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.

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.

Pig Ears Recalled Due to Salmonella

This just in...

Associated Press
The following recalls have been announced:

JONES NATURAL CHEWS PIG EARS

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.

Giardia--The Parasite Your Vet May Not Be Looking For

First of all, I want to apologize for another "parasite blog." I'm really not all that preoccupied with small creatures that invade our pets (and sometimes us). It's just that I received a report last week summarizing the number and types of parasites found from our patients' fecal tests over the past two months. The report was furnished by our outside lab service (Antech Diagnostics). I was stunned to see that 17% of the patients were infected with Giardia. That's almost one out of every five. Statistics from all St. Louis-area practices showed a slightly lower infection rate of 14%.

There are a couple of things that make these numbers highly significant. First of all, Giardia is one of those parasites that is contagious to people. Giardiasis is typically mild in humans with diarrhea as the primary symptom. Additionally, getting Giardia from a family pet is uncommon, with only a few documented cases. Having said that, Giardia infections in immune-compromised persons (people with AIDS, chemotherapy patients, very old or young people) can cause devastating, even life-threatening illness. The other significant thing to note is that most veterinarians do not routinely test for Giardia.

Giardia can sometimes be detected on routine fecal floats done by most veterinarians, but more often than not, the fecal float will not detect the parasite, even if it's done properly. The most accurate way to find Giardia is by performing a specific test (called an ELISA) to look for it.

At our hospital, we strongly urge Giardia testing on all new pets. We offer the test as an optional service to all pets on an annual basis. Many veterinarians do not recommend Giardia testing on asymptomatic pets. This is probably because they think it isn't very common (wrong!), or that their fecal flotation tests will detect it (less than 50% of the time!) In light of the report I received, we might start pushing pet owners to test for this parasite every year. We have a link on our hospital website with more information on Giardiasis: http://www.horseshoepets.com/giardia.html

Killed By Our Own Pets?

One of my favorite people sent me an article from aolnews.com, titled "Letting Sleeping Dogs Lie in Your Bed Can Kill You" . The article quotes the chief veterinarian from the California Department of Health as well as a veterinary professor at UC-Davis. They are both experts on zoonotic diseases, which are diseases that can be transmitted from animals to people.

The article is factual and well-written, but seems maybe a little distorted in terms of the fears that it may raise in people about their relationships with their pets. It is true that there is a growing concern among DVMs about zoonotic diseases, and at my practice it is policy for the doctors to discuss with pet owners ways to reduce the risks of zoonotic infections. I will describe for you my recommendations for you to enjoy a cuddle-y relationship with your pets without being afraid of catching something.

Be aware that the most common zoonotic pathogens (at least in the Midwest) are intestinal parasites (roundworms, hookworms, and giardia are the ones we see). These parasites produce eggs which are passed out in the pet's feces. The eggs then get in the soil and are picked up by people if they get some of the "contaminated" dirt on their fingers, then put their fingers in their mouth. To reduce your risk: 1.Pick up your pets' feces daily to reduce the risk of eggs getting in the soil 2.Practice good hygiene - no fingers in mouths, wash hands before eating 3.Keep your pets on heartworm/parasite control products every month. I recommend Sentinel for dogs and Revolution for cats 4.All new pets should have a fecal float and giardia test done before being brought home 5.All pets should have fecal floats +/- giardia tests done at least once a year 6.Puppies and kittens should be dewormed multiple times before they reach 16 weeks of age.

Dogs who live near rural areas where there are raccoons, opossums, deer, livestock, or even rodents; or who are at risk for drinking or swimming in any standing water, should be vaccinated for leptospirosis. All pets should be vaccinated for Rabies.

Do not let your pet lick your face or any open sores on you. Control potential flea infestations with monthly flea-control products (again, I recommend Sentinel and Revolution). Pregnant women should not clean litter boxes, and litter boxes should be scooped out daily.


Special precautions should be taken by immune-compromised people living with pets. This would include HIV-positive individuals, people on chemotherapy, people receiving dialysis treatments, the very old and infirmed, and infants. These special precautions should be discussed with the veterinarian and also the attending physician. Not to "toot my own horn," but I find that in the majority of situations, the veterinarian is more knowledgeable than the physician regarding zoonoses.

This sounds like a long list of precautions, but most of them are simple and inexpensive. I know how much I enjoy snuggling up to my dogs and cats, and I do so with confidence knowing my risk of "catching something" is virtually nil.

Veterinarians and "Doing the Right Thing"

OK. I have learned something new about myself: I'm not a very faithful blogger! No one wants to hear my excuses, so I'll move right on to my current topic, "Doing the Right Thing."

Being a veterinarian is incredibly rewarding in many ways. It really feels like a privilege to have this job. I have always felt that it also carries an obligation to "give back" to pets who need help that have no way of getting it without the assistance of a compassionate veterinarian and veterinary team. I enjoy this aspect of my profession as well. It feels good to provide assistance to sick/injured animals who are so trusting of us.

About a year ago, we were brought a very unhealthy puppy who had been found abandoned in a garbage can. My associate, Dr Chris Randla, treated his injuries and oversaw his care as he recovered. The story gained widespread recognition, and a children's book, "Tommy The Throwaway Dog" has been published to tell the story. Around the time the author, Laura Marlowe, came to our area for a book signing (Tommy was there too), we had a similar situation brought to us.

A dog was found in a rural part of our county, staggering along a fence row with an arrow all the way through his abdomen. His owner was located through a microchip, but she didn't want the dog back. Hope Rescues took him and brought him to us for emergency surgery. His spleen and part of his small intestine were removed by Dr Wendy Mollet, and he was treated for peritonitis. He now lives with a physician in a fancy St Louis suburb.

We work closely with several humane organizations to help dogs and cats in trouble. In my opinion, the humane organizations (Partners 4 Pets, Metro-East Humane Society, Hope Rescues, APA) do the hard work of caring for these animals day-in and day-out. The least we can do is lend medical advice and treatment. The humane organizations do get charged for our services, but at a deep discount. We cheerfully lose money on these cases. In addition to this, each doctor at our hospital has a $1,000 Client-Assistance account to help pay medical expenses for pets whose owners show a sincere desire to treat them, but cannot afford all that is needed. The client assistance money is provided by our hospital.

Now, it sometimes gets ugly when someone we've never seen before has a pet that has probably never seen a veterinarian, and now it is sick. Or injured. The person usually comes rushing in demanding treatment. We tend to be less sympathetic in these cases, and immediately we are called "heartless" and "in it for the money." My opinion is that this is a person who never saw to the care of her pet until disaster struck, and now feels it should be our problem. I usually recommend the owner turn the pet over to a humane organization who we WILL work with to help. It may sound "snooty," but I truly feel that pet ownership is a big responsibility, and an irresponsible pet owner does the pet a disservice.

In the meantime, we'll keep trying to "do the right thing."

And I'll try to be a better blogger.

The Scooting Dog

It never fails. My beagle, "Wilson", has made a real sport out of embarrassing me in front of guests. It may be a dinner function at our home, or friends hanging out in our living room enjoying some wine. That is when Wilson will position himself where the majority of company can see him, then proceed to sit down, elevate his back legs ever so slightly, lift his tail, and drag his butt across the floor. Sometimes it's in a circle, sometimes in a straight line, but either way, he certainly seems to be conscious of the best route to maintain the attention of the crowd. And the look on his beagle face? Pure ecstasy.

Of course everyone in the room is thinking, "Look, the vet's dog's got worms." Because that's what people think when they see a scooting dog. And what a nice thing to think when you're having a pasta dish at the vet's house.

The truth is, the majority of dogs who scoot, do so because they have an anal sac impaction. Anal sacs are paired structures just under the skin on either side of the anus in dogs and cats. The sacs are lined with glands which secrete a foul-smelling substance which fills the sacs over time. In some dogs, the full sacs create an itchy sensation, which they try to relieve by scooting. Usually the scooting dog can be relieved simply by emptying the anal sacs. All veterinarians, and even some groomers can do this. Some dogs need it done monthly, and some never need it at all.

Less-common causes of scooting include skin conditions around the anal/tail area (fleas, food allergies, hot spots) or proctitis (which is a form of colitis). Incidentally, the majority of dogs with worms do not scoot! Occasionally, the anal sac may become infected or form an abscess. In that case, there will be pain and a thick discharge from the area. Any dog who is scooting for the first time should see a veterinarian to make sure of the cause. If it is simply an anal sac impaction, subsequent episodes can usually be dealt with by having someone at the veterinary clinic (we use vet techs for this), or the groomer clean out the sacs.

I know of some vets who recommend routine emptying of anal sacs in all dogs. I personally do not agree with this, and only recommend emptying the sacs if they're bothering the dog (ie the dog is scooting). Of course, in Wilson's case I'm thinking of making an exception to that policy, just to save my dignity.