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When you take your cat to visit your veterinarian, one of the most common questions asked of you is whether your cat is an indoor or outdoor cat. Most owners will say that their cats are indoor cats. However, if your cat spends any amount of time outside, even on a covered patio under your direct supervision, he's not an indoor only cat.
Why is this distinction so important? Because any type of outdoor exposure can impact your cat's health in terms of exposures, from other animals to parasites. All of this information helps your veterinarian help you take care of your cat, and can potentially prevent health issues down the road.
Even if your cat is strictly indoors, if you have other pets that go outside, your indoor cat may have additional exposure risks from your other pet. For example, let's say you have a dog as well as your cat. Your dog goes with you to the local dog park where other dogs expose him to fleas, which he brings home with him. Now your cat has been exposed to them too.
If you have a multi-cat household and the other cat goes outside, this can impact your indoor cat in similar ways as having a dog that goes outside. In addition to parasites, your outdoor cat may also bring in viruses that your indoor cat may not otherwise encounter. This means your indoor cat may need additional vaccinations, for example.
Here at Scottsdale Cat Clinic we do recommend keeping cats indoors due to the variety of dangers that are outside. These include parasites, predators - including abusive humans - toxins, cars, and even fights with other cats. We went into more detail on these dangers in our blog The Dangerous Outdoors.
Still, keeping a cat indoors does mean that special attention must be given to ensure a healthy life. Although the always sleeping cat is a popular image, cats do need exercise and mental stimulation, something that can be lacking in the indoor environment. Fortunately, it is relatively easy to add these elements to your indoor cat's life with interactive toys, a well placed perch to check out the great outdoors through a window, or even a companion cat assuming they get along.
Because of the additional exposures and potential risks for cats outside, it is very important for your veterinarian to know if your cat goes out, even for a few minutes. Make sure your veterinarian knows all of your cat's habits so she can help you take the best possible care of your cat.
Many clients wh
en facing a medical decision with their cat will ask me what I would do if it were my cat. Most of the time, that question is asked when an owner is facing difficult decisions. But you may want to know what I do for my cat to keep her from developing severe medical problems.
So this case study is about Kristina, the cat I adopted a little over a year ago. She was about five years old and in good health when I took her home from a local shelter. At that time she had some dental disease and we performed a dental cleaning and radiographs. We also extracted four lower teeth that had problems. She did well with her recovery and was right back to eating her dental dry food and ProPlan canned food.
Last summer, we discovered she has a food allergy. She had developed chin acne, which resolved only when we fed her a hypoallergenic food exclusively. Unfortunately, this meant she could not continue her regular dry food - a dental kibble. As you will see, this led to some other problems.
You might be surprised to know that even though I see Kristina every day, I still schedule a semi-annual exam for her. She gets swept up and whisked into an exam room, where she gets the exact same exam your cat gets when it visits. I do this so I am sure to give her a thorough examination, running through the same checklist and comparing data from her last exam.
At her most recent 
six-month wellness exam, I found she had mild tartar and her gingivitis had returned. Some of this is attributable to her switch from her dental diet to a different food. A few days later, I performed a dental cleaning to treat those issues. I did not find any lesions during the oral exam or on the radiographs, which meant she did not need any extractions. We gave her teeth a thorough cleaning, polishing and applied a sealant. I'll be watching her teeth closer now, knowing that she is susceptible to tartar buildup.
Her blood panel before the anesthesia did show a mild increase in one of her liver enzymes so I will recheck that in the next month. This progress check will let me know if that increase is worrisome or if it was a reaction to her gum disease. If the enzyme is still high, I will run more tests to look for a cause. Tests like these are crucial because there is no way to observe a liver enzyme increase by looking at a cat. The blood panel on Kristina may have caught an issue early. We hope not, but if there is an issue, catching it now is far, far better than later.
If you have met Kristina at our front desk, you will see that she has developed into a very affectionate and outgoing cat. Even though she lives here and is very comfortable with all of us, she still gets nervous when we need to trim her nails and give her vaccines or other care. We handle her gently and reassure her the way we do all our patients so that we can be sure she receives all the medical care she needs. She is up-to-date on her FVRCP and Rabies vaccines, stays indoors exclusively, receives Heartgard once a month, and has her semi-annual examinations.
My goal as a veterinarian is to focus on preventing problems so your cat lives a long and healthy life. Kristina is a healthy cat with a few minor health concerns. Yet because we provide her with regular care, check-ups and dental work, those problems stay minor. It is important to provide regular preventative care to keep our cats in good health as long as possible. Dental health especially can be difficult to notice easily in cats but it can impact their health greatly.
So if you've ever wondered what your veterinarian would do, here was a glimpse into how I take care of my cat.
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Dr. Judy Karnia
In an earlier, recent blog, we discussed many of the hazards and dangers for cats in the outdoors. So how can you make sure a cat that's used to living outside can be happy becoming an indoor cat? With patience and persistence, that's how.
Nowadays, it's a sad fact that many of the cats roaming outdoors have actually been turned out or otherwise abandoned by families that can't take care of them any longer. That means that many of them are already at least familiar with being indoors on a regular basis. Some of these cats will be happy to have a family again and will make the transition more easily. But what about those cats that have only ever known the outdoors?
Stray cats brought indoors, or feral cats trapped, neutered and re-homed sometimes have a difficult adjustment period if kept indoors. Even though to our point of view that living indoors is preferable and cushy, to the cat that has never been confined indoors, the experience can be one of terror and suspicion. In addition, many have never seen a litter box, much less know that's where they should do their "business". Some other common behaviors can be door dashing, constantly meowing at doors and windows, scratching at carpets and even the walls, etc.
You can alleviate the stress these cats face by understanding their behavior and redirecting it in a positive direction. Again, patience and understanding is the key when helping these cats make this big adjustment.
Most importantly, before you bring any cat into your house, be sure to have the cat examined by your veterinarian, spayed or neutered if needed, and vaccines updated. It's also important to check for parasites and have the cat dewormed before coming inside. This is especially important if you already have resident cats. In fact, make sure your resident cats are up to date on their vaccines as well.
One of the ways to ease transition is to use a pheromone diffuser like Feliway. The Feliway brand is a synthetic copy of the natural feline facial pheromone. These specific pheromones let a cat know an object is safe and familiar. Using these types of diffusers can help to reduce the stress and marking behavior in cats.
A good way to start this transition is to time it with the outdoor weather. If you live in colder climes, the cat may be more apt to settle inside during the winter. In Arizona and other hotter areas, summer may be the better season to start this transition.
Here are some additional tips to help your outdoor cat transition to being an indoor cat:
- When the cat first comes indoors, keep him in a small room with non-absorbable surfaces (such as a bathroom). Provide several litter boxes in the area. You can even try different types of litter in the different boxes to see if the cat has a preference. If the cat refuses to use the box, you can try using an organic potting soil or clean sand on top to simulate what is outside. There are also several products available that can be added to
the litter to draw a cat to the box. - Provide places to hide. You don't have to spend a lot of money on fancy cat furniture. A cardboard box, or an old, large carrier without a door, with a towel draped over it will be more than enough for the cat. Unless you have provided soft surfaces for the cat outside, many outside cats have never encountered cushions, so experiment with different textures to see what he prefers, including straw, sawdust or pet bed shavings.
- Plant cat appropriate plants and grasses in a small container, such as catnip or catmint. Many pet stores have pre-planted containers to grow the grasses, and some specialty retailers have organic versions. This gives the cats fresh vegetation to eat, which they would do outdoors, and will discourage the cat from going after houseplants.
- Play with your cat. An outdoor cat possesses a higher prey drive than an inside cat. This prey drive has kept him alive. There are many types of interactive cat toys on the market, and you may need to experiment to see which type your cat prefers. Plus, the more you play with your cat, the stronger the bond you will create with him, adding to his sense of security.
If you already have cats in your house, make sure you take the time to properly introduce the new cat into your family. Whether your new cat has lived with other cats or not, your house has a new set of dynamics for him to integrate into.If your residen
t cats are not finicky about where they eat, while the new cat is still confined, feed the resident cats near the closed door. This will help them associate something they enjoy with the smells of this new cat.Once you are certain the new cat is safe with fabrics and other absorbable surfaces, swap bedding between the new cat and the resident cat as another way to get used to each others' scents. You can also switch out toys and scratching posts. These are good ways for the cats to get used to each other without having direct, face-to-face interaction.If the introduction is not going smoothly, and/or their interactions are too aggressive, separate the cats again and start over. Again, with patience and time, your cats can become a family.Overall, bringing a cat indoors can be a very rewarding experience for both you and the cat.
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.
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Dr. Judy Karnia
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.
PHYSICAL HAZARDS
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 lifestyles 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.
DISEASE AND PARASITES
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 infected 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.
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Coming up in future blogs: how to transition an outdoor cat to an indoor cat; how to enrich an indoor cat's life
As we mentioned in our senior wellness blog, many of the diseases and conditions that commonly develop in senior cats are more easily managed when they are caught in their early stages. This helps maintain or even improve your older cat's quality of life.
In this blog, we will explain in a little more detail what exactly the tests we run tell us about your cat's health.
Many of the same technologies and medical diagnostic testing that help humans live longer, healthier lives are also available to your cat. Even a few standard tests allow us to gather a wealth of information about the well-being and health of your cat. These tests become increasingly important as your cat continues to age.
The most common lab test we run in our clinic is a combination blood panel consisting of a complete blood count and blood chemistry. A Complete Blood Count (CBC) is a series of tests that evaluate the number of cells in circulation in the blood. White blood cells, WBC, help fight infection and inflammation and can increase with cancer. Red blood cells, RBC, carry oxygen to the tissues. Platelets allow clotting of the blood and are another indication of the health of the bone marrow. Overall, the CBC tests for anemia, infection, inflammation and the health of blood cells and the bone marrow.
A blood chemistry panel is performed to get an initial overview of the health and function of body organs. This panel surveys many of the organ systems of the body to make sure they are working properly. Our chemistry test checks the following organ functions: liver, kidney, pancreas, muscle, bone, thyroid and electrolytes.
For many conditions, such as chronic renal disease and diabetes mellitus, a urinalysis should also be run to provide a complete picture of organ function. For example, in verifying renal disease, the specific gravity - or concentration - of urine is a key diagnostic tool in addition to the blood chemistry numbers. In diagnosing diabetes, glucose levels in the urine are examined.
Finally, we recommend radiographs (x-rays), first to establish a baseline at a younger age, and then regularly to monitor any changes or developments. Cats do develop arthritis, but as with many illnesses, they hide their discomfort and it's not always readily apparent until the condition becomes severe. There may be subtle signs, such as taking extra steps to get places, jumping from floor to stool to bed instead of straight from floor to bed, or refraining from jumping at all. Arthritis pain can be managed with a variety of different treatments, including a specialized diet.
Ultimately, the tests performed are designed to ensure the best quality and longevity of life possible for your cat.
Sweetheart is a four-year-old calico cat. She came into the clinic because her family had recently moved here and she needed a refill on medications for her chronic Feline Herpes infection. Due to her chronic problems, her owners keep a close eye on her, but they had not noticed anything unusual with her besides her typical watery eyes and sneezing.
During the exam, I noticed a small lesion on one of her lower premolar teeth. Cats frequently will develop this erosive lesion, called a Feline Odontoclastic Resorptive Lesion (FORL). The cause of these lesions is not known, and an affected cat tends to develop the lesions in multiple teeth over its life. As FORL progresses, the lesion becomes very painful as the loss of enamel exposes the nerves in the pulp of the tooth. The only treatment is to extract the tooth to remove the pain and source of infection.
Sweetheart quickly moved her face away when I touched this tooth showing how painful it was. Her owners were surprised to learn of the problem. Sweetheart had shown no signs of distress. Yet in looking back, they had noticed she was holding her head at a slight angle when chewing and was leaving crumbs of food on the floor when she ate.
They scheduled her the next week for a dental procedure, including ultrasonic scaling and polishing of the teeth, a complete exam under anesthesia, dental radiographs (xrays) and extraction of the affected tooth. When examining her teeth under anesthesia, I found that the opposite lower premolar also had an FORL. The dental radiographs showed that both of the teeth had some resorption of the roots of the teeth as well. The rest of her teeth appeared normal. I placed a nerve block on each side of her mouth to numb the areas, then extracted these two teeth.
The day after the surgery, when I called Sweetheart's mom to check in on her, she said that Sweetheart was doing very well. She was back to her usual self the evening of the procedure and was eating well. At her progress exam two weeks later, the gums had healed well. Her mom was very happy with how well Sweetheart was doing and happy that she no longer had to clean up crumbs around Sweetheart's dish any more. After her extractions she was eating completely normally without any mess.
Cats are very good at hiding dental discomfort. They rarely stop eating, even with severe dental disease. Few even show the subtle signs of discomfort that Sweetheart did. If your cat will let you, you can try lifting his lip to look at his teeth. If you see any yellow or brown matter on the teeth, or redness of the gums, your cat may have dental disease that needs to be treated. If he is reluctant to let you touch his mouth, he may be feeling pain from gingivitis or an FORL. Regular veterinary examination of your cat every six months will help us to find problems early and treat them before they cause pain or infection. We can also discuss what you can do at home to reduce tartar build-up and minimize dental disease. The more knowledge you have about your cat's health, the happier your cat will be.
- Dr. Judy Karnia
