Prince Charming

 I can’t remember anything that happened on May 3rd of 1999.  There are also a vast number of days in 2005 that I have forgotten.  Now that I think about it, all of 1973 and 1993 are lost to retrievable memory.  2008 is foggy as well, other than the Mariners were terrible, which is not that exact of a memory.  Life seems to only allow that one lives life or writes it down.  The time for both is elusive.  Last Thursday was another busy day in practice.  We did good work but I’m already fuzzy on the specifics.  I have practiced for roughly 5000 days and I constantly wish I could record and recall more from them.  I don’t believe that they are gone and consider today their summation.  But, when memories fade I perceive my window to be James Herriot closing.  I have had the pleasure of working on so many remarkable creatures.  I don’t want to forget when Pooh, Bala, Tessa, Bear, or Barney came into my exam room.  I need to believe that nothing good ever dies and when I write about my patients I feel like they live on.

       I’ve said before that I don’t like to admit that I have favorites but I clearly do.  I have treated and cared for many wonderful cats but my favorite kitty patient was a cat named “Prince Charming”.   Perhaps I was swayed by his name, but “PC”, as I called him, was regal.  He was a face rubbing extrovert who didn’t mind coming to the vet.  The face rubbing (also called bunting) cats that interact with the world by tilting their heads and then running into their environment with their face and full body force are the best.  Cat like this are so social that even when fearful and scared they can’t help themselves from rubbing their head and face on us.  With his outgoing personality, PC made friends wherever he went and whenever he came to the clinic.  

I met him within just a short time of working at Lien.  He started at Lien before I did.  His mom used to walk down to the clinic when she was in high school and see Dr. Lien.  She remembers when Dr. King was the new guy in 1968 and she was there, obviously, when Larry hired me in 1990.  Prince Charming quickly became my favorite patient over relatively routine care and I got to know him well treating him throughout his life.  His sister cat “Katrina” was sick when I first met the family and I remember seeing the two of them together many times.  PC was a tolerant and trusting patient.  He didn’t like us doing things like catheters and other things we do but he didn’t fight us.  And, he didn’t blame us.  I know I can’t back up that last statement but you always felt he forgave your interventions.  He seemed to roll with it and move on.  There was always another face rub to say, “we’re cool”.   

Later in his life PC developed lymphoma in one of his eyes.  He had to have that eye removed and started chemotherapy.  Lymphoma is always considered systemic and not just in one place.  He only tolerated a brief time on chemotherapy.  His mom and I decided his reaction to the chemotherapy was too intense and we didn’t push further treatment.  He did fantastic though.  The short time on medication put his cancer into remission.  His type of cancer typically will relapse in 7-9 months; faster relapse would be expected with incomplete treatment.  PC stayed in remission for over two years.  When it came back, it recurred in his other eye and there was little that would help him further.  His illness after initial chemotherapy was brief and transient and he felt great and was very much himself for the duration of his remission.

After PC died, his mom gave me some pictures of him that I recently ran across.  Her husband is now gone too and many of the pictures were with Glen.  I enjoyed the two of them so much.  I promised PC’s mom years ago that I would write someday about him.  This is a short tribute. 

All these years have passed and he’s still my favorite.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice) - Outreach Chairman, American Board of Veterinary Practitioners

Common Toxicities - To Vomit or Not to Vomit

We are often inducing dogs to vomit unauthorized chocolate ingestions.  We have seen some high quality chocolate come back from many canine patients.  Chocolate is tempting to most of us of several species.

There are many other toxins that may be ingested in our patients, as well.   We can induce vomiting, or emesis, for some of them but should not induce vomiting for others.  The veterinary journal “Clinician’s Brief” recently published an article on the top toxins ingested.

The top 5 ingested toxins that require induction of emesis:

  1. Anticoagulant Rodenticides – These compound cause bleeding days after ingestion.  If we get to the patients within the first 6 hours or so after ingestion, we can induce vomiting and give activated charcoal to decrease absorption of any remaining toxin.  Treatment is very effective when started early.

  2. Chocolate – Theobromine, a compound very similar to caffeine, is the toxic component in chocolate.  It causes vomiting, diarrhea, hyperactivity, rapid heart rate and incoordination.  Chocolate can stay in the stomach an extended period, so induction of vomiting and administration of activated charcoal may be effective well outside of 6 hours post ingestion.

  3. Grapes and raisins – These are toxic to the kidneys and there isn’t a direct dose relationship to toxicity.  This means any exposure is too much because it is unclear when toxicity will occur.  The toxic principle is unknown.  Induction of emesis is indicated as soon as possible along with activated charcoal and fluids.

  4. Over the counter pain relievers – Acetaminophen and ibuprofen, along with other medications, account for about 25% of toxic ingestions reported.  They can cause a number of problems including gastric ulceration and kidney and liver issues.  Vomiting should be induced as soon as    possible following significant ingestion.

  5. Xylitol – This is a popular sugar substitute found in gum, candy, dental products, and some baked goods.  It causes hypoglycemia (low blood sugar) at lower doses and acute liver failure at higher doses.  Emesis should be induced if ingestion is discovered.  Activated charcoal doesn’t help decrease its absorption.

The top 5 ingested toxins that do not require induction of emesis:

  1. Acid and alkaline cleansers – These products are too corrosive to risk further esophageal damage trying to have them vomited.  They often cause immediate pain and are bitter so most of their damage is usually in the mouth and throat.

  2. Batteries – If they are punctured, they also cause corrosive damage.  They require surgical or endoscopic removal.

  3. Detergents – Cats may get exposed to these from walking through them and then grooming and dogs may bite into laundry and dishwasher pods.  These also cause corrosive injury.

  4. Hydrocarbons – These are petroleum or wood derived products such as, kerosene, fuel, lubricating oil, paint solvents, stain, or turpentine.  The toxic insult will vary by exposure but all of them may cause aspiration pneumonia if emesis is induced.’

  5. Antidepressant medication – These are medications such as tricyclic antidepressants or serotonin reuptake inhibitors (SSRI’s).  These cause sedation or CNS stimulation, behavioral changes, agitation, or panting.  Treatment includes fluids, sedation as needed, and supportive care.  Since neurologic signs are very common, emesis is not recommended because of the risk of aspiration.  If ingestion is observed, emesis may be considered before clinical signs are seen.

Should you discover any of these ingestions have occurred in your pet, seek medical assistance and advice from a veterinarian as soon as possible, regardless of time of day or night.  Emesis is best induced under medical supervision.

Feline Inappropriate Urination – Part II: Please Make It Stop

nce we've considered who is peeing in the heater vents and we have asked ourselves why they are doing it, we can  tackle the what, where, and how of  solving the problem.  Treatment has to be individualized to each situation and cat, or cats.  Of course, we may not discover the  exact reason for the inappropriate urination  so a multi-modal approach is best in most cases. 

1. The soiled environment.  The urine-soiled area needs to be thoroughly cleaned with an enzymatic cleaner, such as Nature’s Miracle, to  eliminate future visits.  The area also may need to be closed off from the offending cat.  Plastic totes, double sided tape, foil, furniture placement, potted plants, and invisible fencing may all be  used to prevent access.  If the specific area is not easily identified, a black light can help locate soiled spots.

2.The litter box.  Make sure the box is roomy and comfy for everyone who needs it.  Obese cats and large cats need more space.  As a rule, sides, liners and covers are bad.  Kittens, older cats and the infirm may have a hard time negotiating sides on the box.  Liners are just annoying when kitty   tries to scratch around and cover feces and urine.  Box covers trap smells and block kitty’s view of intruding other cats.  As a cat, one typically likes a 360-degree view while eliminating.

3.The box placement and number of boxes.  As stated before, one box per cat, plus one, is recommended; and make sure that there is a box on each level of the house.  Put the boxes in well lit, quiet areas away from food and water but close to where the cats spend the majority of their time.

4. Pick the right litter.  Most cats prefer fine-textured, unscented litter, several inches deep.  If in doubt, try litter box samplers.  Put out several different boxes with several different types of litter - clay, sand, paper litter, or even soil.  Let your cat cast its vote with urine and go with the demonstrated preference. 

5.  Cleanliness.  As a basic rule of thumb, scoop the box daily.  This may not be enough in multi-cat households if one box is particularly popular.  If you ask the cats, they would each want a personal litter box valet that kept the other cats out of the area, looked away while they used the box, handed them a kitty treat as they exited the box, and then removed any offending material immediately.  Always empty and thoroughly clean boxes every 1-2 weeks, depending on use.

6. Avoid punishment.  Never physically punish your cat for inappropriate elimination.  Not only  is that ineffective, but it quite likely will make things worse.  Punishment will create more anxiety and cats will not connect the crime to the punishment.

7. Medical treatment.  If your veterinarian uncovers medical issues such as drinking more water or urinary tract infection, treatment plans will need to be determined and implemented.

8. Anxiety and urine spraying.  Anti-anxiety medications may be utilized.  Drugs such as Prozac, amitryptylline, and busprinone can be  prescribed.  Medication use would need to be discussed with your cat’s doctor.  Such therapy is often life-long, although withdrawal of medication may be considered after long periods of good behavior.  We may also use pheromone sprays, such as Feliway, to promote positive feelings in the cats when they enter the area involved.

Feline inappropriate elimination is a frustratingly common problem.  It is imperative to act quickly when it happens.  The longer such a problem goes on, the more difficult it may be to correct.  Once the offending cat is identified, take him or her to your veterinarian for a thorough physical examination and have a discussion about your options.  Once medical disease is ruled out, together we may tackle the many issues discussed here and formulate our best plan.  With thought, perseverance, environmental manipulation and appropriate medications, we can  often help.