Monday, January 22, 2018

Feline Inappropriate Urination

Dr. Stephanie Waters



Does your cat urinate outside of the litter box, even only occasionally? If the answer to this question is yes, then please continue reading this post!

Urinating outside of the litter box can be both frustrating to owners as well as our feline friends. The first question that we must ask is why? Why would your loving cat pee on your bed?! Well, the answer to that can be complicated, nonetheless the first step to solving this issue is to take your cat to your family veterinarian.

Here at Crawford Dog & Cat Hospital, we start off our appointments by getting a detailed history. How long has your cat been urinating outside of the litter box? Does he/she defecate outside the box also? Have there been any changes in the household recently (family party? Addition of a new human or animal to the family? Moving houses/Vacations? Etc)? Is your cat spayed/neutered? Some of our questions may sound silly, but there is always a reason! The next important step is to get a urine sample in order to test for inflammatory cells, blood cells, pH, bacteria, and crystals.

Basically, we are trying to find out if your beloved feline has a Urinary Tract Infection, sterile or bacterial cystitis (inflammation of the bladder), behavioral issues, urethral obstruction (bladder stones) or maybe even an endocrine disorder such as diabetes or hyperthyroidism! A blood sample may also be needed to help determine the underlying problem with your pet. If a Urinary Tract Infection is diagnosed, the course of treatment may only consist of a course of antibiotics and/or anti inflammatories. Depending on our results, we may move forward to check your cat for radiographic evidence of a stone(s) in the bladder, a urine culture or changes in the bladder wall with an ultrasound appointment.

What happens if all of our tests lead to a behavioral cause for the inappropriate urinating?!  Do not panic, we are here to help your animals mental as well as physical health. We offer several low stress at home ideas (additional litter boxes, changing style/location, cleaning boxes more often, changing the litter type, etc) as well as anti-inflammatory and anti-anxiety medications for your furry feline!

If your feline friend is currently experiencing inappropriate urination, please do not hesitate to contact us at Crawford Dog & Cat Hospital! We offer low stress appointments (feline only hours on Thursday evenings) and house calls throughout the week.

Tuesday, January 16, 2018

A Sad Case History.

We had a heartbreaking case this month that I wanted to share.  Not because things could have been done any differently, not because the owner could have prevented the problem, and not because anyone else did anything wrong with the care of this kitty.  Sometimes, things just go poorly, in spite of everyone doing what is best for their pets and I think that is important for everyone to know.

We went out on a house call to see a cat, a new patient, that had been coughing for a couple of days.  It was a young adult, and the household was made up of the humans that lived there, this cat, her brother and one other cat that was unrelated.  The patient had been healthy since adoption several years ago from a reputable local rescue group and had just started to do poorly over the previous weekend.  The other cats were showing no signs of illness.  This cat was obviously sick.  In fact, it was obvious immediately that it was having difficulty breathing, just with a casual look as we entered the room.  I couldn't hear the heart well and the breath sounds were muffled.  We transported the cat back to the hospital for radiographs and blood work.  My worst fears were confirmed, the chest was filled with fluid and there were some subtle changes in the blood work.




(The orange outline is the only lung that is aerated.  The blue arrows are the fluid line)


After contacting the owner, we withdrew over 150 cc of fluid from the chest and started the cat on some medications in an attempt to help her to breath better.  An ultrasound of the chest was performed to rule out tumors and cardiac disease.  Fluid was submitted for pathology review and bacterial culture.

The test results came back negative for bacterial infection but positive for feline corona virus and our diagnosis is FIP.  FIP, Feline Infectious Peritonitis, is a strange and unfortunately deadly disease of cats.  It is caused by the interaction of a mutated virus and the individual cat's immune system.  There are two forms of FIP.  In the dry form, granulomas (inflammatory lesions) form on the organs and in the lungs.  It is usually a chronic wasting type disease with waxing and waning fevers, eventually leading to organ failure and death.  In the wet form, like we saw here, fluid accumulates in the abdominal cavity or the chest.  It too is progressive and eventually fatal.

The nature of the disease is i that it is infectious (a virus is involved) but not contagious.  While feline enteric corona virus, the type that causes diarrhea is contagious, the FIPV biotype that causes FIP is not contagious.  Increased numbers of cats in the household increase the risk of other pets in the home contracting the disease, mostly due to increased corona virus burdens in the environment with the increased risk of those viruses mutating.

Diagnosis of FIP can be a challenge.  Often tissue samples must be submitted for pathology, especially in the dry form.  In this case the clinical pathology data that we accumulated along with the signs and symptoms of the patient make us as certain as we can be that this is a case of wet FIP.

There is no good screening test to detect carriers or cats that might be infected with FIPV and are preclinical.  There was a vaccine that was determined to be ineffective and in one study at Cornell, actually increased the risk of vaccinated cats contracting the disease when challenged with the FIPV virus post vaccine.

There is no cure for FIP.  Palliative care involves suppressing the immune cells that are causing the problem.  In the case of cats with fluid in the chest, periodically removing that fluid may make them more comfortable.  In the end, cats with FIP will die from this disease.  Once the quality of life starts to deteriorate, euthanasia is often the best option.

I posted this case history, with the permission of this cat's owner.  Of course, the details have been left out to protect everyone's privacy.  I just wanted owners that have had this disease enter their lives to be aware that they did not do anything wrong.  There is nothing that you could have done to prevent this horrible disease, nothing that you could have noticed earlier that would let us intervene earlier and effect a cure, no food, no supplement, no  magic bullet that would have kept your cat from getting sick.

Sometimes, there are just things that are so broken that we can't fix them.  This is one of those times.

Wednesday, January 10, 2018

My Pet Doesn't Have Worms!

Warning, potentially disturbing photo in post.


I hear it all of the time, my pet doesn't have worms.  "How do you know?", I ask.

He had a stool check when he was a puppy.

Well, that's a start but the last test was two years ago, so how do you know he doesn't have worms now?

I never see worms in her stool.

That's good, worms in the stool are often signs of a serious infestation.  But the test we do checks for evidence of parasites in the stool that are too small to see with the naked eye.  Or, we look for microscopic eggs being passed into the stool.  New tests are even more sensitive and look for DNA from the parasites, present before these parasites can cause disease in our pets or our family.

My cat never goes outside.

OK, now we have to have some serious discussions, because even indoor cats can have parasites.  Parasites that can cause disease in our pets and in us as well. (this is not the disturbing photo)



This little guy is only a few months old.  Rescued from the street and actually headed to a good home this week.  (sorry, not for adoption).  He was tested for feline leukemia, feline aids, intestinal parasites, treated and vaccinated.  So good to go for life right?  WRONG!

Here's the thing about worms, at least the most common ones that we see (round worms, hook worms, and whip worms) they are all well adapted to their hosts, and some are not very picky about their hosts.  They can survive very well in their hosts or the environment and pass their traits on to future generations of worms without making their host very sick, sometimes.  The sometimes is the important part.  If the host does not have a good immune system (young, old or sick pets), or, if the host is not the preferred host (dog or cat round worms in people), the parasites can cause serious diseases. Here is a photo of a child with a round worm in his eye.



Not only that, but they are tricky.  Our deworming medications will kill the adult worms present in our pets.  Not the immature ones, just the adult ones.  That is why we need to treat multiple times, killing the parasites as they mature.  The interval between treatments and the medication that we use, will depend on the type of parasite that is present.

To make matters even worse, some parasites, especially the round worms and toxoplasmosis in cats (subject of another blog post) will form cysts in the host.  These cysts can become activated during times of stress, hormonal changes, illness, or just about any reason that you can think of.  Then your indoor pet will be shedding infective eggs into your environment and re infecting themselves and posing a risk to you and your family. (especially children and immune compromised individuals)

Here's a little story that a parasitologist from Colorado State University shared with me and I want to share it with you.

What does your indoor cat do when it sees a fly?  Mine catches it, plays with it, and eventually eats it.  Now, where was that fly before it was in your home?  In many cases it was on a pile of dog poop outside, picking up roundworm eggs.  In fact many critters that find their way into our homes (OK other people's homes) like mice, roaches and the aforementioned flies, can bring in parasite eggs.  

After becoming infected what do most cats do?  They wander around the house, they dig in the litter box contaminating their little paws with feces and parasite eggs, and they jump on our tables and counters... need I say more?

Wait, don't kill the cat.  It's much easier to prevent parasites than you think.  The CDC recommends twice a year fecal tests for all pets, we agree.  They also recommend periodic (quarterly) deworming for all pets.  We have a better answer for now.

Put all pets on a regular parasite control product.  Monthly heart worm protection will prevent the more common zoonotic (contagious to people) parasites.  Every pet, every month.  For cats, we recommend the topical application of either Revolution or Advantage Multi once a month.  This will also prevent fleas and heart worm.  (I know the cat never goes out.  I can't tell you how many indoor cats I see with fleas every year).  If you have a dog, it goes out and can bring fleas in.  

In addition, have stools checked twice a year.  Bring a small sample to your veterinarian.  We send our out to a lab that does a very good job of checking for parasites.

Detection and prevention will decrease the likelihood that you will have parasite issues in your family, both 2 and 4 footed.