Inappropriate Elimination (House-Soiling) in Cats
Wendy Brooks, DVM, DABVP
Despite the cat’s reputation for fastidious cleanliness, house-soiling is the number one behavior problem of our feline friends. Many cats are turned outside, given away, or even put to sleep for this behavior problem, and it behooves the veterinary profession to address it.
Urinating in odd places can mean a medical problem, a territorial marking problem, or some sort of social or environmental problem and sometimes the differences are not clear cut. Several factors may be in play and some conditions involve medical symptoms resulting from psychological stress. In other words, a combination of medical and behavior issues may be at work.
Should the Approach be Medical?
Illustration by Wendy Brooks, DVMThere are several medical conditions that can lead a cat to inappropriate urination and these should be ruled out so as not to get on the wrong track. The cat will need to be examined and get some testing. Conditions to rule out in part depend on the cat's age because young adults tend to get different diseases than do senior cats but, briefly, here are some conditions that should be checked out.
As mentioned, your veterinarian should evaluate your cat medically before you conclude that the problem is behavioral and you embark on a long-term behavioral approach.
Urine Marking / Territorial Anxiety
Cats use urination and defecation as a means of communication with other cats. By leaving their mark, they are telling other cats “I was here on this date at this time.” Other cats may then know this land has been claimed (or has not been recently claimed) and may act accordingly. Cats also mark by rubbing their faces on objects and by scratching vertically on surfaces. Psychological stress, such as other cats, moving to a new home, prolonged or sudden absence of the owner (who is usually viewed as a parent by the cat), noisy construction outside, visiting humans or other animals, or even new furniture may create a need for a cat to reassert a territorial claim. Signs that this kind of stress is causing the problem might include some or all of the following:
If any of these scenarios seem to fit, anti-anxiety medications may be tremendously helpful if the source of stress cannot be identified or cannot be altered.
Medications commonly used as anti-anxiety treatments for inappropriate urination include the following.
This medication has been helpful treating obsessive-compulsive disease and depression in humans and has been approved for canine separation anxiety. It has come to be the first choice of many behaviorists for urine-marking cats. In one study 80% of cats showed at least a 75% reduction in episodes of inappropriate urination within 4 weeks.
This medication is more commonly known as Prozac®. It has been used for feline urine marking and has been found of comparable efficacy to clomipramine. At least 8 weeks of treatment was required to achieve results in over 90% of cats and as long as they took the medication, they did not mark. If the medication is discontinued, marking may resume but is just as likely to respond a second time if the initial treatment was successful.
This medication acts by blocking the effect of serotonin, a brain chemical. Studies have found this medication to be approximately 75% effective in reducing inappropriate urination in about half the cats that used it.
It is typically given orally twice a day for a 2-week period. If it seems to work, the course is continued for a total of 8 weeks. After this period, it may be discontinued. Approximately half the cats in whom it is used do not resume inappropriate urination. The other half re-develop the problem and must continue on Buspar.
A Word on Female Hormone Treatments
These treatments have not shown as wide success as the newer medications listed above plus they have been fraught with serious side effect potential (mammary cancer and/or induction of diabetes mellitus). I recommend that these hormones be used only as an alternative to euthanasia.
Other Products for Anxiety
Several other products that help with anxiety are noteworthy, especially in situations where a cat is not amenable to taking medication or there is a medical condition that rules out medication.
Alpha-casozepine is a natural protein contained in milk and is responsible for the calming features of drinking warm milk. It is available in pill form and has been formulated into calming diets. It is not particularly sedating but has anti-anxiety properties helpful in creating a more "zen" brain chemistry. L-theonine is derived from green tea leaves and is available in tablet form for dogs and cats, and can also be used for anxiety management. Supplements such as these are compatible with the other therapies listed above so they may be used in combination with pheromones or with medications.
Pheromone Sprays and Diffusers
Feliway® spray is for the area being marked rather than a medication given to the cat. The spray has feline pheromones of the type that cats deposit when facial marking (i.e., rubbing their face/cheeks on things to scent mark). These pheromones provide a message in the cat's own language proclaiming that the territory is secure and there is nothing to worry about. This confers a general calming effect and reduces the cat's interest in marking. Feliway is available as a spray to apply to marking surfaces or as a plug-in deffuser that spreads pheromones through the room. Defusers last approximately one month.
When pheromone therapy was new, a study was conducted in 57 households with urine spraying cats. These cats marked on either vertical surfaces only or a combination of vertical and horizontal surfaces. Feliway spray was used twice a day on the urine marked areas for a one-month period. In one-third of households, urine marking stopped completely. In 57% of the households, urine marking was reduced and in 9.3% of households marking was unchanged. (Hunthausen, W., Evaluating a feline facial pheromone analogue to control urine spraying, Veterinary Medicine, Feb 2000, p 151 - 155)
Neutering is the first step in addressing this problem.
Hormonal motivations to mark territory are potent and must be removed from the picture.
Litter Box Aversion/Environmental Factors
Another reason why cats urinate or defecate outside the box is simply that the box is not acceptable to them. The box may be dirty, may not be adequately private, may smell funny or be uncomfortable. The following are clues that an inappropriate urination problem reflects litter box aversion:
The box should not be in a high traffic area. In a single cat home, the cat may have experienced something unpleasant in association with the current litter box (molestation by a child or dog, loud noise etc.) and needs a new bathroom area. It is important not to keep the cat’s food in a location near the box as the cat will not want to use the feeding area as a toilet.
Obviously, any litter boxes should be scooped daily or even twice daily and kept as clean as possible. Clumping litter should be changed at least monthly and non-clumping litter should be changed twice weekly. The box should be washed with soapy water or water alone with no strong-smelling disinfectants that might be objectionable to the cat.
Cat Attract is an herbal product designed to return the cat to the box. If the problem is difficulty in keeping the box clean, a self-cleaning box may be helpful. On the other hand, some cats object to the moving parts so use your judgement.
Another type of litter can be provided to see if the cat prefers a different brand or type. Signs that the cat does not like the litter include: sitting on the plastic lip of the litter box to eliminate, failing to dig a hole in the litter, and/or shaking the litter off the paws after exiting the box.
If nothing seems to work, the cat should be confined in a small area, such as a large plastic carrier, with a litter box. The cat is gradually allowed more area after proving that they will use the box. First, the carrier is the housing area, then a small room such as a bathroom or playpen is allowed, next a large room is added, etc. until the cat again has their usual access. Alternatively, the cat may be boarded in an animal hospital as housing in a small cage commonly brings the cat back to the litter box, plus the cat can be observed for other concerns that might be contributing to the elimination problem.
Odor eliminators should be used in marked areas to discourage the cat’s tendency to return there.
If these tips are not effective in restoring the cat’s proper toilet behaviors, a behavior specialist should be called in. Contact your veterinarian for the best consultant in your area.
Many people waste time and effort on the wrong approach until they are at their wit's end and are considering euthanasia. If your cat occasionally eliminates inappropriately, please inform your vet erinarian promptly.
Heat Sroke Havoc: Horses and Cows and Pigs, Oh My!
“Heat stroke? Horses get that?"
July 22, 2013 (published) | June 20, 2023 (revised)
By Christy Corp-Minamiji, DVM
It’s pretty hard to accidentally lock your horse or cow in the car.
Small animal veterinarians, humane societies, and even municipal police and fire departments have done a great job of reminding folks that car = greenhouse/oven and car + warm day + dog or cat = baked pet. Yet, for most people, that seems to be where the link between animals and heatstroke ends. Somehow, in the public mind, a car-external animal is magically free of all heat-related danger.
I think we may be victims of our own PR, or rather our animals may be the unintended victims of this small, but effective, snapshot of heat stress.
Here’s a slightly different picture of heatstroke – no broken windows involved…
It was the sort of puffy April day made for Easter cards. Before I removed the rapidly rising thermometer from my shaking, flared-nostril patient, I knew the sort of response I was going to get as soon as I made my diagnosis.
“He has heat stroke; can you turn on that hose over there?” I had already moved the horse into the shade for the examination.
My client, an experienced, educated horseman was nonplussed. “Heat stroke? Horses get that? But it’s only about 80F out.”
“Yep. Heat stroke.” I showed him the thermometer which had topped out near an impressive 107°F (a normal horse resides in the 99-101°F range). “We need to cool him down. Ummmm…the hose?”
Heat stress – also known as heatstroke, heat exhaustion, or more officially hyperthermia – happens when an animal either produces too much heat or doesn’t dissipate (get rid of) enough. The dog-in-car case is an example of a failure of dissipation. Temperatures rise in the enclosed environment and the normal methods of heat dissipation (i.e. panting) don’t work since there is nowhere for the extra heat to go. In healthy animals not receiving medications or carrying genes that may predispose them to hyperthermia, excess production usually results from excessive activity.
“But aren’t animals smart enough not to over-do it on a hot day?”
Ummmm…. Met any human long-distance runners lately? Humans aren’t smart enough not to work ourselves into heat stress (card-carrying member of the Stupidly Prone to Overdoing it on Warm Days League here), and neither are our four-legged friends.
The horse with the Death Valley worthy temperature had demonstrated a classic disregard for his own well-being. The owner, taking advantage of the lovely weather, had turned the normally barn-housed young stallion out for a nice romp in the front paddock. Spring is breeding season in the equine world and this young lad could smell all sorts of lovely ladies. The horse equivalent of an early-20s human male, he responded just as his human counterparts would: by showing off.
For two hours, the stallion ran himself silly, bucking, prancing, and bugling to any mare within the county limits. He did not stop for water in his corral, nor did he seek the shade that was at one end of the corral.
A dog turned loose in the dog park or on a beach on a deceptively warm day can run (literally) into the same trouble. Rarely did I ever treat heat stress cases in July or August when sidewalks in our region are made for egg-cookery. Like humans, animals tend to mope around looking for air-conditioning and ice cream when the mercury bursts from the top of the thermometer. It’s the first warm days of spring you have to watch out for.
Even outside the solar-cooker that is an automobile, heat dissipation can become seriously compromised for many animals.
Animals cool their bodies through water evaporation from: sweating (horses), panting (dogs), or soaking themselves in water (pigs). On high humidity days, the cooling effect of evaporation is lost or at least significantly diminished. Adding in even a little extra heat production on those days can precipitate a hot mess.
Dark-coated animals (such as black Angus cattle) or animals with thick fleeces are also at a disadvantage in the heat dissipation game. The “down” (i.e. can’t get up because she’s sick or her foot is injured) black cow, the un-shorn sheep, or heavily fleeced male llama are all heatstroke victims who have crossed my clinical path. Black cows are not quite as unlucky as black cats when it comes to path-crossing unless they step on your toes.
Pity the pig. “Sweating like a pig” is not only an exaggeration. It’s an out-and-out lie. Pigs don’t sweat. They can’t sweat. They don’t pant particularly well either. So, for Wilbur and friends, heat dissipation requires cooperation from their environment. “Happy as a pig in mud” isn’t an exaggeration. Pigs wallow in mud or water in order to cool themselves, not because they have the same aversion to cleanliness as my kids. Pigs need a pond, pool, or misters and fans in order to properly dissipate heat. Since pigs can’t self-cool, it’s important to consider temperature and ventilation when transporting them. The client who brought a pig to me one day for a pre-fair health check nearly had a baked ham by the time he opened the door of the non-ventilated cargo hauler that he had decided to use as a swine-mobile. (We were able to treat the pig in time, and I advised the owner that pigs have different transportation requirements from dirt bikes.)
Just about any animal is susceptible to heat stress; even fish can poach if their bathwater warms. So how can you prevent heatstroke and how (leaving fish out of it) do you recognize signs of heat stress?
Prevention of heat stress is a matter of monitoring the balance between heat production and heat dissipation.
Obvious steps like making sure the animal has access to water and shade – yes, even if you’re just at the dog park or riding your horse for a couple of hours – are important, as is verifying that said animal can reach said water or shade. Shade, especially, tends to move. A horse tied to a trailer in the shade at a show may not stay in the shade, ditto for a dog tied to a tree, stake, picnic bench, etc.
Monitor exercise closely, especially if the weather is warmer than usual, the animal is overweight or out of condition, or there are factors, such as in-season mares, that may cause the animal to exercise more vigorously than normal.
Plan transportation for cool times of the day. This should go without saying, but do NOT leave animals in an enclosed, non-air-conditioned vehicle. Even stock and horse trailers with open vents/windows can get very, very warm when not moving (large aluminum box + heat-producing animals).
Shearing fleeced animals in spring can minimize heat stress, not to mention reducing disturbing fly/maggot antics that tend to accompany warm weather and soiled fleece. (Don’t ask.)
Signs of overheating vary a little between species, but here are some basics:
Definitely don’t leave your pet in the car, but think also of the running horse, the Frisbee-catching dog, the wooly sheep, the invalid cow, and the puddle-less pig. Any animal, yes, even those who live in the great outdoors, can over-do a day in the sun.
Credit: VETz Insight
Watch out for Dog Holes
Digging is normal canine behavior
By Phyllis DeGioia, editor of VIN
My ankle is fractured in two places.
It hurt about as much as you'd think.
I'm hoping you can learn from my stupid mistake. Maybe I currently care more about your bones than you do, but at a certain point you may come to care a lot more, as I did.
Safety Tip #1: Do not put the canoe away in the back yard in pitch dark.
Safety Tip #2: Do not step into a hole dug by your dog during the kind of deep darkness that makes fireworks look good.
I'm pretty sure Zita, my 20-lb Pomeranian mix, excavated that particular hole. She often comes into the house with dirt on her nose, indicating she's been digging.
In the immediate aftermath of the high-volume post-double-fracture screaming, my boyfriend Erik went to look for my ancient crutches in the basement. While he was getting them, I crawled through the back yard on my hands and knees towards the back door. I almost threw up.
Knowledge Tip #1: The orthopedic nurse said if you feel nauseous almost immediately afterwards, you have likely broken a bone because nausea is one of your brain's reflexive responses to pain.
Your fibula and tibia would really, really, really like for you to stay as far away as possible from any irregular ground caused by digging canines. A few other bones are likely to feel the same way.
Safety Tip #3: In daylight, look for holes dug by your dog(s). Varmint holes aren't likely to bother an adult human fibula. However, the convex hole typically dug by canines is usually big enough to be noticed, has no lawn or flowers left, is surrounded by loose dirt, and may not seem big or deep but waits for you like a tick on a blade of grass. Fill in those holes.
You may be asking yourself at this point why dogs dig.
Digging is normal canine behavior, according to veterinary behaviorist Dr. Christine Calder of CattleDogPublishing. Some dogs are not interested in moving so much as a nail full of dirt; Lady of Lady & The Tramp comes to mind, flipping her stunning ears around like a movie star's tresses. But I'd bet my bottom dental chew that Tramp scored more than a few holes.
Some dogs dig because they were bred to do so. In French, ‘terrier' translates as ‘burrow,' and In German, ‘dachs' means badger, and ‘hund' means dog, indicating a dog who hunts rather vicious animals that weigh up to 30 pounds. During fox hunts, fox terriers were released when the fox went below ground. The deceptively innocent-looking Australian terrier goes after snakes and vermin, and usually wins. A Bedlington terrier will go after rabbits or mice, and so on: it's part of the genetic job description.
In dogs not bred to excavate, holes can still wait for your ankle for a number of reasons, Dr. Calder tells me. (By the way, as an undergraduate she fell off a horse and broke her talus – the main ankle bone that your fibula and tibia are attached to - and was supposed to be non-weight bearing for 6 long months. Because we are all stupid at that age, she went to classes rather than dropping out for a semester. She ended up repeating the classes anyway, but let's give her points for effort. Also, like me, Dr. Calder is barely taller than a garden gnome, so falling from a horse is quite a distance.)
Anyway, non-hereditary reasons for dogs to dig holes include:
At any rate, I am pleased to say that as soon as I'd crawled my way to the house and got inside, it pretty much stopped hurting. I could move my toes and bear a teeny tiny amount of weight. “Oh gosh, it's not that bad!” The ER said I could wait until the next day.
Knowledge Tip #2: Don't wait. If you think you've broken a bone, go to the ER. I waited about 15 hours, which is when I could get into my regular clinic in the afternoon on Monday. They took x-rays, gave me a walking boot, and referred me to an orthopedist, but I didn't get in there until Friday. Had I gone to the ER, I could have had five less days being non-weight bearing in the fiberglass cast, and if I'd needed surgery, I would have had it sooner.
Non-weight bearing is so frustrating to independent types (like me and Dr. Calder) that in the beginning I cried several times every day. I must say that except for those excruciating minutes right after the fracture, my ankle has not hurt as long as I don't bear weight on it, so I didn't need pain pills.
Safety Tip #4: On hard floors, be careful not to place the tip of either crutch in one of those swirling tumbleweeds of dog hair dust bunnies unless you want to fall again, possibly emulating a turtle stuck on their back. Life can be brutal.
Sadly, I suck at crutching due to insufficient upper body strength from being an LOL (Little Old Lady). I get around in a wheelchair or crutches right now and have a walker and a quad cane ready to go for later, because I also suck at being non-weight bearing with a walker. I've even crunched a toe on the good foot by running the wheelchair into it; it's summer and I'm foolishly barefoot. Given my generally clumsy nature, which Erik insists is due to inattention rather than actual clumsiness – and who am I to argue? – I will eventually need mobility aids again. I'll be in a walking boot for two or three weeks after the cast comes off, then taper off. The boot is decorated with stickers of bunnies and capybaras because last time I used one I learned the Swarovski crystals eventually fall off.
Here in the Midwest, summer is the best weather of the year. It is awful to miss it, and I won't be in our new canoe for a while. I will have spent the majority of these lovely summer days on the couch with my leg elevated, whining like a puppy. For the first few weeks after the injury, I cried a few times every day about the unfairness of life. Well, suck it up, buttercup.
However long it takes to heal, I am truly grateful that it wasn't worse, like Dr. Calder's injury.
I strongly recommend that you check for holes around your yard and add some enrichment activities for your dogs if they have any tendency to dig. Don't be lazy like me: just get out there and do it. It may save you from the unspeakable indignity of imitating turtles.
Credit: VETz Insight
The Opioid Crisis Affects Pets, Too
It was the simplest thing to give Gucci a dose of naloxone
By Tony Johnson, DVM, DACVECC
My otherwise peaceful Thursday ER shift was abruptly disrupted by the metallic clang of the treatment room's doors opening and the squeak of a gurney.
Heaped atop said gurney was a pile of dark grey pit bull, unresponsive and laying on her side, breathing slowly. I noticed mammary development, which probably meant she was an unspayed female, and may have given birth recently.
“OK – what do we have?” I asked the tech steering the gurney to the treatment table and oxygen.
“Intact female pit, 2-3 years old, found unresponsive at home.”
“Nothing, else, huh?” I asked.
I did a quick physical exam called the primary survey, which is just the initial things that threaten life: airway, breathing, and circulation. I found nothing but the slow breathing and a slow, but steady, heart rate.
Owners of pets brought into our ER are asked to answer two questions before anything else is done, even before registration paperwork with the pet's name, address, etc.
Can we begin treatment for pets needing immediate care?
In the event it is needed, should we begin CPR?
Both questions are accompanied by rough costs for each.
The tech's Vocera (a little Star Trek communicator gizmo that each tech wears to communicate within the hospital) made its little bloopy sound and one of the receptionists chirped “She's a yes and yes,” which was our shorthand that the owner had answered yes to both questions.
So, we started in.
We gave oxygen through a facemask and placed an IV catheter. I did a more complete physical exam and found not much more than on the primary survey. Blood was drawn for later analysis. We set about getting a few vitals, like body temperature and blood pressure. I dispatched the tech to talk to the owner, and to specifically ask about toxins and drugs, either of the prescription or recreational kind while I attended to my nonresponsive new patient.
My tech (we'll call her Laura) came back a few minutes later.
“Nothing in the house. She says she has a 4-year-old kid, her place is childproofed, and no drugs. Dog's name is Gucci.”
“Anything in the yard? Antifreeze, rat poison?” I asked.
“OK,” I said, thinking perhaps she had a uterine infection (common in unspayed females) and had become septic due to overwhelming infection.
“One more thing,” Laura said.
I had a pretty good idea what was coming.
“She has no money, no insurance.”
“OK – we'll do what we can.”
This is an every day occurrence in the veterinary ER, and I'll refer the reader to the many times we've covered this at VetzInsight. I am well-versed at working within an owner's financial constraints, and, thankfully, most of the time we can get done what needs to be done for the patient. Not every time, and there are many cases that still gnaw at me – cases I could have saved, but it was not realistic or possible for the family.
I had a sinking feeling about this one, though. If she was septic, the rule #1 of treating sepsis is “remove the septic focus,” meaning cut out (or drain) what is killing the patient. This almost always involves surgery, an extensive ICU stay, and significant cost.
At the intersection of “no money” and “septic shock,” the shops sell only sadness.
The other informal rule we have in the ER is that pets named after luxury items (Versace, Vuitton, etc.) rarely have the financial backing needed to get the job done. Perhaps the owners have already spent too much on other things to afford medical care for their pets. I don't know.
I don't judge, but I do notice.
Just about then, Laura's phone rang. We usually discourage taking calls while on the clinical floor, but she took it anyway.
And good thing she did.
After hanging up, Laura told me that (completely by chance) she and the owner of the dog on my gurney had a common friend. The friend told her that the owner was reluctant to tell us what happened to Gucci because she thought she'd get in trouble.
I asked Laura if she wanted me to go in the room, and she said, “Hold on, give me a minute with her.”
I don't know what went down in the room, but Laura came back a few minutes later and said, “She's ready to talk to you.” I didn't wait for more explanations.
Just as I got into the room, before I could extend my hand and introduce myself, the owner said “It's fentanyl.”
So much for childproof.
Fentanyl, as nearly everyone now knows, is a potent opioid. It is 50 times stronger than heroin and 100 times stronger than morphine. I use it almost every day for my patients, as it is a truly effective means of controlling pain. It is also highly addictive, and one of the main drugs that has been abused and has killed thousands of people across the U.S. and the world.
Luckily, it has an effective and cheap antidote: naloxone (trade name: Narcan). I was recently lecturing to a group of veterinarians in Kentucky and saw my first naloxone/overdose station at the lecture hall. It brought into stark relief how bad the opioid crisis has grown.
And now it's affecting pets like Gucci. Not to mention the child that also lives in that home. What if it had been her instead of Gucci? A 4-year-old little girl snuffling around on the floor and wondering if that white powder was sugar?
I told the owner I would be right back after giving Gucci the antidote, and assured her it was not my job to call the police unless the dog was intentionally poisoned, which she hadn't been. But, I said, I wanted to talk to her about safety in her home. I usually stay in my lane, but this one was just too egregious to overlook, and I have received some criticism for not notifying Child Protective Services about conditions in the home.
Since we already had an IV catheter in place, it was the simplest thing to give Gucci a dose of naloxone straight through her IV. It takes effect almost immediately, and within about a minute she popped her head up and she looked around as if to say “How did I get here? Who are you people?”
She did just fine.
Fentanyl has a short duration (usually less than an hour), but we watched Gucci for a couple of more hours to be sure. She did not need any further testing or treatment, and the owner managed to find the money to pay her bill. (If memory serves, it ended up being less than $300.)
I stepped back in to talk to the owner and basically re-stated what I said above about her daughter and the implications if she had ingested the fentanyl instead of Gucci. That would be trouble. I didn't want to see her daughter exposed to the same substance that had sickened Gucci and killed so many people; in the U.S. alone, fatal fentanyl overdoses have risen 279% since 2016. And I didn't want the state to have to take away her child.
She got the message.
Zinc Poisoning in Dogs and Cats
Wendy Brooks, DVM, DABVP
Most people have at least a passing familiarity with hemoglobin. Hemoglobin is the iron-containing protein that is responsible for the red color of blood. It binds the oxygen we breathe in and carries it to our tissues, exchanging oxygen for carbon dioxide and carrying that to our lungs to be exhaled away. Our red blood cells have no nucleus and no DNA, and they do not participate in most normal cellular functions; they are simply bags of hemoglobin being conducted around our blood vessels.
A normal canine red blood cell lives approximately 120 days (60 days for feline red cells), and it dies when it either becomes too stiff to fold itself through tiny capillaries and bursts trying to do so, or it simply cannot generate enough energy to keep itself alive.
The spleen is responsible for removing old red blood cells. The spleen possesses many tortuous, winding blood vessels where red blood cells may break if they are not supple enough to pass through. The spleen then collects the hemoglobin for recycling, but since hemoglobin by itself is not safe for release into the bloodstream, a conversion is necessary. The hemoglobin is broken into a protein part (which is broken apart and recycled), iron (also broken off even further and recycled) and heme which is converted into a substance called bilirubin for transport. Bilirubin is sent to the liver to be chemically processed for removal (the process is called conjugation). This process enables the bilirubin to dissolve in water so that it can be excreted in bile and disposed of through the intestinal tract. Bilirubin is responsible for the brown color of feces.
If too many red blood cells are being destroyed at once, the systems described above get overwhelmed.
What is Hemolysis?
Hemolysis is the destruction of red blood cells. Red blood cells may be destroyed by:
This dog has swallowed a coin (readily visible as a white disk in the stomach). Photo courtesy of Jennie Marvelle, DVM, Boothbay Animal Hospital Boothbay, MEIn 1983, the U.S. government began minting pennies made of zinc wafers coated in copper rather than out of pure copper. As it is not uncommon for young animals to swallow pennies, zinc toxicity became recognized.
Other zinc sources include nuts, bolts, zippers (some metal zippers contain zinc), and zinc oxide-based skin creams, such as diaper rash cream and sunscreen. You can see a penny or other radiodense object of about the right size on a radiograph, or there may be a known history of penny eating. It is important to rule out immune-mediated hemolysis as this is a common condition requiring specific (and very different) treatment.
The clinical signs of zinc toxicosis include:
If an object possibly made of zinc is seen on an X-ray, it should be removed promptly. This might involve surgery, endoscopy, or possibly inducing vomiting if the object does not have sharp edges. Support then becomes crucial. Fluid therapy is important to keep adequate circulation to the kidneys and help prevent failure. Transfusion may be necessary to combat anemia, and anti-nausea therapy is justified. Zinc is corrosive to the stomach so medication to protect the stomach will be needed. Antacids are helpful in reducing the absorption of zinc, which is enhanced by stomach acid. Research is looking at methods for binding excess zinc in the circulation similar to the way lead poisoning is treated.
Once the zinc source is removed, most pets are able to recover within 48-72 hours with supportive care, but of course, this depends on the severity of the poisoning.
Anorexia, or Lack of Appetite, in Dogs and Cats
Wendy Brooks, DVM, DABVP
Appetite loss and appetite reduction are important factors in illness assessment, and they must be recognized and reported as soon as possible. Acceptance of favorite foods often determines if a pet should be hospitalized or not. A couple of off days is generally not a big problem as long as the pet maintains hydration one way or another and recovers promptly, but recurring episodes of poor appetite or slow, gradual reduction in appetite are important and frequently point to a chronic progressive illness. Nutritional support not only helps the pet recover but buys time to keep the pet stable while diagnosis and treatment are worked out. The pet must be fed in order to get well.
The term anorexia simply means eating no food. Many people get confused by the human eating disorder anorexia nervosa. When the veterinarian says the pet has anorexia, it does not mean the pet has a distorted body image; it simply means the pet is not eating.
So how do we get a pet to eat? We will review some techniques here. Be sure to check with your veterinarian regarding the proper amount of food to feed and which foods are acceptable. Eating only a few bites of food or drinking the gravy does not constitute a good appetite so when asked if your pet is eating, this isn't really a yes or no question. Be specific about quantity.
Don't wait for the appetite to completely disappear before seeking veterinary assistance.
Pets with a poor appetite are sick, and if you wait until the appetite is completely gone, it may be too late for recovery. This is particularly true for cats. As the appetite fades, the pet must depend on stored fat for nutrients. When large amounts of fats are mobilized to meet energy demands, they must be processed by the liver before being used for calories. The feline liver is not designed to handle large amounts of fat and will fail in a condition called hepatic lipidosis.
First Offer Canned Food
If you think your pet’s appetite is poor but are offering only kibbled food, your first step is to get some canned food and offer that. Most animals find canned diets far more palatable than dry foods, and you may find that this step alone fully alleviates the problem. There is a misconception that canned food is somehow of poor nutritional quality. In fact, canned food and dry food differ primarily in their water content and, thus in texture. If you consider the food without water, the unprepared diet is basically a powdered meat mix similar to a flour. It can be baked into a kibble or steamed into a canned food. Canned foods differ in quality just as dry foods do. See if the pet will eat a canned food or a mixture of dry and canned food. Adding a flavored broth or cooked egg is also helpful in enticing the pet to eat a kibbled diet.
Second, Offer a Delicacy
Foods that are generally regarded as delicacies among pets include canned chicken, cooked egg, and canned tuna. Therapeutic recovery formula diets are generally well accepted.
With the exception of the recovery diets, these treats are not nutritionally complete but can make a good jump starter for pets. A pet who has not been eating may feel continued discomfort until eating begins again. Something tasty may be necessary to get the appetite restarted.
Do not simply put the food in a dish in front of your pet. Instead, rub a small amount on the teeth or spoon a little in the mouth so that the pet can get a taste. Don't be surprised if he spits it out; we are just trying to get the taste of the food in his mouth. Hold the bowl up to the pet's nose so that the aroma is inescapable. You may find that coaxing in this way gets the appetite started.
A Note on Gourmet Cat Foods (Yes, Dogs Eat Them, too)
Several "extra tasty" products available in the grocery store can be really helpful in tempting a pet with a poor appetite. Fancy Feast by Purina comes in numerous textures and flavors, each can containing approximately 100 calories. The diet is complete and balanced for cats and is often a good appetite jump starter. Temptations®, by Mars Petcare, are especially well-accepted treats made for cats. Because many cats will not eat anything else, they have been balanced to be nutritionally complete for cats and can be used as a cat's sole diet if necessary.
A Note on Starting Prescription Diets
If the pet is supposed to eat a prescription diet but refuses, do not attempt to starve the pet into eating the prescription food.
Many prescription diets are relatively bland and pets do not wish to eat them, particularly if they are used to eating large amounts of table scraps (always a bad practice) or a more flavorful regular food. Starving the pet will only make him sicker. Try a gradual change from the regular food to the new food over a week or so. If the pet simply will not accept the new food, be sure to let your veterinarian know this. There may be an alternative flavor to try; further, prescription diets are guaranteed by the manufacturer meaning you can get a full refund on the bag or case if the pet does not accept the food. Sometimes it is necessary to forgo the therapeutic aspect of the special diet just to get the pet to eat, but your veterinarian will help you with these guidelines.
Be sure other pets at home do not bully or distract the sick pet. In a multi-pet home, it may be difficult for the sickly or elderly pet to eat without the younger pets taking his food. Many animals wish to eat at their leisure, particularly if they do not feel well. Consider giving your pet a private area and her own dish. Never feed multiple pets from the same bowl as one is sure to get the lion’s share of the food to the other’s disadvantage.
Many pets like to eat overnight when no one is watching.
Appetite-stimulating medications are available.
There are several products available that can create a sense of hunger:
Capromorelin: This is an oral liquid that mimics the body’s natural system that generates the sense of hunger. It is best given daily rather than only on bad days. Capromorelin is available in both a canine and a feline formula.
Mirtazapine: This is a pill originally developed as an anti-depressant for humans but was found to have appetite increase as a side effect. It is available as a tablet, typically given daily for dogs or every two to three days for cats, or as a transdermal gel for cats which is applied daily to the inner surface of the ear.
Cyproheptadine: This is a psychoactive anti-histamine that has an appetite stimulation side effect. It is available as a pill and is typically used twice daily.
Prednisolone/Prednisone: This hormonal anti-inflammatory has a number of uses in the treatment of immune mediated conditions, inflammatory conditions, cancer therapy and many other situations. One of its side effects is increased appetite and it is sometimes used for this effect, though because it affects so many body systems, it is generally not used for its appetite effect alone.
These medications represent non-invasive ways to medically improve appetite.
Non-invasive methods are all well and good but the bottom line is that an animal that does not eat will get sicker and ultimately die. Receiving nutrients is the basis of recovery and one cannot simply wait around for days for medications to work. Nutrients must be delivered ideally in a way that is not stressful for either the pet or the human caretaker.
An E tube. Photo by Dr. Jen DeveyFeeding tubes are the least stressful method of delivering nutrition and can be placed through the nose, throat, directly into the stomach or into the intestine. Liquid diets are delivered through the tube, usually with no resistance from the patient whatsoever since the mouth and face are not manipulated.
Gaining in popularity is the esophagostomy or E tube. This tube is placed in the esophagus via an incision in the side of the neck. A bandage or special cloth collar may be used to hold it in place though many patients do not require a wrap of any kind. The placement procedure is fairly short, and the tube is comfortable for the pet. Protective cone collars are not generally needed and the pet can go about his or her life with the tube in place. The larger size of the tube allows for blenderized diets which can be prepared at home for less expense than prepared liquid diets. Feeding does not require fussing with the pet’s face and thus is more comfortable. Bandages must be kept clean around the area, and tubes must be kept in place for a minimum amount of time to allow for proper scar tissue to form, sealing the feeding hole to the outer tissue. When the time comes, the tube can be pulled, and the hole seals up. These kinds of tubes require brief surgical placement, and thus anesthetic risks apply.
Nasogastric tubes (N-G) that go through the nose require no anesthesia to place but do require an Elizabethan collar to prevent the pet from yanking the tube out. They can accommodate only a liquid diet because of their small diameter and are difficult to manage at home. Most animals will not want a piece of equipment attached to their face and will try to remove it. N-G tubes are best used for patients that are too sick to try to pull out the tube. Alternatively, they can be placed for the feeding process and then removed.
Feeding tubes can similarly be placed in the stomach (G-tube) and protrude from a belly bandage. The G-tube has all the advantages of the E-tube and is favored by some doctors. Again, the tube diameter is large enough to accommodate a slurry rather than a liquid, and the tube is comfortable to wear and use. A brief surgery under general anesthesia is required to place the tube.
Syringe or Force Feeding
An E tube. Photo by Dr. Deb ZoranIn the past, syringe or force-feeding was used in an effort to get calories into a pet. There are several disadvantages to this technique and no advantages. First, the pet is not going to like it, and there will be struggling, stress, and mess. The pet may be too sick to withstand stressful feedings, and creating ongoing unpleasant feeding experiences can result in what is called "food aversion," where the pet may not ever have a normal appetite again. Feeding too quickly can lead to choking or food aspiration if the feeder is too aggressive. Talk with your veterinarian before using this method, as it can be detrimental to your pet.
Nutritional support is essential to proper recovery and it is important to realize that there are several techniques available to see that the pet does not suffer extra debilitation from malnourishment. If you think your pet has a problem with weight loss or inadequate appetite, do not wait until the problem is extreme; see your veterinarian promptly.
Reverse Sneezing in Dogs
Becky Lundgren, DVM
Date Published: 06/26/2006
Date Reviewed/Revised: 01/30/2024What is Reverse Sneezing?
Reverse sneezing is a disconcerting event in which a dog makes unpleasant respiratory sounds that sound like it is dying -- or will die in the next few minutes. This is called reverse sneezing because it sounds a bit like a dog inhaling sneezes. The sound the dog makes can be scary, and reverse sneezing sounds similar to the honking noise made by a dog with a collapsing trachea. However, the good news is that reverse sneezing is a far simpler condition that usually does not need any treatment.
Because it can be difficult for an owner to recognize a reverse sneezing episode when it first happens, it is a good idea to check with the veterinarian to determine if it's reverse sneezing or something more serious.
Click on the image to view a video of a dog with a reverse sneeze:
Video courtesy of Geri A. Carlson, DVM
Causes of Reverse Sneezing
The most common cause of reverse sneezing is an irritation of the soft palate and throat that results in a spasm. During the spasm, the dog’s neck will extend and the chest will expand as the dog tries harder to inhale. The problem is that the trachea has narrowed and it’s hard to get the normal amount of air into the lungs.
Anything that irritates the throat can cause this spasm and subsequent sneeze. Causes include excitement, eating or drinking, exercise intolerance, pulling on a leash, collar/tags pressing on and irritating the throat, mites, pollen, foreign bodies caught in the throat, perfumes, viruses, household chemicals, allergies, and post-nasal drip.
If an irritant in the house is the cause, taking the dog outside can help simply because the dog will no longer be inhaling the irritant. Brachycephalic dogs (those with flat faces, such as Pugs and Boxers) with elongated soft palates occasionally suck the elongated palate into the throat while inhaling, causing reverse sneezing. Small dogs are particularly prone to it, possibly because they have smaller throats.
Monitoring and Treatment
Reverse sneezing itself rarely requires treatment. If the sneezing stops, the spasm is over. Some veterinarians may recommend massaging the dog’s throat to stop the spasm; some may suggest covering the nostrils for a few seconds, to make the dog swallow, which clears out whatever the irritation is and stops the sneezing.
Treatment of the underlying cause, if known, is useful. If mites are in the laryngeal area, your veterinarian may use drugs such as ivermectin to get rid of the mites. If allergies are the root of the problem, your veterinarian may prescribe antihistamines. If reverse sneezing becomes a chronic problem rather than an occasional occurrence, your veterinarian may need to look up the nasal passages (rhinoscopy), and may even need to take a biopsy to determine the cause of the problem. Sometimes, however, no cause can be identified.
Some dogs have these episodes their entire lives; some dogs develop the condition only as they age. In most dogs, however, the spasm is a temporary problem that goes away on its own, leaving the dog with no after-effects.
Cats are less likely to reverse sneeze than dogs are. However, owners should always have the veterinarian examine the cat in case it's feline asthma and not a reverse sneeze. Feline asthma requires more treatment than reverse sneezing does.
Credit - VIN
Seizures and Convulsions: First Aid
A seizure is any sudden and uncontrolled movement of the animal's body caused by abnormal brain activity. Seizures may be very severe and affect all of the body, or quite mild, affecting only a portion of the pet. The pet may or may not seem conscious or responsive, and may urinate or have a bowel movement.
Seizure activity that lasts longer than 3 to 5 minutes can cause severe side effects, such as fluid in the lungs (pulmonary edema) or brain (cerebral edema). A dramatic rise in body temperature (hyperthermia) can also result, causing internal organ damage.Seizures can be caused by epilepsy, toxins, low blood sugar, brain tumors, and a host of other medical conditions. Your veterinarian can help you determine the cause of seizures in your pet, and if necessary, can refer you to a specialist to help with the diagnosis or treatment of seizures. In general, animals less than one year of age typically have seizures due to a birth defect such as hydrocephalus (water on the brain) or a liver defect called a portosystemic shunt (among others). Animals that have their first seizure between 1 and 5 years of age typically suffer from epilepsy, while those over 5 years of age often have another medical condition causing the seizures such as a brain tumor, stroke or low blood sugar. These are general guidelines, however, and they may or may not apply to your pet.
All pets that have a seizure should have lab tests to help diagnose the underlying cause and make sure their organs can tolerate any medications that may be needed to control seizures. Once underlying diseases are ruled out by your veterinarian, some pets require medications such as phenobarbital, Keppra (levetiracetam), or potassium bromide, among others, to control seizures. These medications may require frequent dose adjustments and monitoring of blood levels, so it is best to have an open and honest discussion with your veterinarian about the effort and costs involved in treating your pet for seizures. Most dogs (3 out of 4) can be well-controlled and have few or no seizures while on medications. Seizures and epilepsy are rare in cats.
What to Do
If your pet is a toy breed, such as a Yorkshire terrier or Maltese, or a diabetic, the seizure may be due to hypoglycemia (low blood sugar). If the pet is able to stand, is not vomiting and acts normally, offer a small meal. If the pet is non-responsive, vomiting or actively seizing, rub some honey or pancake syrup on the gums - take care not to get bitten - and proceed immediately to your veterinarian or local emergency center. Prolonged low blood sugar can cause irreversible brain injury.
A Peaceful Farewell provides compassionate at home pet euthanasia to fellow pet owners in Chandler, Gilbert, Mesa, Tempe, Ahwatukee, Scottsdale, and most of the Greater Phoenix Metropolitan Area.
Feline immunodeficiency virus and feline leukemia virus are incurable, but they are not an immediate death sentence for a cat, writes veterinarian Mike Fietz. Vaccines for the viruses are helpful but not completely effective, and infected cats that are kept indoors and receive regular veterinary care to prevent and treat secondary conditions can live full, long lives, Dr. Fietz writes.
A Peaceful Farewell provides compassionate at home pet euthanasia to fellow pet owners in Chandler, Gilbert, Mesa, Tempe, Ahwatukee, Scottsdale, and most of the Greater Phoenix Metropolitan Area.
As researchers tout the physical and environmental benefits of a plant-based diet for humans, a growing number of people have put their pets on plant-based diets, according to the AVMA, but what is good for people is not necessarily good for their dogs and cats. Veterinarian Megan Shepherd notes that dogs are omnivores, not herbivores, research on plant-based diets is scant, and a veterinarian should be consulted about food choices to ensure dogs are getting adequate amino acids and other dietary components.
Source: USA Today
A Peaceful Farewell provides compassionate at home pet euthanasia to fellow pet owners in Chandler, Gilbert, Mesa, Tempe, Ahwatukee, Scottsdale, and most of the Greater Phoenix Metropolitan Area.
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