Reader Question: Dem ol’ Litterbox Blues

Dem ol’ Litterbox Blues. 
My colleague, Alice Moon-Fanelli, chimes in on what to do when cats start avoiding their litterbox.

QUESTION:  I have 5 felines; 4 females and 1 male.  Three of the cats are older (2 females and 1 male), between 5-6 yrs of age.  The other two are young females. About 5 weeks ago, one of the young  females was spayed.  About 2 weeks ago, this female, Buttercup, began defecating and now, urinating,  on the family room and other small rugs.  The rugs have been cleaned and sprayed with anti-marking solutions and Nature's Miracle, but she continues to defecate on the spot and is not concerned about who is watching.  I live in a large home, with a large lanai which is enjoyed by all the cats.  There are 3 large litter boxes available and I use the "World’s Best Cat Litter" in them. Do I need to increase the amt of boxes?  Should I have her checked for a UTI or other illness? I am getting ready to change all the litter in all the boxes to fresh litter.  She is a beautiful, sweet little cat, but is making me crazy!  Any help/advice will be greatly appreciated.

Julie Lapitino
Viera, FL

ANSWER: Dear Julie,
I always encourage owners who notice a seemingly abrupt behavior change in their pets to discuss their concerns with their local veterinarian to ensure there is no underlying medical cause for their pet’s new behavior.  Assuming Buttercup’s recovery from her spay went as expected and she has no other illness that would account for her recent lapse in litterbox usage, then we need to decide whether her behavior is house soiling due to a litterbox aversion and/or location/substrate preference or territorial marking as a result of environmental stress.
Even though you have 5 felines, you don’t mention any social disputes among them and my general impression is that all is fairly harmonious in your home.  You note that   Buttercup elects to defecate and now urinate on the family room rug and other small area rugs in your home.  Because the rugs are not particularly “interesting” from a scent post point of view and you report her using a consistent substrate, namely rugs, I suspect that she is house soiling (as opposed to marking) and has developed a substrate preference.  Another observation in favor of soiling versus marking is that the lapse in litterbox usage began with defecating and later expanding to include urination.  Some cats will mark with fecal material but this is far less common than urine marking.
Assuming Buttercup is house soiling because she prefers to eliminate on fabric, you need to carefully inspect your litterbox set up and make sure it is more attractive to Buttercup than your rugs.  It also helps to make your rugs unattractive elimination sites.
You have 5 felines and 3 litterboxes and you wonder if you should increase the number of boxes.    The general rule of thumb is to have one litterbox per cat plus an extra one, and to place them in low traffic, quiet areas that the cats frequent. Six litterboxes is a lot for most households! The litterboxes should also be distributed in various areas of your home, as opposed to having multiple boxes in one room.  If possible have one on each floor of the house.  Buttercup should feel that she can safely go to a box at any time, without any competition or anticipation of being pounced upon.  Try putting an open litterbox in an area that is wide open so that she can scan the area and keep better tabs on your other cats’ whereabouts.
If she is particularly fastidious and prefers rugs because she can always find a clean area, then you need to make certain she always has access to a clean box.  Some cats prefer to urinate in one box and defecate in another so increasing the number of boxes and ensuring cleanliness may be important.
Thorough and proper cleanup of all soiled areas is essential because if it smells like a latrine, it is fair game to Buttercup.  There are a variety of excellent new products on the market for cleaning urine stains and completely eliminating odor.  [ Be sure to use according to the manufacturer’s instructions for best effectiveness.]

Cats prefer litterboxes that are 1½ times the size their torso.  You did not mention placing tracking mats around the boxes or using plastic liners inside the box, but these can be an annoyance to some cats, so I advise against them.  You currently use Best Cat Litter which should be fine, but some cats have specific preferences.  Most cats prefer unscented fine granule (sand-like or even finer) clumping litter so you might wish to try a couple different brands.  I recommend having at least 4 inches of litter in the boxes, which cats also prefer so they can dig and bury their excrement easily.  Clumping litter should be scooped daily and changed completely every 2-3 weeks if not more frequently.  One product I like is Zero Odor which can be used to break down odor particles on the soiled rugs and also in the litterbox.  After scooping or cleaning the box, spray the litter with Zero Odor litter spray.  Since cats can be quite sensitive to the smell of chemicals, it is important to eliminate such odors from the box.  Avoid perfumed cleansers or strong-smelling products when washing the litterboxes; rather, use unscented soap and warm water and rinse the box thoroughly.

Once her litterboxes are set up to her liking, it is important to change the function of the soiled locations or make them aversive so her litterbox is her best option.  This will help break old habits! You may elect to pick up and temporarily store your area rugs until Buttercup’s inappropriate elimination issue is resolved. Then you only have to focus on making the family room rug a less attractive option. One strategy is to take advantage of the fact that most cats do not like to eliminate in their feeding areas.  You could try moving Buttercup’s sleeping, feeding, and play area near the family room rug.  Alternatively, you can use a citrus deodorant spray or Boundary Spray on the rug, which are available in most pet supply stores.  If you are concerned about damage to the rug, you can spray a towel with one of these products and lay the towel over the area/s most frequently soiled.  Rubber mats, nubby side up, may also deter a cat from approaching a specific area and you could use these to keep Buttercup off the couch when you aren’t around.  Another strategy for large, flat surfaces is to cover a piece of cardboard with contact paper, sticky side up and cover the area that is being soiled.  Cats do not like to walk on sticky surfaces!  Double sided sticky paper in sheets or in the form of a tape dispenser is available in many pet stores. 

If moving her eating areas to the spot she is eliminating on does not deter her, then perhaps you should move a litter box to these areas.  If she expresses an interest in eliminating in a specific area no matter what, it is best to have a litterbox in this spot so she can eliminate appropriately.  I recognize that this option is not aesthetically pleasing, but in some cases the litterbox can be moved back incrementally to a location that is more appealing to you, a month or so after the elimination issue is resolved.

If your initial attempts fail to resolve Buttercup’s issues then I recommend you seek a behavior consultation with a qualified professional such as a certified applied animal behaviorist ( or veterinary behaviorist (

Good luck with Buttercup!  House soiling issues generally have a decent prognosis for resolution if you can identify and rectify your cat’s disappointment in her latrine facility.
Alice Moon-Fanelli PhD, CAAB
Animal Behavior Consultations, LLC
Brooklyn Veterinary Hospital
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Reader Question: Feline King of the Hallway

One of my readers has a cat whose desire to be King of the Hallway is driving her crazy!  Here’s what noted veterinary behaviorist Nick Dodman has to say about it:

QUESTION: I have a 14-month-old ragdoll who constantly wants to go into the hallway of my apartment building to the point that he is driving me “crazy”.  He will sit by the front door and cry and cry and cry, put his paw on the doorknob, and literally beg me to open it.  Once I take him for a walk, the first thing he does is rub himself all over the carpet then strolls the hallway as if he were King.  I tried putting a harness on him so I can take him outside, but he won’t allow me to.  This happens several times a day, and it really has become very annoying.  Could you please make a suggestion as to what I can do to get my “strolling” cat to want to stay inside?

Phyllis Kohl


ANSWER: Dear Phyllis:
There is something outside in the hallway that your ragdoll really likes or likes to do. It sounds as though he has taken over that hallway as part of his territory and likes to promenade around there and rub himself on the ground to mark it with his scent (an olfactory mark of ownership). Your mistake was opening the door in the first place and subsequently responding to his demands to revisit the hallway in question. I believe the only effective solution would be to totally ignore his requests to go out for a period of time—it may take several weeks—until he learns his demanding behavior no longer works to achieve the desired effect. You may need white noise, a closed door between you and your cat, or ear plugs (for you) in order to get through this difficult period. To help you on your mission, you could try making outside a little less attractive by, for example, neutralizing all appealing odors with a product like Zero Odor and/or making the odor of the hallway repugnant to cats by applying, say, a citrus-scented spray or plug-in. At the same time, making your apartment more user-friendly for your cat through the addition of numerous mobile toys, food puzzles, hidey holes, climbing frames, and window perches might help too.

Dr. Nicholas Dodman
Head, Animal Behavior Section

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Bee Sting on a Cat's Paw

The other day, I took a glance at our afternoon appointment schedule, and I saw that a cat was coming in for a “bee sting”. This is not a common presenting complaint at our hospital, so I was intrigued, but skeptical. When the cat came in, however, the story the owner related sounded pretty plausible.

The owner noticed a bee in the apartment, and he tried to shoo it out, but to no avail. Finally, he managed to swat it with a magazine, and the bee fell to the ground. Apparently, it wasn’t dead, though, and his curious cat ran over to check it out before he could get rid of it. The cat didn’t show any sign that she had gotten stung, though. He dispatched the kitty and disposed of the bee, and that appeared to be the end of it. However, the next day, her foot was markedly swollen. This is what made him bring her in.

I checked out the cat. Yes, indeed, her foot was pretty swollen. We had our hospital iPad handy, so we took these striking photos.

The foot wasn’t painful at all. She was able to walk on it just fine. On the top of the forearm, the skin was a little firmer than the rest of the leg, like a small “knot”. I suspect that this was the spot where she was stung. Everything did fit with a bee sting.

All I had to do was give an injection of Benadryl. Fortunately, at the time she was stung, she did not have any reaction at all. Some cats, like people, can exhibit anaphylaxis as a result of a bee sting, and it can be potentially life-threatening. This kitty, however, will be fine. Pretty neat case.
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It’s snot what you think… or maybe it is

My clients crack me up sometimes.  

As you know, I own a cat hospital, and cat clients are a little different than dog clients.  Cat clients are intense.  I mean that in a good way, of course.  Some cat clients are worriers.  They watch their cat’s every move, and if something is just a tiny little bit off… WHOOSH… they’re off to the vet, terrified something terrible has befallen their cat. 

Today, I saw a young married couple.  A few days ago, they were playing with their young Bengal cat. They took out his favorite toy (which they call “Mr. Feathers”), a wand with a string and a clump of feathers on the end.  (Note:  this toy should not be confused with their cat’s other favorite toy, a similar plaything except for the color of the feathers, which are bright pink.  They call this toy “Mrs. Feathers”.  I kid you not.)  Their kitty was playing so rambunctiously with Mr. Feathers that he banged his head very hard on a nearby table while leaping after his toy.  Now, a few days later, they were worried because a black substance has appeared around the cat’s nostril, and they fear that this must be blood that is dripping from an internal head injury he must’ve suffered at the hands of Mr. Feathers.

I examined the cat.  He was a robust, yet surprisingly mellow Bengal.  His eyes were fine.  Ears were pristine.  Nice clean teeth.  Normal  lymph nodes.  Heart and lungs normal.  Abdomen normal.  Haircoat shiny and sleek. The picture of health. Okay, now time to examine the nose.  Ah yes, I see the offending substance clinging to his nostril.  I inspect further.  Drum roll, please…  

The diagnosis:  kitty booger.

Yes, my clients were worried sick over snot.  Garden variety, run-of-the-mill, dime-a-dozen kitty boogers.
This is why I love feline practice.  Not only do I get paid to play with cats all day, but I get to deal with cool clients who love their cat so much that they schedule an appointment for kitty boogers.  Were they embarrassed?  Not at all.  When they found out that it was something harmless, they were truly grateful and palpably relieved. I totally made their day just by picking their cat’s nose.  Should they have been embarrassed?  Absolutely not.  They love their cat.  And I really like that they love their cat.  Considering the number of sick cats I’ve seen lately, I really enjoyed this appointment. 
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Dr. Plotnick's Response to *50 Things That Your Veterinarian Won't Tell You*

There’s a post from the Reader’s Digest website that is making the rounds. It hasn’t gone “viral”, but I’m seeing it pop up on a lot of the newsfeeds that I subscribe to. It’s entitled “50 Things That Your Veterinarian Won’t Tell You”. They make it sound like you’re getting some super-secret scoop on what really goes on behind the scenes, like Anthony Bourdain’s book “Kitchen Confidential”. 

Many of the comments don’t really pertain to me or my practice, since I only do cats. But I do think some of the points are worthy of commentary. I’m selecting a few that I think are relevant to me, my clients and my readers. Feel free to read RD's entire post if you like.

1. “People always ask, ‘How do you handle pit bulls and rottweilers and big German shepherds?’ The truth is, the dogs that scare me most are the little Chihuahuas. They’re much more likely to bite.”—Mark Howes, DVM, owner and medical director of Berglund Animal Hospital in Evanston, Illinois

So true. Back in the days when I used to treat dogs, I put Chihuahuas at the top of my list of dog breeds I dreaded in the exam room. They were usually decrepit, geriatric Chihuahuas, with their tongues hanging out of the left side of their face due to missing teeth. They were usually named Taco or Paco or Pepe or something like that, and were held by a woman who made sure that the dog’s feet never touched the ground. The few remaining teeth in their vicious little heads were so nasty and covered with tartar that if I did get bitten (and I’ve come close), I’d probably go into septic shock. I thank these Chihuahuas for my career in feline medicine.

2. "We know when you’re twisting the facts. If your dog has a five-pound tumor hanging from his skin, please don’t tell me it wasn’t there yesterday.”—Phil Zeltzman, DVM, a traveling veterinary surgeon in Allentown, Pennsylvania, and the author of Walk a Hound, Lose a Pound.

I’m fortunate that in my practice, my clients are so seriously in tune with their cats that they would never let a growth get too big before bringing their cat in to see me. In fact, it’s often the opposite. I usually find myself examining some microscopic little wart that the client discovered while petting his cat and is panicked that it might be malignant. I much prefer it this way. Early detection is the key to successful treatment, and my clients do not wait for things to grow before they zip the cat in to see me.

7. “Here’s a pet peeve: owners who don’t want to pay for diagnostic tests but then cop an attitude because you don’t know what’s wrong with the animal. Since you wouldn’t let me do the blood work or X-rays, how the heck do you expect me to know?”—A vet in South Carolina.

As an internist, I can sympathize with this doctor, but fortunately, I can’t relate that well. My clients fully understand that diagnostic tests are usually needed to make a proper diagnosis. I usually get permission to do the tests. If not, I can usually do a few inexpensive in-house tests (a blood sugar to rule out diabetes, a urine specific gravity to get an idea if there’s renal failure, etc.) to at least help me hazard a logical guess as to what might be wrong.

10. “Every time I save a life, every time I fix a patient, that makes everything worth it. And I love it when a client says, ‘I wish my physician would treat me as nice as you treat my pets.’”—Phil Zeltzman, DVM.

Yes, indeed. This is what motivates me to get up every morning. And when they say that they wish their own doctor treated me as well as I treat their cat, it’s music to my ears.

14. “Every time we help a pet, we help a person. The classic example is the 80-year-old grandma who has nothing in life but her cat. She’s a widow with very limited social contact, and the cat is what connects her to life. So when we help her cat, she’s really the one we’re helping.”—Phil Zeltzman, DVM.

At my hospital, we’re aware of this all the time. Of course, we do what’s best for the cat, but we know that every cat has a person attached to it, and it’s nice knowing that when we do something good for the cat, it has the added benefit of doing something good for the person.

20. “Your vet may not have gotten into vet school! Vets who can’t get into traditional U.S. veterinary programs due to bad grades and poor test scores often go to for-profit schools in the Caribbean, where, basically, if you can pay the tuition, you get in.”—A vet in California.

This is a ridiculous thing for a vet to say; it only sows unnecessary fear and suspicion in our clients. The percentage of vets in the U.S. from these schools is miniscule. Concerned? Just ask the receptionist before making the appointment where the vet went to school.

22. “I hate to break it to you, but your $2,000 designer dog is a mutt. Puppy stores and breeders have created these cute names like Morkipoos and Puggles, and now people are paying $2,000 for a dog they couldn’t give away at the pound ten years ago. Whoever started the trend is a marketing genius.”—Dennis Leon, DVM.

This should be obvious to most people. Your “puggle” is not a breed. It’s a mutt. You can only get a puggle by breeding a pug and a beagle. If you breed one puggle to another puggle, the puppies do not look like little puggles.

26. “The cheaper, over-the-counter spot-on flea and tick treatments are extremely dangerous. I’ve seen animals having violent seizures after using them; I’ve seen animals die. Ironically, most of these animals still have live fleas crawling all over them.”—A vet in California.

I cannot overemphasize how true this is. The popularity of the once-a-month veterinary-only flea control products resulted in some companies manufacturing similar-looking products that may be unsafe for pets. These products often contain concentrated doses of permethrin, an insecticide that can make pets (especially cats) very very sick. In fact, I just cut (and am pasting below) the paragraph from the article I wrote about this, several years back: In an effort to tap into the lucrative flea-control market, some manufacturers have produced flea control products with packaging similar to the veterinary products, i.e. in small, single dose tubes for topical application. These products contain permethrin, an insecticide commonly found in low concentrations in a variety of canine and feline flea sprays and shampoos. In low concentrations, cats tolerate these products with minimal adverse effects. These small single-dose tubes, however, contain concentrated permethrin (45% to 65%) as the active ingredient. Concentrated permethrin spot-on products are labeled for use in dogs only, and may cause severe and often fatal toxicosis if applied to cats, especially kittens. Be safe use veterinary products only.

27.“After their kitten vaccinations, indoor cats don’t really need to be vaccinated. They’re not going to get rabies sitting inside the house. Vaccines have the potential to create a lot of harm for cats, including possible tumors at the vaccine site.”—Jill Elliot, DVM, owner of Holistic Vet in New York and New Jersey.

Nonsense. This may be true for rabies, but rabies vaccination is required by law, and I can’t change the law. The FVRCP vaccine, however, DOES need to be given. I wrote a blog post about this and it bears repeating: The FVRCP vaccine protects cats against three viral diseases: panleukopenia, herpesvirus, and calicivirus. Panleukopenia (often called feline distemper) is not a worry in adult cats; it mainly strikes kittens. The other two viruses are respiratory viruses. Vaccination against the respiratory viruses is a little different than vaccination against rabies. The goal of vaccination against rabies is to prevent infection. The goal of the respiratory virus vaccine is not necessarily to prevent infection. The goal is to prevent clinical disease. The main respiratory virus is the herpesvirus, and as we all know, herpesviruses like to stay in the body forever. Most cats have been exposed to the herpesvirus as a kitten. They get a cold, they recover, and the virus then stays in their body, in a state of dormancy. In times of stress or immunosuppression, the virus can re-emerge from dormancy, much the same way a cold sore (also caused by a herpes virus) can re-emerge in people. Cats who are well vaccinated usually only experience mild clinical signs. Cats who are poorly vaccinated can get a whopping head cold and cat get pretty sick. Plus, the herpesvirus has been implicated in many syndromes in cats, such as eosinophilic keratitis (inflammation of the cornea), and herpes dermatitis (a skin condition that often affects the bridge of the nose in cats). Cats do not need to be vaccinated annually for the respiratory viruses. Every three years is adequate. Yes, vaccines have the potential to cause possible tumors at the vaccine site, but the modified live virus vaccines that have been developed are much less likely to do this, and of all the feline vaccines (FVRCP, leukemia, and rabies), the FVRCP vaccine is the least likely to cause problems. So I strongly disagree with Dr. Elliot’s statement that indoor cats don’t need to be vaccinated.

31. “Unfortunately, I’ve had to work in low-cost clinics, and many of them are cutting corners to make a profit. Some places give half doses of vaccines instead of full doses, which is totally illegal and ineffective.”—A vet in California.

I’m horrified if this is true. Giving half a dose of vaccine is wrong wrong wrong. It’s unconscionable, and any vet who does this should be reported to that state’s board of veterinary examiners. This is NOT how you cut corners.

33. “Some people worry that paying for pet insurance will be a waste if they don’t use it. But when you renew your fire insurance on your house, do you say, ‘Shoot, my house didn’t burn down last year—I wasted all that money’?”—Phil Zeltzman, DVM.

If you have an insurance policy that covers annual exams, labwork and vaccinations, then by all means, use it. I personally don’t like these policies. I feel that if you’re going to be a pet owner, you should understand and be willing to pay for the basic medical needs of your pet. I prefer policies that cover illness only. Most people can handle the cost of an annual physical exam, annual vaccines, and perhaps annual blood tests. But not everyone can be expected to easily handle a $4000 veterinary bill if their pet breaks its leg or swallows a sewing needle. So if you’re going to get insurance, get the kind that covers illness only, and as Dr. Zeltzman says, be thankful if you never have to use it. That’s money I would not mind wasting.

39. “One way to make sure your vet is up on the latest stuff? Ask how he puts your pet to sleep. If he says he uses ketamine or halothane gas, that’s not good. That’s like 1970s medicine. Isoflurane and sevoflurane are a lot safer.”—Rachel Simpson.

Um, Rachel… I think you mean “anesthetizes your pet” rather than “puts your pet to sleep”. Big difference. (We use isoflurane, by the way. I don’t think anyone uses halothane anymore. )

42. “Some veterinary drugs have a generic version that’s made for humans, and if your vet believes it’s a safe and effective alternative, you can get it from a human pharmacy and pay ten times less than you’d pay for the animal version. But recognize that there are legitimate reasons why the generic might not be appropriate for your pet.”—Patty Khuly, VMD.

Hey, I’m all for saving money. I’m one of those people who goes to Barnes and Noble, writes down the titles of the books that interest me, and then go home and order them on (or better yet, get them used and in great condition at for less money. If you want to get the drug right from our hospital right at the time you need it, cut into half or quarters for you if you want, we’re happy to do it. If you’d rather have me write a prescription or call it into your own pharmacy, I’m happy to do that too. I just want your cat to get the medicine. Where you get it doesn’t matter to me, really.

43.“Don’t ever share your medicines with your pets unless your vet says it’s OK. One Tylenol will likely kill a cat.” —Amber Andersen, DVM.

I’ve written about the dangers of Tylenol in cats. I can’t emphasize this enough. Read about it yourself:

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Reader Question: Introducing a Trouble-Making Cat into a Stable Cat Household

Veterinary behaviorist Nick Dodman weighs in on the mayhem caused by the introduction of a trouble-maker into a stable cat household

QUESTION: I have two cats (not from the same litter) who are 8 years old:  Patches (19 lbs.) and Molly (half-Manx around 9-10 lbs.).  I also have two miniature dachshunds Annie and Acee, who are 6 years old.  I introduced a new cat about a month ago, whose name is Cutie.  I would say she is around 1 year old.  We live in the country, and she showed up on my back porch (where I feed several feral cats) wearing a collar but no tag.  She is very sweet and loving to humans, and she seemed so vulnerable; however, she doesn’t like other cats (except for an aggressive tom cat).  Since being in the house, she has chased Patches three times…now he is terrified of her and hides in the closet.  Molly has wandered out but gets in hissing/growling contests with Cutie.  Additionally, Molly has now stopped eating, but she is diabetic which is controlled through diet.  I don’t want to give up Cutie, but I don’t know what to do.  Molly would start eating again, I’m sure, if I can just get Patches out of my closet (where she normally eats uninterrupted).  I keep Cutie in the den where my dogs are kept in a crate during the day and night when I am not home or sleeping.  Can you offer any concrete suggestions?  Thank you very much for your help.
Elissa Patadal


ANSWER: Dear Elissa:
 You have indeed got yourself into a pickle by allowing Cutie into your house. Your resident cats, Patches and Molly, do not appreciate the newcomer’s intrusion, and their lives have been totally disrupted by it. It is a fact that not all cats immediately get on together and enjoy each other’s company. Indeed some seem to have a natural dislike for each other; that seems to be what’s going on in your home. The best solution would be to find a new home for Cutie so that Patches and Molly can get their lives back. Patches is terrified and hiding, and Molly is so anxious that she’s stopped eating, which is very serious for cats in general and diabetic cats in particular. If you decide not to take this course, then the only other humane option is to keep Cutie in a separate part of the house so that she cannot see, be seen by, or chase your other cats. Over time it may be possible to allow them to see each other through an inch crack in the door, graduating from this to some kind of screen, and then to controlled interactions in the same room, but I would certainly not hurry this process along and would not bank on it being successful. It seems to me that Cutie and your other cats may just be an oil-water mix.

Dr. Nicholas Dodman
Head, Animal Behavior Section
Tufts Cummings School of Veterinary Medicine
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Reader Question: Can Cats be Hoarders?

Can cats be hoarders? My colleague Alice Moon-Fanelli says anything’s possible!

QUESTION: We have had Heff for a year. He was a humane society cat and the vet said he was about 2 years old so now he would be 3 years old. During the day, he will find pairs of socks or other piece of clothing and bring it into the kitchen area, meowing, a specific meow, while doing the transport. We cannot figure out what triggers this behavior. He appears very well adjusted to indoor life and outdoor cat cage time, he eats well and gets along with my 4 other cats. I can come home to 3-4 pairs of socks on the kitchen floor!!! He also does this behavior when we are home. Do you have any thoughts on his behavior?

 Joanne Priebe

ANSWER: Dear Joanne,
Heff seems well-adjusted so why does he carry your socks and other clothing into the kitchen area? My own spayed female cat loves to retrieve clean folded socks from the laundry basket and deposit them in our upstairs rooms, especially the study. She makes a characteristic guttural vocalization when she’s transporting her “babies”, which is always my clue to interrupt and redirect her behavior to her very own catnip filled socks – my nice angora socks that shrank in the dryer- and put my laundry away! Her behavior looks like a mother cat moving her babies from one nest to another for safety reasons.

This is a tidy explanation, except then why are there numerous reports of castrated male cats engaging in the same behavior?

Adult cats often carry prey home. Perhaps the socks represent a prey substitute – especially if they haven’t seen the laundry recently! Females, especially those with kittens, do carry prey home more frequently than either intact or castrated males but both sexes engage in the behavior to varying degrees. Perhaps cats without kittens bring home “leftover” food that they don’t intend to eat right away as they find themselves in a conflict situation- so much food so little appetite! You mention that Heff makes an unusual vocalization when transporting your socks.

Female cats bring prey to the nest for kittens and emit a guttural “keening” cry of urgency (not alarm) to call the kittens’ attention to the catch. By calling to her young she “ensures” that they will benefit from her success and the catch will not be lost to a nearby unrelated animal. The similar behavior exhibited by spayed or neutered housecats may be an attenuated maternal behavior or (now I am really going out on a limb!) attention seeking behavior stemming from retained kitten experience (look what I’ve brought – always brings the kittens running and always means food). It is interesting that Heff brings your socks to the kitchen. Is this where he is fed? Is he fed meals or ad lib? My TiAmo, who is meal fed, focuses her sock “deposits” in my study, which is where she receives her meals.

Finally some cats have been reported to be collectors or hoarders of various household items, for whatever reason. According to anecdotal reports, these cats usually have a “cache area” where they leave their booty. If Heff’s behavior is problematic for you, you can discourage his sock stealing if you deny access to his most favored items by storing them in cat proof drawers or closets. If he does not have access to his preferred clothing items for a while, the behavior may extinguish.

Heff sounds like quite the character, despite his seemingly eccentric sock fetish – which in fact has a logical ethological explanation. Enjoy and good luck finding matching sock pairs!

Alice Moon-Fanelli PhD,
CAAB Animal Behavior Consultations, LLC
Brooklyn Veterinary Hospital
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Cat Man Do Awarded Cat Blog of the Month by aims to bring you quality information about cats, as well as keep you entertained. And that is exactly what Dr. Arnold Plotnick's mission is with this blog "Cat Man Do." Which is why our blog won TCS' Cat Blog of the Month April 2012! MEOW! is everything cats cats cats! For in-depth cat information check out the numerous articles on cat care, cat health, cat behavior and cat breeds. Or just pass the time reading some Cat Snips to further your knowledge about cats. Join in at their Cat Forums - Share cat care advice or just chat with fellow cat lovers.
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Reader Question: Why do Cats Bring their Toys to the Water Bowl?

Ever wonder why cats bring (and sometimes drown!) their toys to the water bowl?  Here’s what my colleague Alice Moon-Fanelli has to say about this:

QUESTION: I have a four-year old tiger striped cat named Quincy.  He was adopted from our local Humane Society when he was just seven months old.  Since that time he has grown into a very beautiful and playful cat.  However, he has one very odd habit which I cannot seem to get an answer.  Quincy has a favorite toy which is a stuffed mouse.  He constantly drops this mouse which has stuffing inside into his water dish which saturates the mouse with water.  He will carry this saturated mouse around the house which we sometimes step on and will get an unpleasant wetness under our feet.  But, the worst of this habit is when he drops the mouse in his water dish and then proceeds to jump on the bed with the mouse in his mouth and drop it on or near me when I am sleeping.  Again, my sheets and I are getting saturated with the water from this mouse.  The other morning he hid the saturated mouse inside my pillow case and woke me up trying to bite at my pillow trying to get the toy out.  I then awoke to half my pillows soaking wet because of his saturated mouse he had placed inside.  These rituals that he performs are always in the early morning hours.  Can you tell me why he has to keep saturating his toy mice and why they must be brought to me in my bed? 
Best Regards,
Terri Oreck

ANSWER: Dear Terri,

Quincy’s toy dunking behavior is not unusual, but no tried and true explanations for this behavior exist.  Speculations run the proverbial gamut from the mundane to fanciful notions.  If Quincy’s toy or play area is located near his food and water dishes, a rousing game of predator/prey could logistically result in a mouse in the water.  Quincy may enjoy floating the mouse in his water bowl and then “fishing” for it – this adds a whole new dimension to the hunting game. “Fishing” behavior is quite typical for cat play behavior.  Perhaps the more appealing wet or soft texture explains why Quincy prefers to carry a saturated mouse toy.  It is interesting that he sometimes chooses to deposit his mouse inside your pillow case.  Some speculate that cats try to find a “safe” place for their favorite things.   In the wild, cats often take their prey back to their "nest" area, and hide it from predators. Indoor cats don't really have a "nest" per se, so they may consider their food and water dishes and in Quincy’s case your pillow as the "safest" areas within their "territory". Cats are crepuscular, meaning they are most active at dawn and dusk so Quincy’s “hunting” hours are quite normal, even if his activities may be disruptive for you.
Predatory behavior is mostly innate but kittensfine tune their skills by trial and error and by observing their mother or other female cats who first bring home dead prey and eat it in front of the kittens.  Later the mother will bring a nearly dead creature to the kittens for them to finish it off. It is very common among some household cats, especially females, to bring home dead prey and drop it right in front of their owners. This behavior may exhibit her need to teach others, even if they are not her kittens, how to eat prey.  It has been suggested that the human recipient serves as a deputy kitten of sorts!  A more neutral explanation is that the domestic satiated cat finds itself in conflict with food it does not intend to eat but brings it back to the “nest” as part of its conflict behavior.  It is interesting to see how our domestic cats retain their natural behaviors and adapt them to their indoor environment so they still have a healthy outlet.  Have patience with Quincy and his quirks – they’re all natural!
Alice Moon-Fanelli PhD, CAAB
Animal Behavior Consultations, LLC
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Reader Question: Feline Marking Behavior

Here are two reader questions that deal with marking behavior.  As you’ll see in these two letters, some cats mark with poop.  Others mark with pee.

QUESTION: My wife and I are retired and have two 3-year-old cats, Mr. Charles Dickens and Ms. Charlotte Bronte, (male & female/neutered & spayed, indoor only) adopted from the local cat rescue. Mr. Dickens is the “alpha” cat and weighs 17.5 lbs. Ms. Bronte weighs 12.5 lbs. The cats like to sleep on our bed at night and almost all the time when we are away. Otherwise, during the day they sleep in many different locations. Mr. Dickens is more outgoing with strangers and will be the first to “check them out” when we have guests. Ms. Bronte is very shy and takes a considerably longer time to investigate strangers (if at all).

During the holidays, our son visited us and was staying in our guest bedroom. Somehow our son closed the bedroom door when he went to sleep not knowing that the male cat was under the bed in his room. Unfortunately, the male cat needed to use the litter box, and instead of waking our son, he found our son’s open sports bag which was on the floor with some clothing in it and used it as a litter box. The cat immediately began a habit of defecating in the center of the master bedroom bed instead of in the litter box about once every other day. About three days ago, he defecated on the center of the guest bed as well. This occurred shortly after we had weekend guests who slept in the guest bedroom and when we thought that the bed in the master bedroom was the only target.

The bed linen and covers were laundered after each occurrence, and more recently “Zero Odor” has been sprayed in the master bedroom. We have tried a Feliway plug-in in the master bedroom, all to no avail. The only way we can prevent this behavior is to close the doors to both bedrooms during the day, opening them when we are ready to go to bed, which we would prefer not to do routinely as it makes the house seem smaller. Closed doors worked for several days in a row until I inadvertently left the master bedroom door open for not more than 10 minutes, in which time the male cat slipped into the room, repeated the act, and slipped out. The female cat is not a party to this behavior. She seems to ignore his bad manners and does not seem to be offended when he exhibits his bad behavior while she is sleeping on the master bedroom bed.

We have no idea how to begin behavior modification of Mr. Dickens. We are quite sure that his behavior is deliberate and not accidental. We love both cats and enjoy their company.

I apologize for the length of this letter. I wanted to include all the information I thought was pertinent. We hope you can help.

Sincerely, David and Janet Harden

ANSWER: Dear David and Janet:
The problem that Mr. Charles Dickens is presenting you with is one of fecal marking, otherwise known as “middening”. As you note, Mr. Dickens is a bit of an alpha cat, is outgoing, and no doubt somewhat territorial. When your son visited, I don’t think Mr. Dickens was “caught short” but rather that he was sending your son a territorial message when he eliminated in your son’s open sports bag. Shocked to the core by the apparent invasion of his territory, Mr. Dickens then began to make it very clear which areas of the house were his and his alone; specifically, he began defecating in the very center of the master bedroom bed. His message: Kilroy lives here!

I have no doubt that Mr. Dickens uses his litterbox most of the time but every so often, when his cryptic message has faded, he refreshes his mark. The fact that he defecated in the center of the guest bed right after you had guests sleep over means that he is claiming the guest bed as his territory as well.

The cause of Mr. Dickens’ middening is territorial anxiety, and I’m afraid that the only way to shut it down is by the judicious use of mood stabilizing medication, specifically fluoxetine (veterinary trade name Reconcile®). You were right to launder the bed linen and covers and spray the marked area with Zero Odor®, but that alone will not solve the problem. I have no faith at all in Feliway® and hate to say I believe you wasted your money there.

With Prozac in place, Mr. Dickens’ anxiety level reduced to a trickle, and your sheets fresh as a daisy, you will be in a position to open your doors and enjoy your whole house once again. Please be advised that this is not your fault, but rather a result of Mr. Dickens’ territorial nature. I leave you with a quote from the original Charles Dickens, who said “Accidents will occur in the best regulated families.” That appears to be what has happened in your case.

Yours sincerely,

Dr. Nicholas H. Dodman
Director, Animal Behavior Clinic at the Cummings School of Veterinary Medicine at Tufts

QUESTION: Dear Doctor,
 I have been given a very sweet, 1 yr. old spayed female who has had 1 litter of kittens.  She had attached herself to a lady in a retirement community where animals were not allowed.  She had her kittens in that lady's apartment and so, just as soon as the kittens could be taken to the local SPCA, the affectionate, short-haired calico was brought to me.  She is very active, purrs readily, plays incessantly, and uses her kitty box very well.  The only problem I can't deal with is that she pees on my pillow on my bed, every chance she gets.  I've cleaned the bedding with hydrogen peroxide and soda, changed the pillows, bedding, and mattress cover.  I'm now forced to keep the bedroom door closed but the instant I turn my back, if the door is open, she runs in to pee!  I live alone and have no other pets and do enjoy her company but I am at my wits end.  What can be wrong?  How do I break her of this most offensive act?  Please help.  I really want to keep her and I'd love to be able to leave the bedroom door open, especially in the middle of the night when I need to pee.
Patty Meeko

ANSWER: Dear Patty,
Since your one year old spayed female calico regularly uses her litter box for routine elimination, I will assume that she finds the latrine arrangement you have provided satisfactory.  In that case, the most likely explanation for her “pillow peeing” is marking behavior.  Some cats deposit a large volume of urine on their owner’s personal items if the cat is experiencing some discontent with its relationship with the owner.  Is there any reason your cat may be trying to send you a not-so-subtle message of her discontent by urinating on your pillow and potentially other objects that contain your scent?  Some cats, who are extremely attached to their owners, urinate on owner’s personal belongings as a reaction to separation anxiety or an upset in their environment.   However, you do not describe any association with her urinating on your pillow and any particular stressor, such as you giving less attention, travelling or having guests in your home.  In fact she seems to run out of habit  into your bedroom any chance she gets.  If you close her out of the bedroom at night depending on her motivation this may actually contribute to the problem.  Finally, it is possible this is a habit she developed while pregnant and living in the retirement community.  She may have had designs on delivering her kittens on the lady’s bed and chose to mark it as her territory.  Now she has retained this behavior and has carried it over to your home.  It’s really anyone’s guess with the limited information that is available.

Whatever her motivation, I agree we need to change her ways! First, it is essential to deodorize soiled locations using an enzymatic or bacterial odor neutralizer specifically prepared to break down urine.  Zero Odor and Anti-IckyPoo, both available from the Internet, are two products that I have found to be effective.  Hydrogen peroxide and soda are ineffective at eliminating urine odors. If urine has seeped into your mattress and pillows, you will need to thoroughly cleanse the pillow and mattress as well.  If your pillows and bed smell like urine, she will continue to view it as a scent post.  

She may benefit from more mental and physical stimulation.  Enriching her environment with a variety of toys, including food stuffed toys and perches may help.  She sounds very intelligent and physically active so scheduling daily play and training sessions will help her be more content.  You might consider clicker training to teach tricks and train her to negotiate an agility (obstacle) course.

You should continue to deny her access to your bedroom when you are not present while you work on cleaning the area and breaking her habit.  If it is simply a habit she has developed following birthing her litter of kittens, it will extinguish over time if she is not given the opportunity to continue to soil your pillow.  If she is marking your pillow because she is experiencing some stress, then identifying and addressing the stressor will be necessary to eliminate this behavior.  You may find it helpful to schedule a consultation with a qualified animal behaviorist to help you get to the root of this problem and develop a detailed treatment program.

Good luck with her.  She sounds like a fantastic feline friend with the exception of this one issue – Put on your detective hat and with guidance from an appropriate professional you will be able to discern her underlying motivation and redirect her behavior.

Alice Moon-Fanelli PhD, CAAB
Animal Behavior Consultations, LLC
Brooklyn Veterinary Hospital

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Reader Questions

From August 2004 to January 2012, I served as the medical editor of Tufts University’s Catnip newsletter, under the brilliant and professional guidance of my friend and colleague, Arden Moore.  [It would take an entirely separate blog to detail Arden’s contributions to the world of animal education and entertainment.  Just check out her website and her podcast and see what I’m talking about].  Arden left Catnip to bigger and brighter endeavors, and the publisher decided to revamp the newsletter.  In short, the medical editor’s position was eliminated.  Sigh. 

However, while I was the medical editor, I got to work with two excellent behavior specialists, Dr. Nick Dodman and Dr. Alice Moon-Fanelli.  I frequently called on them to answer some of the more challenging letters sent in by Catnip readers.  I’ve decided to share their wisdom with you.

In the near future look for blog posts by myself as well as my fellow colleagues (look for the tags "Questions" and "Answers". I'm very excited to be able to provide you with their insights on my Cat Man Do blog.
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Just another Manic Monday - Part 2

(Continued from part 1) After that crazy morning I had a little break, or so I thought.   I was hoping to cram a little food in my face, but my technician Hiromi was doing a dental cleaning, and she informed me that I had a tooth to extract.  It was a carnassial tooth (the third upper premolar), and that’s a three-root tooth.  The gums around the largest root were very diseased, and there was a very deep pocket between the gum and tooth, indicating that the periodontal ligament (which attaches to tooth to the gum) was diseased.  However, the gums around the other two roots  were okay.  Trying  to extract a tooth with one diseased root and two healthy roots is NOT easy.  It took me a good 20 minutes, but I got the tooth out intact, leaving me 10 minutes to scarf down my salad.

Next, I looked at Jack,

FeLV and FIV positive (yes, positive for BOTH viruses. Sigh.) with an absolutely horrendous ear condition. Jack was rescued from Animal Care and Control by the good folks at Empty Cages Collective.  Jack deserves a blog post all to himself, which I may or may not ever get to.

After looking at Jack, I had what was probably the easiest case of the day:  Fanny, here for a blood pressure measurement.  Fanny was recently diagnosed with chronic renal failure, very early stage.  There’s not much you can do to improve a cat’s kidney function, but there are lots of things you can do to slow the progression of the disease, and that becomes the focus of our management of cats with chronic renal failure.  Twenty percent of cats with CRF have high blood pressure, and this can accelerate the progression of the kidney disease if not treated.   It can also affect the eyes, the heart, and the central nervous system.   Whether or not cats have high blood pressure is unrelated to the severity of the CRF.  Cats with severe disease can have normal blood pressure, while cats with mild CRF can be seriously hypertensive.  Thankfully, Fanny was a mellow little angel, and we easily obtained our five blood pressure measurements.  They were all perfectly normal.  So, that’s one less variable we had to worry about in terms of her kidneys.  We sent Fanny’s owner home with our famous “kidney variety pack”, a bag containing all of the available prescription diets currently  manufactured for cats with CRF.  We almost always find one that the cat likes, even the most finicky feline.  Studies have proven without a doubt that feeding a low-protein, low-phosphorus diet extends the lives of these cats.  I’ll see Fanny back in six months.

Next came Lola.  Lola is a Bengal kitten that I spayed four days before.  Her owner was concerned that the incision was open.  Well, things tend to come in threes, and Lola completed the trifecta of spitfire cats.  Sharkey, Harley Davidson, and now this little maniac.  Lola wasn’t really aggressive, but she was a screamer.  As in blood-curdling shatter-your-ear-drums Friday-the-13th –horror-movie scream.  It took two technicians to hold this little kitten down just so I could peek at her incision, the edges of which had separated slightly.  Normally we use surgical adhesive on our spays rather than sutures. It allows us to avoid dispensing the dreaded, feline-despised Elizabethan collars.  We rarely ever have a problem.  I particularly wanted to avoid sutures in this kitty, because of her temperament. There is no way this hyperactive little spitfire would tolerate a collar.  I therefore deliberately placed a few subcuticular sutures.  These sutures were right under the skin, pulling the edges of the incision closer together so they are under less tension, allowing for more reliable gluing.  Alas, to no avail.  Lola’s owner confirmed that she spent the last few days running around like a total nutjob (her prompt recovery either being evidence of my surgical skill, or evidence of her having  the kitten version of ADHD. I suspect the latter), and the skin incision did separate a tiny bit.  The subcuticular sutures were holding fine, though.  So we cleaned and dried the incision and applied a little additional adhesive.  Lola screamed her way back into her carrier, and then screamed her way out the front door.

Val arrived next.  Val  is an 11 month-old kitten who also got into lilies!  Her owner caught her nibbling on a lily plant and brought her into Blue Pearl Veterinary Specialists on Sunday evening.  Bloodwork showed no kidney damage at the time of admission, and she was put on intravenous fluids throughout the night as a precaution.  Monday morning, she was transferred to us.  She looked fine on physical examination.  We admitted her to our hospital for another 24 hours of fluid therapy, and another check of her kidney function.  (She ended up doing fine).  (Later that afternoon, when I logged onto my computer, a reminder popped up that said “Don’t forget to post the warning about lily toxicity on your website”.  Timely, no?)

My next appointment was Jasper, an elderly cat that was sent to me for a second opinion.  The doctor is a very good vet, so when he sends me a case, it’s going to be frustrating for me, because undoubtedly, he’s worked it up pretty thoroughly and I’ll end up being stumped.  But that’s okay. Sometimes, a doctor just wants a new set of hands and eyes on a case, partly to see if there’s something you might have missed, and partly to just have someone validate that you indeed worked things up to their logical conclusion and that there’s no clear diagnosis or answer.  Jasper is a diabetic cat who was losing weight despite having the diabetes pretty well controlled.  The cat is not hyperthyroid and does not have renal disease, two other common causes of weight loss in an older cat.  He had abdominal ultrasound performed by Dr. Patrick Hopper, and the liver looked a “hyperechoic”, meaning that there might be some kind of cellular infiltrate in the liver.  The pancreas also looked inflamed, and the intestines looked thickened.   Dr. Hopper got a needle biopsy of the liver, which turned out to be normal.  He also did a PLI test to see if there was pancreatitis, and the test came back elevated, indicating that there is indeed pancreatitis going on.  Peter also did a TLI test, and a B12 and folate level.  No need to elaborate too much on this, except to say that his workup was very thorough indeed, leaving me with little to add, in terms of commentary.   The big kicker in this case is that the cat has a dramatic, large, firm mass on the right flank. Specimens were sent to the lab for cytology, but the results came back as “reactive”, i.e. no cancer cells seen.

After thinking about this case for a while, my take on it is this:

The presence of thickened intestines on the ultrasound suggests that there is something infiltrating the intestinal tract, the most likely culprits being inflammatory cells, in which case the cat has inflammatory bowel disease (IBD), or cancerous lymphocytes, in which case the cat has lymphoma.   Often, if a cat has IBD, it will be accompanied by inflammation of the pancreas and the liver.  All three organs are anatomically linked in the cat.  When all three are affected, we call this “triad disease” or “triaditis”. We know the pancreas is affected, because it looks swollen on the ultrasound, and the PLI test has come back elevated.  The liver, surprisingly, is normal (confirmed by biopsy).  Whether the cat has primary pancreatitis, or pancreatitis secondary to IBD is really immaterial here.  The cat is not showing clinical signs of pancreatitis, i.e. vomiting, poor appetite, abdominal pain, etc.  Some might argue that the diabetes could be a sign that the pancreas in inflamed; the pancreas makes insulin, and when it is inflamed and not working properly, it won’t release insulin properly and the cat becomes diabetic. But Jasper has been diabetic for years, so I think the pancreatitis we’re seeing in Jasper is mild and is likely secondary to presumed IBD. 

The mass on the flank is dramatic.  The nice thing about an aspirate is that it is a non-invasive procedure. The potential disadvantage of an aspirate is that the results might not be fully reflective of what’s going on.  Sometimes the mass doesn’t exfoliate its cells into the needle very well, leading to a misleading diagnosis, or even a non-diagnosis.  A biopsy specimen is much more accurate, but this requires anesthesia and surgery. 

My recommendation would be to have the cat undergo endoscopy so that we can see if the cat has IBD or lymphoma.  While the cat is asleep for endoscopy, remove the mass on the leg and send it to the laboratory.  If the mass is benign, fine.  It would be good to have this big mass off the leg regardless. If the mass turns out to be malignant, it definitely would be good to have it off, and we can deal with post-operative management based on what the biopsy reveals.  The big question we’re going to have to address later on, if the cat does undergo endoscopy, is:  how would we manage the IBD or lymphoma?  Treatment of either illness involves administration of prednisolone, a steroid that should not be used on a diabetic animal, since steroids can mess up the regulation of the diabetes.  There are other ways to treat IBD or lymphoma that might not involve the use of prednisolone, but cats respond very nicely to good ol’ pred, the tried and true treatment.

Next up, Nairobi. Nairobi is a black cat with a similar scenario as Jasper.  Here’s a little background:  He was hospitalized with us for a few days with a fever and poor appetite.  His fever was stubborn.  It varied from 103 to 104.7 over the course of a few days, but it never broke.  Exactly why he had the fever was a mystery.  He had a high white count and bacteria in his urine, so pyelonephritis (a kidney infection) was on our list.  I was leaning against this because he was put on very good antibiotics, and yet his fever did not break, and most cases of pyelonephritis respond to antibiotics pretty readily.  Nairobi also had a low calcium and moderately high blood sugar.  There aren’t too many reasons for a low calcium in cats.  Pancreatitis is on the list of causes of low calcium, and the fever, high white count, and high blood sugar did fit.  The pancreas makes insulin.  When the pancreas is inflamed, it may not secrete insulin properly. Insulin lowers your blood sugar.  If the pancreas is inflamed and not secreting insulin properly, you’ll often have high blood sugar.  To complicate matters further: Nairobi also had a low folate and low vitamin B12 level.  Folate and B12 are vitamins that are absorbed into the bloodstream from the gastrointestinal tract.  If the folate and B12 level are low, it’s because the intestinal tract cannot absorb the vitamins properly. The most common reasons for this are inflammatory bowel disease, or low-grade gastrointestinal lymphoma (a type of cancer).  Often, when a cat has inflammatory bowel disease, they will have concurrent pancreatitis and liver inflammation.  Two of Nairobi’s liver values were elevated, suggesting that there could be an issue with the liver.  So, to summarize:  Nairobi could have a kidney infection; he could have pancreatitis as a primary disorder;  or he could have inflammatory bowel disease with concurrent inflammation of the pancreas and liver, the so called “triad” disease.  Or any combination of these.   To figure out exactly which of these scenarios might be the cause of Nairobi’s illness would require additional diagnostic tests.  Additional tests would be cost prohibitive for the owner, as the case was already taking a significant financial toll, (not to mention the emotional toll of having a very sick cat.)    After much discussion, we decided to send Nairobi home.  I don’t like to send a cat home if he still has a fever and is not eating, but given the cost of the additional supportive care, the owner elected to try him at home.  Some cats will rally when they’re back in their home environment, with their favorite bed, food bowl, litter box, etc.  We sent him home with a variety of medications to treat a variety of presumptive illnesses, and we had her come back in three days for us to re-evaluate him.  This is why he’s here today.

Nairobi’s owner tells me that he’s done poorly since arriving at home.  Lethargic, not eating a thing, not responding to appetite stimulants, and his abdomen looked distended to her.  I examined him, and yes indeed, his abdomen was distended with fluid.  A fever was still present.  These findings led me to put another illness on our list: the dreaded Feline Infectious Peritonitis (FIP).  This is a viral disease that is invariably fatal, and only adds more gloom to his poor prognosis.   Poor Nairobi.  I could see on the exam table that he was miserable.

With his persistent fever, enlarging abdomen filled with fluid, zero appetite, and loss of muscle mass, his owner elected to euthanize him.  She got no argument from me.  Clearly something dreadful was going on with him, and even if we could do all of the diagnostics we’d want to, I feel we would end up diagnosing something that would not be treatable.  Sigh. 

Pandora was next, and was probably the easiest case of my day.  Pandora’s owner brought her in because she saw a worm “crawling out of her cat’s butt”.  She described the worm as small, white, and wriggling, expanding and contracting as it tried to move.  This description leaves no doubt as to the identity of this creepy critter:  this is a tapeworm

Pandora’s owner was concerned for her three other cats.  I told her not to worry.  Cats get tapeworms from swallowing a flea that is carrying tapeworm eggs. That’s how the life cycle works.  You cannot get tapeworms from eating a tapeworm segment.  You can only get them from eating a flea.  Pandora must’ve had an infected flea on her, and as she zealously groomed herself, she swallowed it. 

Pandora is indoors only, though.  So where did she get the flea?  Well, not only are there three other cats in the house, there’s a dog.  I suspect the dog brought in some fleas (even though he supposedly is given a monthly flea preventative.) In any event, we treated Pandora with Profender, a topical once-a-month anti-parasitic drug.  This would take care of the tapeworms easily.  I also dispensed four doses of a topical flea-control medicine.  This would kill any fleas on any of the cats in the house.  An easy appointment.

The last appointment of the day was Princess.  She came in because the owner noticed one of her canine teeth on the floor.  A while back, we examined Princess and discovered pretty significant periodontal disease.  I recommended that we do some bloodwork, and then schedule a dental cleaning.  We did the bloodwork, but life sometimes gets in the way, and somehow the dental cleaning never got scheduled.  Finding a diseased canine tooth on the floor was a big wake-up call for the owner. 

I examined Princess and as expected, her mouth was a mess.  Several other teeth were diseased and would probably need to be extracted.  We repeated the pre-anesthetic bloodwork (the previous bloodwork was now out-of-date), and were ready to schedule the dental cleaning.  But there was a little catch: Princess had a prominent heart murmur.  Before anesthetizing a cat with a murmur, it would be ideal to discover the reason for the murmur, since heart disease could affect whether or not we could anesthetize her safely.  I recommended that we have the cardiologist evaluate her before the dental, and she agreed.  As it turned out, Princess’s murmur was physiologic, not pathologic, and there would be no problem anesthetizing.  We cleaned her teeth, extracted a few diseased ones, and sent her home, where she’s doing great. 

And that was my day.  Now home for dinner, a movie (courtesy of Netflix), and a magazine in bed before hitting the sack.  Tomorrow it starts all over again.  Crazy and stressful? Yes. But I wouldn’t have it any other way.

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Just another Manic Monday (a.k.a. Whatever happened to a plain ol’ feline physical exam and vaccines?)

After 23 years of being a vet, I finally have a nice work schedule.  I work Monday, Tuesday, Thursday, Friday, and every other Saturday (for four hours).  I’m off Wednesday and Sunday.  It’s perfect.  I think of Monday and Tuesday as my “mini-week” and Wednesday as my “mini weekend”.  Then I work Thursday and Friday and (every other) half-Saturday, and get Saturday afternoon and Sunday off.  This schedule keeps me pretty sane.  No complaints.

This past weekend I had the entire weekend off. It’s a good thing, too, because Monday turned out to be totally crazy.  My practice has gotten really busy lately (no complaints about that, either.  With this economy, I consider myself very fortunate), and it’s all been pretty challenging stuff.  Here’s my actual day, with very little dramatic embellishment.  This is what comes through my office – and what goes through my brain – on a manic Monday.

First thing in the morning, right at 8:00, Beowulf’s owner dropped him off for his chemotherapy.  Beowulf is a middle aged cat who initially presented for frequent vomiting. We worked the case up pretty thoroughly, and ultrasound and endoscopy revealed high-grade lymphoma.  He’s been getting chemotherapy for a few months and has been doing great.  Last week, Beowulf was due for his adriamycin infusion, but he jerked his leg when we tried to put in his intravenous catheter, and the catheter did not go in perfectly.  We tried his other front leg, but there was too much scar tissue in that leg due to prior chemo injections.  Because the catheter did not go in absolutely perfectly last week, we aborted his treatment that week.  You see, the drug adriamycin is a very effective chemo drug, but if any of the drug leaks out of the vein into the surrounding subcutaneous  tissue, it causes a horrendous, horrifying skin reaction. Some animals can actually lose the leg from the reaction.  So, unless we’re 100% certain the catheter has gone in properly, we err on the cautious side.  Today, the catheter went in smoothly, and he received his medication.

My first appointment was to see a cat named Cheyenne, a 16 year old cat with multiple problems.  Her owner brought her in for straining to defecate and foul diarrhea.  On physical exam, the cat had lost weight, and I thought I felt something not-quite-right in the abdomen when I palpated.  I noticed that the cat was breathing hard during the exam, and as the physical exam progressed, the cat’s breathing became increasingly labored.  I stopped the exam and let the cat chill out on the exam table.  Labored breathing is not a good sign in any cat, especially an older cat. Common causes for labored breathing would be fluid in the lungs (i.e. pulmonary edema), or fluid trapped between the lungs and the chest wall (i.e. pleural effusion).  I percussed the chest, i.e. I tapped on both sides of the chest with my fingers, listening to the sound it made.  A hollow, resonant sound suggests that there’s air in the lungs.  A dull, flat sound suggests fluid.  Percussing is very “old school”, which is why I like it.  We tend to rely more and more on fancy equipment to make our diagnoses.  I think it’s still important to use our senses in the exam room.  In my opinion, that’s “real” medicine.  I don’t always need a chemistry panel to tell me a cat has kidney failure; I can smell the uremia on the cat’s breath.  And I don’t necessarily need an x-ray to tell me if there’s air or fluid in the lungs/chest.  I can percuss and listen.  Which I did.  I thought there was pleural effusion. I took an x-ray to quantify it. When a cat has labored breathing, you have to be very careful when taking an x-ray.  If the cat struggles or fights the x-ray, you have to let up; you cannot restrain the cat.  If the cat struggles and cannot meet the increased oxygen demand during the struggle, the cat can go into respiratory arrest.  Bearing this in mind, I took a dorso-ventral (DV) x-ray of the chest, rather than the more-informative ventro-dorsal (VD) view, because the DV view allows the cat to just sit there on the x-ray cassette while we snap the picture.  For the VD view, the cat is positioned on its back while we pull the front legs forward and the rear legs backward.  Cats aren’t too crazy about the process.  Trying to do this to Cheyenne would have been deadly.

The DV film confirmed a huge amount of fluid in the chest.  To give the cat some relief, we would have to “tap” the chest – remove the fluid using a syringe and needle – and then (ideally) send the fluid out for analysis to hopefully determine the reason why the fluid developed.  Given the cat’s age, the likely presence of a mass in the abdomen, the chest full of fluid (there are very few benign conditions that lead to fluid in the chest; most of the time, it’s something serious) and the owner’s financial limitations, she elected to euthanize the cat.  I thought this was a reasonable decision.  This cat clearly had something terrible going on, and even if we could do all of the diagnostics necessary, it would be very unlikely to lead to a diagnosis of anything treatable.  So we euthanized poor Cheyenne.

Sharkey’s owner then dropped off his cat for a three-day stay at our hospital, on IV fluids.  On Friday, I examined Sharkey.  Well, I tried to, at least.  Sharkey is a Russian Blue, and he is a little feisty. Very feisty.  Spawn-of- Satan feisty.  He was very difficult to examine.  We needed to wrap him in a towel, and put on a muzzle, and even then, he gave us quite a workout.  Sharkey had experienced a drop in his appetite and was a bit lethargic. (Ha! Yeah, right.)  Several months before, he was diagnosed with mild chronic renal failure.  (He’s an older cat.)  I suspected a worsening of his kidney disease.  We managed to get blood and urine on Friday morning, and by Friday afternoon my suspicions were confirmed.  Sharkey’s BUN and creatinine (two blood markers of kidney disease) were elevated, as well as his phosphorus (another marker), all to a degree that I felt warranted a brief hospital stay.  During his stay, we would put in an intravenous catheter, and then administer fluids at a pretty decent rate, with the intention of reducing the level of his kidney toxins.  Sharkey was building up the toxins quicker than we could get him to pee them out.  Our intention during his hospital stay would be to make him pee them out quicker than they were building up.  This would likely make him feel better.  Then we’d instruct the owner on how to give fluids subcutaneously (under the skin) at home every day, to maintain this new balance of him peeing them out quicker than they build up.   If, after a month of daily fluids, he was able to maintain a decent blood level of kidney toxins, we could maybe cut back his fluids to every other day, indefinitely.   Bringing Sharkey in over the weekend would be tricky, though, because of his temperament.  For us to place a catheter in him, we would need more than just our weekend staff.  Fortunately, Sharkey was doing fine at home, eating and drinking well; he wasn’t showing signs of illness despite the elevated toxin level.  So we scheduled him to drop off on Monday.  Getting the catheter in him today indeed turned out to be a bit of a fight, as we needed several people to help hold his towel-wrapped body (and muzzled snout) while we put in the catheter.  But we were successful, and we set him up in a quiet, comfortable cage.

Then Fig arrived.  Fig is a 4 year-old cat who was being transferred to us from Blue Pearl Veterinary Partners.  He was taken there the night before because he had apparently chewed on a lily plant.  Easter is coming up soon, and ‘tis the season for Easter lilies and lily toxicity.  Lilies are VERY toxic to cats.  All parts of the plant – leaves, stems, even the pollen.   Blue Pearl saw him the night before and started him on intravenous  fluids to try to prevent kidney damage.  It’s unknown exactly how much of the plant Fig ingested, if any.  In this circumstance, you play it safe and treat as if he was exposed.  The initial chemistry panel that they ran on him showed normal kidney numbers.  We admitted him, with the intentions of keeping him on fluids all day today, and all day Tuesday.  Tuesday night we would  draw blood for a chemistry panel, and send him home if things looked good.  (Update:  It looks like one of his kidney parameters, the creatinine, turned out to be a little elevated [3.2].  The BUN is normal.  So Fig might indeed have experienced a little hit to his kidneys.  After a two days of fluids, he did well, and we sent him home; a recheck of his kidneys showed the numbers to be normal. He’s fine. Whew!)

Next was Harley Davidson.  Harley is a middle aged cat with a history of urinary issues, mainly cystitis.  He’s been on a prescription diet designed to minimize any bouts of cystitis, and the number of episodes he’s had has been  greatly reduced as a result.  But he was apparently going in and out of the litterbox at home a tad more frequently than usual, so his owner dropped him off for us to evaluate him and perform a urinalysis and urine culture.   Well, Harley is similar to Sharkey, i.e. super-aggressive.  Sigh.  So…again with the towels and muzzle.  Fortunately, Harley had urine in his bladder and I was able to obtain enough for a urinalysis and culture.   Harley’s owner wasn’t going to pick him up until toward the end of the day, so we set him up in a boarding cage downstairs, rather than in the hospital ward.  We had a few sick ones in our hospital ward, and a cat like Harley who growls and hisses every time someone gets near his cage just gets the other cats all worked up, making them difficult to handle as well.  So Harley had the nice quiet comfortable boarding ward all to himself. 

After that, I had a little break...

....which is also a good time to take a break from this blog post.

Manic Monday Part 2 will be posted in a few hours. Stay tuned.

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