When a cat has been scheduled to have a procedure that requires an anaesthetic to be administered, the following instructions should be followed.

1. Do not allow your cat to eat after 8 pm the night before the procedure.
2. Water is allowed up until admission.
3. Bring your cat in at the arranged time.
4. Advise us of any problems your cat has had with anaesthesia in the past.
5. Advise us of any drug allergies your cat has.
6. If your cat is receiving medications ask us prior to giving them on the morning of the procedure. If in doubt DO NOT give the medication and advise us at admission.

In order to minimise the risks of anaesthesia our staff use only the best anaesthetic agents and equipment. Our staff will closely monitor the cat before, during and after the procedure. In some cats it is necessary to shave areas of fur for the placement of drips and some of the anaesthetic monitoring equipment. The areas that are often shaved are on the front legs, the wrist and under the tail. If blood tests need to be taken there may also be a shaved area under the neck. If a surgery is being performed there will be a large amount of fur shaved around the surgery site. Ultrasound examinations will also need to have fur shaved.

We routinely measure heart rate, breathing rate, blood oxygen levels, breath carbon dioxide levels, gum colour and refill, blood pressure and depth of anaesthesia. Measuring all of these allows us to identify and correct any abnormalities that can arise during anaesthesia before they become a problem. Despite taking all precautions it is possible that complications, including death, can still occur in very rare circumstances.

Cats discharged the same day anaesthesia was performed may still be slightly sedated when arriving home and should be confined inside in a warm quiet environment for the first night. All signs of sedation should be gone in less then 24 hours.

Unless advised otherwise, cats may be offered a small meal and water when arriving home. Many cats have “shrunken” stomachs from being fasted and will vomit if allowed to eat a large meal immediately. Don’t be alarmed if they are not interested in food that evening but if they are not back to normal the following morning then it is best to contact the clinic.

If you have any questions about your cats anaesthetic or procedure, please feel free to ask.

Measurement of blood glucose concentration (BG) is usually the best method of determining the correct insulin dose for diabetic cats. Stress hyperglycaemia occurs commonly when cats visit a veterinary surgery and can result in the wrong dose of insulin being selected. Thus, the stress-free environment at home is the best place to measure a cats BG.

Most human glucometers are very accurate at measuring cat blood. We prefer the Accu-Chek brand which can be purchased from any chemist for approximately $60.

The easiest and safest place for owners to sample blood from is the ear veins. Cats have small veins that run around the outside of their ears and these veins can be easily accessed from the dorsal surface. Blood can be sampled on both the cranial and caudal border of each ear giving a total of 4 sites to sample. Shaving the hair directly over the vein with a scalpel blade allows much better visualisation and with very slow hair regrow, will last for many weeks.

Procedure
1. Turn the glucometer on or insert test strip so the digital display is requesting blood.
2. Hold the edge of the ear between index-middle finger and thumb-fourth finger and firmly pull taut.
3. Quickly prick the vein with an insulin needle so a small drop of blood is produced on the skin surface. Pre-used insulin syringes are fine to use for this.
4. Bring glucometer down to the skin and place the end of the test strip into the blood until it beeps.
5. Read the number on the display and record it.
6. Wipe any excess blood away with a moist tissue.

Cats rarely react to their ears being pricked but topical anaesthetic creams such as EMLA can be applied prior to sampling if required. The most common complaint from owners is spraying of blood around the house if they shake their heads while blood is pooled on the skin. This can be minimised by not releasing the initial grip on the ear until blood has been transferred (with one hand) to the glucometer and a tissue applied to the ear.  Blood glucose samples are best collected just before an insulin dose is due so dose adjustments can be made immediately if required rather than waiting until the next injection.

Selecting insulin dose
For newly diagnosed diabetic cats (less than 2 months):
If BG is above 12mmol/L then increase insulin dose 0.5 units (half a unit)
If BG is between 6 and 11mmol/L then keep insulin dose the same
If BG is between 3 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 3mmol/L then don’t give insulin and call the clinic to discuss

For longer-term diabetic cats (more than 2 months of insulin therapy):
If BG is above 25mmol/L then increase insulin dose 1 units
If BG is between 14 and 25mmol/L then increase insulin dose 0.5 units
If BG is between 6 and 13mmol/L then keep insulin dose the same
If BG is between 4 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 4mmol/L then don’t give insulin and either check for remission or call the clinic to discuss.

How often to sample
Ideally, diabetic cats should have BG sampled several times daily (just like humans do) but for many reasons this is not practical. We recommend that newly diagnosed cats should have their BG checked every 2-3 days for the first few weeks and longer-term diabetic cats be sampled every 1-2 weeks. If insulin dose is changed, then a repeat BG should be done 2-3 days afterwards to check the right decision was made, whereas if the insulin dose is kept the same then a repeat BG is probably not required for 1-2 weeks.

Record keeping
A table should be kept which contains the date, current insulin dose, the BG reading and the new insulin dose selected. Initially, this table should be reviewed by a veterinarian in consultation every few weeks. Your veterinarian will assess the BG readings and the decisions you have made and comment as necessary. Most owners rapidly become competent at sampling blood and selecting the correct insulin dose making it unnecessary to consult us for long periods.

An abscess is a collection of pus.  In cats, abscesses are common after a cat fight. Cats are territorial animals, and will fight with other cats to defend their territory. If your cat gets bitten during a fight, bacteria from the other cat’s teeth infect the wound and cause an abscess.

Bites are most common around the face and shoulders or around the rump and tail.

If you know your cat has been in a fight, have him or her checked out by a veterinarian. If your cat starts taking antibiotics within 24 hours after the fight, you may be able to keep an abscess from forming.

Symptoms

Abscesses usually appear two to seven days after your cat gets bitten. Usually, your cat will act like he is not feeling well. He may be listless and not eating well.  She may be cranky, especially if she is touched where her injuries are.  She could feel warm and have a fever.

If you gently probe where the cat is tender (put rubber gloves on for this—you could get a nasty surprise), you may feel a soft, warm lump. If the abscess has burst, you will find an open wound that is draining pus. Some of the skin around the abscess may have died from the pressure created by the pocket of pus.

Treatment

Abscesses are treated with surgery to flush out the pus and cut away any dead skin. Small latex drains may be inserted to drain the pus out so that the wound can heal.

Your cat will also need to take antibiotics to fight the infection that is causing the abscess.

Post-operative Care

You will need to continue to care for your cat after you take her home. You will need to:

• Gently tug at the drains twice a day.
• Remove any scab that forms twice a day. This is extremely important so that the wound stays open and the pus can drain out.  If necessary, you can soak the area in warm salty water (1 teaspoon of salt to 1 litre of warm water) to make it easier to remove the scab.  Neither you nor your cat will enjoy this procedure.
• Keep your cat indoors. He may need to wear an Elizabethan collar to keep him from chewing the drains out.  Keep him indoors so that you can make sure he doesn’t get the collar off or get in another fight.
• Make sure your cat takes all the antibiotics. Follow the directions on the packet.
• Call your veterinary if you think the wound is not healing correctly, or if you have any other concerns.

Preventing Future Abscesses

Most abscesses are caused by cat fights, so the best way to prevent them is to keep your cat from fighting. You can do this by:

• Keeping your cat indoors as much as possible, especially at night. More cat fights happen at night.
• Get your cat neutered. Male cats fight more than females, and they fight over territory and females. Neutered males don’t get in as many fights.

If you think your cat has been in a fight, take him to the vet as soon as possible. You can prevent abscesses from forming by getting early treatment for any injuries.

FIV (Feline AIDS) Infection

Cats spread FIV through bites and scratches. Any time he has a cat fight wound, your cat may be exposed to Cat Aids.  We recommend a blood test 2 months after the injury to see your cat has contracted FIV.

We strongly recommend vaccination against cat aids (FIV) for all cats that go outside. Please contact us for more information or to arrange a vaccination.

What causes chronic upper respiratory tract disease?

Chronic upper respiratory tract (URT) disease is a relatively common problem in cats, and can have many causes. The most common form is termed chronic post viral or idiopathic rhinitis. In this condition viral infection (e.g. cat ‘flu - caused by feline herpes virus or feline calici virus) causes the initial mucosal damage; but the chronic signs relate to secondary bacterial infection of the damaged nasal passages. This may then lead on to chronic osteomyelitis of the turbinate bones and cartilage (bacterial infection of the fine bones within the nose).

More unusual causes include:-

1.       Fungal infections including cryptococcosis.

2.       Inflammation which can result in polyps of inflammatory tissue.

3.       Neoplasia (cancer) which can be localised within the nose, or be part of more widespread disease.

4.       Physical damage which can result from foreign objects getting stuck up the nose, facial trauma (e.g. from cat bites or car accidents), or be associated with severe dental disease.

What are the clinical signs of chronic URT disease?

The main signs are nasal discharge and difficulty in breathing i.e. chronic ‘snuffles’. The exact nature of the discharge, whether both sides of the nose are affected, and the presence of other clinical signs are dependent on the exact nature of the disease process occurring within the nose, and on the presence of any other illness the cat may have.

In order to determine the extent and nature of the disease it is important that the cat be given a thorough physical examination by a veterinary surgeon. Particular points that the vet will look for include:-

1.       The presence of nasal discharge, and whether it is bilateral (affecting both sides of the nose) or unilateral (affecting only one side of the nose). Some diseases tend to show unilateral signs (e.g. foreign bodies, or cancer), while others more often cause bilateral signs (e.g. chronic post viral rhinitis, cryptococcosis).  The type of discharge can also be important; whether it is clear, purulent (pus), or blood stained. Although the presence of a discharge can be helpful in making a diagnosis, it can on occasion be misleading.

2.       Facial swelling may indicate a more serious underlying problem such as cancer or fungal infections arising within the nasal chambers. Although facial pain is seen rarely, resentment of facial examination is common among cats with URT obstruction, especially those with intranasal foreign bodies, or polyps.

3.       Sneezing, difficulty in breathing, noisy breathing and mouth breathing may all be seen, but their presence is usually of little diagnostic value.

4.       Examination of the eyes may reveal ocular discharge ‘runny eyes’, usually resulting from tear duct damage associated with previous URT viral disease or post viral conjunctivitis, but occasionally associated with cancer within the nose. Another legacy of URT viral infection can be the development of chronic inflammation of the cornea (the clear front part of the eye).

5.       Evidence of painful or infected ears may be associated with inflammatory polyps. Cats with polyps may have problems eating if the polyps are large enough to cause obstruction at the back of the throat, and these cats often have a snoring type of breathing.

6.       Cats with URT obstruction often have a poor appetite and so experience a degree of weight loss. Marked weight loss is more suggestive of cancer, fungal disease or severe systemic disease.

7.       The size and shape of the kidneys may be altered if certain cancers are present.

8.       Mild to moderate enlargement of the lymph nodes (glands) at the angle of the jaw is common, resulting from a local inflammatory response. If the lymph nodes become very large, or if lymph nodes elsewhere in the body are also affected, cancer or fungal infections are most likely to be the cause.

Over-interpretation of clinical signs can be very misleading since different diseases can give rise to similar signs. However, a few general rules do apply, e.g. facial deformity (changes in face shape) with associated pain, especially if accompanied by a unilateral nose bleeds or marked lymph node swelling is suggestive of more serious underlying problems such as nasal cancer or fungal disease. Lack of these clinical signs does not rule out these diagnoses as some cases of nasal lymphosarcoma (a common type of cancer) can cause bilateral nasal obstruction and little nasal discharge of any kind. Although post viral rhinitis usually presents as chronic bilateral purulent discharge, it can also result in unilateral discharge, sometimes blood tinged and occasionally with severe nose bleeds after ‘sneezing fits’.

Does the history of the cat make a difference to the likely diagnosis?

Yes. It is very important to know the answers to a number questions relating to the cat’s previous experiences. e.g.

1.       Did the cat have an acute URT infection (cat ‘flu) as a kitten? This is the most common initiating cause of chronic rhinitis.

2.       Is there any history of facial trauma, dental disease or ear infections?

3.       At what age did the cat first develop the clinical signs? The age of onset and speed of onset of clinical signs can often be misleading, but can occasionally be of help in the diagnosis.

4.       Has the nasal discharge always been of the same type, consistency and colour, and has it always been unilateral or bilateral? Are the signs progressing, is the cat systemically ill, and has the cat responded to any previous treatments? The answers to these questions may help determine the underlying cause of the problems.

My cat had ‘flu as a kitten and has had ‘snuffles’ ever since, although he is well in himself. Should I ask the vet to find out what is wrong with him?

Arrange for your vet to examine your cat but if chronic post viral rhinitis is believed to be the most likely cause of the patients clinical signs, and the cat is not too distressed by the nasal discharge, it is probably best not to put it through further examinations. Further investigations are generally best left for cats with severe or progressive clinical signs, or those with evidence of generalised disease.

When considering treating cats with severe chronic URT disease it is helpful, (where possible), to differentiate between the possible underlying causes. This allows for the correct treatment to be given and the probable outcome to be discussed. However, since most cases of URT disease will result from chronic post viral damage, it is important to remember that tests may give negative results and the likelihood for full recovery, even with treatment, may be guarded to poor.

What tests can be done to find the cause of the disease?

1.       Non-invasive tests, such as haematology, biochemistry and tests for FeLV and FIV may help to determine the extent of systemic disease.

2.       Nose and throat swabs may be taken to look for the presence of fungi.

3.       For the best hope of finding a diagnosis it is necessary to give the cat a general anaesthetic in order to perform more extensive investigations. These include taking radiographs (X-rays) and examining the nose, throat and mouth using endoscopy. Detailed examination includes looking up the cat’s nose, and examining behind it’s soft palette (the flap of skin at the back of the throat). While examining the nose it is possible to take samples to look for bacteria, fungi, evidence of inflammation or cancer cells. Endoscopy allows access to the nasal chambers, but it is is possible that underlying disease may sometimes be missed. Deep biopsies of the nasal cavity with special forceps are very helpful in obtaining an accurate diagnosis.

Can chronic URT disease be treated?

Yes, but in only some cases is treatment likely to give a long term cure. In most cases the clinical signs can merely be controlled, since the chronically damaged bones cannot be repaired.

Antibiotics can be given to reduce secondary bacterial infection. However to control the clinical signs it is usually necessary to give them for long periods of time or as repeated courses in order to control the clinical signs. Some cases can be permanently cured with long courses of expensive antibiotics. In the remaining cases it is generally hoped that with time the cat, and its owners, will learn to live with the cat’s disease, without the need for repeated courses of antibiotics.

Other treatments that can be considered include drugs to reduce the thickness of the nasal secretions (mucolytics), or treatments to help the cat breath more easily (anti-congestants or steam inhalation). If the cat is severely affected by ‘snuffles’ and is undergoing further investigation, it is possible to therapeutically flush the pus from the nasal passages while the cat is under general anaesthetic. Although this procedure can occasionally give some degree of short term relief, the clinical signs usually return. The most essential aspect of treatment is good nursing care; keeping the cat’s face clean and clear of discharge, and encouraging it to eat by feeding warmed up food that is strong smelling.

Specific treatments can be given where a specific causes have been found, e.g. polyps can be surgically removed, some cancers can be controlled with chemotherapy, and fungal disease can be cured with anti-fungal drugs.

Chyle is a mixture of lymph and chylomicrons from the intestinal lymphatics that contains 60-70% of all ingested fat. It is connected to the venous circulation by way of the mesenteric lymphatics that empty into a dilated lymphatic collecting channel at the base of the diaphragm known as cisterna chili. The cisterna chyli continues forward as the thoracic duct and is located between the aorta and the azygous vein on the left side of the dorsal thorax. The thoracic duct empties into the left external jugular vein of the neck or the jugulosubclavian angle.

A lesion or obstruction along this pathway will result in the collection of chyle in the chest and sometimes abdomen as well. Trauma, neoplasia, malformation, lymphatic obstruction, congestive heart failure are known to cause chylous effusion. Many times though, no cause can be identified and is termed idiopathic chylothorax. This effusion can compromise respiration and cause breathing difficulties. Fibrosing pleuritis or constrictive pleuritis is a frequent sequela to chylothorax. The pleura becomes fibrosed and thickened causing atelectasis and preventing normal lung expansion.

Causes:
Heart disease, heartworm disease, congenital, diaphragmatic hernia, idiopathic, lung lobe torsion, lymphangiectasia, neoplasia, pancreatitis, obstruction to thoracic duct flow and traumatic rupture of thoracic duct.

Clinical findings:
ANOREXIA, ARRHYTHMIA, ASCITES, COUGHING, CYANOSIS, CARDIAC MURMUR, DYSPNEA, FEVER, TACHYCARDIA, WEAKNESS
Slow heart rate, heart sounds muffled, abdominal breathing, open mouth breathing, rapid shallow breaths, restrictive breathing pattern, cachexia, depression, dehydration, hypothermia, malaise
chest percussion dull, pulmonary sounds decreased, chest trauma, exercise intolerant or reluctant to move, onset gradual, chronic pale mucous membranes

Diagnosis:
Evidence of pleural effusion from thoracic radiographs or ultransonography. Thoracocentesis demonstrates chyle from the lymphatic system in the thorax. The distinguishing features are an opaque milky fluid, of moderate protein content, and moderate cellularity. Chylous and pseudochylous fluids are difficult to separate. Chylous fluids are high in triglycerides (cholesterol:triglyceride ratio less than 1), are positive for orange staining chylomicrons when stained with Sudan III, and clear when alkalinized and mixed with ether.

Treatment:

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What is cystitis?

Cystitis is a general term referring to inflammation in the urinary bladder. The term cystitis does not imply a specific underlying cause.

In cats, diseases of the lower urinary tract (the bladder and urethra) are grouped under the term ‘feline lower urinary tract disease’ (FLUTD) as it can be difficult sometimes to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures.

What are the signs of FLUTD?

Typical signs in cats with FLUTD are those of inflammation and irritation of the lower urinary tract. The common signs are therefore:-

•           Increased frequency and urgency of urination.

•           Difficulty in urinating (spending a long time straining on the litter tray while passing only small quantities of urine).

•           The presence of blood in the urine or blood spots in the litter tray.

•           Occasionally complete obstruction to the passage of urine (straining persistently without producing any urine).

With the latter sign particularly (straining without the passage of any urine), it is important to seek urgent veterinary attention as complete blockage to the flow of urine is life-threatening if left untreated.

What causes FLUTD?

There are a vast number of potential causes of FLUTD, but in many cats there may be severe inflammation of the bladder and/or urethra without an identifiable underlying cause (so called ‘idiopathic' FLUTD). These idiopathic cases have to be differentiated from other potential causes of the clinical signs, however, so that appropriate treatment can be given.  Some of the potential causes of FLUTD are listed below:

•           Idiopathic (inflammation with no known cause) but possibly caused by stress

•           Bacterial infections

•           Urinary calculi (‘bladder stones’)

•           Neoplasia (cancer)

•           Anatomical abnormalities

•           Urethral plugs (blockage of urethra with a mixture of crystals or small calculi/stones, mucus and inflammatory material)

How is FLUTD diagnosed?

The initial diagnosis of FLUTD is based on the identification of signs of lower urinary tract inflammation. The clinical signs displayed by the cat are often characteristic of FLUTD, but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood.

Initially, a cat with uncomplicated FLUTD may be treated symptomatically. However, if the signs do not respond to this treatment, or if there is recurrence of the clinical signs, further investigation may be required to identify the underlying cause of the FLUTD.

What further investigations are required to diagnose the cause of FLUTD?

Where clinical signs are persistent or recurrent, a number of investigations may be required to differentiate idiopathic FLUTD from the other known causes of urinary tract inflammation.

These investigations may include:

•           Laboratory analysis of a urine sample

•           Bacterial culture of a urine sample

•           Blood samples to look for other evidence of urinary tract disease or systemic disease

•           Radiographs (x-rays) and/or ultrasound examination of the bladder and urethra

The information from these investigations should help to identify a specific treatable underlying cause if one is present.

What is the treatment for FLUTD?

This depends on the underlying cause. For example:

•           Cases of idiopathic disease may respond to treatment with anti-inflammatory or analgesic (‘pain-relieving’) drugs, but it is crucial that you only use drugs specifically prescribed by your veterinary surgeon, as many human products are extremely dangerous to use in cats. Dietary therapy and anti-depressant medications may also be very effective.

•           Bacterial infections of the lower urinary tract, although uncommon in cats, will usually respond well to antibiotic therapy.

•           If a cat develops a blocked urethra (this almost exclusively occurs in males), emergency treatment is required to remove the blockage, which may require flushing of the urethra while the cat is given a short anaesthetic. Most cats will need to stay in hospital for several days.

•           If bladder stones (calculi) are present they may have to be removed surgically or, depending on their type, they may be able to be dissolved by using a special diet, or dietary additive

There is no universal treatment for FLUTD. Each case has to be investigated to determine the underlying cause, and then the treatment has to be tailored to the individual cat. Sometimes despite appropriate investigation and treatment, clinical signs may still recur, requiring further therapy.

How can FLUTD be prevented?

It is impossible to completely prevent diseases of the lower urinary tract occurring. However, several therapies may be beneficial in reducing the number of attacks of idiopathic FLUTD. These include special acidifying diets (only available at vet clinics), adding water to food or feeding canned food, anti-depressant medications and anti-inflammatory medications. Minimising stressful events is very important in some cases.

A perineal urethrostomy is recommended for cats that have recurrent blockages of their urethra. This involves surgically removing the penis and approximately 3cm of urethra leaving a large opening for urine to be excreted from.

Cats often need a visit to the dentist and we are well equipped to cater for them. If treatment is required for tooth extractions or further dental prophylaxis, a short general anaesthesia is required. This allows complete ultrasonic scaling and polishing of every surface of the teeth. The equipment used in the clinic is the same high quality that you would expect when you visit your own dentist. X-rays can be taken of suspicious teeth and when required we perform surgical extractions using an iM3 dental machine. We can even treat fractured canine teeth with either a root canal therapy or pulp capping.
Prevention is always better than a cure. Various dry foods have been formulated specifically to clean your cat’s teeth as well as a mouth rinse and drinking water additive.

Dental disease is one of the most frequent ailments seen by veterinary surgeons. Most cats over two years of age who are fed exclusively with commercial cat food have some degree of dental disease.

The most common problems are:

• Periodontal disease
• Gingivitis
• Neck lesions (also called resorptive lesions or odontoclastic lesions).

What signs am I likely to see that indicate my cat might have dental disease?

Noticeable Signs:

• Lack of interest in eating
• Reluctance to eat after approaching his food bowl
• Obvious caution or discomfort while chewing
• Dropping food from her mouth
• Difficulty swallowing
• Dribbling, possibly with blood in the saliva
• Bad breath
• Pawing at his mouth or shaking his head
• Weight loss

What usually causes dental disease?

The most common cause of dental disease in cats is tartar accumulation. Just like people, cats accumulate bacterial plaque on the surface of their teeth. If plaque is not removed, it quickly becomes mineralised to form tartar (also called calculus).

Tartar is easily identified by its light or dark brown colour - it is normally first seen at the gum edge, especially on the back teeth (premolars & molars). In severe cases it may entirely cover the teeth.

The accumulation of tartar and bacteria on the teeth surfaces will, sooner or later, lead to infection and gingivitis (inflammation of the gums). If the disease is caught at this early stage, thorough professional veterinary treatment will permit a full recovery.

However, if gingivitis is allowed to persist untreated, then irreversible periodontal disease will occur. When that happens, the bone and ligaments that support the tooth are destroyed. Eventually, your cat will start to lose her teeth.

Tooth sockets may become infected and your cat can get tooth abscesses, or even more severe problems.

Once periodontal disease starts, the degenerative changes cannot be reversed. These changes make it easier for more plaque and tartar to collect, resulting in further disease.

Is gingivitis always associated with dental disease?

Some kittens and adult cats may show a slight degree of redness, indicating mild gingivitis, just below the edge of the gum. This can be normal if there is no other evidence of dental disease.

Some cats develop severe gingivitis with minimal signs of accompanying dental disease. This usually happens in pedigreed cats, although mixed breeds may develop gingivitis, too. Sometimes the gingivitis extends beyond the gums to other areas of the mouth, such as the throat or tongue. It is probably caused by Feline Calicivirus infection. This condition is often very difficult to control and may require repeated or constant treatment.

What are tooth neck lesions?

Neck lesions result from a progressive destruction of the tooth substance. Slowly deepening “holes” form in the teeth. Eventually the sensitive parts of the tooth are exposed and the lesions become intensely painful. Most of the time, the tooth has to be pulled.

The cause of tooth neck lesions is unknown, but poor oral hygiene is suspected to play a role. Neck lesions are very common, especially as cats get older.

What should I do if my cat has signs of dental problems?

If you can see that your cat has evidence of tartar accumulation, gingivitis or is exhibiting any signs of mouth pain or discomfort then you should take it to your vet for a check-up. Your vet may advise examining and cleaning the cat’s teeth under general anaesthesia.

The rate of tartar accumulation is very variable between individual cats, and some cats may need to have their teeth cleaned on a regular basis (every 6-12 months)

What can I do to help prevent dental disease in my cat?

The best way to prevent dental disease is to keep your cat’s mouth as clean as possible and reduce the rate of tartar build up. You can do this by including things in her diet that encourage chewing. Chewing stimulates the production of saliva, which contains natural antibacterial substances. In addition, the mechanical action of chewing helps scrape plaque and tartar from the teeth.

Some dietary options to help prevent dental disease are:

• Tough pieces of meat and raw meaty bones, like chicken wings and necks. These can be added to your cat’s diet several times a week
• Commercially prepared dry food that has been developed to prevent dental disease, such as:
• Hills Science Diet T/D or Oral Care
• Royal Canin Dental SO

• Hexarinse is a mouthwash that is very effective in reducing the number of bacteria in the mouth which can be an effective way of reducing plaque build up and gingivitis. It is administered into the mouth daily. Most cats don't mind the flavour
• Aquadent can also be added to drinking water to improve oral hygiene

It’s best to introduce these foods at an early age.

Another way to help prevent dental disease is to have your cat vaccinated against Feline Calcivirus.

Periodontal disease is defined as disease of the structures surrounding and supporting the tooth ie. the gum, the bone of the jaw, and the ligament holding the tooth in the bone. There are two types of periodontal disease: gingivitis and periodontitis.

Gingivitis -
Earliest stage of periodontal disease and is reversible with treatment.
(Inflammation of the gums)

Clinical features

• Redness
• Swelling of the gum
• Discharge of pus
• Gums bleed easily

Periodontitis -
Inflammation of the gums and surrounding tissue with irreversible loss of bone and connecting ligament.

Clinical features

• All of the signs of gingivitis, as well as:
• Bad breath
• Possibly visible pain on eating
• Looseness of teeth
• Retraction of gums

Untreated periodontal disease causes any or all of the following:

• Pain
• Tooth loss
• Bacteria in the blood stream
• Abscess formation
• Halitosis (bad breath)
• Difficulty in chewing
• Bone loss with subsequent fracture of the jaw

Untreated periodontal disease is a major cause of a serious reduction of the quality of life, particularly of older cats, and frequently causes premature death through secondary effects such as kidney failure.

CAUSES

Periodontitis is caused by bacteria living in the mouth. They form plaque, which eventually hardens to become tartar (calculus) and invade the gums and surrounding tissue. Every time a cat with periodontal disease chews on food, some of these bacteria are injected into the bloodstream: from there they end in the kidneys.

TREATMENT

Our main aim should be prevention through good oral hygiene, such as regular chewing. However where the disease already exists it is necessary to:

• Scale the teeth to remove tartar and plaque
• Perform root planing to remove tartar below the gums
• Polish the teeth (a smooth surface reduces new plaque formation)
• Depending on the severity, it may also be necessary to extract teeth that are impossible to save

ONGOING HOME CARE

• No matter how well cleaned the mouth is, it must be maintained with proper home care.
• The mainstay of reducing plaque build up is dietary therapy. The best diets for this is Hills T/D, Hills Science Diet Oral Care and Royal Canin Dental SO. Natural foods such as raw chicken wings and necks and strips of tough chewy meat can also be effective. Plaque-reducing foods need to be 50% or more of the diet to be effective.
• Hexarinse is a mouthwash that is very effective in reducing the number of bacteria in the mouth which can be an effective way of reducing plaque build up and gingivitis. It is administered into the mouth daily. Most cats don't mind the flavour.
• Aquadent can also be added to drinking water to improve oral hygiene.

We will closely check the teeth each time we see a cat, as cats that have had dental problems are at risk of further problems during their life.

Diabetes mellitus is a hormonal disease that occurs in about 1 out of every 400 cats. It is characterised by elevated blood glucose (blood sugar) levels. If untreated, it can lead to life-threatening metabolic disturbances.  Diabetes in cats is most similar to type II or adult onset diabetes in humans.

The hormone insulin is produced in the pancreas and is responsible for allowing glucose to be transported into cells to provide energy.  If there is resistance or reduction in the amount of insulin produced, then the cat becomes diabetic.

Cats who are MOST at risk:

• Over eight years old
• Male
• Burmese breed
• Overweight

Signs and Symptoms

Clinical signs of diabetes include:

• Excessive drinking
• Excessive urinating
• Increased appetite
• Problems with mobility e.g walking or jumping (this is caused by neuropathy - poor nervous control to the cat’s hind legs)

Diagnosis

Blood and urine tests are used to demonstrate high blood glucose and the presence of glucose in the urine. Occasionally, a test for fructosamine is required to distinguish between cats which are stressed and those that are truly diabetic.

Treatment

Diabetes is a very treatable disease, but requires long term commitment.

Treatment options include:

• Treating underlying disease (if there is one)
• Insulin therapy (the preferred method, and the one that provides the best control of blood sugar)
• Dietary management (there have been significant advances in dietary treatment of feline diabetes recently)

After your cat has been diagnosed, the next step is to determine the correct type and dose of insulin for them; this varies for each cat. Your cat will spend several days in the hospital while blood glucose is measured every few hours to determine the correct dose.

Insulin Instructions

• Must be stored in the refrigerator
• IF your cat is on a crystalline insulin it must be gently mixed by rolling for 30 seconds prior to each use
• Glargine (Lantus) insulin does not need to be mixed
• New syringe should ideally be used for each injection
• Injections can be given under the skin anywhere on the body but the "scruff" is often easiest and less painful

Your cat MUST be monitored closely during insulin therapy.

Monitoring the effect of insulin dosing including:

• Placing a continuous glucose monitor which lasts for 2 weeks
• Ear vein sampling OR
• Regular blood glucose curves at the clinic

Insulin dose can be changed according to the Home Glucose Monitoring guidelines without consulting your veterinarian but initially most clients phone us to discuss their decisions and we are happy to provide this service.

IMPORTANT!

If your cat gets TOO MUCH insulin it can cause blood glucose levels to become dangerously low, become weak, lethargic or unsteady on their feet and in severe cases could go blind, go into a coma or die.

If your cat accidentally gets too much insulin or if it shows any of these signs, take her to the vet immediately. You might try rubbing honey or glucose syrup on her gums as an emergency treatment.

Remission

Approximately 50% of cats diagnosed with diabetes and treated appropriately will go into remission and no longer require insulin injections. Early diagnosis and aggressive treatment with long-acting insulin and a low carbohydrate diet will increase the chance of your cat going into remission.

What is a durogesic patch?

A durogesic patch provides continuous pain relief to your cat. The medication is absorbed through the skin. As such, a small area of fur is clipped from the back of your cat’s neck in order that the medication can be absorbed. A bandage is placed around the cat’s neck in order to prevent the patch from being scratched off.

How long does the durogesic patch last?

Each patch lasts 3-5 days. An appointment is then to be made in five days to see a nurse. The nurse will remove the patch and dispose of it appropriately.

Care of the durogesic patch

Do not allow the patch to become wet or overheated as this will cause the rate of absorption of the medication to rapidly increase and can lead to overdosage. If the patch does become wet contact the vet clinic immediately.

What if I think my cat is still in pain despite the patch?

Contact your veterinarian immediately and they will advise you on the appropriate course of action.

What are potential side effects of the patch?

Your cat may be more drowsy than usual. You may also notice dilated pupils. The patch does effect decision making so please keep your cat indoors while the patch is in place. If you are concerned that your cat is displaying unusual behaviour please contact The Cat Clinic.

The patch is potentially very dangerous if swallowed by your cat or a child. Please seek medical attention immediately if you believe this may have happened.

Entropion is an inward rolling of the eyelids. Lower lid entropion is more common than upper lid entropion.

Why does my cat have this?

• Congenital (since birth)
• Spastic
• Result of injury or inflammation

Entropion permits the lid hairs to rub against the cornea.

Symptoms:

• Chronic conjunctivitis
• Purulent ocular discharge
• Corneal ulceration
• Neovascularisation
• Weeping eyes
• Painful eyelid spasm

Etiology

Anatomic entropion is uncommon in cats, although pure breeds are more likely to be affected. Brachycephalic cats (Persians and Himalayans) typically have lower lid entropion close to their nose (medial canthal entropion).

Aquired entropion occurs in the cat and often only affects one eye. Spastic entropion may develop secondary to corneal disease, conjunctivitis, ocular pain, etc. in any age and breed of cat. Spastic entropion can become permanent if allowed to persist. It is believed that ocular surface diseases associated with feline herpesvirus-1 (FHV-1) may be the most common cause of acquired entropion in the cat. These cases eyelid conformation is normal at birth but entropion develops later, usually after chronic ocular irritation has occurred.

Older cats may develop secondary entropion with profound weight loss.

Clinical Signs

Many cats with entropion have mucoid ocular discharge, painful eyelid spasms and are often treated for conjunctivitis without any clinical improvement. The irritation from the hairs rubbing on the cornea and the conjunctiva can cause mucoid conjunctivitis, corneal vascularization and/or ulceration. With prolonged irritation to the cornea, cats with entropion may develop corneal sequestration.

Diagnosis

In most cases the diagnosis is obvious on the clinical examination. The eyelid hairs can be visualized rubbing on the cornea. Spastic entropion usually reverses after application of topical local anaesthetics. Anatomic entropion does not reverse with local anaesthesia. Local anaesthetic is used to further examine the eye. Fluorescein staining of the cornea is done to assess for ulcers and closely examine for secondary changes (e.g. vascularization, pigmentation, scarring, sequestrum formation) from the entropion.

 Treatment

In almost all cases surgery is required to correct feline entropion. This involves excising an elliptical piece of skin in the area of inrolling and suturing the defect closed to roll the eyelid out (similar to a face lift for the eyelid!!). It is a matter of clinical judgement and experience as to how much tissue should be removed.

What is cardiomyopathy?

Cardiomyopathy is a term used to describe diseases of the heart muscle. Cats can suffer from primary cardiomyopathy, or they can get cardiomyopathy as a result of another illness.  In either case, it can lead to heart failure.

What symptoms indicate my cat might have cardiomyopathy?

Early on, there won’t be any symptoms. As the disease progresses, your cat will adjust her activities to compensate for cardiomyopathy. In fact, your cat will probably not have any symptoms until the disease is advanced.  At that point, you may notice rapid or difficult breathing, loss of appetite, lethargy or loss of the use of her back legs.

What causes the symptoms of advanced cardiomyopathy?

• The breathing problems, loss of appetite and lack of energy are because your cat’s heart cannot pump very well. Fluid backs up into her lungs, just like it does in people.
• Sometimes the blood flow within your cat’s heart gets stagnant enough that clots form. If a clot breaks off and travels through the body, it may lodge at the bottom of the aorta and block circulation to her legs. This is an extremely painful and possibly fatal complication of cardiomyopathy.

How is cardiomyopathy diagnosed?

Your veterinarian may suspect that your cat has cardiomyopathy based on his symptoms. Your vet may perform the following tests to confirm the diagnosis:

• Chest x-ray
• Electrocardiogram (ECG). The ECG isn’t very helpful in diagnosing cardiomyopathy, but it will help determine if there are any other heart problems.
• Cardiac ultrasound. This helps determine which kind of cardiomyopathy your cat has (there are at least three major types).
• Specific tests to determine if another disease is causing the cardiomyopathy.

What causes cardiomyopathy?

There are many causes of cardiomyopathy. The most frequently seen ones are:

• Thyroid disease (hyperthyroidism). This is most often seen in older cats.
• Taurine deficiency. Taurine is an essential nutrient for cats. Taurine deficiency is rarely seen in cats who are fed fresh meat or commercial cat food.
• Idiopathic cardiomyopathy. That means that no cause can be found.

How is cardiomyopathy treated?

If an underlying cause is found, that is treated first. Sometimes that is all the treatment that is needed. Hyperthyroidism is the most treatable cause of cardiomyopathy, and treating the thyroid problem can cure the cardiomyopathy.

If no cause is found, or if treating the cause doesn’t help, your vet may suggest different medications.

• Diuretics for congestive heart failure
• ACE inhibitors—another medication for congestive heart failure.
• Beta blockers and calcium channel blockers—to regulate the heart rate and help the heart muscle relax
• Aspirin—to decrease the risk of clots. Aspirin is not always used because aspirin can be toxic to cats, and the dose has to be carefully regulated. DO NOT give your cat aspirin without a veterinarian’s advice.

Does a cat with cardiomyopathy need a special diet?

For most cats with cardiomyopathy we recommend moderate salt restriction. The diets that best meet this requirement are diets for senior cats and diets for kidney disease. If your cat has taurine deficient cardiomyopathy then taurine supplementation will be necessary. Many cat treats that are sold are very high in salt and are probably best avoided.

What is the prognosis for a cat with cardiomyopathy?

The prognosis depends on what caused the cardiomyopathy and how advanced it is. Some cats remain stable and live near-normal lives for several years after being diagnosed with cardiomyopathy.

There are some great advantages to be gained by keeping your cat confined indoors. These include decreased risk of injury and disease, and as a result, a significantly longer life expectancy. There is the added benefit for wildlife and the appreciation of the non-cat lovers in the community. With a bit of extra effort, these cats can still have a lifestyle that meets their needs.

Even cats that spend some time outdoors can benefit from additional opportunities for mental and physical activity in their home environment. This is particularly true for individuals prone to anxiety disorders. The following suggestions allow cats to focus their energies in a healthy, positive way that helps to relieve stress. Cats are individuals so it is important to trial as many of the following as possible so that you can identify the elements that your cat appreciates the most.

TOYS

Cats are very sight sensitive to moving objects, so providing toys with an element of movement will help to attract your cat’s interest and enthusiasm for play. These can vary from simple home-made items such as scrunched up pieces of newspaper on the end of elastic, attached to a stationary object or tied to your belt so they bobble around on the floor behind you as you walk. Various types of toys are also available commercially and these include such things as balls containing bells, cat dancers and various furry items such as mice.

Some cats have a genetic predisposition to respond pleasurably to catnip. Toys are available that contain this substance or you might like to grow your own indoor garden and include catnip, catmint or catgrass. Simple items such as table tennis balls or non-toxic soap bubbles can provide avenues for fun interaction.

INTERACTING WITH THE OUTSIDE WORLD

Cats will often be content with a view of the outside world, even if they can’t venture into it.  Some are quite happy with access to a window ledge while others may be more satisfied with an enclosed outdoor run that extends out into the garden area. There are companies that specialise in erecting and designing these structures with cats’ particular needs in mind.  Supervised access to the outdoors on a harness is another alternative.

If you have more than one pet and consider there is some tension between different members of the household, you could consider allowing your cat exclusive access to one viewing area that is particularly favoured. It can then become an area of relaxation for this cat that will be identified as a haven from potential threat. Providing a cubby, such as a cardboard box containing an unwashed sweater, in this or other areas of the house will also help your cat feel secure. Making an entry and exit hole and placing it up high also adds to the feeling of security.

GAMES

Cats often enjoy chasing concentrated dots of light from a penlight or similar source. They like to explore items such as paper bags and boxes, which you can encourage by popping the odd surprise inside. A commercially available “ Busy Kitty” takes advantage of this natural curiosity. Cats can be trained to search the house for small piles of food, rather than providing them in one spot. Gradually sprinkle the food away from the bowl until your cat catches onto the idea that it is worth looking in hidden spots for its ration. A Kitty Kong can also have food items placed inside it to extend the pleasure of meal time. Raw chicken wings can help keep teeth and gums healthy and provide a suitable chew item.

Scratching posts can prevent damage to furniture items while allowing the cat to enjoy scratching indoors. A climbing post can provide access to areas such as exposed beams and double as a scratching post if covered in a suitable material such as cut pile carpet.  Some young, exuberant cats will appreciate the company of a slightly older, energetic cat who they can play with; however some individuals prefer solitude.

QUALITY TIME

There is quite a marked variation in the amount of time different cats like to spend being cuddled. Many will appreciate extended periods of sitting on your lap, being patted or groomed while others dislike too much physical contact at one time. Some owners like doing some obedience work with their cats which can include teaching tricks or games such as retrieve or hide and seek. With patience they can respond very well to this type of attention.
Taking time to make life more interesting for your cat can really increase the quality of life that it enjoys and is an opportunity to give back some of the pleasure that their company gives to us.

A compulsive disorder, feline hyperesthesia syndrome usually begins in cats at 1 to 4 years of age. It is also known as self-mutilation syndrome, rolling skin syndrome, twitchy cat disease, and atypical neurodermatitis.

What happens is that affected cats have episodes in which the skin twitches, the body jerks around suddenly, and the tail moves far more than usual. Hyperesthetic cats vocalize and groom excessively, don't want to be touched, and zoom around at high speed. Sometimes the skin on the cat's back, just above the tail, will seem to ripple. Some affected cats will groom/chew at themselves so much that they will lose their hair, develop skin irritation, and even create skin sores. While some of this may sound a bit like normal fun behaviour, it is different in how far it goes. The cat will appear to be in distress, rather than having a good time; pupils will be dilated, and the cats may appear to be scared and depressed -- or stare into space. Episodes will last from a few seconds to several minutes.

Any breed can be affected, but Siamese, Burmese, Himalayans, and Abyssinians are the most commonly affected breeds.
In some cases, the problem may turn out to be strictly behavioural. In other cases, there may be a physical cause. There is no specific test that can diagnose this problem, so this syndrome requires diagnosis by exclusion. (The veterinarian will have to eliminate every other possible cause of this behaviour, thus leaving hyperesthesia syndrome as the final diagnosis.)

Diagnostic tests will include a complete neurologic exam, blood work, spinal radiographs, skin scrapings, etc.
Treatment for hyperesthesia syndrome may require anti-seizure medications, corticosteroids, anti-anxiety drugs, or behavioural/environmental modification. It may take time to determine which medication will be most effective. Once an effective medication has been found, your veterinarian may try decreasing the dosage over time, to see what the lowest effective dose is.

The signs typically return if medication is discontinued, so treatment is usually lifelong. Some veterinarians think that behavioural and environmental stresses should be reduced, as some cats resolve all symptoms when they move to a new house or environment. Meals should be given on a regular routine, and feeding several small meals a day is better than feeding one or two large ones.

If there is a specific environmental condition that causes signs, such as excessive noise or a disliked companion cat, eliminating that environmental cause can be successful in eliminating the syndrome.

Flea allergy dermatitis (FAD) or Flea bite hypersensitivity is a hypersensitive reaction to the bite of the flea.

When a flea bites a dog or cat (or human), it injects a small amount of saliva into the skin. It is this saliva that the patient develops an allergy to. Consequently, even one flea bite can cause intense itching and irritation. In turn, it can occur even when no fleas or flea dirt is found. A severe flea infestation, where lots of fleas or flea dirt is found, can cause the same signs in non-allergic patients. FAD is most commonly seen in the summer months when fleas are more prevalent, but can occur even in Winter, because even low numbers of fleas can cause a reaction. Pets suffering from flea bite hypersensitivity will bite, chew and lick their skin continually.

Cats react slightly differently to dogs. Some cats develop small scabs over their back and in severe cases over their whole body which is called ‘miliary dermatitis’. Meanwhile, others lick until they develop bald patches specifically on their belly and the back of their hind legs.

Conditions other than flea bites may cause similar signs, so we may recommend tests to confirm the diagnosis, especially when there is no evidence of fleas.

This condition is not life threatening, but is not curable. In the short term, hypersensitive pets who have been exposed to fleas and are suffering from FAD need medication to relieve the itching, stop them scratching and give their skin a chance to heal. Some will also need antibiotics for infections that have developed in the damaged skin.

In the long term, all pets suffering flea bite hypersensitivity need to have their exposure to fleas minimised - constantly.

There are many excellent products available to kill adult fleas, larvae and eggs both on your cat and in the environment. Easy to use spot-on applications include Revolution, Advantage, Advocate, Frontline and Activyl. Where large environmental contamination with flea eggs exists, we usually recommend treatment with frontline spray, Comfortis or a Serestro collar which kills fleas for 8 months.

Other pets in the household also need treatment constantly. Even though they are not affected (if they are not allergic), they do carry fleas which then can bite the allergic cat.

Please talk with staff regarding a specific flea prevention treatment program for your cat.

Food Allergies

Just like dogs, cats get allergies too. They can cause one or more of the following signs:

• Itching
• Rashes
• Diarrhoea
• Hair loss
• Red ears
• Vomiting

Cats can become allergic to protein in food, treats or table scraps. They can develop skin problems, such as rashes, itchiness, reddened ears and hair loss, or gastrointestinal problems, including vomiting and diarrhoea.

The signs of food allergies can look like those caused by allergies to fleas, plants or pollen. Just like people, cat can be allergic to bites and some plants (contact) and pollens (inhaled). Usually though, allergies to pollen and plants show up more during Spring and Summer while food allergies can occur any time of year. Some animals develop multiple allergies.

In the past, to diagnose food allergy, a diet had to be formulated that was expensive, fiddly and very difficult to balance. This usually required choosing a novel protein source and a novel carbohydrate source, ie. one that the animal has never been fed before.

The most innovative advancement for managing food allergies in cats is hydrolysed Prescription diets. Hydrolysation breaks down the proteins in food so they are too small to cause an allergic reaction. This same process is also being used to manufacture formula for human babies who are allergic to milk protein. Examples of these Prescription diets are Hill’s z/d and Royal Canin Hypoallergenic.

If your cat does have a food allergy, it can be diagnosed & controlled easily. We place the cat on this Prescription diet ONLY (ie. no other food source) for 4-6 weeks. If the signs disappear, owners can elect to keep the cat on this diet, or to “challenge" the cat with a different type of food every week. If the cat is allergic to one of these foods, signs will start again within the next day or so. If no response is noted, then a different food is added the next week.

There are two levels of diet: one has only hydrolysed proteins so it won’t cause an allergic reaction at all; the other has low allergen loads with hydrolysed animal proteins and some whole plant proteins. These plant proteins are considered “safe" because they have very little chance of causing a reaction.

The benefits of this Prescription Diet are:

• Virtually no chance of reaction. There is very little chance allergy symptoms will return if you feed your pet Prescription Diet exclusively.
• 100% complete nutrition
• Highly palatable
• Convenient - you won’t have to worry about changing your cat’s diet again or fixing homemade food. This diet requires no preparation on your behalf.

The transition period for changing from feeding your cat old food to a Prescription Diet should be spread over seven days or so, gradually adding the new food to your pet’s previous diet. Remember, your cat can have no other food besides the Prescription Diet once the transition period is over. When the symptoms disappear, you might be tempted to start feeding your cat its old food or treats, snacks and table scraps.

A cats’s food allergy is like a human food allergy. If you’re allergic to milk or chocolate, you have to stop ingesting it if you want to avoid the return of symptoms. Even a small amount may cause the allergy symptoms to come back.

Gastroenteritis is inflammation of the stomach and intestinal tract.  Its signs are most commonly vomiting and/or diarrhoea.  Potential causes are many and varied, the main ones being intestinal worms, infections (bacterial or viral) and eating something that upsets the gut (eg, ‘garbage’, cooked bones, excessively fatty meals).

Often when cats have gastroenteritis they will still be quite bright and happy.  If they present with lethargy/depression as well as vomiting/diarrhoea, other more serious conditions may be present and blood tests (or other diagnostic tests) may be required.

The treatment of gastroenteritis involves ruling out worms and intestinal parasites as a cause first. This is done by either knowing the cat has recently been effectively wormed or by worming them at the time. A faecal sample is usually analysed to help with the diagnosis. Then we give the stomach and intestines a rest.  A common problem we see is that cats have been fed too much too soon after the signs started, which triggers another bout of vomiting or diarrhoea.

In most cases the best course of action is to feed nothing for 24 hours (allowing free access to water) and then introduce regular, small, bland meals.  ‘Bland’ means that the type of food is not ‘rich’ and will not upset the gut (easily digested).  ‘Small’ means that the volume of food will not over stretch the gut and cause further irritation.  Bland food may be boiled chicken (no skin, no fat, no bones) and boiled white rice; or one of the commercially prepared prescription diets available from us.

When the vomiting/diarrhoea has stopped, the meals are gradually increased in size and the frequency is reduced, then normal food is added little by little.

Many cats will get better if they revert to normal feeding earlier than this, but some will return to vomiting/diarrhoea.  You cannot know which ones will do this until it happens, so it is best to treat all patients as if they will be one of the more sensitive ones.  If at any time the vomiting or diarrhoea recurs it is very important to let us know so we can reassess the diagnosis and treatment.

Cats with gastroenteritis can lose significant amounts of water quickly and can find themselves severely dehydrated quickly. Some cats need to be hospitalised and rehydrated with intravenous fluid therapy. An injection may be given to settle the nausea/vomiting and sometimes a course of antibiotics will be prescribed if bacterial infection is suspected.  Antibiotics are often held in reserve as most patients improve rapidly even without them. Unidentified viral diarrhoea will usually resolve without medications.

Regular worming, flea control, vaccinations and being careful with your cat’s diet will greatly reduce the chance of gastroenteritis reoccurring.

What is hyperthyroidism?

Hyperthyroidism is the most common endocrine (hormonal) disorder that affects cats. It is rarely seen in cats less than eight years of age and there is no sex or breed predisposition. It is caused by an excessive production of thyroid hormone by the thyroid glands situated in the neck.

Thyroid hormone controls the body’s metabolic rate, or activity level, and too much of it (hyperthyroidism) causes your cat to be hyperactive and to lose weight even if he is eating well.

What causes hyperthyroidism?

Usually, hyperthyroidism is caused either by excessive growth (hyperplasia) of the thyroid gland, or by a benign tumour of the thyroid (adenoma). Both thyroid glands are usually involved, although one gland may be more severely affected than the other. The cause of this benign change is unknown. However, it is likely that multiple factors are involved, including genetics, diet, environment and the immune system.

In rare cases, the disease may be due to a malignant tumour (thyroid adenocarcinoma).

What are the signs and symptoms of hyperthyroidism?

Clinical signs of hyperthyroidism are usually subtle at first, and get more severe as the disease progresses. The most characteristic signs are:

• Weight loss
• Increased appetite
• Hyperactivity and restlessness

Less common signs include:

• Increased heart rate (tachycardia)
• Increased urination and/or thirst
• Vomiting or diarrhoea

In advanced cases, your cat could become lethargic and weak and lose her appetite.

Are there any complications of hyperthyroidism?

Yes.  Cats with untreated hyperthyroidism can develop hypertrophic cardiomyopathy (in which the heart muscle becomes abnormally thickened) and hypertension (high blood pressure). Initially, these complications may require specific treatment, but usually resolve once the underlying hyperthyroidism is well controlled.

How is hyperthyroidism diagnosed?

Once hyperthyroidism is suspected, a thorough physical examination and some blood tests will be required to confirm the diagnosis.

On physical examination, an enlarged thyroid gland may be felt as a small, soft mass, on either side of the neck. It may be difficult to detect, as the glands are freely movable and can slide along and behind the windpipe (trachea). In some cats, it may not be able to be palpated.

Diagnosis is confirmed by determination of serum thyroid hormone levels. In most affected cats, both thyroxine (T4) and triiodothyronine (T3) are elevated. However, elevation of T4 is a more reliable indicator of hyperthyroidism.

In rare cases, a cat may have normal thyroid hormones, but has all the symptoms of hyperthyroidism. In those cases, your vet may do further testing. Usually all that is required is to repeat the thyroid hormone testing at another time.

Other laboratory tests that might be ordered are:

• Liver enzymes, which may be elevated with hyperthyroidism
• Chest x-ray or ultrasound if cardiomyopathy is suspected
• Doppler blood pressure monitoring to check for high blood pressure
• Testing for renal failure before starting treatment.

How is hyperthyroidism treated?

There are three options available for the treatment of hyperthyroidism: administration of anti-thyroid drug therapy, surgical thyroidectomy and radioactive iodine therapy.

Anti-thyroid drug therapy

Anti-thyroid drugs act by interfering with the production of thyroid hormone. These drugs control hyperthyroidism, but do not cure it.  Your cat will need treatment for the rest of his life.

Most of the time you will need to give your cat the medication three times a day for two or three weeks, until her thyroid level is normal. After that, she will need the medication twice a day. She will also need regular follow-up appointments with the vet.

Some cats experience mild and usually transient side effects from the medication. They usually go away within a few weeks. You could see:

• Poor appetite
• Vomiting
• Lethargy

More serious side effects include low white blood cell count, clotting problems or liver disorders. Your vet will perform routine blood tests to monitor for these problems.

Surgical thyroidectomy

Surgical removal of the affected thyroid gland (thyroidectomy) can produce a permanent cure. However, in some cats, signs of hyperthyroidism may recur, due to the production of thyroid hormone at other sites previously unaffected.

Surgical skills and experience are necessary to minimise the risk of post-surgical complications.

The major risk associated with thyroidectomy is inadvertent damage to the parathyroid glands. They lie just next to the thyroid glands and are essential in regulating blood calcium levels.

If your cat has hypertrophic cardiomyopathy because of the hyperthyroidism, using general anaesthesia is a concern.  To reduce the risk of anaesthetic complications, these cats are usually stabilised with medications for a few weeks prior to surgery.

Radioactive iodine therapy

Radioactive iodine therapy (I131) can be used to provide a safe and effective cure for hyperthyroidism. Radioactive iodine is selectively taken up by active thyroid tissue and destroys the tissue.  Radioactive iodine therapy is a good option when surgery is contraindicated, or when the excess thyroid tissue can’t be surgically removed.  A single dose is curative in the majority (98%) of cats.

Radioactive iodine is the only effective treatment for cats with thyroid adenocarcinoma.

The treatment can only be performed in a specially licensed facility. Your cat will usually have to stay in the hospital until the radiation level has fallen to within acceptable limits. This is usually for a period of 7 days following treatment.

Summary

Hyperthyroidism is a common disorder of older cats and is due to an increased production of thyroid hormone. Due to the action of thyroid hormone on multiple body organs, it can have wide and varied effects. However, if recognised early and treated appropriately, the outlook for affected cats is generally good.

What is spraying?

Urine spraying is part of the cat's normal scent-marking behavioural repertoire which also includes scratching, rubbing, chinning, bunting (depositing secretions from head glands on twigs etc., and middening (leaving faeces uncovered). Using these scent markers cats can deter others from their range and cats which share a hunting range can avoid one another without coming into direct conflict.  Spraying is also designed to help females in oestrus ('in season' or 'on heat') to attract males for breeding.  When spraying the cat stands with its tail vertical (often quivering at the tip) while it delivers a squirt  of urine backwards onto a vertical surface.  This spray probably contains information about sex, age, hormonal state, assertiveness and general health.

Why do cats spray?

Cats may spray when frustrated, upset or subject to competition or challenge and spraying can be interpreted as the cat increasing its own sense of security by surrounding itself with signals of its own occupancy in its territory.  The more anxious the individual, the more he or she will need familiar odours for comfort.

Do only tom cats spray?

No, all cats, male or female, neutered or not, may spray, usually outside where we may not see them.  Un-neutered toms and queens in oestrus will spray more.

Why do cats spray indoors?

Most neutered pet cats feel sufficiently relaxed in their own home and do not spray.  They identify it by rubbing scent from their body and do not need to mark by spraying, scratching or middening. 

The most common sites for indoor spraying are near entrances to the house or room, curtains and new items brought into the house, e.g., plastic bags, new furniture etc., although individuals may have their own idiosyncratic targets such as washing machines, video players or even certain people!  As with most behavioural problems a little detective work may be needed to get to the root of the behaviour problem.  While there may be no 'quick fix' solution in some cases, helping to find and understand the motivation for the behaviour will help while you work towards a solution.

There can be many triggers for a cat marking indoors:-

1.      The arrival of a new cat, dog or person in the family, or a bereavement.

2.      Changes in the home area such as furniture or new carpets. Disruptions such as  building work.

3.      Installation of a cat flap which can make the cat feel insecure indoors.

4.      In rare cases, spraying can be a learned attention-getting behaviour.

Occasionally urine marking may be carried out from a squatting position usually on the floor, but often on bedcovers or chairs. The cat may still use the litter tray for eliminating larger volumes of urine.  This often occurs when owners leave their cat at home but in their neighbour's care when they go on holiday and may be a form of 'associative 'marking - the cat feeling anxious because it is alone, is relieved when it associates its smell with that of the owner - usually in a spot where the owner's smell is concentrated such as on the bed or armchair.

Can urinary tract infections cause spraying behaviour

Quite commonly cats with urinary tract infections or inflammation will also spray urine. For this reason, it is important for the veterinarian to perform a urinalysis on all spraying cats to ensure that the correct therapy is instituted. The treatment for a urinary tract infection will be very different to behavioural spraying so a correct diagnosis is necessary.

Can the problem be treated?

Cats marking indoors clearly require a clear and extensive approach to diagnosis of cause(s) and careful development of treatment which will not unsettle them even more!  It is vital to discover under which situations the problems occur as treatment often depends on defining any specific anxiety-inducing trigger(s) for the behaviour.

It is useful to know the following:-

1.      When did the problem first occur?

2.      Which people or other animals are normally present in the house. What are the attitudes of all the family towards the cat.  What are they doing before, during and after the problem occurs.

3.      Are there any other behaviour problems in the cat or its feline housemates and is it receiving any medical treatment?

4.      Where is the marking occurring? The layout of the house and even the garden may be important. Are there rival cats outside?

5.      What is the cat's daily routine? Does it have free access to outside? Where does it eat and sleep, how much time is spent interacting with the owner and what do they do together.

6.      What methods have already been tried to solve the problem? How are the marks cleaned?

The main aim of treatment is to reduce the perceived threat to the cat and make it feel more secure in its home territory, thus reducing its levels of arousal and curtailing the need to scent mark. 

Identifiable sources of stress should be removed, e.g., by excluding local rival cats from entering the home by blocking the cat flap or replacing it with a selective one.  Carefully introduced friendly routines of handling, feeding and playing will help provide reassurance, providing such contact does not further alarm the cat at any stage.  In many cases there may be no single obvious threat and the cat's behaviour may be the result of the cumulative effect of several influences. 

If such sources of stress cannot be removed or even fully identified the cat should be provided with a safe haven of a small core territory of one room in the house to which it can safely retreat or be placed to relax without fear of disturbance for regular periods and where it should only feel the need to mark normally by rubbing and bunting.

Often people simply become 'over-catted' - they enjoy their feline housemates and because one extra takes up little more physical space and is no more effort to feed, they will continue to collect more.  This may be fine until a certain mix of characters just doesn't gel and relations within the group become strained and spraying begins. 

Careful introductions can help but sometimes certain individuals simply cannot share a home without stress and it is better to re home one or more.  Although this may not be a popular decision, it may be the only option if home hygiene is to be maintained as trying to manage the problems can be very difficult with a number of cats and associated variables.

All forms of punishment should be discontinued (even if the cat is 'caught in the act') as this is only likely to raise the cat's level of arousal and anxiety.  You may feel often angry and want to react if you catch the cat 'in the act', however, stopping all punishment and threatening behaviour is an essential first step towards improvement.

Placing food (dry food is best) or a bed at the base of spraying sites is often helpful at protecting those particular areas as cats are extremely reluctant to spray their own key resources, although they may simply move to other areas and mark there instead.  Food and beds are also reassuring and may reduce anxiety.

Spraying can be triggered by the smell of previous marks so marked areas should be thoroughly cleaned (not with ammonia-based products as ammonia is a constituent of cat urine). A damp cloth should be used to remove any fresh urine marks and while some commercially available 'urine digester' products remove the smell (to the sensitivity of the human nose at least), no data has been published on relative efficacies. 

An enzymatic or biological washing powder or liquid may be just as effective at removing residues. Follow with agitation using a light brush with a low grade alcohol (test the colour fastness of material/carpets first).

It is unlikely that spraying will be effectively resolved with drugs without trying to ascertain the cause of the problem and without employing management changes and behaviour modifications. 

Some very good drugs are available but their use should be based on sound understanding of the problem, cat and the effects of the drug on the feline physiology. Drugs should alter a cat's mood to enable it to learn new forms of behaviour and the drugs should then be withdrawn.

Recently a plug in diffuser called “FELIWAY” has been available which supplies a feline facial pheromenone to a 75m2 area and has been very effective controlling many feline behavioural problems, including urine spraying.

Water Intake Test

Water intake tests are very important to help us work out whether your cat is drinking too much water. Some diseases make cats drink more water than they should. Monitoring the water intake can be an important part of checking the response to treatment for diabetic cats.

Water intake can vary depending on many factors, including the weather, the type of food your cat eats and how much activity he or she does. Consequently the amount of water your cat drinks can vary from day to day. Because of this, we do a Water Intake Test over 2 consecutive days (2x 24 hour periods) so that we can average out how much is actually taken.

It is very difficult to assess water intake if there is more than one animal in the household, as they share water sources. To do a Water Intake Test accurately, animals may need to be kept separate over the time of the test. Alternatively they may need to be hospitalised so that they only get to drink from one source.

Step 1: Empty out all bowls that your cat normally drinks from, inside and outside the house.

Step 2: Measure exactly how much water you add to each bowl. Make a note of this.

Step 3: Don’t allow the bowl to be empty of water. Note down the amount of water you add to the bowl during the day and add this figure to the figure from Step 2.

Step 4: After 24 hours, measure exactly how much water is left in each bowl or bucket.

Step 5: Subtract the amount left over from the amount in Step 3.

Step 6: Repeat Steps 1-5 over 1 more 24-hour period.

Bring your calculations into the clinic or call us so we can assess the amount taken in and work out whether this is normal or abnormal.

To understand your cats kidney disease (renal disease), it is important to know some background information about the roles and functions of the kidneys.

The kidneys perform a number of essential roles necessary to sustain life.

The major ones are:

• Removal of waste products from the blood stream (urea and creatinine)
• Regulation of body water
• Balance of acid-base and electrolytes
• Production of erythropoietin, a hormone necessary for production of blood cells.

Each kidney contains about 200,000 nephrons, tiny units that perform those functions.  Kidney disease occurs when nephrons are destroyed.  If enough nephrons are destroyed that the kidneys can no longer perform their essential functions, kidney failure results.

Causes of Kidney Disease

There are numerous causes of chronic kidney disease in the cat and they can be very broadly classified into the following categories:

• Inflammation
• Infection
• Congenital or hereditary problems
• Toxins
• Cancer

Staging of Kidney Disease in Cats

An international staging system (IRIS) has been developed to categorise these different stages and can be found at http://www.iris-kidney.com/.  Cats' kidney disease can be staged based on their urine concentration and blood creatinine levels.

As nephrons are destroyed, the kidney becomes damaged, and it can’t perform normally.  The cat enters a stage of chronic renal insufficiency (Stage 1 IRIS) where they are still able to excrete waste products and maintain their weight, but will drink more water in order to do it. They may remain in this stage for several weeks to many years. They may be relatively healthy unless they get stressed or sick.

Eventually all cats will enter a stage of chronic renal failure (Stage 4 IRIS), which is the progression of disease which results in build up of waste products, dehydration, anaemia and eventually death.

There is also a new test called SDMA, offered by IDEXX labs, which can indicate the presence of kidney disease even before creatinine levels are high. A high SDMA level can prompt further diagnostics and increased monitoring of a cat, so kidney failure can be slowed down as much as possible.

Clinical signs of kidney failure

• Excessive drinking or urinating
• Weight loss
• Poor appetite
• Lethargy
• Vomiting
• Bad breath and mouth ulceration
• Unkempt or dull fur coat

Diagnosis

The most common way of diagnosing kidney disease is with blood and urine tests. Unfortunately, demonstrating a high level of waste products (urea/creatinine) in the blood tells us that the kidneys are not working properly, but it does not tell us what has caused the initial problem. Additional tests are often needed and may include:

• Urinalysis, where we look at urine concentration, and the presence of glucose, protein, blood, bacteria, crystals and cells in the urine
• Urine culture and sensitivity if infection is suspected
• Abdominal ultrasound
• Abdominal X-ray
• Needle aspirates or biopsies.  This is often done under ultrasound guidance if the kidneys are enlarged.
• Other tests, such as excretion tests, protein:creatinine ratios, etc

It is important to identify the cause as many diseases are treatable. In many cases it is impossible to identify the underlying cause without the use of these additional tests.

Treatment

The treatment for kidney disease will be different for every cat, depending on the cause and severity of the disease.

These include:

• Fluid therapy (intravenous or subcutaneous)
• Dietary protein restriction
• Dietary phosphorus restriction
• Controlling high blood pressure
• Iron and specific vitamins
• Appetite stimulants
• Erythropoietin
• Other specific treatments depending on the cause of kidney disease

If your cat has been diagnosed with chronic renal insufficiency, they should see a veterinarian every 3-6 months in order to record her body weight, get blood and urine samples and measure her blood pressure. This careful monitoring allows the vet to change her treatment if it becomes necessary.

The treatment for cats with chronic kidney failure will depend on many factors and may change as the disease progresses. Most cats will be treated with special diets, vitamins, iron, appetite stimulants, subcutaneous fluids and, if anaemic, will receive erythropoietin injections.

Outcome for Cats with Chronic Renal Failure

With early diagnosis and appropriate therapy, cats may live for years with chronic renal failure. It is impossible to give an accurate prognosis or life expectancy as there is a lot of variation between individual cats and the type of kidney disease present.

When is it time?

Chronic renal failure is usually a progressive condition. Our aim is to slow the progression as much as possible and maintain a good quality of life for your cat.

As the disease progresses, your cat will get weaker and sicker, and they will eventually die.  This is a very emotional time and careful assessment of your cat’s condition needs to be made.

As a general rule, once your cat loses his appetite despite our therapy, we will recommend that they should be put to sleep. The “right time” will be very different for every cat and for every owner. We will always be available to discuss your situation and do our best to make things as comfortable as possible for you and your cat.

Pectus excavatum is a congenital malformation of the sternum and costochondral cartilages resulting in a ventral dorsal narrowing of the chest or a depression of the sternum into the chest cavity. This deformity reduces effective pulmonary function and may also interfere with cardiac function.

Causes that have been discussed have included congenital predisposition, intrauterine pressure abnormalities, shortening of the central tendon of the diaphragm, thickened substernal ligament, congenital deficiency of the musculature in the cranial diaphragm, abnormal osteogenesis and chondrogenesis, upper respiratory obstruction, environmental factors, and posturing difficulties.

In humans, it is more frequently found in males and may be inherited as an autosomal dominant characteristic. In one survey it was twice as frequent in male than female cats, but not in dogs.

Signs often include exercise intolerance, weight loss, dyspnea, pneumonia, cyanosis, coughing, postural deficits. A heart murmur may be asculted and echocardiography is recommended to exclude the possibility of a concurrent primary heart disease. This is especially true in older cats that develop clinical signs as adults. It has been associated with other congenital defects e.g. pericardio-diaphragmatic hernia.

Radiographic findings may include decreased thoracic volume, cardiomegaly, and left displacement of the cardiac silhouette.

Causes:
Congenital, Genetic, hereditary

Sex predilection:
Male

Age predilection:
Juvenile
Newborn

Clinical findings:
AFEBRILE, ANOREXIA, CARDIAC MURMUR, COUGHING, CYANOSIS, DYSPNEA, GAIT ABNORMAL, WEAKNESS
Cachexia, Malaise, Weight gain insufficient
Exercise intolerant or reluctant to move, Walking difficulty
Heart sounds muffled, moist lung noises
Rapid breathing, Panting, Hyperventilation, Restrictive breathing pattern
Pulmonary infections recurrent

Diagnosis:
Thoracic radiographs showing cardiac displacement, cardiomegally, lordosis and sternal concavity.

Treatment/Management/Prevention:
SPECIFIC
1. Those with moderate to severe deformity should be treated surgically with placement of an external fiberglass splint contoured to normal thoracic shape.  One possible adverse side effect of exteral splint correction is re-expansion pulmonary edema.
2. Older patients who have less thoracic compliance may benefit from a partial sternectomy.

What is pyothorax?

Pyothorax refers to the presence of infected fluid and bacteria (pus) within the chest cavity.

What causes pyothorax?

Pyothorax is usually caused by a bacterial infection in the chest cavity. Usually, pus is present in both sides of the chest although occasionally only one side will be affected.

The source of the infection is rarely found although possible causes include:-

1. Penetrating wounds to the chest wall.

2. Wounds to internal structures such as the oesophagus (food pipe), trachea (wind pipe) for example following ingestion or inhalation of a foreign body.

3. Migrating foreign body such as a grass seed which entered the body elsewhere.

4. Extension of infection from a lung infection (pneumonia) - this is the most likely cause in the majority of cases.

What are the clinical signs seen with pyothorax?

Rapid shallow breathing which may be painful, depression, lethargy and other signs of ill health such as a reluctance to eat are seen in most cats with pyothorax. The severity of these signs is extremely variable and rarely cats may suddenly die without having had any previous signs of illness.

Cats with pyothorax usually have a high temperature which contributes to some of the clinical signs seen. The breathlessness is caused by the presence of fluid in the chest which prevents the normal expansion of the lungs.

RADIOACTIVE IODINE-131 FOR TREATMENT OF HYPERTHYROIDISM
INPATIENT DISCHARGE INFORMATION

INTRODUCTION
The thyroid glands are located in the neck of the cat are responsible for producing thyroid hormone. An excess of thyroid hormone production causes hyperthyroidism. The thyroid glands trap Iodine from the blood stream and concentrate it within the gland. When a cat is given radioactive iodine-131 the dose is concentrated in the thyroid gland. The radiation then destroys the overactive thyroid gland but doesn’t cause damage to other parts of the body.

Cats receive a single dose of radioactive iodine by either subcutaneous injection or by a capsule given by mouth. This single treatment will cure 95-98% of cats. It will take about a month for thyroid levels to return to normal in most cats. A small number of cats will remain hyperthyroid after treatment, if this is the case your cat will need to have either a second treatment or to use other medical or surgical methods of treatment. A small number of cats will have very low levels of thyroid function after treatment (hypothyroidism) that may require lifelong supplementation with thyroid hormone.

Side effects from radioactive iodine therapy are very rare, 1.5% cats will have temporary difficulty in swallowing or a change in voice.

WHAT ARE THE RISKS TO PEOPLE?
Compared to people cats receive quite a low dose of radioactive iodine-131 for the treatment of hyperthyroidism. This is because they are much smaller than people and have smaller thyroid glands. Even though your cat will still be mildly radioactive when it goes home, following our guide will ensure that any radiation exposure at home is well within the safe levels determined by the government.

The risk of radiation exposure comes both from the cat directly and also from any bodily fluids or wastes such as urine, saliva, faeces and vomit.

To help protect yourself and other in the house from radiation exposure you should follow some simple rules for the first 2 weeks:

• Limit the time spent with your cat
• Maximise the distance between yourself and your cat – radiation levels drop very quickly as distance increases (by the inverse square law)

Children and unborn babies are more sensitive to radiation, so children and pregnant women should not be responsible for caring for a treated cat for at least 21 days after the date of treatment; this is usually 14 days after your cat goes home.

WHAT DO I HAVE TO DO AT HOME? For Days 8-21 After Treatment

• Your cat is allowed inside and outside and does not need to be continuously confined.
• Your cat must not sleep in the same room as you for this period. Your cat should be a minimum of 1 metre from a bed, remember that radiation can travel through walls.
• You must limit close contact with your cat to 30 minutes per day for each person.
• The cat litter tray should be cleaned with a scoop once daily using disposable gloves. Litter may be discarded with the household waste.
• Wash your hands after contact with your cat.

From 22 days after treatment you may treat your cat as normal, as the levels of radiation will have fallen to very low levels.

WHAT DO I DO IF?
• My circumstances have changed and I can't follow the guidelines any more

Contact the Radiation Safety Officer at Creek Road Cat Clinic and we will develop a suitable plan. It may be necessary to admit your cat to hospital.

• My cat is unwell and needs to see a vet within 21 days of treatment

If possible see a vet at the Creek Road Cat Clinic, the clinic has a 24 hour emergency service. If this is not possible advise your vet that your cat has been treated with radioactive iodine-131, the dose and the date the treatment was given. Advise your vet to contact the Radiation Safety Officer at Creek Road Cat Clinic if they require advice on the safe handling of your cat.

• My cat urinates, defecates or vomits outside its litter tray

Use disposable gloves and paper towels to clean up the mess. Be very careful not to step in the mess. Flush any paper towels down the toilet and place the disposable gloves in a bag and place in the outside rubbish bin. Wash your hands thoroughly with soap and warm running water for at least 5 minutes. Contact the Radiation Safety Officer at Creek Road Cat Clinic.

• My cat scratches or bites me

Clean the wound under running water for at least 5 minutes. If the wound is bad seek medical attention and advise the medical staff that you have been bitten or scratched by a cat that has had radioactive Iodine-131 treatment. While there will be some radioactivity transferred in saliva from a bite it will be a very small amount. Please contact the Radiation Safety Officer at Creek Road Cat Clinic

• I spill urine, faeces or vomit on my skin or clothes

You should remove any items of clothing that are contaminated and place them in a plastic bag. Wash any areas of skin that have been contaminated with soap and warm running water for at least 5 minutes. Clothes should be washed promptly. Contact the Radiation Safety Officer at Creek Road Cat Clinic for further instructions.

FOLLOW UP
• Please arrange an appointment with your regular vet for a physical examination, weight check and blood test for thyroid and kidney function 4-6 weeks after treatment.

Please do not hesitate to call the clinic if you have any questions or concerns.

At The Cat Clinic we strive to give our feline patients the best of care, and your cat’s health is our priority. As the years go by, the ageing process can create more and more concerns for your cat and just like in people, early detection is the key to successful treatment.

The problems that our senior patients are at risk of developing include:

• kidney disease
• diabetes
• overactive thyroid glands
• heart disease
• cancer
• high blood pressure
• arthritis

Over the last few years there have been excellent advances in the treatment of many of these diseases seen in older cats, especially kidney disease. For these new treatments to have their greatest benefit though, they must start early before you notice any signs of illness.

We consider any cat 10 years of age or older to be a senior cat and re recommend that all senior cats start on our Senior Cat Care Program. The program involves a full veterinary check up, weigh in, dental examination, arthritis assessment, blood pressure measurement and some simple blood and urine screening tests designed to detect early signs of disease. Senior cat checks can be done at the same time as an annual vaccination which saves on one extra trip to the vet.

Senior cats should then be reassessed every 6 months to ensure any disease is diagnosed early and optimal treated provided. A senior cat program allows us to provide your cat with the best possible care and advise you on the special needs of your senior cat to ensure a long healthy life.

How old is your cat in human years?

The clinical examination is an essential part of preventative health care, however, we need to do some tests to help up see how the body is functioning. A brief description of the tests and what they mean follows.

Blood pressure is just as important in cats as it is in people, it is much harder to measure in cats though.  We use an ultrasound detector to amplify the pulse to we can make the measurement. High blood pressure is often caused by kidney disease or overactive thyroid glands.

Urine specific gravity is a test on the urine that lets us know how concentrated a cat’s urine is.  Cats are desert animals and they are supposed to have concentrated urine. This is one test where a high result is good. Urine that is not concentrated can be the first sign of many diseases including kidney disease and diabetes. When urine is not concentrated, you will usually see an increase in thirst.
Urine dipstick analysis use test strips to measure the levels of many chemicals in the urine. This is an excellent way of screening for diabetes and urinary tract disease. Information about some parts of kidney function can also be determined.

Creatinine is a waste product that is made in the muscles. The kidneys remove creatinine from the blood. We measure the levels in the blood to help see how well the kidneys are working.  If they are not working well then creatinine will build up to high levels. Although it is the best routine blood test available it is not able to detect very early kidney disease

Urea is a waste product made from the breakdown of spare protein, much of which comes from food. Like creatinine we can measure urea and a build up show the kidneys are not working properly. It is not as accurate a test as creatinine but it will often detect kidney disease slightly earlier.

ALT is an enzyme that is found in the liver and elevated levels indicate liver problems. Common causes of liver problems in older cats include bacterial infections, liver cancer and overactive thyroid glands.

Total protein is a simple test that measures the levels of protein in the blood. Abnormalities can be caused by many problems including inflammation, blood loss, liver, kidney, or intestinal disease.

Packed cell volume is a measure of how many red blood cells your cat has in their blood and tells us if anaemia is present or if there is dehydration.

Phone us today to arrange a senior check for your cat and join our Senior Cat Care Program.

Tick Toxicity in Cats

With the onset of Spring comes the onset of the Tick Season in Brisbane. The Paralysis tick (Ixodes holocyclis) is unique to the east coast of Australia. Where the ticks occur in Australia seems to coincide with where the long-nosed bandicoot has its natural habitat, because this bandicoot can carry the different life- stages of the tick. However other native animals like possums and lizards can also transport the tick.

The paralysis tick is also believed to climb trees vertically until it hits an angled branch. It will then follow this branch to the end and can drop off to attach to unsuspecting animals. This might explain why backyards with overhanging trees from a neighbour’s yard may have paralysis ticks, whilst not necessarily having much in the way of trees or possum habitat itself.

The Paralysis Tick (Ixodes holocyclis)

As in most conditions, cats are unique in how they present their signs of illness compared to other species such as dogs. For one thing the ‘paralysis’ aspect of this condition may not be the first sign seen or noticed in the cat. We may therefore refer to this condition as “tick toxicity”, rather than “tick paralysis”.

Cats may look as if they are quieter in behaviour than normal, reluctant to take more than a few steps before lying down again. The other important signs to look out for are increased breathing effort and changes in breathing noises, especially a ‘grunting’ sound when breathing out. A ‘wheeze’ or asthmatic sound may also be heard. Some cats may have a change in their meow.

Very particular and peculiar to our cats is a throat clearing type of action. Your cats mouth may open wide with a gagging sound, making many owners think their cat has something caught in the throat. This action is happening because the cat’s vocal chords are paralysed and small amounts of saliva or mucus are very irritating on the larynx, making the cat feel like he or she is choking.

This can be extremely distressing to your cat, and the more anxious they are, the more difficult it is for them to clear the throat. This is why veterinary attention for your cat often starts with medications to relax and reduce anxiety, after which breathing becomes a while lot easier.

More advanced stages of tick toxicity will include a more obvious difficulty in walking, staggering and swaying. Or your cat may be found lying down on his or her side, unable to sit up at all. Immediate veterinary attention must be sought.

The paralysis ticks themselves are grey in colour with orange legs and head part, with the legs all coming out from the “head” end rather than down the sides of the body. This describes the adult female tick, the main cause of tick toxicity.

Larval stages can cause signs of tick toxicity but usually in large numbers, and this occurs much less commonly. The tick itself can be tiny to start but is usually about 4mm across by which time it causes signs of tick toxicity. The tick may have been present for a few days before reaching this size, hence ticks found early and removed may prevent signs of tick toxicity.

Finding ticks in your cat’s coat is best done by “finger walking” through the coat, rather than looking for them visually. The most common areas to find ticks are around the head and neck, around or in the ears, even inside the lips. The next place to look is the front end of the body up to about the level of the elbows. All of these areas are more difficult for the cat to reach and groom.

Also the ticks are attracted to carbon dioxide. Hence the other area to look for ticks is around the back end, the bottom, tail and genital area. We are much less likely to find ticks in the ‘middle’ area of the cat, but would advise thorough searching. Cats who go outside in areas where possums and bandicoots are prevalent should be checked for ticks daily.

The availability of commercial products that may help prevent ticks is very limited for cats, and in fact it should be noted that products labeled for use in dogs only for tick prevention can be HIGHLY TOXIC and possibly fatal for your cats. If you wish to discuss use of products for assisting in tick prevention please call our clinic for a consultation. It is worth noting that there is no single product that can be relied on for tick prevention in cats an ‘finger walking’ is still recommended despite the use of products.

If you find a tick on your cat, despite urban myths and legends, you are advised to pluck the tick off immediately. It is not possible to ‘leave behind the head’ or to ‘inject more toxin’ by doing so. You may use fingers, tweezers, or special tick hooks are available. You are then advised to seek veterinary attention. There is a tick toxin anti- serum that can be administered to your cat, along with other supportive care deemed necessary.

It is not the anti- serum alone that treats these affected cats, as this ‘antidote’ can only remove some of the toxin in the blood stream and cannot reverse the toxin already affecting your cat. The overall supportive care for your cat’s breathing and comfort is equally as important as this medication. On average, cats may need two to four days in hospital for a full recovery.

We are happy to report that most cat’s recovery from tick toxicity is excellent. Just as cats present differently to dogs with tick toxicity, they also experience far fewer of the complications that befall their canine cousins. Confirming yet again that cats may indeed enjoy nine lives, with a little help from their friends: you the owner, and your veterinary team.

Rhett Marshall BVSc, MANCVSc, PhD
The Cat Clinic
189 Creek Road,
Mt Gravatt, 4122

Basic information

Glargine (Lantus) is readily available from most pharmacies with a script, is not licensed for use in cats.

Glargine must not be diluted or mixed with anything because the prolonged action is dependent on its pH.

Insulin glargine should be kept refrigerated to prolong its life.

Insulin glargine has a shelf-life of 4 weeks once opened and kept at room temperature. We have found that opened vials stored in the refrigerator can be used for up to 6 months.

Discard vial immediately if there is any discoloration. Bacterial contamination and precipitation associated with pH change can cause cloudiness.

If using an insulin pen, the manufacturer recommends that the pen and cartridge be kept at room temperature and not refrigerated. This is to reduce the changes in volume of insulin dispensed associated with changes in temperature.

When performing a blood glucose curve, samples probably only need to be taken every 4hrs over 12 hr in many cats (ie. 0h [before morning insulin], 4h, 8h and 12h after morning insulin).

Dose changes should be made based on pre-insulin glucose concentration, nadir (lowest) glucose concentration, daily water drunk, and urine glucose concentration.

Better glycaemic control is achieved with twice daily dosing rather than once daily.

Some cats that have been treated with other insulin will go into remission, usually within 1-4 months after instituting glargine. Remission in cats that have been treated for more than 2 years is extremely rare.

More accurate dosing may be achieved using 0.3ml U-100 insulin syringes.

Remission is likely to occur if the nadir glucose is in the normal range and pre-insulin blood glucose is less than 12 mmol/l. However, for some cats to achieve remission, the dose needs to be very gradually reduced, tapering off to ½ U SID before being withdrawn. Too rapid withdrawal often requires restabilising at a higher dose for some weeks.

Indications for using glargine

All newly diagnosed diabetic cats (to increase chance of remission)

Poorly controlled or unstable diabetic cats (glargine's long duration of action is likely to benefit these cats)

When SID dosing is desired or demanded (It is important to note that better glycaemic control and higher remission rates will be obtained with BID dosing. SID dosing only provides similar control and remission rates to lente BID)

Ketoacidosis - combined with regular insulin IM or IV

When corticosteroid administration is required in cats in remission. Similarly in cats at high risk of developing clinical signs of diabetes with corticosteroid administration.

Starting a cat on glargine insulin

If BG > 20mmol/L begin glargine at an initial dose of 0.5U/kg ideal body weight q12hrs (BID)

If BG < 20mmol/L begin at 0.25U/kg ideal body weight q12hrs (BID)

Perform a 12hr glucose curve with samples taken every 4hrs. Insulin can be increased daily until normoglycaemia is achieved but careful monitoring is necessary to avoid hypoglycaemia

Decrease dose if biochemical or clinical hypoglycaemia occurs

It is suggested that cats stay in hospital for 3 days to check the initial response to insulin, or home glucose curves are obtained for the first 3 days. Continuous blood glucose monitoring systems are an excellent way of obtaining initial response to therapy and we have great success using the Abbott FreeStyle Libre monitors. These can also be left in place for 2 weeks and allows owners to obtain BG readings without needing to sample blood.

Home glucose monitoring is considered best practice but for owners unable to complete at home then cats should be rechecked at 1, 2, 3 and 4 weeks and then as required.

Ketoacidotic cats may be treated with glargine s/c at the above dose rates in combination with regular insulin IM or IV (we have found 1U regular insulin IM every 2-4hrs based on glucose conc works best). This regime is continued until hydration restored and appetite returns, which usually occurs in 1-3 days.

Monitoring cats receiving glargine insulin

When performing a blood glucose curve, samples probably only need to be taken every 4hrs over 12 hr in many cats (i.e. 0h [before morning insulin], 4h, 8h and 12h after morning insulin).

With the long duration of action of glargine, there should be minimal periods when blood glucose is >14mmol/L for cats treated for more than 2 to 3 weeks, and hence well controlled cats should almost always be 0 or 1+ for urine glucose. A value 2+ or greater likely indicates that an increase in dose is required.

Dose changes should be made based on pre-insulin glucose concentration, nadir (lowest) glucose concentration, daily water drunk, and urine glucose concentration.

Adjusting glargine insulin dose

Once a cat has been stabilised on glargine insulin (i.e. after a week of therapy), the dose may need to be increased or decreased.

1. Indications for increasing the dose of glargine insulin
2. If pre-insulin glucose conc. is > 12mmol/L, then increase dose by 0.25-1.0U/injection

AND/OR

1. If nadir glucose conc. is > 10mmol/L then increase dose by 0.5-1.0U/injection
2. For well controlled cats after several weeks of therapy, an immediate "pre-insulin" glucose measurement > 12 mmol/L suggests that the dose should be increased.
3. Indications for maintaining the same dose of glargine insulin
4. If pre-insulin glucose conc. >10 - <12mmol/L)

AND/OR

1. If nadir glucose conc. 5-9mol/L
2. For well controlled cats after several weeks of therapy, aim for a nadir of 4-7 mmol/L
3. Indications for decreasing the dose of glargine insulin
4. If pre-insulin glucose conc <10 mmol/l decrease 0.5-1.0U
5. If nadir glucose conc <3 mmol/l decrease 0.5-1U
6. If clinical signs of hypoglycaemia develop, then rub honey or golden syrup onto the gums and contact a veterinary clinic immediately.
7. If biochemical hypoglycaemia develops, it can often be managed by feeding the cat, preferably a higher carbohydrate containing food, such as supermarket wet food with gravy.
8. For cats with unexpected biochemical hypoglycaemia (not clinical signs), some owners find that they can manage the hypoglycaemia by delaying the insulin injection until blood glucose increases to 10 mmol/L and then give the same dose (the following dose of insulin may need to be reduced), while others find it best to reduce the dose once glucose is above 10 mmol/L, although this may result in subsequent hyperglycaemia. In some cases, there is a "grey zone" of peak 11 - 14 mmol/L and nadir 3 - 4 mmol/l glucose concentrations. In these cases, the glargine insulin dose may be maintained or decreased depending on the water intake, urine glucose, clinical signs and length of time the cat has been treated with insulin.
9. Insulin dose may be maintained, increased or decreased depending on the water intake, urine glucose, clinical signs and length of time the cat has been treated with insulin.
10. If pre-insulin glucose conc. 11 - 14 mmol/L, or if nadir 3 - 4 mmol/l, clinical parameters are essential for adjustment of insulin dose.

Determining if the cat is in remission

1. Insulin dose should be gradually reduced by 0.25-1 U/cat/injection if nadir blood glucose is in the normal range of 4-7 mmol/L or pre-insulin glucose concentration is < 10 mmol/L. Withdraw insulin SLOWLY until dose is 0.25 - 1 U once daily (SID). Some cats require only small doses of insulin (<1 U/cat BID) and only go into remission if the dose is reduced VERY SLOWLY giving few remaining beta cells a chance to recover.
2. After a minimum of 2 weeks of insulin therapy, if the pre-insulin blood glucose is <10mmol/L and insulin dose is 0.25-1 U SID, insulin should be withheld and a 12hr glucose curve performed. If at the next due dosing time the blood glucose is >12mmol/L, then insulin can be re-administered at 1U BID and then gradually reduced as indicated. If blood glucose is <12mmol/L then continue to withhold insulin and discharge with a follow-up visit in 1 week. Water intake and urine glucose should be closely monitored and insulin reinstituted if glycosuria returns or water intake increases.
3. Some cats may have a pre-insulin glucose concentration <10mmol/L within 2 weeks, but insulin therapy should be maintained for a MINUMUM of 2 weeks to give beta cells a better chance to recover from glucose toxicity. Use 0.5-1U BID or once daily until insulin is withdrawn.
4. Some cats that have been treated with other insulin will go into remission, usually within 1-4 months after instituting glargine. Remission in cats that have been treated for more than 2 years is extremely rare. Remission is MORE likely to occur if the nadir glucose is in the normal range and pre-insulin blood glucose is less than 12 mmol/L. However, for some cats to achieve remission, the dose needs to be very gradually reduced, tapering off to ½ U SID before being withdrawn. Too rapid withdrawal often requires restabilising at a higher dose for some weeks.

Urine Glucose

With the long duration of action of glargine, there should be minimal periods when blood glucose is >14mmol/L for cats treated for more than 2 to 3 weeks, and hence well controlled cats should almost always be 0 or 1+ for urine glucose. A value 2+ or greater likely indicates that an increase in dose is required. This should be confirmed with blood glucose evaluation.

Fructosamine or Glycated Haemoglobin

Urine and blood glucose and water intake (i.e., clinical signs) are usually the easiest way to monitor therapy with glargine insulin. Since many cats go into remission after a few weeks, long-term measures of glycaemic control, such as fructosamine or glycated Hb, are of less value in monitoring patients.

General observations from preliminary use of glargine insulin

Starting doses may be high. Some cats initially require a dose of 5 or 6 U/cat BID to establish glycaemic control. This dose can usually be reduced as insulin sensitivity returns. Cats on these high doses need to be carefully monitored for hypoglycaemia.

Some cats require only small doses of insulin (<1 U/cat BID) and only go into remission if the dose is reduced very slowly giving the few remaining beta cells a chance to recover.

Nadirs can be variable. For many cats, the time at which the nadir (lowest) glucose concentration occurs is often not consistent from day to day, or between cats. Sometimes it occurs somewhere between the two doses, but sometimes the nadir occurs around the time of the next dose. Some cats consistently have their nadir glucose concentration in the evening just before the next insulin injection, and less commonly, it occurs around the time of their morning injection.

BID dosing to start. Better glycaemic control is achieved with twice daily dosing rather than once daily.

To increase the chance of remission, we suggest aiming for perfect control or possibly slightly overdosing during the first 2 months, provided the veterinarian and owner can carefully monitor the cat. There is the potential risk of hypoglycaemia, but we believe this is outweighed by the benefit of diabetic remission to the cat and owner.

Cats requiring intermittent or chronic corticosteroid administration that are either in remission or at risk of developing diabetes can usually safely be placed on 1U SID or BID.

It is a very common observation by owners that when long-term stable diabetic cats are changed over to glargine, usually they do better clinically, even if blood glucose results do not support the clinical improvement.

REFERENCES

Journal Articles

1. Rand JS, Marshall, RD. Diabetes Mellitus in Cats. Vet Clin Small Anim., 2005;35[1]:211-224.
2. Weaver KE, Rozanski EA, Mahony OM, Chan DL, Freeman LM. Use of glargine and lente insulins in cats with diabetes mellitus. J Vet Intern Med. 2006;20(2):234-8.

Proceedings

1. Stenner,V.J., Fleeman,L.M. & Rand,J.S. Comparison of the pharmacodynamics and pharmacokinetics of subcutaneous glargine, protamine zinc and lente insulin preparations in healthy dogs. Proceedings ACVIM 2004.
2. Marshall RD and Rand JS. Treatment with glargine results in higher remission rates than Lente or protamine zinc insulins in newly diagnosed diabetic cats. Proceedings ACVIM 2005.
3. Marshall R, Rand J. Comparison of the Pharmacokinetics and Pharmacodynamics of Glargine, Protamine Zinc and Porcine Lente Insulin in Healthy Cats. Australian College of Veterinary Scientists Science Week, 2003.
4. Marshall R, Rand J. Comparison Of The Pharmacokinetics And Pharmacodynamics Of Once Versus Twice Daily Administration Of Insulin Glargine In Normal Cats. Proceedings ACVIM 2002
5. Marshall R, Rand J. Update on Insulin Glargine Use in Diabetic Cats. Proceedings ACVIM 2005
6. Weaver KE, Rozanski EA, Mahony O, Chan DL, Freeman LM. Comparison of Glargine and Lente Insulins in Cats with Diabetes Mellitus. Proceedings ACVIM 2005.

Regular vaccination is an important part of routine health care for your cat and helps to ensure your cat remains fit and well.

Many serious and life-threatening diseases can be prevented by vaccination.

Regular vaccination is an important part of routine health care for your cat and helps to ensure your cat remains fit and well. Many serious and life-threatening diseases can be prevented by vaccination. In Australia, there are a number of vaccines that are currently available for use in cats to protect against the following diseases:-

Feline Herpes Virus Type 1 (FHV-1; feline rhinotracheitis virus)
Feline Calicivirus ( FCV)
Feline Panleukopenia (feline infectious enteritis; feline parvovirus)
Feline Chlamydial Infection
Feline Leukaemia Virus ( FeLV)
Feline Immunodeficiency Virus (FIV)

How do vaccines work?

Vaccines work by exposing the body's immune system to a particular modified infectious agent.  This causes the white blood cells to react to fight the infection by producing proteins (antibodies) which are able to bind to and neutralise the infectious agent (antigen).  Antibodies work together with other white blood cells (lymphocytes) which are able to identify and kill cells within the body which have become infected by the agent (cell mediated response).  After vaccine exposure, the body 'remembers' the particular antigens so that when they are encountered again it can mount a very rapid and strong immune response preventing the cat from showing clinical signs of disease.

It is important to realise that most vaccines work by preventing your cat from becoming ill and may not prevent it from becoming infected.  This means that if a vaccinated cat becomes infected with ‘cat flu’ it may still shed the disease producing organism which can infect unvaccinated animals which will then become ill.  This is not a major consideration in the pet cat but may be important in the breeding colony.

What is the difference between the various types of vaccine?

The 2 major types of vaccines for use in cats are:

Modified live vaccines- these vaccines contain live organisms that are weakened (attenuated) so that they do not produce disease but will multiply in the cat's body. It is not advisable to use modified live vaccines in pregnant queens or cats whose immune system is not working properly e.g. cats infected by feline immunodeficiency virus (FIV).

Killed (inactivated) vaccines - these vaccines are prepared using fully virulent organisms that have been killed by chemicals, UV light or radiation.  Because, on their own, they do not give such a high level of protection, a chemical (adjuvant) is added to the vaccine to stimulate a better immune response.

When should my kitten be vaccinated?

Kittens should be first vaccinated at 6 to 8 weeks and then every 4 weeks until they are 16 weeks or older. For most kittens this will mean 3 vaccinations. A kitten will not be fully protected until 7-10 days after the last vaccination.  Under specific circumstances we may advise an alternative regime.

How often should booster vaccinations be given?

Guidelines for booster vaccinations are constantly being debated around the world. Vaccines currently used in Australia are labelled by the manufacturer to be given every 12 months. We support this and recommend that after the initial series of kitten vaccinations that cats be vaccinated every 12 months.

Will vaccination always protect my cat?

Vaccination will protect the vast majority of cats but under some circumstance vaccine breakdowns will occur.  There are many reasons for this including:-

1.       Variations between different strains of viruses - this is particularly true of FCV where many different strains exist, not all of which are covered by the vaccines available.

2.       Maternally derived antibodies - when a kitten is born it is protected in its early life by antibodies passed from the queen in the first milk (colostrum).  These antibodies can also prevent vaccination from working properly. The amount of colostral antibodies that each kitten receives is variable and so the age at which a kitten can respond to vaccination successfully will also vary.  This is part of the reason why two or three injections are given in the primary course.

3.       The cat was not healthy at the time of vaccination - 'stress' can prevent a good response to vaccination.  For this reason your vet will give your cat a physical examination before a vaccination is given.

4.       The cat may also be pre-infected with the ‘cat flu’ virus and incubating the disease.

If you feel your cat has contracted an infection for which it is vaccinated then let your veterinary surgeon know.  Investigation to establish why vaccination has possibly failed can be undertaken.

What are the risks of vaccination?

Generally the risks of vaccination are extremely low, severe reactions being very rare. Many cats experience mild reactions at the site of vaccination where a lump may occur that can be painful.  Generalised reactions are sometimes seen, the cat being quiet, lame and often off its food for 24 hours after vaccination.  Occasionally more severe signs occur including vomiting, diarrhoea and profound depression.  Under these circumstances your veterinary practice should be informed.  Vaccine reactions appear to occur more commonly in kittens and some purebred cats.

Which are the most important vaccinations to have?

We suggest all cats be vaccinated against feline herpes virus, feline calicivirus and feline panleukopaenia. This is often referred to as a F3 vaccination.
For outdoor cats, we recommend vaccination against feline immunodeficiency virus (FIV).

Feline respiratory virus infection
Disease is caused by feline herpes virus or feline calicivirus and is commonly termed 'cat flu'.  It is a common disease in unvaccinated cats and can cause long-term problems, including chronic sneezing, nasal discharge, inflamed eyes and severe gum problems.

Feline panleukopenia infection
This is now an uncommon disease that causes a severe and often fatal gastro-enteritis.  Vaccination provides a high level of long lasting protection.

Feline immunodeficiency virus infection
All outdoor cats are susceptible to infection with FIV if bitten by an infected cat unless protected by vaccination against the virus. The initial vaccination is followed up by 2 more vaccinations 2-4 weeks apart and then with annual boosters. FIV vaccines can be given at the same time as regular F3 vaccinations.

Feline Chlamydial infection
This tends to be a particular problem in colony cats. Chlamydial infection causes a painful inflammation and swelling of the conjunctiva (the membrane around the eye) and has been associated with infertility in queens. This vaccine can make many cats sick for several weeks and only suggest vaccination in certain circumstances.

Feline leukaemia virus infection
FeLV causes suppression of the immune system, cancer of the white bloods cells and solid tumours. It is an extremely rare disease in Australia seen mainly in colonies. We only suggest vaccination for FeLV for at-risk cats.

Regular vaccination is an important part of routine health care for your cat and helps to ensure your cat remains fit and well.