F is for Feline Atopy

That's a head scratcher.  What is atopy?

 What is atopy? 

Not only do I sting, I'm covered in pollen!

Atopy is a catch-all term for allergies to airborne particles like pollen or dust.  Just like us, cats can suffer from reactions to inhaled allergens.  Atopy causes multiple symptoms in kitties.  The major problems is pruritis (itching).  Sneezing, wheezing and drippy eyes can also occur, but are much less common.  And right now, all of us are suffering.

Kitties can chew their fur off when they're itchy.

Springtime is the worst time of the year for everyone who has atopy.  The blooming trees, shrubs and grasses hit hard.  Here in the desert southwest, you would think there would be less problems.  But really, the pollen just comes sooner.  Allergy season has 2 peaks in the Las Vegas Valley:  spring and late fall.  This year, Spring sprang early--March.  In an area like Las Vegas, geography plays a role as well.  The valley holds all the airborne schmutz like a cup.  If we are lucky enough to get a windstorm, the dust it stirs up replaces the pollen.

Common allergens vary from place to place, but in the Las Vegas valley, they include tree pollens (olive, mulberry, pine etc), grass pollens and weed pollens, molds, and dust mites. . Others, such as molds, mildew and house dust mites are year-round problems.

Yes, you can actually see pollen flying off this pine tree.  Yay!

One of the most important preventative for atopic disease is to minimize your cat's exposure to things he is allergic to. For example, if a cat is allergic to pollen, he should be kept inside with the windows closed when pollen counts are high or the grass is being mowed. Air filters or purifiers also help remove many airborne allergens to keep the home environment clean.

Other treatment options are chosen based on the severity of your cat's allergy symptoms and the length of his allergy season.

If you suspect your cat has allergies, you should see your veterinarian. Veterinarians will usually make a preliminary diagnosis and treatment plan based on the following information:  seasonality of symptoms, duration of symptoms and areas of the body affected.

Treatments can include bathing in medicated shampoos, anti-inflammatory medications (eg antihistamines, corticosteroids and other immunosuppressants), treating skin infections and possibly allergen desensitization.

Intradermal skin testing

If itching or other signs do not improve with symptomatic therapy, a trip to your veterinary dermatologist may be in order.  The dermatologist is able to perform more sophisticated allergy testing on kitty that can pinpoint the worst allergen offenders.  Based on the testing, kitty can go through a desensitization program to reduce their response to allergens.  The program might include injections, but frequently is only oral drops.  The desinsitization does not necessarily eliminate the signs of allergies, but should make them much less severe and controllable.

As always, contact your veterinarian to make the appropriate plan for your furry feline pal!

Who you callin' furry, "pal"?

E is for (complete oral) Exam

While February is Animal Dental Health month, the kitty's mouth is not just about teeth.  Evaluating the soft tissues (gums, tongue, cheeks and lips) and the lower and upper jawbones (mandible and maxilla) are also part of a good oral exam.

A very symmetrical lynx

An extreme example of asymmetry

When we look at your kitty's mouth, we are looking for symmetry of shape, texture and color.  Remember, if you find something strange, look on the other side of the face/tongue/head and if it looks the same on both sides, there is a good chance that, for your kitty, it is not pathologic.

Freckles are often seen in orange tabbies

Freckles and spots of color on the lips, tongue and cheeks of your kitty can be normal, but changes in color or texture of the tissues, as well as new growths, are rarely normal.

Mild chin acne

  Some of the less dangerous problems that we can see include feline acne.  Feline acne is much like human acne.  Plugged pores fill with sebaceous debris and cause inflammation.  In extreme cases, there is severe swelling and infection.  Some things that help prevent feline acne include good hygiene--help your kitty out if she is unwilling or unable to adequately groom her chin.  Grooming habits often degrade in our geriatric patients.  A warm damp cloth is often sufficient, though you can use a very mild

Severe chin acne

soap--rinse it well!  Also, use stainless steel or crockery food dishes as plastic, even if cleaned regularly, can hold grease and food particles.  Some cats may also benefit from a hypoallergenic diet

 
Other problems include ulcers in the mouth or on the tongue.  These can be immune mediated problems like a "rodent ulcer", inflammation due to an exuberant reaction by the kitties immune system to the plaque on his teeth, or even cancerous conditions.

Rodent ulcer on the lip

Rodent ulcers are collections of inflammatory cells leading to thickening of the tissue.  No one cause has been implicated, but steroid therapy is often successful. 

Ulcerations from stomatitis

However, some ulcers in the mouth--such as stomatitis from dental disease and ulcers secondary to viral infections--will worsen with steroid therapy.

ALWAYS KNOW WHAT YOU ARE TREATING!!!

SCC invading mandible

Cancer is, of course, a possibility when we have ulcers, new pigmentation or growth in the mouth.  The most common oral tumor of kitties is a squamous cell carcinoma (SCC).  These are very

SCC visible next to the canine tooth

aggressive cancers not just growing in the soft tissue, but invading and destroying bone.  If caught early--when they are small--they may be curable, large tumors are difficult to address without removing large parts of the jaw.  Routine oral health exams can help find these and other problems, hopefully to address them in a timely fashion and give us and kitty a chance to fix them.

As always, take advantage of your veterinarian's knowledge and abilities--make an appointment to have your feline friend's annual oral exam today!  You and your veterinarian will be able to make the best plans to keep your kitty smiling.

Sure you are, Grumpy Cat. 

D is for Dental?

What is a dental?

You have advanced gingival disease Mr Crocodile.

This is a very good question.  "Dental" has been used as a catch-all term for anything from the groomer brushing your kitty's teeth, to a quick and dirty tartar removal, to full out oral surgery and endodontics (root canals et cetera).


What is usually meant by "dental" is an oral prophylactic cleaning.  This should include an anesthetic cleaning using an ultrasonic scaler and/or hand scaling tools to remove dental calculus followed by a polishing to help smooth out any defects in the tooth enamel.  Scaling should clean both the crown of the tooth (above the gumline) and below the gumline (periodontal scaling).


After the cleaning, the mouth should be "mapped".  This is when we

Basic feline (and canine) dental map template

systematically evaluate the health of the mouth tooth by tooth, noting wear, gum recession, cavities, missing and extra teeth, rotated or impacted teeth--et cetera.  Then the mouth is radiographed (x rayed) so we can evaluate the teeth roots--teeth can look perfect above the

Pathologic jaw fracture

gum, but below are abscessed through the jaw--this can even lead to jaw fractures or holes into the sinuses!

Then your veterinarian will evaluate all this information and make any further recommendations.  What we want is to find a clean and healthy mouth without any gingival, crown or root disease.  But if further disease is found we talk to you and may proceed with further treatments--or recommend seeing a Veterinary Dentist.

When you are talking to your veterinarian about having your cat's teeth cleaned, make sure you know what their practice includes in their cleaning and evaluation.  A cleaning should be under anesthetic to allow for a complete and safe cleaning and evaluation (both visual and radiographically/xrays).  Anesthesia should include a endotracheal tube (this is a tube placed into your cat's windpipe allowing for both the delivery of gas anesthesia and to protect his precious airway and lungs from being swamped by the fluid and debris loosened when the teeth are appropriately cleaned.  The cleaning itself should be done by a trained and licensed veterinary technician and in most states it is illegal for unlicensed veterinary assistant to perform this service.  Anesthesia should be monitored with at least an esophageal stethoscope--but we feel like it should include IV fluid therapy and support, blood pressure and blood oxygenation measurements.  The health of the teeth and diagnosis and any further surgeries are required to be done by a licensed veterinarian. 

Many groomers and some veterianrians have --for years--offered "dentals" which are either simple tooth brushing (harmless but a misrepresentation of the service) or worse, scaling the tartar off the teeth when your kitty is fully awake and conscious also known as a non-anesthetic dental cleaning.  Why is this bad? you say.  I don't like the notion of my cat under anesthesia.  Balanced anesthesia is very safe and allows for a complete and stress free complete exam and cleaning. 

Removing all the disease of tartar and plaque from teeth will definitely make your kitty healthier.  It will make her teeth stronger and last longer.  It will remove the underlying source of disease a dirty mouth provides. 

Clean teeth = happy cat!

Talk to your veterinarian about your furry feline friend's teeth.  If it is time for an dental cleaning, make the plan, make the appointment, and make her feel better!

Cats and Caries

C is for Cats and the Caries they have...

Not all unsightly teeth are correctable!

Week 2 of kitty dental health brings us to a uniquely feline problem:  caries lesions AKA cavities.  "What?" you say, "People get cavities all the time!"  But cat caries are different.  Human cavities, while unsightly and painful, are usually fixable.  That is to say, the tooth can usually be salvaged with a filling, or if the lesion is deep enough, a root canal et cetera.

Cats have a different sort of problem.  Feline Odontoclastic Resorptive Lesions (FORLs) is the more accurate description for feline cavities.  FORLs are basically openings or holes in the tooth.   FORLs are usually found on the outside surface of the tooth where the gum meets the tooth surface but they can and usually do extend down the tooth root under the gumline.  They are unable to be "fixed" with fillings and the affected teeth are not salvageable.  Extraction of the diseased tooth is the only solution.  And we do need to extract and fix the problem.  Why, you ask?




Pain.
Pain.
Pain.

The lesions are exquisitely painful.  If you have ever had an open cavity, or root canal, the nerve in the canal is directly exposed to outside stimuli.  Every breath of air, every bite of foot, every slight pressure on the lesion is scraping that nerve.  The nerve is so reactive that there is a "chattering" response to any stimuli that can be induced even when kitty is under a general anesthetic!



What do FORLs look like?  


Above the gumline they are usually hidden by overgrowths of gum that are the body's attempt to cover up that nerve exposure.  However that gum is inflamed and doing as poor a job patching the hole as bubble gum on an inner tube.  

Under the gumline is usually even more disease.  A tooth that appears completely normal "up top" can be rotting away underneath.  Teeth affected this way will eventually snap off and leave a ragged, jagged stump to further irritate kitty's mouth.

Extreme tooth resorption seen in an xray

So, you ask, where do FORLs come from, what causes them?

Unfortunately we don't really know that answer.  Lots of causes have been proposed but none have really been proven.  FORLs seem to be a congenital problem, meaning that a cat is predisposed to FORLs from birth.  Of my cats, Millie has had multiple FORLs while Petunia had none.  Same household, same dental care (home and veterinary) and same diet--different genetics.

So what do we do?  Well this is a big problem, affecting an estimated 20 to 60 percent of all cats and close to three-quarters of those five years of age and older.   Routine check ups with your veterinarian will help diagnose this condition early and can save your kitty friend years of debilitating pain.  A basic oral examination will usually indicate a "up top" problem, and when kitty is having her comprehensive oral exam, cleaning and radiographs (xrays), problems under the gumline can be diagnosed and treated.  

What happens if your kitty has to have an extraction?  Extractions are performed surgically by your veterinarian with appropriately cat-sized dental instruments, balanced anesthesia, and, of course, pain control.  Pain control can be many things, but will almost always include perioperative opiods (morphine and morphine like drugs) and usually local anesthetics.  

Afterwards, there is a brief healing period where your kitty should only eat soft or softened food.  After the extraction sites are healed, the only change in your cat's day to day life is to be free of PAIN!  There are many old kitties out there without any teeth left who eat like champions, though I suspect they wouldn't be very good mousers.

As always, the best veterinary care for your cat is accomplished by regular physical exams and consultations with your veterinarian!   

B is for Brush (your teeth!)

Who needs dental care?  Anyone with teeth!  

 According to the American Veterinary Dental College “Periodontal disease is the most common clinical condition in adult dogs and cats, and is entirely preventable. By three years of age, most dogs and cats have some evidence of periodontal disease." 

Some signs of dental disease.

February is National Pet Dental Healthcare Month and in honor of this we will have a 4 part series on taking care of your kitty's teeth.  This week we will go over the most important part of dental care:  what you do at home.


Home care starts with brushing.  Every day.  (Yes, everyday).  Brushing your cat's teeth may seem difficult but here are a few tips to get started.

This is not how to use a toothbrush

 You will need:

A cat.  A toothbrush.  Toothpaste (optional)

The most important part of brushing the teeth is the manual abrasion of debris from the surface of the tooth.  You can use a soft baby toothbrush, a special cat toothbrush, a fingerbrush (my first choice), or a piece of gauze to help you accomplish this.

Fingerbrushes

Using your applicator of choice, gently massage kitty's gums and teeth concentrating first on the surface of the tooth next to the cheeks (the buccal surface).  If you only get this surface brushed, you have accomplished a lot!  The kitty's tongue helps keep the inner surface (the lingual surface) relatively clean.  At first, you may only be able to get you finger/brush in kitty's mouth for a second or 2.  If your cat seems very resistant or stressed out LET HIM GO!!!  A negative, rough experience guarantees 2 things:  you won't get a second chance and you may get bit!  Slow and steady wins the race.  After the brushing, a lot of love and a treat will positively reinforce the experience.  Here is a video produced by the Cornell Veterinary School with some more tips on effectively brushing your cat's teeth.

IF YOU GET BIT BY YOUR CAT, SEEK MEDICAL ATTENTION!

Some notes about available dental hygiene products:

Delicious seafood

Toothpaste is good for 2 things.  First, the taste may make the whole exercise more palatable to your kitty.  Second, a good feline toothpaste will include some type of enzymatic cleaner.  I like the C.E.T. products.  They come in multiple flavors including malt, poultry, vanilla mint and seafood (Yum!)

It is very important to use a pet safe toothpaste!  These are designed so that they are safe if ingested (most human toothpaste is toxic when ingested in large amounts--which isn't much when you weigh 10 pounds!)

Home care also includes things like chew treats.  The most well known of these is probably Greenies.  I also like CET Chews.  Both of these products are designed to be chewed, not gulped.  The material of the chewie then "brushes" the tooth as it moves through and through.

Another "self brushing" product is Hill's prescription diet t/d formula (t/d = Tartar Diet).  As you can see in
the diagram below the fiber matrix of the kibble holds up to the chewing.  If t/d is fed exclusively (which I don't recommend due to

Hill's t/d

Hill's t/d

other dietary concerns to be discussed at a later date) it can be equivalent to brushing kitty's teeth 5 times a week.  When used as a treat on a daily basis, it can be as effective as brushing 3 times a week.  It also has good palatability.

Low at the end of the list of home care are rinses and gels.  You can think of these as mouthwash for cats.  They help hold down bacterial levels in mouths but do not remove existing plaque.  They can help with mouth odor (halitosis) and may slow down the growth of bacteria that create plaque and tartar.

Finally are the products I like to call "You are probably wasting your money".  These include but are not limited to: water additives, breath drops, probiotics specifically for teeth and any product that does not have the VOHC (Veterinary Oral Health Council) seal of approval which can be found on products that have been vetted (hehe) and found to have scientific evidence of effectiveness.

As always, talk to your veterinarian about any concerns about your cat and before undertaking any medical choices!  Regular examinations and a good doctor-patient relationship are necessary to a healthy kitty!

A is for Arthritis

Arthritis.  What do you think of when you hear the word arthritis?  People with gnarled fingers?  Pain?  Difficulty moving?  Aging?  All of the above?  Well it is all these things and more.

Sonny, in my day we caught our own mice!

Often called "wear and tear" arthritis, osteoarthritis (OA) is the most common form of arthritis in cats.  In most cases, over time, cartilage in joints breaks down, and OA symptoms begin to occur.  In cats, the commonly affected joints are in the back, knees, shoulders, and elbows (sound familiar?)  OA can also evolve from a traumatic injury, like a ligament rupture or a broken bone that didn't heal quite right.

Advanced elbow OA

And arthritis is painful (ask anyone who suffers from it!) 

The way cats express pain is different from people and dogs.   With cats, it's  difficult to see the changes in mobility and behaviour that can signal osteoarthritis. Unless you happen to see your cat in the litter box, you might not notice that she's having more difficulty squatting to urinate and can't easily dig to cover her feces. You might not notice that she doesn't jump to the top of the bookcase anymore, and you might like it that she no longer jumps on the counter. You just notice that she's sleeping more and isn't that normal when they get old?

I've got a hint for you,  it's not.

What can be done for our kitty?  Well, nothing will turn back the clock, but we can slow the progression of disease when it is recognized.

Fat cat is sad

1:  Maintain a healthy weight.  Obvious right?  But many of our kitties are carrying around quite a load.  As many as 58% of all pet cats are classed as overweight with 18.7% of these falling into the obese category!


2:  Regular exercise.  Even our geriatrics benefit from routine play.

3:  Pain management.   Numerous products are available to help combat the pain of arthritis; some are best combined with others and some cannot be combined.  What we do know is that arthritis pain is best addressed by what is called a multi-modal approach, meaning that several approaches combined yield better results than any single therapy.

Our first line medications are glucosamines.   These are believed to function both to decrease inflammation around joints reducing discomfort and slowing the progression of arthritic changes, and also to help provide nutrition for the joint fluid that is necessary for a joint to move smoothly.

The most common forms of glucosamines are oral supplements and injectable medication.  For oral supplementation, I like Dasuquin.  It is a powder that can be mixed with kitty's food and has a great track record of palatability. But if your kitty is a finicky eater--and frequently our older kids are--there is another option.

Adequan is an injectable PSGAG (polysulfated aminoglycan) that has proven success in helping maintain joint health.  In kitties, we give a series of injections every 5 days for 1 month, and then monthly for maintenance.  My own Milliecat has benefited from this treatment regime and is able to reach the couch again with ease. 

More advanced medications are available such as non steroidal anti inflammatory drugs such as Onisor, Metacam, and Rimadyl.  They work by reducing the inflammation in the affected joints.  However, these must be used judiciously in cats because there is a very narrow window of safe doses.

And NEVER give a kitty any human medications for pain!  Most will cause illness, and many will cause death!

As always, the best care for your cat is obtained through a thorough exam and consultation with your cat's veterinarian!