Category: cat

Feline Infectious Peritonitis (FIP)

Hearing that your cat has Feline Infectious Peritonitis (FIP) is one of the worst bits of news you can get from your vet. The disease is almost always fatal, although treatments can make your cat’s remaining time more comfortable. If you have more than one cat in your home, taking sensible precautions and following your vet’s advice can help to reduce the risk that your other cats will be affected.

The disease is caused by a virus which is often found in healthy cats and usually causes no major health problems. However, in some cats it causes serious disease.

The disease has two different forms. The more common form is called ‘wet FIP’ because the blood vessels leak, fluid oozes out of the blood and the cat’s belly swells. This may also occur in the chest stopping the cat from breathing properly. The less common form of the disease is ‘dry FIP’ in which there is no build up of fluid but thick scar tissue develops on the cat’s internal organs. Except in rare cases, wet FIP is fatal within about five weeks of diagnosis. The dry form is equally deadly but affected cats may survive for a few months. The accompanying picture shows a cat with wet FIP.

The most vulnerable cats are those with weak defences against infectious diseases – kittens, elderly cats and those already suffering from some other condition. Some pedigree breeds such as Burmese appear to be affected more often than ordinary domestic ‘moggies’. Only about one in a hundred cats is likely to go down with the disease but the risk is much higher where several cats live together such as in a breeding cattery or rescue centre. Overcrowding and other stressful factors can increase the risk of disease developing.

In its early stages, FIP causes a variety of symptoms which can easily be mistaken for other diseases:

  • weight loss
  • lethargy
  • a dull coat
  • diarrhoea
  • poor appetite
  • fever.

Later on your cat’s eyes or nervous system may be damaged causing blindness and paralysis. In the so called ‘wet form’ of the disease fluid may build up in your cat’s tummy (causing swelling of the abdomen) or chest (causing difficulty in breathing).

There is no completely reliable blood test to show that your cat has FIP. Blood tests will just tell your vet that your cat has been infected with a virus which could be FIP. Other samples can be taken from fluid in the chest or abdomen. The only sure method of diagnosis is to take a tissue sample from one of the internal organs. This is often done after the cat has died to confirm that the cause of death really was FIP.

There is no evidence that the FIP virus can cause any disease in humans or other animals such as dogs.

Medicines such as steroids, vitamins and minerals are often given to make your cat feel better, but they do not tackle the disease itself. With careful treatment you may be able to keep your cat healthier for a little longer. Interferon (a powerful drug that suppresses immune reactions) may be helpful in some cats but is very expensive and generally does not provide much increase in life beyond the use of steroids).

In the future it may be possible to treat FIP with one of the anti-viral drugs that are being developed for use against human diseases but this is likely to be many years away.

The virus is spread in the cat’s saliva, phlegm and in its faeces (droppings). Some cats contract the virus but ae able to fight off the disease. These cats may continue to carry the virus and infect other cats. A cat with suspected FIP should be kept indoors in a separate room so as to avoid direct contact with all other cats. It should have its own feeding bowl and litter tray and these must be cleaned every few days.

The virus does not survive long outside the animal and it can be killed using a dilute solution of household bleach (about five tablespoons of bleach in a gallon of water). Use this to clean the feeding bowls, etc. and to wipe down room surfaces.

An FIP vaccine has been developed in the US but vets disagree on how effective it is in preventing symptoms of FIP and it is not yet available in the UK. Vaccinating healthy cats against other important virus diseases, such as Feline Leukaemia, keep their defences strong and may reduce the risk of them getting FIP.

Feline Immunodeficiency Virus (FIV)

As its name suggests, Feline Immunodeficiency Virus (FIV) is closely related to the Human Immunodeficiency Virus (HIV) responsible for causing AIDS in people. There is no cure for either disease and the virus causes the gradual destruction of the white blood cells needed to protect the body against infectious diseases. However, the two viruses will only survive inside normal host species – in other words, there is no risk of humans catching FIV from a cat, or vice versa.

FIV is found in the saliva and other bodily fluids of the cat and passes from cat to cat through bites. It occurs more frequently in un-neutered tomcats than in neutered males and is found most often in strays. Female cats are generally less likely to get involved in fights than males. However, a single bite may be enough to transmit infection and once it is there a cat is incapable of getting rid of the virus.

The virus will also pass between generations; about one in four kittens born to an infected female carries the virus. Infection may pass from mother to kittens during pregnancy (through the placenta) or as a result of the mother licking her offspring or biting the birth cord when they are born. Unlike HIV, there is no evidence that FIV is sexually transmitted.

In the first few days after it is infected your cat may show signs of ill health, such as a slight fever but it is unlikely that you would notice these minor changes. A cat that is already infected with the Feline Leukaemia Virus (FeLV) may show more severe symptoms. However, they soon appear to get better and may then be perfectly healthy for months or even years.

Eventually they will become more susceptible to infection, with effects which vary considerably between different animals such as lethargy, swollen glands, a dull coat, fever, and weight loss. Affected cats often develop inflammation of the mouth, discharging and inflammed eyes, anaemia and diarrhoea.

Certain forms of cancer seem to be more common in FIV-infected cats and in a few cats the nervous system is affected, causing behavioural changes, convulsions, dementia etc.

FIV is more common in areas where there are large numbers of un-neutered male cats. Up to six in every 100 healthy cats carry the virus but it is much more common in ill cats – up to one in six ill cats have the virus. Because there is a long gap between infection and signs showing, the disease is most commonly seen in cats between six and ten years old.

Until a cat starts to suffer from a series of infections, as a result of its failing immune system, there is usually no reason to suspect that it is infected with FIV. A blood test has been developed to detect antibodies to the virus in apparently healthy animals. However, the test is not effective for several weeks after infection because infection is not detectable for that length of time. In a small proportion of infected cats, perhaps one in ten, antibodies will never appear. A more complicated test, which test for the virus itself can be used to check the results of the first test.

As there is no cure, your cat is eventually likely to die from an infection which would not be serious for a normal, healthy animal. Your vet may be able to give your cat some treatment to help counter these infections initially.

In the future it may be possible to treat FIV with the antiviral drugs being developed against the human disease. Trials have shown that the drugs provide short-term improvements in some cats but they are expensive and are not yet routinely available. A vaccine (Fel-O-Vax FIV from Fort Dodge) has recently been licensed in the United States but is not available in Europe.

Making sure that your cat’s vaccinations against other diseases are up to date you can reduce the risk of it catching these diseases.

Cats that live in small groups are less likely to fight and pass on the infection in a bite. However, if you have an infected cat who lives with other healthy cats you may decide that it is safer to keep them apart. Having an infected tom cat neutered may reduce the risk of him passing the disease to his housemates. Female cats with the virus should be spayed to prevent the virus being passed to their kittens.

If your cat dies as a result of FIV you may want to get a new cat. As long as all the other cats in the home are healthy there is no significant risk to the new arrival. The virus quickly dies once it is exposed to the air and the new cat is unlikely to be infected from using the same feed bowl or litter tray as its predecessor.

Chlamydia disease

Chlamydia is not particularly common in the average pet cat but can be a significant problem in cats in close contact. It is very easily spread from cat to cat. It is rarely fatal, but can be a real problem because the symptoms may be very difficult to clear up. Prevention is far better than cure – if your cat needs protection make sure she is fully protected by regular vaccinations.

Chlamydia is a bacterial infection that causes conjunctivitis (sore, swollen eyes with a white discharge) and very occasional breathing problems. It most commonly causes disease in cats that live in groups.

Kittens are often protected by antibodies from their mother until around 8 weeks old. The bacterium is spread in the air and the kittens can be infected as their maternal protection wanes.

The signs of chlamydia infection are very obvious – usually there is redness and swelling of the eyelids. Excess tear production and coloured discharges from the eyes are common. Occasionally kittens are more severely affected and may have coughing, sneezing or difficulty breathing.

There is no evidence that disease can be spread from cats to man. When handling a sick cat you should always take careful hygiene precautions and pay particular care to hand washing. The disease is very contagious and can easily be spread from cat to cat.

Eye drops containing antibiotics can be effective in controlling the infection, but antibiotic tablets may be needed as well. Nursing care is important and eyes should be bathed regularly to remove secretions.

Most fit young cats will recover from chlamydia infection after a few weeks – although in a few cats that do get over the initial illness the bacteria may remain in their system. Cats that have recovered from disease may carry the organism for months or years and pass it on to other cats.

If your cat lives in close proximity to other cats then hygiene is very important to reduce the transmission of all diseases. Good ventilation is important and there should be air spaces between all cages to prevent droplets being carried in the air between cats.

If your cat is at risk from catching chlamydia then vaccination may be helpful. The vaccine is not given as a part of the routine course and you should discuss with your vet whether your cat needs to have the vaccination. Vaccination does not always prevent infection, but it usually stops severe disease developing. Vaccinated cats may still therefore carry infection and can pass it on to susceptible cats.

Cat scratch disease

Cat scratch disease is a disease of people carried by cats. Infected cats usually do not show any sign of illness but the disease can be passed to humans via a bite or scratch from the cat.

Cat scratch disease (CSD), also known as Bartonellosis, is caused by a bacteria carried in the blood of cats. CSD is a zoonotic disease, i.e. it is an infectious disease that can be transmitted from cats to other animals and to people.

The disease is well recognised in North America but is also seen in Europe and increasingly in the UK.

The disease is spread from cat to cat via the cat flea and then can be transmitted to humans via a bite or scratch. While fleas do not directly pass the infection to humans, controlling fleas in cats may decrease the risk of infection to humans; primarily as cats are less likely to become infected if fleas are not present.

Ticks are also a major transmitter of the disease. Ticks also carry other infectious diseases such as Lyme disease. People can be infected with both infections at the same time and, since symptoms of the two conditions may be similar, CSD may be missed when testing for Lyme disease.

Infected cats carry the bacteria in their blood. It appears that the disease can only be spread via infected blood but cat’s saliva can be contaminated with blood so that the disease can be transmitted by bites or licking. Cats may also contaminate their nails with infection whilst grooming and the infected blood may enter the human body through a cat scratch. Cats with fleas are more likely to scratch themselves than so in infected cats scratching increases the risk of the cat contaminating its nails with infected blood and passing the disease onto humans.

Kittens are more likely to carry the bacteria in their blood, and are therefore more likely to transmit the disease than are adult cats.

Cats usually do not show any symptoms but if you cat is sick with clinical signs suggestive of infection your vet can take a blood sample and send the sample to a laboratory for testing to confirm infection. There is no benefit in screening healthy cats for infection. There is no benefit in screening healthy cats for infection.

The bacteria can be relatively easily treated with antibiotics. Your vet may prescribe antibiotics to treat cats when Bartonella infection has been found in their blood.

Regular flea control is the best way to avoid Bartonella infection in your cat. Stray cats under a year of age are most likely to be infected.

People may not realize that they have been infected with CSD. The first sign of infection may be a small blister or lump at the site of a wound. In most cases the most severe signs are swelling of the glands (lymph nodes) near the site of the scratch or bite 2-3 weeks after infection. Occasionally, an infected lymph node may form a tunnel through the skin and pus will drain out. Cat scratch disease is a common cause of chronic lymph node swelling in children.

Other symptoms that may be seen in some people include:

  • Fever
  • Tiredness, lethargy
  • Overall generalised discomfort
  • Headache

Generally, cat scratch disease is not serious and medical treatment is not usually needed. In AIDS patients and in other people who have suppressed immune systems, cat scratch disease is more serious, and treatment with antibiotics is recommended. For some reason most infections occur in autumn and winter.

Since the disease can only be spread through infected cat blood you should avoid contamination of wounds with cat saliva or blood.

  • Avoid “rough play” (or any activity that may result in biting or scratching) with cats, especially kittens. If you are bitten or scratched wash the affected area thoroughly.
  • Do not allow cats to lick your skin (especially if you have any open wounds).
  • Control fleas on your cat.
  • If you develop an infection (with pus and pronounced swelling) where you were scratched or bitten by a cat; or if you develop any symptoms, including fever, headache, swollen lymph nodes, and fatigue, contact your doctor for advice.
  • In some countries declawing has been proposed as a potential way to reduce the risk of transmission of infection; however there is no evidence to support this theory.

More recommendations can be found at the Center for Disease Control website:
http://www.cdc.gov/healthypets/diseases/cat-scratch.html

Cat pox

If your cat is a keen hunter they may be at risk of catching cat pox from their prey. Cat pox is a viral infection that is also known as feline cow pox. Most cases recover without treatment but in a few cases the disease can be much more serious and veterinary advice should be sought. It can also infect humans which is important to be aware of.

Cat pox disease is also known as feline cow pox. It is caused by a virus present in the small rodent population such as voles and field mice. The virus is similar to the small pox virus and infection with this virus protects against small pox.

Despite its other name of cow pox, cats rarely catch cat pox from cattle. The virus is carried by rodents and cats are most commonly exposed during hunting so avid hunters are most at risk. The virus enters the cat through rodent bites or when a cat grooms an existing lesion after eating a rodent.

Most cases are seen in late summer when rodents are most numerous. Over the next week nodular skin sores that may become infected develop (often around the face and nose or limbs as this is where the cats are usually bitten by their vole prey). These crust and scab over and most cats remain well or have a runny nose or eye discharges. Around 10 days to several weeks after initial infection, numerous skin lesions that are ulcerated and crusted can develop over the body. These lesions are not usually itchy. Overall infection lasts six to eight weeks and most cats recover without and treatment.

However in a few cases, primarily cats that have a poor immune system, e.g. those with FIV or receiving steroids, the disease can spread to the lungs and cause pneumonia in which case fast, laboured and noisy breathing will be apparent as well as the cat being very unwell.

Your vet may be suspicious of a cat pox infection just by looking at the sores. However, these can be confused with other conditions like cat bites and ‘rodent’ (eosinophilic) ulcers. In most cases your vet will simply take a sample of the scabby tissue from the body for analysis. However tissue biopsies or blood samples can also be taken and sent to the laboratory. If your cat is unwell other tests will be required to identify any underlying cause of the immune system compromise. X-rays may be needed if there appears to be involvement of the lungs.

It is rare for people to become infected with cat pox (less than 100 cases have been diagnosed in people in the last 30 years) but it is possible, usually via cat scratches. However, as with all infectious diseases, good hygiene is important and if your cat is infected you should ensure that you wash your hands thoroughly after handing your cat.

People with compromised immune systems (e.g. the young and elderly, people on immunosuppressive treatments, pregnant women) and those with severe skin disease are probably most at risk and should avoid infected cats. If your cat is diagnosed with cat pox it should be handled with gloves and contact between infected material and any human skin wounds and eyes avoided.

If your cat is diagnosed with cat pox, it should be isolated from other cats. However cat to cat transmission only occurs rarely and usually is not associated with clinical signs.

There are no treatments that will control the virus. Happily most cats recover over about 6 weeks without any treatment. Antibiotics may be required if the skin lesions are open or infected. Some cats have to wear an Elizabethan collar to prevent them scratching at the sores. teroids must not be given as these can worsen the disease.

Cat ‘flu’

Cat flu is very common in unvaccinated cats and is very easily spread from cat to cat. It is rarely fatal, except in young kittens, but can be a real problem because the symptoms may be very difficult to clear up. Prevention is far better than cure – so to protect your cat make sure she is fully protected by regular vaccinations.

Cat flu is usually caused by infection with a combination of one or more viruses (feline herpesvirus and feline calicivirus) and some bacteria. If one of the viruses gets hold then your cat’s immune system may be so busy fighting it that other bugs (particularly bacteria) will also join in the attack.

Rather like human flu, cat flu is spread by droplets of moisture containing the virus, passing from cat to cat – through sneezing, direct contact or shared food bowls. Infected cats spread virus in the saliva and nasal discharges (snot).

The incubation period (the time for which a cat is infected and carries the disease before the symptoms develop) is up to 3 weeks. This means that it is quite possible for your cat to pick up the disease from another cat which seems healthy. People can spread the virus from cat to cat when handling them.

The signs of cat flu are very obvious and unlikely to be mistaken for anything else. In fact cat flu is often very similar to human flu starting with a high fever which may make your cat feel miserable and off her food, followed by the sneezing, coughing and sore eyes. Signs usually start to get better after about 7 days and, in most cases, your cat should be back to her old self in about 2-3 weeks. In some cats the disease can cause ulcers in the mouth making eating difficult.

No – the viruses that cause cat flu are quite different from those causing flu in humans. Your cat cannot catch the disease from you and you are not at risk of catching it whilst nursing her.

There is no treatment for flu in cats. Your cat will have to fight off the infection by herself and fortunately most, otherwise healthy cats, will do this within a few weeks. But cats, just like people, feel pretty miserable when they have the flu and plenty of nursing care is needed to help her get over it. Make sure she has somewhere comfortable and warm to lay and be sure she gets plenty of water or milk to drink. Although your cat may not want to eat for the first few days, you should try to tempt her to eat by offering tasty warm food to keep her strength up.

You should always have your cat checked by your vet, and antibiotics may be prescribed to treat bacterial infections. If your cat is very congested try putting her in a warm steamy environment (like the bathroom with a hot shower running) to ease her breathing.

Always keep in close contact with your vet and let him know immediately if your cat appears to take a turn for the worse. If you have other cats living in your house take particular care to keep them away from the sick cat and always wash your hands after handling her. However, because she will have been infectious before the symptoms developed, it is likely that your other cats will already have been exposed to the disease and may develop symptoms.

Most fit young cats will recover from flu after a few weeks – although in some cats that do get over the initial illness the problem never really goes away. These animals may be left with persistent problems such as runny noses. Sometimes these cats are on almost permanent medication to control their symptoms. The disease can be much more serious in young kittens, older cats and cats with other diseases, e.g. FeLV or FIV – these patients may need to be admitted to hospital for special treatment but, even so, may not survive.

The sensible precaution is to have your cat vaccinated to stop her getting flu in the first place. The flu vaccine that is given routinely as part of the annual vaccination programme will protect your cat against the common agents that cause serious disease. Vaccination does not always prevent infection, but it usually stops severe disease developing.

Hyperthyroidism

Hyperthyroidism is a disease caused by an overactive thyroid gland, an organ found on either side of the windpipe at the base of the neck. This gland produces thyroid hormone which helps to regulate your cat’s metabolism, or rate of bodily activity. When the thyroid gland produces too much hormone, your cat’s ‘internal motor’ effectively goes into overdrive. Untreated this would eventually be fatal but the condition can now be successfully treated.

Hyperthyroidism was first seen in cats as recently as 30 years ago and appears to be caused by a form of benign cancer in the thyroid gland. However, it is still not clear what causes the cancer to develop. The disease is rare in young cats but becomes more common in later life. It is now the most frequent hormonal disease in middle-aged and older cats.

The first indication that anything is wrong is usually a marked increase in your cat’s appetite. Even though your cat is eating more it may lose weight and its coat may become rough and unkempt. Other changes include restlessness and aggression, body tremors, increased drinking and urinating, vomiting and diarrhoea. In about one case in ten the symptoms are unusual and the opposite of what might be expected, such as depression, loss of appetite and physical weakness.

Apart from recognising the symptoms, there are a number of other steps in making a diagnosis. When your vet examines your cat’s throat the thyroid gland may feel lumpy or enlarged. Blood tests are usually taken to rule out other diseases of the liver or kidneys. Directly measuring levels of hormone in the blood may help confirm the diagnosis but in some cats the thyroxine levels may be normal. Your vet will also want to check your cat’s heart – an abnormally fast or irregular heart beat is often a feature. Early diagnosis and treatment is important to prevent and even reverse damage to the heart and kidneys.

Medication

There are drugs available which block the production of hormones by the thyroid gland. The medication is given one to three times a day.

Advantages

  • Simple and does not require an anaesthetic
  • Suitable for cats with severe kidney disease, which might be made worse by the other types of treatment

Disadvantages

  • Does not tackle the underlying problem and so treatment must continue throughout your cat’s life
  • Difficulties in getting your cat to swallow tablets
  • You must remember top give the tablets every day
  • In some cats there are side effects of the drug ranging from fatigue to anaemia
  • In the early stages your cat must be carefully monitored to make sure that the dose is right

Surgical

The abnormal gland can be surgically removed.

Advantages

  • Treatment should permanently cure the disease so no need for further medication

Disadvantages

  • Not suitable for all cats, such as those with severe kidney disease or the very elderly
  • Your cat may need drug treatment for a few weeks beforehand to show that its kidneys will cope and to stabilise their condition before anaesthesia
  • Needs a general anaesthetic which is always a slight risk but more so in ill animals
  • Possibility of damaging the parathyroid glands, which lie close to the thyroid and control the use of calcium in the body, so needs an experienced surgeon
  • After surgery cats should be carefully monitored for a couple of weeks to make sure there are no changes in blood calcium caused by parathyroid gland damage

Radiation

An injection of radioactive iodine will destroy the abnormal thyroid tissue while leaving normal cells unaffected.

Advantages

  • No anaesthetic required and very few unwanted side-effects
  • A single treatment will permanently cure the disease in 9 out of 10 cases and a second treatment will do the trick in most of the rest
  • Radiation will also work in much rarer cases in which the tumour is malignant or where a portion of thyroid tissue has broken away from the main gland and is normally missed during surgery

Disadvantages

  • Availability – there are only a few places offering the treatment because of tight regulations covering the use of radioactive substances and there is likely to be a waiting list
  • Your cat will have to stay in complete isolation until the radiation level has died down, usually around four weeks
  • Your cat cannot be handled during this time and so this method is unsuitable for cats needing urgent treatment for other serious conditions
  • The cost of treatment and prolonged boarding can be high

The decision on which method to choose should be made after careful discussion with your vet. Each has advantages and disadvantages and not all may be suitable for your cat. There are a number of things to consider, your cat’s age, the severity of the condition, the presence or absence of other diseases and the risk of complications, etc. Cost may also be a factor as both surgery and radiation treatment can involve a significant expense. However, medication may also be costly in a cat diagnosed with the disease relatively early in its life and treated continuously for several years.

Diabetes mellitus

Diabetes is a relatively common disease in older people and is being recognised more frequently in older pets. If untreated the disease has serious effects and will ultimately result in the death of your pet. The good news is that the majority of diabetic animals can now be treated and may live normal, happy lives if you are prepared to invest time and money in their care.

Diabetes is a disease caused when there is not enough insulin in the body. Insulin is a hormone which keeps blood sugar (glucose) at an optimum level. When there is a lack of insulin, sugar from food builds up in the blood and eventually starts to appear in the urine.

Animals with diabetes have high blood sugar levels and lose sugar in their urine. They are more thirsty than normal and often lose weight despite having a good appetite. If the condition is untreated, liver disease, problems walking or other illness may develop. If the early signs of diabetes are missed, more serious signs such as vomiting and depression may develop. If diabetes is left untreated for weeks or months your cat could go into a coma and die.

If your cat has been diagnosed as a diabetic you may be wondering if you have done something wrong. Unfortunately some cats are just more likely to develop the disease than others. Male cats are most likely to get diabetes but any cat can be affected. Obese cats are slightly more likely to develop the disease, but there are many obese cats who do not develop diabetes.

Some other diseases can cause diabetes to develop and your vet will check to make sure your cat is not suffering from anything else. In a few cases treating the other disease will make the diabetes go away for a while, but it is quite likely to come back again later.

Most diabetic cats require regular insulin injections to control their blood sugar levels. Diabetes rarely goes away completely and so these injections must be given on a regular basis (usually once or twice a day), for the rest of your cat’s life. Your vet may need to help you work out a new diet and management plan for your cat. Injections should be given at set times each day but this can be arranged so that it fits into your usual schedule. Once the whole treatment schedule has been set you will have to stick to it in the future.

Most diabetic cats will need insulin injections to treat their diabetes at some stage. In some obese cats weight loss may control their diabetes for a while. A few other cats can be managed by careful weight control and by giving tablets which lower blood sugar (hypoglycaemic drugs). Although you may be worried about having to give your cat injections – most owners find that, with practice, it is easier to give their cat an injection than a tablet.

Insulin is a protein and (as with any other protein), can be digested. If insulin were given as a tablet, the tablets would be digested by the acid in the stomach and the insulin would have no effect. Insulin injections are given under the skin and do not hurt. VetPens, similar to the epipens used in human diabetes, are now available for cats. Along with insulin cartridges, they allow pet owners to give insulin with minimum preparation time.

Most people are naturally concerned that they will be unable to give injections to their pet. Your vet will teach you how to do this and within a few weeks most owners of diabetic pets are happy to give the injections at home. Until you are confident your vet will probably see you every day at the veterinary surgery and help you give the injections.

Your cat should be regularly monitored to make sure it doesn’t gain or lose weight. Your vet needs to examine your pet regularly and review their notes to see how your pet is progressing. Your vet will probably ask you to monitor how much your cat drinks to help monitor progress. At other intervals your vet may want to take blood samples from your cat – and may need to keep your pet in hospital for a day to do this. If you have any concerns about any aspect of your pet’s treatment discuss them with your vet.

There are two important complications which you must be aware of:

  • Low blood sugar (hypoglycaemia): If this is untreated it may result in permanent brain damage. Symptoms develop rapidly with restlessness, confusion, tremors, twitches, convulsions or coma being the main signs. Sugar should be given by mouth, dissolved in water or as lumps. If your pet is still awake it may be offered food and should eat voluntarily. Contact your vet immediately if these signs develop.
  • High blood sugar (hyperglycaemia): This usually develops more gradually and your pet may become unwell over a number of days. As the disease progresses your pet may go into a coma, although will not respond to sugar solutions. Contact your vet immediately if your pet is unwell and they will probably want to admit him.

Cushing’s disease (hyperadrenocorticism)

Cushing’s disease (also called ‘hyperadrenocorticism’ by vets) is rare in cats. Although it is a severe disease it causes subtle changes in the early stages. Many owners do not recognise the signs of Cushing’s disease in their pet, instead confusing the changes caused by the disease with ageing.

Cushing’s disease is caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. It is called Cushing’s disease because it was named after a famous neurosurgeon, Harvey Cushing, who first recognised it. It is also sometimes called“hyperadrenocorticism” or “hypercortisolemia”.

Cushing’s disease is caused by an excess of the steroid hormone, cortisol. In the normal cat cortisol is produced by the adrenal glands, (which are located just in front of the kidneys). Scientists think that cortisol has hundreds of possible effects in the body. Among its other vital tasks, cortisol helps to:

  • maintain blood pressure
  • slow the immune system’s inflammatory response
  • balance the effects of insulin in breaking down sugar for energy
  • regulate the use of proteins, carbohydrates and fats in the body

Because cortisol is so vital to health, the amount of cortisol produced by the adrenal glands is precisely balanced. Cortisol production is regulated by hormones produced in the brain (from the pituitary gland). The hormones produced by this gland stimulate the adrenal glands. When the adrenal glands receive the signal from the pituitary they respond by producing cortisol. In the normal animal cortisol is produced mainly at times of stress – in Cushing’s disease the levels of cortisol in the blood are always too high.

Cushing’s disease can occur following long-term treatment with corticosteroid drugs (so called ‘iatrogenic cushing’s’) or as a naturally occurring disease. The majority (approximately 85%) of naturally occurring cases of Cushing’s disease are caused by a tumour in the pituitary gland. Although this is, strictly speaking, a brain tumour the tumour is usually tiny and benign and causes no effects related to pressure in the brain. A smaller proportion (approximately 15%) of naturally occurring Cushing’s disease cases are caused by a tumour in the adrenal gland.

The two forms of natural Cushing’s disease are:

Pituitary-dependent Cushing’s disease

A tumour in the pituitary causes excess production of the hormone, adrenocorticotropic hormone (ACTH) resulting in enlargement of both adrenal glands.

Adrenal-dependent Cushing’s disease

A tumour of the adrenal gland makes one gland grow bigger and it is therefore able to produce more cortisol.

The signs of Cushing’s disease are extremely variable and can be subtle in the early stages. Cushing’s disease usually affects older pets (average age is 10 years but cats as young as 4 have been diagnosed with this condition).

Because the changes come on slowly it is sometimes easier to spot them if you do not see an animal every day. Often it will be your vet who examines your pet during its annual or bi-annual examination and points out that changes have occurred since your last visit. Many owners do not recognise the signs of Cushing’s disease in their pet, instead confusing the changes caused by the disease with signs of ageing.

The steroid hormones affect almost every tissue in the body and the signs of Cushing’s disease can be diverse. One of the most common problems associated with Cushing’s disease in the cat is diabetes mellitus. In fact most cases of Cushing’s in the cat are recognised because they are being treated for diabetes. The most obvious signs of diabetes are increased thirst and weight loss despite a good (or even increased) appetite. If your cat is drinking more or losing weight you should always take them to the vet for a check-up.

Typically, the diabetes seen in cats with Cushing’s is very resistant to insulin so high doses are needed to control the disease. Affected cats are also often reported to be lethargic and lacking energy. A small proportion of cats with Cushing’s are not diabetic although they may still show signs of increased thirst and increased urination.

Enlargement of the abdomen (a pot bellied appearance) is common and Cushing’s disease can cause changes to the skin and haircoat. The skin may become fragile and thin, lose hair, bruise easily and heal poorly. Minor trauma (grooming or handling) may result in skin tearing and wounds. Often affected cats have a poor haircoat. The tips of the ears may start to curl over.

High levels of steroid hormone in the blood suppress the immune system and healing process; so animals with Cushing’s disease may have repeated infections or wounds that do not heal as quickly as expected.

Iatrogenic Cushing’s is usually straightforward to diagnose as there is usually a history of long-term corticosteroid administration. However, cases of naturally occurring Cushing’s disease can be very difficult to confirm. Your vet may suspect the disease based on simple blood tests but specific blood tests are needed to confirm the diagnosis. These special tests measure the level of cortisol in the blood. However, because the levels of this hormone vary from hour to hour in a normal animal, the disease cannot be diagnosed on the basis of one blood test.

Your vet will need to take a number of blood samples before and after injection of hormones that affect the amount of cortisol produced by your cat. Some of these blood samples have to be handled very carefully and will need to be sent away to veterinary laboratories for analysis.

Ultrasound examination of the abdomen allows your vet to measure the size of each adrenal gland. If a tumour is present in the adrenal gland this should be visible on the ultrasound (and one adrenal gland will appear larger than the other). If the disease is caused by a tumour in the brain then both adrenal glands will be larger than normal.

X-rays may also be needed to show other potential problems caused by the disease.

Examination of a urine sample can be useful in a cat with Cushing’s disease – high levels of cortisol in the blood can cause diabetes mellitus and your vet will want to check for sugar in the urine to rule this out.

Treatment of iatrogenic Cushing’s is relatively straightforward with gradual reduction in corticosteroid administration required. Corticosteroids are potent drugs and it is essential that they are not stopped suddenly. In some cases, successful treatment of iatrogenic Cushing’s can take several months.

Treatment of naturally occurring Cushings disease in the cat is difficult and not without risk. Surgical removal of the abnormal adrenal gland (adrenalectomy) is the treatment of choice for adrenal Cushing’s disease. This is high risk surgery as affected cats are prone to infections and poor wound healing; there are high risks of bleeding at surgery as the adrenals are close to major blood vessels and cats with Cushing’s are more vulnerable to forming blood clots (thrombi) which can have serious consequences.

Pituitary cases are even harder to treat as there is no single perfect treatment. Medical treatment can be problematic in these cats – most of the treatments that have been tried have had poor success, side-effects can be seen and the drugs used are often not licensed veterinary treatments. Radiation therapy has been tried by some clinicians but is not widely available. Surgical removal of the pituitary, the treatment of choice in people with pituitary tumours, is a very high risk surgery that is not often performed in cats.

For these reasons, surgical removal of both of the adrenal glands may be recommended to prevent further cortisol production. This surgery is difficult and should be performed by a specialist in veterinary surgery, but in some cases medical treatment is given before surgery to stabilise the cat. In addition to the risks of surgery itself, it is very important that animals are closely monitored immediately after surgery and they may need to spend time in an intensive care facility.

Most animals with Cushing’s disease are middle-aged or elderly and owners sometimes ask if it is worth treating them. The outcome for cats with Cushing’s disease with treatment is not good. Even with successful treatment fewer than half of all cats will live for more than a year after diagnosis. Unfortunately if a cat had diabetes before treatment for Cushing’s disease there is only a 50% chance that the diabetes will resolve with treatment of the Cushings. Some cats will need to be given insulin to control the diabetes for the rest of their lives. Without treatment the complications can be significant and will seriously affect the quality of your pet’s life.

Ventricular septal defect (VSD)

Ventricular septal defect (VSD) is one of the more common congenital heart defects in cats. It is sometimes referred to as a ‘hole in the heart’. The condition is often discovered in apparently healthy cats by a vet during a routine examination (such as before vaccination).

Ventricular septal defect (VSD) is a congenital heart defect, i.e. it is caused by abnormal development of the kitten before birth. The cat’s heart, like that of humans, is a muscular pump with four separate chambers. The right side of the heart sends blood to the lungs where it picks up oxygen. The left side of the heart pumps the blood around the body. The heart is divided into left and right halves by a muscular wall (the septum). The ventricular septum separates the right and left ventricle.

In a VSD the septum doesn’t develop properly resulting in a small ‘hole’ in the septum allowing some blood to divert from the left side of the heart to the right side. The effects of this on the cat depend on the size and location of the defect. Most cats have small defects that are well tolerated. In some cases, very small VSD holes may close spontaneously. Larger defects can lead to congestive heart failure.

Although the condition is present from birth, signs of a ventricular septal defect (VSD) are usually not noticed until later in life. Many cats with VSD have no outward signs of illness. The murmur caused by a VSD is often detected by a vet (often during a routine health check). When you bring home a new kitten it is always advisable to ask your vet to check for any heart murmurs.

If the defect is large, clinical signs may be seen when the cat is less than two years of age. Severely affected animals may have stunted growth, although this can be difficult to recognise without direct comparison to their littermates. If the condition goes unrecognised and heart failure develops the affected animal may be reluctant to exercise, cough, or have difficulty breathing.

If your vet hears a murmur when listening to your cat’s heart they will want to do some other tests. Heart murmurs are caused by the sound of abnormal and high-speed blood flow and are very common findings in cats with VSD. Very quiet heart murmurs can be present in an otherwise healthy pet so a diagnosis of VSD or other congenital heart disease is not necessarily inevitable.

Ultrasound is the method of choice for finding the cause of a heart murmur. If a heart murmur is heard, an ultrasound examination is recommended. Ultrasound examination of the heart requires considerable knowledge and experience and should be performed by someone with experience in examining young cats.

X-rays are important in the diagnosis and monitoring of heart disease. In cats with severe VSD, evidence of heart enlargement on the left side is often evident. X-rays are also used to see if signs of heart failure are present, if there any signs of further heart failure treatment is usually started immediately.

If the VSD is very small, then your cat may lead a normal life with no treatment being necessary. However, if the defect is large, the outlook is worse and your cat may have a significantly reduced life expectancy. Your vet will discuss the outlook and long term management of your cat with you.

If the ventricular septal defect is small, then no treatment is needed and the hole may spontaneously close. Large VSDs may need medical management to treat heart failure if it develops. Some surgical options are available to help reduce the flow of blood across the hole but definitive repair to actually close the hole is typically not possible

Many animals with ventricular septal defect live a normal life with no signs of heart disease but this depends on the size and location of the defect. Affected cats and their parents (who could be genetic carriers of the condition) should be not be allowed to have kittens.

Cats with more severe defects are likely to develop heart failure at a relatively early age and the long term outlook is poor. Life-expectancy may be reduced and long term medication will be required.