left ventricles (the bottom chambers). The right side of the heart receives oxygen-depleted blood from the body and pumps it to the lungs so it can receive oxygen. The left side of the heart receives oxygenated blood from the lungs and pumps it to the body. Each chamber has a valve at its opening and another valve at its exit. Each entry valve opens to allow blood to enter its chamber, and then it closes. At that precise moment, the exit valve opens and the walls of the chamber contract pushing blood out.
Cardiomyopathy principally involves the left side of the heart, the side that pumps oxygen-rich blood to the body. The left ventricle is involved first, and then the right ventricle often is affected.
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) causes the walls of the left ventricle to become thicker than normal. They are normally 4-5 mm thick; however, if HCM is present they may become over 10 mm thick. As they thicken they also become stiffer and less able to contract with the force needed to send blood to the distant parts of the body. Most of the thickening that occurs in the ventricular walls is directed inward causing the left ventricular chamber to be smaller. This limits the amount of blood that can enter the left ventricle and the amount of blood that can be pumped to the body. In addition, it puts great stress on the mitral valve, the valve between the left atrium and the left ventricle. After a few weeks the valve weakens and begins to leak, creating a murmur. This murmur will often be present several weeks to months before the cat goes into heart failure and may be detected during a routine physical examination.
HCM is also a disease of humans, and 50% of the time it is an inherited disorder. There is mounting evidence that HCM in cats is also a genetic disease, especially since it is often seen in cats less than 2 years of age. It is suggested that littermates of HCM cats be tested for the disease. The diagnosis of HCM is based on several tests. Hearing a murmur or an abnormal heart rhythm is a signal that other tests should be performed. An electrocardiogram (EKG) may show abnormalities that also suggest this disease. Radiographs (x-rays) of the heart usually reveal characteristic changes in the shape of the heart, especially in the latter stages when the left atrium enlarges. However, many cats in the early stages of the disease will have normal radiographs. An echocardiogram (ultrasound study of the heart) is the most precise means of diagnosing this disease. Ultrasound waves are directed into the heart and analyzed by a computer permitting precise measurements of the thickness of the heart's walls and the size of the chambers. We can also observe the mitral valve to access its function. Treatment is determined by the stage of the disease at the time of diagnosis. Cats in advanced disease are in congestive heart failure and treated with several drugs to keep the cat from dying. Diltiazem is used to relax the walls of the left ventricle so more blood can enter and so it can contract with more force. Propranolol is used to slow the heart rate when it is beating too fast. Furosemide is a diuretic that stimulates the kidneys to remove fluid that may have collected in the lungs (pulmonary edema). Aspirin is used to prevent blood clots that often form around the
mitral valve. Eventually, they dislodge from the valve and cause obstruction of arteries in various parts of the body. Enalapril is a new drug used for this disease. One study has shown that its use may result in
thinning of the left ventricular walls and even return to normal thickness in some cats. However, this drug takes 2-4 months to cause these results. If HCM is detected before the onset of congestive heart failure, enalapril and aspirin may be the only drugs that are needed. However, because the disease appears to be genetically caused, it is thought that enalapril probably should be given for the rest of the cat's life to prevent recurrence.
The prognosis is largely dependent on when the disease is diagnosed and how successful treatment is in correcting congestive heart failure. If it is diagnosed early or if congestive heart failure is controlled, many of these cats live for several years.
Dilated Cardiomyopathy
Dilated cardiomyopathy (DCM) results in thinning of the walls of the left ventricle. Instead of being 4-5 mm thick, they may become only 1-2 mm thick. As they become thinner they also stretch and become unable to contract properly. This results in enlargement (dilation) of the left ventricle. Even though more blood can enter the ventricle, the walls become so weak that they cannot pump the blood with enough force to send it to the distant parts of the body. The end result is congestive heart failure. In the 1980's, DCM was almost as common as HCM. However, it was discovered that a deficiency of the amino acid taurine was the cause of this disease in many cats. Cat food manufacturers were notified that cats need more taurine than was previously thought, and they responded by increasing its level in commercial cat foods. Consequently, DCM has almost disappeared. However, it is still seen in cats that eat primarily dog food or table food and occasionally in cats that eat commercial cat food. The latter causes us to realize that taurine deficiency is not the only cause of this disease, although other causes are not known at this time.
The diagnosis of DCM is based on several tests. An electrocardiogram (EKG) may show abnormalities that suggest this disease, although most of these cats have normal EKG's. Radiographs (x-rays) of the heart often reveal characteristic changes in the shape of the heart, especially in the latter stages when the left ventricle is markedly enlarged. However, many cats in the early stages of the disease will have normal radiographs. An echocardiogram (ultrasound study of the heart) is the most precise means of diagnosing this disease. Ultrasound waves are directed into the heart and analyzed by a computer permitting precise measurements of the thickness of the heart's walls and the size of the chambers. Treatment consists of drugs to control heart failure. Digoxin is usually used to cause an increase in the force of the contractions of the walls of the left ventricle. Furosemide is a diuretic that stimulates the kidneys to remove fluid that may have collected in the lungs (pulmonary edema). Aspirin is used to prevent blood clots that often form around the mitral valve. Eventually, they dislodge from the valve and cause obstruction of arteries in various parts of the body. Enalapril has shown some promise in treating this disease even though the mechanism of action is not understood at this time. Unfortunately, we do not have a drug that reverses the thinning of the left ventricular walls. Therefore, the long-term prognosis is not very good in many of these cats.
Restrictive Cardiomyopathy
Restrictive cardiomyopathy (RCM) is an uncommon variation of HCM. The walls of the left ventricle are thickened in some areas and not in others; they also become very stiff. One distinct difference is the presence of inflammation in the walls of the left ventricle. This finding raises the question of some type of infection as a possible cause of this disease. RCM progresses to congestive heart failure, just as the other types. A murmur is common, and the left atrium often dilates. Treatment is much the same as HCM, but the results are often not as good. Enalapril has not been used on enough of these cats to determine its effect.
Thyrotoxic Cardiomyopathy
Thyrotoxic cardiomyopathy is a very mild form of cardiomyopathy compared to the others. This disease is the result of another disease of cats, hyperthyroidism. Hyperthyroidism results in thyroid gland enlargement and overproduction of thyroid hormone. Excess thyroid hormone stimulates the heart resulting in mild thickening of the left ventricular walls. However, in this disease the force of heart contractions is usually greater than normal and these cats often have high blood pressure. Thyrotoxic cardiomyopathy resolves when hyperthyroidism is treated; therefore, it has a very good prognosis if proper treatment for its underlying disease occurs.
Blood Clots
When the heart is functioning normally, blood flows through it in a laminar (straight path) fashion. Each of the forms of cardiomyopathy cause abnormal flow patterns, especially around the mitral valve. This often results in blood clot formation on the valve. These clots get larger and larger until parts of them break off and are carried with the blood into the aorta and other major arteries. Most commonly, a clot will be carried down the aorta toward the rear legs. When the aorta splits to go to the rear legs, each new artery is smaller than the aorta, much like a tree that branches. The clot then is too large to continue down either artery so it suddenly stops, usually in such a way that blood flow is prohibited to the main artery of each rear leg. Suddenly, the cat is in severe pain and cannot use either rear leg. Within a few minutes to hours the feet become cold and the pads become bluish. This creates a severe crisis for the cat. It cannot walk on its rear legs, and it is in a great deal of pain. The clot that obstructs these arteries is commonly called a saddle thrombus.
Fortunately, there are other arteries that go to the rear legs. Although they are not as large, they are able to supply enough blood to the legs to keep the tissues from dying, in most cases. Over the next 5-10 days, these smaller arteries send new branches to the blood-deprived parts of the legs. During that time, various drugs are used to make the cat more comfortable, and massage and physical therapy are performed to support the muscles until they become functional again. The vast majority of cats will regain their ability to walk.
Surgery has been performed on some of these paralyzed cats to remove the blood clot. Sometimes the surgery is very successful, and the cat resumes walking almost immediately. However, the underlying disease that causes the blood clot to form is cardiomyopathy, so many of these cats will die during surgery because of heart failure.
Blood clots may obstruct other arteries. If one enters the renal (kidney) artery, kidney failure will result. If one goes to a front leg, lameness (but usually not paralysis) will occur. If one goes to the brain, a seizure or stroke is likely.
We do not have a drug that will dissolve the blood clots on the mitral valve or in the smaller arteries. However, aspirin is used to prevent their formation. The average 10-pound cat should receive an 81 mg aspirin 2-3 times per week (every 2-3 days). Eighty-one milligram aspirin is sold as "children's aspirin" or "low-dose adult aspirin." Children's aspirin (formerly known as baby aspirin) is usually chewable and orange flavored, a taste that is generally objectionable to cats. Low-dose adult aspirin is often enteric (hard) coated and more easily swallowed; that works best for most cats.
You may have heard that aspirin should never be given to a cat. Obviously, that is not a true statement. However, cats are able to break down aspirin very slowly. One dose remains in the cat's body for 48-72 hours. Therefore, as long as the dose is correct and the dosing interval long enough, it is very safe.
DO NOT SUBSTITUTE ACETAMINOPHEN (TYLENOL) FOR ASPIRIN. ACETAMINOPHEN IS VERY TOXIC TO CATS.
Warfarin is another drug that may also be used to prevent blood clots. It appears to be somewhat more effective than aspirin in some cats, but overdosing results in severe bleeding. Therefore, its use requires very careful monitoring of the cat's blood clotting ability.
Cat Scratch Disease
Cat Scratch Disease (CSD), also known as Cat Scratch Fever, is an infectious disease of humans. Evidence is increasing that the cat becomes infected with the causative organism, but it does not appear to produce disease in the cat. Very little is known or understood about the role as of the cat as a reservoir for this disease.
Contributing factors
A cat scratch is sometimes, but not always, associated with this disease. In one study, 99% of patients with CSD had exposure to cats. An increased risk of transmission is present when a kitten is involved, as opposed to adult cats.
Most cases are reported in the fall and winter, but the reason for its apparent seasonality remains unknown.
Clinical signs
Antibodies are proteins, which are produced by the immune system in response to some stimulus. About 5% of the United States population is known to have antibodies to CSD. Interestingly, about 20% of U.S. veterinarians will test positive for CSD antibodies. Very few of those testing positive have actually had the disease. The majority have had inapparent infections or have been exposed to the CSD organism without any signs of disease.
This is generally a mild disease in humans. Many people experience only fever, chills, and lethargy that last a few days. Unless the skin test is performed or the organism is cultured, it may be diagnosed as influenza. However, the more severe forms of the disease will produce very high fevers, marked lethargy, anorexia, and swollen lymph nodes, usually in the axillae (armpit) or groin. The lymph nodes may enlarge to the point of rupturing, or they may need to be opened surgically to establish drainage and relieve pain.
Cause
The cause of CSD has recently been identified as a bacterium called Bartonella henselea. A cat scratch is not necessary to transmit the organism; contact alone is sufficient.
The role of fleas and ticks in the life cycle and transmission of the organism is an area of research interest at present.
Diagnosis
The organism does not appear to cause disease in the cat. When humans are infected, the physician may make a diagnosis based upon clinical signs, exposure to cats, blood tests, and studies of lymph node biopsies.
Treatment
The appropriate course of therapy will be prescribed by your physician. In many cases, the disease is self-limiting and requires little or no treatment. In others, antibiotics, pain medication, and bed rest may be indicated.
Prognosis
The disease is usually self-limiting. It runs a course of several days to several weeks and then subsides. Even the severe forms respond to treatment within a few days although complete recovery may take several weeks.
Transmission to humans
The cat is involved because many cases of CSD are preceded by a cat scratch. Our best understanding of the cat's involvement is as follows:
1. The cat is almost always a kitten; adults are rarely involved.
2. The cat appears to be contagious for only about 2-3 weeks.
3. Declawing does not appear to decrease the transmission. The organism lives in the cat’s mouth and can be transmitted to the paws by grooming.
One should be very concerned about a family member having CSD. However, indefinitely banning cats from one's household is generally not warranted. It has been shown that less than 10% of family members scratched by the same cat develop the disease. In addition, there has not been a person recorded as having had the disease twice.
Prevention
At present, there is no available test to determine which cats carry the CSD organism. General considerations are as follows:
1. Declawing is not generally considered useful since the organism may be transmitted by contact alone.
2. When a kitten is involved, the likelihood of spreading the organism decreases as the kitten matures.
3. Euthanasia is not indicated because the involved cat is usually healthy.
4. If a cat does scratch or bite, wash the wound thoroughly with soap and water and, if indicated, contact a physician.
5. When an immune-deficient person receives any animal scratch or bite, always contact a physician.
Cholangiohepatitis
Definition
Cholangiohepatitis is a long and intimidating word that means an inflammation or infection in the gall bladder (cholangitis) and liver (hepatitis). It is a disease that is fairly common in cats of any age.
How it Develops
The liver produces bile that is vital to digestion. Although it is constantly produced, it is only needed when food is in the stomach or upper intestines. Therefore, unneeded bile is sent to the gall bladder for storage.
The upper small intestine (duodenum) not only needs bile for digestion, but it also needs bacteria. These are considered “good bacteria” as long as they stay in the duodenum and aid digestion.
The gall bladder is connected to the duodenum by the bile duct. This duct is designed to have one-way flow of bile. However, occasionally normal duodenal bacteria leave the duodenum and ascend the bile duct to the gall bladder and liver. This creates the infection we call cholangiohepatitis.
We do not know the precise circumstances that cause bacteria to enter the liver and gall bladder. Therefore, we consider this to be a disease of unknown cause.
Clinical Signs
Cats with cholangiohepatitis are usually quite ill. They often do not eat and usually have fever. Dehydration often results.
Any disease that affects the liver has the potential to produce icterus or jaundice. Cholangiohepatitis does this in most cats resulting in a yellow color to the skin and whites of the eyes. Liver disease also may cause vomiting.
Treatment
Treating any infection requires that we use antibiotics that are effective against the specific bacterium. If we can perform a culture of the infected site, we can make that determination. However, it is not usually possible to culture the liver or gall bladder without surgery.
Fortunately, we know that the typical bacteria that inhabit the duodenum are fairly limited in number. We also know that a few specific antibiotics are almost always effective against these bacteria. Therefore, most cats are treated very successfully with antibiotic therapy. It usually takes 1-2 weeks to clear this infection. Do not discontinue antibiotics before the prescription is completed, no matter how well your cat appears to be doing.
Some cats are very ill and require hospitalization so fluid therapy and nutritional support can be given. The hospital stay usually lasts 3-7 days. When your cat is discharged, antibiotics are usually dispensed to be continued at home.
Prognosis
A very large majority of cats with cholangiohepatitis recover completely without any long-term effects. Therefore, we definitely encourage treatment.
Recurrence
Because cholangiohepatitis is caused by the cat’s normal intestinal bacteria, the disease can occur again. However, in reality, very few cats have this disease a second time.
Chronic Nasal Discharge in Cats
When a cat has a discharge from its nose that lasts more than 2 months, it is considered chronic. Nasal discharge is classified based on the appearance of the draining fluid. The classification is as follows:
1. The discharge may be thin and clear like water - serous
2. The discharge may be thick and yellow or green in color, similar to pus - purulent
3. The discharge may be bloody - sanguineous or hemorrhagic
4. The discharge may be a combination of any of the above
Development of a chronic nasal discharge is not diagnostic for any particular disease; rather, it is a term that indicates the presence of an abnormality in the nose and frontal sinuses. Disease in the nose is called rhinitis, while disease in the sinuses is called sinusitis.
Almost all disease conditions that occur in the nose will cause inflammation of the delicate, lacy bones of the nasal passage; these fragile bones are called turbinates. With chronic inflammation, the turbinate bones are easily distorted and destroyed. When this occurs, it provides the ideal environment for growth of bacteria and, regardless of the underlying cause, a secondary bacterial infection ensues.
The frontal sinuses are hollow cavities in the skull and are located just above the eyes. They are connected to the nasal cavity by a small canal. Most diseases that occur in the nasal cavity have the ability to migrate up through these canals and involve the sinuses. Most diseases in the frontal sinuses begin in the nasal cavity.
Frequency
Nasal discharge is relatively common in cats. Depending on the breed and age of the cat, certain causes become more likely.
Clinical Signs
As noted above, a variety of nasal discharges may occur. Drainage may involve one or both nostrils. Regardless of the cause, the nasal discharge is usually accompanied by “stuffiness” or congestion and sneezing. In some cases, there may be swelling over the bridge of the nose or a growth protruding from the nostril.
Causes and Transmission
Chronic nasal discharge may result from several disorders involving the sinuses and nasal cavity. These include:
- Viral infection, either acute or chronic
- Chronic bacterial infection
- Chronic fungal infection
- Food allergy
- Nasal foreign body (grass, fly larvae, etc)
- Nasal tumor, usually malignant
- Inflammatory polyp
- Dental disease, especially with presence of a fistula (communication between the oral and nasal passages)
Diagnosis
A complete medical exam, to include a physical examination, bloodwork, and certain viral tests, should be done on cats with a chronic nasal discharge. The blood tests are not diagnostic for the cause of a nasal discharge, but offer information about the general health of the cat and may identify contributing factors for the nasal discharge. Testing for the feline leukemia virus and the feline immunodeficiency virus ("Feline AIDS Virus") is important because these viruses have the ability to weaken the cat's immune system, making recovery from normally mild infections more difficult.
Tests more specific for evaluation of the nasal discharge may include the following:
1. X-rays. Radiographs of the nasal passages and sinuses are helpful in identifying areas of bone destruction, dental disease. Because certain positions are necessary to view the nasal cavity and frontal sinuses, general anesthesia or sedation are required.
2. Nasal flush. A nasal flush is a diagnostic procedure used to collect material from deep within the nasal cavity. This material can be examined under the microscope (cytology) and can also be cultured. This procedure is done under anesthesia and is usually completed after the initial radiographs have been taken.
3. Rhinoscopy. Some veterinarians have a specialized instrument called an endoscope that allows examination of the nasal passage, the back of the throat, and the area around the soft palate. In order to pass this small flexible tube into the area of interest, anesthesia is required. Although foreign objects within the nasal passage can sometimes be detected with radiographs, rhinoscopy can be helpful for those cases where a foreign body is suspected by not seen on the x-rays. It is also helpful in removal of some foreign bodies.
4. Biopsy. There are some diseases that can only be diagnosed with a biopsy of material deep within the nasal cavity. A biopsy requires recovery of an actual piece of tissue, so surgery is often required for this procedure. If the veterinarian has a very small endoscope, the biopsy can occasionally be obtained without surgery.
5. Allergy testing. Allergic conditions (such as food allergy) are not detected by any of the above tests. This cause of chronic nasal discharge is diagnosed with a food trial. A food trial consists of feeding a special, hypoallergenic diet for 4-8 weeks and evaluating the cat's response.
6. Exploratory surgery. When the initial diagnostics are unsuccessful in identifying the cause, surgery is sometimes indicated so the nasal cavity or frontal sinuses can be explored.
It may require several days or weeks of testing to determine the cause of a chronic nasal discharge. When the diagnosis remains elusive, more sophisticated tests may be required. Veterinarians unable to perform these tests often refer the cat to a specialist.
Two viruses that can infect the nose may persist and lead to long term viral rhinitis/sinusitis. No drugs are available to kill them so this type of infection is often incurable. Some cats respond to the administration of a viral respiratory vaccine that is instilled into the nose.
Therapy
Administration of antibiotics alone is usually unsuccessful in curing bacterial infections of the nose and sinuses because the bacteria have become entrapped within the diseased turbinates. As mentioned above, bacterial infection of the nose and sinuses is usually secondary to another underlying problem. Although many cats improve while taking antibiotics, cortisone, or antihistamines, they frequently relapse when these drugs are discontinued.
The most common fungal infection in the nose is caused by Cryptococcus neoformans. Because some of the drugs used to treat this organism are quite expensive and will occasionally cause adverse effects, they are not used unless a firm diagnosis is made. Fortunately, the newer antifungal drugs have fewer significant side effects and many cats with fungal diseases can be treated with a successful outcome.
It is necessary to perform a food trial to make a diagnosis of food allergy. If the chronic nasal discharge responds to a hypoallergenic diet, that diet is usually continued to the exclusion of other foods. In some cases, other foods are tried to see if there may be several foods acceptable. If an acceptable diet is found, the prognosis is good.
When a piece of grass or other foreign material lodges in the nasal cavity, the membrane which lines the nose produces large amounts of mucus in response to the irritation it causes. In addition, affected cats will sneeze violently in an attempt to expel the foreign body.
If the foreign body cannot be sneezed out, the veterinarian must take steps to remove it. When a nasal foreign body is suspected but cannot be seen on radiographs or with an endoscope, exploratory surgery may be needed. If it is found and removed, the prognosis is good.
Most nasal tumors are malignant. Because complete surgical removal is unlikely, chemotherapy or radiation therapy must be considered. Unfortunately, many nasal tumors do not respond to either treatment, so the prognosis is poor. However, when surgery is performed to get tissue for biopsy, most surgeons remove as much of the tumor as possible. Following this procedure, the cat may be greatly relieved of the nasal discharge and remain improved for several months. However, in almost all cases, the tumor can be expected to recur.
Inflammatory polyps are non-cancerous growths that are composed of inflammatory cells. Extensive surgery is often successful in removing much of the polyp, but recurrence will result if not all of the polyp can be removed. Since these often begin in the internal ear and grow down the Eustachian tube into the back of the nose, their removal can require extensive surgery that may not be completely successful.
Prognosis
Prognosis is entirely dependent upon identification and successful treatment of the underlying cause of the nasal discharge. Regardless of the cause, cats infected with the feline leukemia virus or feline immunodeficiency virus will usually have a less favorable outcome.
Coccidiosis in Cats
Coccidiosis is an infection with a one-celled organism; these organisms are classified as protozoa and are called coccidia. Coccidia are not worms; they are microscopic parasites that live within cells of the intestinal lining. Because they live in the intestinal tract and commonly cause diarrhea, they are often confused with worms.
Means of Infection
Oocysts (immature coccidia) are passed in the stool of the cat. They lie in the environment and eventually sporulate (mature) into a more developed oocyst that can infect the cat again. Other cats, dogs, or mice may also become infected. This process can occur in as little as 6 hours, but it usually takes 7-10 days. If the sporulated oocysts are swallowed, they mature in the cat's intestine to complete the life cycle. If the oocysts should be swallowed by a mouse, the cat may also become infected by eating the mouse.
Clinical Signs
Most cats that are infected with coccidia do not have diarrhea or any other clinical signs. When the eggs (oocysts) are found in the stool of a cat without diarrhea, they are generally considered a transient, insignificant finding. However, in kittens and debilitated adult cats, they may cause severe, watery diarrhea, dehydration, abdominal distress, and vomiting. In severe cases, death may occur.
Diagnosis
Coccidiosis is diagnosed by performing a microscopic examination of a stool sample. Since the oocysts are much smaller than the eggs of the intestinal worms, a very careful study must be made. Infection with some of the less common coccidial parasites is diagnosed with a blood test.
Treatment
The most common drug used to eliminate coccidia is a sulfa-type antibiotic. It is given for 10-14 days. The medication is sweet tasting and objection to the taste is usually not a problem. If the sulfa-type drug is not effective, others are available. Additional medication may be needed if diarrhea and dehydration occur.
Reinfection of cats is common so environmental disinfection is important. The use of chlorine bleach, one cup in a gallon of water, is effective if the surfaces and premises can be safely treated with it.
Transmission to Humans
The most common coccidia found in cats do not have any affect on humans. However, less common types of coccidia are potentially infectious to humans. One parasite, called Cryptosporidium, may be carried by cats or dogs and may be transmitted to people. This parasite has also been found in public water supplies in some major cites. Another coccidial organism, Toxoplasma, is of particular concern to pregnant women because of the potential to cause birth defects in newborns.
These two coccidial parasites pose a health risk for immunosuppressed humans (i.e., AIDS patients, those taking immune suppressant drugs, cancer patients, the elderly). Good hygiene and proper disposal of cat feces are important in minimizing risk of transmission of all feline parasites to humans. Although there is risk of the cat transmitting these two particular parasites to humans, it does not warrant removing the cat from the household except in very rare instances.
Corneal Ulcers in Cats
The cornea is the clear, shiny membrane that makes up the surface of the eyeball. It is much like a clear window. To understand the significance of a corneal ulcer, you must first understand how the cornea is constructed.
The cornea is comprised of four layers. The most superficial layer is the epithelium. Actually, this layer is comprised of many, very thin layers of cells. Below the epithelium is the stroma. The next deeper layer is called Descemet's membrane. The deepest layer is the endothelium; it is composed of a single layer of cells. Because all of these layers are clear, it is not possible to see them without special stains and equipment. The cornea must maintain its transparency to ensure clear vision.
Corneal Abrasion vs. Corneal Ulcer
An erosion thorough a few layers of the epithelium is called a corneal erosion or a corneal abrasion. A corneal ulcer is an erosion through the entire epithelium into the stroma. If the erosion goes through the epithelium and stroma to the level of Descemet's membrane, a descemetocoele exists. If Descemet's membrane ruptures, the liquid inside the eyeball leaks out and the eye collapses. At times, differentiation of the two may not be straightforward. For this reason, cats with corneal disease should be rechecked frequently, usually every few days.
Clinical Signs
Because a corneal ulcer is quite painful, most cats rub the affected eye with a foot or on the carpet. To protect the eye, they keep the eyelid tightly closed or will frequently squint in an attempt to the eye closed. Some cats will seek dark areas because light is painful; they may hide under the bed or in a closet. Occasionally, there will be a thick white or yellow discharge that collects in the corner of the eye or runs down the face.
Causes/Transmission
A number of different disorders may lead to corneal ulceration. Some of these include trauma, foreign bodies, abnormalities of the eyelid, decreased tear production, chemical irritation to the cornea, and certain infectious diseases. In cats, viral respiratory disease is associated with a variety of corneal problems. Fortunately, ulcers rarely develop with these common respiratory viruses. Corneal ulcers can be seen more frequently in animals that have a lot of facial folds. When these folds occur close to the eye, they allow hair to constantly rub the cornea.
Diagnosis
Superficial corneal abrasions are usually not visible without special stains. They can be seen when a drop of fluorescein stain is placed on the cornea. The dye will adhere to an area of ulceration and is easily visualized with a special black light called a Wood's light or Wood’s lamp. This is the most basic test performed and may be the only test needed if the ulcer is acute (sudden) and very superficial. If the ulcerated area is chronic or very deep, samples are taken for culture and cell study prior to applying the stain or any other medication.
Treatment
Treatment depends on whether there is a corneal abrasion, corneal ulcer, or descemetocoele present.
Corneal abrasions generally heal within 3-5 days. Medication is used to prevent bacterial infections (antibiotic ophthalmic drops or ointment) and to relieve pain (atropine ophthalmic drops or ointment). Antibiotic drops are only effective for a few minutes so they must be applied frequently; ointments last a bit longer but still require application every few hours. It is suggested that an antibiotic preparation be instilled in the eye 4 to 6 times per day. On the other hand, the effects of atropine last many hours so this drug is only used twice daily. If the corneal ulcer does not heal within these first few days, complicating factors must be identified, if possible.
If a deep corneal ulcer or descemetocoele is present, measures must be taken to protect the eye and to promote healing. Since cats do not wear eye patches well, surgical techniques are often used to close the eyelid and cover the ulcer or descemetocoele. These measures protect the eye for several days, then are reversed so the cat can use the eye again. This approach is also taken if a superficial ulcer is very slow in healing.
Ulcers that do not heal well often have a buildup of dead cells on the edge of the ulcer. These dead cells prevent the migration of new, normal cells over to the ulcer defect. If this appears to be part of the healing problem, the dead cells are removed from the edges of the ulcer before the eyelids are surgically closed. In some cases, removing the dead cells may be all that is needed to start the healing process, so surgical closing of the eyelids may not be necessary.
Drugs Commonly Used
Atropine
A cat with a corneal ulcer has quite a bit of pain inside the eye, so it keeps it tightly shut. Atropine is used to relieve that pain. However, atropine also dilates the pupil widely. This means that the cat is very sensitive to light in that eye. Because of the light sensitivity, the eye will be held closed in bright light. Atropine's effects may last for several days after the drug is discontinued. Do not be alarmed if the pupil stays dilated for several days. Should you accidentally get atropine in your own eye, the same prolonged pupillary dilation will occur.
Antibiotics
Antibiotic drops or ointments are commonly used on ulcers. They do not cause the ulcer to heal better, but they treat or prevent bacterial infections from occurring within the ulcer. Bacterial infections greatly slow or even stop healing of a corneal ulcer. Antibiotic drops and ointments remain on the cornea for a short period of time. Therefore, they must be used several times each day. Ointments remain in contact with the cornea longer than drops, but many cats will object to the gooey medication in their eyes.
Topical Anesthetics
A topical anesthetic is often used to numb the cornea so the diagnostic tests may be performed. However, these drugs are toxic to the corneal epithelium; they prevent proper healing. They are safe for one time use, but they should not be used as part of treatment.
The Danger of Topical Steroids
It is important that steroids not be used in the eye too soon because they will stop healing of a corneal ulcer and may worsen it. Therefore, the fluorescein dye test should be performed before beginning this type of medication. If steroids are used and the eye becomes painful again, discontinue the steroids and have the eye rechecked. Steroids can cause the corneal ulcer to eventually perforate.
Side Effects of Treatment
Rarely, a cat will be allergic to an antibiotic that is instilled in the eye. If your cat seems more painful after the medication is used, discontinue it and contact the veterinarian.
If you see your cat drool or paw at the mouth after instillation of eye medications, do not be alarmed. The tear ducts carry tears from the eyes to the back of the nose. The eye medications may go through the tear ducts and eventually get to the throat where they are tasted. Atropine has a very bitter taste that may cause this response. Again, you are seeing your cat's response to a bad taste, not a drug reaction.
Discontinuation of Medication
The best way to tell that the cornea has healed is to repeat the fluorescein stain test. This should be done after about 2-3 days of treatment. If healing is progressing well, the eye should be checked again before treatment is discontinued to be sure healing is complete. Please consult with us before discontinuing medication unless you have been instructed otherwise.
Neovascularization
The normal cornea has no blood vessels going through it. However, when a corneal ulcer or descemetocoele occurs, the body senses a need to increase its healing capabilities. New blood vessels are created by a process called neovascularization. The new vessels begin at the sclera (the white part of the eye) and course their way to the ulcer. You may be able to see these new vessels as a small red spot adjacent to the ulcer.
Neovascularization is a good response because it hastens healing. However, after the ulcer is healed, these vessels remain in the cornea. They are not painful, but they do obstruct vision. Therefore, it is desirable to remove them. This is done with steroid (cortisone) ophthalmic drops or ointment. Cortisone is used for a few days to several weeks, depending on how many vessels exist.
Prognosis
The prognosis is usually good for uncomplicated corneal ulcers that receive prompt treatment. The prognosis is less certain when the ulcer is deep, the ulcer does not respond to medication, or a complication of the ulcer cannot be successfully treated.
Feline Cystitis
(Feline Lower Urinary Tract Disease)
The term "cystitis" literally means inflammation of the urinary bladder. Although this term is rather general, there is a common form of cystitis that occurs in male and female cats. This disease is also known as Feline Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD). It affects the bladder (not the kidneys), resulting in the production of bloody urine that contains microscopic crystals. The cat often urinates frequently, usually with the passage of only a few drops of urine. This is often confused with constipation.
Contributing Factors
Some of the factors which are associated with an increased incidence of FLUTD include neutering (both males and females), obesity, decreased physical activity, a diet of primarily dry food, and a decrease in water consumption.
Prevalence
The incidence of FLUTD in the general cat population is estimated at about 1%. Certainly many more cats are affected by this disorder than presented for veterinary care; some studies estimate 5-10% of all clinic admissions for cats may involve FLUTD.
Clinical Signs
Many cats will urinate in places other than the litter box, and often on hard surfaces such as tile floors, counter tops, sinks, and bathtubs. They should not be punished for doing so. In this situation, inappropriate urination is a reflection of the cat’s extreme discomfort and is not a behavior disorder.
Most cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort is usually mild but can become much worse if it is not treated. Female cats may develop l/2 inch diameter stones in the bladder that must usually be surgically removed. Male cats may develop enough crystals in the urethra (the narrow tube carrying urine out of the body) to cause an obstruction. This obstruction prevents elimination of urine from the bladder. If the obstruction is not relieved within 48 hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by complete obstruction is almost always found in male cats.
Causes/Transmission
We are not sure of the cause of this problem. Bacterial infections are the most common cause of cystitis in dogs and humans, but almost all cats with cystitis do not have bacteria in their urine. Neutering of male cats and feeding of dry cat food have been proposed as potential causes, but these have been disproved as initiating factors. It is true, however, that many dry foods may aggravate the problem after it begins. A herpes virus has been incriminated and someday may be proven to be the cause. Despite extensive research, the cause remains elusive.
Diagnosis
Diagnosis of FLUTD is relatively straightforward based on history, clinical signs, and evaluation of a urine sample.
Therapy
Each cat with cystitis is treated according to the changes in the urine (pH, crystals, blood, etc.), the type of crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of a bladder stone or urethral obstruction.
If neither a bladder stone or urethral obstruction is present, proper medication will generally relieve the discomfort. A urinalysis is necessary to determine the proper medication. A special diet, explained below, will help to dissolve crystals in the urine and hasten recovery.
If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually 1-3 days later. If he is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are needed.
Following initial treatment, you will be asked to return the cat in 7-10 days for a recheck of the urine. This is very important because some cats will appear to feel much better but the urine is still bloody or contains crystals. If medication is stopped based on how the cat appears to feel, treatment may be terminated prematurely and a relapse will probably occur.
Many cats have recurrence of cystitis. This is one reason that a virus is suspected as the cause. It is also the reason that a proper diet should be fed in the future.
Complications
The most common complication of a urethral obstruction is bladder atony. Atony means that the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to an extreme degree. Not all cats with obstructions develop atony; in fact, most do not. However, if this occurs, longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but this may take several days to as long as a week.
Another complication that occasionally occurs is kidney damage. Although feline cystitis does not directly affect the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary to treat the kidney damage. However, with aggressive treatment, most cats will recover their normal kidney function.
It should be noted that both complications, bladder atony and kidney damage, are the direct result of the bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the problem and prompt medical care.
A Surgical Option
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still have an occasional recurrence of cystitis; however they should not have another urethral obstruction.
This surgical procedure is also performed if the urethral obstruction is so severe that normal urine flow cannot be reestablished or if there are permanent strictures that develop in the urethra. Many cats with urethral obstructions have so much inflammation in their urethras that scarring may result due to the catheterization process. Of ten this is unavoidable.
Surgically changing the cat's urethra makes him more prone to bacterial infections in the bladder and bladder stones. Therefore, this surgery is only recommended if other means of prevention or treatment are not successful. Cats that have 2 or more urethral obstructions and those that re-obstruct within a few days after a catheter is removed are good candidates for surgery. Even if bacterial infections or bladder stones occur following surgery, they are not life-threatening like urethral obstructions so the surgery generally offers a significant benefit for the cat that really needs it.
Prognosis
The prognosis is generally good if the cat is responsive to medical management (i.e., change in diet). The prognosis is more uncertain if the cat has a long-standing obstruction or the bladder becomes atonic, as described above. Generally, cystitis becomes somewhat less common as cats mature.
Prevention
Two things should be done to help prevent recurrence.
1) Special diets are available to help prevent this disease. The specific diet is chosen based on the type of crystals present in the urine.
The most common type of crystals present in the urine is called struvite or triple phosphate. These crystals will dissolve in acidic urine. Therefore, acidification of your cat's urine can be a significant means of prevention. However, if your cat's crystals are not struvite, they are probably calcium oxalate. Acidification may actually make recurrence more likely if calcium oxalate crystals are present. Therefore, if at all possible, the crystals in the urine should be analyzed for their composition. This is the most important step in preventing future problems.
2) Restrict the cat's intake of dry cat food. Though dry foods do not cause cystitis, several studies have shown that the cat's total fluid intake is decreased when dry diets are fed. When the fluid intake is decreased, the urine is more concentrated with minerals and other materials that can cause future episodes of cystitis. Canned foods cause increased fluid intake and more dilute urine.
However, we know that many cats do not like canned food and that there are several distinct advantages to feeding dry food. Therefore, if there have been only a few infrequent episodes of cystitis, these other factors may be more important.
Be aware that diets sold in grocery stores are designed for preventing the type of lower urinary tract disease caused by struvite crystals. Since struvite disease is primarily a disease of young cats, older cats should not be eating them unless it is shown that struvite disease is present. In addition, older cats with kidney disease may have worsened disease if they are eating acidified diets. Therefore, store brand diets are not recommended for middle-aged and geriatric cats, as a rule. If you have older cats in the home that do not have a problem with FLUTD, they should be fed separately and offered their regular diet. For this reason, your veterinarian should be instrumental in helping you choose the food that is best for your cat.
Dental Disease in Cats
Dental disease is a common and often overlooked problem in cats. While cavities represent the most common dental disease of humans, cats are more frequently bothered by tartar buildup on the teeth. Tartar accumulation leads to irritation of the gums around the base of the teeth, ultimately leading to exposure of the roots. Potential outcomes of this tooth root exposure include gum infections and tooth loss.
Contributing Factors
One of the main factors determining the amount of tartar buildup is the individual chemistry in the mouth. Some cats need yearly cleanings; other cats need a cleaning only once every few years.
Diet plays more of a minor role in development of tartar accumulation than most people think. Because dry food is not as sticky as canned food, it does not adhere to the teeth as much and thus, does not cause tartar buildup as rapidly. However, eating dry food does not remove tartar from the teeth. Once tartar forms, a professional cleaning is necessary.
Other known contributing factors for feline dental disease are the feline leukemia virus and feline immunodeficiency virus. Severe disease of the teeth and gums can alert the veterinarian to test for these diseases.
Clinical Signs
In some cases, owners are unaware that their cat has dental disease. The problem may be identified with a routine physical examination or during investigation of another problem. In other situations, the probability of dental disease is apparent to the owner. The cat may have very bad breath (halitosis), difficulty eating, or changes in temperament.
Causes
Many different disorders can lead to dental disease in the cat. In general, the veterinarian will try to determine whether the problem is limited to the oral cavity (primary dental disease) or has developed as a consequence of another disease (secondary dental disease).
Diagnosis
Diagnosis of dental disease is usually very straightforward. In most cases, the true extent of the disease cannot be determined unless the cat is under anesthesia. This facilitates a more complete examination of the oral cavity.
The Cleaning Process
Proper cleaning of the teeth requires complete cooperation of the patient so that plaque and tartar can be removed properly. Anesthesia is required to thoroughly clean the teeth. Many owners have a high degree of anxiety related to general anesthesia for their cats. While there is always a degree of risk with any anesthetic, be aware that your cat’s health may ultimately be compromised by delaying proper dental care.
To minimize risk, our hospital uses modern anesthetics that are deemed safe even for older cats. Also, depending on your cat's age and general health status, blood may be drawn prior to anesthesia to evaluate blood cell counts and blood chemistry.
There are four steps in the cleaning process that will be used on your cat:
Scaling removes the tartar above and below the gum line. This is done with hand instruments and ultrasonic cleaning equipment. The tartar, which is under the gums, must be removed for a dental cleaning to be complete.
Polishing smooths the surface of the teeth, making them resistant to additional plaque formation.
Flushing removes dislodged tartar from the teeth and helps to remove the bacteria that accompany tartar.
Fluoride coating decreases teeth sensitivity, strengthens enamel, and decreases the rate of future plaque formation.
Prognosis
In the early stages of dental disease, the problems may be reversible. At some point, however, even cleaning cannot restore the mouth to normal. This is not a reason to avoid cleaning!
The prognosis is worsened if tartar is left on the teeth indefinitely. Some of the consequences of delayed dental care are:
1) Tartar will mechanically push the gums away from the roots of the teeth. This allows the teeth to loosen in their sockets and infection to enter the root socket. The teeth will loosen and fall out or have to be extracted.
2) Infection will accumulate in the mouth, resulting in gingivitis (gums), tonsillitis, and pharyngitis (sore throat). Although antibiotics may temporarily suppress the infection, if the tartar is not removed from the teeth, infection will return quickly.
3) Infection within the mouth will be picked up by the blood stream and carried to other parts of the body. Kidney and heart infections frequently begin in the mouth.
Prevention
Several preventive measures can be recommended to aid in oral hygiene for your cat.
1. Seek regular veterinary care and have the teeth cleaned when advised.
2. Try to maintain home dental care with brushing the teeth. Special toothbrushes and flavored toothpastes are available. We will be happy to show you how to do this and to recommend a schedule.
3. A tartar control diet is available through our clinic. It can be used as a maintenance diet or as a treat. It will not clean the teeth but will prolong the interval between professional cleanings (under anesthesia).
If we are planning to clean your cat’s teeth, please follow these recommendations:
In order for us to clean your cat's teeth, we ask that you schedule the procedure a few days in advance. It will be necessary to withhold food after __________ PM the night before; please do not withhold water. Your cat should be admitted to the hospital early by __________ AM and will generally be ready for discharge in the late afternoon. It will need to stay indoors that evening to insure that no accidents (falls, etc.) occur until recovery from anesthesia is complete. If that is not possible, you may elect to have your cat spend the night in the hospital. It should be fed and watered lightly that evening and returned to normal feeding the next morning, at which time it should be completely recovered from the anesthetic.
Diabetes Mellitus
Treating a diabetic cat can be a challenge. Some cats just never seem to stay regulated. However, there are several important concepts that make this process much more likely to be successful.
1. Consistency: Our goal is to find an appropriate dose of insulin that will last on a long-term basis. In order to do that, we must eliminate as many variables as possible. In other words, the more things that can stay the same from one day to the next, the easier it is to keep a diabetic regulated. Our goal is to give the same dose of insulin the same times each day, to feed the same food in the same quantities each day, to keep the activity level the same each day, and to keep your cat's stress level the same.
2. Tight control is not necessary in cats. Human diabetics must maintain blood glucose values very close to normal at all times. If they don't, they will develop some disastrous complications of diabetes, such as loss of fingers, toes, feet, and hands, kidney failure, and cataract formation. These complications do not happen to diabetic cats. Therefore, as stated above, it is better for the blood glucose to be too high than too low.
3. Hyperglycemia (high blood glucose) is always better than hypoglycemia (low blood glucose).
4. As the dose of insulin goes up, the blood glucose goes down.
5. Food intake causes the blood glucose to rise. Failure to eat allows the blood glucose to fall below normal.
The latter three above principles are applied as such: If you are not sure if you gave a dose of insulin or if it was properly injected, do not give it again. If your cat does not eat, do not give insulin. If you must miss a dose or two of insulin (occasionally), do not be concerned. Your cat's blood glucose will get too high for a day or two, but that will not cause great problems.
Understanding Diabetes
There are two forms of diabetes in cats: diabetes insipidus and diabetes mellitus. Diabetes insipidus is a very rare disorder that results in failure to regulate body water content. Your cat has the more common type of diabetes, diabetes mellitus. This disease is seen on a fairly regular basis, usually in cats 5 years of age or older. Simply put, diabetes mellitus is a failure of the pancreas to regulate blood sugar.
The pancreas is a small but vital organ that is located near the stomach. It has two significant populations of cells. One group of cells produces the enzymes necessary for proper digestion. The other group, called beta cells, produces the hormone called insulin.
Types of Insulin
In cats, two types of diabetes mellitus have been discovered. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups.
1. Type I, or Insulin Dependent Diabetes Mellitus, results from total or near-complete destruction of the beta cells. This is the most common type of feline diabetes. As the name implies, cats with this type of diabetes require insulin injections to stabilize blood sugar.
2. Type II, or Non-Insulin Dependent Diabetes Mellitus, is different because some insulin-producing cells remain. However, the amount produced is insufficient, there is a delayed response in secreting it, and the tissues of the cats body are relatively resistant to it. These cats may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalize blood sugar. Alternatively, they may be treated with insulin. Cats with NIDDM may ultimately progress to total beta cell destruction and then require insulin injections.
What Insulin Does for the Body
The role of insulin is much like that of a gatekeeper. It stands at the surface of body cells and opens the door, allowing glucose to leave the blood stream pass inside the cells. Glucose is a vital substance that provides much of the energy needed for life, and it must work inside the cells. Without an adequate amount of insulin, glucose is unable to get into the cells. It accumulates in the blood, setting in motion a series of events that can ultimately prove fatal.
When insulin is deficient, the cells become starved for a source of energy. In response to this, the body starts breaking down stores of fat and protein to use as alternative energy sources. As a consequence, the cat eats more; thus, we have weight loss in a cat with a ravenous appetite. The body tries to eliminate the excess glucose by eliminating it in the urine. However, glucose (blood sugar) attracts water; thus, urine glucose takes with it large quantities of the body's fluids, resulting in the production of a large amount of urine. To avoid dehydration, the cat drinks more and more water. Thus, we have the four classical signs of diabetes:
CLASSICAL SIGNS OF DIABETES MELLITUS:
Weight loss
Ravenous appetite
Increased water consumption
Increased urination
Diagnosing Diabetes
The diagnosis of diabetes mellitus is based on three criteria: the four classical clinical signs, the presence of a persistently high level of glucose in the blood stream, and the presence of glucose in the urine.
The normal level of glucose in the blood is 80-120 mg/dl. It may rise to 250-300 mg/dl following a meal or when the cat is very excited. However, diabetes is the only common disease that will cause the blood glucose level to rise above 400 mg/dl. Some diabetic cats will have a glucose level as high as 800 mg/dl, although most will be in the range of 400-600 mg/dl.
To keep the body from losing its needed glucose, the kidneys do not allow glucose to be filtered out of the blood stream until an excessive level is reached. This means that cats with a normal blood glucose level will not have glucose in the urine. Diabetic cats, however, have excessive amounts of glucose in the blood, so it will be present in the urine.
The diagnosis of diabetes seems rather simple, and in most cats it is. However, some diabetic cats do not meet all the criteria. For these, another test is performed called fructosamine. This test represents the average blood glucose level for the past two weeks. It minimizes the influence that stress and eating have on blood glucose levels and can be very helpful in understanding difficult cases.
What It Means for Your Cat to be Diabetic
For the diabetic cat, one reality exists. Blood glucose cannot be normalized without treatment. Although the cat can go a few days without treatment and not get into a crisis, treatment should be looked upon as part of the cat's daily routine. Treatment almost always requires some dietary changes. Whether an individual cat will require oral therapy or insulin injections will vary.
As for the owner, there are two implications: financial commitment and personal commitment.
When your cat is well regulated, the maintenance costs are minimal. The special diet, the oral medication, insulin, and syringes are not expensive. However, the financial commitment can be significant during the initial regulation process and if complications arise.
In some cases, your cat will be hospitalized for a few days to deal with the immediate crisis and to begin the regulation process. The "immediate crisis" is only great if your cat is so sick that it has quit eating and drinking for several days. Cats in this state, called ketoacidosis, may require a week or more of hospitalization with quite a bit of laboratory testing. Otherwise, the initial hospitalization may be only for a day or two to get some testing done and to begin treatment. At that point, your cat goes home for you to administer medication. At first, return visits are required every 5-7 days to monitor progress. It may take a month or more to achieve good regulation.
The financial commitment may again be significant if complications arise. We will work with you to achieve consistent regulation, but some cats are difficult to keep regulated. It is important that you pay close attention to our instructions related to administration of medication, to diet, and to home monitoring. Consistency is the key to prolonged regulation. The more you keep the medication, diet, and activity the same from one day to the next, the easier it will be to keep your cat regulated.
Another complication that can arise is hypoglycemia or low blood sugar; if severe, it may be fatal. This may occur due to inconsistencies in treatment or because some cats can have a spontaneous remission of their disease. This will be explained in subsequent paragraphs.
Your personal commitment to treating this cat is very important in maintaining regulation and preventing crises. Most diabetic cats require insulin injections twice daily, at about 12 hour intervals. They must be fed the same food in the same amount on the same schedule every day. If you are out of town, your cat must receive proper treatment while you are gone. These factors should be considered carefully before deciding to treat a diabetic cat.
Treatment
As mentioned, the key to successful treatment is consistency. Your cat needs consistent administration of medication, consistent feeding, and a stable, stress-free lifestyle. To best achieve this, it is preferred that your cat lives indoors. Although that is not essential, indoor living removes many uncontrollable variables that can disrupt regulation.
The first step in treatment is to alter your cat's diet. Diets that are high in fiber are preferred because they are generally lower in sugar and slower to be digested. This means that the cat does not have to process a large amount of sugar at one time. If your cat is overweight, a reducing-type diet is fed until the proper weight is achieved, then your cat is switched to a high fiber maintenance food.
Your cat's feeding routine is also important. The average cat prefers to eat about 10-15 times per day, one mouthful at a time. This means that food is left in the bowl at all times for free choice feeding. Fortunately, this is the best way to feed a diabetic cat. However, it is also desirable to monitor how much food is eaten each day. We realize that if you have more than one cat, this may be difficult, but please make an effort, as this is part of the home monitoring that should occur.
The second step in treatment is to use a drug to control (lower) control blood glucose levels. The choices are to give insulin injections or to give an oral drug. Either is acceptable, and both have advantages and disadvantages.
Insulin injections are usually the first choice because this approach is to replace the hormone that is missing or made in inadequate amounts. Although may people are initially uncomfortable with the thought of giving injections, for most cats, insulin injections are easier than giving tablets for reasons described below.
This is generally our preferred way to treat diabetic cats, especially if they are as follows:
1) Cats that do not take tablets well.
2) Cats belonging to owners who cannot give tablets.
3) Cats that fail to respond to the oral drugs.
4) Cats that have been ketoacidotic (because Type II diabetics rarely become ketoacidotic).
5) Cats belonging to owners who find injections easier to give than tablets. (Most cats are in this category. This is not because pills are hard to give but because injections are very easy to give.)
Many people are initially fearful of giving insulin injections. If this is your initial reaction, consider these points.
1) Insulin does not cause pain when it is injected.
2) The injections are made with very tiny needles that your cat hardly feels.
3) The injections are given just under the skin in areas in which it is almost impossible to cause damage to any vital organ. Please do not decide whether to treat your cat with insulin until we have demonstrated the injection technique. You will be pleasantly surprised at how easy it is.
The second option for treatment is the use of a tablet that lowers blood glucose. It is estimated that as many as 25% of diabetic cats have Type II diabetes. This means that they may be treated with oral medication instead of insulin injections. There is no reliable, practical test to know if your cat is one of these. Therefore, we must place your cat on an initial dose of glipizide or glyburide, the oral hypoglycemic drugs, for about 1 week. This is usually done at home if your cat is eating well. Weekly blood glucose levels are checked for about one month until it is determined whether or not response is occurring. If response occurs and blood sugar declines, this treatment is continued until it is no longer effective. That may be for many years or for only a few months, depending on the progression of destruction of the beta cells in the pancreas.
One disadvantage to treating with tablets is that some cats only have a temporary response. The tablets function by stimulating the existing beta cells so they work more efficiently. Many diabetic cats have a gradual decline in the number of functioning beta cells as time passes. This means that a time will come with the tablets are no longer effective.
Insulin Therapy and Administration
About Insulin
Insulin comes in an airtight bottle that is labeled with the insulin type and the concentration. Before using, mix the contents. It says on the label to roll it gently, not shake it. The reason for this is to prevent foam formation, which will make accurate measuring difficult. Some of the types of insulin used in cats settle out of suspension in a few hours. If it is not shaken properly, it will not mix well, and dosing will not be accurate. Therefore, the trick is to shake it vigorously enough to mix it without creating foam. Since bubbles can be removed (as described later), it is more important to mix it well than to worry too much about foam formation.
Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures. It should be kept in the refrigerator, but it should not be frozen. It is not ruined if left out of the refrigerator for a day or two as long as it is not exposed to direct sunlight. However, we do not advise this. Insulin is safe as long as it is used as directed, but it should be kept out of reach of children.
Several types of insulin are used in cats. Some are made for use in humans and obtained from regular pharmacies. Protamine zinc insulin (PZI) is made specifically for cats and obtained from veterinarians. PZI has a concentration of 40 units of active insulin crystals per milliliter of fluid. Thus it is called U40 insulin. Insulins made for humans have a concentration of 100 units per milliliter and are called U100 insulins. This is important to know because there are two types of insulin syringes, U40 syringes and U100 syringes. They are made to be used with their respective types of insulin and must not be interchanged or improper dosing will occur.
Drawing up Insulin
Have the syringe and needle, insulin bottle, and cat ready. Then, follow these steps:
1) Remove the guard from the needle, and draw back the plunger to the appropriate dose level.
2) Carefully insert the needle into the insulin bottle.
3) Inject air into the bottle; this prevents a vacuum from forming within the bottle.
4) Withdraw the correct amount of insulin into the syringe.
Before injecting your cat with the insulin, verify that there are no air bubbles in the syringe. If you get an air bubble, draw twice as much insulin into the syringe as you need. Then withdraw the needle from the insulin bottle and tap the barrel of the syringe with your finger to make the air bubble rise to the nozzle of the syringe. Gently and slowly expel the air bubble by moving the plunger upward.
When this has been done, check that you have the correct amount of insulin in the syringe. The correct dose of insulin can be assured if you measure from the needle end, or "0" on the syringe barrel, to the end of the plunger nearest the needle.
Injecting Insulin
The steps to follow for injecting insulin are:
1) Hold the syringe in your right hand (switch hands if you are left-handed).
2) Have someone hold your cat while you pick up a fold of skin from somewhere along your cat's back with your free hand (pick up a different spot each day).
3) Quickly push the very sharp, very thin needle through your cat's skin. This should be easy and painless. However, take care to push the needle through only one layer of skin and not into your finger or through two layers of skin. The latter will result in injecting the insulin onto your cat's hair coat or onto the floor. The needle should be directed parallel to the backbone or angled slightly downward.
4) To inject the insulin, place your thumb on the plunger and push it all the way into the syringe barrel.
5) Withdraw the needle from your cat's skin. Immediately place the needle guard over the needle and discard the needle and syringe.
6) Stroke your cat to reward it for sitting quietly.
7) Be aware that some communities have strict rules about disposal of medical waste material so don't throw the needle/syringe into the trash until you know if this is permissible. If it is not, we can dispose of them for you.
It is neither necessary nor desirable to swab the skin with alcohol to "sterilize" it. There are four reasons:
1) Due to the nature of the thick hair coat and the type of bacteria that live near the skin of cats, brief swabbing with alcohol or any other antiseptic does not really kill all the bacteria.
2) Because a small amount of alcohol can be carried through the skin by the needle, it may actually carry bacteria with it into the skin
3) The sting caused by the alcohol can make your cat dislike the injections.
4) If you have accidentally injected the insulin on the surface of the skin, you will not know it. If you do not use alcohol and the skin or hair is wet following an injection, the injection was not done properly.
Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature. Your cat will soon learn that once or twice each day it has to sit still for a few minutes. In most cases, a reward of stroking results in a fully cooperative cat that eventually may not even need to be held.
Monitoring
It is necessary that your cat's progress be checked on a regular basis. Monitoring is a joint project on which owners and veterinarians must work together.
Home Monitoring
Your part can be performed in one or both of two ways. The first way is to monitor your cat for signs of diabetes. To do this, you need to be constantly aware of your cat's appetite, weight, water consumption, and urine output. You should be feeding a constant amount of food each day, which will allow you to be aware of days that your cat does not eat all of it or is unusually hungry after the feeding. You should weigh your cat at least twice monthly. It is best to use the same scales each time. A baby scale works well for this. If you have several cats that eat together and use the same litter box, monitoring weight is the best because it is specific to this one cat.
If possible, you should develop a way to measure water consumption. The average 10 pound (4.5 kg) cat should drink no more than 7 1/2 oz. (225 ml) of water per 24 hours. Since this is highly variable from one cat to another, keeping a record of your cat's water consumption for a few weeks will allow you to establish what is normal for your cat. Another way to measure water consumption is based on the number of times it drinks each day. When properly regulated, it should drink no more than four times per day. If this is exceeded, you should take steps to make an actual measurement.
Urine output can be measured by determining the amount of litter that is scooped out of the litter box. This is a little less accurate if you have more than one cat that uses the litter box, but it can still be meaningful. The best way to measure litter is to use a clumping litter and scoop it into a sealable container. After a few weeks you will be able to know the normal rate at which the jar fills. Too rapid filling will indicate that your cat's urine production has increased.
Any significant change in your cat's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled. We should see the cat at that time for blood testing.
The second method of home monitoring is to determine the presence of glucose in the urine. If your cat is properly regulated, there should be no glucose present in the urine.
There are several ways to detect glucose in urine. You may purchase urine glucose test strips in any pharmacy. They are designed for use in humans with diabetes, but they will also work in the cat. The use of special non-absorbing kitty litter permits you to dip the test strip into urine in the litter box. Aquarium gravel, Styrofoam packing "peanuts," and commercial non-absorbing litter can be used. Since these are not ideal litter materials, they are best used on a periodic basis.
Another method is as follows:
1. Put about 1 tablespoon of wet litter in a small cup. (A clay type litter is required; clumping litter will not work.)
2. Add about 1 tablespoon of tap water to the litter and stir.
3. Dip a urine glucose test strip into the liquid and read it according to the directions on the bottle.
4. The results will be about half of the actual urine glucose amount because of the dilution of the added water.
If glucose is detected by either method, the test should be repeated the next two days. If it is present each time, we should see your cat for a blood test.
Monitoring of Blood Glucose
Determining the level of glucose in the blood is the most accurate means of monitoring. This should be done about every 3-4 months if your cat seems to be well regulated. It should also be done at any time the clinical signs of diabetes are present or if glucose is detected in the urine for two consecutive days.
Timing is important when the blood glucose is determined. Since eating will elevate the blood sugar for several hours, it is best to test the blood at least 6 hours after eating.
When testing the blood we want to know the highest and lowest glucose readings for the day. The highest reading should occur just before an injection of insulin is given. The lowest should occur at the time of peak insulin effect. This is usually 5-8 hours after an insulin injection, but it should have been determined during the initial regulation process. Therefore, the proper procedure is as follows:
1) Feed your cat its normal morning meal then bring it to hospital immediately. If you cannot get it to the hospital within 30 minutes, do not feed it. In that situation, bring its food with you.
2) Bring your cat to the hospital early in the morning without giving it insulin.
3) A blood sample will be taken immediately, then we will give insulin and feed your cat if it did not eat at home.
4) A second blood sample will be taken at the time of peak insulin effect.
If your cat gets excited or very nervous when riding in the car or being in the hospital, the glucose readings will be falsely elevated. If this occurs, it is best to admit your cat to the hospital the morning (or afternoon) before testing so it can settle down for testing the next day. Otherwise, the tests give us limited information.
Hypoglycemia
Hypoglycemia means low blood sugar. If it is below 40 mg/dl, it can be life-threatening. Hypoglycemia occurs under three conditions:
1) If the insulin dose is too high. Although most cats will require the same dose of insulin for long periods of time, it is possible for the cat's insulin requirements to change. However, the most common causes for change are a reduction in food intake and an increase in exercise or activity. The reason for feeding before the insulin injection is so you can know when the appetite changes. If your cat does not eat, skip that dose of insulin. If only half of the food is eaten just give a half dose of insulin. Always remember that it is better for the blood sugar to be too high than too low.
2) If too much insulin is given. This can occur because the insulin was not properly measured in the syringe or because double doses were given. You may forget that you gave it and repeat it, or two people in the family may each give a dose. A chart to record insulin administration will help to prevent the cat being treated twice.
3) If your cat has a spontaneous remission of the diabetes. This is a poorly understood phenomenon, but it definitely occurs in about 20% of diabetic cats. They can be diabetic and on treatment for many months, then suddenly no longer be diabetic. Since this is not predictable and happens quite suddenly, a hypoglycemic crisis ("insulin shock") is usually the first indication.
The most likely time that a cat will become hypoglycemic is the time of peak insulin effect (5-8 hours after an insulin injection). When the blood glucose is only mildly low, the cat will be very tired and unresponsive. You may call it and get no response. Within a few hours, the blood glucose will rise, and your cat will return to normal. Since many cats sleep a lot during the day, this important sign is easily missed. Watch for it; it is the first sign of impending problems. If you see it, please bring in your cat for blood testing.
If your cat is slow to recover from this period of lethargy, you should give it corn syrup (1 tablespoon by mouth) or feed one packet of a semi-moist cat food. If there is no response in 15 minutes, repeat the corn syrup or the semi-moist food. If there is still no response, contact us immediately for further instructions. (Note: Diabetic cats should not be fed semi-moist foods except for this situation.)
If severe hypoglycemia occurs, a cat will have seizures or lose consciousness. This is an emergency that can only be reversed with intravenous administration of glucose. If it occurs during office hours, come in immediately. If it occurs at night or on the weekend, call our emergency phone number for instructions.
Spontaneous Remission
Spontaneous remission means that a diabetic cat is no longer diabetic. This is a phenomenon that happens in about 15-20% of diabetic cats. Unfortunately, it can happen rather suddenly so a hypoglycemic crisis may be created because the owner does not realize remission has occurred and continues to give the normal amount of insulin .
For a few days after remission occurs, the cat is able to make emergency amounts of glucose as the blood glucose level falls to dangerously low levels. It does so by converting glycogen, a product stored in the liver, to glucose and releasing it into the blood stream. However, at some point in time the glycogen stores are depleted and it can no longer respond; a hypoglycemic crisis then occurs.
When it occurs, the cat may be normal for a few weeks or for many months. However, diabetes will almost always return because these cats have limited ability to make insulin. Therefore, you should watch for the typical signs of diabetes then contact us for insulin instructions.
SUMMARY OF INSTRUCTIONS FOR CATS RECEIVING INSULIN INJECTIONS
1) Read and reread this material so that you understand the specifics of proper regulation and how to recognize and treat hypoglycemia.
2) Give the first injection of insulin of _____units at about _________ AM/PM.
3) Return for a glucose curve at about the same time as you normally give insulin in 5-7 days. Allow your cat to eat through the night or feed it that morning and immediately bring it to the hospital. Do not give insulin, but bring it with you. (If it will take more than 30 minutes to drive to the hospital, call for instructions on feeding.)
4) Feed your cat one of the foods mentioned above.
SUMMARY OF INSTRUCTIONS FOR CATS RECEIVING GLIPIZIDE OR GLYBURIDE TABLETS
1) Have the prescription filled at any pharmacy.
2) Read and reread this material so that you understand the specifics of proper regulation and how to recognize and treat hypoglycemia. If hypoglycemia occurs, discontinue glipizide or glyburide until consulting us.
3) Give _____ tablet (_____ mg) twice daily (about every 12 hours) for 1 week. Return for a blood test about 6-8 hours following tablet administration.
4) Feed your cat one of the foods mentioned above.
Diarrhea in Cats
Diarrhea is not a disease; rather, it is a symptom of many different diseases. Many mild cases of diarrhea can be resolved quickly with simple treatments. Rarely, diarrhea is the result of a fatal illness, such as cancer. Even diarrhea caused by mild illnesses may result in death if treatment is not begun early enough to prevent severe fluid and nutrient losses.
We attempt to classify each case of diarrhea as either a major problem or a minor problem and localize the source of the diarrhea to the small intestine or large intestine (or both). It is important to determine how long the diarrhea has been present and whether the cat has lost weight with the diarrhea. We use all of the information gathered to formulate a plan for diagnostic and therapeutic procedures.
Contributing Factors
Some potential risk factors for diarrhea include dietary indiscretion, exposure to cats with certain illnesses, a positive status for feline leukemia virus or feline immunodeficiency virus, and travel to areas of endemic fungal infection.
Clinical Signs
With minor causes of diarrhea, the cat may have no signs of illness other than the loose stool.
Major causes of diarrhea result in the cat being visibly ill and exhibiting several, but usually not all, of the following:
1. Vomiting
2. Dehydration
3. Loss of appetite
4. Abdominal pain
5. High fever
6. Lethargy
7. Bloody and/or watery diarrhea
Causes
Minor causes of diarrhea include
1. Stomach or intestinal viruses
2. Intestinal parasites
3. Dietary indiscretions (such as eating garbage or other offensive or irritating materials).
Major causes of diarrhea may include
1. Inflammatory bowel disease
2. Neoplasia
3. Fungal or bacterial infection
4. Hyperthyroidism
5. Loss of pancreatic function
Diagnosis
If your cat does not exhibit the clinical signs of a major cause of diarrhea, we classify it as a minor cause. A minimum number of tests are performed to rule out common causes of minor diarrhea. These may include a physical examination, fecal exam for parasites, and possibly an x-ray.
For cats that are visibly ill with diarrhea (major case), diagnostic procedures are usually implemented quickly. We perform a series of tests that allow us to make a diagnosis so that specific treatment may be initiated. These tests may include tests for feline leukemia virus and feline immunodeficiency virus, radiography (x-rays) with or without barium, blood tests, stool cultures, biopsies of the intestinal tract, thyroid profiles, and exploratory abdominal surgery. Once a specific diagnosis is made, treatment may include special medications and/or diets, or surgery.
Therapy
With minor cases of diarrhea, treatment may be geared toward one or more of the common causes of uncomplicated diarrhea. Even with negative fecal examinations, many cats with uncomplicated diarrhea are routinely dewormed. Other therapies often include drugs to control the motility of the intestinal tract, medications that relieve inflammation in the intestinal tract and, often a special diet for a few days. This approach allows the body's healing mechanisms to correct the problem.
With major causes of diarrhea, initial therapy may be supportive; this would include fluid replacement, electrolyte replacement, and perhaps antibiotics. Additional therapy will depend upon the diagnosis.
Prognosis
With minor (uncomplicated) cases of diarrhea, we expect improvement within 2-4 days of initiating therapy. If this does not occur, a change in medication or additional testing may be needed to further define possible causes. Please keep us informed of lack of expected improvement so that we may manage the situation properly.
Transmission to Humans
Some of the bacterial and parasitic causes of diarrhea are infectious to humans. If any members of your household are also experiencing diarrhea, it is important to let us know. This will allow the veterinarian and physician to work together in managing potentially infectious causes of diarrhea.
Prevention
Preventive measures are directed toward the specific diagnosis
DIARRHEA QUESTIONNAIRE
1. How long has the diarrhea been present?
2. Is the diarrhea more severe now than a few days ago?
3. Circle the letter of each item that applies:
Consistency
a. Watery stool
b. Stool is about the thickness of pancake batter or pudding
Blood
c. Very bloody stool
d. Only sporadic blood present
e. Blood not present in stool
f. Bright red blood present
g. Dark, tarry blood present
Degree/Frequency
h. Entire stool is soft or watery
I. Only portions of the stool are soft or watery
j. Diarrhea with each bowel movement
k. Diarrhea is sporadic (some bowel movements are normal)
l. Only 1 or 2 bowel movements per day
m. More than 4 bowel movements per day
Color
n. Stool is dark brown in color
o. Stool is very pale in color
p. Stool is black and tarry in appearance
Miscellaneous
q. Thick mucus or pieces of tissue present in stool
r. Loss of bowel control (defecates in the house on the floor)
s. Severe straining when having a bowel movement
Is your cat's appetite normal? If not, is it eating at all?
What have you been feeding your cat during the last week? (Include dog or cat foods, treats, table foods, milk, and anything else that it gets on a daily basis. Also state what percentage of the diet is each item or category.)
Does your cat have access to foods other than what you feed it? If so, what?
Has there been a significant diet change in the last few weeks? If so, does that correspond with the onset of the diarrhea?
Is your cat as active as normal?
Describe any change in water consumption (increased or decreased).
Has vomiting been occurring? If so, how frequently and for how long?
Does your cat go outside your house? If so, does the cat go outside the yard?
Does your cat have access to garbage cans, either within your house or yard or outside your yard?
Does your cat have play-toys that could have been swallowed?
Does your cat have access to sewing materials, such as thread or needles, or rubber bands, or string?
Do you have other dogs or cats that live with this one? If so, does the other pet have diarrhea?
Do any of the members of your family currently have a diarrhea problem?
At what phone number may we reach you or your spouse today if we need further information?
Ear Infections in Cats
Infection of the external ear canal, also called the outer ear, is called otitis externa. When the middle ear and inner ear are involved, these are described as otitis media and otitis interna, respectively.
Contributing Factors
Normal cats seem very resistant to ear infections. Therefore, finding otitis externa in a cat prompts us to look for an underlying problem which led to development of the infection. For example, there could be ear mites, a foreign body, or polyp in the ear canal.
There are two viruses of cats, which can cause suppression of the immune system. Cats with ear infections, which cannot be explained, should be tested for these two viruses: the feline leukemia virus and the feline immunodeficiency virus (sometimes called the feline AIDS virus). A small amount of blood is needed to test for these viruses. Diabetic cats are also known to have more frequent ear infections than other cats. The diagnosis of diabetes mellitus can be made with a blood and urine sample from the cat.
Prevalence
While ear infections are a common problem in dogs, this disorder is occurs infrequently in cats. The Persian breed appears more prone to ear infections than other breeds of cats.
Causes/Transmission
Ear mites are one of the more common causes of otitis externa in cats. However, ear mite infections are generally limited to kittens and young cats. Ear mites in adult cats occurs most frequently after a kitten carrying mites is introduced into the household. Sometimes, ear mites will create an environment within the ear canal that leads to a secondary infection with bacteria and yeast (fungus). By the time the cat is presented to the veterinarian, the mites may be gone, but a significant ear infection remains.
Other causes include polyps or tumors in the ear canal, foreign material in the ear canal, trauma to the ear, and allergy.
Clinical Signs
A cat with an ear infection is uncomfortable; its ear canals are painful. It shakes its head trying to get the debris and fluid out, and it scratches its ears. The ears often become red and inflamed and develop an offensive odor. A yellowish discharge commonly occurs. When ear mites are present, the discharge may be black in color. An open wound behind each ear may result from the scratching.
Diagnosis
The ear canal is first examined with an otoscope, an instrument that provides magnification and light. This permits a good view of the external ear canal. In many cases, this examination also allows us to determine whether the eardrum is intact and if there is any foreign material in the canal. When a cat is extremely painful and refuses to allow the examination, it must sometimes be completed under sedation or anesthesia.
The next step is to examine a sample of the material from the ear canal to determine whether there are any infectious agents involved in the otitis. This is called cytology. Examination of this material under the microscope is very important in helping the veterinarian choose the right medication to treat the inflamed ear canal. There are several kinds of bacteria and at least one type of fungus that might cause an ear infection. Without knowing the kind of infection present, we do not know which drug to use.
In some cases, the material will need to be cultured. Also, if a mass is seen, it may need to be biopsied or removed.
Therapy
The results of the otoscopic examination and cytology tell us what to do. If there is a foreign body or tick lodged in the ear canal, the cat is sedated so that it can be removed. Cytologic study of debris from the ear canal dictates which drug to use. Sometimes, it reveals the presence of more than one type of infection (i.e., a bacterium and a fungus, or two kinds of bacteria); this situation usually requires the use of multiple medications.
An important part of the evaluation of the patient is the identification of underlying disease. If underlying disease is found, it must be diagnosed and treated, if at all possible. If this cannot be done, the cat is less likely to have a favorable response to treatment. Also, the cat might respond temporarily, but the infection will relapse at a later time (usually when medication is discontinued).
When an ear infection has been very chronic, narrowing of the ear canal occurs. There are medications that can shrink the swollen tissues and open the canal in some cats. However, some cases will eventually require surgery. The surgery for a closed ear canal is called a lateral ear resection. Its purposes are to remove the vertical part of the ear canal and to remove swollen tissue from the horizontal canal. Removing the vertical canal should be successful, but removal of large amounts of tissue from the horizontal canal is more difficult. In some cases, the ear canal is surgically obliterated. This solves the canal problem, but it leaves the cat deaf on that side.
Administration of Ear Medication
It is important to get the medication into the horizontal part of the ear canal. This is best done by following these steps:
1. Gently pull the earflap straight up and hold it with one hand.
2. Apply a small amount of medication into the vertical part of the ear canal while continuing to keep the earflap elevated. Hold this position long enough for the medication to run down to the turn between the vertical and horizontal canal.
3. Put one finger in front of and at the base of the earflap, and put your thumb behind and at the base.
4. Massage the ear canal between your finger and thumb. A squishing sound tells you that the medication has gone into the horizontal canal.
5. Release the ear and let your cat shake its head. If the medication contains a wax solvent, debris will be dissolved so it can be shaken out.
6. If another medication is to be used, apply it in the same manner.
7. When all medications have been applied, clean the outer part of the ear canal and the inside of the earflap with a cotton ball soaked with a small amount of rubbing (isopropyl) alcohol. Do not use cotton tipped applicators to do this, as they tend to push debris back into the vertical ear canal.
Prognosis
In the cat, nearly all ear infections that are properly diagnosed and treated can be cured. However, if an underlying cause remains unidentified and untreated, the outcome will be less favorable. A progress check may be needed before the process is completed, but we expect ultimate success. However, the presence one of the immune suppressing viruses will complicate treatment and will have long term implications on the general health of the cat.
Inappropriate Elimination Disorders in Cats
The term "elimination disorder" is used to describe cats that do not use their litter boxes for urination and/or defecation; instead, these cats eliminate somewhere in the house. Elimination disorders are the most common behavioral problem of cats. Because most owners take pride in their homes, house soiling by the cat can strain the owner-pet relationship to the
breaking point. Unfortunately, in some cases, frustrated owners give up their cat to an animal shelter or elect for euthanasia.
Contributing Factors
In some cases, a medical problem can be related to inappropriate elimination. When this is the case, improvement can be expected if the medical cause can be successfully treated. In most cases, however, inappropriate housesoiling is primarily a behavioral problem.
The more cats there are in a household, the greater the chances that inappropriate elimination will occur. One study found that for every cat present there is a 10% chance. This means that if there are 6 cats in a household, there is a 60% chance of inappropriate elimination occurring.
Prevalence
A recent study performed by an animal behaviorist at the University of Pennsylvania reported that 40 to 75% of all cats presented with behavior problems had an elimination disorder. It appears that longhaired cats are over-represented as compared to shorthaired cats.
Causes
As mentioned above, after medical causes of these problems have been ruled out, the source of the problem is considered a behavioral disorder. Behavioral causes of inappropriate elimination fall into two general categories: 1) a dislike of the litter box, and 2) stress-related misbehavior.
One of the main reasons for the cat avoiding the litterbox is because the box has somehow become objectionable to the cat. This usually occurs because it is not cleaned frequently enough or because the cat objects to the type of litter used; this is called substrate aversion. Sometimes, the cat dislikes the location of the litterbox (avoidance of location). Substrate aversion is by far more common than avoidance of the box because of its location.
There are many possible related causes. Some of these can include the following:
1. A new person (especially a baby) in the house
2. A person that has recently left the house (permanently or temporarily)
3. Several new pieces of furniture or rearrangement of existing furniture
4. New drapes or carpet
5. Moving to a new house
6. A new pet in the house
7. A pet that has recently left the house
8. A new cat in the neighborhood that can be seen by the indoor cat
9. A cat in heat in the neighborhood
10. A new dog in the neighborhood that can be seen or heard by the indoor cat
Therapy
Most successful treatments rely on a combination of behavior modification techniques and drug therapy.
A. Behavior Modification
Behavior therapy involves a dual approaching involving (1) Aversion Therapy and (2) Attraction Therapy. The former repels the cat from the inappropriate location, and the latter encourages the cat to choose an appropriate location.
The purpose of Aversion Therapy is to make the area of inappropriate urination or defecation undesirable for the cat. There are many ways to do this, but the following steps have proven successful in a high percentage of cases.
1. A product to neutralize the odor of urine or stool should be used in places where inappropriate urination or defecation has occurred. Several products are available for this purpose. When using one of these, try it on a hidden piece of carpet (in a closet, etc.) to be sure it does not stain your carpet.
Although many of the available products do a good job, none of them will undo months or years or repeated soiling. The sooner the affected area is treated, the better. If the objectionable location is on carpet, it is necessary to treat the carpet and the pad below because most of the odor will be in the pad. This usually means soaking the carpet with the neutralizing
product so it penetrates into the pad.
2. If the soil in potted plants is being used, place a lemon-scented air freshener at the base of the plant. This will usually repel the cat. In some cases, the plant may need to be removed.
3. Cover the area(s) with aluminum foil and secure it to the carpet or furniture with masking tape. Aluminum foil is a surface on which most cats will not walk.
The purpose of Attraction Therapy is to make the litter box more desirable than the inappropriate site. The following are usually successful:
1. Purchase a new, non-hooded litter box; even well cleaned litter boxes have odor deep in the plastic. Although we like our privacy, most cats find a hooded litter box undesirable presumably because it traps odors inside.
2. Put non-scented clumping litter in the new litter box. If your cat has not been using this type of litter, it will usually find it more desirable than the clay types. In generally, most cats seem to prefer these newer litters because they have a more "natural" feeling to the feet. Some behaviorists theorize that these new litters are more reminiscent to the cat's ancestral elimination substrate - desert sand.
3. Place the new litter box near the area of inappropriate urination until it is used for several days, and then move it 2-3 feet (0.7-1 m) per day back to the desired location. Eventually, there will be two litter boxes side-by-side. When you cat clearly chooses one or the other, remove the extra one.
4. Keep the existing litter box in the normal location in case the aversion therapy causes your cat to return to it.
B. Medical Therapy
This usually involves one of three types of medications.
1. Anti-anxiety drugs, including amitriptyline and buspirone
2. Tranquilizers, including diazepam and phenobarbital
3. Hormones, including megestrol acetate and medroxyprogesterone acetate
While none of the oral medications have been approved for use on cats, most have been in use long enough to give us reason to believe that they are very safe.
Buspirone (trade name BuSpar) is an anti-anxiety drug prescribed by physicians; it is a human drug, not a veterinary drug. It has been shown to be effective in a significant number of cats with elimination behavior problems.
Its success rate is not 100% but, for the intended purpose, it has been shown to be more effective than many of the other drugs.
The following outline should be followed. If the sequence is not clear, please call for further instructions.
1. Give 5 mg (1 tablet) twice daily for 1 week
a. If there is no response, give 7.5 mg (1 1/2 tablets) twice daily for one week
1) If there is no response, discontinue buspirone.
2) If there is good response, give 5 mg twice daily for 8 weeks.
b. If there is good response, give 5 mg twice daily for 8 weeks.
2. If a relapse occurs after successful therapy, resume buspirone at a dose of 5 - 7.5 mg twice daily and continue for 6-12 months.
C. Another Option
Recently, a pharmaceutical company introduced an aerosol spray, called Feliway, which can be used in the area of appropriate elimination. The solution contains a synthetic derivative of feline hormones, called pheromones. It is thought to have a calming and comforting effect on some cats. It has not been completely studied by independent researchers but is
thought to show some promise in decreasing, though not totally eliminating, inappropriate elimination in cats.
Prognosis
The prognosis for improvement is more likely if several of the following are true:
1. The duration is less than 1 month when treatment begins.
2. There are only one or two locations in the house that the cat uses for inappropriate elimination.
3. It is possible to identify and relieve the stress-causing situation.
4. It is possible to neutralize the odor caused by the urine or stool.
5. You have only one cat.
Eosinophilic Granuloma Complex
The eosinophilic granuloma complex is a group of diseases that appear to be related. They causes are distinct lesions on the skin that respond to the same treatment; this is one of the reasons that they are grouped together as a "complex." The name is somewhat misleading because not all variations of the lesions contain eosinophils (a type of white blood cell).
Eosinophils are normal blood cells that are part of the body's immune system. Their numbers increase in certain diseases, including allergies and parasites. They are also found in high numbers in a few other diseases but are typically not related to cancer.
Prevalence
Lesions of the eosinophilic granuloma complex are relatively common in the cat.
Clinical Signs
There are three rather distinct types of lesions in the eosinophilic granuloma complex: 1) rodent (indolent) ulcer, 2) eosinophilic plaque, and 3) linear (collagenolytic) granuloma.
A rodent ulcer (indolent ulcer) begins as an ulcerated area on the upper lip between the large canine teeth. As it increases in size, the upper lip may become swollen and very painful. It is named a "rodent" ulcer because there was a belief that mice and rats were biting the cat's upper lip as they were being attacked. However, this problem has nothing to do with rodents.
The eosinophilic plaque is a round to oval area on the skin that is very red and inflamed. These lesions are characterized by intense itching. Hair is often lost over the area possibly due to licking by the cat. These lesions may be 1" to 4" across and usually occur on the ventral abdomen (belly). They are sometimes accompanied by smaller lesions on the bottom of the feet or in the mouth.
The linear (collagenolytic) granuloma is usually a raised, rope-like lesion along the rear aspect of the upper part of the back legs; however, it may occur in other locations as well. It may be 1/4" to 1/2" across and several inches long. In some cats, it presents as a swollen or “fat” chin. It is non-painful, and the hair usually does not fall out around or over it. Owners often find it as they pet or hold their cat.
Causes/Transmission
Animal dermatologists believe that, in most cases, these lesions are rooted in an allergic reaction. In particular, the lesions may be a response to food allergy, fleabite allergy, or inhalant (hayfever-type) allergy.
Diagnosis
Each of the three diseases has a characteristic appearance and can often be diagnosed just from that. If the diagnosis is not certain, a biopsy may be performed. A biopsy of the eosinophilic plaque reveals a large number of eosinophils. The other two forms may or may not have eosinophils present, but the pathologist can identify other characteristics that make the diagnosis.
Treatment
Each of these diseases responds well to corticosteroids ("steroids" or "cortisone"). The injectable forms of steroids are usually more effective than steroid tablets. Response should begin within one day and near-recovery should occur within one week. The steroid injection may need to be repeated in 3-4 weeks for a complete response.
Some of these lesions are infected with skin bacteria. Therefore, antibiotics may be part of the treatment.
A cat with a rodent ulcer may be having a contact allergy to the food bowl. There are anecdotal reports of cure just by changing from plastic bowls to glass, porcelain, or stainless steel bowls. Since this is a simple thing to do, it probably should be tried if your cat eats or drinks out of a plastic bowl.
Prognosis
Unfortunately, most of these diseases recur when the injection of steroids has dissipated; this usually takes 3-4 weeks. Repeated injections may be needed, although some occur just in certain parts of the year. Many cats can be controlled long-term with oral steroids if the tablets are preceded by an injection.
Feline Hepatic Lipidosis
(Fatty Liver Syndrome)
Hepatic lipidosis, also known as fatty liver syndrome (FLS), is one of the most common liver disorders of the cat. It is also seen in horses, dairy cows and rarely in very young puppies. In dogs, however, it is not thought to cause a significant illness. In humans, it is a serious disease which can occur with pregnancy.
Contributing Factors
In most cases, the cause remains undetermined (Idiopathic FLS). Obesity and a period of anorexia lasting at least one week are common historical findings. Less commonly, the fatty liver syndrome occurs secondary to a disease that might lead to anorexia, such as cancer or an infectious disease.
Prevalence
Idiopathic fatty liver syndrome is most common in cats that are overweight. Many of these cats have lost up to 25% of their body weight when the liver problems are discovered. Also, most cats with idiopathic fatty liver are middle aged and female.
Clinical Signs
In the anorexic cat, fat is broken down to supply energy for normal metabolism. As this fat is mobilized, it is deposited in the liver. Without an adequate source of dietary protein, the fat cannot be removed from the liver. It continues to accumulate until liver failure eventually results.
With time, the cat usually becomes icteric or jaundiced, as evidenced by a yellow color in the whites of the eyes or in the skin. As toxins normally processed by the liver continue to build up in the blood, the nervous system becomes affected. Depression, seizures, disorientation, and head pressing will occasionally occur.
Causes/Transmission
As noted above, for most cats, a cause is not determined. In a few cases, fatty liver develops secondary to a disease that causes anorexia.
Diagnosis
Diagnosis of the FLS is made from blood tests for liver function and from a liver biopsy or fine-needle aspirate. The latter involves inserting a very tiny needle through the skin and into the liver, removing a small number of liver cells, and examining those cells under the microscope. The FLS cat will have a large amount of fat in and among the liver cells.
Therapy
This disease is treatable, but aggressive intervention is necessary. The main thrust of treating FLS is geared toward nutritional support of the cat until it begins to eat voluntarily. A consistently high quality diet will allow the liver to resume functioning so it may remove the fat. This does not occur quickly; it takes an average of 6-7 weeks. Therefore, a method of tube feeding must be used to allow you to feed your cat at home.
Several routes are available for feeding the cat. We have chosen to use the esophagostomy tube, which is a small rubber tube that enters through the cat's skin in the neck. It goes into the esophagus so that food can be delivered to the stomach. It does not go into the stomach because of complications that can arise.
A special food mixture, listed below, is syringed through the tube three to five times per day. This food is formulated to meet the cat's nutritional needs; it should not cause vomiting or diarrhea. To feed your cat, follow these steps:
1. Place 1 can of Feline p/d* + 10 oz of water + 2 oz of Wesson Oil* + 8 Tumil-K* tablets in a blender and run it at the liquefy (fastest) speed until the food is uniformly mixed. After mixing, pour the food through a kitchen strainer.
2. Remove the cap from the feeding tube.
3. Using the syringes provided, inject the food into your cat's feeding tube using the following schedule:
____ ml ____ times per day for ____ days (FOR A TOTAL OF ____ ml PER 24 HOURS)
then
____ ml ____ times per day for ____ days (FOR A TOTAL OF ____ ml PER 24 HOURS)
then
____ ml ____ times per day for ____ days (FOR A TOTAL OF ____ ml PER 24 HOURS)
then
____ ml ____ times per day (FOR A TOTAL OF ____ ml PER 24 HOURS).
4. When the food has been injected, inject 5 ml of tap water through the tube so food does not remain in it; replace the cap in the tube.
5. Any remaining food should be stored in the refrigerator. Before the next feeding, it should be warmed to body temperature under hot tap water or in a microwave oven. If you heat it in a microwave oven, be sure to thoroughly mix the contents prior to feeding because of uneven heating. Also, always check the temperature prior to feeding to be sure that it is not too hot.
Persistence is essential. The average cat requires 6-7 weeks of feeding before it begins to eat. At least once weekly, offer your cat a small amount of its favorite food so that you will know when its appetite returns. The esophagostomy tube will not hinder chewing or swallowing. After your cat has been eating well for 3-4 days, it should be returned to the hospital for tube removal. Removal of the tube is simple and does not require anesthesia; however, you should not attempt to remove the tube yourself.
Persistence is essential. The average cat requires 6-7 weeks of feeding before it begins to eat. At least once weekly, offer your cat a small amount of its favorite food so that you will know when its appetite returns. The esophagostomy tube will not hinder chewing or swallowing. After your cat has been eating well for 3-4 days, it should be returned to the hospital for tube removal. Removal of the tube is simple and does not require anesthesia; however, you should not attempt to remove the tube yourself.
Prognosis
In most cases of idiopathic FLS, the prognosis is good if nutritional intervention is undertaken before the onset of liver failure. When the underlying cause of the FLS is untreatable, the prognosis is not good.
Vomiting is an important sign in determining the prognosis. Although many cats with the FLS will vomit occasionally, those that vomit repeatedly have a lesser chance of recovery. Repeated vomiting usually means that the liver failure is very severe or that a disease of the pancreas (pancreatitis) is also present. Either may result in the cat not recovering.
Transmission to Humans
There is no associated health risk for the owners of cats with hepatic lipidosis.
Prevention
It is possible for idiopathic FLS to occur again. It is helpful for owners to be observant of the cat’s food intake and guard against stressors that might precipitate anorexia. Maintaining an ideal body weight and avoiding obesity in affected cats is advisable.
Feline Leukemia Virus Diseases
Feline leukemia virus infection was, until recently, the most common fatal disease of cats. Because we can now protect cats with a leukemia virus vaccine, we are seeing fewer cases of the disease. However, it still remains a major cause of death in cats.
"Leukemia" means cancer of the white blood cells. This was the first disease associated with the feline leukemia virus (FeLV) and, thus, the source of its name. We often use the term "leukemia" rather loosely to include all of the diseases associated with the virus, even though most are not cancers of the blood. This virus causes many other fatal diseases, in addition to leukemia.
Feline leukemia virus is classed as a retrovirus. The retroviruses are of particular importance because they have the ability to integrate into the genetic material, or DNA, of the host. For this reason, some call the retroviruses “the ultimate genetic parasites.” There are three subtypes of the virus and the diseases caused are dependent upon the particular subtype involved. The feline immunodeficiency virus, or feline AIDS virus, is another feline retrovirus. In humans, HIV is caused by a retrovirus.
Contributing Factors
Cats who are greatest risk for contracting the feline leukemia virus are those who live in close, direct contact with an infected cat. Fighting is a known risk factor because the virus is shed in saliva. Kittens may contract the virus from the mother via the placenta.
Prevalence
In the total population of cats, the incidence of FeLV is only about 1-2%. Free-roaming adult cats that are FeLV-negative have usually acquired age-related resistance to the virus. The incidence is much higher in “exposure households,” or households where there is a FeLV-positive cat living among other cats. In this setting, 30% - 100% of the cats may be found to test positive.
Clinical Signs
There are three major disease categories associated with the FeLV:
1) Leukemia is a cancer of the white blood cells.
2) Lymphosarcoma (also called Lymphoma) is a cancer of many different organs but it begins in lymphoid tissue, such as a lymph node. Almost any tissue may be affected; organs commonly involved include lymph nodes, intestinal tract, kidneys, liver, spinal cord, brain, bone marrow and blood. In young cats, lymphoma often manifests as a mass within in the thoracic cavity; this is called “mediastinal lymphoma.”
3) The Non-Cancerous Diseases include a variety of somewhat unrelated diseases. Anemia, abortion, arthritis, and immune suppression are examples. When the immune system is suppressed, the cat becomes susceptible to many diseases it would ordinarily resist and mild diseases, such as respiratory infections, may become fatal.
Causes/Transmission
The main means of transmitting the virus is through cat fights. Because large quantities of the FeLV are shed in cat saliva, puncture wounds associated with fighting result in injection of the virus into other cats. There are also large amounts of virus in respiratory secretions. Other less frequent routes of viral spread include sharing food and water bowls, cats grooming each other, and transmission from mother to kittens before birth.
Diagnosis
The "leukemia test" is used to determine if a cat harbors the virus. Any of three different tests may be used to detect one particular virus protein in the cat. Some tests detect earlier stages of infection, whereas others are used to detect later (i.e., irreversible) stages of infection.
1. The blood ELISA test is performed on a blood sample and detects the FeLV at any stage of infection. This test turns positive within a few days of infection and, in some cases, may later turn negative if the cat’s immune system eliminates the infection.
2. The IFA test is performed on a blood smear and turns positive only after the FeLV infection has progressed to a late stage of infection. Once positive, the IFA test usually means that the cat has a permanent infection. A cat that tests IFA positive is only rarely able to successfully eliminate the virus. The cat that is IFA positive is called “persistently positive” or “persistently viremic.”
3. The tears/saliva ELISA test is performed on a sample of tears or saliva. It turns positive only in a late stage of infection; therefore, it may yield a false negative result in cats that are in the early stage of FeLV infection. It also has been associated with some false positive results due to inherent errors in the way the test is performed. Because of these problems, the tears and saliva tests are not used routinely.
The Cat that Tests Positive - Possible Outcomes of FeLV-infection
When we are exposed to a virus, such as a flu virus, there are two possible outcomes. Either our immune system responds to the challenge and protects us, or it is unable to respond successfully and we develop the flu. A number of factors determine which outcome occurs and whether or not we will get sick:
1. The amount of the virus (Did someone sneeze directly in your face?)
2. The strain of the virus (Some strains are more potent than others.)
3. The status of our immune system (Are immune suppressing drugs being taken?)
4. Age (The very young and very old are more likely to become infected.)
5. The presence of other infections which might cause debilitation
The behavior of the feline leukemia virus in the cat’s body cannot be predicted. Instead of the two possible outcomes described above (i.e., we get sick or we get well), there are four possible outcomes for cats with FeLV. Understanding these allows one to more fully comprehend some of the unusual situations that may arise in cats.
OUTCOME 1: IMMUNITY The cat mounts an immune response, eliminating the infection.
This is the most desired outcome because it means that the cat will not become persistently infected with the virus. During this period of virus challenge, the cat may actually develop a mild form of illness. Fever, poor appetite, lethargy, and swollen glands (lymph nodes) in the neck may develop and last for 3 to 10 days. Outcome 1 occurs about 40% of the time after a cat is challenged by the FeLV. Immunity to the virus is more likely to develop in the adult cat than in the kitten.
OUTCOME 2: INFECTION The cat's immune system is overwhelmed by the virus.
This is the least desired outcome because the cat is persistently infected with FeLV. All three of the FeLV tests will become positive and remain positive for the rest of the cat's life.
Although the cat may be sick for a few days initially (as described above), it usually recovers and appears normal for weeks, months, or years. Ultimately, most of these cats die of FeLV-related disease, but as many as 50% will still be healthy after 2-3 years and 15% after 4 years. Vaccination of these cats will not cause any problems, but doesn’t help the cat, either.
Outcome 2 occurs about 30% of the time after a cat is challenged by FeLV. Although infection is more likely to occur in the kitten, many cats are persistently infected as adults. Although the main mode of viral transmission is through bite wounds (saliva), direct daily contact with a FeLV infected cat will often result in transmission of the virus. Non-infected exposed cats are at risk and should be vaccinated, although daily viral contact will result in vaccination failure of some cats.
OUTCOME 3: LATENCY The cat harbors the virus but we cannot easily detect it.
Unlike other viruses, the FeLV does not directly kill the cat's cells or make them become cancerous. Instead, it inserts a copy of its own genetic material (called DNA) into the cat's cells; these cells may later be transformed into cancer cells or cells which will no longer function normally. In Outcome 3, the genetic change in the cat's cells will remain undetected for an average of 2 1/2 years, during which time the cat will appear completely normal.
In the early stages of infection, the blood ELISA test will be positive, but it will turn negative about 2-4 weeks later. Following that, the blood ELISA and the IFA tests will remain consistently negative.
The prospect of latent infection presents us with a frustrating situation. Latency is estimated to occur about 30% of the time; it leaves the cat in a precarious situation. Some cats will ultimately reject the abnormal cells, and the state of latency will be terminated. In other cats these abnormal cells will result in the production of new FeLV which will result in Outcome 2. Outcome 2 generally leads to death due to a FeLV disease.
Latency is the state that explains the following situations:
1. Latently infected cats will test negative on all of the FeLV tests. If they are vaccinated, they will not be protected. They may develop a fatal FeLV-related disease later, especially following some form of stress or the administration of steroids. Stressors that may activate latent infections include pregnancy and nursing, overcrowding, movement to a new environment, territorial conflicts, poor nutrition, and other diseases. Steroids are used commonly in cats because they are very beneficial for many feline diseases
2. Lymphosarcoma is the form of cancer normally caused by the FeLV. Cats some forms of lymphosarcoma normally test positive with any FeLV test. Latently infected cats may have lymphosarcoma and test negative on the FeLV tests. It is also thought that some cats successfully eliminate the virus but not before malignant transformation of cells has already occurred. This may be another explanation for FeLV-negative cats with lymphosarcoma.
3. Latently infected pregnant cats may test FeLV negative (and even be vaccinated) but pass the FeLV to their kittens through nursing. These kittens often experience Outcome 2.
OUTCOME 4: IMMUNE CARRIER The cat becomes an immune carrier.
The FeLV becomes hidden in some of the cat's epithelial cells. Although the FeLV is multiplying, it is not able to get out of these cells because the cat is producing antibodies against the virus. The cat will appear normal in every way, except for its test results. The immune carrier will have a positive blood ELISA test and a negative IFA test.
This situation is unlikely to happen; it is estimated to occur 1-2% of the time. These cats may revert to an active FeLV infection (Outcome 2) or may develop a latent infection (Outcome 3). The main reason for understanding this situation is that it explains conflicting FeLV test results. Otherwise, there is not a specific test to detect it.
Treatment
Leukemia. Some forms of leukemia (blood cancer) are unresponsive to all available forms of cancer treatment. Other types of leukemias may respond to chemotherapy, though most of these have an average survival time of less than one year. Because the virus is not affected by treatment, the cat will always remain infected with FeLV. Also, relapse of leukemia is possible (and expected). These factors cause us to recommend treatment of leukemia in very few situations.
Lymphosarcoma. Lymphosarcoma is treatable, but not curable. Research has shown that cats with lymphoma who are FeLV-positive do not respond to treatment as well as FeLV-negative cats.
Secondary infections. Depending upon the type of infection involved and the general state of the cat’s health, the prognosis may range from favorable to guarded. For example, bacterial infections may respond well to antibiotic therapy. Other types of infections, such as certain fungal infections, may not respond well because of the FeLV-induced weakness of the cat’s immune system.
The healthy FeLV-positive cat. Healthy infected cats may remain apparently unaffected by the virus for several years. With good supportive care and prompt attention to all potential medical problems, these cats may live for a number of years. Bear in mind that these cats should be considered infectious and potentially dangerous to other cats. Such cats should be isolated from non-infected cats to prevent spread of infection. Many people find this undesirable or impossible and elect euthanasia to protect non-infected cats.
Prognosis
The prognosis is dependent upon many factors. In general, 80% of all persistently positive cats (IFA positive) succumb within three years, most of these deaths occurring within the first six months of detection. The cat that is transiently positive may expect a normal lifespan, or may become ill if latent virus in the body is reactivated.
Transmission to Humans
Extensive tests have been conducted for over 15 years to determine if the FeLV can be transmitted to humans. To date, no conclusive evidence has demonstrated any FeLV-related disease in humans or other animal species, including the dog. However, persons with compromised immune systems are of concern to many researchers. Newborn babies, persons on chemotherapy, AIDS patients or transplant recipients on anti-rejection drugs should probably not be unnecessarily exposed to this or any other virus.
Prevention
A vaccine is available to protect cats from the FeLV. Although not 100% of cats are totally protected, the vaccine is strongly recommended for cats who are exposed to open populations of cats, (i.e., outdoor cats). We have seen a definite decline in the incidence of feline leukemia virus infection and related diseases since vaccine use became widespread. We strongly recommend it for cats at risk of exposure. If your cat stays indoors at all times and is not in contact with another cat that goes outdoors, the vaccine is generally not recommended. Many owners have concern that the vaccine will cause a cat to test positive for the virus, but this is not true. While the history of vaccination is important for us to know, it does not alter our ability to interpret the feline leukemia virus test.
Testing Prior to Vaccination
Cats that are already infected with the FeLV will not be helped by the vaccine. (They will not be hurt by it, either). We recommend pre-vaccination testing for the FeLV in these particular situations:
1) Cats with a history of cat fights or fight wounds (i.e., abscesses)
2) Cats exposed to FeLV-infected cats
3) Cats from unknown backgrounds (particularly animal shelters, humane societies, or pet shops)
4) Routine health care, especially in multi-cat households
Injection Site Sarcomas
In recent years, a disturbing phenomenon has been identified by veterinary researchers. A relationship has been found between feline leukemia virus vaccine (as well as rabies vaccine) and the development of very aggressive tumors at the injection site. The numbers of cats who have developed these tumors is very small compared to the total number of vaccinations given (1-3 per 10,000), but the outcome is devastating for cats that do get these cancers. Several veterinary schools are actively researching this problem. It remains unclear exactly why some cats develop tumors in response to vaccination; a genetic predisposition is thought to be part of the problem. At this time, feline specialists are recommending that leukemia vaccination be reserved for cats that are at risk for exposure to the virus. Strictly indoor cats generally do not need vaccination against FeLV. We can advise you about exceptions to the routine vaccination protocols.
Feline Infectious Anemia
(Hemobartonellosis)
Feline Infectious Anemia (FIA) is a blood disease of cats caused by a microscopic parasite called Hemobartonella felis (H. felis). Because of the organism’s name, this disease is also sometimes called hemobartonellosis. This organism attaches to the surface of the cat's red blood cells, where its presence is eventually detected by the immune system. Once the immune system recognizes the parasite, it attempts to eliminate it by destroying the red blood cells. With destruction of a large number of red cells, anemia may result.
Contributing Factors
Identified risk factors for FIA include anemia, positive feline leukemia virus (FeLV) status, positive feline immunodeficiency virus (FIV) status, access to the outdoors, a history of cat-fight wounds, and lack of vaccinations. Male cats are probably at greater risk.
Cats with FIA should be screened for the presence of immunosuppressive viruses. The primary viruses are FeLV and the FIV. These viruses can serve as stresses, which promote development of FIA. If one or both of the viruses is found, the prognosis for recovery is more unpredictable than in the virus-negative cat.
Prevalence
The true prevalence of the disease is unknown because of the difficulty in identifying the organism and its inconsistent presence in the bloodstream. The prevalence is higher in sick cats than in healthy cats. Estimates of its presence in sick cats ranges from 0 - 28% of cats examined.
Clinical Signs
Reported clinical signs include depression, weakness, jaundice, weight loss, anemia, enlargement of the spleen, and death.
Causes/Transmission
Although the method of transmission has not been conclusively demonstrated, it is thought to be spread between cats by blood-sucking insects and, possibly, by wounds from cat fights. Experimentally, the organism has been transmitted between cats by blood transfusion. Newborn kittens may be infected, but it has not been proven if the infection is established through the placenta, during birth, or by nursing the mother.
Diagnosis
Because H. felis can be found on the red blood cells of healthy cats, detection of the organism does not always equate with a diagnosis of FIA. In many cases of FIA, the cat has a concurrent disease or another form of stress. This state of debilitation then triggers H. felis and allows the development of FIA.
Diagnosis of this disease is made from a fresh blood smear, which is stained and examined microscopically. If the cat is anemic and large numbers of H. felis are present, the diagnosis of FIA is made. Unfortunately, H. felis is not always present on the cat's red blood cells because it appears in the blood stream in cycles. If FIA is suspected, it may be necessary to examine several blood samples before H. felis is identified.
Treatment
Treatment is relatively simple and usually successful. Most often, medications in the tetracycline family are used. The drugs are not expected to clear the organism completely but, instead, suppress its replication in the cat’s body.
Additional treatments may involve a blood transfusion for severely anemic cats, as well as prednisone for temporary suppression of immune-destruction of the red blood cells.
Prognosis
If treatment is not initiated in the acute phase, up to one-third of all cats with FIA will die. Cats who recover from the early stages of the disease will become chronic carriers of the organism and are thought to be susceptible to relapse with periods of stress or illness. With chronic infection, it may be impossible to detect the organism in the blood because it is present in such low numbers.
Transmission to Humans
This disease is not transmitted to humans.
Prevention
Although there is no way to prevent the disease, chances of contracting the disease may be lessened by keeping cats indoors, preventing fight wounds, providing appropriate vaccination against other diseases, and controlling fleas and ticks.
Feline Infectious Peritonitis
Feline Infectious Peritonitis (FIP) is a progressive, almost always fatal, viral disease of domestic cats. It affects some exotic cats, with the cheetah being particularly susceptible. It does not affect non-feline species, such as dogs.
Cause and Transmission
FIP is caused by a virus in the coronavirus family. The feline infectious peritonitis virus (FIPV) and the feline enteric coronavirus (FECV) are the main coronaviruses of cats.
Disease caused by FECV is usually self-limiting and involves diarrhea in young kittens. Infection with the FIPV is serious and usually has fatal consequences.
Transmission of FIPV between cats is most likely by the fecal-oral route; a susceptible cat is infected by coming in contact with fecal material from an infected cat. The virus is swallowed and begins to reproduce in the lining of the intestine. Once certain blood cells become infected with the virus, they transport it throughout the body. Also, it is considered possible that the virus can be transmitted between cats through nasal, salivary and urinary secretions.
Contributing Factors
Exposure to the virus does not necessarily equate with infection and progression to death. A strong, healthy immune system is important for recognition of the virus and preventing its reproduction in the cat’s body. Some cats are able to completely eliminate the virus, whereas others are infected but show minimal or no signs of infection. These cats may eventually eliminate the virus or continue to harbor a small amount of virus in the body. They may or may not become ill with FIP at a later time. Cats who are unable to eliminate the virus may show signs of serious illness in a matter of a few weeks.
Environmental stresses are important factors in transmission of the disease. Crowding of many cats together leads to stress, suppression of the immune system, and sharing of the virus. This scenario is most common in overcrowded catteries where cats come in close contact with one another. Concurrent infection with immune-suppressing viruses, such as the feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV), also predisposes cats to infection with FIPV.
Prevalence
Male and female cats are affected equally. There are two main age groupings for FIPV: kittens less than a year of age have the highest incidence, followed by geriatric cats over 13 years of age. It is relatively less common in young adult and middle aged cats. Because of its transmission in cattery situations, it is more common in purebred cats.
Because FIP is difficult to diagnose, studies, which evaluate its overall prevalence in cats, provide only an estimate. In infected catteries, 80-90% of the cats may test positive for exposure to one of the coronaviruses.
Clinical Signs
Cats with FIP may initially only show vague, nonspecific signs, such as poor appetite, fever, and weight loss. Virtually any organ system may be affected, so a variety of signs are possible.
In general, we consider that there are two forms of FIP: the dry (non-effusive) form and the wet (effusive) form. The wet form is characterized by the accumulation of large quantities of fluid in the chest and/or abdomen. If it occurs in the chest, the cat will experience difficulty breathing. When it occurs in the abdomen, a large, bloated appearance will result. The dry form affects the target organs in a similar fashion, but no fluid is produced. At different times during the disease process, the cat may pass from one form to the other. Because the type of fluid that is produced with wet FIP is very unusual, it is easier to diagnose than the dry form, where signs may be more vague.
Diagnosis
Diagnosis of FIP may be difficult and frustrating. There are no specific tests, which are reliable in all cases. Biopsy of an affected organ provides the only definitive diagnosis; this provides the pathologist with a small sample of tissue for study. Recovery of such tissue from an already sick cat involves a certain amount of risk.
The following tests are usually used on cats with suspicious clinical signs.
l. Coronavirus Test. Antibodies are the circulating defense agents of the immune system. This test detects antibodies to any coronavirus so this test does not discriminate between exposure to FIPV and FECV. If positive, this test indicates that one or both of those viruses WAS or IS present in the cat. Since antibodies may persist even when the virus is no longer present, a positive test can be misleading in some cases. Also, terminally ill cats may have their antibodies "tied up" when large amounts of the FIPV are present. This can result in a false negative test result. Therefore, this test must be interpreted in conjunction with results of other tests. These tests are listed below.
2. Serum Protein Levels. If the total serum protein is elevated at 7.8 gm/dL AND the A:G ratio (ratio of two different blood proteins) is < 0.6, FIP becomes a more likely diagnosis. A few other diseases may also cause this, but these are also very severe and often fatal. These findings occur in 50% of the cases of FIP.
3. White Blood Cell Count. An elevated white blood cell count (> 25,000 cells/l) is consistent with FIP. However, many other diseases may cause this and some of these are not fatal. Also, many cases of FIP have a normal white blood cell count (less than 18,000 cells/l). One particular white blood cell, called the lymphocyte, is often decreased in number with FIP.
4. Abdominal/Chest Fluid Analysis. If fluid is present in either the chest or the abdomen, analysis of the fluid can be very helpful. If the characteristics of the fluid are appropriate and the cat has the correct clinical signs, a presumptive diagnosis of FIP can be made with greater assurance. Unfortunately, this fluid is not present in the dry form of FIP.
5. Fine Needle Biopsy of the Liver or Kidneys. A few cells may be collected from the liver or kidney without stressing the cat (i.e., with a local anesthetic in the skin). FIP produces a particular inflammatory pattern in these organs which, although not diagnostic, is strongly suggestive for the disease. This helps to rule out other diseases.
6. Radiographs (X-rays) of Chest or Abdomen. Radiographs serve to identify enlargements in organs and the presence of fluid in the chest or abdomen. They are helpful but not diagnostic and are used to decide which other tests are appropriate.
7. A Combination of Three Blood Tests. Cats with the combination of a low lymphocyte (a white blood cell) count, a high blood globulin (protein) level, and a positive coronavirus antibody test have been shown to have a 94% chance of having FIP.
8. Organ Biopsy with a Large Needle or Surgery. Organ biopsy is the only test that is diagnostic of FIP. A case workup in the absence of organ biopsy often includes several or all of the above tests. Strongly suggestive findings with several tests often provide the basis for a presumptive diagnosis of FIP.
Treatment
Many treatments have been tried for cats with FIP, but none have been consistently successful. Apparently, an occasional cat will recover, but this is the exception rather than the rule. Removing fluid from the chest or abdomen in cats with the wet form will make them comfortable for a short while, and a few drugs will make some of them feel better. Some of the available antiviral drugs have been tried alone and in various combinations. Human interferon has had some effect in prolonging the lifespan. Some of the other antiviral drugs are toxic and cannot be given to cats. There is no known curative treatment available.
Prognosis
The prognosis for a cat with FIP is very poor. Once a reasonably reliable presumptive diagnosis has been made, euthanasia is often the most appropriate course of action.
Transmission to Humans
The feline coronaviruses are not transmitted to humans. They are species-specific.
Prevention
The coronavirus may live for up to 3 weeks in the environment. If viral shedding into the environment seems likely, a l:30 mixture of household bleach and water (i.e., 1 cup of bleach in a gallon of water) should be used to disinfect food and water bowls, litter pans, cages, bedding material, and items that will not be adversely affected by household bleach.
A preventive vaccine against FIP is available, but most veterinarians do not recommend that the vaccine be given routinely to all cats. The vaccine is generally recommended for cats in contact with free-roaming cats or for those living in households that have had a cat with FIP. Initially, two doses are given at a 2-4 week interval. An annual booster is needed to maintain immunity. For cats already infected with FIPV, the vaccine is of no known benefit.
Feline Immunodeficiency Virus
The Feline Immunodeficiency Virus (FIV), often called the Feline AIDS Virus, is an important infectious disease of the cat. It is likened to the AIDS virus which affects humans because of the similarities in the two diseases which result. Fortunately, most viruses are species specific. This is the case with the human AIDS virus and with FIV. The AIDS virus affects only humans, and the FIV affects only cats.
Contributing Factors
The FIV is transmitted primarily through bite wounds from other cats that usually occur in fights. Other interactions of cats, such as sharing common food and water bowls or grooming each other, have not been shown to be significant in transmission.
Clinical Signs
An FIV infected cat will generally go through a prolonged period of viral dormancy before it becomes ill. This incubation period may last as long as 6 years. Thus, we generally do not diagnose FIV in sick cats who are relatively young.
When illness occurs, we can see a variety of severe, chronic illnesses. The most common illness is a severe infection affecting the gums of the mouth. Abscesses from fight wounds, which would normally heal within a week or two, may remain active for several months. Respiratory infections may linger for weeks. The cat may lose weight and go through periods of not eating well; the hair coat may become unkempt. The cat may have episodes of treatment-resistant diarrhea. Ultimately, widespread organ failure occurs, and the cat dies.
Diagnosis
Evidence of exposure to the FIV can be detected by a simple blood test. A positive test means the cat has been exposed to the virus and will likely be infected for the remainder of its life. A negative result may mean that the cat has not been exposed; however, false negatives occur in two situations and usually involves adult cats:
Adult Cats
1. From the time of initial virus inoculation into the cat, it may take up to two years for the test to turn positive. Therefore, for up to two years, the test is likely to be negative even though the virus is present in the cat.
2. When some cats becomes terminally ill with FIV, the test may again turn negative. This occurs because antibodies (immune proteins) produced against the virus become attached and bound to the large amount of virus present. Since the test detects antibodies, which are free in circulation, the test may be falsely negative. This is not the normal occurrence, but it does happen to some cats.
Kittens
The vast majority of kittens under 4 months of age who test positive have not been exposed to the virus. Instead, the test is detecting the immunity (antibodies) that was passed from the mother to the kitten. These antibodies may persist until the kitten is about 6 months old. Therefore, the kitten should be retested at about 6 months of age. If it remains positive, the possibility of true infection is much greater. If the kitten tests negative, there is nothing to worry about.
If a kitten is bitten by an FIV-infected cat, it can develop a true infection. However, the test will usually not turn positive for many months. If a mother cat is infected with the FIV at the time she is pregnant or nursing, she can pass large quantities of the virus to her kittens. This means of transmission may result in a positive test result in just a few weeks.
Treatment
No treatments are available to rid the cat of the FIV. Sometimes, the disease state can be treated, and the cat experiences a period of recovery and relatively good health. However, the virus will still be in the cat and may become active at a later date. Therefore, the long-term prognosis is unfavorable.
If you have a cat, which tests FIV-positive but is not ill, it is not necessary to immediately euthanatize it. As long as it does not fight with your other cats or those of your neighbors, transmission is not likely to occur. However, if it is prone to fight or if another cat often instigates fights with it, transmission is likely. In fairness to your neighbors, it is generally recommended to restrict an FIV-positive cat to your house. Owners of infected cats must be responsible so that the likelihood of transmission to someone else's cat is minimized.
Prognosis
The long-term prognosis is poor, however infected cats may experience years of good health.
Prevention
Neutering of male cats and keeping cats indoors are the only available preventive measures that can be recommended. No vaccine is currently available to prevent infection with this virus.
Flea Control for Cats
Successful flea control has two aspects. Fleas must be controlled on your cat, and fleas must be controlled in your cat's environment. Since cats and dogs share the same fleas, the presence of a dog in your cat's environment makes flea control much more difficult.
Diagnosis of Flea Infestation
When a cat is heavily infested with fleas, it is easy to find them. If the numbers are small, it is best to quickly turn your cat over and look on its belly. If you do not find them there, look on the back just in front of the tail. Be sure to part the hair and look at the level of the skin. When the numbers are very small, look for "flea dirt." Flea dirt is digested blood left behind by the fleas. Flea dirt is actually fecal matter from the flea. Finding flea dirt is a sure indication that fleas are present or have been present recently.
Flea dirt looks like pepper. It varies from tiny black dots to tubular structures about 1/32" (1/2 mm) long. If you are in doubt of its identification, put the suspected material on a light colored tabletop or counter top. Add one or two drops of water, and wait about 30 seconds. If it is flea dirt, the water will turn reddish brown as the blood residue goes into solution. Another trick is to put some of the material on a white paper towel and then wet the paper towel with water. A red stain will become apparent if you gently wipe the material across the surface of the paper towel.
Many people find tiny drops of blood in a cat's bedding or where the cat sleeps. This is usually flea dirt that was moistened, then dried. It leaves a reddish stain on the bedding material and is another sign that fleas are present.
The Flea’s Life Cycle
To appreciate the complex issue of flea control, you must understand something about the flea's life cycle.
Although you are only able to see the adult flea, there are actually 4 stages of the life cycle. The adult flea constitutes only about 5% of the entire flea population if you take into account all four stages of the life cycle. Flea eggs are pearly white and about 1/32" (1/2 mm) in length. They are too small to see without magnification. Fleas lay their eggs on the cat, but the eggs do not stick to the cat's hair. Instead, they fall off into the cat's environment. The eggs make up 50% of the flea population. They hatch into larvae in 1 to 10 days, depending on temperature and humidity. High humidity and temperature favor rapid hatching.
Flea larvae are slender and about 1/8 - 1/4" (2 to 5 mm) in length. They feed on organic debris found in their environment and on adult flea feces, which is essential for successful development. They avoid direct sunlight and actively move deep into carpet fibers or under organic debris (grass, branches, leaves, or soil.) They live for 5 to 11 days before becoming a pupae.
Moisture is essential for their survival; flea larvae are killed by drying. Therefore, it is unlikely that they survive outdoors in shade-free areas. Outdoor larval development occurs only where the ground is shaded and moist and where flea-infested pets spend a significant amount of time. This allows flea feces to be deposited in the environment. In an indoor environment, larvae survive best in the protected environment of carpet or in cracks between hardwood floors. They also thrive in humid climates.
Following complete development, the mature larvae produce a silk-like cocoon in which the next step of development, the pupa, resides. The cocoon is sticky, so it quickly becomes coated with debris from the environment. This serves to camouflage it. In warm, humid conditions, pupae become adult fleas in 5-10 days. However, the adults do not emerge from the cocoon unless stimulated by physical pressure, carbon dioxide, or heat.
Pre-emerged adult fleas can survive up to 140 days within the cocoon. During this time, they are resistant to insecticides applied to their environment. Because of this, adult fleas may continue to emerge into the environment for up to 3 weeks following insecticide application.
When the adult flea emerges from its cocoon, it immediately seeks a host because it must have a blood meal within a few days to survive. It is attracted to people and pets by body heat, movement, and exhaled carbon dioxide. It seeks light, which means that it migrates to the surface of the carpet so that it can encounter a passing host. Following the first blood meal, female fleas begin egg production within 36 to 48 hours. Egg production can continue for as long as 100 days, which means that a single flea can produce thousands of eggs.
This entire life cycle (adult flea --> egg --> larvae --> pupa --> adult) can be completed in 14-21 days with the proper temperature and humidity conditions. This adds to the problem of flea control.
If untreated, the female flea will continue to take blood for several weeks. During that time, she will consume about 15 times her body weight in blood. Although the male fleas do not take as much blood, they, too, contribute to significant blood loss. This can lead to the cat having an insufficient number of red blood cells, which is known as anemia. In young or debilitated cats, the anemia may be severe enough to cause death.
Contrary to popular belief, most cats have rather limited itching due to fleabites. However, many cats become allergic to the saliva in the flea's mouth. When these cats are bitten, intense itching occurs, causing the cat to scratch and chew on its skin.
Flea Control
Successful flea control must rid the cat of fleas and it must rid the cat's environment of fleas. In fact, environmental control is as important as treatment of the cat. If your cat remains indoors and you do not have other pets that come in from the outside, environmental control is relatively easy, especially with the advent of the new topical products (see below). However, the cat that goes outdoors or stays outdoors presents a somewhat greater challenge and a few fleas may occasionally be seen indoors.
Many of the older insecticides (which have been the mainstay of flea control for years) have limited effectiveness against fleas because they are only effective for a few hours after application on the cat. Also, these are primarily geared to kill adult fleas. Flea powders, sprays, and shampoos will kill the fleas present on your cat at the time of application. However, most of these products have little or no residual effects, so the fleas that return to your cat from his environment are not affected. Thus, your cat may be covered with fleas within a day after having a flea bath or being sprayed or powdered.
However, there are some newer, more effective sprays that can be a valuable part of the overall treatment plan. They kill adult fleas rapidly and are safe enough to use daily, if necessary. Flea sprays containing insect growth regulators are helpful in managing the overall problem because they help to break the flea life cycle. Some of the newer sprays with growth regulators are not recommended for daily use; once weekly application is recommended. Always read the label when first using any new product on a cat. In general, flea sprays, collars, powders and dips have become less popular since the introduction of the newer products.
Newer Products
Four relatively new products have come onto the market in the last couple of years. The “flea pill” is an oral medication that is given to the cat once a month. This product, Program, does not kill adult fleas but is helpful in breaking the life cycle of the flea. When the female flea produces eggs, they are essentially “sterile” eggs and do not hatch. In effect, this product acts like a birth control product for the flea. Three new topical treatments are applied to the nape of the neck. They are Advantage, Frontline Top Spot, and Revolution. All are safe and very effective.
Environmental Control
The newer topical products do not require the aggressive environmental control that is necessary if only dips, sprays, or collars are used. This is one reason that they have become so popular with pet owners. Please consult with us about the requirements for your specific situation.
When environmental flea control is indicated, it must be directed at your house and your yard.
House. Even though fleas may be in your house, most people never see them. Fleas greatly prefer cats and dogs to people; they only infest humans when there has not been a cat or dog in the house for several days. (There are exceptions to this.) A professional exterminator may be called to treat your house or you may use a house fogger or a long-lasting spray. These foggers and sprays are very effective for adult fleas, but they will not kill adults that are still in their cocoon. You should purchase a fogger or a spray that kills the adult fleas and inhibits development of the eggs and larvae. In climates with extended warm temperatures and high humidity, it may be necessary to treat two or three times with a 30-day residual product before all stages of the fleas are removed from the house. The second treatment is most effective if it is done 2 weeks after the first.
There is at least one company that will treat your carpet with a flea-killing powder. The powder is non-toxic to people. It is worked deeply into the carpet to prevent it from being removed by vacuuming. This treatment has proven very successful, even in the face of heavy flea infestations. However, the treatment does not address fleas in your yard. The same chemical, a form of boric acid, is also available for application by the homeowner. However, the self-application kits do not offer the year guarantee.
Yard. A professional exterminator may also do yard control with various insecticides or you may use some yourself. Be sure that any insecticide that you use has a 30-day residual. This keeps you from having to spray every week. In climates with extended warm temperatures and high humidity, it will often be necessary to treat monthly during the warm months of the year. You should use a 30-day residual product each time. Your veterinarian is able to help you choose the most effective product for your situation.
Re-emergence of Fleas
If you recall, pre-emerged adult fleas can survive up to 140 days within the cocoon. This is significant when your pets are gone from home for extended periods of time. During the time that the house is quiet and empty, pre-emerged adults remain in their cocoon. Even if the house was treated with an insecticide, their cocoon protects them. When people and pets return to the house, adults emerge from their cocoons and immediately begin to seek a blood meal. They jump on cats, dogs, and even people. Although it may appear that a cat just returned from boarding brought fleas to your home, it is also very possible that a sudden emergence of adult fleas may account for the fleas present. If large numbers of fleas are seen, they are almost certainly newly hatched fleas and have not been brought home with the pet.
Food Allergy in Cats
One of the most common conditions affecting cats is allergy. In the allergic state, the cat's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed. These overreactions are manifested in three ways. The most common is itching of the skin, either localized (one area) or generalized (all over the cat). Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing. Sometimes, there may be an associated nasal or ocular (eye) discharge. The third manifestation involves the digestive system, resulting in vomiting or diarrhea.
Types of Allergy
There are four known types of allergies in the cat: contact, flea, food, and inhalant. Each of these has some common expressions in cats, and each has some unique features.
Food Allergy
A food allergy is a condition in which the body’s immune system reacts adversely to a food or an ingredient in a food.
Any food or food ingredient can cause an allergy. However, protein, usually from the meat source of the food, is the most likely offender. Proteins commonly found in cat foods are derived from beef, chicken, lamb, and horsemeat.
Lamb and Rice Diets
Although many people think lamb and rice diets are hypoallergenic, they are not. They are not inherently less likely to cause allergy than other diets. However, they have this reputation. Here is why.
Several years ago there were no cat foods on the commercial market that contained lamb. A manufacturer of prescription cat foods formulated a food from lamb that was suitable for allergy testing, which will be explained below. Because of that situation, lamb-based cat food was considered “hypoallergenic.”
Food Allergy Testing
Cats are not likely to be born with food allergies. More commonly, they develop allergies to food products they have eaten for a long time. The allergy most frequently develops in response to the protein component of the food; for example, beef, pork, chicken, or turkey. Food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress. We recommend testing for food allergy when the clinical signs have been present for several months, when the cat has a poor response to steroids, or when a very young cat itches without other apparent causes of allergy. Testing is done with a special hypoallergenic diet. Because it takes at least 4 weeks for all other food products to get out of the system, the cat must eat the special diet exclusively for 4-8 weeks (or more). If positive response occurs, you will be instructed on how to proceed. If the diet is not fed exclusively, it will not be a meaningful test. We cannot overemphasize this. If any type of table food, treats or vitamins are given, they must be discontinued during the testing period.
Because cats that are being tested for inhalant allergy generally itch year round, a food allergy dietary test can be performed while the inhalant test and antigen preparation are occurring.
INSTRUCTIONS: Those instructions that are specific for your cat have been checked:
___ 1) Your cat is to exclusively eat a hypoallergenic diet. If it will not do so readily, mix it 25:75 with the current diet for several days, then gradually increase the special diet to 100%. If this does not work, contact us for an alternative plan. Discontinue any chewable treats or vitamins. Table food is not allowed. Offer only distilled water to drink, if that is possible.
___ 2) An injection of steroids was given. Relief should be apparent within 12-24 hours. If not, please call. The cat should feel better and itch less for about one month. If an increase in water consumption or urination occurs, please report this to us for future reference. These side effects are common with steroid administration and will go away in a few days without treatment. Return for further evaluation when the first signs of itching recur.
___ 3) Begin oral steroids when the first signs of itching return. Give ____ tablets every other morning. Adjust the dosage upward or downward to the lowest effective dose, with a maximum dose of __________ permitted. Stop giving the medication every 4-6 months to see if there are times of the year when therapy is not needed. Report any increase in water consumption to us at once.
___ 4) We have dispensed oral steroid tablets. Prednisone is most commonly used. The specific drug being dispensed for your cat is labeled on the bottle. Give ____ of the ____ mg tablets every other day for 3 doses (6 days), then ____ tablets every other day for 3 more doses (6 more days). Continue this downward progression (________________________________) until the first signs of itching recur. At that time, go back to the next higher level and report that level to us (so we can be sure it is a safe level). Stop giving the tablets every 4-6 months to see if there are periods of the year when they are not necessary. When itching returns, begin immediately at the maintenance dose. If that does not stop the itching, increase the dosage slightly (to a maximum of ___ tablets) for a few doses, then return to the lower dose. Report any increase in water consumption to us at once. (This may occur at the initial dose but should stop on the maintenance dose.)
___ 5) Your cat has a flea allergy or has enough fleas to make the other allergy problem worse. Flea control is very important and should include treating the cat and its environment. Bear in mind that flea allergies often accompany other types of allergies, especially inhalant allergy.
___ 6) Your cat has a bacterial skin infection secondary to allergy. The following are recommended:
a) Antibiotics are to be used for the next _____ days. If the infection is not gone by the time the medication is completed, call for a refill or for a change in medication.
b) The medicated shampoo,_____________________, is to be used every _____ days. Allow the shampoo to stay in the haircoat for a few minutes before thoroughly rinsing the cat.
c) The topical medication,_____________________, is to be used ______ times daily for __________ days.
Giardia Infection in Cats
Giardiasis is an intestinal infection of man and animals caused by a protozoal parasite called Giardia intestinalis. It is widely known as the source of ‘traveler’s diarrhea.” These single-celled parasites are not to be confused with the common intestinal parasites: roundworms, hookworms, and tapeworms.
Giardiasis is a important cause of illness in animals and man. Fortunately, even though the prevalence rate is high in cats and dogs, clinical disease is less common.
Predisposition
Infection is relatively rare in healthy cats. It is more common in densely populated groups of animals, such as in a cattery, pet store, or animal shelter. Also, kittens have been shown to shed more Giardia cysts in their feces than older cats.
Similarly, human infection is more common in dense populations. Scientific studies have demonstrated greater prevalence in nursing homes and day-care centers when compared to the population at-large.
Clinical Signs
These microscopic parasites attach themselves to the intestinal wall and cause a sudden-onset (acute) foul-smelling diarrhea. The stool may range from soft to watery and occasionally contains blood. Infected cats tend to have excess mucus in the feces. Sometimes, vomiting can occur.
Causes
Ingestion (swallowing) of the cyst stage of the parasite leads to infection. Once inside the cat's intestine, the cyst goes through several stages of maturation. Eventually, the cat is able to pass infective cysts in the stool, where they can contaminate the environment and infect other cats.
Infection can also occur from drinking water that has been contaminated with the cysts.
Diagnosis
Because of the prevalence of Giardia in the cat, presence of cysts in the stool does not necessarily indicate that a problem is present. However, when the cysts are present in a cat with diarrhea, it is important. In particular, kittens and debilitated adult cats are at risk for death from dehydration associated with the diarrhea.
Although a fecal examination is needed for diagnosis, the routine flotation test may fail to detect these small cysts. A special solution may be needed for accurate identification of the cysts in the stool. Occasionally, the parasites may be seen on a direct smear of the feces. A test is available for detection of antigens (cell proteins) of Giardia in the feces. A delay of several days may occur as the test is only performed in select laboratories. Also, the reliability of this test in the cat remains under investigation.
Treatment
Metronidazole and fenbendazole are the drugs most commonly used to treat Giardia. The former is a tablet, and the latter is a liquid. They are given orally for 5-7 days. Other drugs may be needed as supplemental therapy should diarrhea and dehydration occur.
Prognosis
The prognosis is good in most cases. Debilitated or geriatric animals and those with incompetent immune systems are at increased risk for death.
Transmission to Humans
Giardiasis is the most common intestinal parasitic infection of man. In the past, it has been assumed that cats and dogs served as the source of infection for humans. However, current research is beginning to indicate that perhaps cats and dogs do not serve as an important reservoir of the disease for man. Some scientists are suggesting that human-to-human transmission may be the more important factor. Also, in cities that do not have water treatment facilities with a sand filtration system, Giardia may not be removed from drinking water.
Nevertheless, until the issue of transmission is resolved, caution is advisable when a pet has been diagnosed with giardiasis. In particular, humans with immunodeficient states (AIDS, chemotherapy) should use extreme care.
For environmental disinfection, a cup of chlorine bleach in a gallon of water is effective. First be sure that the surfaces and premises can be safely treated with bleach.
Understanding Grief in Children
When an adult loses a beloved pet, grief is a normal reaction. It progresses through very predictable stages that have been defined as denial, sadness, depression, guilt, anger, and, finally, relief (or recovery). The effect of grief and loss on children is less predictable and depends upon the child's age and maturity level. The capacity of the child to understand death dictates their response to the experience of grief and loss.
Two and Three Year Children
Young children typically have no life experiences upon which to draw when they face the loss of a pet. They may consider it a form of sleep. They should be told that their pet has died and will not return.
Two and three year old children should be reassured that the pet's absence is unrelated to anything the child may have said or done. Usually, a child in this age range will easily accept another pet in place of the dead one. Although the child may be unaware of the concept of death, stress in the household can be detected. It is advisable to stick to routines and provide care and reassurance for the young child.
Four, Five, and Six Year Old Children
Children in this age range have some understanding of death but in a way that relates to a continued existence. The pet may be considered to be living underground while continuing to eat, breathe, and play. Alternatively, it may be considered asleep. A return to life may be expected if the child views death as temporary. Some television cartoons may suggest to children that it is possible to return from death.
These children often feel that any anger they had toward the pet may be responsible for its death. This view should be discouraged because they may also translate this belief to the death of family members. Some children also see death as contagious and begin to fear that their own death (or that of others) is imminent. They should be reassured that their death is not likely.
Manifestations of grief may take the form of alterations in bladder and bowel control, eating habits, and sleep. The child should be encouraged to talk with the parent and voice concerns about what has happened. In this age group, a few brief discussions may be more productive than one or two lengthy sessions.
Seven, Eight, and Nine Year Old Children
Children in this age group know that death is irreversible and they are capable of intense grief. They usually do not personalize death, thinking it cannot happen to them. However, some children may develop concerns about death of their parents. They may become very curious about death and ask questions that, on the surface, appear morbid. These questions are natural, and parents should respond frankly and honestly.
Grief may be expressed in a variety of ways. Problems may arise at school with learning and behavior. Interpersonal skills with adults and peers may deteriorate. In rare cases, grief-related anxiety may be expressed through acts of aggression. Additionally, withdrawal, over-attentiveness, or clinging behavior may be seen. Parents should remain alert and attentive, as the difficulties may not arise for several weeks, or even months.
Ten and Eleven Year Old Children
Children in this age range are usually able to understand that death is natural, inevitable, and universal. Consequently, these children often react to death in a manner very similar to adults.
Adolescents
Although this age group also reacts similarly to adults, many adolescents exhibit various forms of denial. This may take the form of a total lack of emotion. They may also act out their pain through antisocial acts. Adults should not expect the grief process to follow a particular time frame with teenagers. Because the teenage years are fraught with excess emotion, some situations require that the parent offer as much reassurance about pet death as would be given to a young child.
Young Adults
Loss of a pet can be particularly hard at this age, especially if the pet has been a family member for many years. Some psychologists say that, in effect, loss of such a pet represents a “rite of passage” to adulthood. Young adults need the same opportunities to voice their feelings as any of the other age groups.
Summary
Professional bereavement counselors are available. Do not be afraid to seek professional advice if you have questions about the experience of grief and pet loss. The normal balance in a family can be so disrupted that, occasionally, it is helpful to solicit outside assistance.
Hookworm Infection in Cats
Hookworms are intestinal parasites of the cat (and dog). Their name is derived from the hook-like mouthparts they use to anchor to the lining of the intestinal wall. They are only about 1/8" (1-2 mm) long and so small in diameter that they are barely visible to the naked eye.
The scientific names for the most common feline hookworms are Ancylostoma tubaeforme and Ancylostoma braziliense. Occasionally, cats will also become infected with the dog hookworm, Ancylostoma caninum.
In general, cats tend to harbor relatively few hookworms when compared to the large numbers found in dogs. Also, feline hookworms tend to be less aggressive bloodsuckers than the canine species.
Contributing Factors
Hookworms are more common in warm, moist environments. Conditions of overcrowding and poor sanitation contribute to re-infection.
Clinical Signs
Feline hookworms tend to “graze” along the lining of the small intestine and are considered “tissue feeders.” When they do suck blood, an anti-coagulant substance is injected at the feeding site. Therefore, the cat can suffer blood loss from ingestion by the hookworm, as well as continued bleeding into the bowel. The blood-loss anemia attributed to hookworms is a more significant problem in kittens than adult cats.
Evidence of hookworm infection includes anemia, the presence of digested blood in the stool, a poor haircoat, and weight loss.
Causes
Adult hookworms pass hundreds of microscopic eggs in the cat's stool that are invisible to the naked eye. Larvae (immature worms) will hatch from the eggs and persist in the soil for weeks or months. When larvae are swallowed by the cat, hookworm infection is established. The larvae may also burrow through the cat's skin and migrate to the intestine, where they may mature and complete their life cycle.
In dogs, prenatal infection (infection prior to birth) may be a significant problem. Puppies may become infected by the placental blood flow and then later through the mother’s milk. Prenatal infection has not been demonstrated to occur in kittens.
Diagnosis
To diagnose hookworm infection, a small amount of the cat’s stool is mixed with a special solution, causing the eggs to float to the top. With a microscope, the eggs are easily identified because of their unique appearance. Since the eggs are produced on a daily basis, hookworm infection is usually fairly easy to diagnose. The number of eggs does not necessarily correlate with the number of worms present. In fact, the number of eggs passed can be greater with light infections (smaller numbers of worms).
Treatment
Fortunately, treatment is safe, simple, and relatively inexpensive. After administration of the deworming medication (called an anthelmintic), the adult worms are killed. Two treatments are needed; they are typically performed at a 2-3 week interval. Ideally, kittens are dewormed during their vaccination series.
Since the cat's environment can be laden with hookworm eggs and larvae, it may be necessary to treat it with a chemical to kill them. There are several available formulations that are safe to use on grass.
In rare cases, kittens or debilitated cats might require a blood transfusion because of severe anemia.
Prognosis
With early diagnosis and treatment, the prognosis is good for full recovery from hookworm infection. However, if severe anemia is present, some cats will not survive.
Prevention
Prevention of hookworm infection should include the following measures:
1. All new kittens should be treated by 2-3 weeks of age. To effectively break the life cycle of the most common intestinal parasites, kittens should be dewormed on the schedule recommended by the veterinarian.
2. Prompt deworming should be given when any parasites are detected; periodic deworming may be appropriate for cats at high risk for reinfection.
3. Appropriate disposal of cat (and dog) feces, especially from yards and playgrounds, is important.
4. Strict hygiene is especially important for children. Do not allow children to play in potentially contaminated environments. Be mindful of the risk posed by public parks and non-covered sandboxes. Sandboxes that have fitted covers are popular and are recommended to prevent infection of children with intestinal parasites.
5. Control of rodents is important since they may play a role in transmission of hookworms to cat.
6. Stool should be removed from litter boxes daily, if possible. Always wash hands after handling litter box material.
7. Contact your animal control officials when ownerless animals are found.
Transmission to Humans
Feline hookworms do not infect humans internally. However, the tiny larvae can burrow into human skin, causing a disease called cutaneous larval migrans. Also known as “ground itch,” this skin infection does not lead to maturation of the larvae. Because contact of human skin with moist, larvae-infected soil is required, infection rarely occurs when good hygiene is practice.
Hypertension in Cats
Hypertension is the term for high blood pressure.
Contributing Factors
In humans, hypertension is related to several factors, including a stressful lifestyle. Although not all the causes of feline hypertension have been identified, stress does not appear to play a role in the development of this disorder in cats. However, kidney disease and thyroid disease are known to cause feline hypertension and will be described in more detail below.
Clinical Signs
Vision abnormalities are the most common clinical findings with feline hypertension. These abnormalities can include dilated pupils that do not constrict with light, blood within the front chamber of the eye, and blindness. Blindness develops because high blood pressure in the eye causes the retina to detach. These cats run into objects in their path because most of them have no vision at all.
In some cases, hypertension is suspected because of a heart murmur or kidney-related signs, such as increased water intake or urination.
Causes
Kidney failure and hyperthyroidism have been identified as the two most common predisposing factors for development of feline hypertension.
Kidney disease. It appears that several different mechanisms may lead to development of hypertension in cats with kidney disease. One theory suggests that as a cat ages, the kidneys undergo normal aging changes, including a slow accumulation of scar tissue. With time, this scar tissue causes the kidneys to shrink in size. When the kidney shrinks due to the accumulated scar tissue, it is harder for the blood to filter through. Because the kidneys normally receive 20% of the blood with every heartbeat, blood backs up into large arteries and leads to an increase in blood pressure. One study found that about 65% of cats in old-age kidney failure have hypertension. Even elderly cats in the early stages of kidney disease may also have hypertension.
Hyperthyroidism. The thyroid gland is located in the neck and plays a very important role in regulating the body's rate of metabolism. Hyperthyroidism is a disorder characterized by the overproduction of thyroid hormone and a subsequent increase in the metabolic rate. This is a fairly common disease of older cats. Although the thyroid gland enlarges, it is usually a non-malignant (benign) change. Less than 2% of hyperthyroid cases involve a malignant change in the gland.
Many organs are affected by hyperthyroidism, including the heart. The heart is stimulated to pump faster and more forcefully; eventually, the heart enlarges to meet these increase demands for blood flow. The increased pumping pressure leads to a greater output of blood and high blood pressure. About 80% of cats with hyperthyroidism have high blood pressure, although most of them do not have blood pressures high enough to cause blindness.
Primary hypertension. This means that there is not an underlying disease present. This is very common in humans and is often related to life-style or stress. Although it is not well recognized in cats, it is possible that some cases do exist.
Diagnosis
Hypertension should be suspected in any cat with kidney disease or hyperthyroidism. Onset of sudden, unexplained blindness should raise a strong suspicion for hypertension and the associated diseases should be considered. Also, the presence of a heart murmur or kidney-related problems may signal the presence of a hypertensive state.
Blood pressure is determined with a device that can detect blood flow in arteries. Obviously, the cat has very small arteries when compared to those of the human. Consequently, the standard blood pressure equipment used on humans will not work on cats. Only two blood pressure machines have been found reliable in cats. One costs several hundred dollars and the other several thousand. Unfortunately, the expense of purchasing this equipment, coupled with the relative infrequency of hypertension, makes ownership of blood pressure equipment prohibitive for many veterinarians.
Treatment
The first step in treatment is to use one or more of several hypotensive agents (drugs to lower blood pressure). Although none are approved for use in cats, we have used several very effectively and safely for several years.
The next step is to diagnose and treat the underlying disease. If it is hyperthyroidism, medical, surgical, or radiation treatment is required. When treatment is completed, hypertension resolves, and further treatment with hypotensive drugs is not needed. If kidney failure is diagnosed, it is usually not curable but often can be controlled. However, most of these cats require long-term treatment for hypertension. If no underlying disease is found, primary hypertension is considered to be present and long-term treatment for hypertension is needed.
Prognosis
The underlying disease that caused hypertension to develop must be cured or controlled. Long-term success depends on whether or not this is possible. If the cat has kidney, heart, or thyroid disease, it is important to treat those aggressively. Hyperthyroidism is curable, but old-age kidney failure is not. However, many kidney failure cats can be managed successfully.
If the cat has blindness due to detached retinas, a medical emergency exists. Blood pressure must be lowered quickly for preservation of vision. If the retinas remain detached for several days, the prognosis is poor for a return of normal vision. Therefore, the key to a successful outcome is rapid diagnosis and early administration of the proper medication to lower blood pressure.
Hyperthyroidism in Cats
The thyroid gland is located in the neck and plays a very important role in regulating the body's rate of metabolism. Hyperthyroidism is a disorder characterized by the overproduction of thyroid hormone and a subsequent increase in the metabolic rate. This is a fairly common disease of older cats. Although the thyroid gland enlarges, it is usually a nonmalignant change (benign). Less than 2% of hyperthyroid cases involve a malignancy.
Many organs are affected by this disease, including the heart. The heart is stimulated to pump faster and more forcefully; eventually, the heart enlarges to meet these increase demands for blood flow. The increased pumping pressure leads to a greater output of blood and high blood pressure. About 80% of cats with hyperthyroidism have high blood pressure.
Contributing Factors
Advancing age is the main factor that increases a cat’s risk for hyperthyroidism. Environmental and dietary risk factors have been investigated and may play a role in predisposing cats to hyperthyroidism, though the specific mechanisms are not known.
No individual breed is known to be at increased risk, although the Siamese appears to have a 10-fold lower risk of developing hyperthyroidism than other breeds.
Clinical Signs
The typical cat with hyperthyroidism is middle-aged or older; on the average, affected cats are about 12 years of age. The most consistent finding with this disorder is a loss of weight secondary to the increased rate of metabolism. The cat tries to compensate for this with an increased appetite. In fact, some of these cats have a ravenous appetite and will literally eat anything in sight! Despite the increased intake of food, most cats gradually lose weight. The weight loss may be so gradual that some owners will not even realize it has occurred. Affected cats usually drink a lot of water and urinate a lot. There may be periodic soft stool or diarrhea, and the hair coat may be unkempt. In some cats, anorexia develops as the disease progresses.
Two secondary complications of this disease can be significant. These include hypertension (high blood pressure) and a heart disease called thyrotoxic cardiomyopathy. Hypertension develops as a consequence of the increased pumping pressure of the heart. In some cats, blood pressure can become so high that retinal hemorrhage or detachment will occur and result in sudden blindness. The heart problems develop because the heart must enlarge and thicken to meet the increased metabolic demands. Both of these problems are reversible with appropriate treatment of the disease.
Causes
A specific cause has not been identified. The possible role of dietary iodine continues to be investigated as a dietary influence on development of hyperthyroidism.
Diagnosis
In most instances, diagnosis of this disease is relatively straightforward. One of the first things to happen is an increase in size of one or both thyroid lobes. If they can be palpated (felt) during the physical exam, the disease is very likely. The first blood test that is performed measures the level of one of the thyroid hormones, called thyroxine (or T4). Usually, the T4 level is so high that there is no question as to the diagnosis. Occasionally, a cat suspected of having hyperthyroidism will have T4 levels within the upper range of normal cats. When this occurs, a second test, called a T3 Suppression Test, is performed. If this is not diagnostic, a thyroid scan can be performed at a veterinary referral center or the T4 could be measured again in a few weeks.
Treatment Options
Because less than 2% of these cats have cancerous growths of the thyroid gland, treatment is usually very successful. There are three choices for treatment; any one of them could be the best choice in certain situations. Many factors must come into consideration when choosing the best therapy for an individual cat.
When possible, tests are done before adopting any form of treatment. These tests are needed to evaluate the overall health of the cat and predict the chances for complications. Such tests include blood work and urinalysis, and x-rays; if available, an EKG and cardiac ultrasound may be performed.
1. Radioactive iodine. The most effective way to destroy all of the abnormal tissue is with radioactive iodine therapy. It causes no damage to normal thyroid tissue or to the nearby parathyroid gland. This requires one or two weeks of hospitalization at a veterinary clinic licensed to administer radiation therapy. This treatment is often limited to veterinary teaching institutions because of governmental regulations regarding radioactive materials. Sometimes, but not always, the expense can be greater than for the other options.
2. Surgery. Surgical removal of the affected thyroid lobe(s) is also very effective. Because hyperthyroid cats are usually over 8 years of age, there is a degree of risk involved. However, if the cat is otherwise healthy, the risk need not be considered significant. If the disease involves both lobes of the thyroid gland, two surgeries may be required, depending on the surgeon’s choice of procedures. In many cats, only one thyroid lobe is abnormal, so only one surgery is needed.
If surgery is the treatment method chosen, the cat is usually treated with an anti-thyroid medication for several weeks prior to the operation. During that time, the ravenous appetite should subside and the cat will probably gain weight. Some cats also have a very fast heart rate and high blood pressure; these problems can be managed with medication before surgery. After one to two weeks, another T4 level is measured.
The cat is generally hospitalized for one night following surgery and returns home feeling quite well. It should eat normally after returning home.
3. Oral medication. Administration of an oral drug, methimazole, can control the effects of the overactive thyroid gland. Some cats have reactions to the drug, but that number is fairly small (less than 20%). However, the side effects may begin as late as six months after the beginning of treatment and can include vomiting, lethargy, anorexia, fever, and anemia. Methimazole does not destroy the abnormal thyroid tissue, but rather ties up the excess thyroid hormone. Therefore, the drug must be given for the remainder of the cat's life. Periodic blood tests must be done to keep the dosage regulated. This type of treatment is appropriate for the cat that is a poor surgical risk due to other health problems. As stated above, it may also be used for a few weeks to stabilize the cat that is at increased surgical risk because of cardiac complications.
Recurrence of the disease is a possibility in some cats. Recurrence is uncommon after radioactive iodine therapy. When surgery is done, it is possible. It is possible that not all of the abnormal thyroid cells will be removed. If those remaining cells grow, the disease may recur. However, this occurs less than 10% of the time and usually after 2-4 years. Another possibility is that one side of the thyroid gland was normal at the time of surgery so it was not removed. Then, months or years later, it may become abnormal.
One potential consequence of treating hyperthyroidism is kidney disease or failure. In some geriatric cats,
kidney function has declined with age. When hyperthyroidism is present, it helps the cat partially compensate for this loss of kidney function. The hypertension that accompanies hyperthyroidism serves to increase blood flow to the kidneys. When the hyperthyroid state is treated, renal blood flow is diminished and the cat may develop kidney failure. This occurs in only a small number of hyperthyroid cats and is most likely if kidney function tests before surgery are abnormal.
Prognosis
Many owners of cats with hyperthyroidism are hesitant to have radiation therapy or surgery because of their cat's advanced age. But remember, old age is not a disease. The outcome following both surgery and radiation therapy is usually very positive, and most cats have a very good chance of returning to an excellent state of health for many years.
Prevention
There are no known preventive measures, but middle-aged and geriatric cats should all receive a complete physical examination by a veterinarian every 6-12 months.
Inflammatory Bowel Disease in Cats
Inflammatory bowel disease (IBD) is an important and relatively common medical problem of cats. It is not a specific disease; rather, the term IBD represents several processes that are manifested as inflammation of the bowel. It may involve only the small intestine, large intestine, or stomach; in some cases, all parts of the gastrointestinal tract are affected.
Contributing Factors
Ingestion of hair can occur with grooming and may lead to development of hairballs, especially in cats who are prolific groomers. While this hair does not lead to IBD, it can be contributory as a source of gastric (stomach) or intestinal irritation.
Prevalence
IBD is most common in middle-aged to older cats. Their ages are generally 5-12 years.
Causes/Transmission
For the most part, the cause (or causes) of IBD in the cat are unknown. When a cause is not identified, it is called “idiopathic IBD.” Some of the identified causes include infection with certain types of bacteria or other parasites, toxins, dietary intolerance, or immune reactions.
There are some spiral-shaped bacteria that can cause vomiting in cats and may be a cause of IBD. The most common is Helicobacter. These bacteria have been shown to be the cause of disease, including stomach ulcers, in humans and are also pathogens in cats. However, they are also found in many normal cats and humans. Therefore, just finding spiral-shaped bacteria on biopsy is not always meaningful. It is considered a pathogen only if an associated inflammation is in the stomach mucosa.
Clinical Signs
Three general presentations have been identified for IBD: (1) cats with primarily vomiting, (2), cats with primarily diarrhea, and (3) cats with both vomiting and diarrhea. Of these presentations, the most common in vomiting. It often begins as an intermittent event but, over months to years, progresses to the point that medical care is sought.
Diagnosis
Chronic inflammation stimulates immune cells, primarily lymphocytes and plasma cells, to invade the stomach and/or intestinal wall. Occasionally, eosinophils and neutrophils will be found. Thus, the disease is diagnosed when these cells are identified in abnormal levels in the tissue. A pathologist is responsible for this part of the diagnosis; his or her report usually calls the disease lymphoplasmacytic gastritis (stomach), lymphoplamsamcytic enteritis (intestine), or lymphoplasmacytic colitis (colon).
In order to obtain these cells, a biopsy is required. In most cases, an endoscope is passed into the cat’s stomach, small intestine or colon (with the cat under anesthesia). A tiny biopsy instrument is passed through the endoscope and used to take small samples of the lining (mucosa) of the affected organ. These biopsies, while fairly superficial, are extremely helpful in determining the type of cells present.
While the presence of an inflammatory process is determined with a biopsy, isolating the cause of the inflammation will usually require other tests. Tests or treatments should be performed to rule out stomach and intestinal parasites, cancer, and infections. Diseases such as hyperthyroidism and diabetes are considered. In addition, diseases of the kidney, liver, and pancreas should also be ruled out. In many cases, the cause cannot be determined.
Treatment
When possible, an underlying cause is identified and treated. Sometimes the above mentioned tests will do that, and sometimes a cause cannot be found. Unfortunately, many cases of IBD are considered idiopathic.
Spiral-shaped bacteria may be an important part of IBD in some cats. When they are found in humans, successful treatment may require several medications or combinations of medications. Currently we are using what is effective in humans to treat cats. This approach is successful in most cats, but we have quite a great deal to learn about the most effective means of treatment.
Some cats with IBD respond to a change in diet. This is done in two ways. First, a food is chosen that contains a protein source that the cat has not eaten in the past. If changing protein sources is not helpful, a high-fiber diet is tried. Unfortunately, a true food trial requires that the test diet be fed exclusively for 4-6 weeks.
If dietary therapy is not successful or feasible, drugs are used to suppress the inflammatory reaction. Corticosteroids (“cortisone”) are the most effective so they are used first. Prednisolone is the most effective of the corticosteroids and has the least side effects. However, it is not effective in all cats. Sometimes a stronger drug is used initially to gain control of the disease. Then, prednisolone is tried again as a maintenance drug. Other drugs can be tried if corticosteroids are not successful.
Corticosteroids are renowned for causing a variety of side effects in humans. Fortunately, cats are relatively resistant to these side effects as compared to humans. Regardless, to minimize any possible adverse effects, our goal is to use the lowest possible dose that is effective and to administer it on an every other day schedule. By giving prednisolone every other day, the last dose is out of the body for about 12 hours before the next dose is given. During this 12-hour period, the adrenal glands are stimulated to function and the body does not forget how to manufacture its own corticosteroids.
The cat’s adrenal glands function primarily in the morning hours. By giving prednisolone in the evening, the 12-hour off period will occur when the adrenal glands are ready to work. Thus, the preferred way to give prednisolone on a long-term basis is to give it every other evening. Even if several tablets are given, all are given at the same time.
It will be necessary to begin therapy with a rather high dose, but once response occurs, the dose is gradually tapered to the point that the signs are controlled. Long-term therapy is required for many cats. Generally, a cat is treated for a few months then prednisolone is discontinued to see if it is still needed. If the signs of vomiting or diarrhea recur, it is resumed.
Prognosis
In most cases, it is reasonable to hope for control of the disease. However, unless a specific cause can be identified, a cure is not expected. Also, the intestinal biopsies taken with the endoscope can be helpful in determining the severity of the IBD, which helps in considering prognosis.
Transmission to Humans
IBD is not transmitted to humans. Potentially, some of the parasitic causes of IBD could be infectious to humans but, in most cases, a cause is not identified.
Icterus in Cats
Icterus is also known as jaundice or yellow jaundice. It means that a yellow pigment is found in the blood and in the tissues. It is most easily seen in the gums, the sclerae (white part of the eyes), the skin between the ears and the eyes, and the pinnae (ear flaps). However, if these tissues normally have a dark color, icterus may not be visible.
Contributing Factors
Icterus is often associated with the presence of fleas or ticks, infection with feline leukemia virus, feline infectious peritonitis, travel to areas endemic for liver flukes or fungal diseases, prolonged anorexia, ingestion of drugs or toxins, and presence of immune-mediated diseases.
Clinical Signs
A yellow color is noted in the skin, white part of the eyes, or on the earflaps.
Causes
The causes of icterus fall into three major categories:
1. Destruction of red blood cells. This can occur within blood vessels (intravascular) or in the spleen and liver (extravascular). The process of red cell destruction is known as hemolysis.
2. Liver disease. Any disease that causes destruction of liver cells or causes bile to become trapped in the liver can cause icterus.
3. Obstruction of the bile duct. The bile duct carries bile, an important fluid for digestion, from the gall bladder to the small intestine. Obstruction can occur within the gall bladder or anywhere along the bile duct.
Diagnosis
Diagnosis of icterus itself is straightforward; the yellow color is detected in tissues or blood. However, determining the cause of icterus can be a challenge and usually requires a series of tests. Within each category listed above are several possible causes of icterus. Once the probable cause can be placed into one of these three categories, additional tests are performed to look for a specific disease that is leading to the icteric state.
Occasionally, blood is drawn and the serum component is found to be icteric before the cat is visibly jaundiced. This information is helpful and can give a clue to impending problems.
Hemolysis
Since hemolysis results in destruction of red blood cells (erythrocytes), determination of red blood cell numbers is one of the first tests performed on the icteric patient. There are three tests that may be used for this. The red blood cell count is an actual machine count of red blood cells. The packed cell volume (PCV) is a centrifuge-performed test that separates the red blood cells from the serum or plasma (the liquid parts of the blood). The hematocrit is another way to determine if there is a reduced number of red blood cells. It is a calculated value that is essentially identical to the PCV. All three of these tests are part of a complete blood count (CBC).
Hemolysis can be caused by toxic plants, chemicals, drugs, parasites on the red blood cells, heartworms, autoimmune diseases, and cancer. Several tests are needed to determine which of these is the cause.
Liver Disease
A chemistry profile is performed on cats with icterus. This is a group of 20-30 tests that are performed on a blood sample. The chemistry profile contains several tests that are specific for liver disease. The main ones are the alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin. If these tests are normal yet there is reason to suspect liver disease, a bile acid analysis is performed.
Although each of these tests is used to “look” at the liver from a slightly different perspective, ultimately they only determine that liver disease is present. None of them are able to determine the exact cause of the disease. To make that determination, a study of liver tissue (biopsy) or liver cells (cytology) is necessary. This can be done in three ways.
1. Fine-needle aspirate. To perform this procedure, a small gauge needle is inserted through the skin into the liver. A syringe is used to aspirate some cells from the liver. The cells are placed on a glass slide, stained, and studied under a microscope. This is the least invasive and quickest test, but it has certain limitations. Because only a few cells are obtained, it is possible that a representative sample from the liver will not be obtained. It is also not possible to view the cells in their normal relationship to each other (i.e., tissue architecture). Some diseases can be diagnosed with this technique, and others cannot.
2. Large needle biopsy. This procedure is similar to the fine-needle biopsy except a much larger needle is used. This needle is able to recover a core of tissue, not just a few cells. The sample is fixed in formaldehyde and submitted to a pathologist for analysis. General anesthesia is required, but the cat is anesthetized for only a very short time. Ultrasound guidance of the biopsy needle is highly desirable to minimize complications. If it is done properly and with a little luck, this procedure will recover a very meaningful sample. However, the veterinarian cannot always choose the exact site of the liver to biopsy. Therefore, it is still possible to miss the abnormal tissue. The most significant difficulty with this technique is the inability to control hemorrhage from the biopsy site.
3. Fine-needle biopsy. This is a relatively new technique that is a combination of the fine needle aspiration and the large needle biopsy. A small needle is used to collect the sample. However, aspiration is not used. Short anesthesia and ultrasound guidance are required to choose the biopsy site and to increase safety. The tissue sample is smaller than the large needle biopsy but much greater than the needle aspirate. A cytopathologist can generally give a very good interpretation. This technique has much less likelihood of bleeding difficulties.
4. Surgical wedge biopsy. The cat is placed under general anesthesia, and the abdomen is opened surgically. This permits direct visualization of the liver so the exact site for biopsy can be chosen. A piece of the liver is surgically removed using a scalpel. This approach gives the most reliable biopsy sample, but the stress of surgery and the expense are the greatest of all of the biopsy methods. Bleeding from the biopsy site is a potential complication from this procedure so coagulation tests are often performed prior to needle biopsy or surgical biopsy.
Some of the causes of liver-related icterus include infectious diseases (feline leukemia virus, feline infectious peritonitis, fungal diseases), neoplasia, hepatic lipidosis (fatty liver), and cholangiohepatitis complex.
Bile Duct Obstruction
Cats with obstructed bile ducts are usually extremely icteric. Their yellow color can often be seen readily in the skin, as well as the sclerae and gingiva. However, an evaluation of the gall bladder and bile ducts is necessary to be sure that obstruction is present.
An ultrasound examination is the most accurate and non-invasive way to evaluate the gall bladder and bile duct. This technology uses sound waves to "look" at the liver, gall bladder, and bile duct. If this is not available, radiographs (x-rays) should be taken of the liver. However, exploratory surgery may be necessary to be properly evaluate the cat for biliary obstruction.
The most common causes of bile duct obstruction include pancreatitis, trauma, cancer, gall bladder stones, liver flukes, and severely thickened bile.
Treatment
Icterus is not a disease; it is a sign that disease is present. Therefore, there is not a specific treatment for icterus. Icterus will resolve when the disease that causes it is cured.
The basis for resolving icterus is to diagnose the underlying disease. When the proper testing is done, this is usually possible. Then, treatment can begin.
Prognosis
The prognosis is dependent upon the underlying cause.
Kidney Disease in Cats
Chronic kidney disease is a relatively common disorder in cats, especially geriatric cats. Renal (kidney) insufficiency or renal failure occurs when the kidneys are no longer able to perform their normal function of removing waste products from the blood. The former is the early stage of the latter.
Kidney failure is not the same as the inability to make urine. In fact, most cats with kidney failure are producing large volumes of urine in an attempt to remove the waste products that have accumulated in the blood. This apparent contradiction between the large volume of urine produced and declining kidney function is often a source of confusion for owners.
Typically, renal failure comes about as the kidneys slowly undergo aging changes and begin to “wear out.” It is a process that develops over months to years. Initially, there may be no apparent signs, and the cat’s bloodwork is normal. However, there are irreversible microscopic changes underway in the aging kidney. Eventually, the kidneys will begin to shrink because of scar tissue and will become small and hard. By this time, there are usually signs of progressive kidney disease, and the labwork will indicate associated changes.
The kidneys are nothing more than filters which selectively keep certain compounds in the blood, while allowing unnecessary waste products to escape into the urine. When aging causes the filtration process to become progressively less effective, blood flow to the kidneys increases in an attempt to improve filtration. This is the reason that the cat with kidney failure is producing a large volume of urine. Because of the loss of excessive fluid through the urine, the cat is obligated to drink more water to avoid becoming dehydrated. This is called a compensatory change.
Thus, the typical clinical signs of kidney failure include increased water consumption (polydipsia) and increased urine production (polyuria).
Prevalence
Various clinical studies have evaluated the prevalence of renal failure in cats. For most cats, onset of clinical signs begins anywhere from 7-12 years of age. However, the prevalence of overt kidney failure is highest in cats older than fifteen years of age. One study found that approximately 30% of cats over 15 years of age had some degree of chronic renal insufficiency or failure.
The frequency of renal failure in male cats is essentially the same as for female cats.
One study indicated no apparent breed predispositions; however, a very large study conducted by 23 veterinary colleges found that renal failure was recognized more than twice as often in the following breeds: Maine coon, Abyssinian, Siamese, Russian Blue, and Burmese.
Causes/Transmission
Chronic renal failure in cats is technically called chronic tubulointerstitial nephritis. This term essentially describes a microscopic finding and is not specific for a particular cause. In most cats, a specific cause for renal failure cannot be determined. In many cats, kidney failure is the end result of several diseases or insults to the kidneys over a prolonged period of time.
Contributing Factors
At the present time, there are three contributing factors identified that may hasten progression of renal disease.
1. Hyperthyroidism (overactive thyroid glands). This hormonal disease is relatively common in older cats. Hyperthyroid cats are usually hypertensive (have high blood pressure), and this results in increased blood flow through the kidneys. As mentioned above, extra blood flow helps the aging kidney maintain function. With treatment of hyperthyroidism, blood pressure normalizes and the extra blood flow to the kidneys is no longer present. This can cause a sudden decompensation of kidneys with already marginal function.
2. Long term intake of an acidified diet. Diets that are used to make urine pH more acid are very common. These diets have been developed to aid in management of lower urinary tract (bladder) problems in cats; this is also called “cystitis.” While these diets are useful for managing certain bladder problems more common to young adult cats, they are potentially very harmful to the kidneys of older cats. These diets cause chronic loss of potassium from the body. Chronic low potassium has been identified as a significant factor in progression of kidney disease in older cats. Even when blood levels of potassium are normal, older cats may have low levels of total body potassium. Because total body potassium cannot be measured, the contribution of potassium depletion can be overlooked.
3. Urinary tract infection. Infection in the kidneys and/or bladder may be present without any apparent signs. To prevent bacteria from further damaging the kidneys, cats with kidney failure should have the urine checked for the presence of bacteria.
Clinical Signs
As described above, the classic signs of kidney failure are increased urine output and a compensatory increase in water intake (thirst). Also, with more advanced kidney failure, other signs may include loss of appetite, weight loss and a poor haircoat, depression, vomiting, diarrhea, and very bad breath. Occasionally, ulcers will be found in the mouth. A heart murmur may be present when the anemia of renal failure develops.
High blood pressure is relatively common in cats with failing kidneys. The sustained high blood pressure causes some cats to detach the retinas in the back of the eye or to have strokes. These situations result in sudden blindness and loss of equilibrium.
Diagnosis
The diagnosis of kidney failure is made by determining the level of two waste products in the blood, blood urea nitrogen (BUN) and blood creatinine, and urine specific gravity. Urine specific gravity is obtained from a urine sample. It helps assess the ability of the kidneys to “do work.” The normal cat has very concentrated urine (high specific gravity), whereas the cat with renal failure has dilute urine (low specific gravity).
When the BUN and creatinine reach certain levels, they are very specific indicators of renal failure. However, the problem with these tests is that they do not become abnormal until late in the disease. Over 75% of kidney function must be lost before the test results are substantially elevated.
Treatment
Treatment is in two phases.
1. Phase 1 - Diuresis
In the first phase of treatment, large volumes of intravenous fluids are given in an attempt to flush toxins from the body. This flushing process, called diuresis, is designed to maximize the function of all remaining kidney tissue. If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for waste removal with the help of this additional fluid. Also, the fluid therapy helps to replace various electrolytes, especially potassium.
Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhea.
Our goal is that intensive fluid therapy will substantially decrease the blood levels of BUN and creatinine (the serum markers for kidney function). If there is improvement in the blood tests after 3-4 days of fluid therapy, the prognosis is good as long as continued treatment at home occurs. If there is no improvement after 3-4 days of fluid therapy, the prognosis is not good. Unfortunately, there is not a test that will predict which cats will respond and which will not.
2. Phase 2 - Ongoing Medical Therapy at Home
The second phase of treatment is designed to continue supporting the kidneys, realizing that if treatment is not continued the kidneys will fail again very soon. This is accomplished with one or more of the following, depending on the situation:
1. A kidney failure diet. This helps in three ways. First, it helps to minimize excess protein waste products that require the kidneys to work excessively. The result is that the BUN will improve, and the cat will usually feel better. These diets also have restricted amounts of phosphorus, and they do not have products that create an acid pH of the urine.
There are several commercially available prescription diets available. Please note that the available brands of cat food which are labeled “For Urinary Health” are designed to manage bladder problems and are harmful to cats with kidney failure. These diets are usually found in grocery stores and pet shops. You will need to purchase the special kidney failure diet from the veterinarian.
2. Potassium supplementation. Potassium is lost in the urine when urine production becomes excessive. A potassium supplement will replace that loss. As mentioned above, depletion of body potassium can worsen kidney function.
3. Fluids given at home. After your cat has completed a course of intravenous fluid therapy in the hospital, fluid can be given at home. The fluid is dripped under the skin, or subcutaneously. This serves to continually “restart” the kidneys as their function continues to decline. This is done once daily to once weekly, depending on the severity of kidney failure. Most owners easily master this technique so don’t be afraid to consider this very helpful option.
4. A phosphate binder. As the filtering ability of the kidneys declines, phosphorous begins to accumulate in the blood. High serum phosphorous contributes to depression and anorexia. Phosphate binders will attach to excess dietary phosphorous in the intestine so that it is not absorbed with the food. Blood levels of phosphorous can be monitored to help tailor the drug dosage. These drugs are used when the kidney failure diets are not able to control phosphorus levels.
5. A drug to regulate the parathyroid gland and calcium levels. Calcium and phosphorus must remain at about a 2:1 ratio in the blood. The increase in the blood phosphorus level, as mentioned above, stimulates the parathyroid gland to increase the blood calcium level by removing it from bones. This can be helpful for the sake of the normalizing calcium:phosphorus ratio, but it can make the bones brittle and easily broken. Calcitriol can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract.
6. A drug to stimulate the bone marrow to produce new red blood cells. The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells. Consequently, many cats in kidney failure have a low red blood cell count (anemia). Epogen, a synthetic form of erythropoietin, will correct the anemia in most cats. Unfortunately for some cats, the drug cannot be used long term because the immune system recognizes the drug as "foreign" and will make antibodies (immune proteins) against it.
7. Drugs to stimulate appetite. Famotidine is a drug that helps to neutralize excess stomach acid. This is often helpful in improving appetite because excess stomach acid is a cause of nausea that adversely affects the appetite. Cyproheptadine may also be helpful in improving appetite in cats with kidney failure. Both drugs may be given, but most cats need only one.
8. Drugs to control high blood pressure. About 65% of cats that have kidney failure also have hypertension. Its control is important in preventing blindness and strokes.
Kidney Transplants
This procedure is being done at a few locations in the country. Generally, the cat must still be in good condition and not ill from the kidney failure in order to be accepted for a transplant. The cat cannot can have other diseases that might complicate the transplant or be life-threatening.
Many transplant centers require that the owner adopt the cat that has donated a kidney for the procedure. Some find this undesirable; others find it very rewarding. Also, multiple medications must be given daily for the duration of the cat’s life; the antirejection drugs can be extremely expensive. Repeated blood tests are required to monitor function of the transplanted kidney and to monitor blood levels of the antirejection drug. The cost for the transplant procedure, medicines, blood monitoring, and follow up care can ultimately be thousands of dollars.
Prognosis
Prognosis can depend on response to the initial stage of treatment and your ability to perform the follow-up care. However, we encourage treatment in most situations because many cats will respond and have the potential for good quality life for months to years.
Prevention
For the most part, kidney failure is not a preventable disease. It occurs as a consequence of aging. However, known causes that can be prevented or managed include the following:
1. Urinary tract infections should be identified and treated.
2. Middle aged and older cats should not be fed acidified diets or those labeled “For Urinary Health.” It is usually safe to give these cats the diets formulated for renal disease as a prophylactic measure, although it is not clear if they may slow the onset or prevent development of kidney disease.
What You Need to Know about Kittens
We would like to congratulate you on the acquisition on your new kitten. Owning a cat can be an extremely rewarding experience, but it also carries with it quite a bit of responsibility. We hope this document will give you the information needed to make some good decisions regarding your kitten.
First, let us say that we are grateful that you have chosen us to help you with your kitten's health care. If you have questions concerning any subject related to your kitten's health, please feel free to call our hospital. Either one of the technicians or one of the doctors will be happy to help you.
Introducing a New Kitten to its New Environment
A cat is naturally inclined to investigate its new surroundings. It is suggested that the cat's area of exploration be limited initially so that these natural tendencies do not create an unmanageable task. After confining the cat to one room for the first few days, you should slowly allow access to other areas of the home.
Introducing a New Kitten to Other Cats in the Household
Most kittens receive a hostile reception from other household pets, especially from another cat. The other cat usually sees no need for a kitten in the household, and these feelings are reinforced if it perceives that special favoritism is being shown the kitten. The existing cat must not feel that it is necessary to compete for food or for attention. The new kitten should have its own food and food bowl, and it should not be permitted to eat from the other cat’s bowl. Although it is natural to spend time holding and cuddling the kitten, the existing cat will quickly sense that it is being neglected. The new kitten needs lots of love and attention, but the existing cat should not be slighted. In fact, the transition will be smoother if the existing cat is given more attention than normal.
The introduction period will usually last one to two weeks and will have one of three possible outcomes.
1. The existing cat will remain hostile to the kitten. Fighting may occur occasionally, especially if both try to eat out of the same bowl at the same time. This is an unlikely occurrence if competition for food and affection are minimized during the first few weeks.
2. The existing cat will only tolerate the kitten. Hostility will cease, but the existing cat will act as if the kitten is not present. This is more likely if the existing cat is very independent, has been an only cat for several years, or if marked competition occurred during the first few weeks. This relationship is likely to be permanent.
3. Bonding will occur between the existing cat and the kitten. They will play together, groom each other, and sleep near each other. This is more likely to occur if competition is minimized and if the existing cat has been lonely for companionship.
Playing Behavior in Kittens
Stimulating play is important during the first week. Stalking and pouncing are important play behaviors in kittens and have an important role in proper muscular development. If given a sufficient outlet for these behaviors with toys, your kitten will be less likely to use family members for these activities. The best toys are lightweight and movable. These include wads of paper, small balls, and string or ribbon. Kittens should always be supervised when playing with string or ribbons to avoid swallowing them. Any other toy that is small enough to be swallowed should also be avoided.
Disciplining a Kitten
Disciplining a young kitten may be necessary if its behavior threatens people or property, but harsh punishment should be avoided. Hand clapping and using shaker cans or horns can be intimidating enough to inhibit undesirable behavior. However, remote punishment is preferred. Remote punishment consists of using something that appears unconnected to the punisher to stop the problem behavior. Examples include using spray bottles, throwing objects in the direction of the kitten to startle (but not hit) it, and making loud noises. Remote punishment is preferred because the kitten associates punishment with the undesirable act and not with you.
Vaccinations
There are many diseases that are fatal to cats. Fortunately, we have the ability to prevent many of these by using very effective vaccines. In order to be effective, these vaccines must be given as a series of injections. Ideally, they are given at about 6-8, 12, and 16 weeks of age, but this schedule may vary somewhat depending on several factors.
The routine vaccination schedule will protect your kitten from four diseases: distemper, two respiratory viruses, and rabies. The first three are included in a combination vaccine that is given at 6-8, 12, and 16 weeks old. Rabies vaccine is given at 16 weeks of age. Leukemia vaccine is necessary if your cat does or will go outside or if you have another cat that goes in and out since this deadly disease is transmitted by contact with other cats, especially when fighting occurs. A vaccine is also available for protection against feline infectious peritonitis (FIP); this vaccine is not necessary for all cats and is recommended in select situations.
The Need for a Series of Vaccinations
When the kitten nurses its mother, it receives a temporary form of immunity through its mother's milk. This immunity is in the form of proteins called antibodies. For about 24-48 hours after birth, the kitten's intestine allows absorption of these antibodies directly into the blood stream. This immunity is of benefit during the first few weeks of the kitten's life, but, at some point, this immunity fails and the kitten must be able to make its own long-lasting immunity. Vaccinations are used for this purpose. As long as the mother's antibodies are present, vaccinations do not "take." The mother's antibodies will neutralize the vaccine so the vaccine does not get a chance to stimulate the kitten's immune system.
Many factors determine when the kitten will be able to respond to the vaccines. These include the level of immunity in the mother cat, how much of the antibody has been absorbed, and the number of vaccines given the kitten. Since we do not know when an individual kitten will lose the short-term immunity, we give a series of vaccinations. We hope that at least two of these will fall in the window of time when the kitten has lost the immunity from its mother but has not yet been exposed to disease. A single vaccination, even if effective, is not likely to stimulate the long-term immunity that is so important.
Rabies vaccine is an exception to this, since one injection given at the proper time is enough to produce long-term immunity.
Intestinal Parasites (“Worms”)
Intestinal parasites are common in kittens. Kittens can become infected with parasites almost as soon as they are born. For example, the most important source of roundworm infection in kittens is the mother's milk. The microscopic examination of a stool sample will usually help us to determine the presence of intestinal parasites. We recommend this exam for all kittens. If we can not get a stool sample, please bring one at your earliest convenience. Even if we do not get a stool sample, we recommend the use of a deworming product that is safe and effective against almost all of the common worms of the cat. Several good drugs are available. It is given now and repeated in about 3-4 weeks, because the deworming medication only kills the adult worms. Within 3-4 weeks the larval stages will have become adults and will need to be treated. Cats remain susceptible to reinfection with hookworms and roundworms. Periodic deworming throughout the cat's life may be recommended for cats that go outdoors.
Tapeworms are the most common intestinal parasite of cats. Kittens become infected with them when they swallow fleas; the eggs of the tapeworm live inside the flea. When the cat chews or licks its skin as a flea bites, the flea may be swallowed. The flea is digested within the cat's intestine; the tapeworm hatches and then anchors itself to the intestinal lining. Therefore, exposure to fleas may result in a new infection; this can occur in as little as two weeks.
Cats infected with tapeworms will pass small segments of the worms in their stool. The segments are white in color and look like grains of rice. They are about 1/8 inch (3 mm) long and may be seen crawling on the surface of the stool. They may also stick to the hair under the tail. If that occurs, they will dry out, shrink to about half their size, and become golden in color.
Tapeworm segments do not pass every day or in every stool sample; therefore, inspection of several consecutive bowel movements may be needed to find them. We may examine a stool sample in our office and not find them, then you may find them the next day. If you find them at any time, please notify us so we may provide the appropriate drug for treatment.
Feeding a Kitten
Diet is extremely important in the growing months of a cat's life, and there are two important criteria that should be met in selecting food for your kitten. We recommend a NAME-BRAND FOOD made by a national cat food company (not a generic or local brand), and a form of food MADE FOR KITTENS. This should be fed until your kitten is about 12 months of age. We recommend that you only buy food that has the AAFCO certification. Usually, you can find this information very easily on the label. AAFCO is an organization that oversees the entire pet food industry. It does not endorse any particular food, but it will certify that the food has met the minimum requirements for nutrition. Most of the commercial pet foods will have the AAFCO label. Generic brands often do not have it.
Feeding a dry, canned, or semi-moist form of cat food is acceptable. Each has advantages and disadvantages. Dry food is definitely the least expensive. It can be left in the cat's bowl at all times. If given the choice, the average cat will eat a mouthful of food about 12-20 times per day. The good brands of dry food are just as nutritious as the other forms. As a rule, most veterinarians will recommend dry food for your kitten.
Semi-moist and canned foods are also acceptable. However, both are considerably more expensive than dry food. They often are more appealing to the cat's taste; however, they are not more nutritious. If you feed a very tasty food, you are running the risk of creating a cat with a finicky appetite. In addition, the semi-moist foods are high in sugar.
Table foods are not recommended. Because they are generally very tasty, cats will often begin to hold out for these and not eat their well-balanced cat food. If you choose to give your kitten table food, be sure that at least 90% of its diet is good quality commercial kitten food.
We enjoy a variety of things to eat in our diet. However, most cats actually prefer not to change from one food to another unless they are trained to do so by the way you feed them. Do not feel guilty if your cat is happy to just eat one food day after day, week after week.
Commercials for cat food can be very misleading. If you watch carefully, you will notice that many commercials promote cat food on one basis, TASTE. Nutrition is rarely mentioned. Most of the "gourmet" foods are marketed to appeal to owners who wants the best for their cats; however, they do not offer the cat any nutritional advantage over a good quality dry food, and they are far more expensive. If your cat eats a gourmet food very long, it will probably not be happy with other foods. If it needs a special diet due to a health problem later in life, it is very unlikely to accept it. Therefore, we do not encourage feeding gourmet cat foods.
Socialization
The Socialization Period for cats is between 2 and 12 weeks of age. During that time, the kitten is very impressionable to social influences. If it has good experiences with men, women, children, dogs, other cats, etc., it is likely to accept them throughout life. If the experiences are absent or unpleasant, it may become apprehensive or adverse to any of them. Therefore, during the period of socialization, we encourage you to expose your cat to as many types of social events and influences as possible.
The Litter Box
The number one behavioral problem of cats is urinating out of the litter box (inappropriate urination). There are several things that cause this frustrating problem, but some of those are related to the litter box. The following comments are included to prevent problems later because cats are particular about their litter boxes, the litter, and the location.
Choose a litter box that is large enough for your cat to fit in comfortably. It needs to be able to turn around freely. An 18 X 14 inch box with 4-inch sides is appropriate for most adult cats. Kittens may need a box with shorter sides so they can get in and out easily.
We do not recommend a box with a top (hood). Although hooded litter boxes are more private and better contain the litter, they also trap odors inside. Because cats are so fastidious, these odors often cause them to seek other places to urinate. Many cats exhibiting inappropriate urination will return to their litter boxes when the lid is removed.
There are three types of litter: clay, clumpable, and organic.
Clay litter absorbs 75-100% of its weight in moisture. This is good but not adequate to keep urine from being absorbed throughout a widespread area of litter. Solid matter and wet litter should be removed 1-2 times per day, but the entire litter box should be changed weekly. Clay litter is also quite dusty. Cats with allergies can have increased problems when breathing the litter dust.
Clumping litter is also called scoopable litter. It absorbs urine and swells to about 15 times its original volume. Therefore, you need only to remove the litter clumps; you do not need to change the entire contents of the litter box. It tends to control urine and stool odors better than clay litter.
Organic litters are made of alfalfa, newspaper, peanut hulls, corn cobs, or recycled, biodegradable materials. They appeal to many cats, but they are also not received well by others.
Some litters contain scented or odor-controlling additives. Some cats tolerate them, but others find them objectionable. To minimize the chances of inappropriate urination, it is better to avoid scented litters.
Fecal matter and wet litter need to be removed once daily for each cat that uses the litter box. Even with clumping litter, a monthly scrubbing of the litter box removes odors that may collect in the box itself. Use warm, soapy water and avoid scented disinfectants.
The location of the litter box is important. It should be on an easily cleaned surface as some cats don't always aim well. Litter is also scratched out or tracked out of the litter box frequently. It is very important that the litter box be placed in a quite, non-threatening location. Cats need their privacy and will avoid a litter box that is in a high traffic area or a location accessible to dogs.
Flea Control
Fleas do not stay on your kitten all of their time. Occasionally, they will jump off and seek another host. Therefore, it is important to kill fleas on your new kitten before they can become established in your house. Many of the flea control products that are safe on adult cats are not safe for kittens less than 4 months of age. Be sure that any flea product you use is labeled safe for kittens.
If you use a flea spray, your kitten should be sprayed lightly. Flea and tick dip is not recommended for kittens unless they are at least 4 months of age. Remember, not all insecticides that can be used on dogs are safe for cats and kittens.
There is a trick to spraying a kitten that will make the outcome safer and more successful. When a kitten is sprayed, the fleas tend to run away from the insecticide. If you spray the body first, many fleas will run to the head where they are very difficult to kill. The best method is to spray a cotton ball then use that to wipe the flea spray onto the kitten’s face, from the nose to the level of the ears. That will keep you from getting it in the eyes and will cause the fleas to run down the neck toward the body. Wait about 2 minutes, then spray the body. Leave the spray on for about 3 minutes, then wipe off the excess. This will permit you to kill the most fleas while putting the least amount of insecticide on the kitten.
There are four products that are used only once per month. Program is a tablet that causes the adult fleas to lay sterile eggs. It is very effective, but it does not kill adult fleas that usually live 2-3 months. Advantage, Frontline Top Spot, and Revolution are the monthly products that kill adult fleas. They are liquids that are applied to the skin at the base of the neck. They are very effective and easy to use.
Trimming Toenails
Kittens have very sharp toenails. They can be trimmed with your regular finger nail clippers or with nail trimmers made for dogs and cats. If you take too much off the nail, you will get into the quick; bleeding and pain will occur. If this happens, neither you nor your cat will want to do this again. Therefore, a few points are helpful:
1. If your cat has clear or white nails, you can see the pink of the quick through the nail. Avoid the pink area, and you should be out of the quick.
2. If your cat has black nails, you will not be able to see the quick so only cut 1/32" (1 mm) of the nail at a time until the cat begins to get sensitive. The sensitivity will usually occur before you are into the blood vessel. With black nails, it is likely that you will get too close on at least one nail.
3. If your cat has some clear and some black nails, use the average clear nail as a guide for cutting the black ones.
4. When cutting nails, use sharp trimmers. Dull trimmers tend to crush the nail and cause pain even if you are not in the quick.
5. You should always have styptic powder available. This is sold in pet stores under several trade names, but it will be labeled for use in trimming nails.
Ear Mites
Ear mites are tiny insect-like parasites that live in the ear canal of cats (and dogs). The most common sign of ear mite infection is scratching of the ears. Sometimes the ears will appear dirty because of a black material in the ear canal; this material is sometimes shaken out. The instrument we use for examining the ear canals, an otoscope, has the necessary magnification to allow us to see the mites. Sometimes, we can find the mites by taking a small amount of the black material from the ear canal and examining it with a microscope. Although they may leave the ear canals for short periods of time, they spend the vast majority of their lives within the protection of the ear canal. Transmission generally requires direct ear-to-ear contact. Ear mites are common in litters of kittens if their mother has ear mites.
Heartworm Infections in Cats
We are still learning about heartworms in cats. There are seven factors that need to be considered:
1. Recent studies have shown that heartworms are more common than we have thought in the past.
2. In these studies, about 25% of the cats with heartworms live indoors all of the time.
3. Heartworms are difficult to diagnose. Although we have newer and better tests than in the past, several different tests may be required for a confirmed diagnosis.
4. There is no good treatment for heartworms in cats. The drugs used in dogs are toxic to the cat, so we try to stabilize the cat and let it outlive the heartworms. This takes about 2 years.
5. Heartworm infected cats can be stable today and die suddenly tomorrow.
6. Heartworm prevention is not toxic, not expensive, and is only given once monthly. It is a chewable tablet.
We recommend that you put your cat on heartworm prevention. The monthly chewable tablet, HeartGard and the monthly topical product, Revolution, are good insurance against a disastrous disease.
Spaying Female Cats
Spaying is the removal of the uterus and the ovaries. Therefore, heat periods no longer occur. In many cases, despite of your best effort, the female will become pregnant; spaying prevents unplanned litters of kittens.
Spaying offers several advantages. The female's heat periods result in about 2-3 weeks of obnoxious behavior. This can be quite annoying if your cat is kept indoors. Male cats are attracted from blocks away and, in fact, seem to come out of the woodwork. They seem to go over, around, and through many doors. Your cat will have a heat period about every 2-3 weeks until she is bred.
It has been proven that as the female dog gets older, there is a significant incidence of breast cancer and uterine infections if she has not been spayed. Spaying before she has any heat periods will virtually eliminate the chances of either. There is mounting evidence to believe that this is also true of cats. If you do not plan to breed your cat, we strongly recommend that she be spayed before her first heat period. This can be done anytime after she is 5 months old.
Neutering Male Cats
Neutering is the surgical removal of both testicles. It offers several important advantages. Male cats go through a significant personality change when they mature. They become very possessive of their territory and mark it with their urine to ward off other cats. The tomcat's urine develops a very strong odor that will be almost impossible to remove from your house. They also try to constantly enlarge their territory, which means one fight after another. Fighting results in severe infections and abscesses and often engenders rage in your neighbors. We strongly urge you to have your cat neutered at about 6 to 9 months of age. If he should begin to spray his urine before that time, he should be neutered immediately. The longer he sprays or fights, the less likely neutering is to stop it.
Breeding Cats
If you plan to breed your cat, she should have at least one or two heat periods first. This will allow her to physically mature allowing her to be a better mother without such a physical drain on her. We do not recommend breeding after 5 years of age unless she has been bred prior to that. Having her first litter after 5 years of age is more physically draining to her and increases the chances of her having problems during the pregnancy and/or delivery. Once your cat has had her last litter, she should be spayed to prevent the female problems older cats have.
Neutralizing Destructive Behavior with the Claws
There are four options that you should consider: frequent nail clipping, nail shields, surgical declawing, and tendonectomy.
The nails may be clipped according to the instructions above. However, your cat's nails will regrow and become sharp again in about 4-7 days. Therefore, to protect your property, it will be necessary to clip them one to two times per week.
There are some commercially available products that are called nail caps. The most common one is called Soft Paws. These are generally made of smooth plastic and attach to the end of the nail with a special glue. The nails are still present, but the caps prevent them from causing destruction. After 2-4 weeks the nails will grow enough that the caps will be shed. At that time, you should be prepared to replace them.
Surgical declawing is the removal of the nail at its base. This is done under general anesthesia; there is very little post-surgical discomfort, especially when it is performed on a kitten. Contrary to the belief of some, this surgery does not cause lameness or psychological damage. Actually, a declawed cat will not realize the claws are gone and will continue to "sharpen" the claws as normal without inflicting damage to your furniture. This surgery can be done as early as 12 weeks of age or anytime thereafter. It can also be done the same time as spaying or neutering. Once declawed, your cat should always live indoors since the ability to defend itself is compromised.
Tendonectomy is the surgical removal of a small part of the tendon on the bottom of each toe. This tendon is needed to make the nail extend. The cat retains its nails, but it cannot extend them for sharpening and scratching. The only disadvantage of this procedure is that the nails continue to grow and may grow into the pads. Therefore, the nails should be clipped every 7 to 14 days.
Pet Identification
The latest in pet retrieval is microchipping. This tiny device is implanted with a needle so the process is much like getting an injection. Our scanner can detect these chips; humane societies and animal shelters across the country also have scanners. A national registry permits the return of microchipped pets throughout the United States and Canada. We recommend it.
Blood Typing
Blood typing is available for cats. This is important should your cat develop anemia (decreased numbers of red blood cells) due to a disease or becomes anemic due to blood loss. It needs to be performed only once in your cat’s lifetime.
Litter Box Training
One of the big advantages of owning a cat is that almost all cats come litter box trained. By nature, they will urinate and defecate in a soil-like substance if it is provided.
The Litter Box
The number one behavioral problem of cats is urinating out of the litter box (inappropriate urination). There are several things that cause this frustrating problem, but some of those are related to the litter box. The following comments are included to prevent problems later because cats are particular about their litter boxes, the litter, and the location.
Choose a litter box that is large enough for your cat to fit in comfortably. It needs to be able to turn around freely. An 18 X 14 inch box with 4-inch sides is appropriate for most adult cats. Kittens may need a box with shorter sides so they can get in and out easily.
We do not recommend a box with a top (hood). Although hooded litter boxes are more private and better contain the litter, they also trap odors inside. Because cats are so fastidious, these odors often cause them to seek other places to urinate. Many cats exhibiting inappropriate urination will return to their litter boxes when the lid is removed.
Litter Box Location
The location of the litter box is important. It should be on an easily cleaned surface, as some cats don't always aim well. Litter is also scratched out or tracked out of the litter box frequently. It is very important that the litter box be placed in a quite, non-threatening location. Cats need their privacy and will avoid a litter box that is in a high traffic area or a location accessible to dogs.
Types of Kitty Litter
There are three types of litter: clay, clumpable, and organic.
Clay litter absorbs 75-100% of its weight in moisture. This is good but not adequate to keep urine from being absorbed throughout a widespread area of litter. Solid matter and wet litter should be removed 1-2 times per day, but the entire litter box should be changed weekly. Clay litter is also quite dusty. Cats with allergies can have increased problems when breathing the litter dust.
Clumping litter is also called scoopable litter. It absorbs urine and swells to about 15 times its original volume. Therefore, you need only to remove the litter clumps; you do not need to change the entire contents of the litter box. It tends to control urine and stool odors better than clay litter.
Organic litters are made of alfalfa, newspaper, peanut hulls, corn cobs, or recycled, biodegradable materials. They appeal to many cats, but they are also not received well by others.
Some litters contain scented or odor-controlling additives. Some cats tolerate them, but others find them objectionable. To minimize the chances of inappropriate urination, it is better to avoid scented litters.
Cleaning the Litter Box
Fecal matter and wet litter need to be removed once daily for each cat that uses the litter box. Even with clumping litter, a monthly scrubbing of the litter box removes odors that may collect in the box itself. Use warm, soapy water and avoid scented disinfectants.
Megacolon in the Cat
The colon is a tubular, muscular structure, which represents the termination of the intestinal tract. It is continuous with the rectum. The colon has several functions, such as absorption of water, storage of feces, and defecation (emptying of the bowel). When the muscles in the wall of the colon are stimulated to contract by nerves from the spinal cord, fecal material is pushed out of the body.
Megacolon is a condition of colonic dilation and is a fairly common problem in the cat.
Contributing Factors
Any condition that slows movement of material through the colon or causes an obstruction in the colon may lead to constipation. Chronic constipation can lead to development of Megacolon. Some possible causes would include refusal to use a soiled litter box, impaction with hair or foreign material, injury to the spinal cord, intestinal cancer, intestinal strictures, and dehydration.
Prevalence
Megacolon generally occurs in middle-aged to older cats, but has also been seen in cats only 3-4 years old. Some investigators feel that it occurs more commonly in male cats than in females. It occurs in both purebred and non-purebred cats.
Causes/Transmission
If the nerves to the colon do not function properly, the muscles of the colonic wall will not contract properly. Eventually, these muscles stretch and the colon begins to enlarge. When fecal material accumulates and is not moved out of the body, severe constipation results. With time, the colon can become 3-4 times larger than in the normal cat.
As noted above, an injury to the spinal cord can result in development of megacolon. Also, mechanical obstruction caused by tumor, foreign bodies, hairballs, and strictures can lead to megacolon. However, in most cases, we can not determine the reason that the nerves to the colon quit functioning so it is termed “idiopathic.”
Clinical Signs
Many cats with megacolon appear relatively healthy and have no signs other than chronic constipation. When other signs are present, these include a distended abdomen, anorexia, weight loss, vomiting, nausea, and straining to defecate. In severe cases, the rectum may protrude from constant straining.
Diagnosis
In many cases, the history given by the owner is suggestive of megacolon and it can be confirmed by palpation of the abdomen or examination of the rectum. It can be helpful to take an abdominal x-ray to determine the extent of the fecal retention.
Treatment
Usually, a medical approach is tried first, with surgery reserved for unresponsive cases. A medical approach involves the use of supplemental fluids, laxatives, stool softeners, colon wall stimulants, and high fiber diets. These do not correct the underlying cause, but they will help fecal material to pass so the cat does not become constipated and ill.
The medical approach may be successful for several months or years, but will generally fail at some time. When this happens, surgery must be considered. A procedure called subtotal colectomy removes most of the non-functioning part of the colon. Although this procedure involves removal of most of the colon, the anal sphincter (valve) is left intact so the cat should not lose bowel control.
Since one of the colon's primary responsibilities is to remove excess fluid from the fecal material, the cat that has had a subtotal colectomy will have rather soft stools immediately after surgery. In addition, there may be several bowel movements each day. However, after 1-2 months, most cats have soft, but formed, stool and average 3 bowel movements every 2 days. There should be no loss of fecal control.
1. Feed your cat _________ cups/cans of __________ each 24 hours in 2-4 feedings.
2. Give your cat the following medications:
_______________________________________________________________
_______________________________________________________________
3. Adjust the dosage of laxatives so your cat has a bowel movement at least once every other day. If diarrhea occurs, reduce the dosage or the frequency of administration.
Prognosis
For cats who depend only on medical therapy, the long-term prognosis is fairly guarded. For those who undergo successful surgery, the prognosis is good.
Prevention
Owners can offer preventive measures with the following:
1. Keep litter boxes clean to encourage frequent elimination
2. Comb the cat (especially longhaired cats) to remove excessive hair
3. Use laxatives (“hairball medication” ) as needed - see your veterinarian for recommended products.
4. DO NOT use any enema products. Always leave this to veterinarians, as some products are toxic to cats.
Pancreatitis in Cats
The pancreas is an important digestive organ, which has two primary functions: 1) to produce enzymes that help in digestion of food and, 2) to produce hormones, such as insulin. The pancreas is located in the right side of the abdomen near the ribs. Pancreatitis is a disorder of the pancreas that involves an intense inflammatory process. Although pancreatitis occurs less commonly in the cat than in the dog, recent research efforts have demonstrated that it occurs more commonly than previously believed.
Contributing Factors
There are no known age, sex, or breed predisposition for pancreatitis in the cat.
Prevalence
In several studies, pancreatitis was found in 1-2% of sick cats that were evaluated.
Clinical Signs
Dogs with pancreatitis are usually easy to diagnose. However, for many cats with pancreatitis, the clinical signs can be vague or nonspecific. Depression and anorexia were the most commonly reported signs in a study of 40 cats with pancreatitis. In some cats, nausea, vomiting, fever, abdominal pain, and diarrhea will predominate. If the attack is severe, acute shock, depression, and death may occur. Even though there are often no specific markers in the history or on physical examination, it has been shown that there are two primary forms of pancreatitis: an acute (sudden) form and a more long-standing chronic form.
Under normal conditions, the digestive enzymes produced by the pancreas are activated when they reach the small intestine. In pancreatitis, the enzymes are activated prematurely within the pancreas itself. This results in auto-digestion of the pancreas. The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the extent of organ involvement.
A few cats will recover from an acute episode of pancreatitis and continue to have recurrent bouts of the acute disease. The associated inflammation allows digestive enzymes spill into the abdominal cavity; this may result in secondary damage to surrounding organs, such as the liver, bile ducts, gall bladder, and intestines. In contrast to the reversible changes of acute pancreatitis, chronic pancreatitis can lead to permanent damage of the pancreas.
Causes/Transmission
In more than 90% of cases of feline pancreatitis, a cause is not identified. In dogs, it is often associated with a rich, fatty meal or the administration of cortisone; however, these associations have not been found with feline pancreatitis.
Diagnosis
The diagnosis of pancreatitis is suggested by clinical signs, laboratory tests, and radiographs (x-rays) and/or ultrasound examination, but these tests are not always diagnostic for the disease. Clinical signs were described above. Laboratory tests usually reveal an elevated white blood cell count; however, an elevated white blood cell count may also be caused by many other things besides pancreatitis. The elevation of pancreatic enzymes in the blood is probably the most helpful criteria in detecting pancreatic disease, but most cats with pancreatitis will have normal levels. Radiographs and ultrasound studies may show an area of inflammation in the location of the pancreas. Unfortunately, many cats with pancreatitis will elude detection with any of these tests. Consequently, the diagnosis of pancreatitis may be tentative in many cases.
Fortunately, a very useful test for screening cats for pancreatitis has been developed in recent years. This test, called TLI, is not routinely performed by most labs and must be sent away to a specific lab. However, it is well worth the effort to send out the sample because it is our most sensitive tool for detecting the disease.
Treatment
Successful management of pancreatitis is dependent upon early diagnosis and prompt medical attention. Resting the pancreas from its role in digestion best treats mild forms of the disease. The only way to "turn off" the pancreas is to withhold all oral fluids and food (“NPO”). This is accompanied by intravenous fluids to maintain normal hydration and electrolyte balance. In addition, anti-inflammatory drugs are sometimes administered. The presence of shock necessitates the immediate and intense use of intravenous fluids and antibiotics.
Prognosis
Prognosis depends on the severity of the disease, extent of damage to the pancreas, development of complications, and the presence of any concurrent diseases. Cats that respond well to initial therapy have a better prognosis than those that present shock with and depression, where as a more guarded prognosis must be expected.
Long-term Effects
If a significant number of cells that produce digestive enzymes are destroyed, there may be serious, long-term complications. Appropriate digestion of food may not be possible, leading to a condition called pancreatic insufficiency. This can be treated by replacing the enzymes with daily administration of enzyme powder in the food. If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result. This can usually be treated with daily injections of insulin. Fortunately, the vast majority of cats recover without either of these problems developing.
Pleural Effusion
A pleural effusion is a collection of fluid in the space between the lungs and the body wall. This space is called the pleural space. When your cat is normal, there should be no fluid or air in it.
Causes
There are several important diseases that can cause fluid to collect in the pleural space. To diagnose a specific disease, it is necessary to determine the type of effuion present. The most important types of effusions are:
1) Chyle: Chyle is part of the body's immune system. It is carried in tiny ducts from one lymph node to another to the large vein that enters the heart (the posterior vena cava). The fluid of chylothorax is white in color.
2) Pus: Pus is formed when an infection occurs in the pleural space. The infection is usually due to bacteria, but fungal infections also occur. The fluid of pyothorax is usually yellow to yellow-green in color.
3) Blood: Blood reaches this space due to trauma to blood vessels trauma or due to an inability for the cat's blood to clot properly. The latter sometimes occurs in cats poisoned with rat poison. The fluid of hemothorax is red in color.
- Modified Transudate: This is a watery-like substance that may be due to cancer (lymphoma), sterile inflammations, or viral infections (Feline Infectious Peritonitis). This fluid may be clear, pink, or amber in color.
- Transudate: This is a very thin, watery fluid that is usually associated with heart disease. It is usually clear.
Diagnosis
Cats with pleural effusions have difficulty breathing because the lungs are compressed by the fluid. This is often the reason they are presented for medical care. The first step in diagnosis is to take a radiograph (x-ray) of the chest to document that the difficulty breathing is due to a pleural effusion. If fluid is present, a small amount is removed with a syringe and needle. Several important tests are performed that include specific gravity determination, cell counts, protein level, and cytology (inspection of the specific cells). These tests generally allow us to classify the type of effusion in one of the above 5 categories. With this information, a list of possible diseases can be developed.
Treatment
The immediate need of your cat is to restore proper breathing ability. This is done by removing the fluid from the pleural space. This procedure is called thoracocentesis. Sedation is usually needed since a needle is inserted between the ribs so the fluid can be withdrawn. Several sites are usually aspirated in order to remove most or all of the fluid. Many of these cats are critical; therefore, sedation will incur some degree of risk.
In many cats, we will remove up to 240 ml (8 ounces) of fluid. If at least 100 ml is removed, breathing is improved. The more that we can remove, the better your cat will be able to breathe. However, the amount removed is also limited by how much is there. Therefore, we generally make another radiograph after fluid removal to determine how much, if any, remains. This may also allow us to see other problems in the chest that the fluid was hiding on the initial radiograph.
The ultimate treatment is to correct the underlying disease. That requires a diagnosis of a treatable disease. Once the underlying disease is cured or controlled, fluid does not reform and breathing remains normal.
Some diseases may be diagnosed quickly but will not be controlled quickly. This results in refilling of the pleural space after thoracocentesis and requires either repeated thoracocentesis or placement of a thoracostomy tube. The latter is a rubber-like tube that enters the pleural space but is anchored outside the body. A syringe is attached at various intervals (daily, twice daily, etc.) so the fluid can be painlessly withdrawn without sedation. The thoracostomy tube is removed when fluid production stops.
Post-operative Instructions
Your cat is recovering from major surgery that requires continued nursing care at home in order to ensure a successful outcome. Your job in the recovery period at home is just as important as the procedure we just completed.
This care at home mainly entails restriction of activity because your cat does not understand the significance of the recovery period. It will become very active in a short period of time, and confinement indoors by you is of the utmost importance! This entails:
- No jumping or running
- No stair climbing
- No playing with other pets
- No “rough-housing”
Your cat is not to go outside the house for _________ days. If your cat is to be left alone, it must be confined to a cage or other small area. This strict confinement must be continued during the entire convalescent period. Excessive activity often leads to re-injury or serious complications that result in failure of surgical implant(s) or necessitate re-operation. This means additional expense to you and added discomfort to your cat.
Observe the incision daily for signs of redness, swelling, discharge or excessive licking. The incision should look better daily. Please do not hesitate to call if any of the above occur. We have available various sizes of protective collars to keep your cat from licking the incision. Licking usually leads to chewing out sutures, which can occur in a matter of minutes. Call us as soon as possible if this occurs because this can result in an infection that is difficult to treat and may require hospitalization.
In general, your cat should improve gradually each day. If it suddenly worsens please call us as soon as possible. Our goal is to help your cat return to a normal and pain free life. Please call if you have any concerns.
Pyelonephritis
Pyelonephritis is an infection in the kidney.
Prevalence
This is a fairly common disease of cats. However, diagnosis requires an ultrasound study of the kidneys. Since only a small percentage of veterinarians have ultrasound capabilities, it often goes undiagnosed.
Clinical Signs
In order to understand the clinical signs of this disease, it is necessary to understand some basics about kidney function.
The kidneys’ job is not to make urine but to remove waste products from the blood. It removes waste products by making urine. Loss of kidney function does not mean the inability to make urine. In fact, the cat’s response to increased waste products in the blood means the kidneys work harder and make more urine than normal.
Therefore, the clinical signs of pyelonephritis often include an increase in urination and thirst. In addition, there may be a low-grade fever, pain in the kidneys on palpation, and even signs of cystitis (bladder inflammation) as the bacteria leave the kidneys and reside in the bladder. Many of these cats have an infection that is ongoing for several weeks or months; they often gradually lose weight and become less active than normal.
Causes/Transmission
The bacteria that cause the kidney infection are in the blood; they are filtered out by the kidneys. They are thought to gain access to the blood from infections or wounds in other parts of the body. The most common source of infection is bacteria associated with tartar on the teeth. The gum tissue has a very rich blood supply so it permits bacteria that are present near the teeth to enter the blood stream.
Diagnosis
The kidneys have a large amount of reserve tissue. It isn’t until 75% of both kidneys are destroyed that the kidneys are no longer able to remove the waste products from the blood efficiently. Because of this, until more than 75% of the kidney is destroyed the kidney tests are normal presumably indicating a normal kidney. While this is good for the cat, it is very misleading to the veterinarian. Therefore, a kidney function test will usually be normal in this disease. This test is important, however, because if elevated, it allows us to assess the extent of the damage to the kidneys.
Pyelonephritis is suspected when bacteria are found in the urine. The most common form of cystitis in cats is not caused by bacteria so their presence in the urine is a red flag that the bacteria may have originated in the kidneys.
Pyelonephritis is also suspected in a cat with low-grade fever and kidney pain.
The diagnosis is confirmed with an ultrasound study, which permits us to look at the internal structure of the kidney. The bacteria cause substantial damage to the kidney; this damage can be seen with ultrasound.
Treatment
The cornerstone of treatment is to identify the bacteria and to determine which antibiotics are likely to kill them. A urine culture permits us to obtain this information. Antibiotic therapy is generally needed for 4 to 6 weeks. When the antibiotics are completed, the urine is cultured again to be sure there are no bacteria present. If that culture is clear, the urine is cultured again in 1-2 months to be sure there is not a relapse.
This can be a difficult disease to completely cure, so prompt urine culturing should be done any time the cat does not seem to be doing well or signs of cystitis occur (frequent urination, blood in the urine, small amounts of urine [one teaspoon], straining to urinate). In addition, if the cat begins to drink and urinate excessively a recheck of the urine is indicated.
Prognosis
The prognosis is generally good if a diagnosis is made before significant damage occurs to the kidneys. However, if kidney function is affected other measures will be needed to support the kidneys on a long-term basis.
Pyometra in Cats
In its simplest terms, pyometra is an infection in the uterus. However, most cases of pyometra are much more difficult to manage than a routine infection.
Prevalence
This disease does not occur in cats that have been spayed (unless part of the uterus was not removed). It may occur in young to middle-aged cats; however, it is most common in cats older than five years of age. After many years of estrous cycles without pregnancy, the uterine wall undergoes the changes that promote this disease.
The typical time for pyometra to occur is about 1-2 months following estrus.
Clinical Signs
Clinical signs depend on whether or not the cervix is open. If it is open, pus will drain from the uterus through the vagina to the outside. It may be noted on the skin or hair under the tail or on bedding and furniture where the cat has laid; however, the fastidious nature of the cat usually causes her to clean up the discharge before it can be seen. This usually prohibits owners from seeing the discharge. Fever, lethargy, anorexia, and depression may or may not be present.
If the cervix is closed, pus that forms is not able to drain to the outside. It collects in the uterus causing distention of the abdomen. The bacteria release toxins that are absorbed into circulation. These cats often become severely ill very rapidly. They are anorectic, very listless, and very depressed. Vomiting or diarrhea may be present.
Toxins released by the uterine bacteria affect the kidney's ability to retain fluid. Increased urine production occurs, and the cat drinks an increased amount of water. This occurs in both open- and closed-cervix pyometra.
Causes
Infection in the lining of the uterus is established as a result of hormonal changes. Following estrus ("heat"), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy. If pregnancy does not occur for several estrous cycles, the lining continues to increase in thickness until cysts form within it. The thickened, cystic lining secretes fluids that create an ideal environment in which bacteria can grow. Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract.
Other Causes
The use of progesterone-based drugs can cause pyometra. In addition, estrogen will increase the effects of progesterone on the uterus. Drugs containing both hormones are used to treat certain conditions of the reproductive system.
Entry of Bacteria into the Reproductive Tract
The cervix is the gateway to the uterus. It remains tightly closed except during estrus. When it is open, bacteria that are normally found in the vagina can enter the uterus rather easily. If the uterus is normal, the environment is not well suited to bacterial survival; however, when the uterine wall is thickened and cystic, perfect conditions exist for bacterial growth. In addition, when these abnormal conditions exist, the muscles of the uterus cannot contract properly. This means that bacteria that enter the uterus cannot be expelled.
Diagnosis
Cats that are seen early in the disease may have a slight vaginal discharge and show no other signs of illness. However, most cats with pyometra are not seen until later in the illness. Any very ill female cat that is drinking an increased amount of water and has not been spayed is always suspected of having pyometra. This is especially true if there is a vaginal discharge or an enlarged abdomen.
Cats with advanced pyometra have a marked elevation of the white blood cell count and often have an elevation of globulins (a type of protein produced by the immune system) in the blood. The urine may be very dilute due to the toxic effects of the bacteria on the kidneys. However, all of these abnormalities may be present in any cat with a major bacterial infection.
If the cervix is closed, radiographs (x-rays) of the abdomen will often identify the enlarged uterus. If the cervix is open, there will often be such minimal uterine enlargement that the radiograph will not be conclusive. An ultrasound examination can also be helpful in identifying an enlarged uterus and differentiating that from a normal pregnancy.
Treatment
The preferred treatment is to surgically remove the uterus and ovaries. This is called an ovariohysterectomy ("spay"). Cats diagnosed in the early stage of the disease are very good surgical candidates. The surgery is more complicated than a routine spay because a very large, pus-filled uterus must be removed with rupturing it. Recovery is also more complicated. Intravenous fluids are often needed before and after surgery; antibiotics are given for 1-2 weeks.
Non-surgical Therapy
There is a medical approach to treating pyometra. Prostaglandins are a group of hormones that reduce the blood level of progesterone, relax and open the cervix, and contract the uterus to expel bacteria and pus. They can be used to treat this disease, but they are not always successful, and they have some important limitations.
1. They cause side effects of restlessness, panting, vomiting, defecation, salivation, and abdominal pain. The side effects occur within about 15 minutes of an injection and last for a few hours. They become progressively milder with each successive treatment.
2. There is no clinical improvement for about 48 hours so cats that are severely ill are poor candidates.
3. Because they contract the uterus, it is possible for the uterus to rupture and spill infection into the abdominal cavity. This is most likely to happen when the cervix is closed.
There are some important statistics that you should know about this form of treatment:
1. The success rate for treating open-cervix pyometra is 75-90%.
2. The success rate for treating closed-cervix pyometra is 25-40%.
3. The rate of recurrence of the disease is 50-75%.
4. The chances of subsequent successful breeding are 50-75%.
Prognosis
Cats that have surgery are expected to recovery completely unless they are not treated until the infection has spread widely throughout the body (septicemia). Cats treated with prostaglandin therapy generally recover; however, if that form of treatment is not successful, surgery is still an option.
The chance of successful treatment without surgery or prostaglandin treatment (i.e., only with antibiotics) is extremely low. If treatment is not performed quickly, the toxic effects from the bacteria will be fatal. If the cervix is closed, it is also possible for the uterus to rupture, spilling the infection into the abdominal cavity. This will also be fatal.
Rabies in Cats
Rabies is a viral disease that may infect any warm-blooded animal. Regardless of the initial site of virus introduction into the animal, the virus eventually invades the central nervous system. With rare exception, it is a uniformly fatal disease.
Contributing Factors
For domestic pets, such as cats and dogs, the greatest risk factor for contracting rabies comes from failing to receive proper rabies immunization and then coming in contact with a rabid animal.
Prevalence
Rabies is found on a worldwide basis. Even though all warm-blooded animals can become infected, some species are more susceptible than others. Skunks, raccoons, and bats are considered most susceptible, with cats, dogs, horses, and humans intermediate in susceptibility. Opossums and birds are relatively more resistant to the virus compared to other species. It is important to note that while wildlife represents the major reservoir of rabies in nature, cats and dogs are the principal source for rabies transmission to humans.
Causes/Transmission
The usual source of rabies infection is the bite of an animal infected with the virus. The virus is found in high concentrations within saliva. Once inoculated into the victim, the virus travels up nerve endings to the central nervous system. There have been a few rare cases of humans contracting rabies by inhaling aerosolized virus in bat caves.
Clinical Signs
Rabies is classically divided into three distinct stages: prodromal, furious, and paralytic. The prodromal stage lasts 2-3 days and is characterized by major behavior changes. Normally friendly domestic animals, such as dogs and cats, become aggressive. In contrast, wildlife will lose fear the normal fear of humans. Also, wild animals, which are normally seen only at night (nocturnal species), may be seen during the day. During the furious stage, cats will typically become very vicious and lunge at any moving object. They may have muscle tremors and incoordination. During the final stage, the paralytic stage, paralysis sets in and death follows. Most cats die from rabies within 2-7 days after they begin to show signs of the disease.
Diagnosis
Rabies can be suspected based on clinical signs, but it can only be confirmed by microscopic examination of brain tissue. For this reason, animals suspected of having rabies are usually autopsied with a sample of brain tissue submitted to a pathologist. Although this can be upsetting for owners, remember that there is no room for error with rabies. If a human has been exposed and does not receive treatment, death is inevitable.
Whenever an animal without proper rabies vaccination bites a human, the animal is usually required to be confined and observed by a veterinarian for at least a 10-day period.
Treatment
Treatment is not recommended for animals with rabies because of the potential risk for human exposure to the virus. In addition, no successful treatment has been found.
Prognosis
Rabies is always fatal in warm-blooded animals that develop the disease.
Transmission to Humans
Rabies can be transmitted to a human through the bite of an infected animal or inoculation of rabies-infected saliva into an open wound. Whenever an animal bites a human, a physician should always be contacted promptly. In some areas, physicians are required to contact local animal control officials so that the vaccination status of the animal can be verified and an appropriate quarantine initiated.
Prevention
Because rabies-immunized pets represent an important buffer between humans and the rabies reservoir found in wildlife, the importance of regular rabies boosters for pets cannot be overemphasized.
The first rabies vaccine is usually given at 12-16 weeks of age, followed by regular boosters. Depending upon local regulations, the boosters are given every year or every three years thereafter. These vaccines are considered safe and effective.
Recommendations for Cat Owners
Pet ownership carries with it the responsibility of being proactive in health care. There are certain steps that you should take to prevent health problems. We recommend the following:
1. Keep vaccinations current
2. Brush frequently to keep hair coat from matting. Many cats do not groom themselves well.
3. Clip toenails as needed to prevent overgrowth. (Most cats less than 10 years need no nail care.)
4. Keep plenty of fresh water available and monitor its consumption.
5. Monitor urine output by measuring the amount of wet litter in the litter box.
6. Keep other pets from preventing this one from free access to food and water.
7. Keep indoors all the time if possible but at least at night.
8. Weigh your cat on the same scale and record results at least every 60 days.
Early Signs of Disease
The following are early signs of disease. Some of these are so minor that they may not seem significant. However, our goal is to diagnose and treat diseases in their early stages when the success rate is much higher. Present your cat for an examination for any of the following:
1. Sustained, significant increase in water consumption. (Abnormal is intake greater than 50 ml/#/day or approximately 1.5 cups (8 oz cups)/day or 12 oz total for 9 pound cat.)
2. Sustained, significant increase in urination or amount of wet litter.
3. Weight loss.
4. Significant decrease in appetite or failure to eat for more than two consecutive days.
5. Significant increase in appetite.
6. Repeated vomiting.
7. Diarrhea that lasts over 3 days.
8. Difficulty in passing stool or urine or prolonged sitting or laying in the litter box.
9. Change in litter box habits, especially if urination or defecation occurs out of the litter box.
10. Lameness that lasts more than 5 days, or lameness in more than one leg.
11. Noticeable decrease in vision, especially if sudden in onset or pupils that do not constrict in bright light.
12. Masses, ulcerations (open sores), or multiple scabs on the skin that persist more than 1 week.
13. Foul mouth odor or drooling that lasts over 2 days.
14. Increasing size of the abdomen.
15. Increasing inactivity or amount of time spent sleeping.
16. Hair loss, especially if accompanied by scratching or if in specific areas (as opposed to generalized).
17. Breathing heavily or rapid at rest.
18. Inability to chew or eat dry food.
Ringworm in Cats
Ringworm is a skin disease caused by a fungus (plural: fungi). Because the lesions are often circular, ringworm was once thought to be caused by a worm curling up in the tissue. However, ringworm has nothing to do with any type of worm.
Ringworm is also known as dermatophytosis. There are four species of fungi that can cause dermatophytosis in cats; however, it is most often caused by the organism called Microsporum canis. The Microsporum canis organism is so well adapted to cats that up to 20% of cats are thought to be asymptomatic carriers, meaning they have the organism but show no outward signs.
Ringworm is actually an infection of the dead layer of the skin, hair, and nails. The organism is able to utilize this dead tissue (keratin) in the skin as a source of nutrition.
Contributing Factors
Genetic and environmental influences play an important role in feline ringworm infection. A significant amount of research remains to be done on this disorder. It does appear that Himalayan and Persian cats are affected most frequently. In catteries, ringworm can be hard to control because of the numbers of animals involved.
Clinical Signs
The fungi live in hair follicles. As the organism invades the hair shafts and they weaken, hairs break off at the skin line. Patches of hair loss tend to be round; however, as the fungus multiplies, the lesions may become irregularly shaped and spread over the cat's body. These patches may be associated with scaling and crusting of the skin. The lesions are sometimes pruritic (itchy) but this is not a consistent finding.
The incubation period is 10-12 days. This means that the exposure to the fungus and establishment of infection occurs 10-12 days before any lesions occur.
Diagnosis
Feline ringworm can be diagnosed by four different methods. In some cases, more than one technique is used.
1. Identification of the typical "ringworm" lesions on the skin. This is the least accurate method.
2. Examination of the scales and hair under the microscope. Some of the fungal elements, such as spores, can be visualized with this technique.
3. Fluorescence of infected hairs under a special light. This is a screening test that is useful because Microsporum canis will sometimes fluoresce as a bright apple green under ultraviolet light. However, failure to fluoresce does not eliminate ringworm as a potential diagnosis.
4. Culture of the hair for the fungus. This method is the most accurate way to diagnose feline ringworm. After some hair is plucked from a lesion on the skin, it is placed on a special gel (culture media) to watch for growth of the fungus. Also, the color of the gel will change from yellow to red as the fungus grows. These cultures are checked daily. Most cats with ringworm will have a positive culture within 10 days, but in rare cases, growth may not occur for 14-21 days.
Transmission
Transmission occurs by direct contact between infected and non-infected individuals. It may be passed from dogs to cats and visa versa. It may also be passed from dogs or cats to people and visa versa. If a child has ringworm, he or she may have gotten it from the pet or from another child at school. Adult humans are relatively resistant to infection unless there is a break in the skin or there is suppression of the immune system (AIDS, chemotherapy, etc). Children are quite susceptible. Consult with your family physician if any family member develops suspicious skin lesions.
Transmission may also occur from the infected environment. The fungal spores may live in bedding or carpet for several months. They may be killed with a dilution of chlorine bleach and water (1 cup of chlorine bleach in a gallon of water) where it is feasible to use it.
Treatment
There are several methods for treating ringworm. The specific method(s) chosen for your cat will depend on the severity of the infection, how many pets are involved, presence of children in the household, and how difficult it will be to disinfect your cat’s environment.
1. Griseofulvin. This is a tablet that is concentrated deep in the hair follicles where it can reach the site of active fungal growth. Griseofulvin should be given daily. Cats with active lesions should receive the tablets for a minimum of 30 days. At that time, the cat should be rechecked to be sure the infection is adequately treated.
These tablets are not absorbed from the stomach unless there is fat in the stomach at the time they are given. This can be accomplished by feeding a high fat diet, such as a rich canned cat food or a small amount of fat trimmings from meats (often available at the meat departments of local grocery stores upon request of the butcher) or by allowing the cat to drink some rich cream. This is the most important part of the treatment. If you are not successful in giving the tablets, please call us for help.
Griseofulvin in the only drug approved for systemic (oral) treatment of feline ringworm. It is very effective and has successfully treated the vast majority of affected cats. However, it does have some potentially significant side effects.
a. Vomiting and diarrhea are the most common side effects. These signs may abate if the dosage is divided over two or three treatments in a day.
b. It is a potent teratogen, meaning it can cause birth defects. As such, it should not be used to treat pregnant cats or cats which might become pregnant during the treatment period. It can potentially cause abnormalities in the breeding tomcat, as well, so may be best avoided for all reproductively active cats. There are no reported effects for queens who become pregnant after griseofulvin therapy is completed.
c. Suppression of the bone marrow is a rare, but potentially fatal, complication of griseofulvin therapy. Toxicity cannot be predicted and may appear without warning; however it is most likely to occur in cats infected with the Feline Immunodeficiency Virus (“Feline AIDS Virus”)
2. Itraconazole is one of the newer drugs being used to treat ringworm. It is not approved for use in cats, but is generally considered safe and effective. The high cost of the drug is prohibitive in some cases. Some reports indicate that it is equal or possibly superior to griseofulvin in achieving a cure. It may offer the advantage of preventing fungal spores from adhering to the dead layer of the skin. For cats that cannot tolerate griseofulvin or are not cured by it, itraconazole is a good choice.
3. Baths using an antifungal shampoo. A bath should be given 3 times on an every other day schedule. Bathe exposed but unaffected pets once. These baths are important in getting the spores off the hairs so they do not drop into the environment and result in re-exposure. A lather should be formed and left on for 5-10 minutes before rinsing. Be aware that antifungal shampoos alone cannot be expected to provide a cure, but are useful in the overall treatment plan.
4. Lime Sulfur Dip. This should be done twice weekly for the first two weeks, then once weekly for 4-6 weeks. Lime sulfur dip should also be applied to other pets (dogs or cats) in the household to prevent them from being affected. If they develop ringworm lesions, they should begin on griseofulvin. You should wear gloves when applying the dip and should remove jewelry before you start. Lime sulfur can change the color of some jewelry. This is an effective form of treatment, but the dip has an objectionable odor (rotten eggs).
5. Ringworm vaccine. This vaccine helps the cat to develop immunity to the fungus. Other products are still used with it, but its use will hasten recovery. This is especially important if several other pets or children are exposed. Some cats are reported to develop hair loss and sterile abscesses at the injection site.
6. Shaving of the cat's hair. A total clipdown of the cat used to be considered standard practice. In some cases, this may still be advantageous; however, it may not be necessary in every case. Some studies have suggested that clipping may cause microscopic nicks in the skin and serve to further inoculate ringworm into the skin. Also, clipper blades can spread the fungus between cats. Clipping is most likely to be of help with longhaired cats and in households where more than one cat is infected.
Treatment will not produce immediate results and the areas of hair loss may get larger before they begin to get smaller. Within 1-2 weeks, the hair loss should stop, there should be no new areas of hair loss, and the crusty appearance of the skin should diminish. If any of these do not occur within two weeks, we should see your cat again.
Infected pets remain contagious for about 3 weeks if aggressive treatment is used. Contagion will last longer if only minimal measures are taken of if you are not faithful with the prescribed approach. Minimizing exposure to other dogs or cats and to your family members is recommended during this period.
When treatment is completed, ringworm should be cured. Although a carrier state can exist, this usually occurs because treatment is not long enough or aggressive enough or because there is some underlying disease compromising the immune system.
Roundworm Infection in Cats
(Ascariasis)
Roundworms are the most common intestinal parasite of the cat. Infection rates in kittens are thought to approach 100%. They can represent an important cause of illness, and even death, in kittens. As their name implies, these are large-bodied round worms, averaging about 3-6 inches (8-15 cm) in length. They do not attach to the wall of the intestine, as do hookworms. Instead, they are literally “swimming” within the intestine.
The scientific name for the feline roundworm is Toxocara cati. Another less common roundworm, Toxascaris leonina, can infect both dogs and cats. Roundworms are sometimes called “ascarids.”
Contributing Factors
Contributing factors for roundworm infection include queens with pre-existing infection, heavily contaminated environments, and the presence of intermediate hosts (roaches, earthworms, birds).
Clinical Signs
Roundworms are not particularly pathogenic (harmful) to mature cats, but large numbers may cause life-threatening problems in kittens and debilitated adult cats. In kittens, common signs include a pot-bellied appearance, abdominal discomfort, depressed appetite, vomiting and diarrhea, or poor growth.
In both kittens and adult cats with light infections (small numbers of worms), no signs may be apparent.
Causes
Transmammary, or milk-borne, infection is the major route of roundworm transmission to kittens. The immature roundworms (called larvae) are present in the mother’s mammary glands and pass through her milk to the kittens. Additionally, both kittens and adult cats may become infected by swallowing eggs that contain infective roundworm larvae. These eggs may come from the feces of infected cats or from the tissues of intermediate (called paratenic) hosts. Common intermediate hosts for roundworms include earthworms, cockroaches, rodents, and birds.
Once ingested, the larvae hatch out in the cat's gastrointestinal tract and migrate through the muscle, liver, and lungs. After several weeks, the larvae return to the intestine to mature. When these worms begin to reproduce, eggs will pass into the cat's stool, thus completing the life cycle of the parasite.
Diagnosis
To diagnose roundworm infection, a small amount of the cat’s stool is mixed into a special solution that causes the eggs to float to the top. The distinctive eggs are easily recognized under the microscope. Roundworm eggs are usually plentiful but, in some cases, it may take more than one fecal examination to find them. Occasionally, intact adult roundworms can be found in the cat's stool or vomit.
Treatment
Fortunately, treatment is safe, simple, and relatively inexpensive. After administration of the deworming medication (called an anthelmintic), the worms will pass into the stool. Because of their large size, they are easily identified. At least two or three treatments are needed; they are typically performed at 2-3 week intervals. Ideally, kittens are then dewormed again with each visit for kitten vaccinations. None of these treatments will kill the immature forms of the worm or the migrating larvae.
Prognosis
With diagnosis of roundworm infection and appropriate deworming, the prognosis is good. In some instances, extremely debilitated kittens may die.
Prevention
Prevention of roundworm infection should include the following measures:
1. Deworming of breeding queens prior to pregnancy and again in late pregnancy. This will reduce environmental contamination for new kittens.
2. New kittens should be appropriately dewormed as recommended by your veterinarian. The first deworming should be given at 2-3 weeks of age. Note that this is prior to the time most kittens are seen for first vaccines. It is entirely appropriate to present new kittens for deworming only.
3. Adult cats remain at risk for re-infection with roundworms throughout their lives. Whenever roundworms are seen, the cat should be promptly dewormed. It is appropriate to routinely deworm all cats who remain at high risk for reinfection. For example, it is advisable for cats with predatory habits to have a fecal examination several times a year.
4. Control of insects and rodents is important since they may serve as sources of roundworm infection for cats.
5. Stool should be removed from litter boxes daily, if possible. Litter boxes can be cleaned with a 1% bleach solution to facilitate removal of eggs. Rinse the litter box thoroughly to remove all bleach since it is toxic to cats. Similarly, surfaces that may be contaminated with roundworm eggs can also be treated with this bleach solution. It makes the eggs easier to rinse away but does not kill the eggs. Always wash your hands after handling litter box material.
6. Appropriate disposal of cat (and dog) feces, especially from yards and playgrounds, is important. Once an environment is contaminated with roundworm eggs, they may remain viable for long periods unless they are exposed to direct sunlight or very dry conditions.
7. Strict hygiene is especially important for children. Do not allow children to play in potentially contaminated environments. Be mindful of the risk that public parks and non-covered sandboxes pose. Even though stool may not be visible, roundworm eggs may be present. Sandboxes that have fitted covers are popular and are well advised to prevent infection of children with roundworms.
8. Contact your animal control officials when ownerless animals are found.
Human Infections
Roundworms pose a very real health risk for humans. The most common source of human infection is by ingesting eggs that have come from soil contaminated with cat (or dog) feces.
As many as 10,000 cases of roundworm infection in humans have been reported in one year. Children, in particular, are at risk for health problems should they become infected. A variety of organs may be affected as the larvae migrate through the body. In suitable environments, the eggs may remain infective to humans (and to cats) for years.
Subcutaneous Fluid Administration
Administration of supplemental fluids can benefit cats with a number of different medical conditions. Most commonly, fluid supplementation is recommended for cats with kidney disease. Although the idea of giving fluids may initially be intimidating, we encourage you to consider learning this technique. It is very normal to feel some anxiety about this, but we believe that you will find that it is not nearly as difficult as it would seem. The potential benefit to your cat will make it well worth your time to learn this simple technique.
Supplies
The equipment consists of a bag of intravenous (IV) fluids, an IV drip set, and a needle. The IV drip set is a simply a tube that connects the fluid bag to the needle. Although it initially seems complicated, you will soon become very comfortable with the procedure described below.
Connecting the Fluid Line to the IV Bag
1. Remove the outer, protective bag from the inner IV bag.
2. Remove the IV set from its packaging.
3. The top end of the IV set has a large, pointed end with a protective cap. Remove this cap, but do not permit it to become contaminated. IT SHOULD NOT TOUCH ANYTHING.
4. Pull the protective covering from the exit port on the bottom end of the IV bag. This will expose a hole that will accept the pointed end of the IV set.
5. Push the pointed end of the IV set into the open hole of the IV bag. It must be seated firmly to prevent leaks.
6. Remove the protective cap from the lower end of the IV set, but do not discard it. Do not permit it to become contaminated. IT SHOULD NOT TOUCH ANYTHING.
7. Close the lock in the middle of the IV tubing by moving the roller. (The lock on a new IV set is often already in the open position.)
8. Gently squeeze and release the bulb at the top of the drip set until the bulb chamber is about half full with fluid.
9. Open the lock (roller) on the tubing, then hold or suspend the IV bag; fluid should flow freely.
10. Be sure that all air bubbles run out of the tubing.
11. Close the lock on the IV line by rolling the roller downward.
12. Remove the protective cap on the lower end of the IV set.
13. Break the protective covering around the needle so that the open end (not the sharp end) is exposed. Do not permit it to become contaminated by allowing it to touch ANYTHING.
14. Remove the protective cap from the lower end of the IV set, and place the open end of the needle on it. Seat it firmly.
Insertion of the Needle
Insert the needle just under the skin in one of several locations that has unusually loose skin. These are:
- At the level of the shoulder blades, slightly to the right or to the left of midline OR
- At the level of the back legs, just to the right and to the left of midline
Fluid Administration
- Choose a location where you will treat your cat. This may be on a table, counter top, or in your lap. Some find that placing the cat in a box with an open top is helpful.
- Hang the IV bag about 3 feet (1 meter) above the level of your cat's head.
- Place your cat in the treatment location. Be sure both of you are in a position that will be comfortable for about 10-15 minutes. The end of the IV set should easily reach your cat.
- Pick up a roll of loose skin in one of the above locations.
- Lay the point of the needle at the base of the roll of skin with the needle horizontal and pointing to the cat's head. This assumes that the cat is in an upright or standing position.
- Advance the needle slightly forward while pulling the roll of skin backward. That should place the point of the needle under the skin.
- Release the roll of skin. The point of the needle should remain under the skin.
- Grasp the IV set lock in one hand. Begin the flow of fluids by rolling the roller upward.
Amount of Fluid to Give
The instructions at the end of this handout will tell you how much to give for your specific situation. As a rule, the average sized cat should receive 100-150 ml of fluids at one time. If you are using two spots, you should give half of that amount in each location.
Completing the Process
When you have given the recommended amount, complete the following steps:
- Stop the flow of fluids by rolling the roller in the IV set lock downward firmly. If you do not close it well and the bag is left hanging, fluid will drip.
-Remove the needle from the skin and replace its protective cap.
-PLACE A NEW, STERILE NEEDLE ON THE DRIP SET AS SOON AS YOU ARE THROUGH. This keeps bacteria that were picked up on the old needle from migrating into the fluids. If you wish, you may return it to our hospital for proper disposal.
- Store the equipment in a safe place until the next fluid administration.
General Considerations
It is not necessary to "sterilize" the skin with alcohol before inserting the needle. In reality, wiping a little alcohol on the skin does not really sterile it, and the odor and feel of alcohol may aggravate your cat. Many cats will taste the alcohol and begin to drool profusely.
Most cats tolerate this procedure quite well. However, if the fluids are unusually cold or hot, they may be uncomfortable. Ideally, they should be stored at about body temperature. However, as long as they are at room temperature most cats are fine. Do not refrigerate them.
As the fluids are running, a lump will form under the skin. Do not be alarmed; this is a pocket of fluid that will be absorbed over several hours. If absorption is slow, gravity may cause the fluids to migrate downward. They could move under the skin of the front or rear legs. However, if this happens, they will still be absorbed.
There is no problem if a few bubbles of air are injected under the skin. If quite a bit of air gets under the skin, you may feel a crackling sound when you push on the skin, and your cat may experience mild discomfort for a couple of hours, but no real harm will occur. The body will eventually absorb the air.
Troubleshooting
What to do if the Fluids Stop Running
This often happens when the end of the needle moves against the skin or the underlying tissue. Do not remove the needle; rather, gently reposition it until the fluids begin to flow again. Experiment with the position of the needle until the fluids flow freely.
What to do if the Fluid Runs Slowly on Subsequent Treatments
When you are finished giving fluids, you should close the lock firmly. However, closing the lock firmly may crush the tubing so that fluid will not flow well on subsequent use. If this happens, move the lock to another place on the IV tubing, and open the crushed area of the tube by pinching it with your fingers.
What to do if the Fluids Become Cloudy in Appearance or Have Floating Particles
If any cloudiness, discoloration or floating particles occur, do not use the bag. It usually means that the fluids have become contaminated with bacteria. If you administer these fluids to your cat, a serious infection may occur under the skin.
Instructions for Your Cat:
1. Give ___________ ml of fluids at each treatment.
2. Treat your cat every ________ days or _________ times per week.
3. Return _______________________ for further tests to monitor treatment progress.
Stomatitis or Gingivitis
Gingivitis is an inflammation of the gums, with or without infection. Stomatitis means that the inflammation involves the entire mouth. Cats have a disease that causes severe gum irritation that may involve almost all of the mouth. The tissues are infiltrated with plasmacytes and lymphocytes, cells of the immune system. Therefore, this disease is called lymphocytic-plasmacytic gingivitis, lymphoplasmacytic gingivitis, lymphocytic-plasmacytic stomatitis, or lymphoplasmacytic stomatitis.
Contributing Factors
Tartar formation on the teeth and accompanying bacteria around the teeth and gums are usually present. Although these factors do not cause this disease, they contribute to its severity and must be controlled as part of the overall treatment protocol. Many of these cats develop tartar at a very rapid rate and need dental cleaning every 4-6 months.
Prevalence
This is one of the more common diseases of the mouth of cats.
Causes
The cause of this disease is not known. Various theories exist, most of which revolve around the immune system. Some affected cats seem to be immune compromised; others seemed to have an over-reaction to the immune system. Another theory is that these cats are having an immune reaction or allergy to the teeth or to the bacteria that often reside around the teeth.
Gingivitis/stomatitis in cats may be the end result of more than one disease that causes the same response by the gum tissue. This theory exists because the response to treatment varies widely from cat to cat.
Clinical Signs
The clinical signs are due to the inflammation and pain in the mouth. Some cats only exhibit a decrease in appetite due to the oral pain. Those that are severely affected do not eat at all, drool excessively, sometimes with bloody saliva, and exhibit severe pain when the mouth is opened.
Diagnosis
Because the inflammation in the mouth is so unique and severe, most diagnoses are made from an oral examination. However, confirmation requires biopsy of the gums. This is especially important if the gums do not have the typical appearance or if there is poor response to treatment. Some forms of cancer can look like this disease; those cases require biopsy for differentiation.
Therapy
Various treatment approaches have been tried, but there is no treatment that is successful for all cats. Thorough teeth cleaning and one to two weeks of an antibiotic are appropriate for almost all cats. Cortisone (“steroids) is beneficial to most cats. Drugs in this category (prednisolone, prednisone, dexamethasone, triamcinolone, etc.) suppress the immune system so many consider this response to confirm that an exaggerated immune response is all or part of the cause.
Some cats respond to immune stimulating drugs (Interferon, Immunoregulin, etc.) This further confuses our understanding of the disease because these drugs have the opposite effect of cortisone. It probably indicates that there is more than one cause of this disease.
Laser surgery can be very helpful or virtually curative in some cats. The laser obliterates the abnormal tissue. However, most cats require more than one treatment and many require periodic treatments for months to years. However, this form of therapy may be the only one that really helps many cats.
Another approach to treatment is to extract all or almost all of the teeth. For some cats, the response is dramatic. However, this is not true for all cats. Therefore, this approach is generally reserved for cats that have failed to respond to the other treatments.
Prognosis
Most cats that are treated aggressively have good to excellent response so their short-term prognosis is good. However, many cats become resistant to many treatments that formerly were successful. Many cats can be managed for years; others become so painful that euthanasia must be considered.
Tapeworm Infection in Cats
Tapeworms are intestinal parasites of the cat (and dog). Because they are classified as cestodes, they belong to a different family than the hookworms and roundworms (called nematodes). Several types of tapeworms are known to infect cats; Dipylidium caninum is by far the most common.
The tapeworm uses its hook-like mouthparts for anchoring to the wall of the small intestine. Eventually, adult tapeworms may reach several inches in length. As the adult matures, individual segments (proglottids) break off from the main body of the tapeworm and pass into the cat’s feces.
Contributing Factors
Fleas are the intermediate host for the tapeworm. In other words, the tapeworm is unable to complete its life cycle without the presence of fleas in the environment. Regardless of whether the owner may have seen fleas, the cat must have ingested a flea in order to have tapeworms. Consequently, tapeworms are more common in environments that are heavily infested with fleas. Lice are also reported as intermediate hosts for tapeworms, but they are relatively uncommon parasites of cats.
The Life Cycle Works Like This: Tapeworm eggs eaten by flea larvae Fleas mature to adult Adult flea swallowed by cat Tapeworm segment passes in stool tapeworm eggs eaten by flea larvae (cycle continues)
Causes
First, tapeworm eggs must be ingested by flea larvae (an immature stage of the flea). Contact between flea larvae and tapeworm eggs is facilitated by contaminated bedding or carpet. Adult fleas do not participate in this part of the tapeworm life cycle.
Next, the cat chews or licks its skin as a flea bites; the flea is then swallowed. As the flea is digested within the cat’s intestine, the tapeworm hatches and anchors itself to the intestinal lining.
Clinical Signs
Tapeworms are not particularly harmful to the cat and few clinical signs are attributed to their presence. Usually, the cat is presented because of the owner’s reaction to the presence of the crawling proglottids. Rarely, tapeworms may cause debilitation or weight loss if they are present in large numbers. Also, a cat will occasionally scoot or drag its anus across the ground or carpet due to the anal irritation caused by the proglottids. However, this behavior is much more common in dogs than cats.
Occasionally, a tapeworm will release its attachment in the intestines and migrate to the stomach. When this happens, the cat may vomit an adult tapeworm several inches in length.
Diagnosis
Most commonly, owners recognize that the cat has tapeworms and bring this to the attention of the veterinarian. When terminal segments of the tapeworm break off and pass into the cat’s stool, they can be seen crawling on the surface of the feces. These proglottid segments look like grains of cooked white rice. Less commonly, they are seen crawling around the cat’s anus. Each of these proglottid capsules contains up to 20 tapeworm eggs.
When these proglottids are released into the environment, they dehydrate and harden; they become quite small and take on a golden hue. Eventually, they break open and release their contents (eggs).
Be aware that tapeworms are not readily diagnosed with routine fecal examinations. Because of this, you should notify your veterinarian when tapeworm segments are found in your cat’s stool.
Treatment
Available treatments are safe and effective. The deworming medication (called an anthelmintic) may be given as a tablet or an injection. After treatment, the tapeworm dies and is usually digested within the intestine, so worm segments do not usually pass into the stool. Side effects, such as vomiting and diarrhea, are rarely reported with the newer medications.
Control of fleas is the cornerstone of preventing tapeworm infection. With the new and exciting flea control products that have become available, this is now much easier than in years past. Depending on the type of product you use and the presence of other pets in your home, your veterinarian will help you decide whether you also need to treat your house and yard for fleas. With some of the newer products, environmental control of fleas may not be needed. Circumstances vary, however, so be sure to talk to your veterinarian.
If the cat lives in a flea-infested environment, tapeworm infection can become re-established within a few weeks. This is very rarely due to treatment failure; in most cases, reappearance of tapeworms represents reinfection of the cat. Additional recommendations include:
1. Prompt deworming when tapeworms are detected.
2. Appropriate disposal of all pet feces, especially in public parks, yard, or playgrounds.
3. Strict hygiene practices for children after playing outdoors.
Prognosis
New medications are safe and effective. The prognosis for successful treatment is good.
Transmission to Humans
Human can become infected with tapeworms, although infection is rare because it is established by ingestion of a flea. Most reported cases have involved children. The risk for human infection with Dipylidium caninum is quite small but does exist.
Another less common group of tapeworms, called Echinococcus, is of increasing concern as a threat to human health. These tapeworms cause serious, potentially fatal, disease when humans become infected. Infection with this parasite is harder to diagnose than Dipylidium because the segments are small and not readily seen. Trappers and hunters in the north central United States and south central Canada may be at increased risk for infection with this worm when strict hygiene is not practiced. Foxes and coyotes (and the wild rodents upon which they prey) are important in the life cycle of this parasite. Dogs and cats may also become infected if they eat rodents carrying the parasite. When eggs of Echinococcus are passed in the feces of the dog and cat, humans are at risk for infection. Free-roaming cats and dogs may need to be periodically treated with tapeworm medication. Rodent control and good hygiene are important in preventing the spread of this disease to humans. As with the more common tapeworm, infection with Echinococcus is infrequent yet possible.
Tapeworms and Pinworms
Tapeworms and pinworms look very similar. However, contrary to popular belief, pinworms do not infect cats or dogs. Any worm segments seen associated with cats are due to tapeworms. Children who get pinworms do not get them from cats or dogs.
Toxoplasmosis
Toxoplasmosis is an infectious disease caused by a one-celled parasite called Toxoplasma gondii. It is a prevalent parasite of cats throughout the world, although other species can become infected. The cat is unique in that it is the definitive host of the parasite, meaning that the organism must pass through the cat to complete all stages of its life cycle.
Contributing Factors
Cats usually become infected by feeding on rodents, some types of insects, and by ingestion of undercooked meat. Although cats who go outdoors are at somewhat increased risk of becoming infected, indoor cats may also contract the disease.
Prevalence
Once the immune system has been exposed to the toxo organism, antibodies will be produced. Antibodies (also called globulins) play a protective role in the immune system. However, detection of antibodies against toxo only means that the person or cat has been exposed; it does not mean that active toxoplasmosis is present.
The scientific literature reports that in the United States, between 30% and 50% of cats have antibodies to toxoplasmosis. About 1/3 of humans are thought to have been exposed. However, those statistics do not mean that antibody-positive cats and humans have toxoplasmosis. The presence of antibodies only means that exposure to the Toxo organism has occurred in the past.
Clinical Signs
In humans, clinical signs are rarely apparent when the immune system is normal. If signs of illness are present, they are usually self-limiting and nonspecific. The majority of clinical signs result from replication of the organism within tissues.
The respiratory system may be involved, giving the impression of a flu-like illness. In other cases, it may appear similar to mononucleosis, with fever and swollen lymph nodes. In humans with weakened immune systems (such as with AIDS or patients receiving chemotherapy), the consequences of toxoplasmosis can be devastating, eventually leading to death of the individual.
In cats, the most common signs are related to inflammatory changes in the eyes. The respiratory system, liver and central nervous system may also be involved, with signs of pneumonia, jaundice, or seizures.
Diagnosis
Owners worried that they have been infected with toxoplasmosis should seek consultation with their physician about testing.
Veterinarians are frequently asked to test a cat that belongs to a pregnant woman for toxoplasmosis. Pregnant women should know the following concerning toxoplasmosis testing:
1. A screening test for toxo antibodies can be performed on both the pregnant woman and the pet cat. A negative result means that the woman (and/or the cat) has not been exposed to the toxo organism.
2. A single antibody titer that is positive, performed on the woman and/or the pet cat, means that there has been exposure to the toxo organism at some time. In order to determine whether there is active infection, a second test must be run 2-4 weeks later. Be aware that no test is available to determine that infection has been acquired by contact with cats.
a. If the two tests give similar results, there has been an infection in the past and a certain degree of immunity exists.
b. If the second test is significantly higher that the first, there is a strong possibility that an active case of toxoplasmosis is in progress.
c. It is very important that both tests be performed by the same testing laboratory in order to properly compare results.
3. Fecal exams are low yield procedures for determining the presence of active toxoplasmosis in the cat. Most cats shed the organism once in their lives and for a period of only a few days.
Treatment
Clindamycin hydrochloride is the drug of choice for treating cats with toxoplasmosis. There is no evidence to indicate that the drug is able to completely remove the organism from the cat’s body, although most cats are improving within 2-3 days of starting the drug. Infections that involve the eyes or central nervous system are more difficult to treat. In general, better results are achieved if the cat is treated for four weeks or longer.
Prognosis
Cats who respond to clindamycin therapy and are negative for feline leukemia virus and feline immunodeficiency virus have a good prognosis. Those with weakened immune systems, advanced stages of the disease, or infections of the nervous system have a guarded prognosis for full recovery.
Transmission to Humans
As stated above, several species may develop the disease toxoplasmosis, including humans and dogs, but the organism can only complete its life cycle in the domestic cat. This means that the cat may be infected with the toxo organism and transmit it to other cats or to other species, including humans. Owners should be aware that human infection resulting from direct contact with infected cats is extremely unlikely. In order for this to occur, the following must happen:
1. The cat must be infected with the toxo organism. This usually occurs as a consequence of carnivorous feeding on mice or ingestion of undercooked meats, such as pork or mutton. Other sources of infection for cats include cockroaches and earthworms.
2. The cat must be shedding the organism in its feces. This occurs for only about a 10-day period. It usually only occurs once in the cat's lifetime.
3. Organisms in the cat’s feces must have 1-5 days to sporulate (“incubate”). This "incubation" must occur after the feces leaves the cat's body. Therefore, fresh cat feces cannot cause transmission of the infection to humans.
4. The toxo organism must be swallowed by the person being infected. It is not spread to humans through the air.
The toxo organism may also be transmitted to humans by eating raw or undercooked meats, especially pork or mutton. Since many hamburgers from fast-food restaurants are made of beef diluted with pork, most authorities feel that human infection occurs much more frequently by this method than by association with cats.
Although this is indeed a real disease with dire consequences, it should be noted that toxoplasmosis occurs infrequently, especially in consideration of the numbers of people with Toxoplasma antibodies. In AIDS patients with toxoplasmosis, the disease is generally considered to arise from reactivation of a prior infection rather than establishment of a new infection. For this reason, it is often not necessary to remove cats from the household of HIV-infected people.
The incidence of toxo antibodies in U.S. veterinarians is not different than that of the rest of the population.
Prevention
At this time, researchers are investigating the utility of a mutant strain of toxo as a potential vaccine source. Until such time as a vaccine would be widely used, prevention of infection is indicated. Practical means of preventing infection include:
1. Do not allow your cat to eat mice or poorly cooked meat. Feeding a commercial cat food and not allowing your cat outdoors reduces the possibility of the cat becoming infected.
2. Clean all feces from your cat's litter box daily. Even if the cat's feces are infected with toxo oocysts, they must incubate for 1-5 days before becoming infectious. To be extra safe, pregnant women should not clean the litter box.
3. When working in soil (flowerbeds) where cats might defecate, wear gloves to keep from getting oocysts on your hands.
4. Avoid eating raw or poorly cooked meats. Be especially careful of fast-food hamburgers. Wash hands thoroughly after handling raw meat. Clean cutting boards, knives and all utensils involved in preparation of raw meat.
5. Wash all fruits and vegetables prior to eating.
6. Keep children's sandboxes covered. Outdoor cats will frequently use the sandbox for defecation. Even if the feces are scooped out, the sandbox may remain contaminated with parasites.
Summary
1. Toxoplasmosis that affects babies is quite rare. The incidence in the United States is 0.028% of all births.
2. Feed commercial cat food and keep your cat indoors.
3. Clean the litter box of all feces daily. Pregnant women should not clean the box.
4. Wash your hands following cleaning of the litter box and handling of soil after gardening.
5. Do not eat undercooked meats.
Upper Respiratory Infections
Cats may become infected with upper respiratory viruses that resemble the common cold in humans. By "upper respiratory," we mean that the infection is limited to the nose, throat, and trachea; the eyes may also become involved. Lower respiratory tract infections involve the lungs.
There are several different viruses known to cause feline upper respiratory infections (URI’s). Two of these cause serious illness, resulting in anorexia, high fever, and ulcers of the tongue and cornea (surface of the eye). These viruses are the feline rhinotracheitis virus (also called feline herpesvirus) and the feline calicivirus. The remaining viruses cause mild sneezing for a few days but are rarely a serious problem.
As a rule, the uncomplicated forms of these viral infections are no more severe than a mild cold in a human. However, even mild infections can become life -threatening if secondary bacterial infections develop in the nose, oral cavity, or eyes. When this occurs, loss of appetite represents the single most serious complication. With time, the anorectic cat may become malnourished and dehydrated. In some cases, death may occur.
Contributing Factors
As mentioned above, in most cases, these viral infections will run their course and the cat is expected to recover. However, when secondary bacterial infections develop, the prognosis is less certain. Also, concurrent infection with the immunosuppressive viruses (feline leukemia virus and feline immunodeficiency virus) is a complicating factor.
Prevalence
The rhinotracheitis (herpes) virus is by far the most prevalent upper respiratory virus. Some prevalence studies have found that 80-90% of all cats have been infected with this virus at one time.
Clinical Signs
Sneezing and ocular discharge are the most common findings with URI’s. Initially, the nasal and ocular draining will be watery and clear. If secondary infection with bacteria develops, the fluid becomes thick and green or yellow in color. Depending upon which virus is involved, the conjunctiva (membranes lining the eyelid) and/or cornea (clear surface layer of the eyeball) may become inflamed or ulcerated. Also, ulcers within the oral cavity and on the surface of the nose may occur in some cases. Generally, the uncomplicated case will resolve in 4-21 days.
When the viral infection invades the sinuses, the delicate lacy bones called “turbinates” may be permanently damaged. Even after the viral infection has resolved, the damage may be irreversible. Frequently, secondary bacterial infections develop in the sinuses and become difficult or impossible to eradicate. This is called “chronic sinusitis.”
Causes/Transmission
The respiratory viruses are spread between cats by sneezing. When the infected cat sneezes, small droplets of nasal secretions are aerosolized. They infect other cats when they come in contact with oral, nasal, and ocular (eye) membranes.
Diagnosis
For acute (sudden) infections in the young kitten or cat, a presumptive diagnosis of respiratory viral infection can be made based on the history and clinical signs. There is usually no need to distinguish between the different viruses because the treatments are essentially the same. However, when chronic eye problems develop, there may be need to do some specific testing to determine the virus responsible. These tests are not routinely done because of expense and the need for specialized laboratory facilities.
Treatment
The first decision in treatment is deciding where it is best to treat your cat - should your cat be hospitalized or treated at home? If the cat is eating, it is preferable to treat it at home. However, if there are other cats at home that are not infected, it may be best to treat it in the hospital to protect the healthy cats. If the infected cat remains at home, it should be separated from the other cats and good hygiene practiced after handling. If your cat is not eating, hospitalization is preferred so that proper antibiotics and nutrition may be administered. If this is done quickly, all but a very few cats will recover completely. If your cat is being treated at home and stops eating, it should be hospitalized for more intense treatment.
Prevention
If a cat has not become infected with the rhinotracheitis virus or calicivirus, vaccination is usually successful in preventing infection. For cats that are already carriers of these viruses, it is still important to vaccinate. If a carrier cat should reactivate the virus and begin shedding, periodic vaccination provides the immune system with a "reminder." This allows the immune system to produce antibodies, the defense agents of the immune system, which can be readily available to begin fighting the infection. Thus, the cat may still develop an URI, but the consequences will be less severe and the recovery will be faster. Even indoor-only cats should be vaccinated since most cats are already carriers of the viruses and need the periodic boost in immunity.
Prognosis
The prognosis is generally excellent if the cat continues to eat, secondary bacterial infections are managed aggressively, and no concurrent medical conditions exist. Infection with the immunosuppressive viruses renders the cat less likely to recover, although it is not impossible. Long term problems can develop when the eyes or sinuses are involved.
Transmission to Humans
These viral respiratory infections pose no health risk for humans. Although URI’s have been likened to the common cold, these viruses do not infect humans.
Vomiting in Cats
Vomiting is not a specific disease; it usually is a sign of a number of different diseases. In general, the veterinarian must to decide whether the cause of vomiting is more likely to fall into a particular category of causes. These are:
1. Vomiting caused by a disorder outside the gastrointestinal tract (systemic disease). Examples of systemic diseases include liver failure, kidney failure, thyroid disease, heartworms, and diabetes mellitus.
2. Vomiting caused by a disorder within the gastrointestinal tract or abdomen. Examples of these disorders include intestinal parasites, dietary indiscretion, pancreatitis, inflammatory diseases of the stomach and/or intestinal tract, and cancer.
Clinical Signs
Initially, it must be determined how ill the cat has become as a consequence of the vomiting. When the vomiting has led to more serious problems, any of the following might be noted:
1. Diarrhea
2. Dehydration
3. Loss of appetite
4. Abdominal pain
5. High fever
6. Depression
7. Bloody vomiting
Causes
As noted above, the source of the vomiting (systemic cause vs. gastrointestinal tract) must be determined.
Many cases of vomiting are self-limiting after a few days and the cause may never be determined. Less commonly, vomiting may result from a serious illness. Even when vomiting is caused by mild illnesses, it may lead to death of the animal if treatment is not begun early enough to prevent severe fluid and electrolyte losses.
Diagnosis
If vomiting is associated with several of the above signs, a series of tests may be performed in the hope that a diagnosis will be made.
Diagnostic tests may include radiography (x-rays) with or without barium, blood tests, biopsies of the stomach and intestinal tract, and exploratory abdominal surgery. Once the diagnosis is known, treatment may include special medications, diets, and/or surgery.
Treatment
In some cases, such as a sudden onset of vomiting, the cause is self-limiting and only supportive care is needed. In this instance, treatment might involve fluid and electrolyte supplementation, medication for nausea, and limiting oral intake of food and water.
In more serious or protracted cases of vomiting, the animal may need to be admitted to the hospital for intravenous administration of fluids, antibiotics, medication for nausea, and observation. It is important to prevent dehydration from developing while additional diagnostics or treatments are underway.
Prognosis
The prognosis is dependent upon identification and treatment of the underlying cause for the vomiting. In some instances, the problem will be self-limiting or caused by a treatable disease. In other cases, vomiting is a sign of a more serious underlying disorder.
For the less serious cases, we expect improvement within 2-4 days. If improvement is not seen or the cat continues to deteriorate, please contact us immediately for additional information.
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