Is Your Cat Really "Indoors Only"?

When you take your cat to visit your veterinarian, one of the most common questions asked of you is whether your cat is an indoor or outdoor cat.  Most owners will say that their cats are indoor cats.  However, if your cat spends any amount of time outside, even on a covered patio under your direct supervision, he's not an indoor only cat.

Why is this distinction so important?  Because any type of outdoor exposure can impact your cat's health in terms of exposures, from other animals to parasites.  All of this information helps your veterinarian help you take care of your cat, and can potentially prevent health issues down the road.

Even if your cat is strictly indoors, if you have other pets that go outside, your indoor cat may have additional exposure risks from your other pet.  For example, let's say you have a dog as well as your cat.  Your dog goes with you to the local dog park where other dogs expose him to fleas, which he brings home with him.  Now your cat has been exposed to them too.

If you have a multi-cat household and the other cat goes outside, this can impact your indoor cat in similar ways as having a dog that goes outside.  In addition to parasites, your outdoor cat may also bring in viruses that your indoor cat may not otherwise encounter.  This means your indoor cat may need additional vaccinations, for example.

Here at Scottsdale Cat Clinic we do recommend keeping cats indoors due to the variety of dangers that are outside.  These include parasites, predators - including abusive humans - toxins, cars, and even fights with other cats.  We went into more detail on these dangers in our blog The Dangerous Outdoors.

Still, keeping a cat indoors does mean that special attention must be given to ensure a healthy life.  Although the always sleeping cat is a popular image, cats do need exercise and mental stimulation, something that can be lacking in the indoor environment.  Fortunately, it is relatively easy to add these elements to your indoor cat's life with interactive toys, a well placed perch to check out the great outdoors through a window, or even a companion cat assuming they get along.

Because of the additional exposures and potential risks for cats outside, it is very important for your veterinarian to know if your cat goes out, even for a few minutes.  Make sure your veterinarian knows all of your cat's habits so she can help you take the best possible care of your cat.

Now At Scottsdale Cat Clinic - Nutraceuticals for Your Cat

Nutraceuticals are foods or food nutrients that are taken orally to provide a health benefit, either for the prevention or the treatment of disease.  Multi-vitamins are an example of nutraceuticals.  They are not as closely regulated as medications so extra caution needs to be taken to be sure you are buying them from a reputable manufacturer.  Because cats can react differently than we do to herbal and vitamin supplements, it is especially important to give them ingredients and dosages that are safe for cats.

Here at Scottsdale Cat Clinic, we have always carried a few nutraceutical formulas manufactured by RxVitamins for Pets.  This company only sells their products through veterinarian offices so we know that each batch has gone through proper quality control.  After learning more about their products and how they can help enhance your cat's health, we have expanded our selection.  


Most of the formulas are hypoallergenic.  This is even true of the formulas that are listed as having specific flavors such as salmon or beef.  All of the proteins that cause allergic reactions have been removed.  Although RxVitamins for Pets has never heard of an allergic reaction from their formulas, if your cat has an extreme allergy to food proteins, caution should be taken.

Below is a listing of the formulas we carry.

• Amino B-Plex Liquid: This formula provides B complex vitamins, aqueous liver fractions and essential amino acids in a highly palatable, easily administrated formula.  It is particularly beneficial for cats who have chronic illness and need enhanced support for vitality.
• Amino B+K Liquid: Similar to the B-Plex formula, this liquid also includes potassium to help cats who have been diagnosed with low potassium.
• NutriFlex Chewtabs: These chewable tablets are a great option to help increase mobility for your cat.  This formula contains chondoprotective agents to help maintain and repair articular cartilage, tendons and ligaments; antioxidants; and glucosamine and other nutrients that are found naturally in joints and connective tissue.
• Hepato Support Capsules: These capsules are designed to help support normal liver function and help the liver recover from disease.
• Liquid Immuno: This formula combines L-lysine with plant based nutrients to promote optimal immune system function.  It has been shown as highly therapeutic for patients with chronic and acute immune system challenges.  The highly palatable, liquid formula makes administration easier.
• Liquid NutriCalm: This salmon-flavored formula is designed for cats exhibiting nervousness or anxiety.  It contains L-tryptophan, an essential amino-acid that the brain converts to seratonin; L-Theanine; valerian root; and ashanganda also help to naturally soothe and relax.
• Nutrigest Powder: This formula contains phytochemicals and essential nutrients that help restore and maintain normal function in the gastrointestinal tract.  It also contains a prebiotic nutrient to help nourish and fortify friendly intestinal bacteria.
• Nutritional Support Powder: This nutrient dense liver/salmon powder is a great overall wellness supplement that helps to support a healthy digestive tract; strengthens the immune system; and improves the appearance of skin and haircoat.
• Onco Support Powder: This formula is designed to provide nutritional support for conditions of the immune system.  The unique combination of elements increases patient vitality as well as improves immune system resistance.  It is specifically formulated to support the increased metabolic needs of the patient with chronic disease and cancer.
• Rx Zyme Powder: This comprehensive and versatile formula was created to address overall digestive function, promote the breakdown and absorption of food and its nutrients and support the normal digest of protein, fats and carbohydrates.
• Rx Essentials for Cats Powder: This powder contains a full range of essential daily vitamins and organically chelated minerals along with spirulina, kelp, milk thistle and taurine for the additional nutritional support that cats need.
• Rx Renal Feline Capsules: The botanical extracts and nutraceuticals in this formula have shown efficacy in stabilizing renal laboratory parameters and improving quality of life.  Each ingredient has scientific evidence supporting its usefulness in effective addressing elevated renal values.
• Rx Biotic Powder: This powder contains a blend of four major probiotic bacterial strains with two prebiotics.  Clinic research demonstrates that beneficial bacterial in the bowel normalizes gastrointestinal function as well as contributes to improved overall immune response.
• Rx Clay Powder: This formula helps regulate bowl function and promotes normal stool by adsorbing bacterial toxins, inflammatory cytokines and metabolic toxins in the gastrointestinal tract.  It is free of heavy metal contamination, contains no available aluminum, and is sterilized.  It can help with chronic diarrhea or acute diarrhea flare-ups.

Please contact us if you would like more information about adding nutraceuticals to your cat's diet.  

Adopting A Cat? Consider one with "Special Needs"

The month of June is designated as Adopt-A-Cat month.  Most rescues run a variety of adoption drives and specials during this month to help the cats in their care find new forever homes.  However, there is one group of cats that always seem to be overlooked: cats designated as "special needs".

What does "special needs" mean?  The term can cover a wide variety of situations from chronic conditions to physical disabilities, but generally means that that specific cat will need a little extra care.  Adopting a special needs cat can be a very rewarding experience and can provide that cat a much needed home and family.

Many times special needs indicates that the cat will need to be on a special diet.  For example, the cat may have chronic cystitis, or inflammation of the bladder.  Or the cat may be prone to crystals or stones in the bladder.  Both of these conditions make the cat prone to urinary tract infections.  In the case of crystals or stones, if left untreated and unmonitored, it can lead to urinary obstructions.  Fortunately, both of these conditions are controlled through proper diet - usually a prescription veterinary diet - and regular preventative visits to the veterinarian.  The rescue may label these cats as special needs because they will require extra financial investment in the specific food and possibly more frequent veterinary visits than just the recommended twice a year preventative exams.

There are other health considerations and/or chronic conditions that may cause an adoptable cat to be classified as "special needs". These can include weight issues, allergies, and even some mild behavioral issues.  In the latter case, a cat that may appear fearful and highly stressed may calm down once out of a rescue setting and into a permanent home.

Of course, there are cats with physical disabilities that wind up in shelters and with rescues.  These types of disabilities include blindness and deafness.  A healthy cat has three very powerful senses that he uses to get about in the world: sight, hearing and smell.  So even if a cat is missing one, he still has two other to rely on.  This means that this cat will still have a very happy and rewarding life.

If you are considering adopting a cat during Adopt A Cat month - or at any time - take a second look at a cat designated as "special needs."  Find out why the rescue has categorized this way and think about if you are able to meet this cat's needs.  You might find the "purr-fect" match for you.

Anesthesia Free Dentals Are Not Good Medicine

A few years ago in a Dental Health Month blog, we briefly discussed the troubling use of anesthesia-free dentistry for pets.  Since then, this procedure - also known as Nonprofessional Dental Scaling (NPDS) - has become increasingly popular with well-meaning owners who understand the importance of dental care but are afraid of the risks from anesthesia.  And because it is usually less expensive, NPDS is also attractive to pet owners who have concerns about cost.

However, as we stated in our first blog on this topic, this procedure actually can cause more harm than good.  Additionally, if this procedure is not performed by a veterinarian, or even under the supervision of a veterinarian, NPDS is actually illegal in many states.

Below are more details and common questions about the procedure.

Is Non-professional Dental Scaling (NPDS) as effective as a cleaning under anesthesia?
No.  NPDS is a purely cosmetic procedure.  Because NPDS only removes tartar build-up from the visible portion of the tooth, it can provide a false sense of completion and illness prevention.  Many times there is plaque built up under the gum line, and most oral disease is actually happening below the visible surfaces of the teeth.  NPDS fails to address or fix these problems.  Dental procedures performed properly under anesthesia are not just about cleaning the teeth.  Radiographs (x-rays) are taken during the process in order to assess general bone health as well as the health of the roots of the teeth.  The visible portion of the teeth can look perfectly healthy, but the cat can have severe bone loss, lesions, or other pathologies below the gumline where they are not visible (see our case study blog on Oz for an example of this type of situation).

Isn't NPDS safer for cats than putting them under anesthesia?
No.  The principal reason anesthesia is required for a proper and thorough dental cleaning is due to patient cooperation.  Unlike with people, we cannot explain to the cat what we are doing and ask that she hold still while her teeth are scaled (have the tartar removed) and x-rays are taken.  Many cats will not tolerate even a cursory inspection of their mouth during a regular office exam, much less a complete exam plus cleaning and x-rays.  Additionally, dental instruments are sharp by design, presenting a clear danger to an awake cat if she jerks away from the process in fear.  And as most of us know from visiting our own dentist, cleaning below the gumline is uncomfortable at best.  Think of the last time you had your own teeth cleaned and how it felt.

We must also worry about the cats ability to breath during a dental procedure.  Dental instruments require water to reduce heat from friction and to rinse the mouth.  When your cat is properly anesthetized, she will be intubated.  This means a tube is placed down her throat directly into her trachea (windpipe) so she can breathe.  Intubation is especially important during dental cleanings to reduce the chance of water getting into the cat's lungs.

Is anesthesia safe for my cat?
Overall, yes.  Of course, there are risks with any anesthesia procedure.  Here at Scottsdale Cat Clinic, we take every precaution to minimize those risks, tailoring our general protocols to specifics for each individual cat.  We always start with a pre-operative exam.  During this exam, your cat's weight is verified in order to ensure she is getting her correct dosage of medications.  The pre-operative medications include analgesics (pain relief), which research has shown improves post-operative recovery.  We also place an IV catheter which helps to maintain blood pressure, keeps your cat hydrated during the procedure, and also allows us to administer any additional medications directly into her blood stream.  While your cat is under anesthesia, her vital signs are constantly monitored, both with state-of-the-art equipment and a trained veterinary technician.

Additionally, dental procedures are part of our regular anesthesia procedures.  This means we know what to look for during oral exams and on the dental x-rays.  This adds up to less time for your cat to be under anesthesia while we evaluate her dental health.  If your cat needs extractions, we use nerve blocks to allow us to perform the extraction without having to have your cat at deeper levels of anesthesia.  All of this leads to safe anesthesia while enabling a complete and thorough dental cleaning and exam for your cat.

At Scottsdale Cat Clinic we feel that any dental procedure that isn't performed under anesthesia fails to provide proper care for your cat.  NPDS is absolutely an inadequate treatment for your cat's dental health.  Any cost savings are completely negated by the substandard results and will almost certainly lead to more serious dental problems later in your cat's life.

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.

---

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.

--

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