Paws Whiskers & Claws, The Feline Hospital

Georgia's premier cat hospital - servicing Marietta, Roswell, Sandy Springs, Atlanta, Vinings, Cumming, Alpharetta, Morningside, Smyrna

(770) 579-6001

4719 Lower Roswell Road, Suite 220
Marietta, Georgia, 30068

Feline Hypertension

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What is hypertension?
Hypertension is the medical term for high blood pressure. It occurs most commonly in older cats with certain conditions like kidney and thyroid disease. Hypertension can be primary or secondary in nature. Hypertension can also be caused by “white coat syndrome” or the stress of the vet visit – this is one of the many reasons why our staff do not wear white coats or other identifying clothing!

What causes hypertension?

Primary hypertension has no identified underlying cause; it is much less common and is poorly understood. Secondary hypertension occurs as a result of an underlying disease process. Chronic kidney disease (CKD) and hyperthyroidism have been identified as the two most common predisposing factors for development of feline hypertension. In humans, hypertension is related to several factors, including a stressful lifestyle. Although not all causes of feline hypertension have been identified, stress does not appear to play a role in the development of this disorder in cats.

·        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, 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 the arteries and leads to an increase in blood pressure. One study found that about 60% of cats in old-age kidney failure have hypertension. 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 metabolic rate. 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 change (benign). 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, and eventually the heart enlarges to meet these increased demands for blood flow. The increased pumping pressure leads to a greater output of blood and high blood pressure. About 25% of cats with hyperthyroidism have high blood pressure.

What are the clinical signs?

Visual 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 chamber of the eye, and blindness. Blindness develops because high blood pressure in the eye causes the retina to detach. Other possible indications of high blood pressure include restlessness, agitation, decreased grooming, head pressing, changes in appetite, thirst and/or weight. Oftentimes, owners feel that their cats are more restless or agitated at night. These problems may be temporary or permanent, just like in people and only time can tell which ailments will resolve and which will be long lasting. Cats that do not feel well, just like people, may act in ways we would refer to as cranky, easily agitated, or aggressive towards people, especially children, and/or other animals.

Why is hypertension bad?

Left untreated, hypertension can lead to a number of negative side effects including:

·        Eye damage: hypertension can cause blindness due to damage of the retina from enlarged blood vessels

·        Brain damage: hypertension can lead to seizures, stroke, altered mentation, head tilt, and neurologic deficits

·        Kidney damage: damage to the tiny working parts of the kidney called the glomerulus can lead to further decreased kidney function as well as protein loss from the kidneys (proteinuria); proteinuria further damages the kidneys and can worsen kidney disease more quickly

·        Heart damage:  hypertension causes increased workload for the heart, which can lead to the development of heart disease which can in turn cause arrhythmias, infarcts to the heart (think of a stroke, but instead of the brain the heart is affected), and heart failure

How is it diagnosed?

Hypertension should be suspected in any older 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, meaning that labwork to detect kidney and thyroid disease should be performed. 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. We use a pediatric blood pressure cuff in a manner very similar to the way human blood pressure is taken. We take the pressure on your cat’s leg.

What is involved in treatment?

The most commonly used drug is amlodipine (generic) which is Norvasc. Daily oral medication is required to control high blood pressure. This is not a cure. If you stop giving the medication as prescribed, the blood pressure can rise up into the abnormal and potentially dangerous high range again. The medication is a very small pill available at our office as well as any human pharmacy.  This medication can be made into a liquid by an outside compounding pharmacy for those who find liquid easier to administer. Rechecking blood pressure once medication is started and then at regular intervals dictated by your veterinarian is extremely important. This is the only way to know whether or not the medication is working and if adjustments to the dose of medication are necessary.

What is the 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 conditions aggressively. These conditions are not curable (with the exception of one type of treatment for hyperthyroidism), so management of the disease is essential. However, even those can be managed successfully in most cats for many years, with excellent quality of life.

If the cat has blindness due to detached retinas, a medical emergency exists. Blood pressure must be lowered quickly in order to regain vision. If the retinas remain detached for more than a day or two, 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.

When controlled, hypertension has an excellent prognosis. Continued monitoring with blood and urine samples is important to rule out concurrent disease contributing to hypertension.

Feline Arthritis

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steoarthritis or degenerative joint disease (DJD) is an irreversible, degenerative disease of the lining of the joint. The shoulder and elbow joints are those most frequently affected in older cats followed by the spine, hips, and knees.  Cartilage is eroded from the ends of the bones making up the joint, and bony spurs (called osteophytes) and thickening occur in bones adjacent to the joint. Arthritis is a painful condition that should always be taken seriously.

How do I know if my cat has arthritis?

Most cats that are middle-aged or older have arthritis. Studies have shown that about 90% of cats over the age of 12 have x-ray evidence of arthritis in at least one joint, and most of the cats in this study did not have signs seen by the owner or veterinarian! Another study showed that of cats older than 6 years of age, 61% had x-ray evidence of arthritis in at least one joint and almost 50% had arthritis in multiple joints! All of this is to say that arthritis is incredibly common and just because your cat is not displaying arthritis signs does not mean they do not already have arthritis!

Most cats with arthritis do not have very visible clinical signs, like lameness. Cats often have arthritis in both joints (i.e., both elbows or both knees) which is why we often do not see them limping. Cats are also very good at hiding their pain. Instead, there are numerous other signs of arthritis such as:

  • Difficulty climbing stairs or jumping (longer anticipation time vs swift leap)
  • Decreased activity, especially play behaviors
  • Decreased interaction with the family – staying in one place/room
  • Decrease or changes in scratching post use, especially vertical use; arthritic cats tend to scratch horizontally as reaching up becomes challenging
  • Difficulty lying down or getting up
  • Favoring/laying down on one side specifically
  • Elimination outside of the litter box as posturing in a loose substrate becomes increasingly difficult; stable surfaces (hard floors and carpet) are often chosen
  • Increased stiffness or limping
  • Inability to groom or be groomed due to pain, resulting in poor coat condition or matting, especially on back half of the body as it is difficult to twist and contort to reach the hind end, groin, and rear
  • Aggression and petting intolerance, less tolerance with other pets/people and “busyness” around them due to their inability to react and move quickly
  • Heat-seeking behavior, such as lying by heat vents, coffee pots, sunny locations, laptops
  • Weight loss or a decreased appetite as cats will always choose to remain in a warm, comfortable bed vs walk down a flight of stairs to eat.

Many pet parents will notice that their cat prefers to jump onto a chair or stool before jumping onto or off a counter/higher surface. If there is no stool, the cat may slide their paws down the vertical surface so as to lower their center of gravity lower to the floor before making the jump. When jumping up, they may do a “rearing” motion instead of just jumping lithely up onto the counter!

If you think your cat may be showing signs of arthritis, they probably are! It’s best to schedule an appointment so we can discuss treatments. It’s very helpful if you can bring videos of your cat walking, running, using stairs, and jumping. This allows us to see how they move around at home since they are often too scared or sleepy on their pre-medications to move here! We also often recommend that all cats around 7-10 years old start on an arthritis therapy to help them be more comfortable. If your cat has had limb injuries or is handicapped in any way (declawed, three-legged, previous hit by car injury, broken pelvis, bad knees, etc.) then it is advised to start joint support earlier in life rather than waiting until they show symptoms. Prevention is the best medicine!

What treatments are available for arthritis?

There are numerous treatment options available for arthritis. Depending on how severely your cat is affected, we may recommend one or multiple of the below therapies.

  • Glucosamine and chondroitin: Glucosamine is a major component of cartilage, and chondroitin aids the formation of cartilage and inhibits enzymes in the joint that tend to break down cartilage. Cosequin is a tuna/chicken flavored powder which comes in a capsule that can be given orally or sprinkled over food. Dasuquin Advanced contains glucosamine and chondroitin like Cosequin as well as additional beneficial arthritis supplements like Boswellia extract, which is a plant based anti-inflammatory.
  • PSGAGs (polysulfated glycosaminoglycans): Adequan is an injectable PSGAGs that is given subcutaneously (under the skin). PSGAGs help to prevent cartilage breakdown and may help to increase the quality of the fluid within the arthritic joints.
  • Omega-3 fatty acids: diets and supplements containing omega-3 fatty acids, particularly DHA & EPA, may reduce pro-inflammatory factor production. Fatty acids from cold water marine mammals are best compared to those from plants. Green-lipped mussel extracts are often used as a great source of omega-3 fatty acids and are found in Antinol Plus, one of our preferred fish oils. Another great option is Vetoquinol’s Triglyceride OMEGA, which contains fatty acids from fish oils from Atlantic sardines, mackerel, and anchovies.
  • NSAIDs (non-steroidal anti-inflammatory medications): NSAIDs are anti-inflammatory and provide pain relief by blocking parts of the pain pathway. It’s similar to a human taking ibuprofen. Since cats cannot have ibuprofen, Tylenol, or some other human pain medications, there are NSAIDs that have been created specifically for cats, such as Onsior and Meloxicam. Unfortunately, in the US no NSAIDs are labeled for long-term use in cats; this does not mean we do not use NSAIDs off-label in cats long-term, because we absolutely do! However, care should be taken when choosing the medication, dose, and frequency of the medication to minimize as many side effects as possible. NSAIDs are processed through the kidneys and so monitoring kidney values is important for every cat on regular NSAID therapy. For many of our patients, receiving daily NSAIDs is what helps to preserve their quality of life and help them be pain-free in their older years.
  • Monoclonal antibody therapy: a miraculous medication that has become available in the US in recent years is Solensia. This injection is given once monthly subcutaneously. Solensia actually works to block a part of the arthritis pain pathway; specifically, it inhibits something called nerve growth factor (NGF) in the pain pathway. By inhibiting NGF, pain signals are inhibited allowing the cat to feel much better and pain-free. When first starting Solensia, the injection is given once monthly for three months; this is because there is an additive effect with each subsequent injection. If after 3 months your cat does not have improvement on Solensia, it is discontinued. Some cats may develop a tolerance to the medication over time which is why we do not recommend this as a first-line therapy.
  • Other pain medications: other pain medications, such as gabapentin, buprenorphine, tramadol, or amantadine, may be used. These medications do not decrease inflammation but instead focus on decreasing pain. We frequently use gabapentin early on because it has minimal side effects and we can adjust the dose easily over time.
  • Alternative therapies: many other options are available for decreasing inflammation and/or minimizing arthritis pain. These options can include acupuncture, laser therapy, PEMF therapy, and CBD therapies (ElleVet). We do not offer these therapies at PWC but can direct you to other local practitioners who offer these services if we believe it may be helpful for your cat!

What else can I do to help my arthritic cat?

Excess weight can overburden already painful joints. If your cat is overweight, talk with your vet about the best way to safely reduce the cat’s weight. Exercise provides a two-fold benefit: it aids in weight loss and it helps keep arthritic joints from becoming stiff. Play with your cat!

Warmth provides comfort for stiff, painful joints. You might provide a heated or thermal pet bed (such as K&H heated pet beds) or use a Snuggle Safe disk to supply safe warmth without electricity. Don’t forget that cardboard is insulating and helps your cat maintain their “thermal neutral zone” without having to use extra energy, so a cardboard box with soft bedding in the sunshine can work wonders!

Large-breed dog beds usually provide thicker cushioning than cat beds, making them an excellent resting spot for your arthritic cat. Many cats will also love the extra cushion provided by memory foam, fleece plush blankets, or orthopedic beds.

Be mindful of your cat’s changing needs. Having a wide variety of choices for all of their environmental needs can help greatly. For example, add a litter box closer to the cat’s favorite napping spot or add a feeding station on each floor so the cat doesn’t have to climb the stairs to eat or get a drink. As a rule of thumb, there should be at least a litter box on every level of the home. If your home is very long, there should be litter boxes on either side of the house. Additionally, you may need to change the type of litter box you have, such as opting for one with a lower side/cutout entrance. Food and water should be easily accessible in all of the places your senior cat spends their time. We recommended spreading out resources when they are young and healthy; when they are senior, think efficiency apartment! Make it easy for them to access their needs.

Add chairs, stools, or pet ramps/stairs between the floor and higher surfaces of the home, such as beds, couches, or counters. If your cat used to jump on the counter to eat their food, make sure the counter is now easily accessible or transition to having the food on a lower level.

With a little special care, your arthritic cat can not only enjoy their senior years, they can thrive!

Cats seek heat (sun) to soothe tender joints, be sure warmth is always available for your senior cat.
Cats seek heat (sun) to soothe tender joints, be sure warmth is always available for your senior cat.

Feline Hyperthyroidism

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The thyroid glands are located in the neck and play a vital role in regulating the body's metabolic rate. 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 change (benign). Less than 2% of hyperthyroid cases involve malignant thyroid gland tumors.

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 increased demands for blood flow. The increased pumping pressure leads to a greater output of blood and high blood pressure. Hyperthyroidism can also mask underlying other diseases such as chronic kidney disease (CKD).

What cats are more likely to become hyperthyroid?

Older cats are at increased risk for developing hyperthyroidism. Environmental and dietary risk factors have been investigated and may play a role in predisposing some cats to hyperthyroidism, though the specific mechanisms are not known. No individual breed is known to be especially at increased risk.

What are the clinical signs?

Cats afflicted with hyperthyroidism usually develop a variety of signs, which may be subtle at first but then become more severe as the disease progresses. The most common clinical signs of hyperthyroidism are weight loss, increased appetite, and increased thirst and urination. Cats may eat new or different types of food than they used to (ex. a cat that always ate dry food now wants to try wet food or people food!). Hyperthyroidism may also cause vomiting, diarrhea, and increased energy (excessive vocalizing, “busy”, pacing). It’s like they are having a caffeinated beverage every few hours. The coat may appear matted or greasy; they may also overgroom because they feel jittery from the excess thyroid hormone. If a cat previously had constipation issues, the bowel movements may now be normal.

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 blindness occurs as a result of retinal hemorrhage or detachment. Heart problems develop because the heart must enlarge and thicken to meet the increased blood flow and metabolic demands. Both of these problems can be reversible with appropriate treatment of the disease.

Hyperthyroid cats, just like people with this or any other disease/illness, may act in ways we would refer to as cranky, easily agitated, or aggressive towards people, especially children, and/or other animals. Pain or discomfort from any source/cause often triggers cats to act out of their ordinary routine. They may hide, be less social, have different eating habits as described above, and/or different elimination habits which often means not using their litterbox to urinate and/or defecate. Sick or painful cats are not being spiteful or acting out of anger, just out of distress. It is their natural instinct to behave this way. In the wild, a sick cat is a weak cat and a weak cat is a potential victim. Changing their normal routine and/or demeanor may ward off a potential predator. So you see, what seems abnormal to the untrained human eye is actually normal to the feline survival instinct.

How is it diagnosed?

In most instances, diagnosis of this disease is relatively straightforward. The first step is to determine the blood 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, other tests, called a Free T4 (FT4) or TSH (thyroid-stimulating hormone), may be performed. These blood tests evaluates thyroid function in a different manner. If this is not diagnostic, a thyroid scan can be performed at a veterinary referral center or the thyroid tests can be measured again in a few weeks.

What are my options for treatment?

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.

Several tests are performed before choosing any form of treatment. These tests are needed to evaluate the overall health of the cat and predict the chances for treatment complications. Such tests include blood chemistry profile, complete blood count (CBC), and urinalysis. Sometimes blood pressure and/or cardiac ultrasound may be recommended.

The three treatment options for hyperthyroidism are:

1. Oral medication. Administration of an oral drug, methimazole, can control the effects of the overactive thyroid gland. Rarely, some cats have reactions to the drug, but that number is small. However, the side-effects may begin as late as six months after the beginning of treatment and can include vomiting, lethargy, anorexia, fever, facial/head itching, and anemia.

Methimazole does not destroy the abnormal thyroid tissue but rather prevents the production of 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 and monitor for side effects. Initially, bloodwork such as a  T4 (thyroid level) +/- other thyroid function tests (a FT4 +/- a TSH), CBC, and the kidneys should be checked 2-6 weeks (the doctor will dictate when) after starting daily medication as well as after any time the dose of medication is changed.

After the thyroid level is normal, the kidney values can increase. The hyperthyroid condition can mask underlying kidney disease. For this reason we recommend a trial with oral medication first, before RI131. If kidney disease becomes apparent, it is easier to manage both diseases with oral thyroid medication than with surgery or RI131. Once the thyroid level is stable, rechecks will be every six months.

The pill is very small, inexpensive, and has minimal to no taste. It is commercially available at all human pharmacies as well as our office.  It also comes in a dissolving tablet called a “mini melt” that is easy to pill directly or dissolve in a small amount of special food.  Cats require once to twice daily dosing and this can change spontaneously over the course of the cat’s life, especially because there is usually growth of the benign thyroid gland over time. That is why it is so important to monitor your cat’s weight and bloodwork regularly as determined by your vet. For those who find liquid medications easier to administer, either directly to their cat or mixed with a small amount of special food, the pill can be made into a variety of flavored liquids at an outside compounding pharmacy. It is also available in a new feline liquid called Felanorm that has a flavor most cats like. Finally, the medication can also be made into a transdermal gel at an outside pharmacy. The gel is applied to the non-haired inside portion of the cat’s inner ear.

Oral medication is by far the most common treatment. Surgery is just about obsolete now that we have other safer and easier options. Recurrence of the disease is a possibility in some cats when surgery is done, if abnormal thyroid cells are left in the cat. The remaining cells will likely grow causing the disease to recur. However, this occurs less than 5% of the time and usually 2-4 years after surgery. Another possibility for disease recurrence is that one lobe of the thyroid gland was normal at the time of surgery so it was not removed. Then, months or years later, it becomes abnormal.

2. Radioactive iodine (RI131). A very effective way to treat hyperthyroidism is with radioactive iodine therapy. It is given by a subcutaneous injection, exactly like a vaccine is, and destroys all abnormal thyroid tissue without endangering other organs. This essentially cures the disease. However, a very small percentage of cats can regrow abnormal thyroid tissue, but this is very rare. If this occurs, retreatment is necessary. Treatment requires an average stay of 2-4 days at a veterinary hospital licensed to administer the therapy. Sometimes, but not always, the expense can be greater than for the other options. This option may make more economical sense if you have a younger cat diagnosed with this disease. We see cats living into their early 20’s (average 16 years old). A 10 year old cat needing daily medicine and at least biannual blood rechecks for this disease (see below) for 10 years could cost about the same. Every once in a while a cat can become hypOthryoid after this treatment (or the next one) and still end up needing daily medication.

3. Surgery. Surgical removal of the affected thyroid lobe(s) is also very effective. Because hyperthyroid cats are usually over eight years of age, there is a degree of risk involved. There is also potential for secondary post surgical complications. 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. The cost is approximately the same as RI131 treatment. Therefore surgery is only necessary for malignant tumors which are extremely rare.

If surgery or RI131 is the treatment method chosen, the cat is usually treated with an anti-thyroid medication for several weeks prior to the procedure. 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.

With surgery, there is also a risk of damaging the parathyroid glands which sit near the thyroid gland. This is particularly of importance if both thyroid glands are removed. The parathyroid gland controls calcium levels; if it is damaged or removed, low calcium can occur which can lead to seizures or heart arrhythmias. Calcium supplementation is necessary if this occurs.

Is the prognosis good?

The outcomes following consistent medication are excellent, most cats have a very good chance of returning to a normal state of health. Of all the common disorders we see in older cats, this is the “good” one to get. Cats can live many, many years with this disease which is easily managed with one of the above treatment options. It gets complicated when they have other medical issues that were masked by the hyperthyroid state. The more we can do to manage other issues that surface as the thyroid normalizes, the better the prognosis.

It is important to note that once a cat is treated for hyperthyroidism and we slow the thyroid levels back to normal, they act their age. Cats with untreated hyperthyroidism have been acting great, often like a young cat again, but this has been a façade. Once we start treatment and normalize the thyroid level, cats will sleep more, eat less, potentially play less, and may gain weight. The older and more medical problems they have, the harder it is for them to gain weight.

With untreated hyperthyroidism, the high thyroid level suppresses the kidney levels so their kidney disease is missed or doesn’t look as bad as it truly is. When we treat hyperthyroidism, we often unmask kidney disease and needed to start therapies for chronic kidney disease, which is very common in older cats. We can also see more problems with arthritis because now these cats are slowing down and acting their age, leading to us seeing more arthritis symptoms. The arthritis and kidney disease were there all along, but masked by the over active hyperthyroid state. If a cat was previously constipated, we may see constipation issues recurring. These are all manageable issues and we can help make managing them positive for you and your cat.

Can it be prevented?

There are no preventive measures to adopt, but middle-aged and geriatric cats should all receive a complete physical examination by a veterinarian every 6-12 months. Special attention should be given to thyroid enlargement and the typical clinical signs of hyperthyroidism. Annual senior bloodwork that includes a T4 can screen for this and other diseases so that we can catch them before they make cats feel badly, lose weight, stop eating, etc.

Kidney Disease in Cats

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Your cat’s kidneys are essential to their health. Their main functions are to filter protein waste from the blood, regulate the level of essential nutrients such as potassium and phosphorus, maintain hydration, and produce urine. They also help to regulate the cat’s blood pressure, body temperature, and the production of red blood cells.

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) occurs when the kidneys slowly stop performing their main functions, leading to a buildup of toxic waste products in the cat’s blood. The kidneys are amazingly efficient, so your cat won’t show signs of illness until at least 75% of their kidney function has been lost to disease. For that reason, damage to the kidneys has probably been happening over a period of months or even years before signs of kidney disease become obvious.

A cat with healthy kidneys can concentrate and eliminate the filtered waste products with a normal amount of water intake. In the early stages of kidney disease, the kidneys can no longer concentrate the waste products as efficiently, so they need to excrete them in a lower concentration with higher volume (more urine which is dilute). This is known as compensated renal failure. After approximately 75% of the kidney tissues are destroyed, there is a rapid rise in waste products in the bloodstream and you’ll see what appears to be the sudden onset of kidney disease.

CKD is most commonly seen in older cats; only about 10% of cases occur in cats less than 3 years old. Often the early signs of disease, such as weight loss and poor coat quality, are dismissed as normal aging changes. Other signs, such as drinking and urinating a lot, mislead owners to think that their cat is well-hydrated and that their kidneys are functioning normally. In fact, the opposite is true. With CKD, your cat is simply unable to drink enough water to make up for the kidney disease. A cat with CKD is constantly dehydrated, which leads them to drink more and more frequently.

What causes CKD?

CKD is often the end stage of other illnesses. It can result from a number of reasons, including:

  • Congenital malformation of the kidneys;
  • Bacterial kidney infections (pyelonephritis);
  • Glomerulonephritis - damage caused by toxins, drugs, inflammatory diseases, etc;
  • Neoplasia - various cancers of the kidney, most commonly lymphosarcoma;
  • Amyloidosis - the build-up of a type of protein that prevents the kidney from functioning normally;
  • Viral infections such as feline leukemia or feline infectious peritonitis;
  • Aging – the most common cause of CKD

How is CKD diagnosed?

Usually your vet will diagnose renal disease by checking the level of kidney waste products in your cat’s blood – SDMA, blood urea nitrogen (BUN), and creatinine – as well as the urine specific gravity, which is the measurement of how concentrated the urine is. Additional tests for substances such as potassium and phosphorus, or to check for anemia, urinary tract infection and white blood cell (WBC) count may be required in order to determine the best treatment for your cat.

Could the kidney disease have been diagnosed earlier?

Early diagnosis is difficult because signs of the disease usually aren’t evident until there has been significant loss of kidney function.

PWC recommends a blood chemistry profile for all senior pets at least once (if not twice) each year in order to check BUN and creatinine, and a urinalysis to diagnose kidney disease at its earliest detectable level.

You should always monitor your cat’s drinking and elimination habits. If you notice excessive thirst and urination, contact your vet right away.

How does CKD affect my cat?

Because the kidneys perform a variety of different functions, the clinical signs of renal disease are not the same in every cat. The most common signs are increased thirst and urination, weight loss, poor coat quality, bad breath, variable appetite (which may be associated with ulcers of the mouth, esophagus and/or the stomach), vomiting, lethargy, and depression.

Sometimes kidney disease is seen as sudden onset blindness that is secondary to high blood pressure. High blood pressure can cause cats to act in ways that you might refer to as cranky, easily agitated, or aggressive towards people and other animals. Illness, pain or discomfort often causes cats to behave in an unusual way. They may hide, be less social, and change their eating and elimination habits. They may also feel too weak to get to the litter box, food and water.

What treatments are available?

Depending on the results of blood tests, your cat may be diagnosed with multiple conditions that require different treatments. Most cats with CKD can be effectively managed with diet change and one or two of the other treatments listed below.

1.Diet

A diet of high-quality protein in lower amounts and low phosphorus will lower the level of waste products in the blood. These prescription diets are only available at a veterinarian’s office. PWC carries a variety of canned and dry kidney diet foods. The canned diet is preferred because it adds more water to your cat’s diet, but both can and dry should be offered daily. Your cat should be allowed to eat as much of these diets as she wants.

However, it is most important that your cat eats a high-quality food regularly. If your cat won’t eat the kidney diet, prescription urinary diets may be recommended instead. While the urinary diets aren’t as restricted in high-quality proteins, they do still have low phosphorus which is very beneficial. If they won’t eat kidney or urinary diets, there is a dietary supplement that may be added to your cat’s regular food. This supplement binds to the phosphorus in the food and removes it from the body, which reduces the work required from the kidneys. If you have multiple cats with different dietary needs, we can help simplify feeding so that all of their nutritional requirements are met.

We may also recommend adding in a supplement like HydraCare. HydraCare is a packet of a broth type food that helps to hydrate the cat and encourage water consumption. It is best fed separate of other foods, but some cats like it with their regular canned foods.

2. Subcutaneous (SQ or Sub Q) fluids

Your cat’s body may need help in removing the waste products from the blood. Because dialysis is not readily available in veterinary medicine, your cat may need SQ fluids. If this becomes necessary, we will teach you how to administer these at home, or you can bring the cat in and wait while we administer the fluids for you. The process takes only about 5 minutes.

It may seem daunting to think about inserting a needle into your cat to give fluids, but it’s actually a simple procedure that gets easier with practice. There are detailed steps available in a separate handout, and our staff will give you a hands-on lesson. We have lots of tips to make it easy for you and your cat!

The amount and frequency of fluids will be determined by your vet, and may be adjusted after periodic rechecks of your cat’s blood.

3. Antibiotics

If your cat has a lower urinary tract infection (UTI, also referred to as a bladder infection) or an upper kidney infection (pyelonephritis), antibiotics may be prescribed.

4. Potassium supplementation

Cats with renal disease tend to lose too much potassium in their urine, which leads to muscle weakness, stiffness, poor hair quality, and decreased appetite. This may not be evident initially in either the blood work or your cat’s behavior or appearance. It may occur after SQ fluids are begun, so potassium levels will be checked regularly when SQ fluids are given on a steady basis. There are a few ways to supplement potassium: in the SQ fluids, as well as orally in gel or tablet form, or a powder that can be mixed with food. We must monitor the potassium levels after starting supplementation because if it somehow gets too high, this can cause life-threatening heart complications.

5. Blood pressure medication

Many cats with kidney disease also have high blood pressure. In some cases, the blood pressure may rise before the BUN or creatinine levels rise. Lowering the cat’s blood pressure not only helps them feel better but also protects the kidneys from the damage that high blood pressure can cause.

Alternatively, blood pressure may be low (due to dehydration) to normal at the time of diagnosis. If SQ fluids are given, you are adding volume to the body and re-hydrating your cat, so the blood pressure may rise too high. For these reasons we will often recommend periodic rechecks of blood pressure, even if it was normal initially.

Blood pressure in cats is treated with an inexpensive human medicine that can be purchased from us or from any pharmacy.

6. Treatment of anemia

The kidneys initiate the production of red blood cells in the body. Many cats with CKD are anemic. This can make them feel weak, lethargic and leads to loss of appetite. Like low potassium, this is often not apparent until after the start of SQ fluids. There is medicine called Varenzin that can help stimulate red blood cell (RBC) production if your cat becomes anemic from chronic kidney disease.

7. Treatment of low body temperature

Cats with advanced CKD can have difficulty maintaining their body temperature. They’ll appreciate having soft bedding in a warm, sunny location. Consider giving your cat a Snuggle Safe, which provides hours of warmth without electricity.

8. Treatment of high phosphorus

Blood levels of phosphorus can rise above normal in CKD and this makes cats feel badly and cause other problems in the body. There are no medications to lower the phosphorus in the blood. Subcutaneous fluids will help dilute and flush phosphorus out. Prescription kidney and urinary diets are low in phosphorus. Additionally, we can use phosphorus binders which bind to phosphorus in food and escort it out of the body in feces so that it never enters the bloodstream. These phosphorus binders can sometimes decrease the palatability of food for a cat that already may not want to eat, so we may not be able to use these phosphorus binders in some cats.

9.Enteric (GI) Dialysis

Azodyl is a capsule supplement given by mouth 1-3 times a day.  It is beneficial bacteria that metabolize and flush out kidney toxins that have diffused from the blood stream into the bowel. This helps slow down the buildup of kidney toxins in the blood, helping your kitty feel better.  Azodyl can be used in addition to or in some cases instead of SQ fluids.

Another great option is called Porus One. It helps with the build-up of those kidney toxins within the intestines by removing the proteins that become the kidney toxins before they have the chance to convert. It is a very fine textured, tasteless powder so it could also be mixed up with a special treat or mixed into food. It has to be given two hours before or after any other medication to work best. Porus One can also be used in addition to Azodyl and SQ fluids.

10. Additional Supportive Care

Many cats with kidney disease become nauseous from their elevated kidney toxins and have a decreased appetite. A cat does not have to vomit  to be nauseous – sometimes they will lick their lips, hypersalivate, have extra crusting around their lips, or walk up to their food as if interested and then walk away after eating no food or only a few bites. If we believe your cat is experiencing nausea symptoms, anti-nausea and anti-vomiting medications, such as Zofran (ondansetron) and Cerenia (maropitant) may be recommended. These two medications work differently, and so we often use the them together for best effects. Appetite stimulants may also be added in once we’ve controlled the underlying nausea as it’s not fair to make a nauseous cat hungry. Appetite stimulants exist in many forms and varieties, and include medications like mirtazapine and capromorelin (Entyce, Elura).

YOUR CKD CAT MUST HAVE FRESH WATER AND CLEAN LITTER AVAILABLE AT ALL TIMES because they tend to urinate frequently and dehydrate quickly. Make sure that there’s fresh water available on every floor of your home. It’s also a good idea to encourage them to eat by also providing additional food bowls. Because these cats must drink so much water, they will have an increased urgency to pass large volumes of urine. You must provide additional large litter boxes throughout your home.

How long can I expect my cat to live?

Most cases of CKD advance very slowly, especially when caught early. With treatment and regular rechecks as prescribed by your veterinarian, your cat can have many good, active years ahead.

In some cases after approximately six months of SQ fluid treatment, the remaining normal kidney tissue can hypertrophy, or enlarge, and essentially compensate to some extent for the damaged kidney tissue.

The best prognosis comes with early detection and intervention with treatments recommended by your veterinarian. We recommend screening all cats for kidney and other common geriatric diseases annually starting at 7-8 years of age.

Feline Diabetes Mellitus

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What is diabetes mellitus?

Diabetes mellitus is a medical condition resulting in an excessive amount of sugar (glucose) in the blood. This is caused by a deficiency of insulin, which is a hormone secreted by the pancreas. Insulin allows glucose to go from the blood into the cells of the body for use. Most cats with diabetes still produce some insulin, but the body’s cells are not able to use the insulin appropriately (called insulin resistance). Few cats produce no insulin at all.

The clinical signs seen in diabetes are largely related to the elevated concentrations of blood and urine glucose and the inability of the body to use glucose as an energy source due to the deficiency of insulin.

Diabetes mellitus affects an estimated one in four hundred cats, and is seen more frequently in middle to old-age cats, is more common in males than females, and in overweight cats than normal weight cats.

It is important to note that feline diabetes does not cause the same long term problems as seen in humans. It is also not managed the same way.

What are the clinical signs of diabetes mellitus?

The most common clinical signs seen in diabetic patients are an increase in water consumption and urination. Weight loss is also a common feature, and an increase in appetite may be noticed in some cats. Poor coat condition and weakness in the legs, more commonly the hind limbs, are other possible signs. Recognition of these signs is variable though, particularly because of the life-style of some cats. If a cat spends a lot of time outdoors, it may drink from ponds or pools of water outside rather than appearing to drink excessively from what is provided indoors. Sick cats, just like people, may act in ways we would refer to as cranky, easily agitated, or aggressive towards people, especially children, and/or other animals. Discomfort from any source/cause often causes cats to act out of their ordinary routine. They may hide, be less social, have different eating habits as described above, and/or different elimination habits which often means not using their litterbox to urinate and/or defecate. Sick cats are not being spiteful or acting out of anger, just out of distress and illness. It is their natural instinct to behave this way. In the wild, a sick cat is a weak cat and a weak cat is a potential victim. Changing their normal routine and/or demeanor may ward off a potential predator. So you see, what seems abnormal to the untrained human eye is actually normal to the feline survival instinct.

How is diabetes mellitus diagnosed?

The diagnosis of diabetes mellitus is made based on clinical signs, persistently elevated blood glucose concentration, and the presence of glucose in the urine. However, a diagnosis of diabetes may not be made on a single blood and urine sample as other conditions such as particular stress may also cause a transient rise in glucose levels. Confirmation of diabetes may therefore require additional diagnostics, such as a test called fructosamine. Fructosamine testing is very similar to A1C testing in humans. It measures the average blood glucose of the body over the previous two weeks. A very high average blood glucose indicates diabetes.

How is diabetes mellitus treated?

Diabetes mellitus is a treatable condition. Although long-term treatment requires commitment, it can be very rewarding to successfully manage this condition.

Initial steps in treating a diabetic cat may involve removal of any predisposing causes for the diabetes. For example, the administration of some drugs (steroids for example) predisposes cats to develop diabetes and withdrawal of these drugs may lead to resolution of the condition. Obese cats are more prone to develop diabetes and weight reduction can lead to resolution of the signs in some cats.

If there are no predisposing causes, or if correction of the predisposing causes does not lead to resolution of the diabetes, specific treatment is required. Most cats will require insulin injections to control the diabetes. During the initial stages of treatment, your cat will require several blood glucose evaluations in the form of a glucose curve (see below) and/or continuous glucose monitoring (ex. FreeStyle Libre) until an appropriate insulin dosage is determined. Most cats will achieve initial stabilization within a few days to a few weeks. Most cats will require twice daily injection of insulin, rarely once daily dosing is used. Very small needles are available which cause no pain to the cat, and within a short period of time the procedure becomes very routine. Administration times, dosages, and type of insulin will be determined by your veterinarian.

You will be taught by our staff how to give insulin injections to your cat.

Diet can also play a role in the treatment of diabetes. Your veterinarian may make a diet recommendation. However, no diet can be helpful if your cat will not eat it. In fact, it can be very dangerous if your cat does not eat while receiving insulin. So, you must make sure your cat likes its food and is eating. You cannot assume that if the cat gets hungry enough he/she will eat whatever you provide. This is not true for most cats and prolonged anorexia can lead to serious liver disease and death in cats. All cats and especially diabetic cats should be allowed to "free feed" on dry food left out all the time. Canned food should be offered at least twice daily, and we suggest combining this with insulin administration for two reasons. First, you can assure your cat has food in their system and second, you can create a positive association between the canned food and the insulin injection.

***Diabetic cats must always have easy access to fresh food and water. Since they will always have to urinate larger amounts more often, they must have additional litter boxes added throughout your home. ***

Is diabetic remission achievable?

Diabetic remission is something that may be achieved in a small subset of cats. Most cats who become diabetic are still producing insulin within their bodies, but their body is just not responding or able to use that insulin. In a small subset of cats, the insulin injections we give can allow the body to rest and “reset.” This means that the cat’s body may start to use the insulin the body produces again. If this occurs, the cat may be able to stop receiving insulin injections and is in what we call “diabetic remission.” If remission occurs, it is often within 1-4 months after diagnosis and starting insulin injections. However, remission is not always permanent. Many cats will become insulin-resistant again over time and require insulin again in the future. This is why monitoring for the symptoms of diabetes is so important!

Do treated cats need to be monitored?

Yes, it is important to monitor treatment to make sure it is working properly, and to determine if any insulin dosage adjustments are necessary.

You will be taught by our staff how to perform blood glucose curves on your cat in the comfort and convenience of your home and schedule. The first curve will take place 1-2 weeks after insulin administration begins as well as each time the dosage of insulin is changed. Once your cat is stabilized as determined by the doctor, curves are to be done monthly. A curve involves taking a blood glucose (BG) measurement, using a glucometer, at the time of insulin administrations and every two hours in between for a 12 hour period. At the time your cat is due for insulin the BG must be > 230 for it to be safe to give insulin. If the BG is < 230 do not give insulin and contact our office for instructions. If it is a Sunday do not give insulin and call our office Monday morning with an A.M. BG reading. Do not give insulin again until we tell you otherwise. It is safer to go without insulin, even for 36-48 hours, than to risk giving too much insulin and possibly causing hypoglycemia (low blood sugar/glucose). BG curve readings are to be recorded and then reported to our office  via email (catspwc@pawswhiskersandclaws.com). This information will be given to your cat’s veterinarian who will interpret the data, decide if a change in insulin dosage is required, what that change will be and when to do the next curve. Our office will then email/call you back with this information. It is not necessary to take BG readings on a daily or twice daily (at time of insulin administration) basis. The weekly or monthly curves are sufficient to assess insulin need and anticipate changes. In addition, cats will typically begin to resent such frequent BG testing. You will also be educated about the signs of hypoglycemia in cats so you will know what to look for on a daily basis and can always check a BG if you suspect low blood sugar.

In some cases, a continuous glucose monitor may be recommended. These devices are used in human medicine and often used for human diabetes management. Some of the devices, such as the FreeStyle Libre, have actually been studied and verified for use in cats. These devices are placed onto the skin after the hair is shaved and prepped by your veterinarian. A phone app is used to scan the device and see BG info. The device can stay on your cat for up to two weeks.

What happens if my cat receives too much insulin?

If a cat receives too much insulin, it is possible for the blood sugar level to drop dangerously low. For this reason it is important to be very careful in ensuring the cat receives the correct dose of insulin. This can also happen if your cat does not eat or is vomiting for a prolonged period of time (as quickly as a day or two) but still receives insulin. No food in his/her system = lower blood glucose levels which will drop even lower with the administration of insulin.

The typical signs displayed by a cat with a very low blood sugar level are severe weakness and lethargy, vocalizing, shaking, unsteadiness, and/or acting dazed and confused. The more serious signs include convulsions/seizures, coma, and death. If a diabetic cat shows any of the less serious signs, it is important to try to offer your cat some canned cat food (Hill's A/D, etc) or a special treat to tempt him/her to eat. If you can, try to get a blood glucose at this time so we know if the signs are due to low blood sugar. It is possible that something else is causing these signs. If your cat is conscious enough to be able to swallow but will not eat on its own, you can use an oral syringe to put some Karo (corn) syrup, honey, or sugar water in its mouth. Then try again to offer your cat a special treat/food. This may be enough to make your cat feel better and return to normal activity and mentation, but you should still notify our office or call the emergency clinic for guidance on future insulin administration. The doctor may also suggest your cat be seen by a veterinarian depending on the circumstances. If your cat is unable to swallow or showing any of the more serious signs mentioned above, you must seek veterinary attention immediately. If you are able to have someone call us or the emergency clinic while you are on your way, we can be better prepared for your cat's arrival and medical needs.

The sooner cats get on an insulin regime, the sooner they start to feel better. The signs you may have noticed at the time of diagnosis will lessen as we get the diabetes under control.

Type of Insulin:
__________________________________________________________________________

Each bottle expires in either 2 months or when the bottle is half empty,whichever is first. Regardless of what the bottle expiration date says. The bottle must be refrigerated. Prior to each use, mix insulin by gently rolling, do not shake.

Type of syringes:
________________________________________________
Amount of insulin to give:
____________________________unit(s) AM _______________________________unit(s) PM
Date first curve is to be performed:
__________________________________________________
Name of person giving BG lesson:
______________________________________________________
Date of BG lesson:
_________________________________________________________
Type of glucometer and test strips to purchase:
______________________________________________

We prefer if you use the brand glucometer we suggest for a couple of reasons: 1) If you are experiencing difficulty using it at home, we can walk you through problems easier over the phone and 2) we know this brand uses the “sip-in sampling" method which makes getting blood from your cat into the machine easier and requires a smaller amount of blood.

During any BG curve, if a BG is below 100, you want to take a BG every hour instead of every two hours as well as watch your cat closely for any of the signs listed above for low blood sugar. Glucometers can run up to approximately 100 points lower compared to the laboratory machines that check blood glucose levels. For this reason, the number alone should not be used to assess how your cat is doing. You should also evaluate how your cat is acting.

Keep in mind that with practice everything gets easier and this will too!! Call us for tips and tricks if you are having trouble getting blood or enough blood from your cat, etc. We are always happy to help you troubleshoot and be successful!

Administering Insulin

Remove the plastic cap on the plunger side of the insulin syringe. Push the plunger all the way in towards the needle. Once the bottle of insulin is removed from the refrigerator and gently rolled back and forth a few times, carefully remove the cap from the needle. Invert the bottle of insulin and carefully insert the needle through the rubber stopper in the bottle of insulin. (The needle should be pointed up towards the sky to meet the rubber stopper.) Pull back on the plunger to remove the appropriate amount of units of insulin. (Each line on the syringe is equal to one unit.) Then replace the cap on the needle. You are now ready to inject the insulin under the skin of your cat. On one side of the cat, in front of the hip, pull out a pocket of skin using three fingers to create a tented area of skin as shown in our office. Remove the cap off the needle and insert it into the skin pocket. Make sure the needle is inserted PARALLEL to the cat, not pointed towards his body. Also make sure the tip of the needle is pointed TOWARDS the head; that way, if something spooks them and they run away, the needle will just pull out instead of getting caught in and tearing the skin. Push the plunger all the way in and then remove the needle/syringe from your cat. Feel the area of skin/fur where you just injected to make sure you do not feel any moisture (insulin). This ensures that you got the insulin under the skin. If you feel moisture or are unsure if you got all the insulin under the skin and into your cat, DO NOT simply give your cat more insulin. Call our office for guidance. It is always safer to give less than more insulin at any one time.

Feline Heart Disease

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What is cardiomyopathy?

Cardiomyopathy is a term used to describe diseases of the heart muscle. In cats, three classes of cardiomyopathy have been described: hypertrophic, dilated and intermediate (restrictive). In all classes, the heart disease usually results in clinical signs of heart failure. Cardiomyopathy may be seen as a primary condition or secondary to other diseases.

What are the clinical signs seen with cardiomyopathy?

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In the early stages of disease, the cat may be able to cope and will not show any signs of disease. This is referred to as compensated heart disease. Often cats will alter their activity levels to those that they can cope with which makes it difficult to diagnose cardiomyopathy until it is quite advanced. Pain, discomfort, or just not feeling well may manifest in other less obvious ways. Pain or discomfort from any source/cause often causes cats to act out of their ordinary routine. They may hide, be less social, and have different eating habits and/or different elimination habits which often means not using their litterbox to urinate and/or defecate. They also may not feel strong enough to get to their litterbox, food, and/or water. Sick or painful cats are not being spiteful or acting out of anger, just out of distress, weakness, illness. It is their natural instinct to behave this way. In the wild, a sick cat is a weak cat and a weak cat is a potential victim. Changing their normal routine and/or demeanor may ward off a potential predator. As a result, what seems abnormal to the untrained human eye is actually normal to the feline survival instinct.

It is important to note that MANY cats with a cardiomyopathy will not have a detectable murmur on physical exam. Studies vary, but it is estimated that less than 50% of cats with hypertrophic cardiomyopathy (HCM) will actually have a murmur on exam. Conversely, approximately 1/3 of healthy cats (with no underlying cardiomyopathy) will have a murmur! This is why heart disease in cats is often considered a silent killer, because we just don’t know that they even heart disease since there is no murmur on their exam, and even if they have a murmur, we don’t know if there is actually disease. An echocardiogram (ultrasound of the heart) is ultimately necessary to know if cardiomyopathy is present.

The major long term concerns with all types of cardiomyopathy are:

1.Development of congestive heart failure:

Labored breathing (increased respiratory rate and/or effort, increased abdominal breathing, etc) and lethargy are the most frequently noticed signs of congestive heart failure and result from failure of the heart to efficiently pump blood.

2.Thromboembolic disease:

Altered flow of blood in enlarged heart chambers increases the risk of blood clot formation within the heart called a thrombus. If parts of the thrombus become dislodged, they can travel in the bloodstream and block smaller blood vessels. These traveling blood clots are called emboli, and the most common place for them to lodge is at the bottom of the aorta. This results in obstruction of the blood supply to the back legs, which is very painful and leads to paralysis. Although some cats may recover with appropriate intensive treatment, this is a potentially fatal complication of any cardiomyopathy. Emboli can also lodge in any other part of the body, including the lungs leading to difficulty breathing and the brain resulting in a stroke.

3.Hypertension:

High blood pressure, or hypertension, is a possible complication seen in many cases of hypertrophic cardiomyopathy (HCM). (Hypertension, especially if left uncontrolled, can also be a cause of HCM.) This may result in spontaneous bleeding, such as nose-bleeds or hemorrhage within the eye and may also cause retinal detachment and blindness. This may be noticed as a sudden loss of vision and a widely dilated pupil(s). This is an emergency situation since the blindness will be permanent unless the retina is reattached within a couple of days. Uncontrolled high blood pressure can also make cats feel anxious and restless (which can lead to excessive howling/meowing), inappetent, thirsty and just overall not well. It can also cause strokes and damage to the heart and kidneys. Drugs that lower the blood pressure may be used to treat cats with this problem. We can measure blood pressure in our office in just a few minutes. It is very similar to the way it is done in people. Examination of the eyes may give early indications of hypertension since the blood vessels of the retina may show changes and small hemorrhages may be seen.

How is cardiomyopathy diagnosed?

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Diagnosis of heart disease can be suspected on the basis of clinical signs (weight loss, difficulty breathing, blue-purple color to the gums, abnormal heart rate and/or rhythm, heart murmur, vision problems, and other signs listed above), chest x-rays, electrocardiography (ECG) and echocardiogram (ultrasound of the heart). As discussed previously, many cats with cardiomyopathy do not have a detectable heart murmur, so we may not find out about their cardiomyopathy until they develop heart failure and show symptoms related to their heart failure. Otherwise, an echocardiogram is necessary to determine if any cardiomyopathy is present.

In cases where hypertension is a possibility, blood pressure can be evaluated if suitable equipment is available. Retinal examination may provide evidence of hypertension where blood pressure measurements cannot be made.

Other tests may be done in order to check that the cardiomyopathy is not secondary to some other disease such as hyperthyroidism or high blood pressure.

What causes cardiomyopathy?

There are many causes of cardiomyopathy, but most types of cardiomyopathy are primary, meaning that there is no underlying cause. For example, HCM (hypertrophic cardiomyopathy) is one of the most common diseases of cats and there is no underlying cause other than genetics. However, in older cats, thyroid disease (hyperthyroidism) can also commonly cause cardiomyopathy. Other causes include a rare cause is dietary deficiency of taurine, an essential nutrient. This is not seen in cats fed a commercial cat food since all of these are supplemented with taurine nowadays.

How is cardiomyopathy treated?

In cases where an underlying cause of the heart disease is found, then treatment of this condition may result in improvement or reversal of the heart disease. Hyperthyroidism is the most treatable cause of cardiomyopathy since complete resolution of the heart disease is possible if diagnosed and treated early. In cases where no cause is identified (referred to as idiopathic cardiomyopathy) and in cases where disease remains following treatment for an underlying cause, then medication may be needed.

Treatment varies according to each case but may include:

  1. Diuretics if congestive heart failure is present.
  2. Beta blockers to reduce the heart rate where this is excessive.
  3. Calcium channel blockers to help the heart muscle relax and hence help more effective filling of the heart.
  4. Aspirin may be used for its effects at reducing the risk of thrombus formation and thrombo-embolic disease. Dosing of aspirin should always be as advised by a veterinarian since aspirin may be toxic to cats. Aspirin poisoning, which occurs if the dose or frequency of aspirin administration is too high, may cause vomiting and internal bleeding. If your cat shows these signs, stops eating or appears sick, aspirin therapy should be stopped and you should consult your veterinarian immediately.
  5. ACE inhibitors - these drugs also help to control congestive heart failure.
  6. Newer therapies are currently being studied for HCM, including a drug called Rapamycin. While these therapies are not commercially available yet, they show promising results and we hope to be able to use them soon!

The long term outlook for a cat with cardiomyopathy is extremely variable depending on the cause of this disease. Cats with idiopathic cardiomyopathy may remain stable for several years.

Does a cat with cardiomyopathy need a special diet?

Low sodium diets, such as Hill’s K/D or multi-organ, may be recommended for cats with cardiomyopathy. This may decrease the risk of developing congestive heart failure and hypertension. Cat treats are often quite salty and should be avoided. We may make specific dietary recommendations for your pet’s condition. Overall, it is most important that your cat eats so if your cat will not eat the recommended diet(s), feed your cat whatever cat food they will eat.

Heartworm Disease In Cats



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img3The good news is that heartworm infection is easy to protect against; the bad news is only 59% of dog owners and less than 5% of cat owners protect their pets by giving them a heartworm preventative! Considering that heartworm disease has been reported in all 50 states, these percentages mean that not all pets that are at risk of infection are protected.

Because heartworms are transmitted by mosquitoes, the majority of cases occur along the Atlantic and Gulf coasts and in the Mississippi, Missouri and Tennessee River valleys. However, all available evidence suggests that the disease is spreading throughout the United States, moving north and west. Heartworm infection is starting to appear with greater frequency in many regions where it was previously uncommon or unknown. This is why we want to stress the importance of keeping your pet protected against this potentially deadly disease.

What is Heartworm Disease?

Heartworm infection takes place when a mosquito carrying microscopic heartworm larvae (immature worm) bites a susceptible animal such as a dog or cat. The larvae then enter a blood vessel in the pet and are carried to the arteries in the lungs, where they cause inflammation. Worms can die at any stage in their life cycle, causing even more inflammation as well as potentially serious complications, particularly in cats. The worms that progress to the adult stage may live undetected for a number of years. But when the adult worms die, they cause inflammation in the heart or lungs that can be severe enough to cause the pet's death.

Heartworm infections in dogs differ greatly from those in cats. The dog is a natural host for this parasite, but the cat is not. Because of this, cats usually have fewer worms and a purportedly lower rate of infection. A dog may harbor 50 to 100 worms, but a recent study on feline heartworm disease from Auburn University found only an average of four worms per cat. Yet the feline body's response is so severe that even these few worms can cause significant damage. In fact, heartworm infection in both cats and dogs can be life threatening.

What are the signs of heartworm disease?

img-4The signs of heartworm disease vary from pet to pet. Dogs may cough, have difficulty breathing and wear out quickly (referred to as exercise intolerance). In cats, the most common signs are coughing, difficulty breathing and vomiting, but they can also include blindness, convulsions, diarrhea, fainting, and loss of appetite or weight.

The signs of feline heartworm disease are often mistaken for feline asthma, allergic bronchitis, or other respiratory diseases, which means that cats with heartworm disease may be misdiagnosed. And both dogs and cats may not exhibit any signs of the disease, which is scary when you consider that heartworm infection can cause sudden death.

How can I protect my pet?

Heartworm preventatives are the best way to keep your pet free of heartworms. Preventatives work by killing heartworm larvae that infected your pet in the prior 30 days, before the larvae have the opportunity to develop into adults. These products also protect against some intestinal parasites. Some products even have activity against fleas and ear mites.

A variety of options are available for preventing heartworm infection, including monthly tablets and chewables and monthly topicals. All these products are extremely effective. When they are administered properly and on a timely schedule, they can completely prevent heartworm infection. Heartworm prevention is safe, easy and inexpensive. In addition, there is no approved treatment for heartworm infection in cats.

The American Heartworm Society and Companion Animal Parasite Council recommend year-round prevention, even where mosquitoes are seasonal. This recommendation makes sense considering that these preventatives also protect against the aforementioned intestinal parasites, which are not seasonal and infect millions of cats and people each year. While this number is alarming, it is not a reason to get rid of the family cat. You can protect your entire family by giving your cat a monthly broad based spectrum heartworm preventative. Speak with us today about a preventative plan that is best for you and your cat.

Five myths about feline heartworm disease

Many people do not realize that cats can get heartworm disease. With more dog owners than cat owners protecting their pets with a heartworm preventative, it might raise the question: Do we love our dogs more than our cats? We don't believe that we do. We think cat owners just need to learn about the risks heartworms pose to their pets, so we'd like to share our top five myths about feline heartworms.

Myth #1: It only affects dogs.

Heartworm disease is not just a canine disease. Cats are getting heartworm far more often than we previously believed. A yearlong study conducted in the Gulf Coast area found that 26% of the cats had been infected with heartworm larvae at some point in their lives, and found adult heartworms in 10% of the cats. Compare this with the feline leukemia virus (FelV) incidence of 5% and feline immunodeficiency virus (FIV) incidence of 6%, and you can see that feline heartworm is much more widespread.

Myth #2: It only affects outdoor cats.

Indoor cats are not impervious to heartworm infection. A North Carolina study found that 27% of cats diagnosed with heartworm were indoor-only cats. It only takes one mosquito to cause an infection, and because mosquitoes can get indoors, both indoor and outdoor cats are at risk.

Myth #3: It's a heart disease.

The name "heartworm disease" is a misnomer for cats, as it mostly affects their lungs, not their heart. Because cats are unique in their respiratory reaction to heartworms, a new title has been given to this particular set of symptoms: heartworm- associated respiratory disease, or HARD. Cats that suffer from HARD can have difficulty breathing and can die from the disease. However, even in the late stages, afflicted animals often exhibit no symptoms.

Myth #4: Only adult heartworms cause problems.

Unlike dogs, cats do not need an adult heartworm to exhibit clinical signs; in fact larvae are a main cause of the problems. Studies show that 50% of cats infected with heartworm larvae have significant damage of the small arteries that supply blood to the lungs. Most larvae in cats never make it to the adult stage, and the Auburn University study found that dead, decomposing worms can cause major damage to the lung tissue, which can lead to airway disease.

Myth #5: It's easy to test for.

Diagnosis is much more difficult for cats than it is for dogs, and current testing practices miss many feline infections. If your cat is exhibiting signs of heartworm disease (e.g., coughing, difficulty breathing, vomiting), talk to your veterinarian.

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Constipation in Cats

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AND...while defecation outside the box is almost always due to an underlying medical problem, it is still imperative that you maximize your litter box protocol. These links will help you do just that!

What is constipation?

Constipation can be defined as an abnormal accumulation of feces resulting in difficult bowel movements. This may result in reduced frequency or absence of defecation. The feces are retained in the large intestine, or colon. Since one of the functions of the colon is water absorption, the retained feces become hard and dry, which makes fecal passage even more difficult.

Constipated cats strain in an attempt to defecate resulting in abdominal pain. Some constipated cats may pass small amounts of liquid feces or blood. They will often vomit during and/or after straining to defecate, whether or not feces are produced. They will also often lose their appetite and/or become lethargic when they are constipated.

Many constipated cats will defecate outside the box and often it is unintentional. They may start out in the litter box trying to defecate but little or nothing comes out until they start to walk away. The physical activity of walking helps some feces fall out to the ground. Alternatively, they may defecate wherever they are if they get the urge, which can be frequently since their colon is so full and a litter box may be too far away. Finally, they may start to associate the pain of straining and difficult defecation with the litter box and develop an aversion to using it because of that.

Painful cats, just like people, may act in ways we would refer to as cranky, easily agitated, or aggressive towards people, especially children, and/or other animals. Pain or discomfort from any source often causes cats to act out of their ordinary routine. They may hide, be less social, have different eating habits, and/or different elimination habits as described above. Sick or painful cats are not being spiteful or acting out of anger, just out of distress. It is their natural instinct to behave this way. In the wild, a painful or sick cat is a weak cat and a weak cat is a potential victim. Changing their normal routine and/or demeanor may ward off a potential predator. As a result, what seems abnormal to the untrained human eye is actually normal to the feline survival instinct.

What causes constipation?

Factors associated with causing constipation include:

  • Hairballs, especially in long-haired cats.
  • Ingestion of foreign bodies.
  • Obstruction caused by tumors, strictures, or masses compressing or blocking the large intestine.
  • Pelvic injuries resulting in a narrowed pelvic canal.
  • Damage of the nerves which cause the colon to contract. This may develop after trauma or may be part of a more generalized neurological disease.
  • Dehydration from other metabolic disease conditions, such as chronic kidney disease.
  • Heart disease, as cats may be weak from their heart disease and have a difficult time actually pushing the stool out, leading to retained fecal material and subsequent constipation.
  • Intestinal disease (chronic enteropathy) can lead to inflammation in the intestines/colon that alters flow of nutrients through the intestines and can lead to constipation.
  • In some cases, there is no underlying cause.

Constipation is a condition seen most commonly in middle-aged and older cats. In the vast majority of cats, there is no underlying cause.

Anal Glands

In addition to constipation, some cats may develop enlarged or impacted anal glands that can also make it difficult for feces to pass through the anus. Anal glands are sacs that are located under the skin at about 4 and 8 o’clock on either side of the anus. They empty with normal defecation. These anal sacs are filled with a foul smelling liquid and a few drops are usually excreted to mark their stool during the process of defecating. For some cats, the liquid within these sacs can become dry and cakey, making it difficult to be excreted. Sometimes anal glands can become infected and even rupture. For cats that are straining to defecate, the anal sacs should be evaluated and emptied to ensure that feces can comfortably pass. Full anal sacs can cause discomfort, be itchy, and contribute to defecation outside of the litter box (and the commonly seen “scooting” behavior).

What is Megacolon?

This term refers to a dilated and weak colon that has lost the ability to contract and push feces out the anus. Megacolon may be seen as a primary problem or following long-term constipation. When the colon becomes distended with fecal material over a prolonged period of time, its ability to contract may be reduced or lost resulting in megacolon.

How are constipation and Megacolon diagnosed?

In most cases, a diagnosis of constipation can be made on the basis of the cat’s clinical signs. Affected cats usually strain unsuccessfully to defecate and may cry in pain. Any feces passed are hard and dry. Often cats will leave small amounts of hard, dry feces outside the litter box as they may continue to strain and pass feces as they walk around your home. Alternatively, they make think they are finished in the litter box and the physical activity of walking helps remove any fecal balls left near the anus. The cat may also show signs of lethargy, reluctance to eat, and vomiting.

X-rays are the primary test for the diagnosis of megacolon. Bloodwork is also helpful in diagnosing any underlying causes of dehydration, such as kidney disease, which can predispose the body to constipation.

How can constipation and Megacolon be treated?

Initial treatment of a cat with constipation may involve administration of enemas and manual extraction of feces by a veterinarian. The latter may necessitate anesthesia. Treatment of dehydration with subcutaneous fluids may also be needed in cats that have become dehydrated. If the constipation recurs or becomes a long-term problem, continuous therapy may be needed to prevent recurrence.

Most cats need a stool softener once to twice a day. A wide variety of treatments are available to soften the feces and promote regular bowel movements:

  • Increasing the amount of canned food intake helps to soften feces. Your veterinarian can help you decide which variety of food would be best for your cat’s overall health. There are prescription diets that are formulated with optimal levels of fiber and good quality protein that may be beneficial for cats with constipation and/or megacolon.
  • Increasing water intake by adding water bowls, drinking fountains, or flavoring the water with chicken broth or tuna water to encourage drinking may be recommended. Always provide a traditional water bowl in case your cat does not prefer the flavored water. A supplemental treat called HydraCare can also help to support increased hydration.
  • Subcutaneous fluid therapy at home may also be recommended on a regular basis to maintain hydration.
  • Lubricating laxatives or stool softeners for example, hairball remedies such as Laxatone*, Laxaire*, Petromalt*, or even plain Vaseline* (petroleum jelly is the main ingredient in the previously listed products) may also be used in mildly affected cats.
    *It is important to note that these products should not be given with any medications as their job is to bind and escort out which lessens the absorption of pill and liquid medications!*
  • Small amounts of dairy products every day can help soften stool since most cats are lactose intolerant. Examples of dairy that many cats enjoy: cream, half and half, sour cream, ice cream, whipped cream cheese, yogurt, and milk. Many people consume non-dairy or lactose free milk. These will not help your cat, so be sure you are offering true dairy products.
  • A prescription stool softener, such as Miralax or Lactulose, may be recommended. Miralax is an over the counter, flavorless powder that can be easily mixed into some canned food. Always consult with your veterinarian regarding what dosing range is safe and appropriate for your cat!
  • Those more severely affected may need motility drugs that stimulate contraction of the colon. The doses of all of these drugs and/or supplements may need to be altered to produce the desired effect.
  • FortiFlora SA contains probiotics as well as prebiotic fibers that can help decrease constipation symptoms. Alternatively, there is a special probiotic called Visbiome Constipation Care that contains probiotics (beneficial gut bacteria) that have specifically been studied and shown to help decrease constipation.

*IMPORTANT* If your cat is already constipated and exhibiting symptoms of straining, yowling, and vomiting, the above listed products WILL NOT soften the hardened stool already impacting your cat’s GI tract. You should see your veterinarian immediately!

Ideally, cats should defecate at least once every other day. Over a period of time, resistance to treatment can occur, necessitating an increase in the drug dosage or a change in therapy. No changes to the treatment protocol should be made without consulting your veterinarian. Even with chronic medical treatment, every once in a while cats may need to see the veterinarian for enemas and/or manual evacuation (this is when the veterinarian manually removes feces from the rectum).

In long-haired cats, regular grooming such as combing, sanitary and stomach shaves, and lioncuts are helpful at reducing the potential for high volumes of fur being ingested. Hairball removal agents listed above and hairball diets may also help reduce the likelihood of hairballs causing constipation or GI obstruction.

It is important to ensure that there is always access to enough large, clean litter boxes dispersed throughout the home so that frequent defecation is encouraged.

If megacolon develops or if the constipation is severe and medical treatment is unsuccessful, surgery may be recommended but this is uncommon. Surgical treatment involves removal of most of the colon called a partial or sub-total colectomy.

What is the long-term outlook for a cat with this problem?

As long as a constipated cat receives their daily medications as prescribed by the veterinarian, cats do well. The long-term outlook varies according to the cause of the constipation; however, the vast majority of cats can be adequately managed without surgery and resume normal, healthy lives. It is imperative that you stay in close communication with your veterinarian about what treatments are successful and which are failing so that you can continue to be guided on further steps to ensure the best possible management of the problem.