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. 

Flooding the Litterbox: Chronic Kidney Disease and your cat

CHRONIC KIDNEY DISEASE: An Overview

Before we re-write the book on Chronic Kidney Disease, please note that there are two extremely thorough and excellent resources for people with cats that have Chronic Kidney Disease (CKD) that we would like to recognize: 

Feline CRF (Chronic Renal Failure) Information Center
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

What is meant by the terms “Chronic Kidney Disease” and "Chronic Kidney Failure"?

The term "chronic kidney failure" suggests that the kidneys have stopped working and are, therefore, not making urine.  However, by definition, kidney disease is the inability of the kidneys to remove waste products from the blood.  This definition can occasionally create confusion because some will equate "kidney failure" with "failure to make urine".  Kidney disease is NOT the inability to make urine.  Ironically, most cats in kidney failure are actually producing large quantities of urine, but the body’s wastes are not being effectively eliminated. This is why many people avoid the term "kidney failure" and prefer "kidney disease". Because the kidneys are so efficient at their job and because cats are so adept at hiding their illnesses, it has been determined that a cat can lose up to 75% of normal kidney function before they begin to act sick. This is one reason that annual checkups with your veterinarian are so important!

There does come a point in CKD at which a cat's kidneys have been destroyed to the point where urine is no longer produced (anuria), but hopefully, the problem is recognized, discussed and treated before this is the case.

When is this likely to happen in my cat?

Commonly, chronic kidney disease is considered to be the result of aging - a “wearing out” process.  Most of the time, when chronic kidney disease is diagnosed, the cause is unknown. Biopsy of the chronic kidney usually results in a non-specific assessment called "chronic interstitial nephritis" - a hardening and inflammation of the filtration structures in the kidney. 

There are some known contributing factors to kidney disease:

• Polycystic Kidney Disease:  an inherited disease seen in certain purebreds where one or more fluid-filled cysts start to gradually replace normal kidney tissue 
• Kidney tumors: lymphoma is a common type of cancer seen in cats, and it can affect many different organs, including the kidneys. White Blood Cells called lymphocytes become affected and interfere with normal kidney structure
• Infections: bacterial infection of the kidneys (known as 'pyelonephritis') may cause enough damage to the kidneys to cause CKD. Kidney infections are usually a complication of a long-standing, untreated urinary tract infection, but can occur more quickly in older cats with dilute urine, cats on immunosuppressive drugs, or cats with concurrent diseases such as diabetes or FIV.
• Toxins: certain toxins and drugs can damage the kidneys - for example, cats that eat plants from the lily family, drink antifreeze or ingest pills from the pain-reliever family like acetominophen or ibuprofen
• Glomerulonephritis: there are small filtration units in the kidneys called "glomeruli" that filter toxins from the bloodstream. These filters can become inflamed for a variety of reasons and if the inflammation is prolonged, this can lead to CKD

For most cats, the early signs occur at about 10-14 years of age. However, some cats may experience early onset kidney disease at 5-7 years or younger. About 20-50% of cats will be diagnosed with CKD at some time in their lives.

What changes are likely to occur in my cat?

The kidneys are the body's filters, removing toxins from the blood and excreting them in the urine. When aging causes the filtration process to become inefficient and ineffective, blood flow to the kidneys is increased in an attempt to increase filtration.  This results in the production of more urine.  To keep the cat from becoming dehydrated, due to increased fluid loss in the urine, thirst is increased so the cat drinks more water.  

Other job functions of the kidneys:

• Maintaining hydration - the body's water balance
• Maintaining balance of salts and electrolytes
• Maintaining the acid balance of the body
• Maintaining normal blood pressure
• Producing hormones involved in calcium processing, red blood cell production, blood clotting and immune system health

Early signs of CKD:

• increased water consumption (polydipsia)
• increased urine production (polyuria) with or without litterbox avoidance
• mild or gradual weight loss 

Signs of more advanced kidney disease include:

• loss of appetite/severe or rapid weight loss
• depression or lethargy
• vomiting
• diarrhea
• poor coat
• anemia
• very bad breath (uremia)
• occasionally, ulcers will be found in the mouth

Additionally, cats with kidney disease tend to have associated high blood pressure.

How is chronic kidney disease diagnosed?

The diagnosis of kidney disease is made by determining the level of two waste products in the blood:  blood urea nitrogen (BUN) and blood creatinine.  A urinalysis is also needed to complete the study of kidney function, with special attention paid to the "specific gravity" of the urine. Urine specific gravity is a measure of the "stuff" (such as proteins) in the urine that make it different than water. Since cats are descended from desert animals, they are very good at concentrating their urine - eliminating a lot of "stuff" and conserving a lot of water. Average specific gravity of cat urine is greater than 1.035, and may be as high as 1.060 if they eat a dry-food only diet. If the urine specific gravity drops below 1.035, it can be a red flag that indicates the cat is not concentrating urine well for some reason - for example: drinking more water than usual or losing kidney function. Comparing the BUN and creatinine levels in the blood to the urine specific gravity can be very informative to the veterinarian.

Although BUN and creatinine levels reflect kidney failure, they do not predict it.  A cat with marginal kidney function may have normal blood tests.  If that cat is stressed with major illness or surgery, the kidneys may fail, sending the blood test levels quickly into the abnormal range. Additionally, other factors can affect the body's BUN and creatinine levels, such as kidney infection, hyperthyroid disease, muscle loss, and anorexia (lack of food intake).

Since this is basically just a wearing out process, can it be treated with anything other than a kidney transplant?

Yes, it can. We must recognize that your cat’s kidneys have reached this point due to aging, so they will never be normal again, but many cats still have enough functional kidney tissue so treatment can be very rewarding.

Treatment generally has two phases.  If your cat has reach a crisis, the first phase is to “restart” the kidneys.  The cat is hospitalized and large quantities of intravenous fluids are given to “flush out” the kidneys.  This flushing process, called diuresis, helps to stimulate the kidney cells to function again.  If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for waste removal.  Fluid therapy includes replacement of various electrolytes, especially potassium.  Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhea.

There are some exciting new developments in diagnosis and treatment of feline chronic kidney disease that will hopefully be very beneficial when they become available outside of university research settings.

A newly discovered biomarker of kidney disease may provide earlier detection and allow for closer monitoring and better, earlier treatments.

Stem cell therapy has been showing some promise in treating feline kidney disease, too. The stem cells for this therapy are cultivated from the fat of young, healthy cats; donor animals are not harmed.

What can I expect from this phase of treatment?

There are three possible outcomes from the first phase of treatment:

1) The kidneys will resume functioning and continue to function for a few weeks to a few years. 
2) The kidneys will resume functioning during treatment but fail again as soon as treatment stops. 
3) Kidney function will not return. 

Unfortunately, there are no reliable tests that will predict the outcome. The best your veterinarian can
do is assess the response of the cat's blood values and attitude while hospitalized and draw on their experience as to whether they recommend continued treatment, and if so, how aggressive that treatment needs to be to keep your cat healthy. A close relationship with your veterinarian will help them design a continuing treatment plan to keep your cat feeling healthy for as long as possible. That plan will need to be continually adjusted based on your cat's progress.

 If the first phase of treatment is successful, what happens next?

The second phase of treatment is to keep the kidneys functioning as long as possible. This is accomplished with one or more of the following, depending on the situation:

1. A high quality diet.  This helps to keep the blood tests as close to normal as possible, which usually makes your cat feel better.  We can recommend a commercially prepared food that has the quantity and quality of protein needed by your cat.

2. Potassium supplementation.  Potassium is lost in the urine when urine production becomes excessive.  A potassium supplement will replace that loss.  Low potassium levels have been shown to further reduce kidney function.  This is the second reason that a potassium supplement is recommended.  Monitoring of your cat’s potassium will guide our decision to supplement.

3. A phosphate binder.  One of the secondary things that occurs in kidney failure is an elevation of the blood’s level of phosphorus.  This also contributes to lethargy and poor appetite.  Certain drugs will bind excess phosphates in the intestinal tract so they are not absorbed, resulting in lower blood levels of phosphorus.  Phosphate binders are helpful only when feeding a phosphate restricted diet, as there is far too much phosphate in a  “normal diet” for these binders to be of benefit.

4. Fluids given at home.  Once your cat is stabilized, fluids can be given under the skin (subcutaneously). This serves to continually “restart” the kidneys as their function begins to fail again.  This is done once daily to once weekly, depending on the degree of kidney disease.  Although this might not sound like something you can do, you will be surprised at how easily the technique can be learned and how well most cats will tolerate it.

5. A drug to regulate the parathyroid gland and calcium levels.  Calcium and phosphorus must remain at about a 2:1 ratio in the blood.  The increase in blood phosphorus level, as mentioned above, stimulates the parathyroid gland to increase the blood calcium level by removing it from bones.  This can be helpful for the sake of the normalizing calcium:phosphorus ratio, but it can make the bones brittle and easily broken.  Calcitriol  can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract.

6. A drug to stimulate the bone marrow to produce new red blood cells.  The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells.  Therefore, many cats in kidney failure have a low red blood cell count, anemia.  Epogen, a synthetic form of erythropoietin, will correct the anemia in most cats.  Unfortunately for some cats, the drug cannot be used long term because the immune system recognizes the drug as "foreign" and will make antibodies (immune proteins) against it.

How long can I expect my cat to live?

The prognosis is quite variable depending on response to the initial stage of treatment and your ability to perform the follow-up care.   However, we encourage treatment in most situations because many cats will respond and have good quality life for up to 4 years. 

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

Feline Arthritis Part 2: 7 Things That You Can Do at Home to Help

Arthritis changes to an elbow joint

 How exactly do you diagnose your cat with arthritis? Your veterinarian may feel differences between the joints on one side of the body versus the other, or may feel abnormalities within the joints. The cat may display the same signs that you are witnessing at home, or adrenaline may take over and mask the problem. Patience and a calm, cat-friendly environment may allow the cat to relax and allow us to see the problem or, if not, our doctors have a few tricks up their sleeves to investigate further. However, the most effective diagnostic tool for arthritis is often an x-ray. Usually two views of the limbs are taken and analyzed for narrowing in the joint space, thickening of the bone, or formation of new, irregular bony projections in or around the affected joint. It doesn't matter whether there are many joints that are affected or just one - arthritis changes to the bones means pain with movement - a lack of joint cushioning so that bone grinds on bone. Ouch!

One arthritic pair of vertebrae in the lumbar spine

Multiple thoracic (upper back) vertebrae with arthritis changes

In our previous post about feline arthritis, we discussed medical treatments that are available for cats with arthritis to help rebuild and protect joints and decrease pain. However, there are things that you can do at home to help your arthritic cat, as well. Most of the home care options include environmental changes.

1. Make or buy pet stairs to allow your cat access to favorite spots in the house like beds or couches. This can be as simple as moving a footstool next to a favorite armchair to make one big jump into a set of small jumps.
   
   
2. Make sure that you have a litterbox on every level of your house so that your cat does not have to go far or up and down a lot of stairs to visit one. This will prevent inappropriate urination or defecation around the house. If it is too much work to get to the litterbox, you can bet that many cats will make their own box somewhere else. Also make sure that the edges of the box are not too high, so that it is easy for your elderly cat to get in and out of the box. It may be a good idea to cut down the side of the litterbox a little to help them out. 
3. Providing extra soft beds at floor level, or even heated beds will help your cat rest more peacefully and wake with less soreness. 

   

   Thickened toenail that is traumatizing a toe pad.

4. Make sure that food and water are easily accessible, not up high on a counter, and possibly elevated a little for cats with cervical (neck) pain. 
5. Cats with arthritis may need extra grooming assistance, and should have their claws checked and trimmed frequently. If they are wearing their nails unevenly, a nail could get caught and torn, or could grow into a toe pad and become painful and infected.
6. Weight control. Another change that helps arthritic cats is to make sure that they are not carrying around a lot of extra weight. Extra pounds put extra pressure on already complaining joints, so put your pudgy oldster on a diet to ease the burden on his aching joints. Work with your veterinarian to determine a good weight loss plan – you don’t want your cat to crash-diet, because that can cause other health problems.   
7. Getting your cat up and moving more can help with weight loss and flexibility. With adequate pain control, your cat should show a renewed interest in play, and you should use that to your advantage. For cats with a reluctance to play, you may try offering meals in a food ball, such as the Eggcercizer, which you can find in our office. Ask our hospital kitties for a demonstration! 

Saving Smoke

Smoke, Day 1

On Thursday, last week, a new client came into our hospital with a very sick little cat. Smoke is a two-year-old male cat that suffering from a urinary obstruction. He was very sick, and his kidneys were in danger of shutting down. Smoke's owner was not able to bear the financial burden of the hospitalization, IV fluid therapy, and the long-term cost of monitoring Smoke and feeding special diets to keep him from having a urinary obstruction in the future. His owner was devastated at the thought of having to euthanize his buddy.

Some of our soft-hearted employees were able to pool their resources and champion Smoke, and his current medical expenses are being met. Smoke’s owner relinquished him to our care because, even if we can fix his problem, he will not be able to care for Smoke’s special needs. We are hoping that, once he is back to 100%, we can find a new home for Smoke with a family that is prepared to manage his special situation with prescription diet and regular checkups.

We started IV fluids and then unblocked his bladder. We removed almost ½ cup of urine from his bladder – which would be like removing almost 1 and ½ quarts from a human bladder! His urine was bloody and filled with crystals, which is what had caused the blockage. We flushed as many of the crystals out of his bladder as we could, and then placed a urinary catheter. We gave him pain medication, antibiotics and also treated his fleas.

While he immediately felt better, he still didn’t feel well enough to eat for a while. He gave us quite a scare on Friday, because instead of improving, his kidney values became worse. We were nervous that we might lose him. We continued to give him lots of fluid therapy to help his kidneys, and continued his pain medication and antibiotics.

Blood clot in Smoke's bladder

On Saturday, his kidney values were better, but now that his bladder was healing, he had developed a large blood clot in his bladder – about the size of a ping pong ball! Since he was feeling better, he did want to eat, but he was not interested in the prescription diets that will help dissolve the crystals. Eventually, we were able to fool him into eating the prescription diets by mixing them with Fancy Feast Fish and Shrimp.

On Sunday, his kidneys were even better – back to normal! By Sunday night, he was eating his prescription food without having to mix it with something else. Today, we stopped his IV fluids and removed his urinary catheter. We checked with the ultrasound and determined that the blood clot is getting smaller. Since he is doing better, we neutered him as well.

Day 5: Loving on the catnip toy

Smoke feels so much better, he was playing with a catnip toy during his exercise time, today. He was rolling on his back, asking for belly rubs, too! He has licked his catnip toy so much that both he and his toy have turned green! 

Investigating the fluid pump

Once he is no longer at risk, he will need to eat a special diet and get regular urine rechecks to ensure that he does not block again. Sometimes, even with meticulous care, cats with this problem will suffer another obstruction. We would like to ensure that his new caretaker is willing and able to manage his special circumstances so that he can live a long and happy life. If you are considering adopting this happy little fellow once he is ready for a new home, please contact our office at 248-666-5287 or ecvh@exclusivelycats.com with any questions or for more information.

Feline Inappropriate Elimination: Breaking the Cycle of Smell

Cats will return to and reuse areas where they have previously urinated. Because of this, cleaning up the areas and items where your cat has urinated or defecated is a crucial step to breaking the cycle, as well as preventing damage to the item. Because it is much easier to eliminate odors in recently-soiled areas, clean them as soon as possible. If you’re not sure of the extent of the soiled spot, a black light will easily illuminate urine and fecal matter on items. The black light will also help identify areas that you may not know were being soiled - check the walls and floor for several feet in every direction from the spot being soiled. It may help to use chalk to outline the urine spots for easy cleaning. Check the underside of chair and couch cushions and pillows to see if the urine has penetrated all the way through - if so, then your enzymatic cleaner will have to penetrate fully, too. Black lights work best in a darkened room. If you have the plug-in variety of black light, use an extension cord so that you have freedom to move around the room without having to constantly move the plug from outlet to outlet. Otherwise, there are a variety of hand-held, flashlight-type options.

Outlined spots for easy treating.

The rule of thumb when treating carpet or other absorbent surfaces for urine spots is to use twice as much cleaner as the size of the spot that you are treating. Urine will disperse down through the carpet and into the padding beneath, and may even absorb into the floorboards below that.

A cat's sense of smell is 200 times stronger than ours; therefore odors must be neutralized, not just deodorized. It is also best to avoid cleaning products containing ammonia or vinegar—they smell like urine and can be irritating. In order to neutralize the odor, use an enzyme-based cleaner such as Urine-Away, Nature’s Miracle, Simple Solution or Nok-Out. These cleaners break down the odor molecules rather than just covering up the smell. Sometimes, if the problem has been going on for a long period of time, it may be necessary to replace urine-saturated flooring.

•   Sheets of plastic, newspaper, sandpaper, double-sided tape, or a carpet runner with the nubs facing up may all discourage your cat from entering a soil-prone area.
•  Try changing the significance of a soiled area. Cats prefer to eat and eliminate in separate areas, so try placing food bowls and treats in previously soiled areas. Playing with your cat in that space and leaving toys there may also be helpful. 
• Spray the area with a pheromone spray or use a diffuser to provide pheromone all day long - the Feliway pheromone is a "happy" smell to a cat and signifies that the area is not for elimination. It also has a calming effect.
•  Try denying your cat access to a given area by closing doors, or by covering the area with furniture or plants. Baby gates will not keep most cats out of a room.
• Catch him in the act. A bell on a breakaway collar tells you his whereabouts. If you can catch him within the first seconds of his elimination routine, startle him with a water gun or shake a jar of pennies, so that he associates being startled with those actions. It is important that you startle rather than scare him; fear will only worsen the problem. Moreover, if you catch him after he's eliminated, your window of opportunity is gone—you must catch him just as he's about to eliminate. 

Never hit, kick, or scream at a cat. Not only does this create more anxiety, which may contribute to house soiling behavior, but also such tactics provide no link between the "crime" and the punishment. Some owners resort to rubbing their cat's face in their excrement to "teach the cat a lesson." This is ineffective, first because cats do not view their urine and feces as distasteful, and second, because even moments later, cats cannot make the connection between the mess on the bed and this kind of punishment.

More information about inappropriate elimination:
Lovin' the Litterbox: Husbandry Reasons Why Your Cat May Not Use the Litterbox
Kidneys and Crystals and Stones, Oh, My! Medical Reasons Why Your Cat May Not Use the Litterbox
Acting Out All Over the House: Behavioral Reasons Why Your Cat May Not Use the Litterbox

Killer lilies are a no-no for kitties!

Image credit: Field of Lilies by Andrea Andrade

We’ve set our clocks forward and have seen crocuses poke their heads up from the frozen earth, and the first thing that many of us want to do is to celebrate spring with some lovely, fragrant lilies – especially the beautiful white trumpet-shaped Easter lilies that appear everywhere this time of year. Unfortunately, for those of us with cats, this is probably the worst way to usher in good weather.

Easter lilies (Lilium longiflorum) are incredibly poisonous to cats. Well, all lilies, really - Tiger Lily ( Lilium henryi and lancifolium spp.), Day Lily (Hemerocallis spp.), Asiatic lily (Lilium asiatica), Stargazer lily (Lilium orientalis) and the rest of the Lilium family. (Not sure if you have a lily? Wikipedia has images of many of the lily species which will help with identification.) All parts of the lily plant are dangerous, including the flowers, stamens, stems, leaves and roots – even the pollen. If a cat gets pollen on its coat and then grooms, it could still cause fatal illness. Cats that get pollen on themselves should be thoroughly bathed as soon as possible.

Most of the time, we only know that a cat has eaten a lily because some part of the lily appears in a very inconveniently placed puddle of vomit. Many people may even initially write it off, thinking, “Oh well, Fluffy got into the spider plant again. Guess I’ll go get the carpet cleaner.” (Spider plants are non-toxic, by the way, so Fluffy can eat away at them all she likes!) However, when it comes to lilies, it is imperative that you seek emergency medical treatment for your cat as soon as possible to ensure proper and effective treatment. In approximately 2-4 days after ingestion of the plant, your cat may begin to show signs of kidney failure. If enough toxin is absorbed to cause acute kidney failure, then the likelihood that your cat will respond to treatment is poor.

A cat affected by lily intoxication will initially show signs of an upset stomach (gastritis): vomiting, a lack of interest in food and lethargy. These initial signs may appear within 2-12 hours of ingestion and may disappear after 12 hours. The cat may improve briefly or appear to act normal before the condition progresses to serious acute renal failure within 48 to 72 hours.

Once a cat’s kidneys have been damaged to the point of failure, they will show a variety of signs such as lethargy, vomiting, increased thirst, and urinating large quantities (in some cases, urine production may stop altogether - anuria). Affected cats are also likely to be dehydrated. If left untreated, death can occur in as little as 3 days.

Diagnosis and Treatment:
There is no “lily poisoning test”, diagnosis is usually made due to someone witnessing the cat eat the lily or vomit part of the plant. Blood tests that check the kidneys (BUN and creatinine levels) will help confirm ingestion, though severe increases are not likely to be seen immediately. If your cat’s kidney values are normal after eating part of a lily plant, this is GOOD! It means that treatment is more likely to be successful.

Within 6 hours of exposure, depending on how quickly the cat is brought to the veterinary hospital, doctors and staff may try to induce vomiting and/or give medications to prevent further absorption of the toxin. Even if blood values are normal and the cat vomits up the lily parts you will likely be advised to hospitalize your cat for monitoring and IV fluid administration for a minimum of 24 hours. If your cat is treated immediately after ingestion, prognosis is good.

Up to 48 hours post-exposure, immediate hospitalization and intensive IV fluid therapy will be recommended. The length of time that your cat will need to be hospitalized depends on how badly his kidneys have already been affected, and how he responds to treatment. Prognosis is guarded to poor – mild to moderate kidney damage may be permanent.

Two to four days post-exposure, depending on laboratory testing of the kidneys, humane euthanasia to end suffering may be the only option. Prognosis is very poor – severe, irreversible kidney damage may result in the inability to produce urine. Left untreated for longer than 18 hours, one can expect death in almost 100% of cases.

If you or anyone in your household suspects that your cat may have ingested any part of a lily, no matter how small, please seek immediate veterinary attention. Hesitation may mean the difference between life and death for your cat!

**Celebrate Pet Poison Prevention Week March 18-24 by sharing this article with at least one other person. You might save a life! **

Calla Lily

Peace Lily

Note: While Calla lilies (Zantedeschia aethiopica) and Peace lilies (Spathiphyllum spp.) are not true lilies, they are still toxic to a lesser degree and can cause oral irritation, intense burning and irritation of mouth, tongue and lips, excessive drooling, vomiting, difficulty swallowing

Lily of the Valley

Peruvian Lily

Lily of the Valley (Convallaria majalis) is also not a true lily, however, it is also toxic and can cause vomiting and cardiac problems such as irregular heart beat, low blood pressure, disorientation, coma, and seizures. Peruvian lily (Alstroemeria spp.) is another lily to be aware of. While many florists advertize it to be non-toxic, large amounts of this lily-lookalike can cause stomach irritation, vomiting and diarrhea. Peruvian lilies come in all colors and are also valued in floral arrangements due to their long life as a cut flower.

  For further information:

ASPCA Toxic Plant List
Pet Poison Help Line – learn the common signs of poisoning, 

make a pet poison first aid kit and more!
PSA website: No Lilies for Cats  - FAQ about lily poisoning
Why veterinarians hate Easter - a Veterinarian’s story
The dangers of lilies – a cat owner’s story 

Feline Inappropriate Urination: Acting out all over the house!

When medical issues have been ruled out, and husbandry issues have been resolved, if a cat is still eliminating outside the box, it is likely to be due to a behavioral issue.  Unfortunately, while litterbox environment and medical issues are relatively straightforward to address, behavioral issues can be complicated.

New furniture can stress your cat.

One of the most common causes of behavioral inappropriate elimination is stress. Stress can come from a variety of sources.  It can be due to a bold or aggressive animal re-establishing his territory or a timid, shy animal urinating because he is a “victim” of his social environment (being passive-aggressive). A change to the household that disrupts the cat’s schedule may also be a contributing factor to a cat choosing not to use the litterbox -- such as a new baby, visitors staying in the home, a child going off to college, a change in someone’s work schedule, a move to a new home, new furniture, a new pet, a family vacation, renovations to the home, a visit from a plumber or other repair-person, etc. In some cases, the behavior will resolve on its own after the event (such as vacations, visitors, and renovations), and in other cases, the behavior may be ongoing (new furniture, a baby, a new home). Each type of stressor may have several solutions.

For example:

If your cat eliminates inappropriately when you go on vacation, you may find that you can curb the behavior by boarding the cat while you are gone, hiring an in-home sitter versus having a neighbor stop by the house once or twice daily, or by taking your cat with you. Discussions with your veterinarian may even lead to recommendations for medicinal therapy while you are gone to alleviate anxiety.

If you are planning on getting a new pet or having a baby, preparing your cat for the new addition may head off any potential behavioral issues. Also, making sure to introduce the new pet to the resident cat on a gradual basis will help lessen the stress your cat may feel about a new addition.

When planning to move to a new home, it is often helpful to establish the cat in the new home prior to moving day, if possible, so that their first exposure to the new home is not amidst chaos. If your cat can be set up in a room with all his familiar things and you can avoid moving things into that room right away, that will also help. If your cat can’t be moved ahead of time, then moving your cats into a room that will be little-disturbed on moving day, such as a bathroom or walk-in closet may also help. Let the cat become accustomed to the moving-day room before allowing him out to explore the whole house. That way, if something about the new house is frightening, he has a safe place to retreat to.

Sometimes inappropriate elimination can become so ingrained in a cat that even once the stress has been removed, the behavior continues. If this is the case it is a good idea to seek advice from your veterinarian as to how to re-train your cat. 

Spraying posture - standing near a vertical surface, tail erect

If a cat chooses to eliminate near a door or window, it is likely that either the presence of feral/stray or wandering neighbor cats may be causing your cat stress, anxiety or frustration or stimulating your cat to mark his territory and warn off these tresspassers. It is important to determine if your cat is urinating or spraying, as these behaviors are approached differently. Spraying is generally performed in a standing position with the tail raised, and the urine is deposited on a vertical surface such as a wall or piece of furniture (though it may run down the wall and puddle on the floor). Spraying tends to deposit small amounts of urine as compared to the size of the urine clumps you find in the litterbox. The tail may appear to quiver or vibrate. When your cat is urinating, he will squat and deposit a large amount of urine on a horizontal surface.

Urinating posture - squatting

It is most commonly the male cat that sprays, but it is not unheard of for female cats to spray, also. Spaying and neutering your cats will help prevent this issue in most cats, as the lack of male and female hormones will dull the desire to mark and maintain territory, and the need to advertise sexual availability – which are the primary reasons that cats urine mark. However, about 10% of neutered males and 5% of neutered females also spray. In households with more than seven cats, the likelihood of spraying is high. 

If outside cats frustrate your cat, you may be able to address the problem by discouraging stray cats from visiting your house. A plant called Coleus canina, also known as the “scaredy cat plant” or the “pee-off plant” is a deterrent to cats, dogs and foxes. Coleus plants are those that you often see with brightly colored leaves. This species of Coleus has green foliage and small, spikes of pretty blue flowers in the summer. The plant only smells to the human nose when touched. In Michigan, Coleus plants are annuals, but can easily be propagated and cuttings can be kept in a frost-free place over winter. They prefer a dry, sandy soil and lots of sunlight and should be planted every 1-2 yards for best results.

Coleus canina flower

Cats also hate the smell of the herb rue. It has beautiful blue-tone leaves and tiny yellow flowers. Cats are also usually deterred by the smell of citrus, so placing orange or lemon peel in your yard may help deter strays. Similarly, coffee grounds, blood meal, cayenne pepper, lavender oil, lemon grass oil, citronella oil, peppermint oil and eucalyptus oil can be used near areas where outdoor cats like to hang out.

Avoid feeding birds or squirrels in your yard if your cat is bothered by stray cats.

Motion detectors that trigger sprinklers can be used to deter them from coming onto your property. Additionally, you can discourage your cat from looking outside by closing blinds or shades, or making the windowsill inaccessible. Double-sided tape, tin foil or strips of carpet runner on the sill may also deter your cat. 

Spraying can also result from territorial disputes between cats in the same household. They may need to be separated and reintroduced slowly, using food treats to reward and encourage peaceful behavior. This re-introduction can successfully develop good relations between cats in some cases, even if the spraying has been going on for a long time.

While the presence of other cats, lack of access to prey species or sexual maturity are the most common reasons that cats perform spraying behavior, other causes can be new or unfamiliar scents in the home (such as new furniture, or digging out the Christmas tree from the attic or bringing a live tree into the home) or frustration due to lack of mental stimulation. Often, spraying new items with a pheromone called Feliway can help lessen your cat’s desire to mark. This product mimics the scent of cat cheek gland secretions. Many cats will not spray on areas that have this scent. Increasing the amount of playtime for an under-stimulated cat may help ease frustration.

Behavior-related elimination issues are often addressed with anti-anxiety medications, such as Prozac (fluoxetine), BuSpar (buspirone), Elavil (amitriptyline), and Clomicalm (clomipramine). Anxitane is a neutraceutical (nutritional therapy) supplement of L-Theanine that has also been shown to aid in decreasing anxiety in cats. Medications are useful in helping to decrease behavioral inappropriate elimination, but they should always be used in conjunction with changes to the home or other environmental changes with the goal of hopefully weaning the cat off the medication, if possible.

More information about inappropriate elimination:
Lovin' the Litterbox: Husbandry Reasons Why Your Cat May Not Use the Litterbox
Kidneys and Crystals and Stones, Oh, My! Medical Reasons Why Your Cat May Not Use the Litterbox
Breaking the Cycle of Smell: How to Stop Habitual Elimination Problems