Tuesday, October 13, 2015

“My cat is peeing all over the house!”

A cat that is urinating outside of the litter box—one of the most common complaints we treat at Wilmington Animal Hospital. Our profession actually has an official name for this: Feline Inappropriate Urination. This problem is so common that we’re making this blog a bit longer than usual.

Perhaps you’ve noticed less or no urine in the litter box. Or maybe your shoes/clothing/bed/bathroom rug/sink/bathtub/favorite expensive Oriental rug/ [fill-in-your-cat’s-favorite-location-here] has cat urine on it. Maybe you had been noticing your cat straining to urinate in the litter box or going back to the box multiple times before noticing these new sites. These are early clues to the problem.

The causes are numerous. I like to think of the bladder and its issues as being “downstream” of the cause of the problem. Pun intended, by the way. Here are a few initiating factors:

·         Physical problems. Not to belabor the pun, but these can often be the result of emotional issues—yes, the physical can be downstream of the emotional cause. But since physical problems can be serious, and in some cases fatal if not immediately addressed, let’s mention them first.

The most serious: blockage. The urethra, the tube leading from the bladder to the outside world, becomes clogged with grit, protein and mucus, or sometimes with a small stone itself. This is overwhelmingly more common in male cats due to the narrow diameter of the urethra. If not addressed in 24 hours, the cat becomes very sick. By 48 hours, the cat will die. Since most cat owners are not skilled in abdominal palpation, if your cat is not passing urine, you MUST take him to the veterinarian immediately!

Most common: cystitis. This is a catch-all term for inflammation in the bladder. Actual infections, like with bacteria, are very uncommon in cats. In fact, since we don’t really associate any particular bacteria or other organisms with cystitis, we call this “idiopathic cystitis.” Idiopathic means we don’t know what the cause is.

What we do know is how cats react when they are dealing with this. The owner will observe frequency of visits to the box (or other newly favorite sites), straining, maybe passing just drops of urine (hopefully because the bladder is empty, not blocked!), and maybe the urine is bloody or blood-tinged. These cats need to visit a vet right away, as this is very uncomfortable. In fact, male cats can be hours away from blocking.

Sand/grit/stones in the bladder: As you can imagine, urinating sand through a narrow sensitive tube can be painful. Stones can cause blockage, even in female cats—and upwards of 25% of cats with bladder signs can have stones! Sand, as mentioned above, can lead to blockage.

Metabolic problems: These include diabetes, kidney problems, hyperthyroidism, liver disease, and more. All of these can result in the cat not feeling well, but also in the production of larger volumes of urine, saturating the box and necessitating a change to the sink/bathtub/rug/you get it.

Tumors: Found predominantly in older cats, these can mimic all the signs of the conditions above. Larger tumors can sometimes be felt by a skilled veterinarian, but more commonly, advanced imaging, like ultrasound, is needed for the diagnosis.

All of these physical conditions can appear very similar, making it very important that your cat sees the veterinarian immediately.

·         Substrate aversion: This fancy name means the cat doesn’t like its kitty litter. Cats tend to not like strong odors (what are you cleaning the box with?), perfumed litter, pelleted litter, non-pristine boxes, and while we’re at it-- covered boxes (can get too dusty), uncovered boxes (some prefer covered!), too few boxes (“I’m not stepping in all this soiled litter!”), too busy and noisy a location, too remote a location (are you making your arthritic senior citizen cat go up and down stairs?)… You get the point.

Do you have at least one more box than the number of cats you have? So 3 cats, you need 4 boxes, at least.

Are you using a multi-cat clumping litter and scooping it at least twice daily, with a thorough cleaning of the box as frequently as needed?

For older cats, are the boxes are conveniently located, and not too high to have to jump into? You can fill the litter to the top to ease the plunge.

·         Emotional issues: These are so varied that I could write a very thick book on them. They vary according to the cat’s sensitivity to stressors. A cat who is bullied by another cat may express this by inappropriate urination. A high-strung cat may just be generally stressed. Or a perfectly content cat may be thrown off-kilter by the smell of a cat urinating outside the window (which is open now because the weather is milder…).

Some cats are very sensitive to the owner’s stress and express this with their urinating behavior. “Owner stress” can include job loss, relationship issues, death in the family, getting ready for vacation, work-related issues, etc.

General household turmoil can affect cats. Lots of visitors- kids, adults, contractors. Big evergreen tree appearing in the livingroom mid-December! A dog (a.k.a. large hairy foreign invader) visiting, once. A housemate cat—or even dog—recently passed. (Note that cats have an “unspoken” relationship with every being in the house, so the passing of another animal, even one that the cat didn’t seem to get along with, can have a profound effect on the cat’s psyche.)

These are just some of the many causes of feline inappropriate urination. The take-home point is that your cat may appear uncomfortable and in need of immediate relief, or may actually be in the throws of a life-threatening situation. As soon as you notice a problem, get your cat to your veterinarian so appropriate diagnostic tests and treatments can be started, and your cat can be on his way to using the litter box again.

Thursday, April 2, 2015

Microbiome Restorative Treatment (Fecal Transplant)

Microbiome Restorative Therapy (aka “Fecal Transplant”) is the transfer of stool from a healthy patient into an unhealthy recipient patient.

What are the indications for this treatment?
Many dogs and cats suffer from chronic gastrointestinal (GI) problems, like persistent poor appetite, weight loss, chronic vomiting, and chronic diarrhea/soft stools. When an underlying diagnosis is not found, or when a patient fails to respond to other therapies, the dog or cat may benefit from receiving the stool from a healthy dog or cat.

What may cause an imbalance from the normal bacteria in a pet's intestines?
A few of the known causes include antibiotic therapy, anti-inflammatory therapy (arthritis medications, steroids, metronidazole), GI parasites like giardia and coccidia, viral infections, and any other causes of poor health.

What is involved in the treatment?
The recipient spends a few hours at our hospital. Initially, the pet will receive a rectal ozone treatment (which takes a few seconds to administer) as well as an infusion of 10 ml of Quinton, a liquid containing over 80 minerals. Quinton offers nutrients that dogs and cats lack in their diets, and enables them to jumpstart the healing process. Immediately following the ozone and Quinton infusions, the pet is given a rectal infusion of feces from a healthy donor. The pet stays with us for a few hours to make sure he does not immediately defecate.

How safe is this treatment?
All patients must first be seen by Dr. Epstein to be evaluated for this treatment. Each batch of feces is obtained from a healthy donor who has been fed a species-appropriate diet and appears to be in excellent health. Each batch of feces is tested for intestinal parasites, including coccidia, giardia, hookworms, whipworms, roundworms, tapeworms, and more. A PCR (DNA) test is run on each batch to check for the presence of parvovirus, coronavirus, Clostridium (2 species that are found in unhealthy stool), Salmonella, Campylobacter, Cryptosporidium, Coronavirus and giardia in dogs, and panleukopenia (Feline Distemper), Tritrichomonas, Campylobacter (2 species), Cryptosporidium species, Salmonella, giardia, and two species of Clostridium in cats.

What should be expected after the treatment?
Immediately after the treatment, the pet should be discouraged from defecating for at least a few hours. Improvements in health can sometimes be seen immediately, and include more energy and a better appetite. Sometimes the improvements can be more gradual. Patients are encouraged to receive further natural therapies, like homeopathy and acupuncture, to address underlying imbalances in their health.
While recovering, it is possible that a patient may need an additional treatment (or more) if the improvement slows or starts to reverse.
If the patient is not improving, further diagnostics may be indicated to search for underlying problems.
Our donor dog, Baxter

Wednesday, October 22, 2014

Acupuncture and Chinese Herbs for Mammary Cancer in Cats

By Elizabeth McKinstry, VMD

Traditional Chinese Veterinary Medicine (TCVM), including acupuncture and Chinese herbs, can help pets when conventional therapies have been exhausted. TCVM often works by strengthening the patient and its immune system, enabling it to overcome a variety of problems, including cancer.

Sydney was a spayed elderly cat with quite a few problems. She was positive for Feline Leukemia Virus, had hyperthyroidism, and suffered from a chronic upper respiratory infection. On top of all of these maladies, she had a malignant mammary gland (breast) mass. This had been surgically removed with “clean” margins, but unfortunately the mass had regrown by the time Sydney presented for TCVM several weeks later.

In Sydney’s case, she was started on two Chinese herbal formulas and injected with vitamin B12 in the appropriate acupuncture points. One of the herbal formulas stimulates the cat’s immune system, builds muscle tissue, increases energy and inhibits mutation. The other works to “soothe Liver Qi,” “move blood” and shrink masses. These herbal formulas and acupuncture points were selected based on Sydney’s specific TCVM pattern and can be different for each cat with mammary cancer.

At the two-month check-up, the tumors had totally disappeared and her chronic upper respiratory infection had also cleared for the first time in two years! Sydney was continued on both herbal supplements for the next year and the cancer did not return. She gained weight and had a beautiful shiny coat!

Acupuncture and Chinese herbs are a growing alternative to conventional therapies, especially when the goal is to improve the quality of life of the whole patient.

Dr. McKinstry practices Traditional Chinese Veterinary Medicine by appointment on certain Saturdays at Wilmington Animal Hospital.

Thursday, June 19, 2014

Think Like a Cat: The Cat Who Urinates Out of the Box

One of the most common problems that veterinarians are asked to treat is a change in litter box behavior: the cat who is urinating out of the box.

The complaint might be in the form of wet yellow surprises on articles of clothing (laundry basket contents are a favorite) or slippers, or even on stovetops, bathtubs or expensive Persian rugs. Many owners notice the cat backing up to vertical surfaces like walls and flicking the tail which is pointed straight up as urine squirts out. You might recognize this as marking behavior. And yet another presentation might be in the form of the distressed cat who is obviously trying to tell the owners something by urinating frequently in front of them, typically in a room frequented by humans, and likely producing miniscule amounts of blood-tinged urine, if any.

This myriad of presentations requires some detective work to determine what is amiss and what needs to be done to correct this.

It’s always helpful to first try to get in the cat’s head. Cats are very sensitive to changes in their environment, whether we’re talking changes in litter box substrate, location or architecture (covered v. open); or changes in the household activity like owners coming or going, new pet acquisitions, stress in the humans from any cause, feral cats marking outside the window or a big evergreen tree that has moved into the living room in December. They can also be very sensitive to “uncomfortable” living situations, like a bully cat in the household, confinement in a room while squirrels and birds tease them at the window or noisy households that might even involve a loud washing machine situated next to the litter box.

In any of the above scenarios, the cat’s favorite target organ for stress can be the bladder.

Even with the best of feline diets, stress can appear in the bladder in any of the above forms, for any of the above reasons (and more). Sometimes the solution is to remove the stressor or relax the cat. If the stressor cannot realistically be eliminated, we recommend Feliway made from synthetic feline facial pheromones, a.k.a. “kitty aromatherapy Prozac” (our special nickname), or Pet Remedy, an aromatherapy with valerian that we import from the U.K.  Both of these are found in spray and aerosol plug-in forms. Many cats respond to individualized homeopathic prescribing which removes the cat’s susceptibility to these stressors. At WAH, we rarely resort to pharmaceutical therapies for psychological use in cats.

Many kitties suffering from bladder distress have secondary physical problems. The most life-threatening of all is the complete urethral blockage in male cats. These cats can’t urinate and will be very sick within 24 hours, dead within 48 hours. Obviously, if you think your cat is not passing any urine, you should bring him to a veterinarian immediately. It’s worth mentioning that a small subset of these cats won’t show any signs of urinary distress—they just stop eating, maybe start vomiting, and act like a generically sick cat. This is a good reason to take your sick cat to the veterinarian immediately, regardless of what your Internet search might lead you to suspect.

 Other non-imminently-life-threatening physical problems include spasms in the urethra (the tube leading from the bladder to the outside world), bladder stones (about 25% of these cats) or infections (less than 5% of these cats). A urinalysis is usually the first (and easiest) diagnostic test to run. Radiographs (a.k.a. “X-rays”) are helpful, either at the initial visit or at a follow-up visit if the problem is not resolving. Ultrasound of the urinary tract can be helpful in intractable cases, especially if a tumor is suspected in older cats.

Specific therapies that might be needed include medication to relax that spasming urethra, antibiotics for those rare bacterial infections, fluid therapy to help flush out crystals and protein-mucus clumps, and pain medication in some cases. While prescription diets might help some of these cats, at WAH we focus on converting to more species-appropriate diets, like high protein canned foods or raw diets if the cat will oblige. A diet with high water content is essential.

Remember: Cats with out-of-the-box urinating behaviors are trying to tell you something. They likely have emotional issues that need to be addressed and physical consequences that require attention.  Yes, the mind-body connection is alive and well in our feline companions and being expressed in the urinary tract!

Tuesday, May 20, 2014

Four Keys to Housetraining Your New Puppy

  1. Use all positive reinforcement—rewards—like your happy voice and occasional treats.
Hint: Be ready to be outside EVERY time with your puppy! Your new puppy relies on you to provide this positive reinforcement. If you are in the house when your puppy is going to the bathroom outside, he/she won’t know how pleased you are!

  1. NEVER use any form of punishment, like scolding, rubbing the puppy’s nose in the mess in the house or hitting your puppy.
Hint: Puppies crave any form of attention, even negative attention. If they get this attention for going to the bathroom in the house, THIS will become an unintentional reinforcement of the wrong behavior, resulting in the pup continuing to go to the bathroom in the house.

  1. Give your puppy the opportunity to do the right thing.
Hint: Take your puppy outside IMMEDIATELY after feeding. A handy little reflex tells the colon to empty when the stomach is full.
Hint: Always take your puppy outside first thing in the morning, before bed, and likely many more times during the day until a routine is established.
Hint: Try to use the same door each time. Ultimately, your puppy may learn to signal you at that door.

  1. DON’T give your puppy the opportunity to do the wrong thing!
Hint: If you can’t give your puppy your full attention, like if you’re reading, cooking, taking a shower or sleeping, then make sure your puppy is confined in small area, like a crate.
Hint: This small area should be large enough for the puppy to stand up and turn around, but not large enough to be able to walk from one end to the other. You want this to simulate a wolf’s den, not a condominium.