New Year's Resolution: Get More Exercise

We all have made the resolution to exercise more at least once in our lives, especially after the holidays. And this is a great resolution to share with your kitty too. Domestication of cats into indoor house pets has removed the need for cats to hunt for live prey, decreasing their exercise and their mental stimulation. This has led to weight gain, boredom, and stress in our cats' daily lives.

Kittens seem to have the natural ability to keep themselves entertained and will exercise themselves silly. However, some cats seem to lose that ability as they get older and will need your help to keep them engaged with stimulating exercising. While it is normal for a cat to sleep eighteen or more hours a day, we still need to ensure that her daily life is mentally stimulating and that she is getting daily exercise. Dedicating some time every day, even ten to fifteen minutes, to play with your cat and providing opportunities to "hunt" will help keep her healthy physically, mentally, and emotionally as well as strengthen the bond between you.

Here are some quick tips to help your cat get more exercise:

• Toys: Homemade or pet shop toys help to encourage your cat to get moving. Every cat has different tastes in toys so it may take a few purchases to find her favorite. It's also good to rotate toys every week to keep her from becoming bored with them.
• "Catch the Light": Shine a flashlight or laser light on the floor and walls and let your cat play.
• Boxing: Let your cat play in a box or paper bag. You can interact with her during this game by scratching at the outsides to get her to punch the sides.
• "Hunting": Put your cat's food in different places each day (including on top of tall furniture) and bring out her inner huntress.

Another great idea, courtesy of petfit.com, is to incorporate ways to engage your cat to exercise with you. Not only will you both get a good workout, but you will both have a good time, strengthening your relationship. Celebrity fitness coach Gunnar Peterson has come up with three great ways to exercise with your cat:

• "Light" Cardio: Everyone knows that many cats love to chase beams of light so why not get your heart rate up at the same time? Try jumping an invisible rope while holding flashlights or laser lights in your hands. You and your cat are sure to get a solid workout. The light should move up and down the wall and in circles, so your cat can have a blast trying to catch it.
• "Light" Abs: Ever do sit-ups with a flashlight or laser light in your hands? When you get to the top of the sit-up, hold your position and crunch your abs for a few seconds while moving the light beams on your wall.
• Curious Cat Curls: Tie an elastic band to a toy around your dumbbells. As you curl, watch your cat go crazy trying to catch the toy as it ascends and descends. Just make sure you keep the elastic band out of reach when not playing so your cat doesn't accidentally swallow it.

Click here to see demonstration videos for these great exercises. The cat videos are about halfway down the page.

Case of the Week - Trosper

For this case study, I'm going to discuss the rather smelly end of the veterinary profession. We've all cleaned up the final product of our cats' daily business. It's mildly unpleasant, but usually routine. In this case, we'll learn a bit about what can happen when that process no longer goes smoothly.

Trosper is an eight year-old Turkish Angora that first came to the clinic nine months ago in distress. He had been having constipation and had needed multiple enemas in the past. When I examined him at the clinic, he was again severely constipated. In addition, his anal sacs were very full. These scent glands are located right inside the anus and create a very strong smelling liquid secretion that cats use to mark their territory. They typically express regularly with defecation or when a cat is nervous. In some cats, the secretion does not get released and starts to build up inside the sacs. The secretion can thicken and build until the sacs are very distended. When this happens, the cat feels discomfort and irritation, especially during defecation. This can then lead to less frequent defecation and finally constipation. I express these glands by basically doing a rectal exam and squeezing them from the inside.

We expressed Trosper's anal sacs to remove all the built-up secretion and gave him an enema. Unfortunately, the enema was not enough to allow Trosper to defecate because of the severity of his constipation. We had to anesthetize him so that I could manually remove the feces from his colon. I was able to push his feces to the end of his colon so I could then pull it out through his anus. (This might qualify me for the Dirtiest Jobs show)

Trosper had been on Lactulose, a stool softener, and Cisapride, a medication that increases the muscle strength of the colon. When a cat is prone to constipation, I have the owner adjust the dose of the Lactulose so that the stool stays soft but formed and the cat is defecating daily. I had Trosper's owner increase these medications to every 8 hours instead of every 12 hours, and increase the dose of the Lactulose.

Trosper took a few days to recover his appetite completely but has been doing well since. He has come in every four months to have his anal sacs expressed so that they do not build up too much and cause him discomfort. On the last check, the sacs were quite full so we will check him every three months now. He is still on his medications and has been defecating very regularly. We've also been working with his owner to get Trosper to lose weight. In otherwise healthy cats, constipation occurs more commonly if cats are overweight. His weight loss is not going as well as hoped, but he has lost a little. We can also see constipation in cats that have other medical problems that frequently lead to dehydration such as kidney disease or intestinal disease. Cats with recurrent constipation should be tested for underlying disorders.

Constipation can cause serious problems beyond just the pain, so it's important to treat it seriously. Just like in your house, when the plumbing isn't working, nothing else seems that important.

Dr. Judy Karnia

New Year's Resolution: Lose Weight

We are already one month into our New Year and most of us are still committed to, or are revising, our list of resolutions. Why not take a moment or two and see if your cat needs to be part of those resolutions too?

If a poll were taken, losing weight would probably be number one on anyone's new year resolution list, especially after all the indulgences available during the holiday season. And even if your kitty did not indulge with you, he or she may also be in danger of being overweight.

You invest a lot in your cat's health, from vaccinations and neutering to regular veterinary wellness visits. Yet one of the best ways to maintain your cat's good health is by simply providing the right type and amount of food. Keeping your cat at a healthy weight is a vital part of keeping him or her fit. Being overweight or obese is detrimental to the health of your cat. Neutering and keeping cats indoors has led to increased life span and better health. However, they have also led to decreased metabolism and activity levels. Add overfeeding of calories and carbohydrates, and we have a large percentage of overweight cats.

The best way to evaluate your cat's size is by a body condition score rather than actual weight. A body condition score is a scale from one to nine with five being the ideal condition. We check this score each time we see your cat, but here's a quick guide for doing this at home:

Healthy Cat

• The ribs are easy to feel
• There is a waist behind the ribs
• There should be minimal fat hanging from the belly

Overweight Cat

• The ribs are difficult to feel
• There is a rounding of the abdomen
• There is a growing abdominal fat pad

Just as with humans, obesity can be a definite health risk for your cat. Being overweight can put your cat at risk for many diseases, including arthritis, diabetes, cardiovascular disease, respiratory disease, etc.

Helping your cat get back to a healthy weight is not just a matter of cutting back food, although that may be part of what your veterinarian recommends. Because cats are at risk of liver disease and other complications if they stop eating, or aren't getting enough nutrition and calories, a diet is something that should be set in place and regularly monitored by your veterinarian. A few months ago, our Case of the Week profiled one of our patients - Nahmi - whose weight loss journey is still progressing well.

How we start a kitty's weight loss journey

1. We conduct a complete physical exam and body score assessment to determine your cat's ideal weight
2. We look for any medical problems that need to be addressed
3. We calculate the daily calorie needs for your cat
4. We may suggest a particular cat food or prescription diet
5. We determine the exact amount of food that should be offered daily

To help your cat get off to a good start this year, Scottsdale Cat Clinic is holding a weight loss contest. We last held one in 2008 and the winner is still maintaining his slender form. For more information about weight loss for your cat, or our Weight Loss Contest, please contact Scottsdale Cat Clinic by phone at 480.970.1175 or by email at info@scottsdalecatclinic.com

If there is any way we can help get your cat off to a great start for 2011, please let us know.

Case of the Week: Gambit

Today's Case of the Week is a simple story of how regular maintenance care and physical exams help to keep your cat healthy. Gambit is a 2 1/2 year old Egyptian Mau. He has been very healthy and his owner has brought him in regularly for his wellness exams and vaccines.

We first met him a year ago when he was due for his vaccination updates. He received his FVRCP and Rabies vaccines as usually recommended for indoor cats. These protect against Feline Panleukopenia (often referred to a distemper), the upper respiratory viruses Herpes and Calici, and Rabies. We also started him on Heargard to protect him against heartworm disease. Heartworms are spread by mosquitoes, cause severe lung damage, and can be difficult to diagnose. By giving your cat a monthly dose of Heartgard or Revolution, you prevent the spread of the heartworm larvae through your cat.

At his following six-month wellness exam, Gambit was doing well at home. On exam, I found that he had gained over half a pound. We calculated his daily caloric needs so that his owner would know how much he should be eating each day. I also found that he was starting to develop gingivitis, an inflammation of his gums, due to plaque accumulation on his teeth. Cats can start developing dental disease as early as one year of age and it can become severe with time. We started a new diet of Purina DH, a dental diet that helps to clean the teeth and break down plaque and bacteria as the cat chews.

Last month, we saw him again for a six-month wellness exam and to update his Rabies vaccine. I did a complete exam as usual and he looked very good. His teeth looked great, no tartar build-up and the gums appeared normal without any gingivitis. He also had lost a quarter of a pound. He is still a little heavy with a body score of 7/9 (5/9 is ideal) but at least he is going in the right direction. Many cats gradually increase their weight each year if their food intake is not controlled. By bringing Gambit in regularly, we were able to find two medical problems that were just starting and work toward reversing them before more severe medical problems could develop. With good care by his owner, he is very likely to live a healthier, happier life.

Dr. Judy Karnia

Diabetes in Cats: Diagnosis and Testing

In our last blog on diabetes, we defined the illness and mentioned several symptoms that could indicate your cat has, or is developing, diabetes. In this blog, we will discuss the tests used to diagnose the disease as well as the short-term and long-term treatment and management.

Diagnosing:
Generally, the following screening tests are recommended when diabetes mellitus is suspected: a complete blood count (CBC), a serum biochemistry profile, and a urinalysis. While it would seem that simply checking for an elevated blood sugar would be enough, a thorough set of screening tests gives us much more information that will help to treat the disease. Cats present a unique challenge in diagnosing diabetes because their blood glucose levels can become elevated simply from stress. Additionally, because diabetes is often found in senior to geriatric cats, there may be unrelated conditions that may affect how your cat's diabetes is treated and may also need to be managed for your cat's optimal health and well-being.

The complete blood count (CBC) evaluates the red blood cells, the white blood cells, and the platelet components of a blood sample. With uncomplicated diabetes mellitus, these results are often within the normal range. Some problems we can see is an elevated white blood cell count if there is an infection, to which diabetic cats are more susceptible. Also the red blood cell count may be elevated if there is dehydration or decreased with anemia, which are common with severe diabetic states and other concurrent medical conditions.

The serum biochemistry profile evaluates substances in the serum component of the blood including glucose, enzymes, lipids (fats), proteins and metabolic waste products. The serum glucose level is usually very elevated in diabetic cats. We can also find changes in the electrolytes (potassium, sodium, etc.) and liver enzymes secondary to the diabetes. Chronic kidney disease is very common in older cats and often seen in diabetic cats.

Another blood test that is very valuable in a diabetic cat is a Serum Fructosamine. This test looks at how sugar levels have been over the previous week and not just at the moment of the blood draw. Therefore, it is not affected by the level of stress the cat experiences at the clinic. This test confirms the diagnosis of diabetes and aids in evaluating how well the diabetes is being managed with treatment.

Finally, a urinalysis is needed. Urine from healthy cats typically does not contain any glucose (sugar). A diabetic cat will have a large amount of glucose in the urine, which aids in the diagnosis. Urinary tract infections are also more common in diabetic cats as the presence of glucose in the urine makes conditions ideal for bacterial growth. By detecting white blood cells in the urinalysis, the infection can be detected and treated.

The presence or absence of ketones in the urine are also evaluated. Ketones are by-products of fat metabolism. Increased utilization of fat occurs in diabetic animals because their insulin deficiency results in poor utilization of carbohydrates as an energy source. The presence of ketones in the urine indicates a more severe or long-standing case of diabetes, which will require more intense treatment.

Treatment:
Once your cat has been diagnosed with diabetes, it's likely that your cat will be started on insulin treatment. Insulin is a very effective treatment for the regulation and management of diabetes. Fortunately, insulin from one mammal is biologically active in another, which means your cat's system will respond to the injected insulin as if it were its own insulin.

Here at Scottsdale Cat Clinic, we generally prescribe Glargine, frequently known by the brand name of Lantus, which can be purchased through a human pharmacy. This is a long-acting human recombinant insulin analog that forms microprecipitates at the site of injection from which insulin is slowly released. It generally starts to work within 2-4 hours, continues working for 24 hours, and does not have a peak effect. There are other insulin formulas available as well.

In addition to starting insulin, we also strongly recommend changing your cat's diet to a high-protein, low-carbohydrate formula, ideally in a canned formula. We do have several diabetic prescription diets available, and there are wonderful resources for finding other high-protein foods on our website.

At Scottsdale Cat Clinic, once a patient is diagnosed with diabetes and prescribed insulin, we follow up with daily phone calls to the owner for the first three or four days to monitor any changes in symptoms and to make sure the insulin administration is going well and without difficulties. Because it can take time to establish the correct insulin dosage for your cat, we recommend having a glucose curve every two weeks until the correct dosage is established. A glucose curve is a test that takes a glucose reading every two hours for 12 hours. Once the correct dosage is established, the glucose curve should be repeated one month later. If everything is still good, then the test can be repeated every 4-6 months.

The long-term goals of treatment are to remove all the symptoms of diabetes, maintain a healthy and appropriate weight and to regulate the cat's glucose levels. If insulin and a high-protein diet are begun fairly early in the course of the disease, many cases of diabetes can even resolve and go into remission. These cats still need a high-protein canned diet, but no longer require insulin injections.

It is very important to follow through on all treatments and diet changes recommended by your veterinarian to have the best outcome for your cat.

Otitis Kittens

This week's case of the week is actually about two young cats from two different families with a similar problem that we saw in the past week. Both of the cats had ear mites and had been treated for them but were still scratching at their ears. The owners were concerned that their cats still had the ear mites.

When I examined each of them, the ear canals were so full of waxy discharge that I could barely see into the ears. We looked at the discharge under the microscope but could not find any mites. We then did a smear of the discharge and put on a stain that helps us see any cells, bacteria, or yeast. By looking at these under the microscope, I found that both cats had large numbers of yeast. We cleaned the ears well and I prescribed medication to place into the ears, which will clear up the infection.

Ear mites are parasites, called Otodectes, that live in the ear canals of cats, dogs, rabbits and ferrets. They are very contagious and are spread with close contact of animals. They cause itching of the ears, which can be quite severe in some cats. A large amount of wax builds up in the ear canals. When the cat scratches at his ears with his hind claws, he can cause damage to the skin, from small scabs to deep scratches that can become infected.

In some cats, I can see the ear mites moving around in the canal when I look in with my otoscope. If I can't see them but I suspect they are there, we take some of the discharge and place it on a slide so we can look under the microscope. If ear mites are present, we can see them moving on the slide. In some cases, we will also see the mite eggs under the microscope.

Ear mites are usually easily treated with medications prescribed by a veterinarian. There are medications that go directly into the ear or onto the skin, which then spreads to the ears to kill the mites. These products are very effective and I rarely see a case where the mites are not completely resolved after one treatment. I have, however, seen many cases in which an over-the-counter medication was tried and did not kill the mites. These over-the-counter drugs are not nearly as effective as the medications available from a veterinarian.

Ear mites, however, can still cause problems even after they are gone. It is not uncommon to see cases like these two kittens in which the cat continues to scratch after ear mite treatment. These are usually due to bacterial or yeast infections. These will occur because of the moist environment in the canals resulting from the waxy build-up cause by the mites. These are a little more difficult to treat but usually resolve well with ear cleaning and the proper medication applied into the ears for several days.

There are other problems as well that cause ear discomfort and discharge. If you notice discharge or see your cat scratching at her ears or shaking her head, have your veterinarian examine your cat and look at the discharge under the microscope (called cytology). Many over-the-counter medications do not work or cause further irritation and may not be addressing the real cause of the problem. It is better for your veterinarian to determine the cause and prescribe the proper treatment so you can resolve your cat's discomfort.

You can find more information in the LifeLearn Library on our website.

Dr. Judy Karnia

Diabetes In Cats Defined

Because of the increase in cases of diabetes in people, the American Diabetes Association declared November to be Diabetes Awareness Month. Sadly, veterinarians are seeing a steady increase of diabetes in pets as well. That's the bad news. The good news is that it is a condition that can be successfully treated with commitment from the veterinarian and the owner.

Diabetes Mellitus is the most common form of diabetes found in cats, and is the second most common endocrine disease in cats. It is estimated to affect one in 400 cats, is found in more males than females, and is a common ailment of middle-aged to senior cats.

Diabetes is a disease of the pancreas. In cats with normal glucose metabolism, food is broken down into components that can be used by the body. Carbohydrates are converted into various sugars including glucose. Glucose is absorbed from the intestines into the bloodstream, providing the body cells with energy. Glucose can only enter most cells if the hormone insulin in present. There are specific cells, called beta cells, located within the pancreas that manufacture insulin.

Diabetes mellitus, or "sugar diabetes" as it is sometimes called, is caused by a lack of insulin available to the cells in the body. This is due either to insufficient insulin production by the pancreas, or by the body cells failing to respond to the insulin. As a result, blood glucose levels are too high and the body cells cannot absorb enough to provide adequate energy.

The most common type of diabetes mellitus found in cats is Type II, in which some insulin producing cells remain in the pancreas. They are either not producing enough insulin for the body to adequately process glucose, the secretion of insulin is delayed, or the cells are resistant to it. Just as with humans, obesity is a predisposing factor to diabetes. The tremendous increase in overweight and obese cats means that more and more cases of diabetes are being diagnosed. It's important to remember that a cat just three pounds over ideal weight is considered obese.

There are clinical (observable) signs that may indicate your cat has, or is developing, diabetes. The most common sign is drinking a lot of water and an increase in urination. There may also be increased incidents of inappropriate urination outside the litterbox and/or on furniture. Sudden weight loss, especially with an increase in appetite, can be a warning sign. As the disease advances, the cat will become increasingly lethargic and will have a dull coat.

If you are concerned that your cat may have diabetes, you should contact your veterinarian. During the appointment, it's important that you relay accurate information about your cat's signs and symptoms and are able to list all the medications and supplements your cat is currently taking. Your veterinarian will be able to do a complete physical exam and run lab work to help properly diagnose your cat.

If your cat is diagnosed with diabetes, it is very important to maintain a good relationship with your veterinarian and the entire team at your animal hospital. With a combined commitment from you and your veterinarian, your cat's diabetes can be easily treated.
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Coming Next Time: Diagnosis and Treatment of Diabetes