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

Case of the Week: Max

Max is a sixteen-year-old Siamese mix. His owner brought him into the clinic because he had stopped eating and drinking and was drooling constantly. On examining him, I found that he was thin, very dehydrated and had a fever. I also saw a large ulcer on his tongue. My first thought was that it was likely he had severe chronic kidney disease and a poor prognosis. We drew blood and urine samples from him and did a panel to evaluate his organ and immune system functions.

His blood test results were surprisingly good. His kidney values were increased, but only a little above normal and he was concentrating his urine fairly well. These results indicated that his kidneys were still functioning well but that Max was dehydrated. I also found that his protein levels and one of his white blood cell counts were increased, which indicated an infection in his body.

It was at this point that Max's history became as important in diagnosing his problem as his blood tests and physical exam. Max's owner had recently adopted a new cat into their home. Max had not had any vaccines since he was a kitten. Therefore, he was not protected against the common viruses that are very contagious and widespread among cats, especially those in shelters. It is very difficult to test for the Herpes or Calici viruses that cause upper respiratory disease in cats. However, Max's symptoms - lethargy, not eating, running a fever, and an ulcer on his tongue - were consistent with upper respiratory disease.

Max received intravenous fluids at the clinic for two days and recovered slowly. We gave him subcutaneous fluids (under his skin) for a few more days and he gradually began eating and grooming again.

Vaccinations are important in all cats to help prevent disease. Because of widespread vaccination, we rarely see Panleukopenia (Distemper) or Rabies in cats in this country. The Herpes and Calici viruses that cause upper respiratory disease are very contagious and stable viruses that still cause problems in many cats. However, severe disease from these viruses are usually only seen in young cats and cats that have not been well vaccinated. Cats that are current on their vaccines have good immunity to these viruses and show minimal signs of illness when exposed.

It's important that owners not become complacent about their cats protection. Even indoor cats can be exposed to viruses. Always discuss with your veterinarian what vaccines are best for your cat.

For more information and guidelines for vaccinations throughout your cat's life, see our Life Stages Health Care Recommendations on our website.

Dr. Judy Karnia

Case of the Week: Bianca

Bianca is a seven and a half year old medium haired cat. Her owners brought her to the clinic because she was having trouble eating and her bottom jaw was shaking. She would also hold her mouth open as if she was having difficulty closing it.

On her exam, she was very sensitive to touch around her mouth and pulled her head away when I tried to open it. I could see tartar build-up on her teeth and gingivitis. There was gum recession at her upper right canine tooth and swelling of the gum there. We ran a blood panel and it was normal except for a mild increase in the protein levels due to inflammation or infection. Bianca also tested negative for Feline Leukemia Virus and Feline Immunodeficiency Virus.

Bianca's problems could have been due to a neurologic disease or a problem with her jaw. However, I thought the most likely cause of Bianca's problems was pain in her teeth and started her on antibiotics and pain medication. She started feeling better and was eating normally again with a couple of days. We anesthetized her to clean her teeth and exam them more thoroughly. Her upper canine tooth had a large resportive lesion and moved in the socket. The dental radiographs showed the root of the tooth was still present. By careful probing of the teeth, I also found resorptive lesions in three other teeth and a large periodontal pocket around the other upper canine tooth. Almost all of her incisors and one of the lower canine teeth were already missing.

I extracted both upper canine teeth and the three teeth with resorptive lesions. I sutured the gums closed with absorbable stitches and did a thorough cleaning of the teeth, polished them and applied a sealant. I gave her an anti-inflammatory medication to control the inflammation and discomfort and sent her home with more antibiotics and pain medications.

While Bianca was under anesthesia we found another hidden problem. Jill, our veterinary assistant, found a tapeworm segment near Bianca's anus. Bianca is an indoor cat and therefore likely to have had the tapeworm for years. Even indoor cats can carry intestinal parasites and often show no symptoms. Fecal tests can help us find many intestinal parasites but tapeworms usually do not shed eggs that would be found in those tests. The tapeworm didn't appear to be causing any problems at the time for Bianca, and it was just a lucky find while she was here. I gave her an injection to clear the tapeworms from her body.

At Bianca's progress exam a week later, she was doing very well. Her owners said that she was more active and playing, and eating well. She was not showing any more signs of pain.

Dental disease is very common in cats and can cause varying levels of pain depending on the severity of the disease. Many cats can suffer a good deal of pain but do not show any signs. Bianca likely had discomfort long before she showed signs. This is why it is important for cats to have regular semi-annual exams and dental cleanings when recommended by your veterinarian. Cat's won't tell us what's wrong and they often hide symptoms. Your veterinarian and technicians can spot trouble before it becomes severe.

Dr. Judy Karnia