Thursday, August 25, 2011

Case of the Week: Koli Poki

Koli Poki is an eight-year-old Burmese that was brought into the clinic to have her teeth checked. Her owners were concerned because she did not seem to be eating well. When I examined her, I found that she had moderate tartar build-up over most of the teeth and the gum above her upper left carnassial tooth was very inflamed. The carnassial tooth is the fourth premolar (cats typically do not have the first premolar present) and has one large and two small roots.

I prescribed an antibiotic to start right away and scheduled her for a dental procedure. I knew I would need to extract this tooth but would also probe and radiograph (x-ray) all of her teeth to see if there were any other problems.

Once Koli Poki was anesthetized for her dental procedure, I was able to thoroughly examine her mouth and discovered many problems with her teeth. She was already missing seven teeth, including her upper right carnassial tooth. Two of her premolars had resorptive lesions - erosions of the enamel of the teeth - which are usually progressive and painful. She had gingival recession at multiple spots including the upper left carnassial and there was gingivitis around most of the teeth. I also did radiographs of all her teeth and found a large amount of bone loss around the roots of her incisors, premolars and molars.

I extracted all of the teeth that were mobile, had resorptive lesions, or a large amount of gingival recession and periodontal bone loss. In all, I extracted fourteen of Koli Poki's teeth. I closed the gum tissue with sutures that dissolve, usually within one to three weeks. I then treated all the extraction sites with the Companion Therapy Laser. Unlike our surgical laser that we use to cut tissues, the therapy laser works to reduce inflammation and pain and helps to speed healing. We also gave her an injection of an anti-inflammatory medication, which also helps with pain, and prescribed oral pain medication for a few days.

The following day, Koli Poki's owner reported that she was doing well. She was eating and acting normally. At her progress exam a week later, her owners were very happy with her recovery. They said she was more active and affectionate than she had been for a while. Her gums were healing very well although they were still a little inflamed. She was eating well and did not seem to have any pain.

Most of our patients develop some dental disease over their lifetime. Even though Koli Poki did show some symptoms of a problem, it was subtle and many cats do not show any signs of pain. Although Koli Poki's owners did notice a problem, they had no idea how severe her dental disease was. They are very happy that we were able to relieve her pain.

A thorough dental exam and radiographs under anesthesia are the best way to investigate any possible problems. At every physical exam, we look for any indication of dental disease and can recommend if your cat needs a dental cleaning and a more thorough exam under anesthesia. Tooth lesions can be very painful but the symptoms a cat will show can be very subtle. Many of our clients, like Koli Poki's owners, are not able to see how much the painful teeth are affecting their cat until they see how much better their cat feels after the problems are resolved.


Dr. Judy Karnia

Thursday, August 11, 2011

The Dangerous Outdoors

Have you ever watched a cat stalk its prey through the tall grass, looking so much like its wild, big cat cousins? Seeing this image, it's easy to believe that being outside is the best life for a cat. However, an outdoor cat lives a more stressful life than an indoor cat, and stress leads to a myriad of physical and psychological disorders. Outdoor cats on the street, or even in the country, are faced every day with territorial disputes, threats from other animals, people or cars, and environmental noises that can cause panic. In addition, the physical threats, illnesses and parasites outside can put free-roaming cats in immediate jeopardy. As a result, indoor cats generally live longer and healthier lives than outdoor cats.

It is a myth that cats easily return to a wild existence and are able to care for themselves after having been pets. Although all cats retain the instinct to hunt, they are no longer
adapted to life in the wild. Domestication has suppressed or even silenced many of the wild skills necessary for survival. As such, feral cat populations are most commonly found in and around well-populated human areas because even feral cats require human intervention to survive.


There are many threats to an outdoor cat, including other cats, dogs, and even predators such as birds of prey and coyotes. The latter become especially hazardous if the outdoor cat is hunting the predator's natu
ral prey such as rabbits. Fights with other cats over territory and food can lead to scratches and bites that can easily become infected, to say nothing of passing infectious diseases. Many dog breeds kept as pets have a high "prey drive", meaning they will see your free-roaming cat as something to attack. Not every cat will be able to get out of the way quickly enough, especially if there is more than one dog.

Sadly, another very real threat to your cat is intolerant neighbors. Not everyone is
fond of cats. Avid bird watchers may be angry that your cat is stalking the birds at their feeders. Others may not appreciate muddy paw prints on their cars. Animal care and control agencies have numerous cases of cats that have been deliberately burned, stabbed, kicked and even poisoned by humans (see this recent blog posting from The Phoenix New Times).

Even if your neighbor doesn't have it out for Fluffy, normal parts of human lifestyle
s can pose tremendous hazards to your cat. Grooming after walking across treated landscaping can lead to poisoning. Another possible danger is fluid spilled from a car, such as oil or antifreeze. These every-day car essentials are poisonous to animals and can cause them to become incredibly ill. Outdoor cats are especially drawn to this hazard as they are naturally curious and tend to explore unfamiliar fluids tongue first. Cats may also scavenge in garbage when something smells too enticing to pass up. Small bones, plastic wrappers or even some medications can be found in neighborhood trash, all of which could threaten a cat's health.

The number one killer and crippler of outdoor cats is cars. Even a quiet residential street has enough traffic to pose the danger. It only takes a moment for even a street-wise cat to lose concentration and dash into oncoming traffic when being chased by a dog, pursuing prey, or distracted by other kitty delights. Even parked cars can pose a risk if it's a cold day and the cat goes inside a warm engine block for shelter. The cat can be injured, if not killed, the next time the engine is started.


Cats who roam in the great outdoors are at much greater risk of exposure to diseases and parasites, some of which they can pass on to their human owners.

The Feline Leukemia Virus (FeLV) compromises a cat's immune system. While there is an effective vaccine against FeLV, no vaccine can be 100% effective. Once a cat is in
fected with FeLV, his or her immune system is compromised, and the cat will have difficulty fighting off any other type of infection and can even develop cancer. The virus is shed in bodily fluids and is primarily spread through biting, although there is a small risk from grooming and sharing dishes. Kittens can be infected by their mother while in the womb or during nursing after birth.

Feline Immunodeficiency Virus (FIV) also affects a cat's immune system and is ultimately fatal. There is no cure for this virus or for FeLV. There is a vaccine for FIV but it is not proven effective and will always cause any tests for the virus to come up as "positive" making it impossible to know if the cat is really infected. FIV leads to chronic infections and can affect organs
and bone marrow. The most common transmission of the virus is through bite wounds and the carriers are most commonly un-neutered, free-roaming males.

Rabies is a caused by virus, which can infect warm-blooded mammals, including cat
s, people, wildlife, and farm animals, and is always fatal. Outdoor cats are at risk of contact with rabid wild animals such as raccoons, skunks, foxes and bats. As noted in a previous blog, in Maricopa County one of the most common carriers of rabies is bats. According to the U.S. Centers for Disease Control and Prevention, cats are the domestic animal most commonly found to be rabid. Cats are closely associated with people and rabid cats often become aggressive. These two factors increase the risk of human exposure. Bites are the most common means of transmission. Rabies is lethal if not detected and treated immediately. Rabies attacks the central nervous system, resulting in paralysis and death.

Plague is cause by the bacterium, Yersinia pestis, and is transmitted primarily by wild rodent fleas mainly in the states of NM, AZ, CO and CA. Cats can become infected from flea bites or from eating infected small mammals. In 2011, a barn cat in Oregon tested positive for plague. The most frequent route of transmission to humans is via the bite of an infected flea. People can also contract the illness by direct contact with the secretions of an infected animal
or person through scratches or bites, or from inhalation of infective droplets released by coughing or sneezing. In recent years, almost all human cases of the most lethal form of the disease, pneumonic plague, have been linked to domestic cats.

There are additional parasites, including roundworms, hookworms, tapeworms, Giardia, toxoplasmosis and bacteria that cats can become exposed to while roaming outside. Most of these are zoonotic, which means they can be transmitted to humans. For more information about zoonotic parasites, visit the Companion Animal Parasite Council website.

So while it may seem that allowing your cat to indulge his or her "wild side" by roaming free outside is the natural thing to do, the reality is that it can be dangerous and stressful for both your cat and your family.


Coming up in future blogs: how to transition an outdoor cat to an indoor cat; how to enrich an indoor cat's life

Thursday, August 4, 2011

Case of the Week: Orange Boy

Orange Boy was a young neighborhood stray cat. He visited many houses, but when he had a bad fight a few months ago, he came calling to the right house. His new owner saw the terrible wound on his face and knew he needed treatment right away.

When Orange Boy was brought into the clinic, he had a large wound on the rig
ht side of his face about three inches in diameter. There was a large scab from under which oozed green, puss filled liquid. We sedated him so we could clean the wound and evaluate it better.

The most likely cause of Orange Boy's wound was a ruptured abscess due to a cat bite. Outdoor cats will often fig
ht over territory and can inflict a large amount of damage on each other with teeth and claws. The cat canine tooth, or fang, is long and pointed and will puncture another cat's skin. The wound in the skin is only a few millimeters deep and heals over quickly. However, when the tooth punctures the skin, it injects bacteria deep inside. These bacteria will replicate and cause severe infection. The body of the cat will attempt to fight the bacteria by sending white blood cells to the site leading to pus being formed. This can form a large soft pocket under the skin called an abscess. The abscess usually causes a fever, pain and lethargy in the cat. The skin over the abscess usually will die and slough off, leading to oozing of the pus. In some cats, such as Orange Boy, the amount of skin that dies can be quite large.

We anesthetized Orange and scrubbed his wound. I removed the scab over his wound and trimmed the dead tissue around the edges. I also cleaned the wound with surgical scrub to remove any infected material. The wound had some good pink granulation tissue, which is the healing tissue, extending three inches in diameter across the whole side of his face. There was also firm swelling on the lower part of the wound due to inflammation from the infection. Because the wound extended from the base of his ear almost to his mouth, I was not able to close it surgically. I therefore left the wound to close on its own by what is called "second intention" in which the normal healing process of the skin closes the wound with time. As the body tries to heal, the skin edges on a wound contract and tissue gradually rejuvenates from the edges of the wound inward. Since the wound was so large, though, I thought I might need to do surgery at a later time to close the wound completely.

While Orange Boy was under anesthesia, we took care of some other preventative measu
res and tests. A blood panel showed that he was negative for the Feline Leukemia Virus and Feline Immunodeficiency Virus. His white blood cell counts and protein levels were increased due to the infection on his face, but his organ function tests were all normal. We also neutered him. Neutered males are much less likely to be territorial and get into fights.

I prescribed antibiotics for Orange Boy along with a medicated spray to keep the wound clean and help healing. When he came in for his progress exam a little more than a week later, the wound had already improved greatly. The wound was half the original size, much more shallow and much of the inflammatory swelling had resolved. I removed some scabbed tissue from the top of the wound and cleaned it thoroughly. After another week and a half, the wound was down to a 1x2cm scab with scar tissue around it.

Now Orange Boy spends a good deal of time indoors in his new home. He is up to date on all of his vaccines and has been treated for possible intestinal parasites.

Cats have a great ability to heal well and often surprise me with how well they handle many injuries or illnesses. However, when they go outdoors there is a great chance that they will be exposed to bites and other types of injuries or be exposed to infectious disease and parasites. If your cat does go outdoors, be sure to protect him or her from disease by keeping vaccines up to date and giving parasite medications (including heartworm prevention). If you notice any wounds or swellings, bring your cat to your veterinarian promptly so that any infection can be treated as quickly as possible. This will reduce your cat's pain and distress and often save money by addressing the problem early.

Dr. Judy Karnia