Sunday, June 20, 2010

Another kind of hip hop

With almost an hour drive time between work and home, I have a lot of time to listen to the radio. One of the commercials I hear lately tells the story of a man who's arthritic hip is causing him enough pain that he can't enjoy his usual activities (golf) and causes him to walk with a noticeable limp. His children call the limp his "hip hop". The ad educates us about the benefits of seeing a particular hospital's Orthopedic Surgical Department for arthritis diagnosis, education and treatment.

Degenerative joint disease occurs in cats too. It is more commonly known as osteoarthritis, or just plain arthritis. Arthritis is commonly present in shoulders and elbows; hips, stifle (knee), hock (ankle) and lower spine. So, you may see more than just a "hip hop" when a cat has arthritis.

When I was a veterinary medical student,we were taught that cats did not get arthritis. Years later, I read an article about new studies indicating arthritis was more common than was previously assumed, yet the number of cats with arthritis was nonetheless still incredibly low. The most recent study we have has now revealed that over 90% of cats 12 years and older actually show arthritic changes on x-rays. Studies also now show that arthritis isn't even limited to elderly cats! While arthritis is most commonly an older cat disease, it is now often seen in much younger cats.

Amazingly, most cats with arthritis will not limp or refuse to use the painful limb(s). In fact, some cats with arthritis show no obvious signs at all!

Ok, I know what some of you are thinking right now..."of course they don't show signs, how can they show signs when they sleep 18 hrs a day?"

In my post about the Veterinarian as Detective, I explained how veterinarians pick up clues through observation. You can do this too.

Observing your cat's body language and knowing what to look for can help. Is your cat is slower or stiffer when he or she first gets up after a nap or sitting on your lap? Does going up or down the stairs take longer than it used to, or your cat just doesn't go up or down as often? Will your cat stand up in the litter box when he or she used to squat? These may be important clues in our diagnosis.

Moreover, even when you observe changes that please or displease you, they may be important in our diagnosis. When Fluffy doesn't jump up on the counters like she used to, you might be so happy with this change you don't realize she doesn't jump because it hurts her to do so. Just the opposite, you might be frustrated with the fact that Boots isn't using his litter box as often without realizing that it's because it's too painful for him to bend his hips & knees to get over the high sides. The normally affectionate Sweetie is now irritable and bites when petted or picked up because arthritic joints hurt. "Grizabella the glamour cat" might look pretty ragged these days because painful joints won't let her reach the places she needs to in order to keep that coat well groomed. So, be sure to tell us about all behavioral changes you see.

What should you do if you think your cat has arthritis? See your veterinarian. A thorough exam that includes an orthopedic exam is a good start. Such an exam may reveal swelling or crepitus (the medical term for the creaks and cracks we hear when your cat's joints are moved). Range of motion (an evaluation of how well or poorly the leg can be bent or extended) may show poor range or discomfort. X-rays may not detect very early arthritis changes, but are helpful to rule out other diseases. With increasing frequency I am finding obvious changes on x-rays. I never cease to be amazed at how severe some of the x-ray findings are in a cat that only has the mildest of limps.

Arthritis is a chronic condition, and while it may not be curable, there are a few things that you can do to help your cat live a more comfortable life. Weight management is something everyone can do and it is important in order to decrease stress on arthritic joints. Controling your cat's weight is also one of the few things you can do to help prevent or delay arthritis development.

You can also make changes in your cat’s environment at home so that your cat's life will be easier and more comfortable after diagnosis of arthritis. This can include adding ramps to allow your cat to reach higher areas (beds or furniture) without having to jump, providing litter boxes with lower sides to make it more comfortable to get in and out; and having a box on each floor so that your cat doesn't have to go up & down stairs as often..

Medical management has come a long way from the early days when we treated symptoms with aspirin and hoped for the best. We now have supplements such as Dasuquin and Adequan that help support joint health. Omega 3 fatty acids, and anti-oxidants such a SAM-e can decrease inflammation. When supplements alone are not enough to decrease discomfort, there are an increasing number of pain relief medications such as buprenorphine or gabapentin that are now available that can help. Other non-traditional treatments such as Acupuncture or Massage can also decrease your cat's arthritic discomfort.

Recognizing and treating arthritis can make a difference in your cat’s quality of life. And while your cat may not be a golfer like the gentleman in the radio ad, diagnosing and treating your cat's "hip hop" can help them enjoy many if not all of the things they used to do.

This cat has severe arthritis in both hips. The normally smooth ball and socket hip joints are not smooth, and are flattened instead of rounded as they should normally should be. The red arrows show additional bony deposits resulting from arthritis.

The red arrows point to arthritis changes in this cat's knee joints. None of these structures would be here in a cat without arthritis.

This large extra bony deposit confirms shoulder arthritis.

Tuesday, June 8, 2010

June is Adopt-A-Cat Month

Adopt-A-Cat Month
June 1, 2010

Approximately 4 million cats end up in shelters every year, including thousands born every spring and summer during “kitten season.” To help promote adoptions of these fun, affectionate animals, American Humane celebrates Adopt-A-Cat Month each June.
Your local shelter is brimming with cats of every breed, age and personality just waiting for a loving home. Whether you prefer young and frisky or mature and mellow, you’re sure to find the perfect cat companion during Adopt-A-Cat Month!

Tuesday, June 1, 2010

Happy Birthday Marta

Statistics state that 60% of Feline Leukemia positive cats die within 2 years of diagnosis, the number goes up to 85% by 3 years. That was the first thought to go through my mind when Heather, a clinic client, called to ask if I might be able to give a Feline Leukemia positive (FeLV+) cat a home.

Heather had called me in the past knowing that I had a FeLV+ cat at home and had given a home to several similar kitties over the years. She was fostering a FeLV+ momma and her new kittens. Having their own non-FeLV kitties to care for meant keeping the 2 groups separated. This is not always an easy task. My heart felt for the momma and kittens, but sadly, I had to say no, I was not able to add so many more cats to the household.

With time the virus took it's toll and one by one, momma and the kittens died. Now alone, her family gone, and hearing people and cats on the side of the door where she couldn't be, the 2 year old cat meowed her loneliness. Again, my heart felt for her.

This time it was one cat not several. This time I could see my own FeLV cat was lonely for a feline friend. This time I could say yes, but... the statistics ran through my mind.

My own "statistics" (it sounds so harsh when speaking about cats I loved so dearly) were worse. The 2 FeLV+ females that preceded this cat each lived only 15 months, my first FeLV+ male lived just past 2 years, my current FeLV+ male was just reaching 1 years old. Did I really want to take on a 2yr old FeLV cat, especially with my history? Did I really want to take on a cat that would break my heart at any time? Could I really ask my husband, who loved the cats as much as I did, to do it all again?

For any of you who have seen the movie, "Risky Business", you may recall the memorable quote by Joel's father "Sometimes you just gotta say what the heck". Maybe you recall Joel's friend Miles telling him the same thing only more graphically.

It was time for me to say "what the heck". For those of you who know me, this is not done easily or often, but I said it. I had a cat that needed a friend, there was a cat that needed love and a family, and I had plenty of love to give. What the heck.

Heather brought her to the clinic for for an exam and vaccines, and to introduce us. Her name was Marta. She was a 2 year old brown tabby and white short haired cat. She was overweight due to her lifetime of restriction to a single room, but otherwise healthy. She was a sweetheart.

At the end of the day Marta, along with her favorite toy, a flexible styrofoam rod, came home with me. She was quiet during our ride home, and quiet as she explored the new room that was to be her new home as she acclimated to her new life.

Marta's next few days were spent under the bed, coming out only when Bill or I were there with her. Soon, we found her snoozing on the bed or up on the perch we had set up for her to look out the window. During this time, Butters, my FeLV+ cat, stood watch at the door curious at the new kitty on the other side. From time to time, paws reached under the door from both directions.

When we thought she was ready, we opened the door to let her meet Butters and to begin to explore the rest of her new home. Butters adored Marta, Marta did not share his feelings but tolerated him. Marta preferred the safety of the familiar room but began to venture out and explore the bottom level. She spent her days gazing out the sliding glass door.

Milestones occurred...she took her first cautious steps on the stairway and a month after coming home, made her 1st appearance on the middle level. Soon afterward, she gathered the courage to climb the open stairway to the top level. The entire house was now her domain. Butters was accepted.

Summer came and went, giving way to winter. Marta helped put up her first Christmas tree. Winter gave way to summer, and as the sun moved farther south in the sky, the sunny spots in the house changed and Marta moved with them. Sadly, Butters became one of the 60% of FeLV cats that die within 2 years of diagnosis. Marta beat the odds, Marta turned 3, then she turned 4, and 5, and kept going.

Like most cats throughout their lifetime, Marta would show signs of illness. A vomiting spell, a period of decreased appetite, a bout of coughing. But she wasn't like most cats, she had Leukemia. Each time I feared the worst, was this "it"? And each time she recovered.

On Christmas eve day 2006 Marta wasn't herself. Always the Veterinarian, I examined her and felt a very large firm bladder. I recall telling Bill that if she were a male cat, I'd be concerned about a urinary blockage. As our families were arriving for Christmas, Marta and I were on our way out the door to the Emergency Clinic for Animals. The Dr. agreed with my assessment, so blood and urine tests were ordered. A quick ultrasound was performed on her bladder didn't find any stones but it looked like there may be a mass in her bladder, more tests were needed. I returned home to continue with Christmas activities but my thoughts were with Marta and her bladder mass. Lymphoma is a type of cancer associated with Feline Leukemia...was this an unusual presentation or did she have the still uncommon but more typical bladder tumor...was this "it"?

Late that night I received the diagnosis..special x-ray studies had confirmed that it was a bladder stone, not a mass. This was great news, the stone could be removed surgically. Would I authorize surgery on a 5 year old FeLV+ cat that had lived well past the time most cat do? Would I authorize surgery on a cat that potentially could die of leukemia at any time? Absolutely. What the heck.

Marta had an ammonium urate stone. This type of stone accounts for only 5% of bladder stones found in cats. Leave it to Marta to have a rare stone AND to be the only obstructed female cat I have seen in 20 years of practice, she's beaten the odds again!

Marta still has the occasional spell of vomiting and decreased appetite but her most recent lab tests look good. She has to contend with summer thunderstorms which she hates, and the addition of Gator, our Catahoula/Lab mix puppy adopted in January. She now has to duck under a barricade to get to her litter box and jump up to the counters to eat, but otherwise life is good.

Days are spent dozing in the sunbeams or gazing out the 3rd story windows watching the birds and animals that make their homes in our 5 acres of woods and prairie. Every jump up to the counter is rewarded with favorite treats, and brushing occurs as often as she'll allow. Evenings are spent on laps as we watch TV or work on the laptop. Nights are spent sleeping on the bed with us, starting out on Bill and moving to the pillow where she sleeps ON my head.

Over the last year, she has expanded her "duties" and has become "Nurse Marta". Marta rarely left Bill's side as he recuperated from his broken hip suffered last Memorial Day weekend in a bicycling accident (we joked that Nurse Marta was applying heat therapy because she insisted on laying on the broken hip) and did the same when the rod & pin were removed this May. After I was diagnosed with a blood clot in my leg and told to lay with my legs higher than my heart, Nurse Marta settled in on my lap, ensuring that I wouldn't move for fear of disturbing her.

Today, June 1, is the date that 9 years ago was designated as her birthday. Today she continues to beat the odds. Everyone who knows me, has heard me refer to her as my "miracle girl". Words can't express how grateful I am that 9 years ago Heather
called one more time to see if I could give her a home, and that I said "what the heck". Words can't describe how comforting it is to fall asleep to the sound of purring every night, even if it is on my head; and how stress melts away when petting her soft silky coat. I love to watch as she gets so excited watching the birds or see her completely as peace sleeping in her favorite sunny spots.

Happy Birthday Marta, I love you with all my heart.

Marta on her sunny spot on the stairs