Sunday, May 17, 2015

Cats and the Veterinary Physical Exam - Twice a Year For Life

"Twice a Year For Life"

Take your feline friends to the veterinarian for semi-annual exams. 


            At our cat practice, we recommend that clients bring their cat in for evaluation every six months.  Most of our clients accept this without question, but some of our clients are puzzled by this.  “I always thought cats were supposed to be examined once a year”, they tell me.  I tell them that once a year is a minimum.  I really think twice a year is more appropriate for cats.  Here’s why:

            Cats are experts at hiding their clinical signs.  Evolutionarily, cats are programmed to hide signs of illness.  Predators instinctively look for the weakest or sickest animal to prey on, so cats do everything they can to pretend that they’re not sick, until they simply can’t hide it anymore.  By the time the cat reveals to the owner that the cat is sick, sometimes the illness has progressed too far to successfully treat. 

            In a previous blog post, I posted a chart comparing a cat’s age to a human’sage.  Early on in life, cats age relatively fast.  Once they hit adulthood, it’s a pretty steady progression, with each cat year approximating four human years.  Going to the veterinarian once every year would be the equivalent of a person going to the doctor every four years.  Going every six months would be the equivalent of going every two years, which is more reasonable.   I hate going to the doctor as much as anyone, and I delay it if I can, but even I will admit that going once every four years is too infrequent, and even every two years is still not often enough.  To illustrate my point, I’m going to use two real life examples, starring yours truly, and yours truly’s own cat, Crispy

             About a month ago, I went to my doctor for my annual physical examination.  I felt fine and I didn’t really want to go, but my insurance pays for one comprehensive physical exam a year, and I was due.   The first part of the examination was the usual temperature, weight, and blood pressure.  This was performed by the nurse.  My weight and temperature were fine.  As she was taking my blood pressure, she asked, “Are you nervous?”  I said no, but that I always have a little bit of “white coat effect”, so my blood pressure tends to be a little high on the first reading.  She said, “Your blood pressure is fine.  Your heart rate is pretty high, though.”  I asked her how high.  She said “148”.

            Whoa!  I’m not a physician, but even I know that this is pretty darn high.  She asked if I was feeling any palpitations.  I said no.  Feeling lightheaded?  No.  Experiencing any weakness, shortness of breath, less tolerance for exercise?  No, no and no.  In fact, about three hours before the appointment, I was on the cross-country ski machine at the gym, doing my usual 45 minutes.  I felt great. 

            They performed an EKG and then I waited while for my doctor to finally come into the exam room.   He came in and asked me the same questions about weakness and palpitations.  When I told him I felt fine, he said, “Well, your EKG indicates that you’re either in atrial flutter or atrial fibrillation.  I’m going to transmit the EKG to your cardiologist and see what she says.”

            To make a long story much shorter, I had atrial flutter.  Two weeks ago, I had a minor procedure performed, called an ablation, that corrects the rhythm.  It was successful, and I’m back to normal.  The major point here being:  I had ZERO clue that anything was wrong with me.  If I had not scheduled that appointment, eventually, I would have started to feel the weakness and exercise intolerance that they asked me about.  The heart is a muscle, and it is not meant to contract at 148 beats per minute for prolonged periods of time.  The weakness and exercise intolerance that I would have felt, had they not detected this when they did, would have been signs of heart failure!   Most people with heart rates of 148 beats a minute do feel something, but I go to the gym regularly.  My doctor said that because I work out a lot, my body is pretty used to having periods of high heart rate.  People who are out of shape or who don’t work out tend to have heart rates that stay within a relatively narrow range. If they develop atrial flutter and their heart rate zooms up, they feel it.  They feel the palpitations. They feel weak and out of breath.  I guess I’m like a cat.  My clinical signs remained hidden.  Eventually, I would not have been able to hide it, but because I went to the doctor for a ROUTINE physical, it was detected. 

            And now, another case to illustrate the point:  my own cat, Crispy.  If you’re a regular reader of this blog, you are familiar with the saga of Crispy’s cancerdiagnosis and successful surgery.  I won’t rehash the entire story here, but I will reiterate the critical part – detecting the problem in the first place.  As Crispy has aged, she has become a little less fastidious in the grooming department.  So, I take her into Manhattan Cat Specialists for a bath, and while she is there, I run some blood tests and make sure she’s okay. 

            Two months ago, I brought her in for her bath, and I drew some blood for a senior profile.  I then tried to get urine for a urinalysis.  As I felt her abdomen to try to isolate her bladder, I felt a mass.  My colleague Dr. Sheheri was working that day, so I asked her to feel, and she confirmed that something indeed did not feel right.  Fast forward:  Crispy ended up having an intestinal tumor.  It turned out to be a highly malignant tumor called a hemangiosarcoma.  It’s also an uncommon tumor.  I’ve seen a few in cats, mainly affecting the skin.  In dogs, they commonly affect the spleen and the heart.  Visceral hemangiosarcoma, where the tumor is affecting an abdominal organ, is a rarity.  There’s very little published about this tumor in cats, but the survival after surgery is usually not very good.  Well, I can’t tell you what Crispy’s long term prognosis is, but now, about 8 weeks after surgery, she is feeling fantastic.  In fact, she really has never seemed better.  She’s even better than before the surgery!  She’s active, lively, very mentally engaged in her surroundings, loves to eat, and even has been playing with strings that I dangle in front of her.  The reason why I think she is doing so much better than the cats in the published reports is that these cats were diagnosed with their illness after they began showing clinical signs of illness.   This type of tumor doesn’t appear overnight.  It grows slowly, and cats hide the fact that they’re ill, and when they finally can’t hide it any longer, they show you they’re ill, and by then, the disease is very well established.  My Crispy had NO clinical signs at all.  She was eating well, drinking normally, no vomiting, no diarrhea.  She had lost about a pound, but it was subtle enough to miss if you’re living with her every day.  I detected Crispy’s tumor on a routine physical examination before any signs of illness were present.  And that’s the point. With cats, early detection is key.  The best way to achieve early detection is to examine cats frequently, and do blood and urine tests regularly. 

Early detection is key.  I’m living proof of this, and so is my cat. 

Twice a year for life.  I can’t say it enough. 



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