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Wednesday, March 30, 2011

Cats That Pee On The Floor

I love cats. I have three at my house! Having said that, for some animal-lovers, the point of choosing a cat instead of a dog is to avoid dealing with the whole housebreaking thing. Cats use litter boxes, therefore no one needs to be home to let them outside to "do their business." Ah, but as with so many things in life, the cat doesn't always stick to the plan. At our hospital we see several cats a week for what we term "litter box avoidance."

We can generally classify the causes of litter box avoidance as either due to bladder pain (physiologic), or due to environmental factors (behavioral). Most of us who have ever had a UTI can relate to the bladder pain issue. These cats feel pain which they associate with urination, which they associate with the litter box. So they avoid the litter box. They also may feel like they have to "go" all the time, and they just can't make it to the box. We can usually tell which cats fall in this category based on the history (frequent, small-volume urination; vocalizing when urinating), and urinalysis results which show evidence of inflammation in the urine (usually increased red or white blood cells).

Once we determine that a cat has a bladder problem, we can bet that it's one of four things: an infection (UTI), a stone, a tumor, or "interstitial cystitis" (IC). You all know what the first three are, but probably haven't heard of interstitial cystitis. "IC" goes by many other names (Feline Urologic Syndrome, Feline Lower Urinary Tract Disease, Idiopathic Cystitis) which usually means, as in this case, that not much is known about it. The disease causes pain and inflammation in the bladder (including the presence of blood, crystals, or other substances), and in male cats can lead to urethral obstruction and the life-threatening inability to urinate.

Current thinking is that IC is a stress-associated condition which only occurs in certain predisposed cats. But we really don't know. There is no good treatment, but the symptoms often run their course, sometimes to reoccur later. The best therapy in my hands is feeding canned food exclusively (preferably Science Diet C/D --I really think it helps!) and the anti-anxiety drug amitriptylline. Encouraging a cat's natural predatory instincts (hunting, stalking prey) also seems to help. This can be accomplished by letting the cat chase a string, toy mouse, etc...

Diagnosing IC is also challenging. Here are my guidelines for diagnosing/treating cats with bladder inflammation. First of all, I know that UTI's and IC are far more common than stones and tumors; furthermore, UTI's are more common in old cats (and diabetic cats), while IC is more common in young cats. So if the cat is old or diabetic, I will try antibiotics first and see if things get better. If the cat is young, I will treat for IC first. If treatment is not successful (in either case), I will take an X-Ray to look for a stone. If there is no stone, I might do a urine culture to verify the presence or absence of bacteria (UTI). If all tests and treatments are unsuccessful, and the cat still has blood (or other stuff!) in the urine, I will recommend an ultrasound to look for a tumor. Again, with IC, all tests will be normal.

One thing that bothers me is when vets automatically put all cats with blood in the urine on antibiotics. If the cat is young, it probably does not have a UTI. When the cat is rechecked a few weeks after the antibiotic, it may be better. This is not due to the antibiotic, but because of the waxing-waning nature of IC. Even though antibiotics are generally safe, their indiscriminate use can lead to the development of resistant strains of bacteria. And that is becoming a big problem in our country.

As I mentioned at the beginning, some cats who have "litter box avoidance" have normal results on their urinalysis. I generally classify these cases as behavioral. They may be avoiding the box because they don't like the box (it's not clean enough, they don't like the cat litter, they don't like sharing it with other cats, it is not in a "private" enough location, etc...), or something else has upset them and they are showing their displeasure by urinating in inappropriate places. This might be due to a new pet or person in the house, a strange cat in the yard (cats love to look out the window), or some other change in their routine. It could also be due to the cat not feeling well. Sometimes the first sign of serious illness in a cat is litter box avoidance. For this reason, these cats should always be checked out by a vet.

Believe it or not, litter box avoidance is a fairly common cause of euthanasia in cats. I hope this blog helps shed some light on the issue.

Monday, March 28, 2011

A Tribute To My Staff

I have to say, I really love my job. It is a rare day that someone doesn't tell me they've wanted to be a veterinarian at some point in their life. As an animal-lover, nothing could be better than going to work to help sick pets or keep pets from getting sick. But among veterinarians, I think I am more blessed than most, thanks to the people I work with every day.

I try to be a guy who appreciates all his blessings, but a particular incident last week really made me realize how cool it is to work at Horseshoe Lake Animal Hospital. I was doing a physical exam on a cat, and talking to her owner when we heard a bit of commotion coming from the back of the building. We stopped talking to try to figure out what the noise was.

At first it was difficult to discern, but after a few moments we realized we were listening to female voices singing, and the singing was, well, enthusiastic. As we listened more closely, the client looked at me and said, "You give love a bad name." I was definitely thrown off by her remark and said, "Excuse me?" "You Give Love A Bad Name. The Bon Jovi song. That's what they're singing," she said. Ok, that was a relief; and as I listened to them, I couldn't help but laugh out loud.

I have no idea what prompted the singing, but my client looked at me and said this must be a really fun place to work. My tech and I had to agree that it was. The people who work here are seriously underpaid - they're all here because they love what they do. It is pretty stressful at times, because our standards are high, and we take our responsibility to our patients and their owners very seriously. Not to mention this is a ridiculously busy place. But in spite of it all, we really like each other, and our jobs.

I'm also a drummer in a rock 'n roll cover band, and whenever we play out, about twenty or more people from work show up to socialize and dance. I love the show of support for me, and the fact that after spending a whole week together, these folks want to hang out. They get a little crazy sometimes, but that just makes me all the more impressed by the serious work they do at the hospital. It is the perfect example of knowing when to have fun, and when to bear down. And it makes me one lucky veterinarian.

Wednesday, March 9, 2011

Pig Ears Recalled Due to Salmonella

This just in...

Associated Press
The following recalls have been announced:


DETAILS: Pig ear dog chews manufactured by Jones Natural Chews Co. of Rockford, Ill., and shipped to distributors and retailers in Connecticut, Iowa, Illinois, Massachusetts, Maine, Michigan, Minnesota, Missouri, Montana, North Carolina, North Dakota, New Jersey, New Mexico, New York, Pennsylvania, Virginia, Washington and Wisconsin.

WHY: The chews may be contaminated with salmonella, which can cause nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever in people, and cause pets to feel lethargic and have diarrhea or bloody diarrhea, fever and vomiting.

INCIDENTS: None reported.

HOW MANY: 2,705 boxes.

FOR MORE: Call 877-481-2663.