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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
Orange Boy was a young neighborhood stray cat. He visited many houses, but when he had a bad fight a few months ago, he came calling to the right house. His new owner saw the terrible wound on his face and knew he needed treatment right away.
When Orange Boy was brought into the clinic, he had a large wound on the right side of his face about three inches in diameter. There was a large scab from under which oozed green, puss filled liquid. We sedated him so we could clean the wound and evaluate it better.
The most likely cause of Orange Boy's wound was a ruptured abscess due to a cat bite. Outdoor cats will often fight over territory and can inflict a large amount of damage on each other with teeth and claws. The cat canine tooth, or fang, is long and pointed and will puncture another cat's skin. The wound in the skin is only a few millimeters deep and heals over quickly. However, when the tooth punctures the skin, it injects bacteria deep inside. These bacteria will replicate and cause severe infection. The body of the cat will attempt to fight the bacteria by sending white blood cells to the site leading to pus being formed. This can form a large soft pocket under the skin called an abscess. The abscess usually causes a fever, pain and lethargy in the cat. The skin over the abscess usually will die and slough off, leading to oozing of the pus. In some cats, such as Orange Boy, the amount of skin that dies can be quite large.
We anesthetized Orange and scrubbed his wound. I removed the scab over his woun
d and trimmed the dead tissue around the edges. I also cleaned the wound with surgical scrub to remove any infected material. The wound had some good pink granulation tissue, which is the healing tissue, extending three inches in diameter across the whole side of his face. There was also firm swelling on the lower part of the wound due to inflammation from the infection. Because the wound extended from the base of his ear almost to his mouth, I was not able to close it surgically. I therefore left the wound to close on its own by what is called "second intention" in which the normal healing process of the skin closes the wound with time. As the body tries to heal, the skin edges on a wound contract and tissue gradually rejuvenates from the edges of the wound inward. Since the wound was so large, though, I thought I might need to do surgery at a later time to close the wound completely.
While Orange Boy was under anesthesia, we took care of some other preventative measures and tests. A blood panel showed that he was negative for the Feline Leukemia Virus and Feline Immunodeficiency Virus. His white blood cell counts and protein levels were increased due to the infection on his face, but his organ function tests were all normal. We also neutered him. Neutered males are much less likely to be territorial and get into fights.
I prescribed antibiotics for Orange Boy along with a medicated spray to keep the wound clean and hel
p healing. When he came in for his progress exam a little more than a week later, the wound had already improved greatly. The wound was half the original size, much more shallow and much of the inflammatory swelling had resolved. I removed some scabbed tissue from the top of the wound an
d cleaned it thoroughly. After another week and a half, the wound was down to a 1x2cm scab with scar tissue around it.Now Orange Boy spends a good deal of time indoors in his new home. He is up to date on all of his vaccines and has been treated for possible intestinal parasites.
Cats have a great ability to heal well and often surprise me with how well they handle many injuries or illnesses. However, when they go outdoors there is a great chance that they will be exposed to bites and other types of injuries or be exposed to infectious disease and parasites. If your cat does go outdoors, be sure to protect him or her from disease by keeping vaccines up to date and giving parasite medications (including heartworm prevention). If you notice any wounds or swellings, bring your cat to your veterinarian promptly so that any infection can be treated as quickly as possible. This will reduce your cat's pain and distress and often save money by addressing the problem early.
Dr. Judy Karnia
Any allergy sufferer will tell you how uncomfortable those allergies can be. But did you know that your cat can also suffer from allergies?
An allergy is a hypersensitivity to a substance that is otherwise considered harmless. Some of the most common allergens - those things that cause the reactions - include pollens, dust mites, molds, insect bites, fibers, foods and dander. The most common contact with allergens is through physical contact, inhalation (breathing in) or ingestion (eating). This contact causes the body's immune system to overreact and produce antibodies to attack the invading allergens. These can show up as skin and/or eye conditions, respiratory issues, or even gastrointestinal issues.
Allergies are an inherited trait and a lifelong condition because they are the result of an immune system imbalance. The tendency to develop allergies is a genetic trait. When one parent is allergic, there's an increased likelihood that his/her offspring will also be allergic. Allergies are not curable, but they can be managed with immunotherapy treatment, medications that treat symptoms and simple avoidance of the offending allergen.
Cats, just like people, can suffer allergic reactions to a wide variety of allergens. In fact, there are estimates that about 15% of cats suffer from one or more allergies. Research has shown that the immune system imbalance that causes allergies in humans is essentially the same in cats.
There are four known types of allergies in the cat: contact, flea, food, and inhalant. Each of these has some common expressions in cats, and each has some unique features. These allergies might be why your cat has itchy skin, respiratory problems, sneezing, or even vomiting and diarrhea, the latter being possible indications that your cat has a food allergy.
Contact allergies are the least common of the four types of allergies. They result in a local reaction to the skin. Examples of contact allergy include reactions to flea collars or to types of bedding, such as wool. If the cat is allergic to such substances, there will be skin irritation and itching at the points of contact. Removal of the contact irritant solves the problem. However, identifying the allergen can require some detective work.
Flea allergy is common in cats. A normal cat experiences only minor irritation in response to flea bites, often without any itching. The flea allergic cat, on the other hand, has a severe, itch-producing reaction when the flea's saliva is deposited in the skin. Just one bit causes such intense itching that the cat may severely scratch or chew itself, leading to the removal of large amounts of hair. There will often be open sores or scabs on the skin, allowing a secondary bacterial infection to begin. The most commonly involved area is over the rump (just in front of the tail). In addition, the cat may have numerous, small scabs around the head and neck. These scabs are called miliary lesions, a term which was coined because the scabs look like millet seeds.
The most important treatment for flea allergy is to get the cat away from all fleas. Therefore, strict flea control is the backbone of a successful treatment. Unfortunately, this is not always possible in warm and humid climates, where a new population of fleas can hatch out every 14-21 days. However, a topically applied monthly parasite treatment that covers fleas may kill fleas before they have a chance to bite your cat.
Inhalant allergies are the most common type to affect cats. Cats may be allergic to all of the same inhaled allergens that affect us. These include pollens, molds, mildew and the house dust mite. Many of these allergies occur seasonally, while others are with us all the time, such as molds, mildew and house dust mites. When humans inhale these allergies, we manifest the allergy as a respiratory problem, or hay fever. The cat's reaction, however, usually produces severe, generalized itching. In fact, the most common cause of itching in the cat is the inhalant allergy.
Most cats that have an inhalant allergy are allergic to several allergens. If the number is small and they are the seasonal type, itching may last for just a few weeks at a time during one or two periods of the year. If the number of allergens is large or they are present year-round, the cat may itch constantly.
The second most common type of allergy to affect cats is food allergies. Generally cats will develop allergies to food products they have eaten for a long time. The allergy most frequently develops to the protein component of the food; for example, beef, pork, chicken or turkey. A food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress.
Treating allergies depends on the type of allergy that the cat is suffering. As noted, the contact allergy is the easiest to treat, once determined, as it simply involves removing the offending item. Limiting exposure to fleas by keeping your cat inside and treating with a regular, monthly parasite control will help. Inhalant allergies may need to be treated with steroids to control seasonal outbreaks. Food allergies may require a specialized diet in order to prevent recurrance.
If you are concerned your cat may be suffering from an allergy, schedule an appointment with your veterinarian to review and discuss your concerns.
One-year-old Duke and his brother Sebastian are two cute and sweet cats waiting for adoption at Safe Haven for Animals. Duke and Sebastian had developed a severe upper respiratory infection at the rescue home. It is very common for shelter kittens to develop viral and bacterial upper respiratory infections due to the wide exposure to other cats and the stress on their bodies from changes in their life. When I first saw Duke, he was very congested, not eating well, and was very thin and lethargic. He had a fever of 104 degrees and his lymph nodes under his chin were enlarged. I prescribed an antibiotic for him, started L-Lysine which helps fight herpes virus, and switched him to a high calorie prescription food.
He improved quickly. He gained one and a half pounds in three weeks and his sneezing and nasal discharge cleared. However, he still had a loud noise when he breathed through his nose. This presented a difficult challenge for me. When feeling a cat's soft palate way back in his mouth, he only gives you a second or two to get a feel before jerking away or biting. In that brief moment, I thought I could feel a firm mass above Duke's palate. This, and the noise in his nose, led me to suspect a growth or foreign body up in his nasal sinus.
I placed Duke under anesthesia, pulled back his soft palate, and found a large, soft, pink growth. With firm but gentle traction, I was able to remove the growth from his sinus. The growth was a 1.5 cm spherical polyp with a long stalk. Polyps are inflammatory growths that can form in the nasal sinus or ear canal of cats. They mainly cause problems by blocking the interio
r of the sinus or ear canal stimulating discharge and causing discomfort. Removal by traction - that is, pulling the polyp until it comes loose - can be successful in many cases although some may grow back. Removal by surgery is needed in those cases. In Duke's case, it appeared I had removed the entire stalk of the polyp, which minimizes the chance of it recurring.
Since his procedure Duke has been doing great. He breathes without any noise and does not have any nasal discharge. He is very active, and we are hopeful that this marks the end of his problem.
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Dr. Judy Karnia
For more information about Duke, his brother Sebastian, or any of the other cats available for adoption through Safe Haven For Animals, please visit their website at www.azshfa.org
This week's case is about a one and a half year old blue point Siamese. Romeo moved from New Jersey to Arizona at the beginning of 2011. His owner brought him into the clinic because he had been coughing for a few months. His previous veterinarian had done x-rays and saw that he had bronchitis - inflammation of the airways - but was not able to determine the cause. His owner told me that Romeo was mainly an indoor cat, but he did sit outside in a large cage for a while some days. Hearing that the cat had some outdoor contact, my first thought was to rule out heartworm disease.
Heartworms are injected into a cat by a mosquito. The heartworm larva will then travel throughout the blood stream and pass through two more larval stages before becoming a worm. We obtained a blood sample from Romeo and ran an antibody and antigen heartworm test. The antibody test would show if he had any exposure to heartworms sometime in the last months or years. The antigen test detects if there is an adult female worm in the cat's body. Cats are actually good at fighting off the heartworm infection and will only have immature worms or one or two adult worms if any survive. Dogs, on the other hand, tend to have many worms in the heart and lungs.
This ability to resist the parasite makes it difficult to definitively diagnose heartworm disease in cats since many infected cats have no worms that will cause the antigen test to turn positive. The cat may also completely fight off the parasite and have his antibody test turn negative after months or years. But even if a cat has beaten the parasite, his lungs may still have lasting damage from the heartworm. While fighting off the parasite, the immune system will mount an inflammatory response that leads to significant lung disease. This is called Heartworm Associated Respiratory Disease (H.A.R.D.). The disease can be mild to severe and can cause various symptoms including coughing, difficulty breathing, vomiting, weight loss and lethargy.
Romeo's antigen test was negative but his antibody test was positive. This did not tell us if he had any heartworms currently in his system but it did tell us that he was exposed at some point. I prescribed steroids for Romeo to help reduce the inflammation in his lungs. This decreased the irritation and mucus secretions so that he would not cough. I hoped it would also prevent further damage to his airways. He immediately improved and is no longer coughing. He is back to himself, and his owner is protecting him from being infected with heartworm again with the regular use of Revolution, a monthly heartworm preventative.
We still do not know how much damage has been done to Romeo's lungs and if he will need to be on steroids for the rest of his life or not. He likely was exposed to the heartworms back in New Jersey before he moved here. However, heartworm disease is becoming more prevalent in Arizona and can be spread by mosquitoes here just as easily as anywhere in the country. We strongly encourage heartworm preventative for all cats living in the valley.
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Dr. Judy Karnia
Very few animal lovers would dispute the soothing quality of an animal's companionship. Animals have a wonderful way of making us feel better even on our worst days. And cat owners in particular know how uplifting a purring cat can be even in the darkest times.
For years, therapy dogs have visited nursing homes and hospice facilities, bringing moments of happiness and ease to the patients and residents. In recent years, there have been increasing requests for cats to become therapy animals as well.
One of our patients here at Scottsdale Cat Clinic, Champagne Hermann, recently became part of the Hospice of the Valley's Pet Connections Program. Says his owner, Linda Hermann, "One day I received this friendly phone call from a friend of a friend who had personally met Champagne and observed his interactions with an 8-year-old boy and his triplet 6-year-old sisters. Who was this friend who called? Ann Roseman, Pet Team Coordinator with Hospice of the Valley.
"At first, I was surprised as I have heard of dogs being involved in this program and did not realize there was a calling for cats too. Champagne and I jumped at this opportunity to be involved with Hospice of the Valley. How delighted we are to visit each patient and see the joy that we bring to the patient and their families. Our visits are one or twice a month. Champagne makes himself comfortable in the patient's lap as the patient pets him and scratches his ears, brushes his fur, or feeds him treats. It's apparent Champagne and the patient have a unique bond. As we leave, I remind the patient that Champagne and I will be coming back soon; and we all look forward to that time."
Officially, research theories vary widely on whether there is true therapeutic value to animal visits, but those on the receiving end of those encounters seem to find them very uplifting. According to Ann Roseman of the Hospice of the Vally, "As an officially registered pet therapy cat, Champagne (and his pet parent, Linda) has already brought much joy to many Hospice of the Vally patients, family members, and caregivers since joining us this past November. He has visited patients in their own private homes, assisted living facilities, group homes, skilled nursing facilities, and our Hospice of the Valley inpatient units. Depending on the patient, his visits range from 10 to 60 minutes, from one time only to once every several weeks.
"The Hospice of the Valley care team members are constantly referring new patients for cat visits. So if your cat is good at riding in the car and arriving at their destination calm and ready to interact, please consider getting your cat tested to be a therapy cat. One of the tests will be to see if your cat can lie comfortably in the laps of several people for several minutes each. Your cat will also have to be comfortable in a collar or harness and leash. They need not walk on the leash, but it must remain attached to them and in your hands at all times."
The Delta Society is a national organizations that helps prepare pets to be part of their Pet Partners program. For more information, visit their website at www.deltasociety.org.
For information on becoming part of the Hospice of the Valley Pet Connections Program with your cat (and/or dog), please contact Hospice of the Valley Pet Team Coordinator by email at aroseman@hov.org or by phone at 602-287-6660.
