Friday, September 17, 2010

Case of the Week - Midnight

Midnight is an eight and a half year old domestic short hair cat. She first came into the clinic nine months ago because she was straining to urinate and defecate. I examined her and found that she was constipated and obese. We want cats to be a healthy 5/9 on our body condition score scale. Midnight was an 8/9. Her bladder was too small to obtain a urine sample, but I suspected a urinary tract infection due to her symptoms. We gave her an enema and started antibiotics and medication to soften her stool. We also advised her owner to start feeding canned food and started her on a prescription diet food to start weight loss and relieve her constipation.

Two weeks later at her progress exam, Midnight had improved and was urinating and defecating better. However, a urinalysis showed that there was still blood in her urine so we ran more tests. Her bladder and kidneys appeared normal on an ultrasound and a urine culture ruled out bacterial infection. Since no underlying cause could be found, I diagnosed her with "cystitis" which is inflammation of the bladder. In many cases, we do not know the cause of the cystitis but it can be caused and/or made worse by stress. Stress in a cat's life can be very subtle and can be related to their environment, other animals, their diet, or painful medical conditions.

I prescribed Metacam for Midnight to help ease the inflammation and discomfort in her bladder. Metacam is a non-steroidal anti-inflammatory medication. As with any medication, repeated and long-term use may cause some side effects. If we make sure we use proper dosages and the cat is monitored well, Metacam relieves discomfort in many cats with cystitis and arthritis.

Midnight immediately started feeling much better. She was much more active. Her owner said that she had noticed stiffness in Midnight's hind end previously, but she was now moving much better.

At her progress exam a month later, Midnight was still doing very well. She was urinating and defecating normally. She no longer needed stool softeners. Her diet was doing well and she had lost almost a pound by this point. However, her urinalysis showed that she still had blood in her urine indicating that her cystitis was not fully resolved.

In order to try to improve this, we started Adequan injections to help the bladder and the likely arthritis. Adequan is polysulfated glycosaminoglycans; these are normal components of joints and the bladder wall. We give it as an injection under the skin - weekly or bi-weekly - then fewer injections as the cat improves.

Midnight is currently given Adequan injections once monthly and Metacam every fourth day and continues to do well. She has lost almost two pounds and is active and feeling well. We needed to switch her prescription food to a low calorie food with high protein rather than high fiber. This has produced more regular bowel movements for her but still helped with her continued weight loss.

Nearing nine years old, Midnight is now classified as a senior cat. Like human senior citizens, it is common to see multiple problems in senior cats. Keeping a healthy weight and feeding quality cat food helps all aspects of their health. But even trim senior cats can be plagued with troublesome and intersecting problems. Many times we have to prescribe multiple medications to address the various problems and make sure we are treating them as well as possible.

Dr. Judy Karnia

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