Dr. Stephanie Globerman - 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
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    • Kidney Disease in Cats

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    Your cat’s kidneys are essential to her 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 her 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 her 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 her 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 and the most common geriatric disease in cats

    How is CKD diagnosed?

    Usually your vet will diagnose renal disease by checking the level of two waste products in your cat’s blood-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 maybe 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,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.

    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 urinary tract infection, 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.

    5. Anti-ulcer medications

    Kidney disease may cause the blood and bodily fluids to be more acidic. This can lead to nausea, vomiting, orulcers in the GI tract.We may recommend Pepcid AC as directed by the veterina rian.The generic of Pepcid AC, called famotadine,is a less expensive, equally effective alternative. Pepcid AC and famotadine are available without a prescription from any pharmacy. We will instruct you on how much and how often to give this medication if needed.

    Do not use any other variety of Pepcid except Pepcid AC; Pepcid Complete is not acceptable.

    6. 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.

    7. 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 that can help stimulate red blood cell (RBC)production if your cat becomes anemic.

    8. 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.

    9. 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 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.

    10.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.

    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 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.

    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/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 more than one blood sample collected over a period of one to five days.

    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 doesnot lead to resolution of the diabetes, specific treatment is required. Although a small proportion of cats will respond to oral hypoglycemic medication, 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) 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 a small dose of insulin, rarely once daily dosing isused. 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 behelpful if your cat will not eat it. Infact, 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 can not 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 can be offered once to twice daily and we suggest combining this with insulin administration for two reasons. First, you can assure your cat has food in his 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 litterboxes added throughout your home. ***

    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 5-7 days 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 insulinadministrations 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 the next business day either by phone (770-579-6001) or fax (770-579-6013). The receptionists will give this information to a doctor who will interpret the data, decide if a change in insulin dosage is required, what that change will be and when do to the next curve. Our office will then 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 that need. 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.

    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, 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.

    Paws Whiskers & Claws 770-579-6001

    North Fulton Animal Emergency Clinic 770-594-2266

    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. Diabetic cats will always drink and urinate more than a non-diabetic cat. That is why it is important to provide additional large litterboxes and water bowls in several locations throughout your home.It is possible for diabetic cats to stop needing insulin and essentially become not diabetic.The pancreas cells can start making insulin again. Diabetics can also spontaneously need more or less insulin. It is for these reasons that doing the curves as prescribed by the veterinarian are so very important.

    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. Not only do we have lots of diabetic feline patients, but many of us have diabetic pet cats at home and we have one that lives here at the clinic.

    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 him and he runs 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 Cardiomyopathy

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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?

    img-1In 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 the 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. So you see,what seems abnormal to the untrained human eye is actually normal to the feline survival instinct.

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

    1.Development of congestive heart failure:

    Labored breathing 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 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), inappetant, 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?

    img-2Diagnosis 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 cardiac ultrasound scans.

    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 hyerthyroidism or high blood pressure.

    What causes cardiomyopathy?

    There are many causes of cardiomyopathy; however, in older cats thyroid disease(hyperthyroidism) commonly causes 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 as pirin 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.

    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, are 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 he/she 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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    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 very 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. So you see, 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:

    1. Hairballs, especially in long-haired cats.
    2. Ingestion of foreign bodies.
    3. Obstruction caused by tumors, strictures or masses compressing or blocking the large intestine.
    4. Pelvic injuries resulting in a narrowed pelvic canal.
    5. 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.
    6. Dehydration from other metabolic disease conditions.
    7. 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. Or 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 also 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 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.

    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.

    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 anyy 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, 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.

    *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 its 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.