Holy Feline Diabetes Batman

I remember a few years ago, David Letterman joked in his monologue that he saw an ad that said, “Lose weight without diet or exercise!”  Well, said Letterman, “that pretty much just leaves disease”.

I see a lot of overweight and obese cats in my practice, and I’m always happy to see these cats shed some pounds.  But last week, I saw two cats with dramatic weight loss, and I wasn’t all that happy about it.  Why?  Hint: it wasn't due to diet or exercise.

The first cat was Batman, owned by Ms. Catlubba (client's name has been changed).  Ms. Catlubba is my longest active client.  I took care of her cats when I was at the ASPCA.  She found out that I started my own practice a few years later and tracked me down, so I’ve been caring for her cats for 14 years now.  Her cat Batman used to be 20 pounds.  Granted, that’s huge, but it’s not like he was a 20 pound cat in a 10 pound body.  He was a 20 pound cat in a 16 pound body.  At 20 lbs, he wasn’t grossly obese, but still, if I were him, I wouldn't wear a Speedo at the beach.

Ms. Catlubba brought Batman in for weight loss.  I asked about his appetite, and she said it was still pretty good.  She thought he was drinking a lot and urinating a lot.  When cats lose weight and have increased thirst and urination, a couple of diseases immediately spring to mind:  hyperthyroidism, diabetes, and chronic kidney disease.  Cats with kidney disease tend to have poor appetites.  Cats with hyperthyroidism or diabetes tend to have excellent appetites.  About a month before this appointment, Ms. Catlubba brought in her cat Lucky with similar signs.  Lucky was diagnosed as being hyperthyroid.  We started him on methimazole, the oral medication we use to control hyperthyroidism, and he responded well.  His elevated thyroid level quickly dropped to normal, and his clinical signs resolved.  I figured Batman was hyperthyroid as well, because in my veterinary practice, things like to come in two’s and three’s, for some weird reason.  Batman was an older cat (14) and most diabetics tend to be younger.

I drew blood and got some urine, and sent it to our laboratory.  I was pretty surprised to discover that Batman’s blood sugar was in the 400s!  (Normal is 65 to 165).  No big diagnosis mystery here...

My observation about things coming in two’s and three’s was correct, because  the very next day, another long-time client, Mrs. Kibbletreat (name changed), brought in her cat, Tux, because he was losing weight.  Tux was another 20 pounder, and he came in weighing 14 lbs.  She said that he was drinking a lot, urinating a lot, and eating like a pig.  She said that he was a little weak in his rear legs, she thought.  He was having a little trouble jumping up on the couch, even though he had lost weight.  Tux was 8 years old.

I told Mrs. Kibbletreat that her cat was the absolutely classic textbook description of a diabetic:  an 8 year old, indoor, sedentary male cat that was drinking a lot, urinating a lot, eating like a pig, losing weight, and weak in the rear legs.  You could not have scripted it any better.  I took blood and urine samples, but rather than wait for the lab to tell me what I already kinda knew, I grabbed the glucometer and measured Tux’s blood glucose right on the spot.  It was in the 400s.  Two newly diagnosed diabetics in two days.

The incidence of diabetes is definitely increasing in the cat population.  There are several theories why this is happening.  Lots of people are blaming dry food, saying that the increased carbs in the food is leading to diabetes.  However, there’s no scientific evidence to back up that claim. (I know I’m opening up a can of worms here, but to anyone who disagrees: show me FACTUAL support for your argument, rather than opinion or anecdotes before you start writing.)  From what I’ve read, dry food increases the risk of cats becoming overweight, and being overweight predisposes cats to diabetes.  It’s not the dry food per se.  It’s the weight gain.

So what happens next for these cats?  Well, the first thing I did was run a fructosamine test on them.  Measuring the fructosamine levels essentially answers the question, “How well-controlled has your cat’s diabetes been over the last two weeks?”  I know that the fructosamine level will come back high, and that’s because the diabetes hasn’t been controlled at all.  But that’s our starting point.  Next, we start the cat on ProZinc insulin, 1 unit twice daily, for the next two weeks.  We also switch to a new diet, a high protein/low carbohydrate diet, like Purina DM or Hill’s MD.  Then I’ll measure the fructosamine again.  This time, it will answer the question, “How well controlled has the cat’s diabetes been over the last two weeks  with your cat on 1 unit twice daily?   If the fructosamine has dropped into the normal range, then that’s the cat’s dose: 1 unit twice daily.  If the fructosamine is lower, but still higher than we like, we tell the owner to increase the dose to 2 units twice daily, and we check the fructosamine again in 2 weeks.  The typical diabetic cat requires anywhere from 1 to 4 units on insulin twice daily.  If we’re lucky, the cat comes back two or three times until we find the correct dose.  If we’re not so lucky, it may be 4 or 5 visits before we discover the proper dose.  From that point on, it’s usually smooth sailing, with us checking the cat every six months.

I have no doubt both cats will do well.  Both clients are conscientious cat owners who will watch over their kitties the way parents watch over their children.  Once we get the cats regulated, the increased thirst and urination will diminish, the cat will gain back some of the weight, and the ravenous appetite will decrease a bit.  Tux should gain some of the strength back in his rear legs, too.   Occasionally we get lucky: in some cats, the diabetes goes into remission and the cat can usually be maintained on diet alone, with no insulin necessary.  That would be ideal.  When it happens, it usually occurs in the first six months after diagnosis, so we’ll be watching closely.

Next week, you’ll hear about the case I had two days ago – a cat with elevated liver enzymes and a discharge from one of her mammary glands.  Stay tuned!

PS: We're about to send out our Manhattan Cat Specialist's Newsletter! Want a copy? Go HERE or text CAT to 42828
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Corneal Ulcers in Cats

Anyone who has ever experienced having an eyelash trapped under a contact lens or a grain of sand blown into their eye quickly discovers that the cornea is loaded with pain receptors.  A corneal ulcer – a scratch or scrape involving the cornea – is a relatively common, potentially vision-threatening disease of the cornea in cats.

Cornea 101 – the basics

                The cornea is the clear membrane that covers the surface of the eyeball.  Anatomically, it is composed of several layers.  The outer surface layer is called the epithelium.  Just beneath the epithelium is the stroma.  The innermost layer is called Descemet’s membrane.

                “All cat breeds are potentially at risk of developing corneal ulcers”, warns Dr. Chris Pirie, a board-certified veterinary ophthalmologist at the Cummings School of Veterinary Medicine at Tufts University. However, cats in general have pretty refined defense mechanisms to prevent damage to their corneas. They have vibrissae (specialized “whiskers” above their upper eyelids) that can detect objects that approach their eyes, allowing them to take evasive action.  They also have a well-developed blink response.  Attached to the back of the eyeball is a muscle called the retractor bulbi muscle.  When this muscle contracts, the eyeball is pulled back into the socket.  This retraction of the eye allows the nictitating membrane – sometimes called the “third eyelid” – to elevate, protecting the cornea. Despite these sophisticated mechanisms, cats will occasionally suffer trauma to the cornea, and an erosion occurs on the corneal surface.  If the erosion goes through the entire epithelium into the stroma, this erosion is called a corneal ulcer.   If the ulcer goes deep into the stroma all the way down to Descemet’s membrane, the condition is called a descemetocele (pronounced “dess-a-met-a-seal”).  If the ulcer goes deeper, through Descemet’s membrane, the fluid inside the eyeball flows out and the eye collapses.

The latin root for cornea is kerat. When the cornea becomes inflamed, the medical term for this is keratitis.  If an ulcer is the cause of the inflammation, the condition is called ulcerative keratitis.

The causes

“Corneal ulcers in cats are typically secondary to a primary ocular disorder” says Dr. Pirie. “The most common of these would include feline herpes virus.” Trauma is another  common cause of corneal ulcers in cats.  Although a scratch from another cat is a frequent cause of corneal damage, there are more innocent causes of trauma, such as rubbing the eye on the carpet, or an unexpected interaction with a plant or tree branch.   Chemical burns, such as that caused by shampoo can cause corneal ulcers if the shampoo gets into the eye.  Decreased tear production – a condition called keratoconjunctivitis sicca or “dry eye” – can predispose cats to corneal ulcers.  This condition is more common in dogs than cats.  “Conformation plays a significant role” adds Dr. Pirie. “Breeds at risk, based on conformation alone, would include any of the brachycephalic (flat-faced) breeds, for example Persians  and Himalayans. These breeds often have macroblepharon (wide eyelid openings) and lagophthalmos (inability to completely close the eyelids), both of which contribute to premature drying of the cornea and disruption of the normal tear film.”

                Eyelash and eyelid disorders can also lead to corneal trauma. Eyelash disorders such as distichia (extra eyelashes) or ectopic cilia (misdirected eyelashes) can lead to corneal trauma as the abnormal lashes rub against the cornea.  Fortunately, eyelash disorders are rare in cats. Eyelid disorders are more common.  Entropion is a condition in which the eyelid rolls inward, causing hair near the eyelid margin to contact the cornea.  As the hair continually rubs against the cornea, an ulcer can form.

Julie is an 18 year-old domestic shorthaired cat, one of six cats owned by Mary Baysinger. In 2007, Julie was diagnosed with intestinal lymphoma.  Julie responded well to chemotherapy and is doing well nearly 3 years after her diagnosis.  However, Julie lost almost 3 pounds early in the course of her illness, causing her eyes to become sunken.  When her eyes retracted into their sockets, she developed bilateral entropion – both lower eyelids rolled inward, toward the eyeball.  Poor Julie developed corneal ulcers on both eyes.  At age 18 and with her cancer in remission, Ms. Baysinger was reluctant to have Julie undergo general anesthesia and corrective surgery. “Julie has done so well, despite her age and her intestinal cancer. If something happened  to her while under anesthesia, I don’t think I’d forgive myself”, said Ms. Baysinger.  Fortunately, she has been able to successfully manage Julie’s ulcers with frequent applications of antibiotic eye ointments that form a protective barrier between the hairs and the cornea. “These eye ointments have made her much more comfortable. If she were younger and healthier, I’d do the surgery right away. For now, she seems happy and comfortable”, she adds.

How can you tell?

                Corneal ulcers are painful, and most cats with corneal ulcers will exhibit some signs of discomfort, such as tearing, rubbing the eye, and keeping the affected eye partly or completely closed.  To prove that an ulcer is the cause of the discomfort, a fluorescein stain is usually performed.  To perform this test, a drop of a fluorescent orange-colored liquid is applied to the cornea.  If the cornea is intact, the dye washes smoothly over the corneal surface.  If an erosion or ulcer is present, however, the dye will adhere to the exposed stroma and can be easily detected using a black light.


                Treatment of corneal ulcers varies, depending on the depth and severity of the ulcer.  Antibiotic drops  or ointment is applied to the cornea several times a day, to prevent an infection from occurring, and  superficial ulcers typically heal in 3 to 5 days.  Irritation of the cornea often leads to spasm of a muscle inside the eye called the ciliary muscle.  When this muscle spasms, it causes pain for the cat. Atropine drops or ointment, applied to the affected eye, causes paralysis of the ciliary muscle and reducing pain and discomfort.  Atropine will cause the pupil to dilate widely, making the affected eye very sensitive to light and causing squinting, especially in bright light.  “If herpes is suspected, antiviral medicine is warranted” notes Dr. Pirie. Ulcers caused by feline herpesvirus-1 take longer to heal than superficial ulcers caused by trauma. Cats who rub at their eye a lot may need to be fitted with an Elizabethan collar to prevent further trauma.

 Occasionally, a superficial ulcer is slow to heal because the edges of the ulcer contain dead cells.  The dead cells prevent a new layer of epithelium from growing across the ulcer and filling in the defect. In these cases, removing the dead cells from the edges of the ulcer with a sterile cotton swab may be necessary to start the healing process. After a few (5 to 7) days of treatment, the fluorescein stain test is performed again. If the cornea does not take up any stain, it is considered to be healed.

                Deep ulcers and descemetoceles that are at risk for perforating require more aggressive therapy, such as applying a soft contact lens to the affected cornea, or some type of surgical technique designed to cover the ulcer or descemetocele .  A common surgical procedure is a conjunctival graft.  In this procedure, a small piece of tissue adjacent to the cornea is sutured over the ulcer. This allows blood vessels to deliver nutrients, antibodies, and infection-fighting cells to the damaged cornea, as well as providing mechanical support, in a similar fashion to how a skin graft promotes healing of a severe burn.  Another common procedure is partial tarsorrhaphy (pronounced tar-sor-a-fee), in which the eyelids are temporarily sutured together. The partial closure of the lids protects the cornea. Once the cornea has healed, the tarsorrhaphy is reversed so that the cat can use the eye again. If special techniques, diagnostic equipment or surgical skill is required, your veterinarian may suggest referral to a board-certified veterinary ophthalmologist.

                Ulcerative keratitis is a potentially vision-threatening condition.  Prompt diagnosis and aggressive treatment is required to preserve vision and keep cats comfortable.

Sidebar – administering eye medications

Administering eye medication

“We often suggest owners try to have the animal learn a positive association (i.e. receiving a treat) with the application of a medication. However, this is often more effective with dogs”, says Dr. Chris Pirie, a veterinary ophthalmologist at Tufts. “Regarding the application of the medication (i.e. drops), we generally suggest the owner rest their right hand (if right-handed) on top of the animals head, while holding the bottle using their thumb and forefinger. The palm and pinky finger are concurrently used to elevate the upper eyelid to allow application of the drop from above.  During all of this, the left hand is used to stabilize the animals head and the owner’s body (animal sitting on their lap) to prevent the animal from backing up and getting away. It is important to note that the hand applying the medication is resting on the animals head, as if the animal moves, so does the dropper , which reduces the risk of the dropper tip hitting the globe and causing further injury.”

Further info: Corneal Ulcers in Animals
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Pocket of Fluid on Leg

A quick scan of my appointment schedule on any given day reveals a litany of the typical problems encountered by pet cats. Interspersed with the well-pet and update-the-vaccinations exams you’ll find “vomiting”, “diarrhea”, “urinating on the rug”, “runny eyes”, “losing weight”… the list goes on. It’s not often I see “pocket of fluid on leg”, so I was particularly curious about this one. 

(Please note, what follows is semi-graphic material (no pictures, just written experience).  Proceed with cation if blood, pus, and ooze makes you queasy.  If you just chuckled at "blood, pus, and ooze," then you'll be fine.)

When I examined Percy, sure enough, there was a noticeable bulge coming off the lateral surface of her left front leg. It was kinda floppy, as if it was filled with some kind of gelatinous material. It didn’t feel watery, like a cyst, and it didn’t feel smooth and solid, like a lipoma (a fatty tumor). I really hadn’t seen anything like this before.

Percy was getting a little cranky during the examination, and she wouldn’t let me feel her front leg as thoroughly as I would have liked. I recommended that we admit her for a few hours, sedate her, and then I could obtain a good quality x-ray, and then insert a needle into the swelling. If it turned out to be a solid mass, I would aspirate the contents into the hub of the needle, and then spray it onto a slide for evaluation by a cytologist. If the swelling contained fluid, I would submit the fluid to our laboratory for analysis. Percy’s owner consented.

We sedated Percy and I shaved the fur off her leg to get a better view of this swelling. (Percy is a long-haired cat and the hair was camouflaging the blob on her arm pretty effectively.) The swelling was centered over the lateral part of the forearm, between the elbow and wrist. The largest area was right in the middle of the arm. The elbow was not involved. The elbow was normal, and then about an inch down from the elbow, the swelling abruptly appears. As you progress down the leg, the swelling doesn’t abruptly go back to normal. It tapers as it approaches the wrist, but it looks like the wrist is not involved. 

The x-ray revealed that the bones are not involved at all. The radius and ulna were normal, and the elbow joint and wrist joint were unaffected. 

I decided to try to drain this swelling. I stuck a needle into it and aspirated. The syringe filled with fluid, but not your normal watery cyst fluid. This fluid was the color and consistency of corn syrup. It was very thick and it filled the syringe very slowly. I touched the syringe onto a microscope slide and squeezed out a drop, and when I pulled the syringe away, a long stringy strand of fluid appeared, connecting the drop to the syringe. This stuff was weird and sticky. I drained about 20 cc of fluid from the mass and saved it in some tubes. I submitted the tubes for analysis by a pathologist.

After I drained the fluid, I felt again. There was no solid mass at the base of the fluid pouch. All that was left was an empty sac. I called one of the surgeons at Blue Pearl Veterinary Partners for another opinion. The surgeon I spoke to confirmed that this was indeed bizarre, and he suggested that this could be some type of mass, like a sarcoma, that is secreting the sticky fluid. There are sarcomas called myxosarcomas that secrete a sticky material that resembles mucus (for lack of better description). Neither of us could come up with much else. He said he’d be happy to look at the cat once the fluid analysis came back, and we could then decide if this was something that was best addressed surgically. Percy woke up uneventfully and I sent her home.

Yesterday the analysis came back. The pathologist is calling this “joint fluid”. When I first aspirated the fluid, I thought it resembled joint fluid, but the swelling didn’t involve a joint! It seemed to begin in the mid-shaft of the forearm. The elbow and wrist weren’t involved. If the joints were normal, joint fluid accumulation would be unexpected. There was no sign of infection, and no signs of cancer, according to the pathologist. 

For now, Percy’s owner is going to just monitor things at home. I’m going to recheck her in a month to see if the fluid as re-accumulated. If it has, I think I will send the cat to Blue Pearl for a surgical consultation. Whether this thing needs to be removed or not remains to be seen. I suppose if it refills but causes no problems for the cat, she can live with a small bulge on her left forearm. If it continues to grow, or if it starts to bother her and affect the way she walks, she’ll probably need some procedure to reduce the size of it. I’m tempted to err on the cautious side and have a surgeon take a look sooner, as surgical removal would be more challenging if the bulge grows too large and starts encroaching on the joints above and below the swelling. In any event, we’ll revisit this puzzling cases in a later blog post, when she comes back for her recheck.

Never a dull moment, I tell ya.
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Adopt Rufus the Cat - Manhattan Cat Specialists Cat for Adoption

Rufus was abandoned by a family that moved away. Left outside to fend for himself he was found by a member of our staff.

He's about a year old, he's neutered, tested negative for FelV/FIV and he is up to date with all his vaccinations. He can only be adopted into a home that curently does not have cats.  If you are interested in adoptiong Rufus please visit our “Adoption Corner.”  Additionally, you may want to fill out our Pre-Adoption Application.

Please Recommend our adoption program to your friends by sharing this info.
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Top 10 Most-Read Cat Stories on CatChannel in 2011

Top 10 Cat Stories of 2011 on CatChannel

Visitors to found the following 10 articles most interesting in 2011.

10. Loose Stool
Find out what a vet recommends for dealing with loose stool. Click to continue

9. Cat Dandruff
Find out what causes dry, flaky skin in cats. Click to continue

8. Does Your Cat Have a Fever?
A vet explains how to recognize a feline fever and take a cat's temperature. Click to continue

7. Is Your Cat Depressed?
This checklist will help you find out. Click to continue

6. Do Cats Get Lonely If Left Home Alone All Day?
CatChannel behavior expert Marilyn Krieger, CCBC, explains why interaction with humans and animals is essential in a cat’s world. Click to continue

5. Why Does My Cat Drink Lots of Water?
Find out what a vet recommends for a cat who drinks excessive amounts of water. Click to continue

4. How Old Is My Cat in Human Years?
CatChannel veterinary expert, Arnold Plotnick, DVM, provides a chart for estimating a cat's age as it compares to a person's age. Click to continue

3. Should a Cat's Nose Be Wet or Dry?
CatChannel veterinary expert, Arnold Plotnick, DVM, says the notion that a cat's nose must be wet is not entirely accurate. Click to continue

2. Are All Orange Tabby Cats Male and Are All Calico Cats Female?
CatChannel veterinary expert, Arnold Plotnick, DVM, explains how cats get their gender and colors. Click to continue

1. Why Does My Cat Throw Up After Eating?
CatChannel veterinary expert, Arnold Plotnick, DVM, explains the possible causes for frequent vomiting in cats. Click to continue


Dr. Arnold Plotnick, feline veterinary expert, answers medical questions about your cat  Dr. Arnold Plotnick, DVM
Warm greetings to my fellow feline enthusiasts. I'm Dr. Arnold Plotnick, one of CatChannel's health experts. I am the owner of Manhattan Cat Specialists, a cats-only  veterinary hospital in New York City, and I maintain a blog called Cat Man Do. I'm very excited that I've been given this opportunity to answer your cat questions and share my experiences as a practicing feline veterinarian.
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Announcing Manhattan Cat Specialists' First Retirement

Manhattan Cat Specialists is a relatively young hospital.  We opened in January 2003, so we’re 9 years old.    

And yet, we’re ready to announce our first retirement.  

After (approximately) 6 years of valiant service, our hospital cat, Topeka, has donated her last unit of blood.  If I had to estimate, I’d say that Topeka is called on to save the life of a gravely anemic cat approximately twice a year.   We think that she’s earned the right to keep her blood to herself for the remainder of her life.  However, we’re calling it a SEMI-retirement, because we still call upon her to act as our “demo” cat when we show clients how to give subcutaneous fluids, insulin injections, pilling techniques, and how to perform syringe feedings.    

Considering the life of luxury she leads

it’s a small price to pay.

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The Most Popular Cat Names of 2011

The list of most popular cat names in 2011 was recently released.  They are, in order:


 What about Mufasa?! No.. No Mufasa for 2011

As a feline practitioner, I recognize these names as being very popular indeed.  It had me wonderingif my own hospital’s population of Bellas, Maxes, and Chloes ranked in the same order of popularity as the national list.  So I checked.  Here’s our list.  The national ranking is in parentheses next to the name.

-Max (2)
-Lucy (5)
-Chloe (3)
-Bella (1)
-Oliver (4)
-Charlie (9)
-Tiger (8)
-Shadow (6)
-Smokey (7)
-Tigger (10)

They’re close.  Bella topped the 2011 list, but in my hospital, Bella is bested by Max, Lucy, and Chloe. 

These may be the most popular names in 2011, but if you’re wondering, the most popular cat name in our hospital is, and probably always will remain:  Kitty.

Here's a few at the bottom of this year's list

A Reminder: We are about to send out our Winter 2012 Manhattan Cat Specialists' e-Newsletter. If you would like to receive a copy, add your email address below (We send out 4 issues a year).

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Your Cat's Kidneys.... and the Metric System.

Two days ago, my last appointment of the day was a new client with her cat, George.  The appointment book said that the cat had chronic renal failure (CRF)

The client arrived at 5:30 p.m.  She had a copy of the records from her previous veterinary visits.  It was a sizable stack, but leafing through it, I finally found some bloodwork results.   I recognized the format of the bloodwork as the kind that was performed on an in-house machine.  I admit to having some bias when I see these type of reports, because although they’re likely accurate, I always feel that they are inferior to bloodwork performed by a well-known, well-established reference  laboratory.  Regardless, I looked at the results and noticed that the reference range for some of the parameters were odd.  I looked at the top of the page, and quickly discovered why: the bloodwork was performed in the United Kingdom!   I then looked at the next line on the report, where they list the cat’s age, weight and color.  George was only 1 ½ years old!

I questioned the client.  Yes, George was a youngster.  I had assumed that he was a senior or geriatric cat, since about 95% of cats with CRF were elderly.  CRF in cats less than 10 is uncommon, and less than 2 years old is EXCEPTIONALLY uncommon.   George had started drinking a lot of water while the owner was living in England, so she took him in for evaluation.  The veterinarian performed some blood and urine tests. 

Cats are very good at producing concentrated urine.  They’re like desert animals in that regard; they can conserve water if necessary, and produce very strong urine.  We describe the urine  concentration in medical terms by referring to the urine “specific gravity”.  If the kidneys are essentially doing nothing to the urine, the urine concentration will be 1.010 (which we abbreviate “ten-ten”).  If the kidneys are working properly, they’ll concentrate the urine to at least 1.040 (“ten-forty”) or higher.   A typical young cat that walks through our doors, if we were to test, would have a urine specific gravity of 1.048, or maybe 1.057...something like that.

I looked on George’s report.  At one point, it was 1.018.  That is indeed dilute, and confirms the owner’s observation that he was drinking a lot.  (When you drink a lot, your urine becomes dilute.  Beer drinkers know what I’m talking about.)   Another urine sample had been reported as being 1.024.  A third was 1.032.   All of these samples are more dilute than you’d expect in a young cat.

The kidneys’ job is to filter toxins from the bloodsteam and put them into the urine.  When the kidneys start to fail and cannot filter properly, the toxin level will start to rise.  The cat compensates by urinating more frequently.  After all, if the failing kidneys can only put half of the toxins into the bladder, the cat compensates by urinating twice as much.  He then drinks twice as much, to avoid getting dehydrated.  This is why cats with kidney disease drink a lot and pee a lot.  (In other words, cats with kidney disease aren’t peeing a lot because they’re drinking a lot.  They’re drinking a lot because they’re peeing a lot.  The peeing comes first.  The drinking is compensatory.)

George’s urine suggested that he was urinating and drinking a lot.  Was the level of his kidney toxins elevated in his bloodstream?  I looked at the records.  There was some ambiguity. 

The two main toxins we evaluate are the blood urea nitrogen (abbreviated BUN) and the creatinine.  Both of these toxins elevate, usually in tandem, when the kidneys start to fail.  Phosphorus is another toxin we follow, although that usually does not elevate above the high end of the reference range until late in the course of the disease.  George’s BUN was normal.  His creatinine, however, was above the in-house machine’s reference range.  But I admit, I was flustered, because the creatinine was reported in units that were very unfamiliar to me.  Those Brits, with their grams and their kilometers and their Celsius degrees…  my brain can’t handle it.   The units shouldn’t have mattered much.  The number was above the reference range.  It was elevated.  Elevated creatinine and dilute urine usually means CRF. Still, I like my American units.  USA! USA!

Still… the BUN was in the normal range, and… the cat is 1 ½ years old!  On physical examination, he looked great.  Normal eyes, normal ears, clean teeth, normal lymph nodes, heart and lungs sounded fine, abdomen palpated normally.  Shiny hair coat.  A robust 13 lbs.  This cat did NOT look like a cat with CRF. 

George’s previous doctor had prescribed Hill’s Prescription Diet K/D, a diet designed for cats with CRF.  He has also prescribed Fortekor, the brand name for the drug benazepril.  This is a very British thing to do.  Benazepril is a drug that we prescribe to cats with CRF if they are urinating out an excessive amount of protein in their urine.   One study has suggested that the drug, when given to cats with CRF, will slow the progression of the disease, regardless of whether the cats have excessive protein in their urine or not.  The study was not definitive and left more questions than in answered.  In America, routine use of benazepril in cats with CRF hasn’t caught on.  In the UK, it has. 

I told the George’s owner that I didn’t believe that George had CRF.  She was shocked, of course.  She had already accepted that he did have CRF, and that his lifespan was going to me markedly shortened as a result.  I told her I would like to repeat some of the blood tests, using our very-reputable laboratory, so I can evaluate the numbers in units that were familiar to me.  She was fine with that.  Whatever was necessary, she said. 

I obtained blood and urine.  To me, the urine looked pretty dark.  I usually just wait for the lab to report the results, but curiosity got the best of me, and I put a drop of urine on our refractometer.  This is a small instrument that allows you to measure the urine specific gravity pretty accurately in-house.  I looked.  It was 1.059!!

“Your cat does NOT have kidney disease”, I told her.  There is simply no way that a cat has concentrate  his urine up to “ten-fiftynine” unless those kidneys are working normally.  There’s just no way.   I told the owner that I wanted to wait to see what the bloodwork showed, and to see what specific gravity the lab reported, but I felt very confident that George was fine.

The owner was elated.  George hated the kidney diet he was on.  (The other vet didn’t tell her that there were many other varieties of prescription kidney foods available now; we can usually find at least one or two that the cat enjoys.)  George also was difficult to pill, and giving that Fortekor every day wasn’t easy.  But most importantly, a normal report gives George a new lease on life.  We’d know the results tomorrow.

The next morning the results were in.  Urine specific gravity: 1.064.  BUN and Creatinine: normal.   The verdict: perfectly functioning kidneys.

I don’t fault the vets in the UK for their diagnosis.  George DID have one of the notable clinical signs of CRF – the excessive thirst and urination.  His urine was dilute, but  the bloodwork was iffy, and the age and clinical appearance just didn’t fit.  I wouldn’t have been so definitive about the diagnosis, if this was my case initially.  I probably would have stressed that we need to recheck the blood and urine in a month or two, and I would have suggested ultrasound to assess the kidneys from a different standpoint. Cats with CRF often have small, dense kidneys on ultrasound, with the normal architecture of the kidneys being altered.  This was not performed, or offered.   With the bloodwork being so definitively NOT indicative of CRF, I felt that to offer ultrasound now would be a waste of money.  It would likely tell me what I already now know: George’s kidneys are fine.

Don’t you love stories with happy endings?
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A Week in the Life of a New York City Cat Veterinarian in the Trenches

A new year has begun, and along with the new year comes the resolutions.  I try to be realistic with mine, and make them not too unreasonable to achieve.  This year, the list was pretty realistic:  spend more time with my sister; read at least one book a month; stay below 170 lbs; and write more blog posts. 

Finding  the topics to blog about isn’t that difficult when you work in a New York City cat practice.  Every day, I encounter interesting people, notable cats, and intriguing medical conditions, all of which provide excellent blog fodder.  Turning them into blog posts, however… that’s the challenge.   So I’ve decided to start a new weekly feature on the blog where I discuss actual cases that come in the door, to give a realistic view of the kind of things I encounter in a busy Manhattan cat practice. 

The cat names are real.   

The client names have been changed.

Stay tuned; A week in the life of cat veterinarian in the trenches... coming soon.
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