Archive for the ‘Cats’ Category

What is CKD in cats?

CKD means Chronic Kidney Disease – it’s also known as kidney failure and chronic renal failure. It is a progressive condition causing the cat’s kidneys to gradually stop working. 

What do a cat’s kidneys do?

The kidneys have four main functions.

Firstly, they regulate the cat’s water and salt balance. If the cat is dehydrated, they retain water – producing smaller amounts of more concentrated urine – whereas if they have drunk too much, the kidneys produce larger volumes of more dilute urine. At the same time, they control the amounts of various salts in the cat’s blood – sodium, potassium, calcium, phosphate and others.

They also have a vital role in getting rid of waste products. The most important are urea (a breakdown product from protein in the diet) and creatinine (a waste product produced by the muscles). These chemical wastes are actively concentrated in the cat’s urine.

As well as water balance, the kidneys also help to regulate blood pressure, via a cascade of enzymes in the blood that cause the blood vessels to constrict (raising the pressure) or dilate (dropping it).

Finally, they help to control the numbers of red blood cells in the blood by releasing a hormone called erythropoietin (of cycling cheat fame!) which tells the bone marrow to make more.

What causes CKD?

There is a range of possible causes, including damage to the kidneys by infections or toxins; tumours in the kidneys; and some birth defects. There is also a genetic condition called polycystic kidney disease (PKD), where kidney tissue is progressively replaced with large fluid-filled cysts (it’s most common in Persians and related breeds).

However, in most cases, the cause is far simpler – degeneration due to old age and a high protein diet. As obligate carnivores, cats need a lot of protein in their diet to survive, but this means the kidneys have to work harder to remove the breakdown products than the kidneys of herbivores such as horses – so chronic, long-term damage is much more common.

Fortunately, there is a great deal of functional reserve – a cat can survive perfectly well if only ? of their kidney tissue is working properly. As a result, CKD is rarely seen in young cats – it is probably developing, but until ? of their kidney volume has failed, there won’t be any symptoms.

What cats are at risk?

All cats – some estimates suggest that as many as half of all cats who reach 15 years old have clinical CKD. Even really well cared for pets – and big cats like lions in zoos – are at the same risk.

OK, so what are the symptoms?

The symptoms are usually subtle and vague to begin with, but get gradually worse with time as more of the kidney tissue fails and more waste products build up in the blood. Typical signs include:

  • Increased production of dilute urine; this may cause incontinence.
  • Increased thirst
  • Dehydration
  • Weight loss
  • Poor coat quality
  • Loss of appetite
  • Lethargy
  • Muscle weakness (due to salt imbalances in the blood stopping the muscles from working properly – usually low potassium levels)
  • Vomiting (due to the build-up of toxins)
  • Bad breath (often it smells metallic, as blood urea levels rise)
  • Seizures, collapse and death will eventually follow

Cats may also develop anaemia (causing pale gums and shortness of breath) and high blood pressure (which can cause blindness or strokes).

How is CKD diagnosed?

CKD is usually diagnosed with a combination of blood tests and urine tests. We do blood tests to look for increased urea, creatinine and, sometimes, a newly discovered marker for kidney function called SDMA. Elevated levels suggest kidney disease.

The most important urine test we can do is the urine specific gravity, which tells us how well the kidneys are concentrating the cat’s urine. A normal cat should have a specific gravity of over 1.035, whereas a CKD cat often has a value well below this. In addition, protein in the urine can sometimes be a marker of kidney problems.

We’ll use these same parameters to monitor their progression, as well as regular blood pressure checks.

How can it be treated?

CKD in cats cannot be cured. However, it can be managed, with changes in lifestyle, diet, and medications.

Cats with CKD have higher than normal water requirements, so making sure they always have access to fresh water is vital. Some cats don’t like to drink still water, so there are a variety of water fountains available for them!

A specialist renal diet is really important – these are specially formulated to support the kidney’s function (less phosphate and protein, to reduce the kidney’s workload, and more potassium). However, not all cats accept these diets; if not, a phosphate binding agent and (sometimes) supplemental potassium must be added to their normal food.

The mainstays of drug treatment in CKD are medications to reduce protein leakage out of the damaged kidneys, and control blood pressure. ACE inhibitors (like benazepril) and a new drug telmisartan are most commonly used because these have both effects. Sometimes, medication specifically to reduce blood pressure (such as amlodipine) is also needed.

What about transplants?

At the moment, it is illegal to carry out kidney transplants in cats in the UK because of concerns over the welfare of the donor cats, and worries about the risks of establishing a black market in feline organs.

However, cats with CKD can survive for many months or even years with appropriate care and treatment.

If you think your cat may be showing signs of kidney disease, make an appointment to see one of our vets as soon as possible. Early diagnosis makes treatment much more effective!

What is FIP?

FIP, or Feline Infectious Peritonitis, is a viral disease of cats that is almost universally fatal. However, it’s a really complicated condition, and (bizarrely) the “FIP Virus” probably isn’t transmissible from cat to cat in most cases. 

OK, so what causes it?
There’s a virus in cats called Feline Coronavirus (FCoV). This virus usually causes mild diarrhoea, as it replicates in the cells of the cat’s gut lining (as a result, it may also be called Feline Enteric Coronavirus, FECV). About 25% of pet cats have or are exposed to this virus, but that number goes up to over 80% in multi-cat households and may reach 100% in large colonies.

Now, most cats, once infected, are a bit poorly and have diarrhoea for a few days, but then recover. In the meantime, however, they have shed the virus (mainly in the faeces) to every other cat in the area. Some cats develop a strong, long-term immunity to it, but for most, their immunity fades over time, and they then become reinfected later.

How does that relate to FIP though?
The problem occurs when one of the virus particles in the cat’s body mutates in a specific way. This mutation (which occurs periodically but randomly as a result of the way the FCoV replicates itself) means that the virus can no longer replicate in the gut lining, but instead attacks the cat’s immune system and blood vessels. We call this the FIP Virus, but really it’s just a damaged and defective Feline Coronavirus. The good news is that, because it doesn’t replicate in the intestine, it is very unlikely to be spread to other cats; but the bad news is that it is a much, much more serious infection.

Some cats are able to mount a very strong “cell-mediated” immune response and kill the virus rapidly at this stage – these cats never develop the disease, despite being infected with the mutated FIP Virus.

Most cats, however, are unable to do this, and instead make antibodies – which doesn’t kill the virus, and in fact makes the symptoms worse. These cats will almost always die of the infection.

What cats are at risk?
Any cat infected with FCoV – this is predominantly younger cats (80% of FIP cases are less than two years old), and those in multi-cat homes or large colonies.

What are the symptoms?
The initial symptoms (that may persist for days or even weeks) are very vague and non-specific – typically lethargy, loss of appetite and a low fever. If the cat’s immune system cannot clear the virus at this stage, the condition will progress to one of the two main forms of the disease (although some cats may develop both simultaneously).

Wet FIP (also known as Effusive FIP)

  • This is characterised by damage to blood vessels, so they leak fluid. This causes fluid build-up and inflammation in body cavities.
  • Peritonitis – fluid in the abdomen, causing a pot-bellied appearance.
  • Lumps or masses forming in the abdomen – these aren’t tumours but are essentially abscesses (pyogranulomas) in the gut, lymph nodes or other organs.
  • Liver failure, causing jaundice.
  • Pleural effusion – fluid in the chest, causing difficulty breathing. Many infected cats eventually suffocate or drown.
  • These cats usually deteriorate rapidly, and die or have to be put to sleep in a matter of days or at most weeks.

Dry FIP (also known as Non-Effusive FIP)

  • This occurs when the immune system is able to slow down the replication of the virus, but not stop it completely. It is characterised by chronic inflammation of blood vessels in the organs.
  • Inflammation of the eyes (about 30% of cases) causing changes in shape and colour of the iris and fluid, bleeding into the eye, and often severe pain and sensitivity to light.
  • Inflammation of the brain (encephalitis, and/or meningitis, also seen in about a third of cases), causing wobbliness, paralysis or seizures.
  • Inflammation of any other organ, causing it to gradually fail.
  • Cats with dry FIP will eventually die, but it is usually a much slower disease process, with cats surviving for potentially many months.

How do you diagnose it?

The only way to conclusively prove that the cat has FIP is by taking a biopsy (a surgical sample) of an infected tissue and sending it off to a lab to check if the mutated virus is present – blood tests cannot distinguish between normal FCoV and FIP virus. Unfortunately, many cats with the disease are too sick for surgery, so we would usually diagnose it based on the clinical signs, and the exact nature of the fluid (in wet FIP).

Can it be treated?

FIP remains a challenging and difficult disease to treat, however there have been significant recent developments in the management of this once fatal condition. Recent research has shown that some newer anti-viral drugs such as remdesivir, may be effective following trials in Australia. Remdesivir injection and GS-441424 tablets have recently become legally available in the UK, although they are a novel treatment, have not undergone extensive trials and are available only under special licence. The drug has been used to treat human viral infections including SARS-CoV-2 (COVID-19). Initial experience has been positive with response rates of 80-95% and therefore we have reason to be optimistic for the future, however the treatment remains very expensive and requires a long course of treatment. We look forward to learning more about the treatment of FIP over the next few years.

Please see icatcare.org for further information on FIP.

If you are concerned your cat may have FIP, make an appointment for them to be seen by one of our vets as soon as possible.

What is HCM?

HCM is the most common heart disease in cats and stands for Hypertrophic Cardiomyopathy. Although it has occasionally been reported in dogs, this is very rare.

So what actually is it?

HCM describes a condition where the muscle wall of the heart becomes diseased. The walls grow additional layers of muscle, becoming stronger and stronger (which sounds like a good thing). However, this causes two problems – firstly, the space inside the heart (the lumen) is narrowed, meaning that the volume of blood that can be pumped out with each heartbeat is reduced. The second problem is that the thicker heart wall cannot relax properly – so the heart cannot fill effectively between beats. This means that the cat’s heart rate increases, to maintain their blood pressure – but of course, the harder the heart works, the stronger and thicker the muscle becomes.

What causes HCM?

There are three main causes:

  • Primary HCM occurs in an otherwise healthy cat. It is the most common form and is thought to be a genetic disease. In some high-risk breeds (Maine Coons and Ragdolls) the exact mutations have been discovered and there are DNA tests that can be carried out, but these aren’t available for most cats.
  • Secondary HCM is a response of the heart to another disease process. This may be:
    • Hyperthyroidism (an overactive thyroid), the most common secondary cause.
    • Hypertension (high blood pressure), usually in turn due to kidney failure.

What are the symptoms?

Most affected cats show no symptoms at all in the early stages of the disease. This is because even though the heart is becoming less efficient, the cat’s body can compensate for the disease, masking the symptoms. In this phase, one of our vets may hear a heart murmur when checking your cat over at vaccination, but there usually aren’t any other signs. However, the condition is progressive, and eventually, they won’t be able to mask it any longer. Some cats progressively develop subtle signs that gradually worsen, but many appear absolutely fine until they suddenly collapse, or even drop dead – this is known as an acute decompensation crisis.

There are two different clinical syndromes associated with HCM:

  • Congestive Heart Failure – where the heart can’t pump blood effectively enough, leading to pooling of fluid in the lungs and other organs. Typical symptoms usually appear in more-or-less the following order:
    • Heart murmur
    • Abnormal heart rate or rhythm
    • Increased time spent sleeping
    • Less time being active or playing
    • Increased breathing rate
    • Increased breathing effort
    • Pale or blue gums and cold extremities
    • Collapse or fainting
    • Open-mouth breathing
    • Sudden death
  • Thromboembolism – the failing heart isn’t pumping blood smoothly through its chambers, and as a result, blood clots start to form within the heart. At any stage, bits of these clots can break off and travel round the body. If they come to rest, they will grow and block an artery, and the symptoms will depend on where this occurs:
    • Stroke – where the blood clot blocks blood flow in the brain. Symptoms include fits, collapse, blindness and coma.
    • Pulmonary embolism – occurs in the lungs, resulting in very sudden onset difficulty breathing.
    • Aortic thromboembolism, also known as a saddle thrombus, is the most common form – it is one of the most common presenting symptoms of a cat with HCM. This occurs because a blood clot has cut off ALL circulation to one or both hind legs, causing extreme pain and paralysis, and is often fatal.

How is HCM diagnosed?
There are two ways the condition can be diagnosed; however, the DNA test is not one of them. This is because some cats who have the mutation don’t develop HCM, while many cats without it do.

A better “screening test” is the proBNP blood test – any cat with a raised proBNP level is likely to have some form of heart disease and needs further investigation.

The “gold standard” for diagnosis, however, is echocardiography, where a vet uses ultrasound to look inside your cat’s heart and measure how thick the wall is and how well their heart is working.

It’s important to remember, though, that just because a cat doesn’t have HCM, it doesn’t mean they’ll never develop the disease – it’s a condition that can develop at any age, and so cats in high-risk breeds should be regularly tested.

Is there any treatment?

Sadly, there is no cure for the genetic form of the disease. Affected cats should never be bred from, and if possible, all Maine Coon and Ragdoll cats should undergo DNA testing before they breed, in case they are carriers of the defective gene. Cats with Secondary HCM, however, can sometimes be returned to almost normal heart function if the underlying disease is detected and treated early enough.

In most cases, medical treatment is required. The mainstays of treatment are:

  • Slow down the heart rate – our vets may use drugs such as beta-blockers for this.
  • Help the heart relax between beats – a drug called diltiazem is licensed for this purpose in the UK.
  • Prevent clots from forming – using human drugs such as aspirin or clopidogrel at specific feline doses on prescription.
  • Reduce fluid buildup – ACE-inhbuilduprugs like benazepril and diuretics like frusemide are commonly used to reduce fluid pooling, helping the cat to breathe.

How long can a cat live with HCM?

The prognosis for cats with HCM is very variable – some cats may never develop clinical signs and will live normally for many years. Once symptoms appear, most cats survive less than two years; if the first symptom is a blood clot, the average survival time is only six months. As a result, the best prognosis is thought to be for cats diagnosed early, before symptoms appear!

If your cat is in an at-risk breed, or you are concerned about heart disease, make an appointment to get them checked out by one of our vets. If necessary, they can arrange blood testing or heart scans to see what’s actually going on!

What First Aid can I do for my cat? Part 3

In Part 1 and Part 2 we looked at how to approach an ill or injured cat; in this final part of the series, we will be talking about how to manage specific emergencies and conditions. Remember, this is first aid – it is intended to help you provide emergency care to your cat before you get them to us, not to replace proper treatment! 

What constitutes an emergency?

An emergency is any situation you find your cat in where their life or welfare is unexpectedly threatened. In more practical terms, we need to see them ASAP if…

  • They have open wounds or are unable to take weight on a leg.
  • They have lost consciousness (even if only for a short while) or have had a fit or a seizure.
  • They are collapsed or unable to stand.
  • They are struggling to breathe (in cats, this usually means they are breathing through their mouths or panting – this is deadly serious).
  • They seem to be in pain.
  • They are unable to pass urine or faeces.

Now, to finish off this series, we’ll briefly look at how to manage a range of different common situations, while you wait to get them in to see us.

Road traffic accidents (RTAs)

Cars moving at speed can cause a huge amount of damage to a cat’s body; however, cats are very good at getting out of the way and only then collapsing. This is why cats who have been hit by cars often manage to limp or crawl home, even if they have very serious injuries.

On assessing a cat after an RTA, it is quite likely that the full extent of their injuries won’t be apparent – internal bleeding, diaphragm ruptures and crush injuries can be hard to distinguish from “simple” shock. These cats should be handled and moved as little as possible and brought to us as rapidly as you can – please call ahead so we know you’re coming in and can get set up! Even if the injuries seem minor, we need to see them – some conditions (like lung bruises) seem fine until a few hours later, and can then rapidly become life-threatening without urgent treatment.

Cat fights

Cats are solitary hunters, and if they find a strange cat invading their hunting grounds, are likely to respond violently. Most cat fights result in superficial wounds and scratches, but if a tooth or claw goes deeper under the skin it can set up a “Cat Bite Abscess” which is really quite a nasty thing. Often, you won’t realise that they’ve been in a fight until a few days later when the abscess starts to grow. These aren’t usually life-threatening, but they do need to be seen by one of our vets for the best treatment (antibiotics, pain relief and often drainage of the pus). Make an appointment within the next day or so unless your cat is really sore or unwell in themselves; it is also helpful to bathe any wounds with warm salty water.

Eye injuries

These are most commonly due to cat fights – when quarrelling, cats don’t fight fair, instead, they slash with their claws at their adversary’s weak spots, like the eyes. This often results in “corneal lacerations”, slashes and cuts on the front of the eye. Often, the only symptom is a runny eye that the cat holds closed. These can usually be treated effectively, but eyes are fragile so need seeing as soon as possible.

Breathing difficulties

Open mouth breathing or panting is highly unusual in a cat and often suggests a serious respiratory problem (although it can also occur with diseases like cat-flu). Any difficulty breathing, or altered breathing rate is an emergency. Put the cat in a box, keep it quiet and calm, and get them to us ASAP.

Burns

Most burns are relatively superficial, but they’re really painful, so don’t get hurt yourself! The best treatment, in general, is to run cold water over the burn for at least 5 minutes, then get them to us for treatment. That said, if the burn is really large or deep (with obvious charring around the edges, for example) it may not be painful because the nerves have been burned away. If the burn seems moist or oozy, cover it with cling-film before cooling it (to reduce fluid loss) and then get them to us asap.

They’ve been exposed to something poisonous

Cats are sensitive to a wide range of different poisons, including many plants, most human medicines, and a number of household chemicals like cleaning agents, antifreeze and paint. If your cat is behaving abnormally or seems to be covered in some strange material, call us for advice straight away.

Fits or seizures

Fits are fairly uncommon in cats, and are usually due to poisoning, metabolic diseases (like diabetes mellitus), or injury to the brain (such as a stroke). While your cat is having a fit, it is best to leave them in a quiet, dark place to recover. They can’t “swallow their tongues” so don’t put your fingers in their mouth, don’t try to stroke them or talk to them (it can prolong the seizure), just let them recover. You can bring them in the be checked out once they’re over it. The exception is any seizure lasting more than a couple of minutes, or if they have multiple overlapping fits. These are medical emergencies that need seeing right now if we’re going to save their life.

If your cat is suddenly ill or injured, call us for advice!

What First Aid can I do for my cat? Part 2

In the first part of this blog, we talked about assessing the situation – making sure you aren’t at risk, and assessing the cat to see what you need to do then and there before rushing them in to see us. In this part, we’ll be looking at what you can do – how to resuscitate a cat, stopping bleeding, and transporting them safely to us. 

[Push], [Push], [Push], [Push], staying alive, staying alive… the art of feline CPCR 

CPCR (CardioPulmonary Cerebral Resuscitation) used to be called CPR, and if you want to use that term, feel free! Whatever you call it, it is essentially providing breathing and a heartbeat for a cat who is unable to do so on their own. Any cat who is so severely injured that they require CPCR is unlikely to survive – the TV programmes showing people miraculously reviving after a chest compressions are, sadly, very misleading. However, there are cases every year where rapid CPCR can genuinely save a cat’s life, so it’s always worth a try!

  • Breaths – for a cat who is not breathing on their own, and clearing their airway hasn’t solved the problem. You cannot do mouth-to-mouth with a cat, but you can do mouth-to-nose. Do be careful, however – if the cat wakes up suddenly (or is less unconscious than they appear) they may bite you! In addition, any cat with a nasal discharge or blood in their mouth may conceivably be carrying a disease that you could catch – it is unlikely, but not impossible. If you know the cat and are confident that they are healthy (except for whatever has just happened to them), then you can carry out “rescue breaths” mouth-to-nose, otherwise, use a “spacer” (like the styrofoam cup described below):
    • Form a seal over their nose – for the reasons given above, it’s probably best to use a styrofoam cup with the end knocked out rather than wrapping your lips around their nose, but that is an alternative.
    • Extend their head and neck so the neck is a straight as possible (avoid if they have obvious injuries to their head or neck).
    • Blow gently into their nose until you see the chest rise; then allow the air to flow out again. Ideally, you want to be giving roughly 20 breaths per minute.
  • Compressions – for a cat who has no heartbeat. Note, however, that a cat with severe bleeding may have such a weak heartbeat that you can’t feel it – in this case, stop the bleeding first!
    • Lie the cat on their right side (so their right legs are underneath) – if they seem to have suffered a spinal or head injury it is best to avoid moving them, and chest compressions can be done with them on their left side, but it isn’t as effective.
    • Place your hand around their chest, just behind the elbow, and squeeze the chest so it is compressed by about a third.
    • Repeat approximately 100 times a minute (yes, the song “staying alive” does work for cats!).
    • As you’re probably having to breathe for them as well, give two rescue breaths every 3-5 chest compressions.
  • Know when to stop – if the cat hasn’t made any response in 3 minutes, it’s time to stop. If their heart and breathing haven’t started on their own in this time, they aren’t coming back.

Stopping the Bleeding

If a major artery is cut, a cat can bleed to death in thirty seconds or so. However, most injuries affect smaller vessels and, give half a chance, the blood will clot and the bleeding will either stop or at least slow down enough to give you a chance to get the cat to us.

The key to stopping bleeding is pressure – but once again, make sure you aren’t injured by a miserable cat when you start pressing on a sore spot! It can help to have an assistant to hold the cat still while you try to stop the bleeding, but if not, you can use one hand to restrain them and one to work on them.

Ideally, try and apply a fairly tight pressure bandage – however, this may be difficult one-handed, and it’s important not to cut off circulation to the leg (see tourniquets, below).

If you can’t, or the wound is somewhere you can’t bandage (e.g. around the neck), then apply digital pressure with your fingers through a sterile dressing (if you have one!) or a clean cloth like a handkerchief.

If all else fails, it is possible to apply a tourniquet to a limb – a really tight bandage that will stop all blood-flow to the limb. A tourniquet can only stay on for about 15 minutes, though, or else the limb will die and become gangrenous, so do not try it unless you know how or we tell you to.

Bring them to us!

Although first aid is genuinely vital, it doesn’t usually save lives on its own – what it does is buy time to get the cat to us so we can work on them. However, transporting an ill or injured cat is something of an art form… The trouble is there’s no one single way to do it, it depends on what’s wrong with the cat. In general, however, try to follow these rules:

  • Do not transport cats loose, held or on your lap. However badly injured they are, they need to be transported in a box or basket, to stop them trying to escape en route.
  • Don’t move or bend cats with possible spinal injuries any more than necessary (e.g. weakness or paralysis or obvious injury to the spine or back). These cats should be gently “scooped” off the road or wherever using a rigid board (actually, a shovel is usually pretty good) and transported in whatever position they’re in.
  • If there is an open wound, an “Elizabethan” collar or “cone” is really useful to prevent them from making it worse.

In Part 3 we’ll talk about the management of specific types of injury or illness. If your cat is suddenly ill or injured, call us for advice!