What brings you here, today? The top 10 feline medical problems of 2014

Dr. Brooks examines a pediatric patient

If you have had a cat for any length of time, you have probably had to take him or her to the veterinary hospital for something other than an annual checkup at least once - anything from a bite wound from another cat to a broken toenail; stuffy noses, runny eyes or even (every cat owner's nightmare) choosing to urinate outside the litterbox.

Have you ever wondered, while sitting in the exam room waiting for the doctor, what other visitors to the hospital are bringing their cats in for? Veterinary Pet Insurance analyzes their claims each year, which can give us a good idea why most people are bringing their cats in to see the veterinarian. Last year, the top 10 reasons that cats visited the veteirnarian for a health issue were:

Cancerous cells typical of lymphoma

10) Lymphoma: a common and treatable form of cancer that affects one of the white blood cells (lymphocytes) and lymph nodes of a cat



9) Upper respiratory infection: Many young cats and kittens visit us because they are sneezing or have a runny nose or watery eyes. Some cats that have been affected by an upper respiratory infection as a young cat may have chronic but fairly manageable problems for the rest of their lives.

8) Inflammatory Bowel Disease: IBD is not a single disease but a complex group of symptoms and conditions that result from increased inflammation in the digestive tract. This condition can cause problems with digestion and absorption of nutrients, susceptibility to bacteria and viruses in the intestinal tract, vomiting, diarrhea, weight loss, poor hair coat, increased production of hairballs and more. For more information, you can read our blog article on IBD, here.

Drawing up insulin injections for a diabetic cat

7) Diabetes: Middle-aged to older cats, especially males and overweight cats are at higher risk for diabetes. As the obesity problem in US pets grows, the prevalence of diabetic pets has also increased. Almost 60% of cats are overweight in the United States, according to data collected by the Association for Pet Obesity Prevention (APOP) last year (2014).  For more information, you can read our blog article on diabetes, here.

6) Diarrhea or intestinal upset: Sometimes caused by intestinal parasites, diarrhea can be any stool that is soft or not well-formed, whether the cat can make it to the litterbox or not. Other causes of diarrhea may include diseases such as thyroid disease, IBD, or other problems, such as constipation (oddly enough), or eating a non-food item, such as a toy or ear plug.

5) Excessive thyroid hormone: Overactive thyroid glands produce more thyroid hormone than necessary, which can cause symptoms such as increased hunger and thirst, rapid heart rate, hyperactivity, vomiting, diarrhea and weight loss. For more information, you can read our blog article on hyperthyroid disease, here.

4) Vomiting/upset stomach: Vomiting may be related to an underlying medical issue such as thyroid disease, or may be caused by a food allergy, ingestion of a non-food item, a hairball that has become stuck in the digestive tract, heartworm disease, constipation or other problems.

3) Chronic kidney disease: A common problem in older cats is a progressive decrease in kidney function which can cause symptoms such as weight loss, vomiting or nausea, poor appetite.  For more information, you can read our blog article on Chronic kidney disease, here.

Annual oral exams help prevent serious dental disease

2) Periodontitis/dental disease: About 85% of cats over the age of 3 years have some amount of dental disease. Imagine the state you might be in if you didn't brush your teeth for three years or more! Most cats will need some level of dental care at some point in their lives. Just like people, a lot of a cat's dental health is related to genetics - enamel strength, tolerance of bacteria in the mouth, but regular dental checkups and cleanings can help prevent severe dental disease. For more information, you can read one of our blog articles about dental disease, here.

Making sure your cat likes the litterbox can help prevent urinary issues

1) Bladder or urinary tract disease: Just like VIP, the most common reason that we see cats for
medical care at Exclusively Cats is due to bladder or urinary problems - often because the cat has started to urinate outside the litterbox. There are many reasons that a cat might develop litterbox issues, many of which are medical and none of which are due to revenge or spite, despite what many people think or feel. As Dr. Deporter at Oakland Veterinary Referral Service is fond of saying, a cat's urine marking behavior is like leaving a sticky note with important information in a certain area. When we go by and clean up the urine without looking for the root of the problem, we are removing valuable cat information from the spot. This means the cat feels the need to re-post the sticky note - and they will continue to do so until the problem is addressed. The cat can read the "sticky note", other cats can read the "sticky note", but we humans cannot read the "sticky note" and need to use other means to figure out what the cat is trying to tell us. Sometimes it may simply be "Hey! My litterbox is stinky!" other times it may be a different cry for help. For more information, please read the 4 part series of blog articles that we have prepared on bladder and litterbox issues which begins here. 

Client question: How often should my cat have his teeth cleaned?

Question:  I clicked on your dental care link and thought it was very educational. At what age should a cat have it's teeth cleaned? And how often? Thanks.

Exclusively Cats Veterinary Hospital Thanks for a great question! 

Fractured canine tooth with exposure of the nerve and blood supply

 
A cat's dental health is dependent on many things: age, overall health, FeLV/FIV status and breed or hereditary characteristics. Many cats may need a dental cleaning as early as 4 years of age, if we are talking about preventing dental disease. Breeds such as Persians, who have short noses, still have the same number of teeth in their mouths as longer-nosed cats, and develop dental disease more rapidly due to tooth-crowding. Cats that are FeLV or FIV positive or have other diseases that decrease the effectiveness of their immune system may need dental cleanings more frequently because they are more susceptible to the bacteria that build up in the mouth. Cats that are adventurous explorers and fall and break a tooth, or those that chew on hard objects frequently may need more frequent care or emergency care. 

This Abyssinian kitten has all her adult teeth except her upper canines. X-rays show that she has no adult canines! When and if she loses her baby teeth, she will be missing two teeth.

Generally, we recommend that cats come in for a fluoride treatment around the age of 7 months, when all the adult teeth should have erupted. At this time, fluoride can be applied to the teeth (some cats will already have a little tartar buildup, which we will clean!) to strengthen the enamel - this application is most effective at strengthening before 18 months of age. After that, fluoride applications help prevent pain due to exposed dentin in inflamed mouths. We can also check to see if there are any abnormalities - extra teeth, missing teeth, retained baby teeth, teeth out of position, etc. that will cause problems later in life and require more care than the average cat.

This kitten has an upper tooth that is causing injury to his lower gum

We like to examine cats' mouths annually and their wellness exams to decide whether the cat will need a dental cleaning in the near future. Most cats will benefit from annual cleanings, but some cats may need cleanings every 6 months, and others may be able to go 2-3 years between cleanings. We try to balance the aggressiveness of our recommendations for treatment with the cost of treatment - since they require anesthesia for cleanings, we know that it may be daunting to consider the cost of a dental procedure. However, just like human dentists, veterinarians who advocate good oral health care for cats would prefer to perform a "dental prophylaxis" or cleaning, versus performing "dental surgery" and tooth extractions! We are sure that our patients would prefer it, too!

Chronic Nasal Discharge in Cats

CHRONIC NASAL DISCHARGE

What is meant by the term "Chronic Nasal Discharge"?

When a cat has a discharge from its nose that lasts more than 2 months, it is considered chronic.  The discharge may be thin and clear like water (serous), thick and yellow or green like pus (purulent), bloody (sanguinous or hemorrhagic), or a combination. Clear fluid or mucousy discharge may be an indication of irritation or viral infection. Thick, yellow fluid or pus may be a sign of a bacterial infection. Reddish fluid can be a sign of intense or chronic irritation, destruction of the nasal mucous membranes or bones (turbinates). Trauma can also cause a bloody nasal discharge.

Foreign bodies only affect one nostril. Fungal infections and tumors may affect one or both nostrils, while viral infections most often affect both, though one side may be worse than the other.

What causes a chronic nasal discharge?

A view into the nasal canal and the papery turbinate bones

Chronic nasal discharge is not a diagnosis; rather, it is a term that describes the signs of disease in the nose and frontal sinuses.  Almost all disease conditions that occur in the nose will cause irritation and inflammation to the lacy bones in the nose, called turbinates.  The presence of disease in the nose is called rhinitis.  The turbinate bones are easily distorted and destroyed.  When that happens, bacteria that normally live in the nose grow rapidly, causing a secondary bacterial infection.

The frontal sinuses are hollow cavities in the skull and are located just above the eyes.  They are connected to the nasal cavity by a small canal.  Most diseases that occur in the nasal cavity have the ability to move through these canals into the frontal sinuses.  When the sinuses become involved and develop inflammation, this is called sinusitis.

Chronic nasal discharge may result from several disorders involving the sinuses and nasal cavity.  These include:

                Chronic viral infection

                Chronic bacterial infection

                Chronic fungal infection

                Dental disease

                Nasal foreign body (e.g. grass seed)

                Nasal tumor

                Inflammatory polyp

                Parasite infection

What tests should be done to make an accurate diagnosis?

There are several diagnostic tests that should be done for a cat with a chronic nasal discharge.  A blood profile will often detect underlying diseases that can contribute to a nasal disease.  Testing for the feline leukemia virus (FeLV) and the feline immunodeficiency virus (FIV) is important because these viruses have the ability to suppress the cat's immune system, making recovery from normally mild infections difficult (or even impossible). 

Nasal x-ray. One side of the nose has poor detail which suggests that the delicate bones of the nasal passages, the turbinate bones, are being destroyed.

It is very important to make radiographs (x-rays) of the skull.  Special positions are necessary to view the nasal cavity and frontal sinuses.  These require sedation or a short-acting anesthetic.  A nasal flush is a diagnostic procedure used to collect material from deep within the nasal cavity.  This material can be studied under the microscope (cytology) and can also be cultured.  Although it is not particularly traumatic to the cat, anesthesia is required, so this procedure is usually done in conjunction with radiographs.  This allows more than one procedure to be done while the cat is under anesthesia.

Anesthesia allows close inspection of the throat, the area above the soft palate, and the nasal canals. This cat had a large buildup of extremely thick mucus above the soft palate.

Some veterinarians have a specialized instrument called an endoscope which allows the veterinarian to actually look inside the nose, as well as to examine the back of the throat and the area around the soft palate.  In order to pass this small flexible tube into the area of interest, anesthesia is required.

There are some diseases that can only be diagnosed with a biopsy of material deep within the nasal cavity.  A biopsy requires recovery of an actual piece of tissue, so surgery is often required for this procedure.

Fungal organisms and a plaque of fungal growth inside the nose of a cat 

Foreign objects within the nasal passage can sometimes be detected with radiographs.  If a foreign body is suspected but not visualized, endoscopy may be helpful, depending on where the foreign body is located.  For some cases, exploratory surgery of the nasal cavity is needed.

As you can see, it may require several days or weeks of testing to determine the cause of a chronic nasal discharge.  When the diagnosis remains elusive, more sophisticated tests may be required.  Veterinarians unable to perform these tests often refer the cat to a specialist.

How is a chronic viral infection treated?

Respiratory viruses, which can infect the nose, may persist and lead to long term viral rhinitis/sinusitis.  No drugs are available to kill these viruses so this type of infection is often incurable but many cats respond to antiviral medications such as Famciclovir.

How is a chronic bacterial infection treated?

Administration of antibiotics alone is usually unsuccessful in curing bacterial infections of the nose and sinuses because the bacteria have become entrapped within the turbinates, and reinfections are frequent.  Although many cats improve while taking antibiotics, cortisone, or antihistamines, they may relapse when these drugs are discontinued.  The use of drugs that stimulate the immune system and the surgical removal of the turbinates have been successful in some cats.  However, others do not respond well.  Overall, the prognosis is guarded.

How is a chronic fungal infection treated?

The most common fungal infection in the nose is caused by Cryptococcus neoformans. Because some of the drugs used to treat this organism are quite expensive and will occasionally cause adverse effects, they are not used unless a firm diagnosis is made.  Fortunately, the newer antifungal drugs have fewer significant side effects and many cats with fungal diseases can be successfully treated.  If the cat is infected with the feline leukemia virus or feline immunodeficiency virus, the outcome will usually be less favorable.

The image below shows a cat named Parker who came to us with a severe swelling in her nose. Microscopic evaluation of samples collected from her nose showed the fungal organism Cryptococcus. Treatment was started and over time, her nose returned to normal.

How is dental disease treated? 

A cat's tooth roots are located very close to the sinus cavity, and if the tooth becomes infected, pus or fluid may drain from the nose. If the infected tooth becomes a severe enough problem, the cat may have facial swelling or swelling of the eye, the tongue may stick out, or the tooth may completely fall out, leaving an opening straight into the sinus cavity.

Disease of this type is treated with a thorough dental cleaning and extraction of the infected teeth, followed by a course of antibiotics. If the disease is bad enough, the cat may be prescribed antibiotics prior to dental care, too.

Read more about what is involved in feline dental care.

How is a nasal foreign body treated?

Nasal mites

When a piece of grass, a seed, parasites or other foreign material lodges in the nasal cavity, the membrane which lines the nose produces large amounts of mucus in response to the irritation.  In addition, affected cats will sneeze violently in an attempt to expel the foreign body. 

If the foreign body cannot be sneezed out, the veterinarian must take steps to remove it.  When a nasal foreign body is suspected but cannot be seen on radiographs or with an endoscope, exploratory surgery may be needed.  If it is found and removed, the prognosis is good.

The following video shows the removal of a Cuterebra larva that was lodged in a cat's nose. He had chronic nasal discharge and excessive sneezing that was not improved with antibiotic treatment. After the Cuterebra was removed, his nasal discharge went away and he stopped sneezing.

How is a tumor treated?

Most nasal tumors are malignant.  Complete surgical removal is very unlikely, so chemotherapy or radiation therapy must be considered.  Unfortunately, many nasal tumors do not respond to either treatment, so the prognosis is poor.  However, when surgery is performed to get tissue for biopsy, most surgeons remove as much of the tumor as possible.  Following this procedure, the cat may be greatly relieved of the nasal discharge and remain improved for several months.  However, in almost all cases, the tumor can be expected to recur. In some cases, however, chemotherapy and/or radiation treatment are successful and the cat will go into remission for as long as several years. It is notable that after a cat has been treated with radiation, the hair at the site of the treatment will likely change color.

This 12 year old cat has been having chronic nasal discharge and sneezing for 2 weeks. He has significant dental disease, but another likelihood at his age is that he may have a tumor. Dr. Brooks' plan for him is to extract his infected teeth and perform a surgical biopsy to determine the extent of his problem.

Several of this cat's teeth have already fallen out and another is almost ready to.

How is an inflammatory polyp treated?

Inflammatory polyps are non-cancerous masses of tissue that are composed of inflammatory cells. Surgery is often successful in removing much of the polyp, but there is a high probability of regrowth if all of the polyp cannot be removed.  Since polyps often begin in the internal ear and grow down the Eustachian tube into the back of the nose, their removal can require extensive surgery that may not be completely successful.  The prognosis for an inflammatory polyp is guarded because the entire polyp cannot be removed in some cases, however, if the entire polyp is successfully removed, the cat will completely recover.

The cat below had an extremely large nasopharyngeal polyp. Once it was removed, her sneezing and nasal discharge resolved completely!

Any time that your cat has discharge from the nose, it is a good idea to have the cat examined by a veterinarian, because the potential causes of chronic nasal discharge are extremely varied, and treatment for chronic nasal discharge is highly dependent on the cause. 

Blanco: The Trials and Tribulations of a Battle-Scarred Tomcat

Blanco is a 15 year old neutered male cat. He appeared, one day, and won the hearts of a family with his rough and tumble scruffiness. He was several years old at the time, and you could read his past like a newspaper on his raggedy coat. He was probably about 5-6 years old when he was taken in, neutered and tested. He was also FIV positive - not surprising, since he was a battle-scarred un-neutered male wandering the streets. However, he was otherwise healthy, and his FIV positive status did not deter his family. They confirmed that he was positive with an IFA test, and then continued to treat his battle wounds.

Dermatitis of Blanco's ear

All four of his canine teeth were fractured from fighting, and one was infected. The other three had broken far enough down the tooth that the canal to the nerve and blood supply was open and at risk for infection. He was scheduled for dental care, and lost a total of 10 diseased teeth, and 4 more teeth were discovered to be missing. He also got a microchip.

After his dentistry, his owners noticed that he was no longer "teething" and chewing on things around the house.

Dermatitis of Blanco's nail beds

Starting in 2011, Blanco began to have issues with itchy skin. He ran through several different antibiotics and tapering doses of steroids, before his dermatitis responded well to a combination of Prednisolone and Atopica. Since that time, he has been comfortable in his skin.

Later in 2011, Blanco began losing weight, and his senior bloodwork showed that he had developed hyperthyroid disease. A month later, he came in to our hospital to stay with us for a week while he received Radioactive Iodine treatment for his hyperthyroidism. His thyroid has been normal ever since.

In 2013, his kidney values began to creep up. So far, they continue to be only mildly elevated, but we are continuing to monitor them regularly.

Blanco's right eye is becoming cloudy and discolored

In 2014, Blanco started to suffer discomfort from old injuries to his right eye. The lens had been displaced by the trauma from a fight long ago, and when he started to form a cataract due to old age, the problem became worse. The body started treating the lens as a foreign body and he developed a condition called "uveitis".  The pressure in the eye decreased, and the eye became sensitive and  painful. On October 14, he had an enucleation surgery to remove the eye, and on November 6th, he came in for suture removal. His mom and dad were very happy and reported that he was brighter, more active and must have been in a lot of pain before his eye was removed. Now he is doing great, and as long as he is doing well, we don't plan to see him again for 6 months. At that time, he is planning on participating in the high blood pressure screening study that is going on, right now at our hospital.

If anyone wonders whether FIV positive cats can live a long and fruitful life, Blanco is happy to say that he has been FIV positive for close to 10 years, and feels great due to the loving family he has, and due to the exceptional care they give him. We appreciate that they turn to us to help give him that care, and we hope that he has many more FIV positive years ahead of him!

Blanco's right side after suture removal

Blanco's proud, scarred face

We can't wait to see how handsome he is when all his fur has grown back!

Microchips Really Do Work! - Fluffy's (aka Cooney's) Unusual Story

 So often, when stray cats are brought into our office by concerned cat lovers, even if they are spayed, front declawed, Siamese, Persian, Maine Coon....none of them have microchips. Or, if they do have a microchip, it isn't registered anywhere and leads to a dead end. On Monday, we had a happy microchip story, though maybe not the story you might normally hear.

This little stray kitty has been being fed outdoors for 3 years by some of our clients. Over time, they started calling her "Fluffy". They noticed that she had dental disease and decided to bring her in to their house and care for her teeth. They brought her to us for a checkup, wondering if she had a former owner. When we examined her, we found that she had a spay scar and a microchip, so we called the microchip company. Sure enough, she was registered! We contacted her former owner and discovered her full story...

Her owner was a woman from Germany that lived in Royal Oak. This little cat was a stray, and was living under her deck. Attempts to bring her into the house were unsuccessful. Four years ago, the woman from Germany was recalled to her home country for one reason or another, and was not able to take this little girl with her. Instead, she made provisions for her to be re-homed with a good friend. Again, attempts to bring her inside were unsuccessful. She was miserable, not wanting to eat, and hiding in the basement, so Cooney was taken to the vet and microchipped in case she tried to return to Royal Oak. Her new owner set up provisions for her in her back yard, just as she had been used to, but shortly after returning her to the outdoors, she disappeared. That was in 2010. Her first owner was devastated. Her newer owner was sad that she had failed both Cooney and her friend who had entrusted her with Cooney's care. She put up signs in her own neighborhood and in Cooney's former neighborhood in Royal Oak, as well as approaching neighborhood friends and neighbors.

Monday, "Fluffy" was brought into our office. She was very nervous, but very cooperative and sweet, and she acted like a cat that was used to humans. We examined her, checked for a spay scar, drew blood for a Feline Leukemia/FIV/Heartworm combination test, trimmed her nails, checked her for fleas, and scanned her for a microchip. Once we had the microchip number, we called the company, who directed us to the registered owner and the veterinary hospital where the chip was implanted. We were able to contact her former owner who was beside herself with excitement - she had been certain that Cooney was dead. She wanted to know if Cooney was happy. We suggested that she speak with the people who had been feeding her and decide between them what the best plan was for Cooney.

In the end, since it was her home that Cooney ran away from, Cooney's former owner decided to relinquish ownership to the people who have been caring for her for the last 3 years, hoping that she had finally found a home where she would be content. We called her former veterinarian and they sent us her previous records. We discovered that she was 11 years old (she looks more like a 5-7 year old cat, which is pretty good for a cat that has lived outdoors!), and she is now scheduled to have her painful mouth treated.

What a happy ending! Cooney - now Fluffy - was never abandoned, and was always loved and missed. She has a brand new home, and her former owner can rest assured that her beloved cat is safe and sound a whole ocean away.

The tooth about your cat's dental health

Fish breath got you down?

February is Pet Dental Health Month! Time to sit back and think about your cat's teeth!

Many people don't like to think about their cat's teeth - they're sharp, pointy reminders that your cat is a natural predator and would love to shower you with gifts of innocent birds and mice, or the occasional frog. We're reminded of their teeth when they love-nip our toes in the middle of the night, or when we get a whiff of fish-breath after dinner. However, the health of your cat's mouth is more critically important that you might realize!

Dental disease is linked to kidney disease, heart disease and other chronic illnesses. Regular dental cleanings can often prevent dental disease and the need to extract teeth. It also gives us an opportunity to address other mouth abnormalities - check for cancer, broken teeth, misaligned teeth, etc. Read on to learn more about some of the conditions that can affect your cat's mouth.

If your cat has misaligned teeth, they can poke painfully into the lip, tongue, gums or the roof of the mouth. Additionally, crowded, extra, or missing teeth can cause the same trouble.














Tartar and plaque can build up underneath the gum line and destroy the tooth from below.

 Because most dental disease begins at the root of the tooth, and cat cavities (called "resorptive lesions") start from the inside and work their way to the surface, what appears to be a healthy tooth can actually be a tooth that is in the process of being destroyed.

 Bacteria and white blood cells build up at the base of the tooth and can enter the blood stream or build up a pocket of infection called an abscess, which can cause facial swelling, fever, nosebleeds or sneezing, and poor appetite. Sometimes this can occur even when most of the tooth has fallen out.

 This tooth is filled up with pus (white blood cells and bacteria).

That missing tooth left a big open hole that can fill with bacteria and cause infection. Besides the large blocks of tartar on the upper teeth, there is a large, painful cavity on one of the lower teeth, and a very painful area surrounding the exposed roots of another tooth affected by dental disease.

 This painful condition is "stomatitis" - a severe and extremely painful swelling and inflammation of the mouth. Ouch!











If your cat has never had his teeth cleaned before, you may wonder what happens during a dental cleaning or dental surgery. To find out, you may want to read more about why dental care costs so much in veterinary medicine.

Ask any one of our patients who has had a bad tooth removed! You may not realize it, but while most cats will not stop eating if their mouth is painful, they may play less, sleep more, and lose weight. Many people are simply amazed at the positive change in their cat's attitude and health after their teeth are cleaned. Ask Rowan!

Rowan's New Healthy Teeth

I have been a cat person for over 50 years.  I can see when a cat is hurting.

Rowan is a 10-year-old chocolate-point Himalayan who has been living
with me for some few years now.  All eight pounds of him.  You can
read all about Rowan in the recently published children's storybook
'Missygirl the Calico Cat'.
Roawn shares in Missygirl's adventures!
Rowan was in extreme discomfort.  He was hurting bad.  Rowan's teeth
had never been cleaned and some of them were in pretty bad shape.  If
you have ever had a toothache consider having half a dozen all at once
for months on end. He slept too much, not really interacting. He just
wanted to be left alone.  Rowan had a hard time eating and began
acting grouchy and out of sorts most of the time.

I would have acted sooner had I realized just how bad it really was.
As it is I am glad I got him to you in time for some major dental work
to extract the really bad teeth and to clean those he was able to
keep.  I do believe you saved his life.

Rowan now spends much less time sleeping and much more time seeking
the attention he once spurned completely.   His behavior is remarkably
more mellow and he is a visibly happier cat now that the pain is gone.

I can't thank you guys enough for what you did to help Rowan and I am
sure he is far more grateful than I can ever express in mere words. It
is worth it at any cost to see my little buddy doing the things a cat
should be doing and not suffering.

Thank you again.  Best wishes for a bright future, Neil E. Clement 

Rowan in "full fur"

February is National Pet Dental Health Month!

Annual oral exams are important!

Many people think that as long as their cat is still eating, their dental health is great! Unfortunately, this is not often the case.

 The American Veterinary Dental College (AVDC) has this to say about the diagnosis and treatment of periodontal disease:

“Unfortunately, other than bad breath, there are few signs of the disease process evident to the owner, and professional dental cleaning and periodontal therapy often comes too late to prevent extensive disease or to save teeth. As a result, periodontal disease is usually under-treated, and may cause multiple problems in the oral cavity and may be associated with damage to internal organs in some patients as they age…. Studies in dogs have shown that periodontal disease is associated with microscopic changes in the heart, liver, and kidneys.”

Resorptive lesion has broken through the tooth from below

In cats and dogs, much dental disease occurs beneath the gum tissue where we can’t see it – so even if your cat’s teeth are pearly white, there may be problems eating away at the tissues that keep your cat’s teeth firmly rooted in their sockets. Most cat “cavities” or resorptive lesions start below the gumline as well, eroding the roots of the teeth first, before they start to affect the crown or visible portion of the tooth. These resorptive lesions are so painful that even while sleeping under anesthesia, cats will react strongly to gentle probing of the affected tooth! In the canine tooth pictured here, a small red defect in the tooth is visible, but if you look at the x-ray pictured below, most of the internal structure of the tooth is destroyed, and the root of the tooth has completely fused with the jaw. This cat had already lost the other lower canine to disease.

Because of this, it is generally a good idea to have your cat’s teethcleaned before visible disease appears. If we can clean the teeth before they are damaged, we can keep the periodontal ligament healthy and strong, and help prevent damage that may cause the loss of your cat’s teeth.

Tooth destruction

In addition to scheduling regular, routine dental cleanings as insurance against oral decay, you can supplement your cat’s diet with oral health diets such as Science Diet Oral Care or Royal Canin Oral Sensitive 30, or any diet that has a larger-sized kibble that cats have to actually crunch on. Most cats that eat regular maintenance diets end up swallowing the majority of their tiny dry kibble whole! The Veterinary Oral Health Council has compiled a list of foods, treats and oral health products that have been scientifically proven to improve oral health in cats and dogs.

Just imagine what your own mouth would feel like if you went for long periods of time without brushing your teeth! According to the AmericanAnimal Hospital Association, dental check-ups should begin when your patient is five months old. At Exclusively Cats Veterinary Hospital, we look in your cat’s mouth at every visit! We recommend a fluoride treatment around 6 months of age, and at that time, your cat gets a full oral exam under anesthesia with dental charting of his or her baseline oral health. We can also make sure that all of your cat’s baby teeth have fallen out and all the adult teeth have erupted appropriately. Just like some humans need orthodontic care because their bite is not correct, some cats have misaligned teeth that can eventually cause sores in the mouth, jaw pain or difficulty eating. Once we have recorded your cat’s baseline oral health, we can then make an individualized recommendation on when next to schedule an oral exam or cleaning. At minimum, your cat’s teeth should be examined once a year.

Greenies treats - available in our office in 5 yummy flavors!

There are many reasons to take an active role in promoting good oral health in your cat. Periodontal disease is a very hard-to-detect infection that can not only cause pain when eating, but causes bone loss in the jaw and tooth loss, as well as heart, liver and kidney disease in the long run.  If such an infection were not hidden inside the mouth, but plainly evident on the bodies of our cats, it would be much more obvious the level of concern this matter should cause. Unfortunately, because our cats are often resistant to having their mouths examined, so oral health tends to be more “out of sight, out of mind”.

If it has been a while since your cat has had his or her teeth examined, celebrate National Pet Dental Health Month by calling your veterinary hospital and scheduling a checkup!

Why does dental care cost so much?!?

Our own Mr. B is 10 months old. His teeth are pretty good, but he already has a tiny bit of buildup on his upper premolar.

Most people do not realize that the quality of dental care can vary from veterinary hospital to veterinary hospital. Contacting a veterinary hospital and asking what they charge for teeth cleaning may not give you the whole picture. Many veterinary hospitals will tell you that they cannot give you a good estimate for a dental procedure before examining your cat, and there is good reason. As a rule, until a veterinarian performs an exam under anesthesia, we do not have the whole picture of the cat’s oral health and can only offer a range of possibilities, not an exact quote. Often, the whole picture does not emerge until after dental x-rays are taken.

At Exclusively Cats Veterinary Hospital, we take pride in the quality of our care and are happy to discuss treatment plans with you, making sure that you have a clear understanding of exactly what fees and services you are paying for.

As an educated pet owner, there are questions that you should ask when getting a quote for dental services:

1. Are there any additional charges associated with a teeth cleaning, such as labwork, tooth extraction, x-rays, medications or other after-care? The estimate for treatment that we give you is comprehensive. We even try to anticipate all the extractions that may be needed. You may want to clarify whether an estimate for teeth cleaning that you receive elsewhere includes everything, or whether the clinic you called gave a minimum estimate over the phone and might add additional charges to the estimate once you are in the office.

Bloodwork is one of the best ways to get information about a cat's health

2. Will preanesthetic bloodwork be done? We check labwork on each pet prior to the dental procedure to highlight any health issues that could compromise the anesthetic procedure. The type and extent of labwork will vary based on the age and health of the patient, and also may depend on prior labwork that we have recently evaluated.



3. Will my pet be given IV fluids? An IV catheter allows instant access to the circulatory system if an emergency situation should arise. Anesthesia over time will decrease the blood pressure. Fluid therapy supports kidney function during anesthetic procedures and keeps the blood pressure in a safe range while your cat is asleep. Any time that a cat is having teeth extracted, we place an IV catheter. Also, patients of a certain age will routinely receive IV fluids. If at any time we feel that our dental patient may be a critical anesthetic risk, we will place an IV as well, for the safety of your pet.

Four-handed dentistry!

4. Who will be performing the procedure and what is their level of training? Any dental surgical procedure should include a minimum of 4 hands (a veterinarian and technician). Our most experienced and well-trained technicians assist the doctor during dental procedures and only our veterinarians perform extractions. In some cases with highly critical patients, a second or third technician may be required to ensure the safety of the cat.

Dogs and cats experience dental disease in markedly different ways. At a practice that sees both dogs and cats, it is common for the veterinarian’s experience to be primarily canine dentistries, whereas our veterinarians have 100% of their experience with feline dental procedures. Since Exclusively Cats Veterinary Hospital opened its doors, our staff members have performed over 5,000 feline dental cleanings and oral surgeries. There have been multiple instances in which veterinarians from other hospitals have called to consult with or ask advice from our doctors about complex or difficult feline dental cases.

Pulse and oxygen monitor

5. What type of vital signs monitoring will be performed, and who will be performing the monitoring? Different veterinary hospitals monitor anesthesia different ways. Our patients’ heart rates, blood pressure and oxygen delivery are monitored throughout the procedure by a technician. In higher risk patients, an EKG and blood gas level are also monitored. The entire time that the veterinarian is working on your cat’s mouth, a technician is by their side, assisting and monitoring, and in critical risk patients, one or more additional technicians will be at hand to help ensure the safety of your pet.

Dental models and x-rays are used to help explain what happened during the procedure

6. What kind of discharge information will you receive and from whom? If your cat has any kind of abnormality observed during the dentistry, the dental technician will discuss the dental x-rays and findings with you at the time of the discharge appointment.



7. What type of anesthesia will be used? We use isoflurane gas anesthesia for our dental patients. Isoflurane is an extremely safe anesthesia –the gas begins to leave the system as soon as the cat exhales for the first time after the gas is turned off. Some injectable anesthetics remain in the system for hours after use, with no way to counteract it if there is an emergency. Each patient has a breathing tube inserted into their trachea to keep water from entering the lungs during the dental procedure. Each cat is given a pre-surgical sedative to help decrease the amount of anesthesia needed and increase safety. We had a client report to us that they were changing veterinarians because their 4-year-old cat died under anesthesia while having a dental procedure performed elsewhere. At Exclusively Cats Veterinary Hospital, we have never lost a patient under anesthesia for dentistry.



8. Will my cat be sleeping on a heated blanket during the procedure? Low body temperature is a very high risk during dental procedures. Since anesthesia lowers body temperature and the water from the dental procedure can lower temperature even more, every dental patient at our hospital is placed between two warm circulating water blankets to keep their body temperature normal.

The tooth on the far right is missing above the gumline but there is still a root remaining

9. Will dental films be taken and reviewed by a veterinarian? Considering that 80% of pets over 3 years of age have some degree of dental disease, most of it below the gumline where it cannot be seen, estimating for dental care even after examining the mouth is difficult. The real dental exam happens while the cat is sleeping, once large amounts of tartar have been removed and each tooth has been probed and x-rayed. In some cases a tooth that looks healthy or is missing above the gumline may be developing problems at the root – if we only looked at the part of the tooth that could be seen above the gum, you might find your cat with a painful abscess within weeks to months after a thorough tooth cleaning. That is why x-rays are so important. Every dental procedure that we perform will have dental films taken.

In many cases, we have found areas where tooth remnants have been left behind by other hospitals where x-rays have not been taken. These remnants can cause pain, or become infected and cause more serious issues. In some cases, we have had other veterinarians refer patients to our office for a repeat dentistry within days of having a dental procedure performed elsewhere. In these cases, we do invite the referring veterinarian to sit in on the dentistry for educational purposes.

Feline Dental Chart

10. Will dental charting be done to record the health of the teeth for future knowledge? This allows us to track changes in each tooth’s health so that we can take action before there is irreversible disease and the tooth must be extracted.

Cat "cavities" start below the gum instead of at the crown

11. Will nerve blocks be used if teeth are extracted? Just as your dentist uses novocaine prior to working on one of your teeth, we use numbing drugs to reduce post-operative pain in your cat.



12. Will pain medication be given? Anyone who has had a wisdom tooth extracted knows how painful a tooth extraction can be. We give 2 different pain medications (a short-acting and then a long-acting) to ease this burden for your cat.



13. How long will your cat be observed after the dental procedure? At our hospital, the post-surgical patients are housed in the main treatment area where they can be observed from the time they are finished with their procedure until they are discharged. There are a number of instances where we have been able to make a cat more comfortable after surgery because we have been monitoring the cat throughout the afternoon, where a cat in a separate kennel area may not have had the need for additional comfort noted.



14. Will an ultrasonic scaler be used to clean the teeth or manual scaling techniques or both? Hand scaling (picking off the buildup on the tooth by hand) is not as effective as ultrasonic scaling to remove buildup on the teeth, but using an ultrasonic scaler alone could cause tooth damage if large amounts of buildup are present. We manually remove large chunks of calculus (tartar) from the teeth first, and then remove the microscopic amounts with the ultrasonic scaler.

15. Will polish be applied to the teeth after cleaning? Scaling the teeth leaves behind tiny scratches that become an anchor for buildup to form. Polishing removes these scratches and smoothes the surface of the tooth so that it is harder for buildup to gain a foothold.

Oravet Barrier Sealant

 

16. Will fluoride be applied to the teeth after polishing? Fluoride helps strengthen the enamel of the tooth as well as adhering to pores in the tooth that can be painful when exposed to air.



17. Will sealant be applied to the teeth after polishing? We apply Oravet sealant to the teeth after the procedure to seal the gumline and provide more resistance to future buildup.

Painting the teeth with a protective sealant

At Exclusively Cats Veterinary Hospital, we do all of these things. We have had many people report to us that their cats had a change in personality (for the better!) after we performed a dental treatment for their cat. Some previously antisocial cats have become more social; some quiet, older cats have had an increase in energy and a new interest in play.

We recently had a client who chose to take her cats elsewhere for a surgical procedure in order to save $100. After the procedure was over, she learned that she was not getting the services that she thought she was paying for and had to call our office several times in the weeks following the procedure to ask questions about post-surgical complications. She ended up spending that $100 and more (both at the other hospital and then later at ours) in order to make her cats feel better.

We take pride in the skill of our staff and the care and thoughtfulness that we can provide for each patient. It is always your prerogative to choose where you seek your veterinary care and decide what is best for your pets. Our ambition is to help you achieve your health goals for your cats however you allow us to do that.