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CLASSIC LIST

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ABOUT THE DIAGNOSIS

Eosinophilic granuloma complex includes three distinct skin diseases in cats. All are thought to be either a result of allergies or reactions to parasite infestations and all respond to similar treatment.

The name of the disorder comes from the observation that in all cases, microscopic examination of the affected tissues reveals large numbers of eosinophils, a type of white blood cell that is involved in allergic reactions. In cats, allergies often produce skin itchiness and skin lesions as the predominant symptom. In cats with any of the eosinophilic granuloma complex diseases, the underlying trigger may be allergies to fleas or other parasites, to food ingredients, or to environmental substances such as pollens or house dust mites. Studies have shown that, at least in some cases, the tendency to develop eosinophilic skin diseases is inherited genetically. This observation means that both genetic predisposition, an environmental trigger, seem to combine to play a role in causing eosinophilic skin diseases. The fact that these disorders are rarely caused by a single trigger helps explain why eosinophilic granuloma diseases may flare up despite treatment, and may persist for months or years.

At least three specific types of skin lesions make up the eosinophilic granuloma complex:

  • Eosinophilic plaques are hairless, flat, raised areas on the skin that are often red, moist, and glistening. Plaques are most often found in the groin or axilla (armpit) or on the inside of the thigh. The condition seems to be very itchy, and cats often will lick the areas constantly.
  • Eosinophilic granulomas are hairless, raised, yellow areas of skin or of the mouth; they often have sores on the surface. The most common site is along the back of the thigh, although other areas of the body can be affected. Eosinophilic granulomas can occur inside the mouth and on the tongue. Cats with mouth involvement may drool and be unable to eat.
  • Indolent ulcer, or rodent ulcer, affects the upper lip. The lip becomes swollen, and a sore develops where the skin meets the mucous membrane of the inner lip.

LIVING WITH THE DIAGNOSIS

Skin problems caused by the eosinophilic granuloma complex tend to wax and wane. If the underlying allergic cause can be determined and controlled, the problem can be prevented from reoccurring. Therefore, one aspect of dealing with eosinophilic granuloma complex should be to discuss with your veterinarian how to control some of the more common culprit allergens, such as initiating a diet that contains ingredients with a low likelihood of triggering an allergic response.

In some cats, the problem is seasonal. If fleas are present, a rigorous flea control program should be started. Seasonal problems may be due to bites of insects, such as mosquitoes, or to environmental substances that trigger allergic skin responses, such as pollens. Environmental allergies are identified by intradermal skin testing. Consulting a veterinary dermatologist may help in determining and eliminating underlying causes.

TREATMENT

All three forms of eosinophilic granuloma complex respond to treatment with corticosteroids (cortisone-like drugs). Administration may be either by mouth (pills/tablets) or by long-lasting injection. Long-lasting injections are much more convenient but they carry a greater risk of causing adverse effects, including diabetes and unmasking (emergence of symptoms) of heart disease. Therefore, these sustained-release injections should be used in moderation, if at all, and only once an effort has been made to find the underlying cause of the allergic reaction and to eliminate it. If corticosteroids are used, whether given by you at home (orally) or by your veterinarian (injection), they should be given for as short a period of time as possible. The skin problems tend to wax and wane, so reoccurrence is unpredictable except in cases that tend to reoccur seasonally.

Since corticosteroids mask the problem rather than eliminate it, a reasonable effort should always be made to identify the cause and possibly use other types of treatment if effective. Here, too, a veterinary dermatologist may be extremely helpful.

DOs

  • If giving medication by mouth, follow directions exactly.
  • Realize the value of seeking a second opinion with a veterinary dermatologist for confirmation of the diagnosis and the most recent forms of treatment. Veterinary dermatologists are known as Diplomates of the American College of Veterinary Dermatology; your veterinarian can suggest a referral to one of these specialists. (Directory: www.acvd.org in North America; www.ecvd.org in Europe)

DON’Ts

  • Do not use lotions, ointments, or other topical medications on the areas unless directed to do so by your veterinarian. Cats quickly lick off topical medications, and some may be harmful if swallowed.

WHEN TO CALL YOUR VETERINARIAN

  • If the areas do not heal with the prescribed treatment
  • If the condition reoccurs
  • If your cat is having difficulty eating due to eosinophilic granulomas in the mouth

SIGNS TO WATCH FOR

  • •See the description of each form of eosinophilic granuloma complex in the About the Diagnosis section for initial symptoms, which are also the signs to watch for as an indication of recurrence if treatment is not working.

ROUTINE FOLLOW-UP

  • If your cat needs long-term corticosteroid treatment to control its skin disease, periodic testing, including blood samples, may be recommended to monitor for side effects.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.


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ABOUT THE DIAGNOSIS

Cause: Diabetes mellitus (DM), often simply called diabetes or sometimes “sugar diabetes”, is a disease that affects cats and dogs, just as it affects people. In DM, the body fails to metabolize glucose (a form of sugar) correctly, leading to both high blood glucose concentrations at the same time the body’s cells are starving for the energy contained in the glucose. There are several hormones that help regulate blood sugar, but key among these is the hormone insulin. In DM, there is either inadequate production of insulin (made in the pancreas, an organ in the abdomen) or there is inadequate use of insulin at the level of the cells in the body’s tissues.

There are two types of diabetes mellitus. Type I (also called insulin-dependent diabetes mellitus, or in humans, juvenile diabe-tes) occurs when the pancreas does not produce insulin. Type II (non–insulin-dependent diabetes mellitus) occurs when the body cannot utilize insulin as normal. Cats can get either type of DM – a failure to produce insulin, or a failure to use insulin. If a cat with a failure to use insulin receives appropriate treatment, he or she can go into a remission of DM. However, such cats are susceptible to developing disease again later, and can even convert to the irreversible form in which no insulin is produced (Type I). Diabetes mellitus is one of the most common endocrine (hormonal) disorders of cats. Diabetes mellitus usually affects middle-aged to older cats. Any breed can be affected, with males slightly more often affected than females. Overweight or obese cats are more likely to develop DM than lean cats, although DM will cause weight loss once it develops. Usually, the trigger for DM is undetermined. We do know that genetic factors, medications, recurrent bouts of pancreatitis, or other endocrine (hormone) disorders can cause DM.

Diagnosis: The signs of DM vary from cat to cat. Early on, you might notice that you have to fill the water bowl more often or that the litter box is heavier with urine as the cat drinks more water and urinates more often. Weight loss occurs as sugar is lost in the urine instead of being used by the body’s cells. Over time, the cat might walk with the hocks (heels) dropped toward the floor as a result of diabetic neuropathy. The most serious complication of DM is ketoacidosis, which is considered a medical emergency. Uncontrolled, ketoacidosis produces diabetic coma and may be fatal. Animals with diabetic ketoacidosis are most often lethargic (sluggish), have little or no appetite, and generally seem profoundly ill; diagnostic testing by a veterinarian is necessary to identify ketoacidosis, and intensive care treatment is necessary for animals with diabetic ketoacidosis.

Your veterinarian will begin by asking you several questions to try to determine if diabetes mellitus, or another type of problem altogether, could be responsible for symptoms. You should provide whatever information you have when you answer these questions, which often include: the type of symptoms observed, the length of time they have been occurring, effects on vital functions such as appetite and urine elimination, current diet, and any current medications or supplements you are giving your cat.

When examining your cat, your veterinarian will look for some of the abnormalities that can occur with diabetes mellitus, which include obesity/overweight, dehydration, jaundice, and a liver that can be felt by the fingertips to be enlarged (occurring as a result of abnormal fat accumulation within the liver as the body tries to compensate for abnormal glucose utilization), oily haircoat with dandruff, and diabetic neuropathy.

Routine lab tests consisting of blood and urine tests are recom-mended in order to diagnose DM as well as rule out other possible medical problems that produce similar symptoms. A blood sugar (glucose) level and urinalysis are the first tests of choice. Finding persistently high levels of glucose in the blood (hyperglycemia) and urine (glucosuria) in a fasted (no intake of food for 8 or more hours) animal is typically diagnostic for DM. It is important to keep in mind, however, that healthy cats can have high levels of glucose in the blood as a result of anxiety from the visit to the veterinary hospital, not just from diabetes. If the glucose value in the blood and urine is only moderately high, it may be necessary to repeat the testing, or to measure glycated hemoglobin or fructosamine levels.

These tests give a better indication of what the blood sugar levels have been in the animal over the previous several weeks and are less affected by short periods of stress such as travel to the veterinary clinic.

A complete blood count (CBC), biochemical profile, urine culture and sensitivity, imaging techniques (x-rays and ultrasound), and tests for other hormonal problems are also commonly performed to identify other concurrent illnesses and underlying diseases. Urinary tract infections are common in diabetic animals and can impact disease treatment.

The diagnosis of DM, and its treatment, can be complex and challenging. No two individuals with this disease are alike. If there are questions, or simply for a second opinion, your veterinarian may refer you to a veterinary internal medicine specialist for a second opinion (directory: www.acvim.org or www.vetspecialists.com for North America; www.ecvim-ca.org for Europe)

 

LIVING WITH THE DIAGNOSIS

Diabetes mellitus is a serious and life-threatening disease if left untreated. On the other hand, most diabetic cats that are diagnosed and treated properly will respond well to treatment can live a normal or near-normal life span with a good quality of life. Managing a diabetic animal requires a great commitment of time, education, observation, and follow-up care.

The most important factor in a diabetic animal’s life is routine. Ideally meals and treatments (usually, insulin injections) are given as close to the same time as possible each day. Give all prescribed medications as directed by your veterinarian. These medications are essential in regulating blood sugar levels as well as improving the quality of your cat’s life. Some cats can go through periods of time where they no longer require medication for diabetes mellitus, called the diabetic honeymoon period or remission. In a few of these cases, cats will never require antidiabetic medication like insulin again, whereas in most cases, symptoms will develop again at a later time and require further treatment.

Many pet owners are anxious about the need to inject insulin. However, most pets are not bothered by the injections in the least, and with a little practice, it is not difficult. You may know people that receive pills for treatment of DM; oral antidiabetic medications are not a good option for most cats. While they may help some cats with abnormal insulin utilization in the short run, those cats will not enter a remission and eventually will simply not make enough insulin at all. Therefore, if at all possible it is best to begin treatment with insulin injections. It is very important to become familiar with the proper handling, administration, and disposal of insulin. There are not only multiple types of insulin, but multiple types of insulin syringe—it is important that you know which type your cat receives, and you use the correct syringe. You will want to check each time you receive a refill that both the insulin, and the insulin syringes, are the correct type for your cat. If you have trouble using the syringe, or your vision makes it difficult to read the small numbers on the syringe to give the tiny volume of insulin your cat is likely to require, you can discuss the use of an “insulin pen”. These devices allow you to “dial in” the dose needed rather than drawing it up out of a vial. You then deliver the dose to your cat by holding the pen against the skin and pushing a button.

Your veterinarian will be able to give you detailed instructions on how to store, handle, and administer insulin. Different types of insulin have different handling instructions, but it is important that it be kept in a cool dry place (refrigerator is usually ideal). For most types of insulin, the bottle should be mixed carefully and thoroughly before drawing up the insulin dose. Ideally the bottle is rolled gently in the hands until thorough mixing is achieved. On the other hand, other types of insulin (e.g., Vetsulin, Caninsulin) must be shaken to form a milky suspension. After you give the insulin, the needle and syringe should be disposed of and not reused. You can collect them in a puncture-proof container (e.g., empty bleach jug) and bring it to your veterinarian for disposal according to state/provincial/local laws on medical waste.

You should discuss an ideal diet for your pet with your veterinarian and feed only the recommended foods. For cats, canned foods are recommended over dry. Some prescription pet diets are made especially for diabetic patients and should be used if your cat enjoys the taste of them because they can improve an animal’s diabetic control. If your cat is no longer willing to eat a prescription diet, contact your veterinarian prior to changing foods about other options. Portioned meal feeding has advantages over allowing the cat to eat whenever they like, including the ability to recognize quickly if your cat is not eating as he or she should. Usually, two meals a day are fed, each one at about the time of insulin administration. For cats that have always had dry food available at all times, the transition can be easy or difficult, but your veterinarian can discuss strategies to make the change. Always provide unlimited access to fresh clean water to drink. It is also important to talk to your veterinarian about any changes that should be made to your pet’s medications if he/she is unwilling to eat or if digestive problems such as vomiting occur. In many cases, the insulin dose may be halved or skipped entirely if the cat misses one of the major meals.

During the first few months after an animal is diagnosed with diabetes mellitus, several trips to the veterinarian will be required for rechecks and tailoring of the treatment. In most situations, your cat will begin with a low dose of insulin that might need to be gradually increased by your veterinarian based on rechecks until diabetes is well-controlled. Often, your veterinarian will perform a “blood glucose curve” to make a graph of what happens to glucose levels during the day after insulin administration. Blood sugar levels are measured every hour or two for a 12- or 24-hour period 1 to 2 weeks after starting the insulin (the first recheck visit) and periodically thereafter to ensure that appropriate glucose levels are seen. This helps prevent giving too much insulin to your pet and causing dangerously low blood sugar levels, and it allows for fine-tuning of the insulin dose.

It is common initially for blood glucose levels to be checked by your veterinarian every 1 to 2 weeks. To do this, your cat generally will have to stay in the hospital for the day in order to monitor blood glucose levels every few hours. Once the diabetes is well regulated, these visits will be less frequent, but some degree of monitoring is still required (a few times per year) since insulin requirements can change with time. Some cat owners choose to learn to measure blood glucose at home so that they can perform the curve themselves with less stress for the cat, then sharing the information with their veterinarian for interpretation. Other times, veterinarians may ask the cat owner to check urine glucose at home. The point of assessing urine for glucose is not to increase the insulin dose if urine glucose is present, but to consider reducing the dose if urine glucose is consistently absent. That is because an absence of glucose in the urine might indicate that your cat has entered remission and it may not need insulin, at least for now. It also is very important to carefully note any changes in your cat’s weight, drinking, urination, and eating habits between appointments. Keeping a daily diary of your observations and of the dosage and timing of insulin injections is very helpful and can also help you keep track of medications. When there is more than one adult in the family, it is not unheard of for a pet to be accidentally overdosed when two members of the family each give insulin, not realizing that a dose was already administered.

Once your pet has started any treatment for DM, monitoring for signs of low sugar levels (hypoglycemia) is very important. Too much insulin can cause blood sugar levels to go too low. Low sugar levels can cause disorientation, sluggishness, seizures, coma, and even death if prolonged. If you notice that your pet seems disorientated or weak but is still responsive, offer tasty food immediately. If your pet is unconscious (cannot be awoken despite loud calling and shaking), apply a sugary solution like corn syrup or maple syrup to the gums. In both of these cases, contact your veterinarian or local emergency veterinary hospital immediately.

TREATMENT

The goal of treating a diabetic animal is to minimize blood glucose fluctuations, eliminate the symptoms associated with high blood glucose levels (excessive drinking, urination, and appetite), and improve the quality of the pet’s life. Treatment of DM must be based on the individual patient, the severity of the symptoms, the underlying cause, the type of diabetes, and the secondary diseases that may be involved.

Patients with severe symptoms of DM or ketoacidosis will likely need to be hospitalized initially while intravenous (IV) fluids are given to correct dehydration, electrolyte, and acid-base abnormalities and medications including insulin are initiated. Ketoacidosis and severe symptoms (such as loss of appetite, vomiting, and collapse) is a very serious combination that carries a guarded prognosis; one third of patients do not survive even with intensive care.

Luckily, most diabetic cats do not have ketoacidosis; therefore, they do have a good prognosis (outlook) and are likely to do well provided that the cat’s owner is willing to invest the time and effort required to manage the disease. You will probably be administering insulin injections twice daily, meaning approximately every 12 hours. The types of insulin recommended depends on a number of factors, and you might end up changing insulin types during your cat’s lifetime based on response to treatment. Comparison of the insulin types you are most likely to use are given below.

The best chance for a cat with DM to go into a remission is intensive early treatment with insulin and appropriate dietary management. Owners must be very vigilant for signs of weakness, lethargy, or disorientation that might indicate hypoglycemia. This can occur when the owner has given insulin but the pet is in a diabetic remission and no longer needs treatment. Although some cats with type II diabetes mellitus can be managed with diet therapy and medication given by mouth rather than insulin injections, only a very small minority of diabetic animals will respond well to these medications. Your veterinarian will help you decide if this is a good alternative for your pet.

 

DOs

  • Realize that diabetes mellitus is a very treatable disease but thatthe proper management of a diabetic animal requires significant commitment of time, finances, and attention.
  • Have your veterinarian or veterinary technician show you how to give all medications and demonstrate the correct method for insulin handling, administration, and disposal.
  • Double check the insulin and syringe type each time you get a refill.
  • Ask your veterinarian how long you can use the same bottle.
  • Many of the human insulin types (e.g., glargine) are expensive, and they are sold in bottles meant for an adult human. That means that the bottle might still have insulin inside long after it should be discarded, so you might need to replace the bottle before it is empty.
  • On the other hand, manufacturers recommend that some of these same insulin types be discarded after only 28 days when used in humans. As long as they have been stored and handled appropriately, it is safe to keep them for longer (usually up to 6 months).
  • Handle and use insulin as directed
  • Wipe the stopper of the insulin vial with alcohol, then let it dry before use.
  • Either roll or shake the insulin to create a suspension (depend-ing on insulin type).
  • Keep the insulin cool and dry (refrigerator is ideal); never freeze, and never allow it to sit in the sun or in a hot car.
  • Check that the insulin is not discolored and does not contain“chunks” after rolling/shaking that might indicate it has been contaminated and needs to be replaced.
  • Realize that serious and life-threatening complications can arise either from not enough insulin or from too much insulin.
  • Offer food immediately if you notice that your diabetic pet who is receiving insulin seems disoriented but is still alert and responsive. If your diabetic pet who is receiving insulin appears unconscious apply a sugary solution like corn syrup or maple syrup to the gums. In either of these cases, contact your veterinarian or local emergency veterinary hospital immediately.
  • Keep all recommended follow-up appointments with your veterinarian since they are essential in keeping your cat’s blood sugar levels well regulated.
  • Handle and give all medications exactly as directed by your veterinarian. If you feel your pet is having side effects from any medications or you are finding it very difficult to medicate your animal, contact your veterinarian for advice before discontinuing the treatment.
  • Ask your veterinarian questions about information you do not understand.
  • Ask if some form of at-home glucose monitoring, either blood or urine, is right for your cat.
  • Understand that in some cats, diabetes mellitus can be difficult to treat, and a second opinion from a veterinary internal medicine specialist may be helpful. You can discuss this with your veterinarian and a list of these specialists is available at www.acvim.org or www.vetspecialists.com for North America; www.ecvim-ca.org for Europe.

DON’Ts

  • Do not postpone a visit to your veterinarian if you observe any symptoms of illness since early diagnosis and treatment can aid in preventing serious and life-threatening complications of the disease and improving the quality of your pet’s life. The initial screening for DM may only require a physical exam and routine blood and urine tests.
  • Do not give any medications that are not prescribed by your veterinarian for the specific animal in question.
  • Never increase the insulin dosage without discussing with your veterinarian. Your veterinarian might provide you with instructions for lowering the insulin dose if your cat misses a meal, but if more than 2 meals are missed you should seek veterinary care.
  • Do not assume that all sources of information are accurate or complete (i.e., internet sites, outdated pamphlets or books, pet store workers, friends, etc.). Ask your veterinarian for recommended sources of information.
  • If you are giving insulin injections at home, do not reuse needles or syringes, and do not dispose of them in the trash.

WHEN TO CALL YOUR VETERINARIAN

  • If your cat’s symptoms change, worsen, or any new problems arise
  • If your cat refuses food for more than 2 meals or 1 day
  • If you are unable to give medications as prescribed or if you require a prescription refill
  • When you have any questions or concerns related to your pet’s continual treatment plan or current status

SIGNS TO WATCH FOR

Symptoms that could indicate poor diabetic control or an additional medical problem, meaning a recheck visit to the veterinarian should be made promptly:

  • Watch for general signs of illness, which can include changes in appetite, weight loss, decrease in activity, sluggishness, dull or poorly kept coat, and changes in behavior such as hiding and aggressiveness.
  • Watch for signs of diabetes mellitus, which can include an increase in thirst (Are you filling up the water bowls more often? Is your animal drinking water from taps, bathtubs, fountains, etc.?) and urination (Do you notice larger urine spots in the litter box, or do you have to change the box more frequently than usual?), vomiting, weakness, yellow discolorations to the skin, gums and whites of the eyes, and hindlimb weakness with an abnormal flat stance

ROUTINE FOLLOW-UP

  • As insulin requirements of a diabetic cat can change over time, it is very important to keep all recommended follow-up appointments and lab tests with your veterinarian in order to monitor blood sugar levels, document and treat any new problems that may arise, and make any needed medication adjustments

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.



ABOUT THE DIAGNOSIS

Feline asthma is a respiratory disease that can affect cats of any age. It is also known as feline allergic bronchitis, feline allergic lung disease, and feline lower airway disease. Cats with this disease have coughing (sometimes mistaken for “hairballs”) or even episodes of labored breathing (dyspnea) and wheezing. Some cats exhibit open-mouth breathing (pant like a dog), which is abnormal in all cats except under situations of anxiety such as traveling. Cats with asthma have trouble breathing because the tiny airways (bronchioles) in the lungs become obstructed or narrowed. This constriction decreases the amount of air that is allowed to enter and leave the lungs. Over time, these airways can suffer permanent damage and remain constricted. This can be a serious, life-threatening disease for some cats.

Feline asthma can be aggravated by environmental pollutants (allergens) such as cigarette or cigar smoke, dust from cat litter, carpet, household cleaners, and seasonal airborne allergies such as grasses. Stressful events can also trigger these episodes in some cats. The veterinarian may perform tests to look for other causes of respiratory problems. For example, cats can get heartworms, especially in warmer climates. The outward symptoms (clinical signs) of feline heartworm disease can mimic asthma. To test for feline heartworms, a small blood sample is taken.

Other possible impostors for asthma are parasites that can live in the lungs. These can be diagnosed by performing one or more fecal (stool) examinations. Parasites and other organisms such as bacteria and viruses can sometimes be found in the lungs by performing an airway wash (lavage). This can be done while using a special camera (bronchoscope) to visually examine the inside of the airways, or it can be done alone. For these procedures, the cat is anesthetized and a small tube is gently inserted into the windpipe (trachea). A small amount of sterile fluid is injected and removed. The fluid is then examined under the microscope and tested for various organisms.

LIVING WITH THE DIAGNOSIS

As with asthma in many humans, the cause (trigger) for asthma in cats may or may not ever be determined. Medication is available that can help to reduce the frequency and severity of coughing and wheezing. However, once the cat begins to take medication, the symptoms may improve greatly, but it can then be difficult to determine the cause of asthma because the medication masks the symptoms. Therefore, an important component of helping cats that have asthma is to seek out, and eliminate, the most likely triggers.

These include the following:

  • Avoid exposing the cat to cigarette and/or cigar smoke.
  • Change furnace filters regularly.
  • Control molds, mildew, and dust.
  • Do not use perfumes, hair sprays, or air fresheners.
  • Consider using an air filtration system, ideally a HEPA-type system.
  • Use hypoallergenic household cleaning agents.
  • Use shredded paper or even sand instead of cat litter, provided the cat is willing to use the litter box normally with this new litter type.

TREATMENT

Emergency Treatment

Any cat that has a severe breathing problem should be taken to a veterinarian or to the local emergency clinic immediately. With severe symptoms, the cat is likely sensitive to surrounding stress, and an effort should be made to have the trip be as calm as possible under the circumstances to avoid life-threatening respiratory difficulty. Avoid lifting and moving the cat as much as possible, which can be stressful for the cat and can aggravate the breathing problem. The veterinary staff will place the cat in a calm, quiet environment. Oxygen may be given to help the cat to breathe more comfortably. Injectable medication may be given to reduce inflammation and dilate the network of airways (bronchioles) in the lungs. If this is the first time that the cat has had this type of problem and feline asthma has never been diagnosed, or if some features of the examination are inconsistent with asthma (such as unusual heart or lung sounds heard with the stethoscope), the veterinarian may take x-rays of the cat’s chest and perform other tests when the cat is calm. This is because labored breathing in cats may be caused by many different diseases, including those mentioned above, as well as heart diseases, certain types of tumors, fluid accumulation in the chest cavity, and many other types of serious and less serious disorders.

Long-Term Management

Ideally, treatment involves determining what is triggering the asthma (called the allergen) and removing it from the cat’s environment (see Living with the Diagnosis). If the cause cannot be determined, medication is usually necessary to help improve the cat’s quality of life. Asthma is not cured, but signs can be controlled in most cats.

For cats with frequent, severe respiratory distress, meticulously trying to identify and eliminate the triggering allergen becomes secondary to immediate symptom control. For these cats, therefore, medications are required to prevent (ideally) or at least reduce the severity of the episodes and to keep the cat as comfortable as possible. Corticosteroids, which are cortisone-like medications, can help by decreasing inflammation in the airways. Medication can also be given to further open the small airways in the lungs (bronchodilators).

Some cats may need to take both types of medication to feel better. Both corticosteroids and bronchodilator drugs can be given by mouth or through inhalation. Inhalers are used once or twice a day, the same way humans inhale medication using a device called a “metered dose inhaler”. A small tube or mask containing medication is gently held against the cat’s nose. As the cat inhales, the medication is inhaled. Most cats can learn to use an inhaler, and such devices offer advantages over pills including fewer adverse effects from the use of corticosteroids. Inhalers are, however, more expensive than oral medications. For cats with seasonal allergies, medications may only need to be given during a certain period of the year.

Your veterinarian can discuss various treatments with you after test results are known. It is often necessary to adjust the medication (types of medication and frequency of administration) several times to find the right schedule for your cat.

DOs

  • Give medication exactly as directed.
  • Discuss what to do if you cat becomes suddenly worse. Veterinarians will often prescribe “rescue” medications to be given athome before making a stressful trip in the car to a veterinary emergency clinic.
  • Attempt to determine the cause of the asthma in the cat’s environment.
  • Learn to recognize the early stages of respiratory difficulty. Many
  • owners describe labored breathing in their cat as first being apparent from “belly-breathing”: increased depth of in-and-out movements of the chest and abdominal wall.
  • Take your cat to your veterinarian or to the emergency clinic if breathing problems develop.
  • Understand that asthma can be difficult to treat, and that a second opinion from a veterinary internal medicine specialist may be very helpful. You can discuss this with your veterinarian and a list of these specialists is available at www.acvim.org or www.vetspecialists.com for North America, or at www.ecvim-ca.org for Europe.

DON’Ts

  • Do not force any cat to take medications if it is too stressful. Instead, discuss alternative treatment with your veterinarian.
  • Do not stop giving a medication if you suspect that you know the cause of your cat’s asthma until you have talked with your veterinarian. It can be dangerous to suddenly stop giving some medications (withdrawal effect causing relapse).

WHEN TO CALL YOUR VETERINARIAN

  • If you cannot give a medication as scheduled.
  • If you cannot keep a scheduled appointment.
  • If your cat may be having an adverse reaction to a drug; signs include hives (bumps under the skin), loss of appetite, weakness, drooling, vomiting, diarrhea, or anxiety, but are very uncommon.

SIGNS TO WATCH FOR

  • Open-mouth breathing, increased coughing, or wheezing. When these occur, it is useful for you to note what, if anything, changed in the cat’s environment in the previous 24 hours. This is an excellent way of narrowing down the list of possible triggers for an individual cat’s asthma.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.



By keeping your cat indoors only, you are preventing her from coming in contact with other animals/wildlife, run-ins with cars, and many infectious diseases. This saves millions of cats’ lives each year. However, millions of cats die from diseases from which we cannot protect them (inside or outside). Cats are very good at hiding when they don’t feel well, and only a thorough annual physical exam (which may or may not include blood work) by a veterinarian can detect most of these diseases.

Dental disease
Dental disease is not cosmetic (bad breath and yellow plaque/tartar.) It is infection, inflammation, and PAIN. Studies show that over 70% of pets over three years old have some degree of dental disease. And lets face it, how many of us open up our pets mouth and thoroughly look at their teeth on a regular basis? Your veterinarian will.

Metabolic Disease
Older cats in particular are more susceptible to diseases such as diabetes mellitus, hyperthyroidism, and kidney disease. If caught early, they are treatable.

Heart/Lung Disease
Cats with an abnormal heart rate or a heart murmur do not usually show us any signs until the heart disease is advanced and the cat is very ill or worse, dies suddenly. Abnormal heart rhythm (arrhythmias) and heart murmurs can only be discovered through a thorough physical exam. The same holds true for lung disease such as asthma.

Cancer
Sometimes the only sign of cancer is weight loss, which can be subtle in cats. Loss of even 4 oz. is significant, and most of our home scales can’t detect that amount. Annual physical exams allow your vet to monitor your cat’s weight and overall well being for hints of cancer.

Infections
Older cats often have an infection in their urinary bladder, but not show any of the classic signs of an infection. This doesn’t mean they aren’t painful. They can also harbor viruses (such as leukemia and herpes), in their bodies which can cause disease.
Ingrown toenails
When cats are inside only, they often don’t wear down/scratch their nails as much as an outside cat and these can curl around and grow into the pads of their toes. OUCH!

Obesity
Studies show that indoor cats quickly become overweight due to their sedentary lifestyle: They are no longer relying on their hunting skills to eat, and we are feeding them too much. Obesity can shorten cats’ lives by making them predisposed to arthritis, heart disease, diabetes mellitus, asthma, constipation, and more.

Arthritis
90% of cats 12 years and older have some degree of arthritis!! There are two reasons we don’t notice it as easily in cats as dogs : Cats are good at hiding when they’re sick or sore and they usually get arthritis on both sides of their body, not just limping on one leg. What is often interpreted as “slowing down with age” is actually PAIN.

Fleas
Being indoors only doesn’t guarantee your cat won’t get fleas. They are everywhere outside and you can carry the eggs in on your feet or on your clothes. People who come to visit you who have pets can also bring them in. Fleas are not just itchy, they can: carry diseases that cause life threatening anemia, carry tapeworm eggs that infect your cat when she licks off a flea, and cause anemia from the amount of blood they consume from your cat.

Heartworm Disease
That’s right- cats can get heartworm disease, just like dogs. And studies show that inside cats get it just as often as outside cats, as you can still get mosquitoes in your house, which are what transmit heartworm disease

High Blood Pressure(Hypertension)
Just like humans, cats can develop severe, life threatening high blood pressure and unless a blood pressure measurement is taken at your veterinarians during a physical exam, it often goes undetected.


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Medical FAQs – Kim Buck

Introduction

Vaccine reactions — what are they? What can you do about them?

What are the different types of vaccine reactions?

Vaccine reactions can be divided into non-immunological and immune-mediated. Additionally, they can be localized or systemic (Moore 2003, Datz 2010).

Non-allergic (non-immunological) reactions in both humans and some pets include pain, mild transient fever, transient lethargy and swelling at the injection site.

Pain at the time of the injection is unassociated with the vaccinal antigen, but is related to the injection itself. Often, warming the vaccine just prior to injection can reduce the pain, as can exchanging the needle on the syringe between extracting the vaccine and injection.

Local inflammation can occur for up to a week after injection. Abscessation is rare. Any mass that persists for more than 1 month at the injection site should be evaluated further, especially in cats.

Localized vasculitis has been reported in small or toy breed dogs, resulting in focal alopecia. Rabies vaccines have been implicated.

Immune-mediated reactions are less common. These include Types I-IV hypersensitivity reactions.

Type I reactions include urticaria (hives), rashes, angioedema, and anaphylaxis. They can occur within minutes of administration, but can occur up to 24-48 hours after the vaccination. Antibodies to bovine serum albumin and fibronectin have been detected in dogs, presumably due to residues of fetal calf serum used in vaccine production. In dogs, the most common clinical signs are urticaria and angioedema (“hives” or swelling) involving the face, head, and ears. Vomiting and diarrhea may be seen, and respiratory distress is rare but serious. Cats more often have GI signs (acute onset vomiting and diarrhea), and less commonly respiratory distress or urticaria (Datz 2010).

Type II and Type III reactions are due to antigen-antibody complexes, resulting in immune-mediated diseases. Immune-mediated diseases have been associated with vaccines in dogs. However, the mechanisms have not been elucidated and cause-and-effect is not proven. A small retrospective study of 55 dogs suggested recent vaccination as a possible precipitating factor (Jackson & Kruth 1985). A retrospective study published in 1996 concluded that a temporal relationship existed between vaccination and immune-mediated hemolytic anemia (IMHA) (Duval et al 1996). 15 of 58 dogs (26%) with idiopathic IMHA were found to have onset of clinical signs within 1 month of vaccination. (Duval 1996). Other studies failed to identify an association between vaccination and immune-mediated thrombocytopenia or IMHA (Huang AA 2012, Reimer et al 1999). In the United Kingdom, a retrospective study of 41 cases of IMHA or immune-mediated thrombocytopenia (ITP) showed that 12% had been vaccinated within the past month (Warman et al 2007).

A case series in a veterinary orthopedic journal described 27 dogs with immune-mediated arthritis, of which 4 (15%) were recently vaccinated (3-15 days, mean 11 days) (Kohn et al 2003). Clinical signs included stiff gaits, a reluctance to move, and difficulty rising. All received diagnostic workups and were treated with doxycycline and carprofen. Signs resolved quickly (1-2 days after treatment). One dog was revaccinated and developed arthritic signs 12 days later, while another dog was revaccinated with no signs.

Hypothyroidism resulting from autoimmune thyroiditis has been identified in dogs, and antibodies (Ab) produced against canine thyroglobulin are diagnostic of this condition. A study in research Beagles and pet dogs attempted to discover if vaccination could cause this disorder. Results were mixed – Ab were found to canine and bovine thyroglobulin (probably because of bovine protein contaminants in the vaccines) but no cases of hypothyroidism were observed (Scott-Moncrief et al 2002).

Vaccine-associated sarcomas are a well-recognized vaccine-related reaction in cats given rabies vaccinations, although other vaccines have been implicated.

Are any vaccines more or less likely to cause a reaction?

Anecdotal reports suggest that rabies vaccines, killed products such as leptospirosis, and adjuvanted vaccines are more likely to result in adverse reactions compared to modified live vaccines. Evidence is limited, and many animals are vaccinated with multiple antigens at one time which makes identifying a causative product difficult. The more vaccines given at the same time, the more likely an adverse reaction will occur.

Should I continue to vaccinate after a vaccine reaction?

If the reaction is life threatening future vaccinations should be avoided. If mild then consider premedicating.

Are particular breeds of dogs and cats more or less likely to have a vaccine reaction?

One author suggests that Old English Sheepdogs, Akitas, and Weimaraners have higher rates of vaccine-associated immune-mediated diseases than other breeds, but evidence is lacking (Day 2005). Another study suggested that Dachshunds, Pugs, Boston Terriers, Miniature Pinschers and Chihuahuas had higher incidence of vaccine-associated reactions (Moore et al 2005). Hypertrophic osteodystrophy (HOD) has been linked with modified-live distemper vaccines in Weimaraners, with average age of onset 13.5 weeks and 10.5 days post-vaccination (Harrus et al 2002). However, no control group was included in this small study, and this breed has been identified as developing HOD without prior vaccination. Therefore, the role of vaccination in Weimaraner HOD is unclear (Moore & HogenEsch 2010).

In a retrospective study of over one million dogs, the reaction rate (all types) was 38.2/10,000 (Moore et al 2005). Young adult dogs (1-3 years) and small-breed dogs were at higher risk. Boxers were the only large breed with more reactions than average.

Another study of 57,000 dogs found a low incidence of anaphylaxis following vaccination and a relatively low incidence of any type of “vaccine-associated adverse events”(approximately 5 per 1000 dogs) (Miyaji et al 2012).

In one study of 500,000 cats, the reported rate of vaccine-associated adverse events was 51.6 per 10,000 cats (Moore et al 2007).

Should I premedicate and what should be used?

For pets with a history of urticaria, swelling, or GI signs, at all future vaccine visits they are pretreated with an antihistamine and possibly corticosteroids and then monitored in the hospital for at least 8 hours. In cases of life-threatening reactions, future vaccination should be avoided if possible. If absolutely necessary, vaccines should be split into multiple visits (3 or more weeks apart) along with pretreating and careful monitoring.

How should I treat a vaccine reaction?

Treatment is often reserved for type-I hypersensitivity reactions, but can be administered whenever clinical signs warrant. As soon as signs appear, injectable drugs such as corticosteroids, antihistamines, and/or epinephrine are given depending on severity. Other therapies such as IV fluids and oxygen are occasionally needed, and facilities for endotracheal intubation and ventilation should be available.

Will a half dose of vaccine prevent a reaction?

A smaller vaccine dose will not prevent or reduce the risk of a type I hypersensitivity reaction. Additionally, with vaccines such as rabies vaccines, administering a smaller dose could be illegal in some states, as it could leave the patient unprotected.

How can I prevent a vaccine reaction?

Pre-treatment with antihistamines and corticosteroids in dogs or cats that have experienced mild vaccine reactions can reduce the likelihood of a reaction, or the severity of a reaction. The only true “prevention” is avoiding vaccinating the patient.

Is there any genetic predisposition for vaccine reactions?

One study (Moore et al 2005) suggested a higher rate of vaccine reactions in certain breeds than others, which could argue for a genetic predisposition. As stated above, the top 5 breeds for reactions were Dachshund, Pug, Boston Terrier, Miniature Pinscher, and Chihuahua. Boxers were the only large breed with more reactions than average.

Can I skin-test to determine susceptibility to vaccine reactions?

Yes, for type I hypersensitivity reactions. A positive and negative control need to be co-administered, and the dermal response monitored for the next several hours. Micro-doses of vaccines for intradermal testing can usually be purchased from companies that manufacture reagents for intradermal testing. However, interpretation of intradermal antigen testing can be complicated. The tests are considered specific (if the patient reacts to the skin test, they will likely react to a regular dose of vaccine), but not sensitive (lack of a reaction does not rule out the possibility of reacting to a regular vaccine dose).



  • Identify previously preferred substrates and locations, and replicate these.
  • Ensure there is at least one more litter box than the number of cats.
  • Ensure the litter boxes are at least 1.5 cat body lengths long (including tail). This is larger than virtually all commercially available litter boxes for cats, but rigorous research has indicated that this is the size preferred by cats.
  • Identify locations where the cat spends the most time, and place boxes accordingly.
  • Ensure that you do appropriate cleaning regimen:
    • Scoop litter multiple times daily.
    • Totally dump litter, including recyclable multi-cat litters, two to three times a week, depending on the number of cats using them.
    • Wash, rinse, and dry the litter box at least weekly.
    • Avoid liners and scented litters.
    • Ensure that covered litter boxes have good ventilation if they must be used.
  • Use good odor eliminations (e.g., Anti-Icky-Poo [AIP]) on all substrates where urine or feces has been inappropriately deposited.
  • Pheromonal analog products have been suggested for use to “calm” animals, but they may make some animals more reactive. Their efficacy is in doubt insofar as most studies are poor and show at best a weak contributory effect. No study on the use of pheromonal analogs shows efficacy to the extent seen when the underlying anxiety is treated with medication.
  • Identify potential stressors or conflicts in the household (e.g., intercat aggression) and redress them. The most common of these may be relationships between cats in the household. Intercat aggression is a serious concern if
    • One cat is avoiding one or more other cats.
    • One cat consistently leaves the room or a preferred resting spot when one or more other cats enter.
    • One cat cannot or does not eat or drink in the presence of the others.
    • One cat is always hiding.
    • One cat is hyperreactive to any noise or tactile stimuli.

 

  • If more animals are added to the household, clients should expect social upheaval and be prepared to restart analysis of interaction and behavior.
  • Attention should be paid to the victimized cat before the other cats.
  • Litter box hygiene must be meticulous and lifelong.
  • Outdoor or visitor cats should be kept to a minimum or excluded.
  • Consider allowing the cat to be an indoor/outdoor cat if all else fails.

Prognosis & Outcome

  • Without treatment, the prognosis is guarded. Inappropriate elimination is the single most common reason cats in North America are euthanized or relinquished. Many shelters consider cats that have litter box issues “unadoptable” and euthanize them.
  • Clients maintain cats in their household for an average of 2 years after a complaint has been identified, but the more obvious inappropriate urination is to the client, the more likely he or she is to be intolerant of it.
  • Prognosis is improved by early diagnosis, comprehensive treatment, attentive client monitoring, and open communication between clinician and client.
  • Treatment of behavioral conditions is an ongoing process, often for the life of the pet. Relapses may occur with treatment discontinuation or with added stressors.
  • Physical illness is also a stressor and may promote a behavioral elimination problem where previously none existed.

 



Spaying and neutering refer to the surgical sterilization of your cat. This ensures that your pet cannot reproduce.

Cats are typically spayed/neutered when they are 4-6 months old, although the procedure can be done from as early as 8 weeks of age through adulthood. It is ideal to have the surgery done before your cat reaches sexual maturity. Females should be spayed BEFORE their first heat.

We have a responsibility to prevent unwanted animals from being euthanized everyday, simply because there are no homes for them.

Over 3 million cats are euthanized in shelters due to over population

Benefits of Spaying:

  • Prevents Pregnancy and the complications that may arise from pregnancy and delivery
  • Eliminates the heat cycle; you won’t have to listen to the sounds of your female cat in heat, trying to get out and find a mate!
  • Prevents unwelcome males from trying to seek out your female cat in heat
  • Eliminates sexual discomfort, distress or distraction…..making your cat happier and more content
  • Eliminates the possibility of disease or cancer in the reproductive system.

Benefits of Neutering:

  • Reduces the distraction and destructive behavior associated with the male’s efforts to get out and find a mate.
  • Reduces the urge to fight
  • Stops or reduces marking behavior (spraying)
  • Reduces the urge to roam. This makes it less likely that you will lose your cat, which in turn makes your cat less likely to contract a disease, get in a fight, get injured or become a victim to cruelty, poison or traffic
  • Eliminates the risk of testicular cancer

About CVC

Chappelle Veterinary Clinic is a full service Veterinary Clinic which offers a wide range of veterinary care for cats and dogs, including routine exams, vaccinations, preventative care, diagnostics, surgery, spay and neuter, wellness services, dental cleaning, emergency and more.

Working Hours

Monday 8:00 AM – 6:00 PM
Tuesday 12:00 PM – 9:00 PM
Wednesday 8:00 AM – 9:00 PM
Thursday 8:00 AM – 6:00 PM
Friday 8:00 AM – 6:00 PM
Saturday 8:00 AM – 3:00 PM
Sunday Closed

Contact us

14128 28 Avenue SWEdmonton, AB T6W 3Y9

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