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.

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.

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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: 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

Cats Can Have Allergies Too

Any allergy sufferer will tell you how uncomfortable those allergies can be. But did you know that your cat can also suffer from allergies?

An allergy is a hypersensitivity to a substance that is otherwise considered harmless. Some of the most common allergens - those things that cause the reactions - include pollens, dust mites, molds, insect bites, fibers, foods and dander. The most common contact with allergens is through physical contact, inhalation (breathing in) or ingestion (eating). This contact causes the body's immune system to overreact and produce antibodies to attack the invading allergens. These can show up as skin and/or eye conditions, respiratory issues, or even gastrointestinal issues.

Allergies are an inherited trait and a lifelong condition because they are the result of an immune system imbalance. The tendency to develop allergies is a genetic trait. When one parent is allergic, there's an increased likelihood that his/her offspring will also be allergic. Allergies are not curable, but they can be managed with immunotherapy treatment, medications that treat symptoms and simple avoidance of the offending allergen.

Cats, just like people, can suffer allergic reactions to a wide variety of allergens. In fact, there are estimates that about 15% of cats suffer from one or more allergies. Research has shown that the immune system imbalance that causes allergies in humans is essentially the same in cats.

There are four known types of allergies in the cat: contact, flea, food, and inhalant. Each of these has some common expressions in cats, and each has some unique features. These allergies might be why your cat has itchy skin, respiratory problems, sneezing, or even vomiting and diarrhea, the latter being possible indications that your cat has a food allergy.

Contact allergies are the least common of the four types of allergies. They result in a local reaction to the skin. Examples of contact allergy include reactions to flea collars or to types of bedding, such as wool. If the cat is allergic to such substances, there will be skin irritation and itching at the points of contact. Removal of the contact irritant solves the problem. However, identifying the allergen can require some detective work.

Flea allergy is common in cats. A normal cat experiences only minor irritation in response to flea bites, often without any itching. The flea allergic cat, on the other hand, has a severe, itch-producing reaction when the flea's saliva is deposited in the skin. Just one bit causes such intense itching that the cat may severely scratch or chew itself, leading to the removal of large amounts of hair. There will often be open sores or scabs on the skin, allowing a secondary bacterial infection to begin. The most commonly involved area is over the rump (just in front of the tail). In addition, the cat may have numerous, small scabs around the head and neck. These scabs are called miliary lesions, a term which was coined because the scabs look like millet seeds.

The most important treatment for flea allergy is to get the cat away from all fleas. Therefore, strict flea control is the backbone of a successful treatment. Unfortunately, this is not always possible in warm and humid climates, where a new population of fleas can hatch out every 14-21 days. However, a topically applied monthly parasite treatment that covers fleas may kill fleas before they have a chance to bite your cat.

Inhalant allergies are the most common type to affect cats. Cats may be allergic to all of the same inhaled allergens that affect us. These include pollens, molds, mildew and the house dust mite. Many of these allergies occur seasonally, while others are with us all the time, such as molds, mildew and house dust mites. When humans inhale these allergies, we manifest the allergy as a respiratory problem, or hay fever. The cat's reaction, however, usually produces severe, generalized itching. In fact, the most common cause of itching in the cat is the inhalant allergy.

Most cats that have an inhalant allergy are allergic to several allergens. If the number is small and they are the seasonal type, itching may last for just a few weeks at a time during one or two periods of the year. If the number of allergens is large or they are present year-round, the cat may itch constantly.

The second most common type of allergy to affect cats is food allergies. Generally cats will develop allergies to food products they have eaten for a long time. The allergy most frequently develops to the protein component of the food; for example, beef, pork, chicken or turkey. A food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress.

Treating allergies depends on the type of allergy that the cat is suffering. As noted, the contact allergy is the easiest to treat, once determined, as it simply involves removing the offending item. Limiting exposure to fleas by keeping your cat inside and treating with a regular, monthly parasite control will help. Inhalant allergies may need to be treated with steroids to control seasonal outbreaks. Food allergies may require a specialized diet in order to prevent recurrance.

If you are concerned your cat may be suffering from an allergy, schedule an appointment with your veterinarian to review and discuss your concerns.

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

Lending a Helping Paw - Champagne Hermann

Very few animal lovers would dispute the soothing quality of an animal's companionship. Animals have a wonderful way of making us feel better even on our worst days. And cat owners in particular know how uplifting a purring cat can be even in the darkest times.

For years, therapy dogs have visited nursing homes and hospice facilities, bringing moments of happiness and ease to the patients and residents. In recent years, there have been increasing requests for cats to become therapy animals as well.

One of our patients here at Scottsdale Cat Clinic, Champagne Hermann, recently became part of the Hospice of the Valley's Pet Connections Program. Says his owner, Linda Hermann, "One day I received this friendly phone call from a friend of a friend who had personally met Champagne and observed his interactions with an 8-year-old boy and his triplet 6-year-old sisters. Who was this friend who called? Ann Roseman, Pet Team Coordinator with Hospice of the Valley.

"At first, I was surprised as I have heard of dogs being involved in this program and did not realize there was a calling for cats too. Champagne and I jumped at this opportunity to be involved with Hospice of the Valley. How delighted we are to visit each patient and see the joy that we bring to the patient and their families. Our visits are one or twice a month. Champagne makes himself comfortable in the patient's lap as the patient pets him and scratches his ears, brushes his fur, or feeds him treats. It's apparent Champagne and the patient have a unique bond. As we leave, I remind the patient that Champagne and I will be coming back soon; and we all look forward to that time."

Officially, research theories vary widely on whether there is true therapeutic value to animal visits, but those on the receiving end of those encounters seem to find them very uplifting. According to Ann Roseman of the Hospice of the Vally, "As an officially registered pet therapy cat, Champagne (and his pet parent, Linda) has already brought much joy to many Hospice of the Vally patients, family members, and caregivers since joining us this past November. He has visited patients in their own private homes, assisted living facilities, group homes, skilled nursing facilities, and our Hospice of the Valley inpatient units. Depending on the patient, his visits range from 10 to 60 minutes, from one time only to once every several weeks.

"The Hospice of the Valley care team members are constantly referring new patients for cat visits. So if your cat is good at riding in the car and arriving at their destination calm and ready to interact, please consider getting your cat tested to be a therapy cat. One of the tests will be to see if your cat can lie comfortably in the laps of several people for several minutes each. Your cat will also have to be comfortable in a collar or harness and leash. They need not walk on the leash, but it must remain attached to them and in your hands at all times."

The Delta Society is a national organizations that helps prepare pets to be part of their Pet Partners program. For more information, visit their website at www.deltasociety.org.

For information on becoming part of the Hospice of the Valley Pet Connections Program with your cat (and/or dog), please contact Hospice of the Valley Pet Team Coordinator by email at aroseman@hov.org or by phone at 602-287-6660.

Feline Dental Health - It's Always Important

Every February, several veterinary groups, including The American Veterinary Medicine Association (AVMA) and the American Veterinary Dental Society (AVDS) designate the month as Pet Dental Health Month. During this time, the importance of regular dental care is emphasized.

While the official Pet Dental Health Month is drawing to a close this year, the effects of gingivitis and periodontal disease in cats can be so far-reaching it seems as though every month should be dedicated to dental health. According to the AVDS, 70% of cats show signs of oral disease by age three, and 85% of all adult pets have periodontal disease. Left untreated, harmful bacteria from the oral cavity can spread throughout the bloodstream to infect the heart, lungs, liver and kidneys.

Dental disease is the most common disease in cats, and studies confirm a strong relationship between the presence of dental disease and poor general health. Even though cats are very good at hiding any problems, dental disease is a painful condition. Left untreated, many pets suffer silently and age prematurely. As several of our recent Cases of the Week illustrate (see: Bianca; Tommy; Sweetheart), preventing and treating dental disease will keep your cat healthier and improve his quality of life.

Dental disease begins when a combination of food, bacteria and saliva combine to form plaque on the teeth. If plaque is not removed, it mineralizes and forms calculus. As plaque and calculus build up, they lead to gingivitis, an inflammation along the gum line. This is painful for your cat and encourages bacterial toxins to form along the gum. At this stage, gingivitis is reversible with professional dental cleaning and oral home care.

If gingivitis is untreated, there will be a progression to periodontal disease, a destructive process causing a breakdown of the supporting structure of the teeth. This will cause oral pain, loose teeth, and more severe oral infection. As periodontal disease progresses, the gums recede and become more permeable. This allows bacteria to enter and travel through the bloodstream leading to heart, liver, and kidney disease.

Whether your cat is a youngster with shiny white teeth or has advanced dental disease and halitosis, the combination of your good home care and our medical treatment will ensure a healthy mouth and body for your cat. Your cat will live a happier, more comfortable, and longer life.

The first step to ensuring your cat's dental health is a visit to your veterinarian for a thorough exam of the mouth and the entire body. If tartar, calculus, gingivitis, or periodontal disease is already present, your cat will need dental treatment. During the exam, home dental care will also be discussed. If the tartar and gingivitis is moderate to severe, a professional dental cleaning will be needed.

To perform a thorough, safe, and comfortable dental treatment, your cat must be anesthetized. In many cases, the veterinarian can only determine which teeth may have lesions and/or need extraction after the teeth are cleaned and dental xrays are reviewed.

Many cat owners are understandably concerned with having their cats anesthetized. While there is a slight risk with anesthesia, there is much greater likelihood that continued dental infection will adversely impact your cat's health and comfort. Healthy teeth are well worth the risk of general anesthesia. At Scottsdale Cat Clinic, your cat's safety and comfort are our primary concern during anesthesia. We use very safe anesthetic agents and monitor your cat closely throughout the procedure.

Please contact us if you would like more information about our dental care and cleanings. You may reach us by phone at 480.970.1175 or by email at info@scottsdalecatclinic.com

New Year's Resolution: Make New Friends

Friends are a great addition to anyone's life, and the best friend of all is one that can guarantee unconditional love and acceptance. Animals are the perfect example of this. They don't judge us when we have a bad day, or tsk when we sneak that extra helping of ice cream or cookies. And after a long day, there are few things more rewarding than a purring bundle of fur sitting on your lap, or even just near you on the couch.

Making New Friends Method 1 - Adopt a Cat
If you are considering adopting a cat, consider adopting an older cat instead of a kitten. As anyone can tell you, rescue organizations are in the difficult situation of having to turn away cats that are found and/or need to be surrendered. In a few short months, "kitten season" will begin and organizations will be inundated with litters and litters of kittens.

There is no denying that kittens are adorable and are a blast. But they are babies, and like any baby, they require a great deal of attention and energy. Because many people who are looking to adopt a cat want a kitten, older adult cats are often overlooked and stay in shelters longer. And yet, for many families an adult cat would be a better fit.

Adult cats will most likely require less energy in caring for them as they are already up to date on vaccines, neutered and litter box trained. Since cats generally reach their social maturity around 3 years of age, you will already have a good idea of an adult cat's personality. An adorable kitten could grow up to be a grumpy adult. In addition, you won't have to "kitten proof" your house, watching them constantly to make sure they don't try to eat every foreign object they come across. And if you already have a cat in your home, an older cat introduced properly will present less stress as they come in cautiously, unlike kittens who seem to have no fear in new territory.

Making New Friends Method 2 - Foster a Cat
If adopting a cat is not feasible for you right now, consider fostering one. One of the greatest needs many rescue organizations face is the space to help all of the cats who need them. If a rescue does not have a physical facility, the number of cats they can help is limited to the number of foster volunteers they have.

Fostering is not for everyone, especially if you are prone to bonding with every cat you meet! Giving up the cat to her new permanent home can be heart wrenching, even while you have the satisfaction of knowing you gave her the time she needed to find them. Additionally, some rescues cannot financially support all the day-to-day needs, relying on their fosters to provide food, litter, etc. If you already have other animals, you will need to make sure they are fully vaccinated, and that you can keep your foster and your family animals separate.

While fostering is a crucial part of most rescue organizations, think carefully before diving in. Do your research, both in terms of general requirements for fostering and the specific requirements of the rescue you are interested in helping. Discuss the options thoroughly with family and with the rescue, and make your decision from there.

Making New Friends Method 3 - Volunteer
If you cannot adopt or foster right now, consider volunteering with a rescue organization. Rescues that have a physical facility, or shelter, generally need volunteers to help with the care of the animals in their charge. These needs can range from social interactions with the cats to physically keeping the shelter clean.

Even organizations that do not have a physical facility have need for volunteers. Many need people to help participate in events, providing support at information tables or fundraisers. Do you have a particular skill such as photography? Offer to take photos of the cats in their care to help get them adopted. Even purchasing food and other supplies, or a straightforward cash donation can help rescues continue their important work.

Volunteering with a rescue organization can help you meet some amazing cats who will greatly benefit from your help. You will also have an opportunity to meet some amazing animal-loving people, and you never know who might become your new best friend.

New Year's Resolution: Quit Smoking

Are you a smoker? We don't need to tell you the health risks associated with smoking. We probably don't even need to tell you about how bad second-hand smoke is too. But have you realized how bad it is to smoke around your cat?

While there has been extensive, long-term research on the effects of cigarette smoke and nicotine on humans, there hasn't been much documenting the effects on our feline friends. However, recent research has revealed some startling information about second-hand smoke and our cats.

Based on a 7-year study at Tufts School of Veterinary Medicine, cats in smoking households seem to be at a much higher risk of developing lymphoma, a type of cancer, than cats that live in smoke-free environments. This study also determined that cats who live in homes with one smoker have twice the risk of developing lymphoma and cats who live in households with two ore more smokers have four times the risk. Also, cats who are exposed to a smoking environment for over 5 years and those who live in households with over 100 cigarettes smoked per day are also at a significantly higher risk. The exact cause of this increase risk of lymphoma is not known at this time.

New studies suggest that cats are also at increased risk of feline oral squamous cell carcinomas (SCC) when exposed to environments with tobacco smoke. This may result from smoke and nicotine residue landing on the cat's fur. The fastidious nature of cats and their grooming habits cause oral exposure to the carcinogens.

In addition to an increased risk of developing cancer, cats that live in smoking environments are also predisposed to lung disease and eye irritation. Although second-hand smoke alone has not been shown to cause the lung disease or eye irritation, the primary culprit is thought to be chronic exposure to smoke in poorly ventilated areas. If you think about it, smokers don't spend their entire day inside. Most people do spend some time outside. But most cats do not, and thus are forced to breathe and rebreathe the same stagnant, contaminated air. Therefore, environmental tobacco smoke cannot be entirely filtered out through ventilation systems or special fans. It can take many hours for the smoke of a single cigarette to clear.

There are also other dangers to your cat from the nicotine itself. If you leave ashtrays around with cigarette butts, your cat may accidentally ingest one, or part of one if it decides the butt is a toy to bat around. Your cat may also try to eat nicotine replacement gum or patches.

Obviously the best option for everyone would be to simply quit. However ideal that may be, it's not always easy. If you cannot quit smoking, even for your cat, here are some tips to minimize her exposure to the dangers and to improve her health:

• Designate smoke free areas: Consider smoking outside, or smoke only in rooms where pets are not allowed. The less the exposure, the greater the changes your cat will stay healthy. The smoke-free area should include your car. If you are transporting your cat anywhere, don't smoke while she is in the car.
• Use air filters: Air filters may help remove harmful chemicals in the air, reducing how much your cat is breathing into her lungs.
• Clean your pet and your house: Regular baths, or at the very least wipe-downs with a damp cloth, can help remove smoke residue from cat fur. Vacuum and keep all cigarette butts, tobacco products and even nicotine patches out of sight and reach to prevent accidental illness, poisoning or even death.
• Look for symptoms: Excessive drooling or difficulty eating are symptoms of oral cancer, while labored breathing is a sign of lung cancer. Observe your cat frequently, as catching as early as possible always helps with treatment. If something is out of the ordinary, contact your veterinarian immediately.

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

New Year's Resolution: Get More Exercise

We all have made the resolution to exercise more at least once in our lives, especially after the holidays. And this is a great resolution to share with your kitty too. Domestication of cats into indoor house pets has removed the need for cats to hunt for live prey, decreasing their exercise and their mental stimulation. This has led to weight gain, boredom, and stress in our cats' daily lives.

Kittens seem to have the natural ability to keep themselves entertained and will exercise themselves silly. However, some cats seem to lose that ability as they get older and will need your help to keep them engaged with stimulating exercising. While it is normal for a cat to sleep eighteen or more hours a day, we still need to ensure that her daily life is mentally stimulating and that she is getting daily exercise. Dedicating some time every day, even ten to fifteen minutes, to play with your cat and providing opportunities to "hunt" will help keep her healthy physically, mentally, and emotionally as well as strengthen the bond between you.

Here are some quick tips to help your cat get more exercise:

• Toys: Homemade or pet shop toys help to encourage your cat to get moving. Every cat has different tastes in toys so it may take a few purchases to find her favorite. It's also good to rotate toys every week to keep her from becoming bored with them.
• "Catch the Light": Shine a flashlight or laser light on the floor and walls and let your cat play.
• Boxing: Let your cat play in a box or paper bag. You can interact with her during this game by scratching at the outsides to get her to punch the sides.
• "Hunting": Put your cat's food in different places each day (including on top of tall furniture) and bring out her inner huntress.

Another great idea, courtesy of petfit.com, is to incorporate ways to engage your cat to exercise with you. Not only will you both get a good workout, but you will both have a good time, strengthening your relationship. Celebrity fitness coach Gunnar Peterson has come up with three great ways to exercise with your cat:

• "Light" Cardio: Everyone knows that many cats love to chase beams of light so why not get your heart rate up at the same time? Try jumping an invisible rope while holding flashlights or laser lights in your hands. You and your cat are sure to get a solid workout. The light should move up and down the wall and in circles, so your cat can have a blast trying to catch it.
• "Light" Abs: Ever do sit-ups with a flashlight or laser light in your hands? When you get to the top of the sit-up, hold your position and crunch your abs for a few seconds while moving the light beams on your wall.
• Curious Cat Curls: Tie an elastic band to a toy around your dumbbells. As you curl, watch your cat go crazy trying to catch the toy as it ascends and descends. Just make sure you keep the elastic band out of reach when not playing so your cat doesn't accidentally swallow it.

Click here to see demonstration videos for these great exercises. The cat videos are about halfway down the page.

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

New Year's Resolution: Lose Weight

We are already one month into our New Year and most of us are still committed to, or are revising, our list of resolutions. Why not take a moment or two and see if your cat needs to be part of those resolutions too?

If a poll were taken, losing weight would probably be number one on anyone's new year resolution list, especially after all the indulgences available during the holiday season. And even if your kitty did not indulge with you, he or she may also be in danger of being overweight.

You invest a lot in your cat's health, from vaccinations and neutering to regular veterinary wellness visits. Yet one of the best ways to maintain your cat's good health is by simply providing the right type and amount of food. Keeping your cat at a healthy weight is a vital part of keeping him or her fit. Being overweight or obese is detrimental to the health of your cat. Neutering and keeping cats indoors has led to increased life span and better health. However, they have also led to decreased metabolism and activity levels. Add overfeeding of calories and carbohydrates, and we have a large percentage of overweight cats.

The best way to evaluate your cat's size is by a body condition score rather than actual weight. A body condition score is a scale from one to nine with five being the ideal condition. We check this score each time we see your cat, but here's a quick guide for doing this at home:

Healthy Cat

• The ribs are easy to feel
• There is a waist behind the ribs
• There should be minimal fat hanging from the belly

Overweight Cat

• The ribs are difficult to feel
• There is a rounding of the abdomen
• There is a growing abdominal fat pad

Just as with humans, obesity can be a definite health risk for your cat. Being overweight can put your cat at risk for many diseases, including arthritis, diabetes, cardiovascular disease, respiratory disease, etc.

Helping your cat get back to a healthy weight is not just a matter of cutting back food, although that may be part of what your veterinarian recommends. Because cats are at risk of liver disease and other complications if they stop eating, or aren't getting enough nutrition and calories, a diet is something that should be set in place and regularly monitored by your veterinarian. A few months ago, our Case of the Week profiled one of our patients - Nahmi - whose weight loss journey is still progressing well.

How we start a kitty's weight loss journey

1. We conduct a complete physical exam and body score assessment to determine your cat's ideal weight
2. We look for any medical problems that need to be addressed
3. We calculate the daily calorie needs for your cat
4. We may suggest a particular cat food or prescription diet
5. We determine the exact amount of food that should be offered daily

To help your cat get off to a good start this year, Scottsdale Cat Clinic is holding a weight loss contest. We last held one in 2008 and the winner is still maintaining his slender form. For more information about weight loss for your cat, or our Weight Loss Contest, please contact Scottsdale Cat Clinic by phone at 480.970.1175 or by email at info@scottsdalecatclinic.com

If there is any way we can help get your cat off to a great start for 2011, please let us know.

Case of the Week: Gambit

Today's Case of the Week is a simple story of how regular maintenance care and physical exams help to keep your cat healthy. Gambit is a 2 1/2 year old Egyptian Mau. He has been very healthy and his owner has brought him in regularly for his wellness exams and vaccines.

We first met him a year ago when he was due for his vaccination updates. He received his FVRCP and Rabies vaccines as usually recommended for indoor cats. These protect against Feline Panleukopenia (often referred to a distemper), the upper respiratory viruses Herpes and Calici, and Rabies. We also started him on Heargard to protect him against heartworm disease. Heartworms are spread by mosquitoes, cause severe lung damage, and can be difficult to diagnose. By giving your cat a monthly dose of Heartgard or Revolution, you prevent the spread of the heartworm larvae through your cat.

At his following six-month wellness exam, Gambit was doing well at home. On exam, I found that he had gained over half a pound. We calculated his daily caloric needs so that his owner would know how much he should be eating each day. I also found that he was starting to develop gingivitis, an inflammation of his gums, due to plaque accumulation on his teeth. Cats can start developing dental disease as early as one year of age and it can become severe with time. We started a new diet of Purina DH, a dental diet that helps to clean the teeth and break down plaque and bacteria as the cat chews.

Last month, we saw him again for a six-month wellness exam and to update his Rabies vaccine. I did a complete exam as usual and he looked very good. His teeth looked great, no tartar build-up and the gums appeared normal without any gingivitis. He also had lost a quarter of a pound. He is still a little heavy with a body score of 7/9 (5/9 is ideal) but at least he is going in the right direction. Many cats gradually increase their weight each year if their food intake is not controlled. By bringing Gambit in regularly, we were able to find two medical problems that were just starting and work toward reversing them before more severe medical problems could develop. With good care by his owner, he is very likely to live a healthier, happier life.

Dr. Judy Karnia

Otitis Kittens

This week's case of the week is actually about two young cats from two different families with a similar problem that we saw in the past week. Both of the cats had ear mites and had been treated for them but were still scratching at their ears. The owners were concerned that their cats still had the ear mites.

When I examined each of them, the ear canals were so full of waxy discharge that I could barely see into the ears. We looked at the discharge under the microscope but could not find any mites. We then did a smear of the discharge and put on a stain that helps us see any cells, bacteria, or yeast. By looking at these under the microscope, I found that both cats had large numbers of yeast. We cleaned the ears well and I prescribed medication to place into the ears, which will clear up the infection.

Ear mites are parasites, called Otodectes, that live in the ear canals of cats, dogs, rabbits and ferrets. They are very contagious and are spread with close contact of animals. They cause itching of the ears, which can be quite severe in some cats. A large amount of wax builds up in the ear canals. When the cat scratches at his ears with his hind claws, he can cause damage to the skin, from small scabs to deep scratches that can become infected.

In some cats, I can see the ear mites moving around in the canal when I look in with my otoscope. If I can't see them but I suspect they are there, we take some of the discharge and place it on a slide so we can look under the microscope. If ear mites are present, we can see them moving on the slide. In some cases, we will also see the mite eggs under the microscope.

Ear mites are usually easily treated with medications prescribed by a veterinarian. There are medications that go directly into the ear or onto the skin, which then spreads to the ears to kill the mites. These products are very effective and I rarely see a case where the mites are not completely resolved after one treatment. I have, however, seen many cases in which an over-the-counter medication was tried and did not kill the mites. These over-the-counter drugs are not nearly as effective as the medications available from a veterinarian.

Ear mites, however, can still cause problems even after they are gone. It is not uncommon to see cases like these two kittens in which the cat continues to scratch after ear mite treatment. These are usually due to bacterial or yeast infections. These will occur because of the moist environment in the canals resulting from the waxy build-up cause by the mites. These are a little more difficult to treat but usually resolve well with ear cleaning and the proper medication applied into the ears for several days.

There are other problems as well that cause ear discomfort and discharge. If you notice discharge or see your cat scratching at her ears or shaking her head, have your veterinarian examine your cat and look at the discharge under the microscope (called cytology). Many over-the-counter medications do not work or cause further irritation and may not be addressing the real cause of the problem. It is better for your veterinarian to determine the cause and prescribe the proper treatment so you can resolve your cat's discomfort.

You can find more information in the LifeLearn Library on our website.

Dr. Judy Karnia

Diabetes In Cats Defined

Because of the increase in cases of diabetes in people, the American Diabetes Association declared November to be Diabetes Awareness Month. Sadly, veterinarians are seeing a steady increase of diabetes in pets as well. That's the bad news. The good news is that it is a condition that can be successfully treated with commitment from the veterinarian and the owner.

Diabetes Mellitus is the most common form of diabetes found in cats, and is the second most common endocrine disease in cats. It is estimated to affect one in 400 cats, is found in more males than females, and is a common ailment of middle-aged to senior cats.

Diabetes is a disease of the pancreas. In cats with normal glucose metabolism, food is broken down into components that can be used by the body. Carbohydrates are converted into various sugars including glucose. Glucose is absorbed from the intestines into the bloodstream, providing the body cells with energy. Glucose can only enter most cells if the hormone insulin in present. There are specific cells, called beta cells, located within the pancreas that manufacture insulin.

Diabetes mellitus, or "sugar diabetes" as it is sometimes called, is caused by a lack of insulin available to the cells in the body. This is due either to insufficient insulin production by the pancreas, or by the body cells failing to respond to the insulin. As a result, blood glucose levels are too high and the body cells cannot absorb enough to provide adequate energy.

The most common type of diabetes mellitus found in cats is Type II, in which some insulin producing cells remain in the pancreas. They are either not producing enough insulin for the body to adequately process glucose, the secretion of insulin is delayed, or the cells are resistant to it. Just as with humans, obesity is a predisposing factor to diabetes. The tremendous increase in overweight and obese cats means that more and more cases of diabetes are being diagnosed. It's important to remember that a cat just three pounds over ideal weight is considered obese.

There are clinical (observable) signs that may indicate your cat has, or is developing, diabetes. The most common sign is drinking a lot of water and an increase in urination. There may also be increased incidents of inappropriate urination outside the litterbox and/or on furniture. Sudden weight loss, especially with an increase in appetite, can be a warning sign. As the disease advances, the cat will become increasingly lethargic and will have a dull coat.

If you are concerned that your cat may have diabetes, you should contact your veterinarian. During the appointment, it's important that you relay accurate information about your cat's signs and symptoms and are able to list all the medications and supplements your cat is currently taking. Your veterinarian will be able to do a complete physical exam and run lab work to help properly diagnose your cat.

If your cat is diagnosed with diabetes, it is very important to maintain a good relationship with your veterinarian and the entire team at your animal hospital. With a combined commitment from you and your veterinarian, your cat's diabetes can be easily treated.
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Coming Next Time: Diagnosis and Treatment of Diabetes