Monday, December 29, 2014

How could my cat be sick? He acts like a kitten! - Hyperthyroid disease and your cat

The many faces of feline Hyperthyroid Disease | Exclusively Cats Veterinary Hospital, Waterford, MI


What is hyperthyroidism?

The thyroid is a gland located in the neck. It plays a very important role in regulating the body's rate of metabolism. Hyperthyroidism is a disorder characterized by the overproduction of thyroid hormone (thyrotoxicosis). When excessive amounts of thyroid hormone are in the circulation, the body's metabolism speeds up greatly.
Location of the Feline Thyroid Glands | Exclusively Cats Veterinary Hospital, Waterford, MI
Location of the thyroid gland

1: Normal thyroid gland. 2, 3: parathyroid glands. 4: enlarged thyroid gland
Hyperthyroidism is a fairly common disease of older cats. It is estimated that about 5-10% of cats will develop hyperthyroidism in their lifetimes. Although the thyroid gland enlarges, it is usually a non-malignant (benign) change.  Less than 2% of hyperthyroid cases involve a malignant change in the gland.

What does this do to the cat?

The typical cat with hyperthyroidism is middle aged or older; on the average, affected cats are about 13 years of age. The rapid rate of metabolism causes 95-98% of cats with this disease to lose weight. The cat tries to compensate for this with an increased appetite. In fact, 67-81% of these cats have a ravenous appetite and will literally eat anything in sight! Despite the increased intake of food, most cats gradually lose weight. The weight loss may be so gradual that some owners will not even realize it has occurred.  Affected cats usually drink a lot of water and urinate frequently. There may be periodic diarrhea or vomiting, and the hair coat may be unkempt. As the disease progresses, the cat's appetite may decline to the point of anorexia.

In addition to:
  • weight loss
  • increased appetite
  • vomiting
  • diarrhea
  • unkempt coat
other signs of hyperthyroidism that may be noticed include:
  • increased thirst
  • increased or more frequent urination, larger clumps in the litterbox, or inappropriate urination outside the litterbox
  • increased activity
  • increased vocalizations 
  • pacing or restlessness
  • anxiety
  • panting or rapid breathing

How is hyperthyroidism diagnosed?

The disease is most commonly diagnosed by determining the blood level of one of the thyroid hormones; the hormone most frequently measured is T4. Usually, the T4 level is so high that there is no question as to the diagnosis. Occasionally, a cat suspected of having hyperthyroidism will have T4 levels within the range of normal cats. In this case, a second test, called a T3 Suppression Test, is performed. If this is not diagnostic, a thyroid scan can be performed at a veterinary referral center.
Cat before and after becoming hyperthyroid | Exclusively Cats Veterinary Hospital, Waterford, MI
Hyperthyroid cat before becoming hyperthyroid, and again at the time of I131 treatment

Is this disease treatable?

Because less than 2% of these cats have cancerous growths of the thyroid gland, treatment is usually very successful.  There are three choices for treatment; any one of them could be the best choice in certain situations.  Many factors must come into consideration when choosing the therapeutic option for a particular cat.

What would happen if I chose not to treat my cat's hyperthyroidism?

Hyperthyroid is a deadly disease if left untreated. The effects that hyperactive metabolism has on the body are progressive, and this is a disease that will not resolve on its own. Over time, a cat that is hyperthyroid will develop problems associated with malnutrition because the overactive metabolism is using up calories and nutrients more quickly than usual. Add to that the likely side effects of vomiting and diarrhea, and an untreated cat will also become severely dehydrated.

The increased heart rate of a hyperthyroid cat will cause the heart muscle to thicken, and many will develop cardiomyopathy (poor muscle contractions) and eventual congestive heart failure. The high blood pressure that often goes hand in hand with hyperthyroid disease can cause damage to many sensitive organs in the body, including the kidneys, the eyes and the brain - as these blood vessels rupture from constant high pressure, blood supply is lost and tissues become unhealthy. This can cause kidney disease, neurologic effects due to damaged brain tissue, and blindness if the eyes are affected.

1) Radioactive iodine.  Probably the safest, and definitely the most effective way to destroy the abnormal tissue is with radioactive iodine (I131) therapy. In 95% of cats treated with I131, the cure is complete and permanent. Radioactive iodine treatment for cats requires one to three weeks of hospitalization at a veterinary clinic licensed to administer radiation therapy, and involves administration of the iodine via injection or oral capsule. The iodine is concentrated in the thyroid gland and destroys the overactive cells. At Exclusively Cats Veterinary Hospital Cats RadioIodine Treatment Center, the cats are treated with an oral dose and isolated for one week at the hospital followed by one to two weeks of isolation within the home.

Here is a vivid demonstration of a cat before and 3 months after treatment.

2) Surgery.  Surgical removal of the affected thyroid lobe(s) (thyroidectomy) is also very effective.  Because hyperthyroid cats are usually over 10 years of age, there is a degree of anesthetic risk involved, but not necessarily any more risk than for other cats of similar age.  However, the risk is much less than most people think, as long as the cat is otherwise healthy.  Tests are done before surgery to evaluate the cat and predict the chances for complications. If the disease involves both lobes of the thyroid gland, two surgeries may be required, depending on the surgeon’s choice of procedures.  In many cats, only one thyroid lobe is abnormal, so only one surgery is needed. Possible side effects include possible damage to the parathyroid gland, which is intimately associated with the thyroid gland, possible post-surgical hypothyroidism (under-functioning of the remaining thyroid gland, or as a result of bilateral thyroid removal).

3) Oral medication.  Administration of an oral drug, methimazole, can control the effects of the overactive thyroid gland.  After starting the medication, results can be seen in just 2-3 weeks. Some cats have reactions to the drug, but that number is fairly small (less than 20%). However, the side effects may begin as many as six months after the beginning of treatment and can include vomiting, lethargy, anorexia, fever, and anemia. Less frequently, cats may develop facial itching, clotting disorders and liver malfunctions. Methimazole does not destroy the abnormal thyroid tissue, but rather prevents the production of excess thyroid hormone.  Therefore, the drug must be given for the remainder of the cat's life. If the medication is stopped, hormone production will return to high levels again and the cat's symptoms will return.

Some cats can be particularly difficult to regulate, or may be poorly sensitive to this medication, which can be a downside to choosing this method of treatment. Other cats are difficult to medicate and would be better served by I131 treatment. Methimazole is a medication that some cats metabolize well in a transdermal form, but this option is not tolerated by all cat, and there is some risk to the owner in applying a thyroid-inhibiting medication that is absorbed through the skin, so appropriate handling of the medication is important, and transdermal medication may not be an appropriate choice for cats living in a home with small children.
Periodic blood tests must be done to keep the dosage regulated. This type of treatment is appropriate for the cat that is a poor surgical risk due to other health problems.

Y/D Diet by Hills | Exclusively Cats Veterinary Hospital, Waterford, MI
4) Hill's Y/D diet.  Because the thyroid gland needs iodine to make thyroid hormone, feeding a diet with minimal iodine content should decrease the thyroid hormone levels of the cat. Feeding trials have indicated that after 3 weeks of feeding ONLY this diet - no treats, no human foods - thyroid levels are significantly reduced in most cats. Cats will not become hypothyroid while eating this diet, and a two year study suggests that cats that are NOT hyperthyroid that eat this diet will not suffer adverse effects. However, in practice, we have had a very difficult time getting cats to eat this diet, so while it is an option, it is a pricy (4 pounds of food is about $25 dollars and lasts about 3 weeks for a 7 pound cat) experiment that may not always pan out. There are many people who have had excellent results with this diet change, however, so it is definitely a viable treatment option. This treatment is not curative and the cat will need to remain on this diet for the rest of its life.

How Y/D diet works to treat thyroid disease | Exclusively Cats Veterinary Hospital, Waterford, MI
How Y/D diet works

If I elect to have surgery for my cat, what is the procedure?

If surgery is the treatment method chosen, the cat is put on methimazole for one to four weeks before surgery. This treatment should cause the ravenous appetite to subside, and your cat will probably gain weight. Some cats also have a very fast heart rate and may be medicated before surgery with another drug, such as Atenolol. After one to two weeks, another T4 level in the blood is measured.

The operation is performed in a sterile operating room and your cat is under general anesthesia. An incision is made along the neck just below the throat and the enlarged thyroid gland is removed. The skin is sutured together.

Your cat is generally hospitalized for one night following surgery and returns home feeling quite well. He or she should eat normally after returning home. 

Can hyperthyroidism occur again?

Recurrence is a possibility in some cats. Recurrence is uncommon after radioactive iodine therapy.  When surgery is performed, the chance of recurrence is slightly greater. It is usually not possible to surgically remove all of the cells from the abnormal thyroid gland. If those remaining cells grow, the disease may recur. However, this occurs less than 10% of the time and usually after 2-4 years.  Another possibility is that one side of the thyroid gland appeared normal at the time of surgery so it was not removed. Then, months or years later, it may become abnormal.

I think my cat is too old for anything but treatment with the oral medication or diet change.  Do you agree?

Many owners of cats with hyperthyroidism are hesitant to have radiation therapy or surgery because of their cat's advanced age. But remember, old age is not a disease. The outcomes following both surgery and radiation therapy are usually very positive, and most cats have a very good chance of returning to an excellent state of health. Some of the cats referred to our hospital in Waterford, Michigan, for radioactive iodine treatment have been as old as 20 years of age, and have done very well!

Monday, December 22, 2014

What Should I Get my Cat for Christmas?

Cray Cat in Christmas Tree | Exclusively Cats Veterinary Hospital, Waterford, MI

What would your cat like for Christmas? (Besides unrestricted access to the Christmas decorations, of course.)

A survey of pet owners shows that a little over half of people still shop for their pets in brick-and-mortar stores, but that a significant number of people spend their average pet gift budget of $25-50 in online stores. 

Since 98% of pet owners surveyed will use pet blogs as a gift resource, we thought we'd give you our suggestions on just a few of the cat products that cats love! 

 1. Cat toys

Cats love toys and interaction with their humans, so giving your cat the gift of play time is always a good choice! Just make sure that any toys you purchase for your cat are used with supervision if they have easily detachable parts, ribbons, strings, elastics, small bells or buttons that can be swallowed or other choking hazards.

Catnip toys!!
Rabbit Fur Mouse, "Boca Rat" | Exclusively Cats Veterinary Hospital, Waterford, MI
Boca Rat
Large and small, fuzzy, fluffy, tossable, kickable, with or without crinkles! We had Exclusively Cats cats taste test a variety of the catnip toys available from Etsy crafters, and we will be posting their reviews soon!

Boca Rat - Rabbit fur and suede make this cat toy exciting for cats!

Cat Amazing Toy | Exclusively Cats Veterinary Hospital, Waterford, MI
Cat Amazing

Cat Amazing This simple maze toy provides cats hours of fun and learning. Cat Amazing is made from 30% recycled & 100% recyclable cardboard, and printed with certified metal-free inks. There are three levels of difficulty to continue challenging your cat.

Da Bird
Da Bird Toy | Exclusively Cats Veterinary Hospital, Waterford, MI
Da Bird
This cat wand is irresistible! The lures are designed to spin through the air, making a fluttering sound that catches your cat's attention. Drag it along the ground, and it's pounce-able, whiz it through the air and watch your cat soar! Just make sure to keep this toy securely locked away from your cat when you are not supervising him - he may decide to eat it! Additional lures can be purchased that are different shapes - furry, puffs, and sparklers. Some independent companies and Etsy crafters also make lures that mimic insects and other critters which can be attached to the Da Bird wand - however, nothing beats the original!

PetSafe FunKitty Egg-Cersizer | Exclusively Cats Veterinary Hospital, Waterford, MIPetSafe FunKitty Egg-Cersizer

This unique, adjustable food ball can be adjusted to the size of the kibble and the craftiness of your cat. Cats that need mental stimulation will enjoy the "thrill of the hunt" as they bat the ball around to release treats or kibbles, and overweight cats will benefit from having to work for their food, rather than grazing from a bowl all day. For some cats, there is a definite learning curve, however.

2. Cat beds


Cats love boxes, it's undeniable, so often a good choice for a cat bed is something box-shaped, or a basket with a cushion inside. Many cats like the curvy shape of egg or ball-shaped beds, and many cat bed manufacturers have taken a lot of these preferences into consideration. There are even cat beds made from suitcases and doll beds. There are almost as many options for cat bed styles as there are types of cats!
Beds cats love | Exclusively Cats Veterinary Hospital, Waterford, MI

 Additionally, cat hammocks, cat shelves and even cat canoes are fun for your favorite feline!

Cat Canoe | Exclusively Cats Veterinary Hospital, Waterford, MI
Cat Canoe

Cat Canoe Handmade in the USA, this fully washable cat bed expands for your cat, keeping your cat snug and cozy. Its dimensions are 20" long and about 8" wide.

Cat Shelf Wall Bed 

Cat Shelf Wall Bed | Exclusively Cats Veterinary Hospital, Waterford, MI
likekittysville at etsy
Looking for something that is not just your run-of-the mill cat bed? Here's a fancy, modern, wall-mounted bed shelf, found on Etsy. It has a removable, washable cover. Separate covers are available, even in your own materials. Other designs and floor models are also available.

Designed by a Registered Veterinary Technician and her industrial designer husband, these functional pieces are comfortable and design-conscious. Made 100% in the USA.

Kitty Lounger | Exclusively Cats Veterinary Hospital, Waterford, MI

Off the Wall Cat Shelves

Off the Wall Cat Hideout | Exclusively Cats Veterinary Hospital, Waterford, MI
Off the Wall Cat Hideout
This  system of wall shelves, scratching posts, bridges, feeders, beds and hideouts can help you create cat highways all over your house! Custom orders and a variety of carpet choices and wood finish and paint options make these cat beds and shelves uniquely yours.

3. Cat treats and fountains

CatIt Design Senses Water Fountain | Exclusively Cats Veterinary Hospital, Waterford, MI
Cat It Design Senses Fountain
Water fountains - most cats love fresh, circulating water, which is why so many try to drink from the faucet. There are a variety of cat fountains on the market, some fashionable and some functional, some for the cat that loves the trickling sound and others for those that just like to go with the flow. The CatIt DesignSenses Drinking Fountain is a very economical choice - a large, quiet, flowing filtered fountain for around $20.

Drinkwell or Pioneer fountains come in plastic or stainless steel in a variety of styles for around $40-80 each.  Depending on the style of fountain or the material it is made from, both these companies have received both good and bad reviews. The Drinkwell Ceramic Pagoda Fountain got rave reviews from one of our clients. She prefers it to the Drinkwell 360 by a long shot!

Thirsty Cat Fountain | Exclusively Cats Veterinary Hospital, Waterford, MI
Thirsty Cat Fountain

Thirsty Cat ceramic fountains are unique pieces of artwork that also function as a cat fountain for $120 to $240. This company won the 2014 Cat Fancy Editor's Choice Award. You can also purchase coordinating food bowls and treat jars.

Liv-A-Littles Freeze Dried Chicken Treats | Exclusively Cats Veterinary Hospital, Waterford, MIFreeze-dried chicken. Cats love it. No chemicals, artificial flavors, preservatives, by-products, fillers, or rendered meat.

Greenies Dental Treats
Greenies Dental Treats | Exclusively Cats Veterinary Hospital, Waterford, MI
The only tartar control treats that have demonstrated enough benefit to have been given the Veterinary Oral Health Council seal of acceptance. Six delicious flavors to spoil your cat with!

Royal Canin Dental Diet or Oral Sensitive 30, Science Diet Oral Care or T/D
These larger sized kibbles make this diet ideal for offering as treats. The texture of these foods provides some mechanical brushing action when chewed, and the large size encourages more chewing than most smaller sized maintenance diets. Sodium tripolyphosphate binds to salivary calcium and prevents it from helping form dental calculus, and additional enzymes prevent tartar formation in other ways.
Royal Canin and Science Diet Oral Health Diets | Exclusively Cats Veterinary Hospital, Waterford, MI

4. Monthly Subscription Box 

Everyone loves a surprise in the mail, including your cat! Once cat-lovers realized that BarkBox was not going to make a monthly subscription box for cats, a whole slew of options appeared! Have you tried one of these subscription boxes? We're anxious to learn if they're as wonderful as they sound!

Leave us a comment if you have tried one!

KitNip Box - $19-29/mo, 4-6 fun cat toys, delicious treats, must-have accessories, health and hygiene products, innovative new gadgets, and awesome surprises! One of our clients has tried and reviewed this subscription box.
meowbox - $22.95-32.95/mo, 5 items: food and treats that are made with natural ingredients, are tasty, nutritious, wholesome, organic, or locally made
MeowBox - (Not the same as meowbox!) $25/mo, handpicked cat toys, treats, gadgets, accessories and more:  the best, newest and coolest cat-related products they can find. 10% of sales to help less-fortunate felines.
PetBox - $9.95 -59.95/m, 1-12 items - treats, tags, magnets, videos, grooming supplies and more! One of our clients has subscribed to this box and has reviewed the November and December boxes from 2014.
PetGiftBox - $17.99/mo, 4-6 treats, toys, and other great products 
Pet Health Advisor Custom Care Box/Solution Box - $19.95 or $39.95 Detailed Product Choices depending on your pet's health history (not a replacement for regular veterinary visits, of course!)
Spoiled Rotten Box - $19.99 - 24.99/mo toys, treats, samples and more!
Purr-Packs - $24.99-39.99 for 7-12 toys, treats and surprises. Higher end boxes are customizable. Green, recyclable packaging. 10% donation to both national and local rescue and animal welfare organizations.
Fur and Feathers FunPack - $19-30/mo, 4 - 6 high quality, carefully selected goodies, including, but not limited to, toys, treats, specialty items such as skin products, essentials, and of course, food selections   At times, we may also include product samples in our FunPacks.  
CatPax - $22 - 26/mo, fun toys and delicious treats and innovative care products from smaller, independent toy, treat, and hootenanny makers – as opposed to the ones you see at the corporate pet stores.
Dr. D's Pet Packages - $19/mo for cats, subscribe for 3 months and receive a free fleece blanket. 3-8 pet products such as toys, custom treats, grooming supplies, supplements and accessories selected by  veterinarian Dr. D, to suit the needs and preferences of your pet. Their goal is to optimize pet health and well-being by introducing pet owners to high quality healthy pet products which are usually hard to find in local pet stores. 10% of profits go to homeless pet organizations.
WhiskerKits -  $29/mo, average of 5-6 items: unique variety of treats, toys, and pet supplies, and occasionally products for cat parents
PurrBoxes (UK) - £9.95/mo. (It appears that arrangements may be able to be made to have this shipped to the US, but we're not 100% sure...) four or more carefully selected products and presents for your cat – specially selected toys and treats along with a month’s supply of cat grass and catnip!

5. Cat Furniture

Cats love to perch and climb, hide and snuggle, depending on their personality, and of course, all cats like to stretch and scratch! There are a large number of traditional, carpet and sisal rope cat trees out there, and depending on your cat's size and climbing ability, a shorter, broader tree or a taller thinner tree may be preferable for your cat. Just remember that, when choosing a scratching post, a cat likes to extend its legs over its head when scratching, so the bigger the cat, the taller the post should be to maintain its appeal! Additionally, some cats prefer horizontal scratching, so if your cat turns up his nose at a tall tree, a broad, low scratching surface may be more his style.

Lotus Cat Tree | Exclusively Cats Veterinary Hospital, Waterford, MI
Lotus Cat Tree 

This stylish cat tree is almost as much a piece of furniture as it is a climbing piece for cats. It has Berber carpet attached with Velcro,  a Sisal pad perfect for scratching, and soft cushions with washable faux suede covers. It's a bit more costly than your average carpet-covered tree, but reviewers report that it withstands the test of time. 

Katris: Modular cat furniture

These fun, sturdy scratchers are versatile, stackable scratchers for both you and your cat to play with! They come in several different shapes that mimic the computer game "Tetris" and can be stacked into as many imaginative collections as you can come up with. Even better, these top-grade, heavy duty cardboard structures are made of 100% recycled materials. Because of their versatility, these are appealing to cats of many different scratching preferences.
Katris Modular Cat Furniture | Exclusively Cats Veterinary Hospital, Waterford, MI

Katris Modular Cat Furniture | Exclusively Cats Veterinary Hospital, Waterford, MI

Katris Modular Cat Furniture | Exclusively Cats Veterinary Hospital, Waterford, MI

Of course, these are just a few of the many types of cat products out there for your favorite pampered cat. Be sure to visit our Pinterest board for more fun ideas to spoil your cats!

Follow Exclusively Cats Veterinary Hospital's board Cat Gifts for Cats on Pinterest.

If you'd rather shop for the Cat People in your life, here are some fun suggestions from around the internet!

Follow Exclusively Cats Veterinary Hospital's board Cat Gifts for People on Pinterest.


If you don't see your favorite cat gift, here, feel free to leave a suggestion in the comments!

Thursday, December 18, 2014

How do I keep my cat from chewing on my Christmas tree?

Even though most cats do not chew bones like dogs, a good number of them will occasionally get it into their head to gnaw on one thing or another - especially at Christmas when that amazing cat toy comes out of the basement or, even better, comes in from the outdoors to stand there, just asking to become a jungle gym and oral health device!

Chewing behavior can be normal in cats - an expression of curiosity and exploration, teething behavior in young cats, or a result of play, however chewing can also be an expression of boredom or an obsessive-compulsive disorder, and can quickly become destructive!

How do you keep your cat from gnawing the Christmas tree? Here are some tricks to try:

  • Place a heat or motion sensor under the tree, such as the Scranimal, which emits an audible sound when the cat enters the 10 foot x 3 foot area that  it protects. There are other similar products that emit ultrasonic sounds if an audible sound would be a problem at night. 

  • Wrap tree branches in reach with tin foil, bubble wrap, or double sticky tape. Once the tree is no longer fun to chew, the cat will leave it alone and you may be able to remove the deterrent.

  • Wipe branches with a cloth sprayed with Bitter Apple. It is best not to spray Bitter Apple spray liberally in your home because some people find the spray residue obnoxious. Take small items outside to spray with Bitter Apple. 

  • You can combine two deterrents in one and wrap the branches in double sticky tape that have been dipped in cayenne or hot pepper.

  • If your cat likes chewing on dangling things, you can try hanging CET Cat Chews from his cat tree to simulate the tree he is chewing on. It may help to have a cat tree located in the same room as (but not right next to) the Christmas tree. This will give your cat an alternative perch in the same room as the tree which will hopefully prevent him from climbing up into the tree.

  •  You can offer your cat an alternative plant to chew on by growing or purchasing some Cat Grass and placing it in the same room as (but not next to) the tree.

  • If all else fails, you may need to relocate your Christmas tree and/or decorations to a room cat can't access. In the case of the tree itself, you can remove the lower branches (artificial or natural) that the cat can easily reach and hope that he does not try to get up higher in the tree to chew on the upper branches.

Additionally, this WikiHow Article has some great tips on cat-proofing your tree in other ways.

Monday, December 15, 2014

Care and Feeding of a Cat with an Esophagostomy Tube

If your cat has been diagnosed with pancreatitis, oral pain or other condition that makes it difficult or painful to eat, your cat may have had a feeding tube placement procedure recommended. The procedure is relatively quick and, with proper pain medications, painless. Once the tube is placed, a high-calorie, vitamin-rich diet can be given to the cat with minimal stress while he or she is brought back to health. In these cases, placement of a feeding tube often means that the cat is able to go home from the hospital much sooner than would be possible, otherwise.

The type of diet and vitamin or mineral additives that should be fed will be determined by the doctor, based on the individual needs of your cat. Generally a syringable diet will be mixed with water and nutrient powders and placed into the blender to smooth the mixture. Store the food in the refrigerator, and warm a portion of the food to body temperature (101.5 degrees F) in the microwave before using. Do not heat above body temperature!

For most cats with an esophageal feeding tube, food in the stomach may cause nausea, so start slowly. We generally recommend that the average 10 pound cat should start with 50ml of food through the E-Tube four times daily for two days, then increase to 55ml five times daily. Gradually increase the amount you are feeding.  Your eventual aim will be at least 300 to 350ml (over 1 cup) per day.  If  your cat continues to tolerate the feedings you may increase feedings by 5ml per day; up to 75ml per feeding if there is no vomiting. This will allow you to feed fewer times each day.  It is important that you feed enough so that your cat gains weight!

Administer the feedings slowly over 5-10 minutes; slower if vomiting occurs.  Observe for swallowing during the feedings.  Some vomiting (especially at first) is anticipated. If your cat vomits, you should wait an hour and start again. Be organized so things go efficiently with as little handling of the patient as possible.  If feedings are well tolerated, you may gradually become quicker. For some cats, quicker feedings will go more smoothly.

Be sure to flush the esophagostomy tube with 6ml of warm water after each feeding and replace the cap. If the tube becomes clogged, try flushing a small amount of diet cola through the tube with a small (1 to 3ml) syringe.  The esophagus is very stretchy, so your cat CAN eat and drink with this tube in place, however please do not allow your cat to consume grass if they are allowed outside. Grass ingestion is more likely to cause vomiting, and the more frequently your cat vomits, the higher the risk that they will vomit the tube.

Clean the ostomy site (the hole where the tube enters the skin) daily with warm water and surgical scrub. Warm soapy water is ok to use too. Report any concerns.


It is likely that your cat will be on several medications if this tube is in place. An antibiotic should be given to prevent infection at the tube site. Cats with pancreatitis or hepatic lipidosis (fatty liver) will likely be taking anti-nausea medications such as metoclopramide (Reglan) or maropitant (Cerenia). Cats with certain liver diseases may be taking Denamarin or Ursodiol. Cats with kidney disease may be taking Calcitriol, famotidine (Pepcid), potassium supplements, or aluminum hydroxide. Some of these medications can be given in powdered form and mixed with food or water, others come as tablets and must be crushed before putting through the tube.

Your cat’s esophagostomy tube will be sutured in place and there will be a light bandage placed around his neck.   Observe closely to make sure your pet is not pawing at the tube or bandage.  

If  your cat vomits the esophagostomy tube—carefully use scissors to cut off all exposed tube protruding from the mouth.  Do not try to feed!   Your cat  will need to have the remainder removed and the tube replaced.  If the patient is comfortable, tube replacement can wait until morning. Call as soon as possible; if it is after hours and you are in doubt, contact the nearest emergency clinic.  The portion of the tube left in your cat’s neck can be used as guide for replacing the next tube through the same ostomy site, so don’t pull the remaining portion of the tube from your cat's neck.

If you end up at a veterinary hospital that is not familiar with the replacement technique, please direct them to this video.

Monday, December 8, 2014

Did you just call my cat's liver "fat"? - Hepatic Lipidosis in cats

Hepatic Lipidosis, or Feline Fatty Liver Syndrome

What is the Fatty Liver Syndrome, and how does a cat get it?

The feline Fatty Liver Syndrome (FLS) is also known as feline hepatic lipidosis.  This disease is one of the most common liver diseases seen in cats. The liver is the organ in the body that makes proteins that help deliver nutrients to the body and aid in forming blood clots, among other important tasks. The liver also makes chemicals that aid digestion and detoxifying the body. The liver is a vital part of so many body functions that when it fails, the body cannot compensate.

Bilirubin in the blood and urine gives it this distinctive color brownish-orange to highlighter yellow
Often, a cat that has developed FLS has recently gone through a period of anorexia (not eating).  Sometimes, the period of not eating may seem very short, but in fact, the cat has only been eating tiny amounts, spending a long time at the food bowl, but only licking at the gravy or moving kibbles around, but not really ingesting any actual food. The chances of the FLS occurring are greater if the cat was overweight before the anorexia began.  Because the cat is not eating and taking in nutrients, the body begins to break down fat to supply energy. As fat is broken down to supply nutrients for the malnourished cat, the fat is deposited so rapidly in the liver that it cannot be processed. Cats are highly efficient predators that need a large supply of protein in their diet - they cannot process large amounts of fat. The liver stores the excess fat in and around the liver cells, resulting in liver enlargement and eventual liver failure.  The cat often becomes icteric or jaundiced as evidenced by a yellow color in the whites of the eyes or in the skin.  At this point, the disease will be fatal if not treated rapidly and aggressively.

Other conditions that may result in FLS include illness (such as upper respiratory infections or pancreatitis), periods of stress (moving to a new home, addition of a baby, addition of a new pet), changes in diet, diabetes, kidney disease, cancer, aggressive weight loss attempts by owners, and being lost (away from home and meals).

What are the symptoms?

  • Prolonged lack of appetite (anorexia) or poor appetite – often of several week duration
  • Rapid weight loss
  • Hiding in unusual places 
  • Vomiting
  • Diarrhea
  • Constipation or very small stools in the litterbox
  • Muscle wasting
  • Depression
  • Dehydration
  • Downward flexion of head and neck - more than the usual chin tuck when sleeping
  • Jaundice (e.g., yellowing of eyes or skin)
  • Drooling or nausea
  • Weakness, lethargy or eventual collapse
  • Severe cases may exhibit black tarry stool; bruising (abnormal clotting); abnormal behavior, seizures or coma (from buildup of toxins in the body)
  • Other symptoms will be related to concurrent, underlying disease
  • Eventual death, if untreated
How is it diagnosed?

Large fat deposits around liver cells

Diagnosis of the FLS is made from blood tests for liver function and from a liver biopsy or aspirate.  The latter involves inserting a very tiny needle through the skin and into the liver, removing a small number of liver cells, and examining those cells under the microscope.  The FLS cat will have a large amount of fat in and among the liver cells. 

Common tests that would indicate fatty liver would include liver-specific tests, such as ALT, AST, ALP which are liver enzymes. Additionally, a test for bilirubin would usually be elevated in the presence of this disease, because a functioning liver usually filters bilirubin out of the blood stream to eliminate it from the body. Buildup of bilirubin suggests that the liver cannot filter as it should. Similar tests would include checking cholesterol and ammonia levels. Additionally, cats with FLS are often dehydrated, have electrolyte imbalances, or may be anemic due to lack of nutrients and liver function, so testing to determine the scope of the problem in preparation for IV fluid therapy.

Additional diagnostics will likely be done to identify potential underlying causes of the poor appetite, so kidney function, a complete blood count, or other testing may be recommended. Ultrasound or x-rays may also be recommended. If the cause for anorexia is treatable or resolved, the prognosis is reasonably good.

Is this a treatable disease?

This disease is very treatable, but treatment of the FLS requires that the cat receive nutritional support until the appetite returns.  A consistently high quality diet will allow the liver to resume functioning so it may remove the fat.  This does not occur quickly; it takes an average of 6-8 weeks.  Therefore, a method of force feeding must be used to allow you to feed your cat at home. In most cases, we recommend the placement of a feeding tube in order to administer high-calorie feedings to your cat several times daily with minimal additional stress until the cat is eating well again on his own. Most cats tolerate an esophageal feeding tube very well. The liver has remarkable regenerative properties, so supporting the cat and treating underlying disease while the liver heals can be very effective, if intensive.

IV fluid therapy will help to correct dehydration. Anti-vomiting or anti-nausea medications will help the cat keep the food in his stomach. Appetite stimulants are generally not very helpful on their own in these cases because the cat is too ill to have any motivation to eat.

Approximately 2 weeks of eating 1/2 - 3/4 the normal amount of food is often all it takes to develop a fatty liver. If your cat seems to have poor appetite for more than a day or two, it is very important to have him examined by a veterinarian! If caught early, this condition has an 80-90% recovery rate, but if left untreated, death is the result in 90% of cases.

Additional resources:
Hepatic lipidosis information from Mar Vista Animal Medical Center

Monday, December 1, 2014

Ringworm infection in cats - it's not really a worm!


Ringworm lesion
Generalized ringworm lesions
"Ringworm" is the common name for the skin infection caused by certain types of fungi. Despite the name, ringworm is not caused by a worm at all. The fungi feed upon the dead cells of skin, nail beds and hair. In people, this causes a classic round, red lesion with a ring of scale around the edges and normal recovering skin in the center. Because the ring of irritated, itchy skin looked like a worm, the infection was erroneously named. The fungi responsible are called "dermatophytes," meaning "plants that live on the skin" thus the more correct term for ringworm is "dermatophytosis." The characteristic "ring" appearance is primarily a human phenomenon. In animals, ringworm frequently looks like a dry, gray, scaly patch but can also mimic any other skin lesion and have any appearance. The fungi live in the hair follicles and cause the hairs to break off at the surface of the skin. As the fungus multiplies, small round lesions can become large, irregularly shaped patches of hair loss and spread across the whole body. Most commonly, ringworm is seen in kittens, likely due to their weaker immune system. Ringworm most commonly affects the face, head and ears. Less commonly, the feet, tail and nails are affected, and even less commonly do we see generalized infections covering the entire body. High humidity and large populations of cats tend to increase the risk of ringworm infection, and certain breeds like Himalayans and Persians are at higher risk, as well. You can read about Samson and his battle with ringworm on one of our other blog posts. This may be due to increased difficulty in grooming all the way down to the skin due to large amounts of long thick fur. FIV positive or otherwise immunocompromised cats are also at higher risk. Regular or frequent bathing of cats may remove protective skin secretions that help protect the skin from fungal infection.

There are about 40 different species of dermatophyte fungi. The most common species to infect humans is the Tinea family of fungi. Cats tend to become infected by Microsporum canis, Microsporum gypseum, and Trichophyton spp. Microsporum canis is responsible for up to 98% of dermatophyte infections and is considered "true" ringworm.
Different types of dermatophytes look different on culture medium
The spores of dermatophyte fungi are extremely hardy in the environment; they can live for years. All it takes is skin contact with a spore to cause infection. Infected animals are continuously dropping hairs covered with thousands to millions of spores, because infected hairs become fragile and easily break off and shed into the environment. Some animals (about 20%) are carriers and never show signs of skin irritation themselves, but can infect others readily. Ringworm can be transmitted between people, dogs and cats by direct contact, as well as being picked up from the environment. Environmental “hot spots” for contracting ringworm are schools or daycares, gyms, and the out-of-doors in general. Spores may live in bedding or carpet for 18 months or more. Different species of fungi come from different kinds of animals or even from soil, so determining the dermatophyte species can help determine the source of the fungal infection.

Ringworm lesion in a human
Yes, ringworm is contagious to people; however, some people are at greater risk than others. The fungus takes advantage of skin belonging to those with reduced immune capacity. This puts young animals and children, elderly people and pets, those who are HIV+, people receiving chemotherapy or taking medication after blood transfusion or organ transplant and highly stressed people and animals at high risk. If you have cuts or abrasions to the skin, that allows the fungal spores a better foothold, as normal, unbroken and healthy skin is resistant to fungal infection. In general, if you do not already have ringworm at the time your pet is diagnosed, you probably will not get it, since lesions appear about 10-12 days after infection. If you find suspicious lesions on your body, check with your family physician.

In some cases, we know for sure that dermatophyte fungi are present while in other cases we are only highly suspicious. Lesions on animal skin are rarely the classic ring-shaped as in people (in fact, in animals, lesions are often not even itchy) thus some testing is usually necessary. On many animals, ringworm presents as roughly circular areas of broken hairs or bare skin, often with scaly, inflamed skin. Sometimes, ringworm infections can look almost identical to flea allergy dermatitis or other skin diseases. Hair loss is usually involved, but the degree of itchiness and inflammation is highly variable.

Hair shaft fluorescence under Wood's Lamp
Microsporum canis, the most common ringworm fungus, will fluoresce apple green in approximately 50% of cases. Fluorescence is an easy test to perform and may provide a strong clue that dermatophytes are present. Further testing is usually needed, however, to absolutely confirm diagnosis. It is important not to mistake scabrous material, dust particles and free-floating skin flakes as fluorescence. If the fluorescence is present, it will light up along the hair shafts at the edge of the lesion.

Your veterinarian may wish to examine some hairs for microscopic spores. If spores can be seen on damaged hairs then the diagnosis of ringworm is confirmed; however, as spores are very difficult to see, many veterinarians skip this step.

For a fungal culture, some hairs and skin scales are placed on a special culture medium in an attempt to grow the ringworm fungi. The advantage of this test is that it not only can confirm ringworm but also can tell exactly which species of fungus is present. Knowing the identity of the fungus may help determine the source of infection. The disadvantage, however, is that fungi require about 10 days to mature to the phase where they can be identified by their special "fruiting bodies" and spores.
Also, this is the only test that is helpful in determining if animal is an asymptomatic carrier. The other tests require an apparent skin lesion to test. A pet with no apparent lesions can be combed over its whole body and the fur and skin that are removed can be cultured. Carrier animals are usually cats living with several other cats.
Characteristic growth and media color change on fungal culture

Sometimes the lesions on the skin are so uncharacteristic that a skin biopsy is necessary to obtain a diagnosis. Fungal spores are quite clear in these samples and the diagnosis may be ruled in or out. Depending on the outcome of preliminary tests, your veterinarian may begin ringworm treatment right away or postpone it until after more definitive results are available.

Commitment is the key to success especially if you have more than one pet. Infected animals are constantly shedding spores into the environment (your house) thus disinfection is just as important as treatment of the affected pet. Areas of hair loss will likely get bigger before they get smaller. Within 1-2 weeks, hair loss should stop, there should be no new areas of hair loss, and the crusting on the skin should subside. If any of these do not occur within 2 weeks, we should see your pet again. Infected pets generally remain contagious for about 3 weeks after treatment begins.

There are two primary medications being used to treat ringworm: Griseofulvin and Itraconazole (brand name "Sporonox"). Veterinary dermatologists disagree as to which is better. Both medications are relatively expensive, must be given with food, and have significant potential to cause birth defects in pregnant pets.
Treatment with either medication typically is continued for 1-2 months and should not be discontinued until the pet cultures negative. Stopping when the pet simply looks well visually frequently leads to recurrence of the disease.
Characteristic Microsporum fungal macroconidia and spores

GRISEOFULVIN (brand name Fulvicin)
This medication must be given with a fatty meal in order for an effective dose to be absorbed by the pet. Persian cats and young kittens are felt to be sensitive to its side effects which usually are limited to nausea but can include liver disease and serious white blood cell changes. Cats infected with the Feline Immunodeficiency Virus commonly develop life-threatening blood cell changes and should never be exposed to this medication. Despite the side effects, which can be severe for some individuals, Griseofulvin is still the traditional medication for the treatment of ringworm and is usually somewhat less expensive than Itraconazole.

This medication is highly effective in the treatment of ringworm but is available in capsules far too large to be useful to most small animals. This means that a special compounding pharmacy must reformulate the medication into a more useful size. Nausea is a potential side effect for this medication, but otherwise, side-effects are fewer than with Griseofulvin. The primary reason it is sometimes passed by in favor of griseofulvin is expense. Itraconazole is also effective in treating many life-threatening fungal infections whereas Griseofulvin only treats ringworm.
By increasing the amount of Itraconazole in the environment, we may be creating resistance in more dangerous fungi which could become a problem over the years. On the average, cats treated with Itraconazole and nothing else were able to achieve cure two weeks sooner than cats treated with Griseofulvin.

In the late fall of 2000, the Journal of the American Veterinary Medical Association published a study of over 200 cases indicating that Lufenuron (the active ingredient of Program) could be an effective treatment for Ringworm. This began as an observation that animals using Program or Sentinel for flea control did not get ringworm. Questions about this work have come up from the public since the release of this work. The fact is that the study is still under scrutiny by members of the American College of Veterinary Dermatology and “the jury is still out.” It is clear that the doses purported to be helpful with Ringworm should not be harmful. At this time the use of Lufenuron for Ringworm is reasonable if other more conventional treatments are used at the same time, but its efficacy is controversial and it should not be considered as the only method of treatment.

Both the above medications work by interfering with fungal reproduction rather than by directly killing the fungus. This is fine from the pet's perspective as either medication should be able to clear the fungus without further therapy; however, we also would like to reduce contamination of the environment. This means actually killing the fungus on the pet so that the hairs dropped will not be infectious but applying topical therapy. For many years cats with ringworm lesions were shaved to allow for easier topical treatment. We now know that shaving may be spreading the fungus by creating microabrasions on the skin and allowing the spores to take hold in new locations, or simply by spreading spores across the body as the clippers are moved from one area to another. Because of this, shaving is not always recommended (depending on the number of cats present in the home and the length and thickness of the hair).
Ringworm lesions on an ear

Dips are recommended twice a week and can be performed either by the hospital or at home. If you attempt this kind of dipping at home, you should expect:
  • Lime Sulfur will stain clothing and jewelry
  • Lime Sulfur will cause temporary yellowing of white fur
  • Lime Sulfur smells strongly of rotten eggs.
The dip is mixed according the the label and is not rinsed off at the end of the bath. The pet should be towel dried. Shampooing is not necessary.

The problem with decontaminating the environment is that very few products are effective. Bleach diluted 1:10 will kill 80% of fungal spores with one application and any surface that can be bleached, should be bleached. Vigorous vacuuming and steam cleaning of carpets will help remove spores and, of course, vacuum bags should be discarded. To reduce environmental contamination, infected cats should be confined to one room until they have cultured negative. The rest of the house can be disinfected during this confinement period.

In 1994, Fort Dodge released a vaccine which could be used either in the prevention of ringworm infection or in its treatment. Our hospital does not recommend the use of this product as, while it may prevent the development of obvious lesions in a cat, it probably will not prevent infection. This means that vaccinated cats could more easily become carriers of infection. The vaccine does not appear to be available any longer (since 2003), and was meant to be used in a treatment situation where many cats were infected. It was designed as a supplement to the treatments described above rather than as a preventive for cats in general.

There have been several studies which showed that this fungal infection should eventually resolve on its own. Typically, this takes four months, a long time in a home environment for contamination to be occurring continuously. We recommend treatment for this infection rather than waiting for it to go away.