Thursday, October 21, 2010

Case of the Week: Max

Max is a sixteen-year-old Siamese mix. His owner brought him into the clinic because he had stopped eating and drinking and was drooling constantly. On examining him, I found that he was thin, very dehydrated and had a fever. I also saw a large ulcer on his tongue. My first thought was that it was likely he had severe chronic kidney disease and a poor prognosis. We drew blood and urine samples from him and did a panel to evaluate his organ and immune system functions.

His blood test results were surprisingly good. His kidney values were increased, but only a little above normal and he was concentrating his urine fairly well. These results indicated that his kidneys were still functioning well but that Max was dehydrated. I also found that his protein levels and one of his white blood cell counts were increased, which indicated an infection in his body.

It was at this point that Max's history became as important in diagnosing his problem as his blood tests and physical exam. Max's owner had recently adopted a new cat into their home. Max had not had any vaccines since he was a kitten. Therefore, he was not protected against the common viruses that are very contagious and widespread among cats, especially those in shelters. It is very difficult to test for the Herpes or Calici viruses that cause upper respiratory disease in cats. However, Max's symptoms - lethargy, not eating, running a fever, and an ulcer on his tongue - were consistent with upper respiratory disease.

Max received intravenous fluids at the clinic for two days and recovered slowly. We gave him subcutaneous fluids (under his skin) for a few more days and he gradually began eating and grooming again.

Vaccinations are important in all cats to help prevent disease. Because of widespread vaccination, we rarely see Panleukopenia (Distemper) or Rabies in cats in this country. The Herpes and Calici viruses that cause upper respiratory disease are very contagious and stable viruses that still cause problems in many cats. However, severe disease from these viruses are usually only seen in young cats and cats that have not been well vaccinated. Cats that are current on their vaccines have good immunity to these viruses and show minimal signs of illness when exposed.

It's important that owners not become complacent about their cats protection. Even indoor cats can be exposed to viruses. Always discuss with your veterinarian what vaccines are best for your cat.

For more information and guidelines for vaccinations throughout your cat's life, see our Life Stages Health Care Recommendations on our website.

Dr. Judy Karnia

Friday, October 15, 2010

Case of the Week: Bianca

Bianca is a seven and a half year old medium haired cat. Her owners brought her to the clinic because she was having trouble eating and her bottom jaw was shaking. She would also hold her mouth open as if she was having difficulty closing it.

On her exam, she was very sensitive to touch around her mouth and pulled her head away when I tried to open it. I could see tartar build-up on her teeth and gingivitis. There was gum recession at her upper right canine tooth and swelling of the gum there. We ran a blood panel and it was normal except for a mild increase in the protein levels due to inflammation or infection. Bianca also tested negative for Feline Leukemia Virus and Feline Immunodeficiency Virus.

Bianca's problems could have been due to a neurologic disease or a problem with her jaw. However, I thought the most likely cause of Bianca's problems was pain in her teeth and started her on antibiotics and pain medication. She started feeling better and was eating normally again with a couple of days. We anesthetized her to clean her teeth and exam them more thoroughly. Her upper canine tooth had a large resportive lesion and moved in the socket. The dental radiographs showed the root of the tooth was still present. By careful probing of the teeth, I also found resorptive lesions in three other teeth and a large periodontal pocket around the other upper canine tooth. Almost all of her incisors and one of the lower canine teeth were already missing.

I extracted both upper canine teeth and the three teeth with resorptive lesions. I sutured the gums closed with absorbable stitches and did a thorough cleaning of the teeth, polished them and applied a sealant. I gave her an anti-inflammatory medication to control the inflammation and discomfort and sent her home with more antibiotics and pain medications.

While Bianca was under anesthesia we found another hidden problem. Jill, our veterinary assistant, found a tapeworm segment near Bianca's anus. Bianca is an indoor cat and therefore likely to have had the tapeworm for years. Even indoor cats can carry intestinal parasites and often show no symptoms. Fecal tests can help us find many intestinal parasites but tapeworms usually do not shed eggs that would be found in those tests. The tapeworm didn't appear to be causing any problems at the time for Bianca, and it was just a lucky find while she was here. I gave her an injection to clear the tapeworms from her body.

At Bianca's progress exam a week later, she was doing very well. Her owners said that she was more active and playing, and eating well. She was not showing any more signs of pain.

Dental disease is very common in cats and can cause varying levels of pain depending on the severity of the disease. Many cats can suffer a good deal of pain but do not show any signs. Bianca likely had discomfort long before she showed signs. This is why it is important for cats to have regular semi-annual exams and dental cleanings when recommended by your veterinarian. Cat's won't tell us what's wrong and they often hide symptoms. Your veterinarian and technicians can spot trouble before it becomes severe.

Dr. Judy Karnia