New Year's Resolution: Quit Smoking

Are you a smoker? We don't need to tell you the health risks associated with smoking. We probably don't even need to tell you about how bad second-hand smoke is too. But have you realized how bad it is to smoke around your cat?

While there has been extensive, long-term research on the effects of cigarette smoke and nicotine on humans, there hasn't been much documenting the effects on our feline friends. However, recent research has revealed some startling information about second-hand smoke and our cats.

Based on a 7-year study at Tufts School of Veterinary Medicine, cats in smoking households seem to be at a much higher risk of developing lymphoma, a type of cancer, than cats that live in smoke-free environments. This study also determined that cats who live in homes with one smoker have twice the risk of developing lymphoma and cats who live in households with two ore more smokers have four times the risk. Also, cats who are exposed to a smoking environment for over 5 years and those who live in households with over 100 cigarettes smoked per day are also at a significantly higher risk. The exact cause of this increase risk of lymphoma is not known at this time.

New studies suggest that cats are also at increased risk of feline oral squamous cell carcinomas (SCC) when exposed to environments with tobacco smoke. This may result from smoke and nicotine residue landing on the cat's fur. The fastidious nature of cats and their grooming habits cause oral exposure to the carcinogens.

In addition to an increased risk of developing cancer, cats that live in smoking environments are also predisposed to lung disease and eye irritation. Although second-hand smoke alone has not been shown to cause the lung disease or eye irritation, the primary culprit is thought to be chronic exposure to smoke in poorly ventilated areas. If you think about it, smokers don't spend their entire day inside. Most people do spend some time outside. But most cats do not, and thus are forced to breathe and rebreathe the same stagnant, contaminated air. Therefore, environmental tobacco smoke cannot be entirely filtered out through ventilation systems or special fans. It can take many hours for the smoke of a single cigarette to clear.

There are also other dangers to your cat from the nicotine itself. If you leave ashtrays around with cigarette butts, your cat may accidentally ingest one, or part of one if it decides the butt is a toy to bat around. Your cat may also try to eat nicotine replacement gum or patches.

Obviously the best option for everyone would be to simply quit. However ideal that may be, it's not always easy. If you cannot quit smoking, even for your cat, here are some tips to minimize her exposure to the dangers and to improve her health:

• Designate smoke free areas: Consider smoking outside, or smoke only in rooms where pets are not allowed. The less the exposure, the greater the changes your cat will stay healthy. The smoke-free area should include your car. If you are transporting your cat anywhere, don't smoke while she is in the car.
• Use air filters: Air filters may help remove harmful chemicals in the air, reducing how much your cat is breathing into her lungs.
• Clean your pet and your house: Regular baths, or at the very least wipe-downs with a damp cloth, can help remove smoke residue from cat fur. Vacuum and keep all cigarette butts, tobacco products and even nicotine patches out of sight and reach to prevent accidental illness, poisoning or even death.
• Look for symptoms: Excessive drooling or difficulty eating are symptoms of oral cancer, while labored breathing is a sign of lung cancer. Observe your cat frequently, as catching as early as possible always helps with treatment. If something is out of the ordinary, contact your veterinarian immediately.

Case of the Week: Amadeus

For our case this week, we look at a trembling cat and learn what we discovered when we investigated this minor change in behavior.

Amadeus is a four-year-old domestic shorthair that has been coming to the clinic for two years. On his first visit, he weighed seventeen pounds and had a body score of 8/9. A body score of 5/9 is ideal and 9/9 is obese, so Amadeus was quite portly. We started him on a prescription diet food and he began losing weight well. He developed constipation but did well with a regular stool softener added to his food. Over two years, he eventually lost four pounds and decreased to a body score of 6/9.

In December, he came in for an exam before going off to college with his owner. She had noticed him trembling in the past few days and wanted to have him checked out before they left town. He also was not eating as well and seemed constipated again. When I examined him, I did not find any neurological problems or any other medical problems except that his colon was very full with stool. We gave him an enema, which was, to put it delicately, very successful.

We also ran a full blood panel to check his overall medical health. His blood counts and thyroid level were normal. However, his blood chemistry test showed that both of his kidney values were increased and his potassium level was a little low. Muscles need potassium to function well so the low potassium was likely the cause of Amadeus' trembling. The kidney values could have been elevated due to dehydration associated with the constipation or an indication of kidney disease. This would be unusual in such a young cat so we needed to do more tests.

A urine sample showed that Amadeus' kidneys were not concentrating his urine properly. Normally, cats have very high urine concentration, called specific gravity. Amadeus' urine was mildly concentrated but nowhere near what is normal for a cat.

We suspected something was wrong with his kidneys. We had Dr. Green, an internal medicine specialist, perform an ultrasound of Amadeus' abdomen at our clinic. He found stones in each of Amadeus' kidneys but the structure of the kidneys appeared normal. The stones could have formed because of early onset kidney disease or due to diet related factors. We do not typically remove kidney stones in cats because of the high rate of complications with the surgery and most cats do not pass the stones. A special diet and increasing fluid intake can be used to prevent the growth of the stones and help slow kidney decline.

We started Amadeus on a potassium supplement and a prescription urinary diet. We showed his owner how to give him fluids under the skin and she will give him fluids twice weekly. The trembling could also be due to discomfort from the stones. If it does not stop with the potassium supplement, we will see if pain medications help. We will need to examine him and check his blood levels regularly to monitor his kidneys and see if other medications are needed.

Although kidney disease occurs much more frequently in older cats, it can develop in young cats as well. Cats are very good at hiding symptoms and often owners do not know that there is a medical problem developing. Amadeus' owner was right to be worried about an apparently minor change in behavior. The sooner we diagnose kidney disease and other medical problems, the more we are able to do to treat the disease. We recommend that all cats be examined every six to twelve months by their veterinarian. A full blood panel should be done at least once after the cat's first year and then regularly starting at six or seven years of age.

Dr. Judy Karnia

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.