Hypercalcemia in Cats


by Arnold Plotnick MS, DVM, ACVIM, ABVP

Calcium is an essential nutrient, however, excessive blood levels can have serious consequences.  Catnip’s medical editor explains the causes of – and concerns about – too much calcium

Calcium plays an essential role in maintaining a healthy body in humans and animals.  Too much of a good thing, however, can be dangerous, and this is definitely true for calcium.  Discovering an elevated serum calcium level in cats is a fairly common finding in veterinary medicine.  A variety of treatments are available that will readily bring an elevated calcium back into the normal range, but treating with medication should not be the primary approach.  Because the most  effective treatment is to address the underlying cause, our initial approach  to hypercalcemia  (elevated  serum calcium) is to search for the origin.  Once we find the cause (or should I say if we find the cause, because sometimes it can be tricky), we can prescribe the proper treatment.

“Most cat owners wouldn’t know that their cat has an elevated calcium level”, says Dr. Michael Stone, board-certified internist at the Cummings School of Veterinary Medicine at Tufts. “Cats tend to be more resistant to the clinical consequences of hypercalcemia, and in many cases, cats can have a fairly high calcium level and appear totally normal.”  Most of the reported signs are vague and non-specific, such as poor appetite and lethargy. (See Sidebar 1)  Increased thirst and urination are occasionally reported.  Elevated calcium levels can sometimes lead to the development of calcium-containing bladder stones, and cats may show signs such as straining to urinate and blood in the urine.  Very high calcium levels often lead to gastrointestinal symptoms (such as vomiting and constipation) or neurological signs (such as muscle twitches and spasms, or seizures).  Left untreated, the excess calcium can combine with phosphorus in the bloodstream, forming calcium phosphate. Calcium phosphate will deposit in a variety of tissues throughout the body, especially the kidneys, gastrointestinal tract, cardiac muscle, skeletal muscle, tendons, and ligaments. These mineral deposits can lead to tissue damage, including initiation of (or acceleration of pre-existing) kidney disease, decreased cardiac function, and abnormal heart rhythms.

There are many causes of hypercalcemia.  (Sidebar 2).The most common cause of high calcium is chronic renal failure.  Not all cats with renal failure will have high serum calcium, and those that do tend to have only mild elevations.  Fortunately, diagnosing chronic renal failure is easily accomplished via routine blood and urine tests.

Hyperparathyroidism is a well-documented cause of high calcium in cats.  The parathyroids are small glands located near the thyroid gland in the neck.  These glands secrete hormones that regulate the serum calcium level, the main one being parathyroid hormone (PTH).   Some cats, as they age, may develop a benign tumor involving one of the parathyroid glands.  This tumor will secrete excessive amounts of PTH, causing the calcium to rise, often to dangerous levels.    A few cases can be diagnosed by carefully feeling the neck and identifying a small nodule where the parathyroid glands reside.  In most instances, a diagnosis is achieved by measuring the level of PTH in the serum.  An elevated level confirms the diagnosis, although some cats with hyperparathyroidism will have normal PTH levels, confounding the diagnosis.

Neoplasia (cancer) is another common cause of high calcium. “After renal failure, cancer is probably the second most common cause of elevated calcium in the cats we see” notes Dr. Stone.  While any cancer can theoretically cause elevated calcium levels, the most common types are lymphosarcoma, squamous cell carcinoma, multiple myeloma, and mammary carcinoma.  In most cases, diagnosing the cancer is relatively straightforward, however, the diagnosis can sometimes be elusive, especially in the case of lymphosarcoma.    Calcium levels are high in some cases of cancer because the malignant cells are secreting a protein that is very similar to PTH, the hormone that regulates serum calcium levels.   In fact, this protein is called parathyroid hormone-related protein, abbreviated PTH-rp.   In normal animals, PTH-rp  levels are not detectable.  In cats, PTH-rp is not a very sensitive marker for cancer; some cats with cancer-associated hypercalcemia may have undetectable blood levels of PTH-rp. However, the PTH-rp test is very specific, meaning that if the levels of PTH-rp are elevated, a diagnosis of cancer is certain.

Granulomatous diseases are usually infectious diseases that result in a characteristic type of inflammatory response by the body.  Most of these diseases are fungal, but bacterial, viral, and parasitic disorders can cause granulomatous inflammation as well.  The mechanism by which these diseases cause elevated calcium levels is complex, and has to do with altered vitamin D metabolism.  Diagnosis of granulomatous diseases is usually straightforward and may involve cultures, blood tests, and other common diagnostic procedures.

Osteolytic diseases – disorders in which bone is being destroyed – is an uncommon cause of high calcium in cats.  Occasionally, tumors will invade or spread to the bones, or an infection will occur in a bone that causes enough bony destruction that the calcium will become elevated.  Again, this is quite rare.  X-rays will often reveal the bony destruction.

Vitamin D toxicosis is another uncommon cause of high calcium levels in cats, and could occur theoretically if a cat was deliberately oversupplemented with vitamin D.  A few years ago, a new type of rat and mouse poison was introduced on the market.  This new rodenticide had calcitriol as its active ingredient.  Calcitriol is the active form of vitamin D, and it killed rats and mice by elevating their calcium levels.  Cats that ate it, or ate rodents poisoned by it, would develop hypercalcemia.  Fortunately, these products are no longer widely available, at least in the U.S.    A more common cause of vitamin D toxicity is ingestion of calcipotriene, a substance very similar to calcitriol that is found in a topical preparation used to treat psoriasis in people.  To date, this has only been reported in dogs.  Cats, apparently, are smart enough to not eat this ointment. 

Hypoadrenocorticism (also known as Addison’s disease) is a condition where the adrenal glands produce inadequate amounts of certain hormones.  Affected animals will often have elevated calcium levels, although the mechanism behind this remains unclear.  “Addison’s disease is uncommon in dogs, and is even less common in cats.  I would venture that most practicing veterinarians never see a case of feline Addison’s disease in their career”, says Dr. Stone.   Diagnosis of Addison’s disease is achieved by measuring serum cortisol levels before and after injecting the cat with a hormone called ACTH.  A normal cat will show a significant increase in serum cortisol levels after the injection.  A cat with Addison’s disease will not.

A common cause of high calcium, and one that should not be overlooked, is a spurious lab result, i.e. an error in measurement by the laboratory.   Diagnostic laboratory capabilities have gotten much more sophisticated over the years, and the quality control in these labs has improved markedly.  No laboratory is 100% perfect, however, and mistakes do occur.  I once ran routine senior bloodwork on a 13 year-old Somali named Rudy, and the calcium came back at 19 mg/dl, a shockingly high number.  With Rudy showing no clinical signs of illness at all, I had the laboratory re-run the test on a new specimen.  The new calcium result was 10.8 mg/dl, which was totally normal. 

In some cases, after an extensive diagnostic workup, no cause for the hypercalcemia is ever revealed.  Since the early 1990’s, cases of unexplained hypercalcemia have become increasingly more apparent, and has been termed idiopathic hypercalcemia (IHC).  “Idiopathic” means that there is no known cause.  IHC is turning out to be one of the most common causes of hypercalcemia in cats. 

As stated earlier, treatment of hypercalcemia is based on the cause.   For example, hyperparathyroidism is treated by surgically removing the overactive parathyroid gland; cancer is treated with surgery, radiation, or chemotherapy; Addison’s disease is treated by administering the deficient hormone(s).   If the cause cannot be determined, as in IHC, then a variety of interventions can be attempted. 

Elevated calcium levels can sometimes be restored to normal by changing the cat’s diet.  High fiber diets, diets designed for cats with renal failure, and diets designed to prevent calcium oxalate bladder stones have all been shown, in various studies, to normalize the calcium level in some hypercalcemic cats.  If, after feeding a new diet, the calcium level remains elevated, treatment with glucocorticoids should be considered.  Most cats with IHC respond favorably to glucocorticoid administration.  Ideally, the dose should be tapered to the lowest dose that controls the hypercalcemia, to minimize any adverse effects (such as diabetes). As an alternative to glucocorticoids, cats can be given biphosphonates, a class of drugs designed to prevent the loss of bone mass.  Biphosphonates are often given to women to treat or prevent osteoporosis. They are very effective at lowering the level of calcium in the blood. 

Determining the cause of hypercalcemia can be a challenge.  A careful evaluation of the history, physical exam findings, and various laboratory tests often leads toward a logical path to a diagnosis.  The best chance of successfully treating hypercalcemia in cats is to eliminate the underlying cause.

Sidebar 1
Clinical signs of hypercalcemia in cats
Decreased appetite
Increased thirst and urination
Changes in urinary behavior (straining, increased frequency, blood in urine)

Sidebar 2
How Catnip’s medical editor remembers the causes of hypercalcemia in cats
In veterinary school, we are asked to memorize thousands of fact and figures.  It would be impossible to do this without mnemonic devices, those cute little learning aids that help us remember important facts.  There are several mnemonic devices for the causes of hypercalcemia in animals. Since Catnip is a family publication, I’ll share a non-racy one:  GOSH DARN!
G = granulomatous diseases
O = osteolytic disorders
S = spurious laboratory result
H = hyperparathyroidism
D = vitamin D toxicosis
A = Addison’s disease
R = chronic renal failure
N = neoplasia (cancer)

As I go through my list, if none of the letters explain the cause of the cat’s high calcium, then the cat likely has idiopathic hypercalcemia - the calcium is high for no discernable reason.
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Top 20 Internet Cat Videos of 2011

We've gathered together our 20 favorite cat videos from 2011 that we posted throughout the year on our Manhattan Cat Specialists' Facebook Page. Without further ado:

Oskar the Blind Kitten's First Toy

Cat and Dolphin Play Together

Newborn Kitty having a bad dream, then Mommy Hugs

Guilty Cat

Plastic Cat Fortress

Cat Barks... until he's Caught! then Meows

The Two-Faced Cat: Frank and Louie

Cats Yawning

Brave Kitty Stands up to Dog

NoNoNoNoNo Cat

Violet the most Relaxed Cat Ever

Kitty Pro Wrestling

Cat Ruins Video

Cats try to understand the Treadmill

Hungry Fat Cat wants More

Thumbs Up Cat

Hamster Ball Cat

Spider Cat

Cat Massages Dog

Glass of Water Cat

Make sure to check out the Top Fun Feline Blog Posts of 2011

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Dr. Plotnick's Top 13 (Educational) Feline Blog Posts of 2011

We've gathered together Dr. Plotnick's CAT MAN DO top EDUCATIONAL blog posts of 2011 

13) The Cat Age to Human Age Comparison (Part Three) - A New Chart Helps Pet Parents Calculate Their Cats' Age in Relation to Human Years

12) What We Tell Our Clients When their Cat is Diagnosed with Ringworm - Despite the name, ringworm is not a “worm”.  It is a fungal infection (dermatophytosis) of the hair and skin.  It is also one of the few feline infectious diseases that can be transmitted from cats to humans.  Cats that test positive for ringworm need some kind of treatment.  Treatment plans may vary somewhat for each individual cat, but they all involve three basic steps – topical therapy (bathing) with some type of shampoo, oral medication, and environmental decontamination.

11) Tropic of Cancer (a.k.a. lymphosarcoma. a.k.a. lymphoma) - I see a lot of cancer in my cat practice.   A major reason is that cats are living longer than ever before.  Now that they’re living to 17, 18, (and even longer), they’re living long enough to develop cancers that we never saw when they died at 12 or 13.  Another reason is that major medical advances have given us the technology to detect cancers that previously went undiagnosed.  An increased awareness of cancer, coupled with more sophisticated technology, has allowed veterinarians to become pretty adept at making the dreaded diagnosis. The diagnosis of cancer in a beloved cat can be devastating.  However, it is important to realize that, as in human cancers, many types of cancer in cats can be treated, managed, and sometimes even cured.   

10) Heart Murmurs: What’s the Scoop? - Everyone has heard of heart murmurs, but not everyone knows exactly what they are, and what their significance may be. I’m hoping this blog post can help.  

9) Hot-Weather Tips for our Cat & Dog Companions - When summer arrives, it is very important that we take the proper precautions when dealing with our pets. Here are a few important tips and facts that should help protect our furry friends.

8) Language Barriers - I run an all-feline veterinary hospital, and we have a fairly large Japanese client base. This is not by accident. One of my technicians, Hiromi, is Japanese, and she made it clear to me when I hired her 8 years ago that she would like to actively help me cultivate a Japanese clientele. In speaking with her cat-owning Japanese friends and acquaintances, Hiromi has heard countless tales of frustration, as they described the difficulty in explaining exactly what it is about their cat that had them worried, as well as their inability to fully understand what the doctor had told them.

7) First Aid and Your Kitten: What to Do in an Emergency - Most kittens endure kittenhood relatively unscathed. A few, however, deplete several of their nine lives in the course of growing up. Knowing the principles of first aid can be invaluable in seeing that your kitten survives that turbulent first year of life.

6) First Aid and Your Cat: What to Do in an Emergency - If you came home from work and found your cat having convulsions, paralyzed, or bleeding, would you know what to do?  April is "Pet First-Aid Awareness Month". The American Animal Hospital Association, (AAHA) states that 1-out-of-4 pets would survive an accident or illness if pet owners were familiar with and capable of providing first aid when necessary. Owners that are aware of proper life saving techniques and how they apply to our pets are better equipped to handle emergencies as they arise. 

5) Why You Should Spay or Neuter Your Cat - Cat overpopulation is a very serious problem in the United States. There are simply too many cats and not enough people to care for them. Responsibility is the key to cat ownership, and a major part of that responsibility is guaranteeing that your cat doesn’t reproduce.  Neutering and spaying are two of the most commonly performed elective procedures.  Not only do they help curtail cat overpopulation, they also bring many health and behavior benefits to both you and your cat.

4) Top 5 Healthy Cat Treats - Cats require a nutritionally complete and balanced diet to live an active, healthy life. Life is meant to be enjoyed, however, and every now and then it’s OK to toss your cat a tasty treat.

3) Early Spaying and Neutering in Cats. Get ‘em while they’re young - Every year in the U.S., animal shelters and humane organizations euthanize millions of homeless and unwanted dogs and cats. Spaying and neutering has to remain the cornerstone of any program designed to reduce overpopulation of dogs and cats. In my practice, clients will often bring me a kitten for examination and vaccination. Our protocol is typical for most veterinary practices: we vaccinate around 8 or 9 weeks of age, and again at 11 or 12 weeks of age, and once more at 15 or 16 weeks of age. Then, at 24 weeks of age, we neuter or spay. This protocol of spaying and neutering around 6 months of age has been the professional standard for years. This posed a problem for shelters, however. 

2) How Pet Owners Can Best Help Veterinarian Make their Diagnoses - Veterinarians are faced with a variety of diagnostic challenges on a daily basis. The ability for a veterinarian to obtain a detailed and complete history is our most important diagnostic tool. When accurately interpreted, this information lays the groundwork for a logical diagnostic and therapeutic plan, and may prevent unnecessary diagnostic testing and needless discomfort to the patient and cost to the owner. 


1) Anatomy of the Feline Mouth - As a cats-only practitioner, I don’t mind when people say that I’m looking down in the mouth, because the feline mouth is fascinating. Cats use their mouths for a lot of things – eating, drinking, grooming, and communication. Although cats breathe mainly through their nose, the mouth provides an additional passageway for air to enter the lungs.


Make sure to check out the Top Fun Feline Blog Posts of 2011

Make sure to check out our Top 20 Favorite Cat Videos of 2011

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Dr. Plotnick's Top 8 (Fun) Feline Blog Posts of 2011

We've gathered together Dr. Plotnick's CAT MAN DO top FUN blog posts of 2011

Number 8) Cats in History
Here's a collection of photographs of cats throughout the 1800s and 1900s.

Number 7) 10 Best Talking Cat Videos
This talking pets concept is nothing new (think Mr. Ed), however, the raw camera footage, the innocent pet facial expressions, and each the animals exhibiting their own personalities all make a great palate for the 10 best talking cat videos

Number 6) 10 Epic Drama Cat Videos
Sometimes accompanied with a contemporary cinematic orchestra, and sometimes without, here's the best epic cat drama videos.

Number 5) The New York City Bodega Cat
The Internets Celebrities have created a mini documentary on New York City's beloved Bodega Cats

Number 4) 20 Close-Up Photos of Cat Tongues
As the title suggests, here's 20 close-up cat tongues. 

Number 3) Must Re-home - Urgent!
We must get rid of our children IMMEDIATELY because we just know how time consuming our new little kitten is going to be and it just wouldn't be fair to the children. Since our little kitten will be arriving on Monday we MUST place the children up for adoption this weekend!

Number 2) Dr. Plotnick's Visit to Katten Kabinet in Amsterdam
For the regular culture-vultures, no trip to Amsterdam is complete without a visit to the van Gogh Museum, the Anne Frank House, and the Rijksmuseum.  For those hooked on cat-culture ( like yours truly), you cannot visit Amsterdam without popping into Katten Kabinet, the only art museum in the world devoted solely to artwork depicting cats.

Number 1) Dr. Plotnick's Cat Expedition in Istanbul, Turkey
Dr. Plotnick took a trip to Istanbul trekking through stray kitties looking for stray kitties. There were SO MANY cats in town!  The 11-post travelog and photoblog begins here.

Make sure to check out the Top 13 (Educational) Feline Blog Posts of 2011

Make sure to check out our Top 20 Favorite Cat Videos of 2011

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Cats Are The 1%!! Get Your Cats Spayed or Neutered.

Know the facts. 99% of cats live a more lavish lifestyle than 99% of the top 1% of humans. OCCUPY CATS! Get Your Cats Spayed or Neutered.

SEE: Why You Should Spay or Neuter Your Cat

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Cat Writer's Association Awards 2011

The Cat Writer's Association(CWA) is an organization of professionals writing, publishing and broadcasting about cats.  Members include writers, editors, publishers, artists, public relations specialists, broadcasters and others. 
 Every year the CWA sponsors a contest in which they give out awards for the best written articles in a variety of categories.  The winners are announced at their annual conference.  This year, I submitted a few articles for consideration, and I’m pleased to announce I won three (!)  awards this year!

I won TWO Muse Medallions:
1) Newsletter Article – Any Other Topic
Judge’s comment:  “This is an entertaining and informative article that takes the reader on a unique journey into Holland’s famous floating cat shelter and examines its veterinary care practices.  The writer succinctly narrates a personal account of the ways another culture manages its homeless cat population.”
The Muse Medallion goes to: Dr. Arnold Plotnick for "Cats in Amsterdam" published in Cat Fancy.
 2) Online Article – Health and General Care
Judge’s comment:  “There were many excellent articles in this category.  With their fluid, easy-to-read style, the winner’s entries, in particular, provided enjoyment while dispensing useful and important information.”
The Muse Medallion goes to: Dr. Arnold Plotnick for "Why We Vaccinate (Even Indoor Cats)" published in Cat Man Do.

And last but not least, the big one) The PURINA ONE® HEALTH AWARD sponsored by Purina is for the outstanding single article reporting on feline health issues.
Judge’s comments:  “The winning article has good information.  It is readable, accurate and applicable.  This article can help everyone at all levels of ownership and experience understand the importance of oral health in cats.”
The winner is Arnold Plotnick for “Anatomy of the Feline Mouth.”
Also, see:
2011 Certificate of Excellence Winners (PDF) 
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Shelter Sketches: Meet Vincent, Marellus, and Mia

This is amazing! Meet Chelsea Conlin, a freelance illustrator who also uses her artform to save animals. She is in charge of Shelter Sketches on ILRA )

Each week, Chelsea snags a photo posted from an animal shelter or rescue group of animals that need homes, and transforms the picture into a work of art.

This week Chelsea picked the three kitties rescued, and up for adoption at Manhattan Cat Specialists! Yay!  We posted this picture with some information about how to adopt these kitties:

Before Chelsea:

And Chelsea transformed that picture into this:

After Chelsea:

Chelsea is truly outstanding!  And her blog post is terrific as well. This is such an incredible method for her to do exactly what she loves and save lives.  She gets to do illustrations of animals each week.  She gets to help rescue animals with a brilliant way of spreading the word.  She gets to watch her artform travel worldwide while people are sharing their desire to help animals in need.
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Pulp Kittens - available for adoption now at Manhattan Cat Specialists

Manhattan Cat Specialists kittens for adoption.

We have three new rescue kittens available for adoption at Manhattan Cat Specialists; Vincent, Marcellus, and Mia are approximately 8-10 weeks old..  These kittens were scheduled to be euthanized. Instead, they're relaxing with us at the hospital, shaking off small colds, and almost ready to be adopted into loving homes.

All specific info (testings for FIV and FeLV, vaccination record, ect) will be updated here in about a week.  In the meantime, if you are in the New York City metro area and would like to adopt a cat, please visit our adoption info page, and then give us a call.  If you have friends or family that may be interested in some adorableness in their lives, please share this post.  These kitties deserve loving homes.

230 West 76th Street  |  New York, NY 10023  |  212-721-2287
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Cat Litterbox Problems Solved

CatChannel solves all your cat litterbox problems.

Cat Resources
Cat Litterbox Resources Get answers to your cat litterbox questions with a quick check of litterbox resources from and CAT FANCY. Find articles that discuss cats’ inappropriate elimination, cat constipation, loose bowels in cats, cats who use the litterbox to sleep and other cat litterbox conditions. Looking for something not on our cat litterbox resources list? Contact a CAT FANCY and expert to ask your about your cat’s litterbox condition. All this and more can be found in our cat litterbox resources section.
What will happen when you fix your cat? Find out from an expert.
Constipation Sources
Learn why your cat might have a stoppage of stools.
Cat Spraying
When your cat uses scent marking to mark territory, try some simple steps to help redirect your cat's behavior.
Locate the LItterbox
Check this quick tip to see how good litterbox location will help your cat have healthy habits.
Inappropriate Elimination
Going outside the litterbox is a common cat problem. See how to help correct this behavior and get your cat to use his litterbox again.
My Cat Is Sleeping in the LItterbox — Why?
Your cat might be trying to tell you something if he's using his litterbox for a bed.
Soft Stools
Your cat's loose bowels can signal a problem. Get expert advice on your next step.
Keep It Inside the Box's veterinary expert explains how to teach cats to use their litterboxes.
Defecating Outside the Litterbox
Your cat could avoid the litterbox for everything. Get tips on how to correct bad litterbox behavior from cat behaviorists.
Why Cats Stop Using the Litterbox
Do some detective work to discover why your cat went from using the litterbox to using the floor around it.
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Hepatic Lipidosis in Cats

Hepatic Lipidosis in Cats

by Arnold Plotnick MS, DVM, ACVIM, ABVP

Section: Overview

Hepatic lipidosis (fatty liver disease) is a syndrome characterized by an accumulation of excessive amounts of lipid (fat) within the cells of the liver, abnormal bile flow within the liver, and impaired liver function. Severe impairment of liver function may affect the liver's ability to detoxify the blood. As toxins accumulate, they can affect the mental status of the cat, leading to mental dullness, severe depression, and seizures. Hepatic lipidosis can occur as a primary event, or it can occur secondary to other disease processes, such as diabetes. It is the most common liver disease encountered in cats.

Adult cats of either sex can be affected. Any breed of cat is susceptible. Middle aged to older cats are most likely to be affected.

Hepatic lipidosis can be a serious disease. Even with aggressive therapy, a significant number of cats die from the condition.

The cause of hepatic lipidosis remains unknown. Obesity is thought to be a predisposing factor, as most (but not all) affected cats are obese at the time of disease onset. A period of anorexia (decreased appetite), occurring as a result of a stressful event (such as the addition of a new pet or family member, or a sudden change to a less palatable diet) can trigger the onset of hepatic lipidosis.

What To Watch For

Loss of muscle mass
Jaundice (yellow tint to the whites of the eyes and possibly the skin inside the ears)
Severe depression
Possible seizures

Diagnostic Tests

The diagnostic tests needed to confirm the presence of hepatic lipidosis and exclude other liver disorders include:

Complete medical history and physical exam. This includes examination of the gums, whites of the eyes, and other part of the body for jaundice (yellow discoloration).

Blood tests and urine analysis to confirm that the liver is affected

Bile acid test to assess how well the liver is functioning

Abdominal x-rays to evaluate the liver

Abdominal ultrasound. This is a painless procedure in which a probe is held against the abdomen and is used to detect valuable information about the health of the liver.

Fine-needle aspirate of the liver. This technique allows for a small sample of liver cells to be obtained and evaluated.

Liver biopsy. Obtaining a biopsy specimen (a small piece of the liver) is the definitive test for making a diagnosis of hepatic lipidosis.


Dietary therapy is the mainstay of treatment. Affected cats may need to be force fed, or fed through a tube in the nose, esophagus, or stomach. Hospitalization is usually required for the first few days. Treatment for hepatic lipidosis may also include some or all of the following:

Medication to control vomiting

Drugs that help control gastrointestinal bleeding for cats that develop stomach ulcers

Medications that help control the mental signs of hepatic lipidosis in severe cases

Blood transfusion if the impaired liver cannot normally regulate blood clotting

Appetite stimulants

Drugs to improve bile flow within the liver

Home Care and Prevention

Follow all feeding instructions very carefully, as dietary therapy is the most important aspect of therapy.

If a nasal, esophageal, or stomach feeding tube has been inserted, follow all instructions as to the care and maintenance of this tube, and report any problems to your veterinarian immediately.

Give all medications and dietary supplements as directed.

Although the actual cause of the disorder is unknown, obesity and anorexia have been noted to be associated with the onset of disease. Therefore avoid overfeeding your cat to prevent obesity and avoid stressful situations that may cause a cat to suddenly stop eating, such as the addition of a new pet or family member, or suddenly changing your cat's diet.

Section: Information In-depth

Hepatic lipidosis (fatty liver disease) is a common disease of the feline liver in which abnormally large amounts of lipid (fat) accumulates within the cells of the liver. In other animals (humans, dogs, laboratory animals), lipid accumulation tends to be harmless, however, the cat's unique pathways of protein and fat metabolism cause lipid accumulation in the liver to have severe consequences. Any breed of cat may be affected, and both sexes seem to be affected equally. Middle aged to older cats are more susceptible than young cats.

Most, but not all, affected cats have a history of being obese, as well as a history of a sudden loss of appetite, often precipitated by a stressful event, such as a move to a new home, separation from an owner, a new pet or family member in the household, or a sudden switch to an unpalatable food. Anorexia, depression, and intermittent vomiting are the first signs usually noted by the cat owner. As liver function worsens, cats may develop jaundice (a yellow discoloration to the whites of the eyes, gums, and skin), severe loss of muscle mass, drooling, and signs of mental dysfunction (severe depression, sudden blindness, seizures). Cats often lose at least 25 percent of their body weight. The diagnostic tests recommended will help differentiate hepatic lipidosis from other liver diseases such as:

Cholangiohepatitis - an infection or inflammation of the liver and bile ducts

Feline infectious peritonitis - a deadly viral disease that can affect many organs, including the liver

Toxic liver disease - caused by ingestion of a drug or other harmful toxin

Liver cancer

Feline leukemia virus

Parasites - such as liver flukes (uncommon)

Section: Veterinary Care In-depth

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

There are a variety of diagnostic tests that may be run so that a diagnosis of hepatic lipidosis can be made. These tests may include:

Medical history review and complete physical exam. A history of obesity and sudden onset of anorexia after a stressful event is a classic finding in hepatic lipidosis. Physical exam usually reveals dehydration, severe weight loss, drooling and jaundice.

A complete blood count usually reveals mild anemia, and abnormally shaped red blood cells (known as poikilocytes), which are often an indicator of liver disease.

Blood tests that test organ function are especially important. Cats will usually have moderate to severe elevations of several liver parameters. A thyroid test is necessary to rule out a hyperactive thyroid as a cause of the liver enzyme elevations.

A bile acid test is a special blood test that may be necessary. It requires a blood sample after a 12 hour fast. The cat is then fed (force fed, if necessary), and another blood sample is taken two hours later. This simple test assesses the function of the liver.

Analysis of the urine may give information concerning the function of the liver.

X-rays of the abdomen allows assessment of the size and shape of the liver, and may help rule out a tumor as a cause of the liver problems.

Ultrasound of the abdomen allows limited assessment of the internal structure of the liver. It allows some assessment of the gall bladder and biliary system, and may rule out cancer as a cause of the liver disease. It may also help provide a method for obtaining a biopsy sample.

A fine-needle aspirate of the liver is a small sample of liver cells that are obtained by inserting a needle into the liver. This technique requires no or minimal sedation, and complications are extremely rare. Results must be interpreted cautiously, however, because concurrent liver diseases cannot be ruled out and may be missed.

A liver biopsy, in which a small sample of liver tissue is obtained, is the definitive test for diagnosing hepatic lipidosis. A biopsy specimen may be obtained surgically, or may be obtained using a special instrument that is inserted into the abdomen while being guided by the ultrasound probe. Surgical biopsies can be obtained by most veterinarians. Ultrasound-guided biopsies are often referral procedures.

Therapy In-depth

Therapy for hepatic lipidosis is aimed at reversing the accumulation of fat in the liver, and treating the signs of liver dysfunction. The primary treatment for reversing the fat accumulation is aggressive nutritional support.

Dietary therapy is the mainstay of treatment. High protein diets are usually recommended (except in cases where the cat is showing mental signs of liver disease). Because nearly all affected cats are completely anorectic, food is administered through a nasal, esophageal, or stomach tube. This requires hospitalization, and sedation or anesthesia.

Several dietary supplements such as carnitine or arginine may be beneficial in treating cats with hepatic lipidosis, and may be recommended or prescribed by your veterinarian.

Vomiting is a frequent finding in cats with hepatic lipidosis. Many cats require a medication to help control vomiting, such as metoclopramide, especially during the initial 1 or 2 weeks of tube feeding.

Some cats with liver disease develop ulcers and subsequent gastrointestinal bleeding. Drugs that control gastric acidity, such as Tagamet, Zantac or Pepcid, may be necessary to help control this. Carafate, a gastric protectant, may be used in conjunction with the antacids.

Antibiotics may be necessary in severe cases. They help kill off bacteria that produce harmful toxins that may lead to various mental manifestations of liver disease (drooling, depression, blindness, seizures).

Blood transfusions may be needed if the liver is so impaired that it cannot produce adequate clotting factors or cannot regulate the ability of the blood to clot properly.

Appetite stimulants (oxazepam, cyproheptadine) may be tried, but are seldom useful. They seem to work best in the recovery phase of the disease.

Ursodeoxycholic acid, a drug that improves bile flow within the liver, may be helpful in selected cases.

Section: Follow-Up

Optimal treatment for a cat with hepatic lipidosis requires a combination of home and professional veterinary care. Follow up can be critical, especially if your pet does not rapidly improve. With early detection and aggressive nutritional support, survival rates for hepatic lipidosis are 60 to 80 percent.

Administer all prescribed medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.

Follow strict instructions concerning the care and management of any feeding tube that has been placed in your cat.

Follow strict feeding instructions in terms of the type of food, amount of food, and frequency of feeding, as dietary therapy is the most important aspect of therapy. As the cat improves, tube feeding should be decreased, and palatable food offered so as to encourage the cat to eat on his own. The tube is removed when the cat is voluntarily eating enough to meet his energy requirements.

Your cat should be re-examined every 3 to 7 days to have body weight, hydration status, and degree of jaundice evaluated.

A complete blood count, and a panel of blood tests evaluating the liver should be performed every one to two weeks during treatment.
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Need a New Wingman? Adopt a Cat.

Here's a great pro-cat adoption PSA by the Denver Dumb Friends League
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Top 5 Healthy Cat Treats

Top 5 Healthy Cat Treats

Don’t serve up tricks, just treats that your cat can eat for health this holiday and beyond.

Cat eating treats
The best treats serve two purposes: tasty reward and healthy supplement.
Cats require a nutritionally complete and balanced diet to live an active, healthy life. Life is meant to be enjoyed, however, and every now and then it’s OK to toss your cat a tasty treat.

Not all cat treats are the equivalent of kitty candy. Some “treats” are actually beneficial for cats and are almost on par with giving medication. Here’s my list of five “treats” that can make your cat happy and healthy.

1. Dental Treats - Dental problems are the most common disease that we see in cats. They can lead to bad breath, swollen and bleeding gums, loose teeth, oral pain and difficulty eating.

Periodontal disease is very common in cats. Untreated, it can lead to oral pain, abscess formation, osteomyelitis (bone infection) and tooth loss. Oral bacteria can enter the bloodstream through diseased oral tissues, affecting other organs as well, most notably the heart valves and kidneys. Treatment of periodontal disease requires professional cleaning under general anesthesia. The plaque and calculus are removed, and the root surfaces are cleaned.

Prevent advanced periodontal disease with early detection and treatment. Home care is essential after professional cleaning, and that includes brushing and — you guessed it — cat dental treats! Most cats aren’t too crazy about having their teeth brushed, but tartar-control treats seem to be popular with many cats. Cat owners who regularly give their cats treats should consider using crunchy tartar-control treats over the softer treats, especially for cats prone to dental disease.

2. Hairball Remedies - Hairballs are a constant problem for cats (and cat owners). The most important part of hairball prevention is to brush your cat regularly and to remove as much loose hair from the coat as possible. Get your cat used to being handled and brushed regularly while he is a kitten.

If cat hairballs become a problem despite diligent brushing, other deterrents include feeding specially formulated hairball diets, administering the brown gooey oral hairball remedies from pet stores and veterinary offices or handing out some crunchy hairball treats with the gooey hairball gel in the center. Many cats love the gel and/or the gel-filled treat, and it’s a great way to reward your cat and prevent hairballs at the same time.

3. Heartworm Preventatives - Heartworm disease has been a major concern for dog owners for the last few decades. For cat owners, however, heartworm disease barely registers a blip on our radar screen, with most cat owners wrongly assuming that cats aren’t susceptible to the disease. In fact, feline heartworm disease (FHD), although relatively uncommon, is a serious and potentially fatal disease in cats. Fortunately, the disease is entirely and easily preventable.

Some FDA-approved drugs are marketed for monthly use in cats. One very popular formulation (Heartgard for Cats) is a chewable treat!  Because the consequences of cat heartworm disease are potentially dire and treatment options are limited, give monthly preventatives to cats living in endemic areas. Remember, even if your cat goes crazy over the taste, you can only give the treat once a month.

4. Lysine - Upper respiratory infections are very common in cats, most frequently caused by the feline herpes virus. Lysine is an amino acid that many believe speeds the resolution of herpes virus infections, and is recommended for cats with clinical signs of herpes virus.

Lysine tablets are quite large and are difficult to administer to cats. Crushing them and hiding them in the food is fine, if the cat will take it that way, but easier options exist these days. A variety of veterinary preparations of lysine now available include powders, pastes and … crunchy lysine treats! Each treat contains 50 mg of lysine, which means a typical cat can get five treats twice daily. Ten treats a day, prescribed by a veterinarian — Not bad! Bear in mind that herpes viruses stay in the body forever and during times of stress the virus may re-emerge from dormancy and cause recurrence of the upper respiratory symptoms. Keeping cats current on their vaccination status should help reduce the severity of the upper respiratory infections.

5. Glucosamine and Chondroitin - Arthritis is common in cats, especially elderly cats. The hips and elbows are the most commonly affected joints. The most obvious signs would be lameness and stiffness when walking or an inability to jump well, however, other more subtle signs may exist, such as urinating defecating outside the litterbox because arthritis makes it difficult to step into or crouch in the litterbox. Hair matting or an unkempt coat might appear because arthritis in the spine can make it difficult to properly to groom.

One way to help relieve the discomfort of arthritis is to give glucosamine and chondroitin, the same supplements humans use for arthritis. This supplement comes in several forms. A popular form is a capsule containing a chicken-flavored powder. Most cats enjoy the taste and regard it as a treat. It’s an easy way to administer glucosamine and chondroitin. Cats who fail to respond may require stronger medication, such as anti-inflammatory drugs.

So there is a tasty way to stay healthy. Take these five treats and enjoy them in good health!

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My Stray Cat Expedition in Istanbul, Turkey - Day 7

My Stray Cat Expedition in Istanbul, Turkey - Day 7 (continued from Day 6)
Dr. Arnold Plotnick
(click pictures to enlarge)

It’s our last day in Istanbul.  Sigh. 

When I booked the flight, I had originally planned on taking the 11:00 a.m. flight, bringing us back into NYC  at 2:30 p.m.  Instead, accidentally, I booked the 5:15 p.m. flight.  Once I did this, it was too late to switch without paying a substantial penalty.  So I kept  the 5:15 flight.  This flight would arrive in NYC at 9:00 p.m, and by the time we got home it would be 10:30 or 11:00.  Having to work the next  day, it wouldn’t give much time at all for unwinding or unpacking.  As it turns out, I’m glad I did it this way, because we didn’t have to catch the shuttle to the airport until 1:00, giving us a half day of sightseeing.

I woke up early and took one final look out the hotel window. 

First thing I see is a kitty across the street.  This should be a good omen for the rest of the day.

Our goal today was to see the Quincentennial Museum of Turkish Jews.  The museum is located not far from the Galata Tower, so we took the same route that we took a few days ago, starting with our beloved Istiklal Street.   This time, however, we were seeing Istiklal Street early in the morning before the swarms arrive.  It’s that nice time of the morning, when shop owners are just opening and laying out their fruits and fish and other wares for the day. 

As we strolled down the street, we took a little detour down an interesting side street, and at the end of the street was a gate, behind which was a courtyard for some old building.  I don’t know what type of building it was, but I tell you, I hit the kitty cat jackpot!  There were TONS of cats in this courtyard.  Take a look for yourself!

All shapes, all sizes, all colors.  All looking pretty well-fed.

You can see I’m enjoying myself.

All of them were  really sweet.  I’m sure they were looking for food, but I prefer to think that I just have this type of animal magnetism.

One  last look at the kitty crew, and then we’ll move on:

We finally found the entrance to the Quincentennial Museum of Turkish Jews. In 1492, King Ferdinand and Queen Isabel of Spain ordered their Sephardic Jewish population to accept the Christian faith, or leave and “dare not return”.  The Ottoman sultan Beyazit Han was the only monarch of th time who extended an invitation to take in these refugees.  Jewish people remain a vibrant part of Turkey’s cultural mosaic.  This museum, founded 500 years (hence “quincentennial”) after the Spanish expulsion, commemorates those first Sephardic Jews who found a new home here.  The museum is housed in an inactive early 19th-century synagogue, and displays items donated by the local Jewish community.

After the museum, walked around in search of the Camondo staircase.  This is a short, curvaceous double staircase leading up from Voyvoda  Street, the historic banking hub.  It was build by Avram Camondo, a leading merchant in the Jewish community and head of the prosperous Camondo family.  He was the first foreigner given the right to have real estate in the Ottoman Empire.  He built this much-used staircase in the 19th –century as a mark of his gratitude, and also to ease the uphill journey to the family’s home when their baby Moise was born in 1860.  I checked my map, and found the staircase.

I climbed up and got a good picture from above, looking down.

We continued the Jewish history tour with a quick visit to the Schneidertempel Art Gallery.  Built in 1894 as one of the city’s few Ashkenazi synagogues, this well-restored building holds temporary exhibitions relating to Jewish life and culture.  The most striking feature is the simple Star of David stained-glass window, above the area which used to be the ark (the ornamental closet that contained the Torah scrolls).   “No photos allowed”, the sign said, but you know how I feel about that silly rule.

After the gallery, we strolled back slowly to the hotel, lingering over souvenir shops.  There was a nice looking hotel on the street we were walking, with a cat (wearing a collar) sitting on the step outside, observing the world go by.

We headed back to Istiklal Street, then to our hotel nearby.  Here are the last cat photos I took on the trip.  First, this little gray kitty watching the woman in the shop prepare for the lunchtime rush.  I’m sure he thinks he’s gonna grab some lunch there, too.

As we passed the high school, I spotted these cats in the front courtyard.  Someone had just tossed down a huge handful of kibble.

Here’s another of the high school cats

We got back to the hotel, grabbed our bags, and headed over to Taksim Square where we caught our shuttle bus to the airport. 

Istanbul.  It’s the historical, cultural and financial center of Turkey, and it’s onne of the world’s most dynamic cities.  It’s the crossroads of civilizations where Europe meets Asia and where East meets West. Great food, great shopping, great people, and as you know by now,  a city teeming with friendly, sweet, well-cared for cats.  I had the time of my life.  I hope you’ve enjoyed reading about my trip and seeing all the cats I met while I was there.

The Istanbul, Turkey Stray Cat Adventure:   
Day 1   Day 2 pt1   Day 2 pt2   Day 3 pt1   Day 3 pt2   Day 4 pt1   Day 4 pt2   Day 5 pt1
Day 5 pt2   Day 6   Day 7

Other Dr. Plotnick adventures:  Amsterdam   Vienna   Budapest   Bangkok (coming soon)
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My Stray Cat Expedition in Istanbul, Turkey - Day 6

My Stray Cat Expedition in Istanbul, Turkey - Day 6 (continued from Day 5 part 2)
Dr. Arnold Plotnick
(click pictures to enlarge)

            Monday was our last full day in Istanbul.  Today, the plan is to take a cruise up the Bosphorus.  Anyone who’s read Orhan Pamuk’s book, “Istanbul” knows the importance the Bosphorus Strait plays in the lives of the people of Istanbul.  The 19 mile-long Bosphorus serves as Istanbul’s main highway, hosting a never-ending stream of vessels, from little fishing boats to humungous oil tankers to luxury cruise ships.  It’s one of the busiest waterways in the world.  It’s the only outlet to the Mediterranean for Russia, and the only route to any sea for other countries on the Black Sea, like Romania, Bulgaria, Ukraine, and Georgia.  The Bosphorus separates two continents – Europe and Asia.  It connects the Black Sea in the north with the Sea of Marmara and (eventually) the Mediterranean in the south.  The Turks view the Bosphorus as much more than just a body of water.  It’s a sacred inheritance.  The locals are very content to just sit for hours on a bench that overlooks the Bosphorus and watch the boats go by.  I crossed the Bosphorus when I headed  over to Uskudar.  A 13 minute ferry ride, however, is no way to experience the strait.  Today, we have a 90 minute cruise up the 19-mile waterway, and I’m excited. 

            The public ferry, which leaves from the Old Town side of the Golden Horn, departs every day at 10:35 a.m.  To ensure a good seat on the left (European side) of the boat, we got to the ferry dock early.  Maybe a little too early.  So, with a bit of time to kill, we crossed over to the Spice Market area and grabbed a pastry and some tea.  The vendors outside the spice market were just setting up their stands.  I noticed in a planter nearby, a cute young cat poking about.  This cat had a red collar on, which I suppose indicated that she was being looked after by someone. 

About a minute after  I took this photo, a vendor from one of the stands nearby  came over and gave the cat a small fish.  A woman came over soon after and admired the kitty, so much so that she picked it up and had her husband take a photo of her with his cell phone camera.

We headed back to the ferry dock, purchased our tickets, and then lined up to board the ferry.  We made a mad dash to the upper deck of the boat and secured ourselves a great seat  and watched the attractions as they floated by.

The water was deep blue, the sky was clear, the weather was warm.  It was perfect. 

Our little section of the ferry contained eight seats.  Mark and I sat across from each other on the railing.  We met, sitting next to us, a couple from Canada, Bill and Jane.  Next to Jane were a couple from Los Angeles, and across from them were a Vietnamese couple from Houston, Texas.  During the course of the trip, we all did a little chatting, and ended up getting along very well.  Jane was impressed with my Rick Steve’s guidebook, which described in detail the various buildings and sites along both shores.  She and I teamed up to identify them all as we sailed past them, so we could point them out to Bill and Mark, who would then take the photos. 

As the ferry pulled away, we saw Hagia Sophia, Topkapi Palace, the Blue Mosque, the Istanbul Modern Arts Museum, Dolmabahce Palace, Ciragan Palace, the Ortakoy Mosque, Kuleli, the Cape of Kandilli, and the Egyptian Consulate, to name a few. Describing all of the important mosques, forts and other structures would fill another ten blog posts.  Needless to say, there were many, and it was both entertaining and educational. 

We arrived at our destination, Anadolu Kavagi, a small fishing village on the Asian side.  From Byzantine times to the present, this has been a strategic checkpoint for vessels going through the Bosphorus.   In this little village, the ferry takes a break and docks for about three hours.

(Note the little kitty sitting by the dock.  I hadn’t actually noticed this until I inserted the photo into the blog.)

There are two main activities you can do in town: eat lunch, or hike up to Yoros Castle.  For cruises that stop in town for just two hours, you can either do one or the other.  For cruises that stop for three hours, you can probably do both.  So that’s what we did.  Bill and Jane asked if they could come along with us, and we were happy to have the company.  We decided to hike to the castle first, and eat afterward.  Yoros Castle is a little run down and it hardly reflects the glory of its past, but it does afford fine views over the Bosphorus and to the Black Sea.  The hike to the castle is a strenuous 20 minute climb.  Before starting, we stopped for refreshments, to take with us on the climb up.  Outside the little grocery, I spotted a kitty sleeping snugly in a planter.

As we climbed, we encountered a sign that signaled a shortcut up to the top.  We took this path, which very cleverly diverted you through a few restaurants.  Although we had the castle as our ultimate destination, it was tough to avoid giving into temptation and stopping for lunch, given the spectacular views at this height:

We finally reached Yoros Castle, at the top of the hill.  You can’t go into the castle, but it makes for a pretty nice photo

 And the views are pretty amazing.  Check out this lovely view of the Black Sea

The walk down was certainly much easier.  We arrived back near the ferry port,  where there were a million restaurants catering to cruise passengers, both international tourists and Istanbul residents who come up here for a nice meal on weekends.  Mark, Bill, Jane and I found a cute place a block or two from the ferry dock and ordered a nice meal.  My meal arrived, and I suddenly felt like I was being watched.  I was.

We headed back to the dock, where people were lining up to get on the boat.  The plan was to sit on the left side of the boat again, so that this time, we’d have a nice view of the Asian side on the way back.  We snagged a nice spot on the upper deck.  We didn’t see the two other couples while we were in the fishing village, or on the ferry dock going back, but we decided to save seats for them for the ride back.  They had no idea we were doing this, were pleasantly surprised to discover that we had arranged for the eight of us to all ride back together.  Steve, from Houston, is Vietnamese, and so is his wife, Kim.  When Kim found out that Mark was also Vietnamese, she sidled up to him and started chatting, and before you knew it, they were yakking away like brother and sister. 

We arrived back in the Old Town, where we all exchanged e-mail addresses so that we could keep in touch and share photos of the cruise with one another.  (That’s Bill, Mark, Steve, and Kim on the ferry.)

With this being our last full night Istanbul, we wanted to spend it by doing something really authentically Turkish.  We considered going to a hammam (Turkish bath), but we decided instead to spend the evening doing what many locals do: smoke a water pipe, drink tea, and play backgammon. 

The  water pipe, called a nargile (nahr-ghee-leh) (but also known as a “hookah” or “super-enormous bong”) is a Turkish tradition. Even non-smokers enjoy these things.  Smoking a nargile is not about the smoke; it’s about the relaxing social ritual.   The water pipes you see in Istanbul aren’t for smoking pot.  Instead, they use low-nicotine tobacco leaves, mixed with things like dried fruit or herbs.  This fruit-infused tobacco contains zero nicotine and give you no buzz at all, but the rich taste and aroma makes it a lot of fun.  We had noted, on the day that we went to the modern art museum (Istanbul Modern) that nearby was an entire row of nargile cafés, filled with young people watching football on TV while playing backgammon and smoking the water pipe.  So we decided to head back to that area and see if we could find a nice place to spend the evening.  The cafés were a bit of a distance from the hotel, but we decided to walk, as it would take us through parts of Istanbul that we hadn’t seen.

The neighborhood we walked through was in the New District, which most people don’t explore much, because most of the touristy sites are in the Old Town.  There were lots of cool shops and restaurants with outdoor seating.  Everyone seemed happy and relaxed.  The streets were lit nicely by the street lamps.  It was a nice atmosphere.  While walking, I did spot some cute cats.  Like this one sitting on this scooter:

And this one sitting  on a cushion outside of a shop selling clothing and knick-knacks:

We finally got to the nargile cafés.  The proprietors see you looking at the cafés, and they try to wave you into their particular establishment.  We eventually found one at the end of the row that looked popular and fun.  We ordered up the pipe, asked for apple tobacco (the most popular flavor, I’m told), some tea, and a backgammon set. 

A brief  word about  tea.  Tea is more common amongst Turks than coffee.  It is grown locally along the Black Sea coastline.  The Turks drink it out of these  little weird shaped glasses.  The glasses don’t hold much tea, but that doesn’t seem to matter to them.  They take tiny sips and make the tea last a long time; it’s more of a social ritual than anything else.  So we added tea to our evening’s festivities.  And finally, backgammon.

Backgammon has been around for thousands of years. The game is originally Persian, and Turks still refer to it by its Persian name, tavla.  Everyone in Turkey seems to know how to play.  Some of the social conventions are interesting.  A man can challenge anyone anywhere, but  it’s considered inappropriate for a solo woman to challenge a man in a traditional coffee shop where most or all of the clientele are male.  It’s okay for a woman to challenge men if she’s traveling with a group that includes men, or even on her own if she’s in a mixed-gender coffee shop in the modern part of the city, like where we were.

So here I am, with my tea, backgammon, and hubbly-bubbly.

You can see that I was not alone; the place was packed.  I guess there was an important football game on, because most of the crowd was glued to the set.

It wasn’t only human companionship that we had surrounding us that night.  A cute black and white kitty  strolled by our table in the corner.  Before you knew it….

So, I’m in Istanbul, with my partner, drinking tea, playing  backgammon, smoking a water pipe, with a friendly cat on my lap.  Does life get any  better than this?

It does:

Good night!

The Istanbul, Turkey Stray Cat Adventure:   
Day 1   Day 2 pt1   Day 2 pt2   Day 3 pt1   Day 3 pt2   Day 4 pt1   Day 4 pt2   Day 5 pt1
Day 5 pt2   Day 6   Day 7

Other Dr. Plotnick adventures:  Amsterdam   Vienna   Budapest   Bangkok (coming soon)
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