Testing Testing 1...2...3? (Part 3)

Back to balancing Precious’s thyroid (Continued from Part 1 and Part 2

I had increased her thyroid medication.  Her owner, who lives on the other side of town, asked if she could have the test run at her previous vet, since she lives much closer there.  I said that was fine.  She brought Precious there, and the vet ran the FT4 test, and also ran a chemistry panel  to see if the liver enzymes had changed at all.  The good news:  the FT4 was now normal and we could proceed with the anesthesia.  The worrisome news: the liver enzymes were still high; in fact, they were even higher than before.

Precious arrived at our hospital and we did the endoscopy as planned.  We also biopsied the liver.  She recovered uneventfully and we sent her home that evening.  Again, I was envisioning two likely scenarios:  we had inflammatory bowel disease with secondary inflammation of the liver, or we had low grade intestinal lymphoma, with lymphoma in the liver as well.  

Of course, nothing is ever what you expect.  The gastrointestinal biopsies revealed moderate inflammatory bowel disease in the stomach and intestine, and low grade lymphoma in the liver!  This is an odd combination.  I suppose it is possible to have these two conditions like this, but this is just not the usual case.

One possibility is that the intestinal biopsies weren’t accurate, and that the cat truly has low grade lymphoma in the intestine as well.   It is universally understood that actual full-thickness biopsies of the gastrointestinal tract are the best and most accurate biopsy specimens available.  To obtain these, however, the cat needs to undergo abdominal surgery, and most clients dread the idea of their cat having this surgery.   Endoscopy can provide an accurate diagnosis if the endoscopist is very experienced, and multiple samples are taken.  Our endoscopist is indeed VERY experienced, and he gets at least 8 samples from every site.  

Another possibility is that the liver biopsy specimen was read incorrectly, but I doubt this.  The pathologist reading the samples is the one we know and like best, and his diagnoses always seem to correlate with what we see clinically.  

I called Precious’s owner and gave her the news.  She was dejected, of course.  I told her, however, that low-grade lymphoma is treatable, and that cats tend to do pretty well.  Exactly how long a cat survives varies from cat to cat, but low-grade lymphoma is not very aggressive (hence the name “low grade”) and that cats can survive months or years.  She was encouraged by this information and was anxious to start treating.  

Frankly, in this case, it doesn’t really matter if the cat has IBD vs. lymphoma in the gastrointestinal tract, because the presence of lymphoma in the liver dictates our therapy.   We treat inflammatory bowel disease with prednisolone.  We treat low grade lymphoma with prednisolone and leukeran.  We’re going to treat Precious with prednisolone and leukeran, and see how she does.  I’ll see her back in two weeks to do a complete blood count to make sure the leukeran isn’t bothering her bone marrow.  A month after that, I’ll check out her liver enzymes to see if they’re coming down in response to the treatment.  About two months after that, we’ll ultrasound her again, to make sure everything looks status quo in the abdomen.  Low-grade lymphoma is unlikely to spread anywhere, but it’s good to do ultrasound just to check. 

The best (and most puzzling) thing about this entire case is that Precious feels fine!  She may have intestinal and liver disease, but you wouldn’t know it by the way she looks and behaves.   A cat who starts out on chemo looking good and feeling well is likely to respond better than a cat who is debilitated because the cancer has started taking its toll.  I’ll keep you posted on how she does over the next few months (hopefully years).
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UPDATE: Can Cats Mate with Rabbits?

An update to the reader question: Can Cats Mate with Rabbits?

...and the answer is still, no. Not even during Easter.
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Easter Lilies and Felines: DANGER DANGER! KEEP AWAY!

Easter Lilies and Felines: DANGER DANGER! KEEP AWAY!

Keep your cats away from lilies; an important springtime reminder.

The ingestion of lilies can cause acute renal failure in cats.  Many plants are called “lilies”, however renal failure has been seen only with Easter lilies, Stargazer lilies, tiger lilies, Asiatic lilies, Oriental lilies, and day lilies. 

All parts of the plant are toxic. Prompt, aggressive treatment is necessary for a successful outcome.  Once renal failure develops, however, the prognosis rapidly declines; some recovery may be possible, but this may take weeks, and peritoneal dialysis or hemodialysis at specialized referral centers may be the cat’s only hope.

Toxic substances are found everywhere in our environment, and cats may fall victim to them via intentional administration by a well-meaning owner, or by stumbling upon them as a result of their inquisitive nature. Prevention is key when it comes to safeguarding your cat. Keep all potential poisons safely locked away, and keep cats indoors if possible.

See Also:  Toxins and Cats

Similar reminders from our friends:

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Sex and the Kitty

Not Impressed....
Sex and the Kitty

Dr. Arnold Plotnick, cat expert gives us the scoop on the feline birds and the bees


The domestic cat is an incredibly prolific creature. In many cultures, cats have been admired (and even worshipped) for their reproductive capabilities. Bastet, the Egyptian goddess of fertility, is depicted as a cat in artwork.

This fertility, however, has a downside. The Humane Society of the United States, in promoting the importance of spaying and neutering in controlling the feline population, informs us of a startling statistic: if one un-spayed female cat and one un-neutered male cat were allowed to mate indiscriminately, and if each of the kittens in the subsequent litters were also allowed to breed, it could theoretically result in the production of over 400,000 kittens in just seven years! Clearly, controlling the reproduction of our domestic pets is important in reducing the number of unwanted animals that end up in shelters where most are euthanized. But how much does the average cat owner know about their beloved cat’s reproductive system and capabilities? Read on, and be amazed!
Boys vs. Girls

Let’s start with some basic anatomy. The major parts of the male reproductive system are the testes (also called testicles), the scrotum, and the penis.
The testes serve two functions: they produce the hormone testosterone, and they manufacture sperm. Because sperm production is influenced by testosterone, these two functions are largely complimentary. The testes are contained within the scrotum, which is located external to the body. The scrotum serves as a temperature regulator for the testes, keeping them several degrees cooler than the rest of the body. This is essential for the normal manufacture and function of the sperm.

Initially, the testes in the kitten are located within the abdominal cavity. Beginning a few days after birth, the testes descend downward. By six to eight weeks of age, both testes have moved into the scrotum. Normally there are two testicles present, however, occasionally one or both will fail to descend into the scrotum. This condition is called cryptorchidism (crypt = hidden; orchid = testicle). Bilateral cryptorchidism (both testes fail to descend) is very rare. Unilateral cryptorchidism is much more common. Because most undescended testicles are retained in the abdomen where the temperature is higher than the scrotum, that testicle is unable to produce sperm.

The major organs of the female reproductive tract are the ovaries, the Fallopian tubes, the uterus, vagina, vulva and mammary glands.
The mammary glands are located in two rows along the outside of the abdomen, running from the groin to the chest. Cats typically have four pairs of mammary glands. The glands store and secrete milk. The ovaries, Fallopian tubes and uterus are located inside the abdomen. The right and left ovaries are located just behind the kidneys. Ovaries produce eggs, as well as important hormones (estrogen and progesterone). The ovaries are connected to the uterus by small ducts called Fallopian tubes (also called oviducts). The uterus is shaped like the letter “Y” with the “arms” of the Y being longer than the stem. These “arms” of Y are the uterine horns, and it is where fertilized eggs develop into fetuses.

The uterine horns join together to form the short “stem” of the Y, which is the body of the
uterus. At the very tip or base of the Y is the cervix. The cervix is a muscular tube that separates the
uterus from the vagina. The vagina provides a passage way from the outside of the body to the uterus.
It also provides a protected passageway for the fetuses as they travel from the uterus to the outside
during birth. The vulva is the external opening of the genital tract.

The Reproductive Cycle

In the Northern Hemisphere, the days get longer in late January and early February. The changes in the light-dark pattern causes queens (female cats) to begin the reproductive cycle, coming into heat approximately every two weeks. This usually continues until late September. In the later months of the year - October, November, and December - cats tend to stop cycling until the new season resumes again in late January. Siamese cats are less affected by photoperiod than other breeds and often cycle all year round.

Puberty occurs between 5 and 9 months of age, on average. This is when sexual development generally begins. As the weather gets warmer and the number of daylight hours increases, female cats will experience estrus, also known as “heat”. This is the period in which a female cat will allow males to mate with her. Each heat period varies in length, but typically lasts between 5 days and 3 weeks. If the female does not successfully mate with a male during a heat cycle, she will experience repeated cycles every 12 to 22 days. Unlike dogs, who will often have a bloody vulvar discharge during their heat period, cats show little or no discharge. “In cats, the main signs of heat are behavioral”, says Dr. Michael Stone, board certified internist at the Cummings School of Veterinary Medicine at Tufts University. “You typically see excessive vocalization, rubbing their head and neck against people and objects, becoming very affectionate, rolling and squirming, making ‘treading’ movements with her back legs, and assuming the mating posture – the rump in the air, tail deflected to the side, and back arched downward.”To some owners, it may look like the cat is in pain! She’s not. “A few cats show minimal behavioral changes and can get pregnant without their owners ever realizing that they were in heat”, notes Stone.

Cats are at their peak fertility between the ages of 1 ½ and 8 years. If allowed to mate naturally, a typical queen having 2 – 3 litters a year, with 3 – 4 kittens per litter, can have anywhere from 50 to 150 kittens in her lifetime.

The Birds and the Bees, aka “Kitty Porn”

When a female goes into heat, the smell she gives off and the vocalizations she produces alerts the male cats in the neighborhood. If several tomcats are nearby they may gather around the female, engaging in fights with rivals. The victorious male will then pursue the female, who may appear to be playing “hard to get”. Initial, premature attempts to mate by the male may elicit an aggressive rebuff by the female. After a few minutes, however, the female becomes willing to mate and will adopt the mating posture. The male will grasp the female by the skin over the nape of her neck and begin copulation. The actual act of copulation is very short, lasting about four seconds. When the male ejaculates, the female will vocalize loudly, hiss violently, and aggressively swat the male away. She then rolls around on the ground while the male retires a discrete distance away. This mating process is often repeated several times, and females may mate with more than one male during their heat cycle. This can result in a variety of different fathers responsible for the same litter. In fact, it is possible for each kitten in a litter to have a different father! (The technical term for this is “superfecundity”.) The males depart after mating and do not participate in the care of their kittens.

Let’s Get Technical: the Hormone Story

Hormones play an essential role in feline reproduction. “As winter turns to spring and the ratio of daylight to darkness increases, the increased daylight stimulates the pituitary gland in the brain to release a hormone called follicle-stimulating hormone, abbreviated FSH”, says Dr. Stone. “This hormone causes the ovaries to produce eggs. When the female cat mates with the male, the pituitary releases another hormone called luteinizing hormone (abbreviated LH). This hormone stimulates ovulation – the release of eggs from the ovary.” Once the eggs are released, they travel down the Fallopian tube into the uterus, where they encounter sperm from the male. Eggs that become fertilized implant themselves onto the wall of the uterus, where they develop into fetuses. “The ovaries now secrete the hormone progesterone. This hormone is responsible for maintaining the proper conditions in the uterus for the growth of the fetuses. About ten days before the kittens are born, the progesterone level falls, and estrogen levels start to increase”, says Dr. Stone. If the names of some of these hormones sound familiar to you, it’s because they are the very same hormones that regulate the human reproductive cycle.


Pregnancy in the cat lasts, on average, about 63 days; it can vary, however, from 58 to 69 days. About ten days before the kittens are born, the progesterone levels begin to drop and the estrogen levels start to rise. These hormonal changes give rise to nesting behavior in the female; she knows that labor and delivery are approaching and will start exhibiting nesting behavior, seeking and preparing a safe place to have her babies. Preparing a cardboard box lined with soft towels and showing this to her is recommended. It should be in a warm and cozy place, but still observable to the owner.

The birthing procedure is a natural process for cats and usually proceeds without any problems.
The birth process proceeds in three stages. Initially, the cervix relaxes and the uterus begins to contract.
In the second stage, the contractions become stronger and more frequent, propelling the first fetus
toward the pelvis. When the fetal head fully enters the pelvis, its pressure causes the cat to voluntarily
contract her abdominal muscles. This deliberate push helps propel the fetus through the pelvis. Once
the head emerges from the vulva, one or two more pushes from the female should result in delivery.
The third stage follows immediately after the kitten is born and is simply the passage of the fetal

membranes, including the dark greenish-black placenta. As each kitten is born, the queen will tear open
the membranes and clear the kitten’s mouth and nose. She will also bite off the umbilical cord and
eat the placenta. The interval between kittens is variable. On average, it takes approximately an hour
between kittens. The average litter size is four.

Spaying and neutering ( Pregnancy Prevention )

Although the ultimate goal is for all U.S. shelters to adopt a “no-kill” policy, sadly, this isn’t going
to happen in the foreseeable future. Millions of cats and dogs continue to be euthanized at shelters
across the country. A major part of the responsibility of cat ownership is making sure that your cat
doesn’t reproduce. Spaying is the surgical procedure performed on female cats. The medical term for
this surgery is ovariohysterectomy – removal of the ovaries and uterus. Neutering or castration is the
procedure used for males. In this procedure, the testicles are removed.

A popular misconception is that it is better for a female cat to come into heat at least once, or to have one litter before spaying. Medical evidence, however, shows the opposite to be true. “Cats that are spayed before their first heat rarely, if ever, develop mammary tumors. This is important, as most feline mammary tumors are malignant”, says Dr. Stone. Also, your cat doesn’t have to have a litter for your children to learn about “the miracle of birth”. Letting your cat have kittens that you have no intention of keeping is a poor lesson for children. There are many videos and books available that can teach children about birth in a more responsible way. Having your cat neutered or spayed is the ultimate sign of responsible pet ownership.


Why You Should Spay or Neuter Your Cat

Early Spaying and Neutering in Cats. Get ‘em while they’re young.

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

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Poor Little Faye and her Herpesvirus Conjunctivitis

Faye, I simply love this cat.  Poor little Faye, a patient of mine for a long time, has chronic herpesvirus conjunctivitis.  Her eyes are always red, always inflamed, always runny.    She’s seen the veterinary ophthalmologist a few times, and basically there’s nothing that can be done except to give antiviral eye drops when she has a flare-up, but otherwise, she’ll always have a low level of eye inflammation.  The cat is fine with this.  This is all she’s ever known, and although the eyes are red, they don’t seem to bother her much.

Except today.
Faye’s owner reports today that Faye’s left eye has been really runny and she’s squinting it, and seems really uncomfortable.  Everything else is fine… appetite, thirst, peeing, pooping… all normal.

I looked at lil’ Faye and could see the problem right away.  Faye’s left lower eyelid was rolled inward a bit, and the hair on the skin just below the margin of the eyelid was now contacting the cornea.  Anyone who’s ever gotten an eyelash caught under a contact lens knows that the cornea is loaded with pain receptors, and that Faye was in significant discomfort.  Her eye was tearing a lot, which was the eye’s attempt at flushing out these irritating hairs, but to no avail.  This condition is called entropion, and it will sometimes happen to cats with chronic eye inflammation.

The treatment for entropion is surgical.  You have to roll the eyelid back out, so that the hairs no longer contact the cornea.  Normally, these cats are sent to a board-certified veterinary ophthalmologist, however, I know how to do this surgery, and I like to do them myself.  You see, when I was in veterinary school at the University of Florida, the dean of the school was Dr. Kirk Gelatt.  He is a big-name veterinary ophthalmologist.  He wrote the main text book about veterinary ophthalmology.  So, our ophthalmology department was very well-developed.  In fact, when I was a senior in veterinary school, we had four ophthalmology residents that were being trained.  Four! That’s unheard of.  So, I was very familiar with the condition, and when I graduated, I decided to give these surgeries a try when I was out in practice.  I did a few, and soon got pretty good at them.  Then, when I was at the ASPCA, I was the only doctor (out of the nine that were there) who knew how to do the surgery, so whenever one of the doctors had a case of entropion, they scheduled me to do the surgery. 

I like the surgery because there’s a little “art” to it.  It’s like plastic surgery.  You need to know how much skin to remove so that you roll the lid out correctly.  You don’t want to take out too much skin and over-correct, and you certainly don’t want to under-correct.  Also, you use very thin suture material, as thin as a human hair, and I kinda like working meticulously with such delicate suture.

I explained all of this to Faye’s owner, and he was fine with it.  We’ve been caring for their cats for years.  In fact, one of their cats, Chester, was adopted from us.  Chester was the sweetest, funniest cat, and we were happy to adopt him out to such nice folks, and we love the fact that we still get to see him twice a year for his exams.  It’s always a great day when he comes in. 

Anyway, we scheduled Faye for her eyelid surgery, and things went very well.  I took the right amount of skin, I believe, and the eyelid looked pretty good when all was done.  Faye did NOT like having the Elizabethan collar around her neck when she went home, though.  But she had no choice.  If she were to rub the incision line, she could disrupt the sutures and the surgery would have to be redone.  We weren’t about to risk that.  The sutures were dissolvable, so after about 7 days, there’d be enough healing so that they could take off the collar, and if she were to rub at the incision, it would be unlikely to break open.  So Faye’s gotta deal with her collar for 7 days.  She’ll be fine. 

I’m sure March will bring its share of fascinating cases as well.  As always, I’ll keep you posted.

Remember to keep voting for this blog "Cat Man Do," a finalist in's 2012 Reader's Choice Awards.  We need your help to win, so keep voting every day, share the voting page with your friends, and remember to tell them to vote CAT MAN DO. 
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Don't Ignore that Cough

I recently had a bummer of a case.  A 12 year old cat who presented to our clinic for itching.  The cat had generalized hair loss all over the abdomen, extending to the inner thighs.  It also had hair loss on the inner forearms, and  some scabs on the head and neck.  The owner said that  the cat was also coughing about two weeks ago, but that  the cough had resolved.

She was worried  that the cat would be stressed out by traveling to the vet, so she had a housecall vet come to her house to evaluate the cat. 

Whenever a cat is losing hair, the first thing I wanna know is:  Is the hair falling out, or is the cat pulling it out?  Clearly, this cat was pulling it out.  She was grooming her abdomen and legs non-stop.  The  next question I ask is:  Does it itch?  Some cats will overgroom for psychological reasons, rather than for dermatological reasons.  Grooming is a comfort behavior, and when cats are stressed or upset, they will often overgroom.  The abdomen is a favorite spot, but other areas, such as the flanks and the forearms are also common areas.  
The owner told me that the vet thought the cat might have ear mites, because the cat was scratching at the head.  She didn’t actually check for ear mites.  I guess a house call vet doesn’t travel with a microscope.  Still… where would a 12 year-old, totally indoor cat get ear mites?  Anyway, to cover all of her bases, the housecall vet threw the kitchen sink at the cat:  Revolution to treat ear mites, antibiotics to treat an infection, and a steroid shot to treat allergic or inflammatory conditions.  Grrrr….  vets like this give the rest of us a bad name.  The owner said that the skin didn’t improve all that much… maybe there was a tiny decrease in the scratching, but interestingly, the coughing resolved.  About three weeks later, the cat was scratching badly again, so she called the housecall vet, and she prescribed antihistamines this time.  Needless to say, this had minimal effect as well, so she brought it to see me. 

I saw the cat and yes, there was definitely a lot of self-induced hair loss.  What had me more concerned was the cough, though.   When the owner described the cough getting better after the first housecall vet treatment, I thought that the cat could have asthma, and the cat responded to the steroids, or it could have been some kind of infectious bronchitis and the cat maybe responded to the antibiotics.  Either way, if a cat is coughing, it’s prudent to take an x-ray of the chest to get more information about the cough.  I couldn’t tell by looking at the skin exactly why the cat was so itchy.  Before discussing the diagnostics we’d need to consider to diagnose the skin condition, I suggested x-rays.  The owner consented.

I took the x-rays, and unfortunately, I saw what I believe was a nodule in one of the lung fields.  It was pretty clear on the lateral view, and also visible (but maybe not as clear) on the ventro-dorsal view.  This is a pretty bad finding.   Sometimes, tumors can cause inflammation in the tissue surrounding them, and steroids will reduce the inflammation and cause temporary improvement.  I suspect this is why the coughing improved after the steroid injection. 

I offered to e-mail the radiographs to a board-certified veterinary radiologist at Blue Pearl Veterinary Partners, for a second opinion on the radiographs.  The radiologist reads hundreds of x-rays a month and his opinion carries a lot of weight.  She agreed to let me do this.  As far as the skin condition, we put that on the back burner.   We had bigger fish to fry.

I sent the films, and the radiologist called a few minutes later and said, “well, there’s a nodule in the lungs”.  Sigh. 

The nodule is almost certainly some type of tumor.  The next question we would want to ask ourselves is whether this is the primary tumor, and whether it is a single solitary nodule.  If so, then theoretically, it could be removed surgically and the cat would be cured.  If, however, this is a metastatic nodule, i.e. the primary tumor is somewhere else in the body, and this nodule is evidence of spread to the lungs, then the prognosis is grave.  I recommended referral to a specialty center for a CT scan of the lungs to see if any further nodules were present.   The owner was distraught.  She had four cats, and this was her favorite of the bunch.  She was a really sweet cat in the exam room, too.  I felt terrible. 

The owner did go to a referral center a few days later.  A place out on Long Island, close to where her son was living.  At the referral center, they repeated the radiographs, only this time, they did three views:  TWO lateral views and a ventro-dorsal view.  Taking two lateral views, one with the cat’s right  side down, and the other with the cat’s left side down,  was a good idea.  We call this a “met check”, or a “metastasis check”, and is probably something I should have offered at my own hospital.   The left lateral view apparently revealed a second nodule.  These were probably metastatic nodules.  The owner declined abdominal ultrasound to possibly look for the primary tumor, since treatment would likely be futile regardless.  She took the cat home and will let the cat live out her life as comfortably as possible.  So far, the cat is doing well; she’s eating and drinking okay, and there’s no coughing, no vomiting, no diarrhea, minimal weight loss.  Just itching.  We’re going to try to control that with a short course of anti-inflammatory medication, omega-3 fatty acids, and medicated baths using an anti-itch shampoo.  It’s really amazing how much cancer I see in my practice.

But it’s not all bad news.  I'm about to see a favorite cat of mine, Faye Clementine.  I'll post her story next.  Stay tuned.

Keep voting for this blog "Cat Man Do," a finalist in's 2012 Reader's Choice Awards.  We need your help to win, so keep voting every day, share the voting page with your friends, and remember to tell them to vote CAT MAN DO.
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A Rabies Update

A few months ago I posted about rabies.  I thought I’d share with you the latest statistics regarding the occurrences of rabies in the U.S. in 2010.  In the U.S., wildlife is the most important source of the rabies virus, but spillover into domestic species does occur.  

In 2010, 48 states and Puerto Rico reported 6,154 rabid animals and 2 human rabies cases to the Centers for Disease Control, which was actually an 8% decrease from the 6,690 rabid animals and 4 human cases reported in 2009. Hawaii and Mississippi did not report any laboratory-confirmed rabid animals during 2010. Approximately 92% of reported rabid animals were wildlife species. Raccoons, skunks and bats were the top three carriers.  Here are the numbers:  2,246 raccoons (36.5%), 1,448 skunks (23.5%), 1,430 bats (23.2%), 429 foxes (6.9%), 303 cats (4.9%), 71 cattle (1.1%), and 69 dogs (1.1%). 

What caught my eye, of course, were the cat numbers.  Compared to 2009, rabies decreased in all species except cats, where there was a 1% increase. Two cases of rabies involving humans were reported from Louisiana and Wisconsin in 2010. Louisiana reported an imported human rabies case involving a 19-year-old male migrant farm worker who was bitten by a vampire bat while in Mexico. This represents the first human rabies case reported in the U.S. confirmed to have been caused by a vampire bat rabies virus variant.

Ewwwwww. Rabies. Yuck.

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Cat Holidays (Awareness for Felines Calendar)

Here is our list of pet holidays relating to cats and feline awareness.

  • Pet Dental Health Month
  • Responsible Pet Owners Month
  • Pet Theft Awareness Day - February 14
  • Love Your Pet Day - February 20
  • Spay Day USA - February 23
  • Preventative Heartworm Awareness Month
  • Poison Prevention Awareness Month
  • Professional Pet Sitter's Week - 1st week of March
  • If Pets Had Thumbs Day - March 13 
  • National Pet Month
  • Prevention of Cruelty to Animals Month
  • National Pet First Aid Awareness Month
  • National Pet Day - April 10
  • National Animal Control Appreciation Week, April 11-17
  • National Pet ID Week - April 18-24
  • Earth Day - April 22
  • World Veterinary Day - Last Saturday in April
  • National Kids Pets Day - April 26
  • Hairball Awareness Day, April 30
  • National Pet Week - 1st week of May
  • Be Kind to Animals Week - 1st week of May
  • National Disabled Pets Day - May 3
  • Animal Disaster Preparedness Day - 2nd Saturday in May
  • Hug Your Cat Day - May 30
  • Adopt-a-Shelter-Cat Month
  • World Pet Memorial Day - June 12
  • Animal Rights Awareness Week - June 17-25
  • National Pet Fire Safety Day - July 15
  • International Homeless Pets Day - August 15

  • National Pet Insurance Month
  • National Pet Memorial Day - September 12 
  • National Animal Safety and Protection Month
  • Animal Welfare Week (AVMA) - October 6-12
  • National Feral Cat Day - October 16
  • National Cat Day October 29
  • Senior Pet Month
  • National Animal Shelter Appreciation Week - Nov 5-11
Please let us know in comments if we are missing any cat holidays or feline awareness days and we'll add them to our list.
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Testing Testing 1...2...3? (Part 2)

So where were we (continued from part 1)?  Right, the FT4 test.  Lo and behold, it came back elevated.  So, the cat is hyperthyroid.  The vitamin B12 and folic acid level came back normal.  If either the B12 or the folate were low, we could say with good certainty that the cat has some gastrointestinal illness.  But a normal B12 and/or folate level does not exclude gastrointestinal disease. So GI disease is still a possibility. 

Two days later, ultrasound was performed on the cat, in our hospital. The ultrasonographer noted that the intestines were diffusely thickened, suggesting that the intestinal tract was infiltrated with something, most likely either inflammatory cells or cancer cells. The liver looked a little more dense than normal, and the pancreas did look a little swollen and inflamed.  The ultrasonographer believes the cat likely has inflammatory bowel disease, with secondary inflammation of the liver and pancreas.  This is the so-called “triaditis” that I described in the last post. 

In order to prove this, we’ll need to do endoscopy and get biopsy specimens of the small intestine.  We’ll also need to get a biopsy of the liver, which we can obtain via ultrasound guidance, at the same time we do endoscopy.  We will not get a pancreas biopsy.  The pancreas is one organ you don’t mess around with.

Because the cat is not showing  any serious clinical signs relating to the presume inflammatory bowel disease (other than weight loss), I’ve decided to postpone the endoscopy and liver biopsy until we get the thyroid under control.  A cat with uncontrolled hyperthyroidism is a bit of an anesthesia risk. It behooves us to regulate the thyroid first, and once that’s done, continue our diagnostics. 

I prescribed methimazole to control the thyroid.  The cat will come back in two weeks for me to check the thyroid level.  If it’s normal, we’ll proceed with the endoscopy, etc.  Of course, I’ll keep you all informed of the results.

Stay tuned for the conclusion to this interesting case coming soon and remember to keep voting for this blog "Cat Man Do," a finalist in's 2012 Reader's Choice Awards.  We need your help to win, so keep voting every day, share the voting page with your friends, and remember to tell them to vote CAT MAN DO.
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Testing Testing 1...2...3? (Part 1)

I saw a 12 year old cat the other day. The owner was seeking a second opinion.  The cat had been losing weight, but was still eating okay.  The owner took it to her veterinarian.  The vet performed bloodwork, but for reasons I’ll never understand, she only did a complete blood count (CBC) and a chemistry panel.  She didn’t run a thyroid test, and didn’t do a urinalysis.  I find this frustrating, and inexplicable.  It’s a senior cat.  You need to do a senior profile.  I can understand not doing a urinalysis if you can’t obtain a urine sample.  Getting urine from cats can be difficult sometimes.  (I never have a problem with that, though.  After thousands of physical exams, I can get urine from about 99% of the cats I examine. Seriously. I am the urine king.)  So, maybe that’s why no urinalysis was done.  There was no excuse for not running a thyroid test, though, especially in a cat with weight loss and a good appetite.  

The complete blood count came back normal, but the chemistry panel showed elevated liver enzymes.  Four liver parameters were elevated:  ALT, AST, ALP, and bilirubin.  Hyperthyroidism can cause elevated liver enzymes, but when it does, the majority of the time it’s just the ALT that is elevated.  Occasionally, in very hyperthyroid cats, the AST will be elevated as well.  Three liver enzymes (ALT, AST, and ALP) elevated concurrently from liver disease are rarely seen, and all four parameters elevated from hyperthyroidism?  Almost never.   Still, you would think in an older cat with liver parameters elevated, you’d at least add on a thyroid test.  That didn’t happen.  Instead, the cat was put on antibiotics.  That’s not the way I would have approached things, but regardless, the cat was treated as if it had a liver infection.  Two months later, the cat’s liver enzymes were re-evaluated.  They were higher than they were a month before.  I couldn’t tell from the previous written record what happened next.   I don’t think any medications were prescribed.

About a month later the bloodwork was repeated, and this time, the vet actually did a thyroid test.  Once again the liver enzymes were elevated, a few even higher than previously.  The thyroid test results were interesting.  The normal range for the thyroid hormone is 0.8 – 4.0 mg/dl.  The cat’s thyroid level was 3.9.  Technically still in the normal range, but straddling the high end big time.   So, what does this mean?

If a cat’s T4 level is smack dab in the middle of the normal range, or is at the low end of the reference range, then the cat is probably not hyperthyroid.  If the T4 level is toward the higher end of the range AND you have a sneaking suspicion that the cat might indeed by hyperthyroid, the next thing to consider would be to run a more precise test, called the “free T4” test (abbreviated FT4).  This test measures the unbound or “free” thyroid hormone in the bloodstream, and is a more precise test.  I ran that test, because the cat could very well be hyperthyroid.  She’s the right age, and has a few compatible clinical signs.   One other thing to factor in is the fact that when a cat has any kind of illness that does not involve the thyroid (i.e. non-thyroidal illness), it will lower the cat’s T4 level a little bit.  So, for example, if this cat does have some type of liver disease, that alone could lower the T4 level a few notches.  This cat’s T4 level was 3.9.  If the cat has liver disease, then perhaps the cat’s real T4 is 4.5 or 4.6, but the liver disease has lowered the T4 to 3.9.  So how do we take non-thyroidal illness into account?  We run a FT4.  The FT4 test is minimally affected by non-thyroidal illness.  Clearly the FT4 test had the potential to give us a lot of information on this cat.  So I ran it. 

It certainly is possible, too, that the cat has a primary liver disorder.  This is my suspicion, frankly.  The fact that FOUR of the liver enzymes are elevated makes me think the liver enzyme elevation is not due to hyperthyroidism.  Even if the cat turns out to be hyperthyroid, I think the cat could have a concurrent liver disorder. 

One other possibility is that the cat could have inflammatory bowel disease, with secondary inflammation of the liver.  Inflammatory bowel disease is a common disorder in older cats and can cause cats to lose weight.   Most cats with IBD will lose weight.  Some will vomit.  Most will have a decreased appetite, although many do not.  Often, cats with IBD will have concurrent inflammation of the liver and pancreas.  Routine blood tests will reveal liver involvement because there are parameters on the chemistry panel that indicate liver involvement.  But there are no tests on a routine chemistry panel that indicate pancreatic inflammation.  (Those folks who think amylase and/or lipase are indications of pancreatic inflammation are just plain misinformed.)  We artfully call this triad of IBD-liver inflammation-pancreatitis “triaditis”, shoving the suffix “-itis” onto the word “triad”.  Silly.  

One other thought sprung to mind today, while examining the cat.  The cat could theoretically have low grade gastrointestinal lymphoma, a type of cancer that causes gradual weight loss, possibly accompanied by poor appetite and maybe vomiting.  The signs of low grade lymphoma are pretty indistinguishable from IBD.  This type of lymphoma is not too terrible.  It’s treatable using oral medications, and the prognosis is actually pretty decent.  It is, by definition, “low-grade”, meaning it’s not very aggressive and is unlikely to spread to other organs, however, I’ve seen several cases where it does spread, and the first place it likes to go is the liver.  So, this could be low grade GI lympho with secondary liver involvement.  Is your head spinning by now?

So what did I do?  Well, I decided to run a vitamin B12 and folic acid level.  Vitamin B12 and folic acid are two vitamins that are absorbed into the bloodstream through the intestinal wall.  If a cat has a low B12 and/or folic acid level, it’s not because they aren’t getting enough in their diet.  All cat foods have adequate levels of B12 and folic acid.  A low B12 and/or folic acid level occurs because the intestinal tract is infiltrated with some type of cells, like inflammatory cells (in which case the cat has IBD) or cancer cells (in which case the cat has lymphoma).   So, if the B12 or folate is low, it almost certainly tells me that the cat has either IBD or lymphoma.  Unfortunately, a normal B12 and folate doesn’t mean that the cat doesn’t have intestinal disease.  It still might.  So, it’s one of those annoying tests where a positive finding means something, but a negative finding doesn’t.  Frustrating, I know. 

So, that’s where we stand at the moment.  I’m waiting for the FT4 and for the B12/folate level to come back.  I’d be shocked if the FT4 came back normal. 

Hate to leave you hanging, but I’m presenting this case in real time, as it’s happening, so you’ll have to wait on the edge of your seat, just like me.  

Update: Part 2 has been posted. Also, remember to keep voting for this blog "Cat Man Do," a finalist in's 2012 Reader's Choice Awards.  We need your help to win, so keep voting every day, share the voting page with your friends, and remember to tell them to vote CAT MAN DO.
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