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Ask A Vet Online – My cat is itchy with watering eyes…

Ellie Masters asked: My cat is scratching above his eyes and losing fur, sometimes his eyes water too. this happened earlier in the summer he went through testing nothing found, he's treated with stronghold so no fleas etc. All help appreciated as at wits end now
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Ask A Vet Online – Help! The fleas are revolting…

flea-63043_1280 Anne Stafferton asked: This one is a bit boring really I've spent hundreds of pounds on flea stuff only for it not to work I breed cats so it's a nightmare I'm now combing them all every day to get fleas out any suggestions on what really really works Answer: Hi Anne, thanks for your question about fleas in cats. I know exactly what you mean – they can be a real nightmare to get under control! I’m going to answer your question by (briefly!) discussing the flea life-cycle and how it can be broken, and then talking about the specific treatments that are available. As a warning, on a blog like this I am legally obliged to use the generic names for all the drugs and medicines (otherwise I would get nasty letters from the Veterinary Medicines Directorate, the government department who regulate advertising of veterinary medicines). You can, however, look up any of the generic names for the active substances and “translate” them into brand names on the VMD’s Product Information Database. What are fleas? Fleas are a group of obligate ectoparasites – this means that they live on the outside of other animals, and cannot survive in any other way but by sucking the blood of their hosts. Once an adult flea lays her eggs, they fall onto the floor, the carpet, and into the cat’s bedding. Here they hatch into larvae, which live, hidden deep in the fabric, in the dust, and in cracks in floorboards etc. The larvae survive primarily by eating the faeces of adult fleas, which fall off the cat as the “black sand” we all know and hate! This material is semi-digested blood, and is very nutritious for the larvae. After their final moult, they turn into pupae (like the chrysalis of a butterfly but less pleasant) and there they stay, waiting for a chance to hatch. Pupae can remain dormant for months or years, and in this state they are more or less impervious to virtually any treatment we can use against them (although apparently repeated steam cleaning can kill them). When they detect air movement, heat, or increased carbon dioxide levels (all indicators that a cat, dog or human is close), they hatch and leap on board, to feed, breed and repeat the cycle. Traditionally, we think of fleas as being a spring and summer problem; however, with modern insulation and central heating, nowadays we see them all year round. The flea life cycle can only complete in a relatively warm environment, but we kindly provide them with a nice warm, comfy house to grow up in. So how do you break the cycle? There are a number of points at which the cycle is vulnerable – however, it’s important to remember that if the cats go outside (even briefly) they can pick up new fleas (deposited by other cats, dogs, foxes and even small mammals such as rodents). It only takes one amorous flea couple to reinfest a whole household… The adult fleas are actually pretty easy to kill – even old-fashioned drugs like fipronil will kill most of the adults present, and many of the newer medications are much more potent. The larvae need to cut their way out of their eggs (using a special “egg tooth” made of chitin); if their synthesis of chitin is impaired (e.g. by lufenuron) they cannot hatch. The larvae cannot develop into adults in the presence of juvenile hormone – if this is chemically supplied (as an Insect Growth Regulator, e.g. S-Methoprene), they cannot make the change into adults. The number of eggs, larvae and pupae in the house can also be reduced, by washing of fabrics (especially bedding) in hot (60C) soapy water. Although it won’t kill all of them, it will reduce the numbers and wash a lot away down the drain where they can’t hurt anyone! The pupae themselves are pretty much impervious to any treatment, but they can be “tricked” into coming out as adults, which are then much easier to kill. The common method is regular vacuuming – the air movement and heat trick the pupae into hatching; you won’t catch many in the cleaner, but once out, they are vulnerable to environmental insecticides. In fact, if you keep a “closed household”, with all the cats (and dogs if you have any) living indoors 24/7, it is theoretically possible to break the life cycle without treating the adults at all… but it will take a long time (the adults may live for 4-6 months) and you’re always at risk of a new introduction (in your clothes, for example). So how do I kill them? As you’ve found, there are a huge range of different flea control products on the market! Broadly speaking, these can be divided into 5 categories: Environmental insecticides: These are products used to spray the infested house, killing adults, sometimes eggs, and larvae. They will not kill pupae, but if applied rapidly after vacuuming, they can be very effective. Most products contain permethrin, which is toxic to cats – this means that you have to be careful using them, by treating rooms one at a time and shutting the cats out until they have ventilated. The cans will explain how long to leave it for on the label, or talk to your vet, before reintroducing the cats. On-cat environmental treatments: These are applied to, or administered to, the cat, to treat the environment, and rely on the fact that the larvae are eating the flea’s droppings. There are 3 particularly important ones:
  • Lufenuron – a chitin inhibitor, available as an oral liquid, a tablet, or an injection. Does not kill adults, but prevents larvae and pupae from hatching properly.
  • Pyriproxifen – an Insect Growth Regulator, available in some prescription-only fipronil products.
  • S-methoprene - another IGR, available in some prescription-only fipronil products.
  • Imidacloprid – an insecticide available as a spot-on that kills adults and larvae in the vicinity of the treated cat.
Over-the-counter adulticides (products that kill adult fleas only): These are of various effectiveness; most contain piperonyl butoxide or dimpylate (not very potent but pretty harmless) but there are still some on the market containing permethrin, which although effective is potentially lethal to cats. In general, if it is available over-the-counter without any regulation, it’s probably not that powerful. The most popular products in this group are the spot-ons containing fipronil, which is an older drug but still fairly effective. Some of these products are over the counter, and others are classified “NFA-VPS” (which means there are certain restrictions on their supply, but they still do not require a prescription) Contrary to popular opinion, there is no conclusive evidence that resistance of fleas to fipronil is widespread – however, fipronil containing products are water soluble (so may wash off if the cat gets wet) and are much less effective than the modern prescription-only products. The other commonly used active ingredient is imidacloprid, which is a different class of insecticide that is active against adult and against the larvae. Again, it doesn’t suit every cat but may be useful. There is also an interesting product available as a tablet containing nitenpyam, which is very effective at killing adults – but only lasts 24 hours after being given. It is best used to kill off the bulk of the adults when starting a flea control program. Prescription-only products: Fipronil-combos – spot-on products containing fipronil plus an Insect Growth Regulator, to treat the adults and the environment simultaneously. Last between 4 and 8 weeks, but the adulticide (killing of adults) effect tends to wear off after about 4-5 weeks. Flumethrin/Imidacloprid combo collar – this is a collar containing flumethrin (a form of permethrin that is safe for cats) and imidacloprid. It lasts about 6-8 months, and is very effective – if the cat will keep it on! Imidacloprid/Moxidectin combo – another spot-on, that treats a wide range of different parasites. Lasts about 4 weeks. Selamectin – a spot-on product, but one that is absorbed into the cats system so it cannot be washed off – very useful for outdoor cats! It also treats roundworms and both mange- and ear-mites, but does require the flea to bite before it works. Lasts about 4 weeks. Indoxacarb – Another spot-on, but one that is utterly inactive in the cat’s body, until it is “turned on” by a unique metabolic action inside the flea, and the larvae if repeated every 4 weeks. Spinosad – a tablet, given once a month, that is really effective against fleas, but does cause some cats to vomit; if given with food, however, it normally stays down - it does require the flea to bite, but kills very, very fast (in a few hours). Herbal and homeopathic remedies: Available, but no proven effectiveness. I have heard garlic recommended, but, sadly, in my experience it just doesn’t work and is potentially toxic to cats. There’s so much choice! What do I do? Bottom line – you’ll never control fleas if you only attack one stage of the life cycle. You need to kill the adults (and I’d recommend you talk to your vet about the more potent, modern, prescription products rather than rely on older and less powerful medications); however, you also need to decontaminate the environment, with regular vacuuming, insecticidal sprays, and good old fashioned washing and cleaning! If you’re still struggling to get on top of the situation, talk to your vet – not every product suits every cat, and it’s sometimes necessary to try several alternatives until you find the product, and the control methods, that suit your cats and their lifestyle. All the best – I hope you can rid your cats of their unwelcome visitors! David Harris BVSc MRCVS
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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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How to help stressed-out cats whose owners think they are “behaving badly”

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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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Old cat, young cat: a bittersweet episode in the life of a companion animal vet

Mrs Kennedy was an elderly widow, whose only companion was a small seventeen year old cat called Puss. Mrs Kennedy had phoned me because she thought that Puss had broken her leg after chasing another cat.

I wasn’t expecting anything too serious. Cats commonly hurt themselves while fighting with each other. An owner may think that the leg is broken, but in most cases the problem is a simple cat bite abscess, which can be easily treated. However, this time it was different. The owner was right.

Mrs Kennedy explained how a neighbouring cat had sneaked into the kitchen, and Puss had leapt up to chase it away. Immediately afterwards, she’d started limping, and since then she had barely moved from her bed.

When I touched Puss’s shoulder I could feel heat and swelling, and when I gently probed deeper, I could feel the rough ends of broken bone. I asked a few more questions, and it turned out that Puss had been drinking more than normal for a few months, and she had begun to be fussy about her food. She had also started to vomit occasionally. The pieces of the jigsaw began to fit together, and I explained it to Mrs Kennedy.

Puss is very elderly and at this stage in her life, her body is gradually failing her. Her main problem is that her kidneys have stopped working properly, which is why she has developed an increased thirst and a poor appetite. As a result of her kidney failure, her bones have become very fragile. Unfortunately, advanced kidney failure in a seventeen year old cat is not easily treated. And worse again, a broken bone in a cat like Puss cannot be fixed. At this stage, all of her bones will be as weak as egg shells. If she carried on, Puss would continue to suffer from further broken bones during normal activities.”

Mrs Kennedy sadly shook her head. “ So it’s time to say goodbye.” She knelt down beside her cat, and gave her a last, long hug. I gave the painless injection, and Puss quietly passed away, as her owner whispered into her ear.

Mrs Kennedy told me how Puss had originally been a wild stray cat. She had finally been tamed after months of coaxing her into the kitchen with food. She had been Mrs Kennedy’s closest friend, but she would never have another cat. She was elderly and she could not bear to think about what might happen if she died herself. I tried to tell her that somebody would look after her cat, and that this could be arranged in advance, but she just shook her head again. I felt very sad as I left her house.

Two weeks later, I received a call from someone who had a half-tame feral kitten in their garden. They were moving house, and they didn’t know what to do with it. An idea occurred to me. I collected the kitten, and drove on to Mrs Kennedy’s house. When she answered the door, I smiled and I said that I had something that might interest her.

Mrs Kennedy could not take her eyes off the kitten in the basket beside me. “He is just like Puss used to be –the poor frightened creature. Bring him inside”. She went to her kitchen cupboard and took out a tin of cat food. I stood back, as she spooned the food onto a plate, and opened the cat basket. The kitten licked the food hesitantly, and then began to eat heartily. As he ate, Mrs Kennedy chucked his cheek gently. He looked up at her, and to my surprise, he purred. A new friendship had begun.

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