The Senior Cat

Cats are often forgotten members of the household in terms of veterinary care, since they are by nature self-reliant and hide illness and discomfort remarkably well. According to the American Association of Feline Practitioners (AAFP), a “senior” cat is defined as a cat over 11 years of age, while a “geriatric” cat is defined as being over 15 years of age. As age increases, cats are more prone to developing subtle changes in behavior that can help clue us into various common diseases in older kitties, such as arthritis, chronic kidney disease, hyperthyroidism, hypertension (high blood pressure), and small intestinal disease.

Chronic pain caused by osteoarthritis (degenerative joint disease) is the most common condition we diagnose that causes a chronic, negative impact on quality of life. Studies have shown that up to 90% of older cats will have changes consistent with osteoarthritis on x-rays, affecting many different joints in the spine and limbs. Recognition of feline pain and pain management in cats has come a very long way in the last two decades. Some cats will develop visible lameness or signs of discomfort, but often the signs are much more subtle, such as:

  • Hesitation before jumping.

  • Relocating favored perches and sleeping areas to more accessible areas.

  • If in a home with stairs, limiting themselves to one level of the home.

  • Under grooming or over grooming.

  • Not using the litterbox, especially to defecate.

  • Reclusiveness and/or changes in temperament.

Treatment of osteoarthritis is often multimodal, meaning approached from many different angles. We generally start with omega-3 and joint supplements, as well as some prescription foods to manage the disease from a nutritional angle. Weight management is also an important part of nutritional management, as obesity creates a pro-inflammatory state in the body that can worsen disease symptoms (this is true of humans and dogs, as well!). Pain management with various drug therapies are often recommended; as well as physical therapy, cold laser therapy, and acupuncture.

Osteoarthritis and common systemic diseases in cats, such as chronic kidney disease, hyperthyroidism, hypertension, and gastrointestinal disease, often have an insidious onset and a nonspecific set of symptoms (weight loss, increased or decreased appetite, vomiting and/or diarrhea, increased water consumption, and accidents outside the litter box, etc…). The nonspecificity of symptoms, and often coexistence of multiple diseases in a single cat, is why we recommend a blood pressure and comprehensive blood work and urinalysis profile anytime a senior or geriatric cat presents with any combination of these symptoms. We may also recommend diagnostic imaging such as x-rays and abdominal ultrasound to be able to further define symptoms and come to a diagnosis. Treatment of the various common systemic diseases in older cats is also multimodal, often employing a combination of supplements, diet, and drug therapies.

In the generally healthy senior or geriatric cat, the annual physical examination is a great opportunity to review the happenings of the past year with your veterinarian, and have a discussion as to the “normals” and “abnormals” of your unique kitty. We very often have findings on our examinations that are so subtle that clients have not noticed them at home, such as weight loss and painful joints. In addition to our standard annual physical examination, vaccine, and intestinal parasite prevention protocols, the AAFP additionally recommends annual baseline blood work, thyroid, urinalysis, and blood pressure in all senior cats. Having these baseline values for an individual patient is extremely helpful for comparison to their “normal” if illness arises. For some senior and all geriatric kitties, it is often recommend to have examinations, and sometimes blood work, on a biannual basis.

Amazingly, it is not uncommon for cats to live into their early 20’s with regular preventive care, pain management, and early and persistent management of chronic diseases. We absolutely love our well-lived and well-loved senior and geriatric feline patients!

Helpful Resources for Senior Cat Lovers:

Top 10 Tips for Senior Cats:  https://catfriendly.com/cat-care-at-home/senior-care/10-tips/

How Do I Know if My Cat is in Pain?: https://catfriendly.com/feline-diseases/signs-symptoms/know-cat-pain

 

Image courtesy of Austin White on Flickr

Halloween - Trick or Treat?

Halloween is right around the corner, so this week we’re going to discuss… candy!  These tasty sweets can be dangerous for dogs, particularly those that contain chocolate, are sugar-free candy and those containing raisins. Although not life-threatening, ingestion of high-sugar candy can cause diarrhea by pulling water into the gastrointestinal tract and giving gut bacteria too much “food,” leading to excess growth of bacterial populations. Specific candy toxicities are discussed below:

Chocolate contains a compound called theobromine, which is related to caffeine. Dogs do not metabolize these compounds quickly, so they can experience more intense and lasting effects of these stimulants. Common signs of chocolate toxicity are anxiousness, panting, muscle twitches, rapid heart rate, and even seizures. Vomiting and diarrhea are also common and will sometimes be the only symptom in mild cases.

The weight of the dog, the amount of chocolate, and type of chocolate ingested are all factors that determine whether chocolate ingestion is toxic. As a general rule the darker the chocolate is more toxic it is (baking chocolate is far more toxic than milk chocolate), and larger amounts of any chocolate consumed by smaller dogs carries more risk of toxicity. Milk chocolate is often more concerning for the potential to cause illness and symptoms from pancreatitis, as a result of ingestion of sugar and fat, than true chocolate toxicity from theobromine.

Sugar-free candy with the sweetener xylitol is extremely dangerous to dogs. Xylitol causes large amounts of insulin release in the dog. This leads to a rapid drop in blood sugar levels which can manifest as  uncoordinated walking (ataxia), extreme lethargy and/or seizures.

Xylitol can also induce liver failure and blood clotting abnormalities. Any amount of xylitol ingested should be considered very toxic to Any size dog; if you suspect your dog has ingested this substance, you should immediately visit your veterinarian or the nearest emergency veterinary clinic  for emergency treatment, hospitalization and monitoring.

Raisins (and grapes) have the potential to cause acute kidney failure in dogs. The frustrating thing about this toxicity is that we do not know what in the grapes or raisins causes the toxicity, and there is not a widely accepted toxic dose. Raisins tend to be more concerning than grapes as they present a more “concentrated” version of the fruit. Any ingestion comes with recommendations for emergency care to induce vomiting and, preferably, 48-72 hours of IV fluids and monitoring of kidney values.

In all cases of suspected toxin ingestion, it is advised to call your veterinarian, go to an emergency veterinarian or call ASPCA Poison Control  (888) 426-4435 immediately for further direction. If it is determined a toxic dose of a candy has been ingested, seeking medical care to induce vomiting as soon as possible is the best course of action. Depending on the amount ingested, further treatments may be indicated such as: administration of activated charcoal to help absorb toxins within the gastrointestinal tract, intravenous fluids, hospitalization, and drug therapy.

We wish everyone a happy and safe Halloween — and remember to keep that candy out of reach of the pups, which means the more for you as well!

Arthritis

Arthritis is something that we see pretty commonly in our pet cats and dogs. Most people think of big dogs and their predisposition to getting hip dysplasia — but we’ve come to recognize that cats and every size of dog are prone to getting arthritis as they age…much like us. They are just SO much better at hiding the symptoms for so much longer than most of us wimpy humans.

When we break it down to it’s Latin & Greek roots arthritis means “inflammation of a joint.” There are two main classes of arthritis — osteoarthritis: which is a chronic use/degenerative process of a joint that develops from overuse or poor conformation of the joint; and inflammatory/immune mediated arthritis such as rheumatoid arthritis.

Inflammation, in short/brief doses is good for the body — but when uncontrolled can lead to destruction of the cartilage. In attempts to stabilize the joint and reduce pain, inflammation often leads to excess bone production along the joint edge (such as bone spurs) that actually lead to more pain and inflammation…and the cycle continues.

Symptoms of arthritis can include overt joint pain (i.e. lameness, stiffness) but also more subtle changes such as reduced activity (reluctance on walks, jumping, etc…), inappropriate elimination (many times because it is painful to posture to urinate/defecate) or changes in behavior or mood.

True diagnosis of osteoarthritis is made with x-rays — but we are often suspicious of it and may will manage accordingly based on physical exam findings and history alone. Management of arthritis involves nutrition, weight management, exercise, nutritional supplements and depending on the severity prescription pain medications.

A multi-modal approach to pain management often results is better comfort and many times less needed drug. Two of the most important things to start with are weight and exercise.  A trim/fit dog or cat is going to be able to deal with arthritis much better than an overweight/out of shape pet, as the physical stress on the joints is going to be less.

Regular, controlled exercise is also so important as it helps maintain a normal joint range of motion as well as muscle mass — which is necessary to support a joint. As our pets get older they tend to lose muscle mass and get overweight — which exacerbates any predisposition for arthritis development.

Diagnosis of other types of arthritis (such as infectious arthritis or rheumatoid arthritis) often involves a much more extensive work up with blood work, joint taps or other diagnostics, and may involve additional treatments such as antibiotics or immunosuppressive drugs.  

Arthritis, while potentially painful for our pets, can often be well-managed — if you are concerned that your pet may be suffering from arthritis, we recommend talking with your pet’s veterinarian about the best options for him/her.

Fleas 2.0

We’ve discussed fleas previously, but since we’re just starting to see the first real fleas of the season figured it’s a good time to revisit these icky insects.

What exactly is a flea?

Fleas are small (~2-3mm), reddish-brown insects. They feed on the blood of mammals and birds. While they cannot fly, they have incredible jumping ability. According to the website fleascience.com, the average flea can jump about 5 inches high and 9 inches horizontally, though they can reach 8 inches high and nearly 20 inches horizontally.

What diseases can they carry?

Fleas can cause symptoms of mild itchiness to severe itching/scratching and significant secondary bacterial infections, depending both on the flea burden and the individual animal’s sensitivity to flea bites. Additionally, in young puppies and kittens, or severely infested animals, fleas can cause anemia due to blood loss.

Other parasites and diseases can also be carried or transmitted by fleas:

  • The most common form of tapeworms, Diplydium caninum, are carried by fleas. Tapeworms are rarely a significant health concern but can be uncomfortable to the pet and disturbing to the owner who discovers them.
  • Bartonella, the causative agent of Cat Scratch Disease, is also carried by fleas. Typical transmission is from the scratch of an infected cat (who got the disease from fleas), but there is some thought that infected fleas can transmit directly to humans via a bite.
  • Plague, caused by the bacteria Yersinia pestis, can also be transmitted by fleas.

What is the lifecycle of the flea? And why does it matter?

Adult female fleas feeding on an animal can start laying eggs within hours, laying up to 50 eggs per day. Eggs develop in the environment, preferring cool dark places (like under fallen leaves — which is why we tend to see an increase in cases of flea infestations in the fall) and indoors along baseboards, carpets and crevices of furniture or floors.

Larvae then develop into pupae, typically preferring the same places as the larval stages. Finally, adults emerge from the pupal stage and start looking for a host to feed on. This whole process can take as little as a few weeks in optimal conditions. However, the larval and pupal stages can also lie dormant for months, and hatch only once they sense the environmental factors are ideal (vibrations from movement, heat and CO2 can all trigger this).

Because of the prodigious egg-laying of the adult flea, it is possible for a single adult female to quickly lead to an infestation. The environment (which can be outdoors or indoors) quickly becomes contaminated with eggs, larvae and pupae.

How do I know if my pet has fleas?

Sometimes you will actually see the flea moving along the skin under the hair coat, or even jumping from the pet as you rub their belly. A more reliable way to detect them is to look for “flea dirt,” which is digested and excreted blood. The tail area and behind the ears are two common places to see this.

However, sometimes it’s not a simple diagnosis, especially early on. Some pets are very sensitive to flea bites, and will demonstrate intense itching with only a single bite — in these cases, it may be difficult to detect the fleas.

The classic signs of a pet with fleas are intense itching or chewing around the tail base (and in general). The itch associated with fleas is often more intense than we might see with other causes of itchiness (namely, allergies).

What is the best way to prevent fleas?

Fortunately, there are many effective topical and oral options for effective flea prevention nowadays (no more flea dips and sprays.). We recommend consulting with your pet’s veterinarian about the different options and what would be best for your pet.

A word of caution regarding cats — cats are especially sensitive to the pyrethrin class of flea preventatives.   Be sure that the flea preventative you are using on your cat, whether prescription or OTC, is approved for use in cats.

Are there any more natural alternatives for flea prevention?  

At this time, there are no consistently reliable natural alternatives that work as well as conventional drugs. If you are looking for natural alternatives, it is recommended to do daily flea combing. This should be combined with environmental control, which includes very frequent vacuuming and cleaning of floors and baseboards in the home.

Additionally, boric acid or diatomaceous earth can be used on the carpet (following manufacturer recommendations) to kill larval stages — however, neither of these is completely free of potential side effects despite being more “natural.”

Do I really need to give flea prevention year-round?

In short, yes. Again, because all it takes is a single adult flea to set up an infestation in the home, we and the vast majority of veterinarians in our area recommend flea prevention year-round. It doesn’t matter if it’s below freezing outside, as the fleas will be happy little campers inside your toasty warm home.

What about my indoor cat that never goes outside?

It is true that an indoor cat with no dogs in the house has a lower risk of getting fleas than an outdoor cat; however, in our area, where many pets live in apartment buildings with their owners, it’s not uncommon for indoor cats to get fleas. Remember — fleas do not respect doorways.

It is especially important that cats living with dogs be on a regular flea preventative, as fleas can get inside on the dog, and then “set up shop” on the unprotected cat.

If my pet has fleas, do I need to have the house treated (“bombed”)?

It depends. In mild cases, often just treating the pet effectively, combined with diligent cleaning of the home, will be effective. However, if it’s been a long-standing problem, or there are multiple pets in the home, it is often best to get an exterminator involved to treat the environment.

A word of caution here — there are no available products that can kill the pupal life stage — so it is still imperative to have pets on regular preventative because those pupae will hatch into adults; without the pet being treated, those adult fleas will again be able to set up shop.

Additional Resources

The Senile Old Friend

Lets face it, our pets age.  Just like us, some maintain cognitive function and stay sharp as a razor, and others … not so much. Whether you call it dementia or cognitive dysfunction, the symptoms we see in our pets are similar to what is seen in humans with Alzheimer’s or senile dementia.

These pets can get lost in the house, become ornery, not want to do things they used to enjoy, lose house training and litter box habits, pace/vocalize or otherwise seem agitated or anxious (and often at night), just to name a few common symptoms.

Cognitive Dysfunction is relatively common in an aged pet population – though the symptoms are not “normal” signs of aging. When screening and intervention occurs earlier in the process of this syndrome, we can often improve longevity and quality of life for the pet (and often their human companion), though we cannot cure it.

It is important to realize that these symptoms can be seen with many other diseases or chronic pain (such as from arthritis). Ruling out other treatable or manageable conditions is helpful and increases our chances of keeping our aged pets comfortable.

Adequate pain management is by far the most common issue we have to address before determining if additional therapies for cognitive dysfunction are needed. Our fur family is just so good at being stoic that sometimes we don’t adequately recognize subtle signs of pain until it becomes so bad and starts to alter their behavior.

Some other diseases that can cause similar symptoms are other primary neurologic diseases (brain tumors, inflammation around the brain, etc…), kidney disease, hypertension, altered thyroid function and altered adrenal gland function. Blood testing and a comprehensive physical exam are important screening tools for some of these underlying diseases.

Once any and all underlying problems are adequately addressed, management of cognitive dysfunction generally involves dietary management (there are some newer diets that specifically help address the altered brain nutrient needs), increased antioxidant supplements, melatonin and anti-anxiety medications such as selegiline or Prozac.

Reducing outside stressors on our pets has also been shown to be beneficial. If your pet is showing symptoms of cognitive dysfunction – then it is not ideal to make major changes in their life (such as getting a new pet or changing their environment), if possible those stressors can trigger things to get much worse for them, and more quickly.

If major stressors are inevitable, then easing them into the change may be helpful. Additionally, similar to doing crossword puzzles as a human, keeping cognitive skills fresh is important for our pets as well.

Environmental enrichment and mental stimulation is really important: ways we can work on these skills are with tools like puzzle and feeder toys, climbing and agility and general maintenance of a good activity level and ongoing task and obedience training.

If you have an older pet who is experiencing disorientation, changes in their sleep/wake cycle, loss of house training, changes in social interactions, increased agitation or anxiety and/or changes in activity level – talk to your veterinarian about looking into what underlying causes might be present and ways to help support your old friend’s brain health and comfort.

Heart Disease

Heart disease in various forms is quite common in dogs and cats.  In fact, veterinarians frequently diagnose patients with heart murmurs, arrhythmias, congestive heart failure and enlarged hearts, just to name a few.

Heart disease in pets can be due to congenital defects (such as a hole in the heart), age-related change (a thickened valve that becomes leaky), problems with the heart muscle itself, heart-worms living in the vessels around the heart or the heart itself, or even be secondary to an unrelated problem that causes changes in hormone levels or electrolytes.

It is interesting to note that, unlike people, cats and dogs rarely have high cholesterol or triglycerides as the underlying cause of their heart disease, and rarely have true “heart attacks.”

The first step in diagnosing heart disease is obtaining a full history, as often there are clinical signs that may be noted at home even before the pet comes in for a full exam.  These include:

  • Elevated resting respiratory rate
  • Persistent coughing and/or difficulty breathing
  • Decreased exercise tolerance or energy in general
  • Collapsing or fainting episodes
  • Decreased appetite
  • Distended abdomen

Other symptoms that may not be apparent at home, but can be picked up by your pet’s veterinarian, include:

  • Irregular heartbeat / arrhythmia
  • Heart murmur (the sound of turbulent blood flow through the heart)
  • Lung sounds that may indicate fluid build-up in or around the lungs
  • Signs of poor oxygenation such as discolored gums
  • Fluid build-up in the abdomen
  • Abnormal blood pressure

Because pets are very good at “hiding” their heart disease, it is not unusual that they can be seemingly asymptomatic for a long period of time and then quite quickly develop severe symptoms of heart disease such as coughing, respiratory distress, or collapsing episodes.  This is especially true in cats, as they are well-known for showing very few symptoms of heart disease until their disease is quite advanced.

If your pet is diagnosed with a heart murmur or arrhythmia on routine physical exam additional testing may be recommended.  This may include bloodwork to look for underlying metabolic or electrolyte abnormalities, chest x-rays to evaluate the shape and size of the heart and to further evaluate the lungs for evidence of fluid build-up, and/or an EKG to diagnose an abnormal rhythm.

In some cases, referral to a veterinary cardiologist may be indicated. Veterinary cardiologists have special training in diagnosing and treating heart-related conditions.

One of the most important tests they perform is an echocardiogram, or ultrasound of the heart. This allows visualization of the structure of the heart muscle and valves, as well as flow of blood through the heart. This is a specialized test not routinely performed by most family veterinarians, but provides very valuable information about the underlying cause of the symptoms and can help us more effectively manage the heart disease.

Studies have shown that pets in congestive heart failure may live up to 75 percent longer when co-managed by a veterinary cardiologist and their primary veterinarian.

We are fortunate in the Northern Virginia/D.C. metropolitan area to have one of the country’s premier veterinary cardiology groups nearby – Chesapeake Veterinary Cardiology Associates. Their website is a wealth of information for any pet parent whose furry friend has been diagnosed with heart disease.

When caught early, most heart disease conditions in our pets can be managed,and some for quite a long time. If your pet is experiencing any of the symptoms above please consult with your family veterinarian for further evaluation. If your pet has been diagnosed with a heart condition, additional resources and educational material can be found with the links below.

Additional Resources:

Leptospirosis

Having had two cases develop acute kidney failure from this bacterial organism in the last nine months, we felt it prudent to discuss Leptospirosis: what it is, how dogs and humans can get it, and ways to prevent it.

Leptospirosis is a disease that is caused from infection with bacteria in the Leptospira family. These bacteria can cause acute kidney and/or liver damage that can lead to organ failure in many cases. It is also one of the most important zoonotic disease worldwide – meaning it is one of the most common diseases transmitted from animals to humans.

We don’t see much Leptospirosis in humans in the U.S. because we have toilets and good sanitation, but in developing countries it is a significant problem. There is also currently an outbreak of this disease in homeless human populations in New York City. The organism is carried in the urine of infected animals and can be acquired from contact with contaminated water or with the urine of an infected animal.

Late summer and early fall generally bring an increased incidence of Leptospirosis in dogs. Leptospira bacteria are most commonly transmitted in the urine of mammalian wildlife — generally rodents, raccoons, and deer.

Even though we aren’t teeming with wildlife in the Arlington and DC area, we do have plenty of a very important carrier of this organism: city rats. Because of the rodent populations in urban environments most dogs in our area are in fact at risk for contracting Leptospirosis. Interestingly enough, cats do not contract the disease.

Leptospirosis is often under-diagnosed due to the vague signs it can cause. The liver and kidneys are the most common organs to be affected by Leptospirosis, ranging from mild to life-threatening illness. The common signs dogs exhibit after contracting Leptospirosis are fever, lethargy, muscle and joint pain, vomiting, diarrhea and increased thirst or urination, much like having the flu in people.

If your pet exhibits symptoms of Leptospirosis, his or her veterinarian will generally run bloodwork and a urinalysis, as well as testing to detect an immune response in the blood or the presence of the bacteria itself in the blood and urine.  Most animals with illness consistent with Leptospirosis need to be hospitalized on intravenous fluids and antibiotics for several days, and sometimes can be left with permanent liver and kidney damage.

A vaccination against four different strains of the Leptospira bacteria is widely used and reliable for preventing and decreasing severity of disease, as well as prevention of bacterial shedding in the urine to prevent human infection.  Even though there are over 200 strains of Leptospira, the four that are included in the canine vaccine are the ones responsible for about 90 percent of infections.

After an initial series of two vaccines given three weeks apart, the vaccine is given annually. Leptospirosis is an important disease to prevent due to the risk of severe, life-threatening illness to both pets and humans. Given the prevalence of this disease in this area, the severity of the course of the disease, and the safety and efficacy of the vaccination we recommend vaccination for the majority of our canine patients.