Case Study: Kristina

Many clients when facing a medical decision with their cat will ask me what I would do if it were my cat. Most of the time, that question is asked when an owner is facing difficult decisions. But you may want to know what I do for my cat to keep her from developing severe medical problems.

So this case study is about Kristina, the cat I adopted a little over a year ago. She was about five years old and in good health when I took her home from a local shelter. At that time she had some dental disease and we performed a dental cleaning and radiographs. We also extracted four lower teeth that had problems. She did well with her recovery and was right back to eating her dental dry food and ProPlan canned food.

Last summer, we discovered she has a food allergy. She had developed chin acne, which resolved only when we fed her a hypoallergenic food exclusively. Unfortunately, this meant she could not continue her regular dry food - a dental kibble. As you will see, this led to some other problems.

You might be surprised to know that even though I see Kristina every day, I still schedule a semi-annual exam for her. She gets swept up and whisked into an exam room, where she gets the exact same exam your cat gets when it visits. I do this so I am sure to give her a thorough examination, running through the same checklist and comparing data from her last exam.

At her most recent six-month wellness exam, I found she had mild tartar and her gingivitis had returned. Some of this is attributable to her switch from her dental diet to a different food. A few days later, I performed a dental cleaning to treat those issues. I did not find any lesions during the oral exam or on the radiographs, which meant she did not need any extractions. We gave her teeth a thorough cleaning, polishing and applied a sealant. I'll be watching her teeth closer now, knowing that she is susceptible to tartar buildup.

Her blood panel before the anesthesia did show a mild increase in one of her liver enzymes so I will recheck that in the next month. This progress check will let me know if that increase is worrisome or if it was a reaction to her gum disease. If the enzyme is still high, I will run more tests to look for a cause. Tests like these are crucial because there is no way to observe a liver enzyme increase by looking at a cat. The blood panel on Kristina may have caught an issue early. We hope not, but if there is an issue, catching it now is far, far better than later.

If you have met Kristina at our front desk, you will see that she has developed into a very affectionate and outgoing cat. Even though she lives here and is very comfortable with all of us, she still gets nervous when we need to trim her nails and give her vaccines or other care. We handle her gently and reassure her the way we do all our patients so that we can be sure she receives all the medical care she needs. She is up-to-date on her FVRCP and Rabies vaccines, stays indoors exclusively, receives Heartgard once a month, and has her semi-annual examinations.

My goal as a veterinarian is to focus on preventing problems so your cat lives a long and healthy life. Kristina is a healthy cat with a few minor health concerns. Yet because we provide her with regular care, check-ups and dental work, those problems stay minor. It is important to provide regular preventative care to keep our cats in good health as long as possible. Dental health especially can be difficult to notice easily in cats but it can impact their health greatly.

So if you've ever wondered what your veterinarian would do, here was a glimpse into how I take care of my cat.

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Dr. Judy Karnia

Case of the Week: Java

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

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

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

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

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

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

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

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

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

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

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Dr. Judy Karnia

Case of the Week: Oz

Oz is a three-year-old flame point Siamese. When he came into the clinic for his six-month Wellness exam, I could see a small amount of gingival recession on his upper right canine tooth - his fang. He had mild dental tartar build-up and mild gingivitis but no other dental problems visible on his exam. He otherwise appeared to be a healthy young cat, so we scheduled him for a routine dental cleaning.

A few weeks later, Oz came into the clinic for his dental cleaning procedure. After a thorough cleaning of the teeth with the ultrasonic scaler, I performed an exam of his mouth. When cats are under anesthesia, I am able to perform a much better exam of their teeth. As you might imagine, probing a cat's gums with a sharp stick is not the easiest thing to do when he is wide awake. I look at all the surfaces of the teeth and probe the gum line for any defects in the enamel or gingival recession. At the upper right canine tooth, where I had seen the gum recession during his exam, there was a 6mm periodontal pocket. Basically, I could place the probe more than half way down along the tooth root. The upper right carnassal tooth, a three-root tooth towards the back of the mouth, also had a large periodontal pocket around both of its two front roots.

The lower teeth also had some gum recession and periodontal pockets. The lower left first premolar had a 1mm pocket. The lower right first premolar and lower right molar each had a 4mm pocket, which is large for these small teeth.

After the cleaning and polishing of the teeth, I took radiographs (x-rays) of all the teeth. There was a larger amount of bone loss evident around many of the lower teeth. Bone loss occurs due to periodontitis, an inflammation of the tissues that hold the tooth in the bone. In Oz's case, two premolars showed substantial loss of bone and his lower right molar had lost so much of the bone that the roots were almost entirely exposed. Remember that at Oz's Wellness exam, all I could see were minor problems. It wasn't until he was sedated and had radiographs taken that I could diagnose the severity of his dental problems.

Oz's x-ray showing bone loss (on left) vs. a normal x-ray (on right)

I extracted four teeth - the upper right canine tooth, carnassal, lower first premolar and molar. The large pockets around these teeth were allowing bacteria and plaque to extend down the roots leading to infection and pain. These teeth also would have eventually become loose in the mouth, causing more discomfort and even making it difficult for Oz to eat. After extraction of the teeth, I closed the gums over the empty sockets and the tissue healed very well.

Oz may have had more trouble on the right side due to the formation of his skull and teeth during development, or because of how he chewed his food. Sometimes, once a small problem starts and causes discomfort, the cat will chew more with the other side of his teeth allowing the plaque to develop even more. We will continue to monitor the rest of his teeth to watch for further problems.

Oz was not showing any symptoms of any mouth discomfort at home and his routine Wellness exam showed only the tip of the iceberg of his dental problems. In many cats, it is very difficult to see the extent of dental problems until we are able to probe the teeth and take radiographs under anesthesia. His case shows us the importance of routine exams and performing dental procedures whenever there is even a hint of dental disease on the exam.

-- Dr. Judy Karnia

Home Dental Care Tips for Cats

February is annually known as Pet Dental Health Month. To maintain your cat's dental health and to reduce the frequency of needed dental procedures, home care is important. While a small percentage of cats have excellent dental health without any care, the majority will develop tartar, gingivitis and periodontal disease without consistent home care.

Your cat's teeth require cleaning and exercise. Cleaning the teeth removes plaque and bacteria to prevent tartar build up and decrease the amount of harmful bacteria that can pass through the gums. Exercising the teeth keeps the tissue that surrounds the tooth healthy. This helps prevent tooth loss and decreases pockets that can form between the tooth and gum which can collect tartar and bacteria. There are multiple methods to provide home care, depending on your cat's personality and tolerance, and your ability to provide treatment.

Tooth brushing: Brushing your cat's teeth is the single best method if cleaning his or her teeth. Most cats can be taught to accept tooth brushing if you gradually get them used to it. However, do not attempt if your cat is aggressive or prone to biting. Use a toothpaste made especially for cats such as C.E.T. which comes in either seafood or poultry flavors. Do not use human toothpaste - it will upset their stomach and the fluoride can be toxic.

Brushing your cat's teeth might seem difficult or even somewhat silly at first. Your cat may not be thrilled with the idea either, but it can and should be done. It may take a few weeks until your cat accepts tooth brushing. Go slowly and be patient. Offer a treat that your cat really enjoys after you work with your cat each day. You only need to brush the outer surfaces of the teeth, but you should try to brush all the teeth daily if possible. Here are the steps you can follow to get your cat to allow you to brush his or her teeth:

1. Get your cat used to the flavor of the toothpaste. Place a small amount on your finger and let your cat lick it off.
2. Get your cat used to having something put into his mouth. Place a small amount of toothpaste on your finger and rub it over your cat's upper canine teeth. Every day, increase the amount of time and surface you cover.
3. Get your cat used to the toothbrush. Place a small amount of toothpaste onto the brush and let your cat lick it off.
4. Start brushing the outer surfaces of the teeth.

Dental Diets: Veterinary diets such as Hill's t/d, Purina DH or Royal Canin DD are proven to improve dental health. The kibble is larger to encourage chewing and exercise the teeth. The structure of the kibble is formulated to scrub the teeth as the cat chews. The Hill's diet is coated in hexametaphosphate which prevents the calcification of plaque. All three diets provide all the nutrients your cat needs so they can be the dry portion of your cat's diet or you can mix them into another dry diet.

Maxiguard OraZn Pet Oral Care: OraZn is a gel that reduces the deposition of plaque, aids in the reduction of gum inflammation, and neutralizes mouth odors. It contains Taurine which combines with the Zinc to kill bacteria and reduce the bacterial products that cause halitosis and make the gums more permeable to bacterial toxins. You apply a pea-sized droplet with your finger or a cotton swab onto the outside gum areas above the upper molars on each side of the mouth. Use daily for best results.

Maxiguard Oral Cleansing Gel: This is similar to OraZn but has Vitamin C added to help repair tissue. It is recommended for severe oral problems and after a dental procedure.

Oravet Sealant: Oravet is a waxy sealant that is applied to the outer surfaces of your cat's teeth at the end of his dental procedure. It significantly reduces plaque and tartar formation by creating an invisible barrier that prevents bacteria from attaching to your cat's teeth both above and below the gumline. You can then apply the home care Oravet to the outer surface of your cat's teeth once weekly to maintain the barrier against bacteria. It can be used along with brushing or dental chews.

Dental Chews: There are a variety of chews available. Most of them will exercise your cat's teeth and may help reduce plaque. C.E.T. chews have an antibacterial system and time-tested Dual-Enzyme System to control plaque and eliminate bacteria buildup. They can be fed as a treat once a day and come in poultry and fish flavors.

Dental Rinses: Dental rinses contain chlorheidine or xylitol to fight bacterial and reduce plaque build up. This will also help freshen your pet's breath. Chlorhexidine rinses must be applied directly into the mouth. They fight bacteria for up to twelve hours but can have a taste that is unacceptable to your cat. C.E.T. AquaDent contains xylitol which kills bacteria. It is easy to use - simply add 2 teaspoons to a quart of our cat's drinking water every day. However, when you first add any medication to your cat's water, you must make sure he will drink it. It is especially important if he has any medical problems that he continue to drink his water. Xylitol has been proven to reduce dental disease in humans, and it is safe for cats, but no research has shown how effective it is for their dental health.

All of the products mentioned above are available at Scottsdale Cat Clinic. If you are looking to purchase any of pet dental care products at the pet store or grocery store, it's best to look for products carrying the VOHC (Veterinary Oral Health Council) seal. In order to display the seal, the product must have good scientific research backing their claims.

For more information about these products or about your cat's dental health, please contact us by visiting our website.

Cat Food Labels Decoded

You know that proper nutrition is an important factor in helping to keep your cat healthy. But what does that mean? How do you know what is good and what is just clever marketing? Here are some facts, tips and labeling definitions that can help you navigate the shelves of cat food options.

First of all, did you know that pet food products are among the most highly regulated items in a typical grocery store? Pet food ingredients, the manufacturing processes and package labeling are all governed both at the state and federal levels. Almost all of the state laws and regulations are based on the work of the Association of American Feed Control Officials (AAFCO), an organization of state officials who regulate animal feed, which includes pet food. AAFCO has established a standardization of ingredient definitions, nutritional requirements, labeling and other guidelines. This has helped to create uniformity between states so you know you are getting the same quality regardless of where you are buying the food, or where it was manufactured.

At the federal level, the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA) and the Federal Trade Commission (FTC) all have regulatory authority over pet food. In addition to specific state requirements, the FDA also has specific requirements for all food products, human and pet. These include ensuring that the products are "pure and wholesome", "free of harmful or deleterious substances", and "truthfully labeled". In addition, canned pet food has to meet the same conditions as human food canning requirements.

To read more about labeling requirements at both the state and federal levels, visit The Pet Food Institute.

So in keeping with the "truthfully labeled" requirement, what do all those different words mean?

Holistic - This sounds as though it would be a great option, doesn't it? However, under the AAFCO labeling requirements, there is no legal definition of the term "holistic". This means that any company can put the word holistic on their cat food labels without having to define just what makes their food holistic.

Natural - This is also a great sounding option, and it actually does have specific AAFCO requirements to be included on a label. However, "natural" simply means the food consists of ingredients that have not been subjected to chemical synthesis. Plus, natural does not mean organic.

Organic - Just as with human foods, in order for a cat food to be allowed to carry the USDA organic seal at least 95 percent of the content by weight must be organic. And organic is defined as a product that is grown with only animal or vegetable fertilizers.

By-Products - Many of us think that by-product is a dirty word. Not the case at all, and in fact, by-products actually can provide a great deal of nutritional benefit for your cat. A by-product is simply the parts of the animal that are not used for human food production, such as fat, internal organs, etc. If you think about how your cat's wild cousins hunt and eat, they don't waste those parts of the animal and focus only on the whole meat. Many wild animals actually start with the so-called by-products, saving the whole meat for last because the internal organs contain essential vitamins and minerals not found in the whole meat. For example, the liver provides vitamin A and iron, and bone marrow and bones provide calcium, fatty acids and antioxidants. Poultry by-product meal, or chicken meal, can actually be quite beneficial for cats as it contains taurine in much higher levels than in whole meats. Taurine is essential for cats' cardiace and ocular (eye) health.

AAFCO does regulate what is considered a by-product fit for inclusion in pet food. They do not include feathers, hair, hide, hooves, manure or stomach content. As an added green benefit, the use of by-products helps to reduce waste since these are products that would otherwise be trashed.

And now for some of the trickier labeling definitions:

Formulated to meeting nutritional levels established by AAFCO: If your pet food has wording similar to this on it, it has not gone through any feeding and/or digestibility trials. While the formulation method is still highly regulated, there is no documentation on how this particular formula will affect your cat. A much better label wording is animal feeding test using AAFCO procedures substantiate that this food provides complete and balanced nutrition.

Ingredients. Just as in human food labels, ingredients in cat food are listed by weight in descending order. For example, a cat food label that begins "chicken, corn meal, poultry by-products...." has a greater weight of whole meat chicken than corn meal. But be careful. Although ordered by weight, there is nothing that indicates how much more chicken than corn meal may be in there. The weight difference could be as little as less than a tenth of a percent or it could be 20 percent more.

"Beef Dinner" "Chicken Platter" "Seafood Entree" "Liver Formula" You pick up a can that's labeled "seafood entree". That means it's going to be full of yummy seafood for you cat, right? Not necessarily. Diets with these examples of labeling are only required to contain 25 percent of the main labeled ingredient.

"with Chicken!" Any label that has this type of wording, whatever it might be with, is only required to contain 3 percent of that ingredient.

And the silliest labeling requirement of all: "Flavor". As long as the "flavor" is "recognized by the pet", a product can be so labeled. No word on how a flavor is "recognized", though...

It is a good habit to read the labels of your cat's food. Just keep in mind that manufacturers will obey the letter of the labeling laws as far as the content of their products. We hope that this blog has helped you to become a little savvier in reading between the lines.

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For more information on all things pet food related, visit these websites:
AAFCO - Association of American Feed Control Officials
AAHA - American Animal Hospital Association
ACVN - American College of Veterinary Nutrition
The FDA Pet Food Site
NRC - National Research Council for nutrient requirements of dogs and cats
Pet Food Institute

Bringing an Outdoor Cat Inside

In an earlier, recent blog, we discussed many of the hazards and dangers for cats in the outdoors. So how can you make sure a cat that's used to living outside can be happy becoming an indoor cat? With patience and persistence, that's how.

Nowadays, it's a sad fact that many of the cats roaming outdoors have actually been turned out or otherwise abandoned by families that can't take care of them any longer. That means that many of them are already at least familiar with being indoors on a regular basis. Some of these cats will be happy to have a family again and will make the transition more easily. But what about those cats that have only ever known the outdoors?

Stray cats brought indoors, or feral cats trapped, neutered and re-homed sometimes have a difficult adjustment period if kept indoors. Even though to our point of view that living indoors is preferable and cushy, to the cat that has never been confined indoors, the experience can be one of terror and suspicion. In addition, many have never seen a litter box, much less know that's where they should do their "business". Some other common behaviors can be door dashing, constantly meowing at doors and windows, scratching at carpets and even the walls, etc.


You can alleviate the stress these cats face by understanding their behavior and redirecting it in a positive direction. Again, patience and understanding is the key when helping these cats make this big adjustment.


Most importantly, before you bring any cat into your house, be sure to have the cat examined by your veterinarian, spayed or neutered if needed, and vaccines updated. It's also important to check for parasites and have the cat dewormed before coming inside. This is especially important if you already have resident cats. In fact, make sure your resident cats are up to date on their vaccines as well.

One of the ways to ease transition is to use a pheromone diffuser like Feliway. The Feliway brand is a synthetic copy of the natural feline facial pheromone. These specific pheromones let a cat know an object is safe and familiar. Using these types of diffusers can help to reduce the stress and marking behavior in cats.

A good way to start this transition is to time it with the outdoor weather. If you live in colder climes, the cat may be more apt to settle inside during the winter. In Arizona and other hotter areas, summer may be the better season to start this transition.

Here are some additional tips to help your outdoor cat transition to being an indoor cat:

• When the cat first comes indoors, keep him in a small room with non-absorbable surfaces (such as a bathroom). Provide several litter boxes in the area. You can even try different types of litter in the different boxes to see if the cat has a preference. If the cat refuses to use the box, you can try using an organic potting soil or clean sand on top to simulate what is outside. There are also several products available that can be added to the litter to draw a cat to the box.
• Provide places to hide. You don't have to spend a lot of money on fancy cat furniture. A cardboard box, or an old, large carrier without a door, with a towel draped over it will be more than enough for the cat. Unless you have provided soft surfaces for the cat outside, many outside cats have never encountered cushions, so experiment with different textures to see what he prefers, including straw, sawdust or pet bed shavings.
• Plant cat appropriate plants and grasses in a small container, such as catnip or catmint. Many pet stores have pre-planted containers to grow the grasses, and some specialty retailers have organic versions. This gives the cats fresh vegetation to eat, which they would do outdoors, and will discourage the cat from going after houseplants.
• Play with your cat. An outdoor cat possesses a higher prey drive than an inside cat. This prey drive has kept him alive. There are many types of interactive cat toys on the market, and you may need to experiment to see which type your cat prefers. Plus, the more you play with your cat, the stronger the bond you will create with him, adding to his sense of security.

If you already have cats in your house, make sure you take the time to properly introduce the new cat into your family. Whether your new cat has lived with other cats or not, your house has a new set of dynamics for him to integrate into.


If your resident cats are not finicky about where they eat, while the new cat is still confined, feed the resident cats near the closed door. This will help them associate something they enjoy with the smells of this new cat.



Once you are certain the new cat is safe with fabrics and other absorbable surfaces, swap bedding between the new cat and the resident cat as another way to get used to each others' scents. You can also switch out toys and scratching posts. These are good ways for the cats to get used to each other without having direct, face-to-face interaction.



If the introduction is not going smoothly, and/or their interactions are too aggressive, separate the cats again and start over. Again, with patience and time, your cats can become a family.



Overall, bringing a cat indoors can be a very rewarding experience for both you and the cat.

Case of the Week: Koli Poki

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