Thursday, August 18, 2016


Disorders of the Feline Spleen


We’ve all heard of the spleen, but do you really know what it does?  And what does a big spleen mean?





Most people can give you a reasonably accurate description if asked to describe the function of the heart, the kidneys, or the lungs. But ask about the spleen and you’re met with blank stares, despite the fact that everyone’s heard of it.  Let’s end the mystery and delve into the world of the feline spleen.

The spleen is a dark red organ located near the stomach.  It is longer than it is wide, and has the appearance of a giant tongue.  It is covered by a capsule made of sturdy fibrous tissue.   Blood vessels enter and exit the spleen on the same side, in an area called the “pedicle”.  The spleen is usually found in the cranial part of the abdomen on the left side, although the exact location isn’t fixed.  Depending on its size and shape, and the size of the surrounding organs (for example, if the stomach is full), the spleen can shift position to the right side of the body, or to the caudal part of the abdomen.

 
The spleen isn’t essential for life. It can be surgically removed if necessary, and most animals will be fine.  However, the spleen performs important functions and it’s certainly much better to have one than to not have one.


The spleen has several important functions.  It plays a role in “hematopoiesis”, the production of red blood cells.  The bone marrow is the major site of red blood cell production. The spleen is the next major site.  The spleen is also a storage site for red blood cells and platelets.  If the body was suddenly in need of additional red blood cells in the circulation, the spleen has the ability to contract, flooding the bloodstream with additional blood.  Another function of the spleen is filtration.  The spleen acts as a giant filter that traps and removes old or abnormal blood cells from the circulation.  A fourth function of the spleen is the trapping and removal of bacteria, foreign proteins, and old cells through a process called phagocytosis, in which cells of the immune system within the spleen engulf the offending particles.  A final important function of the spleen is the participation in the immune response. 

Anatomically, the internal structure of the spleen consists of areas of “red pulp” and areas of “white pulp”, as well as a “marginal zone” which separates the white and red pulp.  The red pulp contains many sinuses that are engorged with blood, giving the spleen its characteristic red color.  It is in the red pulp that the filtration of foreign proteins, microorganisms, and defective or old red blood cells occurs.  The white pulp is where the red blood cells are produced and where the cells of the immune system reside.  The marginal zone is the area that separates the red pulp from the white pulp.  Its primary role is that of blood filtration.

Disorders of the spleen can be generally categorized as either primary or secondary.   In primary spleen disorders, the spleen itself is the site of the illness.   The spleen can also be secondarily affected by a systemic disease occurring elsewhere in the body.   The most common abnormal finding indicating a problem with the spleen is splenomegaly – enlargement of the spleen.  This can usually be detected on physical examination, by carefully feeling the contents of the abdominal cavity during the physical exam. 

Enlargement of the spleen occurs in two forms: localized and generalized.  Localized splenomegaly is a focal enlargement of the spleen, i.e. a splenic mass.  Generalized splenomegaly is a diffuse enlargement of the entire spleen.  Localized splenomegaly is more common in dogs.  Generalized splenomegaly is more common in cats.

Once splenomegaly is detected on physical examination, there are several diagnostic tests that are helpful in evaluating the cause for the enlargement.  A complete blood count, serum chemistry panel, urinalysis and abdominal radiographs may provide useful information.   Abdominal ultrasound is an excellent, non-invasive tool to distinguish whether the enlargement is localized vs. generalized, and to help further define the underlying disease process. 

In many cases, a definitive diagnosis can only be achieved by obtaining a sample of the cells from the spleen.  This can be accomplished either by aspiration or by biopsy.  Fine-needle aspiration is a procedure in which a needle, attached to a syringe, is inserted into the spleen.  A sample from the spleen is then aspirated into the hub of the needle and the contents sprayed onto a microscope slide.  The slides are then sent to a laboratory to be evaluated by a clinical pathologist.  Aspiration can be performed under ultrasound guidance, usually with only mild sedation. This is a safe, reliable method of evaluating patients with splenomegaly. 

If a diagnosis cannot be obtained by the diagnostic tests described above, exploratory surgery of the abdomen may be required to identify the underlying disease process.  Because the entire spleen is likely to be affected in cats, rather than obtain a small piece of the spleen as a biopsy specimen, the entire spleen is removed. The spleen is then submitted to the laboratory for review by a pathologist.  As stated previously, the spleen is an important organ but it is not necessary for survival, and most animals live healthy lives following splenectomy.

In cats, unfortunately, infiltration of the spleen with cancer cells is the most common cause of splenomegaly.  The most common cancer is mast cell tumor or mastocytosis.  Lymphoma and hemangiosarcoma are two other common splenic cancers.  In a study published several years ago evaluating 19 cats who had undergone surgical removal of their enlarged spleen, 10 of the 19 (53%) had mast cell tumor, 4 had hemangiosarcoma (21%) and 2 had lymphoma (11%).   These were the three most common diseases resulting in splenectomy. 


Feline splenic disease is a much rarer entity than its canine counterpart, but it is still an important condition in veterinary medicine.  The prognosis for cats with splenomegaly varies depending on the cause. 

Monday, August 8, 2016

Gastrointestinal Hemorrhage in Cats

Gastrointestinal Hemorrhage in Cats
by Arnold Plotnick, MS, DVM, ACVIM



Gastrointestinal (GI) hemorrhage is defined as the loss of blood into the GI tract.  Loss of blood can originate from various sites in the GI tract – the mouth, esophagus, stomach, small intestine, and large intestine/colon.  When cats bleed from the mouth, esophagus, stomach, or small intestine, the blood gets digested, resulting in melena – black tarry feces.   When cats bleed from the large intestine or colon, it is beyond the point where digestion occurs, and any blood associated with the feces appears red.  Discovery of blood in the feces when cleaning the litter box is one of the more common reasons for cat owners to bring their cat to the veterinarian.


The clinical signs of GI hemorrhage are not limited to the appearance of the feces. Cats with hemorrhage originating in the stomach may vomit up blood.  This is called hematemesis.  If the bleeding is recent, the blood is more easily recognized, as it still looks red in appearance.  If the blood gets partially digested in the stomach before vomiting occurs, the blood takes on the appearance of “coffee grounds”, which may be more difficult for clients to recognize as blood.  Veterinarians and owners should not be misled into thinking that all instances of vomiting blood and black tarry feces indicate hemorrhage of GI origin. Coughing up blood (hemoptysis) is sometimes misidentified as vomiting of blood.  Hemoptysis results from disease of the airways and lungs.  Cats that cough up blood may swallow some of that blood, resulting in hematemesis and melena, delaying or confounding the true diagnosis. Hemorrhage from the nasal cavity – called “epistaxis” – can also result in hematemesis and melena if the amount of blood swallowed is significant.   Ongoing or severe blood loss can result in anemia – a deficiency of red blood cells – that could be life-threatening and may require a transfusion if the cat is to survive.

Making a definitive diagnosis of GI bleeding involves identifying first the site of the hemorrhage, and then the cause.  As mentioned above, the presence of melena localizes the site to the stomach or small intestine.  A history of hemoptysis or epistaxis suggests that the GI tract is just a conduit for the swallowed blood and is not the primary site of the hemorrhage.  Fresh red blood in the feces suggests a large intestine or colonic origin for the bleeding.  Gastrointestinal bleeding may be acute or chronic.  Chronic hemorrhage may be insidious, and thus more difficult to detect. 

If the clinical signs point to upper GI bleeding, the first place to look is the mouth.  Severe periodontal disease, foreign bodies, oral trauma, and bleeding tumors can result in hemorrhage.  The diagnosis and treatment of these disorders is usually straightforward. 

Diseases of the esophagus (the tube connecting the oral cavity to the stomach) are uncommon in cats.  Foreign bodies, tumors, and inflammation of the esophagus secondary to acid reflux are disorders that may lead to esophageal hemorrhage.  Excessive salivation, difficult or painful swallowing, and regurgitation of food are common signs associated with esophageal disease.  Foreign bodies should be removed, either using an endoscope of via surgery.  Tumors of the esophagus may be addressed with surgery or chemotherapy, although the prognosis for these tumors is often grave.  Inflammation resulting from acid reflux is usually treated by administering drugs that suppress gastric acid secretion, as well as drugs that form a protective barrier on the ulcer and foster more rapid healing. 

The stomach is a common site of origin for GI hemorrhage, with gastric ulcers being the most common cause.  In dogs, most cases of gastric ulcer are associated with drug therapy, especially non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.  Cats rarely get ulcers from corticosteroids, and most NSAIDs are unsafe for cats and thus are rarely given.  In cats, tumors of the stomach are the most common cause of gastric bleeding.  These include gastric carcinomas, lymphoma, and mast cell tumors. Clinical signs again may include hematemesis and melena, chronic vomiting, weakness, lethargy, poor appetite, and weight loss.  Anemia due to the blood loss often leads to the appearance of pale gums on physical examination. Ultrasound of the abdomen is usually helpful in identifying a gastric tumor, however, endoscopy is a better diagnostic test in that it allows direct visualization of the tumor and any associated bleeding, and permits the procurement of biopsy specimens for definitive diagnosis.   Treatment depends on the size, extent, and type of tumor.  Surgical removal may be possible for some tumors.  Others, especially lymphoma, may best be treated with chemotherapy.  A bacterium called Helicobacter has also been associated with gastric ulcers and occasionally gastric bleeding in cats.  Helicobacter is sometimes detected in gastric biopsy specimens during endoscopy.  Because Helicobacter has been identified in biopsy specimens from normal cats, merely finding Helicobacter doesn’t necessarily mean that it is causing illness.  However, identification of the organism in a cat with gastric ulceration and bleeding warrants appropriate treatment.  Treatment recommendations are frequently changing, although they usually consist of giving at least two antibiotics in conjunction with an antacid.

The small intestine is a less common site of hemorrhage than the stomach in cats.  Tumors, as well as severe inflammation from inflammatory bowel disease, are the most likely causes of small intestinal bleeding.  Hookworms are bloodsucking intestinal worms that are more commonly found in dogs, but do occasionally affect cats.  These worms attach to the lining of the small intestine and ingest the cat’s blood.  Severe infections can lead to significant anemia, especially in kittens.  Blood may continue to seep from the site where a worm has bitten, and melena may result.  A diagnosis is made by analyzing a fecal sample.  Most common dewormers will treat hookworm infections. 

Colitis – inflammation of the large intestine or colon – is a very common cause of GI hemorrhage in cats.  There are several potential causes of colitis in cats, such as bacterial or protozoal infections, inflammatory bowel disease, sudden changes in diet, and stress.  Fecal analysis can often detect the presence of intestinal parasites or protozoans.  Inflammatory bowel disease of the colon requires colonoscopy to obtain a definitive diagnosis.  Tumors of the colon are uncommon in cats, but do occur.  If the tumor becomes ulcerated and bleeds, it can be a source of hemorrhage.  Typical signs of colonic disease include straining to defecate, increased frequency of defecation, and urgency to defecate, sometimes resulting in defecation outside the litter box if the cat cannot make it to the litter box in time.  Most cases of colitis result in diarrhea, but not always.  Feces from cats with colitis will often contain excessive mucus, giving it a “slimy” appearance.  Treatment of colitis depends on the inciting cause.  Parasites are treated with dewormers.  Inflammatory bowel disease usually responds to anti-inflammatory medication and feeding a prescription diet.   Tumors of the colon may require surgery and/or chemotherapy.

Not all GI hemorrhage is due to primary GI disease.  Bleeding disorders such as a deficiency in platelets or a disorder of the coagulation system can lead to bleeding tendencies, which may include GI bleeding.  For example, some rodent poisons work by inhibiting certain blood clotting factors, leading to signs of GI hemorrhage. 

Gastrointestinal bleeding is an important cause of anemia in cats and may occur for a variety of reasons.  Some causes are easy to diagnose and treat, such as intestinal parasites, while others, such as tumors, are challenging and may be difficult or impossible to treat.  Cats that vomit blood, pass fresh red blood in the feces, or that have black tarry stools should be evaluated by a veterinarian promptly.

Glossary

Hematemesis – vomiting of blood
Melena – black tarry feces
Hematochezia – passage of fresh blood in the feces
Hemoptysis – coughing up of blood
Epistaxis – hemorrhage from the nasal cavity
Coagulopathy – disorder of the blood clotting system

Sunday, July 31, 2016

The Bicycle Bells of Amsterdam

Amsterdam is a biking city.   There are actually more bicycles than there are residents.  These bicycles all have bells on them, and there are nearly as many varieties of bell as there are bikes.  Solid pastels, floral patters, messages, animals, stars, logos... a little of everything. I took a few pictures of some that caught my eye.






















Thursday, July 28, 2016

Feline Body Parts – The Stomach

Body Parts – The Stomach
by Arnold Plotnick, MS, DVM, ACVIM



If you can’t stomach the thought of an article about the stomach, then this column may not be for you.  But have no fear, I will make this material easy to digest.

The stomach is an important part of the gastrointestinal tract.  Food that is swallowed is propelled by the esophagus into the stomach, where the digestion process begins.  The stomach is comprised of several distinct sections.  The fundus is the small part that lies just above the junction between the esophagus and the stomach.  The inlet or opening from the esophagus into the stomach is called the cardia.  The largest section is the body of the stomach.  This section mainly serves as a storage tank for undigested food.



The next part of the stomach is the antrum.  The antrum is very muscular and serves to grind up the food into smaller pieces.  The pylorus is a sphincter – a ring of muscle – that regulates the flow of stomach contents from the stomach into the duodenum, the first part of the small intestine.  The pylorus also serves as a one-way valve, preventing backflow of intestinal contents into the stomach.  The stomach is shaped like a lopsided kidney bean.  The longer outside margin, on the left side of the body, is called the greater curvature.  The shorter outside margin, on the right side of the body, is the lesser curvature.

The principal job of the stomach is to store, mix, and digest food, and to regulate the emptying of its contents into the small intestine, where digestion continues.  The stomach contains glands that produce acid and enzymes that digest the incoming food.  The acid also helps to kill bacteria that enter the stomach.  The stomach is also lined by glands that secrete mucus, which helps protect the stomach from being digested by its own acid and enzymes.  

The most common sign that something might be amiss with your cat’s stomach is vomiting.   Every cat vomits now and then, and most of the time there’s a harmless explanation for it, such as eating too fast, a sudden change in diet, or hairballs. 

When cats groom themselves, the barbs on their tongues remove the loose and dead hair. These hairs are swallowed. Most of the hair passes through the digestive tract, but some hair may accumulate in the stomach, where it can form into a hairball. Ultimately, cats will rid themselves of hairballs by vomiting them up.  Long-haired cats like Persians and Maine Coons are predisposed to hairball problems. Cat owners should be cautioned, however, from instinctively blaming all vomiting on harmless hairballs.  Certainly if you see a big hairball in the vomited material, and this occurs infrequently, then hairballs is the likely diagnosis.  But cats that vomit hairballs very frequently usually have an underlying disorder, and this should be investigated by a veterinarian.

Inflammatory bowel disease (IBD) is a disorder in which the immune system sends inflammatory cells into various segments of the gastrointestinal tract.  The stomach is commonly affected.  In fact, my own cat Mittens has IBD of the stomach.  Other signs, such as decreased appetite and weight loss may accompany the vomiting.  Most affected cats tend to be middle-aged or older, although any age cat can be affected.  To make a definite diagnosis, biopsy specimens from the stomach are required.  These can be obtained via surgery, or by endoscopy.   Endoscopy is a procedure where a long snake-like tube with a camera on the end is inserted down the esophagus and into the stomach, and biopsy samples are obtained.  This is how my cat’s IBD was diagnosed.  Treatment with anti-inflammatory medications often brings the vomiting under control.

Sadly, cancer of the stomach can occur in cats.  Although it can strike cats of any age, it is mostly seen in older cats.  Lymphoma is the most common stomach cancer, but other types such as gastric carcinoma and mast cell tumors can occur.  If the tumor involves a discrete area of the stomach, surgery to remove the cancerous part of the stomach may be feasible.  Lymphoma is considered to be a systemic disease, and chemotherapy is the treatment of choice.  I treated a cat named Beowulf with chemotherapy for high-grade stomach lymphoma.  He remained in remission after a year of treatment, so we stopped the chemotherapy.  Three years later, he appears to be cured of his cancer. 

Some of the medications we used to treat stomach disorders in cats are similar to the ones we use to treat people.  If excessive stomach acid is believed to be contributing to a cat’s symptoms, we prescribe drugs like cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid).  Cats needing a stronger antacid can be given omeprazole (Prilosec).  However, cat owner should never administer any over-the-counter medications without consulting their veterinarian, because the dosages for cats will very different, of course.








Friday, July 22, 2016

Feline Body Parts – The Kidneys

Body Parts – The Kidneys
by Arnold Plotnick, MS, DVM, ACVIM


    Like all mammals, cats have two kidneys, one on the left, and one on the right.  They are shaped like…kidney beans, of course.  Blood flows into the kidney through the renal artery, and leaves via the renal vein.  As blood passes through the kidney, toxins are filtered from the bloodstream.  These toxins go into the urine, where they are excreted from the body.   The kidney also produces hormones.  One of these hormones, called erythropoietin, is responsible for the production of red blood cells from the bone marrow.  Other hormones produced by the kidneys help regulate blood pressure.

    As most cats age, kidney function gradually declines.  Eventually a point is reached where the kidneys can no longer maintain their normal function, and the toxins in the bloodstream accumulate.  This condition used to be called chronic renal failure, but these days, veterinarians prefer the term chronic kidney disease (CKD).  Unless the underlying cause can be discovered and treated, CKD invariably progresses.  In most cases, an underlying cause cannot be found.  Why most cats eventually develop CKD remains one of veterinary medicine’s biggest (and most frustrating) mysteries.

 





The primary clinical signs of CKD in cats are excessive thirst (polydipsia) and urination (polyuria), decreased appetite (anorexia), weight loss, and occasional vomiting.  Because these signs are also often seen in other illnesses, several tests are required to confirm a diagnosis of CKD.  These include a complete blood count, serum chemistry panel, and urinalysis.  The finding of dilute urine, coupled with an elevated level of kidney toxins in the blood, indicates that kidney function is compromised.  The two primary renal toxins that we monitor are “blood urea nitrogen” (often abbreviated BUN) and creatinine.  Other abnormalities, such as elevated phosphorus, low potassium, and anemia (decreased amount of red blood cells) may also be detected.  Although CKD is incurable, a variety of diet and drug interventions are now available that may slow the progression of the disorder, improve the cat’s quality of life, and extend a cat’s survival time.  Cats who are suitable candidates may be eligible for a kidney transplant.  This is a major endeavor requiring the expertise of a skilled surgical team at a university or referral center.  The procedure, as you might expect, is very expensive, and post-operatively, the cat will require long-term administration of drugs to prevent rejection of the transplanted kidney.



    Although chronic kidney disease is by far the most commonly seen feline kidney disorder, other kidney ailments are occasionally encountered in cats.  Acute renal failure (the currently preferred term is acute kidney injury, abbreviated AKI) is a disorder characterized by a sudden, dramatic decrease in kidney function.   This is a serious condition that, if not recognized and addressed quickly, can lead to rapid decline and possible death.  Unfortunately, the clinical signs of AKI – poor appetite, vomiting, extreme lethargy, weakness, decreased urine production – are nonspecific and may result in delayed recognition that the cat is ill.  The most common causes of AKI in cats are ingestion of ethylene glycol (antifreeze) and ingestion of lilies.  Many people are unaware that all parts of the lily plant – even the pollen – are toxic to cats if ingested. Other possible causes include unintentional administration of toxic drugs (for example, giving ibuprofen to a cat), and any situation that results in decreased blood flow to the kidneys (for example, anesthesia).

    Bacterial infection of the kidney, called pyelonephritis, is occasionally seen in cats.  In this disorder, one or both kidneys become enlarged and tender, and the cat usually develops a fever, high white blood cell count, and poor appetite.  Elevated BUN and creatinine levels may occur if kidney function becomes impaired.  Pyelonephritis usually requires hospitalization and treatment with intravenous fluids and antibiotics.

    Kidney stones (nephrolithiasis) are uncommon in cats and are usually of minimal clinical consequence. However, if a small stone leaves the kidney and becomes lodged in the ureter (the tube that connects the kidney to the bladder), the obstruction of urine flow causes a pressure buildup in the kidney that can lead to functional impairment and, if not relieved, ultimate destruction of the kidney.  Fortunately, this is an uncommon occurrence.

    Feline infectious peritonitis (FIP) is a viral infection that may affect cats of all ages, although it has a predilection for young cats.  There are two forms of the infection, the “wet” form, in which fluid accumulates in the abdomen (and sometimes the chest cavity), and the “dry” form, in which clusters of inflammatory cells infiltrate various solid organs in the body.  The liver and kidney are the favorite target organs for the FIP virus.  When FIP affects the kidneys, their function eventually becomes impaired as the viral infection progresses.  At present, there is no treatment for FIP, and all cats eventually succumb to this disease.  Treatment of FIP, however, is a very active area of research, and veterinarians are more optimistic than ever that an effective treatment will soon be discovered.

    Sadly, cancer of the kidney is a well-documented illness in cats.  The cancer can be primary, i.e. arising from the kidney itself.  An example would be a renal carcinoma. In primary kidney cancer, usually only one kidney is affected.  Cancer can also spread from other organs to the kidneys.  The most common type of cancer occurring in feline kidneys is lymphoma, in which both kidneys are infiltrated with cancerous lymphocytes.  Renal carcinomas, being unilateral, may be amenable to surgical removal.  Lymphoma of the kidneys, however, is almost always bilateral, and must be treated with chemotherapy. 

   
For more on feline kidneys, check out my articles:

     "Long Term Management of Chronic Renal Failure in Cats"
     "New Test for Renal Disease"
     "High Blood Pressure"
     "Polycystic Kidney Disease"

Saturday, July 16, 2016

The Effect of Music on Kitty Anesthesia: Vivaldi vs. Van Halen

The most recent issue of the Journal of Feline Medicine and Surgery contained a pretty interesting article about the effect of various genres of music on a few parameters of feline anesthesia.  Being a big music fan myself, I was intrigued.

The aim of the study was to determine if cats were able to process auditory stimuli even though they were anesthetized.   They evaluated two parameters, respiratory rate and pupil diameter.  These parameters are affected by the depth of anesthesia; as you come out of anesthesia, your respiratory rate increases and your pupils get larger.  Deeply anesthetized animals have a slower respiratory rate and smaller, constricted pupils.

Twelve cats that were scheduled to be spayed were fitted with little kitty cat headphones that completely covered their ears, and were exposed to 2 minute excerpts of music representing three different genres - classical, pop, and heavy metal at three different times during their surgery.  A medical monitor measured the heart rate.  and digital calipers measured the pupil diameter.

The results weren't surprising, really.  Cats showed nice low respiratory rates and small pupils when played classical music.  The values were intermediate for pop music.  Heavy metal caused a faster respiratory rate and larger pupils.

The conclusion:  cats under general anesthesia do indeed process auditory stimuli.  So, depending on the type of music being played in the surgery room, the anesthesiologist may be able to administer a reduced anesthesia dose, minimizing undesirable side effects.

I checked the "materials and methods" section to see exactly what the researchers used as representative of the genres.  Their classical choice was Samuel Barber's Adagio for Strings (Opus 11).  The pop sample was "Torn" by Natalie Imbruglia.  For heavy metal, they used "Thunderstruck" by AC/DC.

I'm trying to envision a cat, under anesthesia, with over-the-ear headphones, being forced to listen to Natalie Imbruglia.  Doesn't this violate animal cruelty laws?




Wednesday, July 13, 2016

Intestinal Intussusception in the Cat

Intestinal Intussusception in the Cat

This big medical term describes an intestinal condition that, if not recognized and treated promptly with surgery, could have dire consequences for your cat.



            A few months ago, a client brought her 4 month-old female kitten, Squeegee, to my feline-only veterinary hospital for an exam.  The kitten had been doing great, eating well, growing nicely, and playing like a maniac, until two days before when she began to vomit.  She became lethargic, the vomiting progressed, and her appetite abruptly disappeared.

            My physical examination revealed a markedly subdued, dehydrated little orange tabby.  Her body temperature was normal, and she was an appropriate weight for her age.    The exam was fairly unremarkable, until I got to the abdomen.  As I gently pressed on her belly with my fingers, I could feel a tubular, sausage-like structure.  She squirmed and tried to get away.  I gave her a little break, and then I softly pressed again to be sure of my findings.  It was unmistakable; there was something seriously amiss in Squeegee’s belly.  She was too young for cancer or inflammatory bowel disease.  A discreetly thickened loop of bowel in a kitten was highly suspicious for a condition called intestinal intussusception.   I recommended abdominal ultrasound to corroborate the diagnosis, and the owner agreed.  My suspicions were quickly confirmed, and preparations for immediate surgery were begun.

 intussusceptum (“inta-suh-SEP-tum). The outer portion that receives the piece of intestine is called the intussuscipiens (“inta-suh-SIP-ee-enz”). (When studying this in veterinary school, my trick for distinguishing between the two parts was to remember that the intussuscipiens is the recipient.) Intussusceptions are named by first citing the intussusceptum, and then citing the intussuscipiens.  For example, a “gastroesophageal” intussusception is one where a piece of the stomach (“gastro”) pushes itself into the esophagus.  An “enterocolic” intussusception is one in which a portion of the small intestine (“entero”) pushes into the colon.  In cats, the most common type is intestinal, where both the intussusceptum (the piece that pushes) and the intusscipiens (the piece that receives) are portions of small intestine.   
           Warning:  big words ahead.  An intussusception (pronounced “inta-suh-SEP-shun”) is a condition in which a piece of intestine telescopes or invaginates into another piece of intestine.  (See drawing.)  The piece of intestine that pushes into the other piece is called the

            Intussusceptions have been well-described in dogs.  They are most common in young dogs, with German Shepherds being the most commonly reported breed, although whether there is a true breed predisposition is debatable.   Less information is available regarding intussusceptions in cats.   In 1994, a series consisting of 12 cases was reported in cats.  Similar to dogs, the majority occurred in cats that were under 1 year of age.  Most cases involved the domestic shorthaired breed, although Siamese and Burmese cats were overrepresented, suggesting that these breeds might be more susceptible.  This was a small study. A few years ago (2009), a larger case series was published (20 cats) that shed additional light on the subject.

            In the more recent study, there was a bi-modal age distribution:  10 of the 20 cats were under a year of age when the intussusception occurred.  Interestingly, nine of the cats were older than 6 years of age.  (The remaining cat was 2 years old.) The most common clinical signs reported were the same signs that I saw in little Squeegee:  poor appetite, lethargy, and vomiting.   Weight loss and diarrhea were also commonly reported.  Most (13) of the cats examined had some degree of dehydration.  Nearly all of the cats had some abdominal abnormality that could be discerned during the physical exam, including abdominal pain, an abdominal mass, or a discreetly thickened segment of intestine. 

            Once there’s a suspicion of intussusception, a diagnosis needs to be confirmed.  X-rays usually reveal some abnormality of the intestinal tract, however, a definitive diagnosis cannot usually be made on x-rays alone.  Ultrasound is a better test for making the diagnosis.   In the study from 2009, seven cats underwent abdominal ultrasound, and in all seven cats, a definite diagnosis was made based on the ultrasound findings.  It was ultrasound that confirmed the diagnosis in Squeegee as well. 

            Intussusception is a surgical disease.  Without surgery, cats will invariably succumb to the disorder.   Once the cat is taken to surgery, an attempt is made to “reduce” the intussusception, i.e. separate the intussusceptum from the intussuscipiens.  While it might seem intuitive to do this by applying traction on the intussusceptum and pulling it out from the intussuscipiens, the proper technique actually involves grasping the intussuscipiens and gently “milking” the intussusceptum from within the intussuscipiens, carefully pushing it out.  In some cases, however adhesions have formed between the two pieces, and they cannot be separated from each other.  In these cases, the entire intussusception needs to be surgically cut from the intestine, and the two normal ends of the intestine reattached to each other. 

            Recurrence of intussusception after surgery has been reported in dogs.  Interestingly, in dogs and people, if recurrence occurs, it is usually in an anatomic location other than the original site.   In an attempt to reduce recurrence, a surgeon may elect to perform a procedure at surgery called “enteroplication”.  This technique creates permanent attachments between adjacent loops of intestine.   Although this procedure is said to reduce the incidence of recurrence, it sometimes leads to complications.   Thus, the decision whether or not to perform enteroplication is at the discretion of the individual surgeon.  Recurrence of intussusception appears to be less of a problem in cats, although data to confirm the actual incidence are lacking.   In the study from 2009, 13 cats underwent surgery.  One cat was euthanized at the time of surgery.  Three of the 12 cats that underwent surgery had enteroplication performed.   Two of those three cats experienced significant complications from the enteroplication; one cat died and one had to be euthanized.  The other 10 cats were discharged from the hospital.  Five of them were lost to follow-up, but the other five did well and never experienced a recurrence of intussusception.  Owing to the small number of cats in the 2009 study that underwent enteroplication, we aren’t able to draw any conclusions as to whether this technique is beneficial or not in preventing recurrence, compared to the potential risks.

            Squeegee’s intussusception was easily reduced at the time of surgery, and enteroplication was not performed.  She was spayed at the same time.   I spoke to her owner a few days ago, as they were preparing to celebrate her first birthday.  She is doing well and she weighs approximately twice as much as when she came in to my hospital feeling sick.  Because recurrence is a possibility, we will always remain on our guard, but for now it seems that she’s made a total recovery.

           

Friday, June 10, 2016

Take Your Cat on an Adventure!

Compensation was provided for this post by Purina
www.mygreatcatadventure.com


Personal friends, Facebook friends, and readers of my blog undoubtedly remember the poignant final weeks that I spent last year with my cat Crispy. 


I wrote several blog posts chronicling her diagnosis with an uncommon type of cancer, her brave battle in the hospital (two surgeries and a blood transfusion), and her amazing recovery at home.  Ultimately, she succumbed peacefully to her illness, however, those last weeks were wonderful in many ways, and looking back on how things played out, I can honestly say that I have no regrets about any decisions I made, and I couldn’t have scripted a more gentle, peaceful passing.

What I hadn’t anticipated, however, was how Crispy’s departure would affect the life of my other cat, Mittens.  Crispy and Mittens were not close.  In fact, they could take or leave each other, and that’s putting it kindly.  You can see the tension below, as Mittens tries to claim a piece of Crispy’s blanket.

Monday, April 25, 2016

Caring Words from a Cat Owner - A Feline's Life was Saved due to Dr. Plotnick's Bartonella Article

Hello Arnold Plotnick,

In a few words, I wanted to thank you for saving my cat's life. She was 4 months old, a silver Egyptian Mau, when she got uvietus. All of her specialist told me she had FIP. I was waiting for her to die while I researched on the Internet daily for a cure. I did this for 8 months with no luck. We treated her infection with daily doses of prednisolone. This kept the infection at bay but it returned instantly if her medication was altered in any way. She remained on this medication until she was around 1 year old. It made her bloated and heavy but she did not die. She did not have FIP after all. She did acquire gingivitis which is rare in young cats.

Sunday, April 17, 2016

Purina Shredded Blend. Finally, a food Mittens truly loves.

Trying to find an ideal food for my cat Mittens is one of life’s great challenges.  Like many cats, the gene for fussiness is firmly embedded in her DNA.  She’s one of those cats that eats to live, rather than lives to eat.  In some ways, it’s nice to have a cat that isn’t terribly food motivated.  She never wakes me up at 4:00 in the morning to ask for food, and she doesn’t pester me every time I go into the kitchen.  As a cat veterinarian, I hear these kinds of complaints daily.  Thankfully, as a cat owner, I don’t experience them myself. 

In some ways, however, I do wish Mittens was a little more enthusiastic about food.  About four years ago, she began having digestive issues.  It’s normal for a cat to vomit occasionally, and Mittens started out as your typical once-a-month vomiter.  However, it soon escalated to twice a month, and then twice a week, and then twice a day!  That familiar, horrible middle-of-the-night retching noise became the soundtrack of my life.  I ran all of the appropriate tests, and my suspicions were confirmed when endoscopy revealed that she has inflammatory bowel disease (IBD).   Fortunately, she has responded dramatically to anti-inflammatory medication, and I literally cannot remember the last time she vomited her breakfast or dinner. 

Cats with IBD sometimes have trouble maintaining their body weight, and I’ve been vigilant in my search for a nutritious food that excites her.  She’s a bit of an oddball in that she has zero interest in canned food.  Sure, she’s interested in the salmon on my dinner plate, but a can of salmon cat food?  Yawn.  She’ll hover nearby when I’m eating a piece of chicken, and will readily eat a little piece if I offer it to her.  But of course, she turns her nose up at a can of chicken-based cat food.  It’s frustrating.

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