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Oscar, the grumpy cat who needed twice daily injections to treat his diabetes

[caption id="attachment_4489" align="aligncenter" width="585"]Oscar does not tolerate humans who annoy him Oscar does not tolerate humans who annoy him[/caption]

Oscar, a ten year old cat, had started to lose weight, despite the fact that he was eating well. His coat had begun to look bedraggled, as if he was not grooming himself as much as usual. His owner had noticed him visiting his water bowl more frequently, and she had needed to fill up the bowl every day, rather than every three days.

When I examined him it was clear that Oscar had lost a significant amount of weight. His ribs were prominent, and I could feel the sharp tips of the bones of his back. When I weighed him, I discovered that he had lost a kilogram since his previous visit.

Physically, I could find no obvious cause of a problem, so I decided that a blood profile was needed. Fifteen minutes later, the printout from the biochemistry analyser gave me the clear-cut diagnosis of his illness.

Oscar’s blood glucose was around four times higher than normal. The only possible reason for this was the condition known as diabetes mellitus. Oscar’s pancreas had stopped producing the hormone called insulin, and as a result, his blood glucose was not being controlled. Weight loss, ravenous appetite and copious thirst are classical signs of diabetes, in cats just as in humans and dogs.

As I explained the diagnosis to his owner, I could see a worried furrow developing across her brow. I explained that Oscar’s condition was treatable, but that he would need to have a daily injection of insulin for the rest of his life. Her shoulders slumped, and she looked at me sadly. “Nobody would dare to give Oscar an injection”, she told me. “He’d just get so annoyed with us if we tried something like that!”

I reassured her that the injection was given with an ultra-fine needle, and that only a tiny amount of liquid would be needed. For a cat of Oscar’s size, the volume of insulin would probably be around one hundredth of a teaspoonful, which is literally a single drop. It was very likely that he would barely notice the injection.

I demonstrated the injection technique, using a piece of fruit – an orange – as a practice target. It took a few attempts until she had learned to hold the syringe correctly, but soon she was able to insert the needle steadily and firmly into the orange. She was still very anxious about injecting her cat, so we decided that it would be best for her to bring him in to see me for his injection every morning for the first week.

The technique was simple. I gave Oscar a bowl of his favourite food, and as he lowered his head to eat, I quickly slipped the injection into the scruff of his neck. He stopped eating for a moment, and looked suspiciously at me before recommencing his meal. On day three, his owner gave the injection herself, and by day five, she was able to do this quickly and confidently.

After several dose adjustments over a few weeks, Oscar’s blood glucose had returned to normal. At the same time, his owner reported that his excessive thirst had disappeared. It seemed that his diabetes had been controlled.

The success of his treatment was confirmed at his final visit six weeks later. As the cage door was opened, Oscar stepped out in a confident and dignified fashion, with his head held high. He had put on weight, he was grooming himself again, and even his whiskers looked alert and bristling. He was definitely a healthy cat again.

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Wikivet blog: oral hygiene – the key to a healthy mouth in pets


It's well known that regular home care of pets' teeth is the only way to ensure optimal dental health, but it's also well known that most owners find this challenging. Dental experts have identified that there are two methods of home care, depending on an owner's ability to get involved: active and passive.

Brushing your pet's teeth a) Active home care is “hands-on” where the pet owner is physically involved with removing plaque and maintaining oral hygiene. Tooth brushing and applying anti-plaque agents directly into the mouth fit into this category. Active home care is the ideal answer, but it isn't always easy. It's known as the "gold standard" of preventive dental care. Clara, a Cavalier King Charles Spaniel, is a ten year old dog who is an ambassador for active home dental care. Her owner started to brush Clara's teeth when she was a pup, and has built tooth-brushing into her daily routine. Clara knows that before she can tuck into her dinner, she has to sit still for a 30 seconds while her owner whizzes around her mouth with a toothbrush and some chicken-flavoured toothpaste. The results of this daily routine are astonishing. Most ten year old dogs have advanced dental disease, with gingivitis, accumulations of tartar and missing teeth. Clara, in contrast, has teeth that are as healthy as a two year old's. Clara provides a good example of the power of active owner dental care. "Letting your pet clean their own teeth" b) Passive homecare refers to aspects of an oral hygiene program that help to reduce plaque in the mouth, but do not require the owner to get involved with the hands-on tooth-brushing or mouth-handling. Examples of passive home care include giving a special type of diet that helps to keep the teeth clean, or offering a dental chew to help reduce plaque accumulation. Jake is a ten year old terrier who has been given a daily dental chew for the past five years. His owner originally tried to brush his teeth, but he wouldn't let her. Many owners have this experience, and this has created a niche in the market that has been occupied by a wide range of commercial products. Jake's owner discovered that he loved the taste and texture of a dental chew, designed to be given once daily. Jake gets this every evening, as a treat before bed. His owner has reduced his daily food ration to take account of the calories in the dental chew, and he's stayed at his ideal weight. Jake did originally need a dental clean up and polish, to remove the build up of tartar that had occurred before he started his dental chews. But the daily chew regime has worked wonders for his back teeth (the molars), and they're as clean as Clara's. The front teeth (canines) have accumulated some tartar (Jake doesn't use these when chewing), but the problem is a minor one that doesn't need any intervention at this stage. Home dental care is an important part of a pet's daily routine, whether you choose an active or passive approach. To find out more, read the Wikivet section on dental hygiene, by clicking here.

How to help stressed-out cats whose owners think they are “behaving badly”


One of the challenges for veterinary surgeons working in the media is that is that they are often asked about one specific patient, with a particular problem. While it's helpful for the individual owner to discuss their own pet, it can be less enthralling for other readers.

Here are a couple of examples:
  • Ginger, a 5 year old neutered tom cat, had started urinating in his owner's bathtub, and occasionally in the sink downstairs. He had always been a "good" cat, going out through the cat flap to do his business. Why would he change like this?
  • Harry, a two year old neutered male tabby cat, had recently started to suffer from injuries caused by cat fights. His owner had seen a big tom cat stalking him in the garden, and the cat had even come into the kitchen on one occasion, stealing Harry's food. Why was this other cat doing this, and what could be done?
Ideally, both of these questions deserve to be analysed in their own right, and a full, detailed response given. Vets in the media often do this, publishing the dialogue and outcome. While this is useful, it isn't always the best way to give a detailed explanation about cat behaviour that will be useful for all readers. This is an area where Wikivet offers a different approach. There are two Wikivet sections that are particularly relevant to the cases under discussion. First, there is an entire section on feline territorial behaviour. This is an up-to-date scientific review of our current understanding of cat social life, and it's highly relevant to any incident involving cat-cat interactions. The Wikivet entry includes some useful facts:
  • In urban areas the density of cat populations may be high, exceeding 50 cats per square kilometre.
  • 81% of 734 UK cat owners whose cats were allowed outdoor access indicated that their neighbours also had at least one cat that was allowed outside
  • In houses with a standard cat flap, 24.8% reported that other cats came into their home to fight with their cats, and 39.4% reported that they came in to steal food.
  • Cats that had experienced injuries due to conflict with other cats showed 3.9 times the rate of indoor spray marking compared with cats that had not experienced injuries.
You can read the full Wikivet page for yourself to find out more helpful facts about cat social life. Second, another Wikivet page  focuses specifically on the issue of indoor marking, highlighting the fact that the two main scenarios leading to indoor marking are conflict with non-resident cats, and conflict with resident cats. The page suggests some answers that may help specific cases, including mentions of treatment approaches ( from an electronic coded cat flap so that outside cats cannot gain access to the home to the use of Feliway diffusers and spray, to mentions of some of the psychoactive  medication that may be prescribed by vets for super-stressed moggies. There are also links to detailed videos by behavioural specialists which go into more details on the subject. So if you have a cat who seems to be agitated by local rivals, or who has taken to indoor urinating, read these Wikivet pages. They may help you solve the problem, and if they don't, you'll be far better informed when you do take your "badly behaving" cat to your vet for the next stage of help.
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Kittens with passengers: ear mites

[caption id="attachment_4382" align="aligncenter" width="640"]Ear mites are very common in kittens Ear mites are very common in kittens[/caption] When a litter of rescued kittens were brought to see me recently, a careful examination of their ears was an important part of the check-up. I introduced the tip ofthe auroscope into each kitten’s ear, and by looking through the instrument I was able to see a magnified view of each ear canal. In normal animals, the pale blue-grey of the eardrum itself can often be seen. However, in these kittens, I could hardly see any normal ear canal. My view was blocked completely by thick, brown, sticky earwax. The cause of the excessive ear wax could be seen very clearly. Tiny white wriggling insect-like creatures could be seen swarming around the inside of each ear. The kittens were infected with ear mites. Ear mites are very common in kittens. They are very small mites, each measuring the size of a pin-head. They are very active, and they tend to move away from bright light. When examining an ear with an auroscope, ear mites can often be seen moving quickly out of the field of vision, as if running away from the vet. Ear mites are highly infectious, and they are especially common in feral colonies of cats. The adult mite feeds on the secretions produced by the lining of the ear. Eggs are laid inside the ear. These hatch out into tiny larvae which then mature into adults, and the life cycle continues. If one cat pushes its head against the body of another cat, ear mites can easily be transferred from one to the other. Kittens are obviously in very close contact with their mothers and with each other, so it is very common to find entire litters of kittens affected by dramatic infestations of ear mites. Most of us are familiar with the discomfort of an irritation in the ear, even from something as harmless as a small quantity of water lodging in our ears after swimming. The concept of live, wriggling insects crawling around inside the ear canal is very unpleasant! In many cases, kittens do show dramatic signs, such as repeated scratching of the ears. In other cases, an owner may have noticed the animal shaking their head more than usual,. However some cats, even with severe infestations, show no obvious external signs. Close examination of a kitten’s ears with an auroscope is essential to detect such ‘invisible’ cases. Ear mites can also affect dogs, but they are less common. Fortunately, there is no risk to humans. Those alarming, tiny, wriggly creatures are not going to crawl onto your hand, up your arm and into your own ear. However, if you have a household of dogs and cats, you do need to treat every animal individually to ensure that you have completely eradicated the infestation. Treatment of ear mites is not always easy. The mites are sensitive to most insecticides and a range of drops and ointments are available from your vet. The only complication is that the eggs of the ear mite are resistant to treatment, and these can remain unhatched for up to three weeks. This means that it may be necessary to continue to medicate affected kittens for an entire three week period, to ensure that all eggs have hatched with the resulting larvae being eradicated. Young kittens can be difficult to hold still, and they often learn how to escape from your grasp, so after the first few days of treatment it can become more difficult to continue. I saw the kittens again two weeks after their first visit. They were all in wonderful form, purring, playing with each other, and growing rapidly. Their ears were clean, both inside and out. They were ready for their new homes – with no passengers included!
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Could your cat have high blood pressure?

High blood pressure is a common problem for humans but did you know that cats can get it too? High blood pressure, also known as hypertension, is actually quite common in older cats, especially those with other diseases such as kidney disease or hyperthyroidism. The symptoms can be quite subtle or mimic those of other diseases so many cases remain undetected for quite some time. If left untreated, however, hypertension can lead to significant secondary health problems, so it’s definitely worth testing for. [caption id="attachment_4332" align="alignleft" width="288"]Bob having his blood pressure checked. Bob having his blood pressure checked.[/caption] What exactly is high blood pressure? High blood pressure occurs when the pressure within the blood vessels exceeds a certain threshold. Think of the hosepipe used to water your garden. If you turn the tap on too strongly, the water shoots out of the nozzle uncontrollably, damaging your flowers. The same is true for the body – organs like the brain and kidneys need blood to survive but if the blood pressure gets too high, it can start to damage the very organs it is trying to keep alive. To further complicate things, blood vessels have a tendency to leak under pressure and this extra fluid can cause further problems. How do cats develop high blood pressure? Many things can cause hypertension in cats from certain medications to neurological disease, but the two most common causes are kidney failure and hyperthyroidism. Both of these illnesses cause alterations in the very precise mechanisms that monitor and control blood pressure. It doesn’t always correlate with the severity of the disease (i.e., severe hypertension can be seen with only mild kidney disease) and in the case of hyperthyroidism, we sometimes see hypertension develop only after the thyroid problem has been treated. What are the symptoms of hypertension? The clinical signs associated with high blood pressure depend on which organs are most badly affected. One of the most common signs is acute blindness because the high pressure within the vessels of the eye causes the retina to detach from the nerves that tell the brain what the eye is seeing. So you may notice the cat bumping into things (although it’s amazing how many owners aren’t aware of their cat’s blindness because cats are so good at using their other senses to compensate), staying closer to home or having very dilated pupils or ‘wide eyes’. Another organ that is commonly affected is the brain so you might see serious signs such as circling and seizures or perhaps much more subtle behavioural changes such as crying out at night or being less sociable when people are around (how else would you tell if your cat had a headache?). You may see bleeding in unexpected places like nosebleeds or blood in the urine. It can also speed up the progression of kidney failure. The list goes on so any unexplained physical or behavioural change warrants a blood pressure check, especially in older cats. How is high blood pressure diagnosed? The only way to tell if a cat has high blood pressure is to measure it. The process is much the same as it is in humans – a cuff is inflated around the arm or leg (or possibly the tail) which controls blood flow to the limb. A special device (sometimes a handheld Doppler unit or sometimes an automatic sensor) then measures the blood pressure. It doesn’t hurt and isn’t usually a stressful process that is good because if the cat is stressed the reading can be artificially elevated. Sometimes the cat objects to the cuff being tightened so it can help to practice a few times before taking the reading. Some cats just plain hate going to the vet or any kind of restraint whatsoever so it isn’t always possible to get a reading, although many clinics have special protocols in place to help the cat stay as calm as possible before attempting to take a blood pressure. If all else fails in the clinic, a reading might be possible at home where they are more comfortable. Is there any treatment? Absolutely. There are several medications that can treat high blood pressure but the one that most vets use these days is called amlodipine. A very tiny dose goes a long way, and it’s important that once you start the medication, you give it regularly to avoid dangerous spikes in blood pressure. Once a cat starts the medication (usually a tiny tablet that most cats seem to tolerate relatively well) it’s important to follow up with regular blood pressure checks to ensure that they are on the correct dose. I’ve seen many cats respond very well indeed to treatment and many owners report that their cat seems years younger once their blood pressure is under control, even if they hadn’t noticed any symptoms in the first place. It is yet another example of how well cats can hide their illnesses and how important it is for owners and vets to work together to detect health problems while there is still time to treat them effectively. If you think your cat is showing signs of high blood pressure or if you have an older cat with unexplained physical or behavioural changes, please speak with your vet about having their blood pressure checked. You may never know unless you make an effort to look for it. Amy Bergs DVM MRCVS  - Visit The Cat Doctor website by clicking HERE
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