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.

Tuesday, April 12, 2016

Here's a Photo of Me in Vet School - 1987 - Hangin' with a Goat





I decided to start an online group for my college classmates, and came across this photo.   Here's me in 1987 hanging with a lil buddy.

Monday, March 21, 2016

My Trip to Burma: Bago, an interesting city to end our amazing trip.

Well, I had a mediocre night’s sleep.  Ambien just doesn’t seem to work for me anymore.  I was hoping for a good night’s sleep, because we have a grueling day ahead.  Hours of sightseeing, then a few hours at the airport (our flight leaves at 10 minutes to midnight), then five hours on a plane to Beijing, seven hours on a layover in Beijing (ugh!), and then almost 14 hours to JFK airport.  Hey, it is what it is.

We met back up with Myo, our guide from our very first day.  Our bags were loaded into the car, and off we went to Bago. Located a 90 minute drive northeast of Yangon, and formerly known as Pegu, the town of Bago was the capital of several Mon and Burmese kingdoms, and flourished as a bastion of Theravada Buddhism in the 15th century, and then as a regional trade center in the 16th century. Each time a new kingdom arose, new gilded pagodas and reclining Buddhas were added. This quiet, scruffy little provincial market town now boasts a spectacular crop of monuments spanning more than 1400 years of history.  Bago has been chosen as the location for Yangon’s new Hanthawaddy International Airport, so the town will become even more accessible, if the project ever is completed. (It started in 1994, so don’t hold your breath.)

The drive to Bago took a while, and wasn't very scenic, I'm afraid.  But as we headed north toward Inya Lake, I knew we were getting close to Aung San Suu Kyi's home, so I asked if we could take a detour and see it.  


 Outside are prominent signs indicating that this is the headquarters of the National League for Democracy, and there's a picture of her father, General Aung San, at the top.


Saturday, March 19, 2016

My Trip to Burma: We return to Yangon for a glorious, unguided afternoon.

Our last morning in Mandalay.  Rough night for my partner, Mark, though.  The very spicy tomato dish we had for dinner last night at Too Too caused heartburn that kept him up half of the night.  A handful of Tums and a couple of Rolaids finally did the trick and he got a few hours of sleep.  We headed upstairs for our final breakfast.  I can’t eat “Asian” food for breakfast.  Fried rice, egg rolls, vegetable stir fry…  not at 7:30 a.m.  Today they had little pancakes, which were pretty good.  Again we had a nice chat with the kindly hotel manager.  We told him we visited Pwin Oo Lwin yesterday. He said he attended boarding school there from the age of 12 to 20.  Marn had told us that the town was known for their fine boarding schools.   

Our driver was waiting for us in the lobby.  True to form, he drove like a madman to the airport, getting us there 30 minutes earlier than anticipated.  We went to our gate and waited, with many others, for our flight to Rangoon.  In Burma, the public address system is a guy shouting out your gate number, followed by a swarm of humanity.  At 10:45, our flight time, an airport worker shouted out some numbers, and everyone rose and rushed the gate.  We got to the gate and were steered back, saying that this was not our flight.  We went back to our seats and watched as everyone boarded the plane except for me, Mark, and four other people.  I don’t know where all those other folks were headed, but I’m thinking, there’s no way that there’s only six of us flying to Yangon.  Two of the others looked American, and they were holding boarding passes from our same airline, AIR KBZ.  I asked where they were going, and they said Bagan.  Now I’m worried.  Did we miss our flight? Are we at the wrong gate?  There was no one there even to ask.  Then, after a few tense minutes, a KBZ guy signaled for us to come through.  We all got on a bus, and were soon joined by about three others, and nine of us were taken to the plane.  Our flight to Yangon was stopping in Bagan first.  And yes, it was just nine of us on the plane. 

The flight from Mandalay was pretty short.  The view from the plane was neat.  The farmlands below gave the landscape the appearance of a patchwork quilt.


We checked into the Grand United 21st Downtown hotel, the same one we started with in Yangon at the start of our trip.  The room was a little better this time, sunnier with a nicer view.  

We had the rest of the day to ourselves, and since our hotel was on the outskirts of Chinatown, we explored Chinatown a little bit. Many big cities have a Chinatown, and Yangon is no exception.  Covering roughly the area south of Anawrahta Road between Shwedagon Pagoda Road and Lanmadaw Street, it’s the home for many of the city’s Chinese-descended residents. This is a pretty fun part of town.  Two main sights in Chinatown are the Guanyin Gumiao Temple and the Kheng Hock Keong Temple. We checked out the Guanyin Gumiao first.  This temple attracts mainly a Cantonese crowd.  The tiles interior is nice, with red tables containing incense pots, flower vases, and nicely lit shrines.

Wednesday, March 16, 2016

My Trip to Burma: The charming town of Pyin Oo Lwin, and the beautiful Kandawgyi Gardens.

Today we got an early start.  We were picked up at our hotel by Marn and our driver, and off we went.  Sixty-five kilometers east of Mandalay, on the western edge of the lush Shan Plateau 1070 meters above sea level, is the town of Pyin Oo Lwin, sitting far above the dust of Central Myanmar. It was established relatively recently (1896) as a military post providing refuge from the stifling heat of Yangon and Mandalay.   It was originally named Maymyo, or “May Town”, after Colonel James May, the town’s first governor, who was stationed on an early army base here. Once the railline to Lashio was completed, the town became the official summer capital of the British Burma administration.  While Mandalay and Pyin Oo Lwin are only 65 km apart, they feel a world apart.  Mandalay marches on to being a modern developed city, while Pyin Oo Lwin nurtures and builds on its past.

Being more than 1000 meters above sea level, the town is famous for its pleasant, much cooler climate than that of Mandalay and Yangon, which appealed to the homesick British.  After Burma gained its independence, the sizable Anglo-Burmese community gradually dwindled, but the Sikh and Nepali minorities whose forbearers were brought here to work on the railroads that are still very much in evidence.  Its role as a hot-season retreat from the steamy plains has seen a new lease on life in recent years, with the rise of an affluent Burmese middle class. Several of the old hotels have been (or are being) renovated, among them Candacraig, and dozens of new establishments have open since the tourist boycott was relaxed in 2010.

The history of this town is still evident today in other ways. Military connections still remain – the Burmese Army’s Defense Services Academy (training the “Triumphant Elite of the Future”) is just west of the center of town. Horse-drawn carriages clip-clop past the mock-Tudor and Scottish Baronial mansions with turrets and ample verandas, the bells of Purcell Tower chime every 15 minutes, strawberries are sold alongside tropical fruit at the Shan Market, and the best of the British leftovers – the National Kandawgyi Gardens – has been revamped, presenting neat beds of tulips alongside half-wild groves of teak trees. Further afield, the plunge pools of Anisakan Falls and the interesting Peik Chin Myaung Cave make Pwin Oo Lwin a perfect day trip.  Perfect, indeed.  

We started at the Shan Market.  Originally, Shan farmers gathered here to sell their produce because of the market’s proximity to their villages east of Pyin Oo Lwin.  But rents have gotten too high, causing the Shan to move to a muddy lane about 1 km further east.  The majority of stallholders and customers are Yunnanese migrants.


Here are some ladies selling Shan noodles.


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