Cats: Exposure to Rabies

One of the most contentious topics in any cat group is the subject of vaccines and whether are not to vaccinate.  Often someone will remark that they have to vaccinate because of the local law.  Some people are unaware that the requirement for rabies vaccination depends on the locality.  Where I live, rabies vaccinations are required by county law for dogs only.  I have friends who live in areas where rabies vaccinations are also required for cats.  The variation in requirements depends in large part on the incidence of rabies in wildlife in an area.

Please keep in mind that the rabies vaccine is NOT for the health of the dog or cat, but to protect humans from the rabies.  This article, Rabies Postexposure Prophylaxis, by M. Gayne Fearneyhough, BS, DVM (p 557-572 in Vol 31, No 3, Vet. Cl. of NA: Small Animal Practice, May 2001) looks at the treatment of humans after they have been bitten by a potential rabid animal.  As I do not particularly care about human medicine, this is a very brief summary.

One statement of interest in this article is "many parts of the western United States are free of terrestrial rabies", which, if you look at the 2010 CDC map for rabies infections in dogs and cats, my area, southern CA, has no cases (despite heavy testing) whereas a state like Pennsylvania is solid yellow in the east.  This explains why my Eastern friends are so adamant about rabies vaccines and here it's a minor concern.

The chart below is the decision tree recommended for humans:

Perhaps the most interesting section had to do with post-exposure treatment in domestic animals.  I have lived under the assumption that if a cat was bitten, that was a death sentence.  Apparently not.  At least 2 studies, one of 713 animals and another of 632 animals (dogs, cats, cattle, horses, sheep, goats, pigs, and 1 llama) were treated.  The first study had a 99.7% survived and 99.5% in the second.  So, yes, a cat bitten by a rabid animal CAN be successfully treated. The main problem mentioned is that the animal may survive but may not be free of rabies. I would think a second problem is to find a place that would quarantine the cat and provide treatment for several weeks.

Cats: A Brief Introduction to Recombinant Vaccines

The article, Recombinant Vaccine Technology in Veterinary Medicine, by Kent R. Van Kampen, DVM, PhD (p 535-538 in Vol 31, No 3, Vet. Cl. of NA: Small Animal Practice, May 2001) was interesting and difficult.  It's been over 20 years since I did anything serious with DNA and gene-splicing, so I had to dredge up a lot of information from the corners of my mind to understand this article.  The exciting thing is this form of vaccine seems to hold great promise -- not only to develop new vaccines for different diseases, but also because the vaccine avoids some of the adverse reactions.

The standard vaccine types have problems.  The killed vaccines often provide only short-lived immunity. The modified live vaccines have the real risk of causing the disease.  So, researchers developed recombinant vaccines, or, genetically engineered vaccines, which are focuses on specific antigens (reactive agents).  With these vaccines, there is little chance of a cat developing the disease.

The general method (and this is a huge simplification) is to chop up the DNA of the pathogen, such as rabies.  Part of the DNA or RNA is then inserted into a recipient cell, such as a yeast, bacterium or virus. The vaccine is then derived. This manipulation of genes can create vaccines in three general ways:

Type I -- Subunit Vaccines
For this type, the gene responsible for producing the antigen is snipped from the pathogen and spliced into a host.  The host is then cultured, which allows it to produce the antigen.  The antigen is then purified and becomes the vaccine.

Type II -- Gene-deleted Vaccines
For this type, one or several genes are removed from the DNA of the pathogen to decrease its pathogenicity, or rather, it's tendency to produce the disease.  The pathogen is cultured and used as the vaccine.

Type III -- Vectored Vaccines
This is the most complicated type.  The genes from the pathogen that are associated with protection from the disease are isolated and then inserted into a gene-deleted host.  This host replicates, is purified, and then used as the vaccine.  The host organism enters various cells in the cat and 'infects' the cat with the protective genes.  Canarypox is often used as the vector (host) and was licensed for use in rabies vaccines.

This article is the tip of the iceberg when it comes to recombinant vaccines.  It was written as the concept was just beginning to be widely studied, in 2001.  From my limited reading of newer articles, the recombinant rabies vaccine is considered safe, very effective, and without a risk of sarcoma.  I hope to have time this summer to do more reading on this topic.

Cats: Vaccines and Veterinarian Liability

I only summarized this article because some times when a cat has a reaction to a vaccine, the owner immediately wants to sue the vet.  This article, The Potential for Liability in the Use and Misuse of Veterinary Vaccines by Duane Flemming, DVM, JD (p 515-523 in Vol 31, No 3, Vet. Cl. of NA: Small Animal Practice, May 2001) clearly explains what a vet legally can and cannot do with regards to liability and vaccines.

Basically, a vet's liability regarding vaccines comes down to 3 questions:
1. Did the vet use the vaccine in accordance with standard veterinary practice?  Do other vets reasonably use it that way?  This does not mean the vet followed the labeling guidelines, but that he followed common practice.

2. Did he obtain informed consent?  Did he tell the owner that there was a risk of adverse reactions?  The owner should have been made aware of what the benefits and risks of the vaccines are and if there are options.

3. Did the vet provide undue warranty?  Did he claim that the vaccine was 100% effective?  Basically, no vaccine is 100% effective for all cats.  For example, the calicivirus vaccine lessens the infection but does not prevent it.

Cats: Vaccine-Related Sarcomas

This was a relatively short article and one topic, thankfully, that I have never experienced.  Since many of my cats do come from unknown backgrounds, I do suspect that some are at risk, but so far, so good. 

Recent Advances in the Treatment of Vaccine-Sarcomas, by Gregory K. Ogilvie, DVM
p 525-533 in Vol 31, No 3, Vet. Cl. of NA: Small Animal Practice, May 2001...

The article focuses on the diagnosis and treatment of the sarcoma and not on the fact that vaccines seem to cause sarcomas.  The latter is assumed by the article. The article doesn't mention, but from other sources the sarcomas are linked primarily to FeLV and rabies vaccines.

Physical exam -- The sarcoma appears as a lump or thickening either at the injection site or, interestingly, on the underside of the cat (migration of vaccine agent).  The lump can appear from days to years afterwards. This timing, days to years, is a bit scary since I do not know the vaccine history of many of my cats.

Evaluation -- The first step is a needle biopsy to confirm that it is a sarcoma.  The next step is xrays to determine if it has metastasized.  Enlarged lymph nodes may need to be biopsied.

Treatment of small tumors -- The recommendation is for a 2cm cuff around the tumor and 1 skin layer deeper.  2cm on both sides is HUGE!  The author mentions the inconclusiveness of both chemotherapy and radiation therapy, and from other sources, this does not seem to have changed significantly in recent years.

Treatment of large tumors -- The author recommends surgical reduction of the tumor followed by radiation treatment.

Metastatic sarcomas -- Chemotherapy seems to be the solution but at the time of writing there was no clear recommendations.

Patient Management -- The author stresses the need to give the client pain meds, anti-nausea meds, and appetite stimulants to help the cat.  Also, the client should be given written instructions and educational material because owners often are very upset when told their cat has cancer.

Prognosis -- For small, non-metastatic tumors, the prognosis is good.  Otherwise, the outcome is usually not good as the tumor recurs.  Who does the surgery and how extensive it was drastically influences the outcome:

"The median time of tumor control was 94 days.  Median tumor control for tumors treated with excision performed at a referral institution (274 days) was significantly longer than that for tumors excised by a referring veterinarian (66 days).  A radical first excision yielded significantly longer median tumor control (325 days) than did a marginal first excision (79 days)..... Few cats (13.8%) receiving only surgical treatment had long-term (>2 years) survival, suggesting that radiation and chemotherapy are highly indicated as adjunctive therapies."  And this is an interesting statement about radiation and chemotherapy given what the author said previously about the inconclusiveness.

These vaccine-related sarcomas are the reason the new vaccine protocols recommend vaccinating for rabies and FeLV in the legs or even tail -- those parts can be amputated to save the cat from the sarcoma.  To me this is very drastic and makes me ever so grateful that I don't have to vaccinate for rabies of FeLV.

Cats: Adverse Reactions to Vaccines

One of the major objections to vaccines by many people who do not vaccinate their cats has to do with reactions to the vaccines.  I know from personal experience with my cats that most cats have little reaction to vaccines, but for others, the reactions can linger for 3-5 days, cause vomiting, and cause stiffness.  I have also heard of much stronger reactions, to the point of death.  (I also acknowledge that some of the reactions may be overstated by upset owners, but still....)

This article, Vaccine-Associated Adverse Events, by E. Kathryn Meyer, VDM (p 493-514 in Vol 31, No 3, Vet. Cl. of NA: Small Animal Practice, May 2001) was interesting for several reasons.  First because it explained how the reactions are noted in the licensing of vaccines.  And second because of the range of reactions which the author admits to.  This latter is especially interesting because in personal conversations with various vets, I have been clearly told that there are none or almost no reactions to vaccines.

General Background on How Vaccine Reactions are Studied

Prelicense Studies:  These are trials conducted by the vaccine manufacturer, involving a small number of animals.  With cats and Chlamydia for example, there are 20 vaccinated cats and 10 control cats.  To get a label claiming prevention, the vaccine must be 80% effective.  Each vaccine batch must be in vitro tested for potency. 

The duration of immunity (DOI) determines the revaccination interval, but DOI studies are not required to support vaccine label recommendations for boosters.  This seems a bit inconsistent to recommend boosters without any evidence that boosters are needed.

The safety of a vaccine is determined by a larger field trial, which may or may not capture adverse reactions which are rare.  If there are adverse reactions observed, these are NOT required by law to be on the vaccine label.

Postlicense Studies:  “systematic monitoring of canine and feline infectious disease, with the exception of rabies, is not routinely performed”.  So, in essence, one cannot say that statistically the use of the herpes vaccine has decreased the incidence of the disease, although common observation would say it does. 

Reactions after licensing also do not have to appear on the vaccine label (except in certain specific cases with dog vaccines) and manufacturers are leery of doing so because it creates the image that their vaccine is unsafe.  The postmarketing surveillance is mainly by passive systems in that the vet contacts both the manufacturer and the USDA, but the few vets do this and in most cases (97%) they will report problems only to the manufacturer.  In 2001, the USDA Center for Veterinary Medicine was going to publish a rule requiring industry reporting of adverse reactions.  It does not seem this rule was ever published because (a) I could find no reference to this rule in vaccine discussions after 2001 and (b) as late as last year, reporting of vaccine reactions still was on a voluntary basis by the individual vet.

Adverse Reactions

Systemic Reactions: Nonspecific Systemic Reactions
This is anorexia, lethargy, fever, and soreness from 1-36 hrs after inoculation.  Most cases are mild, but a few are severe, and are presumed to be an immune response to the vaccine.  In a clinical study, the rate was 1.2% with cats older than 1 year and cats receiving multiple vaccines at greater risk.  The implications of this seem to be that a previous vaccination as a kitten may very well prime the immune system to react to the vaccine.  Also, this seems to be in alignment with many holistic vets' recommendation not to give multiple vaccines at one time.  For example, vaccinate for FeLV one month and rabies the next month, instead of all at once.

Systemic Reactions: Anaphylaxis
This is a reaction involving the lymph system (IgE mediated) involving the skin, intestines, and lungs.  The reaction can last up to 48 hrs and may require steroids, antihistamines or epinephrine.  In a study, 0.26% of cats had an anaylaxic reaction with 66% of those involving the intestinal tract, 22% respiratory, and 12% skin.

Systemic Reactions: Autoimmune Disease
Interesting, there are no reports of vaccines triggering an autoimmune disease in cats, only in dogs.  The time frame was 2-14 days and involved problems like hemolytic anemia.  My personal, non-vet opinion, is that some of the autoimmune diseases, such as IBD, are actually triggered by over-vaccination, but as the author clearly stated, there is no evidence for this view.  Then again, proving causation between a vaccine and a long-term immune problem would be difficult at best.

Systemic Reactions:  Immunosuppression
One study showed that some kittens vaccinated with an intranasal modified live panleukemia vaccine became immunosuppressed which lead to a systematic infection by Salmonella. When I think about this, this is not surprising since a vaccine works by challenging the immune system.  If the immune system is working to fight off panleuk then other bacteria and viruses can easily be overlooked by the immune system.

Systemic Reactions:  Vaccine Virulence
Modified-live vaccines (MLV) can cause reactions similar to the disease.  Calici and herpes MLV are well known to cause sneezing and sniffles 4-9 days after proper vaccination.  Calici MLV can cause ‘limping calici’.  With pregnant cats, MLV can cause fetal abortion or developmental problems. There are reports of MLV for rabies not being inactivated enough that it actually causes rabies.

Systemic Reactions: Product Contamination
Each batch of vaccine is tested for other viruses, fungi, mycoplasma, and bacteria.  Vaccine contamination still does occur and when it does, it affects a large number of animals.  But there are no specific statistics on how wide-spread the problem is.

Local Vaccine Reactions:  Pain
In cats, lameness lasting for a few days to several weeks is not uncommon since vets are now vaccinating in the hind limbs.  The lameness is from an inflammatory response.

Local Vaccine Reactions:  Benign Swellings
These swellings are not considered an adverse reaction by many vets, but the normal reaction.  Rabies vaccines in cats accounted for 72% of reported ‘benign vaccine lumps’.  In a small study of 9 cats, all cats developed them after rabies, only 1 after FVRCP, and none after FeLV.

Local Vaccine Reactions:  Injection Site Sarcomas
This was a topic of a separate article and will be dealt with there.

Local Vaccine Reactions:  Vaccine Site Alopecia
Most reports of hairloss at the injection site are related to rabies vaccine.

Local Vaccine Reactions:  Abscesses
With cats, the reports were linked to ringworm vaccinations.  As a side-note, the ringworm vaccine was never common and now seems to be unavailable in the US.

Local Vaccine Reactions:  Intranasals
Problems involving the FVRCP vaccine include nasal ulcers, oral ulcers, and eye ulcers.

Cats: Recommended Vaccines and Vaccination Schedule

This is a summary of the article:

Feline Vaccination Guidelines, by James Richards, DVM, and Ilona Rodan, DVM, p 455-472 

in Vol 31, No 3, May 2001, Veterinary Clinics of North America: Small Animal Practice

The development of the guidelines was based on the overall goals of vaccination.  These are “to vaccinate the largest possible number of individuals in the population at risk, vaccinate each individual no more frequently than necessary, and vaccinate only against infectious agents to which individuals have a realistic risk of exposure and subsequent development of disease.”  Kittens, which are more susceptible to severe infections, are the primary target and because of the maternal antibodies, they require a series of shots to develop proper immunization.

Use of polyvalent vaccines, that is, vaccines for more than one disease, is discouraged except for the 3 core vaccines (herpes, calici, and panleuk).

Feline Panleukopenia (FPV):  Because the virus can remain in the environment for over a year and because it has a high mortality rate in young cats, vaccination is recommended for all cats.  Maternal antibodies interfere with vaccination in kittens under 12 weeks.  Most vaccinated animals are 100% protected, although intranasal vaccines may not give complete protection. There are studies showing the duration of immunity (DOI) is at least 7 years. The vaccine for FPV does protect cats against canine parvovirus-2b, which can infect cats.  There are no associations with tumors.  Kittens and pregnant queens should not be vaccinated with modified live vaccines because of neurological development problems.

Feline Herpes (FHV-1) and Feline Calicivirus (FCV):  These two cause about 90% of respiratory problems in cats and are highly contagious.  Both are self-limiting in adults, but can be fatal in kittens.  Maternal antibodies interfere with vaccination in kittens under 12 weeks.  DOI is at least 3 years.  Vaccines reduce the severity of the disease, but do not prevent infection.  Topical vaccines (intranasal or conjunctival) are useful for cats placed in situations with ongoing URIs such as shelters and can be given to kittens as young as 10 days.  There are some reports of mild reactions, but no reports of sarcomas.

Rabies: Rabies vaccination is highly recommended for all cats and is required in some places.  The adjuvanted vaccine [adjuvanted means a vaccine with something added to increase the immune response] is associated with vaccine-reactions, such as swellings and with sarcomas.  When this was written, all rabies vaccines were adjuvanted, except for the recombinant form.

Feline Leukemia Virus (FeLV):  Vaccination should be based on age (cats under 4 months are most at risk) and risk of exposure (outdoors or mixed -/+ households are most at risk). Vaccination is NOT recommended for older (> 5 months) cats with little exposure [indoor older cats].  Different brands of vaccine vary in their immune response – separation of infected cats is a better alternative to vaccination.  The vaccines have been associated with fibrosarcomas.  DOI is about 1 year, requiring annual booster shots.

Chlamydiosis:  This bacteria causes conjunctivitis and respiratory problems, which respond well to antibiotics.  As with herpes and calici, the vaccine only lessens the effects, but unlike them, there are frequent reactions to the vaccine.  Because the reactions seem to outweigh the disease, vaccination is not recommended except where Chlamydia has been confirmed.

Feline Infectious Peritonitis (FIP):  The vaccine has two major problems.  First, the vaccine should not be given before 16 weeks of age, by which time most kittens are already infected with the coronavirus.  Second, “there is no evidence that the vaccine induces clinically relevant protection” – in basic, it doesn’t work.  Thus, it’s not recommended at all.

Dermatophytosis (Ringworm):  The vaccine does lessen the duration of ringworm infection and perhaps reduces the spores produced, but will not prevent infection.  DOI is unknown.

Bordetella bronchiseptica:  This causes respiratory problems, can occur into upto 80% of cats from shelters and multi-cat homes, and is self-limiting [cats routinely recover without medication].  At the time of writing [late 2000], there were no independent studies on this vaccine for either effectiveness or DOI.  It is only recommended for multiple cat environments like shelters, catteries, board facilities where Bordetella is known to exist.

Giardia:  This is a protozoan which can cause acute gastric upset.  The vaccine was not recommended for all cats as it was not proven effective in wide trials [as of 2000], but in licensing trials, the vaccine was shown to shorten the duration of diarrhea upon exposure and the length of cyst shedding.  It should be considered for cats in areas with giardia exposure.  DOI is 1 year or longer.

These guidelines were in 2001 very controversial as most vet schools were still teaching that vaccines had to be given annually to ensure immunity.  Likewise the comment that multiple vaccines should not be given at once, except for the main 3 core vaccines, which would eliminate 5-in-1 shots.

The actual vaccine schedule given in this article was later adopted by the American Association of Feline Practitioners and is given below.  Essentially, it is the same, only the timing of the kitten shots has changed and the deletion of vaccines which were deemed not necessary, such as ringworm.

Reading this article confirmed to me that my decisions regarding with respect to vaccinations are okay.  I say okay because I can see there may be a slight potential for improvement.  For most of my cats, I do not vaccinate at all.  They are older, come from shelters which always do the core vaccines on intake.  My cats are all indoors with no FeLV+ cats and no exposure to rabies.  So there's little reason to vaccinate them.

Bodhi, my kitten, may need a booster for the 3-in-1 core vaccines because he is a 'baby' and because he goes to cat shows.  Peaches I will have to think about since she goes to shows but she's older so I don't know.  It's the 'high exposure, stressful situation' in the comments that bother me because of the cat shows.  And Langston, who got his kitten shots at ~1.5 yrs, might benefit from a booster.

This Blog, Facebook, and a New Direction

For some time, I've been wondering what to do with this blog as I don't want to delete it but I don't have time to do a lot of writing for it either.  My Facebook group, Feline Health Research Group, seems to have taken most of my free time between answering questions and reading articles to summarize.  The big problem with Facebook, other than the personal threats, is that searching on there is a joke.  This blog, however, is indexed by Google and is very searchable....

So, I'm going to transfer some of the summaries of articles I wrote for the FHRG to this blog. Not only will the information eventually be searchable, but I can change types, add photos, add links, etc.  I can also do a bit more digging on some topics and add more to the articles, usually newer information.

Cats: Raw Food and FIP

Several cats helping clean the bowl after making the food

A friend asked me, as someone who has done extensive research on raw diets and who has fed raw for years, to comment on cats with FIP (feline infectious peritonitis) and raw diets.

One major arguments against feeding a FIP cat raw is with regards to the usefulness of raw diets.  No, there is no scientific research on the benefits of raw for FIP cats or any other cats because there are no scientific studies on raw vs. commercial.  There are the Pottenger's studies from the mid-1940s on raw vs. cooked diets and there are a lot of anecdotal evidence by long-term raw feeders, neither of which are rigorous scientifically.  But while there is no evidence to support it, there is, likewise, no evidence to not support it.  The concerns the veterinary community has against raw are not based on any scientific evidence to date. The lack of evidence can not and should not be construed to mean anything other than there is no research on the topic.

The second argument against raw is that no one has adequate training to judge the appropriateness of a raw recipe except a veterinary nutritionist.  I take offense at that.  I personally have the biochemistry, the statistics, the nutritional training, and, much more importantly, the experience of 25+ yrs of raw feeding to look at and analyze a recipe for the level of thiamine (1.4mg/1000 kcal ME).  It's not rocket science to take the food components and add up all the vitamins and minerals and then compare them to published requirements -- it's tedious, but this is how researchers do it.  (Many veterinary food researchers are not veterinary nutritionists, but nutritional researchers, some without a veterinary degree.)  There is in fact one

THE book on nutritional requirements for cats

company on line that will analyze raw recipes for all nutrients.  So, if someone does have a recipe, they can have it analyzed, or they can do it themselves, or they can ask those of us who have been feeding raw for years to look at it.

I would remind whoever that the general vet has 1 semester of small animal nutrition (cats, dogs, gerbils, and parakeets).  Vet nutritionists are better trained, but there are only a handful of board-certified ones in the US in private practice (ones with 2 yrs of extra training) -- many of those that are calling themselves nutritionists are not certified.  I had the opportunity to talk to one and was left very unimpressed by his knowledge on feline nutrition -- he was brilliant on canine nutrition, but dogs are not cats.

On a side note -- concerning the whole idea that a layman can't make cat food, I have fed my present recipe for ~15 yrs with no nutritional problems.  The recipe I use is borrowed from Michelle Bernard at Blakkatz Raw Recipes.  (Michelle used that recipe for a good 10 yrs before publishing it and raised champion American Shorthair cats on it.)  I have done nutritional screenings on my cats and there are no deficiencies or excesses.  I have analyzed this recipe and someone else had it analyzed by the company mentioned above -- it's fine.  This recipe also has been 'blessed' by my vet, 3 other vets of friends, and was deemed 'perfect' in terms of nutrition. While there are some whacko raw food recipes out there (ones that claim no supplements are required), there is at least one that is fine.

The third argument against raw is the issue of pathogens in the raw food.  Yes, this risk is there.  Given the number of recalls for canned and kibble foods, the risk is also there and of a much more serious nature since the pathogens found in commercial food seem to be of more virulent strains. But back to raw -- not only is the cat digestive system shorter so the bad 'bugs' have less time to colonize, the acid in the stomach is stronger so many of the pathogens that would sicken humans are destroyed by the cat's stomach acid.  I deal with medically fragile Persians from large public shelters and they all get transitioned to raw.  In the 25 yrs I've done raw, not one cat has had any food-borne illness from my raw.  Among my raw-feeding friends including owners of FIV and FeLV cats, not one of them have had problems either.  If you start with human-grade meats and handle it properly, the risk is minimal.

With respect specifically to pathogens, raw, and FIP, the argument is that the cat's immune system is already stressed so the pathogens are more problematic.  That sounds good, but the immune system in a FIP is over-reactive, not under-reactive.  Cats die from FIP not from secondary infections as they do with feline leukemia, but from the immune system destroying the cells of the body.

So, the bottomline is this -- if I had a cat with dry FIP, would I switch the cat to raw?  Probably yes.  I do not see any harm in a raw diet and I have seen major benefits from it in cats with IBD, diabetes, FeLV, and FIV.  If the cat was already showing symptoms, then maybe not if the cat was hesitant to eat the raw -- I would prefer to have the last weeks of the cat's life to be as free from stress as possible.  As for the wet FIP, no, I would just love the cat until it dies.

Cats: Causes of Chronic Renal Failure

What causes chronic renal failure(CRF) or chronic kidney disease(CKD)?  That is one of the most important questions that remains unanswered in veterinary medicine.  The problem, as I see it, is the cause in one cat may be different from the cause in another cat, which may explain the different progressions of the disease.

A small percentage of cats with CRF have this disease clearly because of genetic problems.  In Persians and related cats, the PKD (polycystic kidney disease) gene goes produce kidney failure due to the growth of multiple cysts in the kidneys which eventually are destroyed by the cysts.  Similarly, amyloidosis is a genetic disease in Abyssinians, Oriental shorthairs, and Devon rexes.

With the exception of genetic problems, the causes of CRF are not clearly known, but there is a list of potential causes.

1.  The after effect of acute renal failure.  Often any type of acute renal failure will scar the kidneys enough that full function is never restored.  With prompt treatment, some of these cats can reach a status where the damage does not lead to more kidney problems.  With others, the damage is too much and the scarring seems to hasten the development of CRF.  This latter group experiences a feedback cycle of lowering kidney function which leads to more stress on the kidneys which leads to lowering the function more.

2.  Immune problem which attack the kidneys.  The main two agents in this category are FeLV and mycoplasma polyarthritis (haemobartonella – feline infectious anaemia).

3.  Infections in the kidneys.  These range from chronic bacterial, to viral (FIP, FIV), to fungal.  Untreated, these infections interfere and then destroy the kidneys’ ability to function.

4.  Cancer.

5. Mechanical problems, such as large kidney stones, granulomas, or even the occasional cyst.

6. Idiopathic – no known cause.  This is, unfortunately, for most cats the ‘cause’ of CRF.   As late as 2 years ago, researchers still had no clear clue as to the causes (and there are probably multiple causes) for the development of most cases of CRF/CKD.  See http://www.ncbi.nlm.nih.gov/pubmed/21262581 

What is interestingly missing from this list is food.  As I will explain in a future post, the moment a cat is diagnosed as having CKD, many veterinarians ask clients to switch the cat to a low protein food.  A few vets and some pet owners have taken this a step further and argued that the protein level in a cat's food should be restricted to prevent CKD from developing.  While researchers have looked into this, there is no scientific support for limiting protein levels to prevent CKD and there are a number of reasons why this could lead to other health problems.

Cats: Demographics of Chronic Kidney Disease (CKD)

One of the leading causes of death among cats over 10 years old is chronic kidney disease (CKD), which is when the kidneys slowly lose functionality.  A note about the name of the problem:  A decade ago, this was called chronic renal failure (CRF) because it involved the kidneys failing over a long period, as opposed to acute kidney failure.  In recent times, the preferred description is chronic kidney disease (CKD) because this name emphasizes the idea that many cats can live with diminished kidney function for years.  I became a 'cat person' when CRF was the term to use and often use that in preference to CKD, but I will try to follow the veterinary trend and use CKD.

Emily -- died of complications due to CKD

In terms of who is getting CKD, the ratio of females to males is 1.06:1, with a population ratio of 1.15:1.0, so females are a tiny bit less likely to get it than would be expected.

Some of the purebreds, eg. Birmans, British shorthairs, and Angoras, seem to be over-represented.  For example, DSH was 11.7%, Angora was 36.4%, Persians 9.9%. This could be either due to the owners of these cats being more able to do repeated early testing, or some yet-to-be discovered genetic factor, or small sample sizes on the rarer breeds.

In researching this topic, I ran across an interesting and horrifying statistic on the incidence of CKD.  In 1990, the estimated rate of CKD was 16 cases for every 1000 cats examined.  Looking at just the older cats, the rate was 77 per 1000 for cats over 10 yrs and 153 per 1000 for cats over 15 years.  The same type of study was conducted in 2000.  For cats of all ages, the rate increased to 112 per 1000, for 10 yrs or older 269 per 1000, and for 15 yrs or older it was 491 per 1000.

While some of this is due to the increased awareness of CKD and the importance of early detection, it is my opinion and the opinion of my vet that there has been an actual increase in the rate.  My vet started practicing in the mid 1980s.  She says she saw CKD in cats 12 yrs or older, but not at a high rate.  This summer we got discussing this and now she is seeing cats as early as 8 yrs old having the same symptoms and bloodwork as the 12 yrs cats in the 1980s.  She also commented that she now expects any cat over 15 to have CRF and is surprised when they don’t.  (She’s in awe of Dante at ~22 with no CKD!)

So, the question becomes what has changed in the last 20 years.  While one might want to blame inbreeding among some purebreds as a cause, this would not explain the increase among randomly bred cats, namely DSH and DLH.  My vet and I agree that there have been 2 significant changes which MAY explain part of the increase.

1.  Vaccines.  In the 1970s, most cats were not vaccinated.  In the 1980s, there were pushes to vaccinate cats for a variety of things.  By the 1990s, cats began to be vaccinated for 5-8 different diseases each year.  Some of the vaccines are grown on kidney tissue, which has lead to the speculation that the residue proteins from the kidney tissue in the vaccines may actually be causing inflammation of the kidneys which then leads to CRF over time. 

This actually has been researched (2005) and the conclusion reached was “Parenteral administration of vaccines containing viruses likely grown in CRFK cells induced antibodies against CRFK [Crandell-Rees feline kidney] cell and FRC[feline renal cell] lysates in cats.  Hypersensitization with CRFK cell proteins did not result in renal disease in cats during the 56-week study.” (http://www.ncbi.nlm.nih.gov/pubmed/15822597)  Now, on the surface, this seems to rule out that vaccines are related to CKD.  Looking at the methodology, I do begin to wonder.  First, only 14 kittens were used.  Not only was the numbers low (14), but these began as 8-week old kittens which means the kidneys and other organs were still growing.  Second, they received 4 FVRCP vaccines at 0, 3, 6, and 50 weeks.  Basically one year of vaccines.  Third, the study concluded at 56-weeks, which is only 6 weeks after the last vaccine.  No one is saying that a vaccine causes immediate detectable damage, so 6 weeks seems far too short.

A different study (2006) did produce interesting results.  Researchers sensitized cats to CRFK lysates (remains of cells) and several cats did develop lymphocytic-plasmacytic interstitial nephritits after 2 years. (http://www.ncbi.nlm.nih.gov/pubmed/16713319 )  A study from 2010 confirmed that vaccination with FVRCP vaccine grown on CRFK (kidney tissue) does produce antibodies after 2 years which have been associated with nephritis in humans. (http://www.ncbi.nlm.nih.gov/pubmed/20136712 )

So, bottomline… There is no clear evidence that vaccines cause (and I mean this is a statistical sense) CKD.  There seems to be evidence that vaccines grown on kidney tissue do cause antibodies against that tissue which (speculation here) may lead to antibodies against all feline kidney tissue which leads to CKD.  What I don’t know (because I don’t follow vaccine stuff) is how common it is for FVRCP to be grown on kidney tissue or if there are other options.

2.  Food. (And note: this is MY pet theory which my vet agrees with now.)  When meat is processed into cat food, the proteins undergo a structural change when cooked.  They are denatured – like the clear egg white cooked becomes white opaque solid.  The cooking process also can create partially denatured proteins.  My personal opinion is that these denatured proteins and especially the partially denatured ones are not easily nor thoroughly digested but are absorbed anyway into the blood stream.  There, the kidneys then must filter out these forms of proteins which they were not designed to handle.  (Think of putting diesel fuel in a car instead of gas.)  These ‘foreign’ proteins then begin to clog the tiny tubules in the kidneys which then lead to more problems and eventually full scale CKD.

My evidence for this is twofold.  First, 40 years ago, the rate of CKD seems to be exceedingly low and many cats were let outside to catch mice, etc.  As the commercial pet food industry grew, so has the rate of CKD.  Yes, this is guilt by association and not causation.

Second, I have observed in my CKD cats virtually none of the secondary problems associated with CRF even in cats that are in stage IV.  My CKD cats in stage IV live an average of 4 years.  I have taken cats in stage IV, put them on raw, given no fluids, and have had the creatinine level drop so that the cat was as low as stage II.  The only explanation I can give is the raw food has a purer protein which spares the kidneys further damage.

Are there other things that may cause problems?  Sure.  Some drugs are excreted via the kidneys and when given in large enough doses can cause kidney failure.  The question remains for some of these drugs what are the long-term low dose effects on the kidneys.  I’m one of ‘those’ people that given any drug, if it can possible affect the kidneys, I immediately ask for an alternative.  Other things, such as water impurities, do affect kidneys both directly and via stone formation.  Scented oils seem to be more of a liver function problem.

Cats: The Use of Folate (vitamin B9)

Folic acid is one of the B vitamins (B9).  It is absorbed in the jejunum and ileum (the middle and last sections of the small intestine), and transported to the liver which either releases it for circulation or stores it.

Gratuitous photo of Spencer 

A deficiency can cause reduced growth in kittens, anemia, neurological development problems, and changes in the bone marrow. It was the relationship to anemia which led to its discovery and to its importance with cats.  As many know, CRF cats often are anemic.  Many owners and vets will give B12 injections to help solve the anemia.  Sometimes this works and sometimes it does not.  When it doesn't, the cause of the anemia may not be low B12 levels, but instead low folic acid levels.  B12 and folic acid work together and both must be present in sufficient amounts to prevent or correct some forms of anemia.

What this means is if you are using B12 for anemia, use mixed vitamin B for the injections and not just B12.  While the cat may have enough folic acid (and other B's), excess folic acid has not known effects.  It is water soluble and so easily removed from the body.

As it is stored in the liver, cats with liver disease often are deficient for folic acid and would benefit from supplementation.  In one study of cats suffering from GI problems (including liver and pancreas problems), 38.8% had low folate levels. http://www.ncbi.nlm.nih.gov/pubmed/17392004

There also are connections between folate levels in the blood and intestinal absorption, bacterial overgrowth, and exocrine pancreatic insufficiency (EPI).  These connections can help with differentiating various gastrointestinal issues.  http://www.ncbi.nlm.nih.gov/pubmed/21596348 

In brachiocephalic dogs, the supplementation of folic acid in pregnant bitches decreases cleft palates significantly.  I could not find any information on this for cats, like Persians, but as neural tube development in mammals seems to be folate sensitive, I would presume cats are equally likely to have this type of developmental problems when folate levels are low.

What all this means is this: 
-- for anemia, you should use mixed vit B and not only B12

-- for cats with liver issues, you should supplement with folic acid

-- for pregnant cats, you should a well balanced food with sufficient folic acid

Cats: The Use of MiraLax

My Robbie has a problem with constipation.  This may be due to low motility of his colon, or thickening of his intestinal tract as part of the development of intestinal lymphoma, or simple dehydration.  Whatever is the exact cause, the result is his feces are very hard and dry.  They don't come out easily, so he will strain for over an hour which in turn causes him to vomit.

Not the most pleasant thing at 3 am.  Or any time really.  And since this is nearly identical to what happened to Bertie, who died a year ago from lymphoma, it's hard.

Thankfully, someone suggested MiraLax, which is the trade name for polyethylene glycol 3350.  It's classified as an osmotic laxative, because it works by pulling water into the intestine to make the feces softer and easier to pass.

The only concern is the warning on the bottle:  "Do not use for more than 7 days."  My main concern was that it might prevent some nutrient being absorbed.  After some research and some discussions with people who used it on cats, it seems this warning is for two things:

1. To encourage people/owners to have problems checked out if the problem does not resolve itself.  Or in simpler terms, the company is covering its legal ass if there is a major undiagnosed problem.  Okay, with Robbie, I know he's got intestinal issues and maybe the beginnings of lymphoma.
2. To prevent dehydration and electrolyte imbalance.  This is very reasonable since it does pull water from the body.  And the fix is simple -- give him fluids with electrolytes.

So for the last couple of weeks, Robbie gets 1/4 tsp of MiraLax and 50 ml of fluids every other day.  The MiraLax is dissolved in 1-2 tsp water syringed into his mouth.  The 50 ml of fluids is lactated ringer's solution given subcutaneously. He neither minds the syringed fluid (which seems to have no taste) nor the sub-Q fluids.  And the results have been great!  He now has firm but not hard feces which pass easily.

In my discussions, some people have used upto 2 tsp of MiraLax daily for several years without any reported problems.  This is encouraging so if he starts having more issues then I can up the dose.

Now, to me, this was what the internet was designed for -- I had a problem, people shared their experiences, some shared links, and everyone learned more.  There was no nastiness.

Day 2 Post(?) Facebook: Recap

Another pretty good day, although I didn't get everything done and it ended badly.  Of the 3 things on my 'must-do' list, I did get the dishes done and my studio cleaned.  I did not get to the bathroom painting because the studio was a big mess.  It looks a lot nicer in here and there is more room, but it wasn't easy and I can still do more.

But I got sidetracked by a sick cat.  Robbie is constipated.  When a cat gets constipated, they can leak feces around the dry mass.  And that's what he did.  All over the bathroom.  All over the carpet in the bedroom.  All over the bed.  And then after I gave him Miralax for the constipation, he tried pooping and threw up.  So he go another dose of Miralax.  And since Miralax is an osmotic stool softener (pulls water into the colon), I now have to give him fluids.  I hate sick cats.

Day 1 Post(?) Facebook: Recap

Well, with a couple of suggestions and some trial and error, I have managed to get Facebook to work.  It still isn't working 100%, but I can use it.  I'm happy and upset by this all at once.  Happy because I know I would miss interacting regularly with some of my friends and miss help kitties.  Upset because part of me was looking forward to not using Facebook (I have a love/hate relationship with it) and because there is something just not right maybe with my computer. (Things should work so when they don't, I get horribly frustrated!)

In any case, I'm going to try to keep Facebook to a minimum, except for my cat health group.  I worked hard to create that group and it does seem to help some people, so I hate chucking it.

I must confess during the time I thought I was off of Facebook, I got a lot done.  I had 3 things on my to-do list and they all got done.

1. Took Tom to the bookstore.  He did well getting there and while we were there, but not so good once we got home.  He found some books, and of course, I found some.  His were mainly science fiction.  Mine were all over the place from self-help (and I really need a lot of help!) to historical fiction to some art books and of course a cat book.
2. Cleaned 4 litter boxes... Oh the fun and excitement!
3. Dug out the tai chi and weight lifting books.  I still need to figure out exactly what I will be doing for the weight lifting, but I also know I need to buy some equipment and find some area to do it in.  I would like to do it in the house, but the cats will help.  So, the garage?  The tai chi I will read over the beginning moves of the 24-forms and practice them tomorrow morning.  I'm thinking even during the school year, I could do the tai chi  and qigong in the morning before I go to work, then weight lifting or walking at night when I get home on alternate nights.

Plus, I got 3 loads of laundry washed, dried, and put away!  This kind of makes up for the fact I didn't do the dishes.  I know part of this is because I stated publicly that I would do this stuff but part of it is also because I didn't have to run and check if so-and-so posted a reply or what about that kitty over there or ....

So, I'm actually fairly pleased with today.

Alpha Lipoic Acid Toxicity in Cats

I tell people over and over -- cats are cats and not short fuzzy people, so just because something is okay in people, it may not apply to cats.  And then I go do it!  Geesh!!!

Dante

Dante, my 20+ yr old cat, is diabetic.  I control it mainly by food and supplements.  One of the the supplements I was giving was alpha lipoic acid.  It does a number of good things in humans and has almost no side effects IN humans, so I assumed it would be fine for him.

Last night I was reading about feline nutrition and came across a statement -- "dl-alpha lipoic acid is highly toxic to cats".  My jaw dropped open.  I reread it 5 times, then looked for any references which it didn't give because this was common knowledge, I guess.  So, I looked it up this morning.  And yes, indeed, it is toxic.  At distressingly low levels -- 30 mg/kg.  Dante weighs about 11 lbs or 5 kgs, so about 150 mg.  Maybe less.  I was using 150 mg capsule, divided up for 2-4 days, so at the most he was getting 75 mg, which is under the tested level, but maybe not under the effective level.  (The researchers tested at 0, 30, and 60 mg/kg levels.)  There was hepatocellular toxicity at the 30 mg/kg level, but maybe lower?  Until someone comes back and tries 10 mg/kg or 20 mg/kg, there will be the question of where the toxicity level lies.

The good news is it effects the liver, which can and does regenerate.  The other 'good' news is I gave it to him off and on, but mainly off because I never could remember to do it.  So, my laziness and forgetfulness may have saved him.

For a summary of the research, see Lipoic acid toxicity research

Cats: Feline Acne

In one cat group I belong to, there has been some recent discussion about feline acne and how to treat it.  The problem I see is most of cat owners and some vets don't distinguish between a cat with a dirty chin (henceforth called 'chin crud') and true feline acne.  The treatments are similar but not identical.

So, what are the differences?

Chin crud is often the build up bacteria and food particles on the hair of the chin.  A cat eats, gets a bit of food on the chin, and because the chin is hard to clean, the dirt allows bacteria to grow.  Over time, the bacteria creates blackish residue on the hair.  But, and this is key, the black crud is on the hair, above the skin, and not in the skin.

Since it's on the hair, this black crud can be washed off, usually with just water in a minute or two.  If there is

more fat in the food, a bit of isopropyl alcohol and/or soap will help quickly remove it.  Because it is bits of food and moisture mixed in with saliva to create black crud, it may stain white hair.

Wendy has this because her tongue hangs out, soaking her chin in saliva.  I use a flea comb to comb off the bigger pieces and then a cosmetic pad with saline for contacts to wash it.  Then I use EyeEnvy liquid and powder on the area.  If I do this ever 2-3 days, her chin will be spotless.  (Unfortunately, I often skip it during the week because I have such limited time.)

Feline acne is like human acne -- it is an infection in the skin.  The skin usually develops blackheads first.  The black areas are in the upper layer of the skin, as in the photo at the right.  Over time, some of these blackheads lead to pimples (or zits of pustules of infection -- which ever is your favorite term) which erupt from the skin. The chin feels lumpy when rubbed. Interestingly, the 3 cats I have had with feline acne had perfectly clean chin hair, as can be seen in the photo at the right and the one below.

Clearing up feline acne may take weeks to months.  Vets will often 'express' the pimples, which one can do at home and is rather disgusting.  But if the pimples are not intentionally popped, they will pop when you scratch the chin or when the cat rubs against objects.  The open 'wounds' do bleed freely and will create a mess. (On a side note, the expression seems in most cases not to cause the cat much discomfort.)  Once the infections are removed, the vet normally prescribes an antibacterial soap or medicine.

When James, Clancy, and Tolstoy developed this, I would express the pimples and then wash the chin with a dilute mixture of goldenseal extract.  The goldenseal has a natural antibiotic property, but it also stains the hair yellow.  (I could live with yellow chinned cats.)  Once I figured out the source of the problem, it took about 3 weeks for it to clear up.

So why is there a confusion?  Basically it comes down to careful observation and lack of distinction.  Most owners and some vets see the black crud and immediately call it feline acne.  They don't stop and determine it the problem is above or in the skin.  Then they treat it with antibacterial soap and it clears up -- not because it was acne, but because the soap killed the bacteria on the hair.

To some, this is splitting hairs.  (Sorry, I couldn't resist.)  The problem is once the owner stops the using the antibacterial soap and the crud comes back, often the vet then uses antibiotics.  I'm not a fan of antibiotics in general, and in this case, they usually won't work, so then the vet tries either stronger antibiotics or suggests steroids.  It comes down to treating a cat with some serious drugs for a problem the cat really doesn't have!

So where does chin crud and feline acne come from?  The most commonly sited explanation is plastic bowls.  And this is true, but not true.  The chemical nature of plastic itself has nothing to do with acne or chin crud.  The problem with plastic is it scratches.  Those tiny grooves allow bacteria to build up.  So for many owners, switching from plastic to ceramic helps.

In my case, my cats already have ceramic plates and stainless steal bowls.  With Wendy, the crud is a byproduct of her malformed jaw.  While I can help keep it clean (and cleaning her teeth will also help by decreasing the bacteria in her saliva), I will not be able to prevent it.

With James, Tolstoy, and Clancy, it was the food.  They got it in period where I was teaching full-time and going to college full-time, so I had little time to make food.  I would often mix canned food with my raw food to extend it.  Once I removed the canned food, the problem began to resolve itself.

Cats: L-Lysine

As I wrote in my post about herpes in cats, L-lysine is one of the few effective controls on the herpes virus.  The L-lysine works in one of two ways.

1. L-Lysine works by competing with the absorption of arginine. Arginine is necessary for the herpes to reproduce, but a cat can easily use the lysine instead of arginine. So, if the system is flooded with lysine, the herpes can't reproduce. 
2. A newer theory is the cat's cells need lysine to use the arginine in the cell. By giving the cat extra lysine, the cat is assured of having enough lysine to use up all the arginine in the cells, thus depriving the herpes of the arginine. No arginine, no little baby herpes viruses.  

Isabel

Which ever model is correct, 500mg is considered maintenance for a 10 lb cat, with 1000mg being recommended for stressful times.  Having said that, I also know from experimenting on Isabel, who does have herpes, that the levels need to be slightly higher for raw-fed cats.  Raw meat has a higher level of arginine in it, so more lysine is needed.  When she has problems, I have upped the dose to 1500mg for 1-2 weeks and this helps bring the herpes back under control.  (While lysine is fairly safe, there are some concerns about high levels, which would be 3000+mg for a cat, impair protein absorption and utilization.)

The lysine itself is available in 3 forms:

1. treats -- The treats are laced with lysine and many cats do like them.  The average cat needs at least 6 treats per day for maintenance (at least in one brand) and they are not cheap.
2. gel -- Similar to hairball remedy, lysine is available in a tube.  The gel, which has only a slight taste (yes, I tried it), is not objectionable to most cats.  None of mine will eat it off my finger, but if mixed in food or put in a syringe, they will eat it.  It is moderately expensive and because it is mixed in a wet medium, it does expire.
3. powder -- The powder itself comes in 3 forms.  Capsules of pure lysine from a health store.  The capsule is opened and spread on wet food.  Bulk lysine (for people) in a jar from a health store or online.  Usually 1/4tsp is 500mg.  And lysine powder for pets.  The lysine for pets is the cheapest and may work for most cats, except, of course, one of mine.  The lysine is listed as "in a palatable flavor base" and that's it.  This is one of my problems with 'pet' supplements -- the labelling is much less strict.  The "base" turned out to be whey powder, which Clancy cannot tolerate.  I put one dose on some food and within 30 minutes his face was swollen, he was drooling, and he was lethargic.  He did survive and he can tolerate lysine -- pure lysine -- so it was the whey powder which caused the problem.

In general, cats do tolerate the lysine well.  I have heard some people say their cats do not tolerate it and get either diarrhea or vomiting.  I am curious to find out what form they tried and if that was not the problem as opposed to the lysine itself.

Clarissa Woes, Part 2

The last week or so have been a nightmare!  Clarissa, my tiny tortoiseshell Persian, had another spell of vomiting and not eating, similar to what she had a month ago.

Similar, but not exact...

She started by not eating all her food, just like last time.  Then she stopped eating or would eat and throw up shortly after, just like last time.  So, I'm thinking, "Oh, just like last time.  Wait and she will be fine."  So I did not panic and I waited.  I gave her some laxative hoping that the hairball would move on.  And then I waited more.  Only this time, on occasion, she would eat and be fine, or she would eat and throw up watery stuff about 2-3 hours later.  Not like last time...  And it dragged on....

Finally, she refused to eat -- even the baby food.  So, I finally took her to an ER clinic to see a vet that does acupuncture.  The thinking was the x-rays last time showed her internal organs were basically normal and her blood work was normal, so conventional medicine could do little more.  Besides, honestly, I did not want her to be man-handled like she had been.  Anyway, the vet gave her a treatment and some serenia pills.

So on Monday I was expecting good things, like her eating.  Nope...  In fact, she pulled back from the food without licking it.  Not a good sign!  (This is a non-scientific indication of the beginnings of liver failure.)

Finally called my homeopathic vet and of course got the receptionist.  I told her my name and that I needed to leave a message for my vet -- PANIC.  (Just one word, all capitals.)  Worked -- vet called back in 30 minutes.  We worked out a plan...

AND IT WORKED!!!  What we did was give her a small dose of prednisone for inflammation, the serenia for nausea, sub-q fluids for any lingering constipation, and B12 for an appetite stimulant.  Clarissa is now back to eating.  And I can breath....

So, why?

It goes back to the hair again.  She grooms a lot, so she gets hairballs.  Unlike my other cats, she doesn't throw them up, so eventually they form a blockage.  This time, I got at least part of the hairball to move, but some of it probably stayed and irritated the stomach or small intestine.  The irritation led to the vomiting.  Eventually, the vomiting caused the gag-reflex to be set to a lower threshold, so any minor problem caused her to vomit.

The key will be to prevent the hair from being ingested and to keep ingested hair moving through.  For the latter, once she's stabilized, I will add pumpkin, psyllium, or tater skins to her food, depending on what she will eat.  (I'd rather do this than constantly give her laxatone.)  To prevent the hairball from forming, I will go back to grooming her daily and bathing every 2-3 weeks.  (This is basically what I was doing when I was showing her and she had no problems.)

I'm just so very glad we could get her sorted out before she did have liver failure.  And I promise never to complain about her pulling all the DVDs off a bookcase at 4 am.

Persians: Unhealthier than other Cats?

Isabel

 Are Persian cats overall unhealthier than other cats?  Interesting question and maybe not as simple as it seems.

The first problem with this question is to define "other cats".  There are mixed breed cats (mogglies) and then there are purebred cats.  I would suspect the answer varies depending on the comparison group.

The another problem is lack of data.  Vets in general do not report to anyone the number of visits by any type of cat.  My vets have made comments like, "We see that a lot in Persians", but this hardly can be translated in claiming Persians are more unhealthy than mogglies.

So, what one is left with is anecdotal evidence, usually based on cost.  Now, I have 6 Persians.  Here's their vet bills for the last year:

• Clarissa -- $700
• Wendy -- $400
• Olivia -- $150
• Isabel -- $150
• Spencer -- $0
• Anya -- $200

Are they more expensive than my mogglies?  Yes, but... here's the problem.  Two of my mogglies, Clancy and Dante, are CRF kitties which I treat at home for basically free.  So, do I include that in for comparison?  $150 per sub-Q fluids... The other thing to remember about my Persians, they are rescues and Clarissa, Wendy, and Isabel all had life-threatening issues when I got them.

Olivia and her mousy

I think, rather than pure cost, one should look at types of problems.  Olivia and Isabel had UTI which occurs in a lot of cats, so I don't think Persians have more problems than others.  Anya's bill was from a routine new cat check up.  Wendy's bill was from two things -- a scratched eye and digestive problems.  Now these are problems I might point to as more common in Persians.  Their eyes with no nose to protect them are so easily scratched.  

As for the digestive problems, well, Spencer can (and does) eat everything.  Wendy can eat poultry raw or Greenies treats -- anything else is a problem.  The difference probably comes down to breeding.  Spencer appears to be from better lines than Wendy and Clarissa, who probably are inbred.  The more inbred, the more problems such as severe food allergies.  Persians are somewhat inbred in general, but thanks to unscrupulous breeders, many are very inbred and so they develop these problems.  But this inbreeding could happen to any cat breed -- ask the Siamese enthusiasts.

Robby, domestic longhair

Another source of digestive problems is the hair.  Clarissa's bill was mainly from her $500 hairball of recent times.  But having had domestic longhairs, hairballs and digestive problems related to hairballs are not a Persian-only problem.  Any long-haired cat has issues!

Now, two areas that I do think are Persian problem areas are their noses and their teeth.  Both are from their  flattened faces.  The nose does cause breathing problems in some cats and must be related to internal structures and nostril size.  Their teeth are generally misaligned and do seem to build-up tartar more than mogglies.  This is especially true for Wendy.

But, interestingly, Persians are seen as much more unhealthy than other cats.  Why?  Well, several things pop into my mind:

1. Vets may remember a gorgeous Persian longer than the average moggly and ascribe more problems to Persians.
2. I hate to say this, but some vets see a Persian and assume the owner has money so the vet, consciously or subconsciously, sees more problems. 
3. Persian owners, especially those who bought expensive cats, may be more likely to take the cats to vets.
4. Related to #3, if owners are taking their Persians to the vet more often, then I would guess they are being vaccinated more.  I'm convinced there is a relationship between vaccinations and immune problems.
5. Persian owners are told and believe their cats are more unhealthy so they look for symptoms.

So, are Persians more unhealthy than mogglies?  I would say they have a few more problems or at least the potential for more problems.  Are Persians more unhealthy than other purebreds?  I honestly don't think they have more problems than any other popular cat breed.   

The answer to the opening question is a definite maybe.

Tortie Tot's Not-So-Fun Adventure

For the last week, Clarissa, my miniature tortoiseshell Persian, has had quite an adventure.

It all started about a week ago, when she pooped a lot -- like 4 times.  The pooh was well formed but soft. One got caught in her butt fuzz and had to be cut out. She ate breakfast with a bit reluctance, but refused lunch and supper.  I was mildly concerned.

On Saturday, she ate breakfast and then threw up!  I tried a bit later and again she vomited.  I skipped lunch and wait until supper.  (Fasting a healthy animal which is vomiting is a good idea as it allows the digestive tract to relax.)  So I was hopeful at supper time.  No luck -- 20 minutes after eating, she threw up.  I tried another food and same results.

On Sunday morning, I found a hairball from another cat.  The 'hair' was not hair, but a synthetic fiber, such as the stuffing from a mouse.  So, I got wondering if Clarissa ate the other half and this was now lodged in her intestines.  Given that she threw up breakfast, I decided a trip to the emergency vet was needed, especially since I couldn't take Monday off to get her to my regular vet.

Off we went to Apple Valley, about an hour away.  Initially, they did bloodwork and x-rays, after giving her a mild sedative (as she objected to the vet techs!).  The bloodwork was fine -- a few values a bit close to the extremes of normal, but considering her not eating, it was okay.  The x-rays showed something in her stomach and intestines.  Since she had been throwing up, it couldn't be food.  Maybe hair?  Maybe mouse stuffing?  Maybe...???  They gave her some fluids and then did a series of barium x-rays.  The barium x-rays showed that the 'stuff' had moved.  The vet felt sure she would be fine and sent us home. (The techs, however, we a bit intimidated by her -- 5 lbs! -- so I had to get her out of the kennel.  One person said it took 3 techs and a pair of welding gloves to give her the barium.)

She wasn't given food that night, and I was so hopeful the next day, but she wouldn't eat at all.  She was also very tired and had a truly pathetic look to her.  Monday night, I stopped and got her baby food which she gobbled up!  Over the next few days, she went from baby food to cat food and from tired to full of tortitude!

When things like this happen, I always like to figure out why, ask what I should have done differently, and try to learn what I can.

The why is easy.  Clarissa weighs ~5 lbs.  She had recently been given more food, namely she was fed 1/3 can in the morning, 1/3 can at night, and then 1/2 a small can at noon.  This was too much for her to handle.  So she got soft poohs.  This led to the one in her bloomers which I cut off.  I didn't wash her butt so she groomed herself and gave herself a giant hairball.  This plugged her up so any food she ate had no place to go.  The barium moved it along, so she got rid of it and could eat.

The 'what I should have done differently' is harder.  I think at every step, I made the correct decision at the time.  I'm not sure the hairball would have dislodged on its own.

There are several things I did learn.

1. Don't discount the problems associated with overfeeding a cat.
2. When a cat has a poopy-butt, clip and then wash it.
3. Keep baby food and chicken broth on hand.
4. Try hairball remedy when a cat vomits 15-30 minutes after eating food.