Case of the Week: Java

In today's case, we will see how therapy laser treatment can be very helpful with a frustrating chronic medical condition.

Java is a fourteen-year-old Burmese cat with a typical problem for many cats. He vomits once in a while. He first came into the clinic three years ago. At his previous veterinary clinic, he had some basic blood tests and radiographs done which showed nothing unusual. Since some cats with vomiting have food allergies causing the vomiting, I tried Java on a hypoallergenic diet. He would not eat it but continued to do okay, just vomiting periodically.

About eighteen months ago though, Java started to vomit more often, twice weekly. We evaluated his abdominal organs with an ultrasound, an again, nothing seemed unusual. I also sent blood to the laboratory for a pancreatic profile. This profile tests pancreatic enzyme levels and cobalamin and folate, two vitamin levels that help us evaluate how well the small intestine is functioning. While most of Java's panel results were normal, one of his enzyme levels - his Pancreatic Lipase Immunoreactivity (PLI) level was three times normal. With this result, we knew that Java had chronic pancreatitis.

Chronic pancreatitis is common in cats, especially as they age. The pancreas is an organ that creates and excretes enzymes into the small intestine to help with the digestion of food. Pancreatitis occurs when the pancreas becomes inflamed or irritated. This causes pain and vomiting and can lead to poor digestion and weight loss. It is often associated with inflammation of the intestinal walls as well, called Inflammatory Bowel Disease, or IBD.

I prescribed an anti-oxidant and a probiotic for Java and also had his owner give him Pepcid AC, an antacid. Java did well on these and his vomiting decreased. A few months later, his owner brought him in for a progress exam and to recheck his blood work. His kidney and liver values and blood cell counts were normal but his PLI had increased from three times to fifteen times the normal level. The antacid and the probiotic were helping the symptoms, but Java's pancreatitis was getting worse. To find out exactly what was going on, we had to perform biopsies on his pancreas and intestines.

In early 2011, we did an exploratory surgery to obtain the biopsies. The pathology report on the biopsies showed that there was inflammatory bowel disease in his small intestine and pancreas. This ruled out cancer and infection so we could treat Java more specifically and aggressively. I could now add corticosteroids to his medications. These steroids are very effective at suppressing inflammatory conditions, such as inflammatory pancreatitis, but can make other diseases worse.

After starting the oral steroids, Java did well. His vomiting continued a little but decreased greatly in frequency and he seemed to be feeling better. Yet despite these modest improvements, neither the owner nor I were satisfied with Java's condition. In consultation with his owner, we also decided to try a more experimental approach. Scottsdale Cat Clinic now has a therapy laser that uses photostimulation to decrease inflammation, decrease pain and promote healing. We've been using the laser for post-surgical treatment and arthritic patients. Although there have been no studies using the therapeutic laser for treating pancreatitis, I believed the same healing results we were seeing on wounds might also occur with Java's problem.

We started therapy on Java three times weekly for two weeks, then twice weekly for a week, then once the following week. After this intense initial treatment, we reduced it to once every three weeks. Java seemed to feel much better. He was more active and affectionate, and he was not vomiting. A month after he started the laser therapy, his PLI had decreased to five times normal. We therefore decreased his steroids from daily to every other day. He returned to vomiting a little and did not seem to feel as good so we increased the frequency of his laser therapy to every other week. His most recent PLI was decreased to just over two times normal. By continuing his laser therapy every two weeks, we are able to minimize his steroid dose and keep him feeling well.

Java is currently doing very well. He is not vomiting, is eating well, and is back to jumping up onto high furniture. His owner is very excited about his response to the treatment with the therapy laser. She says that he is back to his old self, bossing around the other cats, and being very active. In the previous couple of years, she was very concerned about his regular vomiting and slowing down in activity level and is very happy that we were able to diagnose and treat his condition.

Pancreatitis can be a difficult disease to diagnose and treat. It is probably fairly common in cats but usually goes undiagnosed and untreated, leaving the affected cats to deal with the discomfort for many years. Many owners believe vomiting in cats is normal but it can be a sign of a serious disease. Pancreatitis is unlikely to be completely cured, but treatment can help reduce the severity and help the cat to live much more comfortably.

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Dr. Judy Karnia

Senior Feline Care - Arthritis

One of the more common ailments to afflict senior cats is arthritis. Clinical studies have shown that 22-64% of all cats and 90% of cats older than twelve years old have radiographic (x-ray) signs of arthritis. Cats most commonly develop arthritis in their hips, elbows, knees, ankles, and spine.

Arthritis causes pain and loss of movement of the joints. The word arthritis literally means joint inflammation (arth=joint, ritis=inflammation). Inflammation is a reaction of the body that causes swelling, redness, pain, and loss of motion in an affected area. Normally, inflammation is the way the body responds to an injury or to the presence of disease agents, such as viruses or bacteria. During this reaction, many cells of the body's defense system - called the immune system - rush to the injured area to wipe out the cause of the problem, clean up damaged cells, and repair tissues that have been hurt. Once the battle is won, the inflammation normally goes away and the area becomes healthy again.

In many forms of arthritis, the inflammation does not go away as it should. Instead, it becomes part of the problem, damaging healthy tissues of the body. This may result in more inflammation and more damage - a continuing cycle. The damage that occurs can change the bones and other tissues of the joints, sometimes affecting their shape and making movement hard and painful.

As with most illnesses and injuries in cats, the symptoms of arthritis can bey very subtle and easily missed especially if they are gradual in onset. Many of them are dismissed as simply being signs of "old age" and not necessarily indicative of an actual, treatable (or at least manageable) ailment. Symptoms can include:
unusual sleep patterns;
eliminating outside the litter box;
hiding;
avoiding interaction with people or other pets in the home;
dislike of being stroked or brushed;
decreased grooming, reluctance or inability to jump as high as they once could or to go up stairs;
reluctance to jump down or landing ungracefully/with difficulty;
decrease or change in play;
stiff gait or lameness.

Diagnosing arthritis involves a thorough exam that may reveal pain, crepitus, and/or swelling in the joints. Pain can be difficult to interpret in cats during an exam because they are not in their familiar environment. To help with this, we rely on your observations of the cat's behavior at home as well as diagnostic tools as radiographs (x-rays). Radiographs can show changes in the bony structures of the joints, which do indicate developing arthritis. However, there can be cartilage changes that cannot be seen on radiographs.

Although treatment may not turn your senior cat into an agile and active kitten, it will relieve pain and distress and enable your cat to do normal activities. Treating arthritis is tackled with a three-pronged approach: nutrition, medication and environmental changes.

Nutrition: Just as with humans, being overweight can exacerbate symptoms and pain associated with arthritis. If your cat is on the heavier side, we will work with you to help her lose some of those extra ounces. We can calculate calories needed and monitor weight loss with regular progress exams. Additionally, there are prescription diet formulas specifically designed to help with mobility issues in older cats. Finally, we may recommend fatty acid supplements that many help reduce inflammation.

Medications: Most medications used for arthritis in cats are not approved for use in cats by the FDA and are "off-label". This is due to the cost of the research to prove the safety and efficacy in cats. The medications, however, have been used extensively in cats by veterinarians and can be used safely if used at proper doses and with proper monitoring, including regular medical progress exams, blood panels, and communication with your veterinarian.

There are a variety of medication types available to help your cat:
Glucosamine/condroitin promotes the health of the cartilage and joint fluid. Adquean, delivered by subcutaneous injection, is a polysulfate gylcosaminoglycan which also helps cartilage and joint fluid. Stronger medications include NSAIDS (Non-steroidal Anti-inflammatory Drugs), which control inflammation in the joints providing pain relief. NSAIDS can cause gastrointestinal upset and damage to the kidneys, although the side effects are rare with low doses. Analgesics or steroids might also be part of your cat's arthritis therapy depending on various factors.

Many cats with arthritis benefit from multiple medications and supplements. By using various types of medications, we can keep the doses of each lower to minimize side effects. All medication treatments require regular monitoring by your veterinarian through progress exams.

Environmental modifications: In order to improve your arthritic cat's quality of life around the home, here a few suggestions for easy modifications to accommodate her. There are many litter boxes out on the market now that have lower sides, or a least a low entry side, making it easier for her to get into the box and reducing the risks of eliminating outside of it. You can also mound the litter to one side to help her position herself more comfortably when defecating. You might also consider adding additional litter boxes around the house, especially if you live in a multi-story house, so she doesn't have to walk as far to reach one.

Because access to heights is important to most cats, consider adding ramps or steps to help her get to her favorite places. There are many manufacturers of such products, specifically for older cats, or you can do a simple rearrangement of the furniture for her. Make sure she has easy access to food and water. If you feed her on a counter, add steps for her, or start feeding her on a lower plane, or on the floor.

Arthritis is a lifelong disease, and one that is likely to progress over time. The sooner it can be diagnosed and treatment begun, the more comfortable your cat will be.

Senior Feline Health Care - Diagnostic Testing

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.

Case of the Week: Margie

To start off Senior Health Care Month, our case of the week focuses on Margie, our clinic cat. I adopted Margie three and a half years ago, two weeks after we opened the clinic. She had been living at Save Haven cat shelter for years and her age and history were unknown. She was thought to be around twelve at the time and was definitely a senior cat. She did not like living with the other cats in the house and spent all her time in a cat condo cage. Even though the door to the cage was left open, she never left it and did not allow other cats inside. As I am partial to calico cats, I was drawn to her and she yelled at me to take her home with me.

Safe Haven let me borrow her cage to set up in my office so Margie would feel more at home. It took her a few weeks to start venturing out of the cage and then a few months to take her first step outside my office. She eventually became comfortable enough to hang out at the front desk and wander the clinic, although she will still only walk to the back of the clinic when it is quiet. She is a cranky old lady that will bite if feeling annoyed. But she loves to rub her face on shoes and lick my computer and hand while I type.

Her medical problems have grown over the years. She needed a dental cleaning when she first arrived. She has had on and off vomiting and diarrhea, which has required different diet choices. Two years ago I diagnosed her with early chronic kidney disease and we switched her diet to include some of the renal prescription diets. Routine abdominal radiographs indicated mild arthritic changes in her hips and we started her on Adequan injections to help her joints. She became livelier and even started chasing imaginary bugs.

Her kidney disease gradually worsened. Six months ago, her kidney values had increased to moderate levels and she was not eating well. We started giving her fluids under her skin to improve her hydration and help her feel better. We also started her on Mirtazapine, an appetite stimulant that is given twice a week. Her appetite picked up and she became more active.

In the past month, she has declined in her activity level. Suspecting her kidney disease was worsening, I performed another physical exam on her and found a mass in her abdomen. We called Dr. Greene, an internal medicine specialist, into the clinic to perform an ultrasound. He found multiple tumors through her abdomen. Dr. Greene aspirated the tumor, using a needle to select a small sample to send to a pathologist. The pathologist diagnosed Margie with sarcoma, an aggressive malignant cancer that has no treatment except for removal. However, because the cancer had already spread throughout her abdomen, removal was no longer an option. It was a disheartening diagnosis.

So far, Margie is in good spirits. She has good days when she eats well, talks to me as much as usual, and rubs her face on everything she can reach. And she has days when she sleeps on the chair in my office all day. Her abdomen is slowly filling with fluid and she is starting to have difficulty jumping onto the chair. We continue her treatments for her kidney disease, trying to keep her feeling as well as possible.

Having a senior cat is difficult at times but so rewarding as well. Many people are reluctant to adopt an older cat, wanting to raise a cat up from a kitten. Yet so many older cats are just like Margie. They can certainly be aloof at first, reserved and distant as many cats are toward strangers. But given half a chance, they can become devoted pets. They have endearing personalities and lots of love to give is someone will open up to them.

The day when we will have to say goodbye to Margie is fast approaching. She has been a joy to have here at the clinic with us and we will miss her cranky demands for food and treats. She has been a great clinic cat, and I think she has really enjoyed her time here. I have no doubt that the last few years of her life were better at her new home, and we are better for having her at the Scottsdale Cat Clinic.

Dr. Judy Karnia

Senior Cat Wellness Care

September is National Senior Health Care Month and we thought this would be a great opportunity to discuss the senior health of your cat. Advances in veterinary medicine and knowledge mean that cats are living longer lives. Not that long ago, a 15-year-old cat was a remarkable survivor, but these days that cat still has several good years of life left.

So at what age is a cat considered a "senior"? According to the American Animal Hospital Association's wellness guidelines, a cat is considered to be "mature" or middle-aged at just 7-10 years of age. While that may seem early to be labeled mature, many age equivalency charts match 7 years old in a cat to mid- to late-40's in a human. A senior cat is between 11 and 14, and their geriatric, or "golden years", start at 15+.

Just as with humans, as cats get older, wellness visits become more important. As cats age, they are at risk for a number of illnesses and conditions. Most of these are more easily managed when caught early. Regular physicals and diagnostic lab work are essential to keep your senior kitty in the best health possible for a long as possible.

Starting in their mature years, we'll start looking for age-related changes. A full physical exam every six months is key to maintaining optimal health. We also recommend full lab work every other year, which includes a complete blood count, blood chemistry panel, electrolytes, thyroid and urinalysis. We will take your kitty's blood pressure during her exam to make sure no problems are developing there. We also like to establish a baseline on x-rays of the chest and abdomen so any changes are more easily recognized. We also discuss your cat's changing diet needs as well as any changes in behavior or routine that you have noticed.

Once your cat reaches her golden years, we will look more closely at lab tests and behaviors, anticipating changes as she continues to age. We perform tests more frequently, running full lab work every year and taking x-rays every other year, because we know that your cat is more vulnerable at this stage in her life.

The goal of senior care is simple. We want to help you maintain the highest quality of life for your cat and thereby enhance the bond that we all share. Together we can make the senior years the most rewarding years for you and your cat to have with each other.

See our Life Stages Health Care Recommendations page on our website for specific details on wellness at all stages of your cat's life.