In 1986 in Northern California a disease that was causing illness and death in cats was found to be caused by a virus similar to HIV, or the AIDS virus found in humans. Since then, much research has been done on this virus and the disease it causes. To date scientists have not been successful in formulating a vaccine to prevent this infection in cats. There has also been little success in finding methods to treat those cats that have the disease, but we DO know enough about the disease to safeguard our pets from this fatal disorder.

Because of its similarity to the HIV virus, it was named FIV (feline immunodeficiency virus), and the disease it induces is known as FAIDS (feline acquired immune deficiency syndrome). The virus is classified in the same group of viruses as the HIV virus, but it is not identical. The HIV virus does not infect cats, and likewise the FIV virus does not infect humans. There is no danger that a person could catch AIDS from a cat or vice versa.

There is now a reliable blood test, which your veterinarian can perform on your cat to see if it is infected with FIV. As in people, we refer to a cat that tests positive as being "FIV positive" but that cat does not necessarily yet have FAIDS, and may not become sick for months or years or in some cases not at all. When a cat does develop illness, the body's natural defense against disease is broken down. The cat is then susceptible to a great variety of infections, cancers, etc. No one specific symptom is typical. It might be a sickly cat that is not recovering promptly from an illness, or has a chronic illness such as infected teeth or gums, frequent diarrhea or discharge from the nose or eyes. While we do our best to control other infections these cats may acquire, we cannot cure them of the FIV infection, and it is usually fatal.

The FIV virus affects only cats, so the risk for any cat of catching the virus comes through contact with another cat that is infected. The virus does not survive outside the cat's body, so it is not blown through the air or carried on a person's hands or clothing from cat to cat. An indoor cat that does not come in contact with other cats would be at no risk of catching the virus. Cats that are allowed to roam outdoors and may encounter stray cats have to be considered at risk to catch FIV. Studies have shown that the infection is worldwide, and in every area of the United States where stray cats have been tested the infection is present in a certain percentage of those cats. Because cats can live for months or even years while infected, they can transmit the infection to other cats.

Many studies are currently investigating exactly how FIV is transmitted cat to cat. The most common method of transmission is through a bite wound inflicted by an infected cat. In this case the virus in its saliva enters the blood stream of the bite victim. Bite wounds, however, are not the only method of transmission and virus-to-blood contact is not always necessary. FIV infected mothers can transmit the virus to their offspring but not in utero. The transmission to offspring probably takes place during nursing, and experts feel the majority of kittens nursing FIV positive mothers don't get the disease. It is still unknown whether transmission takes place during mating, but since biting can be part of the mating ritual, we have to assume it could. Experimentally scientists have been able to infect cats by giving the virus orally. We don't know, however, in the natural setting of mutual grooming, sharing food bowls, etc., how often this occurs. It appears that in a setting where one cat in a house is FIV positive and has non-biting contact with other cats, those cats have a low probability of becoming infected.

The blood test that veterinarians do to detect FIV is a test not for the virus itself, but for antibodies to the virus that have formed in the cat's system. This is the same as an HIV test in a person in that it assumes that antibodies form only when you have become infected with the virus, and once you become infected you remain so for life. Therefore, a positive test for cat antibodies to the FIV virus would prove that the cat is infected. However, there are two situations which confuse this issue.

One is the kitten born to an FIV positive mother. Antibodies from the mother's blood stream are passed in the milk to the kittens and for a few weeks the mother's antibodies may be detectable if a blood test is done on the kitten, even though the kitten is not infected. So a positive FIV test in a young kitten must be interpreted carefully. A negative test must be interpreted carefully in any cat that was recently exposed. From the time a cat becomes infected with the virus to the time that enough antibodies have built up to cause a positive blood test takes a few weeks. So for the first few weeks an infected cat will have a negative test. In both of the above situations, the confusion can be cleared up by repeating the blood test several weeks later.

Even though we cannot cure FAIDS or vaccinate cats to prevent FIV infections, we do recommend the following steps to ensure that your cats remain FIV free:

• Take any new kitten or cat that you obtain to your vet before bringing it into your home. Be sure that the examination and testing done that day includes the FIV blood test.
• Even the most timid house cat may be inclined to fight to defend its territory when a stray cat comes around, and some stray cats carry FIV. Keep your cats indoors, or allow it outdoors ONLY under constant supervision.
• Preventive health care.

The current status of feline dental disease consists of several well-recognized conditions. Proper and aggressive treatment of these conditions can greatly contribute to the well being and longevity of the patient.

Some conditions are similar to those experienced by humans, while others are unique to felines. The most common condition seen in cats is gingivitis and periodontal disease secondary to plaque and tartar accumulation on the teeth. As in humans, plaque and tartar contain high concentrations of bacteria which cause inflammation and eventual damage to the gums (gingivitis) and as this is allowed to progress the inflammation destroys the bony tissue which anchors the tooth in the socket (periodontitis). In addition to the local damage to the oral tissue, these high concentrations of bacteria enter the bloodstream through the gingiva resulting in cardiac, liver and kidney involvement. Frequent, regular dental cleaning is the key to preventing this condition from becoming irreversible problems. Keep in mind; virtually any dental procedure must be performed while the patient is under general anesthesia. While there is no "perfect' anesthetic agent, the newer inhalant anesthetic agents truly increase the safety margin.

Feline lymphocytic, plasmacytic gingivitis (LPG) is a condition unique to cats that is seen fairly frequently. This condition is characterized by an exaggerated inflammation of the gum tissue in response to a relatively mild accumulation of plaque. The gingival tissue is also very thickened and painful. Sometimes the affected tissue may extend all the way back to the tonsillar area. These patients should be checked for Feline Leukemia, Feline Immunodefiency Virus, and other possible metabolic disease (kidney failure). Most cases of LPG are thought to be some form of immune reaction to relatively low concentrations of bacteria in the plaque. Early cases can sometimes be managed with frequent cleaning, steroids, and antibiotics. Eventually most cases become chronic and non-responsive to this form of treatment. Therefore, the best current long-term treatment for this is total extraction. Although this may sound extreme, by eliminating the surfaces on which plaque is allowed to accumulate, the gingival reaction ceases. Furthermore, by stopping the chronic inflammation, the potential systemic effects are also limited.

Feline odontoclastic resorptive lesions (FORLS) are a form of spontaneous tooth resorption seen in middle age and older cats. These lesions are cavity-like erosions which develop at the gum line and progress inward and toward the ends of the roots. These are very subtle in appearance yet quite painful. Unfortunately, because of their insidious onset, by the time these are found they can be fairly advanced and can only be treated by extracting the affected tooth. To date, there is no known cause. Clearly, felines are susceptible to several different types of dental conditions. Symptoms of the above mentioned conditions can vary. Gingivitis and periodontitis often present as halitosis (bad breath) and occasionally excess salivation and difficulty eating. Lymphocytic gingivitis also presents as severe bad breath and is usually very painful. Odontoclastic resorptive lesions are very subtle and often painful. Occasionally these lesions may cause difficulty eating or if the lesions are advanced, can result in premature tooth fracture.

Preventive measures are most effective for gingivitis and periodontitis. Regular brushing with small brushes, finger brushes and sponge-type devices are often helpful, but must be done on a very regular basis. The only effective dietary management is with the use of Hills Feline T/D diet, but ONLY after the teeth have been professionally cleaned.

And please keep in mind that regular dental exams are helpful to prevent localized dental conditions as well as systemic problems which can arise from dental disease.

The kidneys of a cat can become diseased in a number of different ways. Cats can be born with congenital kidney disorders or the kidneys can become damaged due to injuries, infections, kidney stones, tumors and toxins (such as antifreeze). While all of these conditions are life threatening they are, luckily, all fairly uncommon. The kidney condition of cats which is very common is a progressive deterioration of the kidneys with no apparent underlying cause that progresses with age. We refer to this as Chronic Renal Failure (CRF). This condition is the most common cause of death in aged cats. When deterioration of the kidneys occurs, they are not able to function normally. The kidneys have several important functions. They help clear toxic waste products from the body, keep several blood chemicals at normal levels, and control fluid balance to maintain normal hydration. They also produce a hormone necessary for the production of red blood cells and are involved in the regulation of calcium and vitamin D.

In the very early stages of renal failure the body is able to compensate so symptoms may not be evident. As the disease progresses and imbalances become more marked, symptoms such as increased thirst and urination, dehydration, loss of appetite, lethargy, weakness, and vomiting may occur. Your veterinarian will be able to assess the state of your cat's kidney function using blood and urine tests. In some cases veterinarians may also use x-rays, blood pressure measurement, ultrasound and even kidney biopsies to gain more information about kidney function.

Chronic renal failure has been considered an incurable disorder, however in the last few years kidney transplantation has become a reality in feline medicine. There are only a handful of veterinary centers in the country doing kidney transplants, the procedures are very expensive and not all cats with kidney disease are candidates for transplantation. For those reasons, most cats with CRF will not get transplants and we must regard the disease as a progressive one that we cannot cure but can manage for months to years with proper veterinary care.

One type of therapy your veterinarian may recommend is a change in diet. Several diets are formulated specifically for cats with kidney disease. They differ from other cat foods in that they have lower protein level and modifications in the levels of several other chemicals such as potassium, phosphorus, and sodium. Your veterinarian may feel this is an important part of your cat's therapy. An important part of the treatment for cats with more advanced disease is fluid therapy. Fluids infused through an intravenous catheter or infused subcutaneoulsy (under the skin) help flush out waste products through the kidneys as well as restore hydration and correct certain chemical imbalances. This type of treatment does not always require hospitalization. Many cat owners learn to give their cat subcutaneous fluids at home.

Depending on what specific complications your particular cat has, your veterinarian is likely to prescribe one or more of several medications. These include blood pressure medication, potassium supplements, vitamins, iron, phosphate binders, hormones to correct anemia, and drugs to treat gastrointestinal upsets.

Once chronic renal failure is diagnosed your veterinarian will want to follow your cat's condition with regular check-ups and testing and will tailor a treatment plan specifically for you and your cat. It is hard to predict for each cat how quickly this disease will progress, but with early diagnosis and proper care some cats can enjoy a good quality of life for several years.

Toxoplasmosis (commonly called toxo) is a disease caused by a microscopic protozoan called Toxoplasma gondii. You may have heard about this infection because of the danger to newborn children if a woman becomes infected while pregnant. Another reason cat owners should be aware of toxo is that the cat is considered the "definitive host" of the toxoplasma organism, meaning it is the only animal that sheds infectious toxo in its feces.

All mammals can become infected with toxo. Infection can occur in two ways. One is by ingesting toxo that has been shed in the feces of a cat. This can occur through contact with soil where cats have defecated or through direct contact with a cat or its fecal matter. This is a very uncommon occurrence. The much more common method of acquiring toxo is by eating meat or prey which contains toxo in the form of a tissue cyst. In cats and other predatory animals this occurs commonly when they eat uncooked prey. In people it occurs most commonly through eating raw or undercooked meat since beef, pork and lamb can all contain toxo.

When any animal, including people and cats, become infected with toxoplasma it usually is an inapparent infection with no illness. This is because the body's immune system puts up a defense that stops the spread of the toxo and walls off the organism into a tiny tissue cyst which remains dormant for years. These are the same tissue cysts which if eaten can cause infection.

In people the situation is different if the person who becomes infected has a compromised immune system, such as a person with AIDS or a person on immune-suppressing drugs. In these cases, the spread of toxo may not be held in check and it can develop into an overwhelming and sometimes fatal infection which may affect many organs including the lungs, liver, eyes and brain. The situation is also different if the person who becomes infected is a pregnant woman.

The woman will generally have no apparent illness, but the toxo organism can pass to the fetus and result in damage to the eyes or brain causing congenital disease.

When mammals other than people become infected a similar thing happens. The vast majority never have illness but may carry tissues cysts of toxo for life. Only a few whose immune system fails to stop the toxo will become ill. This holds true for cats as well. A high percentage of cats have toxo cysts but are not ill, but we only occasionally diagnose toxoplasmosis in cats where it causes disease of the eye, lung, brain or other organs.

Cats are unique in that they are the only animal which gets toxo in the intestine. This usually occurs the first time a cat ever ingests toxo. Three days to three weeks after becoming infected the cat begins to shed the toxo in its stool. This usually causes no illness in the cat and the shedding stops after one to two weeks. The toxo that is passed in the stool is not immediately infective. It takes two or more days before the toxo is infective, but it then remains infective in soil or sand for months. There are diagnostic tests which can be done on both the blood and the feces of cats to check for toxoplasma. If your cat is ill with a disease that might be toxo, your veterinarian will probably suggest the blood test for toxo to help determine if that is the cause. The use of the blood or the fecal test on a healthy cat is controversial. The blood test looks for antibodies to toxo in the bloodstream. If present they indicate that the cat became infected sometime in the past. This doesn't mean the cat is or will become ill from toxo. Nor does it mean the cat is shedding toxo in the stool since that period of shedding is only a brief period following the initial exposure. If the blood test indicates the cat has no exposure to toxo, that cat poses no danger to a person now, but if it is later exposed to toxo, it will then shed toxo in the stool.

The test done on the cat's feces is also not completely reliable. The toxo organism is sometimes hard to find under the microscope and since shedding only lasts a short while, it is very easy to miss on a single stool test. If a cat's stool test is free of toxo when the owner becomes pregnant, that does not assure that it will remain free of toxo throughout her pregnancy. Due to the problems with interpreting these test results, each cat owner should discuss with their own veterinarian which, if any, tests they recommend.

Considering what has been said about toxoplasma, here are some recommendations on how to minimize your cat's exposure to toxo.

• Keep your cat indoors to preclude its access to rodents and birds and to areas where stray cats may have defecated.
• Never feed your cat raw or undercooked meat, or unpasteurized dairy products.
• It is likely that in the near future there will be a vaccine to protect cats against toxo and your veterinarian may recommend it.
Here are some recommendations on reducing the risk of toxo for people:
• Eliminate raw or undercooked meat and unpasteurized dairy products from your diet. Remember, far more people get toxo this way than from cats.
• Pregnant woman and immuno-comprised individuals should avoid litter pan care altogether. Another family member should clean out the feces daily since it takes a few days for toxo to become infective. It is best to wear rubber gloves and the pan should be frequently cleaned and disinfected using scalding water.
• Cover children's sand boxes since they are natural litter pans for stray cats.
• Wear rubber gloves when gardening in an area where cats may have defecated.
• Make it a practice to wash your hands after gardening or contact with cats and after handling uncooked meat and vegetables.
• Discuss with your veterinarian whether blood or fecal tests should be run on your cat.
• If you are contemplating pregnancy, discuss with your obstetrician whether to have a blood test done on yourself for toxo.

About the Authors:
Dr. Williams became the St. Louis area's first feline-only practitioner when he founded the Cat Clinic in 1984.
Dr. Pittari has been in feline practice for 10 years and is board certified in feline practice by the American Board of Veterinary Practitioners.

Each year, nearly one million cats are killed by Feline Leukemia Virus (FeLV). FeLV is the number one cause of death due to infectious disease in cats. It is a retrovirus which replicates in the bone marrow, salivary glands and the cells lining the respiratory tract. The virus is most commonly transmitted through close and prolonged physical contact with an infected cat. The virus can be shed in the blood, urine, feces and most commonly, the saliva and respiratory secretions. A pregnant cat can also pass the virus to her kittens while in the uterus or, later, through nursing and grooming. FeLV can kill in two ways. The first, and most common way is by attacking the immune system. As the virus grows in the bone marrow, cats may lose their ability to fight off infectious diseases. A cat infected in this manner can present with a wide variety of diseases, such as mouth infections, wounds that will not heal, anemia, respiratory infections, fevers of unknown origin, reproductive problems, hemobartonellosis, Feline Immunodeficiency Virus (FIV) or Feline Infectious Peritonitis (FIP). Any cat with a chronic illness is suspect.

The second way FeLV attacks the cat is to cause tumors or leukemia. Any cat who is exhibiting anemia or other blood abnormalities should be tested for FeLV.

Not every cat exposed to FeLV will be permanently infected. Approximately 70% of exposed cats are able to clear the virus from their systems. But once a cat is permanently infected, its life expectancy is drastically decreased. There is no known cure for FeLV. More than 85% of infected cats die within three years, and at least half of these will die in less than one year. A small percent of exposed cats neither get ill nor die, but become carriers of the virus and can infect other cats.

Some types of cats are more at risk than others. Adult cats with strong immune systems are much less likely to become infected than young or very old cats. Pure breed cats and outdoor cats are at a significantly higher risk due to their increased exposure rates and the level of crowding and stress in catteries. But the kitten is at the highest risk of all because of its immature immune system. There are several ways owners can protect their pets from the FeLV infection:

• Most importantly, minimize contact with any cats that have unknown FeLV status or those that are not protected by vaccination. Keeping cats indoors is a very good way to minimize contact with unknown pets.
• Cats who will be boarded or shown should be tested and vaccinated regularly.
• Common disinfectants will readily inactivate the virus, so good housekeeping is essential in boarding facilities, veterinary offices, catteries and show facilities.

In order to protect your own cat, have your veterinarian perform a blood test for FeLV as soon as a new pet is acquired and before exposing other cats to it. Discuss with your veterinarian the need for a follow-up blood test eight weeks later to catch infections which were newly incubating. Then have your veterinarian administer a series of two vaccinations 2-3 weeks apart and follow up with a yearly booster. Remember that no vaccine is 100% effective, so limiting exposure is still the best prevention.

With advancements in nutrition and medical care, cats are living to older ages than ever before. With the older age comes diseases which we were unfamiliar with before because most cats did not live long enough for them to develop. One such disease is Hyperthyroidism.

The thyroid gland consists of two flat lobes located on each side of your cat's windpipe. These lobes are flattened and cannot routinely be palpated. Embedded in the front end of each thyroid gland are the parathyroid glands. The thyroid gland acts as the thermostat for the metabolic rate of the body, controlling the speed of (how fast or slow) the body functions. It produces two hormones, referred to as T3 and T4 which circulate throughout the body and affect sensors on the organs of the body.

Hypothyroidism is a condition where there is not enough thyroid hormone produced by the body and thus the metabolic rate slows down. Animals that are hypothyroid usually become obese (weight gain) become less active (lethargic) are more cold sensitive (cold intolerance), and have multiple skin problems that can vary from itching to flaking to hair loss. Cats are rarely affected by hypothyroidism.

Hyperthyroidism results when the thyroid gland produces an excess of thyroid hormones. This happens most commonly when the thyroid gland has become cancerous. Hyperthyroidism most commonly develops in cats over eight years old. Cats that are hyperthyroid are usually hearty eaters, sometimes even ravenous, yet they continue to lose weight in spite of how much they eat. A more serious consequence of hyperthyroidism is the development of a hypertrophic (increased muscle wall) cardiomyopathy (disease of the heart.) This is first detected by an increased heart rate and confirmed by x-rays & ultrasound. Other signs can include increase thirst, increased urination, vomiting, diarrhea, behavioral changes and central flexion of the neck. Not all cats exhibit all of the signs listed above, however, hyperthyroidism must be considered in any cat over eight years of age that is acting ill or losing weight. It is diagnosed by a blood test that measures the thyroid hormone.

Because other diseases can show similar signs like diabetes and renal (kidney) insufficiency, it is important to evaluate all of the organs of the body at the same time. Once hyperthyroidism has been diagnosed treatment can be very successful. There are three methods to treat hyperthyroidism, medical treatment, surgical treatment and irradiated iodine treatment. The following table lists these ways and their advantages and disadvantages:

All three of these treatments can be successful. Which one is best for your cat depends on a combination of factors including the cats' age, other concurrent conditions, your veterinarians' surgical expertise, and your financial resources. Medically, irradiated iodine is the treatment of choice.

As our cats live to older ages, diseases which we have never seen before are being detected. Reasons for this include the fact that we are now more aware of these conditions and are looking for them, our methods of detection are better and cat owners are more willing to pursue diagnosis and treatment. The best way to assure your cat is diagnosed for hyperthyroidism or any other disease is to have timely physical examinations. Your cat should receive thorough physical examinations annually between the ages of 1 to 9 and twice a year from 10 years and older. Patients with existing conditions may need to be checked even more frequently.

Diabetes mellitus or "sugar diabetes" is one of the human diseases which also affect cats. Diabetes is not as common in cats as in people, but it is not uncommon for veterinarians to diagnose and treat diabetes in middle-aged and older cats.

Diabetes results from a failure of certain cells in the pancreas to secrete enough of the hormone insulin. Insulin is needed to allow cells of the body to take up sugars from the blood stream and metabolize them into energy, so in the diabetic cat the blood sugar remains too high. Over the course of time, uncontrolled diabetes in cats will cause adverse effects to various organs of the body. The most serious consequence is that regardless of how much these cats eat they are, in effect, starving because they can't properly process nutrients. Owners of diabetic cats may observe that their cat will lose weight even though the appetite is good. Another symptom of diabetes which may appear even before weight loss is an increase in thirst and urine output.

The cause of diabetes in cats is not clearly understood. In a few cases it can be traced to the use of certain drugs, such as Ovaban, which damages the pancreas. Much more often it seems to just spontaneously occur. The likelihood of diabetes is higher in older cats and obese cats, but any cat experiencing weight loss, increased thirst, increased urine output or increased appetite should be checked.

Your veterinarian can quickly determine if your cat is diabetic by checking blood and urine. If it is determined that your cat has diabetes this should not be regarded as a death sentence. Left untreated it will be fatal, but it is a treatable disorder. Many cat owners are able to control their cat's condition for years. The treatment usually entails giving insulin injections once or twice a day. There may be a small number of diabetic cats that can be controlled through diet and oral medication, but more often insulin injections are needed.

People are often initially reluctant to give injections to their cats, but those who undertake this task invariably find that it is far less traumatic for both the cat and the owner than they expected. Insulin needles are very tiny and the cats usually do not react at all to getting the shots. When one begins to treat a diabetic cat, their veterinarian will go over all the procedures, including feeding instructions and symptoms of too much or too little insulin and what to do in these cases. The veterinarian will also set up a schedule of regular recheck visits to gauge how the therapy is working and to adjust the insulin dose. A diabetic cat's need for insulin may fluctuate up and down requiring a change in the insulin dose. Some cats' needs for insulin will actually cease as the pancreas resumes the secretion of adequate insulin. Not every diabetic cat will need therapy for all of its life.

If your cat becomes diabetic and you are deciding whether or not to treat it, consider these facts:

• Without treatment your cat will probably die
• Your cat will not object to the injections
• Insulin is very inexpensive

If you are willing to work closely with your veterinarian, you and your cat can have many happy years ahead.

Hepatic lipidosis, or the accumulation of fat within the liver cells, is a common disease of cats. The cause of this condition is unknown, but cats that fail to eat for an extended period of time (due to stress or other disease) are at the highest risk. Bile pigments cause the skin and whites of the eyes to look yellow. Affected cats often lose weight, refuse to eat, act lethargic and may vomit. Bloodwork is suggestive of the disease, but other tests may be required to confirm the diagnosis.

Most cats can survive this disease with aggressive supportive care. Forced feeding by mouth or by stomach tube is usually required for at least four weeks.

The moral of this story is: Make every effort to ensure that your cats are eating, especially when moving to new surroundings, changing diets, during illness or any other activities which may be stressful. If they don't eat for several days, please contact your veterinarian immediately.

Think cat and the vision of kittens playing with string springs to mind. Many commercially sold cat toys are either string toys or toys attached to string for cats to chase. Being imaginative creatures, cats also invent toys out of shoe laces, sewing and craft items, yarns, ties on clothing, dental floss, curtain pulls, rubber bands and twines used to wrap up packaging. Holidays post their own sets of temptations with tinsels, ribbons, Easter basket "string," Halloween spider webs and party balloon strings. If a cat swallows a string, medically termed "linear foreign body ingestion," the consequences can be very serious. Signs can include gagging, vomiting, diarrhea, anorexia, lethargy, a painful abdomen, and perhaps an increase in temperature. Sometimes the string can be seen wrapped around the underside of the tongue. DO NOT attempt to pull it out if it is lodged there because the string may be tangled throughout the intestines making removal of it impossible.

If the string is not seen in the mouth, bloodwork is indicated to rule out diseases of the kidneys, pancreas, or liver which may cause similar symptoms. An increased white blood cell count and a history of ingestion of foreign bodies are helpful for a diagnosis of foreign body ingestion. X-rays may or may not be diagnostic as sometimes the swallowed item does not show up on film, or the intestines are not yet in the "loopy" shape that is characteristic of this problem. Surgical correction is usually necessary and can be complicated due to devitalization of the intestinal tissue and the number of incision sites needed to remove the object.

Because domestic cats are often weaned earlier than feral cats, it has been proposed that inappropriate consumptive behaviors may contribute to foreign body ingestion and in face may be a more common problem than many people realize. (Overall, K., Clinical Behavioral Medicine for Small Animals, Mosby, 1997) Early weaned kittens may suck and then chew not only on their owners but also a variety of non-food items. Cats on poor diets or generic food may often try to eat or chew on non-food items looking for better nutrition. Siamese cats are prone to a condition called wool sucking, and are in danger if the item that they are sucking on becomes unraveled and they swallow it.

Owners are advised to remove the dangerous articles from the environment, although sometimes it is easier to confine the cat instead. If the chewing is on one primary object, and objectionable taste smeared on it might helpful (bitter apple, deep heating rub, Listerine, Chinese hot oil). Owners can also provide more appropriate chew items, such as Kong toys or sterilized bones stuffed with food treats such as cream cheese, tuna or canned cat food. Cats can also be taught to enjoy vegetables, rawhides or catnip or cat grasses fastened in bundles.

Despite the dangers posed by string, cats can live long and healthy lives playing with these types of toys. Strings allow owners to safely construct games of chase, providing physical and mental stimulation essential to a cat's well being. Use proper supervision and attention in the creation of a pet safe household, and let your cats have fun.

One of the most poorly understood and enigmatic feline viruses is the feline coronavirus - the virus responsible for feline infectious peritonitis (FIP). It is no exaggeration to say that this is one of the most feared diseases in catteries. Many catteries that remain operative for several years will have a brush with FIP. Despite the fact that this disease is a shared experience in the cat fancy, affected catteries are wrongly feared and ostracized. All breeders need to make efforts to understand this disease and how to control it.

While the first description of feline infectious peritonitis was reported by Dr. Jean Holzworth in 1963, there are reports of clinical cases that are likely FIP going back to1914. Even though we have known about this virus for a long time, we know frustratingly little about it. However, much new research has been done in the past 5 years that is slowly shedding more light on this ever-present feline health problem. This article is designed to present some of the newer information and change some of the older ideas still found in print and other media.

Feline coronavirus operates differently from any other feline virus in several important ways: a) systemic antibodies have no protective function for the cat and may play a role in the disease FIP itself b) antibody titres are meaningless for diagnosis of FIP or prognosis c) a vaccine is available, but there is no consensus on its efficacy or safety

First, some notes on terminology.

• FIP is the term for clinical disease associated with feline coronavirus infection.
• The common benign form of feline coronavirus is referred to as FECV (feline enteric coronavirus).
• When FECV has mutated into a disease-causing form, it is then referred to as FIPV (feline infectious peritonitis virus).
• Feline coronaviruses in general are referred to as FCoV.

FECV is a very common, highly infectious feline virus. It belongs to the genus Coronavirus, which has members that infect other species (man, swine, cattle, birds, dogs). The majority of cats with FECV (about 95% or more) remain healthy. But in a small number of cases, FECV infection is the first step in a chain of events leading to FIP. This happens because coronaviruses are made of large numbers of nucleotides, the basic unit of genetic material, and they are very prone to mutations. As a virus reproduces itself, errors are made in copying these nucleotides. The more nucleotides, the more errors are possible. While most of these errors are harmless, some will have the effect of giving FECV the ability to cause disease. These mutant FECV strains are called FIPV.

Recent research has shown that mutant FECVs arise within an individual cat. Thus, we now know that the vast majority of cats do not "catch" FIP, but they develop it themselves from their own mutant FECV. Transmission of FIP from cat to cat is considered to be rare. This fact has caused leading FIP researchers to state that cats who are ill with FIP are unlikely to be a risk to other cats and thus do not need to be isolated.

It has been estimated that in multi-cat households where FECV has been introduced, 80-90% of all the cats will be infected. Catteries are especially likely to be FECV positive since traffic of cats and kittens in and out of the establishment is common. However, the incidence of cases of FIP is quite low in comparison. Generally, most catteries experience far less than 10% losses to FIP over the years. Rare instances have been documented where an apparent epidemic of FIP is associated with mortality rates of over 10% in a short period of time. One possible factor in these epidemics is the shedding of virulent virus, an uncommon situation. Usually, losses are sporadic and unpredictable. The peak ages for losses to FIP are from 6 months to 2 years old (with the highest incidence at 10 months of age). Age-associated immunity to FIP appears to be possible. Transmission of FIP from a queen to her unborn kittens has not been shown to occur.

What are the factors that predispose a small percentage of cats with FECV to the development of FIP? Research is currently trying to find more answers to this question, but some facts are becoming clear. Dr. Janet Foley and Dr. Niels Pedersen of the University of California at Davis have identified three key risk factors: genetic susceptibility, the presence of chronic FECV shedders, and cat-dense environments that favor the spread of FECV.

A genetic predisposition to the development of FIP was identified by Drs. Foley and Pedersen in 1996. They examined pedigree and health data from 10 generations of cats in several purebred catteries and found that the heritability of susceptibility to FIP could be very high (about 50%). It is likely a polygenetic trait rather than a simple dominant or recessive mode of inheritance. Inbreeding, by itself, is not a risk factor. Selecting for overall disease resistance is a helpful tool for breeders. The likely defect in immunity to FIP is in cell-mediated immunity. Therefore cats that are susceptible to FIP are also likely susceptible to some other infections as well, especially fungal and viral infections. This finding gives breeders the ability to achieve success in reducing the risk of FIP by using pedigree analysis to select breeding cats from family backgrounds that have strong resistance to FIP and other infectious diseases.

Research has shown that there are two main patterns that occur with FECV infection. Most cats will become infected and recover, but will not be immune. They are susceptible to reinfection the next time they contact the virus. A small number of cats become infected but do not recover. They become persistent shedders of FECV in the cattery and are the source of reinfection for the other cats. Therefore, the key to eliminating FECV (and thus the risk of FIP) in a cattery would be the identification and removal of chronic shedders. Currently, however, there is no easy way to determine which cats in a cattery are persistent shedders. The traditional antibody titre for FECV cannot be used to determine which cats are chronic shedders. The most effective and practical tool is PCR analysis of feces for the presence of FECV, a test which is not yet widely available.

In addition to selecting disease-resistant breeding stock, breeders can initiate husbandry practices that discourage the spread of FECV and development of FIP. Cat-dense environments favor the transmission of the highly contagious FECV. Dr. Diane Addie of the University of Glasgow, Scotland, recommends that the ideal way to house cats in catteries is individually. However, since this is not always possible, she recommends that they be kept in stable groups of no more than 3 or 4. Kittens should remain in groups of similar ages and not be mixed with adults in the cattery. Any measures that reduce environmental and social stress in the cattery population will have a beneficial effect.

FECV is spread primarily by the fecal-oral route and, to a lesser degree, through saliva or respiratory droplets. The virus can persist in the environment in dried feces on cat litter for 3 to 7 weeks, so scrupulous cleaning of cages and litter pans is important to reduce the amount of virus in the environment. It is important to have adequate numbers of litter pans available and that they be scooped at least daily and dumped and disinfected at least weekly. Litter pans should be kept away from food bowls and spilled litter should be regularly vacuumed up from the floor.

Dr. Addie has also described a method for early weaning and isolation of kittens born to FECV positive queens. It involves rigorous barrier nursing techniques to prevent the spread of the highly contagious FECV, and so is not for every breeder or cattery. The procedure involves first isolating the pregnant queen in a separate area to have the kittens. When they are 5-6 weeks old (at the time when their maternal immunity to FECV is waning), the kittens are removed from the queen and isolated by themselves. Some of the difficulties with this method involve the strict infection control procedures needed and possible difficulties in socializing kittens. When properly practiced, not only can FECV-negative kittens can be produced, but the kittens are often less prone to respiratory diseases and other common kitten ailments.

As with so many aspects of FIP, testing remains problematic. To date, there is no way to screen healthy cats for the risk of developing FIP. Antibody titres are poorly correlated with risk of FIP and should not be used to screen cats. As well as problems with interpretation of these antibody tests, there are problems with laboratory quality control. There are newer DNA-based tests offered by a few labs that are purported to be FIP-specific. However, these tests are considered unvalidated by experts as they have not been subjected to scientific scrutiny by researchers outside of the labs that offer them. In addition, there are no published studies that have identified the genetic difference between FECV and FIPV. An article was published by the Cornell Feline Health Center in 1998 warning that the so-called FIP-specific ELISA tests are based on insufficient data and the assays are not yet validated.

The fact remains that we have no screening test for FIP in well cats. Neither do we have a fool-proof way to diagnose FIP in a sick cat. The gold standard remains a biopsy or findings at necropsy. Recently, Dr. Andrew Sparkes and his colleagues at the University of Bristol, England, have suggested that combining several test results (globulin levels, lymphocyte counts) with clinical findings and antibody titre can help rule in or rule out FIP with some degree of certainty. It remains true, however, that a negative antibody titre does not rule out FIP. Neither does a positive antibody titre rule in FIP as a diagnosis. One benefit of the new DNA-based tests may be their use on body fluids, such as effusions from the chest or abdomen of a sick cat. If virus is found in these fluids, it strongly supports the presumptive diagnosis of FIP.

Probably one of the most controversial areas in any discussion of FIP is Primucell FIP, the vaccine made by Pfizer Animal Health, available since 1991. The vaccine is a modified-live temperature-sensitive viral mutant licensed for intranasal use in cats at least 16 weeks of age. The manufacturer recommends annual revaccination although no duration of immunity studies are available. The vaccine stimulates local immunity and will also produce an antibody titre. Evaluation of the risks and benefits associated with this vaccine is a difficult venture and has engendered much controversy. Since FIP is a severe and fatal disease, the safety of any vaccine is a paramount consideration. Dr. Fred Scott of the Cornell Feline Health Center, concluded in a recently published paper, that the risks associated with the Primucell FIP vaccine are minimal in most situations. He notes that the vaccine has been in use for 7 years with no increase in the incidence of FIP. Troubling reports of a phenomenon called "antibody-dependent enhancement" (ADE) of infection arose from several labs, where cats vaccinated with FIP vaccines and challenged experimentally with virus developed accelerated disease instead of being protected. It is not known whether the phenomenon of ADE occurs in the real world and there is no easy way to find out. If it does occur, it is likely an uncommon event, but the possibility remains troubling.

On the other side of the issue, the benefits of the Primucell FIP vaccine appear to be small. The best reported efficacy for the vaccine is seen when FCoV negative cats at least 16 weeks old were vaccinated twice (3 weeks apart), in a study by Dr. Nancy Reeves published in 1995. In this study, FCoV antibody-negative cats were vaccinated before entering a large cat shelter where FIP was endemic. The vaccinated cats experienced a significantly lower mortality rate than unvaccinated cats. The efficacy of the vaccination was calculated to be 75% (preventable fraction).

In catteries where FIP is endemic, studies have shown the vaccine had no effect on the incidence of disease. One reason may be that most kittens in catteries are infected between 6 and 10 weeks of age, long before the 16 weeks of age the vaccine is licensed for. Once a cat is infected with FCoV, the vaccine has no benefit. Some cattery owners have been using the vaccine at ages younger than 16 weeks to get around this problem. Dr. Johnny Hoskins has outlined a vaccination protocol for catteries experiencing FIP losses in kittens under 16 weeks of age. He recommends giving the vaccine at 9, 13 and 17 weeks with annual revaccination afterward. Use of this protocol must be made with the knowledge that no controlled studies have been done on kittens under 16 weeks of age and that this is an off label use. It would appear that the use of the vaccine according to the manufacturer's directions is limited to the vaccination of FCoV antibody-negative cats entering high risk situations, such as catteries and shelters.

1. Be aware of the plants you have in your house and in your yard, if your cat is permitted outside. The ingestion of azalea, oleander, easter lily, or yew plant material by a cat could be fatal.
2. When cleaning your house, never allow your cat access to the area where cleaning agents are used or stored. Cleaning agents have a variety of properties; from those that could just irritate the gastrointestinal tract to those that have a corrosive action and can chemically burn the sensitive mucous membranes of the mouth, esophagus, and stomach.
3. When using rat or mouse baits, ant or roach traps, or snail and slug baits, place the products in areas that are inaccessible to your cats. Most baits contain sweet smelling inert ingredients, which can be very attractive to your cat.
4. Never give your cat any medications unless under the directions of veterinarian. Many medications that are used safely in humans can be deadly when used inappropriately. One extra strength acetaminophen tablet (500mg) can kill a 7-pound cat.
5. Keep all prescription and over the counter drugs out of reach of your cats. Pain killers, cold medicines, anti-cancer drugs, antidepressants, and diet pills are common examples of human medication that could be potentially lethal even in small dosages. Only one half of a 200mg naproxen tablet could cause stomach ulcers in cats.
6. Never leave chocolates unattended. Approximately one half ounce of baking chocolate per pound body weight or less can cause clinical signs of toxicity.
7. Many common household items have been shown to be lethal in certain species, including felines. Miscellaneous items that are highly toxic even in low quantities include pennies (high concentration of zinc), mothballs (contain naphthalene or paradichlorobenzene - one or two balls can be life threatening in most species), potpourri oils, fabric softener sheets, automatic dish detergents (contain cationic detergents which could cause corrosive lesions), batteries (contain acids or alkali which can also cause corrosive lesions), homemade play dough (contains high quantity of salt), winter heat source agents like hand or foot warmers (contain high levels of iron), cigarettes, coffee grounds, and alcoholic drinks.
8. All automotive products such as oil, gasoline, and antifreeze should be stored in areas away from cat access. As little as one teaspoon of antifreeze (ethylene glycol) can be deadly in a 7lb cat.
9. Before buying or using flea products on your cat or in your household, contact your veterinarian to discuss what types of flea products she/he would recommend for your pet. Read ALL information before using a product on your cat or in your home. Always follow label instructions. When a product is labeled "for use in dogs only" this means that the product should NEVER be applied to cats. When using a fogger or a house spray, make sure to remove all cats from the area for the time period specified on the container.
10. When treating your lawn or garden with fertilizers, herbicides, or insecticides, always keep your cats away from the area until the area dries completely. Discuss usage of products with the manufacturer of the products to be used. Always store such products in an area that will ensure no cat exposure.

As spring approaches, lilies will become more common in households as potted plants or in bouquets. According to Michigan State University Extension's Grower Guide, Easter lilies are the third most important flowering pot-plant grown in the United States, with l0 to 11 million plants produced annually. Unfortunately, several types of lilies can be deadly to cats. Easter lily, tiger lily, rubrum, Japanese show lily, some species of day lily, and certain other members of the Liliaceae family can cause kidney failure in cats.

Within only a few hours of ingestion of the plant material, the cat may vomit, become lethargic, or develop a lack of appetite. These signs continue and worsen as kidney damage progresses. Without prompt and proper treatment by a veterinarian, the cat will develop kidney failure in approximately 36-72 hours.

All parts of these lilies are considered toxic to cats and consuming even small amounts can cause severe poisoning. If there is a lily in your home, there is always the chance that your cat could be accidentally exposed. For this reason, cat owners should avoid exposing their cats to plants of the Liliaceae and Hemerocallis family.

Lilies that have been shown to cause kidney failure in cats include:

This list is provided courtesy of The ASPCA National Animal Poison Control Center. Neither The ASPCA National Animal Poison Control Center nor The Cat Fanciers' Association, Inc. or their employees make any representation or warranties, expressed or implied, regarding the information in this list, and are released and not liable for any costs, damages, and expenses, including attorney fees arising from any claims, damages, or liabilities asserted by third parties arising from the use of this list.
Last Updated: June 8, 1998

Human Pain Killers that are Toxic to Cats

The use and variety of analgesic drugs has greatly increased in both human and veterinary medicine. This has resulted in an increase in acute toxicoses in pets. Generally, overdoses of over the counter drugs happen either accidentally or may be due to excessive administration by a well-meaning owner.

Aspirin is the world's most extensively used over-the-counter drug, commonly used as an anti-inflammatory drug in companion animals. It comes in 80, 325, and 500 mg per tablet strengths. Cats are especially sensitive to the toxicities of aspirin because they are deficient in certain types of glucuronosyltransferase, including the one that is required for aspirin metabolism. The dose recommended in cats for relief of pain and fever is 10 mg/kg every 48 hours. The toxic dose is 80 to 120 mg/kg for 10 to 12 days.

Signs: Clinical signs of aspirin toxicoses in cats are dose-dependant and may include CNS depression, anorexia, vomiting, gastric hemorrhage, toxic hepatitis, anemia, bone marrow hypoplasia, hyerpnea and hyperpyrexia, hyperthermia, hyperglycemia, and glycosuria. Early in the syndrome, respiratory alkalosis may develop secondarily to the salicylate-induced metabolic acidosis. This would cause hyperventilation, which in turn, stimulates renal secretion of bicarbonate. Thrombocytopenia, anemia, and Heinz bodies are evident in cats with chronic exposure. Elevated sodium and reduced potassium concentrations are characteristic but not diagnostic of aspirin toxicosis. Inco-ordination, loss of balance and falling, hypersensitivity and loss of appetite are also some clinical signs. Vomiting occurs, sometimes it may be bloodstained.

Treatment: If discovered at home, and is only one tablet, induce vomiting and give water or milk, then take to the veterinarians. The primary treatment for aspirin over dose is gastrointestinal decontamination (within four hours of over dose) using emetics, activated charcoal, and osmotic cathartics. Acid-base imbalance should also be corrected with a slow infusion of sodium bicarbonate, but must be carefully monitored and adjusted if pulmonary edema develops. The resulting hyperthermia should be controlled by external cooling; the use of antipyretic drugs should be avoided. If this is still not enough, or as in a severe acute case of poisoning, peritoneal dialysis with an osmotic alkaline fluid may be needed. Treatment for the gastrointestinal mucosa would include histamine receptor antagonists to control the inflammation.

Acetaminophen is another common household analgesic and antipyretic. It comes in 325 to 500 mg strength tablets and is most commonly purchased under the brand name "Tylenol". It is important to note that acetaminophen is not an anti-inflammatory agent in cats or dogs. Cats are extremely sensitive to acetaminophen toxicity. The feline toxic dose is 50 to 100 mg/kg. One regular strength tablet may be toxic to a cat, and a second one ingested 24 hours later may be lethal.

Signs: Cats gums are a dirty brown color, difficulty breathing, blood in urine, jaundice and facial swelling would be noticeable signs at home. Clinical signs are cyanosis, dyspnea, facial and paw edema, hypothermia, and vomiting. Less common signs include coma, generalized weakness, and death. Normally, methemoglobin is reduced to hemoglobin by glutathione, but in the presences of a toxic amount of acetaminophen, glutathione synthesis is reduced, and insufficient free glutathione is available to reduce methemoglobin and bind the reactive metabolite, consequently, the tissues are starved for Treatment: 1. If ingestion is recent (less than 2 hours), emesis should be induced and activated charcoal administered at 2g/kg along with a saline or osmotic cathartic. 2. If severe cyanosis is present, oxygen therapy should be administered, and the animal should be subject to as little stress as possible. 3. IV administration of acetylcysteine, 140mg/kg/hr for 7 hours. Acetylcysteine is a precursor of glutathione, thereby facilitating the detoxification of the reactive intermediate. 4. Ascorbic acid, 30 mg/kg orally to reduce methemoglobinemia to Hb +2 5. Supply supportive care including fluid therapy for possible metabolic acidosis.

Ibuprofen is a common ant inflammatory drug for humans. Its action is to block prostaglandin synthetase. Prostaglandins are active in the gastrointestinal tract by decreasing acid production, and stimulating mucus and bicarbonate secretion by epithelial cells. The toxic effect is depends on the dose, number of doses ingested, age of the cat, and many other factors. Currently, it is known that an acute ingestion of 50mg/kg will produce toxic effect.

Signs: Cats are extremely sensitive to the toxic effects of NSAIDS due to their higher gastrointestinal absorption rates, longer plasma half-lives, and higher plasma drug concentrations. At home you may see vomiting, depression, anorexia, and diarrhea. The clinical signs are gastrointestinal irritation, hemorrhage, and ataxia.

Treatment: Gastric emptying if within two hour of ingestion, followed by administration of activated charcoal and saline. Careful monitoring for development of gastric ulcers or hemorrhaging, and mange as necessary. If gastrointestinal irritation occurs, it can be treated with histamine receptor antagonists such as, cimetidine, rantidine, or omeprazole. Also sucralfate, an ulcer coating agent, metoclopramide, an antiemetic, and misoprostol, a prostaglandin analogue, could also be used if the symptoms indicated need oxygen.

Methlyzanthines include caffeine, theobromine, and theophylline. These are found in coffee, tea, stimulants, medications, and chocolate. Some people do not know the dangers of feeding their cats chocolate, or the cat may get into it if it is left out where they can get to it. A lethal dose varies from 100-300 mg/kg.

Signs: Clinical signs develop within one to fours hours after ingestion and include vomiting, diarrhea, polyuria, weakness, hyperexcitability, tremors, seizures, and coma. Secondary pancreatitis any develop in some animals. Death results from seizures or cardiac arrhythmias.

Treatment: Treatment includes the administration of emetic agents followed by activated charcoal and a cathartic if exposure was within the last two hours. Since methylxanthines may undergo enterohepatic recycling, activated charcoal should be sdministered every 3-6 hour until cat is asymptomatic. Diazepam or Phenobarbital may be used to control seizures. Fluid therapy may be indicated, but steroids should be avoided because they reduce urinary excretion of methylxanthines. The prognosis for a full recovery is generally good with appropriate therapy.

Antifreeze-ethylene glycol remains one of the most common causes of poisoning in small animals. Cats like the smell and taste of it, and it only takes 1.5ml/kg for a lethal dose in cats.

Signs: Triphasic clinical syndrome. Phase 1 signs include ataxia and a drunken appearance within 1 hour of exposure. Phase 2 is characterized by cardiopulmonary involvement (e.g. cardiac failure) and develops 12-24 hours after ingestion. Phase 3 exhibits renal failure, vomiting, depression, renal pain, enlarged kidneys, crystaluria, anorexia, hypothermia, coma, and death.

Treatment: If discovered within two hours of ingestion, induce vomiting, followed with activated charcoal and cathartics. The use of ethanol and bicarbonate is widely accepted. Ethanol blocks alcohol dehydrogenase activity. This stops the first rate-limiting step of ethylene glycols metabolism to glycoaldehyde by alcohol dehydrogenase. Glycoaldehyde is metabolized to glycolic acid, the primary metabolite for metabolic acidosis, and glyoxylic acid. Glyoxylic acid is further metabolized to oxalic acid, glycine, and formic acid. Fluid diuresis, with furosemide, mannitol, and dopamine, may be required to correct for partial renal failure and/or pulmonary edema. Peritoneal dialysis may be used if acute renal failure occurs. A recent treatment of 4-methylpyrazole is being widely used, however, it does not work on cats. Animals exhibiting clinical signs have a poor prognosis because of renal involvement. Renal tubular regeneration is possible, since tubular basement membranes tend to be spared.

Lead is not a common toxilogical problem but may occur from ingestion of lead-containing dust or paint when they groom their contaminated coat.

Signs: Clinical signs of chronic low level poisoning produce gastrointestinal signs, such as vomiting, abdominal pain, anorexia, diarrhea, and megaesophagus. Acute poisoning results in CNS signs, such as convulsions, hysteria, ataxia, tremors, and blindness.

Treatment: Treatment should include eliminating the lead source, and limiting further gastrointestinal absorption. Magnesium or sodium sulfate can be used to precipitate lead in the intestine and pass through, or chelation therapy may be used with calcium disodium EDTA. Oral D-penicillamine is also a chelating agent often used after calcium disodium EDTA. Both to be used only for 1-2 weeks.

Zinc toxicosis is becoming a larger problem, and can result from the ingestion of zinc nuts (transportation crates), or from ingesting pennies minted after 1983.

Signs: Zinc poisoning from elemental zinc results in hemolysis, regenerative anemia, or renal failure. Hypocupremia may be present, due to the zinc-copper antagonism of absorption in the gastrointestinal tract. Zinc oxide poisoning can occur from the ingestion of household products containing zinc oxide such as diaper rash products, rubber products, cosmetics, batteries, soaps, and printing inks. Acute zinc oxide toxicity results in severe vomiting, CNS depression, and lethargy.

Treatment: Treatment involves removing the source through emensis or surgery, supportive therapy, and chelation therapy with calcium disodium EDTA.

Ingestion of button batteries can cause esophageal erosions due to the release of sodium hydroxide or potassium hydroxide, occurring within 12 hours of ingestion. Also, the batteries may contain mercuric oxide, lithium, cadmium, and zinc.

Signs: Clinical signs of mercuric toxicity are CNS stimulation, weight loss, anorexia, and ataxia.

Treatment: Batteries lodged in the esophagus should be removed endoscopically, and should be followed by chelation therapy with DMSA.

Pesticides:

are divided into four groups, rodenticides, molluscacides, insecticides, and herbicides.

Rodenticides are further divided by their mode of action. The first class is anticoagulants, such as Warfarin, Coumateryl, and brodifacoum. This class of rodenticides acts by interfering with vitamin K epoxide reductase, which is responsible for converting "inactive" vitamin K to its "active" state. An single ingestion of 5-50mg/kg or a daily ingestion of 1mg/kg will result in severe toxicoses. Cats probably not poisoned directly, but may eat rats or mice slowed down by their last meal of the bait.

Signs: The clinical signs appear one to four days after ingestion. Clinical signs are depression, weakness, staggering, pallor, dyspnea, coughing, and subcutaneous hematomas, making diagnosis difficult. Hematemesis, epistaxis, melena, ataxia, paresis, seizures, and sudden death have also been observed.

Treatment: If the exposure has occurred within the last 24 hours, emetics, activated charcoal, and cathartics are warranted. Once the clotting factors are depleted, aggressive treatment is necessary, since synthesis of clotting factors takes at least 12 hours. The cat is given IV transfusions of blood or plasma and vitamin K. Administering a small amount of fatty food will aid in the absorption of vitamin K. The therapy may continue for up to 28 days depending on the amount of rodenticide ingested.

Another rodenticide is cholecalciferol. In dogs, a lethal dose can be as little as 5mg/kg, indicating an even lower dose for cats. Cholecalciferol has three mechanisms of action, they are; 1) increase absorption of calcium and phosphorus from the intestinal tract, 2) increase osteoclastic reabsorption of bone, and 3) increase renal distal tubular reabsorption of calcium, all resulting in persistent hypercalcemia and hyperphosphatemeia.

Signs: Clinical signs appear within 12- 36 hours after ingestion, and they are initially anorexia, depression, vomiting, muscle weakness, and constipation. As the disease progresses, hypertension, polyuria, and polydipsia. Materialization of cardiac and renal tissues eventually leads to cardiac or renal failure.

Treatment: Treatment, if caught right away is emensis, activated charcoal and cathartis. However, this is not usually the case. Clinically, furosemide is given to assist in renal calcium excretion, prednisone aids in decreasing both osteoclastic activity and gastrointestinal calcium absorption. Calcitonin is injected subcutaneously every two to three hour to help lower plasma calcium levels, and aluminum hydroxide will help lower plasma phosphorus levels by preventing gastrointestinal absorption. Long-term treatment may include a low calcium diet until calcium and phosphorus levels have stabilized.

Another rodenticide is sodium fluoroacetate, "1080." This rodenticide should never be used around any animals, since there is no specific therapy for this toxicosis.

Signs: Signs start within 4- 10 hours after ingestion, and they are aimless wandering, confusion, disorientation, unusual vocalization,, vomiting, urination, and repeated bowel movement, progressing to frothing at the mouth, labored breathing, and convulsions. Death from respiratory failure ensues within 2 to 12 hours after onset of signs.

Strychnine can be used as a rodenticide or insecticide, but it is most commonly used maliciously. First signs are apprehension, irritability, tenseness, and stiffness. This progresses to violent convulsions stimulated by loud noises or by touching the cat. Death usually occurs from exhaustion or anoxia during a tetatanic seizure. The entire syndrome, if untreated last less than 2 hours. The cat is only marginally savable if it has not reached the convulsion stage. If not convulsing, induce vomiting immediately, then transport to your vet for further treatment.

Insecticides are further reduced to several groups such as; amitraz, borates, carbamates, citrus oils, insect repellents, organochlorine, organophosphates, pyrethrins and pyrethroids, and rotenines. There are many insecticides, and I will discuss the most common ones.

Amitraz poisoning occurs from ingestion of a tick collar. A toxic dose falls in the range of 10-20mg/kg, and occurs within one hour of ingestion.

Signs: Clinical signs occur within one hour of ingestion.

Treatment: Treatment involves emensis, activated charcoal, and cathartics, or physical retrieval of the collar through endoscopy, and repeated injections of yohimbine to reverse amitraz's adrenergic agonist effects.

Pyrethrins and pyrethyoids are used to treat ectoparasites of cats, dogs and birds. However, if used improperly they will cause severe illness. The primary action is to keep the sodium channel open in excitable cells. The onset of toxicosis occurs within 1 to 4 hours after dermal and subsequent oral exposure.

Signs: The clinical signs are depression, hyper salivation, muscle tremors, vomiting, ataxia, dypsnea, and anorexia.

Treatment: Treatment includes bathing, and a combination of emensis, and activated charcoal. Diazepam or methocarbamol after the cat starts to relax to control muscle tremors and seizures, and atropine to control hyper salivation. Most animal recover within 24 to 72 hours after exposure. Insect repellent poisoning (deet) has similar signs and similar treatments

Organophosphates and carbamates insecticides are found in flea collars and snail and slug killers, and are potent inhibitors of cholinesterase activity.

Signs: These insecticides produce three effects: 1) muscarinic (salivation, lacrimation, excessive bronchial secretions, vomiting and diarrhea), 2) nicotinic (muscle tremors, and respiratory paralysis), and 3) CNS (depression, seizures, miosis, and hyperactivity). The recovery depends on the resynthesis of the cholinesterase enzyme.

Treatment: Treatment of organophosphorus or carbamate poisoning begins with life-saving symptomatic therapy. Atropine sulfate to alleviate respiratory distress, enzyme reactivators that act on organophosphorus cholinesterase complexes to free the enzyme and restore function, but only within first 24 hours of initial binding. Pralidoxime chloride is the widest used reactivator and is given intramuscularly to relieve tremors and other nicotinic signs. However, overdoses or rapid IV administration can cause tachycardia, and cardiac arrhythmias as well as depression.

Borate, or boric acid is used as a homemade insecticide. It has a low oral toxicity.

Signs: Vomiting, diarrhea, anorexia, CNS depression, muscle weakness, ataxia, and possible seizures.

Treatment: The problem with this poisoning is that activated charcoal does not absorb it; the only way to get it out of the system is through dialysis.

Herbicides are not a serious problem for cats because they would have to be outside and eat treated grass. If the weed killer was of chlorophenoxy type (2,4-D, MCPA) the prognosis is good.

Signs: Gastrointestinal and neuromuscular signs within 12 hours of exposure. Transient anorexia, vomiting, and diarrhea, and with more severe toxicosis, myotonia (disinclination to move).

Treatment: Treatment is nonspecific and includes decontamination (emensis, activated charcoal, and cathartics), and maintaining normal fluid and electrolyte balance. Prognosis is excellent, with clinical signs abating within 72 hours.

However, if the weed killer was dipyridyl type (paraquat, diquat), then the prognosis is not very good.

Signs: Gut clinical signs appear first, vomiting, abdominal pain, and depression, then 3-4 weeks later respiratory distress signs occur, such as difficulty breathing, rapid respiratory rate, resulting in irreversible lung consolidation.

Treatment: Early veterinary treatment is essential. Mineral absorbents such as kaolin or Fuller's Earth can be used to absorb paraquat from the stomach.

Molluscacides (metaldehyde,"defender"), used in gardens, are dangerous for cats, since they find them attractive. A lethal dose is 100-360mg/kg.

Signs: Clinical signs develop within three hours of ingestion and include tachycardia, salivation, tremors, and seizures, hyperthermia, diarrhea, and depression. Death may occur within 4-24 hours from respiratory failure. Death due to liver failure may occur in three to four days after ingestion.

Treatment: First treatment is to induce vomiting, and then take the cat immediately to the veterinarian.

Here are some tips for keeping your cats out of danger during the holiday season.

• FOOD ITEMS
AVOID Holiday Food Items That Could Cause Problems For Your Cat
• Alcoholic beverages
• Chocolate (baker's, semi-sweet, milk chocolate)
• Coffee (grounds, beans, chocolate covered espresso beans)
• Moldy or spoiled foods
• Onions, onion powder
• Salt
• Yeast dough
• PLANTS

Lilies that may be found in holiday flower arrangements could be deadly to your cat. Many types of lily, such as Tiger, Asian, Japanese Show, Easter, Stargazer, and the Casa Blanca, can cause kidney failure in cats.

Poinsettias are generally over-rated in toxicity. If ingested, poinsettias can be irritating to the mouth and stomach, and may cause mild vomiting or nausea. Mistletoe has the potential to cause cardiovascular problems. However, mistletoe ingestion usually only causes gastrointestinal upset.

Holly ingestion could cause vomiting, nausea, diarrhea, and lethargy.

• HAZARDS AROUND THE CHRISTMAS TREE

Christmas tree water may contain fertilizers, which, if ingested, can cause stomach upset. Stagnant tree water can be breeding grounds for bacteria, which can also lead to vomiting, nausea, and diarrhea, if ingested.

Electric cords - Avoid pet exposure to electric cords. If they were chewed, they could electrocute your cat. Cover up or hide electric cords, never let your cat chew on them.

Ribbons or tinsel can get caught up in the intestines and cause intestinal obstruction. Batteries contain corrosives. If ingested they can cause ulceration to the mouth, tongue, and the rest of the gastrointestinal tract.

Glass ornaments can cut the tissues of the gastrointestinal tract if ingested.

• MEDICATIONS

Keep all prescriptions and over-the-counter drugs out of the reach of your cats, preferably in closed cabinets. Remind holiday guests to store their medications safely as well.

Pain killers, cold medicines, anti-cancer, drugs, antidepressants, vitamins, and diet pills are common examples of human medication that could be potentially lethal even in small dosages. Less than one regular-strength ibuprofen tablet (200mg) could stomach ulceration in a 7-pound cat.

During the holidays, many veterinary clinics have limited office hours. In some cases, pet owners try to medicate their animals without their veterinarian's advice. Never give your cat any medications unless under the directions of a veterinarian. Many medications that are used safely in humans can be deadly when used inappropriately. Less than one regular strength acetaminophen tablet (325mg) can be dangerous to a cat weighing 7lbs.

• OTHER WINTER HAZARDS

The ASPCA and National Animal Poison Control Center have issued the following warning regarding antifreeze and your pet.

Antifreeze has a sweet taste and can be attractive to pets. Ethylene glycol is the most dangerous and also the most common form of antifreeze. Unfortunately, very small amounts can be lethal to pets. As little as one teaspoon of antifreeze can be deadly to a cat; less than four teaspoons can be dangerous to a 10-pound dog. The following are guidelines for pet owners to follow to avoid pet exposures to antifreeze:

Antifreeze Poisoning Prevention Tips

• Clean up antifreeze spills immediately.
• Check your car regularly for radiator leaks.
• Always store antifreeze containers in areas that are inaccessible to your pets.
• Never allow your pets to have access to the area when you are draining antifreeze from your car.
• Propylene glycol is a less toxic form of antifreeze and should be used instead of ethylene glycol.

If you suspect your pet has ingested antifreeze, contact your veterinarian immediately!

Liquid potpourris are popular household fragrances commonly used during the holiday season. Cats are often exposed to liquid potpourri by direct ingestion from simmer pots or spills, or by rubbing against leaky bottles or simmer pots containing the potpourri, or from spilling the containers upon themselves. Oral exposures result following grooming. Exposure of cats to some types of liquid potpourris can result in severe oral, dermal and ocular damage.

Ice melting products can be irritating to skin and mouth. Depending on the actual ingredient of the ice melt and the quantity, signs of ingestion would include excessive drooling, depression, vomiting or even electrolyte imbalances.

Rat and mouse killers are used more commonly during colder weather. When using rat and mouse bait, place the products in areas that are inaccessible to your cats.

ALWAYS Be Prepared !!!!

Your cat may become poisoned in spite of your best efforts to prevent it. You should keep telephone numbers for your veterinarian, a local emergency veterinary service, and the ASPCA Animal Poison Control Center (1-888-426-4435) in a convenient location. If you suspect that your cat has ingested something poisonous, seek medical attention immediately.

• You might be able to buy over-the-counter drugs for your cat, like Kaopectate or Imodium AD for conditions such as diarrhea, but always check with your vet before giving your cat any kind of medication.
• Even if your cat is in distress and you may want to help, do NOT give it human pain remedies without first checking with your veterinarian. Tylenol, Motrin, Advil and aspirin or aspirin derivatives, or any medication containing these items are extremely poisonous to cats, and can be FATAL!
• Most cats keep their own ears clean, but you might have to lend a hand if your pet is less than diligent in this area. Clean the outer ear gently with a cotton ball moistened with water or mineral oil. NEVER use rubbing alcohol.
• Is your cat drooling? Having difficult eating or chewing hard food? Does its breath smell particularly foul? Each is a sign that your cat's teeth may need prompt attention. Your cat's teeth can form plaque as often as your own. Make dental care a regular part of its health routine.
• If your cat stops eating for a couple of days, don't think its OK because it can stand to lose a few pounds anyway. Cats can develop fatty liver disease after only a few days of not eating, which can be fatal. The disease itself also causes lack of appetite, which makes the disease worse and so on. It's a vicious cycle. You and your vet must find the cause of the fasting and correct it. Forced feeding may be required in the meantime.
• If your cat is fed a high-quality cat food you can skip the vitamin supplements. In fact, high doses of certain vitamins and minerals can be toxic.
• There is a dental space just behind your cat's large canine teeth, which is seemingly tailor-made for a medicine. Remember it for easy access the next time you have to give it liquid medications.
• Unless exposed to extreme heat, unlike dogs, cats do NOT pant to cool themselves down. Opened-mouth breathing for a cat is a sure sign of respiratory distress or other stress and requires prompt veterinary attention.
• Unlike dogs, cats do NOT wag their tails when they are happy - they wag their tails when they are aggravated. This is different from a gently swaying tail, and can be a prelude to an aggressive act.
• As a general rule, avoid giving your cat meat with bones in it. Bones can splinter, and a piece might lodge in its mouth or intestinal tract.
• The best preventative for a hairball? Daily grooming. Commercial treatments are also available - and helpful such as Petromalt or Laxatone - as is a simple dab of petroleum jelly, to be licked and swallowed once or twice a week.
• Some playthings that are NOT good for your cat: plastic bags, string or thread, shoelaces, small pieces of foil or plastic, thumb tacks, pins, nails, paperclips. These items can be swallowed causing severe damage to the intestine and can require surgical removal.
• ·Pine cleaning products can be harmful to your cat, as can any strong cleaning solution. Make sure you rinse all cleaned items with lots of fresh water. Only use dish detergent on your cat's food and water dishes. Make sure you rinse these thoroughly as well.

When we have only one cat and she misses the litterbox, it can be hard to fix. When we have more than one cat in the house, it can be even harder. Here's a step-by-step guide to help stop litterbox problems in a multi-cat home.

1. Act Fast. A litterbox problem that continues for a long time can become harder and harder to solve. Litterbox mistakes can lead to territorial responses, and disturb the routines and hierarchies of your entire household. Will Muffin still want to take her daily afternoon snooze on the couch if Tiger urinated there? She may find some other area, displacing more and more of your cats, and creating fighting and other dominance displays. If you put off solving the problem, hoping it will go away on its own, you may find it multiplying in your home.
2. Find the Culprit. Before you even try to determine the "why," figure out the "who." If you catch it early enough, you can hopefully nail it down to one cat. Many people like to isolate each cat to determine which cat is causing the problem, but displacing one cat, even overnight, can sometimes lead to dominance displays in the others, as they claim undefended territory. If you have new cats, or kittens reaching adulthood, you may want to visit the vet for help. Your veterinarian can prescribe fluorescein for your cats, helping you to determine which urine stain(s) glow under an ultraviolet light.
3. Rule out a Veterinary Problem. Veterinary causes underlie many litterbox problems, particularly in household with older cats or those with access to the outdoors. Urinary tract infections are one of many common causes, where the cat develops an aversion to the box as a painful place to be. Other health problems can also cause litterbox mistakes. Worse, without visiting the veterinarian, your other cats may be at risk, which could cause the problem to multiply. No behavior techniques in the world will help a cat with a veterinary problem, so don't skip the trip to the vet.
4. Observe the Behavior. If the vet rules out a health problem, I next recommend a brief observation period. It's always very frustrating to the owner to let the cat continue his litterbox mistakes, but it gives you the knowledge to attack the specific problem. During the observation period, try to concentrate on the things in the environment that may be important to your cat, like litterboxes, food bowls, favorite places, the routines of the other cats and people in the home, etc. Start a journal where you record as much information as you can about every litterbox mistake, then look for links. Does the cat always use the same room? Is it always on carpeting? Does it happen after meals, or at some other time of day? Are the other cats nearby? Did you have guests over? When you isolate the specific stimuli involved, it allows you greater control without making major changes in the environment that may upset the rest of the cats.
5. Break the Habit. Elimination sites are matters of preference, and when the cat gets into the routine of going to a certain location, you'll need to prevent the behavior from recurring. Since the smell of declining urine is a signal for the cat to "reapply," clean the accident site with a pet odor remover - perhaps multiple times to get past the cat's sensitive nose. Block off the area while the product does its work. Remote deterrents, that work whether you are around or not, will keep the cat from returning to the area whenever you aren't standing guard. Double-sided tape or an upside-down plastic carpet runner, pointy feet up, can keep your cat from standing in the same area. Cats also hate to be startled, so anything that can safely surprise the cat when he visits that area can help make the area less "cat-friendly."
6. Make the Current Litterbox More Appealing. While you are preventing bad habits, make good habits more appealing. The litterbox should be clean, have privacy, and in multi-cat homes, escapability is also important. This simply means that the cat can see off a distance, so he won't be ambushed in the box, or on his way there. Most cats prefer clumping, non-perfumed litter, but work with your individual cat to determine whether a box of a different size, shape, or litter would help.
7. Retrain? If it doesn't seem to help to address the individual factors in your journal, or your cat has never regularly used the litterbox, you may want to retrain the cat by himself. Use this as a last resort, since removing the cat from the hierarchy may upset the routines of all the cats in the home. Keep the cat in a small, uncarpeted room, with a clean litterbox, food bowl, and toys in opposite corners. Pick up all rugs from the floor, so the only soft place to choose to eliminate will be the litterbox. Visit the cat often, and clean the box regularly. I also recommend recording the times that the cat uses the box. Many cats stick to a regular routine, so once you've determined when the cat is likely to use the box, you can let the cat out during low-risk times to maintain the hierarchy, and put him back in the room with the litterbox during high risk periods. Repetition of successful use will increase the cat's preference to the box.
8. General Stress Reduction. In some situations, it's difficult to determine specific environmental triggers for a problem behavior. However, sometimes general stress reduction techniques will prove helpful, particularly in multi-cat homes. For litterbox problems that have arisen from territorial disputes, additional resources may reduce competition for resources. Extra litterboxes and food bowls are always helpful, but remember that YOU are also an important resource, so give each cat as much attention as they could possibly want. Exercise can also help redirect cats energies. It can also help desensitize cats to each other, while they are praised for attacking a toy while the other cat watches. Routines are also very important in multi-cat homes, particularly when older cats are involved. Scheduled feeding, petting and exercise periods at the same time and location every day can further reduce stress that may be contributing to the litterbox problem.

Litterbox problems in multi-cat homes can be difficult. However, caring responsible owners can have an advantage solving the problem with they use quick, decisive actions and apply solid behavioral techniques.

AGE COMPARISON

Owners often ask us to compare "cat years" to "human years." A figure that is commonly used is seven cat years for each calendar year; however, this rule of thumb is not completely accurate. Feline development through puberty to young adulthood is accomplished over a period of about 18 to 24 months, rather than 21 years as in humans. Thus, the cat's first calendar year is more like 16 cat years, and the cat's second calendar year is more like five to seven cat years (up to an equivalent age of 21 to 23 years in humans). After that, add about four cat years for each calendar year of cat life. Thus, an eight-year-old cat is like a 46-year-old person. A 10-year-old cat would be 54, a 15-year-old cat 74, and a 20-year-old cat would be 94 cat years of age. Experts differ as to when one would consider an aging cat to be "geriatric," but you can select your own cut-off based on this comparison to the equivalent age in humans.

EVALUATION

Each veterinarian and practice should develop a logical approach to evaluation of the geriatric cat so that abnormalities can be detected in an early, treatable stage. In addition to being consistent with the practice philosophy and appropriate health care objectives, each geriatric-care program should be evaluated - from the cat owner's perspective - to be affordable, within the owner's ability to comply with recommendations, and consistent with the owner's philosophy of the level of care they want for their pet.6-8

Each clinician should decide whether a thorough annual examination and evaluation is sufficient or if it would be best to recommend examination as frequently as every six months for apparently healthy mature feline patients. Some feline practitioners recommend blood pressure evaluation as part of this examination; however, obtaining accurate measurements of feline blood pressure is often problematic. I do not believe that essential hypertension (hypertension without underlying disease, such as renal insufficiency or hyperthyroidism) is sufficiently common in cats to warrant this additional patient stress and owner expense.9-12 For patients that are already receiving medical care for chronic problems, reevaluation should obviously be scheduled as indicated by the specific condition and the patient's response to management.

If you plan to include laboratory evaluation as part of the routine yearly evaluation for healthy geriatric patients, the following are recommended:

• Complete blood count
• Serum biochemistry profile with electrolytes
• Complete urinalysis (collected by cystocentesis because bacterial urinary tract infection, although uncommon in cats, is more likely in older patients)
• Serum total thyroxine

An alternative to this complete laboratory evaluation might include the following:

• Urine specific gravity and dipstick chemistry evaluation
• Packed cell volume and total protein
• Blood urea nitrogen and creatinine
• Alanine aminotransferase, serum alkaline phosphatase, and g-glutamyl transferase

Other tests should be considered for selected patients. Feline leukemia virus (FeLV) antigen and FIV antibody tests are always recommended for sick patients and should be considered for healthy animals that are outdoor or indoor/outdoor pets with possible exposure to these retroviruses. Fecal examination for parasites may also be more important for cats with outdoor exposure. Thoracic radiographs and further cardiac evaluation (electrocardiography, echocardiography) may be recommended for cats with apparent pulmonary signs, cardiac murmurs, or arrhythmia.

MANAGEMENT PRINCIPLES

Older animals may have some age-related deterioration of the immune system that makes them more susceptible to infectious diseases or allows infectious diseases (e.g., FIP, FIV) that have been kept in check by the immune system to cause clinical signs. However, routine yearly revaccination policies are currently undergoing reexamination in light of concerns about vaccine-associated sarcoma in cats. In addition, new information about the duration of immunity actually provided by our biologic products is becoming available.

At present, most progressive practitioners recognize that yearly revaccination recommendations are not based on good science. Consequently, they have extended revaccination intervals for adult cats. In addition, we must be selective about which vaccines are really necessary for each particular patient. Just because a vaccine is available does not mean that it should be used in every patient - regardless of age, health status, and environment.

Older animals (like older humans) tend to get less exercise as they age. This is particularly true of cats, which generally have a more sedentary lifestyle than dogs have. Diminished exercise reduces muscle tone and bone and joint strength and causes a tendency toward obesity.13

Geriatric animals also have a decreased thirst response. Therefore, they are more likely to become dehydrated with illness or even during routine hospitalization or boarding. Dehydration can obviously compromise already marginally functioning body organs and compound deficiencies in renal function. Taste sensation is reduced in older cats. This can lead to anorexia - again, often associated with illness or a change in surroundings. Feeding highly aromatic diets and warming food to body temperature before serving improves palatability.

Cataracts are uncommon in cats, but some degree of visual impairment occurs with age-associated nuclear sclerosis and retinal degeneration.14 Hearing loss is usually gradual and may not be noticed by owners until the cat becomes completely deaf. Both visually- and hearing-impaired cats can and often do function quite normally in a protected environment, such as the home. They should not be allowed outdoors unsupervised, however, because they would be at risk for potentially fatal encounters with such environmental hazards as dogs and motor vehicles.

Older cats typically spend less time grooming. Also, the skin and haircoat tend to become drier with age.15 Owners should be advised to brush mature cats frequently, thus helping to remove debris and improve the distribution of natural oils on the skin and in the haircoat. If necessary, the cat can be bathed with mild hypoallergenic, nondrying shampoo. Longhaired cats may have more problems with hair mats as they age, and the haircoat may need to be clipped to make it easier for the owner to groom the cat.

Musculoskeletal disease (e.g., degenerative joint disease, osteoarthritis) is generally less severe in cats than in dogs because of cats' light weight and limber physique; however, it is surprising how often degenerative joint disease is discovered as an incidental finding on feline radiographs. Sometimes, degenerative joint disease may be a cause of the cat's "slowing down with age." In these cases, treatment may markedly improve the cat's mobility and general well being.

Oral cavity disorders (including periodontitis, gingivitis, stomatitis, dental disease, oral ulcers, or oral cavity tumors) are often overlooked as the cause of significant morbidity in geriatric cats.16 It is remarkable how often appropriate treatment for these oral problems leads to a marked improvement in quality of life and activity. The common signs of oral cavity disease include inappetence, weight loss, halitosis, chattering teeth, abnormal chewing and/or swallowing behavior, decreased grooming, or nasal discharge (usually unilateral). Infection often accompanies oral cavity disease and may result in intermittent bacteremia or septicemia. This may in turn lead to disorders in other body systems (including hyperglobulinemia due to immune stimulation, immune-complex renal disease, chronic interstitial nephritis, hepatitis, and possibly cardiovascular disease).

Apparent senility does occur in cats. Associated behavior changes include confusion, aimless wandering around the house, or getting "stuck" in a corner or under a piece of furniture - the cat is apparently unable to figure out how to get out.17 In others, the changes may include aggression or changes in elimination behavior (usually breaks in housetraining). It is very important to perform a thorough physical examination and laboratory workup to eliminate possible medical problems (e.g., primary central nervous system disease or neoplasia, hepatoencephalopathy, or urinary tract infection) before assuming that these changes are due to senile dementia.18

Impaired thermoregulation is another central nervous system change that may occur in older cats. Affected animals may be more heat or cold seeking, depending on the season and ambient temperature. Body temperature must be monitored closely during and following anesthetic procedures and if the animal is hospitalized.19

EUTHANASIA

Despite the veterinarian's best efforts; there often comes a time when the veterinarian must help the owner make the difficult decision to end the patient's life.25 This is a heavy responsibility, and none of us should take it lightly. In addition to gently alleviating the patient's suffering, we must be sensitive to the bond between the pet and its owner. If possible, euthanasia should be performed after regular business hours, when the clinic is quiet and time is available to perform the procedure calmly, compassionately, and gently. Our ability to communicate with the owner and help them through this difficult time is very important.26

The last decade has shown advances in preventive medicine, improved veterinary care, balanced nutrition and responsible ownership. Therefore, our pets are, on the average, living longer, healthier lives.

Aging itself is not a disease but a normal biological process that results in decreased organ function and increased susceptibility to disease. The effects of aging tend to be irreversible and progressive. The health care programs for geriatric cats attempt to decrease the rate of progression of organ failure and, in doing so, improve the quality of life for the older cat. Diseases that are easily overcome in a younger cat can often be devastating to an older cat.

Most cats are considered geriatric by the age of 12 years. This is highly variable depending upon the lifestyle of the cat. For example, neutered/spayed indoor cats tend to live longer than sexually intact outdoor cats.

In the older cat, the metabolic rate slowly declines resulting in decreased energy needs. The ability to regulate body temperature also decreases, resulting in intolerance to heat and cold. The proportion of body fat to muscle mass increases. The skin loses elasticity and the hair coat becomes dull. Grooming and litter box habits become less fastidious and there is a decrease in mental alertness. There is a greater susceptibility to disease and the occurrence of cancer increases.

The likelihood of dental disease increases with age. The buildup of tartar is accompanied by gingivitis resulting in gum recession, root exposure, decay and tooth loss. Severe periodontal disease can result in bacteria showering the bloodstream. These bacteria tend to lodge in the kidneys and the heart, causing severe disease. Cats are very sensitive to oral pain, causing a decreased appetite. It is extremely important that regular dental care be given to older cats. Regular grooming will help maintain skin health and coat luster. It is imperative that annual booster vaccinations be maintained, as an older cat with a decreased immune system is more susceptible to infectious disease.

With age, the stomach and intestines begin to lose the ability to digest and absorb nutrients, especially calcium and fat-soluble vitamins. The liver function decreases, resulting in slower metabolism of toxins and drugs. Kidney function gradually declines in the older cat, decreasing the capacity to concentrate urine. This results in increased water loss and, combined with a decreased water intake, leads to dehydration. Decreased blood volume from dehydration can overly stress an already failing heart.

The management of the healthy geriatric cat depends as much on the owner as on the veterinarian. A diet with a reduced fat content will help prevent obesity that results from a decreased metabolic rate. The fat present in the diet, however, should be highly digestible and rich in essential fatty acids to compensate for reduced intestinal function. A diet lower in phosphorus and protein will lessen the failing kidneys' need to actively excrete phosphorus and protein waste. An increase in fiber content will help decrease calorie consumption and aid in stimulating colon contractions.

Considering all the changes going on in the geriatric cat, just simply decreasing the amount of maintenance diet fed is often inadequate. Diets specifically designed for the older cat may increase the quality and length of life. However, a decrease in the ability to smell and taste may drastically reduce appetite. The goal is to find the highest quality senior diet that the cat will eat. It is best to feed a lesser amount per meal and increase the number of meals per day. Sudden changes in diet are very rarely tolerated, resulting in vomiting and diarrhea. Water intake should be encouraged.

When dealing with a sick older cat, the veterinarian and owner must realize that a disease in one organ system may lead to dysfunction in other systems. To diagnose adequately the primary disease and identify secondary problems, the veterinarian will get a complete history and perform a thorough physical examination as well as a urinalysis, complete blood count, and biochemical profile. Often x-rays will be taken of the chest and abdomen. Without this basic information, unrecognized problems will progress, leading to little or no response to treatment.

Certain diseases occur with higher incidence in older cats, such as chronic renal failure, hyperthyroidism, diabetes mellitus, liver disease, and chronic bronchial disease. If diagnosed early and proper treatment initiated, many quality years can be added to a cat's life. Tumors are more common in the dog than in the cat. However, the frequency of malignant tumors is much higher in the cat, the incidence of tumors increasing with age. Any lump should be removed and sent to a pathologist for diagnosis.

With increased owner vigilance to diet and changes in behavior, as well as good veterinary care, our cats today can live well into their teens. Very often cats twenty years old and older are enjoying a good quality of life!