Feline Urinary Tract Disease

One of the most common conditions I see in cats is called lower urinary tract disease. The following is information from the Cornell University Feline Health Center and the American Veterinary Medical Association that describes the signs, causes and recommendations for preventing this condition.

Lower urinary tract disease (FLUTD) describes a variety of conditions that affect the bladder and urethra of cats. Cats with FLUTD most often show signs of difficulty and pain when urinating, increased frequency of urination, and blood in the urine. Cats with FLUTD also tend to lick themselves excessively and may urinate outside the litter box, often on cool, smooth surfaces like a tile floor or a bathtub.

While FLUTD can occur at any age, it is usually seen in middle-aged, overweight cats that get little exercise, use an indoor litter box, have little or no outdoor access, or eat a dry diet. Factors such as emotional or environment stress, multi-cat households, and abrupt changes in daily routine may also increase the risk that a cat will develop FLUTD.

Major Signs of Lower Urinary Tract Disease include:

• Straining to urinate
• Frequent and/or prolonged attempts to urinate
• Crying out while urinating
• Excessive licking of the genital area
• Urinating outside the litter box
• Blood in the urine

Note that cats with a urethral obstruction will also show these signs but will pass little or no urine and become increasingly distressed. A urethral obstruction is an emergency and requires immediate veterinary treatment. (See section on Urethral Obstruction.)

Becasuse FLUTD has many causes, it can be difficult to diagnose. Based on your cat's symptoms, your veterinarian will do a physical examination and most likely will run a urinalysis. If the cause is still not identified, tests such as bloodwork, x-rays, and additional urine tests may be recommended.

One possible cause of FLUTD is the formation of urinary stones, also called uroliths. These are collections of minerals that form in the urinary tract of cats. X-rays or ultrasound are usually needed to diagnose urinary stones

The most serious problem associated with urinary function is when a cat's urethra becomes partly or totally blocked. Urethral obstruction is a potentially life-threatening condition caused either by urethral stones or by urethral plugs (the latter are made of a soft material containing minerals, cells, and mucus-like protein).

Male cats (neutered or intact) are at greater risk for urethral obstruction than females because their urethra is longer and narrower. This is a true medical emergency, and any cat suspected of suffering from this condition must receive immediate veterinary attention

Feline idiopathic cystitis (FIC)—also called interstitial cystitis—is the most common diagnosis in cats with lower urinary tract disease. The disease is not fully understood and may involve several body systems in addition to the urinary system.

Fortunately, most cats recover from FLUTD and never, or only occasionally, develop it again. In some cats, however, the condition often reoccurs. To help reduce the chances of recurrence:

• Feed small meals on a frequent basis.
• Consult with your veterinarian about the best diet for your cat. Many commercial diets are acceptable, but some urinary conditions respond better to specialized diets.
• Provide clean, fresh water at all times.
• Provide an adequate number of litter boxes (usually one more than the number of cats in the household).
• Keep litter boxes in quiet, safe areas of the house.
• Keep litter boxes clean.
• Minimize major changes in routine.

Pain and Pet Care

One of the most important questions I am asked in my practice has to do with quality of life issues.  The most important aspect of that quality is living a pain free life. It is important to understand where pain originates and how to evaluate the symptoms that are exhibited by a pet in pain.

Historically it was thought that animals did not perceive pain the same way as humans.  Additionally, it was suggested that pain following surgery or injury was beneficial to animals because it limited movement and thus prevented further injury.

Today there is a better understanding of how pain develops. It is now well established that animals and humans have similar neurological pathways for the development, conduction, and modulation of pain. 

Preventing risk factors early in life reduces the development of pain later in life. For example, providing lifelong dental care reduces the development of oral pain caused by periodontal disease. Preventing obesity reduces the incidence and severity of osteoarthritis in breeds prone to hip dysplasia and the risk of intervertebral disc disease in breeds such as the dachshund.

When I examine a pet, I always check the following organ systems and locations that can become  sources for pain:

The heart can have congestive heart failure and create risk for blood clots. The skin is involved with ear infections, burns, wounds, abscess, urine scalding and severe itchiness.

 Dental pain comes from abscess, ulcers, oral tumors and periodontal disease. The abdomin can reveal constipation, anal sac disease, pancreatitis, obstruction and foreign bodies. Pain involving muscle and bones include arthritis, disc disease, trauma, tendon and ligament injuries.

 We see pain originating from eyes with corneal lesions, ulcers, glaucoma and conjunctivitis. In the urinary tract, bladder and kidney stones, bladder infections and urethral obstruction in cats can all result in pain.

In addition to the above, neurological causes for pain include spinal pain from disc diseases and neurological consequences of diabetes. Cancer in any form is a source of pain.

One general sign of pain is a change in normal behavior. This includes lameness, lethargy, decreased appetite, decrease in grooming, and a decrease in movement or activity.

The expression of abnormal behaviors can be a sign of pain.  Vocalization, inappropriate elimination, decreased interaction with family members and other family pets, altered facial expression, restlessness, pacing, hiding and changes in posture all fit in the definition of abnormal behaviors that can result from painful conditions.

The reaction to touch or palpation is another potential sign to look for when trying to determine levels of pain.  This can be seen as a tightening or increased body tension when gently touching certain body parts like the abdomen or limbs.

Other symptoms of pain are reflected by physiological parameters.  These include a more rapid heart and respiratory rate, increase or decrease in body temperature and dilation of the pupils.

We have the ability to mitigate the consequences of pain and improve the quality of life of our pets by having an awareness of ways to prevent the diseases that cause pain and determining the cause of pain when it appears. Your veterinarian has the ability to diagnose the source of the pain and select a treatment regimen, which can include a choice of several drugs or surgery that can alleviate the discomfort and hopefully cure the disease which is causing it.

Dog Flu Vaccination

Recently, there has been considerable discussion about influenza, particularly H1N1 (swine flu) and whether it can be transmitted to pets, and H3N8, the canine-specific version of influenza, commonly called “dog flu”.

There is a possibility that the H1N1 (Swine Flu) virus can be transmitted from people to pets.  At this time, there are only several confirmed cases.  However, if H1N1 is diagnosed in a household, the pet should be isolated from the affected family members.

Canine influenza is different than H1N1 and is a highly contagious respiratory infection of dogs caused by a novel influenza (H3N8) virus that was first discovered in 2004.  In May, 2008 a vaccine was introduced to protect dogs against this respiratory virus.  

Vaccines are tested for their effectiveness by the USDA.  In this case, the license is  conditional. This means that based on data submitted to the USDA, a reasonable expectation of efficacy is supported.  However, regular licensing will not be awarded until some time later this year. During this time, the vaccine’s effectiveness and side effects will be evaluated.  The data provided to the USDA was provided by tests funded by the manufacturer.

 It is difficult to diagnose this infection because the most common tests are not accurate after the dog stops shedding the virus.  This usually occurs before there are symptoms of the disease and before a veterinarian sees the animal as a patient. Canine Influenza Virus (CIV) cannot be easily distinguished from other causes of respiratory disease in dogs.  Other infectious agents cause similar signs.  Some of the common symptoms are coughing, sneezing, fever, loss of appetite, lethargy, nasal and ocular discharge.  

Based on the difficulty in differentiating this disease entity from other bacterial and viral causes of respiratory disease and in consideration of the fact that it is usually a mild disease, I recommend the following:

If a dog is in a communal housing environment with other dogs such as shelters, boarding kennels, pet shops and breeding kennels, vaccination could be beneficial.

When adopting a pet, isolate it from other pets for 10 days to reduce the risk of spreading any of the pathogens that cause respiratory disease.

Canine influenza has been documented in 30 states and the District of Columbia. The canine influenza virus (CIV) is prevalent in many communities in Colorado, Florida and New York.  At this time, we should be guarded but not  overly reactive to the threat of Canine Influenza Virus.

 This vaccine is not required for household pets with little risk of exposure.   The infection is usually mild and self limiting.  The most common signs are dry or moist cough which are not helped by antibiotics or cough suppressants. 

 Most dogs recover within 2 weeks without any further health complications. However, some dogs progress to pneumonia, which is usually due to secondary bacterial infections. While the overall mortality rate for canine influenza is low, the secondary pneumonia can be life‐threatening. There is no evidence for age or breed susceptibility for developing pneumonia.

There are certain vaccinations that are given to dogs that are considered “core” vaccines. These are given to pets when their value has been proven and the benefits far outweigh any risk.  Other vaccines are considered “lifestyle” vaccinations based on the possibility of exposure to a disease.  An example of a core vaccination is the rabies vaccine.  

At this time, the Canine Influenza Vaccination should be considered a “lifestyle” vaccination.  Check with your health care provider to keep abreast of any changes in the prevalence of this disease in our geographic area.

Caring For Pets in Cold Weather

As we go about our wintry business, shoveling snow, going

for a brisk walk on the beach or just racing from car to

home, we have prepared ourselves for the adversity and

stresses of cold weather. However, it is important to

remember that certain categories of pets have special needs

during this time of year, and all animals can suffer from

hypothermia and frostbite in the worst of conditions.
  Breeds like the Newfoundland, Husky and Saint Bernardlove the snow. When in good health, only extremes in climate change will affect them. Make sure your companion pet does not have a special need in relationship to the cold. The geriatricpatient has far less tolerance and it is always a good idea to have a recent medical examination to evaluate what stresses should be avoided. Conditions like heart disease,kidney failure,diabetes and hormonal imbalances can compromise your pets ability to withstand the stress of cold weather.

When you walk your animal companion, when it gets too

cold for you, consider the conditions the same for her.

Small pets will find themselves immersed in snow and will

require special attention. Those pets with short coats will

require coats in very cold weather. Locally, many pet stores

like Pet Smart and Petco carry coats, as well as the pet

departments in discount stores like Walmart and Target.

The Dog Spa has some pretty snazzy choices too. However,clothing alone is not always a safe alternative in extreme

cold. Dogs loose most of their body heat through their paws,

ears and respiratory tract.

Beware of certain dangers that exist because of special

circumstances created by the cold. The cat that snuggles up

against a warm car engine is at risk as it will not be seen by

the driver starting a car, and a frozen pond or lake creates a

hazard to the dog running off-leash during a thaw. Once an

animal falls thru the ice, it is very difficult to get out, so pay

special attention when near frozen bodies of water and keep

pets on a leash.

There are unusual threats that exist inside the home during

cold spells. The space heater and the fire place can create a

hazard to the dog or cat that snuggles up to them, failing to

realize that a paw or tail could get burned. The potential of

knocking over a space heater is something that pet owners

should be aware of.

When outdoors, there are certain symptoms which may

indicate that frigid conditions are causing a problem. If he

or she whines, shivers or stops moving, your dog may be

feeling the effects of hypothermia (below normal body

temperature). Never leave a dog unattended outside when

the mercury drops. It is obvious that sources of water could

be unavailable and worse, serious conditions such as

hypothermia and frostbite can occur.

Hypothermia occurs when a pet’s body can not regulate it’s

temperature due to extreme cold and drops below normal.

Depression, shivering and an unwillingness to walk will be

seen. As her temperature falls below normal she will

breathe more slowly, her heart rate will slow and she will

respond to stimuli slowly. Pets that show these symptoms

should immediately be taken into a warm environment and

wrapped in a blanket with a hot water bottle or with an

electric blanket.

A less common condition is called frostbite. It occurs in

pets and people when the body is exposed to extreme cold.

In an attempt to protect itself, the circulatory system shunts

blood from the extremities into the core of the body for

warmth. Deprived of the movement of blood, ice crystals

form in the paws, ears and tail. These crystals damage the

tissue. If you suspect frostbite, immediately bring your pet

into the warmth and soak the affected parts in warm water

for 20 minutes. Do not rub the suspected areas as this will

cause tissue damage.

Once you have done the above, take your pet to your

veterinarian. She or he will administer pain medications

and possibly antibiotics.

The winter is a great time to share outdoor activities with

your pets. For many of us, it serves as an incentive to leave

the warmth and comfort of our homes and discover the joy

of walking a solitary beach or feeling the pleasure of a brisk

walk in the woods. With a little care and forethought, the

risks of the cold can be prevented.

Holiday Safety Concerns

This a favorite time of year for all of us and our pets. There are abundant treats available and lots of food left over after big meals. Additionally, unusual plants and tree decorations abound. Unfortunately, some of these represent unusual hazards that could interfere with the joy we share during the holidays. I have described a few of these in previous articles, however, this time of year I would like to share a more comprehensive list of potential health hazards with you.

1. Christmas Trees: The christmas tree water may contain preservatives and fertilizer. If consumed by

pets, it will cause an upset stomach. Stagnant water at the base of the tree can also be a breeding ground for bacteria. Consumption could lead to vomiting,diarrhea and nausea. Christmas tree ornaments,ribbons and tinsel can be dangerous because they can cause an obstruction in the intestinal tract if consumed.

2. Holiday Plants: Pets who ingest holly can experience gastric upset. Mistletoe has it’s romantic side for us humans and could even cause a harmless heart palpitation under the right circumstances, however,for dogs and cats the cardiovascular problems are nota joke and gastric upset is also a side affect. For cats,all parts of lilies are toxic. Even in small amounts, theycan cause life threatening kidney problems. Poinsettia is less toxic than commonly believed, however,ingestion can cause mild stomach upset.

3. Beverages: Holiday beverages containing alcohol cancause vomiting, diarrhea, incoordination, central nervous depression, tremors and even potential comaand death. Carefully monitor the availability of sweetholiday drinks and beverages like egg nog. Coffee can cause agitation, rapid heart rates and vomiting.

4. Chocolate, Macadamia Nuts, Grapes and Raisins:Chocolate can cause cardiac and neurological symptoms,macadamia nuts cause weakness in the limbs,vomiting , and temors. Grapes and raisins have been documented as causing acute kidney failure in dogs. These are all foods that appear harmless and therefore could be left out or unattended in the presence of our pets.

5. Yeast Dough: Cookie and cake dough can be attractive edibles to our pets. Uncooked dough can swell in the stomach and cause extreme discomfort, bloat and depression. Sometimes it is necessary to remove the swollen contents surgically.

6. Bones: Poultry bones can splinter and cause damage

or blockage in the intestinal tract. This happens less

frequently than one might imagine, however, when it

does occur it is life threatening. Personally, I do not

like to see our pets consume any kind of bones. I have

seen large bones slowly chipped away and accumulate

to cause large obstructions in the stomach of a patient.

7. Fatty Food: Excessive fat in the diet can cause

inflammation of the pancreas. When this occurs,

digestive enzymes leak out of the pancreas and into the

abdominal cavity. It is an extremely painful and

potentially fatal condition. For this reason, I

recommend that you very carefully separate any fat

from food leftovers that you might be inclined to feed.

The holidays are a period for sharing joy with our

families and pets. The above list represents some

hazards that could interrupt this happy season. If your

pet ingests the above harmful substances, call your

veterinarian at once for advice. If not available, Angell

Animal Medical Center has an Animal Poison Control

Hotline: 877-2-ANGELL. Jacqie and I wish you and your

pets a happy and healthy holiday

The Influence of Pets in My Life

Some animals come into our lives as blessings.   These pets change us and teach us, and sometimes we understand the profound nature of the relationship only after they leave us.   For me, one such creature was a horse named Snowbird.  Snowbird was just one in a menagerie of  animals that have left me with a wealth of shared experiences and insights.

To understand the influence animals like Snowbird have had on me, many of you can reflect on your own experiences with special pets.  Over the years she was one of a myriad of pets that shared different passages and evolutions. In a previous article I described her influence on me.  Below are the other creatures that blessed my life as a child growing up in the suburbs, one who was my roommate during my college years and the several pets Jacqueline and I have shared.

My experience with pets started as a child living in suburbia with parents who both worked.  An English springer spaniel named Bootsie was my companion in a frequently empty household and my bond to her served as an inspiration for what was to become my profession, veterinary medicine.

 During my university years, an Irish setter named Nina was my constant companion.  After graduating from veterinary college, I joined the U.S. Air Force and was sent to Southern Italy as a military public health officer. At the time,  I had to leave Nina and my girl friend behind. When I returned two years later, my girl friend had moved on but Nina was waiting.  A lesson in unconditional love; at least I was batting 500.

Nina stayed in my life for many years.  We drove across the country and had a scrapbook of experiences to share ala John Steinbeck in his wonderful book “Travels with Charlie”.  

Nina remained with me while I ran a small animal practice in New York City. At the time, NYC was becoming less inhabitable and I ventured on a quest which turned out to be the journey of a lifetime. I left all my material   possessions behind, and researched and implemented a driving expedition accross Africa, living alongside desert nomads, camping alongside ancient species of animals and living with native tribal people who embraced me as part of the universal community of man.  Having to cross many borders, some with potentially life threatening  pitfalls for a pet, I had to leave Nina behind.

When I met my wife, Jacqueline, I inherited a new round of what we might call “step pets”. There was Buzz Bomb, a Doberman Pincher puppy  with every inherited disease known to veterinary medicine.  Also included in Jacqueline’s menagerie was Otis, a finger biting skunk and Katie, a delightfully neurotic parrot. 

Buzz Bomb taught me to respect each animal as an individual and not to accept stereotypes given to certain breeds.  He became our first “child”, and frankly we were silly in love with him.  Some see Dobermans as threatening, while in fact, Buzz Bomb was the gentlest creature imaginable.   We would be entertained by what we called the “Buzz Bomb-Otis show”.  Can you visualize the hysteria that ensues when a skunk named Otis chases a Doberman Pincher around the house?.

Treating the Pain of Arthritis in Dogs

The number one cause of chronic pain in older pets is osteoarthritis. In our practice, it is very common and it is important to treat it as a disease.  Consideration must be  given to the mode of the treatment because there are important factors that must be determined in designing a treatment that is effective and causes the least amount of side affects.

The best way to treat arthritis in the older pet is through a multi-modal approach.  This simply means considering a way to treat the pet that requires the minimum amount of pharmaceutical drugs. 

The first part of this approach is weight control. Excess weight contributes to a shorter life span and causes additional stress on the joints. Weight loss and management is accomplished through a reduction in calories and exercise. Obese dogs have more osteoarthritis and require more medication to control the pain that is associated with arthritis.

The second part of my approach to treating chronic pain due to arthritis is eliminating other causes of weight gain and making certain that the drugs used for pain relief will not be harmful.  The first test that is employed is for hypothyroidism.  We know that dogs that have thyroid disease gain weight.  Once that is established, we test for liver and kidney function and rule out diseases like diabetes.

The next part of the module is nutritional support. The dog is unique in the way that certain essential fatty acids are stored in the cells that make up the tissues in the joints. This is a variation from the process in cats and even humans. Studies have proven that the supplementation of omega 3 fatty acids actually slows down the degradation process in the joints of dogs. When we add      essential fatty acids to the diet we not only slow down the degradation process, but we also know that these essential fatty acids actually act as anti-inflammatory agents and may let us use a lower dose of the drugs that reduce the pain of arthritis.

There are several ways to provide this nutritional support. Essential fatty acids can be given in liquid or capsule form. There is a prescription diet available that combines this supplement with Glucosamine and other nutraceuticals that has proven to be very effective. The level of essential fatty acids is excellent and makes this an economical and convenient choice.

Exercise is another important consideration.  The correct ratio of exercise to rest is important in arthritic patients.  Exercise must not be excessive as this places additional stress on the joints.  At the same time, we must make certain that the muscles that support the joints do not degenerate.

The next part of the multi-module approach is through the use of  drugs called non-steroidal anti-inflammatory pharmaceuticals. (NSAIDS).  You are familiar with ibuprofen (Advil) and a host of other drugs used in human medicine.  Unfortunately, many of these are responsible for unacceptable side affects in dogs. The good news is that there are several drugs which have been developed for use in pets that are very effective.  It is important to remember two facts when administering these drugs.  First, different drugs work differently on individual patients, so a trial can be helpful.  Second, the amount used can usually be reduced by nutritional supplementation.

The older patient with arthritis can have an enhanced quality of life through the use of a multi-module approach of weight control, exercise, nutritional supplementation and the appropriate use of NSAIDS.  Consult with your veterinarian to learn how your older pet can live a longer and happier life.