feline diseases

Making Medical Decisions for Your Cat

During these past couple of weeks, two friends had to make difficult decisions about medical care for their cats, and it got me thinking about what a challenging task this is for so many of us.

Advances in veterinary medicine make it possible to treat medical conditions in cats that would have been a death sentence a decade ago.  From chemotherapy to kidney transplants, cats can now receive almost the same level of medical care as humans.  But just because these treatments are available doesn’t necessarily mean they’re right for each cat.

To treat or not to treat: two stories

Pandora is an 18-year-old calico in chronic renal failure.  It’s unclear which stage her disease is currently in, because my friend has chosen not to pursue medical treatment beyond the basics:  Pandora is on medication to control her high blood pressure, and she gets a thorough check up every six months to monitor her lab values.  Pandora goes through phases were she doesn’t want to eat and becomes withdrawn, but so far, she has always bounced back after a few days.  My friend has chosen to keep Pandora comfortable at home, and when that’s no longer possible, she’ll be ready (or as ready as any of us will ever be) to let her go.

The decision for Bob, a 14-year-old orange tabby belonging to my friend Robin over at Covered in Cat Hair, was more difficult.  He’s FIV positive,  and a recent ultrasound showed a large mass that was wrapped around his liver.  Without a biopsy, there was no telling what was going on.  Surgery is always a risk, but especially for a senior FIV positive cat.  The surgeon told my friend that, in a worst case scenario, if it was cancer and it had spread, she needed to be prepared to authorize euthanasia while Bob was still on the table.  On the other hand, there was also a chance that the mass could be removed, and Bob could have many more months, if not years, of good quality of life.  My friend agonized over this decision, and eventually decided to have the surgery done.  The mass was removed, and as of this writing, Bob has recovered from his surgery and is undergoing chemotherapy for lymphoma.

Not every cat owner would have made these decisions for their cats.  In Pandora’s case, some would choose more aggressive treatment and more frequent visits to the vet, and possibly hospitalization for IV fluids.  In Bob’s case, some would have elected to forgo surgery and just let him live out however much time he may have left without intervention.  These situations are never black and white, and there is no one right decision.  The only wrong decision in these cases would be indecision when it translates into pain and suffering for the cat.

So what factors should a cat owner take into account when faced with making medical decisions?

Get the facts first

The most important thing is to get all the facts first.  Be sure you understand the medical condition your cat is dealing with.  It can be difficult to know what questions to ask your veterinarian when faced with a frightening diagnosis, so don’t be afraid to ask follow up questions once you’ve had a chance to process the initial information.  Make sure you understand all the treatment options, along with cost, side effects, and prognosis for each option.  Get a second opinion and/or go see a specialist if you’re not comfortable with what your veterinarian tells you.

By all means, research your cat’s condition on the internet, but use common sense and look for sites that present facts and not just anecdotes and opinions.  Dr. Nancy Kay, the author of Speaking for Spot:  Be the Advocate Your Dog Needs to Live a Healthy, Happy, Longer Life has written a series of fantastic articles about how to find accurate pet health information on the internet.

A personal decision

Once you understand the medical facts, the decision becomes more personal.  Factors that come into play are your cat’s temperament, your comfort level with providing any follow up care that may be required at home, and your finances.

In my years of managing a veterinary practice, a question many clients often asked was “what would you do if it was your cat?”  I wish I could have answered it, but I couldn’t.  I couldn’t because, first of all, I’m not a veterinarian.  I also couldn’t have answered it because what I would do for my cat could be completely wrong for the client’s cat.

But after having faced having to make difficult decisions for two of my cats in recent years, I now have an answer I would give these clients.  For me, it comes down to this:  Listen to your heart.  After weighing all the factors, try to set aside your fear and worry for your cat long enough to connect with your center.  Some call it gut instinct, or intuition.  And then make the best possible decision for your cat.  Because when it comes down to it, the one thing you know better than all the veterinarians in the world combined is your cat.

Photo of Bob by Robin A.F. Olson, used with permission.  Bob passed away peacefully, surrounded by those he loved, in September of 2011.

Feline Leukemia Does Not Have to Be a Death Sentence

Feline Leukemia Virus (FeLV) is the second leading cause of death in cats, killing 85% of infected cats within three years of diagnosis. The virus affects the cat’s blood, causing various blood diseases.  It also suppresses the cat’s immune system, making it harder to protect against infection by bacteria, viruses or fungi found in our everyday environment that wouldn’t affect healthy cats.  However, feline leukemia does not have to be a death sentence; about 70% of cats who encounter the virus are able to resist infection or eliminate the virus on their own.

How is the virus transmitted?

The virus is transmitted through direct contact from cat to cat.  It only affects cats and cannot be passed to people or other animals.  The primary route of transmission is through saliva and nasal secretions, but it is also present in the urine and feces of infected cats.  Cat-to-cat transfer can occur through bite wounds, but also through grooming.  The virus only lives outside its host for a few hours, and because of this, transference through shared use of litter boxes and food dishes is not as common, but it can occur.

Which cats are affected?

Cats living with infected cats, or with cats with an unknown infection status, are at the greatest risk for contracting the virus, which is why it’s important to always get a new cat tested before exposing her to your exisiting feline family members.  Kittens and young adults are more susceptible than older cats, it appears that resistance to the virus increases with age.

Symptoms

Infected cats show one or more of the following symptoms:

– pale gums
– yellow color in the mouth and whites of eyes
– enlarged lymph nodes
– bladder, skin, or upper respiratory infections
– kidney disease
– weight loss and/or loss of appetite
– poor coat condition
– recurring or chronic illness
– progressive weakness and lethargy
– fever
– diarrhea
– breathing difficulty

Diagnosis

FeLV is diagnosed through a blood test called an ELISA test, which tests for the presence of FeLV antigens in the blood.  This test is highly sensitive and can identify cats with very early infections. Many of these cats will manage to clear the infection within a few months and will subsequently test negative.  A second blood test called IFA detects the second phase of the infection, and the majority of cats with positive results for this test remain infected for life and have a poorer long-term prognosis.

Treatment

There is currently no cure for feline leukemia, and in the past, euthanasia was usually recommended for these cats.  85% of cats infected die within three years of diagnosis, but with regular veterinary check ups and preventive health care, these cats can live with good quality of life for quite some time.

A healthy diet is a requirement as a good foundation.  Conventional veterinary wisdom suggests that feeding a raw diet to immunocompromised cats is contra-indicated due to the potential risk of bacteria or parasites in the diet; however, many holistic veterinarians now recommend a raw diet.   If raw feeding exceeds yours or your vet’s comfort level, a grain-free canned diet is the next best thing.  Other holistic approaches such as high doses of vitamin C, homeopathic remedies or Chinese Herbs can help boost the cat’s immune system.

Conventional medical treatment may include steroids, antiviral drugs such as interferon, chemotherapy drugs, and blood transfusions.  Steroids are used to potentially decrease the number of cancerous lymphocytes in the blood, but since they can also depress the immune system, they may make the cat vulnerable to other diseases.   Antiviral agents may reduce the amount of virus present in the blood of the cat, and they are easier on the body than chemotherapy.  All of these treatments will require assessing the risks of the treatment versus the benefits, and they can put a cat in remission, but will not get rid of the virus.

Prevention and protection

Keeping your cat indoors is the only way to completely protect your cat from the feline leukemia virus.  Outdoor cats and indoor/outdoor cats should be vaccinated with a non-adjuvanted leukemia vaccine to minimize the risk of injection site sarcomas.  New cats or kittens over eight weeks of age should be tested before being introduced into a multicat household.

A positive feline leukemia test does not have to be a death sentence.  Some cats may clear the virus themselves, and for others, proper care can lead to good quality of life for many years.

Photo by Kim Newberg, Public Domain Pictures

Hyperthyroidism in Cats

Hyperthyroidism is a common disease that typically affects middle-aged and older cats.  It is caused by an excess production of thyroid hormones, which are produced by the thyroid gland, located inside the cat’s neck.  Thyroid hormones affect nearly all organs, which is why thyroid disease can sometimes cause secondary problems such as hypertension, heart and kidney disease. 

What causes hyperthyroidism?

The most common cause is an increase in the number of cells in the thyroid gland.  Groups of these abnormal cells form small nodules called adenomas on the gland.  Most of these adenomas are formed by non-cancerous cells, only a very small percentage of hyperthyroidism is caused by malignant tumors.

More recently, there has been speculation on a possible link of an increase in thyroid disease in cats and the coating used on cat food cans.  Another theory is that flame retardants used in furniture and carpeting may be linked to hyperthyroidism in cats.

What are the signs of hperthyroidism?

Afflicted cats often develop a variety of signs, and some of them can be subtle.  The most common signs are weight loss, increased appetite without weight gain, and increased thirst and urination.  Hyperthyroidism can also cause vomiting, diarrhea, and hyper-activity.  The haircoat may become matted and dull.  Some cats will begin to vocalize more frequently.  Rapid heart rates are common, and cats can also present with heart murmurs and high blood pressure.

How is hyperthyroidism diagnosed?

You cat’s veterinarian will perform a physical exam and palpate externally alongside the trachea with thumb and forefinger to feel for any enlargement of the thyroid gland.  Heart rate and blood pressure will be checked, and a complete blood chemistry will be run.  Most hyperthyroid cats will have elevated levels of the thyroid hormone T4 in their blood stream.  However, sometimes a cat with concurrent kidney, heart or gastrointestinal disease may have normal T4 levels.  If other symptoms and exam findings point to hyperthyroidism, your veterinarian may order additional testing to arrive at a diagnosis.

How is hyperthyroidism treated?

There are currently three treatment options:  medication, surgery, and radioactive iodine therapy.  Each option comes with advantages and disadvantages, and you should carefully weigh all options and make the best decision for your cat and your lifestyle in conjunction with your veterinarian.

Medication

Drug therapy, using a drug called methimazole (Tapazole), controls, but does not cure the disease.   It is typically given twice a day in either pill form or as a transdermal gel that is rubbed on the inside of the cat’s ear.  Methimazole therapy will be required for the rest of the cat’s life.   While some cats tolerate the drug well, it can have serious side effects including elevation of liver enzymes, low white blood cell counts, low platelet counts, itchiness of the face, and gastrointestinal problems, including vomiting and loss of appetite. If these signs occur, the medication has to be discontinued and other treatment pursued.

Surgery

Surgical removal of the thyroid gland is an option, although many hyperthyroid cats won’t be good candidates for surgery due to the anesthetic risk caused by their elevated heart rates.  Even though removal of the thyroid gland is a fairly straightfoward procedure, it should only be done by an experienced surgeon, since there are potentially serious complications, including damage to the parathyroid glands, which lie close to or within the thyroid glands and are crucial in maintaining stable blood-calcium levels.

Radioactive Iodine

Radioactive Iodine, also called I-131, is the gold standard for treating hyperthyroid cats.  It involves a one-time injection of radioactive iodine under the skin.  The radioactive iodine will destroy the abnormal thyroid tissue but does not damage the surrounding tissue or the parathyroid gland.  The cat will have to remain hospitalized for a specified period of time (typically 3-10 days, depending on geographical location, the length of the stay is regulated on the state level).  It will be released with some special care instructions, such as limiting contact with the cat and special disposal of urine and feces for a few days following treatments.  The treatment is only available at special facilities that are typically found at large veterinary referral centers, and is somewhat costly, but it is curative, and needs to be weighed against the cost of lifelong medication.

Regardless of which treatment is chosen, unless there are other, underlying diseases complicating things, treatment is usually successful and most cats will lead normal, healthy lives.

The photo above is of Amber, taken the day she went for her radioactive iodine treatment at Radiocat in Springfield, VA.

Feline Heartworm Disease

Most people think of heartworm disease as a problem that affects only dogs, but even though cats are more resistant hosts to heartworms, and they typically have fewer and smaller worms than dogs with a shorter lifespan, it is considered a more serious threat in cats and can lead to significant pulmonary damage and even sudden death.

What causes heartworm disease?

Heartworm disease is caused by a parasite that is carried by mosquitoes, and cats become infected when a mosquito bites into a cat for a blood meal and deposits heartworm larvae into the cat’s bloodstream.  These larvae migrate and mature through several lifestages into adult worms.  At about 3-4 months, they usually settle into the arteries and blood vessels of the cat’s lungs, where they continue to mature into adult worms for another 4-5 months.  Worms do not have to develop into adults to cause symptoms.

Which cats can be affected?

While outdoor cats are more susceptible, even indoor cats can be affected (all it takes is one mosquito bite).  Studies have shown infection rates as high as 10-14% in endemic areas.

What are the clinical signs of heartworm infection?

Symptoms can be non-specific and are often similar to those of other feline diseases.  Affected cats may exhibit general signs of illness such as intermittent vomiting, lack of appetite, coughing, and asthma-like signs such as difficulty breathing or wheezing.  Some cats may show acute symptoms, often related to the organs where the adult worms are thriving.  Cats with an acute onset of symptoms may die quickly without allowing sufficient time for diagnosis or treatment.

How is heartworm disease diagnosed?

Heartworm disease in cats is much harder to diagnose than in dogs, once again proving the old adage that cats are not small dogs.  Physical examination will often be non-specific.  Further diagnostics may include x-rays, echocardiogram, and blood testing.   Diagnostics have limitations, and sometimes, even a negative test cannot rule out infection.

How is heartworm disease treated?

Currently, there are no medications approved in the United States for treatment of feline heartworm disease.  Cats who don’t show any clinical signs will often simply be monitored periodically and given time for a spontaneous cure.  Monitoring through x-rays every 6-12 months may be all that is needed.  If there is evidence of the disease in the lungs or blood vessels, treatment is generally focused on supportive care, sometimes using gradually decreasing doses of prednisone, a steroid.  Cats with severe manifestation of infection may require additional supportive care such as intravenous fluids, oxygen therapy, antibiotics, cardiovascular drugs, and restricted activity through cage confinement.

Can heartworm disease be prevented?

Currently, there are four heartworm preventive products approved for use in cats:  Heartguard for Cats (Merial), Revolution (Pfizer), and Advantage Multi for Cats (Bayer).  Heartguard is taken orally, Revolution and Advantage are topical products.  All of these products come with known side-effects, and deciding whether to use them for your cat will require an informed risk assessment in conjunction with your veterinarian.   It is recommended that cats are tested for antibodies and antigens prior to beginning use of these preventatives.  Never give heartworm or any other parasite prevention product for dogs to cats.

As with all parasites, it is believed that a healthy immune system makes cats more resistant to them.  A healthy diet is key to a healthy immune system.  Feeding a species-appropriate grain-free canned or raw diet may help prevent heartworms and other parasites.

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