Is it Okay for My Cat to be an Outside Pet?

By Patrick Miles, DVM

One of the questions we ask when a cat presents to the hospital is whether they are indoor only, outdoor only or both. A few clients over the years have become defensive or felt guilty over this issue. The simple answer to the above question is yes. Your cat is your pet and your responsibility. There is not one lifestyle that is perfect for every home. Some cats are not good indoor companions due to behavior issues, allergies, house soiling, etc. There are situations in which owners felt pressured to keep their cats indoor by friends, family, adoption agencies, and veterinary professionals. We will often recommend a cat that has been ill or recovering from a surgery become an indoor pet during recovery to reduce complications risks.  However, it still is an owner’s choice to allow their cat to live an outdoor life once healed.

As a veterinarian, the lifestyle of a cat can play an important role in addressing an illness. If a cat lives indoors, it can be much easier to develop a diagnostic and therapeutic plan simply because the possibilities causing an illness tend to be more limited. For instance, patients that present sick that live outside may not be able to answer whether there has been any trauma, vomiting, diarrhea, cough, straining to urinate, blood in stools, etc.  Problems that arise with indoor cats tend to be found earlier simply because of the more intimate proximity, i.e. it’s easy to know if your cat has been vomiting when you accidently step in it or find it on the couch.

Risks for outdoor cats can be extensive. The risk for trauma from vehicles, dogs, other cats, raccoons and other wildlife tend to be more obvious. Infectious diseases are more common due to exposure to other cats.  Feline leukemia and Feline AIDS are more common due to bite wounds from infected cats. They may ingest unknown toxins, things that can cause vomiting and diarrhea, etc. The list of risks can be extensive. Subjectively, outdoor cats tend to have a shorter lifespan than indoor cats.

When we ask this question, it is not to judge your decision on your pet’s lifestyle. It is to help develop and focus the approach to an illness. We may advise additional diagnostic testing for a specific problem based on the lifestyle, thus increasing the financial obligation. The issue is really one of understanding and accepting the increased risk of illness or trauma.

When Repeating Diagnostics Makes Sense

By Beth Davidow, DVM DACVECC 

Many times clients will ask why we are repeating a test.  It does seem that if you have just had blood work done recently, things shouldn’t be that different.  However, when an animal is sick, things can change dramatically over a period of hours.  The following case is a good example.

A seven and a half-year-old pointer was referred to our ICU for care of a suspected reaction to a chemotherapy drug.  A review of his case showed that the dog had a skin lump that turned out to be an atypical form of a cancer called lymphoma.  (Lymphoma is a cancer of lymph nodes and lymphatics and doesn’t usually show up as a skin nodule.)  Initial screening showed no evidence of the cancer anywhere else.  The dog had been given a chemotherapy drug three weeks prior to presentation.  The tumor shrank dramatically in size and he seemed to feel well.  Many chemotherapy drugs can suppress the body’s infection fighting cells, the white blood cells, and this did happen seven days after the drug was given.  The dog was put on antibiotics and seemed to be fine.  However, three weeks after the drug was given, the dog acutely started having vomiting, diarrhea and was severely weak.  He had a fever and a borderline low white blood cell count.  Bloodwork, radiographs and ultrasound were done and no evidence was seen of any new cancer.  It was assumed that he had an infection secondary to having the low white blood cell count.

When the dog arrived at ACCES, he was dehydrated, weak and had a fever.  He had been started on IV fluids, antibiotics and anti-nausea medications at the regular veterinarian and those treatments were continued.  However, at 10:00 pm he was still febrile and now couldn’t stand up.  A blood glucose (blood sugar) was rechecked and had fallen to a dangerously low level. He was given IV glucose and was much brighter.

Why did the blood glucose fall in only 12 hours?  Normally dogs can maintain their blood sugar in a normal range even if they aren’t eating.  In the face of overwhelming infection, sometimes the bacteria are “stealing” the glucose and blood values will fall quickly.  Sometimes, if the body’s normal stress mechanisms aren’t working, it can also fall.  Sometimes, tumors can also “steal’ glucose but we hadn’t found any new cancer.  Our working hypothesis was that we still weren’t on top of the infection.  We started an additional antibiotic.

Over the next 24 hours, the glucose stayed normal and the fever resolved but the dog was still very depressed and wouldn’t eat.  The next morning, 48 hours after the initial illness started, small pinpoint bruises were noted on the skin.  This can be a sign that the clotting system isn’t working.  We checked the clotting blood values and found that the platelets, small particles in the blood that make the initial clot, were now very low, even though they had been OK the day before.  A full complete blood count was sent to the lab.  A falling platelet count can also be a sign of infection or emerging cancer but the fever was under control.  What was happening?

In the afternoon, we had our answer.  The complete blood count, which had only normal blood cells 48 hours before, now showed cancer cells in the blood.  The cancer, despite being gone from the skin, had lodged in the bone marrow and in a 48 hour period and multiplied fast enough to be found in the blood stream.  The dropping glucose and platelets were not from a chemotherapy reaction or from infection but from the emerging cancer we couldn’t yet see.

Thus, repeating the same tests several times allowed us to diagnose the reemerging cancer quickly.  It was a lesson of how rapidly things can change in the body. 

Watch the Litter Box!

By Patrick Miles, DVM

Personally, cleaning the litter box is not one of my favorite chores.  I’ve tried self cleaning boxes and bribing my children.  I have not attempted to train the cats to use the toilet simply because something seems “wrong” about having to share the bathroom with your pet.  Though I’ve heard clients say it works quite well!

However, there is a lot to watch out for with your cat’s use of the litter box.  Houses with multiple cats can be an additional challenge, but can still help to uncover underlying illness in your pet.  Cleaning the litter box on at least a once daily frequency is typically recommended.  The frequency of use, whether there is more or less urine, diarrhea, mucous, blood in urine or stools, all may indicate a developing problem.  Cats that have urinary tract infections or other urinary problems may have an increased urgency and frequency in their use of the box.  Blood or an abnormal odor may be noted in the urine indicating infection, or in some cases complications from diabetes.  Some people are able to detect the smell of “ketones”, which indicate possible complications due to diabetes mellitus.  The amount of urine produced may be decreased if a male cat is developing a urethral obstruction, or increased if diabetes mellitus is present. 

The color and consistency of stools can also help determine the source of problems.  Chronic diarrhea in general may be due to problems involving the small bowel versus the large bowel/ colon.  Small bowel disorders often tend to be larger amounts (cow-pie), may have a dark, tarry consistency if blood is present, and frequency may be normal or increased.  Weight loss tends to be more profound with small bowel disorders.  Large bowel disorders tend to be smaller in volume, increased frequency, mucous and straining may be present, and have visible red (frank) blood.

Though the litter box is not the most enjoyable aspect of cat ownership, attention to its contents and use may be valuable in detecting emerging problems.

Salmon Poisoning in Dogs – Potential Danger in the Pacific Northwest

By Patrick Miles, DVM

Salmon Poisoning is a unique disease in dogs that is really only found in the Pacific Northwest.  The term “Salmon Poisoning” is somewhat misleading, as the disease is not a true poisoning and not a problem from the fish meat itself.  Salmon poisoning is actually an infection found in dogs that occur through a complex life cycle involving a bacteria (Neorickettsia helminthoeca), a fluke parasite (Nanophyetus salmincola), a snail (Oxytrema silicula), certain fish, and dogs.  The infection is caused by a small bacterial organism that lives in a fluke parasite. The fluke lives only in one known species of snail found in the Pacific Northwest coastal freshwaters.  The flukes mature within the snail, and when released, infect fish that spawn in fresh water.  The fish involved spend part of their life in salt water (salmon, certain trout, steelhead, and one species of salamander).   The bacteria cause no known illness in the fish.  Dogs become infected after eating raw fish harboring the fluke, which carries the bacteria.  Once in the dog intestinal tract, the bacteria are released causing infection.  The bacteria do not affect cats.

Signs of infection occur approximately one (1) week later.  Vomiting, diarrhea, fever, and enlarged lymph nodes are often found.  In my experience, the diarrhea is very orange(pumpkin) in color.  The disease can be life threatening if left untreated.  Diagnosis can be based on finding evidence of the fluke eggs on a fecal examination, or finding the bacterial organism on aspiration of the lymph nodes.  Therapy involves addressing hydration, nausea, anti-parasitic medication for the fluke, and antibiotics for the bacteria.  The antibiotic used is not one chosen for other causes of vomiting and diarrhea so the diet history is very important in diagnosis.

ACCES Renton has seen an increased number of cases over last year, which likely has to do with our proximity to salmon runs along the Green and Cedar Rivers.  Cases likely fluctuate based on the size of the salmon run, temperature of the river, seasonality of the salmon migrations, and other local factors that may encourage the growth of the fluke or snails.

 We had one case in which crows or seagulls left salmon carcasses in the yard of a dog with no other exposure to salmon.  In another instance, two dogs drank water from a cooler that held salmon, but did not actually eat any salmon.  Another case was from feeding smoked, uncooked salmon to a family pet.  (Cooking kills the disease causing organism.)  This is often where the confusion regarding a poisoning/toxicity comes from.  It is often thought that the salmon has “gone bad” and is releasing toxins like what one would see with conditions such as botulism, food poisoning from E. coli, or salmonella toxicity.  Though vomiting a diarrhea may occur due to ingestion of decaying, rotting salmon, “Salmon Poisoning” is a specific disease that occurs from specific bacteria, which may not be carried by every salmon, in all locations. 

Raw or undercooked salmon should not be fed to dogs.  If your dog, develops severe vomiting or diarrhea they should always be evaluated by a veterinarian.  Always give your veterinarian a thorough diet and travel history as this helps pinpoint what the cause of illness may be. 

Diabetes in Our Companion Animals – An Overview

By Alan Schreiner, DVM, DACVIM

As many of you already know, our four-legged friends are susceptible to some of the same diseases that affect us. One of those diseases is diabetes mellitus or high blood sugar. In animals as in people, diabetes mellitus occurs when the body is not producing enough insulin or because the cells in the body cannot respond to the insulin produced. Insulin is a protein made by the pancreas that helps keep the sugar in the blood within a narrow range.  Like people, animals with diabetes mellitus are classified into two categories: Type 1 diabetics are insulin-dependent and require injections of insulin while Type 2 diabetics are characterized by having insulin resistance and can be insulin-dependent or non-insulin dependent. Both Type 1 and Type 2 diabetics are recognized in dogs and cats.

Occurrences in Cats vs. Dogs

Non-insulin dependent diabetes mellitus (NIDDM) is more frequently recognized in cats than in dogs and accounts for as many as 30-50% of diabetic cats. One big difference between cats and people is the phenomenon of transient diabetes mellitus. Transient diabetes can be seen in approximately 20% of our diabetic cats. These cats will appear to have insulin-dependent diabetes mellitus (IDDM) initially, then revert to a normal state, not requiring any insulin therapy and have normal blood sugar levels. These patients can then swing back to IDDM. This phenomenon can occur multiple times during the cat’s life as a diabetic.

People always want to know if their pet is at risk for developing diabetes mellitus. No one can predict which pets will develop diabetes, but in general we see occurrences in dogs that are four to 14 years-old with a peak between seven to nine years-of-age. In dogs, females are about twice as likely to develop diabetes as males are. Any breed can develop diabetes mellitus, but the breeds that are commonly seen are Miniature Poodles, Cairn Terriers, Dachshunds, Miniature Schnauzers and Beagles.

As for cats, they are typically older than six years-of-age, but diabetes mellitus can show up at any age. The neutered male cat is predominantly seen verses the spayed female cat and there are no apparent breed predispositions reported.

Signs and Symptoms: Diagnosing the Diabetic Pet

The signs and symptoms seen by most pet owners are very similar to what people experience; an increase in water consumption and urination frequency and an increase in appetite but accompanied by weight loss. One way to think of diabetes mellitus is starvation in the face of plenty.

When a dog or cat is presented to their veterinarian for any of these signs or combination of symptoms, the doctor will order some diagnostic tests. These tests usually include a complete blood count (CBC), a chemistry panel, in cats a thyroid level, and a urinalysis (UA). The classic results will show elevation of sugar (otherwise known as glucose) in both the blood and the urine. Other abnormalities may also be present, such as signs of infection on the CBC, elevation of liver enzymes is common, and ketones maybe noted in the urine. A urine culture should always be done because of the high incidence of concurrent urinary tract infections. Additional diagnostic test may be ordered based on physical exam findings, results of the blood work, or previous medical problems.

Treatment and Next Steps

In most animal patients, successful treatment is centered around an ongoing schedule of  insulin injections. Persistence of signs and the development of chronic complications are directly correlated with the severity and duration of the high blood sugar levels. The goals of therapy are to limit blood sugar fluctuations and maintain nearly normal sugar levels to help minimize signs and symptoms. This can be accomplished through proper insulin administration, diet and exercise.  In addition, avoiding or controlling current inflammation, infections, and hormonal changes (intact males and females) is important for maintaining good blood sugar control. Although, we attempt to keep the blood sugar from rising too high, we must also guard against the development of low blood sugar which can be a serious and potentially fatal complication of therapy.

As in people, our four-legged patients can develop, over time, complications associated with diabetes mellitus. In dogs, cataracts are a common complication and cats can develop nerve problems in their legs just like people. Bacterial infections, especially in the urinary tract, are also common and urine cultures are done periodically to monitor for their development.

It is recommended that the treatment be monitored regularly by the veterinarian with blood glucose curves, fructosamine levels, and sometimes glycosylated hemoglobin levels checked. The blood glucose curve is done to monitor the effect of the insulin on the blood sugar levels. The curve is usually done in the veterinarian’s office during the course of a day. Blood samples are taken every few hours throughout the day and the readings are used to create a graph. This graph helps the veterinarian decide if the insulin is adequately controlling the blood sugar level. If not, then changes are made to the insulin dose or type. If a change is made, then the patient’s body will take about seven to 10 days to adjust to the new regime. Another blood glucose curve will be scheduled to recheck the effects of the change.

The other two tests, fructosamine and glycosylated hemoglobin, are used to obtain an average blood glucose level over different periods of time. These tests are helpful in detecting deteriorating blood glucose control, thus allowing intervention before a problem develops.

Conclusion

Identified early, Diabetes Mellitus in dogs and cats can be successfully managed through the right nutrition, exercise, and, if necessary, regular insulin injections.  While there is no cure for the disease, proper managed care can help the pet live a happy, active life. Your veterinarian is an essential partner to this care and can give advice on the best preventative and management programs.

To learn more about the diabetic pet, please visit www.petdiabetesmonth.com.

Grapes and Raisins – Deadly to Dogs

By Beth Davidow, DVM DACVECC

A gorgeous, full of life five-year old male Australian Shepherd narrowly avoided dying last month. His case is offered as a follow-up to last week’s blog post on toxic dangers to pets. It reminds us all of the potential, deadly dangers that await our pets in our every day food.

Roadie, the Australian Shepherd, had spent the weekend with some friends while his owner was on a trip. During that weekend, Roadie ended up feasting on ripe grapes from a vine in the friend’s yard. Initially, Roadie’s caretakers were not concerned with what he had eaten as their own dog had eaten grapes in the past without problem. However, by Monday, Roadie had become ill and started vomiting.

As Roadie’s condition worsened, his owners took him to their regular veterinarian on Tuesday where Roadie was diagnosed with severe damage to his kidneys. By Wednesday night, his kidneys were much worse and Roadie was referred by his vet to the ACCES ICU for monitored, round-the-clock care. By Thursday, Roadie’s kidneys were barely functioning. Unable to produce urine, all the toxic waste products normally eliminated from the kidneys, were accumulating in his blood stream. Roadie was in such a severe state that dialysis treatment was discussed. After much thought, the owner decided to continue with the current medical treatment.

Through aggressive medications, the ACCES ICU team was finally able to increase the amount of urine Roadie’s kidneys were making. Roadie was then supported with IV fluids while his kidneys healed. It was a close call, but after 10 days in the ACCES ICU Roadie was finally able to go home.

Pet owners should be aware that both grapes and raisins can cause kidney failure in dogs. Unfortunately, the mechanism of action is not known. For awhile, it was hypothesized that it was pesticides sprayed on commercial grapes, but this kidney failure has now been seen in dogs eating untreated grapes. Another proposed theory is that the toxin that affects the kidneys is from fungus that is on some grapes and not others. It is an odd toxicity in that there does appear to be some dogs more prone to the toxins than others. In this case, one dog had eaten off the grape vine for a long time with no signs but the Aussie was severely affected.

The lowest amounts recorded to cause kidney injury are 0.1 ounce per kilogram of body weight of raisins or 0.7 ounces per kilogram of body weight of grapes.

If your pet gets into a quantity of raisins or grapes over these amounts, call your veterinarian immediately. Inducing vomiting and aggressive intravenous fluids for 24 hours can often prevent the development of signs. Most deaths from these foods occurred when treatment was delayed.

Other foods that can be toxic to pets include chocolate, onions, bread dough and macadamia nuts. http://www.aspca.org/pet-care/poison-control/people-foods.aspx. Always talk to your veterinarian first before offering your pet any human food.

If your pet gets acutely sick, always let your veterinarian know about any foods that they might have had access to that would be out of the ordinary.

Sadie Finds Her Way Home – When Microchips Do Their Job

We have all heard the tales of a lost pet making an amazing journey back home after having been missing for months on end. ACCES is happy to share a similar tale a little more close to home; that of Sadie the cat.

An older female cat had been seen hanging around a Capital Hill neighborhood for several months. One day, she was discovered to be not walking, and it was presumed that she had been hit by a car. The Good Samaritan who found her presented her to the ACCES Seattle emergency hospital for care where she she was found to be in shock and to have a broken pelvis.

It is important to note that when a stray animal without a collar arrives at ACCES the first thing that is done is scan them for a microchip. Luckily, the injured cat had a microchip and we were able to quickly find the owner’s contact information. We soon learned that the cat’s name was Sadie and she had been missing for four (4) months! The owners were thrilled Sadie was found and authorized the surgery Sadie needed to fix her pelvis.

Sadie is now doing well and is happy to be back with her people. Her story reminds us all of the importance of microchips. A microchip should be considered for any pet; outdoor, especially, or indoor. One never knows when a pet may get out of the yard or house and get lost.  In Sadie’s case, she had traveled more than five (5) miles (see map below).

All local shelters and many veterinary hospitals have microchip scanners on-hand. If you find a lost pet, bring them in to one of these locations. Who knows. You may unite a long lost pet with its owners.



Sadie's Journey