Cats: Syringe Feeding

 

Syringe Feeding a Cat

Having just gone through several weeks of syringe feeding Gabby, I thought I would share some thoughts and advice on syringe feeding a cat.  This usually arises when a cat stops eating usually because of illness and you have to get food into the cat.  Many people, including vet techs, hate doing it, but I find it a time to bond with the cat.  And actually, many of the cats, like Isabel, who were syringe fed for weeks to months, often come and want to be hand-fed when stressed.  (I actually had to fight her off when I was syringe-feeding Gabby as Isabel wanted the syringe and my lap so badly!)

So here are some suggestions.

1. Time. Slow is better.  I will take anywhere from 10 minutes to 30 minutes to get the food into the cat. I only put a small amount in (maybe 1-2 ml) and I let the cat swallow and relax before the next mouthful.  Because this takes time and because often the cat can't handle larger amounts, I break up the day's food into 3 or 4 meals.

2. Location. I syringe feed the cat in my lap or between my legs while sitting on the floor. I have the cat surrounded with my legs and arms, with my torso draped over the cat. I believe this makes the cat feel safer. Rarely do I have to 'towel' a cat to force feed it -- even with new arrivals.

3. Tools. I use a feeding syringe from FourPaws. It holds a nice amount and the tips can be cut off so that the food comes out quickly. I have tried regular syringes and I didn't like it. If the syringe is re-used, the plunger sticks due to the rubber o-ring. The tip is usually too small unless one uses the 50 ml size and then it's too big to easily handle.  I usually preload 2 syringes, and then have the bowl with a spoon to refill them if needed.

Also have have moist paper towels, to clean up drips and splatters.  Many cats do appreciate you cleaning off around their mouths.

4. Food. I know Science Diet A/D is considered a great force feeding food, but (a) I don't keep it on hand and (b) some of my cats hate it, so I just use my normal raw mixture thinned with water or other liquid. The food needs to be of the right consistency -- not runny, not thick, but something like cold gravy.

Now in the vet world, there is this 'argument' that you should not syringe feed the same food that you normally feed because the cat will develop food aversions.  Bullshit!  I have seen vet techs force-feed a cat with a syringe and watching them squirt 10 ml of canned food into the cat who started to choke on it... I have no doubts as to why that cat would be averse to that food, and it has nothing really to do with the food but how it was delivered.  I have syringe fed many rescue cats and many of my own because of illness, and not one has become averse to my raw.

As for amounts, that is tricky.  To keep a cat from going into hepatic lipidosis, they need a minimum of 3 tablespoons of food... not a lot to prevent it.  With the raw, I shoot for a minimum of 60 -100 ml of food depending on the cat size.  Often for the first 1-2 days, I only give 45 ml so not to overload the digestive tract if the cat has not been eating.  (I know a vet once advised me to give 1.5 3.5 oz cans of A/D to a 3 lb cat...I looked at the vet and laughed -- an 8 lb adult would not be fed that much, let alone a very sick 3 lb cat.)

I usually add a bunch of things to the raw I syringe feed.  The big things are probiotics (specifically PB8) and digestive enzymes -- both will help the digestive tract function better.  Then depending on why the cat is being syringe fed, I may add milk thistle (liver issues), echinacea (infections), ginseng (general tonic), gingko (kidneys), etc...

5. Position of head. I try to keep the head level and squirt small amounts of the food ( like 1 ml) in the middle of the upper palate. This works better than what owners are told to do -- squirt it between cheek and teeth. I know vets and vet techs are afraid owners will choke the cat with the food, but if it's the proper consistency (not a liquid) and if it's small amounts, I've never had any problem.

One last thing, the alternative to syringe-feeding is having a tube placed and then feed via the tube.  I've done that, and found it much harder to deal with -- tube kept getting clogged, easy to overfeed, annoying to cat, etc.  Also, from an alternative medicine point of view, it is much better that food goes in the mouth so that the digestive system is properly triggered, than to suddenly bombard the cat's digestive tract with food in the middle of the digestive process.

Cats: Vaccinations and Titers

A well written article on titers and vaccines by some of the top experts in the field.

AVMA: titer or revaccinate

Titer testing, through the Kansas State University, costs around $50. In most states, a titer test is NOT accepted in lieu of rabies vaccination. 

Cats: Birthing Emergencies

Summarized from "Emergency Interception During Parturition in the Dog and Cat," Frances O. Smith, Vet Clin Small Anim 42(2012): 489-499

There are 3 stages of birthing:
Stage 1: uterine contractions and cervical dilation -- usually 6-12 hrs, but maybe up to 36 hrs.  Queen is restless, may pant, refuses food, nests
Stage 2: fetal expulsion -- usually 4 to 16 hrs, with occasionally upto 42 hrs.
Stage 3: placental expulsion -- usually each placenta is passed within 15 minutes of the fetus

Dystocia (difficult birth) occurs 3.3% to 5.8% in feline births.  Clinical signs include:
-- pregnant queen >71 days after breeding
-- straining for 1 hr continuously before delivering
-- green or black vaginal discharge before delivery
-- resting over 3 hrs between births
-- delivery of stillborn
-- protrusion of fetal membranes for over 15 minutes without delivery of fetus
-- vaginal hemorrhage
-- weak or distressed queen

Causes of dystocia can be divided between problems with the queen and problems with the fetuses.  67.1% are of maternal origin and 29.7% are of fetal origin.  [and no the numbers don't add up, but I didn't write the article!]

Fetal causes:
-- malpresentation (the most common fetal problem) -- 70% of kittens are born head first, and while butt-first is not abnormal in cats, it does increase the risk of death.
-- fetal abnormalities
-- fetal death
-- fetal oversize
-- anasarcous fetuses (fluid filled fetuses)

Maternal causes:
-- uterine inertia (the most common maternal problem) -- Primary inertia, the queen has little to no contractions and does not reach Stage 2.  Partial primary, the queen reaches Stage 2 but the contractions are too weak to expel a fetus.  Secondary inertia arises from anatomic problems.  The uterus may become exhausted in the case of obstructed birth canal.
-- pelvic fracture
-- uterine torsion -- Abdomen is very painful with a racing heart beat.
-- vaginal abnormalities such as bands
-- malnutrition
-- parasites

Medical management
If the queen has not been in labor too long, the cervix is dilated, fetal size is appropriate, and the fetal heart rate is normal, then the use of drugs may help.  Drugs should NOT be used in cases of obstruction or when more than 1 fetus remains in utero due to uterine fatigue. 
-- oxytocin increases the frequency and quality of contractions.  Doses range from 2 to 4 U IM, with a recommended dose of 0.5 to 2 U.  The author spcifies an initial dose of 0.1 U/kg, with a repeat dose after 30 minutes, and no further use after that.  (Oxytocin will cause placental separation and lead to fetal distress.)
-- calcium increases the contractions but "in the queen, calcium use is controversial, due to the very strong uterine contractions seen when it is administered".  [I'm planning on looking into this frther.]

Mechanical management
In the case of malpositioning, it is possible to use sterile lubricant and fingers to rotate and extract the fetus.  Otherwise an episiotomy is possible, but with the complication of scarring and increased risks for future pregnancies.

Surgical management
60-80% of all dystocias result in surgery.  Fetal heartrates below 150 beats/min require immediate surgery, and 150-170 should be monitored closely as surgery is prepared for.  The author does not recommend an ovariohysterectomy at the time of a ceasarean, unless the uterus is damaged, due to risk of hemorrhage and loss of fluids. [skipped all the discussion of anesthetics and surgery as this is not a DIY project, hopefully]

The accompanying flowchart shows neonatal resuscitation.  While it is for neonates after a ceasarean, much of it does apply to normally born kittens too.

Cats: Feline Gestation

Summarized from "Current Advances in Gestation and Parturition in Cats and Dogs", Catherine G. Lamm, Chelsea L. Makloski, Vet. Clinics Sm Animal 42(2012) 445-456

In cats, the normal gestation range is given as 52-74 days, depending on the breed.  As cats are induced ovulators, the luteinizing hormone only surges 24-40 hrs after copulation.  If the copulation is not observed, it is difficult to determine when ovulation occurs.

After 5 days (post breeding) the fertilized ovum enters the uterus with the outer layer (zona pelucida) being shed 10-12 days after breeding.  Implantation occurs at 12-13 days.  Heart beats can be detected at 16 to 25 days.

Pregnancy diagnosis can be made by palpation for the gestational sacs 21-25 days post breeding.  After 35 days, however, the sacs flatten and palpation becomes more difficult.

Ultrasound is the most sensitive and reliable method of pregnancy detection.  With skilled technicians, fetal structures can be detected 11-17 days post breeding.  It is less reliable to determine the number of fetuses.  Heart rates can be monitored from day 25 onwards, and should be greater than 193 beats/min.  Fetal movement can be observed at 28 days.  After 40 days, the gestational age can be estimated using the foloowing two formulas:

Age = (25 x head diameter cms) + 3
Age = (11 x body diameter cms) +21

Mineralization occurs at 38-40 days.  Xrays can then be used to determine the number of fetuses.  Once mineralization begins, age of the fetuses can be estimated as seen in the table.

Use of hormones to determine pregnancy is dependent on the hormone.  Progesterone is not reliable.  Relaxin is specific to pregnancy as early as about 25 days.  Prolactin is not reliable as it will spike in pseudopregnant animals.

Unlike in dogs, queens need a slow increase in calories beginning at 14 days.

Queens may have normocytic, normochromic anemia as well as mild neutrophilia.  Other changes in bloodwork include decrease in proteins, increase in lactate dehydrogenase, increase in cholesterol, and decrease in creatinine. 

For high risk pregnancies, monitoring of progesterone levels should be used.  If a decrease in progesterone level is seen, females can enter pre-term labor, which may be stopped with exogenous progesterone or terbutaline.

Termination of pregnancies can be done either by spaying or, if fertility needs to be maintained, by using a variety of compounds such as estradiol cypionate.

Cats: Hyperlipidemia

General background on hyperlipidemia -- note there are two different kinds, high glycerides and high cholesterols.  It can be caused by increased production (doubtful), increased mobilization (again doubtful in a kitten), and decreased clearance (which makes the most sense here).  To separate physiological from pathological, test after 12hr fast.  HypOthyrdoism keeps being mentioned as a potential cause.

Treatments for hyperglyceridemia:  a low fat diet, <25% fat (raw chicken), omega 3, chitosan...

Treatments for hypercholesterolemia:  soluble fiber,

http://veterinarymedicine.dvm360.com/hyperlipidemia-dogs-and-cats

Homemade Kitten Formula

Orphan kittens ideally should be placed with a nursing queen to get cat milk.  This is not often possible, so caregivers must find a substitute. 

The simplest is fresh, raw goat milk, or even a commercial version.

If this is not available, then either commercial kitten milk (such as KMR) or a homemade version needs to be used.

Under no circumstances should only cow's milk be fed - it lacks important nutrients for kitten growth and there are reports of severe diarrhea when fed exclusively.

The Recipe:

Ingredients for 1-¼ cups kitten formula:

1 cup of goat milk (if unavailable, whole milk can be used but is not preferred)
1 large egg
2 teaspoons of powdered protein
1 teaspoon of nutritional yeast
110 mg of powdered calcium
1-day dose of vitamins formulated for adult cats

You'll also need a mixing bowl, a hand mixer, a saucepan, and a small nursing bottle.

Beat the egg, and thoroughly stir in the remaining ingredients. Warm the formula in a small nursing bottle by placing it into a cup or bowl of hot water. Test the formula on the underside of your wrist to check the temperature. If the formula is too hot, wait until the formula cools down. If the formula is too cold, continue soaking the bottle in hot water. Always be sure to test the formula again before giving it to the kitten.

Never re-use formula that you have warmed. Discard it and use fresh formula for each feed.

Discussion:

There is concern among some kitten fosterers about the use of any cow's milk with kittens.  There concern centers on the lactose content of the cow's milk.  Here are the lactose levels in various milks:

cat milk  4% (constant from birth to weaning)
cow milk  4.5-4.9%  (various authors report different figures)

goat milk  4.1% (or 10% less than cow milk, so 4.1-4.4%)

Feline nutritional experts also agree -- young kittens can digest lactose (obvious from it being in mother's milk), but as they mature to adults, some cats lose this ability and become lactose intolerant.

Lastly, almost all commercial kitten formulas, except where clearly labelled as derived from goat milk, are all make using cow milk in various forms -- casein, powdered milk, whey, etc.

Thoughts on Syringe-Feeding a Cat

Since I seem to have better than average experience with this, a vet invited me to share some tips and tricks with her and others. I have been thinking about and actually spent part of day observing at a local vet clinic to really see what the differences were. I think there are 5 critical differences.

1. Time. I usually am force feeding only one cat at a time and don't have to rush off and do other things. I will take anywhere from 10 minutes to 30 minutes to get the food into the cat. I only put a small amount in and I let the cat swallow and relax before the next mouthful.

2. Location. I force feed the cat in my lap or between my legs while sitting on the floor. I have the cat surrounded with my legs and arms, with my torso draped over the cat. I believe this makes the cat feel safer. Rarely do I have to 'towel' a cat to force feed it -- even with new arrivals.

3. Tools. I use a feeding syringe from FourPaws. It holds a nice amount and the tip can be cut off so that the food comes out quickly. I have tried regular syringes and I didn't like it. If the syringe is re-used, the plunger sticks. The tip is usually too small unless one uses the 50ml size and then it's too big to easily handle.

4. Food. I always feed the food at or slightly warmer than room temperature. (And apologies, Dr. Muns for this next part.) I know Science Diet A/D is considered a great force feeding food, but many cats do not like it. I may use it, but I mix it with other ingredients, such as goat milk, to make a mix that is more appealing to cats. The food also needs to be of the right consistency -- not runny, not thick, but something like cold gravy.

5. Position of head. I try to keep the head level and squirt small amounts of the food ( like .5ml) in the middle of the upper palate. This works better than what owners are told to do -- squirt it between cheek and teeth. I know vets and vet techs are afraid owners will choke the cat with the food, but if it's the proper consistency (not a liquid) and if it's small amounts, I've never had any problem.

10 Books Cat Breeders Should Own

Here's a list of 10 books that cat breeders should have in their libraries.  The books range from genetics to care of kitten.  I wish to thank several of my breeder friends for make suggestions and comments on these books.

1. The Cat Breeder's Handbook  -- This is a collection of articles by various experts on everything from selecting cats for a breeding program to showing cats at a cat show.  There is a good article on cattery design.
2. Feline Husbandry -- One of the classics for cat breeders, which is still useful.  It covers diseases in a multicat environment, caring for kittens and mothers, and nutrition among other topics.  The book is fairly expensive as it is out of print, but it is available for free online through the UC Davis website.
3. Practical Guide to Cat Breeding (Royal Canin) -- I have not personally seen this book but it was highly recommended.  From the description, it sounds good as it has sections on genetics, reproduction problems, pediatrics, and even legal matters.  The down side of this book is the price -- it is out of print and routinely sells for over $100.
4. Robinson's Genetics for Cat Breeders and Veterinarians -- This is THE book on cat genetics and how breeders need to consider relatedness among cats.
5. Notes on Feline Internal Medicine -- This is a technical veterinary book, but one of the best books for clearly diagnosing internal problems, explaining bloodwork, and giving medication suggestions.
6. Veterinary Notes for Cat Owners, Cat Owner's Home Veterinary Handbook, or Cornell Book of Cats -- PICK 2 -- These are more user-friendly books that the above book.  They provide the reader with more background information on disease processes without the technical terminology and the medication suggestions.  Each book explains topics in slightly different ways, hence the suggestion for 2 books.
7. Infectious Disease Management in Animal Shelters -- This book is invaluable to understand and help prevent diseases from spreading in a closed environment, such as a cattery.  While it is for animal shelters, and thus includes dogs, it is very applicable to catteries.
8. Plumb's Veterinary Drug Handbook -- This standard reference on veterinary drugs is invaluable for understanding the biochemisty of drugs as well as for dosages.  Sadly, the book is expensive and some newer drugs are omitted until the newest edition is published.
9. The Pill Book Guide to Medication for Your Dog and Cat -- This is a more user-friendly drug book which covers the most commonly prescribed drugs, discusses the pros and cons of using human medications, and provides a simple first-aid guide.
10. Raising Cats Naturally: How to care for your cat the way nature intended -- For breeders interested in feeding raw food, this is THE book to have.  Not only does it provide clear recipes, it provides the rational behind the ingredients with references to literature.

10 Cat Books the Average Owner Should Own

Here is a list I compiled awhile ago of 10 books that are both readable for the average cat owner and very useful.  (Links are to the book page on LibraryThing.com)

1. Veterinary Notes for Cat Owners or Cat Owner's Home Veterinary Handbook -- These books are well written so the layperson can understand a variety of diseases and conditions in cats.  The photos are particularly helpful at times.
2. Raising Cats Naturally: How to care for your cat the way nature intended -- This is the 'bible' for feeding raw.  Not only does it give 2 options for preparing the food (with and without a grinder), but it explains the rational behind the diet's ingredients with references.
3. The new natural cat : a complete guide for finicky owners -- Excellent book on general cat care, using a variety of alternative treatments.
4. Dr. Pitcairn's Complete Guide to Natural Health for Dogs & Cats -- This was the book that started my interest in both alternative veterinary medicine for cats and in raw food.  While his recipes rely too much on grain in my opinion, his sections on vaccines and then the catalog of diseases and treatments are very good.
5. Cat Wrangling Made Easy: Maintaining Peace and Sanity in Your Multicat Home -- Excellent book by someone who has lived in a multicat home on how to manage things.  Some of the tips and suggestions are brilliant!
6. Cat Vs. Cat: Keeping Peace When You Have More Than One Cat -- Another book on cat behavior and interaction by a top behaviorist.  Her method of introducing new cats has become the standard method and actually does work!
7. Getting in TTouch with your Cat -- This book explains a wonderful massage-type treatment for cats.  It is simple to learn and helps many cats to relax.
8. Cats Naturally: Natural Rearing For Healthier Domestic Cats -- While this is an older book, it is well worth buying it as it is the best guide out there for using herbs with cats.
9. The Nature of Animal Healing : The Definitive Holistic Medicine Guide to Caring for Your Dog and Cat -- A newer and very useful book on holistic medicine for dogs and cats.  Some of the suggestions, such as the Chinese medicine ones, are rarely seen in even other holistic vet books.
10. Starting from scratch : how to correct behavior problems in your adult cat -- Another behavior book, but this one is specifically on how to correct already established bad behaviors.  I like this one since using drugs is the absolute last resort.

Treating Feline Urinary Problems: Cranberries

Cranberries

If you go to any alternative medicine site and look for natural treatments for bladder infections, cranberry in its many forms is touted as a cure or prevention.  But does it work?  And more importantly for me, does it work for a cat?

Cranberry seems to work because a proanthocyanidins (an antioxidant) prevents the E. Coli from attaching to the cell walls in the bladder.  In vitro studies have confirmed that proanthocyanins do cause deformation of the E. coli cells and thus suggests prevents them from adhering to the bladder walls.  The adhesion in one study was reduced by 75%

There are no studies in cats.

There is a study in beagles showing that the metabolites of the cranberry do appear to make it to the bladder and do reduce the adhesion of the E. coli.  The researchers administered 1 Crananidin tablet per day and the dose peaked at 7 days after which it remained steady.

There are human studies that show no significant improvement with the use of cranberries.  Several of the studies do comment that perhaps the potency of the cranberry used in the study was not sufficient.

So what does this all mean?  It does seem that cranberry can prevent UTIs in cell cultures, but there is no evidence that it does in cats.

There are however many anecdotal accounts by cat owners that cranberry pills, cranberry powder, and even cranberry juice has helped cats.  I know from personal expereience, I have used cranberry powder with cats exhibiting UTI symptoms and the symptoms disappeared in 2-3 days.  Was it coincidence?  Maybe, maybe not.  I do know that 1/2 a cranberry extract pill is a much larger dose for a cat than 1 pill 2x a day is for a person.  So maybe, the proanthocyanins did reach a therapeutic level in my cats.

There are also a couple of concerns about using cranberries with cats.  One is cranberries contain salicylic acid (aspirin).  Now, before people panic, cranberry juice contains 7mg/L of juice.  Presumably poders and extracts would contain more.  But.... for cats, the toxic level for aspirin begins at about 50mg/kg of body weight.  So an 11 lb cat (5 kgs) would need 250mg to reach a minimum toxic level, of about 37 quarts (35L) of juice.

The other concern is the presence of oxalates.  Oxalates have been tied to the formation of oxalate kidney stones in humans, but cats rarely develop kidney stones -- they are more likely to have bladder stones, so I am unclear if this is even a concern.  In any case, cranberries contain 5-7 mg of oxalates per 3.5oz of food.  This is the same level for pumpkin, which is wildly used for cats and regarded as beneficial.

Bottomline, if I have another cat with UTI symptoms, I will use it again.  If and when the researchers ever do a sound study on felines and show it does not work, then I may rethink my position.

Summary of scientific studies from "Complementary and Integrative Therapies" by Donna Raditic, in Vet. Clinics of N. Am.: Small Animal Practice,  July 2015

A Simple Recipe for Bone Broth

I've seen a number of cat people encourage owners with sick cats to make bone broth.  This broth supposedly will be loved by cats and will provide them with lots of vital nutrients.

I do remember trying it years ago.  All I really remember of it was that the cats didn't particularly like it and I eventually through the frozen stuff away.  But maybe it was the cats, or the problems, or my preparation... I'm willing to give it another try.

Here's a recipe I found on a website called Pet360.com :

Place bones in pot and cover with water. For each gallon of water, add two teaspoons of apple cider vinegar or lemon juice, for the natural acids that break down bones to release their minerals. Slice in some carrots for flavor; before adding any other vegetables or seasonings. Make sure to consult your vet to be sure all ingredients are feline-safe. Cats should never eat anything containing onions, chives, scallions or garlic—these are all toxic for cats.

Simmer on low heat until any remaining meat residue falls off the bones. Remove  meat and vegetables. Let the bones simmer for another 20-24 hours. Your cat will hover, curious about the yummy scent.

When cooking time is up, skim off the separated fat, remove and discard all bones. Let broth cool completely and transfer to small containers and ice cube trays for easy freezing.

Get bone broth on your cat’s menu by serving it over dry cat food, letting the nuggets soak up the flavor and nutrients. You can also spoon it over canned food like gravy. Or offer a broth cube as a savory ‘popsicle’ that your cat will eagerly lick. That’s another of bone broth’s many health benefits—your cat will definitely enjoy the treat.

From http://www.pet360.com/cat/health/6-ways-bone-broth-serves-up-benefits-for-cats/S46iGtRWEE-Qr4Pg08dcuw

Vascular Access Ports in Cats

If you have a cat that is undergoing chemotherapy which must be delivered into a

vein or a cat that needs repeated  IVs or blood draws, one thing to consider is a vascular access port.  A VAP is a small metal or plastic device implanted under the skin with a catheter tude inserted in a major vein, such as the jugular vein or in a femor vein.  Drugs or blood are then injected or extracted from the port using special needles and only entail a prick of the skin as the needle passes through the skin and into the port.  The port itself causes no discomfort.  General anesthesia is required for placement and cats must not have clotting problems (as in too many clots).

Complication rate in dogs and cats is about 10.5%, which is about 10 times higher than in people.  The most common failure is blockage of the tubing or port so that material can neither be injected nor extracted.  This can be prevented by properly flushing the port with heparinized saline after each use.  Complications are higher for those in leg veins than in neck veins in cats.

Also, because of the need to use special needles and have special training to inject into these ports, at the present, these ports are only being used by researchers and a few select cancer treatment centers.  Since most cats do not need repeated blood draws or injections, the usefulness of these ports is unclear.

From "Vascular Access Ports in Cats", Alane Kosanovich Cahalane, pp585-591, Feline Internal Medicine, vol. 7, 2015

Feline Idiopathic Cystitis (FIC)

One of the main reasons cats are taken to the vet is urinary tract issues, namely, the cat is using the litterbox frequently with little urine produced, or the cat is peeing outside of the box somethimes with blood.  These are the warning signs that the might have a bladder infection, bladder stones, bladder cancer, etc., or it may be suffering from feline idiopathic cystitis (FIC).

A note on acronyms:  In the early 1980s, this was usually termed FUS -- feline urological syndrome.  Thanks to an article in a 1984 journal, it became FLUTD -- feline lower urinary tract disease.  It has also been refered to as LUTS -- lower urinary tract signs and IC -- interstitial cystitis, which was borrowed from human medicine.  I will refer to it as the new preferred term -- FIC.

FIC strikes males and females equally, although males are by far more likely to become obstructed than females.  Risk factors seem to include stress, excess body weight, lack of activity, and multicat homes.

With humans, there are two types -- ulcerative and non-ulcerative.  With cats, almost all are non-ulcerative, and so, biopsies of the bladder are not recommended for cats suspected of having FIC.

The actual cause of FIC is unknown.  There seems to be no clear link between any virus and FIC.  There seems to be some connection with bacteria, namely cats with FIC are at increased risk of bacterial UTI.  The neurons assocaited with the bladder are larger and more sensitve in FIC cats than in normal cats.  Abnormalities in the hpothalamus, pituitary, and adrenal axis have been observed in cats with FIC.  Many cats with FIC also suffer from various other diseases leading researchers to wonder if FIC is a single disease or an expression of a larger disease process which effects other organs also.  One important "cause" is early kittenhood adversity, such as being orphaned or starved.

Diagnosing FIC is by exclusion of other diseases.  (The accompanying diagram shows most of the other possibilities.)  There is no clear diagnostic test, although researchers have found some biomarkers which seem to be linked to FIC.  Abdominal xrays are suggested since 20% with some type of urinary tract issue have crystals.

Treatment involves both drugs and environmental changes.  Narcotic pain-killers are recommended during a FIC period, whereas NSAIDs are not because of decreased blood flow to the kidneys.

The main treatment is modification of the cat's evironment to decrease stress.  An interesting question to help identify stress triggers is at http://indoorpet.osu.edu .  Increased water intake is seen as important, but using acidifying foods is not.  If the cat is fat, a safe diet needs to be undertaken.  Feliway may or may not be useful with FIC cats, but it was discussed and there is research on using it with these cats.  No drug, such as antidepressives, have been found useful.

Summarized from "Feline Idiopathic Cystitis", Jodi L. Westropp and C. A. Tony Buffington, pp.518-525 in Consultations in Feline Internal Medicine, v.7, 2015.

Urinary Tract Infection in Cats

When a cat repeatedly visits the litter box, like 5 times in 10 minutes, or begins to pee outside the litter box, with even a drop or two of blood, one likely cause is a urinary tract infection.

There are several related medical problems that are related and must be clearly distinguished if treatment is to be successful.  They are:  bladder stones, urethral plugs in males, idiopathic cystitis, plus some other causes.  The key to determining IF it is a UTI is a urinalysis.  The urine specific gravity will help determine if the help distinguish upper urinary tract infection, associated diseases (e.g. CRF), or lower urinary tract infection.  A urine culture will determine the bacteria involved.  In more complicated cases, bloodwork, xrays, thyroid tests, and even an ultrasound may be needed.

The likey cause of most UTI's is bacteria spreading from the external opening up into the bladder and then even on to the kidenys.  Few infections seem to begin from blood into the kidneys, except in cases of trauma or urinary tract obstruction.  33-50% of all bacteria is E. coli.  25-33% are one of the many strains of Staph or Enterococci.  The remaining are a mix of 8+ bacteria.  In about 75% of the cases, only one bacteria is responsible for the infection, with 20% of the cases having 2 different species involved.  There is also the slim chance that a fungal infection can be the cause.

The standard treatment is antibiotics.  The first-line options are amoxicillin are trimethoprim-sulfadiazine.  Second-line option is nitrofurantoin.  Other antibiotics can be used, but many seem to be resistent to Enterococci.  Interestingly, the article says about clavamox "not established where there is any advantage over amoxicillin alone", which is intersting because clavamox is often seen as the go-to antibiotic.  Also of interest is the comment on cefovecin (Convenia) "Should only be used in situations where oral treatment is problematic" and it goes on to explain that the long duration interfers then with any post-treatment cultures for over 21 days.

In simple cases, treatment with antibiotics is for 10-14 days, with symptoms lessening in 48 hrs.  Sadly, simple UTI's are rare.  More complicated cases involving CKD or diabetes should be treated for 4-6 weeks.  Reinfection and relapse can occur.

The article also mentions alternative treatments, including cranberry extracts, D-mannose, methenamine hippurate, and probiotics.  Sadly there are no feline studies on any of these products.  Do note that methenamine is "poorly tolerated by feline patients".

Summarized from "Urinary Tract Infections", Shelly Olin and Joseph W. Bartges, pp 509-517, in Consultations in Feline Internal Medicine, v.7, 2015.

Feline Uroliths

80% of all bladder stones (uroliths) in cats are either struvite or calcium oxalate. The remaining 20% are formed from a variety of minerals, each type occuring very rarely, and so I will focus on the two main types.

Struvite crystals form when the urine is not acid enough. These crystals come in two forms, sterile and infection-induced. The sterile form is just precipitated minerals from the urine. They are common in cats 1-8 yrs old, in both male and female. Diets low in magnesium, phosphate, and protein can lead to their dissolving. Prevention includes lowering the urine pH, decreasin urine specific gravity, and decreasing dietary magnesium, ammonium, and phosphates. Increased water consumption also helps prevent formation.

The infection-induced struvite crystals tend to form in very young or older cats. A bacterial infection in the bladder releases urease which then leads to the formation of the crystalline nidus (seed-crystal). The treatment of these crystals is much the same as sterile struvite crystals, except that antibiotics should be used while the dissolution food is being fed. The reason for this is the bacteria trapped in the stone are released as the stone is dissolved and can cause UTI or further stone formation. Antibiotics should continue for 2 weeks past when the stone no longer is visible on xrays or ultrasounds. Prevention of infection-induced struvite crystals does not require any change in diet -- only thorough treatment of any UTI.

Calcium oxalate crystals form when urine is too low in pH. Various medical conditions such as hypercalcemia is associated with an increase risk in calcium oxalate stones. These stones can not be dissolved by diet and must be physically removed. Prevention is treatment of any contributing medical condition and increasing fluid consumption.

In the photo, Photo A shows a typical sterile struvite crystal which is nicely round and smooth. Photo B shows 3 infection-induced struvite crystals -- note that they are smooth but geometrically shaped. Photo C shows a calcium oxalate crystal with typical spikes.

Based on "Update on feline Urolithiasis" by Amanda Callens and Joseph W. Bartges, pp. 499-508, in Consultations on Feline Internal Medicine, v7, 2015

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.