Animal Hospital News

Pandora Syndrome: Inappropriate Urination not just about the Bladder

posted by Dr. Deb on April 17th, 2017 in Cats

FELINE URINARY PROBLEMS is it “Pandora Syndrome”?

“Pandora’s Box”:  a process that generates many complicated problems as the result of unwise interference in something.

 Inappropriate urination.  Urinating around the house.  This is one of the most common complaints of cat owners about their otherwise beloved feline companions.

Facts:

  • Less than 10% of cats under the age of 10 get urinary tract infections. So, cats under 10 years likely does NOT have a UTI.
  • Cats don’t urinate on your stuff or your house guests stuff or anyplace else, for that matter out of “spite”. There is either a physical problem, a behavioral challenge, or a nervous system issue.
  • The two most common reasons for inappropriate urinary behavior (urinating outside of the litter box) in cats under 10 years of age are:
  •       Microcrystals of mineral in the urine (crystaluria). This causes pain as the shards of mineral are passed through the urethra during urination. This causes the urgency and desperation that leads to urinating anywhere possible. Cool, hard surfaces such as bath tubs, sinks and countertops are often targeted.  Crystauria is diagnosed with microscopic examination of a urine sample.  It is often treated with a prescription diet.
  •      Pandora Syndrome, previously referred to as “ Interstitial Cystits” (“ FIC”), “ Stress Cystitis”, “ Idiopathic cystitis”, Feline lower urinary tract disease ( FLUTD )and “ Feline Urologic Syndrome” (“ FUS”). 

 

Pandora Syndrome

As the name suggests, this “urinary” condition is no longer considered to be restricted to the urinary system.  It is now known to be “multi-systemic”.  The fact that this very common condition in cats has been renamed half a dozen times over the last 100 years tells us how very little has been understood about it!

In the 1970’s, we blamed urinary problems in cats on “ash”, the mineral content in their food.  We recommended canned foods, which had less “ash” than dry foods, by weight.  Well, yeah… because 1/3 of the weight of the food was water!  But, guess what?  The incidence of crystaluria in the cat population decreased and so did the incidence of inappropriate urination!  Well, it wasn’t decreasing the ash that was helping the kitties of the 70s.  It was increasing their water intake!

Around the 1990’s we blamed the problem on a disruption of the protective mucous layer of the urinary bladder. This lead to increased inflammation and symptoms.  Now we were getting closer to understanding. Cats with urinary symptoms do have a disrupted mucus layer. Unfortunately, attempts to bolster the mucus layer by giving cats glucosamine, a major part of that mucus layer, wasn’t very helpful.  Cats kept peeing around the house.

In the mid 90’s to early 2000’s, we started to learn about the unique qualities of the feline nervous system. Now we’re getting closer…  We figured out that we could control a LOT of inappropriate urinary behavior with anti-anxiety medication.  Stressed out cats pee inappropriately.  Ah-hah! We’ve figured it out!  …Almost.

Since 2015, with the evolution of genetic science and genetic mapping, we’ve been learning even more!

We have discovered that cats that develop inappropriate urinary behaviors are actually “wired” differently, genetically, than their non-peeing counterparts!  … Really!

First, let’s remember that cats are unique to the animal kingdom in that they are both predator (‘hyper” carnivores) and prey.  They need to be ready to fight for food or flee for their lives, both at the same time, at any moment.  You can see how this is a huge conflict for the nervous system!  Now, it’s clear why cats are so sensitive to everything in their environments!  Some cats are more sensitive than others.  Wild cats are the most alert. Domestic cats less so.  But cats have been far less domesticated than any of our other community animal species, like dogs, cattleor horses. Genetically, even the domestic housecat is almost identical to its brethren of a thousand years ago!  Hence, a lot of that “wild”, cranked up nervous system is still in play.

Recent studies have identified that cystitis (irritated urinary bladder) cats are genetically programmed to produce more Tyrosine hydroxylase which creates norepinephrine, which becomes epinephrine, or adrenaline.  These cats can often be identified by their high “startle response”.   Of course, we know that adrenaline is the flight or fight hormone in all animals.  Some cats are genetically, more prone to be high strung than others. Now take these cats who constantly want to fight or flee and “domesticate” them.  Put them in a tiny box (your house or apartment), that they never get out of because we want to keep them safe.  Add another cat or two, maybe a dog, maybe some noisy, rambunctious kids, our crazy irregular schedules.  Cortisol levels skyrocket! No place to flee. No way to fight.  It’s no wonder cats freak out in their heads!  

All that adrenaline and cortisol targets stress organs in the cat- the gastrointestinal tract, the lungs and particularly, the urinary bladder. Those stress chemicals cause sthe protective mucous layer of the bladder to erode. Chemicals in the highly concentrated urine of the cat irritate the exposed bladder walls, causing pain and even bleeding in extreme cases.  Pain cause the cat to pee around.  Now add the fact that every time she uses the litter box to urinate, it hurts!  Who wants to go back there?  Try the tub. Maybe that’ll feel better. Maybe the bed, the counters, etc.   Poor kitties!  At the mercy of their genetic code and our imposed environmental constraints.

Stressed cats also vomit. Usually just occasionally. Often right after eating, especially if they feel that they need to wolf their food so the other intruder cats in the family don’t steal it.  Sometimes they vomit in association with stressful events like guests coming over, being medicated, or your going away on vacation.

These high strung kitties are also more prone to over-grooming hair loss

So, we can see that inappropriate urinary behavior may be the most obvious, most offensive (to us) symptom of a much larger, multi-system, whole- cat condition. “Pandora Syndrome”-  the new name for what was once believed to be a disease limited to the urinary tract of cats is now known to be a nervous system disorder affecting multiple other organ systems!

HOW DO WE TREAT IT?

                We’re stuck with the genes, so what can we do to prevent or treat this annoying condition?

  • Treat the CAT
    • Treat the pain with medication
    • Treat the stress. This may take medication in addition to the environmental suggestions listed below.
  • Control and Mange the ENVIRONMENT

Minimize stress from an early age.  There is evidence that even cats who are saddled with the super Tyrosine Hydroxylase gene may never “turn it on” if they are never subject to excessive stress How can we do that?

  • Keep the household schedule routine.
    • Feed at the same times of day, preferably by the same person.
    • Avoid People coming and going at different times daily and weekly ( a chaotic houseshold may not be a good home for a cat, unless he is very laid back)
  • Ensure that the environment is “safe”.
    • Ensure that access to food, water and the litter box is not impeded by other pets in the home.
    • Ensure that those resources are also easily accessible, physically, especially for older or disabled cats.
    • Ensure that there is a place to rest, undisturbed: high perches, rooms with cat door access only- “No Dogs Allowed”
    • Ensure that the home has a quiet place for the cat to go, especially if he has a high “startle response”.
  • Enrich the environment so the cat can act out his natural hunting/ fighting instincts
    • Play games with your cat encouraging him to chase a toy or laser light.
    • Play hide and seek (as long as your cat isn’t inclined to actually latch on to you when he does cat you!)
    • Provide meals in food toys that require kitty to first find the toy, then play with it to get the food out. Simply throwing food crumbies around the room can work fine! (watch out not to throw food under furniture of course!)
    • Provide lots of climbing opportunities in your house or in an enclosed outdoor cat run.

 

  • Take Care of YOURSELF
    • Realize that all cats are still a little wild. Some, more so than others.
    • Yours may be a “more so” kind of cat. (Savannah, Bengal, or any mixes with those breeds, Chausie, Pixie Bobs are only a few generations away from their wild roots. They often exhibit signs of Pandora Syndrome, often requiring anti-anxiety medication to live in homes with multiple pets or children)
    • This is going to take some effort to help your kitty cope with domestication
    • This is going to take patience
    • This is a life- long way of living with cats, especially a more ‘high strung” cat.

Your veterinarian can help you along the way.  It can be frustrating and even infuriating, but you have a team of partners ready to help.  From figuring out whether there is a physical cause for inappropriate urination to helping you help your kitty psychologically, and helping to support you emotionally, your veterinary team will be right there with you!l

Cat Ear Infection

posted by Dr. Deb on April 10th, 2017 in Cats

Ear infections are rare in cats. When they do occur in the cat’s outer or middle ear, they can be extremely painful and can result in deafness or facial paralysis if they become chronic.

Signs:

 Some cats show no signs at all or only very subtle signs.  Scratching is the obvious sign, but most cats are much more subtle than that.  “She doesn’t like to have her ears touched” is the most common tip to us that there may be an infection lurking. Does your kitty always “flip” her ears when you touch them?  Are her ears ‘ticklish”?   That’s a sign that they are itchy or painful! 

Causes:

Ear infections are caused by yeast, bacteria, or a combination.  These organisms normally live in very small numbers on the skin of the cat’s ear canals.  When the environment inside the ear changes, the organisms can overgrow.

    The most common reason for that to happen, among our Arizona kitties, is Food Allergies!  Food Allergies cause just the tiniest amount of inflammation in the skin on the whole body.  Those changes are exaggerated by the confined space, increased warmth and darkness of the cat’s tiny ear canals.  A little inflammation increases the moisture and temperature of the ear canal skin, changes the skin pH, and there you have it, the perfect breeding ground for yeast and bacteria!  Mites are the second most common cause of ear infections in cats in the desert Southwest. 

The Persian breed is more prone to ear infections due to their familial tendency to produce more ear wax.  This also provides a great environment for normal skin organisms to over grow!.

Diagnosis: 

Your vet’s view inside the ear. Dark discharge consistent with infection too deep to see with the naked eye

Your veterinarian should perform a cytology of the ear exudate, examining it under a microscope to identify the causative organisms.  Is it yeast, bacteria (what kind?) or a combination of both?  This is critical to determining the best medication for each cat’s individual infection.

 

Treatment/ Recovery

Your veterinarian will give your kitty medication, based on cytology results.  You should have your vet recheck the ears to ensure the infection is gone, not just lurking deep in the ear canal where it is hidden from your eyes, waiting to creep back up the canal and make kitty uncomfortable again.

 Prevention:  

Treat any underlying causes.  Your veterinarian may recommend a Prescription Food Allergy Diet Test if your kitty’s ear infection doesn’t respond to treatment as expected or recurs. FOOD ALLERGY is the leading cause of recurrent ear infection in cats!

 

Routinely check your cat’s ears for sensitivity to touch, redness, odor or residue. Healthy pale pink ears have only a minimal amount of wax.  Your veterinarian may recommend that you clean your cat’s ears twice a week with a prescription cleaning solution to help avoid problems in the future. Otherwise, keep ear canals dry.

Hedgehog Hibernation Alert!

posted by Dr. Deb on December 1st, 2016 in Other

Image result for hedgehog in sackDon’t let your hedgie get cold!

Pet African pygmy hedgehogs need to be kept warm in the winter to prevent hibernation!  Hibernation is actually dangerous for African Pygmy hedgehogs.  It slows their metabolism down, leaving them susceptible to infections, dehydration and starvation.  It’s important to keep your hedgehog in an environment between 72 and 80 degrees.  This is not always comfortable for us humans.  We often keep our homes cooler in the winter than is healthy for our pet hedgies.

Click here for a great article on suggestions om providing your hedgie some supplemental heat from:

Signs of hedgehogs in danger of being too cold are decreased activity, decreased appetite, sneezing (as opposed to puffling).  So, if she’s not on her wheel and exploring at night, eating her food and turning down mealworms and other treats, check the temperature in her enclosure!  If that seems good, get her in to your local hedgehog vet!  (We see them here at Cimarron Animal Hospital!)

PAWS FOR SENSE… Happy Love Voice Calms the Terrified Beast

posted by Dr. Deb on September 18th, 2016 in Behavior, Other

I’m a vet and I recently learned something about being a Pet Parent from my own terrifying experience with our beloved basset, Josie.  

Josie tangled with a Colorado River Toad a few weeks ago.  Nearly killed her.  She didn’t just lick it… she actually mauled it enough to kill it!  

Luckily, we were home.  It was 10 o’clock at night.  Luckily, she started seizuring, loudly, just outside my bedroom window.  Luckily, I was in there, reading a book.  Like a Mom who knows the difference between a “frustrated” cry and an “I’m hurt” cry from their child, I knew that this wasn’t just an “I’m excited” basset yelp!  I raced out to the back yard to find her on her chest, four legs splayed to the sides most alarmingly.  She was yelping senselessly, unresponsive to my voice and blind.  She was definitely blind– the veterinarian in me knew that.  The vet in my head starting cataloging symptoms (we didn’t know about the toad yet).  The basset mommy in my head went from freaking out to “what the he** do I do?” in a microsecond.  I knew she needed to get to a vet clinic.  This wasn’t something that the vet could take care of at home.  But which vet?!  My regular vet (“she’ll open up for this, at this time of night” right – cuz that’s me…) or the 24 hour emergency vet (“they’ll charge me an arm and a leg…” Yup, I thought that, right then.  “But maybe it’s worth it for a rational mind to be applied to this problem” “What’s wrong with my baby Josie!!!????  <freaking out again>). “Get a grip.  Get a catheter in. The clinic, then!”

All this while shouting for my 15 year old son to open the back door.  I set her on the kitchen floor, in the light, to evaluate. Still yelping mindlessly, still not standing, still blind.  Gums beet red. I remembered that I’m good in a crisis. “Son, put on a shirt and shoes, bring Josie to the car.”  

Now.  Add third factor:  15 year old son.  Who LOVES this dog.  It’s his self-proclaimed “emotional support basset”.  He’s never bonded with anything or anyone (pretty sure not even his parents!) like he has with this dog in the last 4 years.  Not given to emotional drama (thank the heavens), he starts asking the rational questions,

“What’s wrong with Josie?” 

“I don’t know”

“Can you fix it?”

“I don’t know”  (honest, but not very comforting, coming from your veterinarian Or your Mom!)

“Just get her in the car. Now!”  … No more questions.  He manned up, right then and there and picked up his baying, pooping, insensible baby girl and carried her to the car.

I made it to the clinic in 4 minutes ( a trip that usually takes 7– no traffic, didn’t care if police “escorted” me to the clinic– we could discuss it there- after I provided emergency care to my baby!) That was a long 4 minutes.  I had lots of time to try to figure out what was going on with our beloved basset.  Colorado River Toad.  It had to be.  Monsoon Season in Arizona. But this is the wackiest response I’d ever seen– not really seizuring- she’s still sitting up, she’s conscious- sort of– she’s vocal- a lot (basset hound, I guess)….

It happened that my husband had just deplaned after a trip out of town. “Call your Dad. Tell him to come directly to the clinic. Josie’s in trouble,” I told my son, tossing him my cell phone. 

My son has never expressed an interest or apptitude for veterinary medicine.  In fact, he gets a little grossed out when I start doing serious stuff involving blood, and he hates to see the animals scared, having to be restrained to help them…  But, again, he manned up. He restrained his baying, unresponsive puppy’s arm so I could place an IV catheter!  My son Rocked!

BUT THIS IS WHAT I LEARNED (besides how much it sucks to be the Pet Parent of a beloved baby and you have no clue what’s wrong, what you can do/ should do/ where to go– I’ve actually been here before…)

While I was working away at that catheter and taking 17 years to draw up a sedative — I’d figured out that my poor baby was having the worst “trip” ever– probably being chased through The Black Forest by giant Basset-Eating Pink  Food Crumbies– I listened to my son try to soothe his best friend and love-hound.  He did what every worried parent does. In clipped phases with the edge of panic on his voice,  “It’s OK, Josie.  Ssshh.  It’s OK.  It’ll be OK.  Hush Josie (for blessed sake, please hush with the baying….).  It’s OK Girl, It’s OK. Mommy will make it better (Oh, cr**, he had to say that?  No pressure, Dr. Mom…).  

HERE IS THE MOMENT OF BRILLIANT INSIGHT:

“Talk to her like you guys are at home snuggling on the couch.  Tell her she’s a good girl.  Call her “Balrog Jowl-rog”, like you do at home when you are both happy and having fun together.”

He paused, I think putting himself in the right frame of mind.  His tone of voice instantly changed to (something closer to) his happy, everything in life is wonderful, puppy play voice.  

And she instantly calmed down.  It wasn’t the sedative.  It was his tone of voice, the words he used and his entire manner.  He had to find the happy place in himself to say those words with a happy play voice.  He had to shed (or momentarily box away) his fear, to assume the calm needed to even remember happy play voice.  Whatever it was, Josie felt it.  She quieted.  She rested, just a little.  Her boy was at least with her, keeping her safe from those Pink Crumbies.

When Daddy arrived, Josie was quiet. The drugs had done their job.  But when they wore off, and Dad started with the Pet Parent Panic litany, my son told him, “talk to her like we’re all happy, snuggling on the couch, Dad.”  The two of them baby- love- puppy talked Josie through her next set of hallucinations til the new round of sedatives kicked in….  

After pulmonary edema secondary to the Colorado River Toad poison- induced shock was treated, Josie survived.  She doesn’t seem to have suffered any brain damage….  But, she doesn’t have to play Mozart, I guess….  And, she’s still eating her crumbies (you bet your sweet bippies!), so that must not have been what was chasing her through the Black Forest… 

LESSON:  When your pet is panicked, pretend your not.  Put your panic away and talk to them like you would if you were enjoying (whatever the two of you enjoy most together).  Say the goofy things to your pet in the face of panic that you do at home.  It is worth at least half a dose of injectable sedative.

I’ve used this calming technique twice with clients in the my exam room since Josie’s incident and it has worked beautifully.  It calmed both owner and pet….

Dr Deb Bohnke

Stopping Heartworm BEFORE it gets into your pet!

posted by Dr. Deb on September 13th, 2016 in Cats, Dogs, New Technology

Let’s talk Heartworms. Not a common problem in Arizona, but it is here. I’ve treated cases! Dogs most likely to be infected: Shelter adoptions/ Strays. Recommendation: every shelter adoption/ stray should be tested for Heartworm, Tick fever and Intestinal parasites upon adoption; investment of $ 87.00. (Most shelter don’t do these tests). Cool new drugs make the fight against these deadly parasites even easier/ better!

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