Adverse Gastrointestinal Food Reactions

Adverse Gastrointestinal Food Reactions (Negative Reactions to Foods that Lead to Stomach or Intestinal Problems)

OVERVIEW

  • The body can react negatively to substances, such as particular foods or ingredients of a food. These negative or “adverse” reactions can be due to true allergic reactions, in which the immune system develops a response to the food (known as “food allergy”). By definition, dietary allergy is an “immunologic” reaction, because the immune system responds to the particular offending substance in the food. Other negative or adverse reactions are not true allergic reactions. The body still reacts to the foods or ingredients of a food, but the immune system in not involved with the abnormal response. When the immune system is not involved, the negative responses are known as “non-immunologic reactions.” These non-immunologic reactions are called “food intolerance”
  • Adverse gastrointestinal food reactions encompass disorders with an immunologic basis (that is, food allergy), non-immunologic basis (that is, food intolerance), and toxic reactions (that is, food poisoning or intoxication)
  • Adverse gastrointestinal food reactions may be associated with vomiting and/or diarrhea in dogs and cats
  • In a practical sense, food allergy and food intolerance may have similar signs, diagnostics, and treatments and may not be easily distinguishable
  • Food allergy is a common cause for signs related to skin problems, such as itchiness (known as “pruritus”), which may be associated with gastrointestinal signs (such as vomiting and/or diarrhea)
  • “Gastro-” refers to the stomach; “intestinal” refers to the intestines
  • “Enteropathy” is the medical term for a disease of the intestinal tract (plural, enteropathies)
  • The small intestines may be described as “small bowel,” as in “small bowel diarrhea”; the large intestines may be described as “large bowel,” as in “large bowel diarrhea”

Genetics

  • Specifics of a genetic basis are not well defined
  • An inherited food allergy has been seen in soft-coated Wheaten terriers
  • Gluten-sensitive enteropathy (specific type of intestinal disease related to the presence of wheat gluten in the diet) has been seen primarily in Irish setters
  • Siamese and Siamese-cross cats may be at increased risk, as compared to other breeds of cats, to develop gastrointestinal food reactions

Signalment/Description of Pet
Species

  • Cats—more common than in dogs

Breed Predilections

  • Inherited food allergy—soft-coated Wheaten terriers
  • Gluten-sensitive enteropathy (specific type of intestinal disease related to the presence of wheat gluten in the diet)—Irish setters
  • Siamese and Siamese-cross cats

Mean Age and Range

  • Any age dog or cat can be affected
  • Irish setters with gluten-sensitive enteropathy—tend to display clinical signs by 4–7 months of age
  • Dogs with long-term (chronic) diet-responsive intestinal diseases (known as “diet-responsive enteropathies”)—generally young adults

Signs/Observed Changes in the Pet

  • Food intolerance commonly produces diarrhea (small or large bowel); vomiting; excessive gas formation in the stomach or intestines (flatulence); decreased appetite (known as “anorexia”); and abdominal discomfort
  • Food allergy is a common cause of skin (dermatologic) changes, such as itchiness (pruritus), which may be associated with gastrointestinal signs (such as vomiting and/or diarrhea)
  • Sudden (acute) food intolerance may accompany feeding a foodstuff to which the pet has never been exposed (known as a “novel foodstuff”; for example, feeding a food that contains “alligator” as an ingredient and the pet has never eaten anything containing alligator), a new food source, or dietary change
  • Clinical signs may cease when the pet is fasted or within days of beginning an elimination dietary trial; an “elimination dietary trial” involves feeding a diet that does not contain substances that the pet normally eats and is free of additives to see if clinical signs improve
  • Physical examination findings are generally non-specific; pet may have abdominal discomfort, excessive gas formation in the stomach or intestines (known as “flatulence”), bloating, or poor body condition

Causes

  • Reactions to food additives, where the individual pet is more likely to develop ill effects (known as “idiosyncratic reactions”)—for example, colorings, preservatives (such as butylated hydroxyanisole [BHA], monosodium glutamate, sodium nitrate, sulfur dioxide); spices; propylene glycol
  • Drug reactions—substances that have an effect on the blood vessels (known as “vasoactive substances,” such as histamine); agents that have an effect on the nervous system to alter mood, anxiety or behavior (known as “psychoactive agents”); stimulants (such as theobromine, caffeine); other drugs
  • Metabolic defects or deficiencies—enzyme defects in the intestinal tract (for example, lactase deficiency leading to lactose intolerance)
  • Toxic reactions to foods or spoiled foods—spices; oxalate toxicity; lectin toxicity; aflatoxicosis (disease caused by eating foods contaminated with aflatoxin, poison produced by certain fungi, including Aspergillus); ergotism (disease caused by eating ergot-contaminated grains or grain products; ergot is a fungus that infects cereal plants); botulism (food poisoning caused by eating food containing botulin, a nerve toxin produced by a particular bacteria); dietary indiscretion, where the pet eats inappropriate things (such as garbage)

Risk Factors

  • Genetic susceptibility suspected in soft-coated Wheaten terriers
  • Young Irish setters susceptible to gluten-sensitive enteropathy (specific type of intestinal disease related to the presence of wheat gluten in the diet) may be at greater risk to develop the disease if exposed to gluten at an early age

Treatment
Health Care

  • Generally treat on an outpatient basis

Activity

  • No restrictions

Diet

  • Feed a novel protein (that is, feeding a protein to which the pet has never been exposed) diet
  • Cats generally are sensitive to more than one dietary ingredient
  • Many high-quality, commercial diets are available for use in dogs and cats
  • If this approach is used, examination of the ingredients of the various diets being fed is recommended to determine if any patterns exist that might help identify the offending ingredient(s)

Medications

  • Generally no medications are used
  • Associated problems (such as antibiotic-responsive diarrhea [ARD] or inflammatory bowel disease [IBD]) may require medical therapy

Follow-Up Care
Patient Monitoring

  • Assess effectiveness of the elimination dietary trial by observing improvement in clinical signs; an “elimination dietary trial” involves feeding a diet that does not contain substances that the pet normally eats and is free of additives to see if clinical signs improve
  • Consider repeating evaluation for primary disease (such as inflammatory bowel disease) if the pet is unresponsive to dietary therapy

Preventions and Avoidance

  • Avoid the offending food ingredient(s)
  • If no specific ingredient has been identified, adhere to a particular exclusion diet (a diet that is designed to eliminate or exclude the food ingredient[s] to which the pet most likely is intolerant)

Possible Complications

  • Antibiotic-responsive diarrhea and inflammatory bowel disease

Expected Course and Prognosis

  • Prognosis for a full recovery is excellent in most affected pets, if dietary recommendations are followed completely
  • Soft-coated Wheaten terriers with food allergy have a guarded prognosis for full recovery

Key Points

  • Feed a diet free of the offending ingredient(s)
  • Do not feed any scraps or vary from the recommended diet
  • Prognosis for a full recovery is excellent in most affected pets, if dietary recommendations are followed completely

Hyperthyroidism

Hyperthyroidism (Excessive Production of Thyroid Hormone)

OVERVIEW

  • Disease condition caused by high levels of thyroid hormones that increase metabolism in the body
  • The thyroid gland normally produces thyroid hormones in response to stimulation by the pituitary gland, the “master gland” of the body; the thyroid hormones normally increase chemical processes occurring within cells of the body; however, in hyperthyroidism, the excessive hormone levels put the cells and body into “overdrive”
  • Thyroid hormones are known as “triiodothyronine” or “T3” and “tetraiodothyronine” or “T4”

Genetics

  • No known genetic predisposition

Signalment/Description of Pet

  • Cats; most common hormonal (endocrine) disease of cats; one of the most common diseases seen in late middle-aged and old cats

Breed Predilections

  • None

Mean Age and Range

  • Mean age in cats, approximately 13 years; range 4–22 years

Signs/Observed Changes in the Pet

  • Involves many organ systems due to the overall increase in metabolism
  • Weight loss
  • Unkempt appearance
  • Poor body condition
  • Increased appetite (known as “polyphagia”)
  • Vomiting
  • Diarrhea
  • Increased thirst (known as “polydipsia”)
  • Rapid breathing (known as “tachypnea”)
  • Difficulty breathing (known as “dyspnea”)
  • Heart murmur; rapid heart rate (known as “tachycardia”); particular abnormal heart beat, known as a “gallop rhythm”
  • Hyperactivity
  • Aggression
  • Large thyroid gland
  • Thickened nails
  • Less than 10% of pets are referred to as “apathetic”; these pets exhibit atypical signs (such as poor appetite, loss of appetite, depression, and weakness)

Causes

  • Cats—autonomously hyperfunctioning thyroid nodules (where the thyroid nodules produce excess thyroid hormones outside of the control of the pituitary gland, so-called “autonomous” production); rarely, thyroid cancer (known as “thyroid carcinoma”)
  • Dogs—thyroid hormone (T4 or T3) secretion by a thyroid cancer (thyroid carcinoma)

Risk Factors

  • Some reports have linked hyperthyroidism in cats to some canned food diets
  • Advancing age increases risk

Treatment
Health Care

  • Outpatient management usually suffices for cats, if drugs that inhibit the production of thyroid hormones (known as “antithyroid drugs”) are used
  • Treatment using a radioactive form of iodine (known as “radioiodine treatment”) or surgical removal of the thyroid gland (known as “thyroidectomy”) require inpatient treatment and monitoring
  • Rare cases of congestive heart failure require emergency, inpatient intensive care

Activity

  • No alterations recommended

Diet

  • Poor absorption of many nutrients and high metabolism suggest the need for a highly digestible diet, with high availability of protein in untreated hyperthyroidism
  • Resolution of signs resulting from excessive levels of thyroid hormones in the body (condition known as “thyrotoxicosis”) eliminates the need for dietary modifications in many pets
  • Dietary modification may be necessary to treat or control complications (such as kidney damage)

Surgery

  • Surgical removal of the thyroid gland (thyroidectomy) is one recommended treatment for hyperthyroidism in cats
  • Surgical treatment of thyroid carcinoma (dogs and cats) is usually not curative, but can control signs (known as “palliative treatment”)

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.
  • Radioiodine (radioactive form of iodine) is a safe and effective treatment; use of radioactive iodine requires special facilities; availability of veterinary facilities offering this treatment is limited, but increasing
  • Methimazole (Tapazole) inhibits the production of thyroid hormones (antithyroid drug) and is recommended most often
  • Methimazole can be administered through the skin (transdermally); transdermal methimazole must be prepared by a pharmacist; resolution of signs resulting from the excessive levels of thyroid hormones in the body (thyrotoxicosis) takes longer with transdermal methimazole than with methimazole given by mouth
  • β-blockers—sometimes used to treat some of the heart and nervous system effects of excess thyroid hormones; can be used in combination with methimazole; mainly used to prepare the pet for surgical removal of the thyroid gland (thyroidectomy) or radioiodine therapy; atenolol is useful for controlling rapid heart rate (tachycardia), but addition of an ACE inhibitor is necessary to control high blood pressure (known as “hypertension”) in cats with hyperthyroidism
  • Carbimazole—another useful antithyroid drug that inhibits production of thyroid hormones; not available in the United States
  • Propylthiouracil—is an antithryoid drug that inhibits production of thyroid hormones; it can be useful if methimazole is unavailable; side effects may be more common and more severe than with methimazole
  • Ipodate—a radiographic contrast agent; can be used to treat some cases of mild hyperthyroidism, but not effective in most hyperthyroid pets; long-term effectiveness has not been established

Follow-Up Care
Patient Monitoring

  • Methimazole—physical examination, complete blood count with platelet count, serum biochemical analysis, and serum thyroid hormone (T4) determination every 2–3 weeks for the initial 3 months of treatment; the dosage is adjusted to maintain serum thyroid hormone (T4) concentration in the low-normal range
  • Surgical removal of the thyroid gland (thyroidectomy)—watch for development of low blood-calcium levels (known as “hypocalcemia”) and/or paralysis of the voice box (larynx) during the initial postoperative period; measure serum thyroid hormone (T4) concentrations in the first week of surgery and every 3–6 months thereafter, to check for recurrence
  • Radioiodine (radioactive form of iodine)—measure serum thyroid hormone (T4) concentrations 2 weeks after treatment and every 3–6 months subsequently
  • Kidney function—kidney filtration rates decline following treatment in most affected pets; therefore, perform a physical examination, serum biochemistry, and urinalysis 1 month after treatment and then as indicated by clinical history

Possible Complications

  • Untreated disease can lead to congestive heart failure; diarrhea that is difficult to treat; kidney damage; detachment of the retina (a layer in the back of the eye) as a result of high blood pressure (hypertension); and death
  • Complications of surgical treatment include low levels of parathyroid hormone (known as “hypoparathyroidism”; the parathyroid glands are small glands adjacent to the thyroid gland, which may be removed at the time of the surgical removal of the thyroid gland); low levels of thyroid hormone (known as “hypothyroidism”); and paralysis of the voice box (larynx)
  • Low levels of thyroid hormone (hypothyroidism) is rare following radioiodine therapy (radioactive form of iodine)

Expected Course and Prognosis

  • Uncomplicated disease—prognosis is excellent; recurrence is possible and most commonly is associated with poor owner compliance with medical management; regrowth of overactive thyroid tissue is possible, but uncommon after surgical removal of the thyroid gland (thyroidectomy) or radioiodine treatment (radioactive form of iodine)
  • Reported mean survival time for cats treated with radioiodine is 4 years; mean survival time for cats treated with methimazole is 2 years; mean survival time for cats treated with radioiodine and methimazole is 5.3 years
  • Cats with pre-existing kidney disease have a poorer prognosis; kidney failure is the most common cause of death in hyperthyroid cats
  • Dogs or cats with thyroid cancer (thyroid carcinoma)—prognosis is poor; treatment with radioiodine (radioactive form of iodine), surgery, or both usually is followed by recurrence of disease; chemotherapy is of questionable benefit

Key Points

  • Disease condition caused by high levels of thyroid hormones that increase metabolism in the body
  • Most common hormonal (endocrine) disease of cats; one of the most common diseases seen in late middle-aged and old cats
  • Rare in dogs
  • Potential side effects of drugs that inhibit the production of thyroid hormones (antithyroid drugs) and surgical complications
  • Be aware of possible (rare) recurrence after treatment

Hair Loss in Cats

Cat Hair Loss – Overview

  • “Alopecia” is the medical term for hair loss
  • Hair loss is a common problem in cats
  • Characterized by a complete or partial lack of hair in areas where it is present normally
  • Pattern of hair loss–varied or symmetrical

Signalment/Description of Pet

Species

  • Cats

Mean Age and Range

  • Cancer-related hair loss (alopecia)–generally recognized in older cats

Signs/Observed Changes in the Pet

  • Hair loss; pattern of hair loss varies—may be localized or widespread
  • Skin itself may appear normal or may be abnormal (such as redness; multiple, pinpoint bumps or scabs; or loss of superficial layers of the skin [known as ulceration])
  • Other signs depend on the underlying cause of hair loss

Causes

  • Nervous system or behavioral disorders—compulsive disorder, in which the cat overgrooms, with resulting hair loss
  • Hormonal disorders—sex hormone hair loss (alopecia); excessive levels of thyroid hormone (known as “hyperthyroidism”); increased levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”); diabetes mellitus (“sugar diabetes”)
  • Immune-mediated disorders—skin allergies (known as “allergic dermatitis”); specific condition characterized by multiple patches of hair loss (known as “alopecia areata”); other disorders
  • Parasites—demodectic mange (known as “demodicosis”); itchy skin disease caused by infestation with Cheyletiella, a type of mite (condition known as “cheyletiellosis” or “walking dandruff”
  • Fungal infection—ringworm (known as “dermatophytosis”)
  • Physiologic or metabolic disorder—condition characterized by multiple areas of hair loss with reddened skin, scales (accumulations of surface skin cells, such as seen in dandruff), and signs of itchiness (known as “pruritus”) with inflammation of the sebaceous glands, the glands that produce oils in the hair coat (condition known as “sebaceous adenitis”)
  • Cancer or cancer-related hair loss
  • Unknown cause (so-called “idiopathic disease”)
  • Inherited hair loss
  • Injection-site reaction, leading to hair loss
  • Effects of medications–steroids
  • Viral infection–feline lukemia virus (FeLV) and feline immunodeficiency virus (FIV) associated diseases

Risk Factors

  • FeLV infection and FIV infection—for demodectic mange (demodicosis)

Treatment

Health Care

  • Treatment is limited for many of the disorders that cause hair loss (alopecia)
  • Behavioral modification or use of a “T-shirt” on the cat may protect the hair coat and help prevent excessive self-grooming
  • Shampoo and treatment applied directly to the skin may relieve secondary problems, such as increased thickness of the outer, keratinized layer of the skin (known as “hyperkeratosis”) in sebaceous adenitis (condition with hair loss, reddened skin, scales, and inflammation of the oil-secreting sebaceous glands); dried discharge on the surface of the skin lesion (known as a “crust”) in demodectic mange (demodicosis); secondary bacterial infections; and malodor for greasy conditions

Diet

  • Removal of an offending dietary item and use of a restricted ingredient diet may alleviate signs of food allergy (such as hair loss, scratching at skin)

Surgery

  • Biopsy of a tumor or the skin may be indicated in the diagnostic workup for some causes of hair loss (alopecia)
  • Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s syndrome)—surgical removal of the adrenal gland
  • Surgical removal of skin cancer or tumors

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Compulsive disorder—amitriptyline as well as other behavior-modifying medications
  • Hormonal hair loss (alopecia) in males—testosterone supplementation
  • Skin allergy (allergic dermatitis)—antihistamines, steroids, “allergy shots” (known as “hyposensitization vaccine”); medications to control parasites on the skin
  • Excessive levels of thyroid hormone (hyperthyroidism)—medications given by mouth, such as methimazole (Tapazole), or radioactive iodine therapy
  • Diabetes mellitus (“sugar diabetes”)—regulation of glucose levels with insulin
  • Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s syndrome)—surgery; no known effective medical therapy
  • Cancer-related hair loss (alopecia)—no therapy for many types of cancer-related hair loss; disease often fatal
  • Epitheliotropic lymphoma (type of cancer in the skin characterized by the presence of abnormal lymphocytes; a lymphocyte is a type of white blood cell, formed in lymphatic tissue throughout the body)—retinoids (isotretinoin), steroids, interferon, cyclosporine, lomustine
  • Sebaceous adenitis (condition with hair loss, reddened skin, scales, and inflammation of the oil-secreting sebaceous glands)—retinoids, steroids, cyclosporine
  • Squamous cell carcinoma (type of skin cancer)—retinoids (applied to skin directly [topical] and administered by mouth [oral]), topical imiquimod cream
  • Alopecia areata (specific condition involving multiple patches of hair loss)—no therapy; possibly counterirritants
  • Demodectic mange (demodicosis)—lime sulfur dips at weekly intervals for 4–6 dips
  • Cheyletiellosis—medications applied to the skin to kill the Cheyletiella mite (medications known as “topical parasiticides”)
  • Ringworm (dermatophytosis)—griseofulvin, itraconazole, terbinafine

Follow-Up Care

Patient Monitoring

  • Determined by specific diagnosis

Preventions and Avoidance

  • Determined by specific diagnosis

Possible Complications

  • Determined by specific diagnosis

Expected Course and Prognosis

  • Determined by specific diagnosis

Key Points

  • “Alopecia” is the medical term for hair loss
  • Hair loss is a common problem in cats
  • Pattern of hair loss varies–may be localized or widespread
  • Skin itself may appear normal or may be normal

Asthma and Bronchitis in Cats

Asthma and Bronchitis in Cats – Overview

  • “Upper respiratory tract” (also known as the “upper airways”) includes the nose, nasal passages, throat (pharynx), and windpipe (trachea)
  • “Lower respiratory tract” (also known as the “lower airways”) includes the bronchi, bronchioles, and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged)
  • Asthma—sudden (acute) or long-term (chronic) inflammation of the lower airways, associated with increased responsiveness of the airways to various stimuli, airway narrowing, and presence of eosinophils, lymphocytes, and mast cells within the airways; “eosinophils” are a type of white blood cell—they are involved in allergic responses by the body and are active in fighting larvae of parasites; “lymphocytes” are a type of white blood cell that are formed in lymphatic tissues throughout the body—they are involved in the immune process; “mast cells” are immune-system cells that frequently are located near blood vessels—they contain histamine and are involved in allergy and inflammation
  • Long-term (chronic) bronchitis—inflammation in the lower airways (bronchi and bronchioles); chronic daily cough of greater than 2 months’ duration
  • The terms “feline bronchitis” and “feline bronchopulmonary disease” are used to describe the clinical syndrome in cats of sudden (acute) or long-term (chronic) coughing and/or wheezing (squeaking or whistling sounds) due to lower airway inflammation

Genetics

Species

      • Cats

Breed Predilections

      • Siamese appear to be more likely to develop asthma or bronchitis than other breeds

Mean Age and Range

      • Any age; more common between 2 and 8 years of age

Predominant Sex

    • One study indicated that females are more likely to develop asthma or bronchitis than males

Signs/Observed Changes in the Pet

  • Coughing (80%), sneezing (60%), labored breathing or wheezing (40%)
  • Signs typically are episodic and can be sudden (acute) or long-term (chronic)
  • Severely affected cats have open-mouth breathing, rapid breathing (known as “tachypnea”), and bluish discoloration of the skin and moist tissues (known as “mucous membranes”) of the body, caused by inadequate oxygen levels in the red blood cells (known as “cyanosis”)
  • Increased sensitivity to feeling the windpipe (trachea) is common
  • Listening to the chest with a stethoscope (known as “chest auscultation”) may reveal short, rough snapping sounds (known as “crackles”) and/or squeaking or whistling sounds (wheezes), or may be normal
  • Labored breathing, with an increase in expiratory effort; “expiratory effort” refers to the act of expiration or exhalation (breathing out)

Causes

  • Triggers or causes of airway inflammation are unknown

Risk Factors

  • Cigarette smoke, dusty cat litter, hair sprays, and air fresheners may make the disease worse
  • Parasitic lung infections are more common in outdoor cats in certain geographic locations
  • Use of potassium bromide (treatment for seizures) has been implicated causing signs of asthma or bronchitis in some cats

Treatment
Health Care

  • Remove cat from the inciting environment
  • Pet should be hospitalized for a sudden (acute) respiratory distress
  • Oxygen therapy and sedatives in a sudden (acute) crisis, characterized by breathing distress
  • Minimize handling during a crisis, in order to lessen stress and oxygen needs of the cat

Activity

  • Usually self-limited by the cat

Diet

  • Calorie restriction for obese cats

Medications

    • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

Emergency Treatment

      • Combine the use of oxygen and a medication that enlarges the bronchi and bronchioles in the lungs, administered by injection (medication known as a “parenteral bronchodilator”)
      • Terbutaline is a β-2 agonist that is used as a bronchodilator; administered by injection
      • A sedative (such as butorphanol, buprenorphine, or acepromazine) can aid in decreasing anxiety
      • A short-acting steroid, administered by injection, also may be required, such as dexamethasone sodium phosphate or prednisolone sodium succinate (Solu-Delta-Cortef), administered by injection, also can be used

Long Term Management

Steriods

      • Decrease inflammation
      • Steroid administered by mouth (oral treatment) is preferred over administration by injection, because doses and duration can be monitored more closely; steroids such as prednisolone; administer steroids as directed by your pet’s veterinarian
      • Some cats only need steroids on a seasonal basis
      • Longer-acting injectable steroids (such as Vetalog or Depomedrol) should be reserved only for situations in which owners are unable to administer medication by mouth on a routine basis
      • Inhaled steroids—require a form-fitting face mask, spacer, and metered-dose inhaler; veterinary brands include AeroKat (Trudell Medical International) or NebulAir (DVM Pharmaceuticals); the most commonly used inhaled steroid in cats is fluticasone propionate (Flovent); Flovent is used for long-term control of airway inflammation (takes 10–14 days to reach peak effect; during this time steroids administered by mouth should be used as well)

Other Drugs

    • Medications to enlarge or dilate the bronchi and bronchioles (bronchodilators), such as theophylline
    • β-2 agonists (terbutaline, albuterol)—inhibit smooth muscle constriction to dilate the bronchi and bronchiolesInhaled medications to enlarge or dilate the bronchi and bronchioles (bronchodilators)—albuterol is the preferred inhalant therapy in cats, providing immediate relief of spasm and constriction of the bronchi—its effect lasts less than 4 hours; ipratropium bromide can dilate the bronchi, and can be combined with albuterol to provide maximal dilation of bronchi
    • Medications to kill intestinal parasites (known as “anthelminthics”)—routinely recommended for cats with clinical signs of feline bronchopulmonary disease, with predominantly eosinophils found on microscopic examination of material obtained from the lower airways; parasitic inflammation of the bronchi and bronchioles (bronchitis) can be difficult to diagnose—treatment is indicated with appropriate clinical signs and geographic location; appropriate medication will depend on specific parasite suspected in the geographic region; examples include fenbendazole, ivermectin, or praziquantel
    • Antibiotics—choice of antibiotic based on bacterial culture and sensitivity testing
    • Cyproheptadine—inhibits airway smooth muscle constriction in experimental studies; unknown effects in cats with asthma/bronchitis
    • Cyclosporine (Neoral or Gengraf)—decreases the immune response; may be helpful in cats that do not respond to medications to enlarge or dilate the bronchi and bronchioles (bronchodilators) and steroid treatment

Follow-Up Care
Patient Monitoring

  • Report any increase in coughing, sneezing, wheezing, or breathing distress; medications should be increased appropriately if clinical signs worsen, as directed by your pet’s veterinarian
  • Follow-up x-rays (radiographs) may be helpful to evaluate response to medical treatment
  • Watch for signs of increased urination (known as “polyuria”) and increased thirst (known as “polydipsia”) that may indicate diabetes mellitus or kidney disease
  • Monitor blood glucose levels
  • Monitor urine (urinalysis, bacterial culture and sensitivity) as urinary tract infections can occur as a complication of treatment

Preventions and Avoidance

  • Eliminate any environmental factors (such as cigarette smoke, dusty cat litter, hair sprays, and air fresheners) that may trigger a crisis situation
  • Consider dust-free cat litter
  • Change furnace and air-conditioner filters on a regular basis

Possible Complications

  • Sudden (acute) episodes can be life-threateningUntreated sudden (acute) episodes can be life threatening
  • Right-sided heart disease may develop as a result of long-term inflammation of the bronchi and bronchioles (bronchitis)

Expected Course and Prognosis

  • Long-term therapy should be expected
  • Most cats do well, if recurrence of clinical signs is monitored carefully and medical therapy is adjusted appropriately
  • A few cats will not respond to medical treatment; these cats carry a much worse prognosis

Key Points

  • Most affected cats have long-term (chronic) and progressive disease
  • Sudden (acute) episodes can be life-threatening
  • Do not discontinue medical treatment when clinical signs have resolved—subclinical inflammation is common and can lead to progression of disease
  • Lifelong medication and environmental changes usually are necessary

Arthritis in Cats

Arthritis in Cats – Overview

  • “Arthritis” is the medical term for inflammation of the joints; “osteoarthritis” is a form of joint inflammation (arthritis) characterized by long-term (chronic) deterioration or degeneration of the joint cartilage
  • Progressive and permanent deterioration of joint cartilage
  • Also known as “degenerative joint disease” or DJD

Genetics

  • Cats—causes of secondary degenerative joint disease (progressive and permanent deterioration of joint cartilage) are dislocation of the kneecap (patellar luxation), abnormal development of the hip (hip dysplasia), and any joint disease (known as an “arthropathy”)

Affects

  • Cats
  • Dogs

Signs/Observed Changes in the Pet

  • Secondary degenerative joint disease (progressive and permanent deterioration of joint cartilage) due to congenital (present at birth) disorders (such as hip dysplasia) seen in immature pets; some present with DJD signs when older (such as cases of hip or elbow dysplasia)
  • Secondary to trauma—any age
  • Cats—obvious lameness may not be seen; instead, may have difficulty grooming, jumping onto furniture, or accessing the litter box; may have increased irritability
  • Stiff-legged or altered gait (such as “bunny hopping” in hip dysplasia)
  • Not using the affected leg(s)
  • Decreased range of motion
  • Grating detected with joint movement (known as “crepitus”)
  • Joint swelling (fluid buildup in the joint [known as “joint effusion”] and/or thickening of the joint capsule)
  • Joint pain
  • Joint instability
  • Obvious joint deformity

Causes

  • Primary—no known cause (so-called “idiopathic osteoarthritis”)
  • Secondary—results from an initiating cause, such as abnormal wear on normal cartilage (examples, secondary to joint instability, abnormal joints, trauma to cartilage or supporting soft tissues) or normal wear on abnormal cartilage (example, secondary to defects in the bone and cartilage [known as “osteochondral defects”])

Treatment
Health Care

  • Medical treatment—usually tried initially
  • Physical therapy—very beneficial
  • Maintaining or increasing joint motion—passive range of motion exercises
  • Pain management—cold and heat therapy
  • Muscle tone/strengthening exercise

Activity

  • Limited to a level that minimizes aggravation of clinical signs

Diet

  • Weight reduction for overweight pets—decreases stress placed on arthritic joints
  • Omega fatty acids may decrease inflammation

Surgery

  • Surgical options—improve joint geometry or remove bone-on-bone contact areas
  • Surgical procedure cutting into or entering a joint (known as an “arthrotomy”)—used to remove aggravating causes (such as bone and/or cartilage fragments or flaps)
  • Using a special lighted instrument called an “arthroscope” (general term for procedure is “arthroscopy”) to allow the surgeon to see inside the joint—used to diagnose and remove aggravating causes; flushing the joint may be beneficial
  • Reconstructive procedures—used to eliminate joint instability and correct structural or anatomic problems (such as in pets with dislocation of the kneecap [patellar luxation])
  • Joint removal—such as removal of the femoral head (the “ball”) of the hip joint for cases of abnormal development of the hip (hip dysplasia; procedure known as “femoral head and neck ostectomy” or FHO)
  • Joint replacement—total hip replacement is common; total elbow replacement still is experimental
  • Joint fusion (known as “arthrodesis”)—in selected long-term (chronic) cases and for joint instability

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and inflammation—examples are carprofen, deracoxib, etodolac, meloxicam, and tepoxalin for dogs; meloxicam for cats
  • Medications intended to slow the progression of arthritic changes and protect joint cartilage (known as “chondroprotective drugs”), such as polysulfated glycosaminoglycans, glucosamine, and chondroitin sulfate; examples include Adequan, Cosequin, Glyco-Flex, and Syn-flex—may help limit cartilage damage and degeneration; may help alleviate pain and inflammation
  • Steroids—decrease inflammation; however, long-term (chronic) use may delay healing and may initiate damage to joint cartilage; examples of steroids are prednisone administered by mouth or triamcinolone administered by injection into the joint (known as an “intra-articular injection”)

Follow-Up Care
Patient Monitoring

  • Clinical deterioration—indicates need to change drug selection or dosage; may indicate need for surgical intervention

Preventions and Avoidance

  • Early identification of conditions that may lead to osteoarthritis and prompt treatment to help reduce progression of secondary conditions

Expected Course and Prognosis

  • Slow progression of disease likely
  • Medical or surgical treatment usually allows a good quality of life

Key Points

  • Medical therapy is designed to control signs of osteoarthritis (known as “palliative treatment”) and not to cure the condition
  • Slow progression of disease likely
  • Medical or surgical treatment usually allows a good quality of life
  • Discuss treatment options, activity level, and diet with us

Acetaminophen Toxicity in Cats

Acetaminophen Toxicity in Cats – Overview

  • Results from owners overdosing the cat with over-the-counter medications containing acetaminophen, a medication intended to control pain or fever in humans

Genetics

  • Cats—genetic deficiency in a pathway that breaks down or changes (metabolizes) drugs in the liver (known as the “glucuronide conjugation pathway”); makes cats vulnerable to acetaminophen toxicity

Affects

  • Cats
  • Dogs
  • Most common drug toxicity in cats; considerably less frequent in dogs
  • Young and small dogs and cats—greater risk from owner-given single-dose acetaminophen medications

Signs/Observed Changes in the Pet

  • May develop 1–4 hours after dosing
  • Progressive depression
  • Rapid breathing
  • Darkened mucous membranes (moist tissues of body, such as gums)
  • Drooling (salivation)
  • Vomiting
  • Abdominal pain
  • Rapid breathing (known as “tachypnea”) and bluish discoloration of skin and moist tissues of body (known as “cyanosis”) due to a abnormal compound (methemoglobin) in the blood (condition known as “methemoglobinemia”) that disrupts the ability of the red blood cells to carry oxygen to the body
  • Fluid buildup (edema)—face, paws, and possibly forelimbs; after several hours
  • Chocolate-colored urine due to the presence of blood in the urine (known as “hematuria”) and the presence of methemoglobin in the urine (known as “methemoglobinuria”); especially in cats
  • Death

Causes

  • Acetaminophen overdosing

Treatment
Health Care

  • With methemoglobinemia (abnormal compound [methemoglobin] in the blood that disrupts the ability of the red blood cells to carry oxygen to the body)—must evaluate promptly; inpatient care
  • With dark or bloody urine or yellowish discoloration of skin and moist tissues of the body (known as “jaundice” or “icterus”)—inpatient care
  • Gentle handling—imperative for clinically affected pets
  • The veterinarian will induce vomiting (known as “emesis”) and may perform flushing of the stomach (known as “gastric lavage”)—useful within 4–6 hours of ingestion of acetaminophen
  • Low red blood cell count (known as “anemia”), blood in the urine (hematuria), or presence of hemoglobin in the urine (known as “hemoglobinuria”)—may require whole blood transfusion
  • Fluid therapy to maintain hydration and electrolyte balance
  • Drinking water should be available at all times

Activity

  • Restricted

Diet

  • Food—offered 24 hours after initiation of treatment

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Activated charcoal—administered immediately after the veterinarian has induced vomiting or flushed the stomach (gastric lavage) and after vomiting is controlled; activated charcoal is used to attract and keep the remaining acetaminophen in the gastrointestinal tract
  • N-acetylcysteine (Mucomyst®) is administered; considered to be an antidote for acetaminophen toxicity
  • Other sulfur donor drugs—if N-acetylcysteine not available; sodium sulfate
  • 1% methylene blue solution—combats methemoglobinemia without inducing red blood cell destruction (known as a “hemolytic crisis”)
  • Ascorbic acid—slowly reduces methemoglobinemia

Follow-Up Care
Patient Monitoring

  • Continual clinical monitoring of methemoglobinemia (abnormal compound [methemoglobin] in the blood that disrupts the ability of the red blood cells to carry oxygen to the body)
  • Serum liver enzyme activities to monitor liver damage
  • Blood glutathione level—provide evidence of the effectiveness of therapy

Preventions and Avoidance

  • Never give acetaminophen to cats
  • Give careful attention to acetaminophen dose in dogs; acetaminophen should only be given to dogs under a veterinarian’s supervision

Possible Complications

  • Liver damage and resulting scarring (fibrosis)—may compromise long-term liver function in recovered pets

Expected Course and Prognosis

  • Rapidly progressive methemoglobinemia (abnormal compound [methemoglobin] in the blood that disrupts the ability of the red blood cells to carry oxygen to the body)—serious sign
  • Methemoglobin concentrations greater than 50%—grave prognosis
  • Progressively rising serum liver enzymes 12–24 hours after ingestion—serious concern
  • Expect clinical signs to persist 12–48 hours; death owing to methemoglobinemia possible at any time
  • Dogs and cats receiving prompt treatment that reverses methemoglobinemia and prevents excessive liver damage may recover fully
  • Dogs—death as a result of liver damage may occur in a few days
  • Cats—death as a result of methemoglobinemia occurs 18–36 hours after ingestion

Key Points

  • Never give acetaminophen to cats
  • Acetaminophen should only be given to dogs under a veterinarian’s supervision
  • Most common drug toxicity in cats; considerably less frequent in dogs
  • Treatment in clinically affected pets may be prolonged and expensive
  • Pets with liver injury may require prolonged and costly management

Feline Tooth Resorption

Feline Tooth Resorption – An Overview

  • Loss of varying amounts of substance of the tooth by a disease process (known as “dental resorptions”) affecting cats
  • “Odontoclastic” refers to “odontoclasts,” which are cells found around the teeth and are believed to lead to resorption (loss of substance) of the teeth
  • A relatively newly recognized syndrome
  • Previously known as “FORL,” for feline odontoclastic resorptive lesion
  • Feline tooth resorption is not the same problem as “cavities” found in people

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Asian shorthaired cats, Siamese, Persian, and Abyssinian may show breed susceptibilities

Mean Age and Range

  • Nearly 50% of cats older than 5 years old will have at least one tooth affected by resorption
  • Likelihood of tooth resorption increases as the cat ages

Signs/Observed Changes in the Pet

  • Most affected cats do not show clinical signs; some show excessive salivation/drooling (known as “hypersalivation”); bleeding from the mouth or difficulty chewing; some cats pick up and drop food (especially hard food) when eating; others hiss while chewing.
  • Some cats have behavior changes—they may hide or become aggressive
  • Pain, evidenced by jaw spasms
  • Tartar or calculus (mineralized plaque on the tooth surface) and excessive gum tissue (known as “hyperplastic gingival tissue”) may cover or hide the tooth resorptive lesion
  • Tooth resorption can be found on any tooth; the most common teeth affected are the mandibular (lower jaw) third premolar and molar teeth, followed by the maxillary (upper jaw) third and fourth premolar teeth
  • Tooth resorption is classified as Stage 1–5, based on its depth and amount of tooth destruction as follows:
  • Stage 1—minimal loss of hard tissue (enamel and cementum) of the tooth
  • Stage 2—moderate loss of hard tissue (enamel and cementum) of the tooth and penetrates the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel), but does not extend into the internal part of the tooth containing the blood vessels and nerves (known as the “pulp”)
  • Stage 3—deep loss of hard tissue (enamel, cementum, and dentin) of the tooth that extends into the pulp (internal part of the tooth containing the blood vessels and nerves); most of the tooth retains its structure
  • Stage 4—extensive loss of hard tissue (enamel, cementum, and dentin) of the tooth that extends into the pulp cavity; most of the tooth has lost its structure; various degrees of structural damage to roots (part of the tooth below the gum line) and crown (part of the tooth above the gum line)
  • Stage 5—the crown (part of the tooth above the gum line) is gone; the gum tissue covers the scant fragments of the roots; remaining hard tissue of the tooth is visible only on x-rays (radiographs) of the mouth

Causes

  • Unknown; likely many factors contribute to development of tooth resorption
  • Affected cats may have calcium-regulation problems; an improper ratio of dietary calcium, magnesium, and phosphorus; or parathyroid-gland malfunction, producing calcium imbalance
  • Hyperreactivity to inflammatory cells, dental plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white blood cells, food particles, and components of saliva), and/or tartar or calculus (mineralized plaque on the tooth surface); various compounds (endotoxins; prostaglandins, cytokines, and proteinases) also are under investigation as possible causes

Treatment

Diet

  • Add water to diet to soften food

Surgery

  • Stage 1—an enamel defect is noted; the lesion is minimally sensitive because it has not penetrated the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel); therapy includes thorough cleaning and polishing and possible surgical removal of some gum tissue (known as “gingivectomy”) and surgical contouring of the tooth surface (known as “odontoplasty”)
  • Stage 2—lesions penetrate the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel); often require either extraction or crown (part of the tooth above the gum line) reduction
  • Stage 3—lesions enter the pulp (internal part of the tooth containing the blood vessels and nerves); require either extraction or crown (part of the tooth above the gum line) reduction
  • Stage 4—the crown (part of the tooth above the gum line) is eroded or fractured with part of the crown remaining; gum tissue (gingiva) grows over the root fragments, yielding a sensitive bleeding lesion upon probing; additional extraction may be needed
  • Stage 5—the crown (part of the tooth above the gum line) is gone and scant root fragments remain; surgically remove any inflamed areas of tissue

Key Points

  • Loss of varying amounts of substance of the tooth by a disease process (known as “dental resorptions”) affecting cats
  • Nearly 50% of cats older than 5 years old will have at least one tooth resorption
  • Likelihood of tooth resorption increases as the cat ages
  • Daily home brushing may help control plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white blood cells, food particles, and components of saliva)

Feline Oral Inflammation

Inflammation of the Mouth and Throat in Cats – An Overview

  • inflammation affecting the gums, mouth, and throat in cats
  • Inflammation of the mouth is classified by its location, as follows:
  • Inflammation of the gums (known as “gingiva”)—gingivitis
  • Inflammation of the tissues that support the teeth—periodontitis; tissues that support the teeth include the periodontal ligament and the alveolar bone (the bone around the roots of the teeth)
  • Inflammation of the moist tissues around the teeth—alveolar mucositis
  • Inflammation of the moist tissues under the tongue on the floor of the mouth—sublingual mucositis
  • Inflammation of the moist tissues of the lip and cheek—labial and buccal mucositis
  • Inflammation of the moist tissues of the caudal areas of the mouth—caudal mucositis; “caudal” refers to the back or rear; in this condition, it describes the location in the mouth—the back portion of the mouth
  • Inflammation of the moist tissues of the tongue (top and underside)—glossitis
  • “Osteomyelitis” refers to inflammation of the jaw bone and bone marrow
  • “Stomatitis” is a general term to indicate inflammation of the moist tissues of the mouth in any location; frequently used when the inflammation is widespread in the mouth
  • Inflammation of the tonsils—tonsillitis
  • Inflammation of the throat (known as the “pharynx”)—pharyngitis

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Purebred cats more likely than other cats—Abyssinian, Persian, Himalayan, Burmese, Siamese, and Somali

Signs/Observed Changes in the Pet

  • Excessive salivation/drooling (known as “ptyalism”)
  • Bad breath (known as “halitosis”)
  • Difficulty swallowing (known as “dysphagia”)
  • Lack of appetite (known as “anorexia”)—prefers soft food
  • Weight loss
  • Scruffy hair coat from lack of grooming
  • Reddened, ulcerated lesions with rapidly growing tissue (known as “proliferative tissue”) affecting the gums (gingiva); the folds of moist tissue extending from the soft palate to the side of the tongue (known as the “glossopalatine arches”); tongue; lips; lining of the cheeks (known as “buccal mucosa”); and/or hard palate
  • Inflammation of the gums completely surrounds the tooth
  • May extend to the folds of moist tissue extending from the tongue to the wall of the throat or pharynx (known as the “glossopharyngeal arches”), as well as the palate

Causes

  • Unknown
  • Bacterial, viral, and immune-mediated causes are suspected
  • Feline calici virus
  • Decreased immune response (known as “immunosuppression”) from feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) also can lead to poorly responsive infections; however, most cats affected with inflammation of the mouth and throat (oropharyngeal inflammation) are negative for FeLV and FIV

Treatment

Health Care

  • Initial therapy for early inflammation of the moist tissues of the mouth (known as “mucositis”) involves professional teeth cleaning (above and below the gums [gingiva]), as well as strict home care; extraction of certain teeth may be necessary
  • Dental x-rays (radiographs) should be taken before and after surgery
  • Post-operative application of fluocinonide 0.05% (Lidex Gel) to the gum margin may help in the healing process

Surgery

  • Biopsy (especially for lesions involving only one side of the mouth) to rule out cancer—primarily squamous cell carcinoma
  • Extraction of the teeth in cats with inflammation of the moist tissues of the caudal areas of the mouth (caudal stomatitis) behind the canine teeth (that is, the premolar and molar teeth) resulted in resolution in 60% of the cases, without further need of medication; 20% of the remaining cases required medication
  • If the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth; when extracting the teeth, pay meticulous attention to removing all tooth substance
  • CO2 laser may be used to decrease inflamed tissue

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Medication and other therapies have been used with limited long-term success; lack of permanent response to conventional oral hygiene products, antibiotics, anti-inflammatory drugs, and drugs to decrease the immune response (known as “immunosuppressive drugs”) is typical
  • Medications should not be used as the primary method to control inflammation of the mouth and throat (oropharyngeal inflammation) in cats
  • Antibiotics—clindamycin, metronidazole, amoxicillin, ampicillin, enrofloxacin, tetracycline
  • Steroids—to decrease the immune response; such as prednisone; methylprednisolone also may help control inflammation
  • Gold salts—Solganal (Schering); used to treat serious immune-mediated diseases
  • Chlorambucil, a chemotherapy drug to decrease the immune response
  • Bovine lactoferrin is a protein found in cow’s milk that may have antibacterial activity and may have an effect on the immune system; it can be applied to the moist tissues (known as “mucous membranes”) of the mouth
  • Interferon is a protein produced by cells of the immune system; has a variety of effects in the body, including fighting viruses and cancer
  • Cyclosporine, to decrease the immune response

Follow-Up Care

Patient Monitoring

  • Monitor response to treatment; if the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth
  • Monitor for potential side effects of medications used in treatment

Expected Course and Prognosis

  • Cases with extensive lesions of rapidly growing tissue (proliferative tissue) in the back part of the mouth and throat (pharynx) that respond poorly to treatment warrant a more guarded prognosis

Key Points

  • Inflammation affecting the gums, mouth, and throat in cats
  • Inflammation of the mouth and throat is classified by its location
  • Extraction of the teeth in cats with inflammation of the moist tissues of the caudal areas of the mouth (caudal stomatitis) behind the canine teeth (that is, the premolar and molar teeth) resulted in resolution in 60% of the cases, without further need of medication; 20% of the remaining cases required medication
  • If the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth
  • Medications should not be used as the primary method to control inflammation of the mouth and throat (oropharyngeal inflammation) in cats.

Maternal Behavior Problems

Maternal Behavior Problems – An Overview

  • Abnormal maternal behavior is either excessive maternal behavior in the absence of newborns (more common in cats than dogs) or deficient maternal behavior in the presence of the dam’s own newborns (more common in dogs than cats)
  • The female dog is known as the “bitch” or the “dam” and the female cat is known as the “queen”

Genetics

  • No genetic basis has been identified in dogs and cats, but a breed tendency in Jack Russell terriers indicates that a genetic component may be involved
  • Genetic models of deficient maternal behavior in mice have been identified; the genes responsible for deficient maternal behavior in mice are imprinted paternally—if this situation is true in dogs and cats, one would expect that rejecting mothers were normally mothered themselves, but their grandmother may have been deficient
  • The genetic basis should be investigated in dogs and cats

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Poor maternal behavior may be more common in Jack Russell terriers and cocker spaniels than in other breeds of dog, but no quantitative study has proven this observation

Mean Age and Range

  • No particular age at risk, but first-time mothers (known as “primiparous females”) and older bitches seem to be at risk of deficient maternal behavior

Predominant Sex

  • Female generally, but some males may allow suckling behavior

Signs/Observed Changes in the Pet

Deficient Maternal Behavior

  • Absent maternal behavior; the mother simply abandons her offspring—this is most apt to occur after cesarean section

Poor Maternal Behavior

  • The mother stays with her offspring but will not allow them to nurse
  • The mother may show inadequate retrieval of young, insufficient cleaning of the young, or failure to stimulate elimination (urination and/or defecation) by the young
  • The bitch carries the puppies from place-to-place without settling down or, in the most extreme form, kills some or all of her litter

Abnormal Maternal Behavior

  • The bitch or queen may allow her offspring to suckle, but kills her offspring either at birth or over a period of days
  • Occasionally the bitch, or more rarely the queen, will abandon or attack her offspring, if it has changed in odor or appearance
  • A female may be disturbed by another animal or by people and can redirect her aggression to her offspring
  • A bitch accidentally may disembowel or even consume offspring completely while eating the fetal membranes (placenta) and umbilical cord; this should be distinguished from normal licking, which can be quite vigorous, even to the point of dislodging the puppy from a nipple

Maternal Aggression

  • Cats (queens) with kittens may be aggressive to other animals, especially dogs in the same household
  • Dogs (bitches) with puppies may be aggressive to unfamiliar people or even to familiar people, especially if they have low levels of calcium in their blood (condition known as “hypocalcemia”)

Excessive Maternal Behavior

  • The “pseudopregnant” bitch or bitch spayed during the latter phase of the estrous or heat cycle may show signs of a false pregnancy; she attempts to nurse and guards inanimate objects (stuffed animals or even leashes)
  • The pseudopregnant bitch may have breast or mammary development and may be producing milk (lactating)
  • The newly spayed queen may steal kittens from a nursing queen; queens also may produce milk (lactate) if suckled, following the spay (ovariohysterectomy)

Causes

  • The presence of kittens in the environment of the recently spayed cat is a risk factor for excessive maternal behavior and kitten stealing
  • The risk of excessive carrying of puppies, redirected aggression, or even cannibalism is increased if other dogs or too many people are present in the nest area
  • First-time mothers (primiparous females) or those delivered by cesarean section (c-section) are at higher risk than mothers that have delivered previous litters (known as “multiparous females”) or naturally delivering females
  • Large litter of kittens or sick offspring

Treatment

Health Care

  • Normal health care

Diet

  • Adequate diet for nursing bitches and queens to meet energy demands
  • Restricted diets for pets with false pregnancies (known as “pseudocyesis”), to discourage lactation and diminish milk production
  • In the case of deficient maternal behavior, the bitch or queen should be fed free choice (known as “ad libitum”) to encourage lactation

Surgery

  • Delay spaying for 4 months post-estrus to avoid post-spaying maternal behavior and its accompanying aggression
  • Spaying avoids future excessive maternal behavior in the absence of young

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Excessive Maternal Behavior

  • Mibolerone (Cheque Drops) was the drug of choice for bitches with false pregnancies or those exhibiting maternal behavior and lactation following spaying; mibolerone inhibits prolactin (the hormone that stimulates secretion of milk) and thereby inhibits lactation; this medication is no longer available commercially and is available only at some compounding pharmacies
  • Bromocriptine (Parlodel) can be used to inhibit prolactin
  • Cabergoline inhibits prolactin and has been shown to be effective in treating false pregnancies in dogs; not commercially available in North America

Deficient Maternal Behavior

  • Oxytocin (the hormone that stimulates milk release during nursing) may be administered either by injection or by nasal spray (Syntocinon)
  • Prolactin (the hormone that stimulates secretion of milk) appears to be necessary for maternal behavior in other species; therefore, a dopamine blocker (acepromazine) can be used; dopamine inhibits prolactin release and thus a dopamine blocker would increase prolactin

Follow-Up Care

Patient Monitoring

  • The puppies or kittens of females with deficient or poor maternal behavior should be monitored daily to be sure that they are gaining weight

Preventions and Avoidance

  • Place a nursing female and her litter in quiet, comfortable quarters—away from noise and disturbances by other animals or people
  • Do not rebreed females with poor maternal behavior; deficient maternal behavior can occur with each litter
  • Determine whether any other female offspring of the female with abnormal maternal behavior also exhibited poor maternal behavior
  • In other species, poor maternal behavior is a paternally imprinted gene; the father must contribute the gene for poor maternal behavior; the daughters of rejecting mothers will not reject, but daughters of their sons may have poor maternal behavior

Possible Complications

  • Loss of offspring
  • Hand-reared puppies and kittens frequently have abnormal or deficient social behavior, due in part to insufficient suckling time and to consequences of lack of maternal licking, which adversely affects response to stress and reproductive behavior

Expected Course and Prognosis

  • Excessive maternal behavior usually wanes around the time of normal weaning (6–8 weeks)
  • Poor and deficient maternal behavior can occur with each litter

Key Points

Abnormal or Poor Maternal Behavior

  • The bitch that is carrying her puppies or exhibiting redirected aggression to them should be isolated in a quiet, dark area
  • The bitch that bites her puppies should be muzzled; the owner must stimulate elimination (urination and/or defecation) of the puppies, because the muzzled female cannot do so
  • An Elizabethan collar inhibits cannibalism in queens
  • The bitch should be attended at the birth of the litter (known as “parturition”) and puppies should be removed temporarily if she is biting the puppies themselves in addition to the umbilical cord
  • Bitches and queens with poor maternal behavior may exhibit the same behavior with subsequent litters

Excessive Maternal Behavior

  • Cats that have stolen kittens should be separated from the biological mother and kittens
  • Mothered objects (such as stuffed toys) should be removed from the “pseudopregnant” bitch (that is, the bitch having a false pregnancy)
  • Food intake should be restricted to inhibit milk production (lactation)

Maternal Aggression Toward Animals or People

  • The best treatment for excessive maternal aggression is to separate the kittens; weaning alone may not suffice because the presence of the kittens alone may sustain or even reinstate maternal aggression in a queen separated from her kittens for several weeks

House Soiling Cats

House Soiling Cats – An Overview

  • Urinating, marking territory with urine, or defecating in a location that the owner considers inappropriate; defecation is the act of having a bowel movement
  • Housesoiling includes inappropriate urination or defecation outside the litter box and urine marking or fecal marking (where bowel movement is deposited in prominent locations outside the litter box)
  • Inappropriate urination is characterized by the cat simply squatting and urinating on horizontal surfaces outside of the litter box
  • Urine marking occurs most commonly when the cat sprays urine on vertical surfaces outside the litter box; also known as “urine spraying”
  • The “lower urinary tract” includes the urinary bladder and the urethra (the tube from the bladder to the outside, through which urine flows out of the body)

Genetics

  • An inherited component may exist for urine marking; parents of affected individuals have been implicated as exhibiting the same behavior in some reports
  • Persians and Himalayans that exhibit inappropriate urination should be tested for polycystic kidney disease, a genetic disorder

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Housesoiling may occur in any breed
  • Persians, Himalayans, and their crosses may be more likely to exhibit housesoiling than other cat breeds

Mean Age and Range

  • Inappropriate urination can occur at any age

Predominant Sex

  • Housesoiling can occur in either sex, intact or neutered; an “intact” cat is capable of reproduction
  • Urine spraying is more common in intact and neutered males than in females

Signs/Observed Changes in the Pet

Inappropriate Urination

  • Sudden (acute) or long-term (chronic) problem
  • Urination in the vicinity of the litter box may suggest dissatisfaction with qualities of the litter box (such as location of the box, type of litter, frequency of cleaning of the litter box)
  • Signs of lower urinary tract disease (such as straining to urinate, blood in the urine [known as “hematuria”]) or generalized (systemic) illness (such as increased thirst [known as “polydipsia”], lack of appetite [known as “anorexia”], vomiting, diarrhea) may suggest an underlying medical problem
  • Presence of abnormal physical findings depends on whether problem is a disease-related or behavioral problem

Urine Marking

  • Marking may be a response to household disruption or another cat(s) in or outside the home
  • Usually manifest as spraying—the cat moves so the rear quarters are close to a vertical surface, the cat stiffens its posture, raises and quivers its tail, and directs a small burst of urine toward the vertical surface
  • Observation of urine marks on vertical surfaces
  • Urine marks around windows and door to outside suggest a response to the presence of an outdoor cat
  • Urine marks on prominent furniture or other objects or urine sprayed on new objects brought into the home

Inappropriate Defecation

  • Straining to defecate; vocalizing when defecating; hard, dry or bulky feces suggest painful defecation
  • Painful defecation may lead to avoidance of the litter box, as the cat may associate the pain with the litter box

Fecal Marking

  • Feces deposited on prominent, conspicuous locations

Causes

Medical Causes

  • Lower urinary tract disease (such as feline lower urinary tract disease [FLUTD] or lower urinary tract infection)
  • Presence of stones (known as “uroliths”) in the urinary tract (condition known as “urolithiasis”)
  • Diabetes mellitus (“sugar diabetes”)
  • Excessive levels of thyroid hormone (known as “hyperthyroidism”)
  • Feline leukemia virus (FeLV) infection
  • Feline immunodeficiency virus (FIV) infection
  • Liver disease
  • Senility or decline in thinking, learning, and memory, frequently associated with aging (known as “cognitive dysfunction”)
  • Caused by or related to medical treatment (known as an “iatrogenic abnormality”)—administration of fluids, steroids, medications to remove excess fluids from the body (known as “diuretics”)

Behavioral Causes

  • Soiled litter box
  • Inadequate number of litter boxes or locations (one litter box per cat plus one is recommended)
  • Litter box located in remote or unpleasant surroundings or subject to interference by Cats or children
  • Inappropriate type of litter box—a covered litter box may maintain odors at an offensive level or may be too small to allow large cats to move around comfortably; a covered litter box allows other cats, pet Cats, and young children to “target” the cat as it exits
  • Time factors—daily or weekly patterns of inappropriate urination suggest an environmental cause; sudden (acute) onset in a cat that previously has used the litter box reliably suggests a medical problem
  • Type of litter—litter type that is unacceptable to the cat (for example, scented litter may not be acceptable); preference tests indicate that most cats prefer unscented, fine-grained (clumping) litter; change in litter box habits that coincide with introduction of a new litter type suggest an association with the change of litter
  • Sudden shift from using litter in the litter box to urinating in an unusual location (such as urinating in a porcelain sink) suggests a lower urinary tract disorder
  • Location—urination outside the litter box may suggest a location preference or influential social factors
  • Social dynamics—consider social conflicts between cats and any changes in the social world of the cat at the time the problem started (such as addition of a new cat to the household)
  • Probability of urine marking or spraying is directly proportional to the number of cats in the household
  • Presence of outdoor cats may elicit urine marking or spraying around doorways and windows
  • Urine marking or spraying may be a response to another cat in the home or outside the home
  • Urine marking or spraying on grocery bags or new furniture suggests olfactory marking, associated with arousal in response to new stimuli
  • Urine marking or spraying on clothing or bedding may be associated with specific people or visitors

Risk Factors

Inappropriate Urination/Defecation

  • Inadequate or infrequently changed/cleaned litter box (or boxes)
  • Litter box features (such as litter type, scent, box size or style)

Urine Marking

  • Male
  • Sexually intact
  • Multiple-cat household
  • History of urine marking by a parent of the cat

Treatment

Health Care

  • Treat any underlying medical condition
  • Use environmental and behavioral therapies before or with medical treatment (see www.vet.osu.edu/indoorcat)
  • Restrict the cat from rooms in which urine housesoiling occurs
  • If the owner requires immediate cessation of the problem, it is helpful to confine the cat to one room in the owner’s absence; provide a litter box, water, food, and resting sites in this room; the cat can be let out of the room when the owner returns and is available for strict supervision of the cat
  • Clean urine “accidents” with an enzymatic cleaner specific for this purpose

Inappropriate Urination

  • Scoop out the litter boxes daily and clean thoroughly weekly and refill
  • Avoid deodorizers, scented litters, or other strong odors in the vicinity of the litter box
  • Move food bowls away from the litter box
  • Provide at least one litter box per cat, distributed in more than one location, and avoid high traffic or noisy areas
  • If the litter box is covered, provide an additional large, plain, uncovered litter box filled with unscented, fine-grained, clumping litter, with no liner
  • Additional boxes may be provided, using a different type of litter in each (so-called “litter box buffet”) to evaluate the cat’s preference for litter box type and litter
  • If one site in the home is “preferred” by the cat for inappropriate urination, place another litter box over this site—after the cat uses this box regularly, move it gradually (approximately an inch a day) to a site more acceptable to the owner
  • Confinement of the cat in a “safe room” when the owner is not available to supervise may be necessary

Urine Marking

  • If signs suggest that the cat is spraying in response to cats outside the house, prevent visual or olfactory access to those cats; an environmental product (Feliway, Ceva Animal Health), a concentrate of synthesized feline facial pheromone, is available commercially as a treatment for urine marking—the product is sprayed regularly or diffused in the environment and may improve urine spraying in up to 75% of cases
  • Block “inside” cat’s ability to see “outside” cats
  • Spend time interacting with the cat daily to focus the affected cat’s attention away from other cats
  • Medications play an important role in the control of urine marking

Surgery

  • Neuter intact male cats and spay intact female cats—this curbs spraying behavior in up to 90% of males and 95% of females that spray

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • No drugs are approved by the federal Food and Drug Administration (FDA) for the treatment of urine marking in cats; your veterinarian will discuss the risks and benefits of medical treatment
  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine
  • Tricyclic antidepressants (TCAs), such as clomipramine and amitriptyline
  • Buspirone
  • Synthetic progestins—the risk of serious side effects has diminished their once-common use; discuss the risks and benefits with your cat’s veterinarian
  • Pheromone therapy (Feliway) reduces urine spraying

Inappropriate Urination

  • Medications usually are not indicated, except in treatment-resistant cases or when inappropriate urination is associated with generalized anxiety or heightened arousal
  • Medications to decrease arousal and anxiety—medications commonly used include fluoxetine, clomipramine, amitriptyline, and buspirone

Urine Marking

    • Medications may be needed to decrease arousal, in order to decrease the frequency of urine spraying

Inappropriate Defecation

      • Medication usually is not indicated

Fecal Marking

      • Medications may be needed to decrease the arousal that drives this behavior

Follow-Up Care

Patient Monitoring

      • Regular follow-up is essential
      • Keep a daily log of elimination (that is, urination and defecation) patterns so that treatment success can be evaluated and appropriate adjustments in treatment can be made
      • Number the litter boxes and count and record the number of urinations and defections in each box and outside the litter boxes each day
      • For marking behavior, after 2 months of successful medication management, as a trial, gradually decrease the medication over 2 weeks; if marking recurs, medication may need to be continued; consult with your pet’s veterinarian
      • An annual physical examination and blood work (complete blood count [CBC] and serum biochemistry profile) and urinalysis are recommended

Preventions and Avoidance

      • Neuter cats
      • Restrict cat numbers to decrease the probability of urine marking
      • Discuss litter box selection, location, and cleaning routines with your pet’s veterinary staff to avoid housesoiling problems

Possible Complications

      • Treatment failure may result in the cat being euthanized, relinquished at an animal shelter, or released outside

Expected Course and Prognosis

      • Client expectations must be realistic—immediate control of a long-standing problem of housesoiling is unlikely; the goal is gradual improvement over time
      • If untreated, urine housesoiling is destructive to household belongings and may negatively impact the human-animal bond, leading to relinquishment to an animal shelter or euthanasia

Key Points

    • Urinating, defecating, or marking territory in a location that the owner considers inappropriate
    • Early identification and treatment of housesoiling problems improve treatment success
    • Cats do not housesoil to be spiteful or vindictive
    • Avoid scolding or punishing the cat, as such actions will cause the cat to avoid the owner
    • Understanding the underlying motivation for the housesoiling behavior is critical for treatment success
    • Create a harmonious, predictable environment to decrease anxiety and arousal that may contribute to housesoiling
    • Client expectations must be realistic—immediate control of a long-standing problem of housesoiling is unlikely; the goal is gradual improvement over time