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: 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 - 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 - 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.

The Value of Microchipping

There is a lot of discussion about whether or not microchipping is an effective tool for reuniting lost pets with their owners. We here at the Scottsdale Cat Clinic do believe it is a very valuable tool and advocate microchipping. In fact, we include a Home Again microchip registration and one year of premium registration with our kitten packages. And of course, we have mentioned the importance in several of our blogs.

We chose Home Again as our microchip partner because they offer a number of benefits to pet owners enrolled in the premium membership including a strong support system to help if your cat gets lost, pet health insurance if your cat is injured while he or she is lost, as well as much more. More importantly, when your kitty is microchipped with Home Again, he or she is registered for life, whether or not you decide to continue the premium membership. And they allow for updating registration information, such as address or phone numbers, at any time through their website: www.homeagain.com.

We recently ran across an abstract on a study conducted by the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University to research the effectiveness of microchips in returning lost animals to their owners. We found the conclusion very interesting. Basically, the study concluded that while the number of animals returned to their owners due to microchips supports its promotion and use, the registration issues continue to undermine the system. If your kitty has a microchip, please make sure to check the information the registry has on file for you is current and up-to-date.

The actual statistics of the study were quite interesting as well. The study looked at 7704 animals with microchips entering 53 different shelters over a year and half time period. 53%, of the total number of animals were classified as strays, meaning they were not surrendered to the shelters by the owners. Of those just over 4000 strays, 3425 animals were returned to their owners because they were implanted with microchips (most of those were dogs). However, for over 800 animals owners were not found and this was largely due to disconnected phone numbers, owners did not respond, or the animal was registered to another group rather than to an individual.

In addition, there were 1,943 animals that had microchips belonging to a specific registry (such as HomeAgain). However, only 1,129 (58.1%) were registered in the database. In other words, the registry acknowledged that the microchip was one of theirs but the owner of the animal had never completed the registration process to add the animal and owner information to the database.

Many rescue organizations that offer microchips do not complete the registration paperwork, instead relying on the owner to do so. This is probably what leads to the type of discrepancy seen in the study. Scottsdale Cat Clinic wants to ensure that the kitties we microchip are registered in the HomeAgain database. We also understand our clients have a lot of things on their minds and don’t need more paperwork in their lives. This is why we include the initial registration as part of our microchipping service.

If you are interested in having your cat microchipped, please give us a call at 480.970.1175 or email us at info@scottsdalecatclinic.com to schedule an appointment.