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

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

Case of the Week: Orange Boy

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 wound 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 help 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 and 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

Case of the Week: Duke

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 interior 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

Case of the Week: Romeo

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

Case of the Week: Amadeus

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

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

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

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

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

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

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

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

Dr. Judy Karnia

Case of the Week - Trosper

For this case study, I'm going to discuss the rather smelly end of the veterinary profession. We've all cleaned up the final product of our cats' daily business. It's mildly unpleasant, but usually routine. In this case, we'll learn a bit about what can happen when that process no longer goes smoothly.

Trosper is an eight year-old Turkish Angora that first came to the clinic nine months ago in distress. He had been having constipation and had needed multiple enemas in the past. When I examined him at the clinic, he was again severely constipated. In addition, his anal sacs were very full. These scent glands are located right inside the anus and create a very strong smelling liquid secretion that cats use to mark their territory. They typically express regularly with defecation or when a cat is nervous. In some cats, the secretion does not get released and starts to build up inside the sacs. The secretion can thicken and build until the sacs are very distended. When this happens, the cat feels discomfort and irritation, especially during defecation. This can then lead to less frequent defecation and finally constipation. I express these glands by basically doing a rectal exam and squeezing them from the inside.

We expressed Trosper's anal sacs to remove all the built-up secretion and gave him an enema. Unfortunately, the enema was not enough to allow Trosper to defecate because of the severity of his constipation. We had to anesthetize him so that I could manually remove the feces from his colon. I was able to push his feces to the end of his colon so I could then pull it out through his anus. (This might qualify me for the Dirtiest Jobs show)

Trosper had been on Lactulose, a stool softener, and Cisapride, a medication that increases the muscle strength of the colon. When a cat is prone to constipation, I have the owner adjust the dose of the Lactulose so that the stool stays soft but formed and the cat is defecating daily. I had Trosper's owner increase these medications to every 8 hours instead of every 12 hours, and increase the dose of the Lactulose.

Trosper took a few days to recover his appetite completely but has been doing well since. He has come in every four months to have his anal sacs expressed so that they do not build up too much and cause him discomfort. On the last check, the sacs were quite full so we will check him every three months now. He is still on his medications and has been defecating very regularly. We've also been working with his owner to get Trosper to lose weight. In otherwise healthy cats, constipation occurs more commonly if cats are overweight. His weight loss is not going as well as hoped, but he has lost a little. We can also see constipation in cats that have other medical problems that frequently lead to dehydration such as kidney disease or intestinal disease. Cats with recurrent constipation should be tested for underlying disorders.

Constipation can cause serious problems beyond just the pain, so it's important to treat it seriously. Just like in your house, when the plumbing isn't working, nothing else seems that important.

Dr. Judy Karnia

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

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

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

Case of the Week - Midnight

Midnight is an eight and a half year old domestic short hair cat. She first came into the clinic nine months ago because she was straining to urinate and defecate. I examined her and found that she was constipated and obese. We want cats to be a healthy 5/9 on our body condition score scale. Midnight was an 8/9. Her bladder was too small to obtain a urine sample, but I suspected a urinary tract infection due to her symptoms. We gave her an enema and started antibiotics and medication to soften her stool. We also advised her owner to start feeding canned food and started her on a prescription diet food to start weight loss and relieve her constipation.

Two weeks later at her progress exam, Midnight had improved and was urinating and defecating better. However, a urinalysis showed that there was still blood in her urine so we ran more tests. Her bladder and kidneys appeared normal on an ultrasound and a urine culture ruled out bacterial infection. Since no underlying cause could be found, I diagnosed her with "cystitis" which is inflammation of the bladder. In many cases, we do not know the cause of the cystitis but it can be caused and/or made worse by stress. Stress in a cat's life can be very subtle and can be related to their environment, other animals, their diet, or painful medical conditions.

I prescribed Metacam for Midnight to help ease the inflammation and discomfort in her bladder. Metacam is a non-steroidal anti-inflammatory medication. As with any medication, repeated and long-term use may cause some side effects. If we make sure we use proper dosages and the cat is monitored well, Metacam relieves discomfort in many cats with cystitis and arthritis.

Midnight immediately started feeling much better. She was much more active. Her owner said that she had noticed stiffness in Midnight's hind end previously, but she was now moving much better.

At her progress exam a month later, Midnight was still doing very well. She was urinating and defecating normally. She no longer needed stool softeners. Her diet was doing well and she had lost almost a pound by this point. However, her urinalysis showed that she still had blood in her urine indicating that her cystitis was not fully resolved.

In order to try to improve this, we started Adequan injections to help the bladder and the likely arthritis. Adequan is polysulfated glycosaminoglycans; these are normal components of joints and the bladder wall. We give it as an injection under the skin - weekly or bi-weekly - then fewer injections as the cat improves.

Midnight is currently given Adequan injections once monthly and Metacam every fourth day and continues to do well. She has lost almost two pounds and is active and feeling well. We needed to switch her prescription food to a low calorie food with high protein rather than high fiber. This has produced more regular bowel movements for her but still helped with her continued weight loss.

Nearing nine years old, Midnight is now classified as a senior cat. Like human senior citizens, it is common to see multiple problems in senior cats. Keeping a healthy weight and feeding quality cat food helps all aspects of their health. But even trim senior cats can be plagued with troublesome and intersecting problems. Many times we have to prescribe multiple medications to address the various problems and make sure we are treating them as well as possible.

Dr. Judy Karnia

Case of the Week: Nahmi

Nahmi is a ten-year-old domestic short hair cat that first visited the clinic in April of this year. She had a history of occasional constipation problems and yeast infections in the past. Although she was not having any symptoms at that time, we wanted to tackle her underlying problem that can cause these issues: Nahmi was obese.

Every cat that comes into the clinic is given a body condition score, ranging from one to nine. By looking at the cat and feeling over its body during the exam, we determine where that cat fits on the body score range. Five corresponds to the ideal condition and weight for that particular cat. One would be given to an emaciated cat and nine is given to a cat that is obese.

Nahmi's body score on her first exam was a nine. She needed to lose a large amount of weight.

To help a cat lose weight, we determine what her ideal weight would be, figure out the calories needed for a cat that weight, then calculate eighty percent of that number. Based on an estimate of Nahmi's ideal weight, I recommended that her owner limit her food to 180 calories per day. When then started Nahmi on a prescription diet, Royal Canin's Calorie Control High Protein canned food.

In order for the cat's weight loss to be successful, the owner needs to stick to the calculated daily calorie count we've given. This can be difficult if a cat is used to eating all she wants whenever she wants. But by slowly decreasing the calorie count over the first week, we can help ease your cat into the new diet. We will also prescribe a prescription diet food, such as the one Nahmi now eats. These formulas contain much fewer calories than over the counter food, allowing a larger, more satisfying portion size. This also ensures the cat is receiving enough protein, vitamins and minerals. Simply severely limiting the amount of a maintenance food may not provide enough protein and other needed nutrients. This may lead to loss of muscle rather than loss of fat. Canned food rather than dry also helps because it contains more protein and more water to help the cat feel more satiated with the limited number of calories.

Nahmi has done very well on her diet, losing one and a half pounds over four months. This is almost ten percent of her starting weight and her body score has improved to an eight. By bringing her in for regular monthly progress exams, her owner ensured that Nahmi is losing weight, but not too quickly. This is important because too quick a weight loss can lead to other health problems.

Nahmi still has two to three pounds left to lose but she is well on her way. Her owner says she already is more energetic and playful. We will continue to monitor her monthly until she is close to her ideal weight.

Obesity is dangerous to a cat's health. Just as in humans, it can predispose a cat to many medical problems including diabetes, arthritis, heart disease and cancer. A dedicated owner working in combination with her veterinary team can ensure proper weight loss and lead to a healthier, happier life for her cat.

Dr. Judy Karnia
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To see the chart we use to measure a cat's body condition, visit the Purina website.

Case of the Week: Rascal

Rascal is a 17-year-old Maine Coon cat. He was brought into the clinic in March of this year because his owner suspected he might have kidney disease. When Dr. Karnia examined him, he was thin and seemed sensitive to touch over his hips. His blood tests showed a mile increase in his kidney values indicating the early stage of Chronic Kidney Failure. Due to the sensitivity in his hips, we took some radiographs (x-rays) which showed moderate arthritis. He was started on the medications Dasuquin and Adequan for his arthritis and vitamin B and calcitriol for his kidney disease. Dr. Karnia also recommended he return for a progress exam in 3 months.

Five weeks later, Rascal came back in because he was not eating well and had lost weight. His blood tests were very concerning - his kidney values had tripled in that time. In addition, his white blood cell count was elevated indicating an infection. Even though Dr. Karnia was not sure where the infection was in his body, she started him on antibiotics. We also taught his owner to give him electrolyte fluids under the skin which she began to do daily. To help with the weight loss, he was prescribed an appetite stimulant.

Two weeks later, his appetite had picked up some and his white blood cell count was back to normal. However, his kidney values had increased a little more and now his phosphorus level showed an increase. Dr. Karnia prescribed a medication that binds the phosphorus in the food and continued his fluids and other medications. His prognosis at this time was not good, as it appeared his kidney disease was progressing rapidly.

At his progress exam three weeks later, Rascal showed some improvement. His kidney values were improved by thirty percent and his phosphorus level had decreased by half. However, his red blood cell count was decreased a little and his white blood cell count was elevated again. He had lost more weight and was under seven pounds. Dr. Karnia switched him to a different appetite stimulant, started him on antibiotics again and vitamin B injections replaced the oral supplement. Even though his kidney values were better, he did not seem to be doing well overall.

A month later Rascal - and his owner - were feeling much better. His kidney values had changed very little but he had gained over a half pound, his white blood cell count was normal and his red blood cell count had increased. He was scheduled to return in two months for a progress exam. Although he wasn't completely out of the woods yet, we were finally getting ahead of the disease and able to give Rascal back a good quality life.

Chronic Renal (kidney) Failure is a common finding in older cats. The symptoms can be subtle at first but generally progress to weight loss, loss of appetite, and vomiting. The progression of the disease is variable in every cat with different symptoms developing at different times and intensities. There can be periods of increased symptoms due to infection, stomach upset, or other factors. There are many treatments that can be utilized to alleviate symptoms, treat underlying causes, and slow the progression of the kidney disease. Chronic Renal Failure cannot be cured, but with proper care, it can be managed and its effects minimized. A dedicated owner and improve and prolong her cat's life in spite of the disease.

For more information on Chronic Renal Failure (CRF), please visit the Links and Resources page of our website. There are several quality websites about this disease there, as well as a link to the Lifelearn Veterinary Library. Please also feel free to contact us by phone at 480.970.1175 or by email at info@scottsdalecatclinic.com if you have more questions or would like more information.

Case of the Week: Van Gough

Van Gough was a feral cat that lived in Bryan's neighborhood. A feral cat is a cat that was never socialized to humans and is therefore very afraid when interacting with people. Feral cats will eat food left out for them but usually will not allow a person to pet them or pick them up.

Bryan had noticed that Van Gough was looking thin and had a large sore by his ear. Knowing that she would never be able to pick him up and put him in a carrier, she caught him in a trap and brought him into the clinic. We injected a sedative into his leg through the bars of the trap and waited for him to fall asleep so we could examine him. He was, unfortunately, in bad shape. He was thin and scarred from years of fighting. In examining his abdomen, Dr. Karnia found that his spleen appeared to be enlarged. He also had ear mites and a large sore on his face from scratching at his ears.

A blood test showed that Van Gough was also positive for Feline Immunodeficiency Virus. This virus suppresses the cat's immune system making healing from illness and injury much more difficult. For a feral cat sometimes literally fighting for his life, and seeing how poor his current condition was, Bryan chose to euthanize him.

Fortunately, most of Bryan's feline family are exclusively indoors and therefore did not come into contact with Van Gough. However, she does have two outdoor cats that she hasn't been able to bring inside yet, and they did have contact with Van Gough and other ferals in the neighborhood. Since FIV can be transferred to other cats through fighting, and because there is no reliable vaccine to protect against it, she will be bringing in her outdoor cats to test them for FIV and make sure they are healthy.

Many people feed stray and feral cats, and even a small gesture like this can help these cats a great deal. Remember, though, to protect your own cats from disease and parasites that these cats may carry. Keep your cats indoors if possible. If they do go outside, be sure to keep their vaccines current and have them on a regular parasite control treatment. Again, there is no reliable vaccine for FIV so cats that go outdoors and get into fights are at risk.

Case of the Week: Clawed

Clawed is a five-year-old domestic shorthair that does go outside regularly. He arrived at the clinic with some soft swelling and yellow fluid drainage from his side. Usually when a cat that goes outdoors comes into the clinic with these symptoms, Dr. Karnia suspects an abscess due to a recent cat bite. In such a case, we clip the fur around the infected area and then flush the wound with a surgical disinfectant. With this treatment and a course of antibiotics, the cat usually heals quickly.

However, from his first visit, the swelling on Clawed's side made Dr. Karnia suspicious that there might be something more going on than just a bite wound abscess. He had had some drainage from the side of his chest for a few days. There was a solid swelling under his skin two inches across and extending along the whole left side of his chest. At the center of this solid swelling was a soft section with a cloudy brown fluid inside it.

We put Clawed under anesthesia in order to drain and flush the wound. The fluid was sent to the lab for a culture to ensure we were giving him the correct antibiotics. No bacteria grew on the culture but the lab did see some light fungal growth. Clawed did very well on the antibiotics but the drainage never completely resolved. When Clawed was brought back for a progress exam, blood was sent in for fungal testing. The results showed that he had Coccidiomycosis, also known as Valley Fever.

Coccidioides is a fungal organism that is endemic to the dry southwestern U.S. The usual route of infection is by inhalation into the lungs. The fungus can then spread to other parts of the body. The infection can cause fever, weight loss, and decreased appetite. Cats are relatively resistant to infection compared to dogs and humans. The most common sign of Valley Fever in cats is an abscess or draining lesion in the skin. Anti-fungal medications, such as fluconazole, are usually effective but may need to be given for several months or even years.

We expect Clawed to do well on the anti-fungal medications, and will report on his progress as his treatment continues.

Case of the Week - Buddy

Congratulations to April on her adoption of a new kitten, Buddy! He did develop some problems due to an upper respiratory infection but recovered well and is now home with his new family. Knowing that young kittens are especially susceptible to intestinal parasites and wanting to make sure Buddy is completely healthy, April brought us our most prized gift from a new kitten - a poop sample. Buddy has been eating well and his bowel movements have appeared completely normal, but we ran a fecal test to be sure everything was fine. Looking at his sample under the microscope, Katrina soon found a large number of Coccidia eggs.

Coccidia is a one-celled parasitic organism called a protozoan. It lives in the intestinal wall lining and can cause diarrhea, vomiting and weight loss, especially in young kittens. Buddy was probably exposed to the coccidian in the feces of his mother or another cat at the shelter, or even before he went to the shelter. Even though Buddy was not showing outward signs like diarrhea, the coccidia could have caused problems later. Coccidia can be difficult to completely resolve, but a course of antibiotics and strict hygiene in the litter box will usually clear it.

Since kittens are more susceptible to parasitic infections, it is even more important to have fecal tests done. It is also important that all young cats and any cats that go outdoors - even for brief periods - should have fecal tests done every 6-12 months. See the articles in our LifeLearn library for more information about parasites in cats.

Case of the Week - Choco

Choco is an eighteen and a half year old domestic long hair. His dad became concerned when Choco was not eating very well. When he stopped eating completely, his dad brought him into the clinic to see if there was anything to be done for him. On exam, Choco was very quiet, but looked good for his age with a good weight and a shiny, long, dark brown fur coat. Just below his tail though, a soft, painful mass could be felt under his skin. Choco had developed an infection in his anal sac causing an abscess to the side of his hind end.

Anal sacs are scent glands that produce a very strong odor. Cats will express them when marking their territory, when they are scared, or when they defecate. In some cats, the secretion does not get expressed and begins to build up and thicken in the sacs. If they become infected, an abscess can form causing pain and fever. The affected cat may lick at his hind end, react to touch of the area, become lethargic and stop eating. The abscess needs to be drained and flushed under anesthesia and antibiotics begun.

Due to Choco's age, anesthesia was a concern. A complete blood panel run in the clinic showed within minutes that Choco's overall health was very good. Dr. Karnia safely anesthetized him and his hind end was clipped of hair and scrubbed with surgical disinfectant. After the abscess was punctured with a scalpel, a large amount of infected fluid was removed. A small part of the skin was so badly affected that Dr. Karnia needed to cut it away and suture the skin closed. The ascessed area was thoroughly flushed and a drain was sutured in place.

Choco felt much better as early as that evening, acting normally and starting to eat. His skin healed very well. He was doing so well that when his sutures were ready to be removed, we anesthetized him again for a complete dental exam and cleaning. Choco bounced right back from that as well. He is a true example that you are as young as you feel.

Case of the Week - Lilly

One of the great aspects of a veterinary clinic is the interesting cases that come through our doors. In a new blog series, we will be presenting a case of the week.

Lilly is a two-year-old grey tabby that likes to play with ribbon. On a recent Friday, she actually swallowed some and started to vomiting it up, and not eating anything else. By Monday, she was still not eating so her mom brought her into the clinic. A radiograph (x-ray) of her abdomen showed an abnormal air pocket that could be an indication of an obstruction in her intestine. We fed her a contrast liquid and took periodic radiographs to watch it move through her stomach and intestines.

In a normal cat, the contrast liquid should pass through the entire intestinal tract in three hours. In Lilly, after four hours, the contrast had traveled through her small intestine but was not yet moving into her colon. We gave her a little food which she ate then vomited up. The vomiting and the slow transit of the contrast liquid were a good indication that Lilly had an obstruction and needed surgery.

As soon as we finished our afternoon appointments, we anesthetized Lilly and prepared her for surgery. A four-inch incision was made into her abdomen and the stomach and intestines were evaluated. Her stomach appeared normal but there was something firm in both ends of her small intestines. After making a one-centimeter incision into the beginning of the small intestine, a black ribbon was removed. It had frayed at the end and a thin thread went further into the intestine.

A thread or string that enters the small intestine is called a linear foreign body. Typically, part of the linear foreign body will get stuck at the start of the small intestine or in the stomach but the rest will continue passing through the intestines. This can create an accordion of the intestines, even leading to tearing of the intestines. Multiple incisions are needed to cut and remove the foreign body while minimizing the trauma and pulling on the intestines themselves. Lilly needed five incisions to completely remove all of the thread. Her intestines did show some evidence of trauma from the thread pulling but fortunately it was only light bruising.

Lilly did very well through the surgery and recovery period. She was transferred to an emergency clinic for continued monitoring throughout the night. By the next afternoon she was lively and eating small amounts. Eight days after surgery, she is eating well and back to her normal self. Her family is now very vigilant about any thread or string-like objects in the house, having learned how quickly something of that nature can be swallowed. Be sure to keep any thread, ribbon, string, yarn or floss out of your cat's reach.