Mr. A's Surgery

We know how everyone loves to hear about Mr. A and Mr. B, so we thought we would share with you something about what's been going on with Mr. A, lately. We had been monitoring some weight loss over the past few weeks. Then we started noticing that he was acting aggressive towards Mr. B. Suddenly, about three weeks ago, we noticed that his urine started smelling strangely like an un-neutered male cat's urine (if you have never smelled it, un-neutered male cat urine smells very distinct: VERY strong and stinky), and he started urinating inappropriately. We were concerned that he had circulating testosterone in his system, which a neutered cat should not have. This led us to believe that he had something wrong with his adrenal gland.

We took some x-rays and drew some blood, and then looked at his penis under anesthesia. Why would we do that? You may not know this but un-neutered male cats have tiny barbs on their penises, kind of like the barbs they have on their tongues. These barbs disappear when a cat is neutered (or never develop, if they are neutered before maturity). Sure enough, Mr. A had developed barbs on his penis. Since his neuter surgery was uncomplicated and straightforward, we knew that he should not have testosterone in his system to produce these symptoms, this suggested even more strongly that he had a malfunctioning adrenal gland. His testosterone test results were the same as an intact male cat's. We then performed an abdominal ultrasound and found a small mass near his kidney that should not have been there.

A week ago, we scheduled him for surgery. During the procedure, we found evidence of recent bleeding or hemorrhage in the retroperitoneal space (a pocket around the kidney and adrenal gland). The bleeding became active during the surgery, and to control the hemorrhage, we performed a blood transfusion and removed the kidney that was associated with the affected adrenal gland. This was done to remove all of the abnormal vessels and adrenal tissue associated with the mass. It appeared that Dr. Bailey was able to remove the entire mass. Now that Mr. A has had a transfusion, he has sadly been removed from the blood donor list because his blood has been sensitized to blood proteins from another cat. This means that his blood is likely to destroy the red cells of a blood recipient.

The pathologist at our reference lab examined the mass for us and reported an unusual result. He could not see any evidence of tumor, but reported that the mass displayed signs of infarction – dead tissue due to a loss of blood supply. This infarct may have destroyed any sign of a tumor, or there may be a problem elsewhere in the body. Certainly, we don’t know at this point what caused the infarct, which means the outlook on his health is unknown. Right now, he is doing well, and recovering. Our staff is impatiently waiting while the pathologist takes a closer look at his biopsy samples in the hopes that he can give us more information.

Case Report: Cessna - His tail's not all it's cracked up to be...

Cessna

This handsome 8 year old came to see us for the first time in May, this year, with a particular tale to tell. His owners had found him on April 18^th, with an injured tail and a trail of blood through the house, leading back to their daughter’s bedroom and under her bed, where he loved to sleep. His owners had no idea what could have happened to his tail.

Cessna's damaged tail bone

They rushed him to a veterinary hospital on emergency basis and they repaired the injury by amputating the injured tip of his tail. About a month later, he returned to the hospital, having traumatized it again. He had been wearing an Elizabethan collar all the time and still managed to injure himself.  In addition, he was hiding, no longer social and good natured. It was recommended that the rest of his tail be amputated. Cessna’s family was uncertain that was what they wanted to do, so they brought him to Exclusively Cats Veterinary Hospital for a second opinion.



On May 24^th, there was no sign of infection, and the tail tip seemed to be healing well, so we re-bandaged it and attempted to manage his apparent chronic pain with a prescription for Tramadol. At this visit (and previously, at the other veterinary hospital), Cessna was notably quite grumpy and intolerant of much handling.

Cessna's new, short tail

Cessna’s hind end was very sensitive and his owners were not able to look at his tail at home, and was also very difficult to medicate. On May 30th he managed to remove his bandage and get at his tail, again. On June 16^th, Cessna’s family found a tick on him and wanted to have us look at him. He had been doing well on the Tramadol, but still seemed bothered by his tail. At least, however, he was not attacking it anymore. On the ride into the hospital, he started attacking his tail again, and urinated and defecated on himself. His family was distraught because they felt that he was miserable and could not live with this issue. They wondered if he needed his entire tail amputated. We took x-rays of the tip of his tail, and it appeared that due to his attacks, he had either exposed a sliver of bone, or some nerve tissue or tendons. At this time, his owners opted to pursue another tail amputation, and another 2 inches of tail needed to be removed. The concern about amputating completely was that if the entire tail was removed and he was still painful, he might start attacking his hindquarters and cause irreparable damage to himself. We applied a pain patch, gave him a mild sedative, an epidural, and a cocktail of other pain medications. He recovered from surgery well, and we sent him home on phenobarbital for pain control, sedation, and suppression of hyperesthesia-like symptoms.

Abnormal bone-like material in one of the tail joints

He went home again, but went into hiding. He started attacking his tail again on the 18^th. His appetite decreased and started trying to bite his mom when she medicated him. He hid under the bed and defecated on himself when his family members tried to get him out from under the bed.

Cessna was a little embarrassed by his Thundershirt, at first...

His family was beginning to lose hope. Cessna was miserable, and they wondered if it wouldn’t be kinder to euthanize him. He was no longer the loving cat they had known, and he seemed to be in constant pain and distress for no known reason. We examined his tail again and reviewed the x-rays from the previous hosptal and discovered an abnormal joint much closer to the base of the tail that did not flex as nicely as the rest. We x-rayed the area and discovered a very small round mineralized object located in the joint space between two tail vertebrae. This is likely abnormal bony growth due to arthritis. Because it is located between two vertebrae, it likely sends shooting pain down the length of the spine whenever he moves his tail. Since the pain was radiating down the length of the tail, Cessna was attacking the part of his tail that he could easily reach, and not the area that was causing the pain.



We amputated the tail behind the affected joint, leaving about 3-4 inches of tail for him to wave, and crossed our fingers. He received another pain patch, a local nerve block and was started on a medication regimen of gabapentin for neuropathic pain, phenobarbital again, and Onsior for inflammation. In addition, Cessna started wearing a Thundershirt. He stayed with us at the hospital for 18 days as we balanced his pain medications – little enough that he could walk around, eat, and use the litterbox, but enough that he would ignore his tail. Over the time that he was here, he grew continually more affectionate and well-mannered. He began asking for attention, rather than hiding. He was allowed some exercise time to sit in the office with the doctors while they worked on paperwork, and he sat on the cat tree with Mr. A.

Cessna became more outgoing after a while

At first, the Thundershirt was hard for him, because he wanted to curl up in a ball and not move with it on, but by the time he was discharged, he was jumping up into laps for cuddle time. Our entire staff enjoyed his antics as he became more adventurous and learned how to steal tuna fish from Dr. Demos, or snuck through the door to visit the receptionists. On July 6 ^th, we took his sutures out and for the rest of the morning, he was angry at his tail again, so we gave him an injection of Simbadol, which is a long-acting pain medication. We suspect that his tail was a little painful again, because we meddled with the tail and scrubbed it to clean the incision area.



On July 7, he went home to his family, and the purrs that rumbled out of his chest were so loud they could be heard across the room! We are hoping that he continues to improve over the next few weeks so that we can stop his medications and continue with just the Thundershirt. We’ll have him wear the Thundershirt for another couple weeks after that before we have his family try to take it off. At that time, we hope that his life can get back to normal – his long tale cut short for good reason!

Environmental enrichment (tuna in a cup) becomes Cessna's preferred method of keeping his tail safe

Why are my cats fighting? Part 3: Finding solutions - the 5 "R"s

If you have read part 1 and part 2 of this series, you now may have a good idea what reasons may be behind your cat's aggression and you have a list of behaviors and locations that clarify the aggression. However, what you really want is a solution, right?

Some forms of mild territorial aggression, such as conflict that occurs after the introduction of a new cat to the household, will resolve themselves over a period of 4 months. Temporary aggression issues, such as conflict after a veterinary visit or other traumatic event, may resolve in 24-48 hours.

Rub cats around the cheeks and face to transfer scents

Re-Scent: If your cats only have problems after one of them visits the veterinarian (non-recognition aggression), try to schedule vet visits at the same time, or segregate the cat that went to the vet in one room with food, water and litter, to let him regain the familiar smell of the household and de-stress before re-introducing him to your other cats. You could speed the process by rubbing the cats with the same towel around their ears and cheeks - the areas that cats use to mark their territory and rub other cats - and then across their bodies.

Re-Introduce: For troubles with a new cat in the house, or long-standing territorial issues, try re-introduction of the cats. Generally, the aggressor cat is the one that should be treated as the "new" cat and the victim should be treated as the "existing" cat. Use rewards to reinforce desired behaviors, but do not physically punish fighting. It will NEVER help the situation, and may make the situation worse. Patience is a big key to working with remodeling your cat's relationships - your goal in cases of aggression is not to make your cats into best buddies, but to give them the ability to tolerate each others' presence without fighting.

Method of exercising cats by mckibillo on Poolga

Redirect: Don't punish aggressive behavior, because that will cause stress, which may increase aggression. Don't reward aggressive behavior by trying to distract the aggressor with treats or attention, either. Instead, try to distract the aggressor before a fight occurs by redirecting his attention with an interactive wand toy, a game of fetch, or a laser pointer or flashlight and try to lure him away from the impending fight. Reward the cat when you catch him acting neutrally towards the victim.

Resource management: Increase the desirable space in your house by adding vertical territory, such as cat trees, perching shelves, or giving cats access to upper levels of existing shelving with ramps and stairs. Make sure that there are plenty of feeding and watering stations, so that essential resources can't be completely blocked, and make sure that you have at least one more litter box than the number of cats in your home, preferably at least one box on each level of your house, as well. This will help prevent inappropriate elimination related to resource blocking or stress.

Remedies:
Medications: If aggression issues are significant, your veterinarian may recommend the introduction of calming medications or anti-anxiety drugs to aid your efforts to train your cats to tolerate each other. These medications will help take the edge off the bully's attacks, or decrease the victim's reaction to aggressive posturing from the aggressor cat. Drugs are generally not the cure for the problem, but can be a useful tool to aid in implementing behavioral conditioning. Sometimes only one cat needs to be medicated, but sometimes the problem is significant enough that both cats need to receive drug therapy in addition to behavioral therapy. Medications such as fluoxetine, buspirone, alprazolam, clomipramine and elavil are prescribed based on the information that a cat owner provides about the types of aggressive incidents that occur. Because the dosages are different for humans and cats, and because the recommendation for medication is based on the behavior of the cat, it is only recommended to start behavioral drug therapy with the guidance of a veterinarian.

In addition to prescription medications, some of the other products that we often incorporate into behavioral solutions are pheromone products, wraps and treats.

Feliway

Pheromone products: Calming pheromones help decrease the stress levels in the household and lower the intensity levels of the aggressive encounters. Products such as Feliway and NurtureCalm contain pheromones associated with marking "happy places" and the chemical a mother cat produces to calm and reassure her kittens.

Wraps: The Thundershirt is a product based on information from studies of autistic children and adults indicating that pressure therapy, massage, and the use of a hugging machine can relieve anxiety. In addition, swaddling of infants has been shown to calm them. While research and controlledstudies are still in the works for this therapy, it is not harmful to employ them in an effort to calm hyper-anxious pets as a part of a behavioral plan.

Mr. B wears a Thundershirt to help him deal with all the cats in the hospital

 
Treats and Supplements: The pill Anxitane and Composure treats contain L-Theanine, (Gamma-ethylamino-L-glutamic acid) which is derived from the mushroom Boletus badius and Camellia sinensis tea leaves. L-Theanine causes a calming effect without drowsiness.

You will probably need to resign yourself to the fact that your cats will never be best friends. If aggression is a significant issue between your cats, the best you may be able to hope for is tolerance of the other cat's presence, and that can take months of baby steps forward (and a few steps back) to accomplish. However, if you are patient, and if you let the cats tell you when you can move forward, you will hopefully eventually be rewarded with a peaceful (if not amicable) household.

Why are my cats fighting? Part 1: Three reasons your cats might not get along

Why are my cats fighting? Part 2: Fighting Styles

Why are my cats fighting? Part 2: Fighting Styles

If you read last week's blog post, you know about some of the common types of aggression that you may see between cats. This week, we will discuss how to recognize aggression and conflict between cats.

There are two main styles of aggression displayed by cats:

1) Overt - This is behavior that is obviously hostile, such as hissing, growling, spitting, biting, piloerection (fluffed up fur), lashing the tail, staring at the other cat, standing over the submissive cat, flattening the ears, dilating of the pupils, and swatting. The following images can be helpful in reading the level of your cat's aggression. In general, the more aggressive cat tries to make himself larger and more intimidating, and the more submissive cat tries to make himself smaller and less threatening.

Cat facial expressions

Cat tail communication

Body postures of the cat, increasing in aggression towards the right and increasing in submission/fear towards the bottom

2) Covert - Physically blocking another cat from resources like food, water, sleeping areas and litter, either through actual contact, chasing, or by sitting in a position of power over the resources. Excessive marking of territory (either with facial pheromones or with urine and/or feces) may also occur. In addition, human contact and attention may be deprived from the victim by physical blocking or threats. The victim may end up urinating or defecating in other places than the litterbox if the aggressor is successful in completely preventing access to the box.

We had one client who had introduced a new, shy cat to her house, and her older, existing cat started urinating inappropriately. She was sure that it was because he was marking territory in the house because of the new cat. However, after consulting with one of our staff members and having a thorough physical exam and urinalysis to determine that there was no medical cause for the inappropriate urination, the owner went home and watched her two cats and discovered that when her existing cat got up and walked towards the litterbox, the new cat would run to the box, get there first, use the box, and then sit next to it and stare at the older cat. He would then turn away and go urinate by the door. There was no fighting or overt physical aggression between the two cats; in fact, they mostly ignored each other. However, the new cat was being covertly aggressive towards the existing cat by blocking his access to important resources. 

Even though these cats aren't fighting, one is acting aggressively towards the other

Determining the best way to find a solution for inter-cat aggression issues can be a complex process, but being able to identify all the ways in which your cat displays aggression can help give a lot of insight to your veterinarian. If you have a problem with aggression between cats in your home, you can provide some helpful information by doing the following:

1) Identify problem areas of the home - areas where most of the conflict takes place. You may even want to draw a map of your home, identifying areas of conflict and prime resource locations (food, water, litter, sleeping spots, favored perches, etc.). 

2) Document the aggressive interactions that you witness - who is involved? How did they behave? How did the conflict resolve?

3) What are the relationships between the humans in the house and the cats in the house? Who spends peaceful time together and when?

4) Describe your cats' personalities in detail. How does each cat feel about visitors, food, affection, and things that happen outside? Do your cats have any health issues?

If you can provide this information to your veterinarian, you will be helping him or her help you and your cat.

Why are my cats fighting? Part 1: Three reasons your cats might not get along

Why are my cats fighting? Part 3: Finding solutions - the 5 "R"s

Why are my cats fighting? Part 1: Three reasons your cats might not get along

There are two major reasons people seek help with their cats' behavior. The first is inappropriate elimination. The second is aggression or fighting.

There are several reasons that cats may fight -

1) territoriality

2) play

3) stress or anxiety

1) Territoriality

While cats do not live in packs, they do form social bonds in wild colonies. However, in the wild, cats have much larger territories than they do in our homes. Various studies have been performed in England and the US, tracking feral cats and indoor/outdoor pets. These studies have found that cats have a range of up to 2 square miles in the suburban U.S. and as large as 8.5 square miles in rural farmland in England.

Cats with indoor habitat tend to roam less than feral cats, but still cover a lot of ground.

These studies have shown that cats live more closely together in urban areas where they have more resources available - more sources of food, water, litter areas and "prime" resting spots. We also know that cats establish small territories within a room, and "time share" resources. Cats in a household can be predictably located in certain areas of the home at certain times of day, just like outdoor cats will patrol certain parts of their territory on a predictable schedule. Because of this, cats are very tied to predictability of their environment, and changes to the environment (a.k.a. territory) can cause outbreaks of aggression. Similarly, changes to resource availability - loss of perches, change in feeding location or feeding schedule, changes in the number of people or cats in the home, elimination or relocating of litterboxes - can cause dominance struggles as well, as cats re-negotiate their territories and schedules.

Territorial aggression issues tend to develop when a new cat is introduced into the home without giving the existing cats a chance to acclimate to the idea. It can also be related to the loss of a cat, either because the cat has moved out of the house, has been hospitalized at the veterinary office, or because the cat is no longer living - this can open up a valued resource in the home, causing cats to fight. It may also develop over time as a confident cat starts to guard resources and threaten other cats over these resources, escalating over time (the dominant cat becoming more aggressive and the victimized cat becoming more anxious or fearful). This situation may progress beyond growling and hissing to inappropriate elimination issues (this can be due to due to litterbox guarding by the aggressive cat, territorial marking on the part of either cat, or due to extreme fearfulness on the part of the victim).

2) Play aggression

Cats under two years of age are still honing their hunting skills. It is not unusual for these cats to dash

Play fighting is usually silent, while real fighting is very vocal

madly around the house with the "kitty crazies" as often as several times a day! They pounce and attack anything that moves interestingly - from the dog's tail to your ankle (especially when you're under sleeping under a blanket at 2am!) and this is considered normal and natural behavior at this age. This type of aggression includes all sorts of predatory behaviors that will aid cats in hunting when they are older - pouncing, biting, climbing, stalking, chasing, attacking, running, ambushing, leaping, batting and swatting. This also means that your 14 year old cat may get his fur ruffled when your new kitten wants to pounce his tail 26 times a minute. Most of the time, the wary can avoid attacks from a kitten - watch for a lashing tail, the "butt-wiggle" as they prepare to pounce, a sudden dilation of pupils. Kittens learn "bite inhibition" through play with siblings, and those kittens that were not raised with a litter or who were removed from their mother and siblings at an early age, may be more aggressive than kittens who stayed with other kittens of their age until they were 8 weeks of age. Kittens that spend long hours in a house by themselves, or kittens that are encouraged to view human body parts (hands, arms and legs) as acceptable toys may display more intensely aggressive play behaviors than cats in a multi-cat household.

3)  Stress or anxiety

Many times, cats will become aggressive when they are uncomfortable with a situation. Perhaps your

cat is frustrated that he can't hunt the chipmunk that teases him through the window, or go out and

Stress and frustration can cause cats to act aggressively

explain to the neighbor's cat that the back yard is HIS territory, not hers. Perhaps you have a pregnant female who becomes anxious when you handle her kittens. Perhaps your elderly cat becomes stressed when you pet him over his arthritic hips. All of these scenarios are potential causes of stress or anxiety in a cat - in addition to the stress of living in a multi-cat household, establishing time shares and territory in an indoor range, sharing litterboxes and feeding stations.

Now that you know some of the reasons that cats may fight, stay tuned to discover what you can do about it!


The paper, “Home Range, Habitat Use, and Activity Patterns of Free-Roaming Domestic Cats,” is available online or from the U. of I. News Bureau. 

Why are my cats fighting? Part 2: Fighting Styles
Why are my cats fighting? Part 3: Finding solutions - the 5 "R"s