CHRONIC RENAL FAILURE
What is chronic renal failure?
Kidneys have many functions - they principally act to remove nitrogenous waste products from the blood stream, maintain essential nutrients eg. potassium at the correct level, maintain hydration and produce urine.

The kidneys have a large amount of spare capacity to perform their various functions so at least 70% of the kidneys need to be dysfunctional before clinical signs are seen. In many cases this means that the damage to the kidneys has been occurring over a number of months or years (chronic) before failure is evident. As chronic renal failure (CRF) is most commonly seen in old cats, early signs of disease such as weight loss and poor coat quality are often put down to normal ageing. In the initial stages of disease the kidneys cope with their inability to concentrate waste products by excreting them at a lower concentration over a larger volume (compensated renal failure), so that the cat drinks a lot more than normal. At some point this is no longer possible resulting in a relatively rapid rise in waste products in the bloodstream and an apparent sudden onset of severe disease.

What are the causes of CRF?
A large number of different disease processes can eventually lead to CRF including: -
1. Congenital malformations of the kidneys - eg. polycystic kidneys in longhaired cats.
2. Bacterial infections (pyelonephritis).
3. Glomerulonephritis - damage to the filtration membrane.
4. Neoplasia - various tumours of the kidney are seen, most commonly lymphosarcoma.
5. Amyloidosis - this is the build up of an unusual material in the kidney which prevents the kidney from functioning normally.
6. Viral infections eg. feline immunodeficiency virus or feline infectious peritonitis virus.

CRF is therefore the end stage of a number of different disease processes rather than a specific condition in its own right.

How is the disease diagnosed?
Renal failure is usually diagnosed by looking at the level of two waste products in the bloodstream, blood urea and creatinine. Tests to measure the blood levels of other substances eg. potassium, phosphorus and calcium as well as the red and white blood cell counts, and other urine tests, can also be important in order to determine the best course of treatment.

Could the renal failure have been diagnosed earlier?
Unfortunately this is very difficult as neither clinical signs of renal failure nor rises in BUN and creatinine are evident until significant loss of kidney function has occurred. In earlier stages of disease there are no clinical signs to indicate that sophisticated renal function tests, which can pick up early renal damage, are required.

How does CRF affect my cat?
Because the kidneys perform a variety of different functions, the clinical signs of renal failure can be somewhat variable. The most common changes seen are:

• weight loss
• poor hair quality
• bad breath
• variable appetite which may be associated with mouth ulcers
• lethargy and depression
• increased drinking and urination
• vomiting and diarrhoea
• sudden onset blindness

What treatments are available?
Treatment will depend on the individual requirements of each cat – and sometimes there may be several problems which require different treatments. The following is a list of possible treatments, but the majority of cats can be effectively managed with diet change and one or two medications.

1. Diet Lowering
The level of waste products in the bloodstream can be achieved by low protein and low phosphorus diets. These can be prepared at home or are available ready prepared from the clinic. The palatability of reduced protein diets is usually not as high as normal cat food, so you may have to persevere and add tasty treats for a while before your cat will eat it.

2. Phosphate binders
Despite low phosphate in the diet, blood phosphorus levels remain above normal in some cats. Reducing blood phosphorus can have a major effect on improving your cat's well being and slowing disease progression. Phosphate binders eg. aluminium hydroxide are given by mouth to further lower the amount of phosphorus absorbed through the gut wall.

3. Antibiotics
Many cats seem to respond well to antibiotics, possibly in response to kidney or urinary tract infection.

4. Potassium supplementation
Cats in renal failure tend to loose too much potassium in the urine, lading to muscle weakness, stiffness and poor hair quality. Low potassium may also contribute to the worsening of the kidney failure.

5. Vitamins B and C
These vitamins are wasted by the kidney and need daily supplementation.

6. Hypotensive drugs
Significant numbers of cats have high blood pressure because of their renal failure. In some cases lowering their blood pressure may be necessary.

7. Treatment of anaemia
The kidneys also function to initiate the production of red blood cell in the bone marrow. Many cats with CRF are anaemic due to a lack of stimulation of the marrow. Stimulation of the marrow can be achieved by the use of some anabolic steroids, or other drugs.

IT IS IMPORTANT THAT FRESH WATER IS AVAILABLE AT ALL TIMES

How long can I expect my cat to live?
Unfortunately, once damaged the kidneys have a very limited ability to recover but progress of disease may be very slow so, with treatment, your cat may have several years of good quality, active life ahead.

Please contact the Kelburn Vet Centre if you would like any more information, or have any questions relating to chronic renal failure.

CARDIOMYOPATHY
What is cardiomyopathy?
Cardiomyopathy is a term used to describe diseases of the heart muscle. In cats, at least three classes of cardiomyopathy have been described. In all cases, the heart disease may result in clinical signs of heart failure. Cardiomyopathy may be seen as a primary condition or secondary to other diseases.

What are the clinical signs seen with cardiomyopathy?
In the early stages of disease, the cat may be able to cope and hence show no signs of disease. This situation is referred to as compensated heart disease. Often the cats will alter their activity levels to those that they can cope with which makes it difficult to diagnose cardiomyopathy until it is quite advanced.

The major longterm concerns with all types of cardiomyopathy are:-
1. Development of congestive heart failure: Breathlessness and lethargy are the most frequently noticed signs of congestive heart failure and these result from a failure of the heart to efficiently pump blood. Blood banks back into the blood vessels of the lungs, resulting in fluid accumulation in or around them.
2. Thromboembolic disease: Altered flow of blood in enlarged heart chambers predisposes to the formation of a blood clot within the chambers of the heart. This becomes organised and is known as a thrombus. If parts of the thrombus become dislodged they can travel in the bloodstream and become lodged in smaller blood vessels. These particles are called emboli and the most common place for them to lodge is at the bottom of the aorta which is the biggest artery in the body. This results in obstruction of the blood supply to the back legs which is usually very painful and the back legs become paralysed and cold to the touch. Although a minority of cats may recover completely with appropriate treatment, this is a potentially fatal complication of any cardiomyopathy. In some cats, a partial recovery which may take a long time, is seen.

How is cardiomyopathy diagnosed?
Diagnosis of heart disease can be suspected on the basis of clinical signs, such as those of congestive heart failure, in addition to more specific tests such as chest x-rays. Electrocardiography (ECG) rarely provides useful information on heart conduction and size. Cardiac ultrasound scans, where available, are indispensable in distinguishing between the different types of cardiomyopathy.

Specific tests may be done in order to check that the cardiomyopathy is not secondary to some other disease. (see below).

What causes cardiomyopathy?
There are many causes of cardiomyopathy, however, in older cats thyroid disease (hyperthyroidism) may cause a type of cardiomyopathy. Other causes include dietary deficiency of taurine, an essential nutrient. This is not seen in cats fed a commercial cat food or fresh meat. Often, no cause of the cardiomyopathy is found.

How is cardiomyopathy treated?
In cases where an underlying cause of the heart disease is found, then treatment of this may result in improvement or reversal of the heart disease. Hyperthyroidism is the most treatable cause of cardiomyopathy since complete resolution of the heart disease is possible if treated early. In cases where no cause is identified, (referred to as idiopathic cardiomyopathy), and in cases where disease remains following treatment for an underlying cause then medication may be needed.

Treatment varies according to each case but may include:-
1. Diuretics if congestive heart failure is present.
2. Beta blockers to reduce the heart rate where this is excessive.
3. Calcium channel blockers to help the heart muscle relax and hence help more effective filling of the heart. These drugs are generally the most effective form of treatment and often are the only drug required (in the long term).
4. Aspirin may be used for its effects at reducing the risk of thrombus formation and hence thrombo-embolic disease although it is being used less frequently these days for this purpose. Dosing of asprin should always be as advised by a veterinary surgeon since aspirin may be toxic to cats. Aspirin poisoning, which occurs if the dose or frequency of aspirin administration is too high, may cause vomiting and internal bleeding. If your cat shows these signs, goes off their food or is sick then aspirin therapy should be stopped and you should consult your vet.
5. ACE inhibitors - these drugs also help to control congestive heart failure.
The longterm outlook for a cat with cardiomyopathy is extremely variable depending on the cause of this disease. Cats with idiopathic cardiomyopathy may remain stable for several years and lead near-normal lives.

Does a cat with cardiomyopathy need a special diet?
Other than in cases of taurine deficiency, no specific diet is recommended although excessively salty foods, e.g. dry cat food should be avoided since these will predispose to fluid retention. This may increase the risk of congestive heart failure. Proprietary cat foods are usually adequate although special low salt diets are available and may be recommended by your veterinary surgeon in specific cases. Cat treats are often quite salty and probably should be avoided.

CONJUNCTIVITIS
What is conjunctivitis?
The conjunctiva is a mucous membrane, similar to that of the mouth and nose, that surrounds the eyeball forming a seal with the inner surface of the eyelids. The third eyelid is also covered by conjunctiva. In normal cats the conjunctiva is not readily visible and has a pale, salmon pink colour. Conjunctivitis is an inflammation of this membrane which becomes swollen and reddened often making it more visible. Conjunctivitis can affect one (unilateral) or both (bilateral) eyes.

How do I know if my cat has conjunctivitis?
Cats with conjunctivitis tend to have a discharge from their eye(s) which can be clear or thick and purulent. The conjunctiva is often more visible and reddened particular in the corner of the eye and can be swollen, partially covering the eye. Frequently the eye(s) are held half closed and the third eyelid is more prominent.

What are the causes of conjunctivitis?
A number of different conditions will cause conjunctivitis, many are sudden in onset and easily treatable others cause a more chronic disease which can be more difficult to control.

1. Mechanical and chemical irritants, trauma (e.g. cat fights) and foreign bodies tend to cause sudden onset (acute) conjunctivitis. In most cases treatment is rapidly effective once the exciting cause has been removed.

2. Immune based diseases including some allergies can cause conjunctivitis. These diseases are rare in cats but can be difficult to treat, sometimes management of the symptoms is the only realistic option.3. The most common causes of conjunctivitis in cats are infectious agents these can be viruses (usually feline herpes virus type 1 - one of the cat flu viruses), bacteria (most commonly Chlamydia) and mycoplasmas (a group of organisms somewhat like bacteria).

How can the cause of the conjunctivitis be diagnosed?
In many cases, conjunctivitis will respond to topical symptomatic therapy using drops or ointment containing antibiotics. Other cases however, conjunctivitis do not respond well to topical therapy or appear to improve and then gets worse again once treatment has ceased. In such cases your veterinary surgeon may feel that a specific diagnosis is required. If the cause of the conjunctivitis is not infectious then a sample of cells from the conjunctiva can be helpful. A small number of cells are obtained by scraping the conjunctival surface with a cotton wool swab or spatula. If a larger sample is required then a surgical biopsy may be necessary. Special tests for Chlamydia can then be performed.

What treatments are available ?
There are three options for treatment:-
1. Local administration using drops or ointments
2. Local administration by injection under the conjunctiva - this technique is used in cats that are difficult to treat (e.g. feral cats) or would require very frequent administration of the drops/ointment
3. Systemic treatment given by injection or by mouth is required to effectively treat some diseases e.g. Chlamydiosis, mycoplasmosis.

How should eye medication be administered?
Regular treatment is essential, most ointments need to be administered at least twice a day, drops need to be given more frequently and so are less practical. Unfortunately, some treatments cause transient discomfort after administration, meaning two people are required, one to hold the cat and the other to give the treatment. Liquid preparations can be applied directly onto the surface of the eye, 1 or 2 drops per eye is usually sufficient. Ointment is applied across the surface of the eye, about half an inch per eye. The eyelids are then closed to spread the ointment over the entire surface of the eye. Generally ointments need to be given less frequently than drops as they persist for longer but some people find drops easier to administer. If you have any doubts as to how to give the medication prescribed then don't be afraid to ask your veterinary surgeon or practice nurse to give a demonstration.

Are longhaired cats more susceptible to conjunctivitis?
Discharges from the eyes are more common in long haired cats due to eyes being prominent and less well protected by the eye socket or abnormalities in tear drainage causing an overflow of tears.

CONSTIPATION
What is constipation?
Constipation can be defined as an abnormal accumulation of faeces resulting in a difficulty in passing bowel motions. This may result in reduced frequency or absence of defecation, and/or excessive straining to defecate. The faeces are retained in the large intestine which is called the colon. Since one of the functions of this part of the bowel is water absorption, the retained faeces become hard and dry which makes passage of these even more difficult. Constipated cats strain in an attempt to defecate and this is often painful. Paradoxically, some constipated cats may pass small amounts of liquid faeces.

What causes constipation?
Factors associated with causing constipation include:-

1. Excessive hair in the stool, especially in long-haired cats, and cats with flea allergy.
2. Ingestion of foreign bodies.
3. Obstruction caused by tumours, strictures or masses compressing the large intestine.
4. Pelvic injuries, most commonly after a road accident, resulting in a narrowed pelvic canal.
5. Damage of the nerves which cause the colon to contract. This may arise following traumatic damage such as a road accident or may be seen as part of more generalised neurological disease.
6. In some cases, there is no obvious cause identified.

Constipation is a condition seen most commonly in middle-aged and older cats.

What is megacolon?
This term refers to a dilated and poorly motile colon. Megacolon may be seen as a primary entity or arise following long-term constipation. When the colon becomes distended with faecal material over a prolonged period of time its ability to contract may be reduced or lost resulting in megacolon.

How are constipation and megacolon diagnosed?
In most cases, a diagnosis of constipation can be made on the basis of the clinical signs that the cat is showing. Affected cats usually strain unsuccessfully to defecate and may cry in pain when doing this. Any faeces passed are hard and dry. The cat may also show signs of lethargy, reluctance to eat and vomiting.

Further tests may be needed in order to diagnose the cause of the constipation and these may include x-rays of the abdomen and pelvis in order to look for pelvic injuries, colonic strictures or tumours. X-rays are also required for the diagnosis of megacolon.

How can constipation and megacolon be treated?
This varies depending on the cause of the problem, hence, if an obstruction is present, such as a colonic tumour, then surgical treatment of this may be performed.

Initial treatment of a cat with constipation may involve administration of enemas and manual extraction of faeces by a veterinary surgeon. The latter of these may necessitate an anaesthetic or sedative. Treatment of dehydration with intravenous fluids may also be needed in severely affected cats. If the constipation recurs or becomes a long-term problem then continuous therapy may be needed to prevent recurrence.

A wide variety of treatments are available and the aims of these are to enable regular defecation of soft faeces. Altering the diet so that this contains more fibre (e.g. Metamucil) may be helpful and lubricating laxatives or stool softeners may also be used in mildly affected cats. Those more severely affected may need drugs that stimulate contraction of the colon. The doses of all of these drugs may need to be altered to produce the desired effect. Ideally, cats should defecate at least once every other day. (Most normal cats defecate once or twice a day depending on their diet.) Over a period of time, resistance to the treatment may be found necessitating an increase in the drug dosage or a change to another therapy. No changes to the treatment protocol should be made without consulting your veterinary surgeon.

In long-haired cats, regular grooming may reduce hair ingestion by the cat and therefore reduce the likelihood of hairballs causing constipation. Likewise treating any concurrent allergic skin disease, e.g. by flea control, is vital also.

It is important to ensure that there is always access to a clean litter tray so that frequent defecation is encouraged.

If megacolon develops or if the constipation is severe and medical treatment is unsuccessful at controlling this then surgery may be advised by your vet. Surgical treatment involves removal of most of the colon which initially will result in diarrhoea since the colon is responsible for water removal from faeces. Over a period of time, this usually improves. The surgery should not result in loss of bowel control.

What is the long-term outlook for a cat with this problem?
The long-term outlook varies tremendously according to the cause of the constipation, however, most cats can be adequately managed without having to resort to surgery, especially if medical therapy is implemented early in the course of the problem.

COUGHING
What is a cough?
A cough is an expiratory effort producing a sudden, noisy expulsion of air from the lungs, usually in an effort to free the lungs of some foreign material (real or imagined). This can sometimes be confused with retching or gagging, although occasionally an animal may retch or actually vomit following a forceful bout of coughing. The presence of a terminal retch may be misinterpreted as evidence of a problem with the digestive system.

Why do cats cough?
In cats, coughing is generally regarded as a sign of a problem affecting the lower respiratory tract, especially some form of bronchitis. Cats can cough for a variety of reasons, including the presence of foreign material within the airway (e.g. pieces of inhaled grass), or irritation from inhaled liquids or gases. Coughing can also result from inflammation of the airway, which may be acute (e.g. cat 'flu) or more chronic (e.g. chronic bronchitis). The inflammation may be caused by a number of factors, including viral, bacterial, or parasitic worm infections, or may be associated with an allergic reaction. Tumours (cancer) located within the chest can occasionally cause coughing. In cats coughing is rarely associated with heart disease, although some cats with hypertrophic cardiomyopathy are presented for coughing as the main sign of disease.

Coughing can also be seen with upper respiratory tract disease, e.g. where irritation, inflammation or other disease affects the larynx or trachea, or where disease in the nose results in excessive secretions draining into the larynx and trachea, hence causing irritation and coughing.

When does a coughing cat need veterinary attention?
It is important to remember that it is normal for all cats to cough occasionally, e.g. when they inhale or aspirate foreign objects, or if their airway becomes irritated by changes in the environment. If the cat only coughs occasionally, is well in itself, and the cough is not productive, it does not require treatment. However, if the cough persists for more than a few days, is severe, productive (i.e. the cat spits something out, or swallows at the end of a coughing fit), the cat appears unwell in itself, or is loosing weight, then veterinary attention should be sought.

How can the vet find the cause of a cat's cough?
Most acute cases of coughing will cure with minimum need for interference, except for perhaps a 7-14 day course of antibiotics. However, if the cough is very severe, or if it has been present for some time, then further investigation may be needed. This usually entails taking a full and detailed history which may help to high-light the underlying cause (e.g. a cat allergic to human skin dust may cough mainly when lying on it's owner's bed). The vet will need to know whether the cough has changed over time, and whether the cat has any other medical problems that may be significant. The cat may then be given a general anaesthetic, so that it's chest can be radiographed. While the cat is anaesthetised the vet may look down it's airway with an endoscope. Samples of fluid and cells can be collected from the airway, either via the endoscope, or by flushing a small amount of sterile salt solution into the lungs and then sucking it back out again. These samples can be used to look for the presence of infection, inflammation or tumours.

How can the cough be treated?
How a particular cat is treated depends on the cause of its cough. In the case of a mild bacterial infection, a course of antibiotics is likely to be sufficient. The removal of a piece of foreign material, or the correct drug treatment for lung worm infection, will also result in a cure.

Once coughing becomes a chronic problem (i.e. has been present for over 2 months), the likelihood of bringing about a total cure is not so good. This is because chronic coughing is associated with chronic inflammation of the airway, often due to chronic exposure to allergens (particles to which the cat is allergic), irritants (e.g. cigarette smoke), or bacterial infection. This chronic exposure results in a number of changes in the structure of the cat's airway, such that even if the initial trigger can be identified and removed, the damage has already been done and the lungs can never fully recover.

In these cases treatment aims to control the coughing, and prevent further damage. It may include removing any known irritants or allergens, giving drugs (bronchodilators) to help keep the airways open, treating bacterial infections with antibiotics, reducing inflammation with corticosteroids, and sometimes giving decongestants. In the case of certain types of cancer, chemotherapy or surgery may be an option.

DENTAL DISEASE
How common is dental disease in cats?
Dental disease is one of the most frequent ailments seen by veterinary surgeons, and can be found to some degree in the majority of cats over two years of age fed commercial cat food exclusively. The most common problems are due to periodontal disease, gingivitis and neck lesions (also called resorptive lesions or odontoclastic lesions).

What signs am I likely to see?
There are a number of signs that should alert you to the possibility of dental disease or other mouth problems being present. Your cat may show less interest in food, or approach the food bowl then be reluctant to eat, or back away. It may chew with obvious caution and discomfort, drop food from the mouth, or may swallow with difficulty. Dribbling may be seen, possibly with blood, and there may be a marked unpleasant odour to the breath. In some cases the cat may be seen pawing at their mouth or head shaking. A reluctance to eat may lead to weight loss.

What usually causes dental disease?
The most common cause of dental disease in cats is due to tartar accumulation. As in humans, cats accumulate bacterial plaque on the surface of their teeth, which if not removed quickly becomes mineralised to form tartar (also called calculus). The bacterial products and decaying food stuck to tartar are one potential cause of bad breath.

Tartar is easily identified by its light or dark brown colour - it is normally first seen at the gum edge, especially on the back teeth (premolars & molars). In severe cases it may entirely cover the teeth.

The accumulation of tartar and bacteria on the teeth surfaces will, sooner or later, lead to infection and gingivitis (inflammation of the gums). If the disease is caught at this early stage then thorough professional veterinary treatment may permit a full recovery. However, if gingivitis is allowed to persist untreated, then irreversible periodontal disease will occur. During this process the bone and ligaments that support the tooth are destroyed leading to excessive tooth mobility and eventually tooth loss. Infection around the socket causes the formation of pus and a foul odour, and may spread deep into the tooth socket creating an abscess, or even more severe problems.

Once periodontal disease starts, the degenerative changes cannot be reversed. These changes make it easier for more plaque and tartar to collect, so resulting in further disease.

Is gingivitis always associated with dental disease?
A slight degree of redness seen as a thin line just below the edge of the gum may be considered normal in some kittens and adult cats with little evidence of dental disease.

Some cats (most commonly, but not exclusively, in pedigree breeds) develop severe gingivitis with minimal signs of accompanying dental disease. The affected areas may extend beyond the gums to other areas of the mouth, such as the throat or tongue. The cause of this disease is thought to be prior infection with feline Calici virus. This condition is often very difficult to control and may require repeated or constant treatment.

What are tooth neck lesions?
Neck lesions result from a progressive destruction of the tooth substance effectively resulting in slowly deepening “holes” in the teeth concerned. Once the sensitive parts of the tooth is exposed these lesions are intensely painful, and usually the only available treatment is to extract the tooth. The cause of this disease is unknown, however poor oral hygiene is suspected to play a role in the disease-process.

What should I do if my cat has signs of dental problems?
If you can see that your cat has evidence of tartar accumulation, gingivitis or is exhibiting any signs of mouth pain or discomfort then you should take it to your vet for a check-up. You will be advised of the most appropriate course of treatment, which may involve having the cat’s teeth examined and cleaned under general anaesthesia.

The rate of tartar accumulation is very variable between individual cats, and in some cases this may necessitate professional cleaning on a regular basis (every 6-12 months)

Do not try to remove tartar from the teeth yourself using any form of metallic instrument. Aside from potentially harming your cat’s mouth (or the cat harming you!), you are likely to damage the tooth surface by creating microscopic scratches, which will encourage more rapid plaque formation and cause further disease.

What can I do to help prevent dental disease in my cat?
In order to help prevent dental disease the prime aim is to keep the mouth as hygienic as possible and to reduce the rate at which tartar builds up on the teeth.

The diet should contain, in part, foodstuffs which encourage chewing, such as large tough pieces of meat, and cooked chicken wings and chicken necks. These should be included in the diet on a regular basis, i.e. several times per week. The act of chewing stimulates the production of saliva, which contains natural antibacterial substances; and the mechanical action helps to scrape plaque and tartar off from the teeth. It is best to introduce cats to this type of food from an early age.

Many cats also benefit from prescription dental foods, such as Hills TD, or Eukanuba, which are formulated to reduce plaque build-up, or to remove this after it has formed.

Talk to one of our veterinarians about the best diet for your cat’s teeth.

DIABETES MELLITUS (Sugar Diabetes)
What is diabetes mellitus?
Diabetes mellitus refers to a medical condition where there is an excessive quantity of sugar (glucose) in the blood. This is caused by a relative or absolute deficiency of the hormone insulin, which is secreted by the pancreas.
The clinical signs seen in diabetes are largely a consequence of the raised concentrations of glucose in the blood, and the inability of the body to use glucose as an energy source (due to the deficiency of insulin).
Diabetes mellitus is an uncommon disease in cats, but is seen more frequently in middle to old-age cats and more common in males than females. Brown Burmese cats are more commonly affected than other breeds.

What clinical signs do you see in diabetes mellitus?
The most common clinical signs seen in diabetic patients are an increase in the volume of urine that is produced and, to compensate for this, an increase in the amount of water that is drunk. Weight loss is also a common feature, and an increase in appetite may be noticed in some cats. Recognition of these signs is variable though, particularly because of the life-style of some cats. If a cat spends a lot of time outdoors for example, it may drink from ponds or pools of water outside rather than appearing to drink excessively from what is provided indoors.

How is diabetes mellitus diagnosed?
The diagnosis of diabetes mellitus is made by finding appropriate clinical signs, together with a persistently elevated blood glucose concentration and the presence of glucose in the urine. However, a diagnosis of diabetes cannot usually be made on a single blood and urine sample as other conditions, and in particular stress, may also cause a transient rise in glucose levels. Confirmation of diabetes may therefore require more than one blood sample collected over a period of time (perhaps several days), or special blood tests that average out the blood glucose level obtained over several weeks.

How is diabetes mellitus treated?
Diabetes mellitus is a treatable condition. Although long-term treatment does require commitment, it can be very rewarding to successfully manage this condition.

Initial steps in treating a diabetic cat may involve removal of any predisposing causes for the diabetes. For example, the administration of some drugs predisposes cats to develop diabetes, and withdrawal of these drugs may lead to resolution of the condition. Also obese cats are more prone to develop diabetes and again, reduction in bodyweight can lead to resolution of the signs in some of these individuals.

If there are no predisposing causes, or if correction of the predisposing causes does not lead to resolution of the diabetes, specific treatment is required. Although a small proportion of cats will respond to a form of tablet (‘oral hypoglycaemic’) designed to increase the amount of insulin produced by the pancreas and increase its effectiveness, most cats will require insulin supplementation in the form of injections to control the diabetes.

During the initial stages of treatment, it is common for a cat to be hospitalised at a veterinary surgery so that appropriate monitoring can be carried out while a suitable dosage and preparation of insulin is being determined. Some vets prefer to stabilise cats on an outpatient basis. Once a cat has been stabilised (which usually takes a few days to a week or so), treatment can be continued at home. For most cats, this involves a twice daily injection of a small dose of insulin. Very small needles are available for this which cause no pain to the cat, and within a short period of time the procedure becomes very routine. Normally insulin is given at 7-8 a.m. and 7-8 p.m. with equal feeds being given immediately to 1 hour after the insulin. Some vets prefer once daily injections with a different type of insulin

Do treated cats need to be monitored?
Yes, it is important to monitor treatment to make sure it is working properly, and to determine if any adjustments are necessary to the dose of insulin given.

Monitoring can be done in part through collection of occasional blood samples by your veterinary surgeon, but it is particularly valuable to keep accurate records of the following information:

Daily records:
• Time of insulin injection
• Amount of insulin injected
• Amount of food fed and eaten (and time)
• Amount of water drunk

Weekly record:
• Weight of the cat

In addition to these records, it can be valuable to monitor the quantity of glucose passed in the urine as a guide to the effectiveness of the treatment. This is best done on urine that is passed during the night or first thing in the morning. To collect urine, it is usually easiest to replace the normal cat litter with clean (washed) aquarium gravel at night which will not soak up any urine passed. The urine collected can either be tested by your veterinary surgeon, or they may supply you with a kit to test it yourself. If there is any marked change in the amount of glucose in the urine, this may indicate the need to alter the insulin dose, but you should never change the dose of insulin without first discussing it with your veterinary surgeon. Changes in the insulin dose are usually based on trends in urine glucose concentrations as there is normally some day-to-day variation.

What happens if my cat receives too much insulin?
If a cat receives too much insulin, it is possible for the blood sugar level to drop dangerously low. For this reason it is important to be very careful in ensuring the cat receives the correct dose of insulin.

The typical signs displayed by a cat with a very low blood sugar level are severe weakness and lethargy, shaking, unsteadiness and even convulsions. If a diabetic cat shows any of these signs it is important to seek urgent veterinary attention. If the more severe signs are displayed (ataxia or unsteadiness during walking, and/or convulsions) a tablespoon of a saturated glucose or sugar solution should be given by mouth immediately. As this is an emergency, it is useful to have a small amount of a glucose solution stored in a refrigerator for any cat receiving insulin.

DIARRHOEA
How is diarrhoea recognised?
Most cats defecate outside, and since they usually bury their faeces, diarrhoea readily passes unnoticed by the owner. It may only be if the cat has an accident in the house or soils the fur around the anus (particularly in a long-haired cat) that the diarrhoea becomes apparent. If the cat uses a litter tray the owner may have much more information about variations in the faeces. Some variation in the appearance and the faeces is quite normal, particularly in some individual cats and may be related to minor factors such as variations in diet. Persistently liquid or semi-liquid faeces, however, should be reported to your veterinary surgeon.

If a litter tray is used in a household with more than one cat it is helpful to establish if it is just the one cat that has diarrhoea or whether more than one cat in the household is affected. If an infectious agent or a common dietary factor is involved all the cats in the household are likely to have been exposed to the same problem. It may be necessary to confine one cat to a specific area of the house at a time to determine which cats have diarrhoea.

What causes diarrhoea?
Diarrhoea is not a disease in itself but a sign which may reflect many different problems, some of which involve specific diseases, whilst others may be related more to management factors, such as diet. If chronic diarrhoea has been present for some time, this is most often, but not necessarily, related to some intestinal disorder.

Initial approach to diarrhoea
Many cases of diarrhoea will respond quite readily to simple treatment, frequently without the initial cause ever being established. Generally acute diarrhoea which has been present for only up to a few days will resolve quickly. Chronic diarrhoea which has been present for some time, often over 2-3 weeks, may prove more difficult to treat effectively. It will help your veterinary surgeon to decide on the most appropriate approach to dealing with the case if it can be established whether the diarrhoea is acute or chronic. Therefore any information you can provide on how long the diarrhoea has been present will be very helpful. Information about any other signs your cat has shown will also be helpful in deciding whether symptomatic treatment or further investigations are appropriate.

Particularly important signs to recognise are:-

1. Does your cat seem ill - lethargic, etc.?
2. Any marked weight loss?
3. Any vomiting?
4. Any change of appetite?

It is also helpful, particularly in cases of chronic diarrhoea to establish whether the diarrhoea is related to a problem high up in the intestines (affecting the small intestine) or lower down in the colon (large intestine).

The pattern and nature of the diarrhoea may provide clues to help differentiate between these two:-

• any weight loss
• the frequency of defecation
• whether increased quantities of faeces are produced
• the appearance of the faeces - very fatty/greasy and smelly
• any fresh blood
• any "changed" blood (very dark faeces)
• any mucus or slime
• any straining or pain on defecation

Another important area which can be of help is in reporting any change in management recently, particularly relating to feeding:-

• what is the cat's normal diet
• has the diet changed recently
• does the cat have milk
• does the cat have scraps or titbits
• has the cat stolen any food recently
• does the cat hunt and eat its prey
• does the cat take food from anywhere else - neighbour etc.
• is the cat wormed regularly

If the diarrhoea is mild
If the diarrhoea is so severe that it is causing other problems to develop such as dehydration and weakness, or the veterinary surgeon decides that either other worrying signs are present or that a serious underlying problem is involved, he or she may recommend certain investigations. However most cases are relatively mild and in this situation, symptomatic treatment is usually tried initially without any further investigations. Most such cases will resolve even though the underlying cause is never clear. Frequently it may be a relatively minor unknown factor such as stealing some food from a neighbour's bird table, or breaking in to the dustbin bag for the remains of last week's roast.

Symptomatic treatment
Symptomatic treatment is usually tried initially in mild cases of diarrhoea. It may involve a number of measures:

1. Withholding food for up to 24 hours. This may help the function of the intestine to return to normal
2. Provision of a simple diet.
Feeding a readily digestible diet may help. You may be provided with a special ‘prescription’ diet for this purpose or your veterinary surgeon may suggest a home-made diet. Boiled chicken or fish with rice or sometimes pasta are often used.

It is very important that the cat does not receive any other foods during this period. This includes milk - the cat should receive only water to drink unless specifically instructed by your veterinary surgeon. It also includes mice or any other prey, tit-bits and next door cat's food! The only effective way of ensuring this may be to confine your cat indoors for a period. This is particularly important if a dietary trial is being undertaken to test whether the cat is allergic to foods in its diet. A single dietary ‘indiscretion’ may ruin the test! If you do not think it is practical to prevent your cat from having access to foods outside: you should mention this to your veterinary surgeon who may suggest hospitalising the cat for a dietary trial.
3. Drugs
There are some drugs which are occasionally used to help improve diarrhoea - by slowing down the passage of food in the intestine, coating the lining of the intestine etc. Antibiotics are sometimes used but are generally reserved for cases in which a specific, severe infection has been diagnosed. Otherwise they may upset the balance of the bacteria in the intestines which may further contribute to the diarrhoea. It is a common misconception that infections are a common cause of diarrhoea. Specific infections are relatively rare causes of diarrhoea in cats.

Do not use human proprietary antidiarrhoeals sold by pharmacists - some of these are very dangerous to cats.

If further investigation is required.
If your veterinary surgeon suspects a serious underlying cause to the diarrhoea or complications are developing such as dehydration and severe weakness, further investigations may be required at an early stage and other treatment may be necessary. In particular it will be important to avoid dehydration. If the dehydration is severe your cat may have to be hospitalised for a ‘drip’.

Since there are many possible causes of diarrhoea, there are many potential tests required to establish the underlying cause. Some of the more commonly used tests are:-

Blood tests - to check for serious viral infections and provide clues of other problems

Faecal tests - to hunt for infections, parasites etc. A fresh faecal sample is required for this and is preferable to a rectal swab.

X-rays - to check for thickenings, blockages, tumours, foreign bodies etc.

Intestinal biopsy - in some cases a diagnosis will only be achieved by microscopic examination of a small biopsy of the intestine. This may necessitate "opening up" the abdomen, which is a major operation, but at specialist clinics it is now possible to obtain biopsies using an endoscope (a flexible viewing tube) passed through the mouth.

These further investigations can be expensive and do not always provide a diagnosis. Chronic diarrhoea can be a very difficult condition to diagnose. In some selected cases your veterinary surgeon may decide to use a series of trial treatments. It is most important that you follow these very carefully if this approach is to be used effectively. Such a trial usually start with a dietary trial (as described above).

If you anticipate or encounter any problems in sticking to the trial, it is important that you discuss this with your veterinary surgeon.

EAR INFECTIONS
How common are ear infections in cats?
Infections of the external ear canal (outer ear) by bacteria or yeast are common in dogs but not very common in cats. We call this otitis externa. The commonest cause of feline ear disease is ear mite infestation. Some cats have similar signs due to excessive wax in ears that are not infected.

What are the symptoms of an ear infection?
A cat with an ear infection is uncomfortable and its ear canals are sensitive. The cat shakes its head trying to get the debris and fluid out and scratches its ears. The ears often become red and inflamed and develop an offensive odour. A black or yellow discharge commonly occurs.

Don't these symptoms usually suggest ear mites?
Ear mites can cause several of these symptoms including a black discharge, scratching and head shaking. However, ear mite infections generally occur most commonly in kittens. Ear mites in adult cats occur most frequently after a kitten carrying mites is introduced into the household. Sometimes ear mites will create an environment within the ear canal which leads to a secondary infection with bacteria or yeast. By the time the cat is presented to the vet the mites may be gone but a significant ear infection remains.

Since these symptoms are similar can I just buy some ear drops?
No, careful diagnosis of the exact cause of the problem is necessary to enable selection of appropriate treatment. There are several kinds of bacteria and fungi which might cause an ear infection. Without knowing the kind of infection present we do not know which drug to use. In some cases the ear infection may be caused by a foreign body, tumour or polyp in the ear canal. Treatment with medication alone will not resolve these problems. Also the cat must be examined to be sure that the eardrum is intact. Administration of certain medications can result in loss of hearing if the eardrum is ruptured. This determination is made by the vet and must be done at the surgery.

How do you find out what is causing the ear problem?
The vet may examine the ear canal with an otoscope, an instrument that provides magnification and light. This permits a good view of the ear canal and allows him to determine whether the eardrum is intact and if there is any tumour or foreign material in the canal. When the ears are extremely painful and the cat refuses to allow ear examination, sedation or general anaesthesia may be necessary. The vet may then examine a sample of the material from the ear canal under the microscope. This is called cytology and is very important in helping the vet choose the right medication. Some cats have such a heavy build-up of debris that sedation or anaesthesia are needed to cleanse the canal and examine it completely.

How are ear infections treated?
The results of the otoscopic examination and cytology tell the vet. what to do. If there is a foreign body lodged in the ear canal the cat can be sedated so that it can be removed. Specific medication can be prescribed for bacteria or fungi; sometimes more than one type of infection is identified and this situation requires the use of multiple medications.

An important part of the evaluation of the cat is the identification of underlying disease. If underlying disease is found it can be treated. If this cannot be done the cat is less likely to have a favourable response to treatment; the cat might respond temporarily but relapse when the medication is discontinued.

Since primary ear infections are uncommon in cats should I be concerned that something else is going on?
Normal cats are very resistant to ear infections. Therefore finding otitis externa in a cat signals us to look for an underlying cause such as an ear mite infestation, an unusual shape of the ear canal or for a disease affecting the cat's immune system.

What is the prognosis?
In the cat nearly all ear infections that are properly diagnosed and treated can be cured. However if an underlying cause remains unidentified and untreated the outcome will be less favourable.

My cat's ear canal is nearly closed. Is this a problem?
Closing of the ear canal occurs when an infection becomes very chronic. There are medications that can shrink the swollen tissues and open the canal in some cats. However some cases may eventually require surgery.

How should I apply medication to my cat's ear?
It is important to get the medication into the horizontal part of the ear canal. This is best done by following these steps:-

• Prior to instillation of the medication, clean the outer part of the ear canal and the inside of the ear flap with a ball of cotton wool. Do not use cotton tipped applicators to do this as they tend to push debris back into the vertical ear canal.
• Warm the medication by standing the bottle in a bowl of warm water for a few minutes.
• Gently pull the ear flap straight up and hold it with one hand.
• Apply a small amount of medication in the vertical part of the ear canal while continuing to keep the ear flap elevated. Hold this position long enough for the medication to run down to the turn between the vertical and horizontal ear canal.
• Put one finger in front of and at the base of the ear flap and put your thumb behind at the base.
• Massage the ear canal between your finger and thumb. A squishing sound tells you that the medication has gone into the horizontal canal.
• Release the ear and let your cat shake its head. If the medication contains a wax solvent debris will be dissolved so it can be shaken out.
• If another medication is to be used apply it in the same manner.

EAR MITE INFESTATIONS
What are ear mites?
The ear mite (Otodectes cynotis) is a surface living mite which lives on cats, dogs, rabbits and ferrets. It is usually found in the ear canal but it can also live on the skin surface. The whole of the life cycle takes place on animals. Cats become infested by direct contact with an infested animal. The mite is just visible to the naked eye and can be seen as a white speck moving against a dark background.

What effect do ear mites have on cats?
Ear mites are by far the commonest cause of feline ear disease. They are the second most common ectoparasite found on cats, the most common is the flea. Infestations are most common in kittens and young cats although cats of any age can be affected. Clinical signs of infestation vary in severity from one cat to another and include combinations of:-

• ear irritation causing scratching at the ears or head shaking
• a dark waxy discharge from the ear
• areas of hair loss resulting from self-trauma - scratching or excessive grooming
• a crusted rash
• aural haematoma - a large blood blister cause by rupture of small blood vessels between the skin and cartilage of the ear usually on the inner aspect - caused by scratching at the ears

Skin lesions most frequently affect the ear and surrounding skin but uncommonly other areas of the body may be affected.

How are ear mite infestations diagnosed?
Typical clinical signs with a history of contagion (spread) between cats or cats and dogs would suggest the involvement of ear mites. Over 50% of feline ear disease is caused by ear mites. However other conditions can result in very similar clinical signs.

A vet can make the diagnosis by demonstrating the mite. This is usually straightforward and may be done either by examination of the cat's ears with an auroscope or by microscopic examination of discharge from the ear. If the ears are very sore the cat may need to be sedated or given a general anaesthetic to allow the ears to be properly examined.

How can I get rid of ear mites from my cat?
A three pronged attack is required:-

• treat the ears of all affected and susceptible in contact animals
• treat the skin of all affected and susceptible in contact animals
• treat the indoor environment because the mite is capable of limited survival off animals

Your vet will advise you about which insecticidal products are suitable. There are several ear medications licensed for the treatment of ear mites. There are no products licensed for use on the house or on animal's skin but products licensed for flea control are effective.

Your vet may ask you to continue the treatment regime for at least 21 days after which he/she may check the cat to ensure that the mites have been eliminated.

Some vets may prescribe ‘off label’ Ivermectin given orally or subcutaneously to treat ear mite infections. This is a very convenient and effective way of treating ear mite infection in multicat households. However there is some risk of toxicity when giving this drug to young cats and kittens. They will discuss this with you prior to commencing this treatment.

Do ear mites affect people?
Ear mites may cause an itchy rash on susceptible people if there are infested animals in the household. Eradication of the mites from the animals will cure the problem.

FIGHT WOUND INFECTIONS
What is the cause of fight wounds on a cat?
Over 90% of septic wounds in cats result from cat bites sustained during a cat fight. Dog, rat and other rodent bites can occur but they are much rarer.

Why do cats fight?
Cats are very territorial. They fight with other cats to protect their territory or to acquire more territory. As a result fight wounds are common in cats. Fight wounds frequently result in infection that can make cats quite ill particularly if they are left untreated. Fight wounds are more common in male cats than females and most frequent in entire Tom cats.

My male cat has been neutered. Why does he still fight?
Entire male cats are very territorial; they will defend an area around their home but try continually to expand the borders of their territory. The desire for more territory and the need to keep intruders off their existing territory means that they are constantly fighting with other cats. In contrast neutered male cats defend a smaller area of territory around their home. If this territory is breached by another cat they will defend it by fighting. The frequency of fighting will depend on the number of cats in the neighbourhood and particularly the presence of entire Tom cats. Female cats will also defend their territory.

What can I do to stop my cat being bitten?
As discussed above neutering is advisable but this will not completely eliminate fighting. Confining the cat to your house particularly at night when cat fights are most common will reduce the number of bites your cat sustains.

What happens after a cat has been bitten?
When a cat bites its teeth go through the skin and then it releases. This leaves small puncture wounds in the skin which rapidly seal over within hours trapping bacteria from the cat's mouth under the skin of the victim. The bacteria multiply under the skin. For several days there may be little or no sign of infection (although observant owners may notice lameness and scratches which result from the fight). Later swelling and pain at the puncture sight are noticed. The cat may also run a fever. If the site of the bite is covered by loose skin a pocket of pus will develop forming an abscess. In areas where the skin is not loose such as on the foot or the tail the infection spreads through the tissues and causes a cellulitis.

Rarely there may be more serious consequences such as a septic arthritis (infection of a joint space) or osteomyelitis (infection of bone).

What should I do if I know my cat has just been bitten?
If you know that your cat has bite wounds antibiotics given within 24 hours by your vet will usually stop the spread of infection and development of an abscess. If several days have elapsed since the fight an abscess will often form. Some vets prescribe antibiotics to be given immediately after a fight in individuals prone to fighting.

How will I know that my cat has a fight wound if I can't find any bite marks?
Puncture wounds heal very quickly so often there can be nothing left to see or feel. The most common sites of bites are on the head, forelimbs or at the base of the tail. If cats have been bitten on a limb this will often be painful and they will be lame on it or may not use it at all. It may be possible to feel heat and swelling in the area of the bite. Some cats may just be lethargic and have a temperature. Frequently scratches can be felt in the coat by observant owners just after the fight.

What should I do if my cat gets an abscess or infected bite wound?
You should take your cat to the vet. If an abscess is present the vet will drain it. This can sometimes be done by removing the crusts over the original bite wou